Supermarkets are becoming home base for coordinated care as hospitals and physician groups team with in-store clinics  to reduce costs and improve health outcomes.
Take, for instance, care offered at The Little Clinics within 18 Cincinnati- and Dayton-area Kroger stores, as part of a new partnership with the affiliated health systems of the University of Cincinnati (UC Health).
“This collaboration allows patients greater access to health care close to home and work,” explained Dr. Ken Patric, chief medical officer for The Little Clinic. “One of our goals is to provide convenient monitoring for those who struggle with chronic care management such as diabetes. Offering a convenient place for routine examinations and supervision of such conditions will enhance compliance and improve outcomes.”
In the past, The Little Clinics’ nurse practitioners and physician’s assistants screened patients at high risk for diabetes through blood sugar testing. Those found to be diabetic were referred to an outside physician who would help stabilize and monitor their condition on an ongoing basis, explained Eileen Myers, vice president of Affiliations and Patient Centered Strategies for The Little Clinic, which is owned by Kroger Co. 
Under a series of medical system affiliations in different regions, The Little Clinic’s model has changed.
Now, after a diabetic is referred to a specialist within the affiliation, and their condition is stabilized, they’re referred back to The Little Clinic for ongoing care through routine evaluations and monitoring of things like lipids-fats, Hemoglobin A1c, and glucose levels. General vital signs such as blood pressure and examinations of the feet and eyes for signs of diabetes complications are likewise monitored at The Little Clinic.
“By using The Little Clinic to monitor the more stable patient, the endocrinologist frees up more of his time to see patients in need of a specialist,” Myers explained.
The model not only makes sense for more efficient use of the physician’s time, but contributes to improved patient outcomes by leveraging data synergies and The Little Clinic’s convenient evening and weekend hours and locations, noted Dr. Myles Pensak, chief executive officer of University of Cincinnati Physicians, the faculty practice group of the UC College of Medicine and the physician division of UC Health.
“It’s a seamless concept both for the instigation of therapy, timeliness, efficiency and doing a 360 in terms of after you’re treated, where do you go? You don’t go back to your doctor’s office, you’re going to continue on at The Little Clinic,” he said.
With the patient’s permission, the Little Clinic and UC Health will exchange medical record information for greater continuity of care.
Whereas in the past, a patient visiting The Little Clinic due to diabetes complications was told they’d need to find a doctor if they didn’t already have one, now an appointment with a UC Health endocrinologist can be scheduled while they wait.
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“The Little Clinic providers will be able to schedule appointments for patient referral,” explained Myers. “For example, if we see someone in the clinic that needs to be seen quickly, with the patient’s permission, our provider will access UC directly to help the patient get set up for the additional care he or she needs. And we will also be able to securely send the medical record electronically to the UC Physician seeing that patient.”
Dr. Pensak is excited by the potential interoperability that could result from Kroger’s other health affiliations. The Little Clinic is engaged in partnerships with University of Louisville Physicians, the University of Colorado Health Partners and The Ohio State University Wexner Medical Center.
“Kroger has already partnered with many other major medical centers,” Dr. Pensak said. “You can just imagine the power of the connectivity, having the synergy of information, possible synergies of protocol; it’s a hugely exciting thing.”
At a time when health care providers are joining Accountable Care Organizations — whereby the government (in the case of Medicare) or a private insurance company offers doctors and hospitals incentive to provide quality care while keeping costs down — models that coordinate care with in-store clinics have the potential to dramatically reduce costs.
Accountable care is different from the traditional reimbursement models by which doctors and hospitals are paid for each test conducted and procedure performed, explained Thomas Charland, CEO of retail clinic consulting firm Merchant Medicine.
“If an entity is taking risk for all of the care for an individual at a fixed price, they are incented to find ways to deliver the right care at the right place at the right price,” said Charland. “Trying to reduce emergency room costs is such an obvious place to start. Prior to [accountable care] a $350 visit for an earache to the emergency room was a good thing for the hospital since it was money that went straight into their purse, but if you’ve guaranteed an employer that you’ll take care of a patient for a fixed amount per month, you have a high incentive to keep those people out of the emergency room.”
While The Little Clinic is not part of an ACO “at this time,” according to Myers, its health system affiliations are designed to avoid nonessential visits to the emergency room.
“Through the triage system with UC Physicians, The Little Clinic will have the option to have a patient be seen more immediately, which can prevent an emergency room visit,” said Myers.
ER visits are also avoided since The Little Clinic is open when most doctor’s offices are not, said Pensak who provided as example a patient who seeks treatment for a migraine on a Saturday afternoon at The Little Clinic rather than the hospital.
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“Additionally, when a patient is discharged from the hospital, a follow-up visit at The Little Clinic may increase overall outcomes and compliance and help prevent readmission,” Myers said.
The Little Clinic’s convenient location within Kroger stores, which some patients already shop several times per week, also supports preventive care.
“If you look at things like chronic obstructive pulmonary disease, diabetes, hypertension, obesity and any number of general health care issues, if you can address it in a local area before someone winds up at the doctor’s office or hospital with a long-term sequella, than it’s going to have a transformative impact on dealing with problems early on,” Dr. Pensak said.
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These partnerships have the potential to drive store traffic, as UC Health physicians will refer existing patients to The Little Clinic. What’s more, is that under Obamacare, more Americans will seek medical care and look to retail clinics for fast treatment of ailments like sore throats, ear infections, sinus infections, pink eye, bladder infections and the flu or common cold.
The Little Clinic’s supermarket locations are also opportune since this is where dietary choices are made.
The plan is for The Little Clinic’s health affiliations to grow into all health and wellness components of Kroger stores from food to pharmacy, Myers said.
“By being located inside Kroger, The Little Clinic has the unique opportunity to engage the patient with the store’s offerings that pertain to health, such as food and how what you eat affects your health along with pharmacy services that help patients understand their medications and assist patients with lifestyle changes,” she said.
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