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The Right Care at the Right Time: Are Retail Clinics Meeting a Need?

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. Quick Facts on Emergency Room Utilization.

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The Right Care at the Right Time: Are Retail Clinics Meeting a Need?

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  1. The Right Care at the Right Time: Are Retail Clinics Meeting a Need? Alliance for Health Reform BriefingWashington, D.C. June 18, 2012 Sam Nussbaum, M.D.Executive Vice President, Clinical Health Policy and Chief Medical OfficerWellPoint, Inc.

  2. Quick Facts on Emergency Room Utilization ER visits are increasing… …for several reasons • 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

  3. As ER Visits Rise, Access, Quality, and Preparedness Remain Significant Challenges ER Departments ER Visits (millions) Source: CDC/NCHS National Hospital Ambulatory Medical Care Survey, American Hospital Association Source: The National Report Card on the State of Emergency Medicine 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 123.8 million.

  4. 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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