The doctor will Skype you now

By Esther Zunker

A nasty sinus infection. Pink eye. A strange rash. Most people have experienced conditions or ailments that need medical attention at times outside regular doctor’s office hours, then had to pay hefty fees at emergency rooms or urgent treatment centers on nights and weekends.

There was no other choice except for sticking it out until morning or the next time the doctor was available – until recently. Thanks to new telemedicine programs like KentuckyOne Health’s Anywhere Care and Anthem BlueCross BlueShield’s LiveHealth Online, Kentucky patients now have inexpensive, 24-hour access to a variety of doctors with a few mouse and computer key clicks.

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Kentucky patients now have inexpensive, 24-hour access to a variety of doctors with a few mouse and computer key clicks.

Baptist Health also has begun a limited telehealth services, currently only for Home Health heart patients in Madisonville.

And on April 30, UnitedHealthcare, the Minnesota-based health benefits provider for many Kentuckians, announced it plans by next year to cover video-based doctor visits through three telemedicine companies, NowClinic, Doctor on Demand and American Well.

“Increasing access to healthcare and strengthening the primary care system in the commonwealth is an important step in our work to create a healthier
Kentucky,” said Ruth W. Brinkley, CEO of Kentucky-One Health.

Patients like telemedicine because it’s fast and easy to use, and cheaper because it’s a low-overhead service. Provider systems feel better about the low overhead, too. And doctors who provide telehealth care like being able to “see” more patients, sometimes doing so from their own homes.

The new telemedicine programs, said John Jesser, Anthem Blue Cross Blue Shield vice president of provider engagement strategy, represent a true shift in healthcare delivery by using technology to make treatment easier and more consumer friendly.

“At this critical juncture in our nation’s healthcare transformation, we are taking a lead in improving access to care and bringing a better healthcare experience to our Kentucky members,” Jesser said.

While telemedicine isn’t new, until recently it has been used mostly to expand access in rural areas with doctor shortages or connect primary-care doctors with specialists. The new approach represents a new way for telemedicine to give patients more control over their healthcare.

Non-emergency care via mobile devices

Both Anywhere Care and Live Health Online allow patients to use their smart phone, tablet or computer to initiate a live video visit with a U.S.-based, board certified doctor of their choice (profiles are available online) to discuss non-emergency health issues from home, work or any other location with Internet access. Doctors with both programs can provide a diagnosis, treatment and a prescription if needed – all for an affordable fee.

LiveHealth Online launched in 2013, first to national employers. It has expanded to the majority of Anthem’s health plan customers, including health exchange members. A LiveHealth Online visit for eligible members a costs the same or less than a primary-care office visit.

Consumers who do not have Anthem Blue Cross Blue Shield in Kentucky as a health plan can use LiveHealth Online by signing up online and paying with a credit card. Doctors participating in LiveHealth Online typically charge $49 per medical “visit.”

Anywhere Care launched in 2013 through a partnership with Carena Inc. and costs patients $35 per visit whether they are covered by insurance or not.

Patients use both programs to communicate face-to-face with doctors about non-emergency medical conditions as colds, aches, sore throats, allergies, infections, rashes and minor injuries. Doctors may prescribe medications, recommend an over-the-counter medicine or provide home-care options. They cannot, however, prescribe or refill prescriptions for controlled substances such as narcotic pain relievers or lifestyle drugs.

If appropriate, healthcare providers will refer patients to an emergency department for a follow-up clinic visit. Anywhere Care and Live Health Online also can provide follow-up reports to the patient’s primary care doctor after an online visit.

Larry Shepherd of Louisville said he recently started feeling sick over the weekend and decided to try Anywhere Care.

“My regular doctor wasn’t open and I really didn’t want to wait until Monday to get an appointment,” Shepherd said. “I called close to midnight and the doctor called back in about 5 minutes. She was very in-depth and asked me what remedies I had tried and what medications I have used before. I was very impressed with the doctor.”

Shepherd got his prescriptions filled Sunday morning and felt well enough to work Monday.

“I use (Live Health Online) when I don’t feel bad enough to go to the emergency room but bad enough to want to go to the doctor’s office,” said Deborah Sue Baker, Anthem BlueCross and BlueShield Kentucky member. “My doctor is an hour away and if I’m sick, that’s a long drive. And sometimes, it’s hard to get an appointment with my doctor.

“The iPad app makes it easy,” she said. “The doctors are very professional and very thorough with their questions. They’ll even call in a prescription. It’s the best you can get without visiting a doctor.”

Providers can mobile-enable their practice

Jesser said telemedicine provides three main benefits to patients: expanded access to care, affordability and an improved consumer experience.

“As we know, care can be limited and is based on being able to get someplace when (a doctor) has an opening. They only have certain hours and that doesn’t always work for when people don’t feel well,” Jesser said. “(Telemedicine) expands access to care for the consumers, making it much more friendly to their schedule and lifestyles.

“Also, because telemedicine doesn’t involve a lot of the overhead that is involved in offices, it allows the price point to be less expensive – especially less than going to the emergency room or urgent care center,” he said.

Consumer experience is improved because telemedicine programs are easy to use.

“You don’t have to have a PhD to understand it. You just get online, choose a doctor and you’re in a visit,” he said.

From the provider’s perspective, telemedicine has the potential to save hospitals and doctors money with less overhead, as well as increase the value of a doctor’s time. It essentially allows providers to web- or mobile-enable their practices.

“That allows them to be available to see patients face-to-face for more hours,” Jesser said. “One doctor in the same location can be available on mobile and web for their patients no matter where they live.”

Telemedicine could help doctors better manage patients who have chronic diseases or mobility issues, as it allows for frequent visits without the burden of travel. And getting early care via telemedicine can help reduce the severity and duration of many typical illnesses such as the flu and infections.

Telemedicine is expected to lessen the burden on primary-care doctors who increasingly feel the pressure of a growing doctor shortage. The Association of American Medical Colleges estimates the United States will have 62,900 fewer doctors than needed this year, with the problem more acute in rural areas.

‘Amazingly positive feedback from patients’

Anywhere Care has been extremely well received since it launched last August, said Kathy Love, director of strategy and business development for KentuckyOne Health’s Central East Kentucky Market.

“We’ve had amazingly positive feedback from patients who have tried this service,” Love said. “People have told me they’ve used (Anywhere Care) multiple times when they’ve needed it … either late at night, or over the weekend.”

While telemedicine is affordable and convenient, Love said patients still need a primary care doctor.

“This is definitely a service that’s intended to be a complementary offering to your primary-care doctor if you can’t get to them for whatever reason and have a non-emergency health condition like a sinus or ear infection,” she said. “It’s something you can access 24 hours a day with a very minimal wait and very professional providers, but it shouldn’t replace your very important relationship with your primary-care doctor.”

Recent upgrades to KentuckyOne Anywhere Care’s system include an embedded video option to visually connect patients with providers directly without using an outside video chat service such as Skype.

Live Health Online has improvements on the horizon also. Anthem plans to expand the Spanish mobile app it has introduced in California nationally in the next couple of years. It is building behavioral health capabilities to add in 2016; it will include basic counseling, a program that provides registered dietician advice, and lactation consultant services for new mothers.

One of its biggest telehealth challenges, Jesser said, is simply making sure people know programs exist and understand how they work. Live Health Online will work to increase awareness among Anthem members in the coming years, he said.

Employers manage costs, meet needs

The LG&E and KU power utility company is one of several major Kentucky businesses offering Live Health Online to their employees.

“We have employees spread out across Kentucky and into Virginia, so this is a beneficial alternative for employees who may not have this same level of convenient access to medical care for common symptoms and illnesses,” said Liz Pratt, LG&E and KU public relations specialist. “We’re continually evaluating services for our employees that allow us to continue to manage costs while still meeting employees’ needs.”

Anywhere Care allows patients to use their smart phone, tablet or computer to initiate a live video visit with a U.S.-based, board certified doctor of their choice to discuss non-emergency health issues from home, work or any other location with Internet access.
Anywhere Care allows patients to use their smart phone, tablet or computer to initiate a live video visit with a U.S.-based, board certified doctor of their choice to discuss non-emergency health issues from home, work or any other location with Internet access.

Stephanie Duncan, manager of labor relations for the company, said her overall experience with Live Health Online was very positive.

“Navigating through the process was straightforward, and I was impressed with the thoroughness of the physician’s assessment,” she said.

Dr. Charles Wallace, a practicing family medicine doctor in North Canton, Ohio, has both in-office hours, as well as designated time slots when he serves patients nationwide via the Live Health Online network. On a Saturday afternoon in mid-late April, he had already visited with nine different telemedicine patients from his home office.

“You get a wide variety of people of different ages – I never knew there were so many accents (in the U.S.),” Wallace said with a laugh. “My last two calls were regarding a 72-year-old lady and an 11-month-old baby.”

Wallace said he enjoys the diversity of patients he encounters through the program, which is available to all Kentuckians and residents in 43 other states plus Washington D.C.

“For the most part, people really enjoy the experience,” he said. “We’re able to give good quality care. People have an expectation (for service), and we can fulfill it.”

Wallace prescribes for about 80 percent of his Live Health Online patients, with acute sinusitis (sinus infection) being the most common diagnosis. Urinary tract infection, pink eye and other skin lesions are common also. He relies heavily on patients’ explanations of their symptoms and guides them through a self-exam, sometimes using flashlights or cell phone lights.

Wallace uses his professional judgment to decide whether he has enough information to treat the patient or they should be seen face-to-face. For example, patients who need X-rays or lab work or who have complex medical conditions need to schedule in-person visits.

Repeat customers have come to trust him, Wallace said, and specifically seek him out to pursue their medical concerns when they notice he is among the online doctors available.

“I usually always get a ‘thank you’ at the end of a visit,” Wallace said. “I’ve thoroughly enjoyed my experience (with Live Health Online)…you get a few minutes to make a difference, and also potentially leave an impact on people from an educational standpoint.”

Managing chronic health conditions

Baptist Health Home Care began that major commonwealth provider system’s first limited telehealth service late last month in Madisonville. Offered only to at-risk heart patients, the new interactive program launched April 21 links patients with nurse coaches to better monitor their health.

It includes in-home equipment such as weighing scales, a blood pressure cuff and pulse oximetry sensors to measure blood oxygen levels. Daily readings are transmitted via telephone lines or an internal cellular modem to a monitoring service. If any readings cause concern, a home health nurse is alerted to contact the patient.

The main objective is to teach patients to self-manage their chronic heart issues, thus reducing their time in the hospital, said Rebecca Cartright, state executive director for Baptist Health Home Care.

“This program gives patients a sense of security when we’re not there that there’s something monitoring their vital signs daily and making sure they’re doing OK,” she said.

Baptist Health expects the program to become a tool to detect and solve potential problems before they worsen and multiply, Cartright said. The new home telehealth program already detected one patient’s weight gain, and a doctor helped remedy the situation.

“We watch for signs that they (the patients) are getting into trouble,” said Cyndi Clark, director of Home Care and Hospice with Baptist Health Home Care in Madisonville. “Then the nurses can teach the patient about cause and effect, such as how eating too much salt leads to unwelcome water retention and weight gain.”

In the coming months, Baptist Health Home Care will extend telehealth services to additional Kentucky communities, including Paducah, Louisville and Lexington. It may also eventually develop criteria for other sets of patients, Cartright said.

Esther Zunker is a correspondent for The Lane Report. She can be reached at [email protected]

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