Keeping America Well

File under: Patient Engagement

The internet has revolutionized retail. In travel, consumers use self-service websites to search for destinations, compare offers and purchase a vacation. Amazon has replaced the knowledgeable bookstore owner with breadth and convenience. Yes there are trade-offs, but most consumers are willing to exchange professional expertise for price and convenience on non-critical decisions.

But not so with healthcare. Yes, consumers go online when they have a health question, but sometimes they leave more confused than before. Convenience yes, but expertise? Questionable.

If you ask Dr. Roy Schoenberg, CEO of American Well Systems, he’ll tell you why. “In the consumer’s mind, healthcare is not online portals or health risk assessment tools. Healthcare is about talking to a doctor.” We receive healthcare when we explain our symptoms to a physician, he or she diagnoses the problem and then recommends a remedy.

There’s still a convenience problem, however. Often at the point of need, many of us can’t get in to see our doctor. It may be 2:00 a.m. and your child is crying, or you are experiencing pain and your doctor’s calendar is booked for the next three weeks.

But what if you could log on to the internet (convenience) and talk live with a physician (expertise)? And what if that physician could call up your health records as the connection was being made? And finally, what if this “doctor’s visit” was covered by your health insurance (price)?

This is the concept behind American Well and their Online Care service. American Well is blending the price and convenience of the internet with the personalized expertise of a face-to-face interaction. They are bringing live healthcare into people’s homes. Think of it as an online doctor’s office with a sign that says “Walk-ins welcome.”

There are hospitals and physician practices that have experimented with telemedicine. Telemedicine is typically used to bring a specialist’s expertise to a rural hospital or clinic via teleconferencing. American Well isn’t traditional telemedicine. They are bringing the expert care to patients in their homes.

How does it work?

American Well is an infrastructure platform where physicians, consumers and health plans meet. Behind the scenes, the Online Care system is managing the schedules of dozens of physicians at any one time who simply check in when they have an hour or two available. Everything that is discussed is written up by the physician after the online visit and e-mailed to the patient’s primary care physician.

Another benefit: as soon as the additional 32+ million Americans soon to be covered by the Affordable Care Act (the healthcare reform bill) enter the system, there will be a significant shortage of primary care physicians. But what if the issue is less about the sheer number of physicians needed and more about proper resourcing? Urban docs with excess capacity serve rural patients, each from the comfort of their own homes.

According to Gartner, by 2013 up to 25% of care that can be handled online will be done online. That’s a staggering change in the model of physician care. One driver of this change, according to Schoenberg, is that technology can help balance the availability of physician time with the increased need for primary care physicians as more Americans are covered by the health insurance.

Online care can also help address the healthcare cost structure. By moving the doctor’s visit online, the consultation removes the overhead costs of the office. This pushes the cost basis of care to a less expensive venue.

But not only a less expensive venue. It’s potentially a more informed venue. “This is really the first step of a very disruptive technology,” declares Schoenberg. “We have the ability to bring a patient’s healthcare records in front of the doctor at the point the patient is engaging in the system. We created the first ‘healthcare teleprompter’ that tells the physician what are the things that are appropriate for the patient in front of them.”

Where could this evolve to? If this is an online platform where professionals and patients can meet confidentially, then the possibilities are promising. Sensitive health topics, chronic disease management, bedridden patients, and diabetes and nutrition education are among the many situations in which an online consultation could actually be preferable to an in-office visit. American Well literally brings back the doctor’s house call.

When American Well signed on their first health plan, Blue Cross Blue Shield of Hawaii, there was great resistance from the medical establishment. But within a few months, after it became clear that this system provided unprecedented access to care for all Hawaiians, the Hawaii Medical Board reversed itself and threw its support behind the program. Today, with deals signed with OptumHealth (UnitedHealthcare) and WellPoint, American Well is on its way to becoming a national platform for physician care.

This year marked the first time that electronic book sales exceeded traditional book sales on Amazon, marking a major paradigm shift in how we as Americans consume our literature. Will online care follow a similar trajectory? Any bets on how long it will take for online physician visits to surpass traditional office visits?

American Well. Another great example of innovation changing the way healthcare is bought and sold.

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