Blue Cross Blue Shield Association Study Shows Retail Clinic Visits Increased Despite Use Lagging Among Individually Insured Americans

As many as 29 percent of emergency room visits were for conditions that could potentially be treated in a retail clinic

CHICAGO – Retail health clinic visits have nearly doubled over the last five years despite use lagging among individually insured members, according to a new study by the Blue Cross Blue Shield Association (BCBSA).

The report, “Retail Clinic Visits Increase Despite Use Lagging Among Individually Insured Americans,” represents a comprehensive study of how Blue Cross and Blue Shield (BCBS) commercially insured members used clinics from 2011 through 2015.*  

Visits to retail health clinics — a low-cost option for consumers seeking convenient care for simple, acute conditions — among commercially insured BCBS members increased from 12.2 visits per 1,000 to 24 per 1,000 members. This upward trend was fueled by consumers who obtained health insurance through their employers. By contrast, usage by new individually insured members has lagged since the Affordable Care Act (ACA) marketplaces started offering coverage in 2014.

“Although they comprise only a small portion of all outpatient services, retail clinics are becoming increasingly popular options for those seeking affordable care,” said Maureen Sullivan, chief strategy and innovation officer for BCBSA. “Surprisingly, despite facing higher out-of-pocket costs for ER visits, individually insured members appear to be underutilizing retail clinics. Given this fact, greater education efforts targeting those new to health insurance may be warranted as a way to increase awareness of the relative convenience and services offered by retail clinics and to clarify insurance plans’ coverage of retail clinic visits.”

The study also finds that:

  • As many as 29.8 percent of emergency room (ER) visits were for conditions that could have potentially been treated in retail clinics.
  • Consumers saved money for routine services at retail clinics; out-of-pocket costs for visiting a retail clinic for minor acute conditions were slightly lower than for visiting a physician's office and much lower than an ER visit.
  • In 2015, the rate at which women visit retail clinics was 72 percent higher than the rate for men.
  • Visits to retail clinics spike in winter months and dip during the summer.

There are more than 2,000 retail clinics located in pharmacies, grocers and “big box” stores that provide care for simple, acute conditions — such as bronchitis and flu — and also administer services such as vaccinations or certain tests. Typically staffed by nurse practitioners, they offer convenient evening and weekend hours as well as walk-in appointments. Prices for retail clinic visits are significantly lower than a visit to the ER and slightly less expensive than a doctor’s office visit.

This is the tenth study of the Blue Cross Blue Shield, The Health of America ReportSM series, a collaboration between the Blue Cross Blue Shield Association and Blue Health Intelligence, which uses a market-leading claims database to uncover key trends and insights into health care affordability and access to care. This report was written by and also includes medical claims data from HealthCore Inc., a wholly-owned and independently operated health outcomes subsidiary of Anthem, Inc.

For more information, visit the Health of America Report.

* The report examines the medical claims of more than 60 million BCBS commercially insured members per year (non-Medicare) from 2011 through 2015 and compares the costs of receiving care for conditions at retail clinics relative to physician office and emergency room visits among enrollees. This report includes visits to national chain retail health stores, which account for more than 90 percent of all visits to retail clinics.

About BHI
Health Intelligence Company is the nation’s premier health intelligence resource, delivering data-driven insights about healthcare trends and best practices, resulting in healthier lives and more affordable access to safe and effective care. HIC accesses healthcare claims data from more than 140 million individuals nationwide, collected over nine years, in a safe, HIPAA compliant and secure database. The resulting conformed, reliable data set has the broadest, deepest pool of integrated medical and pharmacy claims, reflecting medical utilization in every ZIP code. Health Intelligence Company, LLC operates under the trade name Blue Health Intelligence (BHI) and is an Independent Licensee of BCBSA. For more information, visit

About HealthCore, Inc.
HealthCore, Inc  is a wholly-owned and independently operated subsidiary of Anthem, Inc., with a first of a kind large, integrated database and deep understanding of the complexities and nuances of big data. HealthCore helps clients achieve evidence-based competitive advantages through our innovative problem solving, analytics and outcomes research expertise. HealthCore doesn’t sell data. Instead, we design custom data-driven research solutions and guide our clients in the optimal use and interpretation of the data by evaluating the impact of disease, treatment and medical care on outcomes. HealthCore is headquartered in Wilmington, DE with additional offices in Andover, MA and Alexandria, VA. Our team includes scientists, biostatisticians, epidemiologists, pharmacists, and physicians. We are organized into three separate divisions, based on health care sectors, with firewalled teams collaborating with clients.

About Blue Cross Blue Shield Association

The Blue Cross and Blue Shield Association is a national federation of 35 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Indexsm. For more information on BCBSA and its member companies, please visit We also encourage you to connect with us on Facebook, check out our videos on YouTube and follow us on Twitter.

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.