Has Your Doctor said “Hello Health”?

……….How many times have you said, “I wish I could just go online and make my doctor’s appointment.” How many of you actually have the privilege today to shoot your physician or health care provider an email and receive a response back from them.  If you don’t have this privilege, how many of you are guilty of stalking them on Facebook or twitter and sending them a direct message? The norms of each of these behaviors we have yet to determine, as hospitals and physician practices struggle to craft social media policies and redefine the routes through which they are (legally protected and) comfortable communicating with patients.  Insurance reimbursement for these activities is likely a distant fantasy. Electronic medical and health record systems implementation is a task with which many smaller provider organizations continue to grapple, falling behind on their timetables for achieving meaningful use.  The very popular health care social medicine (#hcsm) tweet chat addressed this very question in its June 3, 2012 discussion.

Should Providers Be Compensated for EHR/EMR Usage?

Twitter
HealthSocMed:

For T1, let’s talk about provider compensation & time for SM compared to other aspects of care, especially EHR/EMR usage. #hcsm [via Twitter]

Twitter
DrGhaheri:

T1: Depends on who is doing the compensation. I get compensated, but it’s by the patients who come and see me. #Hcsm [via Twitter]

Twitter
DrGhaheri:

T1: I don’t think insurers should compensate for HCP’s involvement in SoMe. It’s already too confusing out there. #Hcsm [via Twitter]

Twitter
joshdbrett:

T1 If it’s part of your delivery of healthcare services to patients, yes. #hcsm [via Twitter]

Twitter
crgonzalez:

T1: I think providers should be compensated, but to justify it, the care offered via SM ought to be tied to outcome improvement #hcsm [via Twitter]

Twitter
docnieder:

I’d prefer a change in the compensation formula, for instance the DPC model. #hcsm [via Twitter]

Twitter
DrGhaheri:

T1: SoMe involvement is immeasurable. Real, meaningful interactions can’t be quantified by a 3rd party. So can’t compensate for it. #hcsm [via Twitter]

Twitter
DocForeman:

I envision that there will be new HITSM specific provider jobs in the next 10 yrs. It’s work, it takes skill, it’s useful. t1 #hcsm [via Twitter]

Twitter
GautamJaggi:

T1: We’re moving away from paying for time, period. Providers paid more for value, outcomes.#HCSM is no different. [via Twitter]

Twitter
RyanMadanickMD:

T1 #hcsm I’d like to know who gets reimbursed for EHR use or activity?? @HealthSocMed [via Twitter]

This excerpt of the transcript shows just a sampling of the varied opinions on the topic provided within the first 15 minutes of this hour-long discussion.  You can see that the very progressive Dr. Ghaheri is already providing communication to his patients via social media for a fee.  Gautam Jaggi offers a more holistic solution when he states, “We’re moving away from paying for time, period. Providers paid more for value, outcomes. #HCSM is no different.” According to the HITECH Act of 2009, health care providers will receive incentive payments for having an EHR/EMR with the maximum going to organization whose systems go live in 2012.  Meaningful use of those EHR/EMR systems should be demonstrated for all organizations by 2015 or they will receive penalty fees.

Myca Health Offers A Solution

          Seeing the existing gaps and an outstanding need in the system, one company has designed their electronic health architecture to provide one solution while the rest of the stakeholders in the industry continue to figure it all out. Myca Health, a Canadian-based company led by Nat Findlay decided to focus on the sol0 practice primary care physician and small group practices. Unlike sub-specialty physicians, many of these practices are struggling to remain solvent.  Last month at Health2.0 Springfling: Matchpoint Boston, Myca featured their subsidiary, Hello Health in a “deep dive” presentation by Patient Management Officer, Steven Ferguson.  Hello Health is a cloud based patient management platform that includes an electronic medical record (EMR) certified for meaningful use, a patient portal (PHP), and a telemedicine feature.  It is designed so that a primary care provider can completely monetize their workflow and communication.  In our current insurance reimbursement model physicians are not compensated for the cognitive or thinking and consultative care they coordinate and deliver.  Rather they are compensated for the procedures and interventions they perform.  With Hello Health, primary care physician communication with the pharmacy, the laboratory, various specialists, and patients all become fee-for-service transactions.  Hello Health provides this service, the electronic administration of practice transactions and communications to physician practices at no charge to the physicians by aggregating the subscription fees charged to the practice’s pool of patients for premium services on the patient portal.  All patients of a Hello Health practice have access to features of the patient portal but the most robust features are available for an annual fee that ranges between $36-$120 US dollars among the practices that currently use Hello Health. Steven Ferguson (SF) was kind enough to sit down with me in Boston to help me really understand the system, 

“This is not obligatory. This is something patients can sign up for if they want the premium access to services. Every patient has access as some level for free. What happens is when they start to use Hello Health they get access to lab reports, request prescription refills, and schedule their appointments. [They] can now see part of the doctor’s note in the file from the last visit. The doctor has complete control over how much of the file they will share. Now patients know they should be seeing something, so they are becoming a lot more motivated to ask. Physicians can also push patient education material through our platform as well. The patient education aspect means that based on diagnosis, medication, or lab the appropriate patient education gets cued up. We use MedLine Plus. They can use the secure messaging that looks and behaves like email. There’s this whole way of communicating that wasn’t there before.”
I know the thought that has just popped into your mind, and yes, I asked Seven that very question for all of you.

EM:  So it’s not within the telemedicine paradigm that payment is coming? Almost like concierge medicine, perhaps?
SF: (He responds with a little reluctance.) Concierge light…concierge for the masses get thrown around.  It’s not a term we’ve ever used but of course there’s always comparisons drawn to that.

SF: You hit on another interesting point, that is the virtual visit aspect. And, as you know that is typically not covered today by insurance.  There are some pilot programs but (within Hello Health) that’s another revenue source for the physician. [Patients] can select a 15-minute telemedicine consult for say $35.00. But you don’t have to get in your car drive all the way to the doctor’s office
EM: So it’s a little like shopping online.
SF: Yes, but it’s with your doctor, it’s not with just any doctor.
EM: That’s important, because once you have an established relationship with your doctor who knows your numbers and your normal then some of these decisions can be pushed out of the clinical setting.
At one point during the interview, I observed, “It’s how care ought to be.” and Steven agreed, “How care ought to be. You’ve said it!”
          But in today’s healthcare environment this type of access does seem to come at a price. One fellow attendee at Health2.0 remarked to me, “Why am I being asked to pay for something I should be receiving anyway?” He poses a fair question.  Remember, we have yet to convince all Americans that healthcare is a right. Don’t count me among that group.
Listen to further discussion of Hello Health and how it garners patient participation.

          Let’s be clear, this solution opens up access to care for specific demographic segments.   Steven Ferguson explains the characteristics of population of patients they serve. Males and females with an average age in their mid-50’s distribute equally among premium service users to date.  They are college educated with higher incomes. They’ve grown accustomed to doing their banking online and want and expect greater accessibility to their healthcare services.  So while this solution is not relegated to the very rich, the price still tends to skew toward the upper middle and upper classes.
          I do not disparage Myca Health for offering Hello Health, a solution to physician practices while the CMS Innovation Center administers pilot projects under The Bundled Payments Initiative.  We are still in the infancy of the health information technology landscape.  The field remains wide open.  At 6 years of age, Myca Health with its subsidiary Hello Health has put forth what for now is simply a good service built around a good business model.  However, I have not lost hope that health information technology can devise solutions to improve access to care for the most vulnerable populations and I will continue to look for them and share them with you.
          At present, several physician practices in New York have already begun using Hello Health. The company is expanding its sales force and continuously establish new partnerships through physician practice nationwide.  Ask your doctor about Hello Health.
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