Under a mandate to create innovative methods of healthcare delivery, HealthPartners (Minneapolis), a combined insurer (1.4 million covered lives) and healthcare provider (a network of 1,700 physicians and associated facilities) launched virtuwell.com in 2010, and has just received authorization to expand into Michigan. Virtuwell is available as a set of free service sessions for certain HealthPartners clients, or as a call-in service for a fee of up to $40, depending on arrangements with various insurers. Patients go through an expert system-driven analysis, and at an appropriate point, a live care provider comes online to complete a diagnosis and treatment. The medical conditions suited to the online diagnosis are restricted; currently virtuwell covers 40 common conditions, ranging from rashes and sunburns to eye infections or urinary tract conditions. Treatment can include writing a prescription, which is transmitted electronically to a local pharmacy.
The service is proving popular: it had 10,000 visits in its first full year, 28,000 last year, and expects 50,000 this year, says Kevin Pallatao, HealthPartners VP. A paper he coauthored has been published in the latest issue of Health Affairs (vol. 32, no. 2, 385–392), detailing average cost savings for patients of $88—coming in well under the costs of visiting a retail clinic, a doctor’s office, or a hospital emergency room. Patient surveys show a near-100% satisfaction level.
Cost savings, obviously, benefit both the patient and the insurer, which is getting clients serviced with minimal intervention. But the e-prescribing part of the service is fraught: Many states have regulations requiring any prescription to be initiated by a face-to-face consultation with a prescriber (and having a duly authorized prescription is one of the criteria by which the National Assn. of Boards of Pharmacy distinguishes legitimate online pharmacies from rogue sites). “We’ve been working through the regulatory requirements state by state,” says Pallatao. He sees room for accommodation in how regulations define a “relationship” between a prescriber and a patient.
An online health clinic represents not just an alternative to expensive emergency room care, but also a threat to the growing retail clinic business at chain pharmacies. Even with the online clinic, though, prescriptions are fulfilled at pharmacies, and Pallatao notes that one of the unexpected benefits of the service is the ability of virtuwell care providers to guide consumers in selecting OTC products.