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Use of retail clinics rises, but…



A new study from the Blue Cross Blue Shield Association shows progress as insurers try to change their customers’ healthcare  use in order to cut costs.

The study found that among commercially insured BCBS plan members, visits to retail clinics nearly doubled in the past five years, from 12.2 visits per 1,000 members to 24 visits per 1,000 members.

The study says that up 29.8 percent of hospital emergency department visits could be handled at retail clinics. Emergency department visits, of course, are famously expensive. And so, insurers now cover most retail clinic visits.

But FierceHealthcare noted that the rise in use of retail clinics was not equally distributed among those with commercial BCBS plans. “For example, the rate at which women visited retail clinics was 72% higher than the rate for men in 2015.

“In addition, uptake among individually insured members has ‘lagged’ since the implementation of the Affordable Care Act, according to the BCBSA. From 2013 to 2015, the growth rate in retail clinic visits per 1,000 members in the individual market was only 2.6%, compared to a 15.5% growth rate in doctor’s office visits and 35.8% uptick in ED visits.’’

‘’In 2015, there was also a 19% lower use of retail clinics among individually insured members compared to members with employer-based plans.’’

To read the study, please hit this link.

To read FierceHealthcare’s comment on it, please hit this link.

Update on disruption in primary care


Lisa Ward, writing in Modern Healthcare, discusses the current (and sometimes hyped) “disruptive innovation” in primary care.

One example:

Retail clinics have been promoted as  a potentially disruptive innovation in healthcare that could cut overall healthcare costs.

She notes that  “the hope was that retail clinics could provide a cheaper model of healthcare to more people, especially lower income patients who often forgo preventive care and rely on emergency rooms.

“Yet that isn’t how it turned out. The potential of retail clinics hasn’t been fully realized. They are usually located in more affluent areas and their growth has plateaued. ”

But, more hopefully, she discusses

“{A} raft of new entrants like CareMore HealthPlan, Oak Street Health, IoraHealth and Aledade Inc., which, while using some of the same process-based methods championed by retail clinics, are partnering or employing primary care practitioners in a city or region. These firms are focused on coupling primary care with intensive preventive care to halt or reverse the development of chronic diseases like diabetes, heart disease and chronic obstructive pulmonary disease.

“In a world moving to value-based reimbursement, the strategy makes a lot of sense, especially because this new primary care model tends to use capitated payments, rather than traditional fee for service. They take responsibility for the financial cost of patients’ primary, specialty, acute, and post-acute care and the overall quality of clinical care with the understanding that they will be rewarded for providing better outcomes at a lower cost.

“Not surprisingly, large healthcare organizations, which are increasingly using capitated or bundled payments, are starting to pay close attention to the model.”

To read her entire article, please hit his link.

Report forecasts hospitals’ transformation to 2020


This Frost & Sullivan report entitled “The Transformation of the American Hospital: 2015-2020,” is well worth reading.

Tanvir Jaikishen, a senior analyst for the firm, observed about the report’s conclusions:

“The ACA, reduction in Medicare funding and reimbursements shifting from fee-for-service to value-based payments have impacted the way hospitals compete in the U.S. health system. Additionally, declining inpatient volumes and lowering reimbursements are fueling a wave of strategic acquisitions and partnerships aimed at increasing the patient base and improving negotiating power with insurers.”

The transformation, of course, includes more and more hospital and hospital systems focusing their acquisitions on non-acute-care holdings, such as retail clinics and physician practices.

The report also predicted that  more hospitals and  systems will create their own in-house insurance plans to help expand their patient base. But there are many difficult complications involved in entering the insurance business.

To read the report, please hit this link.


Physicians slowly moving to partner with retail clinics


This Medical Economics article looks at why and how physicians can and should work with the burgeoning number of retail clinics to improve primary care, including for the millions of people with chronic conditions.

Most physicians are slowly moving toward partnering with clinics with the goal of improving overall access to and quality of primary care. “We do think there is a home for retail clinics as part of a medical neighborhood but it needs to be integrated back to the primary-care physician so we know what’s happening,” Wanda Filer, M.D.,  president of the American Academy of Family Physicians (AAFP), told the publication.

“There are times when retail clinics work for acute, self-limited conditions, but over-reliance on them can fragment care and disrupt the medical home,” she warned.

“Ideally, the clinics would encourage patients to follow up with their primary care physician and make every effort to transfer their records in a timely way, but frequently that communication doesn’t happen,” John Meigs Jr., M.D., president-elect of the AAFP, told the publication. “The clinics can’t substitute for a long-term relationship with a primary-care provider who recognizes changes in a patient’s condition and works on risk factors and preventive measures to keep them healthy.”

Retail clinics gaining more chronic-care clout


A Robert Wood Johnson Foundation report describes how retail clinics are moving deeper into chronic-disease care  while adding electronic health record systems.

Many of the clinics are connecting electronic health record systems with health systems.

“Meanwhile, physicians apparently are still wondering about how far they need to go to become more retail-friendly, a change that some say is necessary for physician groups to survive in their current form,” reports H&HN.

H&HN reported that “The authors add that the full value of retail clinics won’t be realized without certain things happening, some dependent on the clinics and others on outside forces. Among the needed changes are integration into the delivery system, the provision and measurement of high-quality care and increased scope of practice rules for nurse practitioners and physician assistants in certain states.”

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