Sometimes, health care kind of feels like a playground kickball game nowadays. Everyone is lined up against the fence in some way — be it physicians, hospitals or insurers — hoping that someone will pick them to be on their team. Do you really want to be the last one left or, worse yet, not picked at all?

I've been thinking about that question over the last few weeks as I've been working on an upcoming feature story for H&HN looking at retail clinics and the ways in which they're shaping the hospital field. A recent analysis by Accenture predicted that the number of clinics could double in the next three years, up to 2,800, and save some $800 million each year in health care spending.

Clinics were long viewed as a potential threat by doctors and hospitals alike. But with some operating at or near capacity, that mindset is shifting, and organizations are seeing retailers as a potential "release valve" to relieve that strain, Accenture says. Clinical affiliations keep popping up all over the country, with high-profile systems, from UCLA Health System in the West, to Johns Hopkins in the East. Clinical leaders at the three top chains — CVS' MinuteClinic, Walgreens' Take Care (now apparently called Healthcare) Clinic, and Kroger's Little Clinic — all expressed to me that they have some markets where there are more health systems willing to work with them than they're able to.

But that made me curious. What happens to the smaller health systems or community hospitals that can't find a retailer to add access points, spread their reach out of their core market, and relieve any primary care shortage their docs might be facing? Kaveh Safavi, M.D., managing director for Accenture's North America health business, says there's nothing that precludes those smaller organizations from trying to tailor their offerings to match what makes retail clinics appealing to consumers — mainly convenience and price transparency. Hospitals need to take it on themselves to respond to the shifting market, he says.

"The markets are going to demand more convenient care at a lower, more predictable price," Safavi says. "And if you accept the fact that that is a market challenge and you should respond with an alternative, there's no reason to feel threatened by it."

Kenneth Patric, M.D., the CMO of Little Clinic, told me last week that his organization has seen competition in some markets, such as Cincinnati, with multiple systems vying to partner with their clinics. Ultimately, the partner has to be the right fit for Little Clinic, he says, based on their reputation in the business, values and goals for improving health and wellness. What happens to those smaller hospitals and health systems depends on the dynamics of the local market, Patric says. Some may be forced to consolidate with a larger regional health system that does have such access points, while others may try to create their own form of a retail clinic. Those that fail can't be blamed on the Littles and Minutes of the world.

"What will make them succumb is not that they can't find a convenient care organization to partner with, but that they can't find a bigger organization to be a part of that helps filter the efficiencies and inefficiencies," he says.

My question for you: What do you think will happen to the smaller hospitals and health systems that can't or won't partner with a retail clinic operator? Are they hastening their demise? How have you seen such clinics uniquely shape your hospital's market? Email your thoughts to me at, or give me a ring at 312-422-2605.