Virtual Visits Moving Into Medical Mainstream

by George Lauer

Virtual house calls — or virtual visits to the doctor, depending on your perspective — are making major strides toward the mainstream in North America.

In the United States, two large insurers recently announced plans to reimburse physicians for online consultations with patients.

Aetna expanded a three-state pilot project to the rest of the U.S. after determining that paying physicians to consult with patients online in California, Florida and Washington state was a success.
And Cigna, one of the biggest investor-owned health benefits organizations in the United States, announced plans to pay for online visits beginning in January 2009.

In Canada, the Canadian Medical Association launched a national Web site this month that will let patients and doctors exchange information online and will sometimes serve as a substitute for office visits.

Is this the beginning of a trend? Will virtual doctor visits be commonplace in 10 or 20 years?

“It’s very hard to look that far ahead,” said Susan Pisano, vice president of communications for America’s Health Insurance Plans, a trade association representing 1,300 companies that provide health coverage to more than 200 million Americans.

“There’s new technology every day and health plans are having to react in ways that make it difficult to make long-range predictions,” Pisano said, adding, “Ten years from now, there very well may be a different approach, more advanced technology.”

Pisano said the public’s gradual acceptance of new technology, along with advances in security, might encourage more insurers to pay for e-visits.

Online consultation is “certainly one of the areas that looks promising for a lot of plans,” Pisano said.

Not So New in Some Areas

While e-visits have yet to spread to many parts of the country, in parts of the Northeast, Minnesota and California, they are already an established practice.

“We actually began offering reimbursements for Web visits in 2003,” Tanya Trombley, spokesperson for Blue Cross and Blue Shield of Massachusetts, said, adding, “It’s mostly used by primary care physicians, although there are some specialists who use it as well.”

“We have a kind of core group of 140 physicians who offer this service,” Trombley said. The Blues of Massachusetts have about 41,000 members registered to use the Web visit system.

The most frequent uses of the Web connection are checking lab results, referral requests, prescription renewals and scheduling and checking appointments, Trombley said.

Like many other Web visit systems, including those at Aetna and Cigna, the Blues of Massachusetts use a system designed and operated by RelayHealth.

Trombley noted, “There were some other, smaller players when we first looked to set up our system.” However, she said, “We were looking for a robust structure tool to provide e-visit security as well as administrative and support services.”

RelayHealth, based in Atlanta, is now the clear leader in the new e-visit industry.

Although pricing is different from system to system, patients frequently pay the same or slightly lower copayment as they would for an office visit, depending on the length and depth of the e-visit. Insurers usually pay physicians less for Web visits.

Insurers say e-visits increase patient access, streamline many administrative tasks and save money in the long run.

Where Docs Show Interest

WellPoint, with about 34 million members in its medical coverage plans, is piloting several e-visit programs in New York, Colorado, Wisconsin and Indiana.

“We continue to initiate programs in states where there is physician interest,” Cheryl Leamon, spokesperson for the Indianapolis-based company, said.

“Our initial impression with these programs has been that physicians are slowly beginning to adapt to this type of consultation, and we anticipate as the comfort level grows within the physician community, so too will the use of e-visit programs,” Leamon said.

She added, “We continue to evaluate the results of the programs as they are rolled out and will expand them as appropriate.”

Evolutionary Path Not Marked Yet

If online doctor consultations do become the North American norm, they’ll probably conform to some kind of standardization framework incorporating security measures and administrative features. That kind of framework might evolve parallel to or as part of national efforts to standardize electronic health records.

Because of Canada’s national health plan, standardization will be less of an issue for Canadian health systems. In the United States, standardizing practices and procedures is a key issue on several fronts, including Web medical visits.

Trombley said the Blues of Massachusetts are keeping an eye out for logical next steps in developing the Web visits system.

“We’re exploring opportunities to integrate with other initiatives such as the Patient-Centered Medical Home that several physicians groups recently launched,” Trombley said.

Last month, four physician membership organizations released “Joint Principles of the Patient-Centered Medical Home,” a set of seven principles describing the characteristics of a practice-based care model. It provides the framework for comprehensive primary, which eventually may include routine Internet interaction between patients and providers.

The four groups – the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association — represent some 333,000 physicians.

The patient-centered principles include several references to taking advantage of new IT, including this press release passage paving the way for charging for Web visits:

“The Joint Principles spell out a proposed payment framework for the PC-MH. This framework would reflect the value of physician care management work that falls outside of a face-to-face visit. It would pay for services associated with coordination of care, support adoption and use of health information technology for quality improvement and support provision of enhanced communication access. It would also recognize the value of physician work associated with remote monitoring of clinical data using technology, allow for separate fee-for-service payments for face-to-face visits and recognize case mix differences in the patient population being treated within the practice.”

Trombley said organizations are taking care to find the right framework fit.

“I think a lot of organizations are exploring the use of alternative mechanisms,” Trombley said. “The trick is to find the right mechanisms and systems to fit the organization.”

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