Survey on health insurers advancing NP credentialing is major step for improving access, cost
WHAT IT MEANS AND WHY IT’S IMPORTANT — The message is getting louder and gaining traction: Nurse practitioners are highly skilled health care professionals who need to be able to practice to the full scope of their ability, especially in light of the primary care shortage that is plaguing the nation.
(THE NEWS: Survey: Health insurers show advances in NP credentialing, reimbursement. Click here for the full story.)
Lawmakers and other officials are taking notice and according to survey findings, so are HMOs. As the survey found, 75% of HMOs credential nurse practitioners as primary care providers, an increase over previous years. While this is good news for the nursing industry, there’s no doubt that there is room for improvement.
As the survey stated, there needs to be 100% credentialing in order “for the healthcare system to be ready for the huge influx of new patients in 2014. … All nurse practitioners must be able to practice to, and be compensated for, the full scope of their ability.” This is a standard that needs to be expanded nationwide.
The reason why this is critical is quite clear. First of all, there’s healthcare reform that will put roughly 30 million uninsured Americans into the coverage rolls come 2014, and then there’s the physician shortage in this country. It is estimated that the primary care physician shortage will reach about 60,000 by 2015.
According to numbers provided by the Convenient Care Association, as few as 2% of medical students coming out of U.S. medical schools intending to pursue a career in general primary care. Also, between 30% and 60% of patients of convenient care clinics — which are typically staffed by nurse practitioners — reported not having a primary care physician. Plus, as many as 40% of convenient care clinic patients said they would have sought costlier care or would have foregone care completely if there had not been a convenient care clinic available.
Clearly, there’s a gap in care that needs to be filled.
Meanwhile, a recent Rand survey served as a stark reminder of how the other side can distort the issue with half-truths and oversights.
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Walgreens setting the stage to be an entirely different retailer; new magazine just a first step in that direction
WHAT IT MEANS AND WHY IT’S IMPORTANT — Omni-channel retailing is so yesterday. Omni-national retailing is the space where Walgreens is looking to play, and this magazine is just one of the first examples of how retailing concepts from the Old Country will be imported from across the Pond and translated for the U.S. market.
(THE NEWS: Walgreens launches new biannual magazine showcasing private label, Balance Rewards deals. For the full story, click here.)
The way Alliance Boots handles private label, the way the British retailer approaches seasonal and the way all of that gets brought together through a comprehensive loyalty program are just some of the best practices Walgreens executives identified early on in its partnership with Alliance Boots. For example, Alliance Boots takes a very different approach to seasonal. They’re mostly health- and beauty-focused whereas many stateside retailers are still very general-merchandise-focused.
Walgreens’ new Happy and Healthy magazine appears to seize on each of those elements — private label, health and beauty and tying it together through the Balance Rewards loyalty program — suggesting the two companies are moving quickly to identify and apply relative synergies. To be sure, phase one is unfolding at a quick pace judging from other news announced earlier this week, namely that Walgreens and Alliance Boots have created a new jointly owned development company as part of their strategic partnership’s synergy program.
Meanwhile, growing evidence of the globalization of the pharmacy business continues to unfold as Alliance Boots moved steadily along last week, with the transfer of ownership of Alliance Healthcare Russia from AB Acquisitions Holdings Limited, the parent company of Alliance Boots, to Alliance Boots. Alliance Healthcare Russia will be part of the package when Walgreens pulls the trigger on its second step in the acquisition process: a full merger of the two companies.
And soon, Walgreens may be importing best practices from beyond even the U.K. border. Just last month, Alliance Boots acquired a stake in the Chinese wholesale market, further entrenching its position within that burgeoning economy.
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Study: Evidence mixed on clinic disruption of doctor-patient relationships
NEW YORK — A new Rand study examining the impact of retail medical clinics on the receipt of primary medical care found mixed evidence about whether the clinics may disrupt doctor-patient relationships. And, while the study found that people who visit retail medical clinics may be less likely to return to a primary care physician for future illnesses and have less continuity of care, one could argue that the study is fairly irresponsible and myopic in scope as it overlooks the physician shortage in this country and ignores the fact that clinics connect patients without a medical home back into the healthcare system.
The findings, published online by the Journal of General Internal Medicine, are the first to provide insight about how the growing number of retail medical clinics may affect doctor-patient relationships and use of primary care services, according to the authors of the study.
"There is concern whether retail clinics may disrupt the relationship between patients and their personal physicians, which may make it difficult to maintain the quality and continuity of medical care," stated senior author Ateev Mehrotra, an associate professor at the University of Pittsburgh School of Medicine and a researcher at Rand, a nonprofit research organization. "We found use of retail clinics did have a negative impact on some aspects of primary care."
The study, however, did not find evidence that retail medical clinics disrupted preventive medical care or management of diabetes — two important measures of quality of primary care.
Rand researchers have documented the rapid rise of retail clinics, which now number more than 1,300 nationally. Use of the clinics increased tenfold from 2007 to 2009 among those with commercial health insurance, with use projected to rise more in the future. The walk-in clinics typically are staffed by nurse practitioners and offer basic types of health care with clearly posted prices.
According to the study, researchers examined the link between retail clinics and use of primary care providers by examining the records of a large group of people with commercial health insurance who used a retail medical clinic for an acute medical condition during 2008. Researchers examined their medical care a year before the visit and a year afterward, comparing their patterns of care with those patients who visited a primary care physician for an acute health problem during the same period.
People who visited a retail medical clinic for 1-of-11 common ailments, such as a respiratory infection or urinary tract infection, were less likely over the next 12 months to visit a primary care physician the next time they needed similar care. Patients who visited retail clinics also had less continuity of care, such as seeing the same physician for their medical needs.
Mehrotra, however, said since the use of retail clinics was not associated with less preventive care or poorer management of diabetes, it’s hard to make an overall assessment about the impact that the use of retail clinics had on the quality primary care.
"The interpretation of our findings depends on one’s view about the relative importance of different aspects of primary care," stated study author Rachel Reid of the University of Pittsburgh School of Medicine. "Retail clinics are still in their infancy, and over time we may or may not observe a more negative impact of retail clinics on preventive care or continuity of medical care."
What the study didn’t mention is the critical physician shortage facing the nation. It is estimated that the primary care shortage will reach about 60,000 by 2015. As mentioned earlier, the study also fails to address the fact that clinics — some of which have clinical affiliations with healthcare systems — connect patients without a medical home back into the healthcare system.
Support for the study was provided by the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization Initiative.
Ms. Alexander's critique is quite appropriate, but more can be added. The greater disruption of continuity of care may be placed at the hands of: * employers and insurers, who change health plans and panels of providers every few years; * a traditional medical community that still believes all healthcare is local, despite the fact that people move every few years; and * the fact that the majority of physicians still practice in groups of three or less. Ron Hammerle Chairman and CEO Health Resources, Ltd. Tampa, Florida
What direction is preventive care utilization heading? http://www.healthcaretownhall.com/?p=5596