Retail Health Care: Where It's Been, Where It's Going

As health care has changed through the years, health care payers and policymakers have emphasized and worked toward shifting unnecessary acute care from the emergency department—which is an inappropriate and costly place to treat minor acute illnesses—to other treatment venues. Treating patients who have acute illnesses like rash, bronchitis, and urinary tract infection is more cost-effective when they see health care providers in urgent care clinics or retail health care locations.

Researchers from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts have conducted an assessment of where patients have been seeking care for low-acuity conditions. Their findings indicate that, although we have made progress in redirecting patients to better care locations, improvement is still needed.

The researchers looked at a large claims database from a national commercial health insurer. They tracked visits to emergency departments, urgent care clinics, and retail health clinics between 2008 and 2015.

Annually, an average of 21 million uninsured Americans made 52 million visits to acute care locations. Of these, slightly less than half were for low-acuity conditions.

Patients were much more likely to seek care for low acuity-conditions as the study period progressed. In 2008, insured individuals made 127 visits/1000 members. That number increased by 20% to 154 visits/1000 members by 2015.

Urgent care clinics experienced the greatest growth, increasing 93%. By 2015, insured Americans were making 79 visits/1000 members to urgent care.

Visits to retail health care clinics grew much more quickly, with a 183% increase in visits. However, on a visit per member basis, insured individuals were much less likely to use retail health clinics than urgent care clinics. In 2008, members made 6 visits/1000 members to retail health care clinics. By 2015, that number had increased to 17 visits/1000 members.

Some progress was made in alleviating the burden of low-acuity conditions to emergency departments. The data indicate that emergency room visits for these conditions decreased by 31%. That's the good news. The bad news is that a significant number of Americans still seek acute care for inappropriate conditions at emergency rooms.

The researchers noted that this is a dramatic shift in the way that Americans receive care for low-acuity conditions. The data suggest that care delivered in retail clinics is underutilized, and that more insured individuals could be treated in retail health care clinics. Individuals familiar with retail health care clinics also know that care can be delivered more expediently than care delivered in the emergency department.

Reference

Poon SJ, Schuur JD, Mehrotra A. Trends inside of care for low-acuity conditions among those with commercial insurance, 2008-2015.Ann Emerg Med. 2017; 70 (4S): S69.