Managed Care - March 2009 - (Page 35) tion brokers, rather than an EMR data repository, became a compelling feature of online care,” says Schoenberg. “The system uses technologies to fetch information in real time from all the rthur L. Wilmes, an actuary and principal at Milliman, systems connected to it, so the physistudied American Well’s service and expects a percian treating the patient will have the member, per-month potential savings of $3.36 for commercially insured lives and $6.95 for Medicare lives — if it is used context needed to make a clinically appropriately. sound decision. We use data in the The biggest savings came from replacing nonemergency ER health plan to establish a health sumvisits and in-office visits with a less expensive online consult, mary. We use pharmacological and says Wilmes, whose study was paid for by American Well. Those other data from the health plan. Pereconomies helped reduce overall medical costs by 1.2 percent in sonal health record data, if it is proa commercial population, as well as a Medicare population. vided by the patient, will also get in “We developed an algorithm to try to identify opportunities front of the provider. We created a browhere online care could be a substitute for face-to-face encounkerage rather than a repository.” ters,” says Wilmes. Stoller says that “one of the key deIn developing its formula, he adds, Milliman first created a filcisions we’re moving on involves the ter to analyze ICD-9 claims to identify what he calls symptomadvanced medical home and tying care based diagnoses and then took a second look at the remaining cases to gain a better understanding of the context in which the to a person’s life. It should be interestdiagnoses were made. ing how this system can fit in. This Milliman eventually determined that 90 percent of the visits could offer a good mechanism to propatients made either to their doctor’s office or to the ER needed mote information-sharing among to be made in person. The remaining 10 percent fell into a catephysicians and allied health care progory where the doctor’s diagnosis relied largely on a patient’s fessionals, to help them stay on top of description of the ailment. what is going on.” “The final list included conditions such as headaches, certain For now, Schoenberg has only urinary tract infections, dermatitis, and back pain,” he says. And Hawaii to point to as a real-world exfinally, Milliman estimated how the online treatment option ample of what the system can do, but he could work once both patients and physicians had grown accusis adamant that other plans are giving tomed to using the American Well system. American Well a close inspection. It’s not as big a stretch as you might imagine. Many physicians already perform the same basic diagnosis service on weekends, “The largest national plans are in actalking to patients over the phone, Wilmes adds. tive discussions about deploying on“This is a way to start a dialogue about online care,” he adds. line care,” adds Schoenberg. “This is “This may be an ongoing phenomenon. It could offer a major very applicable at the national level.” change in the way we do diagnosis and follow-up care.” Schoenberg is even more upbeat about the possibilities of a Veterans Administration, Medicare, or Medicaid rollout. seeing on a video camera. But imagine a diabetic ““I expect the bigger health plans to gravitate to patient, one who has been your patient for 20 years. this,” Doty says. “It would give them a way to go The patient may just be following up, asking about after the smaller guys in their respective markets.” insulin concentration or blood sugar monitored But Doty doubts that American Well will ever be with a glucometer. This is the work we are doing able to back away from relying on statewide netwith the clinical organizations and physicians and works of physicians. Every state has its own set of Milliman, which wrote care guidelines, to really regulations and requirements, and a doctor based look at the applicability of online care in many in New York, for example, isn’t going to be accessiareas outside of acute care.” ble to people outside of the state. Schoenberg says American Well has been able to “Do health plans shy away or see it as an opporsteer clear of the confused technological landscape tunity to build a new revenue stream?” Doty asks. that repeatedly trips up health IT vendors. “Time will tell. HMSA is the innovator here.” MC “Paradoxically, our approach to act as informa- In an ideal world, online care can be a money saver for managed care A MARCH 2009 / MANAGED CARE 35
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