News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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UnitedHealth Group’s MedExpress and Walgreens Boots Alliance Initiate Pilot Program to Put Urgent Care Centers in Walgreens Pharmacies

Clinical laboratories should prepare to receive test orders from these mini-medical centers, based on consumer demand for quick, inexpensive, local healthcare

Is the era of clinical laboratory testing offered in retail stores soon to arrive? Dark Daily as long as 10 years ago predicted that walk-in clinics featuring a nurse or nurse practitioner who could diagnose and prescribe for a limited number of health conditions—which had a remedy that could be purchased at the pharmacy in the retail store—would be the door-openers to locating more sophisticated clinical services in retail settings.

Since then, we’ve covered many such openings—including free standing urgent care clinics opening in urban settings to service the consumer demands of busy patients—which have impacted clinical laboratories and anatomic pathology groups in predictable ways.

Late last year, UnitedHealth Group’s MedExpress and Walgreens Boots Alliance (NASDAQ:WBA] announced a joint pilot program to open urgent care centers attached to Walgreens stores.

The premise of the collaboration was based around the belief that consumers would welcome the opportunity and benefits of receiving basic healthcare services in a facility located next to a pharmacy. The Walgreens/MedExpress agreement, however, also indicates that two of the largest healthcare organizations in the world believe consumers would also be interested in visiting physicians who provided more sophisticated medical services, including critical care, in retail settings.

To date, Walgreens has opened MedExpress clinics in 15 locations in six states, including: Minnesota, Nebraska, Nevada, Texas, Virginia, and West Virginia. More such clinics are expected to open this year as part of the collaboration.

“MedExpress is a resource for busy families and employers that need timely access to affordable, high-quality healthcare close to home and work,” Fred Hinz (above), VP of Operations at MedExpress told Drug Store News. “Being connected to Walgreens will enable our patients to receive quality care and purchase any other items they need, all in one trip.” It also will likely result in increased orders for clinical laboratory testing from retail locations. (Photo copyright: Grand Island Independent.)

Future Health System Delivers Critical Care from Retail Locations

Motivated by consumer demand for convenient, high-quality healthcare, the urgent care market in the United States continues to grow. This trend will eventually influence clinical laboratories and anatomic pathology groups seeking to service these providers. It will be a dynamic market as new participants and mergers compete for leverage in this profitable business.

“This is just part of developing an overall higher-performing local health system,” Forbes reported UnitedHealth CEO David Wichmann telling analysts during the company’s earning call last month. “It’d just be one component that may be nested inside a local care delivery market with ambulatory surgical capacities and house calls and things of that nature. This is the future health system that we see delivering considerable value to people.”

The speedy growth in the number of and profitability of urgent care centers is another confirmation that this healthcare trend has legs. And experts believe the growth will continue and accelerate.

A recent report by market research and consulting firm MarketsandMarkets (MnM) predicts the global urgent care market should reach $25.93 billion (US) by the year 2023. The current value of the industry is $20 billion. The growth rate for the industry is expected to be 5.3% with North America being the region accounting for the highest amount of that growth.

The MnM report attributes the rise in the urgent care market to many factors, including:

  • Growing investments in urgent care;
  • Strategic developments between urgent care providers and hospitals;
  • Access to affordable care;
  • Convenience of shorter wait times; and,
  • Increase in the geriatric population.

The report projects that the biggest hurdle facing the urgent care industry will be the lack of a skilled workforce.

Urgent Care a Growth Industry According to Experts

There are currently more than 7,500 urgent care facilities in the United States, according to an Urgent Care Association (UCA) white paper.

According to the UCA, the top six urgent care organizations in the US each have more than 100 locations. Those companies include:

A 2017 UCA benchmarking report states that only 3% of patients who are seen at an urgent care facility were diverted to an emergency room in 2016. The top diagnosis codes for visits during that year were:

  • Acute upper respiratory infection;
  • Unspecified acute sinusitis;
  • Acute pharyngitis;
  • Cough; and,
  • Fever.

A report by Becker’s Hospital Review states that urgent care visits account for 19% of all healthcare visits in the US.

Urgent Care Centers Badly Needed and Highly Profitable

Last year, strategy consulting firm Health Systems Advisors (HSA) commissioned a study regarding the current and future need for urgent care centers. According to Becker’s Hospital Review, the HSA study stated that:

  • “With the recent rise of urgent care development, there is an estimated 22% unmet need for urgent care in markets where urgent care sites could be financially viable;
  • “The unmet demand is so large that approximately 1,600 new urgent care sites can be supported generating nearly $3.5 billion in revenue; and,
  • “For health systems seeking to grow, the urgent care channel presents a unique opportunity to grow their revenue, influence patients’ downstream choices, and create a better experience for individuals desiring more convenience and better access.”

And data collected by FAIR Health indicates that, between 2007 and 2016, insurance claims for urgent care visits grew by a whopping 1,725%! Claims for emergency room visits increased by 229% during the same time period. FAIR Health is a non-profit organization that examines insurance claims for medical services for the purpose of bringing transparency to healthcare costs and insurance information.

Opportunities for Clinical Laboratories to Support Physicians

Clinical laboratories and pathology groups should pay attention to the burgeoning trend in urgent care, as those facilities order medical tests that will require processing, reading, and analyzing.

Exploring opportunities to serve urgent care centers offers clinical laboratories potential revenue streams and opportunities to serve the physicians practices and medical communities they support.

—JP Schlingman

Related Information:

UnitedHealth, Walgreens Partner to Put Urgent Care Next to Pharmacies

Report: MedExpress, Walgreens Pilots Grow to 15 Locations

Urgent Care Center Market by Service (Acute Illness Treatment, Trauma/Injury Treatment, Physical Examination, Immunization and Vaccination), Ownership (Corporate Owned, Physician Owned, Hospital Owned), and Region

Urgent Care Center Market on Track to Hit $26B by 2023

Urgent Care Industry Hits $18 Billion as Big Players Drive Growth

Health System Growth Using Urgent Care

20 Things to Know About Urgent Care

Top Urgent Care Organizations by Number of Centers

The Essential Role of the Urgent Care Center in Population Health

Patient Expectations Driving Growth in On-Demand Care

Urgent Care Centers: US Market Research Report

Consumer Trend to Use Walk-In and Urgent Care Clinics Instead of Traditional Primary Care Offices Could Impact Clinical Laboratory Test Ordering/Revenue

 

 

UnitedHealth Group Soon to Be Largest Employer of Doctors in the US; Clinical Laboratory Outreach More Critical than Ever Before

While consolidation is a common trend across many sectors—including anatomic pathology groups and hospital systems—UnitedHealth Group is the latest example of the payer-provider consolidation trend impacting medical laboratories nationwide

Pending the successful completion of a $4.9-billion acquisition of DaVita Medical Group, UnitedHealth Group (UNH) will be poised to become the largest single employer of doctors in the U.S., according to numbers reported by leading sources.

Clinical laboratories, anatomic pathology groups, and other service providers that service those doctors should already be taking a serious look at their revenue flows and efficiencies to maintain margins and weather the shift into a model of value-based reimbursement.

Controlling Costs with Direct Care

According to a press release, UnitedHealth Group’s (NYSE:UNH) direct-to-patient healthcare subsidiary, OptumCare, currently employs or is affiliated with 30,000 physicians. And, DaVita Medical Group, a subsidiary of DaVita Inc. (NYSA:DVA), lists 13,000 affiliated physicians on their website. Should acquisition of DaVita Medical Group go forward, OptumCare would have approximately 43,000 affiliated or employed physicians—roughly 5,000 more physicians than HCA Healthcare and nearly double Kaiser Permanente’s 22,080 physicians—thus, making OptumCare’s parent company UNH the largest individual employer of physicians in the U.S. The acquisition is reportedly to reinforce UNH’s ability to control costs and manage the care experience by acquiring office-based physicians to provide services.

OptumCare has seen significant growth over the past decade. OptumHealth, one of three segments of UNH’s overall Optum healthcare subsidiary, includes OptumCare medical groups and IPAs, MedExpress urgent care, Surgical Care Affiliates ambulatory surgery centers, HouseCalls home visits, behavioral health, care management, and Rally Health wellness and digital consumer engagement.

Andrew Hayek, CEO of OptumHealth

“We have been slowly, steadily, methodically aligning and partnering with phenomenal medical groups who choose to join us,” Andrew Hayek, CEO of OptumHealth (above), told Bloomberg. “The shift towards value-based care and enabling medical groups to make that transition to value-based care is an important trend.” (Photo copyright: Becker’s ASC Review.)

 Acquisitions of Doctors on the Rise; Clinical Lab Revenues Threatened

Independent physicians and practices have been a hot commodity in recent years. A March 2018 study from Avalere Health in collaboration with the Physicians Advocacy Institute (PAI) showed that the number of physicians employed by hospitals rose from 26% in July 2012 to 42% in 2016—a rise of 16% over four years.

By acquiring physicians of their own, insurance companies like UnitedHealth Group believe they can offset the cost and shifts in service of these prior trends. “We’re in an arms race with hospital systems,” John Gorman of Gorman Health Group told Bloomberg. “The goal is to better control the means of production in their key markets.”

According to Modern Healthcare, the acquisition of DaVita Medical Group is UnitedHealth’s third such acquisition in 2017. Other acquisitions include:

Along with Surgical Care Affiliates came a chain of surgery centers that, according to The New York Times (NYT), OptumCare plans to use to perform approximately one million surgeries and other outpatient procedures this year alone, while reducing expenses for outpatient surgeries by more than 50%.

NYT also noted that acquisition of DaVita Medical Group doesn’t bring just physicians under the OptumCare umbrella, but also nearly 250 MedExpress urgent care locations across the country.

By having physicians, clinical laboratories, outpatient surgery centers, and urgent care centers within their own networks, insurance providers then can steer patients toward the lowest-cost options within their networks and away from more expensive hospitals. This could mean less demand on independent clinical laboratories and hospitals and, with that, reduced cash flows.

According to NYT, Optum currently works with more than 80 health plans. However, mergers such these—including those between CVS Health (NYSE:CVS) and Aetna (NYSE:AET), and the proposed agreement between Humana (NYSE:HUM) and Walmart (NYSE:WMT) to deliver healthcare in the retailers’ stores—indicate that insurers are seeking ways to offer care in locations consumers find most accessible, while also working to exert influence on who patients seek out, to generate cost advantages for the insurers.

This consolidation should concern hospitals as payers increasingly draw physicians from them, potentially also taking away their patients. The impact, however, may also reach independent medical laboratories, medical imaging centers, anatomic pathology groups, and other healthcare service providers that provide diagnoses and treatments in today’s complex healthcare system.

Deep Payer Pockets Mean Fewer Patients for Clinical Labs and Medical Groups

As this trend continues, it could gain momentum and potentially funnel more patients toward similar setups. Major corporations have deeper pockets to advertise their physicians, medical laboratories, and other service providers—or to raise public awareness and improve reputations. Such support might be harder to justify for independent healthcare providers and medical facilities with shrinking budgets and margins in the face of healthcare reform.

Shawn Purifoy, MD, a family medicine practitioner in Malvern, Ark., expressed his concern succinctly in The New York Times. “I can’t advertise on NBC [but] CVS can,” he noted.

While further consolidation within independent clinical laboratories and hospitals might help to fend off this latest trend, it remains essential that medical laboratories and other service providers continue to optimize efficiency and educate both physicians and payers on the value of their services—particularly those services offered at higher margins or common to menus across a range of service providers.

—Jon Stone

Related Information:

With 8k More Physicians than Kaiser, Optum Is ‘Scaring the Crap Out of Hospitals’

30,000 Strong and Counting, UnitedHealth Gathers a Doctor Army

CVS’s Megadeal to Change U.S. Health Care Faces Stiff Challenges

Updated Physician Practice Acquisition Study: National and Regional Changes in Physician Employment 2012–2016

The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care

UnitedHealth’s Optum to Buy DaVita Medical Group for $4.9B: 6 Things to Know

UnitedHealth Buys Large Doctors Group as Lines Blur in Healthcare

UnitedHealth’s Optum to Buy DaVita Medical Group for $4.9 Billion

UnitedHealth Is Buying a Major Doctor Group on the Heels of the CVS-Aetna Deal

DaVita Medical Group to Join Optum

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