Retail clinic visits jump for BCBS plan members

As health insurers strive to lower costs by encouraging members to change their healthcare utilization behaviors, a new study from the Blue Cross Blue Shield Association offers a positive sign that these efforts may be bearing fruit.

Among commercially insured BCBS plan members, visits to retail clinics have nearly doubled in the past five years, from 12.2 visits per 1,000 members to 24 visits per 1,000 members, according to the study

Such clinics, the organization said, are a low-cost, comparable-quality alternative for traditional clinical settings that excel at treating simple, acute conditions such as bronchitis or flu. As many as 29.8% of emergency department visits could be handled at a retail clinic. Thus, health insurers now cover most retail clinic visits.

The rise in utilization of retail clinics, however, was not equally distributed among those with commercial BCBS plans, the study found. For example, the rate at which women visited retail clinics was 72% higher than the rate for men in 2015.

In addition, uptake among individually insured members has “lagged” since the implementation of the Affordable Care Act, according to the BCBSA. From 2013 to 2015, the growth rate in retail clinic visits per 1,000 members in the individual market was only 2.6%, compared to a 15.5% growth rate in doctor’s office visits and 35.8% uptick in ED visits.

In 2015, there was also a 19% lower use of retail clinics among individually insured members compared to members with employer-based plans.

BCBS graphic
Source: Blue Cross Blue Shield Association
“Given this fact, greater education efforts targeting those new to health insurance may be warranted as a way to increase awareness of the relative convenience and services offered by retail clinics and to clarify insurance plans’ coverage of retail clinic visits,” Maureen Sullivan, chief strategy and innovation officer for BCBSA, said an in announcement.

However, a previous study that analyzed claims data from Aetna suggested that retail clinics may not be the cost-saving solution they are made out to be. It found that 58% of retail clinic visits for low-acuity conditions represented new utilization, compared to the 42% that were substitution for visits to other clinical settings.