Convenient options for treating minor health problems are an important new feature of the health care landscape. Ateev Mehrotra discusses these options and their implications for the medical marketplace.
What is the “convenience revolution?”
The “convenience revolution” refers to the rapid rise of new options for treating simple acute medical problems (or “low acuity” conditions), such as rashes, bronchitis, or urinary tract infections. Until recently, alternatives for care were limited. Patients could wait to see their primary care doctor, go to the emergency room, or stay home.
Now, patients have many more options, such as a consultation over the Internet, a nurse home visit, or a trip to an urgent care center or retail clinic (a health care site inside a major store such as Target or Wal-Mart). What these options have in common is convenience: patients can get care without appointments, even during evening and weekend hours. In some cases, they don’t have to leave home.
How much of the health care market is affected by the convenience revolution?
There are about 50 million visits annually for low acuity conditions. If we assume that these cost about $100 each, this represents a $5 billion annual market. While this is still a fairly small share of the overall health care market — less than 5 percent — the use of convenience care options is on the rise. For example, retail clinic visits increased four-fold between 2007 and 2009 and now account for almost 6 million annual visits, suggesting that the market could get bigger.
Why does this development represent such a big change?
These new care options challenge traditional health care delivery and business models. They point to a future in which growing numbers of patients may receive care outside traditional in-person visits in primary care offices.
In addition, unlike traditional providers, who mainly operate through not-for-profit organizations, many of these new care options are owned or operated by venture capital or large for-profit companies. These new options might suggest that in the future for-profit companies will increasingly compete in the health care industry.
What is driving the growth of these new options?
The popularity of these new options indicates that they fill an unmet market need. The main drivers for patients are, as I mentioned, convenience (shorter wait times, evening and weekend appointments, drop-in care) and competitive and transparent pricing. Pricing is increasingly important given that patients are paying for more care out of pocket. From the provider perspective, a key driver is the growing emphasis on clinical guidelines to address acute problems. These guidelines, combined with increasingly sophisticated health information technology, support the use of kiosks or e-visits that require no direct patient-clinician interaction.
Are there concerns about the growing use of these new treatment options?
Yes, there are several concerns. The main concern is whether the quality of care provided matches the quality provided by traditional clinicians. To date, there is little evidence to support this concern, but the evidence base is small. A second concern is that these new options could lead to more patients seeking unneeded care, which could drive up utilization and spending. Another concern is that these options can decrease continuity of care and increase fragmentation, which is important given the link between continuity and better outcomes. Finally, the loss of revenue from treating low-acuity conditions could increase financial pressures on primary care providers and emergency departments.
Where do you see the convenient care revolution heading?
The future of convenient care options depends largely on two issues. First, will they go beyond treating low-acuity conditions? There are some signs that this is already happening. Retail clinics have expanded into chronic illness care, some worksite clinics and urgent care centers offer complete primary care, and some e-visits offer specialty consultations.
The second issue: will convenient care options erode the patient base of existing primary care clinicians? Many health systems have begun to offer their own retail clinics, urgent care centers, or e-visits. The effect of these remains to be seen, but primary care providers may face a decline in demand if they do not offer a viable alternative to convenient care options.