The Doctor Will See You Now — Online

By Claire Cain Miller
http://bits.blogs.nytimes.com

American Well aims to reinvent the house call.

If Roy Schoenberg, the start-up’s co-founder and chief executive, has his way, patients will no longer have to wait a month to see a doctor for an urgent sore throat, wait all day for a doctor to return their call or leave work midday and drive a long distance for a routine appointment. Instead, patients will log on to their computers and find themselves face-to-face with physicians over Webcam.

Consumers are bombarded with health information from their insurance companies and from the Web, often full of advice from writers or fellow patients, not physicians. “What we’re missing is the very bare-bones health care: talking to a doctor. That’s why I started American Well,� said Dr. Schoenberg, a doctor who has founded two other software companies. He co-founded American Well with his brother, Ido Schoenberg.

He has big plans for the potential of the service to address health care reform in the United States. So far, policymakers’ approach to health care reform has been antiquated, he said. “We need to take a fresh look at what’s available in 2008. Online care means that without reworking the budget, without going through Congress, we can bring affordable health care to people who cannot access it,� he said.

Consumers whose health plans use American Well will log on to their health plans’ Web sites to access the service. The first plan to sign on is Blue Cross Blue Shield of Hawaii, which starting in January will offer patients virtual visits with its doctors. Other states and health plans, yet to be announced, will also activate it in 2009.

Patients who are members of the health plan pay a co-pay, just like at the doctor’s office. Doctors hold 10-minute appointments, which can be extended for an optional fee, and can file prescriptions through the system. Uninsured patients can also use it, for a fee that the health plans choose but which will be less than $50, much less than a visit to the emergency room, which is where the uninsured often end up. Health plans pay American Well a license fee per member to use the software, as well as a transaction fee of about $2 a patient each time a patient sees a doctor.

Doctors, meanwhile, pick up a few extra dollars on the side. They get paid less than an office visit but more than a phone consult and do not have to worry about scheduling, overhead and paperwork. They just log on and wait for patients to come to them. American Well files all the claims, and the money is deposited into the doctor’s bank account.

Dr. Schoenberg expects it to be popular among retired physicians or those who have practices but want to see a few more patients when they have a free hour on a Saturday afternoon. “Then, if they decide they want to watch ‘Lost,’ they’re finished,� he said. “That flexibility is why we’re getting such a favorable response from physicians� who have felt shackled by the burdens of scheduling, chasing down payments, filing with insurance companies and paying for office costs and malpractice insurance.

AIG has agreed to provide malpractice insurance to doctors providing online care, and the cost is low enough that most of the health plans are paying for it instead of charging the doctors, Dr. Schoenberg said.

Patients benefit from receiving continuous care from a doctor who knows their medical history. Dr. Schoenberg said that American Well allows for that. If a patient’s primary care physician is online, the patient can see him or her. If not, the doctor who sees the patient sends a report back to the patient’s usual doctor.

American Well has partnered with HealthVault, Microsoft’s electronic medical records service, so patients can access and share their medical information with doctors while using American Well. It has also partnered with ActiveHealth, a subsidiary of Aetna, which makes a technology that will scan a patient’s medical history and alert doctors about gaps in care during an American Well appointment. For example, if a woman is consulting online with a gynecologist, ActiveHealth would alert the doctor if she had not been receiving regular mammograms.

Of course, not all conditions can be diagnosed and treated over a Webcam. “If you have a heart attack, don’t use our system — go to the E.R.,� Dr. Schoenberg said. “But the vast majority of health care is primary care.�

He said that national studies on online care have found that patients would like to have Web chats with primary care doctors about colds or diabetes management, for example, or with specialists about symptoms such as lower back pain or bad headaches.

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