American Well's telehealth encounters cost $49, which is less than the average cost of a visit to a physician office or an urgent care center, and much less than the cost of an ER visit. With 28 states now requiring insurers to cover telehealth, and some national health plans paying for it, many individuals who use American Well's new service will only have to come up with a copayment.
In a press release, American Well claims to be the only telehealth service "that offers immediate, live video visits on mobile, the Web and at kiosks. The company's unique technology actively manages physician availability -- letting consumers either choose a specific doctor or simply connect to the next available one. Patients can also review doctors' professional profiles and see how other patients rate them."
In response to requests from its customers, which include WellPoint, United, Blues plans, and large, self-insured employers, American Well has assembled a national physician network that encompasses 600 to 700 providers, said Roy Schoenberg, MD, CEO of American Well, in an interview with InformationWeek Healthcare. These include staff doctors in a group called Online Care Group, which describes itself as "the nation's first and largest physician-owned primary and urgent care group devoted to video telehealth."
[ Some healthcare organizations are drawing the line at online consultations. Read Stop Crippling Telemedicine. ]
In addition, Schoenberg said, the company uses on-call physicians who have their own practices and a third tier of independent doctors who are available when needed. American Well offers live video consultations in 44 states and the District of Columbia around the clock, 365 days a year.
During telehealth encounters, the physicians treat patients for health problems such as cold and flu, sinusitis, urinary tract infection and pink eye. They might prescribe drugs from a formulary that does not include controlled substances.
In the past year and a half, Schoenberg said, American Well has seen its business expand not only with payers, which are increasingly embracing telehealth, but also with healthcare systems. Providers are recognizing the value of telehealth as they begin to take financial risk through accountable care organizations, he said.
American Well made the decision to move into the direct-to-consumer space, he said, for two reasons. First, many health plans still don't cover telehealth. Second, some insurers are offering American Well's service only to select employer customers. United, for example, is rolling out American Well gradually, whereas WellPoint now offers it to all of its plans' customers, he said.
"When we offer the service directly to consumers, we can do it much faster than when we do it behind the scenes," Schoenberg noted. He emphasized that the firm is providing the service with the full knowledge of its payer customers.
Selling telehealth services directly to consumers is not new; RelayHealth, now a McKesson subsidiary, began doing it a decade ago. But RelayHealth's online consultation service, which it also marketed to health plans, did not gain traction.
With RelayHealth, Schoenberg noted, patients didn't know how long it would take their doctor to respond to their questions, which they entered into e-mail templates. American Well's customers, in contrast, can get a consult with a physician very quickly, using the latest videoconferencing technology, he said. An increasing number of state medical boards, he added, have decided that the approach used by RelayHealth and some other services is not the best medical practice, because patients and doctors are not interacting in real time.
Of course, telehealth services that use a patient's personal doctor offer a continuity of care that no product based on on-call physicians can match. But Schoenberg said that American Well is doing its best to ensure continuity of care. For example, he noted, the company has connected to the backend systems of health insurers. That allows it to pull diagnostic and procedure codes that it supplies to its physicians when they consult with a particular patient. In addition, the doctors can see the medications a patient is taking, based on records from Surescripts and pharmacy benefit managers, he said.
In the direct-to-consumer offering, he added, American Well will be able to forward claims-based information to its doctors if the consumer is a member of a client plan, and it should also be able to get the person's medication list from Surescripts. In either case, the American Well doctor documents the telehealth visit and forwards that note to the next care setting the patient plans to visit.
Besides state laws requiring telehealth coverage, another factor that is expected to increase demand for telehealth is the expansion of the insured population under Obamacare, Schoenberg noted. Although millions more people will be visiting primary care doctors as a result, the number of doctors will not increase soon. Telehealth can take some of the pressure off doctors' offices, urgent care centers and ERs, he said.