The State of Convenient Care

Earlier this week, the Convenient Care Mini-Summit was held during the National Consumer Driven Healthcare Summit in Washington, DC. The Mini-Summit was sponsored by the Convenient Care Association. Speakers included: Tine Hansen-Turton, Executive Director, Convenient Care Association; Mary Kate Scott, President, Scott and Company; Chris Kersey, MD, Chief Business Development Officer and Chief Medical Officer, RediClinic; Ann Ritter, Policy Director, Convenient Care Association; Sarah Ratner, Senior Legal Counsel, MinuteClinic; and Brian Jones, Chairman and Chief Executive Officer, MedBasics.

Here's some key tidbits on what's going on in the Convenient Care sector that the faculty shared during the Mini-Summit:

• The first Convenient Care clinic opened in 2000, today there are 500 clinics operated by over 20 companies, and there may be as much as 700 clinics by the end of the year
• New facilities getting smaller - many around 220 square feet in size
• Health Plan formulary compliance has not a significant issue due to limited scope of services
• 30-35% of clinic patients represent a new Rx to the sponsoring Rx retailers
• Minute clinic has experienced 1 million cumulative visits with no malpractice cases. The lack of malpractice claims is at least partially due to the limited scope of services provided in a Convenient Care setting
• The target demographic, based on studies: the most typical Convenient Care consumer is female, the healthcare decision maker in their household, and a mom.
• BCBS Minnesota for example in their claims for Convenient Care found that 63% of patients were female and 48% under age 21
• The two big challenges facing Convenient Care are state regulations and proving the financial model. Regulation of the industry is fragmented on a state-by-state basis, with some states proactively welcoming the industry, while a few have hostile regulations that often don't apply to other types of providers. Problem regulation states cited included NY, CA, PA, and KY.
• A clinic system might have 85% fixed costs, with 100+ clinics needed for breakeven in a standard retail model
• A Hospital sponsored financial model is very different than the standard retail model

For any stakeholder interesting in Convenient Care Delivery, if they aren't already a member, they should consider joining the Convenient Care Association. More information about the Association can be obtained at their web site: www.convenientcareassociation.org , or by calling 215-731-7140

Health literacy: do we have the mantra right? (Part 1 of 2)

Health literacy: do we have the mantra right? (Part 1 of 2)

The Mantra

“Health literacy is increasing; consumers are becoming more sophisticated.”

This statement supports the textbook definition of health literacy: the ability to obtain and use health information and services. Unfortunately, patients’ motivation to (1) cultivate and (2) utilize that capacity is often missing from both the definition and reality.

In what other consumer behavior would we overlook the fact that action requires both motivation and capacity? Walk into any car dealership and you’ll see how quickly the salesperson assesses your motivation, as distinguished from your capacity to act!

The Gap

Unlike literacy in general, which has clear utility in daily life, there are significant disincentives for health literacy, e.g. the potential consequences of a bad choice, the effort of making it, etc. It is also relatively easy to choose not to exercise health literacy, whereas it would be difficult to choose not to read more generally. Moreover, a plethora of choices is a natural rationale for denial and shutting down.

We’ve all experienced some version of health care hell, in which decisions:

o Had to be made while in physical and/or emotional pain

o Were only supported by information that was either over-simplified, or in a foreign language

o Were clearly a “choice between evils” and/or offered less than even odds of the most favorable outcome

Thus, choice is often less about empowerment (the movement to redefine CDHC as “patient-empowered care” notwithstanding) than necessity and hope. Everyone who seeks to influence health behavior should consider daily that information-seeking, care-seeking and self-treatment each carries significant emotional, physical and economic (including opportunity) costs. Though making one’s own decisions with appropriate support may be better than the alternatives, it is not the pain-free, no-muss event too often portrayed.

So the circular incentive presented for exercising health literacy (“take charge of your health”) may be less than persuasive when it comes to action. For many, including the uninsured, that directive entails time and/or money they don’t think they have, and/or appears to be a code word for increasing OOP costs.

With great power comes great responsibility. Health literacy can increase both, yet, often, neither is desired.

Next, some thoughts on alleviating the huge burden of health decision-making. Please leave a comment (with a URL if appropriate) to let everyone know what your organization is thinking and doing, as well.