Roundtable participants see a bright future for the convenient care industry By Cynthia L. Saver, RN, MS
The convenient care industry (CCI) is well positioned to enjoy the benefits of current healthcare trends by leveraging its strengths and expanding its services to include managing patients with chronic conditions, according to participants in a roundtable held by the Convenient Care Association in Philadelphia on November 20, 2014. However, challenges such as insufficient
consumer choice,” she added. Clinics focus on evidence-based practice and provide care primarily through nurse practitioners (NPs [95%]) and sometimes physician assistants (PAs). The number of clinics continues to grow, with 43 states and the District of Columbia now having clinics. “We know we fill a void,” Hansen-Turton said. “More than 40% of people who use the clinics do not have a medical home.” The growth rate of clinics is highest among
Quality scores and rates of preventive care at retail clinics are higher than in other ambulatory delivery systems. providers play an important role in the industry’s future. “Convenient Care Industry: Trends and Forecast” gathered nine nationally known thought leaders in the CCI to share experiences and discuss issues before a group of invited guests. ■ Industry overview “To date, the nation’s more than 1,800 retail clinics are known for providing affordable, accessible quality care to more than 30 million people across the country,” said Tine HansenTurton, executive director of the Convenient Care Association and program moderator. These people would often have had to wait hours, days, or even weeks for a primary care appointment. “The focus of the industry is quality, convenience, and
hospitals, health systems, and corporations, although most individual clinics are still operated by nonhospital companies. Benefits of retail clinics include lower price points (costs are significantly lower than at an urgent care center, primary care office, or ED), higher quality scores, and higher rates of preventive care. Both quality scores and rates of preventive care at retail clinics are higher than in other ambulatory delivery systems, such as urgent care centers and EDs.1,2 Challenges include lack of providers and the amount of time it takes for providers to become credentialed through Medicaid. Many members of the CCI are working closely with colleges and universities to provide clinical
opportunities and are even providing programs to accommodate new NP graduates into the field. “This market will only continue to grow,” Hansen-Turton summed up, noting that Accenture Research projects clinics will grow 25% to 30% annually to more than 2,800 clinics in 2016. ■ Information technology Dan Haley, vice president of government affairs and assistant general counsel at Athenahealth, a provider of cloud–based services related to information technology, discussed the need for retail clinics to use technology so providers can focus on providing care to patients. “People are starting to ask the question, ‘why is it that we’re all carrying these little supercomputers in our pockets, but we’re all getting chased around by faxes,’” Haley said, adding that the macro reason technology is “so bad” in healthcare is because, “We accept that the information technology we use in healthcare is 10 to 20 years behind that super computer in our pockets. I think it’s changing slowly, but too often our providers don’t demand enough from our industry.” Haley also cited three micro reasons for the poor technology in healthcare: structural, policy, and economic. Structurally, most of the healthcare technology does not operate on the Internet, which is the easiest way to share information.
This column developed in cooperation with the The Convenient Care Association.
24 The Nurse Practitioner • Vol. 40, No. 2
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.tnpj.com
Roundtable participants see a bright future for the convenient care industry
When it comes to policy, Haley believes that problems occurred when the meaningful use program became part of the stimulus program. The pressure to spend money quickly meant technology platforms received government approval as meeting meaningful use criteria, even though they were not the best option. Economically, Haley says that other than healthcare, “Everywhere else in our society, information is a commodity.” People can pay for the information. But in healthcare, payment for information related to referrals is considered a felony. For care coordination to occur, payment must be possible—without it being a felony. “For the convenient care movement to truly achieve its potential, we need to have a much greater degree of information sharing,” Haley added. That includes sharing among provider care networks. Ideally, data should be shared through the Internet so that the information can travel with the patient and be accessed in real time. ■ Mega trends “In 2015, the biggest segment of the working population will be millennials,” said Jonah Frohlich, managing director for Manatt Health Systems. Millennials have different expectation because they grew up with technology and expect both convenience and instant access. Frohlich’s company has compiled megatrends for healthcare, and he shared the ones that are most relevant to the CCI. ■ Consumers taking charge Consumers are shopping for healthcare. “In some cases they are being compelled to do it, in other cases, they are doing it themselves,” Frohlich said. “They are also being compelled to take more risks,” as more costs are shifted to employees. www.tnpj.com
Employees are also accessing more information online to help them understand conditions they might have. He cited a Pew study stating that 72% of consumers had looked online for healthcare information in the past year and added that there are 40,000 healthcare apps in the iTunes store. Providers are doing more with less as the healthcare system moves from volume-based care to valuebased care. There is more emphasis
He noted that health systems are integrating, with hospitals buying other hospitals to create mega systems, and health plans and provider organizations are being purchased by each other. The goal is to support the entire continuum of care, from tertiary care in hospitals to telehealth, with the ability to deliver the right care at the right time. Networks are also becoming narrower, which means better control for employers.
Providers are doing more with less as the healthcare system moves from volume-based to value-based care. on population health management and expanded roles of NPs and PAs, who know when they should treat a patient and when they should refer. “We are starting to see innovative payment systems based on value,” Frohlich says, citing the example of Geisinger Health System, which guarantees one cost for some of its procedures, even if complications occur. Accountable care organizations are also becoming more common. Healthcare is everywhere. “Having supercomputers in your pocket is changing how people are accessing service,” Frohlich said. Now, people are realizing that they can access care not just at a hospital or in a physician office, but at home, in a pharmacy, or through telemedicine. By 2016, more than half of Kaiser’s encounters will be done virtually (via e-mail, phone, or video). These types of visits will save money. Health systems are joining. “The push towards trying to manage costs has forced insurers, providers, health systems, and physicians to come together in new ways to try to manage risks and offer value and cost reduction strategies for employers who are paying for it,” Frohlich said.
States are playing a more central role than they have in the past. Medicaid expansion has contributed to this trend by becoming part of the insurance spectrum. In California, one in three people is on Medicaid. “You can’t ignore it [Medicaid], they are too big now,” Frohlich said. Payors and providers are seeking value through data analysis. Although many hospitals are still struggling with how to use data they are currently collecting, the trend is to create and analyze giant data sets. This allows for real-time analysis that creates what Frohlich called “a learning health system” and allows for the rapid deployment of evidence-based changes to improve outcomes. Employers are recalibrating. Employers are dropping coverage because they cannot afford it. “There is a lot more regulation,” Frohlich said, adding that the recent election results may result in changes in healthcare. Employees are now contributing more to their premiums, and many employers are giving employees funds and allowing them to shop for coverage on exchanges. The Nurse Practitioner • February 2015 25
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Roundtable participants see a bright future for the convenient care industry
■ Now and future directions After the presentations from Haley and Frohlich, the entire panel engaged in a lively discussion. Here are a few points: • There is a shortage of healthcare providers for retail clinics that is expected to worsen. This is leading to the concept of involving additional providers in patient care, such as health coaches and nutritionists • More hospitals are now operating retail clinics • Younger people with largedeductible healthcare plans are turning to retail clinics for their care • Integrated technology is key for continued success in the CCI • Providers are now much more accepting of retail clinics • The CCI’s focus on customer service creates a significant benefit for patients. It is also leading to the
creation of larger, more userfriendly clinics. It will be important to maintain that experience as care moves more to telehealth • Price transparency trends benefit retail clinics • The CCI needs to expand into management of people with chronic conditions. In the future, panelists agreed that retail care will continue to be an important patient-focused option for many people in the United States. “The next 10 years will be amazing,” Hansen-Turton concluded. ■ Panel members In addition to those quoted in this article, other panel members include: • Patrick Carroll, chief medical officer, Walgreens • Peter Goldback, chief medical officer, RediClinic/Health Dialog
• Mathew Kollman, chief operating officer, Memorial Physicians, PLLC • Steve Lazzari, director, FastCare • Eileen Myers, vice president, affiliations and patient centered strategies, The Little Clinic • Michelle Saborit, director of convenient care, Baptist Health Medical Group • Joshura Tirado, senior group manager, Clinics at Target, Target Corporation REFERENCES 1. Mehrotra A, Liu H, Adams JL, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med. 2009 Sep 1; 151(5):321-8. 2. Shrank WH, Krumme AA, Tong AY, et al. Quality of care at retail clinics for 3 common conditions. Am J Manag Care. 2014 Oct 20(10):794-801. Cynthia L. Saver is President of CLS Development, Inc. DOI-10.1097/01.NPR.0000459988.71115.af
26 The Nurse Practitioner • Vol. 40, No. 2
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.tnpj.com
The convenient care industry (CCI) is well positioned to enjoy the benefits of current healthcare trends by leveraging its strengths and expanding its services to include managing patients with chronic conditions, according to participants in a roundtable held by the Convenient Care Association in Philadelphia on November 20, 2014. However, challenges such as insufficient
consumer choice,” she added. Clinics focus on evidence-based practice and provide care primarily through nurse practitioners (NPs [95%]) and sometimes physician assistants (PAs). The number of clinics continues to grow, with 43 states and the District of Columbia now having clinics. “We know we fill a void,” Hansen-Turton said. “More than 40% of people who use the clinics do not have a medical home.” The growth rate of clinics is highest among
Quality scores and rates of preventive care at retail clinics are higher than in other ambulatory delivery systems. providers play an important role in the industry’s future. “Convenient Care Industry: Trends and Forecast” gathered nine nationally known thought leaders in the CCI to share experiences and discuss issues before a group of invited guests. ■ Industry overview “To date, the nation’s more than 1,800 retail clinics are known for providing affordable, accessible quality care to more than 30 million people across the country,” said Tine HansenTurton, executive director of the Convenient Care Association and program moderator. These people would often have had to wait hours, days, or even weeks for a primary care appointment. “The focus of the industry is quality, convenience, and
hospitals, health systems, and corporations, although most individual clinics are still operated by nonhospital companies. Benefits of retail clinics include lower price points (costs are significantly lower than at an urgent care center, primary care office, or ED), higher quality scores, and higher rates of preventive care. Both quality scores and rates of preventive care at retail clinics are higher than in other ambulatory delivery systems, such as urgent care centers and EDs.1,2 Challenges include lack of providers and the amount of time it takes for providers to become credentialed through Medicaid. Many members of the CCI are working closely with colleges and universities to provide clinical
opportunities and are even providing programs to accommodate new NP graduates into the field. “This market will only continue to grow,” Hansen-Turton summed up, noting that Accenture Research projects clinics will grow 25% to 30% annually to more than 2,800 clinics in 2016. ■ Information technology Dan Haley, vice president of government affairs and assistant general counsel at Athenahealth, a provider of cloud–based services related to information technology, discussed the need for retail clinics to use technology so providers can focus on providing care to patients. “People are starting to ask the question, ‘why is it that we’re all carrying these little supercomputers in our pockets, but we’re all getting chased around by faxes,’” Haley said, adding that the macro reason technology is “so bad” in healthcare is because, “We accept that the information technology we use in healthcare is 10 to 20 years behind that super computer in our pockets. I think it’s changing slowly, but too often our providers don’t demand enough from our industry.” Haley also cited three micro reasons for the poor technology in healthcare: structural, policy, and economic. Structurally, most of the healthcare technology does not operate on the Internet, which is the easiest way to share information.
This column developed in cooperation with the The Convenient Care Association.
24 The Nurse Practitioner • Vol. 40, No. 2
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.tnpj.com
Roundtable participants see a bright future for the convenient care industry
When it comes to policy, Haley believes that problems occurred when the meaningful use program became part of the stimulus program. The pressure to spend money quickly meant technology platforms received government approval as meeting meaningful use criteria, even though they were not the best option. Economically, Haley says that other than healthcare, “Everywhere else in our society, information is a commodity.” People can pay for the information. But in healthcare, payment for information related to referrals is considered a felony. For care coordination to occur, payment must be possible—without it being a felony. “For the convenient care movement to truly achieve its potential, we need to have a much greater degree of information sharing,” Haley added. That includes sharing among provider care networks. Ideally, data should be shared through the Internet so that the information can travel with the patient and be accessed in real time. ■ Mega trends “In 2015, the biggest segment of the working population will be millennials,” said Jonah Frohlich, managing director for Manatt Health Systems. Millennials have different expectation because they grew up with technology and expect both convenience and instant access. Frohlich’s company has compiled megatrends for healthcare, and he shared the ones that are most relevant to the CCI. ■ Consumers taking charge Consumers are shopping for healthcare. “In some cases they are being compelled to do it, in other cases, they are doing it themselves,” Frohlich said. “They are also being compelled to take more risks,” as more costs are shifted to employees. www.tnpj.com
Employees are also accessing more information online to help them understand conditions they might have. He cited a Pew study stating that 72% of consumers had looked online for healthcare information in the past year and added that there are 40,000 healthcare apps in the iTunes store. Providers are doing more with less as the healthcare system moves from volume-based care to valuebased care. There is more emphasis
He noted that health systems are integrating, with hospitals buying other hospitals to create mega systems, and health plans and provider organizations are being purchased by each other. The goal is to support the entire continuum of care, from tertiary care in hospitals to telehealth, with the ability to deliver the right care at the right time. Networks are also becoming narrower, which means better control for employers.
Providers are doing more with less as the healthcare system moves from volume-based to value-based care. on population health management and expanded roles of NPs and PAs, who know when they should treat a patient and when they should refer. “We are starting to see innovative payment systems based on value,” Frohlich says, citing the example of Geisinger Health System, which guarantees one cost for some of its procedures, even if complications occur. Accountable care organizations are also becoming more common. Healthcare is everywhere. “Having supercomputers in your pocket is changing how people are accessing service,” Frohlich said. Now, people are realizing that they can access care not just at a hospital or in a physician office, but at home, in a pharmacy, or through telemedicine. By 2016, more than half of Kaiser’s encounters will be done virtually (via e-mail, phone, or video). These types of visits will save money. Health systems are joining. “The push towards trying to manage costs has forced insurers, providers, health systems, and physicians to come together in new ways to try to manage risks and offer value and cost reduction strategies for employers who are paying for it,” Frohlich said.
States are playing a more central role than they have in the past. Medicaid expansion has contributed to this trend by becoming part of the insurance spectrum. In California, one in three people is on Medicaid. “You can’t ignore it [Medicaid], they are too big now,” Frohlich said. Payors and providers are seeking value through data analysis. Although many hospitals are still struggling with how to use data they are currently collecting, the trend is to create and analyze giant data sets. This allows for real-time analysis that creates what Frohlich called “a learning health system” and allows for the rapid deployment of evidence-based changes to improve outcomes. Employers are recalibrating. Employers are dropping coverage because they cannot afford it. “There is a lot more regulation,” Frohlich said, adding that the recent election results may result in changes in healthcare. Employees are now contributing more to their premiums, and many employers are giving employees funds and allowing them to shop for coverage on exchanges. The Nurse Practitioner • February 2015 25
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Roundtable participants see a bright future for the convenient care industry
■ Now and future directions After the presentations from Haley and Frohlich, the entire panel engaged in a lively discussion. Here are a few points: • There is a shortage of healthcare providers for retail clinics that is expected to worsen. This is leading to the concept of involving additional providers in patient care, such as health coaches and nutritionists • More hospitals are now operating retail clinics • Younger people with largedeductible healthcare plans are turning to retail clinics for their care • Integrated technology is key for continued success in the CCI • Providers are now much more accepting of retail clinics • The CCI’s focus on customer service creates a significant benefit for patients. It is also leading to the
creation of larger, more userfriendly clinics. It will be important to maintain that experience as care moves more to telehealth • Price transparency trends benefit retail clinics • The CCI needs to expand into management of people with chronic conditions. In the future, panelists agreed that retail care will continue to be an important patient-focused option for many people in the United States. “The next 10 years will be amazing,” Hansen-Turton concluded. ■ Panel members In addition to those quoted in this article, other panel members include: • Patrick Carroll, chief medical officer, Walgreens • Peter Goldback, chief medical officer, RediClinic/Health Dialog
• Mathew Kollman, chief operating officer, Memorial Physicians, PLLC • Steve Lazzari, director, FastCare • Eileen Myers, vice president, affiliations and patient centered strategies, The Little Clinic • Michelle Saborit, director of convenient care, Baptist Health Medical Group • Joshura Tirado, senior group manager, Clinics at Target, Target Corporation REFERENCES 1. Mehrotra A, Liu H, Adams JL, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med. 2009 Sep 1; 151(5):321-8. 2. Shrank WH, Krumme AA, Tong AY, et al. Quality of care at retail clinics for 3 common conditions. Am J Manag Care. 2014 Oct 20(10):794-801. Cynthia L. Saver is President of CLS Development, Inc. DOI-10.1097/01.NPR.0000459988.71115.af
26 The Nurse Practitioner • Vol. 40, No. 2
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.tnpj.com
