Doctors to Make Web Calls in Hawaii

Clearly the most innovative move made so far in this very young year by a health plan has to been the decision of the Hawaii Medical Service Association, the state’s Blue Cross-Blue Shield licensee, to make the Internet version of the house call available to everyone in the state.

American Well, a Web service that puts patients face-to-face with doctors online, will be introduced in Hawaii on Jan 15.

Patients use the service by logging onto participating health plans’ websites. Doctors hold 10-minute appointments, which can be extended for a fee, and can file prescriptions and view patients’ medical histories through the system using HealthVault, Microsoft’s electronic medical records service.

According to a recent story in the New York Times, the Hawaiian health plan’s 700,000 members will pay $10 to use the service. But, what is really unique, the insurer is also offering the service to uninsured patients for $45 – considerably less than the $95 to $265 that WikiAnswers says a typical visit to a family practice doc would cost. Health plans pay American Well a license fee per member and a transaction fee of about $2 each time a patient sees a doctor.

The Times article points out that Hawaii is particularly well suited for online medicine because the islands are remote, it takes time to travel among them and it is difficult for the state to recruit doctors to rural areas. (Humm.. seems that description applies to most of the country.)

However, it also notes that some critics of doctor visits via webcam worry that doctors will miss important symptoms if they do not see patients in person. Others doubt that the poor and uninsured will have the broadband connection and webcams to use the service.

Health Plan Innovation Take: Back in September, The Health Plan Innovation Blog featured a post about a white paper touting the use of  telehealth for both episodic and chronic health care.

The paper, “Telephone Connectivity Supports Medical Home Model and Removes Barriers to Care,” authored by Kenneth P. Moritsugu, M.D., M.P.H., F.A.C.P.M., articulated the value of telehealth – namely the utilization of the telephone to provide physician or consumer-directed cross coverage 24/7 – as an emerging and effective application in tackling specific issues related to episodic care as well as chronic care management for diseases such as diabetes, cancer, and cardiac disease.

So, if talking to a doctor by phone (now an ancient technology) can be good, wouldn’t it stand that being able to talk to one another and see each other would be even better?

The “connected home” through broadband connectivity has now become a reality for the majority of Americans. Why not use this tool to better monitor persons with chronic conditions or to follow up on episodic care? This is Patient-Centered Healthcare that uses a direct communication model that helps providers by empowering them to monitor and manage patient care from a distance, without regard to location, and minimizes the need for patient travel when not necessary for the interaction.

As we said back in September, sometimes a simple change in the system such as coming up with a way for physicians to be compensated for a telephone (insert the word “online”) consultation can have wide ranging impact of the overall system.

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