She knew that the kind of regiment she needed would require her to see a physician. But due to a recent job loss, Soderberg had lost her insurance — and she estimated it could cost her as much as $600 for the visit.
As a patient of Franciscan Health System’s primary care clinic in Port Orchard, Soderberg learned about an alternative option: virtual urgent care, at the cost of $35. All she had to do was make a call from her living room couch, answer a few screening questions, and wait for a doctor to call her back.
By the end of her virtual visit, the physician had not only reviewed her medical history and prescribed medications, but had also called Soderberg’s pharmacy to find the least expensive drug option.
“He went above and beyond,” Soderberg said. “I was very sick and had a hard time walking, and I only had to make one trip — to the pharmacy.”
Soderberg is one of a growing number of patients who are choosing to “see” a doctor from the convenience of their homes — or any other place — instead of driving to the office.
Telemedicine was introduced more than 40 years ago as a way to treat patients in remote areas. Today, virtual care is being embraced by hospitals and primary-care practices alike. The American Telemedicine Association estimates that more than 10 million people used some form of telemedicine in 2013, double the number from 2010.
“It’s amazing to see how quickly it’s becoming a new trend,” says Matt Levi, director of Virtual Health Services for CHI Franciscan Health. “It’s becoming not something that’s ‘nice to have’ but a must-have.”
Franciscan’s Virtual Urgent Care
Franciscan has been offering a virtual urgent care program to the public in Pierce County since October 2013 and in Kitsap since January. The healthcare organization estimates that it has saved patients more than $600,000 in healthcare costs and more than 4,200 hours (from avoiding visits to the emergency room or a primary or urgent care clinic).
One of the first hospital systems in the country to offer wide-scale virtual urgent care, Franciscan launched the service in partnership with Carena. This year, it has also started offering the option in-house, to Harrison Health Partners and Franciscan Health Group physicians.
Patients pay $35 for the visit, and have the option of linking up with a physician (or nurse practitioner) either via the phone or video through an online portal or Skype. Levi says that about 60 percent of the patients using the service are either new or haven’t been with Franciscan for the past two years.
He estimates that 80-90 percent choose the portal option.
“A lot of it is about convenience,” Levi says. “It’s a service that allows patients to receive care when and where they need it.”
All the providers who treat patients virtually undergo special training that includes coursework, job shadowing and post-visit patient case review.
For about 75 percent of the patients, the virtual service is a “definitive care plan” that doesn’t require a further primary care or emergency room visit. Those who can’t be treated virtually, however, receive a refund for the $35 fee.
For the physicians, virtual care is a little different than seeing a patient in person, says Dan Diamond, MD, medical director of Harrison Urgent Care Centers.
Diamond was one of the first Harrison physicians to be trained for virtual urgent care. He says the doctors have to use other ways of getting information that they may get from physical clues by being in a room with the patient.
“It takes a little bit of getting used to,” he says. “We have to ask a lot more questions, and we use a set of virtual-clinical guidelines.”
MultiCare Doctor on Demand
MultiCare Health System launched a virtual urgent care option for the public at
at the end of April through Doctor on Demand, a company that specializes in virtual care. Patients are only treated by board-certified physicians who have been additionally credentialed by MultiCare.
The visit costs $40 (first one is free). The service works on any platform — either through an app or the MultiCare website.
After completing the screening questions, the patient is placed into a queue for a callback. So far, the turnaround time has been under five minutes, with two minutes average, according to Christi McCarren, RN, vice president of Retail Health at MultiCare.
She expects the service to be especially popular with busy professionals and the younger generation.
“The new generation coming up is very technologically savvy and they want healthcare when they want it, where they want it — and they want it to be affordable,” she says.
A Growing Trend
Besides the tech-savvy generation, a major factor impacting virtual health care is the shortage of primary-care physicians. Some of that shortage is likely due to the Affordable Care Act. Nationwide, the American Association of Medical Colleges estimates a shortage of 45,000 primary-care physicians.
“The volume of patients has skyrocketed and we believe that is in part because people have healthcare coverage where they didn’t in the past,” McCarren says, adding that many of the primary-care clinics struggle with getting patients in because of the demand.
One way virtual care lessens the strains on brick-and-mortar urgent care clinics is by offloading the high-peak morning visits, Levi says. But it’s also freeing up primary physicians’ time — for example, Franciscan is seeing a 50 percent reduction in follow-ups for doctors who are on call (which is not considered virtual care).
“Most of the physicians I know are incredibly busy,” Diamond says. “We have to do something differently from what we’ve been doing, and virtual care is a more appropriate use of resources.”
Both Franciscan and MultiCare are looking to telemedicine in some specialties as well. Franciscan, for example, is piloting it for routine conditions like diabetes and other chronic diseases.
MultiCare has been offering a virtual visit option for four years for pregnancy care. Women who have low-risk pregnancies can choose to have every other visit virtually until four weeks before their due date. At that point — or if there are complications in the meantime — care reverts to all-office visits.
McCarren says that initially, this option was mostly popular with women who have had a previous pregnancy.
“What we’re seeing now — especially because everyone has a smartphone — is more interest even from first-time moms and Spanish-speaking moms,” she says.
Diamond noted that the new trend in healthcare is to move from a physician- or hospital-centric environment to a patient-centric one.
And patients seem to be ready to give up their in-person encounters with their doctor. An American Well survey estimates that 64 percent of Americans would be willing to do a video visit — and an American Hospital Association report estimates that 76 percent of patients find access to care more important than the need for interaction with their providers.
Soderberg is one of those patients. She says she will definitely use virtual urgent care again.
“Even if I had health insurance, if I’m really sick, I would still try this first,” she says.
Legislative Discussions
Telemedicine would not only help solve capacity and access (including to places like nursing homes) but could also save on the costs of healthcare delivery. The American Telemedicine Association estimates that delivering care via hybrid technologies could save 850,000 transports to the emergency room every year. That is $537 million in savings from emergency care alone.
So perhaps it is not surprising that insurance companies are slowly embracing the idea of virtual care. United HealthCare, for example, announced at the end of April that it will cover virtual care physician visits for employer self-funded funds, and will expand it to employer-sponsored and individual plans next year.
But many states aren’t waiting for insurance carriers to volunteer. Currently, about a dozen states either have some type of telemedicine-parity legislation or are in the process of discussing it.
In Washington state, Gov. Jay Inslee signed a bill in April requiring insurance companies, Medicaid-managed plans and state-employee plans to reimburse providers for telemedicine services. But the bill does not apply broadly to all virtual care situations. For example, carriers only have to reimburse providers who have a contract with them.
Still, McCarrey, of MultiCare, sounds optimistic.
“There are numerous conversations happening (legislatively),” she says. “There’s enough traction and support for virtual visits because of what it brings to the market. This is an option we must have for patients.”
Date: June 8, 2015