The Value Urgent Care Brings to Payer Networks

Updated on August 1, 2017

SullivanAs the healthcare industry transitions to a quality-over-quantity system, patients, providers and payers are searching for cost-effective solutions without sacrificing quality of care. Focused on convenience and affordability, urgent care centers are at the forefront of providing value-based care while controlling unnecessary costs. When included in payers’ networks, urgent care centers assist payers in meeting the Centers for Medicare & Medicaid Services’ Triple Aim Goals, which form the basis of the value-based healthcare model, as well as comply with new requirements for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

When urgent care is utilized effectively, the healthcare industry enjoys numerous benefits.

Reducing Per Capita Costs
Urgent care centers provide a convenient, affordable alternative to overcrowded emergency departments (ED) for the treatment of non-life-threatening, non-limb-threatening immediate concerns. Diverting patients with non-emergency conditions from EDs can dramatically reduce overall healthcare costs while improving efficiency.

An average visit to an urgent care center costs less than $150, while an ED visit averages $1,354 according to Medical Expenditure. Visiting an urgent care center for low-acuity concerns can ensure the condition does not worsen or lead to more costly ED visits or hospital admissions.

Excellus BlueCross BlueShield analyzed ED utilization in upstate New York and found if just 10 common, low-acuity conditions had been treated outside of the ED, New York State could have saved $1.3 billion in healthcare costs. Nationally, 27 percent of all ED visits can be handled at an urgent care center or retail clinic, generating cost-savings of approximately $4.4 billion annually, a 2010 Health Affairs article reported.

In addition, a 2015 study by the Massachusetts Health Policy Commission found when patients have access to urgent care centers or retail clinics nearby, the rate of ED visits drops by approximately 30 percent. The study concludes that greater access to after-hour care options is strongly associated with lower ED use.

Enhancing the Patient Experience
Increased access to urgent care also impacts patient satisfaction. Urgent care centers provide primary care services during weekend, walk-in and evening hours – when primary care physicians are often unavailable – for increased accessibility and convenience. In fact, 97 percent of urgent care centers are open seven days a week, which is important for 63 percent of Americans who report having difficulty accessing care on nights, weekends or holidays without visiting an ED, a Commonwealth Fund International Health Policy Survey reported.

A typical ED visit comes with an expensive bill and long wait – especially for low-acuity conditions. The national average ED wait time is four hours due to overcrowding and limited resources. The average urgent care wait time is 30 minutes or less at 92 percent of centers, according to the Urgent Care Association of America (UCAOA) 2016 Benchmarking Survey. When non-life-threatening conditions are handled at urgent care centers, patients enjoy more efficient care in both urgent care centers and EDs – as resources and manpower are more efficiently utilized.

Improving Population Health
In patient-centered medical homes (PCMH), a small percentage of patients account for the majority of costs. When partnered with urgent care centers that help provide coordinated care for episodic illnesses and injuries, the medical homes can dedicate more time and resources to chronic care and disease management.

Furthermore, millions of Americans have no health insurance, many of which are not affiliated with a medical home. According to the Robert Graham Foundation, urgent care centers treat 20 percent of patients unaffiliated with a medical home, providing an essential link for those suffering from a chronic illness in dire need of medical home services – such as patients with diabetes. An even greater percentage of patients have limited access to their medical home, and instead opt for treatment at urgent care. These centers play a vital role in lowering healthcare costs through models that support wellness screening and care coordination.

Advancing the Industry Forward
A need in the marketplace has led to a boom in urgent care growth and use nationwide. With more than 7,100 urgent care centers across the country, the UCAOA estimates 1,000 new centers have been added annually since 2013. This growth mirrors the demand for lowering healthcare costs while increasing access to on-demand, high-quality care. 

The value-based reimbursement model is one of the main goals of MACRA and to achieve this, there must be strong coordination among healthcare providers, payers and patients. In fact, many payers have recognized the value of urgent care centers in the continuum of care and are rewarding those that have demonstrated excellence through formal certification or accreditation by including and promoting them in networks.

The demand for urgent care stems from all corners of the healthcare industry, yet the full potential of the value-based model will only be realized when urgent care centers are included in payer networks and leveraged to make a strong impact on population health and wellness.

Pamela Sullivan, MD, MBA, FACP, PT is President of UCAOA Board of Directors.