Insurers Pushing for Increased Use of Retail Clinics

Insurers Pushing for Increased Use of Retail Clinics

By Rebecca Adams, CQ HealthBeat Associate Editor

Insurers see retail clinics as one potential way to reduce costs and avoid emergency department visits, experts said Monday at an Alliance for Health Reform briefing that was co-sponsored by WellPoint Inc.

“Retail clinics will play a role as health care reform is implemented,” said WellPoint regional vice president Manish Oza. If the U.S. Supreme Court upholds the 2010 health care law, tens of millions of U.S. residents will gain insurance and presumably seek greater amounts of medical care. Oza and other officials suggested that since there may not be enough primary care physicians available to handle the demand, retail clinics could play a part in treating minor contagious ailments such as strep throat or pink eye.

Oza said that the insurance company had created a series of ways to inform patients about options besides emergency care departments, including retail clinics. The prompts include a print brochure, an online tutorial that explains which conditions do not require urgent care and emergency department wait times and a Google map that allows patients to type in their zip code and find a retail clinic or other low-cost alternative nearby. The insurer also has developed a smartphone version of the Google map but is still refining it.

RAND Corp. policy analyst Ateev Mehrotra said that the quality of care in retail clinics is the same or better than that in other settings, such as a physicians’ offices or urgent care centers. Mehrotra’s research also found that retail clinics prescribed antibiotics at about the same rate as professionals in other settings.

One concern about retail clinics has been that if patients visit a clinic instead of a primary care physician that they regularly see, then the patient-physician relationship could be disrupted and doctors may not know what types of medication or care their patients are receiving. However, Mehrotra found that this fear was overblown for a simple reason: most retail clinic customers don’t have a regular physician who oversees their care. Fewer than 40 percent of clinic customers reported that they routinely see a physician.

Experts on the panel were asked whether they agreed with new state laws that attempt to discourage patients from visiting emergency departments when they have minor sicknesses. For instance, Washington state announced in December that the Medicaid program will stop paying for unnecessary emergency visits.

But experts at the forum said that it is hard for patients to accurately judge when a medical concern is a true emergency and that the policy could backfire by discouraging patients who really do need emergency care from seeking it.

“I actually have a lot of concerns about that approach,” said Mehrotra. “It’s a little like Monday morning quarterbacking” to determine what was urgent and what was not.

Oza agreed that ”what Washington started is not the solution.”

Rick Kellerman, the chair of the Department of Family and Community Medicine at the University of Kansas School of Medicine in Wichita, said that physicians who feel threatened by retail clinics should alter their practices by operating later, when patients need care, or offering real-time advice in other ways, including emails. Kellerman said that the development of retail clinics is a symptom of a bigger problem — the “neglect of the primary care system in the United States.”