We noted with interest the release of Ahmed & Fincham’s study of retail clinics over 3 weeks ago. Informed commentary (some with a portion of self-interest) on the report is beginning to emerge. Three such comments can be found at this page of The Annals of Family Medicine, which was first to publish the Ahmed/Fincham study. Medscape posted the study today (free registration required).Tweet
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….Tweet
Only $4,500, says an organization identified as Spatial Insights, at the web page referenced in this press release.
Merchant Medicine is identified as the source of the data, so the locations information is almost certainly credible – but $4,500?
We have three words for you, dear reader: contact us first.Tweet
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.Tweet
ABC News/Health online ran a long (4 pages) weekend piece on March 20th, ostensibly about retail clinics’ tentative movement into providing some types of treatment for people with chronic health conditions (Retail Clinics Branch into Chronic Disease Treatment).
Unfortunately it meanders from a high-level discussion of the whys and wherefores of chronic care in retail clinics, to the conventional & longstanding objections of some established physicians groups to the very existence of retail clinics, to the current status of state-level regulatory activity regarding clinics. So, nice exposure for the clinic concept, but not much substance.Tweet
The preso for the release of the results summary for the National Business Group on Health/Towers Watson’s survey of large US employers notes that just over 1/3 of large employers’ health plans cover treatment at retail clinics – and that fewer than 1/2 are likely to cover clinic treatments at the close of 2010.
You, dear reader, face at least two challenges in interpreting this information:
- The number of employers who have/have not implemented a particular health plan provision is not a particularly effective way to understand how many people are affected. If, in a group of 100 employers – even big employers – only Walmart covers retail clinic visits, just 1% of employers offer that provision – but all by itself Walmart’s offer may mean 10% or more of those employers’ employees may take advantage of it (of course the number depends a lot on who the other large companies are in that group of 100).
- If you’re trying to predict increases in clinic usage, mere coverage of clinic visits gives you less to work with than you think. Given the thin distribution of clinics across the US, and the nature of clinic usage generally, a great deal depends on where those employers’ employees are located. You might logically conclude that those employers newly covering clinic visits have lots of employees living in service areas of existing clinics – but that may not hold true. Furthermore, you don’t have any idea whether these employers have made retail clinic treatment visits more or less attractive than visits to more conventional primary care givers. If it costs me the same $25 to visit a retail clinic as it does to visit a conventional MD, my behavior will be different than if my first clinic visit is $5 vs the $25 MD visit.
Finally, of course, people need to be able to find clinics easily, and currently that’s probably not as easy as it should be.Tweet
Interesting story in Monday’s San Diego Union Tribune online about a legal dustup between two SoCal health districts, Palomar Pomerado Health and Tri-City Healthcare District, that has apparently been provoked by the former’s introduction of retail clinics (Hospital Clinics in North County Turf War, 3/22/10; immediate access).
Palomar has opened retail clinics in two Albertsons’ grocery stores, and wants to open three more – outside its operating district (gotta love California and its proliferation of special purpose political districts). A Palomar spokesperson has apparently noted that 20% of the patients at Palomar’s existing clinics live in Tri-City territory.
So Tri-City is fighting back in court.
There’s not much more to the story currently, but we plan to follow developments there.
PPH wouldn’t appear to be much of a retail health competitor: while they have a dedicated URL for their clinics: pphexpresscare.org – it redirects to a page at PPH’s main website, where they inexplicably provide the phone numbers, but NOT the addresses, of their current clinics (the addresses are provided as an afterthought in the media release PPH issued when the clinics were first opened – probably not the first place anyone would look to find the locations of their clinics).Tweet
So we’ve enjoyed a lovely week out of the country, drinking in the cultures of faraway lands, only to discover on our return to America that on Friday, March 19, Dr. Mehrotra briefed Congress on the subject of retail clinics.
No sign yet of a transcript of his briefing at Rand’s site; we’ll keep our eyes peeled.Tweet