Health 2.0

American Well world domination plan on course

They may have started with a Blues plan in a small state (Hawaii) and been moving deceptively slowly for a while, but having got Optum (part of United Healthgroup) on board last year, today American Well announced the landing of the other big Kahuna. Wellpoint will be rolling out American Well’s online care program in “certain markets” in Q4 this year.

If California isn’t one of those markets, expect some bitching and whining from at least one Wellpoint member in San Francisco! More seriously, as I’ve been saying for a while, Wellpoint’s online services for its members are a mess, and I’m looking forward to what the integration with online care looks like from the user end.

More from American Well to come, as I’ll be popping by their session at AHIP this morning (yes, it’s a slow recovery from last night in Vegas).

Full Disclosure: American Well is a corporate supporter of both THCB and Health 2.0.

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Categories: Health 2.0, Matthew Holt

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Health Insurance RatejdVikram CVikram CNate Recent comment authors
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Nate
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Nate

“The downside of using claims data is that to generate accurate estimates you need to look back quite a while” Exactly, lacking large enough data set is a huge problem and one reason we needed to partner with the PPOs, we have business in most states but not significant data in any one. If we only relied on our data it would be meaningless. The problem we are left with is not all PPOs support this concept, many are just shakedown partners for providers. If they won’t let us audit a certian hospital’s bills I am certain they aren’t going… Read more »

jd
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Looks like we’re basically going in the same direction. One reason to use historical claims over fee schedules is that you also collect data on practice patterns. A sophisticated algorithm will bundle claims usually seen together for treatment of a condition (actually seen together, not just hypothesized according to best practice theory). Likewise, if provider A tends to upcode while provider B does not, you could capture that in the algorithm to generate the cost estimate. I like this feature a lot. The downside of using claims data is that to generate accurate estimates you need to look back quite… Read more »

Nate
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Nate

“If a doc has unused capacity in Duluth that would go to waste, instead someone hours away in Grand Portage could go for a visit without leaving home.” This is a very interesting point and the effect it could have on rural healthcare. A doctor could set up shop in small town america, have affordable housing and excellant quality of life and still treat the patient base in the big dirty cities. Not all visits can be remote but a good number of doctors have a better life to look forward to. We use maybe 30 different PPOs so it… Read more »

Health Insurance Rate
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Thanks for the guide i found it really helpful.

jd
Guest

Nate, are you using individual provider fee schedules, or something else? Big article in the NY Times on Castlight Health and price transparency. They apparently are using EOBs (not sure how they collect them), though presumably you wouldn’t have to resort to that. We’re also going in this direction. My take based on early data: for now, people will use this than they do PHRs, but not by that much, and it depends on the amount of cost-sharing in the product. Also, in keeping with my previous post: if your website doesn’t have much of interest on it other than… Read more »

jd
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American Well is interesting. I met some of those folks at the World Healthcare Congress a couple months back, and they definitely have a slick and appealing presentation. The future will without any doubt involve a lot of tele-health, but we’re still very early on the adoption curve. I don’t think the pieces are in place for this to be a substantial chunk of the market for 5 years, and even then I think it will take a decade before this really settles in as normal and common. Video capability is the main barrier for potential users, aside from inertia.… Read more »

Nate
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Nate

I don’t see that as much of a threat. If Suburb hospital came to me and demanded the same reimbursement as cleveland clinic I would tell them to pound sand. In communities where you don’t have provider competition I could see that as a problem and there are other ways to deal with that. Providers compete for business, historically it was newess of facilities and latest technology, we need to make that competition on price

Vikram C
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Vikram C

By transparency issues I was referring to fact that provider with lower contracted fees will demand higher fees. That’s been the argument against displaying provider fees information publicly.

Nate
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Nate

great question, human nature, but what part I have no idea. Its the same part that leads people to over pay for Rx when the pharmacy down the street gives it away for free or take brand when generic is available. I think it all comes back to not being their money, so far I haven’t seen any transparency where the patient really suffers for their decision.

Vikram C
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Vikram C

Nate- I believe you are showing prices for the benefit of your HDHP members. It’s interesting as we had heard about price transparency causing problems. Wonder why wouldn’t your subscribers use it.

Nate
Guest
Nate

the website shows PPO doctors/Hospitals within a set number of miles who perform a service. It shows the range of PPO reimbursement then links to outside quality measures and also has feedback from other members.
It targets provider of rqual quality with price difference, if the hospital across town does the same thing just as well 30% less why not go there?

Vikram C
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Vikram C

It’s distracting from this topic but I couldn’t exactly figure out Nate’s methodology of finding most efficient provider. Are folks looking for most efficient or best provider? It’s interesting because I had a colleague walk up to me and asked help to find him best doctor since I keep ranting about this topic. So we went through few steps but it was tedious and I wonder how many actually look out for best doctors.

Nate
Guest
Nate

it would be interesting to get Matt’s dream list, offer it to him then see if he would even sign up….

Nate
Guest
Nate

we are rolling out a new tool that allows members to see the PPO discounted range of proces for services to hopefully pick the most efficient provider. In discussing it the major carriers have considered it a failure becuase members aren’t using it. While they get bashed for not doing more what they have done has next to zero ROI. I’m hoping ours performs much better and we can get some adaption, only way to find out is to try it. If it doesn’t work I should send the bill to Matt and all the other 2.0 fanatics and bashers… Read more »

Vikram C
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Vikram C

That’s nice but will they come to Wellpoint’s website? It’s a vicious circle. They don’t place great deal of information because no one comes except to check for unpaid claim. Clients don’t come because claims mostly get paid out. Then Matt says they are claims processors, nothing more. Maybe, it will be nice if Matt could lay out his wishlist in entirety.