Specialty Urgent Care: What’s the Best Option for Your Market?

Demand for both emergent and physician office care will continue to surge over the coming decade as the nation’s insured population expands and ages. In response, providers are racing to develop an array of first-line delivery sites, including urgent care centers (UCCs), to extend capacity for unscheduled visits while solidifying a key gateway into their systems. Although not yet a major factor in some markets, many markets already have dozens of UCCs, giving health systems in those areas a narrow window of opportunity to determine if or how to add this access center model to their System of CARE.

Success in this often fiercely competitive arena requires an understanding of local demographics, a solid operating plan and effective marketing outreach. If your market is already saturated with UCCs, how can your organization get in the game? Providers can opt to differentiate urgent care services based on their established service line or virtual health capabilities. Read on for insight into 3 flavors of UCCs that you may want to consider.

Orthopedic and Spine Urgent Care
Outpatient orthopedic and spine care is anticipated to grow by over 20% by 2025. However, today’s demand has already outpaced current capacity. Many patients with an urgent orthopedic injury or spine condition find themselves in the ED or waiting days for an appointment with an orthopedic surgeon. General urgent care facilities, meant to provide quicker access to lower-cost health care providers, often lack the expertise to quickly diagnose and treat orthopedic conditions.

Leading orthopedic programs are developing orthopedic-specific urgent care centers to:

  • Appropriately meet the rising demand for orthopedic care
  • Decant lower-acuity volumes from the ED
  • Offer convenient access at low cost
  • Offer the specialization necessary for high-quality outcomes
  • Capture lucrative downstream sports medicine volumes

Development of these urgent care centers can occur as an extension of an existing orthopedic practice, an adjacency to existing urgent care offerings or through a partnership with third parties. Hospitals with ED backlogs caused by routine orthopedic injuries or hospitals simply looking to move orthopedic market share should find an orthopedic urgent care strategy successful.

Hospitals must carefully consider their relationships with orthopedic surgeons when developing orthopedic urgent care centers. It is important not to “compete” with loyal independent surgeons but to work with them on development of this site of care offering (eg, through joint venture). Ultimately, the decision to build, outsource or partner depends on the hospital’s desire to outlay capital to develop and run the facility. As with outpatient rehabilitation, “big-box solutions” can be efficient partners in delivering high-quality care while still filling a needed node in the System of CARE.

Pediatric Urgent Care
Across the System of CARE in your market, there may be a number of lower-cost access points in which a child may receive immediate services for non-emergent conditions: urgent care centers, retail clinics, primary care offices (via after-hours programs) and perhaps even virtual visits. An urgent care strategy for pediatrics goes beyond the urgent care center and must be integrated into an overall access strategy for the well child who has an occasional illness or injury requiring time-sensitive assessment and care. The access strategy has the potential to provide new revenue opportunities by offering pediatric expertise, convenience and lower cost to families.

Patients who would go to a newly opened pediatric urgent care center would be shifting from a number of sites of care, dependent largely on the access constraints in the community. Typically, a pediatric urgent care center does not aim to pull visits from physician offices but seeks to best fill the gap when offices are closed (eg, evenings and weekends). However, the “pull” from physician offices should not be overlooked, as it may be a perceived threat to many community primary care pediatricians. A pediatric urgent care center would require the support of physician offices, as it would serve as an access point for their patients when their offices are not open. In some cases, a joint ownership of a pediatric urgent care center or partnership to create after-hours clinics may present the best opportunity.

A pediatric urgent care strategy also has the potential to decant volumes of lower-acuity care from the ED; it is estimated that 40% to 60% of all emergency department visits for children are considered non-emergent. Even if competitor sites exist, some conditions are more acute than a physician office or retail clinic normally handles yet do not necessitate the level of care provided in the ED.

Virtual Urgent Care
Sg2 anticipates that 16% of evaluation and management visits will occur virtually by 2025. Much of this growth will occur for lower-acuity conditions that can be handled via a virtual consult with a physician or advanced practitioner. As health systems, physician groups and nontraditional providers—like CVS and Walgreens—compete over ambulatory access points, virtual urgent care offerings are emerging as an alternative, highly convenient and potentially cost-effective new way to interact with patients.

Like brick-and-mortar UCCs, virtual urgent care programs provide opportunities to extend a health system’s reach to new providers, relieve primary care capacity strains or reduce the overall cost of care by providing services in a lower-cost setting. However, there are some additional nuances with payment, partnerships and scalability to consider when providing urgent care services virtually.

One virtual urgent care success story involves Franciscan Health System, a 7-hospital system based in Tacoma, WA. In 2010, Franciscan partnered with Carena, a telemedicine solution company specializing in primary care services, to develop a virtual urgent care service. First focused on Franciscan’s employees, the virtual urgent care program has since been rolled out to the public as part of a multiyear process.

Next Steps
An emphasis on “the right care in the right setting” and increased consumerism will drive substantial growth in urgent care settings by shifting patients out of the ED. Shifting to lower-cost sites of care will be supported by payers, patients and families as they realize the impact of high-deductible health plans. Numerous factors determine which access approach will best serve a specific market and provider system. Key considerations and data analyses include:

  • Complete a comprehensive inventory and forecast of your market’s demand for unscheduled visits, including an analysis of current and future ED, primary care, and (as appropriate) specialist capacity and volume.
  • Assess which access models will work best for the population you serve and your physician partners. Ideally this step will include market research of consumers, physicians, health plans and employers.
  • Review the regulations and payment rules within your operating state and how they may impact site designation.
  • Reach out to Sg2. We can help by providing further detail on the current and future landscape of urgent and retail care, supporting your organization in data analyses, and more.
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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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