Retail Clinics Rise With High-Deductible Health Plans

By Joanne Wojcik

Jul. 31, 2008

Much of the growth in the retail medical clinic industry has been attributable to insurers adding clinics as in-network providers in traditional health plans, but the consumerism movement is expected to further boost this fledgling market.

When retail clinics appeared on the health care scene in the early part of this decade, they seemed as if they could be a natural complement to consumer-driven health plans that were emerging at the time. In fact, retail clinic growth has pretty much coincided with that of consumer-driven health plans.

Even though retail clinic providers saw consumer-driven plans as a potential growth catalyst, disappointing initial enrollment in such plans forced retail clinics to consider alternatives, says Tom Charland, CEO of Merchant Medicine, an online consulting and research company that focuses on retail medicine.

“We had not yet actually figured out how to get the attention of employers and, at the time, it was cash-only” to visit a retail clinic, says Charland, who is also a former executive of Minneapolis-based MinuteClinic Inc., the largest and one of the first providers of retail clinics.

“So we went through a whole process of working with employers and insurance companies. This was back when insurance companies were first hearing about getting medical care in a retail store,” he says. “The medical directors at these insurance companies were looking at us sideways and were not real excited about the idea.”

‘Some proving to do’
“Health plans and employers initially wanted to understand whether retail clinics were actually going to reduce costs or whether they were an additive service on top of other things people were doing,” says Steve Raetzman, senior health care consultant at Watson Wyatt Worldwide in Arlington, Virginia. “So the industry had some proving to do.”

But once the consumer-driven health plan market started to ignite, so did the retail clinic industry. Today, there are nearly 1,000 retail clinics operating in the U.S., compared with about 100 in 2006. MinuteClinic is the largest operator, with 511 clinics in 24 states.

“Once we saw it start to take off, it was an accidental synergy that was remarkable,” Charland says. “So that’s why we had a number of employers start to get very interested in it.”

In 2005, Black & Decker Corp., based in Towson, Maryland, was among the first employers to contract directly with MinuteClinic so its employees could access the clinics in nearby Target stores as an in-network provider, says Ray Brusca, vice president of benefits at the manufacturer.
At the time, Black & Decker’s health plan administrator, Cigna HealthCare, did not recognize the clinics as an in-network option, he says.

“Cigna was opposed initially to the use of clinics,” Brusca says. “Its medical director was convinced that all the visits would have follow-ups with primary care physicians,” thereby increasing, rather than reducing, the use of medical services.

Fortunately, Black & Decker’s experience proved otherwise, and Cigna as well as most major insurers now include most retail clinics in their provider networks.

Because Blue Cross & Blue Shield of Minnesota is based in MinuteClinic’s home state, it was among the first health insurers to embrace the retail clinic concept, says Louise Clyde, director of allied network management at the Blues affiliate.

Birthplace of the retail clinic
“Minnesota is the birthplace of the retail clinic, she says. “Retail clinics bring care to the member rather than the member looking for care.”

In tracking utilization by member type, Blue Cross & Blue Shield of Minnesota is finding that retail clinic users are younger than the general population, are significantly less ill than those visiting other medical providers and are twice as likely to be enrolled in a consumer-driven health plan than any other plan type, Clyde says.

She also says Blue Cross & Blue Shield of Minnesota’s experience has found that the care delivered by retail clinics can be equal to or better than traditional medical providers.

For example, applying both the National Committee for Quality Assurance and Minnesota’s own Institute for Clinical Systems Improvement guidelines, Blue Cross & Blue Shield of Minnesota found that retail clinics performed better than urgent care and doctors’ offices in treating patients for two specific conditions, Clyde says.

Urgent care centers and doctors’ offices provided appropriate care for respiratory infections 84 percent of the time, but retail clinics did so 93 percent of the time, she says.

In addition, urgent care centers and doctors’ offices provided appropriate care for sore throats 81 percent of the time, compared with 97 percent for retail clinics.

Although quality may eventually be a selling point for retail clinics, most health industry experts are finding that cost and convenience are the primary reasons that individuals use the clinics, which is why experts say enrollment growth in consumer-driven health plans likely will spur additional growth of retail clinics.

“There are 11 million people in consumer-driven plans now. It could be a contributing factor to the growth of the retail clinic market,” says Amrita John, a Bloomfield, Connecticut-based director in the product area at Cigna. Moreover, hospital systems and physician groups are jumping into the market, causing further expansion, she adds.

“There’s enough membership in those plans now to suggest that the people who use them are becoming more aware of their alternatives and purchasing behaviors as it relates to the utilization of care,” says Chip Phillips, president of MinuteClinic. “And, as people become more aware … they begin to ask more questions with respect to price and service. As we assume more financial responsibility for the cost of our care, we start to pay more attention to where and how we’re spending those dollars.”

“Retail clinics can become a big part of the health care delivery system,” particularly because they are proving to be “no worse and maybe even better than traditional care,” says Abir Sen, co-founder and chief strategy officer of RedBrick Health, a Minneapolis-based consumer-driven health care communications and education company.

Joanne Wojcik writes for Business Insurance, a sister publication of Workforce Management.

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