Impact of Convenient Care in the Healthcare Industry

May 20, 2008Sandra F. Ryan, Chief Nurse

Practitioner OfficerTake Care Health Systems, LLC

Co-Chair Clinical Advisory Board CCA

Agenda

Evolution of an IndustryCurrent LandscapeCCA: Driving Quality CareThe Future of Convenient Care: The Take Care Health Model

Evolution of an IndustryThe first Convenient Care Clinic (CCC) opened in 2000900 clinics operated by over 20 companiesIncreased shortage of primary care physicians and will get worsein future

35% of current physicians are nearing retirement.Fewer than 30% of current medical students say they intend to be primary care physicians.

Significant annual increases in health insurance deductibles andco-paysGrowing popularity of ‘consumer driven’ health plans (CDHPs)Rapid growth of uninsured population that now includes nearly 47 million peopleIncreasing time pressure on consumersHow can Convenient Care impact healthcare moving forward?

Current Landscape and Scope of Practice

Acute, Self-limiting conditionsLimited Scope of Services

Bronchitis, common colds, coughs, ear infections, flu, laryngitis, sinus infections, sore throat, strep throat, upper respiratory infectionsBladder infections, diarrhea, nausea and vomiting, early lymedisease, fever, head lice, skin rashes, mononucleosis, eye infections, seasonal allergies, swimmer’s ear

Minor InjuriesAbrasions, minor burns, splinters, sprains/strains, staple/suture removal

Other ServicesInclude vaccinations, screenings, and administrative physicals

Current Synergies with the Medical Community

Overflow outlet forBusy provider practicesEvening/weekend/holiday coverageOverburdened emergency rooms

Quality access to healthcareElectronic prescribingRegulatory compliancePeer and CP ReviewEvidence-Based practice that follow AMA and AAFP guidelines

Easier access to healthcareParticularly for those individuals without a PCP, without insurance, and/or in underserved areasConnects individuals without a PCP to a health care home

Earlier access to healthcareReduces illness severity and spreading of infectionsEncourages preventive careReduces overall health care utilization

Current Synergies with the Medical Community

An April 2007 study* by a market research company found that 18% of convenient care clinic users were referred to another health care provider for additional treatment at the end of their visit.

60% of those people who required referrals were able to schedule the referral on-site at the convenient care clinic before the end of their visit.

27% of all referrals were directed to family physicians/primary care providers.

Only 7% of CCC users were referred to the emergency room for care, suggesting that CCCs are helping to reduce unnecessary ER use by providing the right level of care, in the right place, at the right time.

*Market Strategies Inc., ‘Retail Clinics: Health Care Evolution or Revolution?’, April 2007.

The Convenient Care Association: Driving Quality Care

Association Goals:Develop common standards of operation to ensure the highest quality of careUnite behind one voice to advance the needs of CCCsand their customersStreamline marketing efforts to promote the concept and respond to questions about this evolving industryReach out to the existing medical community and creating new partnershipsBuild synergies with traditional medical service providers

CCA StandardsCCA standards adopted in March 2007

Thorough credentialing for licensure and experience Quality monitoring, including but not limited to:

peer review;collaborating physician review; use of evidence-based guidelines; collecting aggregate data on selected quality and safety outcomes; collecting patient satisfaction data.

Relationships with traditional health care providers and hospitalsEncouraging patients to establish a relationship with a primary care provider, and to making appropriate referrals for follow-on care.Compliance with applicable OSHA, CLIA, HIPAA, and ADA standards.

All CCA Members follow CDC guidelines for infection control through hand-washing.

Quality and Safety StandardsProvide health promotion and disease prevention educationUse of Electronic Health Records (EHR) to ensure high-quality efficient care and promote continuity.

Commitment to sharing health record with providersProvide an environment conducive to quality patient care and meet standards for infection control and safety. Establish emergency response procedures and develop relationships with local emergency response service providers.Empower patients to make informed choices about their health care. Prices should be transparent and accessible.

Practice Guidelines and Certification

Best Practice document developed for members as a guideline

Recommendations for the delivery of high quality, affordable, convenient healthcare Provides policy recommendations

CCA Certification Review ProcessDepartment of Health Policy at Jefferson Medical College

Review of policies and procedures to ensure compliance with CCA quality and safety standards

High-quality Health Care Clinics

Professional exam rooms; some clinics have exam tablesRooms meet OSHA, CLIA, HIPAA, and ADA standardsRunning water for hand-washing in room or near by; appropriate sanitation in roomEMR technology

Commitment to QualityCollaborating physician review, peer review and compliance auditingReferral process and integration

Patients referred to primary care provider and/or CP for follow-on care (up to 20%)Patients do not have healthcare home (up to 30%)Patients would have gone to the ER, Urgent Care or not sought treatment (Over 40%)

CCCs strive to monitor quality and practice standardsPractice guidelines based on widely accepted professional standards Most CCCs advocate or conduct CME’s, Grand Rounds for their providers

Data: Evidence of QualityAmerican Journal of Medical Quality reported that retail clinics provide “exceptionally high-quality care” for acute pharyngitis (sore throat) when practitioner training is combined with EMR support tools*

Among 39,350 cases indicating a negative rapid strep test result, MinuteClinic nurse practitioners and physician assistants adhered to clinical guidelines in 99.05 percent of patient visits by not prescribing unneeded antibiotics. Among the 13,471 cases with a positive rapid strep test result, 99.75 percent received an appropriate antibiotic prescription. The combined guideline adherence rate for both positive and negative results was 99.15 percent.

*Represents a one-year study of acute pharyngitis that analyzed 57,331 patient visits at 28 MinuteClinic health care centers in Minneapolis and Baltimore between September 2005 and September 2006.

Data: TCHS Evidence of Quality

Preliminary quality data from Take Care Health Systems shows that appropriate antibiotic usage far exceeds national benchmarks – up to 50%.Significantly better than NCQA standards:

Utilization of RAPID strep testsAppropriate antibiotic prescribing for bacterial strep infectionsAppropriate treatment of pediatric age upper respiratory infections and adult bronchitis

The Future of Convenient Care: The Take Care Health Model

Future Impact of Convenient Care

Public Health and SafetyFirst-line management of National Emergencies

Chronic Disease Management & Health PromotionInfusionsLab ServicesEducation

Convenient ED conceptAbsorb non-emergent patient visitsEducate patients about healthcare homeRefer into hospital provider baseImprove patient satisfaction

Corporate On-Sites

Corporate On-SitesA healthier workforce costs less and is more productive.A Kaiser study found that only 24 percent of costs associated with illness resulted from direct medical costs. Almost 70 percent were related to absenteeism or employees working while ill and unable to fully perform. A comprehensive wellness program is necessary to control ancillary costs.A 2004 study by CCH and Harris Interactive found that the annual costs of employee absenteeism can range from $60k for smaller employers to $1M for large companies.Access to quality, affordable and convenient healthcare near at work Provide large company employees and health plan members seamlessaccess to health centers and pharmacies at worksites and in the community after-hours and on weekends Potential to Offer:

Health PromotionOccupational HealthDisease ManagementRisk Management

Created March 17, 2008

Announced intent to acquire I-trax/CHD Meridian Healthcare and Whole Health Management, two leading providers of workplace-based healthcare

Acquisitions will complement May 2007 acquisition of Take Care Health Systems, leading manager of convenient-care clinicsWith retail pharmacies, Walgreens will have nearly 7,000 points of careAcquisitions bring more than 500 health centers, including Take Care Health ClinicsAdds thousands of healthcare professionals to Walgreens, including physicians, physician assistants, nurse practitioners,and nurses

Walgreens Health and Wellness Division: Creation

Walgreens Health & Wellness Division

I-trax/CHD Meridian Healthcare

Provides worksite health services, including:Acute care/Primary CareWellness & disease management servicesPharmacy Health and fitness programming

160 employers including: BMW, Disney, Eastman Chemical, Gillette, Goldman Sachs, Horizon Blue Cross Blue Shield of New Jersey, Lowe’s, and Toyota

Whole Health Management

Provides:Primary CareUrgent CareWellness ProgramsHealth coachingOccupational Health Services

69 worksite health centers for 27 clients, including Continental Airlines, Florida Power and Light, Harrah’s Entertainment, Scotts Miracle-Gro, and Sprint

I-trax/CHD Meridian, Whole Health, Take Care Health Systems Overlap

©2008 Walgreen Co. All rights reserved. 20

Market Landscape

45%

37%17%

Service provided by in-house clinicians

No service provided in workplace

Service provided by 3rd party vendor

7,600 corporate campuses of 1,000 employees, plus families and retirees

2,836 (37.3%) do not provide work-site healthcare 3,446 (45.3%) internallyprovide work-site healthcare1,321 (17.4%) use a third party to provide work-site healthcare

The number of companies with on-site clinics is projected to increase by 26% in 2008 – Watson Wyatt 2007 survey

Health and Wellness Division: Objective and Vision

Expand healthcare beyond traditional retail sitesProvide large-company employees and health plan members seamless access to quality, affordable, and convenient healthcare near home and at work

Access to health centers and pharmacies at worksites and in the community after-hours and on weekendsNon-worksite employee population–including dependents and retirees–can access care in retail locations

Continue expansion of Take Care Health Clinics®

Create value for employers and health plans by lowering costs and improving outcomes

Focus on enhancing productivity and a healthier workforce

Thank You