Repeat Retail Clinic Visits: Impact of Insurance Coverage and Age of Patient Kurt B. Angstman, MS, MD, Matthew E. Bernard, MD, James E. Rohrer, PhD, Gregory M. Garrison, MD, and Kathy L. MacLaughlin, MD Abstract As retail clinics provide a less costly alternative for health care, it would be reasonable to expect an increase in multiple (repeat) retail visits by those patients who may have expenses for receiving primary care. If costs were not a significant factor, then repeat visits should not be significantly different between these patients and those with coverage for primary care visits. The hypothesis for this study was that patients with the potential for out- of-pocket expenses would have a higher frequency of repeat retail clinic visits within 180 days compared to those with primary care coverage. A retrospective chart review was conducted of 5703 patients utilizing a retail clinic in Rochester, Minnesota from January 1, 2009 through June 30, 2009. The first visit to the retail clinic was considered the index visit and the chart was reviewed for repeat retail clinic visits within the next 180 days. Using a multiple logistic regression model, the odds of a pediatric patient (N = 2344) having a repeat retail visit within 180 days of the index visit were not significantly impacted by insurance coverage (P = 0.4209). Of the 3359 adult patients, those with unknown coverage had a 25.6% higher odds ratio of repeat retail clinic visits than those with insurance coverage (odds ratio 1.2557, confidence interval 1.0421–1.5131). This study suggested that when cost is an issue, the adult patient may favor retail clinics for episodic, low-acuity health care. In contrast, the pediatric population did not, suggesting that other factors, such as convenience, may play more of a role in the choice of episodic health care for this age group. (Population Health Management 2012;15:358–361) Introduction I n the spectrum of health care reform, with significant legislative policy changes either enacted or proposed, the marketplace expansion of retail clinics may be looked at as a ‘‘disruptive technology.’’ The impact of this new model of care on health care systems has potential concerns (quality, lack of continuity) and yet others see areas of opportunity with the increased capacity and efficiency of care that this model may provide. 1 Cost savings has been shown to be one of the factors as- sociated with patients choosing retail clinics. 2 An initial study in 2008 did demonstrate significant diagnosis-specific cost savings per episode of care. 3 A recent study found that for 3 common illnesses, retail clinics were less costly and had no apparent change in quality metrics when compared to other primary care sites. 4 If the benefits of retail clinics to the health care system are efficiency and cost-effectiveness, is the patient able to determine the level of services they need appropriately? One recent study demonstrated that patients seen in retail clinic settings tended to be less complex and that there was no difference in follow-up for their chronic disease management, 5 suggesting that patients are able to appropriately self-select the level of care needed for their low-acuity medical conditions. If overall cost to the patient were the major consideration, it would be reasonable to expect an increase in multiple (repeat) retail visits by those patients without insurance coverage, as retail clinics provide a less costly alternative for the patient. If cost were not a significant factor, then repeat visits should not be significantly different between those patients with insurance coverage and those without. Retail clinics do have a limited ‘‘menu’’ of services provided. Pa- tients who have utilized the services previously have expe- rienced the potential benefits and limitations to this type of episodic care. Thus, those patients are making a distinct choice if they choose to make a repeat visit to a retail clinic versus a primary care provider. Because access to primary care availability also may have an impact on the utilization of retail clinic services, patients of 1 large primary care practice were compared. The patients were divided into 2 groups: those with institutional Department of Family Medicine Mayo Clinic, Rochester, Minnesota. POPULATION HEALTH MANAGEMENT Volume 15, Number 6, 2012 ª Mary Ann Liebert, Inc. DOI: 10.1089/pop.2011.0088 358