A Retail Clinic Across the Street: Five Forces, a SWOT, and Three Moves for a Community Health Center
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Health Care Administration Program, Aspen University
HCA 320: Healthcare Policy and Economics
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A Retail Clinic Across the Street: Five Forces, a SWOT, and Three Moves for a Community Health Center
Competition changes how health care organizations must think about the patients they serve. This paper analyzes the competitive position of Harbor Community Health Center, a composite federally funded health center that runs three clinics for about 14,000 patients, after a national pharmacy chain opened a retail clinic across the street from its largest site. It applies Porter's five forces to the local primary care market, summarizes the center's position in a SWOT built from its own data, reviews evidence on how retail clinics affect use and spending, and recommends three strategic moves with measures of success.
The Market Through Porter's Five Forces
Porter (2008) argued that the pressures on any industry, and how much profit it can sustain, come from five sources: how fiercely current competitors fight, how easily newcomers can enter, whether customers can turn to substitutes, how much power buyers hold, and how much power suppliers hold. Applied to Harbor's market, the forces look like this.
Rivalry is moderate: a hospital-owned primary care practice and two independent practices compete for insured patients, but few accept uninsured patients on a sliding fee. The threat of new entrants is high and has just materialized in the retail clinic, which needs little capital and benefits from a pharmacy's existing traffic. Substitutes are growing: telehealth apps offer quick visits for minor illnesses at a flat price. Buyers, mainly Medicaid managed care plans that assign patients, hold considerable power, since they can steer members to clinics with better access scores. Suppliers of labor are powerful as well, because the center competes with hospitals for nurse practitioners and medical assistants. The force that matters most is not the retail clinic itself but what it exposes: patients with a sore throat will go wherever they can be seen today.
What the Evidence Says About Retail Clinics
Retail clinics are sometimes promoted as a way to replace costlier visits. Using Aetna claims data from 2010 to 2012 for eleven low-acuity conditions, Ashwood et al. (2016) found that 58 percent of retail clinic visits represented new use of care rather than a substitute for a physician office or emergency visit, and that retail clinic use was associated with a modest increase in spending of $14 per person per year. For Harbor, this suggests that the retail clinic will not simply take its existing visits; it will also create new demand for quick care. But the visits it does take are likely to be the simple, well-paid ones that help cover the cost of complex care for the center's sicker patients.
SWOT Analysis
Table 1 summarizes Harbor's position, with each entry drawn from the center's own data or the analysis above.
| Category | Entry |
|---|---|
| Strength | Sliding fee scale, with visits costing $30 to $60 for patients below 200 percent of poverty |
| Strength | Integrated behavioral health and on-site pharmacy at the main site |
| Strength | Long relationships with patients who have chronic conditions |
| Weakness | Same-day appointments available for only about 30 percent of requests |
| Weakness | No evening hours after 5:00 p.m. |
| Opportunity | Medicaid plans reward access scores with assignment and incentive payments |
| Opportunity | Telehealth visits are billable at parity under current state Medicaid rules |
| Threat | Retail clinic open twelve hours a day, every day of the week, about $139 per visit for self-pay patients |
| Threat | Low-acuity visits, 18 percent of Harbor's total, are those most easily lost |
Three Strategic Moves
The analysis suggests Harbor should compete on access and continuity, not price alone. First, redesign scheduling so that at least 60 percent of same-day requests are met, by holding open slots each morning and using nurse triage by phone. Second, add evening hours until 7:00 p.m. three nights a week at the main site, with telehealth visits for minor illnesses available until 9:00 p.m. Evening access appears to change where patients seek care: in a cohort study of nearly 58,000 Medicaid plan members across 353 practices, emergency visits were a fifth lower when a member's practice kept its doors open more than 12 evening hours each week (Lowe et al., 2005). The same access that keeps patients out of the emergency department should keep them from crossing the street. Third, turn continuity into an advantage: when an established patient is seen for a minor illness, use the visit to close gaps in chronic care, such as overdue blood pressure checks or diabetic eye exams, something a retail clinic is less able to do because it lacks the patient's full record.
Measures of Success
Each move has a measure reported monthly to the board. Same-day access: the share of same-day requests met, from a baseline of 30 percent to 60 percent within six months. Evening and telehealth hours: the number of visits after 5:00 p.m. and the share of those patients who are established Harbor patients. Retention: the share of low-acuity visits among total visits, which should hold near 18 percent rather than falling. Continuity: the number of chronic care gaps closed during acute visits. Financial: net revenue from low-acuity visits compared with the prior year.
Risks and Trade-Offs
Evening hours and open slots cost money and require staff the center already struggles to recruit, a reflection of supplier power in the labor market. If the new hours are not used, they will add cost without revenue. The center should therefore pilot evening hours for six months before making them permanent, and staff them with clinicians who prefer later schedules rather than extending existing shifts. It should also recognize that some patients will choose the retail clinic regardless, and that this is acceptable if Harbor remains the home for their ongoing care.
Conclusion
A retail clinic across the street threatens Harbor's easiest visits, and the evidence suggests it will also add new demand for quick care. Porter's five forces show that the underlying pressure is on access, from new entrants, substitutes, and payers who reward it. Harbor can respond by meeting more same-day requests, offering evening and telehealth hours, and using its continuity with patients as an advantage, measured against clear targets.
References
Ashwood, J. S., Gaynor, M., Setodji, C. M., Reid, R. O., Weber, E., & Mehrotra, A. (2016). Retail clinic visits for low-acuity conditions increase utilization and spending. Health Affairs, 35(3), 449-455. https://doi.org/10.1377/hlthaff.2015.0995
Lowe, R. A., Localio, A. R., Schwarz, D. F., Williams, S., Tuton, L. W., Maroney, S., Nicklin, D., Goldfarb, N., Vojta, D. D., & Feldman, H. I. (2005). Association between primary care practice characteristics and emergency department use in a Medicaid managed care organization. Medical Care, 43(8), 792-800. https://doi.org/10.1097/01.mlr.0000170413.60054.54
Porter, M. E. (2008). The five competitive forces that shape strategy. Harvard Business Review, 86(1), 78-93.
How this HCA 320 Module 7 example is structured
Aspen's catalog describes HCA 320 as covering how businesses and providers influence health care, and the course page lists a SWOT or competitive analysis and warns against plans without metrics. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example applies a named framework, adds evidence, builds a sourced SWOT, recommends moves with targets and names the trade-offs.
HCA 320 Module 7 questions, answered
What does HCA 320 Module 7 usually ask for?
Work in this part of HCA 320 often asks for a SWOT or competitive analysis of a health care organization with strategic recommendations. Aspen does not publish module deliverables, so your classroom's instructions govern.
What are Porter's five forces?
Rivalry among existing competitors, the threat of new entrants, the threat of substitutes, the bargaining power of buyers and the bargaining power of suppliers.
Do retail clinics reduce health care spending?
One study of Aetna claims found that 58 percent of retail clinic visits for low-acuity conditions were new use rather than substitutes, with a modest spending increase of $14 per person per year.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.