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Retail Clinic Use Rises Steeply But Impact on Costs Is Unclear

MANAGED CARE February 2012. © MediMedia USA
News & Commentary

Retail Clinic Use Rises Steeply But Impact on Costs Is Unclear

MANAGED CARE February 2012. ©MediMedia USA

The use of retail clinics is soaring but exactly what motivates people to go to seek care in them remains unclear for now, and that’s a crucial factor in determining clinics’ cost-effectiveness. Care at retail clinics is 30 to 40 percent cheaper than care at primary care physician offices, says the Rand study “Trends in Retail Clinic Use Among the Commercially Insured.” It’s 80 percent cheaper than emergency department care.

It’s not an opened-and-closed case, however. “If the growth in retail clinic visits we observed represents substitution for other sources of care, then the increase in retail clinic use could lead to lower costs,” says the study, which was published in the American Journal of Managed Care. “However, if these visits represented new utilization (i.e., patients seeking care when previously they would have stayed at home), then costs could increase.”

The study uses claims and enrollment data from 2007 to 2009 that were provided by Aetna, which has 13.3 million enrollees in 22 markets. The increase in retail clinic use was striking, rising almost 1,000 percent over the period.

“Marketing from the retail clinics themselves as well as education and awareness efforts from plan sponsors and health plans probably had an impact on utilization,” says Jeff D. Emerson, head of “health care management and the regions” at Aetna. “One could also speculate that patients’ relationships with primary care physicians have eroded in the current health care system to where patients may have difficulty gaining timely access or are referred to specialists or even to the ER.”

The growing emphasis on patient-centered medical homes may help reverse this trend and improve the PCP/patient connection, he says. Still, convenience is a key factor that can shape patients’ experiences.

“If people have a good experience, then they are more likely to go back and also to tell their friends,” says Emerson.