29
Apr 10

Primary Care Busy-ness: NEJM Article Has Major Media Hotness

So Dr. Richard Baron’s What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice shows up in the Occasional Notes section of the New England Journal of Medicine on 4/27/10, and the watchful editors at the New York Times and USA Today are already busily turning it into News Of More Than Occasional Note.

And rightly so.

So what’s being said?

The NY Times’ Steve Lohr, a health journalist who “gets it”, doesn’t seem to get this one – at least not in his opening lines:

A new study detailing the uncompensated work burden on family doctors points to the need to change how they are paid, medical experts say — particularly as the new health care law promises to add millions more patients to the system.

Really Steve? The thrust of the piece is that doctors need to be paid differently? Or is it rather that they have to practice differently, so there is justification for paying them differently?

You can probably guess what we think, but here’s a passage directly from Dr. Baron’s post that bolsters our confidence in thinking so (with our emphasis):

The work we describe arises from the needs of patients in a society that assigns many roles to physicians — from making diagnoses and providing treatment to ordering tests and filling out forms — and the practice must be organized to respond reliably. How and by whom the work is done is a continuing project of primary care redesign, dependent on both the skills of available nonphysician staff and the extent of information-technology support.

Meanwhile, correspondent Lohr only gets to this concept indirectly, at the very end of his brief report, and then thanks to a quote from Obama administration HIT point man Dr. David Blumenthal (again, we’ve provided the emphasis):

….Dr. Blumenthal said the study showed “the enormous strain” on family doctors, but also “a pathway toward escaping at least some of those burdens: the electronic health record combined with changes in workflow and payment.”

USA Today’s Rita Rubin gives greater emphasis to the “what are primary care doctors actually doing?” aspect of the story – taking it less for granted that what primary care doctors are doing is what everyone thinks they’re doing, and what they ought to be doing – but she still does not delve into the trickier, thornier, more sensitive matter: what if, once what’s going on there is fully sorted out, everyone discovers that other health care practitioners are better situated to do some of those things, in league with a “re-purposed” contemporary primary care physician?

Now there you would have a platform for disruptive innovation.

EXTRA CREDIT: It may seem unrelated at first, but we feel The Data-Driven Life (New York Times, 4/26/10) supplies valuable commentary on the vital issue of applying data to the information-driven business of deciding “what am I doing, is it what I fully intend to be doing, and what might I do differently to do what I intend to do better?”


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


28
Apr 10

Initiatives to Reduce Avoidable ER Visits Dept.

No, we don’t have “departments”, a la old-timey print periodicals, but we’ll probably strive to keep an eye out for stories similar to this unprepossessing notice that appeared in the 4/28/10 Chillicothe Gazette:

New Initiative Designed to Reduce ER Visits

A kickoff meeting for IMPROVE (Implementing Medicaid Programs for the Reduction of Avoidable Visits to the Emergency Department) is scheduled for this morning in Columbus….

According to the very brief article, the program will

  • redirect ER visits to more appropriate treatment venues
  • increase communication quality among care providers and health care systems
  • promote ER visit alternatives “consistent with the medical home concept”

to accomplish its mission.

Big goals, short article, no publicly available details we know of, yet. Looking forward to learning more about it.


26
Apr 10

Q&A With MinuteClinic’s Sussman on Providing Chronic Care

Just when we were all set to mope about the shortage of new retail clinics stuff to kibitz about, along comes Drew Weilage’s Our Own System blog with a sharp note regarding the Minneapolis Star Tribune’s Q&A with MinuteClinic CEO Andrew Sussman on MinuteClinic’s new chronic condition monitoring services (Minneapolis Star-Tribune, 4/18/10). The Star-Tribune’s Chen May Yee is atop her formidable reportorial game with this question (though the reply is not particularly revealing):

Q I’m intrigued by the lineup of MinuteClinic CEOs so far. You had Michael Howe, who came from the fast-food world, followed by Chip Phillips, who came from the pharmacy world, and now you, a doctor who comes squarely from the traditional health care world. What does this say about MinuteClinic’s ambitions?

A I come with great excitement for delivering health care services in new ways that meet patients’ needs, that’s accessible, affordable. Right now, that’s what our country needs.

We like both Weilage’s reference to the Star-Tribune’s article (how do we miss so many of these gems ourself? All those geeky alert and monitor code thingamabobs, for naught!), and also Weilage’s blog, from its minimalist design to its optimalist content. Good stuff, that.

PS: here’s another terrif piece, introduced to us in the same Our Own System article, on nurse-centric programs crafted to manage hospital readmissions more effectively (or, more accurately, to avoid them)


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….


22
Apr 10

Retail Clinics: Harvard Business Review Learns Howe

From Michael Howe, former MinuteClinic CEO, in this 4/20/10 blog post: The Intersection of Retail and Health Care.

Howe is strongest on the essential organizing principle of the disruptive innovation that is retail clinics, and the merits of fresh leadership from outside the healthcare industry:

“what may be novel to health care companies is their need to take the service principles from consumer-focused organizations — managing customers’ expectations and experiences, for instance, and conducting consumer research — and apply them to their operations. “

Established health care leaders must look outside the industry to understand how to adapt to this new reality.

However, his corporate-y recap of retail clinics present & future does strike some off-notes. For example, ” WebMD, DestinationRx, and other online resources” have hardly “created” “informed, intelligent and engaged” consumers – though they certainly supported the take-charge efforts of many who fit that description. Procter & Gamble attorneys are almost certainly cringing at Howe’s brisk assertion that P&G “will begin providing health care services” via its MD VIP concierge network; to the ears of attorneys general in most if not all jurisdictions that would sound quite like the corporate provision of health care, something off-limits in most places.

Further, while they certainly enjoy ease & convenience of routine non-emergency care when they need it, with little or no delay, most people are not as sanguine as Mr. Howe imagines about the notion that retail clinics might be “taking over many of the traditional tasks of the private physician’s practice”, in ways “requiring far less direct interaction with physicians”.

Finally, few physicians are likely to cheer Howe’s insinuation that they have been making like motor-vehicle clerks, and simply “must become educators, coaches and advisers who cater their services to the unique circumstances and demands of individual patients”, as if there have not been barriers other than retail enlightenment to keep them from performing their roles more in keeping with their abilities and training.

There’s lots to cheer in the emerging shape of retail health services, and Howe’s leadership has been indispensible to the success not only of MinuteClinic’s particular approach but to the early successes of the industry overall. We’d just underscore that the book on retail clinics not only hasn’t been completed; – the introduction is still in draft stage.

While we’re thumbing through HBR, though, we should note that “Megatrend” #8 in the Review’s Megatrends in Global Health Care (published 4/21(?)/10) is “Non-MDs Providing Care


22
Apr 10

Health Reform Is Retail Clinics’ Road To Success: Drug Store News

So sayeth Drug Store News’ Antoinette Alexander, in this 4/16/10 article: Healthcare Reform Paves the Way for Success of Retail Clinics

Drug Store News has a two-word answer for why retail clinics will continue to grow for a very long time: health reform. And there are 32 million reasons why that growth will be quite dramatic.

Our feeling? The new federal health law doesn’t, on balance, hurt retail clinics’ chances – but “major catalyst”? That seems doubtful to us, for a few reasons. Here’s just one; legislation – whether federal, state, or local – tends to encapsulate social trends rather than galvanize them.

Another, more tactical (so more subject to emerging changes): we haven’t looked at the data, but we would gather from work by Ateev Mehrotra and others that many of the 30 million uninsured live, work, and seek their care most often in places other than those served by retail clinics.

As longtime employee benefits grinds, we’re pulling for The Little Clinic’s new chief, Michael Stoll, a successful employee benefits executive of long standing. That said we’re not convinced his appointment is so much a harbinger of TLC triumph than an acknowledgement that clinics’ success may well be reliant on some retail clinic/onsite clinic hybrid, a la Take Care Health, and significantly dependent on strong, rapid employer adoption.

Finally, the little-noted Sec. 10104(3) of the Patient Protection and Affordable Care Act of 2010 (yes, that’s the new health law, and Section 10104(3) just a paragraph of the act), with its support for the development of qualified direct primary care medical homes, does offer some paving materials to retail clinics as well as concierge practices, but is not in itself a retail clinics traffic-ready superhighway.


20
Apr 10

A Tidal Wave of Retail Clinic Openings…Is Coming…?

So one would gather from examining the wind patterns of the recent flurry of news stories and media releases from clinics industry leaders on the topic. Most of these are fueled by the speculation that the recently passed federal health legislation will generate a significant surge in demand for clinic services.

The latest entries reached the street yesterday afternoon. The first essentially summarized previous stories on MinuteClinic’s expansion plans. The Wall Street Journal titled it CVS Caremark May Have A Retail Clinic Advantage (4/21/10):

CVS Caremark Corp. (CVS) may have an edge in what could be the next wave of expansion for retail clinics: its pharmacy benefit manager business.

The company, which owns about 500 MinuteClinics, said it plans to double the number of those clinics in five years, and is developing new ways to integrate MinuteClinic with its PBM coverage, including voucher programs for flu shots and biometric screening services….

And Healthcare Design Magazine’s online edition weighed in with a survey: Healthcare Reform’s Effect on Retail Clinics (4/19/10) in which 75% of respondents are reported responding in the affirmative to this question:

With the passage of healthcare reform, do you think there is going to be a change in the presence of retail clinics?

And then there is this much-retweeted post at New America Foundation’s blog titled The New Health Dialogue (April 16,2010). An excerpt (with our emphases):

Timing, convenience, workplace pressures and transport are reasons that even insured people end up in emergency rooms — which are not a good place to be taking care of chronic disease. (For a very good update on why ERs are not good places to take care of chronic disease — and why the strain on them may grow during health reform implementation, read Tim Noah’s piece this week in Slate.)

Obviously the retail clinics need watching, monitoring and evaluation as they expand in number and purpose — and our preference is that they don’t become another “silo” or fragmented bit of medical care, but that they get connected in a better more integrated and more accountable delivery system. We need continuity of care, adequate patient education, and coordination with and amongst physicians, whatever the setting. But it’s worth thinking about how clinics can fit into an improved system in the coming years, and what kind of relationships they can form with “medical homes” or large group physician practices or “accountable care” groups.

While we are in harmony with regard to the potential purposes and uses of retail clinic providers in a more integrated – and mostly “open-integrated” health system, we have made mild contrarian noises regarding the likelihood of an explosion in numbers of retail clinics in previous posts, and generally feel that while the new law will benefit the clinics industry, it will likely do so in less direct ways. We hope to identify some of those ways in posts to come.


20
Apr 10

New Clinics Locator – And Clinic Treatment Is (Often) Free!

Or at least this is what the Partnership for Prescription Assistance says at their web pages for the Partnership for Prescription Assistance’s new Blackberry and iPhone clinic locator apps:

With this application, patients can scroll through the medicines offered by PPA member programs or locate one of 10,000 free health care clinics across the United States…..Many patients will get their medications at no cost or at discounted prices….The Partnership for Prescription Assistance can help you find free or low-cost health clinics near your home.

Here’s a link to the online version of the locator itself: Partnership for Prescription Assistance Low-Cost Health Clinic Finder.

Hat tip to MedGadget for posting this info.


14
Apr 10

Real Life in Retail Health: Frustrated NPs

As if on cue, this post appears at Real Life in Retail Health:

What Frustrates NPs in Convenient Care?

You aren’t be getting this kind of reportage in other resources, friends.