Retail clinics and hospitals are integrating their EHRs to provide accessible and affordable primary care services—bolstering patient outcomes and reducing readmission costs.
The retail healthcare space is booming due to a shortage of primary care providers, an increase in the number of insured Americans under Obamacare, and stiffer penalties facing hospitals for readmissions of patients with chronic diseases. The number of retail clinics across the United States have increased 20% since 2013 and now number around 1,700. About one-third of Americans live within a 10-minute drive of a retail clinic, according to a Rand Corporation study.
Retailer-Hospital Partnerships on the Rise
Partnerships between retailers and hospitals are increasing. One recent affiliation between CVS Caremark and MedStar Health will integrate the electronic medical records (EMRs) of MedStar’s network of 10 hospitals and 4,000 physicians with 7,600 CVS pharmacies and its 900 Minute Clinics in Maryland and Washington, D.C.
In addition, CVS has inked similar agreements with the University of Maryland Medical System, the University of Alabama at Birmingham (UAB) Health System, and the University of Texas Medical Branch at Galveston. CVS already has existing partnerships with the Cleveland Clinic and Henry Ford Health System. CVS now has affiliations with 44 health systems nationwide.
Competitor Walgreens has 20 such partnerships of its own. Even retail chains like Wal-Mart, Target and Safeway now have their own in-store primary care clinics.
“We look forward to working with these health systems to develop collaborative programs that improve patient outcomes, lower costs and help people on their path to better health,” CVS/Caremark chief medical officer Dr. Troyen Brennan said about the partnership, as per Forbes. “Through these clinical affiliations, we will also be integrating our electronic medical records and information systems to enable us to support patients with medication counseling and chronic disease monitoring.”
Hospitals Eager to Ink Deals
Hospitals are eager to forge these partnerships to help them avoid paying penalties associated with readmission rates. Under tougher rules implemented starting in October 2012, Medicare had fined 2,225 hospitals for excess readmissions. For erring hospitals, the penalties come in the form of reduced Medicare payments amounting to around $330 million annually. Facilities now realize that linking with pharmacies can help them keep those Medicare dollars by helping patients cope with post-discharge disease-related issues.
According to a study by University of Cincinnati's James L Winkle College of Pharmacy, readmissions could decrease as much as 20 percent if community pharmacists work with high-risk patients after discharge to provide continuity of care.
Another study by Atlanta Medical Center showed that
“patients who received one-on-one medication and disease management discharge counseling from a pharmacist had a 50 percent lower 30-day readmission rate than patients without intervention.”
Clinics Offer Many Perks
Retail clinics are staffed by nurse practitioners and physician assistants who can administer vaccines, perform health screenings and treat minor illnesses like strep throat. But increasingly, they also help manage chronic conditions like hypertension, asthma, heart disease and diabetes. Some retail clinics offer lab tests as well. They are usually open 12 hours a day on weekdays and 8 hours on weekends. Many services cost less than $100. The convenience, longer hours and up-front pricing offered by retail clinics support their success.
With this increased access to their customers’ medical records, retail clinics round out their strengths. As Healthcare Dive’s Tammy Worth explains: “The medical centers and CVS will be integrating electronic medical records, allowing CVS to provide information on medical interventions and medication adherence to physicians. They will also provide visit summaries and medical histories to the medical centers. Physicians will work with Minute Clinic providers on joint clinical programs and care coordination.”
CVS and Epic Are Hand-in-Glove
CVS’ Minute Clinics recently switched from a proprietary system to Epic, the most widely-used EMR in the U.S., addressing a prior hurdle to full integration and coordinated care. CVS can now tap Epic’s data analytics and population health features.
"Retail clinics play an important role in community-wide care delivery," said Carl Dvorak, Epic president, in a statement. "Patients receive the most value in terms of quality, cost, and overall wellness when care is well-coordinated across disciplines and locations, so we're glad to have CVS Minute Clinic join the nation's largest network of care organizations securely sharing patient information.”
Retail Clinics Fill a Need for Prevention
Failure to fill prescriptions and drug interactions are two of the primary causes for readmissions. Integrating EMRs allows pharmacists and nurse practitioners to see a customer’s/patient’s full record, so they can spot drug interactions—as well as the potential for side effects, allergies, non-adherence, and other risks. Integrated electronic health records are essential to the success of the retail clinic model. According to the American Academy of Family Physicians (AAFP), retail clinics should have five core attributes:
- An EMR that is compatible with the Continuity of Care Record standard for exchanging basic patient information
- A well-defined and limited scope of service
- Use of evidence-based medicine
- A formal connection to physician practices in the community to provide continuity of care
- A referral system to physician practices and other entities for patients with symptoms beyond a retail clinic’s scope of work
Critics say retail clinics are a threat to small hospitals and primary care physicians. But the shortage of care providers in the community setting, exacerbated by an increase in the number of Americans obtaining insurance, means that retail clinics will likely increase in number. On the other hand, proponents hope that retail clinics as a healthcare delivery model continue to expand access to healthcare and help people manage chronic diseases more effectively.