The Growth Of Retail Clinics And The Medical Home: Two Trends In Concert Or In Conflict?

Headnote

ABSTRACT

There has been growing interest in the patient-centered medical home as a way to provide coordinated, high-quality primary care. At the same time, the number of retail clinics has increased dramatically. Many are concerned that retail clinics undermine the medical home by fragmenting care. In this article we explore the juxtaposition of these trends, highlighting shared characteristics and sources of tension. We describe three types of relationships between retail clinics and primary care providers. We argue that for some relationships there is no conflict, and we describe areas of potential concern for others.

The patient-centered medical home has garnered increasing support as a mechanism to better coordinate care, improve quality, decrease costs, and revitalize primary care.1-3 During the same period that the medical home concept has gained prominence, there has been tremendous growth in the number of retail clinics, which offer convenient care for simple illnesses and preventive services.

At first glance, these two trends would seem to be in opposition. The medical home emphasizes coordination of care, while retail clinics focus on single-visit acute care. Retail clinics might lead to increased fragmentation,46 as a visit to a retail clinic may represent one fewer visit to a medical home. This could undermine a patient's connection to his or her medical home and could prevent the medical home from providing coordinated and continuous care.

However, on closer examination, it becomes clear that the medical home and retail clinics share a number of core principles. In this article we examine these shared principles and identify where retail clinics might be in conflict with the medical home. We first describe both models of care and then define three different types of relationships that exist between retail clinics and primary care physicians. For each relationship we highlight how care coordination and financial considerations may promote or impede collaboration between the two care settings.

Patient-Centered Medical Home

The medical home has received growing attention as a way to reinvigorate primary care by providing "continuous and coordinated care throughout a patient's lifetime to maximize health outcomes."7 In this issue of Health Affairs, a number of authors, including Daniel Fields and colleagues,8 describe some of the many ongoing medical home pilot programs.

There is no single definition of a medical...