Improving Access for Chronic Care Needs and Supporting Primary CareFriday, July 27, 2012
Through its MinuteClinic, CVS Caremark now offers people with diabetes (PWD) a convenient way to get check-ups, diagnostic testing, and general overall health updates on their conditions. These retail medical clinics offer a supporting role to primary care helping where needed, and giving PWD the ability to walk-in and be treated during hours flexible for their needs.
By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net
Back in 2000, CVS Caremark opened its first MinuteClinic locations in the U.S. These clinics, located inside CVS/pharmacy stores were developed to respond to patient demand for at-need medical care. These retail clinics gave people a convenient, walk-in option to address acute family illnesses such as ear, nose, and throat infections, sprains, and minor skin wounds.
And since its inception, MinuteClinic has grown to more than 600 locations in 25 states and Washington, DC. MinuteClinic has now generated over 12 million patient visits, and has a 95 percent patient satisfaction rating.
With the growing prevalence of chronic diseases like diabetes, MinuteClinic saw a need to address such illnesses and decided to expand its services into the chronic care continuum, according to MinuteClinic Chief Medical Officer Nancy Gagliano, MD.
Dr. Gagliano (pictured, lower right) believes MinuteClinic can help PWD conveniently stay on top of their chronic conditions aiding them in a number of ways including giving them access to testing, examining current pharmaceutical regimens, and offering medical advice.
And within a backdrop of a new federally mandated healthcare law, the medical care environment will likely change in the next few years. This may include primary care physicians (PCP) taking on more patients in already busy practices. Thus, Dr. Gagliano sees MinuteClinic playing a supportive role for PCPs.
DiabetesCare.net talked with Dr. Gagliano about how MinuteClinic can serve PWD, the company’s philosophy as it relates to primary care, and plans for growth of these clinics.
DiabetesCare.net: Can you provide an overview of what Minute Clinic is?
Gagliano: We provide care on a walk-in basis, seven days a week including evenings. The care is provided by nurse practitioners and physician assistants. All of the MinuteClinic practitioners have a collaborating physician in their region to call upon for any questions.
We use a standard electronic medical record, so if you had your A1c checked in New Jersey, it would be available in any of our other locations all across the U.S. In the record, we have our care protocol template, so the care we provide is consistent.
In the early years of MinuteClinic we primarily focused on minor illnesses, flus, colds, or coughs, bug bites and minor injuries like ankle sprains. Over the last few years, we have expanded into wellness and chronic care.
DiabetesCare.net: How do Minute Clinics differ from primary care clinics?
Gagliano: From a philosophic standpoint, we firmly believe in the medical home model. We are not trying to become primary care, we are trying to help support primary care. I was a primary care provider for 21 years myself, and most of the leaders of MinuteClinic are clinicians.
One of the things I found in my practice was that for the patients that had easy access to me, I was a good resource and I was able to take care of them. What I didn’t appreciate at that time was that for patients to get to the doctor, it takes a large chunk of time to accomplish, especially during the week when people have to work. For some patients, this time crunch alone makes it difficult for people to take care of themselves.
By providing access out in the community and helping to supplement and support primary care practitioners, we see it as a nice fit. We are certainly not trying to take over the PCP field; we are trying to be in the medical neighborhood of the office of the PCP.
Everyone should have their PCP, but there are some things that don’t necessarily require the expertise of the physician. Having easy access is the key for us, and making sure we are connected with the primary care physician. For example, for any patient who comes to MinuteClinic and has a PCP, we send the visit summary to their primary care practitioner—with the patient’s permission. For those patients who come to Minute Clinic and don’t have a primary care practitioner, at the end of their visit, we print out a listing of local physicians, and we encourage these patients to develop a relationship with a PCP.
And in addition, over the last three years or so MinuteClinic has put a lot of emphasis on community relationships. We now have 19 healthcare affiliations across the country with reciprocating record-sharing across the country.
For example, we are affiliated with the Cleveland Clinic in Ohio, and we have integrated our patient records with them. So, if a patient of the Cleveland Clinic comes in to see one of our practitioners, we can pull the patient’s record to see what type of allergies the patient might have, what medicines the patient is taking, and the MinuteClinic visit summary goes directly into the patient’s overall record, so the Cleveland Clinic can access this information as well.
It is a bi-directional record, so our providers can access the Cleveland Clinic, and their physicians can access our visit summaries.
This is a big way in which we can support practices and patients with chronic illnesses. At one point, approximately 40 percent of our adult patients when they came in, their blood pressure (BP) was elevated. We started to think, what a great way to make a difference in a community.
Even in situations when people are coming into MinuteClinic for other concerns, it is a great opportunity for us to gather them in a medical safety net. We might see them for a sore throat and we uncover the fact that their blood pressure is elevated. We can then inquire further about their BP and ask them about medicines. We can ask them to consider coming back in a week to check them when it is convenient for them to stop in. And if in the following week their blood pressure is still elevated, we can then get them reconnected with their PCP. We want to be an easy access point to enhance the care in chronic illnesses.
For a person with diabetes, they should be getting their A1c checked four times a year. And we know, generally speaking, there are many who are not being compliant with their testing or their care. As a PCP, I was very much focused on medication, and asking about specific symptoms, and not always able to spend as much time as I would have liked focusing on diabetes education.
Whereas, the nurse practitioners and physician assistants at our clinics can be a safety net to get the testing and lifestyle education to supplement their primary care visits.
DiabetesCare.net: MinuteClinic just recently wrapped up its free diabetes monitoring service campaign. Why did you decide to do the campaign?
Gagliano: Not everyone knows about MinuteClinic, and for those that do, they predominately think of it as an acute care, minor illness location. We want to raise awareness that there is the additional chronic care layer of services; therefore, by having this campaign, we can increase awareness, and we can try to reach the people who are not being seen by their PCP.
These people may not like to go to the doctor’s but have a family history of diabetes. We have had quite a few patients who stopped in who had not been taking care of their diabetes. Hopefully, in those cases, this gave them the motivation to follow-up with their PCPs.
DiabetesCare.net: How would you characterize the overall campaign and what you are doing in chronic care?
Gagliano: We are looking over the next few years to build our chronic care services. I look at diabetes, hypertension, and hyperlipidemia as conditions many people are not good about paying attention to or remaining compliant in their care.
Having campaigns are a way to raise community awareness that MinuteClinic can monitor their conditions, and get more people to start paying attention to them.
DiabetesCare.net: How is reimbursement handled?
Gagliano: Approximately, 85 percent of our visits are covered by insurance. These chronic care visits are considered a healthcare visit. In addition to offering A1C testing and taking their blood pressure, we can go over their medicines, review their risks for cardiovascular disease, and we can do a skin sensation test and urine test to check for proteins in the blood. It is just like a comprehensive visit you would get in a traditional primary care office.
DiabetesCare.net: As clinical medical care is evolving and innovative methods are being developed, does MinuteClinic want to step into a bigger primary care role in the near future?
Gagliano: I do believe our emphasis over the next five years will be to broaden the scope of services that we have, but being very focused in continuing in the primary care supportive role.
With the recent ruling by the Supreme Court upholding the federal healthcare mandate, we do anticipate millions more people will be covered with insurance who need care, and in addition, the primary care physician shortage will continue to grow. If we can leverage the scarce resources of the primary care provider by offering a chunk of those services for patients, that is in the best interest of everyone.
At this point, however, we are not looking to have the MinuteClinic center be the primary care medical center for the patient.
DiabetesCare.net: Does MinuteClinic have plans to continue to grow its number of clinics?
Gagliano: Absolutely. Last year we added 100 clinics, and this year we are adding another 100 clinics. Our plan is to continue to grow by at least 100 clinics a year for the next four to five years. We are aiming to have 1,000 clinics within the next few years.