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Starting small with e-visits

By Shannon Geis
October 1, 2016
Body of Knowledge Domain(s): Operations Management, Patient-Centered Care

Despite the popularity of telemedicine in healthcare in recent years, actually implementing a telemedicine program can be difficult. For Gundersen Health System, a physician-led nonprofit healthcare system headquartered in La Crosse, Wis., the key has been to start small. 

“We’d been talking about doing this about three or four years ago, but we finally started moving on it again [earlier this year],” says Chuck Johnson, regional business development director. 

Group members looked at what they could do to better fit the needs of their patients, who wanted more affordable, convenient care, and saw offering online medical evaluations as a way of doing that. “We only offer a limited scope of conditions,” Johnson says. For now, the program is only available to Gundersen employees on the system’s healthcare plan. 

The process

Patients who would like an online evaluation must log into the online patient portal, which is connected to Gundersen’s EHR. A patient must have a pre-existing care record and a portal account to participate. 

A questionnaire helps to determine the patient’s eligibility for an evaluation. Because Gundersen has clinics in multiple states, information from the questionnaire is used to place the patient with a doctor in the patient’s state. Information is also gathered about the patient’s current condition, known allergies, pre-existing conditions and current medications.

After the questionnaire is completed, nurses who monitor the queue forward the patient to a provider who makes a final call about whether to approve an online evaluation or set up an appointment with a local clinic. Patients directed to a clinic are not charged for the e-visit. 

Eligible patients are connected to the provider via the online portal’s text chat to discuss the patient’s condition. The provider is able to chart the e-visit electronically and send prescriptions if necessary. 

Benefits and drawbacks

The biggest benefits of the program so far are for the patients, who are provided with a more convenient way to access care for common conditions. The program also allows the Gundersen insurance plan to be competitive by offering a service that employees might not be able to access with another insurer. 

“Because we have a self-insured plan, we have influence over what is covered,” Johnson explains. “There is a lot of red tape with outside payers.”

Still Gundersen has some technical kinks to work out before it can expand the program. “We don’t have an audio or video component yet, but we hope to add them in the future,” Johnson says. 

For now, the hours the service is available are limited to Monday through Friday, 9 a.m. to 5 p.m. “Even as a larger system, it’s challenging to expand the service,” Johnson says. “It’s hard to add weekends or after-hours; we have to incentivize providers [to participate].” 

Expanding the program

If the program is successful, Gundersen executives hope to make it available to nonemployee plan holders. “Beyond that, there are a lot of rules with outside payers,” Johnson says. 

The fee for the visit is $45; it is a $10 copay with the Gundersen health plan. “We wanted to make sure that the price for the visit is still reasonable — even if it is not a covered benefit — so that if we decide to expand the program, it’s still something that people can afford,” he says.  

“We are certainly not the first to do this, but it’s more than just getting patients to buy in,” says Kelley Bahr, MD, chair, department of family medicine. “Providers need to buy in as well. It really is a paradigm shift. 

“If we keep patients at the center of focus, we need to cater to what patients are asking for,” she adds. And many are asking for more convenient ways to see their doctor.

Shannon Geis, Staff writer/editor, MGMA

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