Retail Clinic Use Nearly Doubles Among BCBS Members

January 23rd 2017
Lauren Santye, Assistant Editor
Lauren Santye, Assistant Editor

Nearly 30% of emergency department visits could be treated in retail clinics.

During the past 5 years, Blue Cross Blue Shield Association’s (BCBS) commercially insured members’ use of retail clinics has almost doubled, but despite this increase there are no signs of clinics reducing emergency department (ED) visits, according toLifeHealthPro.com.

The analysis was conducted by Health Intelligence Company LLC, a think tank affiliated with the Chicago-based BCBS, consisting of the review of medical claims data for approximately 60 million Blues plan enrollees.

The analysts only examined data on enrollees with individual or group commercial plan coverage, and claims submitted between 2011 through 2015. Only claims from health clinics at national chain retail stores, such as CVS or Walmart, were used. Claims from independent retail health clinics and preventive care visits were excluded.

The results of the study showed the retail health care visit rate at commercial Blues plans increased from 12.2 visits per 1000 enrollees in 2011 to 24 visits per 1000 enrollees in 2015.

Over the same period, the physician office minor condition visit rate dropped from 1123 per 1000 enrollees to 973 per 1000 enrollees, according toLifeHealthPro.com. Additionally, use of physician offices for all conditions increased from 3800 to 3835 per 1000 enrollees.

Admittance to EDs for minor condition did increase slightly during the same period.

Blues analysts believe the increase in ED use may be due in part to the rapid increase in the share of commercial coverage users with individual insurance in 2014,LifeHealthPro.comreported.

Individual coverage holders were less likely to use EDs than group plan enrollees; however, their use of both physician office visits and EDs has been on the rise.

Since 2011, the use of retail health clinics among group plan enrollees has been steadily increasing. For individual coverage holders, use of retail clinics rose from 2011 through 2013, dipped in 2014, then returned to close to 2013 levels in 2015, according toLifeHealthPro.com.

Group plan enrollees had 24.5 visits per 1000 enrollees in 2015, while individual coverage holders had 19.6 visits per 1000 enrollees.

The study showed a significant disparity between clinic use by BCBS members who purchased their insurance through an employer versus on the individual market, with 19% lower clinic usage among those who were individually insured.

The analysts suggest that one possible reason for the gap in retail clinic use might be due to a lack of individual coverage holder awareness of retail clinic options.

Related Content