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Retail Health Informatics: A Care Delivery Alternative that’s Making a Difference Susan Brown, MSN, FNP-BC, CPHIMS, Director - Clinical Informatics, CVS Health
Retail Health Informatics: A Care Delivery Alternative that’s Making a Difference Susan Brown, MSN, FNP-BC, CPHIMS, Director - Clinical Informatics, CVS Health
Conflict of Interest Disclosure
Susan Brown, MSN, FNP-BC, CPHIMS
• Employed by CVS Health
© 2014 HIMSS
Learning Objectives
1. Describe the phenomenon of retail healthcare clinics, including breadth and scope of services provided, clinical resources available, and treatment of the whole patient.
2. Identify the benefits to patients and their families as they experience the retail health care difference.
3. Review the various clinical informatics technologies in use within the retail health care setting and how they contribute to effective patient care.
“The convenience revolution challenges traditional health care delivery and business models. Treatment options such as retail clinics offer consumers accessible care that is generally less expensive than more traditional options.
Telemedicine, another component of the convenience revolution, links physicians and patients via telephone or Internet.”
– Rand Health, 2015
Phenomenon of Retail Health Care: Alternative Delivery Models
• May 2000
• Cash-only
• Common medical conditions
In the beginning…
Cost Effective
High Quality
Convenient
RETAIL HEALTHCARE CLINICS
Convenient, accessible, cost-effective
• Open 7 days a week, including evenings • No appointment necessary • Located in retail outlets with adjacent pharmacies • Transparent pricing • In-network with major insurers
Cost-effective Care
$110 $166 $156
$570
Retail Clinic PCP UC ED
Cost of Providing Care: Commercially-insured
RETAIL HEALTHCARE CLINICS
High-quality care for children and adults
• Qualified Nurse Practitioners & Physician Assistants • Evidence-based national standards of care • Peer/collaborating physician chart review • National accreditation for Quality and Safety
Quality Benchmarks: Pharyngitis
Quality Benchmarks: Pharyngitis
Quality Benchmarks: Bronchitis
Retail Clinic Operators
Retail Clinics
Since 2000
40+ States
1,900 + Clinics
14 + Operators
25 mil + Patients
Affordable
Accessible
Convenient
Transparent
• Acute – Bladder infection – Bronchitis – Ear infection – Influenza – Minor injury – Sinusitis – Skin infections – Sore/strep throat
Retail Healthcare Services
• Wellness – Biometric screening
– Physical exams (camp, DOT, school, sports)
– Risk assessment
– Smoking cessation
– Vaccinations
– Weight management
Retail Healthcare Services
• Chronic – Diabetes
– Hypertension
– Hyperlipidemia
• Behavioral Health
Disruptive Innovation
Disruptive innovation “transforms an existing market or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost are the status quo.”
• Clayton Christensen, 1997
“In health care, for example, disruptive innovation can be seen in the emergence of retail clinics… staffed by nurse practitioners, these facilities enable many people to have access to more affordable, convenient health care.”
• Clayton Christensen Institute for Innovative Disruption
• Registration kiosks
• Electronic medical records
• Electronic prescribing
• Online scheduling
Technologic innovation
Electronic Health Records
Reporting and evaluation
Data mining
Care Coordination
EHR-enabled Innovation in Retail Clinics
Clinical Decision Support Centor Score Calculation Biosurveillance feedback
Centor Score Validation of Centor and McIsaac
prediction scores Fine, et al; 2012 Home score for clinical prediction of
strep pharyngitis Fine, et al; 2013
GAS Pharyngitis Real-time biosurveillance for GAS pharyngitis Fine, et al; 2011
EHR-enabled Innovation: Case Study
Validation of RSAT Performance
Confirmatory DNA probe/Culture
Retail Clinic EHR Data
Rapid Strep Antigen Testing (RSAT) Rapid point-of-care strep antigen testing performance data MFR
Telemedicine
“Use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.”
- American Telemedicine Association
Telemedicine: Connected Care
HIE
ACO ACA
Retail clinics are expected to be a key treatment location for millions of uninsured Americans once they obtain health coverage Jan. 1, 2014 either through a private health plan operating on an exchange or through the expanded Medicaid health insurance programs for the poor. – Forbes, 12/15/2013
RETAIL INFORMATICS FUTURE
Retail Health
Informatics Predictive Analytics
Chronic Disease
Wellness Programs
Interoperability
Clinical Decision Support
Value Proposition of Retail Clinics (RWJ, April 2015)
• Integrate retail health into delivery system • Measure & report quality of care • Improve access in underserved communities • Provide services to young children • Standardize scope of practice rules for NPs/PAs • Support telemedicine through adequate reimbursement • Support public health and emergency response efforts
RWJ Recommendations: Optimizing Value & Advancing Culture of Health
• Strong presence in second decade of operation – Approaching 2,000 clinics – More than 10 million visits annually
• Extending services to include wellness and chronic care – Telemedicine
• Informatics – Clinical Decision Support – Quality benchmarking – Predictive analytics
Retail Healthcare Clinics
