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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.

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Presentation on theme: "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."— Presentation transcript:

1 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.

2 2 Company Confidential | Do Not Copy Quick Facts on Emergency Room Utilization 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) Frequent users: 5% account for 25% of visits; complex illness and lack of social networks 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 ER visits are increasing… …for several reasons

3 3 Company Confidential | Do Not Copy As ER Visits Rise, Access, Quality, and Preparedness Remain Significant Challenges Source: The National Report Card on the State of Emergency Medicine Source: CDC/NCHS National Hospital Ambulatory Medical Care Survey, American Hospital Association ER Departments ER Visits (millions) 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 million.

4 4 Company Confidential | Do Not Copy Retail Clinics Encompass Retail Settings: pharmacies (Walgreen, CVS), mass merchandisers (Walmart, Target), supermarkets Limited set of services – routine care, minor illnesses, staffed by nurse practitioner/physician assistants 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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