Online clinic saves time and money, researchers say

An online clinic launched by HealthPartners Health Plan in Minneapolis delivered savings of $88 per care episode – plus high patient satisfaction ratings – for simple conditions such as acute sinusitis and urinary tract infections, according to a study published Feb. 4 in the Health Affairs.

The study, which compared the cost of visits to HealthPartners virtual clinic – virtuwell – to non-virtuwell visits, showed that well-designed online care can save health costs and increase patients’ access to care.

Dr. Neil Calman, president and CEO for the New York City–based Institute for Family Health, responded to these findings in an interview: "Online visits are one of many electronic interactions that are becoming more prevalent every day.

"Technology, especially the almost ubiquitous evolution of handheld devices like smartphones, has facilitated interactions with supermarkets, airlines, major merchandisers, and now with health care providers as well. In the past, our offices were open at our convenience. But moving forward, we must make health care interactions convenient and accessible to our patients. This is part of a very important movement to increase patient engagement in care and improve access and quality while decreasing cost," he noted.

Dr. Jeffrey J. Cain, president of the American Academy of Family Physicians, noted that the AAFP applauds opportunities for patients to communicate with physicians on newer platforms, such as e-visits, but only when it occurs in the context of a patient-centered home and there is an existing face-to-face relationship between the patient and the primary care physician giving the advice.

Dr. Patrick T. Courneya, a family physician and medical director of HealthPartners Health Plan in Minneapolis, and his coauthors, noted that "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" (Health Aff. 2013; 32:385-92 [doi:10.1377/hlthaff.2012.1157]).

In an interview, Dr. Courneya said that he sees the scope of care provided by virtuwell as comparable to that provided by retail clinics. "We can’t remove a splinter virtually, but when you look at the list of services you can get at one of the retail clinics, it’s obvious that we can meet the lion’s share of visits that are common to them," he said.

About half of those patients who come to virtuwell wind up needing care at a different venue, and about half also do not have a primary care relationship, Dr. Courneya said.

And that is exactly what worried Dr. Cain: "The problem with a virtual clinic such as the one described in the study is that it may exist outside the context of the patient-centered medical home. When health care is as dysfunctional as it is in many parts of the United States, a patient may get one piece of care from a virtual clinic, another from a walk-in clinic, a third from the emergency department, and still another from a primary care provider. All these providers do not communicate with one another. The result may be the ordering of duplicate tests and medication.

And yes, the visit to the e-clinic may be inexpensive but in the end all that fragmented care delivered without coordination drives up health care costs for that patient and for the country, said Dr. Cain, a family physician in Denver.

In defense of such reservations, Dr. Courneya noted that about half of those patients who come to virtuwell wind up needing care at a different venue, and about half also do not have a primary care relationship. Because of this, HealthPartners has worked with clinics to ensure that patients can connect with a primary care office

As described in the study, the HealthPartners online clinic program, established in 2010, is accessible 24/7 and offers treatment for about 40 simple conditions. It uses sophisticated interview algorithms, plus reviews by nurse practitioners or physician assistants.

Patients visit the site (http://virtuwell.com) and answer questions about their conditions and symptoms, plus their medical histories, allergies, and other medications. A certified nurse practitioner then reviews the information and writes a treatment plan, which usually is ready within a half hour or less. If a prescription is needed, that scrip is sent electronically to a pharmacy chosen by the patient.

The patient may speak to a nurse practitioner at any time during or after the visit – in fact, virtuwell nurse practitioners call patients in about half of the cases, the researchers reported. The retail cost for the visit is $40, although about 85% of virtuwell’s more than 96,000 total customers have used insurance to cover at least some of the cost.

About 40,000 patients have received treatment plans from virtuwell, and another 56,000 patients with symptoms beyond the scope of the service have been referred to in-person providers, according to the researchers. More than three-quarters of those using the service have been female, and most have been aged 24-45.

When measuring total claims costs, the researchers found care provided through virtuwell cost an average of $113.13, compared with $201.16 for care provided through traditional channels. Virtuwell treatment for the three highest volume conditions – acute sinusitis, conjunctivitis, and lower genitourinary system infections – cost $20-$30 less than that of convenience clinics, $80-$142 less that of office visits, $82-$124 less than that of urgent care visits, and $159-$469 less than that of emergency department visits.

In addition, there was no evidence of increased patient demand for health care services, despite round-the-clock availability of the online service. Postvisit surveys indicated that at least 90% of virtuwell visits displaced in-person visits, and only about 6% displaced a "watch and wait" or home care approach.

Dr. Calman noted in an interview that the study offers one indication that "we are at the beginning of a revolution in health information technology."

The shortage of primary care providers nationally, predicted to worsen in the coming years, necessitates a major effort to provide information to people to help them determine when an acute office visit is needed, he said.

"This is not rationing care, but rationalizing care," Dr. Calman stated. "It will save time, save money, and save valuable physician time so that more patients who really need face-to-face care will have it available."

Even if patients opt not to engage in virtual clinics, the Internet gives patients the ability to investigate symptoms and determine if they need to seek care at no cost to the medical system, said Dr. Calman, who is also professor and chair of family medicine and community health at Icahn School of Medicine at Mount Sinai in New York.

Eventually, Dr. Calman said, it may be possible for patients to use algorithm-driven sites similar to virtuwell at no cost to determine whether they need care, potentially saving the price of many office visits. "The more people who do this, the more people will be able to care for themselves. We’re democratizing medical information – taking it out of the hands of the medical community," he said.

Dr. Courneya, Dr. Cain, and Dr. Calman reported that they had no relevant conflicts of interest.

An online clinic launched by HealthPartners Health Plan in Minneapolis delivered savings of $88 per care episode – plus high patient satisfaction ratings – for simple conditions such as acute sinusitis and urinary tract infections, according to a study published Feb. 4 in the Health Affairs.

The study, which compared the cost of visits to HealthPartners virtual clinic – virtuwell – to non-virtuwell visits, showed that well-designed online care can save health costs and increase patients’ access to care.

Dr. Neil Calman, president and CEO for the New York City–based Institute for Family Health, responded to these findings in an interview: "Online visits are one of many electronic interactions that are becoming more prevalent every day.

"Technology, especially the almost ubiquitous evolution of handheld devices like smartphones, has facilitated interactions with supermarkets, airlines, major merchandisers, and now with health care providers as well. In the past, our offices were open at our convenience. But moving forward, we must make health care interactions convenient and accessible to our patients. This is part of a very important movement to increase patient engagement in care and improve access and quality while decreasing cost," he noted.

Dr. Jeffrey J. Cain, president of the American Academy of Family Physicians, noted that the AAFP applauds opportunities for patients to communicate with physicians on newer platforms, such as e-visits, but only when it occurs in the context of a patient-centered home and there is an existing face-to-face relationship between the patient and the primary care physician giving the advice.

Dr. Patrick T. Courneya, a family physician and medical director of HealthPartners Health Plan in Minneapolis, and his coauthors, noted that "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" (Health Aff. 2013; 32:385-92 [doi:10.1377/hlthaff.2012.1157]).

In an interview, Dr. Courneya said that he sees the scope of care provided by virtuwell as comparable to that provided by retail clinics. "We can’t remove a splinter virtually, but when you look at the list of services you can get at one of the retail clinics, it’s obvious that we can meet the lion’s share of visits that are common to them," he said.

About half of those patients who come to virtuwell wind up needing care at a different venue, and about half also do not have a primary care relationship, Dr. Courneya said.

And that is exactly what worried Dr. Cain: "The problem with a virtual clinic such as the one described in the study is that it may exist outside the context of the patient-centered medical home. When health care is as dysfunctional as it is in many parts of the United States, a patient may get one piece of care from a virtual clinic, another from a walk-in clinic, a third from the emergency department, and still another from a primary care provider. All these providers do not communicate with one another. The result may be the ordering of duplicate tests and medication.

And yes, the visit to the e-clinic may be inexpensive but in the end all that fragmented care delivered without coordination drives up health care costs for that patient and for the country, said Dr. Cain, a family physician in Denver.

In defense of such reservations, Dr. Courneya noted that about half of those patients who come to virtuwell wind up needing care at a different venue, and about half also do not have a primary care relationship. Because of this, HealthPartners has worked with clinics to ensure that patients can connect with a primary care office

As described in the study, the HealthPartners online clinic program, established in 2010, is accessible 24/7 and offers treatment for about 40 simple conditions. It uses sophisticated interview algorithms, plus reviews by nurse practitioners or physician assistants.

Patients visit the site (http://virtuwell.com) and answer questions about their conditions and symptoms, plus their medical histories, allergies, and other medications. A certified nurse practitioner then reviews the information and writes a treatment plan, which usually is ready within a half hour or less. If a prescription is needed, that scrip is sent electronically to a pharmacy chosen by the patient.

The patient may speak to a nurse practitioner at any time during or after the visit – in fact, virtuwell nurse practitioners call patients in about half of the cases, the researchers reported. The retail cost for the visit is $40, although about 85% of virtuwell’s more than 96,000 total customers have used insurance to cover at least some of the cost.

About 40,000 patients have received treatment plans from virtuwell, and another 56,000 patients with symptoms beyond the scope of the service have been referred to in-person providers, according to the researchers. More than three-quarters of those using the service have been female, and most have been aged 24-45.

When measuring total claims costs, the researchers found care provided through virtuwell cost an average of $113.13, compared with $201.16 for care provided through traditional channels. Virtuwell treatment for the three highest volume conditions – acute sinusitis, conjunctivitis, and lower genitourinary system infections – cost $20-$30 less than that of convenience clinics, $80-$142 less that of office visits, $82-$124 less than that of urgent care visits, and $159-$469 less than that of emergency department visits.

In addition, there was no evidence of increased patient demand for health care services, despite round-the-clock availability of the online service. Postvisit surveys indicated that at least 90% of virtuwell visits displaced in-person visits, and only about 6% displaced a "watch and wait" or home care approach.

Dr. Calman noted in an interview that the study offers one indication that "we are at the beginning of a revolution in health information technology."

The shortage of primary care providers nationally, predicted to worsen in the coming years, necessitates a major effort to provide information to people to help them determine when an acute office visit is needed, he said.

"This is not rationing care, but rationalizing care," Dr. Calman stated. "It will save time, save money, and save valuable physician time so that more patients who really need face-to-face care will have it available."

Even if patients opt not to engage in virtual clinics, the Internet gives patients the ability to investigate symptoms and determine if they need to seek care at no cost to the medical system, said Dr. Calman, who is also professor and chair of family medicine and community health at Icahn School of Medicine at Mount Sinai in New York.

Eventually, Dr. Calman said, it may be possible for patients to use algorithm-driven sites similar to virtuwell at no cost to determine whether they need care, potentially saving the price of many office visits. "The more people who do this, the more people will be able to care for themselves. We’re democratizing medical information – taking it out of the hands of the medical community," he said.

Dr. Courneya, Dr. Cain, and Dr. Calman reported that they had no relevant conflicts of interest.

An online clinic launched by HealthPartners Health Plan in Minneapolis delivered savings of $88 per care episode – plus high patient satisfaction ratings – for simple conditions such as acute sinusitis and urinary tract infections, according to a study published Feb. 4 in the Health Affairs.

The study, which compared the cost of visits to HealthPartners virtual clinic – virtuwell – to non-virtuwell visits, showed that well-designed online care can save health costs and increase patients’ access to care.

Dr. Neil Calman, president and CEO for the New York City–based Institute for Family Health, responded to these findings in an interview: "Online visits are one of many electronic interactions that are becoming more prevalent every day.

"Technology, especially the almost ubiquitous evolution of handheld devices like smartphones, has facilitated interactions with supermarkets, airlines, major merchandisers, and now with health care providers as well. In the past, our offices were open at our convenience. But moving forward, we must make health care interactions convenient and accessible to our patients. This is part of a very important movement to increase patient engagement in care and improve access and quality while decreasing cost," he noted.

Dr. Jeffrey J. Cain, president of the American Academy of Family Physicians, noted that the AAFP applauds opportunities for patients to communicate with physicians on newer platforms, such as e-visits, but only when it occurs in the context of a patient-centered home and there is an existing face-to-face relationship between the patient and the primary care physician giving the advice.

Dr. Patrick T. Courneya, a family physician and medical director of HealthPartners Health Plan in Minneapolis, and his coauthors, noted that "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" (Health Aff. 2013; 32:385-92 [doi:10.1377/hlthaff.2012.1157]).

In an interview, Dr. Courneya said that he sees the scope of care provided by virtuwell as comparable to that provided by retail clinics. "We can’t remove a splinter virtually, but when you look at the list of services you can get at one of the retail clinics, it’s obvious that we can meet the lion’s share of visits that are common to them," he said.

About half of those patients who come to virtuwell wind up needing care at a different venue, and about half also do not have a primary care relationship, Dr. Courneya said.

And that is exactly what worried Dr. Cain: "The problem with a virtual clinic such as the one described in the study is that it may exist outside the context of the patient-centered medical home. When health care is as dysfunctional as it is in many parts of the United States, a patient may get one piece of care from a virtual clinic, another from a walk-in clinic, a third from the emergency department, and still another from a primary care provider. All these providers do not communicate with one another. The result may be the ordering of duplicate tests and medication.

And yes, the visit to the e-clinic may be inexpensive but in the end all that fragmented care delivered without coordination drives up health care costs for that patient and for the country, said Dr. Cain, a family physician in Denver.

In defense of such reservations, Dr. Courneya noted that about half of those patients who come to virtuwell wind up needing care at a different venue, and about half also do not have a primary care relationship. Because of this, HealthPartners has worked with clinics to ensure that patients can connect with a primary care office

As described in the study, the HealthPartners online clinic program, established in 2010, is accessible 24/7 and offers treatment for about 40 simple conditions. It uses sophisticated interview algorithms, plus reviews by nurse practitioners or physician assistants.

Patients visit the site (http://virtuwell.com) and answer questions about their conditions and symptoms, plus their medical histories, allergies, and other medications. A certified nurse practitioner then reviews the information and writes a treatment plan, which usually is ready within a half hour or less. If a prescription is needed, that scrip is sent electronically to a pharmacy chosen by the patient.

The patient may speak to a nurse practitioner at any time during or after the visit – in fact, virtuwell nurse practitioners call patients in about half of the cases, the researchers reported. The retail cost for the visit is $40, although about 85% of virtuwell’s more than 96,000 total customers have used insurance to cover at least some of the cost.

About 40,000 patients have received treatment plans from virtuwell, and another 56,000 patients with symptoms beyond the scope of the service have been referred to in-person providers, according to the researchers. More than three-quarters of those using the service have been female, and most have been aged 24-45.

When measuring total claims costs, the researchers found care provided through virtuwell cost an average of $113.13, compared with $201.16 for care provided through traditional channels. Virtuwell treatment for the three highest volume conditions – acute sinusitis, conjunctivitis, and lower genitourinary system infections – cost $20-$30 less than that of convenience clinics, $80-$142 less that of office visits, $82-$124 less than that of urgent care visits, and $159-$469 less than that of emergency department visits.

In addition, there was no evidence of increased patient demand for health care services, despite round-the-clock availability of the online service. Postvisit surveys indicated that at least 90% of virtuwell visits displaced in-person visits, and only about 6% displaced a "watch and wait" or home care approach.

Dr. Calman noted in an interview that the study offers one indication that "we are at the beginning of a revolution in health information technology."

The shortage of primary care providers nationally, predicted to worsen in the coming years, necessitates a major effort to provide information to people to help them determine when an acute office visit is needed, he said.

"This is not rationing care, but rationalizing care," Dr. Calman stated. "It will save time, save money, and save valuable physician time so that more patients who really need face-to-face care will have it available."

Even if patients opt not to engage in virtual clinics, the Internet gives patients the ability to investigate symptoms and determine if they need to seek care at no cost to the medical system, said Dr. Calman, who is also professor and chair of family medicine and community health at Icahn School of Medicine at Mount Sinai in New York.

Eventually, Dr. Calman said, it may be possible for patients to use algorithm-driven sites similar to virtuwell at no cost to determine whether they need care, potentially saving the price of many office visits. "The more people who do this, the more people will be able to care for themselves. We’re democratizing medical information – taking it out of the hands of the medical community," he said.

Dr. Courneya, Dr. Cain, and Dr. Calman reported that they had no relevant conflicts of interest.