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Healthcare Upside/Down: Pearls and Pitfalls for Integrated Urgent Care Strategies
00:27:24
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- [00:00]
Molly Gamble
Welcome to Healthcare Upside Down, a podcast by Becker's healthcare and ECG Management consultants in which we'll explore the upsides and downsides of healthcare and the industry's most current trends. I'm Molly Gamble and today I'm thrilled to be joined by two guests. Nick Zima, Vice President of Corporate Development with wellstreet Urgent Care, and Katie Fellin, Partner with ECG Management Consultants. Nick Katie, welcome to the podcast. Thank you so much for joining me.
- [00:25]
Katie Fellin
Thanks so much, Molly.
- [00:27]
Molly Gamble
Well, to start us off, can you introduce yourselves and tell us a bit more about your work in health care? Nick, I'll turn to you first here.
- [00:34]
Nick Zima
Thanks so much Molly. Glad to be here and I'm looking forward to our conversation today. As you mentioned, I serve as well Street Urgent Care's Vice President of Corporate Development where for the past five years I have assisted and supported health systems across the United States to develop and operate better and more frictionless ambulatory strategies. More specifically, my focus is and has always been on how do we deliver better patient centric, more financially sustainable urgent care strategies tailor made to help our patients find the care they need, when they need it, where they need it and how they need it. Urgent care to an outside observer might seem simple, but it is not. It is an incredibly difficult service line and function to master despite having become such a crucial access point into today's healthcare ecosystem. It requires attention to detail, it requires efficiency, it requires the ability to thrive in high patient throughput environments without ever sacrificing on clinical quality or patient experience levels. And look, to be frank, this is something we have seen health systems struggle with in recent years. So that's where I've spent my time and what we at Wellstreet have obsessed over for the past 10 plus years. Last year we cared for more than 2.1 million patients in our 150 urgent care centers across the nation by helping our partners to always put that patient first, to deliver a best in class patient experience and to strategically partner and develop and operate retail urgent care networks that are fully integrated into our partner's EMR system. For us, it is always on EPIC and to also deliver that care under our partner's brand so our patients cannot distinguish whether it's a well street urgent care or a health system urgent care and give those patients that best in class experience that they're demanding as customers in today's healthcare ecosystem.
- [02:20]
Molly Gamble
Great. Thank you so much Nick. And thanks for the context too. I think you put some great texture on this topic and why it's so Rich to talk about today. Katie, let's turn to you next.
- [02:29]
Katie Fellin
Yep. Thanks Molly. So, as you mentioned, I am a partner at ECG Management Consultants. ECG is a national healthcare only consulting firm with about 230 consultants across nine offices in the country. I actually joined ECG in 2007 and I've spent the entirety of of my time in our payer strategy and contracting division. I currently split my time between supporting hospitals and health systems, children's hospitals, independent provider groups, private equity firms, or their provider organizations in their portfolio, urgent care providers and behavioral health providers. And the way that I support them is to either help them define their reimbursement strategies or to help them directly in negotiations with payers, sort of navigating the evolving reimbursement environment. And that's how I got to know Nick, through our work together in that space. So thanks for having me today. I think it's gonna be a great discussion.
- [03:27]
Molly Gamble
Yeah, excellent. And Katie, what a vantage point since 2007 in the payer space. You must have feel like you lived many lives in that time from what you've seen.
- [03:37]
Katie Fellin
I do and I felt quite old, Molly, at the same time. All of those things it has gone past, but also when you think back about like that amount of time that it's. It really has been a fun space to work in.
- [03:47]
Molly Gamble
Yes. Yeah, very much so. Nick, I'm going to go back to something you said. This is a difficult service line to run. You mentioned keeping the patient the center. You're devoting your time to scaling urgent care strategies. The market, it was valued at about 47 billion in 2024. It's only expected to continue to grow. What right now is driving momentum in US Urgent care. And, and then if you can also how you distinguish a successful urgent care expansion from one that falls short because you have seen that this has been a rocky space for a number of companies.
- [04:26]
Nick Zima
Yeah, Molly, you are absolutely spot on. And just to put some context to the overwhelming growth that the industry has seen, I mean every year since 2007 or 2008, there has been an addition of roughly 7 to 8% unit count growth. So it has been a pretty meteoric rise in just urgent care center count nationwide. Today we sit with about 14 to 15,000 centers. And from our perspective, we expect it to keep growing for at least the next five years. And so at well street, we're optimistic about the future. We love the space we're in. Helping health systems to kind of better scale and operate is really what keeps us coming to work. Every single day to put some context around why that growth has happened. It's a question we get asked every single day. And where does this growth end? We spend our days trying to solve that, better understand it. And interestingly, in the past nine to 12 months, Wall street has undergone a market research campaign to just ask local consumers what their healthcare preferences are, why they choose care where they do, why they avoid care where they avoid that care. When I'm saying we're running market research, we're running market research across more than 10 major metros with 45 million residents. So this is representing a pretty robust subset of the U.S. population, at least 10 to 15% coverage. So some interesting tidbits kind of arose through that market research. And first and foremost, loyalty to primary care is lower than we've ever seen it. Traditionally. Access to the health care ecosystem has been through a primary care relationship. There's been independent studies nationwide that have suggested about one in every two Americans no longer maintains a relationship with a primary care provider. And our market research kind of found that exact data point again, where what we were seeing is patients don't maintain that loyalty anymore. And frankly, they're showing a preference away from that loyalty, even more so going forward. And so what does that mean? Well, there's really only one other avenue of approach excluding urgent care, and that's the ER. Patients, interestingly, resoundingly, want to avoid the ER. I mean, 65 to 70% of respondents, depending on the metro area that we were surveying, show that no one likes going to the er. No one likes getting the high, the extremely high bills. No one likes to sit in a waiting room for two hours, three hours, whatever it might be. So that's where urgent care has really kind of fit in. Entrepreneurial physicians apps kind of over the years have seen that opportunity, that access gap, and that's exactly why that meteoric rise has happened. So piggybacking and just answering the second part of your question of what makes a successful urgent care strategy, it's really being able to deliver access. Patients are demanding convenience, patients are demanding high quality. Covid was an interesting time for our industry, and it increased consumer education. People know what to look for in a healthcare access point. And so we have to put the patient first. We have to be diligent in making that patient pathway, their patient journey, frictionless. We have to be convenient, we have to be local. That's exactly what is going to differentiate a good versus a bad urgent care strategy. And interestingly, in that market research, just about 70% of respondents also indicated that they don't want to use an urgent care that's unaffiliated with the health system. So there's a strong signal of value in an urgent care that's affiliated with the health system. And so that's why we at well street are so optimistic. I mean, we are a health system first model. We only partner with health systems to run urgent cares. We don't operate in independent urgent cares nationwide. And we are here to be that kind of expert. And that's where our partners have been excited lately, to continue investing and continue growing with us. And it's been a fun few years, Nick.
- [08:24]
Molly Gamble
I mean, it sounds like this Wall street research paints such a nuanced picture and defies some of the assumptions about patient demand. When we think about things like wait times, we can often operate in this assumption that patients are demanding time with their primary care physician. What you just pointed to is in fact that demand and loyalty is really low, but at the same time they want urgent care affiliated with the health system. So I'm appreciating this information and I think it's really important to keep in mind. And I wanted to check in with you on one other point and then we'll hear from Katie. But so many urgent care strategies are rooted in the cost savings potential. Also their capability for offloading or diverting care from the ed, which you just helped us better understand. Patients don't necessarily want to go or be. At the same time, you've got some research on urgent care suggesting that this setting can increase net overall spending on lower acuity care. So how do you see and think about urgent care's real value, especially as we see those health systems you mentioned just continue to deal with tightening margins and some financial headwinds and unknowns?
- [09:34]
Nick Zima
Yeah, absolutely. And it's a fair concern. There have been many studies published kind of along the same lines. And this area of research, it's notoriously difficult. And obviously I'm coming at this from an urgent care perspective, so I'm going to take a very favorable urgent care lens. However, keep in mind that in any research study that's being done, we're going to try to isolate out independent variables to measure effect on a dependent variable. What's effectively happening here is there's an underlying assumption or kind of a foundational assumption in every research study that's happening that's going on nationwide to say before urgent cares came into the market or came into existence, access was perfect. There was no need, there was no gap. And so if we are Analyzing a study or kind of trying to interpret a study from the perspective of access is perfect. And urgent cares have grown. There's kind of a fallacy in that thinking alone because why would urgent care have been here in the first place? And why would urgent care have been able to grow so successfully? So patient preferences definitely come into play. And that's from our perspective, that's the most important dependent variable here of we're not selling airline tickets, we're not selling vacations. Like people aren't coming into the healthcare ecosystem in the United States because they want to, they're coming because they need to. They either have a distinct acute need for care or a perceived need for care. And if even if they have a perceived need for care, it's our job as the healthcare professionals and healthcare providers in this country to provide that care. So as we're kind of going back to the market research and seeing that people want to avoid a primary care, that they don't want to wait in line for an appointment, they don't want to wait seven days, they don't want to go to the ER today because they're going to receive an expensive bill. That's what's so important to keep in mind as we're considering those. And if we kind of reset the baseline assumptions to say that there is a care gap in this, in this country that has allowed urgent care to grow and has. More than 60% of urgent cares in America are affiliated with health systems today. There's a reason for that. This is a ambulatory strategy evolution and there really truly is a cost savings to that patient. Because if I'm a patient and I have a perceived need, I'm going to pursue care. I can be seen in an urgent care for 50% of the lower acuity visit purposes that I have go to the ER for, of course I'm going to pick that and have that 5x to 20x savings.
- [12:05]
Molly Gamble
Katie, let's turn to you here because I think Nick helps us understand the landscape more broadly. Consumer attitudes and patient attitudes and preferences. Let's talk about reimbursement. This is your area of expertise. When we talk about these financial challenges, what do you see as the biggest pain points when it comes to reimbursement for urgent care services today? How big are those barriers when we talk about continued innovation in this space?
- [12:31]
Katie Fellin
Yeah, those are two really good questions and actually very closely linked. I kind of see three primary issues recurring when we talk to urgent care providers across the country. The most common issue we see is that Urgent care centers, as Nick has said, are being designed to maximize the consumer and patient experience and create that sense of loyalty, if you will, that sort of waning from their primary care providers. But reimbursement from payers really only factors in the cost to deliver basic care, right? So the payer is trying to control costs for its membership base and they don't want to reimburse a higher rate for a prime location or an updated lobby or supplemental services on site. So we have a lot of urgent care providers who are saying, right, we've got to maximize the efficiency, the flow, the throughput that takes money. And the payers are saying, well, that's great, and we do care about our member experience, but we don't need them to have the Ritz Carlton experience on urgent care. We need them to get the access to the care they need when they need it. Right. And so there's a sort of continual disconnect between those two things. Interestingly, the other area where there's a disconnect and it's related to this is as we're seeing the increased use of high deductible health plans. Consumers will tell you they both want the experience that Nick has described, but they also don't want the high price tag that comes with that experience. Right. Because more is coming out of their pocket for services. So it's a little bit of a disconnect between sort of the provider of the service and the funding source. Right, for the service. So that's the most common issue, number one. The second common issue is that payers generally view urgent care as a necessary subspecialty, but not really as primary care. And frankly, many ACOs or CINs or others in the market who are considered payers are taking the same perspective. And so if an urgent care joins an ACO or a CIN or some other funding entity, they're typically paid and incentivized as specialists, not as primary care providers. And when you're thinking about the transition to value or value based reimbursement models, primary care providers typically have the attributed lives and yield the higher incentive payments. Urgent care is fundamentally helping to close those care gaps and can help reconnect patients back to their primary care, but they're generally being treated as specialists with lower level incentives. We're asking them to play this very interesting role in the care continuum, but not necessarily at a high level of reimbursement. Then the third biggest pain point is really reimbursement for Medicaid. Many, many, many urgent cares across the country have opted out of Medicaid participation and are serving commercial patient populations only. And frankly, that doesn't help address the real care gap that exists. And so working with the health systems and the managed Medicaid payers to align reimbursement rates, even at parity with Medicare, would be a big help in solving sort of the reimbursement challenge that exists for that patient population. And Molly, sort of like on that point, when we think about it, your second question was more aimed to, like, how do those barriers impact continued innovation? Well, the reality is that many urgent carers could actually play a pretty critical role in the primary care continuum, helping to close hedis gaps or create new avenues for other patient populations to access care when they need it. Let's think about, like, foster care populations, if you will. Right. Where we know we don't have enough access, but we just can't. We can't quite get there because we can't align the payment models in a way that incentivizes urgent care to expand. I think the real opportunity that remains is going to be tied to those urgent carers who are fundamentally integrated emr Right. With the health system and who can share data and information and say, hey, look, a patient coming to my urgent care with an ear infection doesn't increase cost for you payer because that patient had to get the ear infection treated one way or the other in the primary care office or here. But if I'm connected via the emr, I can look at that patient's chart and say, oh gosh, this is your third ear infection in a month and a half. What antibiotics have been prescribed before? Do we need a referral back to an ent? Right. It's that connectivity, I think, Molly, that's going to make the difference on the reimbursement and innovation in the future.
- [17:43]
Molly Gamble
Katie, it sounds like the job description, if you will, of urgent care is growing and the job description gets lengthier and lengthier. It's serving more masters, if you will, but the pay is not matching and it's not in accordance to how they continue to function in the system.
- [18:02]
Katie Fellin
Couldn't have said it better, Molly. Actually, I probably could have said it just like you said it in fewer words. That's. That's exactly right.
- [18:08]
Molly Gamble
Okay, so Nick. Thank you, Katie. And Nick, I think this brings me to my next question because you had said, you know, is so core to your work making sure patients are really at the center of all this because they can be strategically beautiful and make so much sense. And if the reimbursement is even matched. But then that doesn't necessarily mean they're serving patients the way they were meant to. Can you talk about this a bit? Innovations and partnerships that you see as the most promising to ensuring that this care setting remains convenient for patients. It remains fruitful and beneficial for continuity of care. How do you think about this? There's more and more expectations for how these settings settings function and what benefits and how they drive the system forward. How do you make sure patients are in the center of it all?
- [18:54]
Nick Zima
Frankly, this is exactly where entities and companies like well street urgent Care fit into the spectrum. And this is where all of our excitement about the future growth lies. Because I mean last year Wall street urgent care cared for 2.1 million patients were on pace to surpass 2.4 million patients. This is across four states with just about 150 urgent cares today. Patient experience net promoter score well north of 80 year to date. We are a fully integrated urgent care where we are using our health system partners instance of epic. We're using our health system partners brands above the door. A patient comes into a well street urgent care they have no clue they're in a well street urgent care they're going to think they're in Clinton, they're in one of our partner facilities with seeing medical group providers using the exact same emr. So this is where so much of the promise comes into play and it's been a fun few years to be part of this. The growth and the kind of evolution of the partnership mentality. Pre Covid health systems were starting to outsource non core services and functions. The velocity of partnerships post Covid with the financial strains that these systems have been seeing and have been exposed to nationwide, it has only accelerated. And we believe very firmly that there are other health systems out there that we can help close care gaps in their communities. We can help operate that best in class urgent care. We can transition their legacy medical office building based urgent cares that are capturing 5 to 10% new patients on an annual basis into a retail setting. I'm talking at the corner of Main street and Main Street. We're next to the Starbucks, next to the grocery store that people are living and breathing in and around every single day, driving by on their way to work, driving by on their way to their sons or daughters soccer practice in the evenings. And so kind of the partnership mentality and the velocity moving forward, I mean that's what really has us so excited from an innovation standpoint. This is another great topic because there's been so Much talk about AI and how it'll transform healthcare. However, there's still so much opportunity in just making the patient journey easier, more frictionless, putting the patient first, putting the patient obsessing over the details of how many clicks does it it take for that patient to find and discover care? How many left hand turns does that patient have to make across four lanes of traffic to access the care once they've found that care? How long is that patient sitting in a waiting room waiting to be triaged and brought back into an exam room? How long is that patient waiting for a lab result or a urine culture to come back from the diagnostic lab, the third party diagnostic lab. And that's where we're investing so much of our time and other urgent care operators frankly should be as well. A few kind of interesting call outs that I'll share with you and the audience here is in 2025 we've invested in our in house PCR testing capabilities. We just rolled out a multi panel respiratory test that allows our providers to, instead of ruling out that you don't have Covid, this allows our providers to say you have a viral case of a respiratory illness. So it's helping with our antibiotic stewardship and kind of playing back into Katie's points of providing value to our payers. This, this allows for quicker test and treat mentality in our clinics where our providers are conclusively diagnosing a patient, starting the antibiotic, the correct antibiotic, documenting it into a fully integrated emr. We just also rolled out an STI PCR test. This is for both males and females where the test will be resulted within 20, 25 minutes. That patient will be tested and treated. That course of treatment will have have begun before that patient ever leaves our clinic. So just great, exciting innovations in that regard, but also making our patients lives as easy as possible. You've probably heard that we obsess over this, the friction points and it's because we have to. We are a patient advocate just as much as the patient themselves. We're here to close the gap in care and provide the access and that's how we're able to kind of fundamentally help health systems shape their broader ambulatory strategy and become that front door into an integrated network.
- [23:14]
Molly Gamble
Nick, the pressure is on, right? I mean convenience is not so much a destination, it's a direction you constantly need to be headed in which it sounds like Wall street is certainly pushing things forward in that regard. Some of the details you just shared there, pretty remarkable. I think we've hit this topic from a few different angles. But Katie, Nick, is there anything I did not ask you that you'd like to make sure our listeners hear today or something else that you want to share?
- [23:41]
Nick Zima
I mean, urgent care at times has, has been looked at as a just necessity, but it doesn't have to be that necessity. This can truly be transformational for health systems. Health systems traditionally have looked at this as, as an asset that they have to have. This isn't from, from our perspective, this is an asset that they get to have and they get to brag about. They get to show off to the communities, they get to welcome new patients, they get to maintain established patients. They get to fight the lack of patient loyalty that everyone's facing today. And it can become truly a strategic asset. And obviously I'm excited about this. I'm excited to kind of continue the growth trajectory that we talked about today. I'm excited about the ability to continue to partner, to bring care to every community, equitable care to every community, I should say. So if there's anyone that is listening that would love to have a conversation, obviously I'm, obviously I'm always open to that. You can find us@wellstreet.com, you can reach out on LinkedIn, however you'd like to get in touch. Happy to have the conversation.
- [24:46]
Katie Fellin
And I think the only thing I would add is from a payer and reimbursement perspective, a lot of times success in negotiations comes from finding the person on the other side who can relate to the specialty or the experience that you're describing on behalf of their members. For example, if we're negotiating for ABA Services for autism, if you happen to have a rep on the other side of the phone who has a personal experience with autism, the discussion is a little more real because they know what you're talking about. One of the opportunities, Molly, that I think exists is you would be hard pressed to find anyone in this country who hasn't had an urgent care experience at some point in their life, either for themselves or a member of their family. And I would probably hedge a bet that when you have those discussions, they're going to have had a positive experience and they're going to have had a negative experience, and they'll be able to juxtapose those and be able to have an opinion for themselves. When you're describing what you think is a positive value add to their network, does that resonate with them? And how does that help you help them help us design more appropriate reimbursement models for these providers. We're still very early on this, but I actually have some optimism about that. When the service is relatable, it makes the discussion around on what the payer values and what are their employers. Right. The employers are who they need to make sure keep care costs local for what their employers value. And what we're hearing more and more is employers want their employees to come to work and they can come to work faster if they can get access to the care they need faster in the appropriately cost setting. So I think there's a lot of opportunity and I'm excited to see sort of how the discussions progress across the next five years.
- [26:47]
Molly Gamble
Yeah, likewise, Katie. The familiarity of Urgent Care I think makes this just additionally interesting and you both outlined so well some real opportunities in this space amid some real and remaining challenges. So I want to thank each of you, Nick and Katie, for your time and just this really educational discussion today. I also want to thank our podcast sponsor for this episode, ECG Management Consultants. Listeners, you can tune in to more podcasts from Becker's Healthcare by visiting our podcast page@beckerspodcast.com Nick Katie, thanks again.
- [27:19]
Katie Fellin
Thanks Molly.
- [27:20]
Nick Zima
Thank you.