When health clinics started popping up in retail pharmacies a decade ago, insurers and employers saw a way to keep patients healthy while holding down costs.
There are now close to 2,000 retail clinics in the U.S., and the number is growing. Most of them are owned and operated by large retailers such as CVS Health, Wal-Mart, and Walgreens.
Fueling their growth are access and cost, athenahealth CEO Jonathan Bush told Healthcare Dive. He noted at HIMSS16 during a presentation that, over the course of the Obama administration, there has been a 700% increase in retail care. Retail clinics are routinely staffed by nurse practitioners and physician assistants and offer services in evenings and on weekends when most doctors’ offices are closed.
What’s more, they are easy to get to. More than 50% of the U.S. population is within 10 miles of a CVS Health MinuteClinic, Bush points out. “Consumers’ expectations are for easily accessible care that is fast, convenient, and with transparent, published costs,” and they’re “voting with their feet,” he said.
Too good to be true?
However, a new study by the Rand Corp. suggests that rather than curtail costs, retail clinic use has led to a slight, yet significant, rise in healthcare spending.
In the study, researchers looking at claims data from 2010 to 2012 for people insured by Aetna in 22 localities found retail clinic use added "$14 per person per year." Most of the visits were for nonacute conditions like colds and earaches that go away on their own and did not substitute for times that a patient would normally see their doctor.
“The main point of the study is that we have this convenient option for care that is also less expensive on a per person basis, and so there’s the potential to save money by avoiding more expensive options like physician offices and emergency department,” said lead author Scott Ashwood. “What we find, however, is that because these retail clinics are so convenient, more people are going to them who would otherwise stay home. The net effect is not savings, but a cost increase.”
While it’s possible that people simply want to get healthy quicker and retail clinics offer a convenient, low-cost option, from a health system perspective the current trend is not necessarily one of value, Ashwood said. “It may not be worth it, in other words, to be spending a little more on an upper respiratory infection.”
Defending their honor
Retail clinics take issue with the study, noting retail clinic visits are 40% to 80% less costly than visits to a doctor’s office or ER. The clinics help to fill a need caused by the current primary care physician shortage, supporters say. According to the American Association of Medical Colleges, the shortage will reach 45,000 by 2020.
Andrew Sussman, president of CVS’ MinuteClinic, said half of their patients don’t have a primary care provider, either due to a shortage of PCPs in their area or because they can’t afford to see one.
The Rand study “fails to recognize that reaching this underserved population is not excess utilization; rather it is the underlying objective of many health system innovations,” he said in a statement. The study also relies on older data that doesn’t consider the current 40% of retail clinic care focused on preventive services, wellness and chronic disease — all of which help to reduce overall healthcare costs, Sussman said.
Ashwood acknowledged the studies limitations. Because the study looked only at people who had commercial insurance, “we don’t know what the response is among people who don’t have insurance or are underinsured,” he said. “We don’t know how the results would translate to that population.”
Potential symbiotic growth opportunities
And it may not be just a lack of primary care providers that is driving some people to retail clinics. A recent study found that as many as 14% of plans on the federal ACA exchange lack physicians in at least one of the common specialty areas.
Walgreens spokesman James Cohn said their goal is to complement the primary care system and “help to ensure care coordination.”
To that end, Walgreens recently announced it was transitioning to the Epic EHR platform to enable more seamless connection with health systems and local providers. The company is also exploring new collaboration models that benefit patients, payers and the larger healthcare system, Cohn said.
Market implications reach into doctor's hours
Retail clinics may also force doctors to expand hours to retain patients, Sussman said, adding some physician offices have begun offering evening and weekend hours.
Whether retail clinics might also spur doctors and EDs to lower prices is less certain, since there’s not a lot of pressure on people with commercial insurance to shop around — though that’s changing to some extent with the higher deductible health plans.
What the Rand study points out, above all, is that people value convenience when it comes to healthcare, Sussman said. But that convenience may come at a price — increased medical utilization and overall costs.