The urgent care market experienced two opposing forces during the pandemic: Health care companies mothballed growth plans even as more patients sought care from these walk-in medical centers.

In the midst of it all, Minnetonka-based UnitedHealth Group significantly scaled back its MedExpress urgent care operations in Minnesota and across the country.

But now, the go-go urgent care market seems poised for a comeback with plans for new facilities resurrected to meet demand from patients who recently discovered they like the convenience.

In August, a franchisee with Alabama-based American Family Care opened a clinic in Hopkins — the company's first urgent care location in Minnesota — and plans to open a second center soon. Compcare Occupational Medicine & Urgent Care, a Minnesota company, added locations this summer in Cottage Grove and Eagan. And in May, Duluth-based Essentia Health opened a new center in Cloquet.

Centers were too busy with patients during COVID-19 surges — and too constrained by staffing shortages and supply chain problems — to open many more facilities during the pandemic, said Lou Ellen Horwitz, chief executive of the Urgent Care Association.

There are just more than 11,000 free-standing urgent care centers across the country, the trade group says, up 20% year-to-date. A more typical annual growth rate is about 11%, Horwitz said, adding that the number of centers across the U.S. basically held steady during 2020 and 2021.

Operators are optimistic, she said, because many patients turned to urgent care for the first time during the COVID-19 health crisis and are now coming back for more.

"Urgent care did very well through the pandemic because we were open," Horwitz said. "Growth in terms of new centers pretty much stopped on a large scale, mostly because there was so much scrambling to manage the pandemic that there was not a lot of bandwidth for building clinics. But now, we're catching up."

Urgent care centers generally treat on a walk-in basis illness and injury that is not life- or limb-threatening, although specific services can vary. They provide a mix of health services that often are offered at primary-care clinics and/or hospital emergency rooms, as well — treating everything from coughs and colds to fractures and stitches.

Prices at urgent care tend to be much lower than at hospital emergency rooms, said Dr. Franz Ritucci of the National Urgent Care Center Accreditation, a nonprofit in Florida. Crowding at primary care offices can make it difficult to get a prompt appointment, so urgent care serves as an important back-up source, Ritucci said.

"Urgent care centers are the reliever airports for the system," he said, using the term for relief airports that provide extra capacity for landing planes. "Growth is back. The numbers are surging up."

Over the past decade, urgent care emerged as one of several ways for large health care companies to get a foothold in the business of delivering medical care directly to patients.

UnitedHealth Group acquired MedExpress in 2015, when the business included about 140 urgent cares.

The next year, the company was poised to shake up Minnesota's urgent care market by opening as many as 19 centers in less than two years. But in the end, the health care giant opened only a dozen MedExpress clinics across the state and has since downsized operations here to just five locations.

MedExpress operates more than 150 centers, down from more than 260 in 2019.

"We respond to local market conditions when determining our footprint, and we remain committed to serving patients in comprehensive and convenient ways that support their health," UnitedHealth Group said in a statement to the Star Tribune.

UnitedHealth and other large conglomerates are still investing in care delivery. This month, Rhode Island-based CVS Health announced an $8 billion deal to acquire Signify Health, a large employer of doctors and nurses that provides care in patient homes.

Most urgent care providers in Minnesota are part of large health systems like HealthPartners, which consolidated three area urgent cares during the pandemic. That took the total number of centers from 22 down to 19, and the Bloomington-based nonprofit expects the count will hold fairly stable over the next year.

Minneapolis-based M Health Fairview operates 11 urgent care centers — the same number as before the pandemic.

"Entrants to the market come and go," Kim DeRoche, chief of primary care at M Health Fairview, said in a statement. "But we have more than 100 years of providing high quality, efficient patient care to Minnesotans and that won't change regardless of who enters this market."

The Urgency Room, a chain of three urgent care centers in the east metro, is looking to expand, said Dr. Craig Matticks, the group's medical director.

With ownership by a large group of more than 200 emergency physicians, the Urgency Room can provide more acute care than others and saw a surge of patients during the pandemic for COVID-19 testing, Matticks said.

The centers continue to see more patients, he said, in part because of hospital backups where transitional care centers with staffing problems are struggling to take discharges.

"We are still seeing high volumes due to the through-put issues many health systems are experiencing in their emergency departments and from the closure or reduced hours of some local urgent cares," he said.

In 2019, Compcare opened its first location in Owatonna with a goal of bringing urgent care to rural communities. Last year, it launched an urgent care center in Rochester in a building that used to house a MedExpress.

Cooper Rendon, owner of the Inver Grove Heights-based company, is an entrepreneur and physician assistant who said he started the business after seeing a need for walk-in urgent care. The company's seven centers also treat workplace illness and injuries, and they've introduced physical therapy services.

"We added three new locations this year and I don't foresee that slowing down," said Kati Poterucha, Compcare's vice president of marketing.

The new American Family Care franchise in Hopkins offers urgent care and occupational medicine in six exam rooms plus space for procedures, X-rays and an on-site lab.

A student of health administration, franchisee Tom Stevens opted to go in a different professional direction his family's business running Maynard's Restaurants in Excelsior and Rogers and Malone's Bar and Grill in Maple Grove. The restaurants have grown while being community-minded, Stevens said, and he's hoping for the same in urgent care.

The clinic already is in-network with most large local health insurers, and he's working to add one remaining major carrier, Stevens said. Dr. Paul Allegra, a local emergency physician, is the urgent care's medical director and a co-owner.

Owners at other American Family Care franchises have cautioned against trying to grow too far too fast, Stevens said, adding: "We really want to start with two [urgent cares] and then just basically take a step back and make sure our model and our systems are in place and working."