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OptumHealth, a division of UnitedHealth Group, and American Well adapted the technology behind Optum's NowClinic for retail clinics at Detroit-area Rite Aid pharmacy locations. Both online and at Rite Aid, patients can pick an available doctor to "see." Image courtesy OptumHealth

Rite Aid clinics place new twist on "doc-in-a-box"

The pharmacy chain is operating in-store clinics in Michigan where doctors and patients interact only through an online video screen.

By — Posted Feb. 6, 2012

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When patients walk into a NowClinic at any one of nine Detroit-area Rite Aid pharmacies, they can choose among multiple physicians to see about what's ailing them.

Not see in person. See on a computer monitor.

What's going on at these Rite Aids is a merger of multiple trends focused on providing more convenience to patients than, presumably, a physician's office can deliver.

"A lot of people, unfortunately, are left disconnected from their doctor, whether it's clinical reasons or financial reasons or availability," said Ido Schoenberg, MD, chair and CEO of American Well, the technology vendor behind the virtual clinics.

Neither telemedicine nor retail clinics are new -- but combining them is.

Like the other retail pharmacy chains, Rite Aid is trying to brand itself as a wellness center as much as a pharmacy.

The retail clinic business, which sells itself as quick, convenient, inexpensive, walk-in care, has been a tool for such branding. It is a sector dominated by Rite Aid competitors CVS and Walgreens, which together accounted for 904 out of 1,355 in-store clinic locations as of the end of 2011. Rite Aid, until fall 2011, only had nine, according to Merchant Medicine, a Shoreview, Minn.-based retail clinic consultancy.

Rite Aid and OptumHealth joined forces to find a less expensive alternative to traditional clinics, which are staffed by nurse practitioners and physician assistants who are contracted from a local hospital group. Those startup costs have been a factor as to why growth of retail clinics, until a nearly 100-location expansion by CVS' Minute Clinic in 2011, had been mostly flat in recent years.

Rite Aid and OptumHealth decided it would be more cost-effective to go with virtual visits -- nurses and physicians seeing patients via a computer screen.

OptumHealth launched the NowClinic concept in August 2010 as an online offering that patients in Minnesota could access at home. Through the NowClinic website, patients and physicians connect via Web chat or video conferencing, the same way they would from the NowClinic exam rooms at Rite Aid. The online system has since expanded to 22 states. Other insurers have launched similar systems, including WellPoint, which also contracts with American Well, to offer virtual visits to members in several of its markets. Rite Aid's clinics began opening in fall 2011.

Here's how NowClinic works:

A patient walks into a private room, usually near the pharmacy counter, and registers himself or herself on the computer terminal. Either an account can be created with OptumHealth, or UnitedHealth Group plan members can use their member information, to avoid the registration process on subsequent visits. When registration is complete, the patient goes through a series of computer-prompted questions to get at the problem or complaint. The patient can access several free educational tools or talk with a nurse via video chat. The NowClinic website says a pharmacist can help get a patient connected.

The services offered at Rite Aid are the same as for the online NowClinic: treatment of allergies, bladder infection, bronchitis, cough and cold, diarrhea, fever, insomnia, nausea, pink eye, rash, seasonal flu, sinus infection, sore throat and viral illness.

James V. Springrose, MD, senior director of provider strategies for OptumHealth, said there's no charge for virtual consultations with a nurse, who also can advise patients whether a doctor visit is warranted.

If the patient would rather talk to a physician -- or the nurse advises that the patient should -- he or she can pay $45 for a 10-minute visit and enter credit card information. The system does not accept insurance coverage, though patients can submit claims to their plan to get reimbursed.

Patients can pick a physician from a list with background information, including specialties and customer reviews, for each physician. The physician can help guide the patient to in-person care, if needed, or write a prescription when appropriate.

Vitals are taken by the patient -- such as blood pressure on an automatic cuff -- in the room or elsewhere and communicated to the doctor. Vaccines are delivered by a certified immunizing pharmacist on site. Additional time can be added to the exam for $5 to $10 for each additional five minutes. Dr. Springrose said physicians providing the care keep the majority of the fees collected.

Any physician licensed to practice in Michigan can contract with OptumHealth to treat patients through the NowClinic. They download software to the computer where they plan to work, either at home or in the office, and make themselves available according to their own schedules. When a patient requests to be "seen," the system will alert the physician to go online.

Expansions possible

OptumHealth is planning to expand to other retail settings beyond Rite Aid. The company also is looking at setting up virtual work-site clinics.

At least one other company is doing something similar. HealthSpot, a Dublin, Ohio-based company, has created the Care4 Station physician kiosks. The company announced in December 2011 that it partnered with Mission Essential Personnel, a professional services company, to make the stations available to government and military personnel across the globe.

Attorney Dan Schulte, co-chair of the health care practice group at the Michigan-based law firm of Kerr, Russell and Weber, said the Michigan State Medical Society, for which he is the general counsel, has concerns about whether a physician is capable of making a proper diagnosis when the patient is not physically present.

"Perhaps for some conditions, it can be. But for others, it cannot be. Nobody can give you a finite list of which type falls into which category. It's the kind of thing where you know it when you see it," Schulte said.

There is also concern that these visits would disrupt the relationship between primary care physicians and their patients if regular visits are being skipped in favor of a visit to a retail clinic, Schulte said.

However, Robert Thompson, executive vice president of pharmacy for Rite Aid, said his company's intention is not to replace the physician office. Many surveys show that the number of physician office visits is falling, but analysts generally blame a down economy and its effect on consumer spending -- not retail or virtual clinics.

Merchant Medicine CEO Tom Charland called NowClinic "a very medical practice-centric approach to convenient care." But he said the concept is likely to be more popular as something patients access at home.

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External links

NowClinic, Optum Health (link)

NowClinic at Rite Aid (link)

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