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WellPoint expands telemedicine opportunities for doctors

WellPoint is offering some physicians the chance to be paid, without having to submit claims, for evaluations when on call. Software provided by the health plan would allow them to see patients on online video.

The program, made available through a website called LiveHealth Online, is an extension of a previously announced plan that would allow WellPoint members to have online video consultations with any physician in their state who is contracted by the health insurer. The company said the program would be launched in California and Ohio over the first half of 2013 and would be expanded to other states later.

Physicians would be hooked up to the system for free, and would be paid an unspecified fee for each visit. But they would be required to pay an undisclosed licensing fee to do online video consults with established patients.

WellPoint would pay doctors for each consult, with the claim automatically generated through LiveHealth Online. The patient fee would be based on an office visit. But since WellPoint assumes that physicians are accessing the system from home, fees would be discounted to reflect no office-related costs on the physician’s part. The health plan is talking to medical groups nationwide about signing up for the program.

Like other health insurers such as UnitedHealth Group and various individual BlueCross BlueShield-affiliated plans, WellPoint is turning toward greater use of tele-medicine because it believes offering what it sees as more timely care is likely to reduce health spending. One particular goal is to reduce spending in the emergency department, said John Jesser, WellPoint’s vice president of provider engagement strategy.

Roy Schoenberg, MD, MPH, is president and chief executive officer of American Well Systems, the Boston-based company providing the technology for WellPoint. He said doctors could benefit, because with more emphasis on paying based on quality, telehealth might give physicians a chance to interact more with chronic care patients, even during the regular workday, to help them stay on top of their care.

“If the patient does well, I win, and if not, things can go wrong financially for me, and I’ll become financially paralyzed,” Dr. Schoenberg said. “I need to find a better instrument [to keep tabs on patients], because it takes two to tango, and some patients are resistant to seeing doctors in person every week for updates.”

In the model where physicians would be on call for WellPoint to see any member in their state, the online program functions like a “web walk-in” where patients between the hours of 7 a.m. and 11 p.m., including holidays, contact doctors from the privacy of their own homes, Jesser said.

Patients navigate to the LiveHealth Online site, where they can view doctors’ biographies and credentials and pay fees and submit claims based on their plans.

If doctors accept patients, they have Skype-like chats about the patients’ symptoms, Jesser said. Doctors can prescribe medication, but not controlled substances, he said. Physicians can decline to see particular patients, messaging them that they should go to emergency departments if their symptoms suggest it.

WellPoint has not said how many physicians are signed on to LiveHealth Online, either to see their own patients or to see others. The program is currently accessible only through a computer or laptop, with no smartphone or mobile capability.

Telemedicine programs are expected to become more prevalent. A 2012 report from Massachusetts-based market research firm BCC Research said the global telehealth market is expected to grow from about $11.6 billion in 2011 to about $27.3 billion by 2016.

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