Retail Clinics Offer Member Satisfaction, Savings for Payers

June 28, 2017 - At a time when many individual private and employer-based health plans include higher deductibles, retail clinics are becoming a popular option for beneficiaries seeking high quality care at a lower price point.

Payer partnerships with these growing networks of clinics based in grocery stores, retail pharmacies, and other convenient locations are producing high member satisfaction rates and accruing savings for payers, explained Michele Paige, Vice President and General Manager of Cigna Onsite Health to HealthPayerIntelligence.com.

“The goal of this healthcare delivery system is to meet the member where they are in their day to day lifestyle,” she said.

“What we have noticed is that more people are using and accessing lower cost care because a lot of people have high deductible plans, and they really need to watch their healthcare dollars,” said Paige.   

The rise in retail clinics is an emerging opportunity for growth, Cigna says, as it represents a new way to connect with patients, get involved in population health management, and potentially cut spending from higher-cost settings like the emergency room.

READ MORE: Cigna, CVS MinuteClinics Partner for Expanded Healthcare Access

For Cigna, a recent partnership with CVS Health and their in-store Minute Clinics was a logical fit.  The collaboration provides members with convenient access at CVS’s multiple retail locations while also allowing them to utilize the co-located pharmacy and purchase additional health-related products.  

“A consumer-centric connected care experience is all about thinking through what that person's path is going to be as they’re utilizing a convenience care store,” said Paige. “What transactions are they going to have? Are they going to pick up something and grab a birthday card? Are they going there to fill a prescription and then grab some Advil?”

“We’re really looking to think about that person's experience and how their health plan can help support it end-to-end. Retail clinics turn healthcare into a one-stop shopping model.”

Cigna’s focus on retail clinics complements its interest in health clinics located on-site at employer campuses, allowing employees to access care while on the job.

Beyond offering preventive care and coaching, many employer-located health centers offer full-time primary care practices, or site-specific specialists.  Some on site health centers also focus on acute episodic care as well as wellness and preventive services.     

READ MORE: Healthcare Payers’ Top 5 Areas of Advancement, Opportunity

“The Cigna employer-located health and wellness health centers are not only designed to get out prepackaged generic medications as part of a routine visit, but also about giving members a holistic experience where their health plan is integrated,” said Paige.  

This includes aligning employer-based routine care clinics with company-wide preventive health initiatives, such as wellness incentive programs and coaching.  

Cigna has its own on-site health center at its headquarters in Bloomfield, Connecticut, said Paige. Employees can receive care for everything from a sore throat or headache to a routine checkup or biometric screening.

Cigna employee Joe Monday uses the onsite health clinic to visit a health coach as well as his primary care physician (PCP).   Monday has noticed the streamlined, interconnected delivery approach has allowed him to maximize the effectiveness of his health insurance coverage.  

“Typically, an out-of-network doctor can’t answer questions about what my plan covers, because he’s dealing with a lot of plans and doesn't know things specific to my plan like the physician at the onsite clinic does,” he said.

READ MORE: Healthcare Spending Growing at Slower Than Expected Rate

Providers at retail clinics also try to offer a personalized experience, and will work with patients to foster relationships with primary care providers if they do not have one already.

“The provider at a Minute Clinic can see on the patient’s profile screen that she does not have a PCP,” explained Paige.  “They will be able to see a list of local doctors so they can refer the patient to someone they can form a relationship with.”

“If this individual is eligible for other health improvement programs under Cigna, we can let them know about that, too,” she continued.  “That’s the sort of concierge experience a member would have at the onsite clinic, where the providers know everything about you and benefits, because they’re versed in your employer’s benefit package.”

Retail clinics and many on-site employer locations aren’t intended to be substitutes for a robust relationship with a primary care provider, Paige added. 

“Payer integration into these locations gives us the ability to direct members to additional in-network resources,” she said.  “The care experience becomes a very synergistic and complementary extension of the health plan.  We can offer a very convenient and relevant experience that doesn’t require the member to do all the work.”

Retail clinics have been making a point to equip themselves with technology that can further these efforts.  Many have adopted top-shelf electronic health record (EHR) systems from recognizable brands such as Epic Systems, giving them the same access to patient data as any other full-fledged provider location.

If a member visits a retail clinic or on-site employer location, but needs to see a specialist or PCP, information about their visit can be sent over to those partners electronically.

“Sharing that visit summary back with the PCP is really critical for enabling the PCP to understand what’s happening,” explains Paige.  “It helps the providers to stay in the loop and have that continuity of care that’s so important to patients.”

For payers, the benefits are also financial. 

“We absolutely see fewer emergency room and fewer urgent care visits,” stated Paige. 

“What we can do with connected care is enhance that ability to get people to the right level of care at the right cost, driving affordability for our clients.”

Cigna sees a bright future for the growth of convenient care.  

“We will be learning and measuring the impact connected care has across the board, and really understanding the right levers to help consumers use their benefits in a more optimal way,” said Paige.

“The idea of integrating a health plan experience into all the places that consumers access care is definitely the trend that we’re working towards.  We are going to need to engage in a lot of collaboration in order to change healthcare for the better and create a much more complementary ecosystem.”