Featured Health Business Daily Story, Sept. 9, 2015

More Blues Plans Are Connecting Members, Docs Through Telehealth

Reprinted from THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS, a hard-hitting independent monthly newsletter on new products, market share, management strategies, profitability, strategic alliances and executive compensation of BC/BS plans. (Not affiliated with the Blue Cross and Blue Shield Association or its member companies.) Sign up for a $72 two-month trial subscription today.

By ,
September 2015Volume 14Issue 9

The living room, or even the kitchen, could become the new waiting room for a growing number of Blues plan members.

Blue Cross and Blue Shield of Michigan and Pennsylvania-based Capital BlueCross are the latest Blues plans to partner with American Well Corp., an eight-year-old Boston-based telehealth company that has a dozen other Blues plan clients.

Brooke Nordai, Capital’s director of product innovation, is quick to point out that the new telehealth option, which will be available to members beginning Jan. 1, is not meant to replace traditional office visits. Instead, it’s being touted as a convenience-focused service for members who might not have time for an office visit, or who might need care outside of normal office hours.

“If I wake up with a sinus infection, and have to get kids on the bus and make it to work for a 9 a.m. meeting, I don’t have a couple hours to sit in an urgent care center. But I might have 10 minutes to spend on my mobile,” she says.

A virtual visit is similar to an in-person office visit except the doctor and patient see each other via desktop computer, tablet or mobile phone that uses a 3G or 4G mobile network. She says Capital has been planning to roll out a televisit option for the past two years.

Members Pay $39

The retail cost of a televisit is $49, but Capital members will be charged $39. The cost will count toward the member’s annual deductible and out-of-pocket maximum. A traditional office visit, by contrast, runs between $80 and $100, and an urgent care visit typically is between $150 and $200, according to Nordai.

During telehealth appointments, doctors can diagnose common conditions and transmit electronic prescriptions to a member’s pharmacy. Patients are connected to a doctor in less than two minutes, and can request an appointment with a specific telehealth doctor. Some participating doctors will be part of Capital’s local telehealth provider network through their own technology partnerships, while others may contract directly with American Well. The service is available 24 hours a day, seven days a week.

In March, Blue Cross Blue Shield of Massachusetts teamed up with American Well to launch WellConnection, a two-year telehealth pilot program. Video visits will be used to assess and treat patients with certain conditions. It might, for example, be used to monitor a patient’s recovery from a concussion, or as a wellness coaching tool, or to monitor recovery and help prevent re-hospitalizations, according to the insurer.

In April 2014, the Federation of State Medical Boards adopted policy guidelines to help ensure the safety and quality of medicine practiced through telemedicine technology. According to the American Telemedicine Association (ATA), 27 states and Washington, D.C., have telemedicine parity laws. In 2014, CMS reimbursed nearly $14 million in telehealth claims, and has considered expanding its usage.

But barriers to access still exist, as issues with state medical licenses linger and state medical boards hesitate to greenlight a tool with the potential to threaten the physician-patient relationship. ATA recently began accrediting telehealth programs.

All but two states — Connecticut and Rhode Island — cover some telehealth services under Medicaid. Medicare Advantage plans are not prohibited from covering telehealth as a supplemental health benefit, so it’s up to providers to be “proactive” and negotiate telehealth payments in their contracts. CMS’s Innovation Center is considering a demonstration project that would let Medicare Advantage plans offer telehealth as a basic benefit, which could exponentially expand the number of plans covering telehealth.

Anthem Caused ‘Shockwave’

Anthem, Inc. (then WellPoint, Inc.) partnered with American Well in 2013 to launch its LiveHealth Online service, which connects patients and caregivers via secure two-way video. Danielle Russella, American Well’s president of customer solutions, says the Blues plan operator helped pave the way for telehealth when it decided to treat electronic visits as a covered benefit on par with traditional office visits.

“That sent a shockwave through the industry,” she tells The AIS Report. Anthem’s telehealth program is now available to more than 15 million members in 12 of its 14 states.

American Well is far from the only telehealth player. On July 7, Teladoc, Inc., a competitor, said it closed an initial public offering of 9,487,500 shares of its common stock at a public offering price of $19 per share. On Aug. 12, the company reported its first quarter as a publicly traded company.

The company ended its first full quarter with $18.3 million in total revenue, 11.5 million members and 125,322 visits. Revenue for the company’s third quarter 2015 is expected to be in the range of $19 million to $19.5 million. Total visits for the full year are projected to be between 520,000 and 540,000. Other telehealth vendors include MDLive and Doctor on Demand. American Well sued Teladoc for patent infringement shortly after it filed the Form S-1 with the SEC. Teladoc previously denied the allegations brought in the suit.

When new technologies and new care delivery models are introduced, network providers worry about the potential impact on the traditional care model, notes Jay Simmons, Capital’s vice president of provider network engagement.

While he says some of Capital’s providers have voiced concern about the telehealth option, they also want to participate. “The concerns tend to revolve around how the technology interacts with the patient and the effect on the provider-patient relationship,” he says. But he predicts providers will gravitate toward telehealth because the technology allows them to be more efficient and see more patients.

Visits Aren’t ‘Blind Dates’

Russella says her company encourages network doctors to participate in the service because it improves the chances that a member will be able to connect with a family doctor. But if the member’s doctor isn’t available, information from the visit is sent to the member’s primary care doctor. Many of American Well’s core doctors are licensed to practice in 30 to 40 states.

The visits aren’t “blind dates,” she says. Members have access to information about available doctors. Once one is selected, information about the member comes up on the doctor’s screen. The doctor also receives information about previous diagnoses and prescriptions based on claims history. It also collects credit card information. Visits also can be conducted at integrated kiosks, which could be located in a mall, airport or in an employer’s onsite clinic.

© 2015 by Atlantic Information Services, Inc. All Rights Reserved.


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