Retail Health Clinic Chain Offers Free Health Care to Newly Unemployed

Take Care Health Systems, operator of the nation's second largest chain of retail health clinics, stepped into the spotlight March 31 when it announced the launch of a short-term plan to provide existing clinic patients with free health care.

The Take Care Recovery Plan offers consumers who lose their jobs on or after March 31 and who qualify for the program free treatment for illnesses and injuries at Take Care Clinics for themselves and their dependents. To qualify for the plan, consumers must have no health insurance. In addition, they or one of their dependents must have been a patient at a Take Care clinic before the family breadwinner became unemployed.

Take Care Health Systems, a wholly owned subsidiary of Walgreens, oversees 342 Take Care clinics in 19 states. According to a March 31 press release, the offer of free treatment for acute conditions, such as respiratory illness, seasonal allergies, urinary tract infections and minor skin conditions, is good through the end of 2009.

Lauren Nestler, director of communications for Take Care Health Systems, told AAFP News Now the company is taking this action because "this is the right thing to do. Patients should not have to sacrifice basic health care or choose among basic necessities, such as health care, food or housing, in a challenging economy."

Jim "Woody" Woodburn, M.D., is president of Woodburn Health Consulting LLC in Deephaven, Minn. Woodburn served as chief medical officer of Minnesota-based MinuteClinic LLC from 2005-07, and he understands the business of retail health clinics.

Woodburn said Take Care's offer of free health care didn't surprise him at all. "My guess is that they are filling unused capacity by offering something that will give them (public relations) value," he said.

Woodburn called the move a "good marketing tactic" in a tough business climate and applauded the company's efforts. Hospitals provide charity care all the time, he said. "If they have unused capacity or they can't charge for something, they give it away, and they get marketing value out of that. It's nothing new."

AAFP President Ted Epperly, M.D., of Boise, Idaho, was cautious in his praise for the program. He recognized the precarious position of laid-off Americans and said he appreciated the efforts that Walgreens and Take Care were making to help.

However, he also wondered about ulterior motives.

"There is a fine line between intent and reality. This isn't a magnanimous, unbelievable gesture of generosity," said Epperly. "This is a way to try to capture increased revenues by using health care as a loss leader. I find it disingenuous."

Epperly said shrewd business people run the clinics, and they are betting that the majority of people who come in to use the clinic are going to get their prescriptions filled in the store. Before they leave, "those same people are going to buy toilet paper and flashlight batteries, too," he added.

Epperly pointed out that many family physician practices -- including his own -- have procedures in place to help patients through tough financial times. For instance, Epperly said he offers a sliding fee scale for hardship patients and sometimes even writes services off.

"Family physicians are doing what they can," but many practices operate on slim margins, he said. First and foremost, family physicians need to keep their doors open to patients. "We can't say something as outlandish as 'We'll provide free health care to the nation's uninsured' because we're not in business to also sell prescription drugs and other retail goods in our offices."

Epperly said uninsured consumers who take advantage of Take Care's new program also should watch their pharmacy expenditures by tapping into Walmart's $4 prescription program. His advice to patients? "Make sure that you're getting the $4 medication instead of the $44 medication."

In addition, patients should be mindful of the limitations of the retail clinic model, said Epperly. Take Care clinics never treat infants younger than age 18 months. And the free health care offer doesn't apply to the wellness, preventive or ongoing chronic disease services that embody the patient-centered medical home family physicians provide for their patients, he added.

For her part, Nestler made it clear that Take Care's nurse practitioners and physician assistants never make direct referrals to Walgreen's pharmacy and don't try to sell patients store products. However, she said, many Walgreen's customers appreciate the convenience of a neighborhood store that offers health care and retail products.

"We provide care and counsel, write prescriptions if clinically necessary, and provide patients with options that are best for them," she said.

On a broader scale, Epperly expressed concern that Take Care's highly publicized offer of free health care could distract the nation's consumers and lawmakers from the bigger picture of health care reform. "At a time when America needs true health care reform and a more robust primary health care base -- which is what the Academy is helping to build -- Take Care's plan actually furthers the fragmentation of care," he said.

Epperly argued that Take Care was offering patients a short-term fix -- "a Band-Aid plan" -- that should not be seen as a substitute for integrated primary care.

Nestler noted that public reaction to the plan has been very favorable. "It's our way of helping ease the burden of patients going through a challenging time," she said. "This is our chance to do our part."

She added that Take Care has never claimed to be the entire solution to America's health care woes. "But we do believe we're a key part of providing access points and affordable, quality, accessible care," she said.

"No doubt, awareness of Take Care clinics and the convenient care industry in general will grow based upon the knowledge of the Take Care Recovery Plan," said Nestler. "And we consider that a good thing."

According to the Convenient Care Association, which comprises companies and health care systems that operate retail-based health care operations, about 1,200 retail health clinics currently operate in the United States.

Woodburn noted that the launch of Take Care's recovery plan comes on the heels of news from MinuteClinic that it is shifting 90 clinics in markets across the country to what the company calls "seasonal clinical status," meaning the clinics will be closed until influenza season arrives in the fall.

According to company spokesperson Brent Burkhardt, MinuteClinic, which currently operates 460 clinics around the country, made the decision to better align its services with customer demand. The company also has expanded its weekend hours at many of its year-round locations.

Woodburn said upper-level managers at both MinuteClinic and Take Care likely are tinkering with the clinics to offset low patient volume. "There is insufficient clinical disease volume for those clinics to be revenue-generating day in and day out consistently over time," he said. "There's just not enough strep throat, pink eye and sinusitis to go around in most locations in the country."

In fact, last year, AAFP News Now reported that Take Care had withdrawn its support of the AAFP's list of Desired Attributes of Retail Health Clinics and had acknowledged a desire to expand its scope of services to increase revenues.

The fact that Take Care is offering patients free health care between 11 a.m. and 3 p.m., Monday through Friday, speaks volumes, said Woodburn.

"This is, historically, the slow time for practitioners. Walgreens is clearly experiencing zero volume or very low volume at that time; otherwise they wouldn't give up that kind of revenue," he said.

According to Woodburn, the two retail health giants are "mirror images of one another," with the same footprint in store size and the same competitive positioning. "The macroeconomic environment is causing them to make more abrupt and significant changes relatively simultaneously," he added.