Managed Care - January 2009 - (Page 15)

ery systems Geisinger Clinic (CareWorks, Pennsylvania), Sutter Health (Sutter Express Care, California) and Mayo Clinic (Mayo Express Care, Minnesota), have opened branded clinics in retail areas as a way to direct referrals to their own physicians and facilities. As with all disruptions, the clinics will hone their service, quality, and convenience, get better, and expand beyond their current services. Already some clinics, like the Houston-based RediClinic chain, are involved in wellness screenings for diabetes, hyperlipidemia, and more. It isn’t hard to imagine that as clinics become more ubiquitous, health plans could eventually penalize patients seen in physician offices for minor ailments that could easily be treated at a retail clinic, just as patients are sometimes penalized now for medically unnecessary ER visits. TELEMEDICINE Several coalescing technologies help move care from physician offices to less expensive venues under the umbrella term telemedicine. They include advances in network bandwidth, Internet access, software development, medical devices, advanced telephony, and video conferences. The business model is to deliver care conveniently to patients, often at home. Telemedicine improves access, promises better outcomes, and enables early screening and diagnosis to prevent more serious adverse and expensive health events. As much as $200 million could be saved over 25 years if patients communicated electronically with their providers, the economist Robert Litan reports in “Vital Signs by Way of Broadband: Remote Health Monitoring Transmits Savings, Enhances Lives,” released in October by the not-for-profit group Better Health Care Together, a business, labor, and public policy consortium. For four chronic diseases alone, outcomes and quality of life could improve for 10 million people, Litan writes. In addition, Deloitte’s Keckley estimates that at least 60 percent of adult care living facility or skilled nursing facility residents could remain at home with electronic devices. “It’s better care at lower cost,” he says. Medication nonadherence is a key reason that seniors move to these facilities, Keckley says. “That doesn’t require a person to walk into their rooms. There is a way to prompt, alert, and remind Aunt Bea to take her medications and to monitor her depression and anxiety.” Former Intel CEO Andrew Grove agrees. “Many of the elderly who now enter nursing homes could be enabled to remain in their own homes through the adoption of digital technologies that are not much more complicated than a DVD player or cell phone player,” he said in a 2006 speech. “We can equip homes with electronics and reduce cost by at least a factor of 10 compared to nursing homes.” Keckley estimates a potential annual saving of $400 billion if just two expensive health care populations are managed with in-home technologies. One group consists of those who have just been discharged from hospitals, such as patients with preterm labor; patients who just sustained a heart attack, and those who have cancer.The other group comprises those with a chronic condition intensely related to self care, such as obesity, hypertension, or depression. “Payment systems must change to support monitoring for these patients,” he says. Some carriers are leading the charge. Starting this month. Hawaii Medical Services Association, part of the Blue Cross & Blue Shield Association, is offering “virtual consults” to 1.3 million members using technology developed by American Well. It enables an insured patient to contact any credentialed medical specialist on his or her insurer’s network around the clock over the phone or by Web (including webcam), video conference, secure messaging, or secure chat to help determine whether the medical issue can be worked out at home, requires an office visit, or warrants and urgent trip to an ER. It takes convenience a giant leap forward, beyond retail clinics, with 24/7 online access to medical care from home, offices, or just about anywhere. American Well works with carriers that pay member doctors $25–$45 for electronic consults with patients. The fees are lower than for an office visit, but the clinician can work from home, an office, or any convenient location with a computer. It’s additional income doctors earn at their discretion by logging onto American Well’s Web site and clicking “I am available.” The innovation may draw retired physicians back into practice because they JANUARY 2009 / MANAGED CARE 15

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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