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Blues see use of retail clinics doubling

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Retail health clinics may be displacing some physician office visits for minor conditions.

But they may not be doing much to displace misuse of hospital emergency rooms.

Analysts at Health Intelligence Company LLC, a think tank affiliated with the Chicago-based Blue Cross and Blue Shield Association, have published figures supporting that conclusion in a review of medical claims data for about 60 million Blues plan enrollees.

The analysts looked only at data on enrollees with individual or group commercial plan coverage, and only at claims submitted from 2011 through 2015.

The analysts used only claims from health clinics at national chain retail stores, such as CVS drug stores or Walmart discount stores, and not claims from independent retail health clinics. They excluded claims for preventive care visits.

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At commercial Blues plans, the retail health care visit rate increased to 24 visits per 1,000 enrollees in 2015, from 12.2 per 1,000 enrollees in 2011, according to the report.

Over that same period, the physician office minor condition visit rate fell to 973 per 1,000 enrollees, from 1,123 per 1,000 enrollees. Use of physician offices for all conditions increased to 3,835 per 1,000 enrollees, from 3,800.

Use of hospital emergency rooms for minor conditions increased slightly, to 54.3 visits per 1,000 enrollees in 2015, from 53 in 2011.

The increase in emergency room use may be partly due to the rapid increase in the share of commercial coverage users with individual insurance that took place in 2014, thanks to Affordable Care Act market changes, the Blues analysts say.

Individual coverage holders were less likely than group plan enrollees to use emergency rooms. Their use of both physician office visits and emergency rooms, however, has been rising, according to the Blues experience data.

Group plan enrollees’ use of retail health clinics has been increasing steadily since 2011.

Individual coverage holders’ use of retail clinics rose from 2011 through 2013, fell in 2014, then returned to close to 2013 levels in 2015.

In 2015, group plan enrollees had 24.5 visits per 1,000 enrollees, and individual coverage holders had just 19.8 visits per 1,000 enrollees.

The Blues analysts did not adjust for enrollees’ distance from retail clinics or in-network access to retail clinics in their study. The analysts suggest that one reason for the retail clinic use gap might be a lack of individual coverage holder awareness of retail clinic options.

“Greater education efforts targeting those new to health insurance may be warranted,” the analysts write. 


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