SplashX - What does the future of clinics look like?

Entrepreneurs from Omada Health, JustAnswer and Oscar Health weighed in

Last Thursday, Vator and HP held the first of four events centered around the advances in healthcare. Taking place at HP Headquarters in Palo Alto, this event centered around the future of clinics, and how local clinics can become hip to a new generation.

Our second panel of the day focused on tech pioneers and healthcare incumbents, who shared with the assembled audience how they are re-shaping the clinical setting.

Led by moderators Archana Dubey (Global Medical Director, HP Health Centers, HP) and Bambi Francisco Roizen (Founder and CEO, Vator), the panelists included Patrick Carroll (Chief Medical Officer Healthcare Clinics, Walgreens), Nikki Sims (Director, Sutter Health Walk-in Care), Nico Arcino (Senior Director, Strategic Partnerships, Kaiser Permanente), Munjal Shah (CEO & Co-founder, Health IQ), Sean Duffy (Co-Founder & CEO, Omada Health), Neil Parikh (Senior Medical Director of Care Delivery, Oscar Health), Andy Kurtzig (CEO, JustAnswer)

Francisco led off the discussion by asking the question: what does the future of clinics look like?

“When I look at the future of clinics, one, the access to care is changing, whether it’s telemedicine and on demand or these new clinics, but also the type of care, the type of services is changing a la Omada Health. What are you doing to either increase access to care or clinics or changing the services of care to the consumer?” she asked.

Shah was the first to give his opinion, noting that clinics have to be tailored to the communities they are serving.

"As you think about these clinics, and how 44 percent are starting in the ER because people are just ostriches in the sand about their health, you can make the most easy to access clinic and they’re just not going to go because they don’t want to. But, as with any new product, you want to find the early adopters, and what we found was the heath conscious are the few people who really like to find out more about their health. They will go proactively get a blood test," he said.

"In fact, when we do our life insurance applications, they frequently want their data and they’re almost showing off with it. 'I’m an athlete, want to see my cholesterol? It’s really great!' It’s not even that, it’s the well managed diabetics who are showing off so I think there’s an interesting conversation of don’t just try to build a clinic for everyone, but figure out what’s the right early adopter segment and to focus on that, and maybe where to deliver it, such as maybe the clinic should be bundled next to the gym since the early adopter clinic is the health conscious, rather than bundling it with the supermarket."

To Arcino, the future of clinics will revolve more around the technologies that make them more efficient. 

"We have 600 clinics and I think with that we’ve had to change the design of them. We have to reach out to what you need from a technical standpoint, from the point of your health all the way to where you’re going to the clinic. We’ve introduced 14 different technologies that do that, like checking in early, getting to there. It’s different at the clinic; there’s no waiting room in our new model, you just go there and we actually know that you’re there. We have your identity, you can check in, you can know when the doctor’s running late, and we’ll also notify you when the room is ready for you to be seen. There’s a whole workflow behind that that we’ve created, so it makes the doctor, nurse, not on a one to one basis, but more of a shared model. So we’ve been changing the way we do that in Southern California for the last two or three years and now we’re spreading that to the rest of the United States," he said.

Duffy then brought up the topic of healthcare touchpoints, or how many times the patient interacts with the healthcare facility. Clinics, he said, have to make those interactions easier and with less friction for the patient. 

“To me, access consists of a number of things. How many visits and interactions do you have to have on a long term basis? Because if you need your knee replaced, you may consider driving three hours. That may be a one time thing; you’ll do it, it’s not ideal but you’ll make that trek and you have access. In the space we’re in, every single bit of data and evidence shows that you need so many touchpoints over a long, long period of time to have any clinical outcome and impact on someone at all," said Duffy.

"So there’s really no choice in our world but to approach people and be where they’re actually living, and today’s life is in front of screens. So I think when you’re designing for what the ideal system or touchpoints or experience is for someone, I think it’s always important to consider who you’re thinking about access and what that actually means for the outcome you’re trying to give, how many touchpoints you have to have? That can help you calculate exactly what you need to build."

Omada is in the chronic disease space, and, as he pointed out, "all chronic diseases require multiple touchpoints over a long period of time and to have them come in every single time for a conference actually reduces access significantly. So I do think it’s condition specific but the key differentiator is the actual touchpoints and how many you need.”

Parikh reiterated the notion of touchpoints, calling them "very critical" and noting that "we’re probably a decent ways away from understanding all the touchpoints that are required to actually, truly influence behavior up to the point of measuring change in outcome."

"But it’s important to understand that touchpoints take very different shapes and healthcare’s still very much a people game and that’s part of why this panel around clinics is here. So, it’s understanding what can be done in a clinic, what can be done in a virtual manner, what needs to be done on the post encounter aspect of this, that can either be done remote or in person," he said.

"One of the things we focused on at Oscar, and one of the questions is why is Oscar in the business of building a clinic, is we recognized that when you’re taking a member focused approach, then you have to access members at all these various touchpoints and it would be better that you could integrate them, either to use telemedicine or to potentially route to a clinic and then back to concierge services to be able to engage in any sort of follow up, you are creating a most holistic experience that then hopefully maintains the engagement that ultimately allows you to potentially influence behavior.”

“It seems like Kaiser has built a network of insurance to hospitals to providers and Oscar is kind of going in that direction. It seems like CVS Aetna merger is also going in that direction. Is that the future of how it looks like, of clinics?” asked Dubey.

Carroll then spoke about the strategy that Walgreens has deployed in terms of its clinics. 

“I don’t comment on what their strategy is at CVS, but I can tell you we have a very different strategy since I came to Walgreens around clinics. When I came four years ago, we had about 450 clinics, and speaking to our health system partners, what we realized is they wanted to be more involved in the care models to create these access points. So, over the last three years, in markets around the country, we’ve partnered with health systems where they come in and, actually in our existing markets, hire our providers, bring in their EHR, and they’re really connected back to their system and back to their providers. It’s really enabled them to expand scope of care beyond the 25 to 30 doctors that have traditionally seen in retail health. That being said, we still run 160 to 170 clinics at Walgreens, that we’ve grown the care model. So two-thirds is run by health systems and a third is run by Walgreens," he said.

"We also look at expanding those access points to care and we have a strategy called the Healthcare Neighborhood, which has been very exciting to us. We’ve opened up about 15 urgent cares around the country because we see urgent care as a lot of value in terms of an access point. They litercally can take care of 95 percent of the conditions that come through their door. Great access points, particularly the three that we set up in rural and semi-rural communities. It is a fundamental access point to care in that community. We’ve also set up lab services in our stores, hearing, vision services, a really robust virtual health offering, including a partnership with New York Presbyterian where in out Duane Reed stores there are telehealth kiosks that connect to an EU group run by New York Presbyterian physicians. So we really look at creating a healthcare neighborhood that allows an access point to care and really trying to push that retail health model in collaboration with our partnerships to go beyond those 30 diagnoses, because we have to get into chronic disease management in the retail health space to really make an impact.”