Presentation is loading. Please wait.

Presentation is loading. Please wait.

convenient care models

Similar presentations


Presentation on theme: "convenient care models"— Presentation transcript:

1 convenient care models
3/25/2014 Amer Kaissi, Ph.D.

2 Other convenient care models Future
Outline Convenient care Retail clinics Other convenient care models Future

3 Then there is Jurassic Park."
"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." I am going to start with this picture of an ancient physician’s office. A while ago, I was attending a presentation and one of the speakers commented and said…. What did he mean? He meant that many healthcare organizations especially hospitals and physician offices, have not kept up with the times. Think of the last time you tried to schedule an appointment with a doctor. You picked up the phone- how long did it take for you to talk to a real person? How long were you on hold? What options were you given to you in terms of appointment times? In most office, the options are Monday-Thursday, from 8-5. of course, on Friday they are closed because the doctor is playing golf. How many weeks did you have to wait? And then once you go there, how many forms did you fill up? How long did you wait in the waiting room? And then in the examination room? How long did you wait for your prescription to get refilled? The point is we have designed our HC system around the preferences of the providers, no the patients or the consumers.

4 61% of primary care physician offices do not have an arrangement where patients could be seen after hours What that leads to is that for many people, the only option for after hours care is the emergency room! Schoen et al. (2009)

5 68% of emergency room visits are neither “immediate” nor “emergent” in nature Emergency room visits are classified into five categories, depending on the level of immediacy (in minutes) assigned upon arrival by the triage staff: (1) Immediate (patient needs to be seen immediately); (2) emergent (needs to be seen within 15 minutes upon arrival); (3) urgent (between minutes); (4) semi-urgent (1-2 hours) and non-urgent (2-24 hours) (Niska, Bhuiya & Xu, 2010). In 2008, 4% of emergency room visits were for patients that needed to be seen immediately; 12% were emergent; 39% were urgent; 21% were semi-urgent, and 8% were non-urgent (Cunningham, 2011). These numbers indicate that about 68% of emergency room visits can, theoretically, be taken care of in other lower-acuity settings such as urgent care centers, primary care physician offices, retail clinics and others. Cunnigham (2011)

6 Time Required to See Provider
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 min 68 min Non-urgent > 120 min 76 min This has lead to overcrowding of ERs and long wait times. Emergency room visits are classified into five categories, depending on the level of immediacy (in minutes) assigned upon arrival by the triage staff: (1) Immediate (patient needs to be seen immediately); (2) emergent (needs to be seen within 15 minutes upon arrival); (3) urgent (between minutes); (4) semi-urgent (1-2 hours) and non-urgent (2-24 hours) Government Accountability Office (2009)

7 expected primary care physician shortage by 2025
46,000 expected primary care physician shortage by 2025 Another contributing factor is the well know PCP shortage that is reducing access Bodenheimer (2012)

8 Convenient Care Care that is cheap, effective, and delivered in more convenient settings than traditional physician offices In the face of all of this, convenient care options have started to appear in the last 10 years or so.

9 Disruptive Innovations
Same as ATMs, mobile phones A powerful change in which a larger population of less-skilled providers can provide care in more convenient, less expensive setting that historically was only provided by expensive specialists in centralized, inconvenient locations

10 Other convenient care models Future
Outline 10 Convenient care Retail clinics Other convenient care models Future

11 Up-front menu-style pricing
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

12 RC started in 2000 in Minneapolis at a Kruger Store.
Rick Krieger is the founder of QuickMedx (which became Minute Clinic later) and so is credited for being the father of retail clinics. In 1999, Krieger’s son had a sore throat. Realizing that he needed to test him for strep, he drove him to an urgent care center in Minneapolis. After waiting for two hours, the physician performed a strep test that turned out to be negative. Krieger recalls: “We started talking about why there was not a way to just get a simple question answered or a simple test, like strep throat, done. Why was there not a way to just slip in and be seen quickly? Wasn’t there some way to get care in a timely manner for a relatively simple illness? A quick, convenient way to diagnose without waiting in the ER or clinic for two hours? We are not talking about diabetes, cancer, or heart disease! We are talking about colds and throat and ear infections” (Bohmer & Groberg, 2002). Along with two business partners, Krieger set up pilot clinics in the Cub Foods grocery store chain.

13 Conditions treated: 90% of the conditions treated fall within 10 diagnoses
Upper respiratory infections Urinary tract infections Sinusitis/Bronchitis/Pharyngitis Ear infections Conjunctivitis Immunizations Screening laboratory tests/blood pressure checks

14 Condition/Test Price Allergy symptoms $79-$89 Earache/infection Blisters Bug bites & stings Asthma screening $59-$69 Physical exam $59 Sport physical

15 Clinics are mostly located in densely populated states and major metropolitan areas
Current number is 1,574 clinics

16 774 388 109 91 57 Major Players # of clinics
These constitute 89% of all clinics- market is very consolidated

17 $570 Cost per visit $103 $106 Emergency room Urgent care
Physician office Retail clinicl $103 $106 $66 Mehrotra et al. (2012)

18 Quality scores Mehrotra et al. (2009)
Arguably, the most influential study on retail clinic quality is the one conducted by the Rand corporation and published in 2009 (Mehrotra, Liu, Adam, et al., 2009). The researchers examined episodes of care (initial and follow-up visits, pharmaceutical and ancillary tests) for three conditions treated: otitis media (ear infection); pharyngitis and urinary tract infections. They constructed 14 quality indicators based on guidelines published by the American Academy of Pediatrics, the American Academy of Family Physicians, and the Infectious Diseases Society of America, and created an aggregate quality score for all conditions. They also measured whether patients received specific preventative services in the three months following their visits. They compared care provided for the three conditions in retail clinics, physician offices, urgent care centers and hospital emergency rooms. Overall, aggregate quality scores were similar at retail clinics (63.6%), physician offices (61.0%) and urgent care centers (62.6%), but were lower for emergency rooms (55.1%). Individual quality scores on the specific measures showed that retail clinics were better or as good as other settings Mehrotra et al. (2009)

19 Net Promoter Score

20 Company NPS Apple Hardware 71% Trader’s Joe 73% Amazon.com 76%
Retail Clinics 80% USAA Banking 83% Customers respond on a 0-to-10 point rating scale and are categorized as follows: Promoters (score 9-10) are loyal enthusiasts who will keep buying and refer others, fueling growth. Passives (score 7-8) are satisfied but unenthusiastic customers who are vulnerable to competitive offerings. Detractors (score 0-6) are unhappy customers who can damage your brand and impede growth through negative word-of-mouth. To calculate your company's Net Promoter Score (NPS), take the percentage of customers who are Promoters and subtract the percentage who are Detractors. Si if you like your I-phone, you will like retail clinics

21 2013 Consumer Survey-RC 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%

22 “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” Wang et al. (2012) 22

23 61% of patients that visit a retail clinic indicate that they don’t have a primary care physician Mehrotra et al. (2012)

24 Other convenient care models Future
Outline 24 24 Convenient care Retail clinics Other convenient care models Future

25 Other convenient care models Future
Outline 25 25 Convenient care Retail clinics Other convenient care models Future

26 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 While most retail clinics are located inside retail/grocery stores, UCCs are usually free-standing in less crowded settings such as strip-malls. Moreover, UCCs have at least one physician that is present at the clinic all the time, even though care is typically delivered by a physician assistant, nurse practitioner or nurse. This is due to the fact that UCCs can treat, in addition to minor conditions, more serious conditions such as sprains, strains, lacerations, contusions, back pain, fractures and even minor surgeries.

27 There are approximately 8,700 walk-in, stand-alone UCCs, and they continue to grow with new clinics opening every year The top 17 operators own less than 10% of the clinics

28

29 2013 Consumer Survey- UCC 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%

30 Online Health Services
24/7 access to provider Minor medical conditions Answer questions based on algorithm/protocol /text/video communication Low fee allows patients unlimited online access to a nurse practitioner for the treatment of 40 common medical conditions. Patients describe their medical conditions by answering online questions based on medical protocols. Shortly after, a nurse practitioner reviews the answers, designs a treatment plan, and then contacts the patient by or text message. The treatment plan includes a diagnosis and prescriptions that are sent directly to the patient’s designated pharmacy. The service is currently offered at a fee of $40 or less

31 “VirtuWell,” a service provided by HealthPartners in Minnesota allows patients unlimited online access to a nurse practitioner for the treatment of 40 common medical conditions. Patients describe their medical conditions by answering online questions based on medical protocols. Shortly after, a nurse practitioner reviews the answers, designs a treatment plan, and then contacts the patient by or text message. The treatment plan includes a diagnosis and prescriptions that are sent directly to the patient’s designated pharmacy. The service is currently offered at a fee of $40 or less, depending on insurance status

32 Example: Hello Health

33 Provider visits home/work on evenings and weekends
House Call Services Provider visits home/work on evenings and weekends Contracts with employers/ insurance companies Annual membership + low visit fee White Glove” offers patients a yearly membership in return for unlimited access to care. Patients pay a monthly fee to become members and when they need medical attention, they can request an appointment via phone or web. Within hours, a nurse practitioner visits the patient at work or at home. During the visit, the nurse practitioners diagnoses and treats the patient and provides him/her with most of the generic medications that are prescribed on the visit. Patients also have secure online access to their information including their medical history, lab results, visit history, etc. The scope of care is more or less similar to that of a retail clinic and each visit costs $35 out of pocket.48 It is important to note that White Glove is an alternative for people who already have insurance. Many large employers are offering it as part of their benefits, and therefore individuals don’t have to pay the annual fee, only the visit fee. Therefore, it is unlikely that people from a lower socioeconomic status will seek this service

34

35

36 Other convenient care models Future
Outline 36 36 Convenient care Retail clinics Other convenient care models Future

37 “Prediction is very hard, especially about the future”
Yogi Berra

38 Increased utilization New models
Predictions 38 38 Increased utilization New models

39

40

41

42

43 Predictions A two-tiered health care system:
43 43 43 A two-tiered health care system: Basic primary care delivered by NP/PA in convenient locations/ways Complex primary care & specialty care delivered by MDs in more traditional locations

44 ‘Flipping’ Health Care:
Retail Clinics and Other Convenient Care Models Amer Kaissi 44


Download ppt "convenient care models"

Similar presentations


Ads by Google