Transcript The Right Care at the Right Time: Are Retail Clinics Meeting a Need? Alliance for Health Reform Briefing Washington, D.C. June 18, 2012 Sam Nussbaum,

The Right Care at the Right Time:
Are Retail Clinics Meeting a Need?
Alliance for Health Reform Briefing
Washington, D.C.
June 18, 2012
Sam Nussbaum, M.D.
Executive Vice President, Clinical Health Policy
and Chief Medical Officer
WellPoint, Inc.
Quick Facts on Emergency Room
Utilization
ER visits are increasing…
• 32% increase in ER visits from 1996 –
2006 (National Hospital Ambulatory
Medical Care Survey)
• 150M visits in 2010; approximately 10%
of all ambulatory care visits; as many
as 30-40% avoidable or inappropriate
• 15% uninsured; 20% Medicare, 15%
Medicaid, 47% private insured
• 80% visits due to lack of access of
alternate providers; 66% seriousness of
medical problem (CDC, NCHS, National
Health Interview Survey)
…for several reasons
• Lack of access to primary care; poorly
coordinated care
• Individuals with higher needs for health
care services: Medicare, Medicaid,
chronic conditions and poor health
• Lack of clinical knowledge on when ER
is/not appropriate
• Lack of transparency on availability of
ER alternatives
• Frequent users: 5% account for 25% of
visits; complex illness and lack of
social networks
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Source: CDC/NCHS National Hospital Ambulatory Medical
Care Survey, American Hospital Association
ER Visits (millions)
ER Departments
As ER Visits Rise, Access, Quality, and
Preparedness Remain Significant Challenges
Source: The National Report Card on the State
of Emergency Medicine
Visits to hospital emergency departments increased to an all-time high of 136 million in 2009,
according to estimates released by the Centers for Disease Control and Prevention. This
represents almost a 10% increase from the 2008 figure of 123.8 million.
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Retail Clinics
• Limited set of services – routine
care, minor illnesses, staffed by
nurse practitioner/physician
assistants
(n = 270K visits; ER 182K, UC 76K, RHC 12K)
Costs
• Encompass Retail Settings:
pharmacies (Walgreen, CVS), mass
merchandisers (Walmart, Target),
supermarkets
Comparative Costs for NonEmergency Diagnoses
$1,000
$500
$0
Sinusitis
Pharyngitis
Retail Health
Clinic
Otitis media
Bronchitis
Emergency
Room
Cold/flu/viral
Urinary
infection
Urgent
Care
• Convenient hours, shorter wait
times
• Lower cost than physician office,
urgent care and emergency rooms
• Quality outcomes
• Linkages with primary care/delivery
system
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