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Insurers turn to retail, urgent care clinics to keep members out of emergency rooms

BY DSN STAFF

Shifting patients away from hospital emergency rooms and into retail-based and urgent care walk-in clinics can significantly lower healthcare costs, improve access to care and reduce the impact of such chronic diseases as diabetes and hyperlipidemia, two health benefits experts asserted in a recent online presentation.

In a webinar titled "How Retail and Urgent Care Clinics Can Be a Win-Win for Health Plans and Their Members," the two experts — Susan Menendez, director of strategic provider relationships for Blue Cross and Blue Shield of North Carolina, and Tom Charland, CEO of health consulting firm Merchant Medicine — laid out a strong case for walk-in clinics as a powerful tool to reduce expensive visits by health plan members to emergency rooms and provide an accessible professional care alternative for millions of Americans living in areas facing a shortage of primary care physicians. Such clinics also can extend a local health system’s reach within a community as part of an accountable care organization, provide a medical home for some patients and make patients more responsible for their own health, they said.

Retail and urgent care clinics, Charland said, are "expanding the scope of services" they offer walk-in patients, providing "an alternative to primary care." And health plan payers, he said, are taking notice. Increasingly, they’re looking to clinics to play a role in improving patient access to health services, lowering costs for routine and preventive care, and serving as ad hoc medical homes for patients "where there’s an extreme shortage of primary care physicians,"he noted.

Given "the hours, the locations, the consistency of service," Charland said, "I personally believe that walk-in medicine has done more for patient-centric behavior and patient satisfaction — and the focus on patients as customers — than anything since doctors made house calls." Charland attributed the rise in retail and urgent care clinics to "medical providers acting like merchants, and acting like they want patients to come back and have a positive experience."

"It’s no longer built around the provider, or providers’ hours or locations," he added. "It’s built around the patient."

To this point, however, retail and urgent care clinics have followed different growth tracks. Although urgent care has seen steady gains over the past decade, the retail clinic market experienced "a leveling off in 2008 and 2009, when people were trying to figure out what was going on, and it’s only just recently that MinuteClinic, under CVS’ guidance, has decided to start opening new clinics," Charland said.

Nationally, the use of retail clinics saw healthy gains from 2006 to 2009, according to a study from Rand Corp., from 1.48 million total patient visits to roughly 6 million. "But those figures still pale in comparison to ER and regular physician visits," noted Atlantic Information Services in a report. "An estimated 117 million ER visits and 577 million visits to doctors’ offices are made each year."

Nevertheless, said Charland, "these clinics are here to stay" as health plans, payers and patients incorporate them into the nexus of care. He also predicted "a lot more cooperation" from doctors as "the changing economic model is starting to change their behavior from being able to do as many procedures as you can, to getting that procedure in the spot where it can be done with the highest quality at the lowest cost. And if that does take over, I think we’ll see walk-in clinics start to be integrated into more of these ACOs and clinically integrated networks."

Although most retail clinics "have yet to break even," Charland added, the profit picture is improving as operators have learned to "smooth out some of the seasonality" of their business by broadening their menu of services and as patient traffic has picked up. "Now that these clinics are at break-even, we’re going to start to see some of the operators open more clinics," he predicted.

CURBING ER USE

The need among health plan payers to curb the rising costs of emergency room care for non-emergency health problems has become increasingly urgent, Menendez said. "We have seen our costs for emergency room services continue to increase over the last several years," said the Blue Cross Blue Shield strategist. "We know that thousands of patients visit crowded emergency rooms for non-life-threatening conditions that we believe can be treated very cost-effectively and efficiently in urgent care centers. And we know that a visit to an emergency room can cost up to 10 times more than visiting an urgent care center … [at] nearly $1,500," she said.

In response, BCBS purchased a stake last year in FastMed Urgent Care, the largest urgent care clinic provider in North Carolina. "In those pockets of the state where we have primary care shortages, this type of model is very attractive to us," said Menendez. "We know that primary care shortages in North Carolina will only worsen in 2014 and beyond. So we’re looking now at solutions around primary care, as well as having options other than the local hospital for these members."

Menendez said the Blues launched a project in 2010 "to look at these ER costs and services, and really try to understand what is driving members going to ERs. What are the behaviors and the most common diagnoses that members go to ERs for?"

ER-use rates are higher in rural areas of the state, she said, at rates of "around 200 per 1,000 members, and that’s incredibly high," versus about 140 visits per 1,000 members living in urban areas. In addition, BCBS knows that "women of childbearing years and young males have the highest ER rates. We’re trying to drill down into that and understand why."

The Blues tracks a list of 15 to 20 diagnoses that drive the most nonemergency ER visits, including headaches, back pain, sore throats, urinary tract infections and upper respiratory infections.

One big reason for the high ER utilization rates: the shortage of primary care physicians, coupled with the fact that many residents in North Carolina don’t have a regular doctor to visit for treatment and counseling, even for common conditions. And again, BCBS members in rural areas — including "some pockets of the state where the only option for receiving nonemergent care is the local hospital," Menendez said — are the least likely to have a primary care physician. "That’s very concerning to us, given some of the health crisis issues we have today."

What’s needed is a broader, more comprehensive approach to providing health services that encourages patients to make better use of other care options like retail clinics and urgent care centers. To that end, BCBS invested in FastMed, a network of 26 urgent care centers across North Carolina. The insurer also began a pilot project with several employer groups to help educate their workers on alternative care sites like clinics.

"We believe that providing access to additional clinics in North Carolina can help us achieve that reduction in ER visits," Menendez said.

Indeed, shifting patients away from the ER and into retail or urgent care clinics in the state would yield significant cost savings. "An overall 5% shift in ER to urgent care utilization would result in about a 74 cent-per-member-per-month savings, and that translates into almost $8 million annually,"she said.

BCBS of North Carolina and FastMed now co-sponsor community events like health fairs, wellness and prevention events, and blood-pressure checks. "We did a huge voucher mailing in mid-November to members who live close to a FastMed location, waiving co-payments for those members. And we continue to work together to identify short- and long-term strategies around strategically placing new clinics across the state where we have high ER costs and inappropriate utilization.

"We know that if we can get these members who don’t have primary care physicians into that [clinic-based] primary care space, and get them linked into preventive and wellness programs, we can do incredible things to head off such chronic diseases as diabetes, hypertension and cardiovascular problems — all the things that we are so struggling with here in North Carolina due to environmental factors," Menendez added.

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Docs outweigh smart device research for Rx intel, but mobile is mecca for savvy shoppers

BY Michael Johnsen

Smart device usage has become an active part of in-store shopping. According to a recent poll of Accent-Health smart device owners, nearly 3-out-of-5 have used their phone or tablet to aid in product selection while shopping in-store. However, consumers are more likely to research their next TV on their mobile device than their prescription medication. According to AccentHealth VP market research, Natalie Hill, "When it comes to medical treatment, healthcare professionals remain the most trusted source for information. Of those viewers using smart devices in-store, only 16% report doing so to investigate Rxs or OTCs." Consumers using mobile devices in-store are most often in search of savings, with the majority (91%) comparing prices online or at other stores while shopping.

As retailers strengthen mobile strategies, it is not surprising to find that half of consumers surveyed own a retailer app. Of those, more than three-quarters report having an app for a pharmacy or a mass merchandiser with pharmacy.

Mobile apps are doing much more than just displaying products for sale. While app features vary by retailer, 71% of respondents indicate they use their apps to receive discounts/coupons; store locator searches, shopping, and loyalty card/rewards access follow as the next most commonly used features. Given the investment retailers are making in app development and benefits to the purchasing process, it is not surprising that app usage is reported to increase in the future.

Among non-users of retailer apps, nearly half indicate they would be likely to download an app in the future. Among users, three-quarters report they are likely to increase their frequency of use or use new features. Cost-savings seekers will continue to fuel app usage; however, significant interest in less commonly used tools — such as live expert chatting, barcode scanning and Rx management — are expected to contribute to growth in app use.

Patient Views is a consumer insights feature that appears in every edition of DSN magazine, as well as in the daily e-newsletter DSN A.M.

For the latest Patient Views, click here.

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Telehealth could supplement self-diagnosis as more young people go online for health information

BY Alaric DeArment

The number of Americans who want technology to play a role in their healthcare is growing, as up to 64% of Americans use online health resources, and 40% use them to self-diagnose, according to a new survey conducted by the Atlantic and GlaxoSmithKline. Yet while 94% of those using online resources consider them important to their health, only 12% report contacting doctors via email or text message regarding a health question.

The Atlantic-GSK survey and others indicate that the group favoring online health information tends to skew younger.

According to a Pew telephone survey of 3,014 adults conducted between August and September 2012 and released in January, 47% of those aged 18 to 29 had looked online to diagnose a condition, compared with 43% of respondents aged 30-49, 29% of those aged 50-64 and 13% of those aged 65 and older. Overall, the survey found that 59% had looked online for health information in the past year, and 35% were "online diagnosers," meaning they had used the internet to figure out what condition they or another might have.

Meanwhile a study released Friday by Research2guidance found that the market for mobile health apps will reach $26 billion by 2017. 

At the same time, the percentage of those in the youngest cohort who had followed up with a medical professional was the same as those in the oldest (47%) compared with 55% of those in the 30-49 cohort and 58% of those in the 50-64 cohort. Nevertheless, doctors remained a primary source of information and support during serious health episodes, with 70% of respondents getting information, care and support from medical professionals.

This is where programs like Rite Aid’s recently expanded NowClinic can be useful. According to the Atlantic-GSK study, younger people tend to place greater emphasis on removing face-to-face interaction with healthcare professionals. While NowClinic relies on a webcam connection – i.e. face-to-face interaction – it allows for remote consultation between the doctor and patient.

A 2011 study in Australia indicated that when it came to sexual health services, 85% of people aged 16 to 24 would prefer meeting a doctor in person, while 63% would prefer a telephone consultation and 29% would prefer a consultation via webcam. Use of webcams for consultations was favored more among men, respondents with same-sex partners and those with more than three sexual partners in the previous year. Concerns about the possiblity of consultations being recorded, saved and potentially searchable online were the main objections to webcam consultations. But the study concluded that despite the small number of respondents who would prefer consultations via webcam, they could benefit youth who would otherwise lack access to sexual health services, and they might be more palatable if they included guarantees of privacy.

As any doctor will say, it’s unwise to try and self-diagnose, at least without consulting a qualified professional. Some news media have reported on "cyberchondria," in which patients go to doctors for an imaginary illness because they’re convinced that a symptom such as a rash or cough is evidence of a serious illness, as well as doctors’ frustration with it.

But it would be equally unwise to ignore the growing number of people who seek medical information online to try and figure out what’s wrong with them. After all, according to the Pew study, 53% of online diagnosers had discussed what they found online with clinicians, and 41% had their self-diagnoses confirmed, but 35% had not visited a clinician to get a professional opinion.

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