Business Models, Vaccination Services, and Public Health Relationships of Retail Clinics: A Qualitative Study.

EXECUTIVE SUMMARYDespite the rapid growth of retail clinics (RCs), literature is limited in terms of how these facilities offer preventive services, particularly vaccination services. The purpose of this study was to obtain an in-depth understanding of the RC business model pertaining to vaccine offerings, profitability, and decision making. From March to June 2009, we conducted 15 interviews with key individuals from three types of organizations: 12 representatives of RC corporations, 2 representatives of retail hosts (i.e., stores in which the RCs are located), and 1 representative of an industry association. We analyzed interview transcripts qualitatively. Our results indicate that consumer demand and profitability were the main drivers in offering vaccinations. RCs in this sample primarily offered vaccinations to adults and adolescents, and they were not well integrated with local public health and immunization registries. Our findings demonstrate the potential for stronger linkages with public health in these settings. The findings also may help inform future research to increase patient access to vaccination services at RCs.INTRODUCTIONTo respond to consumer demand for common, acute care services, and faced with a shortage of primary care physicians (PCPs), retail clinics (RCs), urgent care centers, and telemedicine have emerged as new healthcare models that provide basic medical care in a convenient setting for consumers. These convenient care models have received considerable attention from researchers and policy makers as they weigh the new models' benefits (such as lower costs and better access for consumers, regardless of insurance status) and risks (disruption of care continuity) (Ehley, 2014; Mehrotra, Wang, Lave, Adams, & McGlynn, 2008; Robert Wood Johnson Foundation, 2015). RCs-which typically are located in retail settings such as grocery stores, pharmacies, and discount chains-are of particular interest given their exponential growth over the past 15 years. There are approximately 1,200 RCs in the United States, and this number is expected to double by the end of 2015 (Dermody, 2013). Research has estimated that the three largest clinic operators had a combined 8.9 million RC visits from 2007 to 2009 (UscherPines, Harris, Burns, & Mehrotra, 2012). Furthermore, many major insurers now cover services offered at RCs, and almost all RCs accept insurance payment (Ahmed & Fincham, 2011).RCs are generally limited in the scope of the medical services they provide, which range from treating common acute illnesses and infections to preventive care (Mehrotra et al., 2008; Wang, Ryan, McGlynn, & Mehrotra, 2010). Vaccines are one of these preventive services, and in 2009 they accounted for more than 40% of visits to the three largest RCs (Uscher-Pines et al., 2012). While vaccines are among the most cost-effective clinical preventive services to offer, they also are essential for decreasing morbidity and mortality in vulnerable populations (Healthy People, 2014). However, despite steady improvement, the rates of vaccine coverage among adults and adolescents remain suboptimal for most routinely recommended vaccines, and they fall short of the Healthy People 2020 targets (Centers for Disease Control and Prevention [CDC], 2012a, 2012b). Visiting venues such as RCs may be a viable method of increasing access to vaccinations.Despite the rapid growth of RCs, their increased usage by consumers, and their potential to reduce the burden on primary care providers, literature is limited in terms of how RCs offer preventive services-in particular, vaccination services. This exploratory mixed-methods study aimed to obtain an in-depth understanding of the RC business model pertaining to vaccine offerings, profitability, and decision making. The study also explored the eagerness and ability of RCs to partner with public health agencies and helped gauge RC interest in future partnership efforts to potentially improve vaccination rates. …