I knew within five minutes of meeting Janie Vinch that she was the healthcare provider for me. Three months before meeting her I had been shocked when lab tests revealed that I had high cholesterol. My LDL, “bad cholesterol,” was 109, a good nine points above normal. My primary care physician had refused — without explanation — to give me statins. But obsessive reading of heart health books had turned up a consensus that statins are miracle drugs, capable of eradicating heart attacks. It’s malpractice not to prescribe them, one author went so far as to say.
I shot off an E-mail to my primary care doctor, asking him to explain why he did not want to prescribe a statin. The heretofore pleasant young man sent a curt, chilly note in return. The subject would have to wait for my next visit — still months away, he said.
So I quizzed Vinch on the subject. I was about to write an article on her healthcare organization, and wanted to check out its new Ewing location anyway. Why not get a little medical advice while I was at it?
Vinch, just like my primary care doctor, was in no hurry to reach for a prescription pad. She agreed that there was no need to rush to statins. But here is the reason that Vinch is the person I want to see from now on about any and all medical issues: She explained her advice. And she did so in a warm, engaging, non-judgmental way.
“Try lifestyle changes first,” she said. “Your numbers are really not that bad. Work at exercise and diet for four months or so, and see if it makes a difference.” Every drug has the potential for side effects, she continued. Better to try to control cholesterol yourself first. It might not work, she cautioned, explaining that a large portion of cholesterol is made by the body itself, but it’s worth a try.
We had a good conversation. I liked her a lot — it would be hard not to. If there were a bedside manner test, she would get an A ++ every time.
But Vinch isn’t set up to offer continuous healthcare. She operates out of a small office near the bakery department of a supermarket, just an aisle or two away from a Dunkin’ Donuts, and within sniffing distance of the floral department.
Vinch is a nurse practitioner, and she works for ExpressCare, a Cranbury-based start-up, spun off from EMA (www.ema-ed.com), a 30-year-old Livingston-based company that staffs and manages the emergency rooms at 19 hospitals, including Fuld and Mercer. ExpressCare is funded in large part by Spark (www.spark-consulting.com), a Cranbury-based family of companies owned by Rajan Desai, a successful IT entrepreneur who also owns RealSoft (www.realsoftinc.com), a 500-person, $30 million a year company specializing in call center software technology.
If ExpressCare is right, Vinch, and nurse practitioners like her, are the future of healthcare.
ExpressCare, a new entrant in the infant industry of retail healthcare, has recently opened mini healthcare centers in five ShopRite supermarkets. In addition to the Olden Avenue ShopRite where Vinch works, it has locations in Neptune, Brick, Woodbridge, and at Oxford Avenue in Philadelphia. All are open from 9 a.m. to 9 p.m. on weekdays and from 9 a.m. until 5 p.m. on weekends. The company aims to have about 30 such outlets a year from now in a build-up to an eventual nationwide network of 1,000 healthcare centers.
There are only a few other companies in this niche. Scott Richards, ExpressCare’s chief operating officer, says that Minute Clinic, based in Minneapolis, is the biggest player, with 300 in-store healthcare centers, 17 of them in New Jersey. The Mayo Clinic is about to roll out its own retail healthcare centers, and is also calling them ExpressCare.
“The real growth of the industry began in 2007,” says Richards. “There are now 500 to 700 centers in the United States.” Locations for these in-store health centers include CVS, Walgreen, Target, Wal-Mart, and ShopRite.
Scott Serbin, ExpressCare’s marketing director, says that Vinch is typical of the nurse practitioners who staff the company’s locations, both in her training and experience, and in her ties to the community. Vinch, who graduated from Lawrence High School in 1975, talks about how much fun it is for her to treat shoppers with whom she went to high school — a common occurrence.
“I’m a townie,” she proudly declares. Her family name is emblazoned on large yellow trucks that run around Mercer County every day. “They’re hard to miss,” she says. Her twin brother, Sam, operates Vinch Recycling. “He works right around the corner,” she says.
Her other siblings, all six of them, run Vinch Demolition. The company was founded by her grandfather, Charles Vinch, and was then run by her late father, also Charles Vinch. The demolition company’s offices are right next to her house. “It’s a shoebox, one bedroom,” says Vinch, who lives there with her husband, Eric Galullo, an electrician with Local 269, who also “works right around the corner” from the Olden Avenue ShopRite where she practices medicine.
Just one bedroom or not, Vinch is never leaving that house, which sits on 25 acres on Eggerts Crossing Road, right next to the Armory. Her riding horses are there and so are two donkeys she has adopted. “They’re wild,” she says. “They don’t do any work, they just graze.”
Vinch is a fabulous conversationalist with fascinating ties to the area — a person with whom it is a pleasure to discuss cholesterol in an unhurried setting. And it quickly becomes clear that her medical ethics are solid. She says, for instance, that patients very often demand antibiotics. And more sympathetic she could not be.
“They’ve paid their $40, and they want something for it,” she says. But she is careful about prescribing the drugs, taking all the time necessary to explain that a decades-old trend of over-prescribing antibiotics has given rise to super infections that no antibiotic can cure. When patients are still not persuaded, Vinch tells them that they can come back in two or three days, at no charge, for a follow-up visit if they are not feeling better.
Vinch, like all of ExpressCare’s nurse practitioners, is well educated. In fact, she appears to be something of a serial student. “I like school,” she says. She earned a B.S. in chemistry at TCNJ “sometime in the late 70s,” before going to work as a researcher for Bristol-Myers Squibb. A few years later she earned a BSN at TCNJ. She then continued to work for Bristol-Myers while, at the same time, working in the intensive care unit and critical care unit at Capital Health System. After deciding to work full time as a nurse, she earned a nurse practitioner’s master’s degree from Thomas Jefferson University.
But no matter how well-qualified and personable Vinch is, she and her fellow ExpressCare nurse practitioners are not out to become anyone’s primary healthcare provider. The centers are set up to provide one-time care only. “We’re not looking to replace the primary care doctor or the hospital,” says Desai. “We’re not trying to steal anyone’s patients. We offer episodic care.”
Clearly printed on the wall behind the counter at which Vinch greets patients, and offers brochures to a continuous stream of curious shoppers journeying between the ShopRite’s Verizon kiosk and its tower of pink grapefruit, is a list of ExpressCare’s services and prices.
They include examination and treatment for bladder infections, $39; bronchitis, $39; cold and coughs, $39; cold sores, $29; sprains and strains, $49; and toothache, $29. Screenings for cholesterol, diabetes, pregnancy, and strep throat range from $19 to $29. Physicals for camp, school, CDL licensing, sports, and pre-employment are $39 or $49. Lab tests are limited for now. “We can tell you total cholesterol, but can’t break it down into LDL and HDL yet,” says Vinch, “but we’re going to partner with LabCorp and Quest, and then we’ll be able to do more complete lab work.”
Service is strictly walk-up; no appointments are needed — or accepted. Insurance is not accepted, but, as of December 11, the company will accept the co-pay from any insurance plan except Medicaid. If an insurance plan carries a $6 co-pay, for example, the charge for having a sprain treated would be $6 rather than the posted price of $49. On that date a $10 senior citizen discount went into affect, also. So people over 55 would pay $39, rather than $49, to have the sprain attended to.
Accepting payment, with or without discounts, is not something that Vinch relishes. “Accepting money, that part is new to me,” says Vinch. “I’m used to treating patients, not treating them and then asking for money. It’s uncomfortable.”
But other than that, she loves the job, which she does two or three days a week on a per diem basis when she isn’t teaching nursing at the College of New Jersey or working as a per diem occupational nurse at Princeton Hospital. “It’s a great opportunity for a nurse practitioner,” she says. “You’re autonomous. You create a chart, examine the patient, print out a prescription, and give the follow-up instructions.”
All of ExpressCare’s Centers are staffed by nurse practitioners. There are two full-time nurse practitioners and three or four per diems like Vinch at each location. A lead nurse practitioner is in charge. There are no other employees on site. The receptionists, medical billers, insurance liaisons, lab technicians, and physician assistants that staff the typical medical practice are absent, making for vastly lower overhead.
All of ExpressCare’s nurse practitioners are hired by Patricia Dempsey, ExpressCare’s director of operations. Dempsey is herself a nurse practitioner. She was bribed into the profession by her parents.
“I wanted to be a journalist, but my parents said there was no future in it,” she says. “They said that if I tried nursing school for a year, they would let me transfer to a four-year school after that.” Preoccupied with other interests, including competitive tennis, she allowed herself to be persuaded. She started out at the Ann May nursing school at Jersey Shore Medical Center, made friends, found that she liked nursing well enough, and went on to earn a B.S. at Monmouth College (Class of 1992).
The training for a nurse practitioner is demanding. In addition to her nursing degree, Dempsey has two master’s degrees, in science and in nursing, both from Rutgers. The master’s that offers training for nurse practitioner status includes 800 hours of clinical work over two years. Dempsey worked as a nurse before completing that degree and looks for experience in the nurses she hires. “We don’t really want someone who has gone straight through school,” she says. “We look for people with work experience.”
With all nurses in short supply, finding such highly trained nurses is a challenge, says Dempsey. ExpressCare has to offer competitive salaries — a nurse practitioner earns about $100,000 plus bonuses in the Northeast, she says. The new organization also prides itself on providing a professional working environment.
Standing at the counter, speaking with Vinch, and facing away from the always-busy ShopRite’s grocery aisles, the scene says nothing but “doctor’s office.” The ShopRite’s famed CanCan specials seem very far away. Straight ahead, there are the usual anatomical charts, standard issue waiting room chairs, and beyond them, but within sight of the front desk, are two beautifully-equipped examination rooms.
“The otoscope is the best I’ve ever worked with,” says Vinch. “You could see individual hairs in the ear — not that you’d want to.” Picking up the ophthalmic scope, she says that it, too, is of unusually high quality and provides detailed information on what is going on in patients’ eyes.
There is a computer in each examining room. It displays the patient’s chart, and is used to create notes on each visit, and to type up prescriptions, which print out at the main desk. There will be no messy handwriting prescribing errors at this healthcare site, which prides itself on making extensive use of technology.
When a patient walks up to an ExpressCare desk, he is asked to sign in at an electronic kiosk. “It’s supposed to be very easy to use, but patients have trouble, so I usually do it for them,” says Vinch.
Information typed into the kiosk includes the usual name, address, Social Security number, allergy, and symptom data. Once it’s entered, a chart is created. The chart is then available at every ExpressCare center and at the office of the doctor who owns the practice (more on that in a minute). Once a patient has created a chart in Ewing, his information is readily available should he stop in at ExpressCare Woodbridge or Neptune — and eventually at ExpressCare locations around the country. It can also be sent to his primary care doctor or to a hospital or clinic with the press of a key.
Once a month the nurse practitioners go over their charts with the Marlton-based medical practice, owned by Dr. Manu Dadhania and his wife, Dr. Ketki Dadhania, that officially owns ExpressCare. This group is called ExpressCare Health. “In New Jersey only a doctor can own a medical practice,” says Desai. “A corporation can’t own a medical practice.”
Is the doctor merely a figurehead? Desai insists not. In addition to the monthly chart review, the doctor is always available for consultations. Vinch says she can always call if there is a question about a diagnosis, or about whether a patient should be sent to a hospital emergency room.
The Marlton-based doctors are now the supervising doctors for all five of ExpressCare’s health centers, but Desai says that his plans include bringing in local doctors and hospitals in that role. For doctors, he says, “it would be an extension of a practice, a second location.” For a hospital, it would be a chance to channel patients toward all of its services.
ExpressCare, after all, does not cover all medical situations. Stitching up wounds, for example, is not on the menu of services. “No bleeding in the supermarket,” is how Dempsey puts it.
Desai stresses that patients who present with maladies outside of the range of ExpressCare’s medical menu are directed to the proper healthcare setting. More than directed, Desai insists. “If the person needs to be in an emergency room, we will call the ambulance,” he says. “We will call ahead to tell the ER doctors that he is coming in.”
Less acutely ill patients are advised to see their primary care physicians for follow-up. Notes on every patient are sent electronically to his physician as a matter of course at the end of each visit. If a patient doesn’t have a primary care physician, he is given the names of area clinics, and encouraged to go there. But what if a person just likes the convenience and modest cost of getting healthcare at the ShopRite, and wants to keep coming back? “We encourage everyone to see their primary care doctors for follow up every time they come in, but we don’t turn anyone away,” is how Vinch answers the question.
Another question is why anyone would think of going to a ShopRite to get relief from a bladder infection, pink eye, or swimmer’s ear. ExpressCare’s key executives have lots and lots of answers to that one — as well they should, since their fledgling business depends on them.
“There is a shortage of primary care physicians,” says Desai. “In a few years, America will be short by 60,000.”
“There are many more uninsured people,” says Dempsey. “Small employers often can’t afford to provide insurance, or the rates are prohibitively expensive. Deductibles are higher.”
“People are more familiar with nurse practitioners,” says Richards. “And they can now prescribe drugs.”
On a roll, they offer more reasons why more people need low-cost, convenient healthcare: Hospitals are closing, emergency rooms are seriously over-crowded, employers often refuse to cover spouses and children. The numbers of people who are uninsured is in the headlines every week. But, say ExpressCare’s executives, less attention is paid to the enormous number of people who are underinsured.
Dempsey recalls recently seeing a patient who said that her deductible was $4,000 a year. As employers groan under the cost of providing insurance such deductibles are becoming common. People who once blithely went to the doctor with no thought of what a visit would cost are now footing the bills themselves, and are shopping for the best deal.
This shift in healthcare costs toward the consumer was one of the reasons that Richards, ExpressCare’s COO, began to think of in-store healthcare centers as a good business idea. A graduate of Bloomsburg College (Class of 1980), he has spent his whole career working in healthcare operations. He joined EMA, the ER staffing company, in 2000, and an important part of his job became looking for strategic business opportunities. He saw the first mention of retail healthcare centers in news articles in 2003. EMA liked the idea, and ExpressCare was incubated there, with Richards heading up the effort. In addition to being the new company’s COO, he continues to work for EMA, which owns 10 percent of ExpressCare.
ExpressCare did its filing as an LLC in March, 2006, and opened its first outlet in June, 2007. Three months before that, in March, 2007, EMA, looking for a lead investor for ExpressCare, brought in Desai.
“We had known him for a long time,” says Richards. Desai, whose IT firm has specialties in the pharmaceutical, telecommunications, and financial industries, had done work for EMA through the years.
A majority interest in a chain of retail healthcare centers would seem to be a stretch for Desai, but he says that it really isn’t. He and a partner, Neil Shroff, have owned retail properties, including five-star hotels, gas stations, and convenience stores.
A native of Baroda, India, where his father was a government auditor and his mother was a homemaker, Desai earned a bachelor’s degree from M.S. University in India in 1982, and then immigrated to the United States, where he earned a master’s degree in chemistry from the University of Florida, and then a master’s degree in computer science from Texas Tech.
A West Windsor resident, Desai moved from Texas to marry. “She lived in New Jersey,” he says of his wife, Dipika, with whom he has two daughters, Shaili and Sheena, and a son, Shiv. Dipika works with him at his family of companies.
Desai founded RealSoft, also known as RSI, in 1991. The company’s specialties include voice recognition software for call centers and software to monitor call center performance. RealSoft, says Desai, sells off the shelf products, and also works on-site and off “to help call centers run better.” In addition to its Cranbury headquarters, the company has offices in New Hampshire, Florida, and Singapore, and in Bangalore and Baroda, India. Approximately 230 of its employees work in the United States.
In 2004 RealSoft acquired Spark, which had been based in Watchung. The company had “complementary clients and complementary software,” Desai says. Spark, which has revenues of about $6.5 million a year, is now the umbrella for a number of ventures, including ExpressCare. Desai declines to say how much Spark has invested in the start-up to date, but does say that it is possible to get an idea of what it will take to get the company started from the size of the second round of financing it plans to raise in May, 2008. He puts the figure at $10 to $20 million.
Desai says that it’s important for a start-up to go slowly in pulling in financing. “Raising money is a little tricky,” he says. “You raise too much, and you give away the company. I want to raise just enough to get to the next stage.” He would like to continue to hold a majority interest in ExpressCare, and says that Spark will put money into the company as needed. “We’re not reliant on rounds of financing,” he says.
With a decade and a half of varied business experience behind him, Desai sees ExpressCare as a good bet. “It makes sense for Spark to get into it,” he says. “We see it as a good business opportunity. ”
He points out that a marriage of healthcare and retail is not new to consumers. Sears has had eye centers “forever,” and Wal-Mart, CostCo, and Sam’s Club have long offered eye exams. The esteemed Mayo Clinic is about to jump into the retail healthcare business, too, says Desai. He smiles as he reveals the name that the Mayo Clinic has chosen — “ExpressCare.” He says that he doesn’t much care. “We’ve filed a patent for the name,” he says, “but there are people ahead of us.”
Perhaps the courts will decide who gets the name. Desai doesn’t appear to be troubled by the matter. He is busy building the business, although much of the work is delegated to Richards, the chief operations officer.
“We all meet once a week, on Mondays,” says Richards. The start-up is pretty much a virtual company. Dempsey, who recruits and supervises the on-site nurse practitioners, works mostly from her home, in Wall Township. Richards and Serbin, the marketing chief, who came to a recent Monday meeting wearing a golf shirt bearing the EMA logo, still have ties to EMA. The nurse practitioners are not technically ExpressCare employees, but rather are employees of ExpressCare Health, the medical entity set up to own the healthcare centers.
For now, all of ExpressCare’s healthcare centers are in ShopRite stores, but Desai emphasizes that his company merely rents space, “just like Dunkin’ Donuts does.” There is no exclusivity agreement on either side. ExpressCare can, and probably will, open healthcare centers in other retail locations, and ShopRite is free to lease space to other healthcare companies.
The advantage to supermarkets like ShopRite, says Desai, is that healthcare is one more item in their basket of offerings. The Ewing ShopRite already has a pharmacy, a Verizon Wireless store, a bank, a Chinese restaurant, a Dunkin’ Donuts, a liquor store, and a photo center. Adding flu shots and treatment for sore throats just adds more reasons for people to stop by — and to pick up their groceries, greeting cards, and diapers while they’re at it.
Those shoppers are supplying most of ExpressCare’s revenue now, but Desai and his team are setting the groundwork for other revenue streams as well. At the end of November the company launched an ExpressCare plastic card. “It’s just like a Starbucks card,” says Desai. Instead of giving the gift of coffee, purchasers can give the gift of cough relief, diabetes care, or a physical. “I had one mother buy a card for her daughter to take with her to college,” says Dempsey, the nurse practitioner in charge of in-store operations. “That way she knows she will spend the money on healthcare.”
Single purchasers are good, but ExpressCare is counting on the appeal that the cards could have for small businesses. “I’m working with a 600-student nursing school,” Dempsey adds. She declines to name the school, but says that every one of its students needs a physical and inoculations. The hope is that the school will buy the ExpressCare cards for its students, or will sign up to use the company as its provider of physicals.
Likewise, the company is courting employers in the trucking industry. Every person who applies for a CDL, a commercial driver’s license, needs a physical. Giving drivers a pre-paid healthcare card could well be the least expensive way for employers to make sure that they get them.
“The cards are not a form of insurance,” says Desai, “but employers could use them that way. Every employer knows that workers will jump to a company that offers health insurance, any kind of health insurance, even catastrophic insurance.” His cards, he reasons, offer workers at least some access to healthcare, and perhaps the only access that many small employers can afford to offer.
So revenue is expected to come from single visits, from contracts with small employers, and from sale of the pre-paid cards. All three revenue streams should become more robust as more centers open. ExpressCare’s principals recognize that the benefit of the cards and of contracts with employers will be of limited use until its network expands. So the roll-out continues. Among future locations is the ShopRite in the Mercer Mall, which is expected to open next year.
While ExpressCare is targeting mid-to-low income neighborhoods, where there are large numbers of uninsured and under-insured residents, Desai says that the concept should work well in wealthy areas, too. “For the affluent communities you need to emphasize convenience,” he says. “You have to approach the markets differently.”
But there can be overlap.
“On the day after Thanksgiving I saw a child who had conjunctivitis in both eyes,” says Vinch, the per diem nurse practitioner at the Ewing ExpressCare. Anyone who has experience with conjunctivitis, or “pink eye,” knows how very miserable — and very contagious — it is. Treatment needs to start right away.
But wealthy or poor, insured or not, no one has an easy time scheduling a doctor’s appointment on a holiday weekend, or a Sunday, or late in the evening. In that situation, a parent in any demographic category might well decide to strap a sick children into a shopping cart and head for an in-store health center — perhaps stopping along the way to pick up ice pops and DVDs.
Still there are many healthcare situations where ExpressCare can’t help out. It offers no heart attack intervention, no childbirth assistance, and no Marcus Welby-like lifetime relationships — and, remember, it insists that there be no bleeding in the aisles. But it’s possible that the new service will find its niche as routine healthcare becomes less an entitlement, and more just another expense that needs to somehow fit into the household budget.
For now, Vinch and her fellow ExpressCare nurse practitioners are spending a lot of time explaining its concept and services to the curious as they stop to stare at the medical office sandwiched between the bakery aisle and the produce section.