The role of retail clinics is having a significant evolving impact on the delivery of healthcare nationwide. A study by Manatt Health, a healthcare consulting firm, funded by the Robert Wood Johnson Foundation, specified that “retail health will fuel the move to value-based health care and a ‘culture of health.’”
Let us look, then at how offering health risk assessments (HRAs) in retail settings can help health plans improve quality.
Why Quality Matters
The delivery of high quality healthcare to as many people as possible reduces risk to members, providers, insurers, and society. Health Risk Assessments (HRAs) are critical tools in the healthcare system’s toolbox to assess a member’s health status and play a role in better member outcomes that prevent late interventions at higher costs.
As for quality care delivered by retail clinics, Dr. Ateev Mehrotra, an associate professor of health care policy at Harvard Medical School, reports: “We’ve found that the quality of care at retail clinics is equal to or superior to some doctor’s offices, because the clinics are more likely to follow national guidelines of care.”
Retail clinics are staffed by physician assistants and more typically by nurse practitioners. Looking at their ability to deliver quality care, Regina Herzlinger, Harvard Professor of Business Administration and author of Who Killed Health Care?, says: “Whatever they do is guided by evidence-based protocols…. Not only are nurse practitioners required to follow specific care guidelines, but they must also keep meticulous records on the care they’ve provided…. They have a record of what they’ve done that’s very detailed.”
Below are 7 Ways Retail Clinics Boost Health Care Quality:
For HRAs to make a qualitative difference, a member has to become engaged in the healthcare system. Retail clinics are the difference between fly fishing—the catch-one-at-a-time option if the fish swim close enough—and casting a wide net to catch more fish. Engaging more members is key.
The convenience of retail clinics is proven. They are affordable, easy to access, and hold extended hours:
Most visits occur during hours when physicians’ offices are shut, especially on weekends.
Most members are in the 18-44 age range.
Most people can better afford a retail clinic visit.
Simply put, offering HRAs through retail clinics means many more members will receive one.
2. Comfort Level
We all know that some people’s blood pressure rises at the mere sight of a white lab coat at the doctor’s office. Retail clinics, therefore, have a bonus attraction: people simply may be more comfortable accessing healthcare at their familiar retail site with a nurse practitioner than calling for an appointment, going to a physician’s office, and talking with an M.D.
That is more than just convenience: it is a comfort level factor that often is omitted in risk and quality control calculations.
The higher comfort level at retail clinics increases acceptance rates and allows for more members to undertake an HRA. It offers a safe place for an exchange of member information.
Offering HRAs at retail clinics places prevention front and center in the delivery of quality healthcare. That makes HRAs in retail settings a critical component of the culture of health.
For example, HRAs in retail settings will uncover a member’s vaccination history and create an opportunity for staff to counsel members on the benefits of vaccinations and the importance of preventing the spread of contagious diseases.
This alone boosts the quality of prevention nationwide, especially considering the demographic of those who have shown themselves more willing to access the healthcare system by going to a retail clinic:
The RAND Corporation’s data suggest that 43 percent of retail clinic visitors are under age 45—the age range of parents with younger children who need vaccinations. These parents are busy and may be stretched thin financially. Retail clinics are the perfect response from the healthcare system to meet the needs of this demographic. As a bonus, they will teaching their younger children to address healthcare needs as they arise and before they escalate into emergencies.
HRAs in retail settings also can elicit member data on compliant prescription drug use and other behaviors, which may prevent adverse effects on long-term health.
4. Identification of High Risk Members
Members who do not access the healthcare system on a routine basis may be oblivious to signs that they are at high risk for a critical health condition. Similarly, members who may be confused about their prescribed drugs may also be at risk for noncompliance or inappropriate use of their pharmaceuticals.
Retail clinics that offer HRAs provide the best opportunities to check in with members averse to accessing medical information from their PCPs and ensure that high risk situations are spotted and addressed in a timely manner.
5. Lower Costs
Once, ER visits were the only option after hours when physician offices were closed, or when members carried no healthcare insurance. However good they are at emergency care, most ERs and trauma centers have to focus their resources on addressing the acute illness or injury that brought the member in. They generally are not equipped to take the time to perform HRAs.
According to the RAND Corporation’s research, “13.7% - 21.1% of all ER visits could take place at a retail or urgent care clinic, potentially saving the healthcare system $4.4 billion a year.”
Retail clinics also can play a strong role in reducing hospital readmissions by making follow-up visits easier, coaching members on compliance with physician recommendations, and performing HRAs.
6. Timing of Interventions
PCP shortages, which began in rural areas but now are spreading into cities, translate into longer wait times. Meanwhile, members may give up waiting and skip their visit or wait until they need an ER.
Health risk assessments not only require that the member takes the time, they require the provider make the time as well. In a shortage situation, performing regular HRAs places a greater squeeze on physician access.
Retail clinics have taken up the slack just in time. Their presence relieves physicians’ offices of the burden of managing immediate access when a member is acutely ill, and creates opportunities to perform HRAs on many more people. members with simple, acute illnesses can both access immediate care and receive the benefit of an HRA while at their local retail clinic.
HRAs are akin to early intervention in that they improve preventive care, save costs, and ultimately save lives.
7. Lower Barriers
As noted earlier, people who are new to their insurance benefits have a significant barrier to accessing the healthcare system. It is critically important that these people, who may not yet experience that “culture of health,” are offered health risk assessments and subsequent counseling on healthful behaviors. Retail clinics now are a viable option for this constituency.
Retail clinics accept private insurance and Medicare. Prices in retail settings are lower than in physician offices by 30 to 40 percent, and about 80 percent less expensive than ER visits.
In addition, many of these members do not have a PCP. Studies indicate that about half the visitors using retail clinics do not have their own PCP. Retail clinic staff can encourage members to sign up with a primary care provider, especially if they are older, have chronic conditions, or need more closely coordinated care for other reasons. Retail clinic staff also may counsel shoppers on affordable ways to access health insurance in their region, also making the retail clinic a viable recruiting and sales option for health plans.
In summary, retail clinics are able to boost HRA offerings through significantly higher member engagement and education, resulting in improved quality based on prevention and early detection.
MedXM, a national leader in helping health plans improve meber engagement, focuses on risk adjustment and quality solutions tailored to each client’s specific requirements. For more information on how our services can help you, please contact us and follow us @MedXM1.