Cost, quality and transparency drive insurer, health system interest

There are very logical reasons that a growing number of health systems, large payers and insurers continue to embrace the retail clinic model: cost and quality.

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According to a recent Robert Wood Johnson Foundation study, there are currently more than 100 partnerships between retail clinics and health systems. “Some delivery systems seeking to improve primary care access and manage total cost of care are using retail clinics to reduce unnecessary emergency department visits. One study estimated that up to 27% of ED visits could be handled appropriately at retail clinics and urgent care centers, offering cost savings of $4.4 billion per year,” noted the April 2015 RWJF study, “Building a culture of health: The value proposition of retail clinics.”



“The cost of providing care for commercially insured patients has been found to be significantly lower when care was initiated at retail clinics ($110) than when it was initiated in physician offices ($166), urgent care centers ($156) and EDs ($570),” according to the RWJF report. “Studies have also found that for five common conditions treated at retail clinics — pharyngitis, otitis media, acute sinusitis, conjunctivitis and urinary tract infections — cost savings of $50 to $55 per episode could be realized and that cost of care for consumers who visited a retail clinic on aggregate was $262 less than those who did not.”



Retail clinics also are starting to emerge in new patient care models like the Accountable Care Organization and Patient-Centered Medical Home models. “BlueCross BlueShield of Minnesota has created an ‘aligned incentive’ ACO program that now accounts for 40% of its network spend. They have developed an ACO-like product with Allina Health Network and have ‘wrapped’ AHN’s network with other providers, including retail clinics,” according to the RWJF study.



It’s not just all about dollars and cents. The other critical reason that payers and providers are aligning with retail clinics is simply that the quality of care delivered at retail clinics is as good or better than most other practice settings. Retail clinics had almost 93% compliance with quality measures for appropriate testing of children with pharyngitis versus the Healthcare Effectiveness Data and Information Set (HEDIS) average of less than 75%, according to the Convenient Care Association.