Innovation profile: HealthPartners' online clinic for simple conditions delivers savings of $88 per episode and high patient approval

Health Affairs

Volumn 32, Issue 2, 2013, Pages 385-392

  Courneya, Patrick T ^a   Palattao, Kevin J ^a   Gallagher, Jason M ^a  

^a HEALTHPARTNERS INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIBIOTIC AGENT;

ARTICLE; BILLING AND CLAIMS; BRONCHITIS; CONJUNCTIVITIS; DENTAL CLINIC; DIAGNOSTIC ACCURACY; DRUG MISUSE; EMERGENCY WARD; HEALTH CARE; HEALTH CARE DELIVERY; HOSPITAL; HUMAN; NURSE PRACTITIONER; ONLINE SYSTEM; PATIENT CARE; PRESCRIPTION; PRIMARY MEDICAL CARE; SINUSITIS; TREATMENT PLANNING; URINARY TRACT INFECTION;

EID: 84874780808     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: None     Document Type: Article

References (18)

1. Mehrotra A, Paone S, Martich GD, Albert SM, Shevchik GJ. A comparison of care at e-visits and physician office visits for sinusitis and urinary tract infection. Arch Intern Med. 2012:1-2. [Epub 2012 Nov 19.] This study reported online clinical care quality as consistent with face-toface clinical care for sinusitis and urinary tract infections as measured by frequency of follow-up. However, there was a higher use of antibiotics. The study hinted at a cost savings opportunity but did not include a rigorous cost-savings analysis.
2. Adamson SC, Bachman JW. Pilot study of providing online care in a primary care setting. Mayo Clin Proc. 2010;85(8):704-10.
3. Rohrer JE, Angstman KB, Adamson SC, Bernard ME, Bachman JW, Morgan ME. Impact of online primary care visits on standard costs: a pilot study. Popul Health Manag. 2010;13(2):59-63. This study showed that e-visit patients tended to be less costly ($161 for online versus $219 for same-day acute visits) as measured by costs in the six months following the indexed visits.
4. Berwick DM, Nolan TW, Whittington J. The Triple Aim: care, health, and cost. Health Aff (Millwood). 2008; 27(3):759-69.
5. A complete listing of conditions is available at virtuwell. Conditions we treat [Internet]. Bloomington (MN): HealthPartners; [cited 2013 Jan 11]. Available from: https://www .virtuwell.com/conditions
6. More information is available at Institute for Clinical Systems Improvement [home page on the Internet]. Bloomington (MN): ICSI; 2013 [cited 2013 Jan 11]. Available from: http://www.icsi.org/
7. In referred cases, the customer is asked for his or her ZIP code and presented with a list of convenient primary care providers. The service does not ask for registration, payment, or insurance information until the customer's answers suggest that his or her condition is within the scope of the service, our intention being to allow any user to test the service before committing to payment. Today we see a much lower proportion of triaged cases to paid cases than we did in virtuwell's early months (approximately 1.4:1 versus 3:1), which we attribute to customers' learning more about virtuwell over time.
8. Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000;49(2):147-52.
9. Vijayaraghavan V, Christensen CM. Health-care changes signal muchneeded shift. Washington Post Innovations [blog on the Internet]. 30 Nov 2011 [cited 2012 Oct 12]. Available from: http://www .washingtonpost.com/national/oninnovations/ health-care-changessignal- much-needed-paradigmshift/ 2011/11/30/gIQAZLUNDO_ story.html
10. As have others in consumer sectors that have migrated a portion of their consumer transactions online, we have incorporated hundreds of ecommerce security protocols into the system design. We chose to construct the entire system in-house, in partnership with experienced interactivity developers, instead of selecting an off-the-shelf system upon which to base the service.
11. Hussey PS, Sorbero ME, Mehrotra A, Liu H, Damberg CL. Episode-based performance measurement and payment: making it a reality. Health Aff (Millwood). 2009;28(5):1406-17.
12. Interestingly, chronic sinusitis with comorbidity was the only condition where the difference is not statistically significant. We believe that this is a function of two things: (1) the ETG software and how an acute sinusitis visit is longitudinally linked with subsequent care, which could convert the virtuwell visit to chronic sinusitis; and (2) the higher degree of variability in treatment and costs associated with chronic sinusitis. Despite the nonsignificant result, the direction of the cost differential is consistent.
13. After we confirmed that the average episodic costs per setting were not equal using the Kruskal-Wallis test (p < 0:0001), the Wilcoxon-Mann- Whitney non-parametric test was applied with the Bonferroni adjustment for the number of comparisons.
14. The resolution rate represents episodes that have no additional face-toface visits associated with them after the initial encounter. If a virtuwell visit or other visit requires additional care beyond the first visit, the episode is classified as "not resolved." In this way, the inverse of the "resolved" rate is not a measure of adverse events, rather simply that more care was sought to resolve the issue.
15. National Quality Measures Clearinghouse. Avoidance of antibiotic treatment in adults with acute bronchitis: percentage of adults 18 to 64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; [cited 2012 Oct 12]. Available from: http://www.qualitymeasures.ahrq .gov/content.aspx?id=34647
16. National Committee for Quality Assurance. Quality Compass. Washington (DC): NCQA; 2011.
17. Although we recognize that this is a relatively low response rate and susceptible to selection bias, we believe that the strength of the results is noteworthy and suggestive, at a minimum, as an indicator of highly favorable customer response. We are moving to make changes to our methodology to increase response rates (by implementing multiple requests to answer our survey) and to link responses back to individual demographics.
18. National Council of State Boards of Nursing. Nurse Licensure Compact [Internet]. Chicago (IL): NCSBN; 2013 [cited 2013 Jan 11]. Available from: https://www.ncsbn.org/ nlc.htm