eVisit Online eVisit Online Consultations:Consultations:

Ready for Prime Time?Ready for Prime Time?

Marc-François Bradley President, Sophrona Solutions

Minnesota MGMA ConferenceeVisit Breakout August 2, 2007

Paul C. Seel MD Medical Director, Sophrona Solutions

What is an eVisit?What is an eVisit?

• Gives patients 24/7/365 Convenience• Reduces practice phone calls• Compensates physicians for non-office patient communication

Two-way physician-patient communication of clinical information conducted over a patient portal

Structured vs. Unstructured Structured vs. Unstructured CommunicationCommunication

VS

Structured eVisit

Elements of a Structured eVisitElements of a Structured eVisit

► Chief complaintChief complaint► History of the present illnessHistory of the present illness► Past medical historyPast medical history► Surgical historySurgical history► Social historySocial history► Family historyFamily history► AllergiesAllergies► Alcohol, tobacco and caffeineAlcohol, tobacco and caffeine► Pharmacy informationPharmacy information

Why Do eVisits?Why Do eVisits?

► QualityQuality Improved documentation of phone callsImproved documentation of phone calls Increased touch points for chronic disease patientsIncreased touch points for chronic disease patients Improved access to careImproved access to care

► CostCost A low cost way to provide low intensity, non-urgent serviceA low cost way to provide low intensity, non-urgent service Reduced costs for data entry—the patients do itReduced costs for data entry—the patients do it Level staff work loadLevel staff work load Reduced phone trafficReduced phone traffic

► Revenue OpportunitiesRevenue Opportunities Provides reimbursement for phone callsProvides reimbursement for phone calls Allows a shift to higher intensity servicesAllows a shift to higher intensity services

Ingredients for InnovationIngredients for Innovation

► MarketMarket Patients want itPatients want it Payers have begun to embrace itPayers have begun to embrace it Physicians will adopt if it benefits some combination of Physicians will adopt if it benefits some combination of

efficiency, quality and reimbursementefficiency, quality and reimbursement► ProductProduct

Internet based platforms for asynchronous communicationInternet based platforms for asynchronous communication Logic driven interviews to generate structured historiesLogic driven interviews to generate structured histories

► Salience Salience Is there sufficient clinical application?Is there sufficient clinical application? Can it create efficiencies?Can it create efficiencies? Does it make business sense?Does it make business sense?

Patients Want the Convenience of This Patients Want the Convenience of This Type of Access to Their PhysiciansType of Access to Their Physicians

In a HarrisInteractive survey, 74% of In a HarrisInteractive survey, 74% of patients desire the ability to patients desire the ability to communicate with their physicians via communicate with their physicians via some sort of e-mail; only 8% of patients some sort of e-mail; only 8% of patients report such access.report such access. 11

University of Minnesota MHA students University of Minnesota MHA students found similar desires (77.9%) in the found similar desires (77.9%) in the Twin Cities patients along with evidence Twin Cities patients along with evidence of the patients being web savvy (74% of the patients being web savvy (74% on-line banking)on-line banking). . 22

13.5% said they had no interest in any 13.5% said they had no interest in any on-line communication. on-line communication. 221http://www.harrisinteractive.com/news/newsletters/wsjhealthnews/WSJOnline_HI_Health-

CarePoll2006vol5_iss16.pdf2 U of MN MHA students; 104 randomly selected Strategic Positioning Analysis 2007

The Retail Clinics…..The Retail Clinics…..patients are patients are seeking convenient access for simple health seeking convenient access for simple health

carecare problemsproblems

80% of retail clinic users judged the clinics satisfactory on quality, cost and convenience criterion.

64% of the general population was concerned a serious condition might be missed, down from 71% in 2005.

Other concerns such as staff training were also decreasing.

HarrisInteractive Health Care Survey March 2007

By The NCHS’s Numbers By The NCHS’s Numbers 11

►Office VisitsOffice Visits 910 million total outpatient physician 910 million total outpatient physician

visits/yrvisits/yr 92.4 visits/primary care MD/week92.4 visits/primary care MD/week 48.3% of all visits were in follow-up for a 48.3% of all visits were in follow-up for a

condition previously seen by the physiciancondition previously seen by the physician

►Phone CallsPhone Calls 26 phone calls/primary care MD/week26 phone calls/primary care MD/week1 National Center for Healthcare Statistics

http://www.cdc.gov/nchs/data/ad/ad374.pdf

Urinary Tract InfectionsUrinary Tract Infections►17 million UTIs in patients < 65 yrs of 17 million UTIs in patients < 65 yrs of

age age 11

►164,000 physicians involved in active 164,000 physicians involved in active IM, FP and Ob/Gyn practice IM, FP and Ob/Gyn practice 22

►100 episodes /yr in patients< 65 yrs of 100 episodes /yr in patients< 65 yrs of age/ physicianage/ physician

►Evidence based medicine supports the Evidence based medicine supports the treatment of uncomplicated UTIs treatment of uncomplicated UTIs without a face-to-face encounter without a face-to-face encounter

1 Data pooled from UpToDate incidence stats2 http://www.cdc.gov/nchs/data/ad/ad374.pdf

Ambulatory Care Points of Ambulatory Care Points of Pain Pain

►““I spend hours a day on the phone I spend hours a day on the phone rendering uncompensated care”rendering uncompensated care”

►““I have no time to see the patients I I have no time to see the patients I need to, let alone new patients”need to, let alone new patients”

►““My overhead is killing me”My overhead is killing me”►““Why in the world are my patients Why in the world are my patients

going to the retails clinics”going to the retails clinics”

What does it cost to provide a What does it cost to provide a Service? Service? Profitability Analysis of a Phone Profitability Analysis of a Phone

CallCallProvider Net Profit – Phone Call

Receptionist cost @ $12/hr

RN cost @ $30/hr

Physician cost @ $200/hr

Billing cost @ $15/hr

Phone Calls ($ 1.00) ($ 5.00) ($ 33.33)

-

Total Cost ($ 39.33)

Reimbursement 0

Net ($39.33)

Profitability AnalysisProfitability Analysis

Provider Net Profit - eVisitReceptionist cost @ $12/hr

RN cost @ $30/hr

Physician cost @ $200/hr

Billing cost @ $15/hr

00T47 eVisit - ($1.50) ($26.00) ($3.75)

Total Cost ($31.25)

Reimbursement $ 35.00

Net $ 3.75

Comparison: eVisits vs. Phone Comparison: eVisits vs. Phone Medicine?Medicine?

► FinancialFinancial Net loss with a Net loss with a

phone callphone call -$ 39.33-$ 39.33

Net profit from an Net profit from an

eVisit +eVisit +$3.75$3.75

Overall differenceOverall difference

$ 43.08 $ 43.08

►Non-FinancialNon-Financial Improved Improved

documentationdocumentation

Save time and Save time and avoid phone tagavoid phone tag

Asynchronous Asynchronous advantagesadvantages

eVisit Pilot Survey eVisit Pilot Survey After 250 eVisits by 16 After 250 eVisits by 16

PhysiciansPhysicians► Physician Physician

SatisfactionSatisfaction(10 out of 16 respondents)(10 out of 16 respondents)

100% Adequate info 100% Adequate info to make a clinical to make a clinical judgment judgment

90% Easy to use and 90% Easy to use and will continue to usewill continue to use

50% Saves time50% Saves time

► Patient SatisfactionPatient Satisfaction ((132 out of 250 respondents)132 out of 250 respondents)

97% Satisfied with the 97% Satisfied with the clinical response and clinical response and medical contentmedical content

87% Easy to use and 87% Easy to use and 100% would use again100% would use again

91% Saves time91% Saves time

• Clinical Appropriateness -- Patient use and clinical response audit found use to be appropriate in each case upon review of the records.

Patient Portal TechnologyPatient Portal Technology

ASP (application service provider) architecture is ASP (application service provider) architecture is common.common.Typically no additional hardware needed.Typically no additional hardware needed.Usually licensed as a service and not sold.Usually licensed as a service and not sold.

Patient Portal TechnologyPatient Portal Technology

►Ease of useEase of use Seamless connection from websiteSeamless connection from website Single patient loginSingle patient login Simple for office staffSimple for office staff

►Secure & HIPAA compliantSecure & HIPAA compliant►Broad set of communication functions:Broad set of communication functions:

Pre-Registration, Bill Payment, Pre-Registration, Bill Payment, Appointment SchedulingAppointment Scheduling

What does an eVisit What does an eVisit look like?look like?

Quick DemonstrationQuick Demonstration

Pitfalls & Critical Success Pitfalls & Critical Success FactorsFactors

PitfallsPitfalls►Over reliance on the software to Over reliance on the software to

provide the solutionprovide the solution► Inappropriate clinical applicationInappropriate clinical application► Inattention as critical mass volume of Inattention as critical mass volume of

eVisits developseVisits develops►Lack of recognition for physician work Lack of recognition for physician work

componentcomponent

Pitfalls & Critical Success Pitfalls & Critical Success FactorsFactors

Critical Success FactorsCritical Success Factors► Insurance reimbursement ($35 in MN)Insurance reimbursement ($35 in MN)►Patient populationPatient population

Internet savvy patient population that Internet savvy patient population that prizes personal time and convenienceprizes personal time and convenience

For patients on high-deductible plans – For patients on high-deductible plans – eVisits are the lower cost optioneVisits are the lower cost option

►Structured eVisit.Structured eVisit.►Easy access to charts.Easy access to charts.

Pitfalls & Critical Success Pitfalls & Critical Success FactorsFactors

Critical Success FactorsCritical Success Factors►Clinic Readiness AssessmentClinic Readiness Assessment

Do doctors really understand how Do doctors really understand how expensive phone calls are for them?expensive phone calls are for them?

►Triage & Flow PlanningTriage & Flow Planning►Patient Adoption Marketing PlanPatient Adoption Marketing Plan► Internal policies:Internal policies:

Level of service, physician responsibility, Level of service, physician responsibility, and assuring coverage.and assuring coverage.

eVisit FAQseVisit FAQs

* HarrisInteractiveHarrisInteractive, September 2006

QuestionsQuestions AnswerAnswerWho will use it and are Who will use it and are their demographics their demographics unique?unique?

74% of patients wish to communicate 74% of patients wish to communicate with their physician*.with their physician*.

How to maintain How to maintain confidentiality?confidentiality?

Password protected, HIPAA compliant.Password protected, HIPAA compliant.

How to avoid patient How to avoid patient rambling and rambling and inappropriate usage?inappropriate usage?

Controlled list of eVisit types, Controlled list of eVisit types, structured question sets for each.structured question sets for each.

What about What about reimbursement?reimbursement?

In MN BCBS, HealthPartners, and some In MN BCBS, HealthPartners, and some Medica and PreferredOne plans will pay Medica and PreferredOne plans will pay $35. $35.

What are the liabilities?What are the liabilities? Currently malpractice makes no Currently malpractice makes no distinction based on whether a distinction based on whether a physician is doing eVisits.physician is doing eVisits.

Thank You

Copy of today’s presentation: www.sophrona.com/resources.htm