Electronic Patient Visits Gaining Traction

Published September 1, 2006

National and regional health insurers have begun to reimburse providers for electronic patient visits, in the hope these payments will improve care quality as well as doctor-patient relationships.

Cigna Health and Blue Cross/Blue Shield of Florida, for example, reimburse providers around $30 for a “virtual health consultation” with a patient. Additional insurers are expected to begin reimbursing for virtual visits within the next year.

Electronic patient visits, or virtual consultations, are one component of electronic systems that use secure Web sites to allow patients to send physicians everything from appointment requests to symptom reports. For insurers, virtual visits are part of a larger trend, including the push to create electronic medical records and electronic prescriptions aimed at digitizing medicine.

Doctors Requesting Service

Secure online visits offer several advantages–such as compliance with federal privacy rules–over merely asking doctors questions via email, said Dr. Giovanni Colella, chief executive officer for Emeryville, California-based Relay Health, which makes a secure visiting tool used by two national health plans and 13 smaller plans.

Joe Mondy, assistant vice president for communications at Cigna Health, which in 2007 will begin virtual visit reimbursement in major markets including California, Florida, and the New York tri-state area, said physicians, patients, and employers have requested the service.

“Employers are asking if it’s possible for us to have their employees do doctor visits online. Doctors are saying they can improve their office workflows for non-urgent matters by doing this,” Mondy said. “This fits in with our overall strategy to improve health care outcomes by making health care more convenient and at a lower cost.”

Tools Save Office Time

Relay Health and similar services use online forms to detail patients’ symptoms and medical history, then route information requests to the appropriate staff person at the doctor’s office. A patient must first have an established relationship with a provider to be able to use the secure tools.

Blue Cross/Blue Shield of Florida, which has reimbursed providers for virtual visits since 2004, has found providers and patients are more likely to use the administrative functions than diagnostic and treatment options.

This June, for example, of the more than 4,000 messages sent between patients and physicians, fewer than 1,000 concerned patients’ symptoms or treatments, said Bruce Middlebrooks, a spokesperson for Blue Cross/Blue Shield of Florida. The rest dealt with administrative details, such as setting appointments.

Process Is More Efficient

Dr. Robert Mirsky, senior medical director for professional programs of Blue Cross/Blue Shield Florida, said many physicians first use the system to “help streamline the way [doctors] interact with the patients.” In particular, Mirsky said, office staff use online tools to make administrative tasks such as setting appointments more efficient.

Mirsky said physicians and patients gradually ease into more significant contact online, including reimbursable health discussions.

Colella said physicians prefer virtual visits because the tools collect the sort of information a doctor once had to obtain over the phone or on paper before making a diagnosis. He noted that during his 10 years as a practicing physician prior to working for Relay Health, he returned an average of 15 patient calls a day, for which insurance companies did not reimburse him.

“You have to spend time and do good medicine,” Colella said, “and you don’t get paid.”

Virtuality Increases Volume

Clinical studies suggest physicians take advantage of the efficiency gains provided through secure visiting. A study in the Spring 2005 edition of the Journal of Healthcare Information Management found physicians using virtual visits could expect an 11 percent increase in the number of patients they could see each day.

Colella said virtual visits also offer advantages to insurers and patients. The tools allow patients to avoid unnecessary trips to doctors’ offices for routine medication refills, and insurers save an average of $1.50 per month for each patient who signs up for virtual visits.

Insurers said virtual visits also offer care improvements over phone calls.

“It allows [physicians] to get a fair amount of information that helps them with clinical decision-making in a way that they generally are not able to do through getting messages or brief phone conversations with patients on the go,” Mirsky said.

Systems Use Safeguards

Although practicing medicine over the Internet would seem to be rife with safety problems, both Mondy and Mirsky noted virtual visits offer doctors tools to protect against lawsuits and reduce medical errors. Unlike phone calls, virtual tools produce written records of physician-patient interactions that could help protect physicians against malpractice suits.

Web sites also offer clear warnings that in case of emergency, patients should go to the hospital, Colella said.

“We signal everywhere that this is not for emergencies,” Colella explained. While “it’s always a concern” that patients with life-threatening conditions might use the system, “it has never happened. People are smart enough that when they’re sending an email, they shouldn’t expect the doctor [to answer instantly].”

Because insurers are using virtual visits as part of larger electronic programs, Mondy said electronic tools actually eliminate doctor-shopping and other questionable patient behavior. At Cigna, “we have a tool for comparison-shopping for medications at 54,000 pharmacists nationwide,” Mondy said. “One of the things you do is you fill in how many drugs can be prescribed [for an individual patient] in a period of time–if it’s outside the formulary [of standard dosage recommendations], the doctors would be advised of it.”

Mirsky added that because the Blue Cross/Blue Shield suite of electronic tools collects patient medical history information, doctors can better avoid prescribing drugs that might have harmful interactions with other drugs.

Usage May Grow

Noting that initial adoption of virtual visiting tools was slow after Relay Health’s launch in 1999, Colella said the company started making significant inroads in 2003 and is planning to employ 800 salespeople in anticipation of substantial near-term growth.

Mondy said Cigna hopes to improve on virtual visits by integrating multimedia into future options. “If you have a bruise on your arm,” Mondy said, and “you have a cell phone that takes pictures, you could get it over by the ‘Net.

“The next step will be video doctor’s visits,” Mondy added, saying video conferencing could allow patients to stay at home with family and still interact with doctors, improving patient comfort and reducing the number of people in doctors’ waiting rooms.

Bradley Kreit ([email protected]) is a writer in San Diego, California.