Massachusetts Insurers To Cover Retail Clinic Visits

Main Category: Health Insurance / Medical Insurance
Also Included In: Primary Care / General Practice
Article Date: 28 Jul 2008 - 10:00 PDT

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Harvard Pilgrim Health Care and Tufts Health Plan have signed contracts with CVS Caremark to cover member visits to the company's retail clinics in Massachusetts, the AP/Boston Herald reports (AP/Boston Herald, 7/24). Under the contracts, copayments for visits to the clinics -- which typically cost between $59 and $69 --will range from $10 to $25, compared with usual emergency department copays of $59 to $150. The clinics offer services that include vaccinations and treatment of common illnesses, such as ear infections, poison ivy and minor burns.

Tufts Health Plan is also considering covering member visits to Walgreen subsidiary Take Care Health Systems' clinics. According to the Boston Globe, the "endorsements by insurers [are] likely to turn retail clinics into major health care providers in the state" because they will offer lower prices and shorter wait times than EDs. The Massachusetts Medical Society disapproves of the clinics because of concerns regarding safety, oversight of caregivers and spread of germs. However, the state Public Health Council in January approved CVS Caremark's MinuteClinic plan, saying expanded access to care outweighed concerns about patients using the clinics as a substitute for regular physician visits.

Neil Minkoff, Harvard Pilgrim medical director of network medical management, said, "We're helping our members get access into a medical system and reduce inappropriate use of the hospital emergency room," adding, "We believe that contracting with MinuteClinic will allow for some reasonably simple high-volume care to occur in this different setting." Tufts Health Chief Medical Officer Allen Hinkle said, "We want to make sure our members get access to simple care when they need it," adding, "We'll save money, and the member saves money."

CVS Caremark plans to open as many as 28 MinuteClinic retail clinics in its Massachusetts stores this year and 100 within five years. Blue Cross and Blue Shield of Massachusetts also is negotiating with CVS Caremark and Take Care (Boston Globe, 7/24).

Retail Clinics Decreasing Nationwide
The number of retail clinics nationwide last month decreased by 12, from 981 to 969, likely because of the economic downturn and concerns from private investment companies, according to a recent report from Merchant Medicine, a research and consulting firm that has tracked the growth of the industry for the past two years, the Chicago Tribune reports.

During the last few years, hundreds of retail clinics -- low-cost, walk-in facilities often located in supermarkets, pharmacies and large retail stores -- have opened nationwide. Last year, retail clinics opened at a rate of about one daily, according to Merchant Medicine. Merchant Medicine CEO Tom Charland said that last month marked the first in which "we saw a net drop" in the number of retail clinics.

Health insurers, employers and consumers groups support retail clinics as part of an effort to improve access to care, and many consumers use the facilities. However, "financial backers can be key" to whether retail clinics remain open, as facilities that have "failed tend to be backed by private backers who partner with large retailers," the Tribune reports. Charland said, "The big ones that have closed have been backed by private investors rather than those backed by large retailers," adding, "The track record of private investors and venture capital firms has been abysmal." According to the Tribune, "whether the recent credit crunch has anything to do with private-equity backers pulling the plug" on retail clinics remains undetermined, but "analysts say that could be a contributing factor" (Japsen, Chicago Tribune, 7/24).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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