In-store retail clinics are playing a growing role in the delivery of ambulatory care, according to a study, which finds that proximity and convenience are the main draws. Access to primary care is not a factor in the use of retail clinics.
Retail clinics, those in-store locations that focus on the delivery of preventive care such as flu shots, as well the treatment of minor health problems, are playing a growing role in the delivery of ambulatory care, according to the latest RAND Corporation study on the retail clinic trend.
People are "voting with their feet," says Scott Ashwood, a RAND researcher who is the report's lead author. With more health plans covering visits to retail clinics, and with copayments equal to those at a physician's office, convenience and proximity are drawing patients to retail clinics.
That's all good news for healthcare insurers, because according to earlier RAND studies, the clinics offer quality services for routine illnesses at prices that are lower than even the cost of physician office visits. And here's an added bottom-line bonus: RAND researchers estimate that 17% of ER visits could be handled at retail clinics or urgent care centers, with a potential total savings of $4.4 billion annually.
The latest RAND study in the retail clinic series looks at the demographics of the clinic patients and what drives utilization by the commercially insured. It appears in the American Journal of Managed Care.
Researchers studied claims in 2007-2009 and enrollment data for more than 13 million Aetna enrollees in 22 markets where retail clinics provide a treatment option. About 29% of the enrollees visited a retail clinic during the study period.
The study focused on 11 acute conditions that account for 88% of retail clinic visits: allergic rhinitis, bronchitis, conjunctivitis, influenza, otitis externa, otitis media, pharyngitis, upper respiratory infections, urinary tract infections, sinusitis, and viral infections.
Retail clinic visits for those 11 conditions increased 10-fold from January 2007 (less than one visit per 1,000 enrollees) to December 2009 (almost six visits per 1,000 enrollees). Researchers don't know if the enrollees selected retail clinics for treatment over a physician office visit or a trip to the ER, but care initiated at retail clinics is 30% to 40% cheaper than similar care at a doctor's office and a whopping 80% less expensive than care received at the local ER. That has to make health plan executives smile.
According to the report, distance from the retail clinic was the strongest predictor of use. Aetna enrollees living less than one mile away were significantly more likely to use a retail clinic than someone living one to five miles away. The most common users were young adults with no chronic diseases. That demographic is less likely to have a relationship with a primary care provider and may visit a retail clinic because they have no alternative. It may also indicate that "retail clinics continue to appeal to a more select group of patients rather than to a more general population," the report says.
Women were more likely than men to visit a retail clinic. People with incomes of more than $59,000 were also more like likely to use a retail clinic for medical services. That may reflect the adage that time is money. Retail clinics offer walk-in appointments and there is usually no waiting.
One surprising discovery: while conventional wisdom suggests that retail clinics fill unmet demand in areas with a shortage of primary care, RAND researchers found no relationship between the use of the clinics and access to primary care.
There are about 1,200 retail clinics across the country, most are located in suburban and urban settings. According to the report, 2007 was the boom year for retail clinic expansion. There has been little growth since then.
That may change with healthcare reform. As millions of uninsured are set to enter the health insurance market, providers are looking for new ways to control the cost curve. CVS's MinuteClinic and Emory Healthcare just announced a clinical affiliation that will make Emory physicians the medical directors for the 31 MinuteClinics in the metro-Atlanta area. The two will integrate their electronic health records to streamline care coordination.
Of course the big news right now is a memo leaked to National Public Radio that describes Walmart's plans to become "the largest provider of primary healthcare services in the nation," by expanding its retail clinic presence into diagnostic services and chronic care management. The giant retailer currently operates around 150 clinics but has more than 4,000 Walmart and Sam's Club stores nationwide. Add a health insurance plan to the mix and the mind boggles at the potential.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
