Express medicine sites take off in Maine, fueling business for developers, builders

Photo / Jim Neuger Lee Moehlenkamp, owner and managing director of AFC Urgent Care in South Portland, cites the corner visibility and proximity to Starbucks as positives for the franchise, her second with American Family Care of Birmingham, Ala.

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By Renee Cordes

In the time it takes to order and sip a cappuccino at South Portland’s newest Starbucks near the Casco Bay Bridge, a patient could get treated for a sprain or infection at American Family Care (AFC) Urgent Care next door.

Both opened last summer in a 5,300-square- foot former Wendy’s renovated by Portland’s Commercial Properties Inc. and marketed by SVN |The Urbanek Group. They found an eager tenant in Lee Moehlenkamp, the owner of an AFC franchise in Braintree, Mass., who was looking to expand into Maine.

The Falmouth resident had considered Topsham and other places in Maine. But she liked the busy corner — with “great signage” and visibility at 230 Waterman Drive — and an ideal size she sees as a “sweet spot” for urgent care, proximity to the Mill Creek Shopping Center. She also liked having Starbucks as a neighbor.

“You think about the quality of that brand, and the people that are coming into our center — women, families, 25-plus — it’s a similar target,” says Moehlenkamp, an advertising- and marketing-industry veteran who says she’s always been passionate about health care.

Though the franchises are among 200 nationwide under the American Family Care banner, Moehlenkamp is proud of being a local owner and always being accessible to patients and staff. She runs the South Portland clinic with Dr. Andre Couture, a board-certified emergency medicine physician.

“We partner wonderfully together,” she says. “He’s managing patient care, and I’m managing patient experience.”

Urgent care, a growing field of on-demand health care, is opening up opportunities in Maine for entrepreneurs, builders and developers. It aims to provide an affordable alternative to emergency rooms in a quick-service, walk-in setting for treatment of non-life-threatening illnesses and injuries.

AFC Urgent Care, which accepts insurance from more than a dozen providers, gives an average co-pay range of $10 to $40. For patients that don’t have insurance, it offers reduced pricing that starts at $145.

“We’ve tried to keep the pricing very simple,” Moehlenkamp says, underscoring that patients who pay in cash won’t ever be surprised with a big bill later. “Everything is very transparent.”

Growing niche

The country’s first urgent care centers were opened in the 1970s by emergency medical physicians. Fast forward to today, with 9,279 urgent care centers as of November 2019, up from 8,774 in 2018 and 8,125 in 2017, according to the Warrenville, Ill.-based Urgent Care Association.

A 2018 report by the same group pegs the industry size at $12.98 billion to $18.4 billion, based on the average $115 insurance reimbursement per visit. The average reimbursement amount applies to all visits, including sports physicals, drug screens, Department of Transportation physicals and other types.

The industry explosion bodes well for real estate professionals like Commercial Properties CEO Dan Caitlin, who hopes the five-month South Portland project for American Family Care will lead to others.

“I’ve done a lot of medical offices in the past, but this was a little different,” he says, noting the on-site X-ray. “We hope to do some more business with AFC, and we’re standing by to look for the next location.”

For patients, urgent care centers offer a number of advantages over hospital emergency rooms from convenient hours and locations to lower, more transparent costs. Interestingly, UCA data shows that urgent care is more popular with millennials and young Generation Xers up to age 45 than with older groups, and that visits to emergency rooms go down in areas where there is urgent care. Facilities are found mainly in densely populated urban and suburban areas. From a real estate perspective, far more centers are found in freestanding buildings than within shopping centers or strip malls.

Though urgent care is more prevalent in large states including Florida, California, and Texas, Maine is quickly starting to catch up, with 45 centers in UCA’s latest tally. With a variety of ownership structures and real-estate business models, they all aim to provide an affordable alternative to overcrowded hospital emergency rooms.

UCA Executive Director Laurel Stoimenoff says the growth comes from a combination of new entrants tapping underserved markets and health systems looking to expand their footprint. Urgent care centers “are great connectors to both primary care and specialty care, when needed,” she adds.

Both are true in Maine, where Central Maine Healthcare is building a network of urgent care clinics. Working with Portland developer Bateman Partners LLC, it has a nationally accredited clinic in Topsham and is getting ready to open a clinic in Lewiston by March 31 for which it will also seek accreditation.

“Urgent care is certainly one of the areas in which we’re hoping to grow,” says Central Maine Healthcare spokeswoman Kate Carlisle, adding that accreditation will remain a priority amid the expansion drive. “One thing people worry about is whether urgent care is going to be as good as the hospital, so we’re working to make sure that every ambulatory facility that we open is as accredited as possible.”

Centers from north to south

Central Maine Health Care isn’t the only provider expanding its urgent-care reach. Portsmouth, N.H.-based ConvenientMD, one of the region’s fastest-growing brands, opened facilities in Portland and Westbrook in 2017, Bangor in 2018 and Brunswick and Saco in 2019.

“We do everything from pediatrics to geriatrics,” Lynn Derocher, Maine director of business and community relations, says during a tour of the Saco site on Main Street near a Krispy Kreme. Part of her job is outreach to employers such as the State of Maine, which encourages its 27,000 health plan members through incentives to use high-quality, low-cost services like those offered by ConvenientMD.

Photo / JIM NEUGER

ConvenientMD’s new Saco location

Doing so “not only saves money for the state’s health plan, but also for employees who use those services,” notes Kurt Caswell, the state’s executive director for employee health and benefits.

On its website, ConvenientMD gives an average visit cost of under $225, with an average copay of $25 to $80, compared to a co-pay of $200 to $300 for a $1,500 emergency-room visit and a co-pay of $80 to $150 on a $540 visit to hospital urgent care.

ConvenientMD was founded in 2012 by venture capitalists-turned-entrepreneurs Gareth Dickens and Max Puyanic, who have enlisted Massachusetts-based Coastal Construction Corp. and local contractors to build 24 clinics across three states. To help finance growth, they brought in New York-based insurance and investment firm C.V. Starr & Co. as a partner last year. Ellsworth is next on the list for Maine, with a new facility going up in June.

Photo / Jim Neuger

Lynn Derocher, Maine director of business and community relations for ConvenientMD Urgent Care, in the medical supplies store room at its Saco clinic.

“We are always looking for markets with high emergency-room utilization per capita so we can figure out the communities with the greatest need for our services,” says CEO Puyanic. “When we opened in Bangor, we saw people coming down from the Canadian border. That helped us recognize that in Ellsworth, we would also have a big draw area of the northern sea coast.”

ClearChoiceMD, a physician-owned regional urgent care chain based in New London, N.H., entered Maine five years ago with a facility in Scarborough and is looking elsewhere in the southern part of the state for further locations.

“Probably in the next few months we’ll be able to make some announcements about our plans for Maine,” says CEO and founder Dr. Marcus Hampers, who founded the company six years ago after two decades as an emergency room physician.

“In those 20 years,” he says, “I literally saw thousands of patients who safely could have been treated in an urgent care center.”

Besides Scarborough, the firm has eight sites in New Hampshire and four in Vermont, which are a combination of renovations and new builds. It works closely with Midland General Contractors, an Illinois-based firm specializing in construction and labor management for urgent care clinics.

Back at AFC Urgent Care in South Portland, Moehlenkamp says she would consider opening a third franchise as long as it is close enough in proximity to the others she oversees so they can be properly managed. Taking stock of her experience so far, she says she finds the business to be much harder, and more rewarding, than expected.

“When we got into this business, naively I thought, ‘We’re going to treat flu [and] strep throat and repair lacerations, but sometimes cases are more serious," she says, recalling emails and letters of gratitude she’s gotten over the years for saving a patient’s life. One that stands out came from a man who hadn’t felt well while travelling for business in Massachusetts and visited the Braintree facility, where he we was stabilized and transferred to the hospital. He had quadruple bypass surgery that same day and credits the center with saving his life.

“You get letters like that,” Moehlenkamp says, “and you’re thankful that you did what you did.”

Two experts weigh in

Photo / mainecahc.org

Mitchell Stein

Mitchell Stein, a Brunswick-based independent health care consultant, sees urgent care centers as a “mixed bag” with pluses and minuses.

He has some concerns that more players means higher long-term costs for the system, noting: “We’d love to believe that increased competition leads to lower prices, but we have never seen that happen in health care because it is such an artificial environment … My question for the public is, ‘How do we want to be spending our health care dollars, and is this the most efficient way for us to be moving forward?’”

Photo / northernlighthealth.org

David Prescott

David Prescott, an associate professor and coordinator of health administration and public health at Husson University in Bangor, says that while urgent care centers offer patients shorter wait times, lower costs and more price transparency, there are also negatives.

“The downside is that, for some illnesses or injuries, the urgent care might not have the treatment you need down the hallway, whereas a hospital is more likely to do so. Also, for people with chronic health conditions, urgent care-based models don’t provide the continuity that is best for treatment.”