Doctors offices that don't require appointments and are open at all hours are changing the way Americans get medical care
- Urgent care centers have become an increasingly popular way to get healthcare in the US.
- Big players from health plans to hospital systems to private equity investors all want in on urgent care, which has grown 25% between 2014 and 2017.
- The growth in urgent care is coming at a time when the way Americans access healthcare is changing.
Richard Park started his career as an emergency room doctor.
But in 2005, he started working somewhere else: an urgent care clinic in New Hyde Park on Long Island.
"It looked really unimpressive, a hole in the wall," Park told Business Insider. "They probably thought I was a doctor who couldn't hack it in a hospital because I was young."
Park would give out his cell phone number to patients. He recalls years later, he'd still get calls from them, asking for recommendations for cancer doctors, for instance, after a family member got a diagnosis.
Park went on to found CityMD, an urgent care company that now has more than 100 locations in New York, New Jersey, and Washington state. That initial location in 2005 didn't end up becoming a CityMD, but Park said he still wants that same kind of patient connection to develop at his clinics today.
"We want you to call us for the UTI, the sore throat, the chest pain, but also for the abdominal pain, the cancers or the really big things," Park said.
Urgent care is catching on as Americans increasingly seek convenient ways to get healthcare. According to the Urgent Care Association, the industry's trade group, there were 8,154 urgent care centers in the US in 2017, up 25% from 2014. Urgent-care visits have climbed rapidly, too, according to one study.
"They're definitely popping up everywhere," Dr. Lisa Bielamowicz, the president of Gist Healthcare, which consults with health systems, told Business Insider. "There's a huge amount of competition for the convenient care space."
Investors are taking note.
In April 2017, private equity firm Warburg Pincus took a majority stake in CityMD in a deal that reportedly valued the urgent care company at $600 million.
Optum, a unit of insurance behemoth UnitedHealth Group, bought MedExpress in 2015 for a reported $1.5 billion. MedExpress is the largest urgent care operator in the US, with 250 locations.
Private equity firm American Development Partners in July 2017 said it would invest $1 billion in the second-largest operator, American Family Care, to help open more clinics.
How urgent care works
The way Park sees it, urgent care can function as primary care for the otherwise healthy person who just needs a quick check-up, prescription refill, or fix for their infection, issues they'd typically see their primary care doctor for. And it can also treat many of the same conditions that you'd otherwise go to the emergency room for.
"Urgent care is primary care for 20-to-50-year-olds," Park said.
The urgent care center in your neighborhood is likely equipped with the tools and medical professionals to help with everything from a sore throat to a deep cut or minor fracture. It can also refer you out if you need a follow-up appointment or direct you to an emergency room if the case warrants it.
Urgent care don't require appointments, and often come with an estimate of how long you might be waiting before you see someone. The centers are usually staffed by doctors trained in emergency medicine, and provide far more types of care than a retail clinic inside a pharmacy.
There are some drawbacks to urgent care. For one, it tends to be more expensive than a visit to the doctor's office, which could lead to higher healthcare costs for individuals and for the country. There's also the concern that more transactional outlets like urgent care tend to prescribe antibiotics at higher rates in cases where they're not needed.
Where it's headed
Health systems and health plans alike are looking to use urgent care centers to their advantage. Health systems are seeking to use the centers to funnel patients who need more care to their hospitals, while health plans are counting on them to provide a lower cost alternative to emergency rooms and help reduce spending.
"Urgent care is really the front door to that hospital," Laurel Stoimenoff, the president of Urgent Care Association, told Business Insider. Systems like Advocate Health Care in Illinois and Banner Health in Arizona, have been leading that charge.
There's been an increase in visits to urgent care centers, while emergency room visits declined, according to a paper published in October in JAMA Internal Medicine that's based on data from one commercial health plan. There were 157 urgent care visits per 1,000 members in 2015, a 137% increase over 2008, the study found. Emergency room visits declined over that period to 198 per 1,000 members, from 231.
UnitedHealth, for instance, counts its MedExpress urgent care chain as part of the company's OptumHealth unit, alongside surgical care and physician practices. You don't need to be a UnitedHealth insurance customer to see a MedExpress doctor or visit one of its surgery centers, but the company's strategy is to use these doctors to deliver lower cost care, giving it an advantage over rivals, according to Morgan Stanley analysts.
The Morgan Stanley analysts expect the division to generate $100 billion a year in annual revenue by 2025, up from an estimated $23.4 billion this year.
The scope of what urgent care centers can do is growing, too. In some cases, that's led to more specialized practices. For example, PM Pediatrics in the New York area provides urgent care solely to kids. Many urgent care centers don't treat children.
Others, such as Zoom Health in the Pacific Northwest and San Francisco-based Carbon Health are pursuing hybrid models where it's not just urgent care, it's primary care too. That means that in addition to getting care for an immediate need - like a cut - you can get care for more chronic conditions as well through follow-up appointments at the same location.
The way CityMD's Park sees it, he's working to keep people out of the ER not just the first time they come in, but in the future too, by providing more consistent care.
"If a patient comes in with chest pain, he might not want to go to ER today, and you can keep them out of the ER with some tests," Park said. "But that person has to see a cardiologist."
Park said CityMD has a Long Island City call center with 90 people taking calls to make sure that follow-up visit happens.
All of this hinges on the idea that urgent care centers are here to stay. Web Golinkin, who became CEO of FastMed, one of the largest urgent care chains in the US, in 2017, has spent the past 13 years in the convenient care space, co-founding a chain of retail clinics that were sold to Rite-Aid. The way he sees it, the services grew out of a consumer need, one he doesn't see changing any time soon.
"I don't see that trend reversing any time soon," Golinkin said.