Retail Clinics Save Money; Patient Centered Medical Home....Does Not (But Improves Quality)

Two studies about innovation in health care delivery were published in the last week.

An excellent study in the September 1 Annals of Internal Medicine examined 700 matched patients seen in retail clinics, physician offices, urgent care centers, and emergency departments who had ear infections, sore throats, and urinary tract infections.  The study showed that retail clinics were substantially less expensive ($110 total cost compared to $156-166 in urgent care and physician offices and $570 in emergency departments).  Three critical concerns about retail clinics are elegantly addressed in this study.

1) Rates of prescribing antibiotics was no higher in the retail clinics. Because these clinics are usually housed in pharmacies, some had worried that nurse practitioners would overprescribe.   This problem is in any event no worse than in conventional medical settings.

2) Quality appeared equivalent (using standardized RAND measures).

3) Patients were no LESS likely to have a preventive service in the following 90 days (and a bit more likely, not reaching statistical significance).  Some physicians have worried that retail clinics will disrupt continuity of care; this article refutes that concern.

This study covered three diagnoses that represent about half of all visits to retail clinics -- and the results are unequivocal.  Retail clinics, a "disruptive innovation" in health care delivery, save money with no sacrifice in quality or continuity.   

Reports on another innovation in health care delivery, the Patient Centered Medical Home, show improved quality with no increase in cost (but without the decrease in costs promised by advocates of patient centered medical homes.)  Group Health Cooperative designated one of its centers as a "patient centered medical home," and determined that compared to other centers, this center had
- Lower staff burnout
- Better patient satisfaction
- More specialist visits
- Fewer emergency department visits
- More web and telephonic visits
- Increased composite quality score
There was no substantial difference in cost of caring for patient; higher costs of primary and specialty care were about equivalent to savings in emergency department.

It's possible that this is a premature report -- we're only looking at a year of data.  This study was performed at Group Health Cooperative, an excellent and progressive group where the 19 control clinics were pretty advanced, and  showed large quality improvements during the study period.  However, GHC chose one of its best clinics as the trial site - so it's disappointing not to see any cost savings.   Reading the case, it's also clear just how much work and investment went into setting up this patient-centered medical home.

We need innovations in health care delivery. Retail clinics save money, with no significant loss of quality, and medical home improves quality without increased cost (but a lot of increased effort).  The hope is to define interventions that will raise quality and lower costs simultaneously.