Better Phone-free Virtual Visits

July 1, 2006

Aetna covers online doctor-patient communication for insured members in Florida and California.

Has anyone on this planet not been frustrated by the typical call-routing system used by his physician’s office? Press “one” for this, press “two” for that, stay on the line to speak with an operator.

Aetna covers online doctor-patient communication for insured members in Florida and California.

Has anyone on this planet not been frustrated by the typical call-routing system used by his physician’s office? Press “one” for this, press “two” for that, stay on the line to speak with an operator.

For Aetna health plan members in Florida and California, that could be history. In May, Aetna announced that it will cover online physician-patient consultations using technology from RelayHealth, Emeryville, Calif. That means fully insured members in these states can utilize webVisits, RelayHealth’s tag for online provider-patient consultations; self-insured employers with employees in these states also can opt to have their Aetna members participate. And that means, potentially, a drop in phone calls to doctors’ offices, a reduction in office visits for purposes that don’t require an office visit, more efficient utilization of office staff and increased member satisfaction. Everyone wins.

Work in Progress
While the value of online doctor-patient communications has been discussed for years, the real hot button has been provider reimbursement for them—or lack thereof. One thing is sure: Members want online consultations. In survey after survey, consumers say they want to be able to communicate with doctors the way they communicate with the world at large—electronically—especially about nonurgent issues that don’t require a face-to-face office visit, and especially if electronic communication could eliminate the need for one.

Physician receptivity remains a “work in progress,” according to Aetna’s National Medical Director, Quality Management, Charles Cutler, M.D. “Right now,” he says, “The greatest concentration of doctors who participate with RelayHealth is in Florida and California, so we have critical mass with which to launch our program in those states. Generally, our discussions with doctors indicate that they welcome this kind of interaction for a couple of specific reasons.”

The first, he says, is that right now, doctors aren’t compensated for telephone consultations, and yet most of the topics that patients e-mail about are the same ones they would call about. Compensation for webVisits puts money on the table where there was none for telephone calls.

Equally important, Cutler says, “webVisits allow physicians to improve workflow—their own workflow and that of office staff.” Traditionally, the patient might connect with a front-desk receptionist, a medical assistant or possibly a nurse. That person would collect information from the patient about why he wanted to speak with the doctor and structure the information for clinical presentation to the doctor, and then the physician and patient might play a round of phone tag before connecting personally.

Structure is the Key
With webVisits, the front-end work performed by office staff goes away, and some of the back-end work might too, with increased adoption of electronic medical records. RelayHealth is known for providing structured, secure online communications, a feature that Cutler says was very important to Aetna in its vendor selection, and a feature that tends to make physicians more receptive to electronic queries from patients, because they know the information they receive has already been formatted and structured accurately for their clinical review.

To electronically communicate with her physician, the patient must first complete an online webVisit questionnaire. RelayHealth offers more than 145 individual webVisits including topics related to pediatrics, women’s health, chronic conditions, general health, test results and medication questions to name a few. Each webVisit is algorithm-based, and consists of a moderate series of questions constructed around the individual topics. All questionnaires are targeted to elicit specific information about the patient’s perceived condition and the reason for the online consultation. For nearly every question presented, the patient can select from multiple choices that are written in layman’s language, in the words a patient would normally use to express herself. See “In Their Own Words” on page 26 for examples of specific patient choices and responses.

The system organizes data so that information keyed by the member is presented to the physician as a clinical note. Cutler says that online data capture and organization “gives physicians a larger window of opportunity to manage both the incoming query and the internal workflow to respond to it.” At the same time, the patient actually may get a response sooner than she would with a phone call request, since the system handles the intake and structure of data that goes to the doctor. “Potentially, physician practices may reduce overhead costs with online communications,” says Cutler, because office or support staff don’t have to serve first as telephone intermediaries and, secondly, as information filters for the physician.

Proof Is in the Payment
Wanting online consultations is one thing. Paying for them is another. According to Cutler, Aetna had been involved in an earlier program with RelayHealth, as well as with other electronic transaction companies, and supports the concept from a practice efficiency standpoint.

But as a payer, he says, “Aetna had to evaluate a number of considerations,” before deciding to cover webVisits. “The first question we had to answer was, ‘Is this a safe and reasonable service to provide for our members?’ We had to evaluate a host of clinical issues from both the provider and member perspectives, and then we had to determine if we thought our participating physicians also would find this an attractive option. A third consideration was, ‘What is the overall effect of covered online consultations on medical costs?’ We’ll be tracking and assessing this closely in the future, as the program progresses.”

Aetna is not the only entity paying, however. Because webVisits are treated as regular physician consultations, members incur a copayment, usually the same amount they would pay for an office visit. The copay is charged at the end of the webVisit, when the member keys credit card information in the system; RelayHealth collects the copay online and reconciles behind the scenes with the provider’s office. It is likely that the combination of thoughtfully structured webVisit questionnaires, along with a patient financial obligation attached to the online consultation, will prevent members from viewing this methodology as something as simple as shooting off an e-mail to the doctor.

For their part, medical practices face only minor up-front investments. Because webVisits are offered on an ASP basis, practices pay a monthly subscription fee to participate and need only a computer and Internet connection; then they may utilize the service as much as is practical each month.

Employers, too, support online consultations. When it comes to nonurgent care, employers would rather see employees query and consult physicians electronically than be forced to leave the work site for a two-hour office visit.

Finally, health plans like Aetna, that will reimburse physicians for electronic consultations with patients, may favorably influence an increase in physician adoption of EMRs. For practices unwilling to make a five-figure commitment to install an EMR, utilizing webVisits first is a low-cost, low-risk way to gently but personally test the waters of automation before diving full-force into full-scale electronic documentation. It is a healthy first step that could easily lead to next steps.

For more information about webVisits from RelayHealth,