March 17, 2016; Chicago Tribune, Kaiser Health News and Boston Business Journal

The RAND Corporation and the Harvard Medical School just released a surprising report analyzing usage data of 1.3 million Aetna health insurance clients. The study concluded that retail clinics, predicted to relieve pressures on healthcare costs and generate needed savings to the U.S. healthcare system, could actually be moderately increasing costs to our system at a rate of $14 per person per year. There are, however, important questions tied to whether this recent report is comprehensive enough to warrant a firm conclusion on the effectiveness of these clinics.

Research pulled client records over a two-year period and analyzed eleven low-acuity conditions common to retail clinics. The findings, published in the March edition of Health Affairs, found that around 520,000 Aetna clients sought services at a retail clinic. These clinics, typically located at a big box retailer like Target, Walmart, or CVS, have been spreading across the healthcare landscape and are predicted to cover as many as 10.8 million visits a year and save $800 million in annual healthcare spending.

Dr. Ateev Mehrotra, a co-author of the study, estimated that the cost of these visits would be $100 each in a typical clinic. Retail clinics provide these same services at 30 to 40 percent less than a physician’s office and at similar quality. This was predicted to create significant savings in what is a $5 billion low-acuity market.

The Aetna study drastically contradicted these estimates by concluding that those seeking services at the retail clinics actually spent slightly more for low-acuity services than the 60 percent of Aetna clients who did not seek healthcare services at a retail clinic. Researchers believed the most likely explanation was that the retail clinic users were seeking care they would not have sought had the clinic not been available. In other words, a patient with a minor symptom would seek advice at the retail clinic due to convenience and cost, while attending a physician clinic or going to the local hospital emergency room might have been too inconvenient and more expensive.

While the $2.9 trillion healthcare sector is currently at its first “slowdown” in growth in years, it still continues to rise at a rate above inflation and accounts for 17.4 percent of the U.S. economy. Debates can be heard across the public and private sector on waste costing the system billions of dollars a year. An area that could cost an average of $14 per person per year seems almost trivial; however, if the study is sound, an inability for these retail clinics to serve as a much-needed release valve to the cost pressures in the healthcare sector is significant and heartbreaking to advocates.

The president of the MinuteClinic unit at CVS, Dr. Andrew Sussman, called the study “flawed.” He said about half of MinuteClinic patients don’t have a regular family physician, and his clinics are able to prevent minor conditions from becoming major illnesses requiring costlier care. “It is a step backward to think of people who did not have a primary-care physician and get care as excess utilization.”

When looking at the larger system of care, several factors key to a true understanding of the clinics’ impact appear to be missing. The predictions of clinic savings focus on “downstream costs”—the long-term effects of having low-cost access, help with referrals, and early diagnoses. When the analysis is restricted to eleven low-acuity diagnoses and not the impact of wraparound services over time, the recent release does not appear to be quite comprehensive enough to determine the true savings to the healthcare system. The report also does not account for inpatient hospital data or medication costs. Without these additional data sets, the overall impact of visits and savings to the system cannot yet be concluded.

Retail clinics have expanded their scope to encompass areas like diabetes and hypertension and have identified themselves overall as key entrance points into the concept of the medical home model and referral sites. It is possible that the $14 in cost to the system could ultimately result in a return of significant savings—keeping residents from delaying medical attention (and ultimately finding themselves in the hospital) and helping those entering the system without access to a primary care home find appropriate care and support for chronic disease management.—Michelle Lemming