House calls: health insurers are responding to the demand for online medical consultations.In the midst Adv. 1. in the midst - the middle or central part or point; "in the midst of the forest"; "could he walk out in the midst of his piece?"
midmost of a busy Thursday morning, Dr. Braswell Deen Braswell Drue Deen (June 28, 1893 - November 28, 1981) was a U.S. Representative from Georgia.
Born on a farm near Baxley, Georgia, Deen attended public and high schools and South Georgia College, McRae, Georgia. , a physician at Deighton Family Medicine and a faculty member on staff at Providence Hospital Providence Hospital is a 247 bed acute-care facility located east of downtown Columbia, South Carolina. The hospital was founded in 1938 by the Sisters of Charity of Saint Augustine as a ministry to the Catholic community, in both body in spirit. in Detroit, is consulting with a patient experiencing difficulties associated with his diabetes.
But this consultation is different from the traditional office visit that's a decades-long staple 1. (language) STAPLE - A programming language written at Manchester (University?) and used at ICL in the early 1970s for writing the test suites. STAPLE was based on Algol 68 and had a very advanced optimising compiler.
2. in medical care. Technology is at the heart of this visit.
Deen logs onto his computer and receives notification of an e-visit consultation by the patient. After reviewing the patient's responses to a thorough set of questions and a detailed description of his symptoms, Deen is able to offer assistance without seeing the patient in the office.
Online medical consultations-also commonly referred to as e-visits or Web visits--are slowly becoming part of today's health-care system. Office visits and traditional ways of getting a lab result or medication refill refill noun A second allotment of a prescription agent obtained from a pharmacy, which is allowed by the original prescription verb Pharmacology To obtain more of a particular drug, after the initially prescribed amount of the agent has been used or are becoming things of the past for a growing number of patients and their providers. The technology's payoffs? Increased efficiency, greater convenience, around-the-clock access and improved member and provider satisfaction are being touted by all constituents.
Health plans recognize the benefits. A number have recently begun promoting online medical consultations to their network physicians and/or established incentives and compensation for physician services delivered online. Cigna Health Care recently joined the ranks of more than a dozen other health plans that have teamed with RelayHealth, a provider of secure, online health-care communication services, to offer eligible members access to various e-capabilities. Earlier this year, Cigna expanded availability of "virtual house calls" for nonurgent health issues to all self-insured customers in California, Arizona, Florida and parts of New Jersey, Connecticut and New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of .
"There's greater demand in the market and members are beginning to adopt this technology as an alternative to meeting their traditional health-care needs. It provides more choice and convenience versus the traditional route of going into the office," said Wendy Sherry sherry [from Jérez], naturally dry fortified wine, pale amber to brown in tint. The term sherry originally referred to wines made from grapes grown in the region of Jérez de la Frontera, Andalusia, Spain; today it may refer to any of the , assistant vice president of strategy product marketing for Cigna Health Care.
Three-quarters of adults would like to use e-mail to communicate directly with thor doctor, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. a recent Wall Street Journal Online/Harris Interactive Health-Care Poll. Only 4% said they currently use such technology, however, and 4% said they have it available to them but don't use it.
Insurers at Work
Online medical consultations are becoming part of several health plans' covered benefits.
In these plans, Cigna reimburses for all types of services "where a physician would be charging related to an online e-visit," said Sherry. "We've aligned member cost share to that of an office visit. If a member has a $10 copay co·pay
A copayment. or 10% co-insurance for an office visit, they would pay $10 or 10% co-insurance for an online visit"
Generally only online medical consultations are included in plans' benefits designs. Most online administrative services, such as scheduling an appointment and requesting a lab result, are unchargeable services.
Mary Jo Baughman, business development manager for WellPoint Inc., said one of the underlying foundations for online visits and getting adoption in the market is cost. E-visits are generally less expensive than traditional office visits, with the average online medical consultation cost ranging from about $25 to $30 per visit.
"If physicians decide they need to see a patient in their office, the provider does not charge for the [online] visit encounter," said Dr. Roki Chatthan, vice president--medical services and medical director for quality at Premera Blue Cross Premera Blue Cross is a nonprofit Blue Cross Blue Shield licensed health insurance company based in Mountlake Terrace, Washington. It sells health insurance plans under the Blue Cross license in Washington state except Clark County and under both the Blue Cross and Blue Shield . He said there are numerous checks and balances in place to ensure patients aren't charged in those instances. In January 2006, Premera Blue Cross entered into an 18-month pilot with Virginia Mason Medical Center Virginia Mason Medical Center (VMMC), founded in 1920, is a private, non-profit organization located on Seattle, Washington's First Hill offering a system of integrated health services. Gary S. Kaplan, MD, serves as chairman and CEO, and J. in Seattle and the Microsoft Corp. using RelayHealth's technology. Today, 100 Virginia Mason physicians and about 5,000 Microsoft members are participating in the pilot.
Many health plans said they've made the jump to e-visits largely to provide greater access to care. "For years we've encouraged physicians to adopt electronic claims submission and other processes, provided them with information on our Web site and allowed members to do various things through our Navigator See Netscape Navigator, Netscape and Norton Navigator.
Navigator - Netscape Navigator Web site. The next step was to support electronic communications. The challenge was doing what we want to do in a way that's safe and efficient," said Dr. Charles Cutler Sir Charles Benjamin Cutler, KBE, ED (20 April 1918 - 23 September 2006) was an Australian politician, holding office for 28 years as an elected member of the New South Wales Legislative Assembly, who served as NSW Deputy Premier for 10 years and Country Party leader for 16 years. , chief medical officer of national accounts for Aetna Inc.
One of the safety concerns is that the technology should be used only for nonurgent conditions, such as back pain or cold symptoms. "It's not an online chat service," said Sherry. System providers post warnings alerting users to contact 911 in the case of a serious injury or illness.
Sherry said a common misconception mis·con·cep·tion
A mistaken thought, idea, or notion; a misunderstanding: had many misconceptions about the new tax program. is that most online medical consultations are e-mail transactions. "Safety and security reasons keep some plans from using e-mail as the communication device," she said.
One health plan sees that differently. Kaiser Permanente Kaiser Permanente is an integrated managed care organization, based in Oakland, California, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney R. Garfield. members can e-mail their providers messages via the company's KP.org Web site. "Physicians like the efficiency of being able to answer a patient's question or give advice by e-mail; there's no waiting for a call back or leaving a message with a teenager wondering if the patient will get it" said Kate Christensen, medical director for KP.org. "The physician and patient can both compose com·pose
v. com·posed, com·pos·ing, com·pos·es
1. To make up the constituent parts of; constitute or form: their e-mail messages when it's convenient for them, even after clinic hours. And having the interaction automatically recorded into the chart saves more time that would be spent documenting a phone conversation."
The ability to connect e-visits with electronic health records may increase adoption rates.
Dr. Robert Mirsky, senior medical director of professional programs for Blue Cross Blue Shield Blue Shield A US not-for-profit health care insurer that is a reimbursement intermediary for physicians. Cf Blue Cross. of Florida, said while Web visits are a stepping stone for a number of practices, several others are embracing the technology to see how it might be embedded Inserted into. See embedded system. into electronic health records and other related tools.
The U.S. Institute of Medicine and Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Health and Human Services, HHS have advocated electronic patient-provider communications as a core functionality of an electronic health record.
RelayHealth is making the connection. Its Interoperability The capability of two or more hardware devices or two or more software routines to work harmoniously together. For example, in an Ethernet network, display adapters, hubs, switches and routers from different vendors must conform to the Ethernet standard and interoperate with each other. Toolkit technology provides data sharing The ability to share the same data resource with multiple applications or users. It implies that the data are stored in one or more servers in the network and that there is some software locking mechanism that prevents the same set of data from being changed by two people at the same time. between its service and any commercial or custom-built electronic health records. Providers can link, import and store secure messages in patients' electronic medical records.
For Kaiser Permanente, all e-mail messages between clinicians and members are recorded into the electronic chart, said Christensen. "The member sends their message from their KP personal health record so, for example, they can look at their lab results or instructions from their last doctor's visit and then e-mail their physician with any questions. This is the benefit of having an online health record connected to your doctor-people and their doctors can look at the same information and communicate about it online;' she said.
While some health plans said the technology may cut costs by eliminating trips to the emergency room and unnecessary medical tests, they believe overall savings for the health insurance industry will likely be "cost neutral"
"I don't think it will drive up utilization or costs and I'm not convinced it will decrease costs," said Premera's Chauhan.
A Stanford study showed, however, that online consultations' reduction in spending related to physician office visits was $1.92 per patient-month and total health-care claims were cut by more than $3 per-member per-month.
A growing number of doctors, health-care executives and industry analysts conclude that online communication between doctors and patients is no longer an "if" but a "when," according to a RelayHealth survey.
"The technology will begin to change the face of the health-care industry as more tools become available and members begin to take an active role in their health-care dollars" said WellPoint's Baughman.
Several health plans are already looking at future expansion. Cigna will consider expanding its e-visits offering beyond just its self-insured market in several states, while Kaiser Permanente is working on plans to enable members to attach digital images to messages.
"I think there will be an expectation that you can access your medical record and e-mail your doctor online and those companies that don't offer it will suffer," said Kaiser Permanente's Christensen.
* Adoption of online medical consultations is slowly beginning to increase as a way for patients and physicians to reach out to one another.
* A number of health plans are beginning to pilot e-visits and reimburse re·im·burse
tr.v. re·im·bursed, re·im·burs·ing, re·im·burs·es
1. To repay (money spent); refund.
2. To pay back or compensate (another party) for money spent or losses incurred. for all or some of the service.
* Online medical consultations' link to electronic health records may help drive the technology's adoption.
Benefits Online Doctors' Visits
Insurers--Increased provider and member satisfaction, improved quality of care, ability to attract and to retain employer groups employer group Association of employers Managed care An entity with a current group benefits agreement in effect with a health plan to provide covered health care services to its employee-subscribers and eligible dependents.
Physicians--Efficiency and convenience
Consumers--Greater access to providers, schedule appointments, view lab results and request prescription refills Source: RelayHealth
Weighing the Risks
Physicians' initial reluctance concerning online medical consultations is changing. A RelayHealth survey found that 56% of physicians preferred the webVisit--the company's technology that connects patients and their physicians via a secure, Web-based guided interactive process--to an in-office visit for handling nonurgent patient health needs.
"Providers are excited because webVisits offer them another opportunity to help patients meet their health-care needs and is a way to help improve their own office productivity," said Wendy Sherry, assistant vice president of strategy product marketing for Cigna Health Care.
While acknowledging that online consultations are a step in the right direction, some point out that challenges must be overcome to enable significant growth in the market. Man hattan Research, a New York consulting and research company specializing in health-care technology, said only one quarter of all physicians now are using e-mail or online consultations. "Their biggest concern is liability," said Erika Fishman, a senior research analyst. "While there are some guidelines guidelines,
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. for secure messaging, there aren't any specific conduct codes with regards to such things as the tone and applicable shorthand shorthand, any brief, rapid system of writing that may be used in transcribing, or recording, the spoken word. Such systems, many having characters based on the letters of the alphabet, were used in ancient times; the shorthand of Tiro, Cicero's amanuensis, was used , which is very concerning to physicians who already have huge medical-malpractice insurance:'
Many believe medical malpractice Improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional. fears are unfounded, however. "Actually there's the feeling that this [technology] protects physicians against medical malpractice because it documents everything, including information that's collected and the conversation between them and their patients. The risk of malpractice malpractice, failure to provide professional services with the skill usually exhibited by responsible and careful members of the profession, resulting in injury, loss, or damage to the party contracting those services. is markedly decreased by using a format that documents the questions asked, the patients' answers and the physician's recommendations," said Dr. Charles Cutler, chief medical officer of national accounts for Aetna Inc.
Barbara Worsley, vice president and manager of risk management for medical professional-liability insurer SCPIE SCPIE Southern California Physicians Insurance Exchange Cos., said online communication offers physicians "another modality modality /mo·dal·i·ty/ (mo-dal´i-te)
1. a method of application of, or the employment of, any therapeutic agent, especially a physical agent.
2. of communication with patients?' She said, however, that insureds who choose this mode of communication should realize that "it does come with new and unique challenges." To minimize such risks, she recommends that physicians adhere to adhere to
verb 1. follow, keep, maintain, respect, observe, be true, fulfil, obey, heed, keep to, abide by, be loyal, mind, be constant, be faithful
2. the e-mail guidelines drafted by the eRisk Working Group for Healthcare, of which SCPIE is a member, and Medem--a network provider initially founded by the nation's medical societies,
While SCPIE doesn't have specific policy exclusions or endorsements for its insureds who use online communication, the company prefers not to insure Insure can mean:
Providers will play a key role in driving adoption of e-consultations technology, said Mary Jo Baughman, business development manager for WellPoint Inc. But thus far it hasn't topped their radar screens, she said. "They've had many other things going on in their offices--first dealing with HIPAA (Health Insurance Portability & Accountability Act of 1996, Public Law 104-191) Also known as the "Kennedy-Kassebaum Act," this U.S. law protects employees' health insurance coverage when they change or lose their jobs (Title I) and provides standards for patient health, transactions, then electronic health records and now this technology."
Clinicians will need to do several things to help drive adoption, said Fishman. "They need to market online consultations adequately to their patients and there needs to be 'physician cheerleading' to demonstrate to their peers that it works: She also foresees a spike A burst of extra voltage in a power line that lasts only a few nanoseconds. See power surge, power swell, sag and surge suppression.
(jargon) spike - To defeat a selection mechanism by introducing a (sometimes temporary) device that forces a specific result. in adoption rates if Medicare begins reimbursing for e-visits.
Aetna Health and Life Insurance Co. AM. Best Company # 08189 Distribution: Brokers, consultants, retail network (pharmacy pharmacy, art of compounding and dispensing drugs and medication. The term is also applied to an establishment used for such purposes. Until modern times medication was prepared and dispensed by the physician himself. In the 18th cent. products)
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How Online Medical Visits Work
RelayHealth's technology--called webVisits--works by connecting patients and their physicians via a secure, Web-based guided interactive process.
1. Members log on to RelayHealth's Web site and go through an algorithm-driven, clinically-structured interview comprised of 149 nonurgent medical conditions--similar to questions asked by a nurse or physician during a traditional office visit.
2. Depending on the nature of their answers, the technology's branching logic prompts users through a series of additional questions. "The different questions help get at what's ailing someone and what's needed to treat the condition," said Wendy Sherry, assistant vice president of strategy product marketing for Cigna Health Care.
3. After the interview is complete, information is sent to the physician and he or she is notified of the webVisit via e-mail, fax or a message sent to a pager. Physicians then log onto the system, review the e-visit and determine an appropriate diagnosis or treatment plan. Clinicians also have the ability to send a prescription directly to the patient's pharmacy.
One of the service's rules of engagement is that there is an established relationship between the member and provider. "The doctor knows his or her patient and their medical history, so it's not just a doc-in-the-box," Sherry said.