Alternate Sites of Care: Meeting Patients Where They Are
In L.E.K. Consulting’s first article about consumer health, we described how escalating costs, growing patient demand for convenience and greater competition are driving healthcare toward consumerism. One way the industry is responding is by shifting focus to alternate sites of care. In this article, we explain what we mean by alternate sites of care and how they add value.
Let’s start with a look at how care settings have shifted over time from the traditional model of facility-based inpatient care at a hospital or health system. This model is driven by acute care that is, for all intents and purposes, reactive.
However, there’s been a shift toward outpatient care settings over the past decade. It began with ambulatory surgical centers to reduce hospitalization costs. Recently, a wider variety of sites have emerged to take advantage of progressive care elements such as:
These sites emphasize reactive and preventive care models that meet consumers where they are, reduce costs and create better outcomes. In doing so, alternate sites of care help both patients/consumers and healthcare organizations meet their objectives in seeking and providing care (see Figure 1).
Approaches that mix and match these objectives are already appearing in the marketplace. Some approaches offer the potential for new treatment paradigms of patient care. Here are a few examples we have observed through our work in consumer healthcare.
Issue. The initial outbreak of COVID-19 saw hundreds of patients waiting hours in line to get tested for the disease. The ordeal negatively affected not only their consumer experience but also the opportunity for clinics to retain patients for future services.
Approach. In response, CityMD rolled out a software solution specific to its urgent-care setting. Patients could now avoid the walk-in line by scheduling an appointment online and waiting elsewhere until their turn arose. This approach led to a rapid bump in the provider’s Net Promoter Score. It also integrated with CityMD’s preexisting virtual aftercare services — including results delivery, follow-ups and personalized care plans — to help with consumer retention.
Why was this successful? CityMD provided a logistically convenient solution that helped consumers save time and access care, resulting in a positive end-to-end consumer experience. Ultimately, the organization stood to improve customer acquisition and retention due to the enhanced patient experience. Given the value of this model, it is unsurprising that it is gaining traction in the market. In 2022, the pharmaceutical chain Walgreens acquired CityMD.
Issue. Foot care is often difficult for or neglected by many patients. This is especially true for seniors and those with chronic diseases that can limit mobility and the ability to see or touch their feet. These patients often resist seeking care unless they think it is urgent, and this often leads to more severe consequences due to later intervention. A very typical and often severe example is the case of diabetic patients who are predisposed to foot ulcers that can go undiagnosed for extended periods. In other cases, early symptoms of diseases can be identified by examining the patient’s feet, leading to earlier treatment.
Approach. With its at-home pedicure and foot care services, Belle can serve as a first line of defense. The company’s technicians provide a personalized, valued pedicure for consumers through convenient at-home service, and each Belle technician is trained to recognize conditions that may indicate a more serious disorder such as diabetes or vascular disease. Upon identifying a condition that requires intervention, Belle can help coordinate with payers and other providers as necessary.
Results for Belle? Nearly all members report high satisfaction, with a Net Promoter Score of 95. They also tend to rebook appointments on the spot, providing a follow-up touchpoint for additional care. Earlier diagnosis gives payers a chance to prevent potentially critical disease progression, and the service itself can make benefit plans more attractive.
Why is this successful? For consumers, Belle provides easy, on-demand access to care and a positive end-to-end experience. In many instances, consumers establish comfortable, trusting relationships with their therapists, engendering a greater ability for them to positively influence outcomes. For insurers and care providers, Belle provides an additional touchpoint to patients to ensure better outcomes by catching progression of diseases before they become more severe, more difficult to treat and more costly to remedy.
Issue. U.S. maternal mortality rates are on the rise. Treatments are subject to patient mistrust, misunderstandings and fear. A significant number of Americans find their employer-based fertility benefits challenging to navigate.
Approach. Enter Maven, a telehealth provider focused on women’s and family health. Maven offers on-demand advice from a network of specialists like midwives and prenatal nutritionists. Through the company’s online platform, members can schedule assessments, proactive check-ins and human touchpoints to identify risks and prevent costly complications.
According to Maven, same-day appointments have an average wait time of 27 minutes and patients rate their satisfaction at 4.9 on a 5-point scale, regardless of specialty. The company also reports better patient outcomes with its model, including fewer C-sections and admissions to the neonatal intensive care unit.
Why is this successful? Maven’s platform offers patients easy, on-demand access to personalized treatment. This sets the stage for better clinical outcomes, an improved provider experience, greater customer acquisition and retention, and a lower total cost of care for patients.
Issue. Many consumers lack access to primary care clinics, keeping them from receiving preventive care and services to diagnose and treat chronic and acute illnesses. Consumers face financial and geographical barriers. Many consumers lack health insurance; rural areas often have a shortage of health professionals.
Approach. Many Americans may be out of range for a medical clinic, but 90% live within 10 miles of a Walmart store. At stores equipped with a Walmart Health facility, patients can receive a variety of care from certified nurse practitioners — including diagnostic tests, vaccinations and prescriptions. Walmart contracts directly with insurance companies so that patients pay little to no money out of pocket (e.g., Walmart currently has a 10-year contract with UHG/Optum to ensure superior care to patients). Meanwhile, the one-stop-shop model for primary and dental care simplifies the patient experience.
Why is this successful? Logistical convenience and easy, on-demand access helps patients eliminate gaps in their care, keeping them on track with treatment and avoiding costly complications. For Walmart, the total cost of care for patients can be lower than traditional stand-alone clinics. The approach also enables the company to capture a greater share of wallet by giving customers another reason to return and spend time at the store, perhaps by filling a prescription at the pharmacy or picking up the groceries recommended for their diet.
By providing the right care at the right place and right time, alternate care settings support a more preventive healthcare system — one that does not wait for patients to become so sick they end up in the hospital. Instead, consumers can tap into the healthcare system from the stores they go to, the homes they live in and the mobile devices they use every day.
The idea of meeting patients where they are may run counter to traditional notions of effective healthcare. But as these examples show, alternate sites of care can deliver a host of benefits for consumers, healthcare providers and payers.
For business leaders interested in developing their own alternate site of care strategy, the first step is to identify the target consumers. After that, they must gain a thorough understanding of target consumer objectives and map those to the organization’s objectives. To learn more about how L.E.K. can help, please contact us.
Joyce Sun, a consultant, and Alyssa Yun, a senior associate consultant, also contributed to this article.