The urgent care business is about to get a lot bigger in the Twin Cities

Urgent care clinics are proliferating across the Twin Cities as patients footing a bigger share of their medical bills hunt for convenience.

Up to 19 new urgent care centers will be rolled out across Minnesota by the end of next year by the Optum unit of Minnetonka-based UnitedHealth Group, bringing a 20 percent increase in the state from just one provider.

Hospitals and clinics that have been offering urgent care for several years also are promising expansions, setting up a battle to retain patients and capture new business.

Urgent care operators cite the potential savings of keeping people out of pricey emergency rooms, while some observers lament that the proliferation could drive up costs by undercutting efforts to coordinate patient care.

Most agree that the growth reflects a broader shift toward retail-style medical services that aspire to make seeing the doctor as easy as buying a gallon of milk.

"It's all a drive to consumer-friendly health care — to actually make it more convenient at long last, rather than 'you should feel lucky that we see you at all,' " said Mark Pauly, a health economist at the University of Pennsylvania.

Urgent care centers typically consist of a free-standing physician office with extended hours and walk-in service. Many offer X-rays and laboratory testing, plus treatment for cuts and broken bones.

Their growth across the country follows the expansion of retail clinics, which offer a more limited set of medical services in pharmacies, grocery stores and discount outlets. In 2010, researchers at the RAND Corp. estimated that up to 27 percent of emergency department visits could be treated at retail or urgent care clinics, at a potential annual savings of $4.4 billion.

"It's a fraction of the cost," said Dr. Vic Starcher, chief of medical affairs at MedExpress, the name for Optum's urgent care business. "The argument is: Are we doing it fast enough, quick enough and broad-based enough to help drive down the health care costs in the country?"

When Optum acquired the business in the first half of 2015, MedExpress already was one of the nation's largest urgent care providers with 141 centers in 11 states. MedExpress now has plans to operate more than 250 urgent care centers by the end of 2017.

Centers are open from 8 a.m. to 8 p.m. Appointments aren't necessary. Located in strip malls and other retail settings, they're meant to give easy access to consumers.

MedExpress plans 12 locations in the Twin Cities, including two that opened in September. Its clinic in Plymouth is part of a shopping center that features Cub Foods, Taco Bell and a store with a sign for CPR — Cellular Phone Repair.

"For something as simple as a strep test, it's easier to just get it over and done with," said Taylor Nash, 24, of Elk River, as she strolled past MedExpress last week. Nash said she likes the idea of urgent care because "hospitals can take a long time."

Hospitals and traditional clinic operators say they're making care more convenient, too.

Robbinsdale-based North Memorial Health Care has opened five urgent care centers since 2011, including two in the past year in Eden Prairie and Plymouth — the first two suburbs targeted by MedExpress. Minneapolis-based Fairview Health Services opened two urgent cares in the past two years, and has plans for more, said Steven Endrud, vice president for clinical operations at Fairview Clinics.

Hospital and clinic operators draw a distinction between the urgent care centers they operate, and those run by independent groups like MedExpress — particularly if they use a different electronic medical record system.

"These kind of urgent cares could add a layer of headache for consumers/patients with respect to care coordination," Wendy Burt, a spokeswoman for the Minnesota Hospital Association, said in a statement.

Independent centers could add to health care costs by ordering tests and providing services that patients don't need, said Dr. David Thorson, past president of the Minnesota Medical Association. Doctors at those clinics don't necessarily have the patient's full medical history to coordinate care for efficiency, Thorson said.

"Unless you can say there's an unmet need, 12 more urgent cares is going to simply add cost," he said.

Urgent care works well when it's connected to other providers that can provide good follow-up care, said Matt Brandt, chief executive at Multicare Associates Inc., a physician practice with locations in Blaine, Fridley and Roseville.

Brandt argues that independent urgent cares don't have the overhead costs that come with caring for patients over the long run.

"They're taking the easy stuff, which is how they make money," he said.

Starcher, the MedExpress official, said his company wants to work with primary care providers. MedExpress physicians obtain a thorough health history that prevents duplicative services and work to connect patients with needed follow-up care, he said.

MedExpress doesn't use the electronic health record software used by most health systems in the Twin Cities, Starcher acknowledged, but providers still can exchange patient information across different systems.

Independent urgent cares might complicate the goal of traditional health care providers coordinating patient care for efficiency, said Pauly, the health economist at the University of Pennsylvania. But some patients are happy to trade coordination, he said, for convenience.

One of the first big markets for MedExpress was Pittsburgh, which has no shortage of traditional hospitals and clinics, said Stephen Foreman, an associate professor of health care administration at Robert Morris University in suburban Pittsburgh.

Despite all the competition, the company was able to profitably open roughly a dozen centers in that area, plus many more across the state.

"I think they're taking some of the pie," Foreman said, "but I do think they're probably growing it, too."

From a cost perspective, there's often concern that health care expansions inevitably drive more demand.

In March, for example, RAND researchers published a study suggesting that retail clinics actually added costs, because they made it easier for people to use more care. Urgent cares weren't part of the analysis.

For now, it's understandable why competitors might view the new centers as "skimming" business, said Tom Charland of Merchant Medicine, a consulting firm in Shoreview. But the trend is not going to stop.

"It was one thing when this was covered by your insurance, and your insurance said, 'You should go to this location,' " Charland said. "If it's now coming out of my pocket, I'm going to shop around."

Christopher Snowbeck • 612-673-4744

Twitter: @chrissnowbeck