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Original Publish Date: April 3, 2015
In generations past, medical care was commonly delivered in the home. The house call was personal, convenient and dependable. Fast forward now to a time when greater access to coverage does not necessarily mean greater access to care.
The national shortage of primary care providers limits access and results in overcrowded ERs and long waiting times, which in-turn, results in patients receiving care for simple, non-emergent conditions in overly expensive ERs, which unnecessarily drives up the cost of health care.
Deja vu? 35 years ago, Dr. C. David Molina, an emergency medicine physician in California was faced with the same challenges. The inappropriate use of the ER for non-emergent conditions was driven by the basic lack of access to primary care doctors. He opened the first Molina primary care clinic in the Los Angeles area to expand access, improve the quality of care – and lower the cost for all of his patients and the community. Today, Molina is again changing the model of care, adapting it to the challenges and opportunities of a new generation. Enabled by technology, many of the barriers our members face - lack of transportation, affordable childcare, challenging job schedules - can be easily overcome with telemedicine. Health care can now be delivered on our members’ terms, when they need it, not when there’s an opening in a doctor’s schedule. What’s old is new again; virtual care is bringing house calls back in a big way. The virtual house call is the new personal, convenient, and dependable way to access quality health care.
Molina Healthcare and the CHI Franciscan Health System have recently launched a pilot program to offer virtual urgent care services free of charge to Molina’s Medicaid members who are patients of Franciscan primary care physicians. First introduced in September 2013 Franciscan Virtual Urgent Care began treating private-pay patients via webcam, landline phone, smartphone, tablet or PC for $35 per virtual visit. Since its launch, the program is estimated to have saved patients an estimated $600,000 compared to the cost of seeking care at an emergency department, urgent care center or clinic.
Molina is proud to be the first Washington Managed Care Organization to cover the cost of virtual urgent care visits for its members who are CHI Franciscan patients. This service is now available to over 16,000 Molina members at no charge. Now, the right care, in the right setting, is available 24/7/365 at no charge to Molina members.
Good Medicine; Good Stewardship of Your Tax Dollars
We’re excited about this innovative new way of fulfilling our mission to provide low income individuals and families with affordable, accessible, high quality health care. We believe telemedicine’s time has come and it should be an integral component of the services and benefits offered by every managed care organization and insurance company in the state. It’s good medicine...and good stewardship of the taxpayer’s dollar since it helps avoid unnecessary and costly ER visits. We encourage others to join us.
How Does Virtual Care Work? It’s Easy.
When members connect to Virtual Urgent Care, they can do so via multiple access pathways – smartphone, computer, landline – with or without video. They begin by completing a brief survey that includes their symptoms. Not all medical problems are appropriate for virtual medicine, but many common conditions can be completely addressed and resolved with only one telemedicine encounter. No ER, no Urgent Care. A visit from the comfort of home (or any location) provides high quality, high touch medical attention without the wait. Request-to-service is on-demand, and usually under 15 minutes. Washington-based board-certified and licensed physicians and nurse practitioners (ARNPs) review the member’s medical concerns, and if appropriate for a virtual visit, will establish a diagnosis and recommend treatment, which may include a prescription. After the virtual visit, a digital copy of the medical record is shared with the member’s primary care provider and incorporated into the member’s permanent medical record to ensure seamless communication and follow-up related to the episode of care. In addition, an electronic summary of the encounter is shared with the patient, on-line, in a HIPAA secure environment, including the diagnosis, treatment plan, follow-up and how to escalate care if symptoms change – all in easy-to-understand language. Finally, a digital copy of the encounter is shared with Molina’s case management nursing team to enable coordination of follow-up medical appointments (if recommended). Molina also helps the member with any follow-up medication, transportation, or education relating to better condition management.
What are Molina Members Saying About Their Virtual Urgent Care Service Experience?
Thus far, after only three weeks since the launch of the pilot, every member has rated the experience excellent – giving it the top rating of five out of five stars.
What is Virtual Urgent Care Not About?
The virtual urgent care encounter promotes continuity of care and supports the primary care relationship where it belongs--between the patient and his/her primary care provider. It is not a replacement for primary care or an alternative to establishing a highly engaged, long-term relationship with one’s primary care physician. Likewise, it is not a replacement for appropriate ER use for truly emergent conditions. It IS an alternative to inappropriate ER use for low acuity care, and it is an extender of primary care when a member’s primary care provider is unavailable.
Convenience Can Enhance Healing
Though virtual treatment is not a replacement for face-to-face care, research suggests many instances where it can be just as effective, if not more so. After all, it’s hard to beat the convenience of care you can access 24/7/365.
In a review of 40,000 online cases, 98% of patients said they “would recommend” virtual visits.1 These were simple cases like flu and sinusitis. These results beg the question: Does virtual medicine make sense for other applications?
The answer is YES! Urgent care is just the beginning for Molina. Telemedicine offers countless opportunities for improved access to care in many other areas such as specialty care, behavioral health, care in skilled nursing facilities, and the home-based management of chronic conditions, just to name a few.
In the case of complex chronic care, research is beginning to indicate that telemedicine may actually result in healthier outcomes. For example, a recent study of patients with Parkinson’s Disease found that web-based videoconferencing provides benefits similar to in-person care.2 And online treatment offers the additional advantage of allowing those who are easily disoriented or fatigued to avoid stressors like crowds, unfamiliar surroundings and prolonged travel. Additionally, when people are treated in the comfort and safety of their home or other setting of their choosing, the potential barriers of travel and transportation to appointments become non-issues.
What’s more, virtual medicine may reduce the spread of contagious illness. Instead of bringing germs into an emergency room, waiting area or doctor’s office – or getting exposed to them –online treatment keeps bugs and viruses contained, and others healthier.
Virtual urgent care is not a solution for all conditions or all people at all times, but it is part of an emerging facet of healthcare that offers real solutions, in real time. For Molina and our members, we believe it’s a step in the right direction.
1 Expanding Primary Care Capacity By Reducing Waste And Improving The Efficiency Of Care, Health Aff (Millwood) November 2013 32:111990-1997
2 JAMA Neurol. 2013;70(5):565-570. doi:10.1001/jamaneurol.2013.123.