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Retail Clinics—
Cost Saving, or Just Convenient?
N. Marcus Thygeson MD
HealthPartners
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Retail Clinics
•Introduced in the Twin Cities in 2003
•> 1000 clinics in 38 States
•A limited menu of acute and some preventive
care services in
•Retail settings (grocery, pharmacy)
•Staffed by mid-level providers, with remote
medical director oversight
•Largely limited to major urban markets
•95% of clinics operated by four biggest
providers are in top 50 US markets
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But….
• Distribution limited to metro areas
• Reduced ER use not observed in commercial
insured population
– Impact in uninsured population?
• RC patients
– Healthier
– Less likely to have established provider relationship
• Impact on Medicare population?
• Induced demand?
• Adaptive response from existing providers?
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PD PD
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Induced Demand?
•Interviews with 61 RC patients in California
–Mixed insured/uninsured
•“Alternative source of care if RC not
available?”
–Self-care: 30%
–ER: 26%
–MD care or “other”
: 44%
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Induced Demand at
HealthPartners—Too Early to Tell
Top Five RC-Eligible Episodes/ 10KMM
265
260
255
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220
Pre-RCyear Post-RC Y1 Post-RC Y2 Post-RC Y3
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PD PD
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Adaptive Response
By Bricks and Mortar Inc.
Causal loop diagram:
3
2
Adaptive responses (may do all three): 1) more visits for other patients, 2)
increase price of other services, 3) compete with RCs
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PD PD
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RC Impact on Population
Health Costs
•HealthPartners population health costs for
top 5 RC-eligible episodes continued to
increase about 4.5% per year after Minute
Clinics opened
•Cost/episode: 3.4%/year
•Episodes/year: 0.9%/year
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PD PD
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Policy options…
• EMR and knowledge management technology that enables
expansion of mid-level and PCP scope of practice
• Provider price and total cost of care (and quality)
transparency
• Benefit design and provider contracting approaches
(payment reform) that promote
– Product-orientation:
•Standardization
•Feature and price transparency
– Reengineering of care delivery operations
–“ Marketplaces”for provider products
• Malpractice laws that afford higher level of protection for
guideline-driven care
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PD PD
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Summary