Healthcare Payers: Are You Prepared for the Retail Revolution?

Retail clinics have grown in popularity among patients who need faster and more convenient care. Walmart, Walgreens, CVS and other large retailers have set up kiosks offering last-minute appointments next to pharmacies. You can now grab your throat lozenges and travel a few short aisles to see the doctor about your sore throat. This convenience and accessibility are driving fast growth.

As of 2020, there were over 3,000 retail clinics in the United States — and this number is expected to rise. But that increase doesn’t come without growing pains, which may inadvertently affect healthcare payers.

Walmart, for example, opened 20 primary care clinics across several states between 2019 and 2021, but the retail giant struggled with hurdles created by patient overpayments and payer reimbursement challenges. However, with no signs that this “retail revolution” will slow soon, many healthcare payers are looking at improvements to support this trend and improve the patient experience.

Technology bottlenecks and transparency issues

Many of the challenges around retail clinics involve interoperability problems between different computer systems. For example, a member of one healthcare system may visit a retail clinic expecting a $20 copay, but due to interoperability issues, pays more. And even if the necessary interoperability does exist, that doesn’t guarantee real-time data accessibility, which can create additional problems with verifying copayments and coverage.

Another challenge involves delayed payer enrollment processes. Retail clinics are growing fast and hiring quickly. Delays with new provider enrollment are creating issues with payer reimbursement, affecting the patient experience.

Patients are feeling the disconnect

Patients expect more from all corners of the business, including their healthcare payer. They want faster and more convenient experiences, which is why so many are visiting retail clinics. And if a patient has a bad experience at a retail clinic, feelings about that experience may also affect their feelings about their payer.

When considering expectations around the experience of visiting a retail clinic, over half of the people surveyed said that most companies need to improve the customer experience. Speed, convenience and friendliness rank high with 70% of those surveyed.

Access and convenience drive people to visit retail clinics in the first place, and in the context of healthcare equity, budget concerns or other factors might also play into the situation. In addition to being extremely convenient, visiting a retail clinic that is open evenings or on the weekend might be far more affordable than scheduling an appointment, missing half a day of work and spending money on gas to travel to and from an appointment at a doctor’s office.

Supporting faster provider enrollment 

Looking at existing interoperability and technologies that support increased visibility is an excellent first step, and many payers are already doing that. Another area that provides opportunities for improvement is the more rapid credentialing that must be completed when a medical provider enrolls in a new health plan network.

One of the largest challenges in the recent Walmart situation was not having new providers credentialed fast enough, resulting in issues with payer reimbursement. Improvement in this area can enhance the patient experience. But where should you start? A few questions to drive improvement include:

  • What does your existing credentialing process include? Do you have or could you create a provisional process that reduces processing time?
  • Are there any barriers that can be removed that will make the process faster while still maintaining quality assurance standards?
  • What changes can be implemented from a procedural perspective to show improvement?

When considering procedural improvements, evaluate how you currently manage contracts and credentialing. If you can get credentialing information faster and expedite clinic interactions, you can quickly process the required details to support clinics and, consequently, the patients.

Moving into alignment with retail clinic expansion

There is no doubt that patients are changing how they want to receive medical care. They are visiting doctors through telehealth options at increasing rates and demanding convenience like never before, driving the retail clinic trend.

Healthcare payers that support the new way that patients want to receive healthcare create more seamless experiences with the people they serve and foster greater access to care in convenient locations, so people can get required services when they need them most.