PPO offering online answers to members' medical queries

Some question whether it's a good idea for First Health's medical directors to offer advice to patients they've never seen.

By Tyler Chin, amednews staff. Sept. 8, 2003.

First Health this month is launching a service allowing members of the Downers Grove, Ill.-based PPO to have their medical questions answered by its medical directors via electronic mail.

Although some health plans reimburse physicians for online consultations with their patients, and even more plans offer health information online to members, First Health is among the first to allow members to communicate online with its medical directors, some observers believe.

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The online service, which is free to patients and called the First Health Medical Director Q & A, also is unusual in that the doctors will field and answer questions from people they have never seen.

Such a relationship, however, isn't necessary because First Health isn't diagnosing or treating members online, said Scott Smith, MD, the PPO's chief medical officer. The service is designed strictly to offer patients health information that is personalized yet general in nature, he said.

For example, if a patient asks whether she should have a C-section, the PPO would respond by saying, "Well, this is the information you may want to look up about C-sections. This is why they are done, this is what it is, these are the possible complications,' and leave it at that," Dr. Smith said.

It also would advise them to discuss the matter with their physician. "Our doctors really have no motivation in all of this except to provide information," Dr. Smith said.

Honest broker?

But whether the PPO's medical directors fill the role of honest information brokers will hinge on how they answer questions, some say.

"The devil's in the details," said Thomas E. Sullivan, MD, a cardiologist in Danvers, Mass., who is a member and former chair of the AMA's e-Medicine Advisory Committee.

First Health pays doctors $25 for an online consultation.

Dr. Sullivan noted that AMA guidelines call for physicians to offer advice via e-mail only to patients with whom they have a relationship. The AMA also believes that health plans should be held accountable for advice their physicians give to their members, he said.

"If you're going to give advice -- whether it's over a telephone, face-to-face or by e-mail, and you represent yourself as a physician, then obviously you should be properly qualified to give that advice," Dr. Sullivan said. "You [also] should be accountable for that advice."

But First Health asserts that it is simply offering patients general information, not medical advice.

Dr. Smith points out that members who want to engage in online consultations with their physician can do so through First Health, which in 2000 became the first insurer to reimburse for online consultations. The company pays doctors $25 for an online consultation.

Patients want service

Over the past couple of years, several surveys have found that a majority of consumers want to communicate with their physicians via e-mail. Physicians, however, generally have been reluctant to e-mail patients, for reasons including lack of reimbursement, privacy concerns and fear that their practices would be inundated with e-mails.

But patients' inability to reach their physicians by e-mail was not a factor in the PPO's decision to offer its e-mail service, Dr. Smith said.

One reason why First Health is offering the service is that it believes it will help the insurer retain and attract new members and employers, Dr. Smith said.

The PPO also wants to enhance customer service and help educate members about their health so that they can make better health decisions in conjunction with their physicians, he said.

For example, PPO members could use the service to supplement in-office discussions, ask about something they forgot or didn't quite absorb, or get help interpreting a medical study, Dr. Smith said.

To access the service, which started Sept. 1, users must go to First Health's Web site and first enter a user ID and password.

Some 15,000 people are eligible to use the service. First Health, which has 14 million members and about 400,000 physicians in its network, expects to expand its access to more members during the next three to six months.