For much of the 20th century, the pharmacy was a community gathering place, dispensing medicine, advice, and even ice cream. Over time, pharmacies have evolved into mini department stores, and today they are expanding to offer patient care with in-store clinics.
It’s clear that retail clinics have an important role to play as healthcare shifts from fee-based to value-based care—providing convenient care for patients in a low-cost setting is essential to controlling overall costs. Further, as evidenced by the CMS Final Notice distributed on April 7, 2014, the government strongly commented on their concerns regarding health plans using home assessments where “enrollee risk assessments were being used as a vehicle to collect diagnosis data for payment without providing treatment or follow-up care, and supported our proposal to exclude these diagnoses for risk adjustment purposes.” CMS went on to state that although 2014 home assessments would be allowable for improvement to patient risk score accuracy adjustment, this policy was going to be under significant scrutiny the rest of this year and likely to incur material change in next year’s dates of service. CMS very clearly stated in the February 21, 2014, Advance Notice their desire for these assessments to occur in a “clinical setting.”
To meet the needs of health plan risk score accuracy and quality improvement while addressing enrollee preference of convenient evening and weekend health visits, retail clinics have become an excellent alternative to home assessments. Retail clinics such as Healthcare Clinic at select Walgreens are carefully providing the following value propositions in a burgeoning market:
- Understand the specific value proposition related to Medicare Advantage, managed Medicaid, commercial qualified health plans, and ACOs.
- Leverage data-driven health-assessment decision-support platforms to provide the highest level of value to the consumer and the health plan. These decision-support platforms also provide a level of clinical and process standards for the thousands of healthcare clinics across the nation.
- Provide timely electronically signed medical records to the consumer’s primary care physician or principally relevant doctor overseeing the patient’s care.
- Ensure CMS, NCQA, URAC, and OIG guidelines are being met to address risk score accuracy and quality improvement oversight requirements.
- Make point-of-care vaccinations and biometric screenings easily available to consumers.
- Deliver services at typically lower cost and higher yields than a home assessment.
Opportunity is knocking
The most obvious advantage for retail clinics is customer convenience. Being able to visit a clinician on their way to work, on their lunch hour, or over the weekend is critically important to busy professionals, families, and individual preference.
Since CMS has indicated their plans to take a critical look at diagnoses established during in-home Medicare Advantage patient risk assessments, retail clinics provide both patients and health plans an ideal, convenient alternative. In addition to the benefit of establishing diagnoses in a clinical setting, providers such as Healthcare Clinic at select Walgreens offer services such as vaccinations and biometric testing. They can also counsel patients on the need to refill prescriptions to close gaps in care and provide valuable patient education.
Retail clinics have the potential to improve access to care and care coordination for patients while supporting the healthcare system’s move toward value-based care. By making preventive healthcare more convenient, including counseling for medication adherence and offering vaccinations, retail clinics promote wellness. By identifying gaps in care and working in tandem with primary care physicians, retail clinics can help with ongoing diagnoses confirmation of chronic conditions and help prevent hospital admissions or readmissions for patients with chronic disease—all while helping to close gaps in care and improve risk score accuracy.
To successfully serve patients, health plans, and other providers, retail clinics must have sophisticated assessment and communications systems. The most valuable system for retail clinicians is one that guides them through the encounter, ensuring the right questions are asked and no care gaps are missed. It should then allow them to create an electronic encounter summary for transmission to the patient’s community of care providers and the health plan.
Ideally, those patient assessments should be driven by analytics. For example, all 400+ Healthcare Clinic at select Walgreens locations have Inovalon’s ePASS® decision support platform available to leverage predictive analytics to give providers point-of-care insights into possible diagnoses and necessary care improvement. Studies have shown that data-driven assessments significantly improve risk score accuracy and patient quality outcomes as compared to those assessments that do not provide patient-specific actionable information. These data-driven assessments establish a new level of lower delivery cost, efficiency, thoroughness in documentation, evidence-based standards, and measureable impact, providing the ultimate combination of the right focus on the right issues for the right patients at the right time.