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Insurers still weighing pay for online consultations

Plans are considering continuing or expanding programs to reimburse for Web visits on a regular basis.

By Tyler Chin, amednews staff. July 1, 2002.

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To reimburse or not to reimburse? After nearly a year of reimbursing for Internet visits on an experimental basis, a handful of insurers are assessing the data they have collected to determine whether they ultimately will continue or broaden payment for "Web visits" or "e-visits" between physicians and established patients.

Since last spring, Blue Shield of California and ConnectiCare Inc. reimbursed doctors $20 for a Web visit as part of two studies designed to determine, among other things, whether physicians and their patients will adopt the technology and what impact it may have on health care costs.

Blue Shield of California and ConnectiCare said they were pleased with what they had seen so far. The volume of Web visits ranged from low to above expectation.

"There were a lot of very positive anecdotal comments from patients and physicians," said Jeffrey Rideout, MD, president of Blue Shield California's CPS Foundation and former chief medical officer of Blue Shield of California. The managed care company ended a 9-month test in May involving about 250 physicians and 3,240 patients with PPOs.

"My impression is that having the opportunity to be reimbursed for work done over the Internet is a huge plus for physicians -- just like we thought it would be," he said.

Blue Shield of California is awaiting the results of its study, which will be released within the next several months, before deciding whether to pay for online visits on a regular basis, and if so, to what extent, Dr. Rideout said. He referred questions about the level of usage to Healinx Inc., Emeryville, Calif., which is sponsoring the study of two tests in the state.

Giovanni Colella, MD, CEO of Healinx, said usage exceeded expectations but declined to be specific because data are being analyzed now.

Getting it together

While Blue Shield of California has ended its test, ConnectiCare is still conducting its test. The Farmington, Conn.-based HMO will not wrap up the program until it sees 400 Web visits. That's the threshold the insurer believes it needs to reach so that it will have sufficient data to conduct a meaningful analysis, said Paul Bluestein, MD, the HMO's chief medical officer.

Dr. Bluestein anticipates that ConnectiCare will hit that target by the end of year. ConnectiCare is paying $20 per online visit, with patients paying a $5 co-pay.

About 25 doctors who are part of ProHealth Physicians, a 160-doctor primary care practice in Farmington, and 215 patients are participating in the ConnectiCare study, which is separate from the study in California, said Eric Zimmerman, Healinx's director of product development.

Internist Jim Cox-Chapman, MD, ProHealth's chief medical officer said physicians like the Web visits because they believe the visits benefit doctors and patients alike.

Handling routine matters over the Internet could free up more time for complicated cases and would allow physicians to spend more time with patients, he said. "We definitely would like to see more insurers offer it, but its use has to be appropriate and there has to be reimbursement."

He and others believe that adoption of online visits will increase as physicians and patients become more familiar and comfortable with the technology.

"I believe this is going to become part of medical delivery in the future," Dr. Bluestein agreed.

That could take some time, said Scott Smith, MD, national medical director of First Health Group Corp., a Downers Grove, Ill.-based PPO. The plan has signed up 30 employers that have agreed to cover online visits by chronically ill employees, but Dr. Smith said physicians and patients have been slow to take advantage of the service.

Since First Health began offering the service in January, the level of activity has been "minuscule" even though more than 300,000 physicians and 400,000 members are eligible to participate, Dr. Smith said.

Physician resistance and lack of Internet connectivity at the office have been the key obstacles, he said.

Another factor that has slowed adoption is that not all patients own computers. "We've had patients say that [online reimbursement] sounds like a great idea. 'Can you give me a computer?' " Dr. Smith said.

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