Health plans pitch 'e-visits' to seniors

The nascent trend of patients getting health care online is coming to the Silver Sneakers crowd.

A growing number of Medicare health plans are introducing "virtual visits" as an option for seniors, with formats for handling minor ailments ranging from live video connections with doctors to online information exchanges with nurse practitioners.

For several years, the e-health trend has focused on the under-65 crowd, with online services marketed to busy parents and younger professionals accustomed to both the internet and mobile devices.

Aversion to technology and complicated health conditions likely make virtual visits virtually impossible for many with Medicare coverage. But there's a growing number of "silver surfers" who are spending more time online and are likely willing to give virtual health care a try.

"I don't sell seniors short on their ability to take up on this new model at all," said Ezra Golberstein, a health policy researcher at the University of Minnesota. "It's not going to be for everybody … but it is a useful addition."

Minnetonka-based UnitedHealthcare, the nation's largest insurer, launched virtual visits in January for more than 1.1 million people enrolled in the company's Medicare health plans.

The visits promise to reduce costs for low-acuity care, the insurer says. It's fully covering online sessions for diagnosis and treatment of basic conditions like allergies, bronchitis or the flu through real-time, interactive audio and video telecommunication and transmissions.

"We're seeing a lot of Medicare plans begin to add telehealth services," said Dr. Sylvia Romm, a medical director with American Well, the Boston-based company that's one of two outside vendors providing the UnitedHealthcare service. "And we're seeing good uptake from older Americans."

The coverage applies only to "Medicare Advantage" plans where seniors obtain benefits through a private health insurer, rather than the traditional Medicare program. Kentucky-based Humana, which along with UnitedHealthcare is one of the nation's largest Medicare Advantage operators, started offering virtual visits in some states last year.

In Minnesota, virtual visits aren't an option yet in most Medicare health plans.

But Minneapolis-based UCare and Duluth-based Essentia Health included "e-visits" with no copay when they launched a new Medicare health plan for 2016 in the northeast portion of the state. The visits are an online exchange of non-urgent medical information over a secure encrypted website, but there isn't yet a video component, said Dr. Michael Van Scoy, medical director of care management at Essentia Health, which operates hospitals and clinics in the region.

HealthPartners is launching Facebook ads this year directed at seniors touting its Virtuwell service, where nurse practitioners provide diagnosis, treatment and prescriptions for more than 60 common conditions like sinus or bladder infections and minor skin conditions. First launched in 2010 and expanded to Medicare health plan enrollees two years later, the service doesn't require an appointment or video connection.

"While the uptake in the senior population is not as high as what we see in the rest of the book of business, we continue to see that grow," said Dr. Kevin Ronneberg, a vice president with HealthPartners. "It's growing at a rate that I would say is consistent with adoption of technology for that same age group."

HealthPartners has published studies documenting savings with the service, Ronneberg said, saying Virtuwell lets patients get care at times they might otherwise go to costly care settings like urgent care and ERs.

Historically, seniors have been late adopters of technology, but many are making deeper dives into the online world, according to Pew Research Center.

Whereas just 14 percent of those age 65 or older were going online in 2000, the share among all adults at the time was 50 percent. By 2013, 59 percent of seniors were going online, compared with 86 percent of all adults.

Among seniors, the Pew survey found two distinct groups. Younger, more highly educated or more affluent seniors tend to have "relatively substantial technology assets," the report said, plus a positive attitude about the benefits of online life. Older and less affluent seniors, including those with significant health problems, often are cut off from the new technology tools.

There isn't a lot of good evidence yet about the quality of care with virtual visits, said Dr. Ateev Mehrotra, a Harvard Medical School researcher who has published studies on the trend, which he calls "direct-to-consumer (DTC) telemedicine."

Testing rates among those receiving online care are lower, research has suggested, a finding that could be a good thing or a bad thing depending on the condition, Mehrotra said. Some state medical boards have raised concerns about the lack of in-person physical examinations, and the potential lack of follow-up and access to medical records.

"These treatment options are very good for patients who are generally healthy, and this is just a problem that they have and they need to get it taken care of," he said. "For patients who have a lot of chronic conditions, it gets a lot more complicated in terms of what medications can be chosen and also what could be going wrong with them."

Seniors, as a group, are more likely to have complicated health problems, so online care might not be as good an option, Mehrotra said. Many seniors also have tight relationships with their primary doctors, he added, which also might make virtual visits a tough sell.

In the vast majority of cases, Mehrotra said, patients who talk with a doctor through online video are not talking with their regular physician. And Mehrotra argues the trend might drive up medical spending, rather than cut costs, because "if you make things more convenient, more people will use it."

In a study published in Health Affairs earlier this year, researchers estimated that just 12 percent of DTC telemedicine visits replaced visits to doctor offices or emergency rooms, while 88 percent represented new use of medical services.

"There may be a dose response with respect to convenience and use — the more convenient the location, the lower the threshold for seeking care and the greater the use of medical services," Lori Uscher-Pines, a policy researcher at Rand who worked with Mehrotra on the study, said in a statement.

The point isn't to shut down DTC telemedicine, Mehrotra said, but to get insurers to consider whether the visits add enough value to justify the cost, rather than rely on what he sees as the "erroneous argument that such visits save money."

Investors have put money behind the trend, nonetheless. A 2016 report from the consulting firm Accenture-listed American Well and one of its competitors as two of the Top 10 funded "on-demand" companies, with combined financial backing of $386 million.

The consulting firm has published survey results showing a majority of U.S. consumers are willing to use a wide range of virtual health services, but only 21 percent actually had done so.

"People across all age ranges want their health care experience to be a lot like everything else they do in their life with technology," said Frances Dare, managing director of virtual health services with Accenture.

That's true to a point with seniors, said Susan Malley, 68, of Duluth. She worked for decades in health care IT and says she sees potential benefits for patients and the overall health care system with online care. Some seniors love using Skype or FaceTime, she notes, to talk with faraway grandkids.

But Malley also sees plenty of seniors who lack computer skills, particularly in her work as a volunteer instructor teaching classes for seniors who want to learn about the internet. Virtual visits won't work for those Medicare beneficiaries, she says, adding that she fears the trend is being pushed to compensate for all the physicians who have left the profession out of frustration in recent years.

"We're in a huge transition phase," Malley said. "We still have a tremendous part of the population that says: 'Huh? I don't even want a cellphone.' "