It might seem like the stuff of science fiction — patients jumping online, answering a few questions to a computer program, and receiving a diagnosis and even prescription order without leaving their desktop. But one Minnesota provider is making that pipe dream a reality, with the help of its new web-based clinic.
After years of developing best practices and consulting patients on the phone, technological advances allowed Bloomington-based HealthPartners to start developing an online clinic called virtuwell. The integrated delivery system — which has six hospitals, 1,700 physicians and a 1.4 million-member health plan — used sophisticated algorithms to develop the software program, in house, rolling it out in 2010. For $40 a pop, patients can log in, answer a series of questions, get a diagnosis, and even a prescription, all without leaving the house. In its first two years, the clinic has cost HealthPartners about $88 less per episode compared to the typical health care setting.
Doctor resistance has been nil, since physicians helped to develop the tool, and it gives them more time to treat more complex patients face-to-face, says Patrick Courneya, M.D., a family physician and medical director of the HealthPartners Health Plan.
"All of us, as primary care docs, are busy enough with our more complicated patients, and we have a lot of accountability for managing that population very well," Courneya says. "Allowing some other means of getting those more simple things treated is kind of a welcome relief in our schedule."
Starting with "What do you think you have?" virtuwell asks a series of questions to reach a diagnosis. All told, the program can treat about 40 different common conditions — from acne, to bladder infections, sunburn and lice — all which don't require any lab tests, and that are associated with high-diagnostic accuracy. A certified nurse practitioner reviews the patient's case, develops a treatment plan, and then fires it off via email or text, typically within 30 minutes or less. Prescriptions orders, too, are sent electronically to the patient's pharmacy of choice.
Those with more complicated conditions, meanwhile, are referred to a primary care physician for further treatment, without having to pay for their virtuwell visit. After two years, more than 50,000 patients have been referred to in-person services.
Thus far, the results have been eye opening. More than 51,000 patients, from every single county in both Minnesota and Wisconsin, have logged into virtuwell and completed the process as of last week. On top of the volume, HealthPartners has saved about $88 per visit compared to more traditional brick and mortar settings, saved customers about 2.5 hours per visit, and 98 percent of patients have responded that they "would recommend" the service.
HealthPartners has found quality in the care it's provided early on, in the low rate of diagnosing antibiotics for acute bronchitis (overuse in such cases can lead to drug resistance). Such prescribing was appropriately avoided in 94 percent of cases, according to an article published in Health Affairs, higher than both the rate in the commercially insured population and national benchmarks.
Visits cost $40 apiece, and about 85 percent have involved an insurance claim so far. In 2011, virtuwell was the first online clinic authorized for Medicare coverage.
Most surprising for Kevin Palattao, vice president of virtuwell and of clinic patient care systems, was the programs competitiveness in the highly saturated Minneapolis-St. Paul market. Patients have dozens and dozens of retail clinics to choose from in the area, but chose the online route instead.
"Consumers have a lot of choices. And the fact that we're generating these savings when they're already used to going to lower-cost venues than emergency rooms, that was pretty impressive to us, and it just says that this thing probably has even bigger legs in other markets where that's not the case," Palattao says.
HealthPartners would ideally like to expand virtuwell to other states, but regulatory barriers exist. Some require a face-to-face visit for a clinician to write a prescription, while others mandate that a doctor practice in the same state as his or her patients. The provider would also like to eventually spread the service to more ailments — right now it can only treat 40 out of 9,000 listed in the ICD-9 booklet. Emerging technologies that allow patients to do certain tests from home will only broaden the list, Courneya says. He thinks web clinics such as virtuwell could eventually spread through the industry.
"We recognize that online care really has to expand because, as the country searches for alternatives to face-to-face visits and less expensive ways of taking care of medical problems, creative folks are going to come up with innovative solutions," he says. "We know that it's tough. We know that it took a lot of work to develop and required a great deal of attention to detail, but that doesn't mean it's not going to be possible for others to do it, too."
Content by Health Forum, Sponsored by: VHA.