Visits to retail clinics grew by a factor of four from 2007 to 2009, with patients getting preventive care during hours that most physician offices are closed, according to a study by Rand. The study also compares data from those years with an earlier study of retail clinic visits from 2000 to 2006.

“Preventive care — in particular, the influenza vaccine — was a larger part of care for patients at retail clinics in 2007–09, compared to patients in 2000–06 (47.5 percent versus 21.8 percent),” says the study “Visits to Retail Clinics Grew Fourfold From 2007 to 2009, Although Their Share of Overall Outpatient Visits Remains Low.”

About the last part of that title: In 2009 there were 6 million visits to retail clinics, compared with 1.5 million in 2007. Quite a jump, for sure. However, the study notes that there were 117 million emergency department visits and 577 million visits to physician offices annually over the same period.

Ateev Mehrotra, MD, an associate professor at the University of Pittsburgh School of Medicine and a researcher at Rand, is the lead author of the study. He tells Managed Care that one difficulty the increased use of clinics creates for health plans is that “enrollees going to retail clinics might impact their provision of preventive care, such as immunizations, and their HEDIS score.”

Another concern that plans might have, he says, is “whether this increase in utilization will drive an increase or decrease in their health care spending. This is unclear.”

The study examines data from the three largest operators of clinics — MinuteClinic, TakeCare, and LittleClinic — which, together, run 81 percent of the retail clinics.

The reasons patients use the clinics are convenience, after-hours accessibility, and cost-effectiveness.

Mehrotra says that concerns about quality have been addressed in other studies and that there is no evidence that clinics provide inferior care.

“My sense is that most health plans do cover retail clinics,” says Mehrotra. “The one major exception has been Medicaid plans. Many executives of Medicaid plans feel that they are already paying primary care physicians a capitated payment and it makes no sense to pay additional money to retail clinics.”

Much has been made about patients being more likely to be 65 or older in the 2007–2009 study — 14.7 percent versus 7.5 percent for 2000–2006. However, for the most part, these patients went to the clinic for flu shots. “The most common retail clinic patient was a young adult without a primary care physician,” the study states.

The authors ponder what roles clinics might play as the Affordable Care Act is implemented.

“Newly insured people will probably seek primary care in a traditional setting, which could decrease the demand for retail clinics,” the study says. “However, if wait times for appointments with primary care physicians increase nationwide, as they have in Massachusetts after that state’s health reform, demand for the clinics might increase.”

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.