Study argues against cost-savings benefits at clinics
While much has been made about retail clinics’ ability to trim healthcare costs, a study published in the journal Health Affairs this spring suggested that these walk-in health centers may actually boost overall spending by encouraging people to get care for minor problems that mostly would have cleared up on their own.
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The study — conducted by a six-person team of researchers from RAND; Health Policy and Governing Board of the Health Care Cost Institute at Carnegie Mellon University; Brigham and Women’s Hospital; University of Texas School of Public Health; and Harvard Medical School — found that 58% of retail clinic visits for several minor conditions represented a new use of medical services. Just 42% replaced a costlier doctor visit or trip to the hospital.
The authors concluded that the additional visits caused healthcare spending to increase by $14 per person per year.
Industry officials were highly critical of the results, calling them flawed and too narrowly focused on old data.
“It is not an accurate assessment of retail clinic cost savings and value,” CVS MinuteClinic president Andrew Sussman told the online publication California Healthline. “It is a step backward to think of people who did not have a primary care physician as excess utilization. It’s not excessive costs to take care of people who don’t have a doctor. In fact, we are reaching an underserved population with retail clinics.”
The study, he said, failed to explore the overall savings clinics can provide.
“If you think about a patient with the flu who doesn’t have a physician, they can get care at an inexpensive retail clinic on the weekend before their condition gets worse and they might need a costly hospitalization,” Sussman said.
Quality of care delivered at retail clinics
More than a decade after they began to appear in community pharmacies across the country, retail clinics have become a key provider of health care to millions of Americans. Both the number of clinics and the types of services provided are expanding, and even regional and supermarket chains are joining the trend of becoming a one-stop healthcare destination.
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The market research firm Accenture estimates that by the end of 2016 there will be 2,150 clinics in the United States, and that number will exceed 2,800 in just two years.
Forecasters said the key to retail clinics’ growth and their increased role in the country’s healthcare system will be their continual forging of relationships with other providers and ensuring that they have the technology to work closely with these other healthcare groups. Such partnerships, they noted, will allow more pharmacy operators to add clinics — as evidenced by the recent proliferation of clinics in a wider range of supermarkets and regional chains — and will help walk-in healthcare facilities take their business in a new direction. CVS Minute-Clinic and Walgreens’ Healthcare Clinic, for instance, have said they are exploring moving beyond just offering urgent care to providing more coordinated care for chronic conditions. Meanwhile, others are growing their network of clinics through a combination of corporate-owned facilities and in-store clinics operated by outside companies.
“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,” according to a report released last year by the Robert Wood Johnson Foundation, noting the growing number of alliances being formed between clinics and health systems.
“The cost of providing care for commercially insured patients has been found to be significantly lower when care was initiated at retail clinics than when it was initiated in physician offices, urgent care centers and emergency departments,” the report stated.
In fact, according to the report, slightly more than a quarter of emergency room visits could be handled at retail clinics or urgent care centers, leading to a $4.4 billion reduction in healthcare spending.
In addition, the study found that the cost of treating five common conditions — pharyngitis, otitis media, acute sinusitis, conjunctivitis and urinary tract infections — were about a fifth of what they were if patients used other providers.
Healthcare researchers and clinic proponents stress that the benefits of retail clinics are more than just a matter of dollars and cents. Payers and providers, they said, are aligning with retail clinics because they see the quality of care delivered at these locations to be as good or better than most other practice settings.
For instance, the Convenient Care Association, the trade group representing retail clinics, said that a recent analysis of clinics found that they had almost 93% compliance with quality measures for appropriate testing of children with pharyngitis versus the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set average of less than 75%.
‘With great power; great responsibility’
Jason Reiser, COO at Vitamin Shoppe
Some of life’s greatest lessons can come from the pages of a comic book. Take, for instance, Uncle Ben’s advice to his nephew Peter Parker, aka Spider-Man: “With great power comes great responsibility.”
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“When you dig deeper, what that really means is that when you lead a group of people, you’ve got a team that’s counting on you,” explained Jason Reiser — then chief merchant for Family Dollar, just a few weeks before he would be named COO of Vitamin Shoppe — at the Future Leaders Summit, co-hosted by DSN and Mack Elevation Forum, in May. “I get all my wisdom from superhero movies,” he quipped.
Reiser talked about why purpose matters to leadership.
“My personal leadership purpose is No. 1, about making someone’s life better,” he said, a calling he first felt as a boy working in his father’s pharmacy outside of Philadelphia.
“The second part is, how do I take a team and get results through other people that I — and they — never thought possible,” he said.
To get there, Reiser outlined the 12 key characteristics of a purpose-driven leader:
- You must be willing to be unpopular. “I like to say, ‘Let’s talk about the tough decisions first,’” Reiser said.
- Give and take unfiltered feedback. “Real leaders make themselves accessible,” Reiser said. “When the door is open, do you really listen, [or] do you bite people’s heads off? Are you really approachable?”
- Don’t let data replace judgement. “Sometimes you have to go with your gut.”
- Challenge the status quo. “You want to make sure that your organization doesn’t get complacent,” Reiser said. Quoting Barry Rand, former CEO of Xerox, “If one of the people who works for you is a ‘yes man,’ one of you is redundant.”
- Always be involved in the details. “Ideas and visions mean nothing if you don’t see them on the field.”
- If it ain’t broke — fix it. Purpose-driven leaders forecast how businesses will change. “If the category is not broken today, where is it going to be five years from now?” Reiser asked. “Complacency can be devastating to a business.”
- Only the best people accomplish great things. “This is and always will be a people business. This is the thing that is killing millennials and [younger] people,” Reiser said, lamenting the reliance today on email and text messaging. “What’s lost is tone. God forbid you actually have a conversation with somebody,” he said.
- Don’t get caught up with a fancy title. “’That’s not my job;’ my dad killed that for me pretty early,” Reiser said. “I used to call those people ‘MFNs.’ ‘Money for nothing.’ If you have a ‘money for nothing’ in your organization, get rid of them. They’re a cancer [to the organization].’”
- Never underestimate enthusiasm and optimism. “I would rather have somebody [on my team] who is bullish and probably wrong, any day of the week — [being wrong] doesn’t matter,” Reiser said. “They’re enthusiastic, they bring passion [to the job], [they’re] infectious and they just might strike gold.”
- Simple solutions. “Anything that has [too much] complexity to it is not going to work,” Reiser said. “Not only that, it’s really hard to communicate.”
- Have fun. Sharing a highly personal story from his own life, Reiser urged attendees to remember the one rule that trumps all others — to have fun at what you’re doing and surround yourself with people who are able to laugh at themselves. Personal ambition might fuel you, but never lose track of the things that truly matter.
- Leadership is hard. “‘Don’t tell people how to do things. Tell them what to do, and let them surprise you with the results,’” said Reiser, citing the late, great General George Patton. “I always say be crystal clear on what you want and when you want it done, but be completely vague on how. The stuff that comes back will blow you away.”