Full implementation of the Affordable Care Act kicks in next year. And the race is on to capture the expected influx of health-care consumers.
One business model aiming for a bigger piece of the health-care pie is the "urgent care center." In Delaware, they're called "walk-in care centers" or "medical aid units" to comply with state law.
Whatever the name, the sector is growing at a healthy clip.
In New Castle County, that means a handful of former strip-mall diners have suddenly become shiny new clinics.
"I knew this was here," said Judy Haller, "so we came here as a convenience."
Haller is at a MedExpress Walk-In Care Center near the Wilmington airport. The West Virginia-based chain moved into Delaware with full force last fall, opening four nearly identical clinics in just four months. A new clinic will open in Dover soon.
Haller, who was getting care for her teenage son, says not having to make an appointment is a major draw.
"I actually love the process of checking in here," Haller said. "It's a lot better than other places. I didn't have to fill out all these forms, you know, 'Does he have this, does he have that? Do the parents have this or that?' It was great."
Urgent care is not a new idea.
For more than three decades, it's been a place for midwinter sniffles and injured weekend warriors.
What is new is the profusion of urgent-care centers cropping up over the last four years.
"There's a huge demand for medical care when you least expect it," said Dheeraj Taranath, the area medical director for MedExpress.
He says the urgent-care model is growing because of two factors: fewer family doctors and increasingly crowded emergency rooms.
"So there needs to be something in that middle where people can go to without an appointment," said Taranath.
The growth of MedExpress is also fueled by big time venture capital. The same firm that invested in Apple is a part owner.
MedExpress is ramping up now, Taranath says, because the Affordable Care Act could bring in a flood of new customers. The reform law is expected to extend insurance to 30 million Americans over the next decade.
"We are looking ahead at a large number of the population getting insurance," Taranath said. "And when that happens there's going to be an influx of patients into the health-care system."
Some health-care experts say many of those patients are accustomed to the à la carte experience urgent care offers.
A 2010 study found that nearly 20 percent of ER visits could be treated at urgent-care centers, potentially saving the health-care system $4.4 billion a year.
Many insurers have signed on to cover urgent-care visits. One major insurer even bought the nation's largest urgent-care chain, Concentra.
But while MedExpress is the new kid in town, it's not the only player in the Delaware market.
"We're seeing about a thousand patients a month here," said Christiana Care Health System vice president Pat Grusenmeyer, standing in Christiana Care's medical aid unit in Smyrna.
The health system has a hand in four such walk-in clinics, which see roughly 80,000 visits a year.
Grusenmeyer says they help keep the larger system running smoothly.
"It sees a lot of patients that otherwise might show up at the emergency room," Grusenmeyer said. "It takes some of the pressure off the emergency rooms, which have been very busy over the last few months."
"The general idea originally was kind of 'emergency room lite,'" said Mark Pauly, a professor at the University of Pennsylvania's Wharton School who tracks the health-care industry.
He's watched as the perception of urgent care has transformed -- shifting from the somewhat pejorative "doc-in-a-box" to an emerging source of consumer-friendly innovations.
Still, Pauly says the industry's "one-off" nature — many patients coming in for something urgent and never following up — may put it at odds with health-care reform's major goals.
"There's kind of two trains on the same track here running at each other," Pauly said. "The train that says, 'Let's have our care coordinated.' And the train that says, 'As a consumer, I may not be ready for coordination, I just want to do what's convenient and get out of there.'"
Back in Wilmington, Judy Haller chooses convenience, and is happy her insurance covers it.
On most plans, the co-pay for urgent care is more expensive than for a regular doctor visit, but far less than a trip to the ER.
Medical director Taranath says MedExpress's true innovation is in taking better care of people. He says the company is all about cost-effective care, with a business-like focus on friendly service.
"They walk in, they get a smiling face," said Taranath. "It's that kind of customer care — customers being our patients — that patient care which we want to stand out from as many other medical facilities as possible."
MedExpress and others are hoping those consumer-friendly innovations pay off come 2014 and beyond.
A version of this story will air on a WHYY-TV First Extra: Health+Technology. The half-hour special explores the ways tech innovations are driving medicine and airs at 5:30 p.m. on March 28 on WHYY-TV. It will be re-broadcasted on April 2 at 7:30 p.m.
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