Doctors in Hawaii Now Make Web-Calls

The Hawaiian Medical Service Association, a state program partnered with Blue Cross-Blue Shield, is breaking new ground by making making house calls available to everyone in the Aloha state — via the internet. American Well, the company offering Web-Calls, will begin providing this service in Hawaii on January 15, 2009.

Those who want a faster, easier, less expensive way to visit with a physician will be the first to use the service. The uninsured and those living in more remote or rural areas within Hawaii are amongst the target markets, but others may find the Web-Call more convenient, especially for interactions which don’t really require the doctor to examine them closely.

Some examination is possible via the webcam, but a camera is not required for the visit. Text chatting with the doctor can also be used. While the program is generally well-received, some physicians have expressed concern that it can be difficult to determine the cause of a disease via webcam. Others point out that while it’s a good tool, it cannot replace a personal exam, because over the Internet the physician doesn’t have the opportunity to notice hints of disorders that patients aren’t specifically complaining about. Though it may not substitute for an in-person exam, it can allow doctors the opportunity to do triage, to recommend being seen in person at an E.R., if the concern is grave, or to schedule an appointment, if necessary.

American Well appears to have gained Washington’s attention. Legislators whowant to expand access to health care are giving American Well’s service due consideration. Other states are expected to be offering American Well’s Web-Call service soon.

Within Hawaii, the plan is that the 700,000 members of the Hawaiian healthcare system will pay $10 for their initial ten minute Web-Call with the doctor. (The visit can be extended for additional fees.) During the call the physician can file prescriptions and view patients’ medical histories. American Well is working with HealthVault, (Microsoft’s electronic medical records service,) and
Aetna’s ActiveHealth Management, which scans patients’ medical history for gaps in their previous care and alerts doctors to those gaps during their American Well appointment.

Uninsured Hawaiian patients will also have access to Web-Calls, but they will pay $45 instead of $10 per visit. American Well gets a fee per member and a transaction fee of about $2 for each Web-Call visit.

Concerns that the uninsured might not have internet access have been diminished since Forrester Consulting’s study was released in November, 2008, indicating that about two-thirds of California’s uninsured patients used broadband at home.

The most obvious uses of a Web-Call are for patients who need medication refills or follow-up consultations, and for the elderly and homebound. It is not expected that a Web-Call will ever replace office visits, but is seen as a welcome and useful tool, and an affordable option. Using Web-Call visits to resolve basic needs and concerns could go far towards reducing the cost of healthcare for both the insured and uninsured patients.

What affect this may have upon Professional Liability for those physicians remains to be seen. Neither the insurance industry nor the nation’s healthcare providers have checked in on this novel method, nor have patients fully expressed their views. it is expected that patients will welcome the convenient and affordable access to healthcare providers. Feel free to Comment your thoughts or opinions here!

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