Monday, May 03, 2010

#whccic BCBSMN and American Well - innovative delivery models for accessible and affordable care

More real time notes from the WHCC Innovation Congress.

This session has MaryAnn Stump SVP, Chief Strategy and Innovation Officer from BCBS Minnesota and Roy Schoenberg, CEO of American Well talking about new delivery models that leverage the Internet to deliver accessible, affordable, Quality care.

Roy Schoenberg led off the session. He talked about American Well's Online Care solution.

Online care is a technology solution that allows patients to be connected with physicians. It is more than just a video chat session. Patients are members. They have a health history. They have benefits. Providers have a relationship with the plan too. The interaction needs to recognize allo of these aspects to the care transaction.

Capture the opportunity of an available provider and match that to patients that require access.

The benefit to - 
Consumers: Immediate access to care from their home
Physicians: Freedom to practice on their own terms.
Payers: shift care home in to the most convenient low cost setting.

The typical referral process involves the consumer in traveling 6 times:
1. To Doctor
2. From Doctor
3. To Specialist
4. From Specialist
5. To Doctor
6. From Doctor

While Physicians practice within state lines. Physicians can refer across and consult across State lines.

In the past 12 months the online care systrm has gone to:

UHG/Optum - National

Gartner projects that by 2013 25% of encounters in US and Europe will take place over the web.

MarryAnn Stump then talked about the experience with Online Care at BCBSMN

"Transforming Care Delivery"

What we are currently doing isn't working. 

Employers are worried too.

BCBSMN has a number of innovative employers in their region.

What attracted BCBSMN to American Well was:

- A real time approach connecting consumers to providers online
- Live interactions
- Upholds PCP coordination and care continuity
- Offers new practice opportunities and flexibility for health providers
- Delivers increased access and affordability

It allows care to come to people and not force people to go to get care.
BCBSMN started by testing on their own employee base.

The Goal: 24hr affordable access

A typical employee clinic costs about $200k to build.
They recreated the employee clinic as a virtual employee clinic

The PC for access but also some monitoring equipment that is integrated to Microsoft HealthVault

Access is by Video, Telephone or IM texting.
There were challenges in introducing the service in to the day-to-day practice at providers. 

The project is 14 weeks old. so what has been learned:

Over 1100 registered users. 66 visits so far. They bypass the claims system. It is a retail solution. Peak hours are during the work day. They are learning what to recommend when they roll out to other employers. 

Of the 66 visits: 88% replaced an office visit. 9% replaced a retail visit. 9% = other -reflects unmet need for advice from a doctor.
from the Doctors perspective:

52% replaced a retail clinic visit, 27% replaced an office visit, 23% are new uses.

82% said online care is good value. Cost is 45$ and it is subsidizes with $25 making a net cost of $20. Given the harsh winter this has been very popular. 50% of the participants said they learned something new by using online care.
82% said they saved an hour or more by using online care. 18% saved 3 or more hours. 80% said the time saved was during work time.

They engaged with physicians early in the process. This is disruptive technology. The 45$ price was driven by under cutting Minute Clinic but giving access to a doctor. All parties agreed in a multi year agreement to take 20% out of the cost of the transaction.

This is a consumer model. Providers think of the people they serve as patients. The plans think in terms of members. Both have to now think about "Consumers"

The challenge with Minute Clinics is the inbound and outbound data flows. The clinician doesn't know anything about the consumer. Even if they have to provide the data back to their PCP after the event. In online Care the feed to the PCP is at the option of the Patient. However, the system can provide background to the online physician before the event. Care continuity is a pillar of the system.

The process has a "wrap-up" step that allows the physician to revisit the notes. The system uses rules to attach patient education materials that reflect the decisions made during the visit. 

Milliman looked at Online Care. They looked at Episodic Treatments and looked at potential substitutions. On acute conditions only they looked at a $7PMPM saving in the medicare population. Primary Care, Chronic Care and Follow-up with Physicians.

Online Care is set to become a substitution level of care.  Online care extends Primary Care in a non Bricks and Mortar context. 

Is Online Care mobile: Yes - There is an IVR front-end that can enable use with just a phone. The interface is no where near as rich. AmericanWell is working on an iPhone App. 

[Editor's Note:] Wow - Think about an iPad version of online care using Chat and voice. All it needs is for the iPad to include a camera.

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