1. Convenient Care Clinics: Meeting a Need for Accessibility, Affordability, and Quality Tine Hansen-Turton, MGA, JD, FCPP, FAAN June 18, 2012

2. Limited access to routine and preventive care. Millions of consumers do not have an established physician relationship or health insurance. Healthcare costs are rising at unsustainable rates. Consumers are increasingly pressed for time and are demanding convenience. Access will worsen with the provider shortage, and ACA implementation resulting in ~32 million more insured. Healthcare Access is in Crisis

3. Disruptive Innovation at Work Affordability Quality Accessibility

4. Convenient Care Clinics (CCCs) are: Small health care facilities Located in high-traffic retail outlets with pharmacies Ownership includes retailers, health systems, corporations, FQHCs Usually staffed by certified nurse practitioners or physician assistants, with local physician collaboration Focused scope of services What Are CCCs?

5. CCC Services Work with patients from 18 months through 65+ Acute care Immunization Wellness/preventative services School, camp and sports physicals EpiPen Instruction and Prescription Physical assessments/diagnostic encounters (need specific but general data here) 20-40 patients/day Strep testing Urine analysis Influenza A and B testing TB/PPD testing Chronic disease detection and management A1C hemoglobin/blood glucose testing Hypertension analysis Spirometry screenings Nebulizer treatments Injection services Education and wellness Smoking Cessation Weight Management Diabetes Education Prescribe medications when necessary

6. Introduction to the CCA Founded in 2006, we are the national trade organization representing the convenient care industry. Our membership includes 95%+ of all clinics in operation. CCA membership is diverse, representing many companies, health systems, and others around the country.

7. Where We Started At our founding ~150 clinics open. Concept was very novel. Clinics were mostly cash-only, offered a very limited scope of services, and were nearly all operated or owned by corporations. Many questioned the viability and legitimacy of the model. Strong early opposition from physician organizations.

8. Where We Are Today More than 1,350 clinics nationally and growing. Greater acceptance publicly and support for an emphasis on patient-centered care. More partnerships with traditional healthcare providers and practices as well as other stakeholders. Many health systems now operate clinics, largely due to perceived benefits of the relationship in supplementing and extending existing care (RAND 2010). Scope of services is growing with an eye towards disease prevention and chronic disease monitoring.

9. Non-Traditional Care Growing Nurse managed health centers run by nurse practitioners in underserved areas; offer full range of comprehensive primary care. Urgent care walk-in access and more affordable than emergency care; growing in numbers and use by patients. Telehealth variety of applications (in-home, over the computer, kiosk-based); very convenience-oriented; huge potential for rural access.

10. Health Reform Opportunities Access points for ~32 million more insured. Integrating EHRs to streamline care. Being included in medical home/accountable care organization concepts as alternative/complimentary delivery sites. National focus on preventive and wellness focused healthcare. Retail clinics engage in creative partnerships (employers, community health centers, private sector, payors). Potential cost-savings mechanism (PricewaterhouseCoopers 2012).

11. What The Research Shows Clinics are good for access 7 days a week, no appointments. Clinics are good for cost less costly than primary care, urgent care and emergency care; accept most insurance. Clinics are good for quality meeting and exceeding quality metrics and evidence- based protocol adherence.

12. Industry Growth The industry is in an expansion phase. Scope of services is growing with an eye towards disease prevention and chronic disease monitoring. More hospitals and health systems now operate clinics than non-hospital companies, though the majority of individual clinics are still operated by non-hospital companies. Growth among hospitals is largely due to perceived benefits of the relationship in supplementing and extending existing care. (RAND, 2010).

13. Thank you! Tine Hansen-Turton, MGA, JD, FCPP, FAAN Executive Director Convenient Care Association Tine@ccaclinics.org (215) 731-7140