Retail Health Clinics Are Key on the Path to Health Equity

October 17, 2022 - Healthcare’s cross-sector collaboration on health equity work is something that Jay Bhatt, MD, the executive director of Deloitte’s Center for Health Solutions, hasn’t seen at a level like this before. The work to give everyone an equal opportunity for health and well-being is happening across the care continuum, with a renewed focus on retail health clinics and other alternative care sites coming to the fore.

“We’re creating more access points and putting opportunities to address drivers of health,” Bhatt, who’s also the executive director of the Deloitte Health Equity Institute, told PatientEngagementHIT in a Zoom call. “We're seeing grocers and retailers partner with community health centers and other care settings to enable access to care in the context of addressing healthy behavior and shopping and food security as well as connection to other social service agencies.”

Alternative care sites, such as retail health clinics, urgent care clinics, telehealth, and virtual health options, create more front doors through which patients can get medical care. And when looking at traditionally marginalized groups, especially Black and Brown populations, this is important.

In turn, patients are flooding toward them. In Deloitte’s 2022 Survey of US Health Care Consumers, which sent questionnaires to some 4,500 people in February and March of 2022, the consulting firm saw increased energy around access to retail health clinics.

Somewhere around 10 percent of all patients have accessed a retail clinic in the past 12 months, the survey showed, with White folks being the most likely (12 percent accessing retail clinics) and Asian people being the least (8 percent accessing retail clinics).

But the real finding is the interest among patients to visit retail clinics in the future, especially groups that historically experience health disparities.

Two-thirds of Asian people said they are interested in getting primary care and wellness checks in a retail health setting, the most out of any racial or ethnic group surveyed. Sixty-three percent of Hispanic people said the same, followed by 59 percent of non-Hispanic Black people and 52 percent of non-Hispanic White people.

That’s not actually all too surprising, Bhatt said. Marginalized populations are healthcare consumers, too, and they want the same principles the industry discusses when referring to healthcare consumerism.

“Consumers want a convenient, frictionless experience. We know that these retail sites are in communities that have been historically underserved or marginalized, so the access piece is easier for these communities,” Bhatt explained. “It's bringing care closer to where people are, making care more convenient in terms of place and time. And so, we're also seeing retail organizations invest in sites of care in those communities.”

But retail health clinics aren’t just opening more doors for patients. That’s only half the battle for improving patient access to care, especially with a health equity lens.

“Health equity moves at the speed of trust,” Bhatt said. “We know trust between a patient and a healthcare team is linked to improved patient experience, health outcomes, and a patient's perception of the care received. But we know that there is not the same level of trust in different healthcare teams and care settings.”

Retail clinics, which are usually located in grocery stores or the local CVS or Walgreens, are also places folks feel comfortable visiting. They go there for their regular shopping, know which aisles to walk down, and are used to navigating the parking lot or taking a bus route to get there.

Moreover, when a patient steps into a retail health clinic or a community health clinic, or logs into a telehealth visit, they’re more likely to see a medical and administrative staff that looks more like them. That can make all the difference in patient experience and outcomes.

Racial concordance (when the patient and provider are of the same race or even simply language preference) can result in more family-centered care, according to 2021 data published in JAMA Network Open.

That racial concordance doesn’t happen very often, Urban Institute figures have shown. About three-quarters of White patients have access to a doctor of the same race, but only one in five Black patients can say the same, 2022 data said.

According to Bhatt, alternative care sites are more likely to have a diverse medical staff because they are located in community settings. It’s easier to get a racially diverse workforce, one steeped in community history, because there are fewer roadblocks to staffers getting to the office or clinic. That’s true for virtual care, too.

“You have more flexibility with virtual and digital and retail in terms of the workforce because they may have more ability to participate in those work arrangements,” Bhatt stated. “Others may have to travel miles, take multiple buses to places where they don't feel comfortable, feel discrimination, feel racism, feel bias.”

“It's not only comfort in terms of the consumer and patients, but it's also the care team feeling comfortable that they can be authentic and deliver the right care at the right place at the right time,” he added.

All of these principles are replicable for mental healthcare, too. Mental healthcare needs and concerns are far outpacing mental healthcare access, with 2022 data from athenahealth showing that 42 percent of adults who wanted to access mental healthcare in the past year could not.

That trend can be attributed to a number of factors, including a dearth of mental health providers and the social stigma patients might feel visiting a mental health provider.

But according to the Deloitte survey, telehealth and non-traditional virtual care options may help circumvent that problem. Telehealth for mental healthcare is almost equally as amenable as in-person care, particularly with younger people who have busier schedules and more mental healthcare access barriers, Bhatt said.

“Virtual visits are a way to increase access to mental health care and support individuals who might feel stigma and fear going to traditional care settings,” he stated. “The policy opportunity is to continue supporting telehealth and virtual and digital models of care as well as remote monitoring and engagement. Because that can be really helpful to understand how mental health is impacting chronic disease as well as allow for digital interaction to build trust and move behavior.”

Realizing a future in which retail health clinics and virtual care support equitable patient care access will require support for providers, Bhatt contended. In his own practice, offering both patients and providers the training needed to use remote patient monitoring and other engagement tools has yielded better adoption and engagement, Bhatt offered as an anecdote.

That provider investment is needed across the country as organizations continue to work on health equity. Non-traditional care sites can open new doors for patient care access into settings that are comfortable and convenient to historically marginalized groups. Continuing on that road will require educational investments from health systems.

“While physicians explore ways in which to improve their virtual interactions, organizations should support them in the sustained use of virtual health and other care sites and doing that well,” Bhatt concluded. “It's a continued work in progress, but I see great promise ahead.”