A Midwestern health system is working toward its goal of providing high-quality care at a manageable cost with a web-based patient care platform.
Technological advancements have made care more convenient and accessible for patients, but new challenges such as the increasing popularity of high-deductible health plans have healthcare providers asking the same question they asked themselves years ago: How can we improve access, with the same quality (or better), and at a more affordable price?
As high-deductible plan participation rises, consumers are more aware of their out-of-pocket costs for care. Employers want to make sure that employees have affordable options. And health plans are recognizing that cost savings are accruing when members select online care, or mobile health, instead of the more traditional options.
Modern technology is enabling fresh thinking about how innovation can be accelerated and is unleashing new potential to solve age-old health care problems. Mobile, in particular, unshackles us from the “visit” mindset and forces us to think beyond physical locations and limited hours, into a 24/7 online and mobile environment.
Finding Solutions
When it comes to healthcare costs, few groups, if any, are feeling satisfied with the current situation. Employers, members, patients and consumers are all looking for better answers. HealthPartners, a consumer-governed, not-for-profit healthcare organization with six hospitals, 55 primary care clinics, 22 urgent care locations, and numerous specialty practices in Minnesota and western Wisconsin, was and is among the groups seeking mobile health solutions. Such solutions have begun to emerge in various forms, but for HealthPartners, none has been as strongly embraced by members and patients as the health system’s telemedicine offering, virtuwell.com.
A Focus on the Consumer
Making a bold promise to consumers compels an organization to design in ways that not only are operationally efficient and effective, but also make the organization approachable for consumers. HealthPartners therefore chose to design for the consumer first, disrupting its own processes as it did so. For example, HealthPartners designated a special team to focus on innovating the product and getting it to market quickly. Thus, HealthPartners was able to launch virtuwell in 18 months.
In any business model, if an organization cannot solve a consumer need, it risks being left behind in its market by competitors that are finding solutions. HealthPartners’ leaders therefore recognized the need for an unrelenting focus on the consumer, driving the organization to reset its thinking and establish new norms as it designs new products and services.
For instance, virtuwell leaders generally avoid using the word patient because even that label connotes a traditional relationship and hierarchy that tends to be less empowering for the consumer. Through the telemedicine site, a person can access care whenever his or her schedule allows. Patients are guided appropriately through the interaction in a way that engages them as knowledgeable participants in her own care. The benefits of this approach are validated in consumer surveys, which indicate 99 percent of users find the tool simple to use, and 98 percent would highly recommend the service.
Simple by Design
HealthPartners’ leaders strongly believe in the idea of simplicity. The healthcare industry is well known for adding complexity, but the system has worked to reduce, clarify, and simplify for its patients.
HealthPartners started with a set of 60 common conditions that can be safely treated via the online tool. Some examples include sinus and bladder infections, the flu, allergies, and minor skin conditions like acne and rashes.
As customers provide answers to simple questions, the mobile health platform leverages sophisticated algorithms to make sure all the right questions are asked about symptoms and medical history. The service also leverages the high-definition photo capabilities of modern smartphones when visualization is needed. The visit experience is asynchronous and breaks from conventions like appointments, waiting rooms, live video, and upfront registration.
At the mobile health website, the proprietary interview reliably replicates the questions one should hear at a physician’s office. Once a patient answers, the platform reacts and adapts to ask the next set of questions for a thorough clinical interview. A visit starts immediately through any connected device and doesn’t require an app download or special hardware. The process, however, is discreet, allowing consumers to conduct a private exchange wherever they are, even in public. Customers have reported that they appreciate this private exchange and the ability to complete an interview discreetly from work, home, or even social settings.
Through the interview, the platform also evaluates the answers against hundreds of safety protocols to make sure the customer is getting the highest standard of care and is safe for their unique situation. If online care is not the right approach, a consumer is directed to seek in-person care and is provided the up-to-date science behind that recommendation.
Saving Time and Money
For those who can be safely treated online, the interview answers are submitted to board-certified nurse practitioners who make the diagnosis and complete the treatment plan. Typically, the wait for the treatment plan is about 20 minutes once a patient is finished providing information. Patients are notified by text and email, allowing them to immediately get back to their work and family life.
The combination of certified nurse practitioners and smart technology enhances both the experience and the affordability of the service. With a staffing model that employs and trains providers, consistency and adherence to best practices is the norm, not the exception. In addition, the nurse practitioners are working to the top of their license, creating improved access for primary care and specialty physicians for more complex care needs.
Even the pricing model breaks from the fee-for-service convention by offering a fee for outcome promise. The cost of a visit is $49 and includes a personalized written treatment plan and unlimited follow-up phone calls. Members of participating health plans often have a benefit design that eliminates their out-of-pocket cost. Any required adjustment to a patient’s treatment plan is made at no additional cost, and if virtuwell cannot deliver treatment, the patient similarly incurs no cost—attractive features for anyone paying the bills, whether an individual, employer, or health plan. There are no access fees or monthly subscription fees for insurers or consumers, and the mobile health site is open and available to all residents of licensed states.
The benefits offered by health plans, including HealthPartners, continue to reflect the confidence they have in the experience and affordability provided by the mobile health site. Although some copay plans started at a convenience care copay tier, the claims savings to health plans were so evident that most plans have shifted to unlimited free visits. As one of few low-cost options, the platform is a significant contributor to bringing down the total cost of care.
Lessons Learned
Today, more than seven years since the first treatment plan was sent, the mobile service has fundamentally changed the way HealthPartners approaches care delivery innovation. Influenced by strong reviews from customers and strong growth of the service, this innovation is transforming the way HealthPartners thinks about designing for consumers, and leveraging technology to improve access and reliability.
A well-designed online clinic also can outperform traditional models of care clinically. One example is strong compliance with antibiotic prescribing guidelines. Through its online clinic, the health system has scored 100 percent on HEDIS measures for antibiotic appropriateness for bronchitis. Treatment is customized for every customer, but needless variation is removed, letting the best evidence guide the recommended treatment plans and prescriptions.
With convenience and access prominent in the mobile health business model, the system has achieved a satisfaction record of 98 percent and simplicity to use of 99 percent.
Finally, demonstrated savings are real. Based on the claims analysis model published in Health Affairs, a recent calculation shows that shared savings to health plans, employers, and consumers surpassed $36 million since virtuwell’s 2010 launch.a
And the online clinic is proving there are benefits beyond improved health. Environmentally, the online clinic has helped to eliminate 3 million car miles from the road, contributing to the sustainability goals of the organization.
To date, the platform has provided more than 350,000 treatment plans, not including the thousands of visits that result in free triage or the follow-up care exchanges that are covered within the initial visit. By removing many of the barriers often linked to health care, consumers are responding with trial and repeat visits.
Realizing the Potential: Advancing Mobile Health
Based on its experience with its mobile health solution, HealthPartners offers the following recommendations for health systems embarking on a similar strategy.
Embrace mobile health care. This segment represents only about 1 percent of the total healthcare book of business in the United States. But the demand is growing, and consumers are calling for convenient solutions. The industry needs to have a network of great telemedicine offerings, because just as health plans and employers could not reasonably offer just one primary care group to its members, neither should they offer just one telemedicine option.
Provide incentives. Mobile health care is still in a nascent state. But emerging data strongly suggests that the quality and safety of this approach to health care is equal to or better than traditional health care.b A healthcare organization can support continued innovation in affordability, quality, and experience by showing confidence through benefit design choices within the organization itself.
Open the lines of communication. Mobile health options are challenging the way mainstream providers, health plans, employers, and consumers think about how health care works, and even how it should work. Employers and health plans are uniquely positioned to decide what is acceptable and desirable. Stronger support to communicate and educate on the availability and efficacy of modern mobile health care services will help the healthcare industry realize the full financial, quality, and experience benefits that are there for the taking.
Footnotes
a. Courneya P.T., Palattao K.J., Gallagher J.M., “HealthPartners’ Online Clinic for Simple Conditions Delivers Savings of $88 per Episode and High Patient Approval,” Health Affairs, February 2013. The original analysis was updated 2014 and revealed an average savings of $105 per episode.
b. Wicklund, E., “Kaiser Study Gives Telemedicine High Marks in Stroke Treatment,” mHealth Intelligence, Dec. 18, 2017; Kaiser Permanente, “The Rise of Telemedicine & Lower Costs;” Leventhal, R., “Geisinger Study Finds Telemedicine to Cut Readmissions, Costs for Heart Failure Patients,” healthcare informatics, Oct. 3, 2014; “Pande, R.L., Morris, M., Peters, A., et al., “Leveraging Remote Behavioral Health Interventions to Improve Medical Outcomes and Reduce Costs,” American Journal of Managed Care, Feb. 27, 2015.
