A telemedicine service priced at only $35 a visit creates a new access point for patients and averts ED visits.
Can healthcare be made faster, better, and cheaper all at the same time? Franciscan Health System, a six-hospital network based in Tacoma, WA, last week launched a mobile health service that offers around-the-clock care for only $35 a pop. Patients and provider alike may save money; a pilot version of the initiative, called Virtual Urgent Care, avoided about 300 ED visits. The new program could be particularly attractive for patient newly insured by health insurance exchanges.
Virtual Urgent Care is aimed at care for acute symptoms via phone or video chat on a smartphone, tablet, or PC. This service was originally offered in 2010 as an employee program called Franciscan Anytime to Franciscan's employees and their dependents through its employer-sponsored health plan, which covered about 10,000 lives at that time.
The program was a success from the start, says Cliff Robertson, MD, Franciscan's COO. "Because of the time of day or because it was a weekend, those employees would have gone to the ER if they didn't have the ability to have real-time access to a physician or nurse practitioner," he says.
Leaders at Franciscan, which is part of the Catholic Health Initiatives mega-system, decided to offer the service to patients. About seven months ago, the health system quietly rolled it out under its new name to its primary care physicians' existing patients, then recently to the wider community.
"We had to figure out how to deploy this to our patients for complaints that were consistent with what could be handled comfortably over the phone or computer," Robertson says. "It allows us to take a very expensive resource—physicians and nurse practitioners—and scale them."
Robertson, a family physician by training, sees the service as an extension of primary care. "Generally what we handle through this approach is the acute symptoms or complaints from people who don't know if what they have is serious enough to need to see a doctor. We are not doing chronic disease management."
Robertson says there are several long-term business strategy arguments to be made for Virtual Urgent Care. For one, it allows Franciscan to have a greater presence in the urgent care market than might be feasible otherwise.
"What would it cost to build an urgent care center, to hire all the staff it would require? To stand up that building and hope someone shows up is an incredibly expensive proposition. When you take the approach of using virtual technology to deliver care, it is a much different cost structure," he says.
Robertson acknowledges the loss of immediate income from ED visits that are averted, but he says one of the biggest downstream benefits of Virtual Urgent Care is that it is a good population health management strategy.
"We now know we can eliminate ER and urgent care visits that can be handled in a different setting," he says. "This is revenue we now won't capture through an ED visit, but we, as an organization, have made the strategic decision that we have to be a leader in reforming the cost of care and providing lower cost alternatives to our patient. This is about as patient-centered as you can get."
Although Franciscan does not currently have any capitated reimbursement contracts, Virtual Urgent Care is helping it prepare for an eventual move in that direction, Robertson says. "This has significant ROI in a fee-for-service world and has as big or bigger ROI in a capitated world, a population health management world."
It's also a strategy to pick up market share when newly insured consumers enter the healthcare arena, thanks to policies they will soon buy on the health insurance exchanges.
"We know there are a significant number of people who do not have a primary care physician, and we believe there will be even more with healthcare reform. We see this as an opportunity to put Franciscan in the front of their minds for ongoing care," Robertson says.
"It's a fourth access point for patients seeking care," in addition to primary care, urgent care, and the ED, he adds.
Virtual Urgent Care is also a potential referral source to Franciscan's ED and primary care network, as well as a way to capture some business from consumers who do not seek regular care, Robertson says.
"We have metrics around the number of patients in our service area without established primary care relationships. Those patients would be referred in our system as appropriate," he says. "We also realize there is a subset of the population—the 'young indestructibles'—for whom their only encounter with the healthcare system is urgent care."
Additionally, Robertson notes that because patients pay the flat $35 charge with a credit card up front, much of the revenue cycle work that is usually required to collect payment is eliminated. "We are not chasing after the insurance," he says, noting that if a patient is referred to an ED or brick-and-mortar urgent care center for treatment, the fee is waived.
So far, patients appear to like the service. Of Franciscan's employees who have used the service, 92% report being satisfied with their experience.
"Patient satisfaction is off the charts," Robertson says. "It's amazing, but it's also a no-brainer. We are actually doing something that makes sense from a patient perspective, and it's truly adding value. This is so old, it's new, if you think about how primary care was delivered 40 years ago."