Study: Nearly 30% of ER visits could be treated at a clinic

CHICAGO — Retail health clinics have seen their visits almost double over the past five years but haven’t drawn the same level of usage from health insurance exchange-covered individuals, according to a Blue Cross Blue Shield Association (BCBSA) study.

Among commercially insured BCBSA members, retail clinic visits climbed from 12.2 visits per 1,000 members to 24 visits per 1,000 members during the 2011-2015 period of the study, done in tandem with Anthem Inc. subsidiary HealthCore. Retail clinics had a 19% average annual growth rate in visits over the five years, compared with less than 1% for doctor’s office and emergency room visits.

BCBSA said the rise in retail clinic visits was driven by members with employer-provided health insurance, whereas clinic use has lagged among members who purchased health insurance via the Affordable Care Act (ACA) marketplaces since they began offering coverage in 2014. ACA-insured consumers had 19% lower usage of retail clinics than members with employer-provided insurance, the study found.

At the same time, doctor’s office and ER visits by ACA-insured consumers rose. The growth rate in retail clinic visits per 1,000 members in the ACA-insured market was 2.6%, compared with 15.5% for physician’s office and 35.8% for ER visits, BCBSA reported.

“Although they comprise only a small portion of all outpatient services, retail clinics are becoming increasingly popular options for those seeking affordable care,” Maureen Sullivan, chief strategy and innovation officer for BCBSA, said in a statement. “Surprisingly, despite facing higher out-of-pocket costs for ER visits, individually insured members appear to be underutilizing retail clinics.

“Given this fact, greater education efforts targeting those new to health insurance may be warranted as a way to increase awareness of the relative convenience and services offered by retail clinics and to clarify insurance plans’ coverage of retail clinic visits,” Sullivan added.

BCBSA noted that the nation’s more than 2,000 retail clinics — located inside pharmacies, supermarkets and mass retail stores — could pare health care costs by absorbing minor acute care visits to the ER.

According to the study, 29.8% of ER visits in 2015 were for minor acute conditions that could be addressed at a retail clinic. About 70.7% of retail clinic visits involved minor acute care — such as upper respiratory conditions, ear infections, urinary tract and dermatological conditions, conjunctivitis, gastrointestinal ailments and headaches — compared with 25.3% of doctor’s office visits. Of retail clinic visits for minor acute care, nearly 49% were for upper respiratory conditions and almost 10% were for ear infections.

Source: Blue Cross Blue Shield Association/HealthCore study, “Retail Clinic Visits Increase Despite Use Lagging Among Individually Insured Americans”

“ER use has largely stabilized since 2011 — even with an influx of ACA members who are more likely to use the ER. This leveling off implies that consumers may be becoming aware of a range of alternative quick care options, which include retail clinics, as well as urgent care and telehealth,” the BCBSA study said. “In contrast, physician office visits for acute minor conditions have declined over the same five-year period by more than 13%, despite total physician office visits remaining largely steady.

“This may also indicate that patients are turning increasingly toward more convenient care settings to addresses these conditions,” according to the report. “However, since the number of retail clinic visits are still a small portion of total routine care visits (just 24 per 1000 in 2015), they are at best accounting for a small proportion of the overall decline in physician office visits.”

With the growth in high-deductible health insurance plans, consumers have become more sensitive to out-of-pocket costs, which has influenced where they choose to get health care, the study said, adding that retail clinics offer a low-cost option for minor acute conditions. For example, commercially insured members’ out-of-pocket cost per visit at a retail clinic was $35 for upper respiratory conditions (versus $37 for doctor’s office and $377 for ER), $36 for ear infections ($39 for doctor’s office and $414 for ER) and $30 for urinary tract conditions ($35 for doctor’s office and $572 for ER).

Other key findings in the study, titled “Retail Clinic Visits Increase Despite Use Lagging among Individually Insured Americans,” included the following:

• The rate per 1,000 members at which women visit retail clinics was 72% higher versus men.

• Younger consumers are more apt to go to a clinic for care. In 2015, retail clinic visits per 1,000 members for those ages 18 to 39 were 30.5, compared with 20.5 for ages 40 to 64 and 9.2 for ages 65 and older.

• Clinic use varied considerably by season, with more visits coming during the fall and winter. Retail clinics had a 42% higher visit rate from January to March and from October to December versus from July to September.

“The quality of care for the conditions most commonly treated in retail clinics has been shown to be at least as good as what is provided in traditional settings,” the BCBSA study said. “As such, most health insurance plans cover retail clinic visits. Despite some concerns about continuity of care, retail health clinics offer some attractive quick care advantages.”