Advancing health through alternative sites of care

Alternative care sites could improve access for underserved populations

Alternative care sites can help make care more equitable and accessible by providing more patient touch points and expanding the location options for well visits, mental health care services, and so much more. Our survey findings show that retail clinics, virtual health, and community health centers could bridge care delivery gaps for populations that have been historically underserved.

The survey revealed a large gap between consumers’ current utilization of these alternative sites and potential future utilization. For example, just 10% of consumers have used a retail clinic over the past year, but many more say they would be “likely to” or “maybe would” use retail clinics for preventive care (55%) or mental health care (47%). Black, Asian, and Hispanic respondents said they’re more likely than white respondents to use retail clinics, and urban respondents are more likely than rural respondents (figure 1). In addition, rural respondents appear less willing to use retail clinics, perhaps because awareness is lower or the retail locations in their areas do not yet offer the services. With these findings in mind, retail clinics have an opportunity to deliver care for these populations.

We also explored how consumers’ use of virtual health is shifting from just urgent or acute care to also include preventive and mental health care. Since 2018, the number of consumers using virtual health has increased across all age groups (figure 2). Our study data not only revealed that the biggest uptake was among millennials, but that use among seniors had increased too—albeit at a slower pace. The 2020 survey was conducted pre–COVID-19 in late February to early March, so it’s worth noting that this may have affected our data on how consumers were using virtual in 2020.

We see an opportunity for even more consumers to use virtual health, which in turn, would help address gaps in care. Consider:

• Nearly three in four consumers with Medicaid (74%) or HIX plans (73%) would use virtual health (apps or virtual visits) for mental health visits.
• More urban consumers (65%) would use virtual visits for well visits than suburban (53%) and rural (51%) consumers.
• Nearly two-thirds of consumers—across all races/ethnicities—would use virtual visits for preventive care.

Alternative care sites help build trust by connecting consumers to diverse care teams

From our research on rebuilding trust in health care, we know that trust deficits are still a major barrier for people seeking care.⁶ Consumer and community trust in health care providers and organizations is critical for optimal health, as trust influences patients’ willingness to get medical care, preventive screenings, and mental health care.⁷ Trust between a patient and a health care provider also is linked to improved patient experience, health outcomes, and the patient’s perception of the care they receive.⁸ However, it is also well documented that not all communities in the United States have the same level of trust with their health care providers. A critical area of focus for health equity—the fair and just opportunity for every individual to achieve their full potential in all aspects of health and well-being—is therefore rebuilding trust with racially and ethnically diverse communities.

We found in our 2021 focus groups that:

• Two out of three participants who identify as Black and half of Asian and Hispanic participants would prefer to see a health care provider who is similar to them, either in race/ethnic background or lived experience.
• For Asian (59%) and Hispanic (53%) participants, having a provider who is empathetic and culturally competent is a top priority when choosing a provider.
• About half of the participants are willing to trade access to convenient, in-person care for a virtual visit with a provider who looks like them and is culturally competent. About half of those who identify as Hispanic (54%) and Black (49%) are willing to use virtual visits, as are 41% of Asian participants.

Alternative care sites—if staffed with diverse and empathic care teams—could be opportunities for health care organizations to connect with their consumers and rebuild trust. One step to rebuilding trust is employing clinicians and care teams who look like, have shared experiences, and demonstrate empathy toward the communities they serve. Consumers most often look for providers that empathize, understand, connect, and care for their well-being. Yet many report that they aren’t connecting with their health care provider or aren’t seeking care at all because they can’t connect, have experienced racism, and/or have been subjected to unconscious and implicit bias.

Alternative sites of care could improve access to mental health services

Mental health is a core component of health and wellness, yet it is not available or easily accessible for many who need treatment. Demand for mental treatment continues to rise, particularly since the onset of the COVID-19 pandemic. In a recent study of psychologists, respondents reported increased demand compared to prior to the pandemic, and the increase continued to grow from 2020 to 2021.⁹ In addition, many with mental illness are not accessing treatment. Consider, nearly 50 million adults in the United States experienced some form of mental illness in 2022, yet more than half of them received no treatment for their conditions.¹⁰

For consumers seeking mental health services, some of the biggest barriers are accessing care and being connected to effective therapists. Access to mental health providers is uneven across the United States, with 37% of the country living in a mental health provider shortage area, which are areas with one or fewer mental health professionals per 30,000 residents.¹¹ Two-thirds of those shortages occur in rural or partially rural areas.

The Deloitte 2022 Survey of US Health Care Consumers found that alternative care sites could serve as a bridge that connects consumers—particularly young and racially and ethnically diverse populations—with the appropriate mental health care. We found that young consumers are more willing than their older counterparts to consider using alternative care sites for the mental health needs. In fact, half of Gen Z (50%) and Gen X (47%) and 61% of millennials would consider going to retail clinics, more than 60% of these generations would consider going to community health centers, and about 70% would consider virtual visits (figure 3). In contrast, just about half of baby boomers would choose virtual therapy services and 30% would use retail clinics.

According to our survey data, virtual mental health care is nearly as popular as in-person visits. Virtual visits could be a way for increasing access to mental health care, particularly for individuals in communities where stigma is high. Virtual health could provide access to a clinician who has a shared background or lived experience that an individual may not be able to see during an in-person visit.

It is also well documented that navigating the mental health system is challenging and is another major reason why individuals don’t access care, even when they are interested in getting treatment. Finding a mental health clinician that is affordable or takes health insurance can require a level of patience and persistence that can be difficult, especially when an individual is in distress or crisis.¹² Retail clinics, community health centers, or virtual health apps that can feel like a safe and accessible way for individuals to access care, could fill a much-needed gap for consumers who want mental health treatment.

Alternative care sites could meet consumers’ demands for convenience and transparency

Consumers’ desire for convenience is well-known, but important—and we need to solve for it because consumers are increasingly expecting a health care experience that feels like experiences in retail, banking, and other industries. Our research suggests that consumers would be more likely to use alternative sites for their health care needs if they can figure out how to deliver a better experience.

In fact, convenience is driving consumers to virtual health visits (it’s the No. 1 reason why consumers use virtual health) but bad interpersonal connections are turning people away from virtual health offerings (figure 4).

The top two reasons why consumers who have had a virtual visit choose not to return are:

• Bad experience with the technology.
• Poor connection with the physician and/or health care provider.

Another component of a positive patient experience is transparency. In our 2018, 2020, and 2022 consumer surveys, consumers said “having clear explanations of costs” was the best indicator of a good patient experience in health care. Retail clinics and therapy apps tend to provide fixed and transparent pricing, and most accept insurance/Medicare, which is not necessarily true among more traditional providers.

Implications for health care organizations

• Create more access points and include opportunities to address drivers of health. Organizations have an opportunity to address the issues that exacerbate disparities. Retail clinics and community health centers can enable better access to traditional care as well as access to food, educational resources, connections to other social services agencies, and information.
• Develop diverse care teams. Consumers are most likely to be comfortable receiving care from teams that are “like them.” One avenue is to cocreate teams with the community versus assuming what consumers wants in a health care team.
• Ensure care continuity. For individuals with chronic conditions or older adults requiring more complicated care, retail clinics can focus on seamless interaction with other health systems or the primary care setting.

- Provide an easy mechanism to send the patient’s visit details with the patient’s entire care team.

- Create a reminder for patients to bring their complete medication lists.

• Invest in virtual health technology. Investing in virtual health technology and facilities can benefit both consumers and organizations. Improving telehealth capabilities and designing a process whereby consumers can access their own physicians instead of third-party services could help health care organizations streamline and maximize the benefits of virtual health.
• Train clinicians on virtual health. Consumers still aren’t completely satisfied with their virtual interactions with physicians and other clinicians. Training these personnel in building virtual interpersonal relationships can be a major step toward improving the virtual visit experience. And while physicians explore ways in which to improve their virtual interactions, organizations should support them in the sustained use of virtual health, instead of returning to traditional in-person visits to ease the friction.

Ensuring alternative care sites meet consumers’ needs

By focusing on expanding access, building connections, and having empathy, health care organizations can not only improve health outcomes but bring us closer to achieving health equity. By understanding what consumers’ needs are today and incorporating the wide range of perspectives in their communities, organizations can shape better strategies—and connect consumers with a better health care experience.