Do Retail Clinics Save Money?

This month's Health Affairs carries a number of thought-provoking articles -- more on this in coming posts. An article from Minnesota's Health Partners suggests that the insurer's contract with Minute Clinic did improve patient access - but didn't save any money on a risk-adjusted basis. This study was done using "episode treatment groups" for five acute episodes - which made up over 3/4 of Minute Clinic visits. Minute Clinic provided only a bit over 3% of the care in these episodes.

How could that be? Minute Clinics charge so much less per visit -- shouldn't they save money?

There are a few hypotheses. It's possible that many patients receiving care at Minute Clinics would otherwise have waited and thus a lower price is still more costly than NO cost to the health care system. This study would likely have missed this - as episodes are only triggered when patients seek care. In any event, overall Health Partners cost for these types of episodes increased - and most of this was driven by cost per unit rather than the number of episodes. The author also states that other providers could have raised their prices to account for the lost business.

Finally, although the press coverage trumpets "no cost savings," the actual article is more nuanced. In fact, the mean costs for episodes at Minute Clinics were substantially lower - but this was washed away by risk adjustment. Another piece of good news - physicians in Massachusetts have worried that pharmacy-associated nurse practitioners will prescribe antibiotics in every case. Mean pharmacy costs were significantly  lower (not by many dollars) than pharmacy costs in physicians offices and urgent care facilities.