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In just a few years, 鈥渞etail鈥� health clinics have become close to ubiquitous around Portland. These small acute care facilities, open late hours and on weekends, are popping up in commercial spaces around the metro area 鈥� strip malls, discount centers and grocery stores.

They represent a new way of interfacing with the growing health care sector, and, as such, new opportunities for builders. One, Bremik Construction, has now built retail health spaces for three different providers, with plans to keep going.

And with the stigma of retail clinics wearing off and the Affordable Care Act increasing access to medical care, the era of retail clinics doesn’t seem to have crested just yet.

Retail-spin

The first retail clinic in the U.S. opened in 2000, according to a 2009 study in the Annals of Internal Medicine. And they’ve been the subject of controversy ever since.

Today, retail clinics are opposed by a number of doctors’ groups, including the American Academy of Family Physicians and American Academy of Pediatrics, who worry about 鈥渇ragmentation鈥� of patient care. They say the clinics are a cop-out, rather than a solution to actual problems of limited access. The American Medical Association has opposed them for nearly a decade, on the basis that insurance companies shouldn’t steer patients away from a primary care provider, or toward facilities staffed by nonphysicians.

Convenience is one main reason for the surge in retail health. Most doctors’ offices are open traditional business hours and only on weekdays. One common knock on health care in America has been that many patients use emergency rooms as a first stop for all manner of conditions. Another perceived benefit is cost. Visits to retail clinics were found to cost around $110, while the doctor’s office and urgent care centers cost around $160.

Retail clinics are said to offer convenience and low cost, though professional medical groups counter the facilities are often incentivized to over-prescribe medication and provide lower-quality care.

Researchers with the Health Care Financing & Organization have found that the proximity of a clinic increases the chances that a patient will visit. And said to be more likely to visit are young people, women, people without a chronic condition and high-income people. For these reasons, researchers expect retail clinic utilization to continue to increase.

Zoom+Care = growing

Industry observers say the market is rapidly expanding 鈥� Providence Express Care, Zoom+, GoHealth and Kaiser Permanente are still developing their plans, and each model is a bit different. And there are several smaller competitors like Doctors Express.

Providence’s focus is on same-day, no-wait neighborhood clinics intended to handle low-acuity conditions 鈥� coughs, colds, sinus issues, stitches, sprains, strains 鈥� that don’t require a trip to the emergency room.

鈥淚 think what makes Providence unique is that we have a very deep continuum of care 鈥� a deep bench, in other words,鈥� said David W. Ray, Providence’s Oregon director of retail operations. 鈥淲e’ve got these neighborhood clinics and the 45 primary clinics and a number of specialists in the Portland-metro region and in the hospital system. So wherever you enter into our system, we’ll both take care of you and follow your care, and to get you better faster.鈥�

With one in development in Bethany, Providence will have 14 stand-alone clinics in Portland by the end of 2016. The Seattle area is home to 15.

Providence is mission-based, and accepts all patients, regardless of insurance.

Zoom+’s health clinics are similar to the others, but the fast-growing local company’s business model is much more unique. It offers a holistic health insurance plan, which patients can use at many Zoom+ storefronts in the Portland area 鈥� Zoom+Smile (dental), Zoom+Performance (fitness) and Zoom+Care (health), with other variants in the works.

It’s targeting people who are younger, and thus generally healthier, and hiring specialists to develop a health plan.

鈥淭he jury’s still on whether they can get the members to cover the risk involved in the concept,鈥� Ray said. 鈥淭hey are making a lot of money.鈥�

Provider preference

Bremik has now built retail clinics for three owners 鈥� Providence, Kaiser and Zoom+. The latest one, for Providence, is in the Enso building in the Pearl District. The contractor has built stand-alone clinics and 鈥渆mbedded鈥� ones inside larger stores, like Walgreens.

鈥淭hey’re each unique; Zoom, Providence and Kaiser each have their own needs,鈥� said the company’s health care project team superintendent, Paul Miller. “They’re different and similar in a lot of different ways. Each one of those companies have their own project team and they work together on their own design hand in hand with the architect.鈥�

The outskirts of Portland are home to more of these embedded clinics. In inner Portland, they’re more focused on 鈥渘eighborhood鈥� care.

The layouts are fairly simple: usually two exam rooms, a reception area and bathrooms. Providence has used JRJ Architects, Kaiser has used ZGF Architects and Zoom+ has used Hacker. The projects are more or less like standard tenant improvements. The timing is quick: projects usually take less than a couple of months, depending on the quality of the building.

Bremik has constructed eight Providence Express Care clinics, after entering the retail health market last summer, Miller said. Kaiser, meanwhile, is developing a project in the Pearl.