MinuteClinic, CHW collaborate in Phoenix

MinuteClinic, the retail clinic subsidiary of CVS Caremark, has entered into an affiliation with Catholic Healthcare West in which the system's family physicians will serve as medical directors of the 10 MinuteClinics in the Phoenix metro region, and they will also collaborate with the clinics' nurse practitioners on disease management and patient education.

The deal gives a major boost to the flagging retail clinic movement and a major poke in the ribs to organized medicine.

While collaboration involving retail clinics and hospital and health systems is nothing new, the trend of these clinics offering disease management has drawn fire from the American Academy of Family Physicians. On April 1, MinuteClinic introduced its Monitoring Made Easy service line in 20 states and the District of Columbia, providing support for patients with previously diagnosed asthma, diabetes, high cholesterol and hypertension.

“We also look forward to collaborating with Catholic Healthcare West on information connectivity and a broad range of programs, including our new monitoring services and lab testing for diabetes, high blood pressure and high cholesterol and asthma patients,” says Andrew Sussman, M.D, MinuteClinic president and CVS Caremark senior vice president/chief medical officer, in a news release.

CHW spokesman Paul Szablowski says the system's physicians would not be onsite but would be available for consultation and would review quality data and charts, though he says he does not know what percentage of charts would be reviewed.

He adds that there may be more affiliations of this nature in the future.

“CHW is evaluating additional opportunities to potentially collaborate in other markets,” Szablowski said.

He noted that CHW initiated discussions with MinuteClinic in part because the company already has many other similar health system affiliations and because of MinuteClinic's status as being Joint Commission-accredited, but also because it would provide CHW patients with access to healthcare during off-hours and on weekends.

“It's an option for patients not wanting to leave work,” Szablowski says. “That's really a positive aspect for us.”

Under the new agreement, CHW and MinuteClinic have pledged to fully integrate their electronic health-record systems. According to a news release, if patients permit, medical information generated from MinuteClinic visits will be shared with CHW locations. CHW has three hospitals in the area, the 738-bed St. Joseph's Hospital and Medical Center, Phoenix; 224-bed Chandler (Ariz.) Regional Medical Center; and 182-bed Mercy Gilbert (Ariz.) Medical Center.

While not commenting on the specifics of the CHW-MinuteClinic arrangement, AAFP President Lori Heim, M.D., says her organization opposes the expansion of retail clinic scope of practice to include the management of chronic conditions, saying that it further fragments the healthcare system “and does not lead to good patient care.”

According to a MinuteClinic news release issued April 1, their chronic condition monitoring services involve MinuteClinic practitioners reviewing a patient's medical history and performing “an exam and tests based on nationally established clinical practice guidelines for standards of care, which may include an A1c test and comprehensive foot exam for diabetes, breathing and oxygen level testing for asthma, a lipid profile for high cholesterol and a blood pressure check and microalbumin test for high blood pressure.”

“It's not to say nurse practitioners don't have a role in a team approach,” Heim says. “Family physicians work with nurse practitioners all the time in a collaborative way. The problem is with my walking in and reviewing a chart for a patient I have no relationship with compared to being directly involved in that patient's ongoing care.”