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The Little Clinic: Retail Health in the Continuum of Care


Saturday Afternoon 'To Do' List: Take son for rapid strep test, purchase salad and salmon for dinner, get prescription filled after getting a positive on strep, earn fuel points, accomplish everything under one roof.

One of the early entrants into the retail health space, The Little Clinic was founded in Louisville, Ky. in 2003 with a mission to simplify healthcare and make it more convenient and accessible to the patients served. Three years later and with a total of five clinics, the company moved its headquarters to Nashville. Today, there are more than 220 clinics in 10 states.

In 2010, the healthcare provider was purchased by Cincinnati-based grocery giant Kroger and now has corporate offices in Nashville and Cincinnati. Marc R. Watkins, MD, MSPH, FACOEM, chief medial officer and vice president of The Little Clinic (TLC), said the relationship with a major grocer provides unique opportunities for TLC to work with patients to connect food choices with improved overall health.

Marc R. Watkins, MD

Watkins noted clinic services are generally considered 'primary care lite' with treatment for minor injuries and illnesses. While that is certainly true, he said TLC also provides treatment for chronic stable disease including monitoring hypertension and diabetes, sexually transmitted diseases, travel health, some health and wellness screens including sports physicals and biometric screening, vaccines and immunizations, along with basic behavioral health.

Staffed by nurse practitioners and physician assistants working in concert with collaborating physicians - all board certified - he added the clinics have formed referral relationships and affiliations in their markets to connect patients to the larger healthcare system. Recently, TLC announced a collaborative partnership with Results Physiotherapy to offer patients additional pain solutions for a number of chronic conditions and injuries.

"Committing to a model where we're not in the business of prescribing opioids or controlled substances allows us to really look for partners that are doing the same," Watkins added of the relationship with Results.

Continuum of Care

Watkins said he absolutely sees retail health as an important part of the continuum of care. The company's vision, he noted, is to offer convenient neighborhood medical care that feeds the human spirit and helps people live healthier lives.

"We recognize we can't do it alone," he said. "To help people live healthier lives, we need partners." However, he continued, "We stand as part of the ecosystem. We should be seen as a healthcare destination like any location."

Watkins noted, "One of the rubs that we've had from traditional medicine is that somehow we fragment healthcare." However, he continued, healthcare is fragmented when there is a lack of communication. Watkins said TLC has made an aggressive push around sharing information with PCPs and other providers.

Nurse practitioners and PAs are actively asking patients to identify a PCP if one exists and to consent to an electronic transfer of information. If the patient opts in, then a visit summary is automatically pushed to the physician on file.

However, Watkins noted, "Almost 60 percent of our patients don't have a declared primary care provider." He added the goal is to connect those patients with locally based PCPs. "We've worked successfully in a lot of markets to make sure they (patients) don't go unattributed ... that they are connected with care."

He continued, "One of the things that we stress is that we're not replacing PCPs in what we're doing. We want to complement the PCP activity."

To that end, Watkins said TLC also has been aggressive in working to close gaps in care, particularly when it comes to age-appropriate screenings such as connecting patients to community providers for mammograms or colonoscopies.

Triple Aim

Watkins noted TLC is an important part of delivering the right care at the right place for the right cost.

"We want our nurse practitioners and our physician assistants to practice to the top of their licenses in order to deliver the best evidence-based care for our patients," he explained. "We will evaluate all of our patients understanding there will be times when conditions exceed our resources and capabilities. We are committed to providing evidence-based evaluations and recommendations that make good sense and that stay within the lane of safety and quality."

Watkins said by handling routine primary care, seeing patients outside of traditional office hours, and helping manage chronic stable patients, TLC providers free up physicians and ERs to care for patients at a higher acuity level. "We can create more capacity through our partnership and affiliations by decompressing these specialists and the primary care physicians to allow them to focus on more complicated chronic disease," he said. "Having care delivered at the right place is part of using healthcare dollars wisely," he pointed out.

Watkins attributed the clinic's success to the attention placed on healthcare's triple aim. "Part of what make us a little bit different is that we're focused on providing the highest quality and the lowest cost ... so we want to bend that cost curve but keep a high degree of quality." He added, "We have a gold seal from The Joint Commission."

TLC also participates in a quality payment program and uses their EMR as part of their participation in MIPS. With their focus on preventive screening, the nurse practitioners and PAs ask age appropriate questions about alcohol use, seat belt safety, tobacco use, immunization status, and other important factors at every visit. "We are coding that into our EMR so it's part of our workflow," he added.

Simplifying Healthcare, Meeting Consumer Demands

Leaning on more than 15 years of customer loyalty data, Watkins said, "We've been active listeners to our customers. We want to create a fantastic patient experience for those who choose to come see us. We know it's a competitive landscape."

An important element of the patient experience is offering transparent pricing, he continued. "We're committed to trying to simplify healthcare. Our prices are our prices. Payers know what we're changing for our services, and we're not afraid to put those up because the consumer deserves to know."

He added most folks, particularly those accessing the system through walk-in medicine, want to be able to go the website and find a menu of services and costs. While 80 percent of TLC patients are covered by insurance, having transparent pricing allows the patient to decide if they want to pay cash, use their HSA, or run the cost through their insurer.

Another key element of the delivery model is meeting consumer demand for convenience. In addition to hours seven days a week, TLC offers patients the opportunity to get in line ... online.

"One of the things that we've done in terms of innovation is we've allowed folks to secure their spot online. We don't want to waste the time of our patients - it's valuable. This will hold your spot. It's not an appointment, but it will hold your spot and give you an estimated time when you can arrive. It also allows you to tell us a little bit about you so it speeds up the registration process."

The Food Connection

"I think we offer something unique to this business vertical," Watkins said of being housed inside a grocery store. "Our core business from Kroger is that we're in the food business ... we're in the nutrition business." That core competency, he added, meshes nicely with improved health.

In addition to weight management services, he said TLC's registered dietitians and nutritionists offer medical nutrition therapy, host discovery events showcasing healthy food prep, and create patient-specific meal plans. "We have a pretty novel program called Navigating for Nutrition," explained Watkins. "These registered dietitians can actually take a patient - maybe a diabetic or someone who wants to go vegan or just to eat healthier - and help them navigate through the store to help them make the right decisions."

Kroger, The Little Clinic and Feeding America have also teamed up for a second year of the 'One Shot, One Meal' campaign. Through April 2018, Kroger will donate a meal through the Feeding America network of food banks for every flu shot administered at a Kroger pharmacy or TLC location. Last year, the campaign helped Kroger reach a new milestone of donating 330 million meals.

Next Steps

Watkins anticipates continued expansion of the TLC model. "Organizationally last year, we eclipsed two million patients. We'll be in place to add another million or so patients to what we see this year so our volumes are growing,"

Part of that growth could come from an expanded telehealth platform, which Watkins said has been in pilot mode but is nearing broader rollout. "We believe that's going to offer an opportunity to provide more access points and offer a great deal of flexibility in terms of convenience to patients," he said.

Watkins credited The Little Clinic's success to keeping healthcare simple, affordable and easily accessible. "We're customer first in everything we do."


The Little Clinic



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Health Clinic, Healthcare Consumerism, Kroger, Marc Watkins, Primary Care, Retail Health, The Little Clinic, Walk-in Care
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