Christopher Cheney, for HealthLeaders Media , January 13, 2015
Clinical affiliation deals between retail clinics and hospitals or health systems expand access to services, speed care, help control spending, and drive patient referrals.
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For hospitals and health systems, relationships with retail clinics are a relatively easy sell: They help boost patient volume for inpatient and outpatient services while effectively outsourcing basic healthcare services such as vaccinations.
|James Parobek, SVP of Operations
Texas Health Physicians Group
James Parobek, SVP of operations for Arlington, TX-based Texas Health Physicians Group, says affiliations between hospitals and retail clinics benefit both sides of the healthcare partnership and their patients.
“The clinical affiliation between Texas Health Resources and CVS MinuteClinic has created another access point to Texas Health for residents of the Dallas-Fort Worth metroplex. This allows patients to receive care at the appropriate place and price for minor illnesses that do not require care in an emergency room or urgent care center. Over time, we believe this will decrease some of the activity in the emergency room to allow truly emergent patients to be seen quicker,” Parobek says.
How Physicians Benefit
Plans to establish a clinical affiliation with MinuteClinic did raise concerns among some Texas Health doctors. “[They] were concerned they would lose patients to the MinuteClinics, and/or their patients would not see them for routine minor illnesses, resulting in a potential loss of income,” Parobek explains.
But individual physicians benefit from the clinical affiliation between Texas Health and MinuteClinic, he says. “For our Texas Health Physicians Group practices, this allows a patient to be seen quickly for episodic care when they may not be able to access their physician after-hours or on weekends.”
Texas Health Physicians Group leadership “needed to fully explain to physicians the objective of increasing access to Texas Health Resources,” he says. “We also emphasized to our physicians the benefits of this affiliation: the potential for referrals; the fact they won’t lose patients, as the vast majority of MinuteClinic patients do not have a physician; and the potential to supervise the [advanced practice registered nurses] and receive a stipend for doing so.”
“The primary care physicians in our group have seen a number of new patient referrals from the MinuteClinics.” And more than 30 primary care physicians receive a stipend for supervising APRNs working in the MinuteClinics.
The Benefits of Clinical Affiliation Deals
Retail clinic officials say the partnerships they are establishing with hospitals and health systems are win-win scenarios.
“In many of our markets, we have formal clinical affiliations,” says Eileen Myers, VP of affiliations and patient-centered strategies at Nashville, TN-based The Little Clinic. “Each clinical affiliation is unique as it takes into consideration the strengths and resources of The Little Clinic, the health system, and the needs of the community.”
The Little Clinic operates about 150 retail clinics in Indiana, Ohio, Arizona, Colorado, Georgia, Tennessee, Kentucky, Indiana, and Virginia.
“Sharing a healthcare market extends access to patients in need of care,” she says. “With our without a formal clinical affiliation, The Little Clinic provides the community with convenient, affordable and high-quality health and wellness care for the whole family. For businesses, this means we help control healthcare spend. Together with the health system in the community, we provide improved healthcare access to all levels of care.”
The Little Clinic focuses on the core business activity of retail clinics: “a limited scope of service,” Myers says.
“When we see patients who need a higher level of care, we first ask if they have a [primary care physician]. If so, we help the patient make an appointment with their physician. If they do not have a PCP, we have a list of nearby physicians and help the patient make an appointment.”
The Little Clinic is branching out into providing a wider spectrum of services in some markets, such as chronic care.
“Patients without a primary care provider will come to The Little Clinic with elevated blood pressure or elevated blood sugar. The patient’s finances, work schedule, and/or denial of their condition often keeps them from finding a doctor. But the patient agrees to be followed by the provider at The Little Clinic… who follows a protocol approved by the health system and consults with the physician at the health system as needed, Myers says.
Patients are sent to the health system for services outside the scope of the clinics’ capabilities, but are otherwise managed and monitored at The Little Clinic.
Greater Access to Care
Nancy Gagliano, MD, chief medical officer at Woonsocket, RI-based CVS Health’s MinuteClinic, says retail clinics are playing a key healthcare access role for thousands of patients.
“MinuteClinic provides critical access to patients for acute minor illnesses, vaccinations, and important wellness services such as smoking cessation and weight management,” she says.
“We provide much of this care on nights and weekends, when physicians are not available, and we provide the care in coordination with the primary care physicians that are affiliated with us by sending important visit notes” to physicians—directly into their electronic medical records system, if they have an EMR.
MinuteClinic has formed clinical affiliations with 49 hospitals and health systems across the country.
“They include large academic institutions such as the Cleveland Clinic, Emory Healthcare, Dartmouth-Hitchcock, Robert Wood Johnson and UCLA Health as well as smaller, community-based health systems such as Greenville Health System in South Carolina, Virtual Health in southern New Jersey, and The Baton Rouge Clinic,” Gagliano says.
“The collaborations include joint patient education initiatives and the integration of electronic medical records systems. In many markets, the collaborating physicians for our MinuteClinic practitioner teams are provided by the health system affiliate.”
Retail clinics have emerged as an essential slice of the continuum of care, she says.
“We really see no drawbacks. Hospitals and physicians are increasingly organized in accountable care organizations that benefit when costs are reduced and quality is improved. Health systems see us as an efficient alternative to more expensive emergency rooms and urgent care centers,” she says.
“Everyone benefits when we can work together to make healthcare more convenient, accessible, and affordable for patients.”
Making Market Relationships Work
Charles Lewis, executive director of emergency services and ambulatory care at St. Anthony’s Medical Center in St. Louis, says establishing gainful market relationships in a competitive market takes work.
St. Anthony’s not only shares its urban market with independent urgent care centers and retail clinics, but also operates four urgent care centers of its own.
“Whether it’s from retail clinics and urgent care centers, or other hospitals and health systems, there will always be competition to draw patients and clinicians. Those pressures will always exist. It’s up to us to use that competition to improve the care we provide for our community.”
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