Retail clinics drive access to care, fill gaps as physician shortage grows, study finds
But if retail clinics are going to play a primary role, they'll need better placement, authors said.
A CVS Minute Clinic. (handout)
With the shortage of primary care providers already severe in some areas of the country, a recent study published in Health Affairs has found that 58 percent of retail clinic cases were new visits, which drove about a $14-per-person annual net increase in spending.
In a post on the Health Affairs blog, Manatt Health Managing Director Jonah Frohlic and health policy and financing expert Deborah Bachrach found more than half of uninsured retail clinic users went to a retail clinic because they did not have a usual source of care. Also, publicly reported performance measures in Minnesota found that retail clinics ranked highly among other primary care providers in at least three measures.
Frohlic and Bachrach said the data show how retail clinics are an effective means of increasing access at a low cost, while not generating excess utilization.
[Also: Nearly 3,000 retail health clinics expected by 2017, Accenture report says]
The lack of access to primary care is a problem in light of figures showing that, while the ranks of the insured are swelling due in part to the Affordable Care Act, there is an expected shortfall of up to 31,000 primary care physicians over the next 10 years, even when factoring in increased use of advance practice nurses.
If retail clinics are going to play a primary role in filling the gap, authors said, they'll need better placement. They tend to be placed in higher-income, urban and suburban settings, with higher concentrations of white residents and fewer black and Hispanic patients. Meanwhile, an analysis by the United Hospital Fund found that, in New York State, only six of 18 retail clinics were located in medically underserved areas.
"Clearly, if retail clinics are to be part of the solution to primary care shortages in underserved communities, they'll need to open more clinics in those communities," write Frohlic and Bachrach.
[Also: Retail clinics add convenience but also hike costs, study finds]
The authors warn that the study comes with a few caveats. For one, J. Scott Ashwood and his coauthors, using claims data from Aetna, said they could not assess impact on the total cost of care given the lack of hospital and pharmacy claims in their analysis.
The analysis also did not include uninsured people or Medicaid beneficiaries, who are less likely to have a usual source of care, and are generally less able to access that care during regular business hours.
But based on the data that is available, Frohlic and Bachrach posit that there is value in the kind of care received at retail clinics, as well as in improving access to that care. They say that about 50,000 adults die annually from diseases that could be prevented by vaccines; one in five adults now receive a vaccination in a pharmacy or retail clinic, second only to a doctor's office. That's 10 times the number of vaccines administered in public health departments.
While the authors acknowledge retail clinics' can increasing utilization, the negatives are not so broad when factoring in overutilization in the U.S. healthcare system. A 2003 Dartmouth Atlas analysis found that patients in some regions received 60 percent more care than elsewhere in the form of more tests, procedures, specialty visits and admission to hospitals, yet had the same survival outcomes and general satisfaction with their care. By contrast, Frohlic and Bachrach say that retail clinics are primarily for low-cost services, and would be "a tiny price to pay" for the increase in primary care access.
[Also: Zoom+ clinic network attracts millennials through 'no wait' convenience healthcare model]
"Indeed the low cost of the retail clinic is the very reason to assure that we are maximizing their value," they wrote, "and that means, among other things, linking retail clinics with or integrating them into health systems to support care coordination, chronic disease management, and prevention." The information sharing that would engender would reduce unnecessary utilization, they say.
They said that policy and business decisions should focus on "how to maximize the intrinsic value that retail clinics can provide and minimize the waste they may generate, rather than on their use as a blunt instrument to reduce healthcare costs."
Twitter: @JELagasse
