impact of convenient care in the healthcare industry may 20, 2008 sandra f. ryan, chief nurse...
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Impact of Convenient Care in the Healthcare Industry
May 20, 2008Sandra F. Ryan, Chief Nurse
Practitioner OfficerTake Care Health Systems, LLC
Co-Chair Clinical Advisory Board CCA
Agenda
Evolution of an Industry Current Landscape CCA: Driving Quality Care The Future of Convenient Care: The Take
Care Health Model
Evolution of an Industry The first Convenient Care Clinic (CCC) opened in 2000 900 clinics operated by over 20 companies Increased shortage of primary care physicians and will get worse
in future 35% of current physicians are nearing retirement. Fewer than 30% of current medical students say they intend to
be primary care physicians. Significant annual increases in health insurance deductibles and
co-pays Growing popularity of ‘consumer driven’ health plans (CDHPs) Rapid growth of uninsured population that now includes nearly
47 million people Increasing time pressure on consumers How can Convenient Care impact healthcare moving forward?
Current Landscape and Scope of Practice
Acute, Self-limiting conditions Limited Scope of Services
Bronchitis, common colds, coughs, ear infections, flu, laryngitis, sinus infections, sore throat, strep throat, upper respiratory infections
Bladder infections, diarrhea, nausea and vomiting, early lyme disease, fever, head lice, skin rashes, mononucleosis, eye infections, seasonal allergies, swimmer’s ear
Minor Injuries Abrasions, minor burns, splinters, sprains/strains, staple/suture
removal Other Services
Include vaccinations, screenings, and administrative physicals
Current Synergies with the Medical Community Overflow outlet for
Busy provider practices Evening/weekend/holiday coverage Overburdened emergency rooms
Quality access to healthcare Electronic prescribing Regulatory compliance Peer and CP Review Evidence-Based practice that follow AMA and AAFP guidelines
Easier access to healthcare Particularly for those individuals without a PCP, without insurance, and/or in
underserved areas Connects individuals without a PCP to a health care home
Earlier access to healthcare Reduces illness severity and spreading of infections Encourages preventive care Reduces overall health care utilization
Current Synergies with the Medical Community An April 2007 study* by a market research company found that 18% of
convenient care clinic users were referred to another health care provider for additional treatment at the end of their visit.
60% of those people who required referrals were able to schedule the referral on-site at the convenient care clinic before the end of their visit.
27% of all referrals were directed to family physicians/primary care providers.
Only 7% of CCC users were referred to the emergency room for care, suggesting that CCCs are helping to reduce unnecessary ER use by providing the right level of care, in the right place, at the right time.
*Market Strategies Inc., ‘Retail Clinics: Health Care Evolution or Revolution?’, April 2007.
The Convenient Care Association: Driving Quality Care
Association Goals: Develop common standards of operation to ensure
the highest quality of care Unite behind one voice to advance the needs of CCCs
and their customers Streamline marketing efforts to promote the concept
and respond to questions about this evolving industry Reach out to the existing medical community and
creating new partnerships Build synergies with traditional medical service
providers
CCA Standards
CCA standards adopted in March 2007 Thorough credentialing for licensure and experience Quality monitoring, including but not limited to:
peer review; collaborating physician review; use of evidence-based guidelines; collecting aggregate data on selected quality and safety outcomes; collecting patient satisfaction data.
Relationships with traditional health care providers and hospitals Encouraging patients to establish a relationship with a primary care
provider, and to making appropriate referrals for follow-on care. Compliance with applicable OSHA, CLIA, HIPAA, and ADA standards.
All CCA Members follow CDC guidelines for infection control through hand- washing.
Quality and Safety Standards Provide health promotion and disease prevention education Use of Electronic Health Records (EHR) to ensure high-quality
efficient care and promote continuity. Commitment to sharing health record with providers
Provide an environment conducive to quality patient care and meet standards for infection control and safety.
Establish emergency response procedures and develop relationships with local emergency response service providers.
Empower patients to make informed choices about their health care. Prices should be transparent and accessible.
Practice Guidelines and Certification
Best Practice document developed for members as a guideline Recommendations for the delivery of high quality,
affordable, convenient healthcare Provides policy recommendations
CCA Certification Review Process Department of Health Policy at Jefferson Medical
College Review of policies and procedures to ensure
compliance with CCA quality and safety standards
High-quality Health Care Clinics Professional exam rooms; some
clinics have exam tables Rooms meet OSHA, CLIA, HIPAA, and
ADA standards Running water for hand-washing in
room or near by; appropriate sanitation in room
EMR technology
Commitment to Quality Collaborating physician review, peer review and compliance
auditing Referral process and integration
Patients referred to primary care provider and/or CP for follow-on care (up to 20%)
Patients do not have healthcare home (up to 30%) Patients would have gone to the ER, Urgent Care or not sought
treatment (Over 40%) CCCs strive to monitor quality and practice standards Practice guidelines based on widely accepted professional
standards Most CCCs advocate or conduct CME’s, Grand Rounds for their
providers
Data: Evidence of Quality American Journal of Medical Quality reported that retail clinics
provide “exceptionally high-quality care” for acute pharyngitis (sore throat) when practitioner training is combined with EMR support tools* Among 39,350 cases indicating a negative rapid strep test
result, MinuteClinic nurse practitioners and physician assistants adhered to clinical guidelines in 99.05 percent of patient visits by not prescribing unneeded antibiotics.
Among the 13,471 cases with a positive rapid strep test result, 99.75 percent received an appropriate antibiotic prescription.
The combined guideline adherence rate for both positive and negative results was 99.15 percent.
*Represents a one-year study of acute pharyngitis that analyzed 57,331 patient visits at 28 MinuteClinic health care centers in Minneapolis and Baltimore between September 2005 and September 2006.
Data: TCHS Evidence of Quality
Preliminary quality data from Take Care Health Systems shows that appropriate antibiotic usage far exceeds national benchmarks – up to 50%.
Significantly better than NCQA standards: Utilization of RAPID strep tests Appropriate antibiotic prescribing for bacterial
strep infections Appropriate treatment of pediatric age upper
respiratory infections and adult bronchitis
The Future of Convenient Care: The Take Care Health Model
Future Impact of Convenient Care
Public Health and Safety First-line management of National Emergencies
Chronic Disease Management & Health Promotion Infusions Lab Services Education
Convenient ED concept Absorb non-emergent patient visits Educate patients about healthcare home Refer into hospital provider base Improve patient satisfaction
Corporate On-Sites
Corporate On-Sites A healthier workforce costs less and is more productive. A Kaiser study found that only 24 percent of costs associated with illness
resulted from direct medical costs. Almost 70 percent were related to absenteeism or employees working while ill and unable to fully perform. A comprehensive wellness program is necessary to control ancillary costs.
A 2004 study by CCH and Harris Interactive found that the annual costs of employee absenteeism can range from $60k for smaller employers to $1M for large companies.
Access to quality, affordable and convenient healthcare near at work Provide large company employees and health plan members seamless
access to health centers and pharmacies at worksites and in the community after-hours and on weekends
Potential to Offer: Health Promotion Occupational Health Disease Management Risk Management
Created March 17, 2008
Announced intent to acquire I-trax/CHD Meridian Healthcare and Whole Health Management, two leading providers of workplace-based healthcare
Acquisitions will complement May 2007 acquisition of Take Care Health Systems, leading manager of convenient-care clinics
With retail pharmacies, Walgreens will have nearly 7,000 points of care
Acquisitions bring more than 500 health centers, including Take Care Health Clinics
Adds thousands of healthcare professionals to Walgreens, including physicians, physician assistants, nurse practitioners, and nurses
Walgreens Health and WellnessDivision: Creation
Walgreens Health & Wellness Division
I-trax/CHD Meridian Healthcare
Provides worksite health services, including: Acute care/Primary Care Wellness & disease management services Pharmacy Health and fitness programming
160 employers including: BMW, Disney, Eastman Chemical, Gillette, Goldman Sachs, Horizon Blue Cross Blue Shield of New Jersey, Lowe’s, and Toyota
Whole Health Management
Provides: Primary Care Urgent Care Wellness Programs Health coaching Occupational Health Services
69 worksite health centers for 27 clients, including Continental Airlines, Florida Power and Light, Harrah’s Entertainment, Scotts Miracle-Gro, and Sprint
I-trax/CHD Meridian, Whole Health, Take Care Health Systems Overlap
©2008 Walgreen Co. All rights reserved. 20
Market Landscape
45%
37%17%
Service provided by in-house clinicians
No service provided in workplace
Service provided by 3rd party vendor
7,600 corporate campuses of 1,000 employees, plus families and retirees 2,836 (37.3%) do not provide
work-site healthcare 3,446 (45.3%) internally
provide work-site healthcare 1,321 (17.4%) use a third party
to provide work-site healthcare The number of companies
with on-site clinics is projected to increase by 26% in 2008 – Watson Wyatt 2007 survey
Health and Wellness Division: Objective and Vision
Expand healthcare beyond traditional retail sites Provide large-company employees and health plan
members seamless access to quality, affordable, and convenient healthcare near home and at work Access to health centers and pharmacies at worksites and in the
community after-hours and on weekends Non-worksite employee population–including dependents and
retirees–can access care in retail locations
Continue expansion of Take Care Health Clinics®
Create value for employers and health plans by lowering costs and improving outcomes Focus on enhancing productivity and a healthier workforce
Thank You