22
May 12

Primary Care’s Entry In ‘Preliminary Care’ Space

The preternaturally observant health care journalist Bruce Japsen summarizes the practice model of direct primary care practice provider Qliance (More Care Up Front For $54 A Month, Bruce Japsen, New York Times, 5/22/12).

We’ve more or less given up trying to pigeonhole all of the variants of convenient, routine, non-emergency health care now on the scene. Retail clinics, urgent care clinics, telephysician visit services, combinations of the last with the first two, concierge services, housecall health care, and on and on – the similarities, the overlaps, the real and potential interrelationships become too numerous to parse.

We do increasingly use a colleague’s deft term for the category – he calls it ‘preliminary care’ – because the name literally embodies the ‘threshhold’ nature of the clinical ministrations the category’s practitioners provide.

Anyway, Bruce notes that if PPACA is revoked, Qliance‘s direct primary care model will be voided, because PPACA explicitly permits direct primary care contracting as a reimbursement model for physicians cleared to provide care to people who are Medicare eligible. Our feeling is this sort of ‘experiment’ would, if even modestly successful, lift all the boats in the preliminary care pond.

Are you listening, free-market zealots? Are you aware, “death panel” harridans? We’re guessing probably not. For shame.


11
Jan 12

RIGHT Is What, With THIS MinuteClinic Picture

Recently we voiced our confusion about the expression of retail clinics – and specifically MinuteClinic’s – value proposition found in a slide deck presented by MinuteClinic CEO Andrew Sussman to a clutch of investors last December 20th. The slide that provoked our concern was this one:

Do Retail Clinics Provide Care of Quality Comparable to ERs, MDs, etc?

Our feeling was that the offending slide did not put MinuteClinic’s best foot forward far enough. We expressed hope that the message conveyed was fully as positive as the chart’s graphics depicted.

Our hopes were answered!

We were contacted by MinuteClinic media relations executive Brent Burkhart, who explained the technical hangup that pushed MinuteClinic’s PowerPoint lamp under a bushel, and who helpfully provided a new, much improved version of the slide – which we share with you here:

Retail Clinics Provide Quality Care at superior prices to ERs, Urgent Care Centers, etc

Now THAT’s making one important facet of the retail clinic value proposition quite clear indeed!

Bonus for our readers: link to the updated presentation deck

Many thanks, Brent!


14
Feb 11

Retail Clinics: New by Re-Assembling Old

We feel Bizmology reporter Anne Law did a terrific job describing her personal experience with a RediCare clinic visit in Grocery-store health clinics: passing trend or shift in care? (Anne Law, Bizmology, 2/10/11)

We also feel her analysis demonstrates how innovations like retail clinics perform best when facets of the innovation’s ‘feature set’ (clinic wait times, convenience of location, etc) mesh with facets of the health care value chain – in the case of her story, health benefit plan incentives to use clinics rather than emergency rooms:

Another driving factor for me, which led me to accept the awkwardness of hanging out in a grocery store for several hours, was the fact that I was able to pay my regular office visit co-pay, as opposed to the ER co-pay I would have had to provide at the urgent care clinic down the road. I would think this would be a bonus to other clinic patrons, especially those who feel that an ER visit should be for an emergency only.


14
Dec 10

Everything’s Coming Up Clinics

Anyone keeping tabs on developments in the clinics space -whether retail, urgent, walk-in, or onsite/workplace – knows that news travels – well, let’s call it “at a stately pace”. There’s just not really hot news for us every day of the week.

But the last few days have produced some interesting stuff – too interesting for us to offer any sage observations about, at least here, today.

So for now we’ll just provide links, headlines, and comic-book adjectives (“Pow!” “Wham!”)

RediClinic’s Operations To Nearly Double (Drug Store News 12/14/10). Related: Retail Clinics Opening At Some H-E-B Stores (San Antonio Express News 12/14/10).

Workplace Clinics: A Sign of Growing Employer Interest in Wellness, a new analysis of employer workplace-based health clinics from the estimable Center for Studying Health System Change. We aren’t wildly enthusiastic about their frankly tepid, conventional assessment, but will defend to the death their right to issue it.

Retail Clinics Pay Off, Finally (HealthLeaders Media, 12/13/10)

For Wuesthoff, the clinics have paid off by keeping EDs clear of non-emergent cases; a survey of its Walmart clinic patients found that 15% said if the clinic was not available, they would have gone to the emergency room.


15
Nov 10

Card-iology: A Retail Health Matter At The Heart of Real Health Reform?

We agree to some extent with Drug Store News editor Rob Eder’s newsatorial on the import of Citi’s announcement of its flu shot card for employer immunization programs:

Flu cards just tip of functioning health-reform iceberg (Drug Store News 11/12/10)

Finally, payers are starting to get it. And that means you can expect some pretty radical changes in the way health care is delivered in the United States.

The reality is that it is cheaper for an employer simply to give its beneficiaries free flu shots administered in a community pharmacy or a retail clinic setting than it is to allow its employees to pick up part of the bill to receive that same shot in a physician’s office…..

….At the end of the day, this is about driving down cost and realigning incentives to put more of a focus on preventive care….

….The bottom line: workers who get flu shots save their employers about $46 a year in total healthcare costs. Getting flu shots at pharmacies and retail clinics brings the cost of the flu shot down more than 60%.

That’s the kind of math that is going to make health reform work.

Mindful that the evidence for efficacy of flu immunization for working-age adults can be contradictory*, we’re not prepared to say unequivocally that Citi’s card is emblematic of the future of health care. We believe Rob’s certainly right that this sort of innovation will be part of more than a few health care futures.

* Find descriptions of past research on efficacy of immunizations for healthy adults here (2009), here (2000) and here (1995)


10
Aug 10

MinuteClinic Visits Up + Conventional Medical Visits Down <> Trend

Sorry, Johnson/Rockoff/Masters, California Healthcare Foundation, Mark Perry, et al – you are NOT on to any particular thing here, however much you wish it so.

MinuteClinic visits up + conventional visits down DOES equal “it’s the economy, stupid” (and no, you bloggers/commenters/industry observers aren’t stupid, either).

We’ll know we have systemic change worth talking about when data on the use of “physician extender services” (gee whiz, is the vocabulary of health care innovation ever lame) shows people prefer the combination of ease, convenience, and quality they offer to care they have obtained from conventional clinicians in conventional settings, in significant numbers.

The data doesn’t show that yet.

Meanwhile, Dr. Jason Hwang, he of The Innovator’s Prescription (along with Clay Christensen & Dr. Jerome Grossman) points to the way Minnesota-based integrated health system HealthPartners is refashioning its delivery of primary care services through the conscious application of wellness programs, worksite clinics, e-visits, and retail clinics.


29
Apr 10

Community Health Centers and Retail Clinics: Are You Thinking What I’m Thinking?

I mean, when I look at the map of community health center locations provided in this New England Journal of Medicine article: (Health Care Reform and Primary Care — The Growing Importance of the Community Health Center, 4/28/10), I say to myself “imagine if that many locations were served by retail clinics”.

And then I occasionally reply to myself, “well, why couldn’t the retail clinic operators do for some – and maybe many – community health centers what they have begun to do for employer-sponsored onsite clinics?” which is namely to supply operating expertise with special attention to the particular needs of the location’s clientele.

And then I frequently go “hmmmm….”

For the time-pressed, here is the map in question – though I strongly urge anyone following retail clinics to check out the entire article:

Nationwide Distribution of Community Health Center Sites, 2008.</p>
<p>Data are from the 2008 Uniform Data System, prepared by the Robert Graham Center, April 2010

Nationwide Distribution of Community Health Center Sites, 2008.
Data are from the 2008 Uniform Data System, prepared by the Robert Graham Center, April 2010
.

The accompanying map of the share of each state’s population that frequents CHCs is also information-rich:

Percentage of the Population of Each State Served by Community Health Centers, 2008

Percentage of the Population of Each State Served by Community Health Centers, 2008


26
Apr 10

Leading Retail Clinic Operators and Employers: What Are They Up To?

We applaud Memphis Business Group on Health for posting a comment & link to Workforce Magazine’s February article on clinics (Work-Site Clinics Gaining Favor Over Retail Clinics, 4/25/10). However, we’re concerned that their blog’s editor may have misconstrued the clinics’ driving impulse.

Worksite Clinics Gain Favor As Retail Sites Lag, written by the invariably astute Jeremy Smerd, is good stuff, laying out a detailed picture of industry trends, and the rising importance in industry leaders’ business models of services specifically tailored to the needs of employers We liked it a lot, & posted our own thoughts on the piece back in March.

Memphis Business Group finds clinics are “focused on cutting employee and employer costs”. We’d urge – strongly urge – their readers to consider that clinics are focused on providing basic services that help keep people healthy, help to maintain their level of functioning health. Cost management can be a happy result of that focus.

We feel there’s a difference in that distinction, so let’s restate it one more time, with feeling. The impetus, the organizing principle, is “help people with routine non-emergency health services”, not “cut costs, then see if we can keep people healthy”. The clinics – and the firms that have intentionally incorporated them in their health strategies – are investing in their populations’ health. It seems unlikely to us that most of them have first trimmed their budget, then chosen what health services to retain.

Consider yourself which starting point is likelier to produce long-term sustainable results….


30
Mar 10

Workplace Health Clinics: Work In Progress

In this case by work we mean research on large employers’ use of workplace health clinics, currently being conducted by The Center For Studying Health System Change, and led by Ha T. Tu with grant financing from the Robert Wood Johnson Foundation’s Changes in Health Care Financing & Organization initiative.

The researchers will examine six research questions (detailed here). We’re most interested in the answers they discover to this one (#2 on their list):

how are workplace clinics structured and organized and how do they fit into the overall structure of an employer’s health benefits

The report is due for completion by June 30, 2010. Stay tuned….


29
Mar 10

Chains Investing in Clinics: Financial Analysis Available

Wall Street Transcript‘s media release for its new 50+ page analysis of consumer health services sector, takes the form of a mini-interview with the author of the report’s concluding section on consumer health trends, Senior Research Analyst Ann Hynes. Here’s a link to the release, published by Yahoo! Finance Monday, March 22: Big Chain Pharmacies Investing In Health Clinics: Senior Analyst Weighs In On This New Trend

The interview unfortunately begins with a fairly conventional observation by Hynes that investment in PBMs is the sector’s standout story right now, “mainly because of the tools the companies utilize to promote generics and mail.” There’s no mention in the interview of the relative maturity of those tools, their resultant diminishing impact on the overall health costs of big payers like self-funded employers, and emerging evidence that substitution strategies driven by copay tiering may in some important instances actually increase plan costs by deterring treatment adherence.

However, the interview quickly turns to the specific subject of retail clinics, where Hynes is on firmer ground. She says

I think what we’re going to evolve into is employers asking insurance companies to add clauses to health plans that if employees go to a CVS or retail pharmacy for a flu shot or basic ailments, they would have no copayments. And if an employee instead chooses to go to a primary care physician for simple matters, the copayment is going to be $30. I think that’s what the model is going to evolve into….I think it’s going to be driven by the employer markets looking for more ways to bring down their health care costs.

While she focuses on the transactional aspect of employer efforts to manage costs -by changing health plan designs to drive covered employees & dependents to less expensive settings – she again fails to note that the employers leading the way in this regard are generally doing so for strategic reasons: enabling their health plan participants to get the “right” care at the “right” time in the “right” setting. It’s an important distinction, for the strategic objective is to flatten cost trend by improving care quality, rather than merely reducing unit costs of transactions by pennies.

Hynes is right about employer concerns for cost management, and that that concern will drive plan design changes and market responses. Still, observers (who may include investors, but of course we are not providing anyone any investment advice whatsoever here: do we even need to say that?) will not want to miss that, for pharmacy chains and retail clinics to succeed, they will need to be attuned to the strategic goals of the leading employers who seek to optimize their workforce populations’ use of alternative care settings like clinics – not merely to their pricing advantages vis a vis favorable copay designs.

We can tell you that you can purchase individual sections as well as the entirety of the referenced report here, and that ordering the Trends section of the report will set non-Transcript subscribers back a thrifty $75.