A provider of urgent and primary care is shining a spotlight on telemedicine's reach. This is more than just a way to reach patients in rural areas and cut healthcare costs. Early data shows that patients and physicians are finding other reasons to like virtual provider visits.
As a young medical student, Ben Green, MD, was a family physician in training at a typical primary care office. Rushing around to fit in as many as 20-30 patients per day, he realized quickly that this wasn't what he envisioned medicine to be, and became disillusioned.
"Ten minutes was the average face-to-face time with a patient," says Lee who is now one of the medical directors at Carena, a Seattle-based virtual telemedicine provider of urgent and primary care. "I don't feel like that's the right thing for patients in a primary care setting. I have a lot of respect for providers who do that, but for me, it didn't fit with my comfort level."
Green found the kind of care he wanted to provide patients at Carena, which in 2007 was providing traditional house calls 24/7 as a way to reduce emergency department visits for patients covered by Microsoft, Boeing, and other self-insured employers.
"They provided us as a service for employees, as a benefit to save on cost," says Green. Back then, visits at home were lasting an hour, but were up to 20% less expensive than an ED visit.
Not only was there was an immediate reduction in emergency department visits, but the company built on its success and started offering virtual visits via Skype in 2011. Green says virtual visits are 20 minutes, still longer than the traditional primary care or urgent care visit, and he likes it because he understands a patient's needs better.
"Intellectually, it's interesting," says Green. "We rely a lot on history and exploring a condition. In a clinic, I felt hurried and rushed."
Take Two Aspirin and Skype Me in the Morning
Green helps lead a team of 15 providers, each of whom works from home. As long as a contracted patient has a computer, a webcam, and an internet connection, they can visit with someone at Carena 24/7.
Green says the "always open" philosophy is easier to staff than some might think, and he's quick t clarify that 24/7 does not mean on-call.
"It's not that hard to schedule," he says. "You would think, 'How do you schedule that overnight shift?' But we have providers who prefer [it]. They're shifts, they're not on call."
Carena's model of telemedicine is slightly different because health systems, seeing the success Carena had with large employers, came calling. First came Franciscan Health System, an eight-hospital system headquartered in Tacoma, WA. It contracted with Carena in 2011 to provide its virtual visit service to its employees. Last year, the health system expanded its contract to include anyone in its service area for just $35.
"We tested the Franciscan Virtual Urgent Care with our own employees before expanding it to the public, so we know this model of care delivery works," says Cliff Robertson, MD, Franciscan Health System COO.
Green says the price point is close to the average amount of a co-pay and provides access for patients who would otherwise seek care in a more expensive setting.
Franciscan Health is affiliated with Catholic Health Initiatives, which led a $14 million round of investing about a year after Franciscan Health and Carena first began working together. The investment was used to expand to other states, and to date, Carena's virtual visits can be done in five states: Washington, California, Illinois, Missouri, and most recently Kentucky. In that state, another CHI-affiliated system, KentuckyOne Health, has launched the same virtual service that Franciscan Health offers.
With the weight of CHI and major employers behind it, Carena is shining a spotlight on telemedicine's reach. And the model is not just a way to reach patients in rural areas. Green says most of Carena's patients are near major metropolitan areas.
Initial Data Encouraging
"Telemedicine is giving patients care at the right time. It's [for] people who are looking for convenience," says Green. "A lot of patients could be treated over the phone or with a webcam. About 75% of the time when a patient calls us, they will not need to be seen in person. We can escalate patients to an ER, urgent care, or PCP office, but that happens only about 25% of the time."
Green also says that it follows up with patients five days after each virtual visit to find out if they sought care at another setting. He also wants to know if patients have gotten better or worse and whether or not they'd use Carena again. Those metrics have been measured monthly since 2013 – not long, but long enough for Green to see two leading indicators that show Carena is on the right track.
Patient satisfaction, measured after every visit via an automated survey developed by Carena, is high. Green says 98% of patients report they would use Carena again and recommend it to a friend. He also says that based on follow-up calls, patients seek care at a second site less than 5% of the time.
"We're proud of that, but we're waiting to gather more data with a larger sample size so that it is statistically significant."
Work/ Life Balance Opportunities
Telemedicine work is particularly attractive to a younger generation of providers, says Green. "The virtual visit provider could help recruit more young physicians to be primary care," he says. "Nowadays you can do anything online. Now medicine is caught up to that and we're enabling that. Doing something new in medicine attracts me and some of the other providers."
Green measures provider satisfaction and says the nurses and physicians are happy. Carena physician Bob Bernstein, MD, says telemedicine offers work/ life balance opportunities.
"For me personally, I'm part of a two-career household with children, and the flexibility and scheduling shifts has been a great boon for my lifestyle" says Bernstein.
Telemedicine has significant reimbursement challenges as well as licensing and credential hurdles that are likely to complicate its universal acceptance for payment. But as health systems like Franciscan Health and KentuckyOne open up access to telemedicine, patients may drive the demand for it. That always tends to speed things up.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.