Marking a significant step in what might be called the “retailization” of health care delivery, Kaiser Permanente is partnering with Target to open medical clinics in stores in Southern California.
Three Kaiser clinics opened last week in Target stores in Fontana, San Diego and Vista. Another is scheduled to open next week in West Fullerton.
Chain retailers — CVS, Walmart, Target and others — have operated clinics in their stores for years, but the Kaiser-Target partnership is a notable new chapter: Kaiser’s size and previously insular reputation suggest a new, perhaps far-reaching change in health care delivery, relying heavily on telehealth technology. The partnership is new and small, but Kaiser officials hope the model will grow in the eight states and District of Columbia where Kaiser does business.
The clinics represent a couple of significant firsts for Kaiser, California’s largest HMO with about 7.3 million members. The move marks Kaiser’s first foray into retail settings and the first time its providers will routinely treat patients covered by other insurers.
Health care changes in California — especially involving the state’s largest HMO — are often carefully watched by the rest of the country.
“This is definitely new for us, however it fits in the larger context of a strategy we have called Care Anywhere,” said Chris Stenzel, senior vice president of business development and innovation at Kaiser.
Rather than “retailization,” Stenzel suggested “you might think about it as the consumerization of health care. We’re doing many things to make our care convenient and accessible.”
Stenzel pointed to mobile health options, an “increasing array of telehealth visits in the home” and a number of work site clinics. In some ways, Kaiser clinics at employers’ sites is coming full circle for the insurer with roots in the Kaiser shipyards in the 1930s and ’40s.
Kaiser’s Target clinics will treat all comers — Kaiser and non-Kaiser members, as well as Medi-Cal and Medicare beneficiaries. Stenzel said Kaiser is negotiating reimbursement agreements with three other large insurers and more may follow. He declined to name the insurers.
Nurse Practitioners, Telehealth Key in Clinics
The clinics will be staffed with nurse practitioners and rely heavily on telehealth technology to connect to physicians and Kaiser’s large clinical and technical infrastructure.
“The telehealth capacity at Kaiser is pretty impressive, so that will certainly add something to these Target clinics,” said Dylan Roby, director of UCLA’s Health Economics and Evaluation Research Program.
Interpreter services, specialty consults and other needs could be coordinated fairly easily because of the infrastructure investment Kaiser has made in electronic health records, videoconferencing and secure e-mail systems, Roby said.
Nurse practitioners’ role as primary care giver at Kaiser and other retail clinics may increase as more people gain coverage through the Affordable Care Act.
“Nurse practitioners have been very involved in primary care and urgent care for many years, and that may increase due to the pressure put on the health care workforce due to the aging of the population, increase in chronic illnesses, expansion of coverage and improved insurance benefits,” Roby said.
“I haven’t heard reports yet of specific providers being overburdened by the ACA, but the general trend is toward a workforce shortage due to population growth, aging, etc. Because NPs have a scope of practice that allows them to do substantial primary care duties and prescribe drugs, they are a popular option at many urgent care centers and community clinics,” Roby said.
More Exposure for Both Businesses
Medical clinics in Target stores are not new. The first opened a decade ago, offering vaccinations and flu shots. But Kaiser’s participation takes them to a new level. The Kaiser clinics will offer pediatric primary care visits, ob-gyn services, management of chronic illnesses, such as diabetes and hypertension, and consultations with specialists.
Although Kaiser officials said the new partnership is not primarily a marketing tool — “This is really not about selling the health plan,” Stenzel said — the exposure won’t hurt.
“Both Kaiser Permanente and Target are well-known brands that could mutually benefit from the arrangement in terms of drawing in customers,” Roby said. Shoppers will be exposed to Kaiser and Kaiser members will be drawn into Target stores.
“I think this is a bit different than other smaller retail clinic chains partnering with drug store chains, where the focus has been on convenience and developing a new brand,” Roby said. “Target and Kaiser have pre-existing brands that have some customer overlap, but there is a lot to gain for both in my opinion.”
As health insurers compete in the new ACA landscape, exposure to new customers is critical.
“Strategically, Kaiser has been trying to lower premiums relative to other carriers through Covered California and get more patients and this could also help them do that,” Roby said.
“If they feel patients from Blue Shield and Medicare will come in, use their services as an in-network provider and like what they see of the Kaiser model — integration, EHR, follow-up — they may be likely to sign up for Kaiser at the next open enrollment via Covered California, their employer, or in Medicare Advantage,” Roby said.
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