HealthPartners, an integrated delivery network and health insurer in Minneapolis, was able to reduce billing by an average of $88.03 per case and save about 2.5 hours per patient, taking into account travel time to and from a clinic, physician office or emergency department, as well as waiting time, the actual clinician encounter and check-in and check-out times, through its Virtuwell online clinic, as compared to traditional means of care. Outcomes were in line with standard care and patient satisfaction was high, with 98% of users surveyed saying they would recommend the service to others, according to a study in the February issue of the policy journal Health Affairs.
At $40 per episode, the service cost $20 to $30 less than convenience clinics, $80 to $142 less than physician office visits, and $82 to $124 less than at urgent care centers. It cost a whopping $159 to $469 less than care delivered in hospital emergency departments for the three most common conditions in the study pool of more than 40,000 cases, namely acute sinusitis, urinary tract infections and conjunctivitis. That works out to an average of slightly more than $88 per case.
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"Not only did Virtuwell treatment for those three high-volume conditions cost less, but it also had an episode resolution rate -- that is, no face-to-face follow-up care was required -- of 89% to 95%, a rate similar to those of convenience clinics," wrote the researchers, who were led by family practitioner Dr. Patrick Courneya, medical director of HealthPartners Health Plan.
The study found scant evidence that online visits increased overall use of healthcare services because of Virtuwell, which launched in 2010 and a year later became the first online convenience clinic to gain U.S. Centers for Medicare and Medicaid Services approval for Medicare coverage, according to The Washington Post. Researchers also observed that the rate of "appropriate" prescribing behavior for acute bronchitis, for which antibiotics often are unnecessarily prescribed, was higher via Virtuwell than among the health system's general population with commercial insurance.
"Two years later, Virtuwell's early results suggest that online care has the potential to meet the 'Triple Aim' goals of a better health care experience for patients, improved population health, and more affordable health care -- especially for conditions typically associated with primary care," the HealthPartners team wrote.
"Caution is warranted, given the relatively small sample of cases we looked at, but this finding suggests that a well-designed online venue can provide appropriate care. Additionally, it may suggest that the online venue better supports providers trying to use antibiotics appropriately or that patients inclined to push clinicians for antibiotics may be less successful in doing so when treated online," they concluded.
Through Virtuwell, HealthPartners offers 24/7 online care for about 40 "simple" primary care conditions. "Conditions treated through Virtuwell are those generally associated with high diagnostic accuracy and treatment efficacy in both traditional and online care venues," the Health Affairs article said. The service does not offer treatment for any health issues that normally require lab work, imaging or physical exams.
After Virtuwell takes patients through an automated interview about symptoms, medical history, allergies and medications, a nurse practitioner reviews each patient's information and sends a treatment plan in a secure message. If necessary, the NP writes prescriptions and sends them electronically to whichever pharmacy the patient specifies. The whole process often takes less than 30 minutes, according to the authors.
Patients may request phone consultations with an NP at any time. In about half the cases, the NPs call patients.
The service has been useful in expanding access to care, the authors said. "Some of the most enthusiastic consumer responses to Virtuwell have come from patients in areas, both urban and rural, where bricks-and-mortar convenience care options, such as retail clinics, are limited or nonexistent. Patients tell us, for example, that before Virtuwell their only option for off-hours care for a urinary tract infection was an emergency department 20 miles or more away, with resulting costs in time, inconvenience, and expense associated with that care venue," they wrote.
Despite these positive results, the national regulatory climate remains unfavorable to online care and other forms of telehealth. Many states require clinicians to be located in the same state as the patient or at least licensed in that state, and some mandate an in-person visit or an existing relationship between patient and doctor for writing prescriptions.
During the study period, Virtuwell was available only to Minnesota and Wisconsin residents. It since has been expanded to Michigan, the researchers reported. "But for online care to deliver on its potential, a reexamination of the regulatory environment is required," the article said. "Following the launch of the service in Minnesota and Wisconsin, we have routinely received inquiries from large employer groups, with employees located in other states, about when the service might be available nationally."
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