convenient care models amer kaissi, ph.d. 3/25/2014
TRANSCRIPT
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
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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