TECH: Apparently there’s something called the Internet

The Web Returns to Health according to the Washington Post. Who knew? SCasedadly not too much in the story. WebMD is still around, Steve Case, Time Warner put money in to something called EveryDayHealth—not launched yet. Healthcentral is back; rescued by defense-contracting money-bags the Carlyle Group. All these guys are aping the mainstream health success of WebMD.

Not in the report but more interesting is the attempt by Healthline, and a host of others—and of course Google—to create health information search verticals, and then the coming attempt to get at consumer long-tail sites which several people have been writing to me about.

Finally, the most interesting development is the integration of this information with the actual health information of individuals—that’s the role of the emerging PHR movement, and that’s where the really interesting health web activity is going on. And one version of that is the combination of those records with physician communication systems. yeah, yeah, I know you’re expecting some crack about RelayHealth and it’s long slow evolution, but the fact that at least the service exists is finally making some news. Today it’s in the Wall Street Journal in the column by single-payer touting Dr. Benjamin Brewer.

We’ve had our Web site going for about a year now and while only about 50 of my patients have taken advantage of our online services, they seem to like them. Currently, my patients pay $30 upfront for virtual office visits with a credit card. The software on the Web site takes a systematic and thorough history for any of more than 3,000 different complaints. I review the information and decide who can be treated online and who needs a face-to-face visit. Patients who are referred for office care are only charged for the standard office visit.

The histories these patients generate via the Web site might sound like a waste of time, but they aren’t: They go right into their electronic medical records, so I have their information ready when they come to see me. Patients like not having to repeat the same story to the receptionist, the nurse and then the doctor. I like it because it saves me time and eliminates transcription costs related to summarizing and recording what the patient told me — instead, I can just add some nuances I picked up while talking to the patient, as well as a key note or two. Online patient registration and insurance updates are our most-popular Web-site features, followed by secure bill payment and prescription-refill requests. (We don’t charge for simple email questions or for processing refill requests.) Patients will soon be able to access their own lab results and review their records online.

And of course there is the minor issue of consumer convenience, and competition for it!

Meanwhile, retail health clinics are springing up in a lot of places. These clinics are dedicated to treating simple problems quickly, and they’re threatening to skim the easy patients and the easy money out of the office. For doctors, online visits are a way to keep this from happening. Two weeks ago I was in a CVS pharmacy in Seattle and noticed most Minute Clinic visits cost $59. My patients get online consultations for the same sort of problems for about half the price — and they get them from their own doctor.

Categories: Uncategorized

Tagged as:

5 replies »

  1. Matt-
    I think the problem is mostly with the writer of the WaPo piece and her focus on the information part of the healthcare equation. Yes, people are looking to mimic WebMD’s success, and with the ad rates they are now getting, who wouldn’t.
    But there is a trend here- Pat referenced what we are doing at PEERtrainer. We are impacting the health of many of our users in a profound way. Buried in the article is also a quote from Steve Case, who talks about putting clinics in Wal Mart and the like. That will help bring down costs. I’ll work more to develop my thesis, but I am convinced there are forces at work to be optimistic about.

  2. Peter,
    I agree that hospitals are where the big ticket costs are. However, over the last 25 years or so, the number of hospital beds nationwide declined about 30% while the population increased 20% or thereabouts. As technology and drugs made it possible to do many procedures on an outpatient basis and/or dramatically shorten hospital stays, the need for inpatient facilities declined. However, excess capacity persists in many markets. I think QALY metrics, more widespread use of living wills, or WHO’s present value of a life approach toward allocating scarce resources which Tom alluded to could further drive down the need for inpatient beds.
    With respect to the introduction of clinics in retail stores, whether staffed by a nurse practitioner or a doc, if these proliferate throughout the country, the potential to replace a $1,000-$1,500 ER visit with a $39-$59 doc in a box visit can save considerable money and take pressure off overcrowded and overstressed ER’s at the same time. HCA tells me that half of its inpatient admissions come through the ER, but only 20% of ER visits result in an admission. At the same time, 35% of its revenue comes from outpatient procedures and services. It is quite likely that a large percentage ER visits are for problems that could be handled in a much less expensive setting. The potential savings are probably impressive and nothing to sneeze at.

  3. The real cost burden of healthcare is not the day to day doc office visits. It’s the huge cost of hospital care. If the cost gains from these inovations are put into place very few would need insurance and lots more would gain access to docs, but where is the push and motivation from providers and insurers to reduce/prevent hospital care?

  4. Hey, Matt, don’t forget online systems of care that don’t involve doctor’s office visits (WorldDoc, PEERtrainer and others). These are, in fact, real consumer-directed health care.

  5. Right on, Matthew. No doubt RelayHealth has been slow to take off, but the idea and technology are fundamentally sound. In 10 years we’ll all be using it. Meanwhile Minute Clinics and the like will spur docs into improving service levels, demonstrating that fear can be a more powerful force than inertia.