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8/16/2019 Session 3 a.How Retail Health Clinics Affect Access to Care for Underserved and Rural Populations
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*Samantha DiMeo, BS Candidate*Catherine Baumgardner, PhD, MBA+Deirdre
McCaughey,
PhD,
MBA
Dept. of Health Policy & Administration*The Pennsylvania State University
+The University of Alabama at Birmingham
Pennsylvania Public
Health
Association
| Pennsylvania
Office
of
Rural
Health
Strengthening the Health of Pennsylvanians: Addressing the Health Care and Public Needs of Vulnerable and Underserved Populations
April 7, 2016 ‐ Lancaster, PA
Retail Health Clinics: How Retail Health Clinics Affect Access to Care for Underserved and Rural Populations
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Learning Objectives
• Examine the retail clinic model, as well as existing challenges associated with clinic structure and operation.
• Describe the
primary
retail
health
clinic
users
and
location
of
these clinics.
•
Discuss
the
importance
of
retail
health
clinics
as
a
potential
solution to improve access to care.
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Overview
• Background
• Research Question
• Methods
• Results
• Implications
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Retail Health Clinics: Background
• Emergence of
industry
in
year
2000.
• Located in drugstores , grocery stores , and/or retail chains.
• Advertise convenient, accessible, and affordable
healthcare.
• Limited scope of services:o Immunizations, preventive health, minor acute
conditions
Thygeson et al., 2008; Mehrotra & Lave, 2012; Rudavsky & Mehrotra, 2010
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Retail Health Clinics: Background
• Two Models:
o (1) affiliation agreement
o (2) clinic ownership
• Consist primarily
of
nurse
practitioners
(NPs)
and
physician
assistants (PAs)… and a few primary care physicians (PCPs).
• Convenient Care Association (CCA): members must ensure quality,
accessible,
and
affordable
health
care.
Kaissi & Zucker, 2010; Williams et al., 2011
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Retail Health Clinics: Background
•
Factors concomitant
to
clinic
expansion:o Access barriers.
o Emergency department (ED) overcrowding:• 13.7 – 27.1 % of ED visits could take place at a retail health clinic or urgent care site.• Shift in care could save $4.4 billion per year.
o Demands for convenient and affordable care.o
Primary
care
physician
(PCP)
shortages.
• Strategic motivations behind clinic formation:o Trialing innovative care delivery method.o Increasing connectivity with consumers.o Expanding market share through hospital and PCP referrals.o Beating
competition.
Kaissi & Zucker, 2010
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• Existing Challenges:o Lack of template to follow.
o Profitability.
o Low patient volume.
o Poor patient
perceptions.
o Medical association (AAP, AAFP, AMA) and physician concerns.
• Clinic Successo A single clinic can expect to generate about $1,000,000 in annual
revenues.
Retail Health Clinics: Background
Mullin, 2009
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Research Question
What is the effect of retail health clinics on
access to care among underserved and rural populations?
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• A systematic literature review
• Databases:o (1)
o (2)
•
Key Search
Terms:
o Retail clinic, retail clinics, retail health clinic, retail care, retail health care, review article, literature review, healthcare, health care.
• Inclusion Criteria:o
Full
text,
peer
reviewed,
published
after
1999,
scholarly
or
credible
source,
healthcare
industry focus, retail clinic focus, and English language.
Methods
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Results: Clinic Location
• Located primarily
in
urban
settings:
o 88.4% in urban setting.
• Driving distance:•
Consumers living
1 mile
of
clinic
are
more
likely
to visit
clinics
compared to those living 10‐20 miles away.
• 1/3 urban population can access clinic within 10‐minute driving distance.
• 90% of
clinic
users
live
within
10
‐mile
radius
to
clinic.
Ashwood et al., 2011Rudavsky & Mehrotra, 2010; Rudavsky et al., 2009; Williams et al., 2011; Wilson et al., 2010
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Results: Clinic Location
• Less likely found in rural and underserved locations.
• 12.5% located in health professional shortage areas (HPSAs):o 20.9% of U.S. population lives in underserved areas.
• Leading predictors of clinic use = Proximity & Convenience.
• Without clinic presence… ED care?
Ashwod et al., 2011; Rudavsky & Mehrotra, 2010
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Results: Clinic Location•
Located in
more
affluent
areas:
• Advantageous from business perspective.
• Too much of a financial burden for the uninsured?
• Factors behind clinic location:o
Population
density.o Convenience.
o Expand network to communities lacking access to particular health system.
o Multiple locations with different demographics … uncover best
locations.o Upper‐middle‐class > lower‐middle‐class.
Kaissi & Zucker, 2010; Rudavsky & Mehrotra, 2010
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Results: Patient Demographics
•
Common Clinic
Users:
o Young adults:• Ages 18‐44
o Have family.
o Women.o Healthier:
• Healthy = without chronic illness.
• 90% clinic patients considered healthy.
o Better‐educated.
Ashwood et al., 2011; Mehrotra et al., 2008; Reid et al., 2012; Wang et al., 2010; Wilson et al., 2010
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Results: Patient Demographics
• Higher‐income individuals:o Higher‐income = netting 600% federal poverty level.
o Lower‐income = grossing
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Implications
• Retail
clinics
are
not
improving
access
to
care
for
underserved
and rural populations.
• Retail clinics are increasing convenience for insured and urban populations.
• Rural areas
need
to
make
the
case
for
more
retail
clinics
by
researching the impact to the population through:o Increases to access to care.
o Improvements in community health.
o Offsetting emergency
department
overcrowding.
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Recap
• Examine the
retail
clinic
model,
as
well
as
existing
challenges
associated with clinic structure and operation.
•
Describe
the
primary
retail
health
clinic
users
and
location
of
these clinics.
• Discuss the importance of retail health clinics as a potential
solution to
improve
access
to
care.
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Thank you
For
further
information,
detailed
references,
or
to discuss research at your organization, contact:
Samantha DiMeo [email protected]
