This blog post was written by our guest blogger Karen Joncas, Healthcare Transformation Coordinator at Research & Marketing Strategies (RMS).

The Patient Centered Medical Home (PCMH) model places the patient at the center of care. The model of care truly embodies the important role of well-integrated and coordinated quality driven healthcare. In a recent blog post we announced the launch of the 2014 PCMH Standards as well as in a second blog, we discussed healthcare trends, the transformation of the healthcare delivery system and the impact that the cost to administer and receive care will have on this evolution.

One thing we know for certain is that the “face” of the healthcare delivery system continues to evolve. With the launch of the Affordable Care Act, all Americans being given access to healthcare, and all required to have health insurance, this will no doubt continue to reshape our healthcare delivery system as we know it today. What we do know is that there is a responsibility that is being placed on patients to become even more responsible and engaged in their patient care. Recently in the Central New York Area, there was an article in our newspaper regarding the expansion of urgent care centers, which prompted us to take a bit of a reflection on the role of Urgent Care Centers in the transformation of the healthcare delivery system. We pondered a few questions:

• Will more engaged patients embrace the use of urgent care centers?
• Will payment reform recognize the role of urgent care centers in the transformation of the healthcare delivery system?
• How will urgent care centers facilitate meeting the triple aim goals of improving the experience of care, improving the health of populations and reducing per capita cost of healthcare?

Interestingly, New York State embarked on a huge initiative back in 2012 in which Governor Andrew Cuomo’s Medicaid Redesign Team (MRT) began leading change in New York with the goal of moving the State’s health care system toward the triple aim goals. The driving force behind the MRT’s efforts is a growing Medicaid program that spends double the national average per recipient but, as its lackluster quality scores illustrate, does not derive equivalent value out of the system for which it pays. A primary strategy of the MRT has been promoting more organized, integrated systems of care with a strong primary care foundation. One point that clearly resonated throughout the article is that to achieve the Triple Aim, primary care must be at the center of any system of care. One point in this white paper discussed the importance of delivering evidence based and coordinated care, as well as to share data across entities to meet the triple aim goals.

No question, Urgent Care Centers have a role in the healthcare delivery model within any region of the country. One argument for expansion of urgent care centers includes an increase in the demand for medical care resulting from newly insured patients gaining access through healthcare exchanges. At the same time, there continues to be a concern about the supply of primary care providers to meet the rising demand. The use of urgent care centers to provide episodic care could free up traditional physician practices to serve chronically ill patients. 

Secondly, costs of providing services at urgent care centers are significantly lower compared to the use of emergency departments. Urgent Care Association of America reported the most common diagnosis in urgent care centers in 2012 was upper respiratory conditions while the most common procedure was wound repair. Based on a 2010 study reported in Health Affairs, an estimated 13.7 to 27.1 percent of emergency department visits could be handled at an urgent care or retail clinic generating a potential cost savings of $4.4 billion annually. Clearly, the treatment for the most common diagnosis and procedure can be provided at urgent care centers at a much lower cost than the alternative emergency department care.

While there is a strong argument for having Urgent Care Centers, and undoubtedly, they will have a growing role in the healthcare delivery system, it is important the well-coordinated care be the cornerstone of care. Not only is it the role of the Urgent Care Centers to be coordinating the care. Primary Care Providers, and practices, need to take a passionate role in discussing urgent care visits with their patients. In some regions of New York State and in other states, there are Regional Health Information Exchange Organizations, where patient health information is shared through a vast electronic system, and this can be of a huge advantage for physician practices to truly serve as the Patient’s Medical Home. However, there are still areas where this advanced technology is not yet available, and this requires communication with the patient.

Primary care providers should be asking patients at each visit if they have sought medical care with other facilities or specialists since their last visit. This has been emphasized in the most recent standards for recognition as a patient centered medical home.

In addition, in a paper published by the Urgent Care Association of America, urgent care centers could be used as key treatment sites for non-life and limb threatening injuries and conditions in the event of a community disaster. Like emergency departments, they provide medical care mostly for unscheduled, walk-in patients and should be considered in community disaster planning.

Weighing the pros and cons of urgent care centers in the overall reform of the healthcare system appears to yield a place for urgent care centers in the overall delivery system. By having primary care providers collaborate with urgent care centers to communicate about episodic visits can become part of the patient’s medical record. This would free up primary care providers to meet the ongoing needs of the chronically ill, the segment of the population that results in the bulk of the costs in the healthcare system.

RMS Healthcare, a division of Research and Marketing Strategies, Inc. (RMS) has over 50 years of collective and proven experience in providing consulting services to meet the specific needs of our clients. Services include strategic planning, marketing feasibility studies, practice transformation services including PCMH recognition, staff training and development, and patient experience measurement. Regardless of your transformation or research needs, RMS can help. If you are interested in learning more, please contact Susan Maxsween, Director of Healthcare and Practice Transformation at SusanM@rmsresults.com or telephone her at 1-866-567-5422.