Walk-in retail clinics, launched in Minnesota eight years ago, continue to carve a niche as providers of basic, uncomplicated health care. Despite recent missteps, slower than anticipated growth and opposition from physician groups, the clinics are becoming an established member of the nation’s health care delivery system, and health plans increasingly are contracting with them.

The reasons: cost, convenience, growing consumer and employer acceptance, generally high-quality care, and a recognition that these clinics can help relieve pressure on overburdened (and expensive) hospital emergency rooms (ERs). Large and small insurers (as well as Medicare) cover their services, typically with modest copayments. Blue Cross and Blue Shield of Minnesota recently dropped its required copays to encourage member use of local retail clinics.

The American Academy of Family Physicians, AMA and American Academy of Pediatrics oppose retail clinics, citing clinical quality and other concerns. But insurers say that clinical quality is not a problem at clinics operated by pharmacy chains, hospitals and health plans.

These clinics have quality care and quality assurance procedures built into their operations, including standardized treatment-decision protocols, chart review and evidence-based medical guidelines from the major medical societies. Most use electronic medical records (EMRs) to share information with a patient’s physician and local hospitals. According to CVS, MinuteClinic is the first and only retail clinic accredited by the Joint Commission.

A few health plans, including HealthPartners, another Minnesota-based plan, have entered the retail-clinic business themselves. Hospital systems, including Utah’s Intermountain Health, Sutter Health in northern California and Wisconsin-based Aurora Health Care, have also joined in, citing solid business reasons for doing so. Andy Vinson, executive director of HealthPartners Central Minnesota Clinics, tells HPW the clinics provide a way to build market share and brand loyalty among consumers.

Two potentially lucrative markets: baby boomers and younger generations that represent a sizable segment of the population that wants (and expects) convenience, faster service and greater choice. According to Deloitte’s 2008 Survey of Health Care Consumers, these groups find the clinics an attractive option.

About 1,000 retail clinics staffed by nurse practitioners (NPs) and/or physician assistants (PAs) are now operating in about 30 states, a hefty increase from 200 clinics just two years ago. The majority now are operated by Walgreen Co. and CVS Caremark Corp. subsidiaries. The Convenient Care Association, the industry’s new trade group, projects there will be 5,000 clinics by the end of the decade.

While media attention has focused on clinics that have set up shop in Wal-Mart and Target stores, most are located in local pharmacies as well as supermarkets and malls. Industry analysts say brand association with a locally recognized health care entity, from a CVS to a HealthPartners or a hospital, is key to success. Indeed, many of the clinics that went out of business over the past year did so because their parent companies had little, if any, health care experience and no local health co-branding, resulting in slow initial walk-in volume. Startup costs and investor impatience with prolonged time before a return on investment also played a role in the demise of smaller companies.

Walgreens, CVS Dominate the Market

Take Care Health Systems, a wholly owned subsidiary of Walgreens, operates 204 Take Care clinics in 14 states. CVS Caremark’s MinuteClinic subsidiary operates 500 clinics in 25 states. Take Care in late 2007 projected opening 400 clinics by the end of 2008. CVS originally projected opening between 150 and 250 clinics this year, but later lowered the number to 100.

Both chains are now moving into Boston and several other Massachusetts metro areas. CVS says it will open about 28 MinuteClinic clinics in the Boston area and another 100 across the state by the end of the year. Take Care is opening an undisclosed number of clinics.

While none of the clinics are open for business yet, Harvard Pilgrim Health Care, Blue Cross and Blue Shield of Massachusetts and Fallon Community Health Plan are reportedly in talks with both chains. None responded to HPW’s requests for comment on that.

Tufts Health Plan is also negotiating, although spokesperson Patti Embry-Tautenhan says it is too early to discuss the details. “We looked closely at the Minnesota experience, which gave us confidence in the quality of care provided by MinuteClinic,” she tells HPW. “We do anticipate cost savings and believe that MinuteClinic offers a responsible alternative that can alleviate ER overcrowding and provide additional convenience for our member.” She stressed that these clinics will augment rather than replace the primary care provider/patient relationship.

HealthPartners opened its first HealthStation retail clinic in the St. Cloud, Minn., market in 2005 and its second in 2006. Vinson tells HPW that the clinics “enhance the HealthPartners brand value in the St. Cloud community.” Another goal: help the HealthPartners’ clinics build primary care market share.

The HealthStation clinics, staffed by NPs and PAs, see patients 12 months of age and older (most clinics use 18 months as the cutoff age). Prices range from $30 to $95. In addition to covering HealthPartners plan members, the clinics also accept six other insurers, including Blue Cross Blue Shield of Minnesota. HealthPartners began covering retail clinic visits in its fully insured plans in 2005. Visits are reimbursed at the same rate as office visits. While self-insured plans administered by HealthPartners are under no obligation to cover care at the clinics, Vinson says “most self-insured plans choose to offer coverage.”

Each HealthStation uses EMRs for all patient visits, and patient records are accessible by HealthPartners’ network physicians. Patients with non-network physicians are offered a summary of each visit so that the records can be shared with their doctor. HealthPartners also created a referral system to direct patients with more complicated health care needs back to their primary clinic or to other medical facilities when patients lack a medical home. The clinics use treatment protocols to ensure consistent quality, and HealthPartners’ medical director conducts regular chart audits. Vinson says no significant health or safety issues have been identified to date.

HealthPartners plans to open a third HealthStation in the St. Cloud area next summer, and a fourth sometime after that.

Plan Drops Copay to Encourage Visits

The Minnesota Blues plan began covering member visits to retail clinics in 2003. In July of this year, the insurer eliminated copays in an attempt to encourage members to use the clinics for “simple medical conditions.” The option is available for members of most fully insured small- and large-group plans. The insurer says that more than 40,000 members used these clinics during 2007, a 100% increase from 2006.

According to Shawn Patterson, vice president of marketing, the Blues plan created the option “because it helps hold health care costs down and is responsive to consumers’ wide acceptance of retail clinics.” The average cost of a visit for typical services is $47, about half the cost of a visit to a traditional medical clinic ($97). Patterson estimates that employers and members collectively saved more than $1.25 million in health care costs in 2007 by using retail clinics.

Source: AISHealth.com
Original Publication Date: September 15, 2008