As the lines between payers and providers blur, payers are increasingly becoming more responsible and aware of what they can do to prevent unnecessary care, extra ER visits and high spend.

THE PROBLEM

According to a recent report from Premier, “Ready, Risk, Reward: Improving Care for Patients with Chronic Conditions,” unnecessary ER visits just for members with chronic conditions account for $8.3 billion annually in extra costs.

Because of this, some are starting to put more emphasis on providing members with easy access to physicians when and where they need it so they can get some peace of mind before automatically heading into the ER.

“The challenge we face in north Texas is poor patient access to primary care-based medical home, combined with a lightly regulated free-standing emergency department environment,” said Dr. Matthew Muller, emergency medicine physician and chief operating officer at Acute Care Transitions, which is contracted to provide virtual care physician services to Texas Health Aetna.

“The result is nationally high rates for utilization of high-expense ‘place of service’ for acute, low-intermediate acuity care,” he said.

Texas continues to be ranked near the bottom nationwide in ratio of primary care physicians to population. The number of days to an appointment with a family medicine doctor in north Texas has more than doubled in the last five years, Muller said.

The challenge is particularly severe for the Medicaid population, with fewer than 25 percent of physicians in north Texas now accepting Medicaid, he added.

“Thus, when presented with an opportunity for our emergency medicine physician group to participate in a shared-risk, population health management revenue model, we needed a tool to create access, engage patients and scale physician services,” said Muller. “It was clear many national solutions were underperforming, with uninspiring outcomes and return on investment.”

Texas Health Aetna needed a differentiator, from the perspective of both technology and a partnership, he added.

PROPOSAL

So Texas Health Aetna found CirrusMD, a vendor of text-based telemedicine technology that enables asynchronous, ongoing communication.

“Instead of coercing and threatening patients to stay away from emergency rooms, or undertaking campaigns on acuity appropriate place of service – choose urgent care, choose your primary care office – CirrusMD proposed we flip the model,” Muller explained: “Remove barriers to engagement, create access and build loyalty with their text-based, value-focused technology that provides patients mobile, near-instantaneous access to Acute Care Transitions’ board-certified physicians.”

For the patient, these “healthcare chat” conversations are continuous, but also asynchronous, meaning that a patient can chat with a doctor whenever it fits into their day; whether it be at work, before a meeting or while watching their kids, and they can come and go as life permits.

“Now, instead of heading to the ER when a problem or concern arises, our patients instead chat with those same emergency room physicians, now online and accessible, to help determine the best course of action,” Muller explained. “Importantly, the model doesn’t charge patients a co-pay and the conversations can last as long as patients need. Our revenue is created and shared through realized savings, via reduction in high-expense utilization.”

MARKETPLACE

There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services and Tellus.

MEETING THE CHALLENGE

Acute Care Transitions partnered with CirrusMD in 2017 to create a virtual care offering for patients. The branded, HIPAA-compliant chat platform gives patients easy access to a physician on patients’ terms and timelines.

“Say, for example, a patient has had stomach pain for a few days and isn’t sure what’s wrong,” Muller said. “Instead of heading to the ER, the patient can log on to the application via their mobile phone or web browser and get connected to a doctor in seconds. The doctor will advise on next steps, whether it be over-the-counter treatment, a prescription or direction to get additional medical support.”

"Our revenue is created and shared through realized savings, via reduction in high-expense utilization."

Dr. Matthew Muller, Acute Care Transitions

CirrusMD integrated the patient app in Acute Care Transitions’ system via its SDK. Not only is this offering helping the provider organization cut costs associated with high-expense care, it’s driving the organization’s reputation as a trusted resource for patients and partners, like Texas Health Aetna, Muller stated.

RESULTS

Acute Care Transitions and CirrusMD have reaped rewards for Texas Health Aetna and its members.

First, an annualized utilization rate of nearly 19 percent: “We’re excited to see that patients are actually using and enjoying the platform,” Muller reported. “Because the response is almost immediate and patients can use it whenever it fits into their day, it’s an easy way for them to get the health support and peace of mind they need.”

Second, an 80 Net Promoter Score and 93 percent patient satisfaction: “In such a competitive market, it is critical for us to offer our patients the resources they need to not only manage their health and wellness but also to help us reduce system leakage,” Muller explained.

“Patients repeatedly tell us how impressed they are with the service, with one patient stating, ‘The response was almost immediate, and the physician was both empathetic and efficient. I appreciated the peace of mind knowing that a physician was just a text away and that I didn’t seek unnecessary care.’”

And third, more than 86 percent of encounters resolved on platform, saving approximately $398 per ER avoidance: “With the CirrusMD platform, patients are getting the peace of mind they need without heading to the ER,” Muller said. “Not only that, but we’re also seeing substantial savings on our end from ER avoidance.”

ADVICE FOR OTHERS

“My biggest advice for provider organizations would be to really focus on the user experience with whichever solution they intend to deploy, and by user I mean both the patient and the provider,” Muller advised.

“From the patient’s perspective, think deep about barriers to care with traditional brick-and-mortar models, and build models to eliminate these and not recreate them in your virtual solution,” he said.

From the provider’s perspective, focus on a simple interface that makes it easy for the provider to operate, Muller added. If one solves for these issues and provides near-instant access to care, one can build trust with both patients and providers, and that trust is critical to providing care that is truly impactful, he said.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com