Whitney Palmer

Pumping New Care Locales into Healthcare’s Pipeline

Published in the Nov. 13, 2012, Billian’s HealthDATA/Porter Research Hub e-Newsletter

By Whitney L.J. Howell

It was a stereotypical healthcare moment – a wife dragged her reluctant husband into a new Walgreens’ Take Care Clinic in Chicago. He hadn’t seen a primary care physician in nearly a decade, and now he was sweaty, shaky, and simply feeling bad.

The nurse practitioner (NP) on duty discovered he had significantly elevated blood pressure. Pairing that data with his other symptoms, she recognized he was in the danger zone for an acute cardiac event. So, she immediately sent him to the emergency department.

What happened the next day surprised her.

“The wife came back with flowers and told the nurse practitioner she had saved her husband’s life,” said Sandy Ryan, Chief Nurse Practitioner and Clinical Advocate at Take Care Clinics. “Her husband needed four stents to open blood flow, and the cardiac surgeon said had he not been routed to the emergency room, he would’ve passed away.”

This type of story happens at retail health centers (RHCs) more often than most people realize, Ryan said. The data of how frequently people use these clinics confirms her point. A recent Health Affairs study reported RHC visits quadrupled between 2007 and 2009, with nearly 6 million patient encounters occurring in 2009 alone. The number of clinics has also steadily grown to nearly 1,200 since the first centers opened in 2000.

These clinics – often staffed by NPs – offer a wide variety of standard health services. Patients can walk in without an appointment and get a flu shot, a vaccine or other wellness services. Children can get routine physicals for school sports or summer camps; and NPs can address allergies, earaches, sore throats, coughs and fevers, as well as write prescriptions. A growing number of RHCs also offer preventive screenings for high blood pressure and cholesterol, and others have launched Medicare wellness visits.

The Walgreens Take Care Clinic doesn’t stand alone in the RHC market – CVS MinuteClinics and Target Clinics also provide similar services. Their mission is simple, but two-fold: provide preventive services to patients when and where they need it and alleviate pressure on emergency departments.

“Not everyone gets sick Monday through Friday from 8 to 5,” Ryan said. “These clinics are open seven days a week, often for 12 hours a day. They complement the traditional model of healthcare, only they’re in a convenient location.”

Impact on Public Health

At every turn, the current healthcare system – and its participants – is struggling. Nationally, there are too few doctors and nurses to serve the current patient population, and that shortage will feel even more severe as healthcare reform funnels more patients into the system. Right now, though, the number of uninsured Americans has increased due to a rise in unemployment.

RHCs address both these problems and are simultaneously making a positive impact on public health, Ryan said, doing so in an affordable way.

On average, a RHC visit price tag hovers around one-third to one-half the cost of a standard primary care appointment. The clinics do accept insurance – the patient mix reflects the national average of 80 percent insured and 20 percent uninsured patients. Those patients without insurance can expect to pay approximately $80 for a visit.

Along with affordability, Ryan also credited the personal engagement patients feel, and one-on-one attention they receive as factors behind increased RHC usage. Many patients greatly appreciate the individual focus they enjoy from the staff NP, she said.

“Patients love our providers because they feel like they’re being listened to,” she said. “They also appreciate the transparency of the clinics – on the clinic website, they can see wait times, costs for services, and even patient satisfaction scores.”

RHCs are also making a direct impact on the quality and cost of care. Little research currently exists about the RHC impact on public health overall, but some studies have looked at their effect on various ailments. For example, a 2007 study determined that 99 percent of patients treated for sore throats in a RHC correctly followed instructions from the staff NP.

From a cost-of-care perspective, the Manhattan Institute for Policy Research reported RHCs can significantly reduce money spent on healthcare. A 2011 Medical Progress Report indicated that if elderly patients used RHCs for minor ailments rather than the emergency department, costs could drop dramatically.  For New York State alone, the cost-savings could potentially top $350 million by 2020.

Partnering With Primary Care Providers

In many cases, RHCs can be a stand-alone care setting, meeting patient needs in a one-stop-shop model. However, there are times when patients require additional services. For those instances, many RHCs have forged collaborative relationships with primary care providers in the community.

“Walgreens is working on strengthening our community connections,” Ryan said. “We see many patients who come in without a primary care provider, and we now have rather extensive referral lists of where we can send patients who need more extensive services.”

Such a network is particularly important for uninsured patients, she said. And, to meet those needs, the Take Care Clinic maintains information about safety net organizations and hospitals where patients who need it can access more affordable care options.

Most recently, Walgreens announced its WellTransitions program targeted specifically to patients at high risk for hospital readmission within 30 days of discharge. To help keep these patients out of the hospital, this program will give primary care providers medication lists and will help patients secure follow-up appointments. WellTransitions will also offer medication reviews, bedside medication delivery and patient counseling.

RHC Versus Urgent Care

Although RHCs offer on-demand appointments just like urgent care centers – both those associated with an academic medical center or privately-owned – it’s important not to confuse the two, said John Eddy, Associate Administrator for Ambulatory Care in Las Vegas’s University Medical Center’s Quick Care division.

“The basic difference is the scope of services provided in an urgent care versus retail model,” he said. “Particularly, it’s associated with the level of training – retail is staffed with nurse practitioners and medical assistants, and urgent care is staffed with licensed and boarded physicians supported by registered nurses.”

With a different set of providers, urgent care centers can address the same healthcare concerns as RHCs, but they are also equipped in-house to handle a more complex level of acuity, such as lacerations, severe burns, fractures or fluid management for dehydration.

Jennifer Swanson, M.D., Senior Medical Director for Duke Urgent Care, a five-clinic network within the Duke University Health System in Durham, N.C., agreed that RHC providers are more suited to tackle less complicated problems. She also pointed out that, while some RHCs can help patients navigate a larger health system, urgent care clinics that are part of academic medical centers are in an even better position to move patients along to higher levels of care. In fact, she said, these clinics are ready-made conduits that connect patients to specialty providers when needed.

“We have referral coordination that can call into a specialist office, schedule appointments, and get pre-authorization from insurance companies for services. Patients might not leave urgent care with an appointment in hand, but they know someone will call them with one shortly,” Swanson said. “With RHCs, that referral system is often a phone number of where the patient can call.”

A Healthcare System Fixture

Even though RHCs bring many benefits to both patients and the healthcare system overall, there are still challenges to providing services in this type of setting, Ryan said. Although most RHCs are staffed by NPs, many states still constrict their scope of practice, preventing them from working to the highest level of their certification. Not only is it a roadblock for the NPs as professionals, but it is also an obstacle for a healthcare system that is currently experiencing a national provider shortage.

Even still, she said, RHCs have made significant inroads into the health community, and the number of patients who view them as safe, reliable points of care continues to grow.

“Retail clinics are here to stay. Several years ago, there was a question of whether the clinics would make it – whether the patients would like and use them. But now, the whole dynamic has shifted,” she said. “In 10 years, people won’t remember a Walgreens without a clinic. These clinics are part of the community, and they promote disease prevention. And, they offer an increased access to healthcare that will change behaviors and increase quality of life.”

To read the article at its original location: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2012/November/Pumping_New_Care_Locales_into_Healthcares_Pipeline

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