Insurers to cover drugstore clinic visits
Copayments to be lower than for hospital ER care; CVS, Walgreens may become major providers
Some of the state's largest health insurers say they will cover visits to the retail health clinics expected to open in CVS and Walgreens drugstores later this year, making the clinics attractive options for the treatment of everyday ailments.
Harvard Pilgrim Health Care and Tufts Health Plan have signed contracts with CVS Caremark, the Woonsocket, R.I., company that operates more than 6,000 pharmacies nationwide. The chain plans to open as many as 28 MinuteClinics in its Massachusetts stores this year and 100 statewide within five years. CVS also is negotiating coverage for clinic services with Blue Cross and Blue Shield of Massachusetts, the state's largest insurer. Together, the insurers have nearly 5 million members.
The endorsement by insurers is likely to turn retail clinics into major healthcare providers in the state because, for many patients, they will be less expensive than hospital emergency rooms, with less waiting time. Under the contracts signed and being negotiated, retail clinic copayments range from $10 to $25, compared with the $50 to $150 copays most insurers assess for emergency room care.
In addition to its talks with CVS, Blue Cross-Blue Shield is negotiating with Take Care Health Systems, the medical clinic subsidiary of Walgreen Co. of Deerfield, Ill., which plans to open in-store clinics in Massachusetts this fall. Tufts Health Plan is considering extending coverage for the Take Care clinics, as well, and Fallon Community Health Plan said it is negotiating to give its members coverage for retail clinic care, but didn't specify at which clinics.
"We have already contracted with some insurers and are in final stages of discussions with others," said Carolyn Castel, a spokeswoman for CVS Caremark. "We see all of these negotiations moving positively."
Retail clinics in Massachusetts will feature weekend and evening hours. Services will include vaccinations and treatment of common ailments such as ear infections, poison ivy, and minor burns. Without insurance, prices range from $59 to $69 at CVS's MinuteClinics, and from $59 to $74 at Walgreen clinics.
Major insurers provide coverage for treatment at MinuteClinics in all 25 states where they operate, according to CVS.
The state's powerful physicians' group, the Massachusetts Medical Society, opposed the clinics when they were proposed by CVS last year, saying they raised concerns about safety, oversight of caregivers, and spread of germs. Dr. Bruce Auerbach, president of the medical society, said yesterday the physicians organization still believes patients are "best served" by doctors in primary care practices, which provide "comprehensive care that is continuous and not fragmented."
Boston Mayor Thomas M. Menino has decried the notion of retailers profiting from illness and said clinics would "jeopardize patient safety."
But despite the medical establishment's objections, the state Public Health Council in January approved the MinuteClinic plan, saying expanding access to healthcare outweighed concerns about patients using the clinics as a substitute for an ongoing relationship with a physician.The oversight and safety issues raised by the medical society have been addressed by new state regulations that govern how the clinics are run.
Dr. Neil Minkoff, Harvard Pilgrim's medical director of network medical management, said the need for the retail clinics is especially intense in Massachusetts, where there is a shortage of primary care physicians.
"We're helping our members get access into a medical system and reduce inappropriate use of the hospital emergency room," he said. "We believe that contracting with MinuteClinic will allow for some reasonably simple, high-volume care to occur in this different setting. Right now, this stuff is unnecessarily clogging up emergency rooms."
Minkoff added, "What's really driving this is that the cost of care performed in a retail setting is significantly lower than when it is done in an emergency room."
Paul Dreyer, director of healthcare safety and quality at the Department of Public Health, said he expects licenses for the clinics to be granted in the fall.
While the clinics could ease crowding at hospital emergency rooms, a significant shift of patients away from emergency rooms could also hurt community hospitals that are strapped for cash and depend on steady revenue from emergency visits.
Lynn Nicholas, chief executive of the Massachusetts Hospital Association, said she still supports the retail clinics.
"Given the shortage of access to primary care, this can only be a good thing in the long run," Nicholas said.
CVS now operates about 500 MinuteClinics. The closest ones are in Connecticut. Walgreen has 189 Take Care clinics in 14 states. The clinics proposed by both chains for Massachusetts are typically staffed by nurse practitioners, registered nurses with advanced degrees who are trained to diagnose and treat common conditions and perform many of the same functions as physicians. The nurses can prescribe medications for the uncomplicated ailments treated at the clinics. If they detect more serious conditions - such as heart attacks - the patients are sent to a doctor or emergency room. Nurse practitioners also will have telephone access to doctors who can provide immediate advice.
"We want to make sure our members get access to simple care when they need it in the evening and on weekends," said Dr. Allen Hinkle, chief medical officer for Tufts Health Plan. "We'll save money, and the member saves money because the copayment for an emergency room visit is much higher."
Hinkle said Tufts has reviewed the track record of retail clinics in Minnesota, where they have been long established, and was satisfied that patients sought care at clinics for the proper type of ailments.
Lauren Tierney, a spokeswoman for Take Care Health System, said its clinics help ease some of the burden on primary care physicians by treating simpler cases. In addition, she said,
Take Care nurses and consulting doctors have contacts in the communities they serve and can refer patients to primary care physicians who have room in their practices for additional patients.
"About 30 percent of the patients we see don't have a primary care physician," she said. "Our goal is to connect them with the system."
Stephen Smith of the Globe staff contributed to this report.
Jeffrey Krasner can be reached at krasner@globe.com.
