E-healthcare takes another step forward this month when First Health Group becomes the first managed care organization to establish a program that eventually will pay physicians for online consultations with patients.
First Health is spending more than $500,000 to launch the initiative within its Care Support program for chronic diabetics, asthmatics and hypertensives, which covers 300,000 enrollees and their dependents, a small portion of the company's 10 million total enrollees. If successful, coverage could be extended to its disease management programs for HIV, congestive heart failure and high-risk pregnancies.
"This is meant for people who need to communicate regularly with our members who are their attending physicians," says Mary Anne Carpenter, the executive vice president for service products for Downers Grove, Ill.-based First Health.
The program was scheduled to begin Jan. 1, a few weeks later than originally planned. "We had to have the clients build this reimbursement policy into their benefit plans," Carpenter says. First Health will start by informing Care Support enrollees of the availability of this benefit and then begin educating physicians about the program.
Those of First Health's 280,000 member physicians who choose to participate will receive $25 per "episode" of electronic patient consultation, essentially a series of e-mails related to a specific medical question or request for advice.
The amount is equal to the fee First Health pays for in-person preventive services. Doctor-patient contact will be conducted via a First Health Web site, where the insurer will capture the information needed relative to payments.
However, First Health has suggested that the limit on claims for electronic consultations with each patient will be greater than the once-per-quarter cap on preventive office visits.
Care Support enrollees will be able to contact their personal physicians through a password-protected link
on First Health's Web site at any hour. "It's for people who say, 'I wasn't feeling so good but I didn't want to bother the doctor,"' Carpenter says.
The site is not intended to be a conduit for diagnosis and treatment of ailments. "We're not trying to cut down on office visits. We're trying to prevent emergency room visits," Carpenter says.
While several other PPOs are said to be working to implement payment programs of their own for online consultation, an industry group is urging managed care organizations and participating physicians to proceed cautiously.
"We've got to be careful that we don't end up with a consultation mill, with doctors sitting in front of the PC all day," says Bill Hale, chairman of the American Association of Preferred Provider Organizations.
Hale also is president and CEO of Beech Street, an Irvine, Calif.-based PPO with 16 million enrollees. His company is not building a fee-based online consultation system. He says of First Health's effort, "I think it's good for the industry, good for medicine and good for the consumer," and believes that a large payer like First Health can develop a workable model for smaller payers to follow.
Still, "The public will accept it as long as (First Health) addresses the issue of preservation of security and keeps it as manageable as possible," he says.
Because of such issues, Hale does not believe the idea will revolutionize medical care. "I think it's a niche of the future," rather than a revolution, he says.
Teresa Devine, director of healthcare financing for the Texas Medical Society, says, "From a Texas perspective, I don't think that there is going to be a groundswell of interest in this from physicians."
Devine notes that her organization has had trouble modernizing the dissemination of information to its members because doctors have been reluctant to provide e-mail addresses, sometimes out of concern for confidentiality breaches. "Physicians as a group are not necessarily on the cutting edge of technology."
The AAPPO's Hale believes that ultimate acceptance of online consultation will depend on its usefulness to physicians and patients alike. "If you can accelerate communications or if you can simplify remedial communications, then hallelujah," he says.