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6/18/2008
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American Well Offers Patients Virtual Doctor Visits

The online health care marketplace lets patients contact an accredited medical specialist live, 24 hours a day, via the Web or phone.

Depending upon what insurer signs up with American Well in Pennsylvania, Lehigh Valley doctors could provide consultations to both Lehigh Valley patients as well as other Pennsylvanian patients, says Sussman. The American Well service lets doctors earn additional revenue "on their own time," he says.

Lehigh Valley doctors will have the opportunity to provide consultation services from their offices or homes, wherever they prefer.

Through the on-demand virtual consultations, "we think we can provide better care on a more timely basis for patients," Sussman says.

That includes helping patients consult with specialists and work out uncertainty on whether their condition warrants an office visit with a doctor, or a trip to the ER. " 'Should I go to the ER' is not always as clear cut as having chest pains," he says.

American Well handles the adjudication process with the insurance companies for doctors so that the physicians are immediately paid for their consultations. Patients pay co-pays specified by their health plans. American Well charges the insurers and health plans license fees based on the number of "seats" or members they have, plus a "small transaction fee" for each consultation, says Schoenberg.

The platform supports private, secure, authenticated, encrypted exchanges, as well as an audit trail for patients. "The information is the patient's asset," says Schoenberg. The site "meets the rules and regulation stated by HIPAA, and meets the most stringent rules about exchanging information," says Schoenberg.

American Well and Microsoft also are partnering to allow information in Microsoft's Web-based HealthVault personal health records to be available to American Well's doctors providing virtual consultations. With patient consent, the doctors can access HealthVault patients' lab results and other health data when providing virtual consultations.

American Well's arrangement with Microsoft isn't exclusive, so American Well could potentially work similar relationships with other providers of online personal health records, such as Google.

"When a physician is interacting with a patient online, it will be as close as possible to an in-office visit," says Schoenberg. The platform also supports Web cam interactions and videoconferencing, so patients who have access to those devices can actually be "seen" by the remote clinician, he says.

Because the platform is for "health care delivery," doctors providing consultations are held to the same rules and regulations involved with on-site health services, says Schoenberg. So, for instance, doctors are only able to provide consultations to patients in states where the physician is licensed to practice medicine.

Because the American Well consultations are real-time exchanges between patients and doctors, the interactions are "much more advanced" than secure e-mail exchanges that some doctors provide as a service to patients through secure messaging platforms such as RelayHealth, says Schoenberg.

Some insurers, including various Blue Cross Blue Shield organizations, have for several years reimbursed doctors for e-mail consultations facilitated by RelayHealth.

In those previous offerings, "it could take 48 or 72 hours to get an e-mail reply" from a physician, Schoenberg says. By contrast, the exchanges on American Well are "on-demand, real-time." If a patient prefers contacting a physician via phone, American Well's VoIP platform can capture a recording of the interaction for transcription, Schoenberg says. The patient can consent to have a summary of the virtual consultation exchange sent to their primary care physicians.

The service also can provide convenience and peace of mind for patients who are waiting to visit a backlogged specialist. "It can take three months for a new patient to see a dermatologist in Boston," says Schoenberg. During that wait, anxious patients can contact a dermatologist via American Well for consultation, he says.

The service also means potential savings for employers, as well as boosts in worker productivity. Instead of calling in sick or taking hours off for nonurgent doctor office visits, employees may decide to get a fast, online consultation with a physician instead, says Schoenberg.

The service can help patients make quicker care decisions when their own doctors aren't available. Like at 2 in the morning.

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