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Two major insurers recognize telemedicine

If you hate going to the doctor’s office, take heart: You might not have to go as often anymore.

Nevada’s two biggest insurers — Anthem and UnitedHealthcare — have rolled out programs that let consumers visit with a doctor online anytime for routine conditions. The idea? Let patients check in with a doc from home or work to spare the hassle of an in-office visit, and to cut down on emergency room and urgent care trips among people who aren’t critically ill.

Anthem’s LiveHealth Online “represents a true shift in health care delivery by using technology to make health care easier and more consumer-friendly,” said John Jesser, the insurer’s vice president of provider engagement strategy.

As with any medical innovation in its early days, online doctor visits have their downsides. Still, insurers say they’re dealing with those potential pitfalls as they ramp up Internet-based services.

LiveHealth Online lets consumers visit 24/7 with a doctor via live Internet video on a tablet, smartphone or computer. And through the NowClinic mobile and tablet app, UnitedHealthcare’s Health Plan of Nevada and Sierra Health and Life plans offer members round-the-clock access to doctors and physician assistants with the company’s Southwest Medical Associates practice.

“In our business, it’s important to be innovative, and we try to provide many avenues of care. People like to have options when it comes to how they access care,” said Dave Allazetta, vice president of sales and marketing at UnitedHealthcare.

Here’s how this particular option works: Patients download a free app, and sign in online on their smartphone, tablet or computer when they want to see a doctor. They choose from a provided list of available doctors and type in why they need a visit, then wait a couple of minutes while the doc gets up to speed on their complaint or looks at their medical records.

Via video, doctor and patient talk symptoms and concerns. There might be a diagnosis in simple cases, or referral to an ER, urgent care center or primary care provider if the case looks more critical. Otherwise, online docs can prescribe antibiotics for cold sufferers or insulin refills for diabetics. They can send a visit log to the patient’s primary care provider. Anthem’s system even produces a doctor’s letter for employees who have to stay home sick.

What online doctors can’t do: Help a patient in the middle of a serious emergency, such as a heart attack, or prescribe controlled substances, such as painkillers, or lifestyle drugs including Viagra.

Anthem’s service costs the same as or less than an in-office primary care visit for members. It’s $49 per visit for nonmembers. UnitedHealthcare’s NowClinic, which is limited to the insurer’s commercial and individual enrollees, charges about $10 to $15 per visit, Allazetta said.

Online visits aren’t yet where many doctors would like them to be: Insurers still don’t reimburse primary care providers for Skype or email consultations, said Greg Billings, executive director of the Center for Telehealth & e-Health Law in Washington, D.C.

Rather, carriers’ new telemedicine initiatives deploy a set doctor rotation. Anthem contracts for its LiveHealth Online providers with American Well, a Boston-based provider of online medical services, while UnitedHealthcare has half a dozen clinicians dedicated only to online visits. In other words, consumers can’t hop online to talk to their family doctor because he won’t get paid for that kind of patient care.

Still, some observers say the new programs are a far cry from just a couple of years ago, when providers would complain that insurers had yet to even recognize the new frontier.

“It has been a big change, and it’s come about fairly quickly,” said Jonathan Linkous, CEO of the American Telemedicine Association in Washington. “I think this is representative of the flood of new ways to deliver health care, and insurers are embracing it.”

Linkous’ association estimates that as many as 1 million doctor visits nationwide will happen via Internet in 2014, up from virtually zero three to four years ago. The group said it expects the number to double again in the next year or two.

It’s too early to say how much traction the trend has locally. Anthem only unveiled LiveHealth Online in September, and UnitedHealthcare opened NowClinic in January. NowClinic has averaged 1,500 sign-ups a month — at the low end of UnitedHealthcare’s expectations and a small number compared with the 350,000 members eligible for it.

Allazetta said UnitedHealthcare hasn’t marketed NowClinic because the company has focused on making sure it works as well as possible. Executives plan the program’s first big publicity push in the fourth quarter.

The trend could pick up steam as insurers begin actively promoting it.

COST SAVINGS A MAJOR DRIVER

One big reason insurers have bought into online computer visits: cost. The programs can cut overuse of emergency rooms and urgent care clinics among patients who don’t want to wait to see their family doctor. And when fewer people go to pricey emergency rooms for routine issues, fewer dollars go toward paying for care.

Anthem said employers can save more than $70 a year per employee by shifting visits from the ER to the Internet for colds, allergies, infections, aches, rashes and pink eye. But the change also benefits consumers. Anthem members say LiveHealth Online has saved them as much as three hours of time over in-office visits, said Mike Murphy, president of Anthem’s Nevada operation.

Acceptance also has come partly from changing public policy. A push among states to mandate that Medicaid cover online visits has helped, Linkous said, as has the Affordable Care Act.

“The ACA is representative of where we’re going in health care delivery, regulations and payment policies. It’s part of the tide that’s turning in health care,” Linkous said. “We’re moving away from the traditional way, where you go to the doctor’s office and they bill for each and every service they provide, and moving into very different ways of delivering care.”

Online care could be a salve for a state with a chronic doctor shortage. Nevada ranked No. 46 in a 2013 study by the University of Nevada School of Medicine for its share of primary care doctors, family practice specialists and pediatricians.

“We have a huge bubble of aging population coming up, as well as increasing numbers of people who are insured,” Linkous said. “We will still have a problem filling the roles of providers.”

Not everyone is applauding insurers’ latest move, though.

RUMBLINGS OF DISSATISFACTION

Not handled properly, online doctor visits might “sacrifice quality of care for cost,” Billings said.

“There are many physicians not affiliated with these programs who are very frustrated that insurance companies will pay for a subscriber to have a first-time encounter with a doctor through a webcam, but if that subscriber saw their own doctor through a webcam, (the doctor) wouldn’t be reimbursed,” he said.

Separating a patient from her primary care doc online could hurt continuity of care, an industry term that means people stick with one family provider who gets to know them and their specific health problems. That holistic approach is critical to the treatment of chronic conditions such as diabetes or asthma. Some doctors worry that random online visits could make it tougher to manage health long-term, Billings said.

It’s also impossible to diagnose some routine conditions via the Internet. You can’t spot strep throat without a swab and culture, Billings said. Nor can you pinpoint an ear infection without an otoscope, or a urinary-tract infection without a urine sample. Try to treat those conditions exclusively online, and you’re “writing antibiotics blind,” Billings said.

Insurers say they’re working around those concerns. Anthem is contracting with American Well to install kiosks with stethoscopes and otoscopes inside community centers or offices of large employers, so online doctors could actually take vital signs and look inside ears. The company doesn’t yet have any kiosks in Nevada.

And UnitedHealthcare’s NowClinic sends transcripts of online visits to each patient’s primary care doctor to keep them in the loop. A NowClinic doc also can see if a patient hasn’t had a flu shot or is overdue on her mammogram. Plus, providers are “very conscious” of the potential for misdiagnosis absent a physical visit, and they will “err on the side of referring” patients to family physicians if they’re not comfortable diagnosing, Allazetta said.

Despite the hurdles, the consumer convenience and cost savings are too powerful to derail online doctor visits, Linkous said.

“If you look at what’s happened in other industries such as banking, the only surprise is that health care hasn’t moved here faster,” he said.

With medicine’s ongoing shift onto the Internet, public officials will need to look harder at how online care is reimbursed and what its standard of care will be, Billings said.

“As more policymakers are confronted with the question of why insurers would pay for 24/7 service for a first-time encounter between a doctor and patient, yet they won’t pay for that same patient to see their own doctor, that might trigger policymakers to say, ‘We need to reimburse for telemedicine across the board,’ ” he said.

The trend might be headed that way all by itself.

“This is in its infancy. This is the beginning of telemedicine. How it evolves is still yet to be known,” Allazetta said. “It could evolve to include visits with your own physician, or more opportunities to manage chronic cases. At this point in time, we’re only working with a dedicated group of physicians. It’s very important to us to be sure this is done right, and to have control through a small group of physicians on how we get there.”

Contact reporter Jennifer Robison at jrobison@reviewjournal.com. Follow @J_Robison1 on Twitter.

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