The Right Care at the Right Time: Are Retail Clinics Meeting a Need?

Alliance for Health Reform BriefingWashington, D.C.

June 18, 2012

Sam Nussbaum, M.D.Executive Vice President, Clinical Health Policy and Chief Medical OfficerWellPoint, Inc.

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Quick Facts on Emergency Room Utilization

• 32% increase in ER visits from 1996 – 2006 (National Hospital Ambulatory Medical Care Survey)

• 150M visits in 2010; approximately 10% of all ambulatory care visits; as many as 30-40% avoidable or inappropriate

• 15% uninsured; 20% Medicare, 15% Medicaid, 47% private insured

• 80% visits due to lack of access of alternate providers; 66% seriousness of medical problem (CDC, NCHS, National Health Interview Survey)

• Frequent users: 5% account for 25% of visits; complex illness and lack of social networks

• Lack of access to primary care; poorly coordinated care

• Individuals with higher needs for health care services: Medicare, Medicaid, chronic conditions and poor health

• Lack of clinical knowledge on when ER is/not appropriate

• Lack of transparency on availability of ER alternatives

ER visits are increasing… …for several reasons

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As ER Visits Rise, Access, Quality, and Preparedness Remain Significant Challenges

Source: The National Report Card on the State of Emergency Medicine

Source: CDC/NCHS National Hospital Ambulatory Medical Care Survey, American Hospital Association

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Visits to hospital emergency departments increased to an all-time high of 136 million in 2009, according to estimates released by the Centers for Disease Control and Prevention. This represents almost a 10% increase from the 2008 figure of 123.8 million.

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Retail Clinics

• Encompass Retail Settings: pharmacies (Walgreen, CVS), mass merchandisers (Walmart, Target), supermarkets

• Limited set of services – routine care, minor illnesses, staffed by nurse practitioner/physician assistants

• Convenient hours, shorter wait times

• Lower cost than physician office, urgent care and emergency rooms

• Quality outcomes

• Linkages with primary care/delivery system