CONVENIENT CARE MODELS Amer Kaissi, Ph.D. 3/25/2014.

CONVENIENT CARE MODELS

Amer Kaissi, Ph.D. 3/25/2014

AMHA for Pharmacists Program, Simmons College2

Outline

1) Convenient care2) Retail clinics 3) Other convenient care

models4) Future

"There's a place where ancient animals are

roaming around near extinction. They are

completely clueless about their future fate.

Then there is Jurassic Park."

61%of primary care physician

offices do not have an arrangement where patients could be seen after hours

Schoen et al. (2009)

68%of emergency room visits are

neither “immediate” nor “emergent” in nature

Cunnigham (2011)

Type of visit Time Required to

See Provider

Actual Wait time

Immediate 0 min 28 min

Emergent 15 min 37 min

Urgent 15-60 min 50 min

Semi-urgent 60-120 min 68 min

Non-urgent > 120 min 76 minGovernment Accountability Office (2009)

46,000

expected primary care physician shortage by 2025

Bodenheimer (2012)

AMHA for Pharmacists Program, Simmons College8

Convenient Care

Care that is cheap, effective, and delivered in more convenient settings than traditional physician offices

Disruptive Innovations

AMHA for Pharmacists Program, Simmons College10

Outline

1) Convenient care2) Retail clinics 3) Other convenient care

models4) Future

10

AMHA for Pharmacists Program, Simmons College11

Retail Clinics

Walk-in clinics located in grocery stores, drugstores and general merchandise retailers

Care is usually delivered by a Nurse Practitioner or Physician Assistant

Up-front menu-style pricing

Condition/Test Price

Allergy symptoms

$79-$89

Earache/infection

$79-$89

Blisters $79-$89

Bug bites & stings

$79-$89

Asthma screening

$59-$69

Physical exam $59

Sport physical $59

Major Players

# of clinics

774

388

109

91

57

Mehrotra et al. (2012)

$66

Retail clinicl

$103

Urgent care

$106

Physician office

$570

Emergency room

Cost per visit

Mehrotra et al. (2009)

Quality scores

Retail clinic

Urgent care

Physician office

Emergency room

50.00% 55.00% 60.00% 65.00%

Net Promoter Score

Company NPS

Apple Hardware

71%

Trader’s Joe 73%

Amazon.com 76%

Retail Clinics 80%

USAA Banking 83%

Reason for use %

I didn’t need to make an appointment

57%

It accepted my insurance 46%

Its location was more convenient

45%

It was less expensive 41%

I didn’t have to wait too long 35%

It was open when the Dr’s office wasn’t

34%

I don’t have a regular Dr. 18%

2013 Consumer Survey-RC

“What would you have done today if the retail clinic was not

an available option?” Answer Percentage

“Just wait and see” 30%

“Go to ER” 26%

“Go to urgent care center” 18%

“Go to any clinic that would see me”

26%Wang et al. (2012)

61%of patients that visit a retail

clinic indicate that they don’t have a primary care

physician

Mehrotra et al. (2012)

AMHA for Pharmacists Program, Simmons College2424

Outline

1) Convenient care2) Retail clinics 3) Other convenient care

models4) Future

24

AMHA for Pharmacists Program, Simmons College2525

Outline

1) Convenient care2) Retail clinics 3) Other convenient care

models4) Future

25

AMHA for Pharmacists Program, Simmons College26

Urgent Care Centers

Usually free-standing At least one MD is present at the clinic all the time

Care is typically delivered by MD+ NP or PA

Can treat serious conditions such as sprains, strains, lacerations, contusions, fractures

Reason for use %

It was open when the Dr’s office wasn’t

54%

I didn’t need to make an appointment

44%

It accepted my insurance 35%

Its location was more convenient

32%

It was less expensive 22%

I didn’t have to wait too long 27%

I don’t have a regular Dr. 16%

2013 Consumer Survey- UCC

AMHA for Pharmacists Program, Simmons College30

Online Health Services

24/7 access to provider Minor medical conditions Answer questions based on algorithm/protocol

E-mail/text/video communication

Low fee

Example: Hello Health

AMHA for Pharmacists Program, Simmons College33

House Call Services

Provider visits home/work on evenings and weekends

Contracts with employers/ insurance companies

Annual membership + low visit fee

AMHA for Pharmacists Program, Simmons College3636

Outline

1) Convenient care2) Retail clinics 3) Other convenient care

models4) Future

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“Prediction is very hard, especially about the future”

Yogi Berra

AMHA for Pharmacists Program, Simmons College3838

Predictions

Increased utilization New models

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AMHA for Pharmacists Program, Simmons College434343

Predictions

A two-tiered health care system:1. Basic primary care delivered by

NP/PA in convenient locations/ways

2. Complex primary care & specialty care delivered by MDs in more traditional locations

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‘Flipping’ Health Care:

Retail Clinics and Other Convenient

Care Models

Amer Kaissi