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Clinical Laboratories and Pathology Groups

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News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Retail clinics ready to expand into chronic disease management and that can be a threat or an opportunity for clinical laboratories

Dark Daily has often predicted that rapid clinics in retail stores would actively look for opportunities to add specific medical laboratory tests to their on-site service menus. Now the largest retail clinic in the U.S. is set to deploy hemoglobin A1c (HbA1c) testing analyzers in its 600 retail clinic sites throughout the United States.

This deal was announced in November between MinuteClinic, a division of CVS Caremark Corporation (NYSE:CVS), and Axis-Shield plc (LSE:ASD, OSE:ASD), of Dundee, Scotland. The agreement calls for MinuteClinic to use Axis-Shield’s Afinion analyzer in all 600 of its clinic locations across the nation. The system’s HbA1c assay is CLIA-waived. The fully automated analyzer will allow MinuteClinic’s providers to collect a patient specimen and get the results of the hemoglobin A1c tests in as little as three minutes.

Of course, the business strategy here is to add the clinical services necessary so that providers can serve patients with diabetes in these retail clinic settings. This represents a sizeable market. According to the 2011 National Diabetes Fact Sheet, there are 25.8 million adults and children with diabetes, and only 18.8 million have been diagnosed. Of greater interest for clinical laboratory managers and pathologists, 79 million Americans are considered pre-diabetic and, in 2010, 1.9 million new cases of diabetes were diagnosed among individuals who are 20 years and older.

Essentially, this is a disease where more than one-third of the American population is either diabetic or pre-diabetic. That is why retail clinics, like MinuteClinics, want to begin serving this market.

Coming soon to the 600 CVS pharmacies in 24 states that have a MinuteClinic will be hemoglobin A1c testing. Providers in these retail clinics will use Axis-Shield’s Afinion analyzer to perform the CLIA-waived HbA1c tests for patients with diabetes. The medical laboratory test results will be available in only three minutes. The addition of HbA1c testing is part of MinuteClinic’s business strategy to offer more services in chronic disease management. (Photo copyright by

Medical laboratory professionals know that hemoglobin A1c (HbA1c) is an indicator of long-term glycemic control. Results from HbA1c tests are used by physicians to make treatment decisions, such as how to maintain or improve a diabetic’s glycemic level. IVD Technology, in a recent story, noted that in vitro diagnostics (IVD) manufacturers are working to develop point-of-care test (POCT) solutions for hemoglobin A1c in order to tap this sizeable market.

“We are pleased to be partnering with the largest provider of walk-in medical clinics to bring [this testing] directly to patients, enabling widespread access to routine hemoglobin A1c testing,” declared Ian Gilham, Chief Executive Officer of Axis-Shield, in a statement on the company’s website.

The Axis-Shield Afinion desktop multi-assay analyzer enables immediate rapid testing, using a CLIA-waived test. According to a company press release, the cartridge-based analyzer offers a range of laboratory-quality tests on a single point-of-care system.

MinuteClinic, a division of CVS Caremark (NYSE: CVS), is the largest retail clinic chain in the U.S. Its approximately 600 clinics are located in CVS stores in 24 states. (See “More Medical Laboratory Testing Expected as Retail Clinics Change Delivery of Routine Healthcare Services”)

Retail Clinics Need Medical Lab Tests for Chronic Disease Management

One notable aspect of the new agreement between MinuteClinics and Axis-Shield is that it demonstrates how the retail clinic industry is actively moving into chronic disease management. Naturally, an expanded menu of medical laboratory tests will be needed to support these additional clinical services.

This trend was affirmed by Sandra Ryan, R.N., MSN, CPNP, FAANP, who is the Chief Nurse Practitioner Officer for Walgreen’s Take Care Health Systems. In a report filed by ABC News, Ryan said that, expanding into chronic disease management is “a new service strategy.

“We’re evolving our clinic offerings from episodic treatment to looking at how do we get more chronic disease management, how do we do more prevention, how do we do more screening?” she said to the ABC News reporter.

Ryan’s comments echo analytical projections on future growth potential for retail clinics. According to a Deloitte report on the implications of retail clinics, this business model is capable of supporting additional revenue streams unrelated to its core operations. That means retail clinics will look to expand in areas beyond services around non-urgent primary care and prescription dispensing. This would include care management services and laboratory testing.

Expect Retail Clinics to Expand Their Use of Medical Laboratory Tests

MinuteClinics’ decision to deploy a point-of-care hemoglobin A1c test in 600 clinic locations nationally is just one rather small step toward a steady expansion in the range of healthcare services that will be offered by the retail clinic industry. It is a reminder of how swiftly new models of care delivery are evolving in the United States.

Also, it was June this year when Dark Daily published an e-briefing that described how Walgreens—a national competitor to CVS, the owner of MinuteClinics—was stocking a product called SmartDiabetes. At that time, we wrote that “SmartDiabetes combines a blood glucose monitor and blood pressure monitor in one device. It can transmit patients’ results to a secure server for review by a physician or other provider. Walgreens expects that the SmartDiabetes service will help pharmacists, physicians, and other providers to coordinate the care of patients who have diabetes more effectively than they can do so now.”

It shouldn’t be too difficult for pathologists and clinical laboratory managers to connect the strategies of Walgreens and CVS when it comes to expanding the healthcare services they can provide to individuals who have diabetes. What becomes more interesting is how local medical laboratories can develop a menu of specialized laboratory testing services that would add value to these retail pharmacies as they roll out expanded services to patients with diabetes and other chronic diseases.

—Pamela Scherer McLeod


Related Information:

Retail Clinics Branch into Chronic Disease Treatment

Axis-Shield, CVS Caremark’s MinuteClinic ink deal

Axis-Shield Partners with Largest U.S. Retail Medical Clinic to Provide Affinion™ Systems for Diabetes Management

“More Medical Laboratory Testing Expected as Retail Clinics Change Delivery of Routine Healthcare Services”

Developing point-of-care A1c tests for diabetes monitoring

Deloitte Report: Retail Clinics—Update and Implications

Standards of Medical Care in Diabetes—2010

ADA recommends A1c test to diagnose diabetes and pre-diabetes

“More Medical Laboratory Testing Expected as Retail Clinics Change Delivery of Routine Healthcare Services”

National Diabetes Statistics, 2011

Walgreens Introduces a Blood Glucose Testing Product for a Diabetes Management System That Links Pharmacists, Physicians, and Patients