Adam Rarick-Varner, Sr. Director of Healthcare Strategy at LexisNexis Risk Solutions

LexisNexis Risk Solutions医疗保健战略高级总监Adam Rarick Varner

Healthcare delivery continues to evolve to meet ever-changing patient demands. Over the years, rural doctors who historically performed house calls have been replaced with regional physician groups and community hospitals that are owned and managed by large health systems with multiple locations. Nearly 70% of physicians now work for a corporate entity instead of private practices.

医疗保健服务不断发展，以满足不断变化的患者需求。多年来，历史上进行家访的乡村医生已被区域医生组织和社区医院所取代，这些组织和医院由多个地点的大型卫生系统拥有和管理。近70%的医生现在为企业实体工作，而不是私人执业。

Telehealth visits increased 26x during the COVID-19 pandemic and have since leveled off, but are still a preferred method for many individuals and types of care..

在新型冠状病毒肺炎大流行期间，远程医疗就诊人数增加了26倍，此后趋于平稳，但仍然是许多个人和护理类型的首选方法。。

The latest industry evolution is the expansion of retail healthcare delivery. Pharmacies, department stores, convenience stores, and technology companies are all shifting the standard of care toward retail or online centers that provide care at the same place you already shop for household supplies, groceries, or prescriptions.

最新的行业发展是零售保健服务的扩展。药店、百货公司、便利店和科技公司都在将护理标准转向零售或在线中心，这些中心在您已经购买家居用品、杂货或处方的同一地点提供护理。

These new entrants are largely focused on offering primary care, urgent care, and a growing list of specialty services to make care more easily accessible, affordable, and cost-transparent. Patient satisfaction, convenience, quality care, and brand loyalty are core to their business models. Retail health centers have the potential to change the landscape of healthcare delivery, but there are challenges to overcome. .

这些新进入者主要专注于提供初级保健、紧急护理和越来越多的专业服务，以使护理更容易获得、负担得起和成本透明。患者满意度、便利性、优质护理和品牌忠诚度是其商业模式的核心。零售健康中心有可能改变医疗服务的格局，但仍有挑战需要克服。。

Patient expectations about provider availability and care coordination can present a challenge for retail centers. Payers have the added complexity of managing accurate directories that include information about retail health centers, fragmented medical histories, and patient engagement. By working together with authentic data, both payers and retail health centers have a unique opportunity to significantly impact patient care..

患者对提供者可用性和护理协调的期望可能会给零售中心带来挑战。付款人管理准确的目录更加复杂，其中包括有关零售健康中心的信息、零散的病史和患者参与度。通过与真实数据合作，付款人和零售健康中心都有一个独特的机会来显着影响患者护理。。

Patient Experience

患者体验

For the patient, the experience at these retail centers can be vastly different from visiting a traditional physician’s office. When seeking care from a retail center, patients are oftentimes not making the decision based on the availability or reputation of a specific physician. Instead, the decision is based on the urgency of the care they need combined with their prior experience with the brand and overall convenience. .

对于患者来说，在这些零售中心的体验可能与访问传统医生的办公室有很大不同。当从零售中心寻求护理时，患者通常不会根据特定医生的可用性或声誉做出决定。相反，这个决定是基于他们所需护理的紧迫性，以及他们之前的品牌经验和整体便利性。。

Once a patient chooses a brand and makes an appointment, they may have little input into how healthcare professional treats them. Rather than physicians, oftentimes, care is provided by mid-level clinicians who are qualified to provide care for the most common conditions. As a result, if a patient suspects their treatment needs are more complex and will require attention from a specialized care team, they may be referred to a physician outside the retail center, causing delays and potential frustration.

一旦患者选择了一个品牌并进行了预约，他们可能对医疗保健专业人员如何治疗他们几乎没有什么投入。通常，护理是由有资格为最常见疾病提供护理的中级临床医生提供的，而不是医生。因此，如果患者怀疑他们的治疗需求更为复杂，需要专业护理团队的关注，他们可能会被转介到零售中心以外的医生那里，从而导致延误和潜在的挫败感。

Effective communication and accurate care coordination are key to maintaining a positive patient experience..

有效的沟通和准确的护理协调是保持积极患者体验的关键。。

Follow-up coordination may be handed off to centralized, back-office call centers with no direct relationship with the patient or the practitioner, possibly leading to negative impacts on both efficiency and care quality. Patients may perceive the transition as impersonal, and the potential exists for additional back and forth if further clarification is needed, producing additional burdens for retail centers to maintain repeat customers and consistently generate a desirable patient experience..

后续协调可能会移交给集中的后台呼叫中心，与患者或从业者没有直接关系，可能会对效率和护理质量产生负面影响。患者可能会认为这种转变是非个人的，如果需要进一步澄清，则可能会出现额外的来回，从而给零售中心带来额外的负担，以维持回头客并持续产生理想的患者体验。。

Challenges for Payers

付款人面临的挑战

For payers, the growth of retail centers poses challenges and opportunities for network administration, care accessibility, and outcome management. Payers have a unique opportunity to add these retail outlets and their staff to their existing networks, resulting in lower member costs and increased convenience.

对于付款人来说，零售中心的发展为网络管理，护理可及性和结果管理带来了挑战和机遇。付款人有一个独特的机会将这些零售店及其员工添加到现有网络中，从而降低会员成本并增加便利性。

In some cases, payers may design their networks and benefit structures to incentivize the use of these centers through lower out-of-pocket expenses or build tighter networks that require the use of retail centers for primary and urgent care. Building proactive partnerships with familiar retail delivery chains increases consumer trust that payers can fulfill patient needs. .

在某些情况下，付款人可以设计他们的网络和利益结构，通过降低自付费用来激励这些中心的使用，或者建立更紧密的网络，需要使用零售中心进行初级和紧急护理。与熟悉的零售配送链建立积极主动的合作关系，提高了消费者对付款人能够满足患者需求的信任。。

Care availability from retail health centers is an undeniable benefit for patients who need care for a non-emergent condition. However, it can pose a challenge for provider data management, as many retail centers schedule their providers to work at separate locations or via telehealth platforms, with different hours on varying days of the week.

零售保健中心的护理服务对于需要非紧急情况护理的患者来说是不可否认的好处。然而，这可能对提供商数据管理构成挑战，因为许多零售中心安排其提供商在不同的地点或通过远程保健平台工作，在一周的不同日子有不同的时间。

This creates a significant hurdle for payers to support their members’ efforts to find care and maintain an accurate provider record for administrative and claim payment purposes. .

这为付款人支持其成员努力寻找护理并保持准确的提供者记录以用于行政和索赔支付目的创造了重大障碍。。

The increase in retail locations has increased care accessibility, frequently leading to higher utilization and a decentralized medical history. Members may still pursue treatment with a traditional primary care provider (PCP) for regular preventive care or chronic condition management, in addition to specialty care and retail centers.

零售地点的增加增加了护理的可及性，经常导致更高的利用率和分散的病史。除了专科护理和零售中心外，会员还可以寻求传统初级保健提供者（PCP）的治疗，以进行定期预防保健或慢性病管理。

This lack of care coordination from a traditional PCP can lead to problems relating to cost and outcome management. Ensuring seamless member navigation through various points of care will require payers to develop deep relationships with the retail centers in addition to local specialty care providers to which they refer patients.

传统PCP缺乏护理协调可能导致与成本和结果管理有关的问题。确保会员通过各种护理点进行无缝导航将需要付款人与零售中心以及他们向患者推荐的当地专业护理提供者建立深入的关系。

This may take the form of proactive partnerships like co-branding, data-sharing arrangements, or value-based contracting that incentivizes outcomes across parties. .

这可能采取主动合作的形式，如联合品牌、数据共享安排或基于价值的合同，以激励各方取得成果。。

Data is key to harnessing the opportunities

数据是把握机遇的关键

While retail care centers create an opportunity to improve access to care, they can encounter issues with coordinating care, maximizing patient engagement, maintaining accurate provider records, and helping members improve their health outcomes and manage costs.

虽然零售护理中心为改善护理提供了机会，但他们可能会遇到协调护理，最大限度地提高患者参与度，维护准确的提供者记录以及帮助成员改善健康状况和管理成本方面的问题。

Obtaining precise provider information is pivotal for payers to help their members find care quickly and for retail centers to have efficient operations for care coordination and referrals. Data on referral patterns and member behaviors across healthcare organizations will be critical for payers and retail centers to effectively manage the current decentralized delivery model.

获得准确的提供者信息对于付款人帮助其成员快速找到护理以及零售中心有效开展护理协调和转诊至关重要。有关医疗保健组织的转诊模式和成员行为的数据对于付款人和零售中心有效管理当前的分散式交付模式至关重要。

Insights and patterns from this data can help payers identify opportunities for value-based contracting, proactive partnerships, and network design that can ultimately reduce cost and improve health outcomes for their members..

来自这些数据的见解和模式可以帮助付款人确定基于价值的合同、积极的合作伙伴关系和网络设计的机会，这些机会最终可以降低成本并改善其成员的健康状况。。

Accurate patient data is key for both retail health centers and payers looking to coordinate care and drive positive outcomes The inability to reach a patient to schedule appointments, follow up on medication adherence, coordinate further care, or engage the patient in available health programs creates an immediate barrier for both retail health and payers.

准确的患者数据对于零售健康中心和寻求协调护理和推动积极结果的付款人来说都是关键。无法联系患者安排预约，跟进药物依从性，协调进一步护理或让患者参与可用的健康计划为零售健康和付款人创造了直接障碍。

When these processes go awry, the patient may perceive a failure of both their payer and the retail health center, making it difficult for both to retain the patient as a customer. .

当这些流程出错时，患者可能会意识到他们的付款人和零售健康中心都失败了，这使得两者都难以将患者保留为客户。。

Patients are increasingly utilizing retail health outlets for their care, and payers are recognizing the value the centers can provide for their members. The key to success lies in thoughtful engagement with the consumer, underpinned by accurate data that enables effective communication, care coordination, and promotes patient-centered care..

患者越来越多地利用零售保健店进行护理，付款人也认识到这些中心可以为其成员提供的价值。成功的关键在于与消费者进行深思熟虑的接触，并以准确的数据为基础，实现有效的沟通，护理协调，并促进以患者为中心的护理。。

About Adam Rarick-Varner

关于Adam Rarick Varner

Adam Rarick-Varner is a Senior Director of Healthcare Strategy at LexisNexis Risk Solutions. Throughout his career, Adam has spent over 20 years working at national health plans in a variety of roles, including leading back-office operations, customer-facing operations, call and claim center innovation, business and IT support, product development and process improvement.

AdamRarickVarner是LexisNexis风险解决方案的医疗保健战略高级主管。在他的职业生涯中，Adam在national health plans工作了20多年，担任了多种角色，包括领导后台运营、面向客户的运营、呼叫和索赔中心创新、业务和IT支持、产品开发和流程改进。

Adam holds an MS in Industrial/Organizational Psychology from the University of Tennessee Chattanooga, and a BA in Psychology from Bryan College..

Adam拥有田纳西大学查塔努加分校的工业/组织心理学硕士学位，以及布莱恩学院的心理学学士学位。。