True convenience for patients requires an integrated care system

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Retail clinic use has surged in recent years, exceeding that of urgent care centers, primary care practices and even emergency rooms. Consumers flocked to these clinics, which are often located in big-box stores, because they addressed a complaint long expressed by patients about traditional primary care: inconvenience.

However, convenience often comes at a hidden cost. The services provided at a retail clinic may seem expedient initially, but they often require a larger time investment later for anyone with complex or chronic health conditions not adequately addressed in a one-off visit that may require specialist care. As a result, patients may end up in emergency rooms or urgent care centers, or skipping care altogether. None of these options are patient-centered or cost-effective.

Amid health care industry upheaval and consolidation, how can health care systems meet this critical consumer need for convenience while also providing quality care? The answer lies in moving to integrated, value-based health care. Prepaid, value-based care, led by physicians and integrated with health care coverage, emphasizes and rewards healthy outcomes while making care more affordable. Such models embrace medical evidence, strive to reduce the burden of chronic disease, and foster collaboration among physicians, specialists and other medical professionals.

Ramin-Davidoff, MD
_{© Kaiser Permanente}

Value-based health care organizations often invest early in modern technologies to improve care delivery. For example, Kaiser Permanente decades ago invested in electronic medical records, which provide more accurate, up-to-date information about patients and enable more coordinated, efficient care. When patients visit a retail clinic that is part of an integrated health care system, their medical information is captured in an electronic system that links it to their medical records. In Southern California, Kaiser Permanente provides care at 35 Target Clinics. These clinics connect to an electronic medical record system that provides a comprehensive view of patients’ medical history and medications to all clinicians who treat them. A broad digital vantage point enables clinicians to look beyond the obvious to achieve better care. What may appear to be a simple urinary tract infection could be bladder cancer, and having all of a patient’s history at your fingertips can make all the difference.

Return rates to primary and urgent care after a visit to a Target Clinic are just slightly higher than that of adult primary care, which demonstrates that the clinics are resolving most patient problems effectively. That fact alone suggests we are expanding health care capacity for the whole health system. In addition, some of these clinics are located in what are known as care deserts — areas whose populations have inadequate access to health care.

Because physicians working in value-based care systems are accountable for the quality, equity and cost of care they provide, they have relationships with specialists and can coordinate next steps for patient care, which is especially important for patients with complex or chronic conditions. Clinicians at Kaiser Permanente — whether working in a medical center or a retail clinic — can also often access specialty care in real time. For example, a clinician who sees a patient with a mole can easily have a photo taken of it and then immediately send that image to a dermatologist who can determine quickly whether it is benign or requires further investigation. Similarly, a clinician or care team member may put a patient with food insecurity in touch with a national online community resource directory to connect them to available services.

Value-based care makes every interaction with the health care system an opportunity to assess the total health and well-being of an individual, regardless of where a patient receives care — in a retail clinic, hospital or medical office, or via video, phone or online chat. Coordination across the system helps ensure that care teams keep an eye out for potential care gaps. For instance, an optometrist may remind a patient that she is overdue for a mammogram. The patient experiences a seamless continuum of care that addresses both her acute and preventive needs requiring minimal effort on her part. Unfortunately, most patients do not have access to this type of fully integrated experience often enough even though it is more convenient, higher quality and often more cost-effective.

In short, while the Target Clinics in Southern California are open to everyone, Kaiser Permanente members have the added benefit of an integrated care experience. Members can make appointments through the organization’s online portal, and staff in medical centers can schedule appointments for members in Target Clinics.

However, partnerships such as the one between Target and Kaiser Permanente “are rare and, in general, have only scratched the surface of their potential,” as academics from Harvard Business School and the University of North Carolina have noted.

The fact is that high-quality, seamless medical care and convenience can coexist, and patients, who are also consumers, should not have to sacrifice one for the other.

Ramin Davidoff, MD, is executive medical director and board chair of the Southern California Permanente Medical Group; board chair and CEO of The Southeast Permanente Medical Group; board chair and CEO of The Hawaii Permanente Medical Group; and co-CEO of The Permanente Federation.