The new GOP leadership’s plans to repeal the Affordable Care Act and significantly alter Medicaid funding present both opportunities and threats for retail clinics.
On one hand, confiscating coverage from newly insured residents by eliminating subsidy support could create a critical gap in care that could make no-insurance-necessary walk-in clinics something of a necessity. That’s because under the ACA, many previously uninsured residents sought medical treatments for the first time, including for conditions they didn’t know they had. Even if these individuals never considered retail clinics prior to the ACA (when clinic utilization was much lower), it is conceivable many would seek out affordable, accessible means like retail clinics to continue their access to prescription drugs and medical care. This theory is underpinned by retail clinics’ dedication to chronic disease management and preventive care.
GOP President Donald Trump’s potential move to block grants for Medicaid could further increase the utilization of retail clinics, given that limited funding could force states to drive Medicaid patients to the cheapest points of care. Some states, like Tennessee, long ago indicated their interest in using retail clinics to drive down unnecessary emergency visits. Telemedicine, alongside retail clinic utilization, is likely to help address patients with low-acuity needs.
On the other hand, a recently released report by the Blue Cross Blue Shield Association shows most growth in retail clinic utilization over the past five years came from individuals in employer-sponsored plans, rather than individuals who selected marketplace plans on or off the exchange. This suggests that employer coverage, potentially due to cost-sharing structures or embedded incentives, plays a large role in funneling patients to a retail clinic rather than the ER. Trump’s potential repeal of the employer mandate could therefore spell reduced utilization of retail clinics among this group of employees.
To be sure, retail clinic utilization is not on the downswing and will not be any time soon. What we could see is the continued outsourcing of existing clinic space to hospitals and health systems who want to expand their footprints and improve population health. Many existing hospital-retail partnerships, after all, do not effectively collect data and track quality metrics as intended. Owning and operating clinics, rather than merely affiliating with clinics, could facilitate the more “patient-centered” types of relationships between providers and patients that new payment models, under MACRA, espouse.
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