Costs While Maintaining Quality
Some Physicians to Be Paid for Online Consults
Blue Shield of California plans to begin paying HMO-
and PPO-contracted physicians for providing online
consultations beginning in the first quarter of 2003. At
press time, the plan had not decided how much physicians
would be paid.
The decision follows release of a study conducted by
a Stanford University researcher and funded by Blue
Shield of California, San Francisco, and ConnectiCare
Inc, an HMO based in Farmington, Conn. ConnectiCare is
not paying physicians for online consultations at this
In the study, physicians were paid $20 per online
consultation involving minor, nonurgent matters. Using a
secure messaging system developed by RelayHealth Corp,
Emeryville, Calif, physicians and patients were able to
communicate about refills, laboratory results,
appointments, and referrals.
Health care spending for office visits by the
treatment group averaged $1.87 less per member per month
(PMPM) compared with spending for office visits by the
control group. Study results indicated that Web visits
cost insurers $0.33 PMPM, a net savings of $1.54 PMPM.
If savings are extrapolated for the 2 million members of
Blue Shield of California, the insurer could potentially
save more than $3 million a month.
Of the physicians who participated in the project,
63% said they were likely to continue using the
RelayHealth service and 56% said they preferred to
handle patients' nonurgent health care needs via the
Internet versus at the office.
The study involving members of Blue Shield of
California and ConnectiCare was conducted by Laurence
Baker, PhD, assistant professor, department of health
research and policy, at Stanford University. Baker
analyzed and compared the health care spending patterns
of 2274 patients in the treatment group who had access
to the RelayHealth Service with those of 3390 patients
in a control group. Claims for the 2 groups were
reviewed for the 12-month period before the RelayHealth
service became available and for an 11-month period
ending February 28, 2002, during which the service was
Participating physicians interviewed in the November
25 issue of AMNews reported a high degree of
satisfaction in being able to offer online consults,
saying that the online system allows them to be paid for
advice previously dispensed over the phone at no charge.
It also saves time for physicians and their staffs by
shifting requests for referrals, refills, laboratory
results, and appointments from the phone to the Web. An
online system provides better documentation of what was
said and when as well.
Ninety percent of adults who use e-mail would like to
be able to communicate with their physicians online in
order to ask questions when no visit is necessary (77%),
make appointments (71%), refill prescriptions (71%), and
receive results of medical tests (70%). The more
affluent persons are, the more likely they would be
willing to pay for this service. As for how much
patients would be willing to pay, the average response
was just over $10 a month as a fixed amount, or nearly
$7 each time they sent an e-mail.
Containing Costs While Maintaining Quality
Mailed Promotions Cut Physician Visits for Arthritis
Patients but Not Others
use of mailed health promotion materials, such as handbooks
and personalized questionnaires, improved the overall health
of patients with arthritis and resulted in fewer visits to
physicians' offices. However, use of health promotion
materials did not benefit patients who have diabetes or
findings are from a study led by Diana L. Dally, PhD, of the
Kaiser Foundation Health Plan of Ohio and published in the
November-December issue of the American Journal of Health
visits for persons with arthritis who received the health
promotion materials decreased an average of 4.4 visits over a
30-month period compared with a control group of patients with
arthritis who did not receive the same materials. The 4.4
fewer visits translated into a net savings of more than
number of outpatient visits by diabetic patients who received
similar mailings did not differ significantly from the number
of visits by diabetic patients in the control group. The
number of visits by patients with hypertension who received
health promotion mailings actually increased an average of
2.89 visits over the 30-month study period compared with a
overall health status of the arthritis group who received the
mailings also improved significantly, while the overall health
of patients in the diabetes and hypertension groups did not
change, according to the study authors.
and colleagues suggest that mailings and other similar
interventions may have a greater impact on conditions that
greatly impair function, such as arthritis, than on conditions
associated with less severe functional impairment, such as
researchers tested the effectiveness of home mailings with 593
members of the Kaiser Permanente of Ohio managed care plan.
Half of the members in the study received regular mailings of
personalized questionnaires, individual feedback on their
returned questionnaires, health education materials specific
to their medical condition, and a health information handbook
at regular intervals throughout the study. Members in the
control group received only condition-specific health
education materials at the end of the first year of the study.
Study participants were aged between 18 and 64 years and had
chronic arthritis, diabetes, hypertension, or some combination
of these conditions that caused them to seek outpatient care
at least 11 times each year over a 2-year period.
Containing Costs While Maintaining Quality
Physicians Say Medicaid Prior Drug Approval Is Seriously
vast majority of physicians responding to a poll say that
prior drug authorization required by Medicaid programs may
potentially lead to less than optimal treatment, more
emergency department visits, and may even place patients'
lives at risk. Physicians also received a vote of confidence
from the general public.
survey of 315 primary care physicians and 2464 adults was
conducted online by Harris Interactive. Results were released
November 15 at the American College of Allergy, Asthma and
Immunology (ACAAI) annual meeting.
than 9 (92%) of 10 physicians agree that "requiring prior
authorization is bad policy for the simple reason that it
takes the decision of what is the most appropriate medication
for a patient in an emergency situation out of the hands of
their physician -- the individual in the best possible
position to determine what is best for a given patient in a
all primary care physicians feel that prior authorization has
a substantial impact on the overall health of patients who
need acute care or rescue medications (92%) and that patients
won't have access to the best available treatment (95%).
addition, more than 9 out of 10 primary care physicians agree
that "even if prior authorization might make sense for
medications to treat chronic conditions, it doesn't make sense
for acute care or rescue medications where many patients will
not have such medication on hand when an emergency arises and
will therefore have no time to seek prior authorization."
adults surveyed, 90% of respondents say they prefer that
treatment decisions stay with their physicians.
people with life-threatening diseases, such as asthma,
delaying prescribed treatment can have devastating
consequences," says Bob Lanier, MD, president of ACAAI.
"This is very clear to the medical community and
population at large, as reported in this survey. This ought to
be clear to the government, insurance companies, and MCOs as
Containing Costs While Maintaining Quality
Medicare Targets Smoking in 7-State Pilot Program
Centers for Medicare and Medicaid Services has launched a
pilot program in 7 states to help determine the best ways to
get seniors to quit smoking. The states are Alabama, Florida,
Missouri, Nebraska, Ohio, Oklahoma, and Wyoming. The
announcement was made November 21 to coincide with this year's
Great American Smokeout Day. Results of the study will be
available in 2005.
program will test the effectiveness of various combinations of
smoking cessation strategies with seniors, including
counseling in person or over the phone, and the use of
nicotine patches, a prescription smoking cessation drug, and
beneficiaries who enroll in the study will receive free
smoking cessation therapy, which may range from physician
counseling to use of medications. Smoking cessation therapy is
normally not covered under Medicare.
beneficiaries in the 7 named states who smoke and want to quit
can call a toll-free number (866-652-3446) to find out if they
are eligible to participate in the study. Once enrolled,
beneficiaries will be assigned to one of the study options
being offered and will have access to these services for 1
year from the time they enroll.