Illinois PPO to pay physicians for online consultations

To reduce the number of chronic care patients needing expensive hospitalization, First Health Group is reimbursing physicians for e-mail contact with patients.

By Bob Cook, amednews staff. May 22/29, 2000.

Physicians in one Illinois-based PPO network are scheduled to become the first in any managed care organization to be reimbursed for Internet consultations.

Starting this summer, First Health Group Corp. plans to pay a $25 reimbursement for any "clinical content" sent between physicians and patients over an electronic mail network the company plans to set up, said Mary Anne Carpenter, executive vice president for service products.

The object of offering payment for online reimbursement is to create an incentive for chronic care patients and their doctors to interact more frequently, thereby reducing pricey acute care hospitalizations that may result when seemingly minor symptoms aren't treated, Carpenter said.

"So many times, people with chronic conditions don't want to bother the doctor," Carpenter said. "The problem is, they start to develop acute care symptoms and don't realize it. What they really need is routine but fairly low-level contacts with their physician to make sure their health status is being retained.

"Truthfully, it's not the [number of] office visits that will go down. If the physician or the patient needs a face-to-face consultation, that's fine. What we believe will go down is acute care hospitalizations."

The idea that e-mail contact will lead to reduced hospitalizations is unproven; the idea is so new that First Health hasn't even tried to project how much it might pay in reimbursements and how much hospitalization costs will go down.

But more physicians are starting to use e-mail and other tools, such as home medical devices that send results straight to a doctor's computer, to monitor patients in hopes of providing better care and maintaining closer contact with patients.

Who gets paid for what

One sticking point in getting more physicians to handle some care decisions online is whether they will be reimbursed for their time. The idea for reimbursing online consultations came in part from requests from First Health Group's member physicians.

Carpenter said First Health Group "couldn't find evidence" that any other managed care organization offered payment for online consultations.

First Health Group has set up particular standards for what and who gets reimbursed.

Patients in First Health Group's 24/7 chronic care support program must first go to the company's Web site (http://www.firsthealth.com/) and set up their own page to use as a conduit to reach their physician. The program has 300,000 patients.

Any of First Health Group's 380,000 doctors could be reimbursed, as long as they are treating patients in the chronic care program. Both the patient and the physician must agree to handling a consultation online.

Physicians would get reimbursed every time there is a company-defined clinical contact. For example, if a doctor wants a diabetic to send in daily blood sugar readings, the doctor would be reimbursed for each reading the patient sends, Carpenter said.

Doctors who answer questions patients pose about their condition also could be reimbursed. "We're not trying to limit what clinical information goes back and forth," Carpenter said.

Patients may have a co-pay, depending on their plans, Carpenter said. That's because First Health Group mostly serves in offering plans to self-insured employers, unions, third-party administrators and insurance carriers, who would be charged for each $25 payment. The company, also a participant in the federal employees' health plan, claims to have the largest directly contracted network in the nation, with members in all 50 states and the District of Columbia.

"I doubt this will add up to the kind of monies that would cause an increase in premiums," Carpenter said. "The aging of the population and the need for chronic care will overwhelm any cost increase."