Monday, February 06, 2012

Markets in Everything: Virtual Retail Clinics

American Medical News -- "When patients walk into a NowClinic at any one of nine Detroit-area Rite Aid pharmacies, they can choose among multiple physicians to see about what's ailing them. Not see in person. See on a computer monitor.

What's going on at these Rite Aids is a merger of multiple trends focused on providing more convenience to patients than, presumably, a physician's office can deliver. Neither telemedicine nor retail clinics are new -- but combining them is.

Rite Aid and OptumHealth joined forces to find a less expensive alternative to traditional clinics, which are staffed by nurse practitioners and physician assistants who are contracted from a local hospital group. Those startup costs have been a factor as to why growth of retail clinics, until a nearly 100-location expansion by CVS' Minute Clinic in 2011, had been mostly flat in recent years. Rite Aid and OptumHealth decided it would be more cost-effective to go with virtual visits -- nurses and physicians seeing patients via a computer screen.

Here's how NowClinic works:

A patient walks into a private room, usually near the pharmacy counter, and registers himself or herself on the computer terminal. Either an account can be created with OptumHealth, or UnitedHealth Group plan members can use their member information, to avoid the registration process on subsequent visits. When registration is complete, the patient goes through a series of computer-prompted questions to get at the problem or complaint. The patient can access several free educational tools or talk with a nurse via video chat.

The services offered at Rite Aid are the same as for the online NowClinic: treatment of allergies, bladder infection, bronchitis, cough and cold, diarrhea, fever, insomnia, nausea, pink eye, rash, seasonal flu, sinus infection, sore throat and viral illness. There's no charge for virtual consultations with a nurse, who also can advise patients whether a doctor visit is warranted.

If the patient would rather talk to a physician -- or the nurse advises that the patient should -- he or she can pay $45 for a 10-minute visit and enter credit card information. The system does not accept insurance coverage, though patients can submit claims to their plan to get reimbursed. Patients can pick a physician from a list with background information, including specialties and customer reviews, for each physician. The physician can help guide the patient to in-person care, if needed, or write a prescription when appropriate."


At 2/06/2012 3:24 PM, Blogger Ron H. said...

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At 2/06/2012 3:25 PM, Blogger Ron H. said...

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At 2/06/2012 3:27 PM, Blogger Ron H. said...

Next step - "There's an app for that."

At 2/06/2012 5:13 PM, Blogger Cabodog said...

Next step, part two: Insurers letting their insured know that these visits are free, with no co-pay. Co-pay for doctor's visits will be $100.

At 2/06/2012 5:53 PM, Blogger Larry G said...

well.. I've said it before (and got hammered for it).. but I believe one of the most important things that could empower people to choose where to receive health care is standardized electronic medical records where software quickly identifies who you are, the drugs you use, the things you are allergic to and your prior medical history.

Anywhere you go for care - they know your history - including all the past tests done... and that not only helps improve diagnosis but it allows you to shop around and even get a truly independent second opinion.

the second best thing would be a market place where every single test and ever single procedure is priced so if you want/need a lipid panel - you can find the best price ... ala Gas Buddy....

Now the tricky thing here is how to have the marketplace develop the standards - rather than the govt.

So far, as far as I know, no marketplace has done this without the "encouragement" of the govt.

At 2/06/2012 5:55 PM, Blogger Marko said...

Next step - maybe fewer medicines should require a prescription. Or, a broader range of health practitioners can write prescriptions for certain medications.

I know when I freakin need antibiotics for a sinus infection, I don't need to attend a trumped up $45 session and say the magic words to get a prescription. Somehow much of Europe survives without requiring prescriptions for many drugs.

At 2/06/2012 6:45 PM, Blogger Craig Howard said...

I've followed with interest your chronicling of innovation in health care delivery. This is one model, I suspect, that may not pan out. That's fine. Worth a shot.

At 2/06/2012 7:56 PM, Blogger Benjamin Cole said...

I think the day will come with you attach some gizmos to your body, peer in a receptacle and send the results to your doctors online. He or she reviews, you chat online for five minutes and bang you are done. Order meds online and they come to your door in three days.

We will have to dereg a lot to get there but first lets delicense lawyers. The rest will come easy.

At 2/06/2012 10:14 PM, Blogger sethstorm said...

Lower quality healthcare, courtesy of the computer screen.

At 2/07/2012 2:18 AM, Blogger Ron H. said...

Marko: "I know when I freakin need antibiotics for a sinus infection, I don't need to attend a trumped up $45 session and say the magic words to get a prescription. Somehow much of Europe survives without requiring prescriptions for many drugs."

But don't you know we are all children, who can't be trusted to understand medical problems even after decades of experience with our own bodies, and we can't possibly learn anything from experience?

At 2/07/2012 8:07 AM, Blogger Larry G said...

re: "children"


check this list and tell me you understand which one to use.

brain power is not the same as knowledge - you know.....

Most folks who prescribe medicine spend a decade in training...

At 2/07/2012 2:32 PM, Blogger Ron H. said...

"check this list and tell me you understand which one to use."

I pick the one that helped me the last 6 times it was prescribed for the exact same problem I have now.

When Marko has a sinus infection, he knows he has a sinus infection, and could easily buy the same antibiotic that helped him previously, without paying the doctor to tell him he has a sinus infection.

If you have a headache and have previously taken Tylenol to eleviate the pain, you don't need a doctor to tell you that you once again have a headache, and should take Tylenol for it.

At 2/07/2012 6:00 PM, Blogger Larry G said...

I dunno Benny ... sounds risky to me.

9 times out of 10.. you'd probably be right.. then the one time.. something else is going on - and you need a doctor taking a look/see and he/she may well prescribe something different.

remember also.. it's not only the drug itself - it's the dose and duration of taking.

Most folks if you ask them what the DOSAGE is of the drugs they are taking - have no clue and they also don't know what a low dosage is or a high dosage is.

when you go see a doc - the good ones want to know what other drugs you are taking - including OTC.

At 2/08/2012 3:57 PM, Blogger Marko said...

Larry G - there is less science to prescribing than you seem to think. When I go to a new doctor, I usually tell them what works for me and they prescribe that. So yes, I know what I need - and actually spending a little time on wikipedia helps too.

The doctor occasionally suggests something new, perhaps because a pharma salesman has been by recently. When that happens, I go online and do my own research and let my doc know if I want it, or not. I am in control of my own healthcare, thank you.

I am not saying I would never go to a doctor - if I am not responding to the first dose of AB I might go in and get my sinuses scoped, but I have to ask a GP or internest for that usually because they are clueless. ENTs are usually better, but it is a crap shoot.

Not everyone knows what they are doing, but if you don't, you can go the full service route. I am a guy that for many issues can go to the self serve line, thank you.

At 2/08/2012 5:10 PM, Blogger Larry G said...

@Marko.. I do a lot of reading also and enough to know that people's existing conditions, other drugs they are taking, and dosage are things that often require medical knowledge to know what to prescribe, what not, and what dose.

I'm not arguing against taking control of your own health care - only that 10-12 years of schooling can't be fully substituted by a person with intelligence who reads a lot.

For myself - just looking at common blood test results ...about 15 different measurements can be pretty confusing if one item is higher than normal while another is lower than normal... what does it mean...are the two connected...what effect do current drugs have and what drugs should not be prescribed based on the test results, etc, etc, ?

realizing that not all docs graduated at the top of their class... and there is a wide range of competence also.

I think folks should be responsible for knowing more about what their tests means and the drugs they take.

but I also think.. all things considered.. a Doc is, if nothing else, a way to hedge your bets a bit and keep from doing really stupid stuff.

when, at some point, you're laid out on an operating table and there is a guy(or gal) standing over you with a scalpel.. you are in their hands... no matter how much you think you know.

those who have never been sick enough to have much more than a few drugs.. may not appreciate just how little "control" you have over your body when you have something serious wrong with you and someone is going to slice you open and expose your organs.

that decision does not come from you telling your doc what kind of drugs you want...

At 2/08/2012 8:04 PM, Blogger Marko said...

Larry G - you raise good points, but your points are in support of visiting a doctor for diagnostic purposes. I am not saying that people should not visit a doctor for check ups and diagnosis, I am arguing that people should not be required to visit a doctor in all cases for many medicines that currently require a prescription. Pharmacist can check for drug interactions (and so can I on the internets) and many countries don't require prescriptions. You can go to the doctor, he tells you what you need, and you go to the chemist and buy it.

Funny how so many people here want to legalize pot, but not antibiotics :)

At 2/08/2012 8:12 PM, Blogger Larry G said...

@Marko - you can get 90 day renewable prescriptions these days but docs are more circumspect over antibiotics.. they think it's not normal for folks to need multiple courses of antibiotics.. because it might be someone more serious going on but also because antibiotics lose their effectiveness if used too often.

I just think that no matter how smart you are or how much you read that unless you've spent 10-12 years learning that you still don't now what a doc knows.

I have a lot of respect for most (not all) docs.

there are dozens, hundreds of combinations of antibiotics and you need someone who is familiar with most of them to decide what to prescribe (or not) and what dose.

I once had Lyme's Disease which started out masquerading as ordinary flu that would not respond to antibiotics that worked before, and by the time it was over.. I was very impressed with the range of drugs involved.



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