Helping Members Avoid Unnecessary ER Visits

BRIEFING
August 7, 2018
Senior Vice President, Chief Medical Officer, CVS MinuteClinic

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At an average total cost per visit of $1,900, the emergency department, or ER, is one of the most expensive places to receive medical care.https://www.beckershospitalreview.com/eds/cost-of-er-visits-increased-31-between-2012-16-5-findings.html Not surprisingly, consumer out-of-pocket costs are also high. According to one study, patients with upper respiratory infections personally paid an average of $377 per ER visit.https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/BCBS.HealthOfAmericaReport.Retail.pdf

Despite these high costs, there were nearly 137 million ER visits in 2015.https://www.cdc.gov/nchs/fastats/emergency-department.html A sizable portion of these visits are for conditions that clearly merited emergent care — trauma, fractures, chest pain — but many others could be successfully treated at easier-to-access and more affordable sites of care. In fact, it’s estimated that 30 percent of ER visits could potentially be treated in walk-in clinics like MinuteClinic.https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/BCBS.HealthOfAmericaReport.Retail.pdf

The emergency department is a critical component in our health care system, and crowding has become a concern among hospitals, policy makers, providers, and payors. Avoidable use among patients with low-acuity problems contributes to long ER wait times and suboptimal care. Avoidable visits cost the system $38 billion a year.http://wellness.totalaccessmedical.com/blog/the-consequences-of-emergency-department-overuse

Why People Choose the ER

In a survey, most ER users cited the severity of their medical problem as the primary reason they sought care in the emergency department. However, 7 percent cited lack of access to a primary care provider, and 12 percent went to the ER because their provider’s office was closed.https://www.cdc.gov/nchs/data/nhsr/nhsr090.pdf With extended hours and walk-in care, retail clinics are a convenient choice for these groups. Retail clinics are a particularly attractive option for younger people who may not have established a relationship with a primary care provider.

The Neighborhood Option for Care

Many of the concerns that bring people to a hospital emergency department can be effectively treated in walk-in medical clinics. Earaches, sprains, skin conditions such as rashes or poison ivy, sore throats and infections of the respiratory system or urinary tract can all be treated at MinuteClinic. In fact, MinuteClinic can treat more than 125 different conditions in patients above 18 months of age.

Patient Out-of-Pocket Costs Per Visit*

URI: Upper Respiratory Infection

Receiving care at MinuteClinic can reduce the cost by as much as 90 percent

Patient Out-of-Pocket Costs Per Visit*

URI: Upper Respiratory Infection

 
Receiving care at MinuteClinic can reduce the cost by as much as 90 percent

Helping plan members and plans avoid unnecessary ER visits remains a part of CVS Health’s vision for building a better, more affordable health care system. MinuteClinic, with 1,100 locations in 33 states and the District of Columbia, offers care seven days a week, including times when many physician offices are closed. Most services at MinuteClinic cost approximately $100. A visit to MinuteClinic — as opposed to an urgent care center or hospital emergency department — costs as much as 90 percent less.

Increasing member awareness of MinuteClinic, its hours and capabilities, can help reduce avoidable ER visits. In a pilot study, members living near MinuteClinic who received direct mail about the clinic’s capabilities and hours decreased their use of the ER significantly.

MinuteClinic Provides Complementary Care

Especially for patients with chronic medical conditions, continuity and consistency of care is critical. Care at MinuteClinic is intended to complement the care of the member’s primary care provider (PCP), when they have one. With the member’s permission, a visit summary can be shared electronically, or by fax or mail, with the PCP. MinuteClinic shares millions of electronic health records with patients’ other clinicians every year to help ensure that transfers in care are seamless. Epic, the most widely used electronic health record system is used at all MinuteClinics. In addition, our electronic health records connect with many other systems, including health plans and other health care-related organizations, as well as to most of the 70+ major health systems affiliated with MinuteClinic.

Thirty to 50 percent of MinuteClinic users report that they don’t have a PCP. Life circumstances can make it difficult to establish a relationship with a PCP. In some areas access to care is limited and patients can face a two-to-three month wait for an initial consultation with a PCP. For patients without an established physician relationship, MinuteClinics can evaluate health concerns, provide treatment and guide them to a PCP. This includes newly diagnosed chronic diseases. In the past year MinuteClinic providers diagnosed diabetes and hypertension in nearly 3,000 patients. These patients received initial evaluations (including laboratory tests), began treatment where indicated, and were guided to establish care at primary care practices.

Expanding Services and Convenience

The scope of services at MinuteClinic continues to grow. In 2017, we launched diagnostic and treatment services for sexually transmitted infections and expanded services for chronic conditions. We now also offer MinuteClinic Video Visits, a new, virtual health care offering for patients with minor illnesses and injuries, skin conditions, and other wellness needs, available to patients 24 hours a day, seven days a week. The service is currently available in nine states: Arizona, California, Florida, Idaho, Maine, Maryland, Mississippi, New Hampshire and Virginia – and Washington D.C.

Efforts to improve the patient experience are also underway. Digital tools allow a patient to check current wait times and to schedule an appointment online. Updated kiosk check-in technology enables quicker and more seamless registration.

CVS Health will continue to develop MinuteClinic as an integral part of our vision of a better, more affordable, and easier-to-use health care system, one that helps to serve the needs and meet the goals of payors and members both.

Want to learn more about how MinuteClinic could help reduce your plan’s total cost of care? Ask Us
BRIEFING
August 7, 2018
Senior Vice President, Chief Medical Officer, CVS MinuteClinic
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*Retail clinic visits increase despite use lagging among individually insured Americans: “The Health of America Report” Blue Cross, Blue Shield Blue Health January 2017. Wong, Charlene et al. The Use and Out-of-Pocket Costs of Urgent Care Clinics and Retail-Based Clinics by Adolescents and Young Adults Compared to Children. Journal of Adolescent Health, 60 (2017), 107-112.

**Yongming Zhao, PhD, et al,. Leveraging pharmacy retail clinic proximity and predictive models to reduce non-urgent emergency department utilization Humana, Inc. at American Pharmacists Association Annual Meeting& Exposition, San Francisco, CA, March 24-27, 2017.

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