2014: Year of the clinic as 'rubber meets the road'

In a new study, which was published in the November issue of Health Affairs, researchers looked at retail clinics and found that eliminating restrictions on nurse practitioners’ scope of practice could lead to lower healthcare costs.

Again, 2014 will be the year for clinics. Why? Because this is where the rubber meets the road and clinics are an important solution in healthcare reform.

As FierceHealthcare reported, researchers found that if retail-based clinic visits make up for 10% of all outpatient primary care visits by 2015, national cost-savings would be $2.2 billion. If nurse practitioners in all 50 states practiced independently, that would add on an additional $810 million. That savings could grow even more — by $472 million — if nurse practitioners could prescribe on their own too. That is significant.

And then there’s the $300 billion dilemma — medication nonadherence. With a primary care shortage already plaguing the nation and millions of Americans set to enter the healthcare system due to health care reform, nurse practitioners are taking a central role in helping patients stay on therapy, according to Manhattan Research's Taking The Pulse Nurses 2013 study.

In fact, Manhattan Research found:

  • Nearly 9-out-of-10 NPs provide patients resources to help them stay on track with their medicines, and 3-out-of-10 NPs have referred them to digital adherence tools such as websites or apps;
  • Almost half of NPs said the time they spend on patient education has increased over the past two years; and
  • More than 3-out-of-5 NPs said patient outcomes are a top priority in their practice for the next one to two years.

The reality is that retail-based health clinics — and the nurse practitioners who work in them — are an important player within the changing healthcare landscape. Clinics are providing patients with greater, more convenient access to care, and that is leading to lower costs.

This point was illustrated during CVS Caremark’s 2012 Analyst Day meeting. For example, CVS Caremark’s MinuteClinic is collaborating with the company’s PBM business to help meet members’ healthcare needs. One way this is playing out is through a reduced co-pay pilot where clients can change their benefits structure to offer a reduced or no co-pay at MinuteClinic in order to lower overall healthcare costs, Andrew Sussman, SVP and president of MinuteClinic, told analysts.

The clinic operator also has been working to expand its scope of services to include biometric screening programs, wellness programs for weight loss and smoking cessation, as well as on-site clinics for clients. Sussman said he expects these programs “to grow significantly over the next five years, as the need for low-cost accessible care intensifies.”

Another way in which the company is helping to drive down costs is by partnering with health plans to help prevent hospital readmission. Hospital readmissions due to not properly taking medication affects nearly 3.5 million patients and results in about $15.2 billion dollars in healthcare costs each year.

How does MinuteClinic come into play? After hospital discharge, if a patient has been classified as “medium risk” for readmission, an appointment can be scheduled at MinuteClinic within a week after discharge to counsel and ensure the medications are correct, explained Troyen Brennan, EVP and chief medical officer for CVS Caremark, during the 2012 Analyst Day meeting.

“With the increasing focus on cost of care in a new environment, our prescription of better health care through innovative pharmacy care is timely and resonant. Finally, the expanded role of providers in population management will demand cohesion, connectivity and convenience, all of which we are prepared to deliver,” Brennan told analysts.

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