Managed Care - January 2009 - (Page 16)

Kiosks like this one allow physicians to interact with patients in distant areas. The machines come with attachments such as a digital stethoscope that are manipulated by a nonphysician clinician where the patient is. high-definition digital otoscope, a digital stethoscope, even a digital dermascope that allows a MidWest dermatologist to see skin rashes in high definition. So far, Vrbicky says, most major insurers are picking up the tab, paying $50–$75 per e-visit. Intel, the chip manufacturer, believes telemedicine has such enormous profit potential that in November, the company released its first FDAapproved telemedicine device, Health Guide PHS6000. It is a unit that care workers can use at patients’ homes with peripheral extensions to measure blood pressure, glucose, lung function, weight, and other characteristics of people with diabetes, heart disease, and other maladies. Still, telemedicine is not a mature family of technologies. Some barriers to overcome are difficultly of use, litigation stemming from misuse, and lack of security in sending and receiving information. In addition, physicians are slow to adapt to electronic patient communication for fear of confidentiality breaches. Already, some payers acknowledge the potential of telemedicine to reduce hospitalizations and lower the cost of physician visits. It is just a matter of time before telemedicine becomes a more commonly accepted system of health care delivery. MEDICAL TOURISM Medical advances in other states and countries and speedy air travel are the technologies that enable medical tourism. The business model relies on wage and medical product price differentials along with a new breed of brokers who create comprehensive travel packages that make having surgery away from home at least 30 percent less expensive than in the United States. Most large companies have always had employees who travel on business, so their health plans already had out-of-network provisions, including offshore coverage. The trend exploded when economically pressured patients with no insurance or with catastrophic coverage or large deductibles, and patients on long transplant waiting lists, became global health care consumers. More than 750,000 Americans left home for treatments and care elsewhere, mostly for elective procedures such as cosmetic surgery, dental work, and surgeries like heart valve, knee, and hip re- don’t need to build or rent brick-and-mortar offices, pay staff, or bill patients. Health care in the countryside, desert, and mountains has always been difficult. One example where telemedicine has been effective is the area within a 250 miles of Norfolk, Nebraska, a rural district with low population density and no medical facilities. Obstetrics-gynecology innovator Keith Vrbicky, MD, has installed kiosks in remote pharmacies. From 7 a.m. to 10 p.m. weekdays and weekends, walk-in patients with minor problems enter the pharmacy’s exam room and, with a pharmacist or technician, go online with Vrbicky’s 15-provider MidWest Health Partners clinic in Norfolk, about two hours from Omaha. The pharmacist or an assistant collects and forwards the copayment, takes a history and types it into the kiosk terminals. There are attachments to the kiosks, such as a 16 MANAGED CARE / JANUARY 2009

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

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.