Retail clinic claims volume up 200% from 2017-2022

Primary care physician claims down 13% in that same timeframe

High-usage during the pandemic drove retail clinic claims to 200% growth from 2017-2022, according to a report from Definitive Healthcare. During that same five-year period, urgent care claims volume increased 70%, while hospital emergency department claims decreased 1% andprimary care physician claims decreased 13%.

Retail clinic: ©Jeff Bergen-

Retail clinic: ©Jeff Bergen-

The report attributes the retail clinic increase in large part because the federal government made national retail pharmacies a key part of its COVID-19 vaccination strategy. As more people were vaccinated, overall retail clinic use declined from 2021 to 2022, but outside of COVID-related claims, retail clinic claims were still up 21% in that time frame.

Retail clinics are moving from basic care for minor illnesses to primary care and disease management. The report examined all-payer claims data to see what types of conditions retail clinics are treating.

The top 15 claims in 2022 for retail clinics according to the report were:

  • Encounter for immunization, 38.8%
  • Contact with and exposure to COVID, 31.2%
  • Type 2 diabetes mellitus without complications, 4.1%
  • Encounter for observation for suspected exposure to other biological agents, 3.7%
  • Type 2 diabetes mellitus with hyperglycemia, 1.8%
  • Chronic kidney disease, 1.2%
  • Screening for respiratory tuberculosis, 1.2%
  • COVID-19, 1%
  • COPD, 1%
  • Acute pharyngitis, unspecified, 0.9%
  • Cough, unspecified, 0.4%
  • Acute upper respiratory infection, 0.4%
  • Type 2 diabetes mellitus with diabetic chronic kidney disease, 0.3%
  • Dietary counseling and surveillance, 0.3%
  • Essential (primary) hypertension, 0.3%

Immunization was the most common diagnosis thanks to public health officials continuing to encourage vaccination and emphasizing the importance of booster shots. When combined with COVID exposure and type 2 diabetes, these three issues made up nearly three-quarters of diagnoses reported by retail clinics, according to the report.

About one in 10 diagnoses at retail clinics were related to chronic conditions, showing that patients are looking to retail clinic for more than just the common cold and vaccines, the report states. With more than 60% of U.S. adults living with a chronic condition, the opportunity for retail clinics to become meaningful players in chronic diseases is large, especially as they move toward providing more primary care.

“As free COVID-19 tests and vaccinations are phased out, we expect the growth rate of retail clinic use to slow down. However, retail clinics will continue to play an important role in health care delivery, especially as retailers branch out to offer a wider range of services, from chronic disease management and primary care to mental health and wellness programs,” the report reads in part.

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