Managed Care - March 2008 - (Page 34) consumer-directed health care and author of the book Who Killed Health Care? describes the importance of health care delivery in “the right place” and illustrates how insurers and consumers together are contributing to the growth of retail clinics, “You do not want your kid who has a sore throat sitting in an emergency room next to someone who has been shot with an Uzi.” Consumers want to be in an appropriate medical setting, and they love access to this convenient community resource. Insurers want to accommodate their increasingly vocal members, which they of concerns with regard to the effect of rising health care costs on their bottom line. By contracting with retail clinic providers, they have the ability to, at once, increase member satisfaction and achieve cost savings. On the issue of cost, Herzlinger adds, “From the insurer’s perspective, retail clinics are cheaper — in an appropriate way. Insurers are saving a considerable amount of money when patients visit a retail clinic, rather than a costly emergency room to receive treatment for a minor medical condition.” Aetna has contracts with community clinics, but MinuteClinic nurses do a great job of not prescribing antibiotics for sore throats that test negative for strep. can do by working with retail clinics. The consumer wins and the insurer wins.” Accessibility has long been an issue for consumers, whose primary care physicians are typically closed at night and on weekends. In what appears to be an attempt to respond to their patients’ use of retail clinics, the American Academy of Family Physicians recently recommended that its 94,000 members increase their hours of availability and capacity to accommodate same-day appointments. a spokesman says that it will be “at least 10 to 12 months before Aetna has credible data on the clinics’ impact on the quality and cost of care.” The right cost In the old days in health care, around three years ago, consumers might not have been motivated by cost savings, even a significant cost savings, for a health care service. Today’s consumers are paying closer attention and responding favorably to “the right cost.” As more employees are encouraged to control their health care expenses through health savings accounts or flexible spending arrangements, health care affordability, even for those with ample insurance coverage, has become more relevant. Tine Hansen-Turton, executive director of the Convenient Care Association, the trade group for retail clinics, says that these clinics began as a cashonly business. “It was really the consumer who helped the managed care organizations realize that retail clinics provided an access point that is affordable for their members. Insurers saw very quickly that this is a good alternative for members in need of basic care when their primary care physicians are not available.” Insurance companies continue to face a number Prescription cost concern HealthPartners, based in Minnesota, reviewed two years of MinuteClinic claims data and determined that total costs for MinuteClinic treatments were 25 percent below those done at physicians’ offices or at urgent-care clinics. Prescription costs were $3 more for MinuteClinic visitors, which might have been due to any or all of a variety of factors, including higher prices, more prescriptions, and less use of generic drugs. Prescription costs have been a concern for some insurers regarding clinics owned by drugstore chains. The suggestion has been that these clinics may increase the use of prescription medications, to the benefit of the pharmacy’s bottom line. “We are watching to see that the retail clinic provider we are currently working with does not use excessive prescriptions,” says Don Bradley MD, chief medical officer and senior vice president for health care services at Blue Cross Blue Shield of North Carolina. “We have looked for a spike of inappropriate use and have not seen it.” Retail clinic operators are aware of these concerns and are monitoring their own pharmacy trends closely. A one-year study titled “Quality of Care in the Retail Health Care Setting Using National Clinical Guidelines for Acute Pharyngitis,” recently published by the American Journal of Medical Quality, analyzed close to 60,000 patient visits 34 MANAGED CARE / MARCH 2008
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