Minnesota Blues Launch Online Physician Consults

Minnesota physicians are about to find out that those who fail to use new technology may become its victims.

Blue Cross and Blue Shield of Minnesota has launched a pilot program that allows patients to consult online with physicians, using instant messaging and webcams. Initially, the service is being made available only to BCBSMN’s 10,000 employees. But if the health plan likes the results, it will offer the service to the public, including non-Blues members. The plan hopes that it will save money and make it more convenient for patients to obtain care for minor problems.
Physicians who treat patients online for the Blues will have access to patient “histories” based partly on claims data. In some Blues offices, employees will be able to use special kiosks that may be equipped with blood pressure cuffs and other devices that can transmit data to physicians.

A similar “virtual clinic” is being provided by the Hawaii Medical Service Association, another Blues plan. Physicians who participate in it can earn $25 for a 10-minute session. The patients who are plan members have a $10 copay; non-members pay $45. So far, 140 doctors and about 1,000 patients have signed up.

Some Minnesota physicians, as well, can be expected to participate for the additional income. But there is likely to be some backlash. George Schoephoerster, a family physician and geriatrician in Robbinsdale, MN, speaks for many doctors when he says that he’s concerned about patients asking for advice from physicians who don’t know them. While he’s not opposed to nonvisit care, he tells BNET that it “ought to be in the context of an established relationship” with a physician.

Schoephoerster, who has worked on state legislation promoting the patient-centered medical home, says that the Blues’ approach is moving away from the medical home and will fragment the care delivery system even further. He views the retail clinics that are common in Minnesota in the same light. “Instead of staying involved with a practice or a physician who knows them, patients are encouraged to go someplace else.”

A few years ago, when retail clinics first came to the state, the Minnesota Blues not only covered visits to them, but also set lower copayments in those sites than in physician offices. That really upset physicians, and Schoephoerster believes that they will have “a huge conflict” when they find out that the Minnesota Blues, one of their major payers, is competing with them for patients.

On the other hand, physicians in Minnesota and elsewhere have been very slow to go online with their own patients. In part, this is because of a reimbursement system that pays them only for face-to-face office visits in most areas. But some plans do cover online consultations, and physicians have always been able to charge patients directly for these virtual visits. While they also fear being inundated by e-mails, it hasn’t been a problem for most physicians who do online consults.

Perhaps what the Minnesota and Hawaii Blues are doing should be a wakeup call for doctors to serve their own patients better before they go elsewhere.