Intermountain Healthcare Launches $49 Telemedicine Visits

The Salt Lake City, UT-based health system wants to tear down silos that often isolate telemedicine visits from the patient's continuum of care.

Over the past several months, Intermountain Healthcare has quietly rolled out its Connect Care telehealth platform for patients in Utah and Idaho.

Program Medical Director William Daines, MD, says Connect Care clinicians will have access to Intermountain patients' medical files as part of a greater effort to include telehealth in the continuum of care. Daines spoke with HealthLeaders Media. The following is a lightly edited transcript.

HLM: Was Connect Care a soft launch?

Daines: We started a launch with Intermountain employees only. That was February 8. It was a great chance for us to solve a few technology problems, to gauge was general interest would be, and also to make sure that our medical protocols and safety mechanisms were working the way we wanted them to.

Sometime in the middle of March we went live with SelectHealth members, our allied insurance partner. In April we started with our public marketing campaign, which included lots of different advertising channels; print, outdoor, television, radio, digital.

There was also a soft digital campaign that launched at the end of March that was on a few patient-facing websites. We've been slowly over the course of February into April increasing our publicity.

HLM: How did you determine the need for Connect Care?

Daines: We've seen direct-to-consumer telehealth has become a growing part of medicine across the country. Utah and Idaho have been a little bit late to the game. When we gauged public awareness of telehealth with surveys in 2015, we only saw that about 10% of people were even aware of telehealth as a concept.

I would venture that if you went to California or New York or bigger cities you would see that telehealth is already a much more publicly known way of getting medical care.

HLM: Were there specific challenges for telehealth in Utah or Idaho?

Daines: There were a few legislative changes that needed to happen in Idaho to give us the legal groundwork to do telehealth. New developments tend to happen on the East or the West Coast and they make their way to Utah a little bit later. It's not that there was any major obstacle. It's just that none of the major healthcare organizations in Utah and Idaho had taken this step into telehealth yet.

HLM: Does Connect Care have a dedicated staff?

Daines: Currently we have two providers and we have two more in the credentialing process. They are going to be on board quickly. We don't know exactly how big our staff will be when we are 100% operational. A lot of it will depend upon patient demand. Our goal is to have 24/7/365 access with wait times of under five minutes.  

Currently, our internal staff sees patients from 8AM to 8PM Monday through Sunday. We have a backup group of physicians called the Online Care Group. From 8PM to 8AM or if our daytime call volumes exceed what one provider can handle, they're there for backup.

Our goal is as soon as possible to be staffed 100% internally and have all the medical care being provided by Intermountain providers.

We feel strongly about that. We feel Intermountain has strong brand recognition and a long and prestigious dedication to high-quality care.

HLM: Are their special challenges that come with telehealth?

Daines: One of the things we have seen with telehealth is that for the past five or 10 years it's emerged as a new way of accessing care, but it is operating separately from people's normal care providers.

They might have a normal primary care doctor who they see on a regular basis. But when they access a telehealth provider, the primary care provider is not aware of it, the medical records don't get transferred, the telehealth provider can't see what medications the patient is already on. The primary care doctor can't see what medications the telehealth provider prescribes.

I am a big believer in continuity of medical care, but it's impossible to ask one doctor to be available for every patient 24/7/365.

Systems such as Intermountain Health Connect develop channels of communications and shared treatment standards so that if you happen to see one of our providers in urgent care or in one of our emergency rooms or one of our primary care practices there is shared communication between all the providers involved in the patient's care and they are all operating according to shared treatment standards.  

HLM: How does the Connect Care platform work?

Daines: All of our visits are video-based. We partner with America Well that has a video based platform. It's like Skype except it is secure, (Health Insurance Portability and Accountability Act-) compliant, and has a high-resolution video feed. We also have the ability to accept photographs or PDF medical records.

HLM: Do you have any expectations for telehealth patient volume?

Daines: That number is in flux. I can't provide solid numbers right now because we are rolling out our marketing campaign. We haven't reached a point that I would consider static or a representative sample. Maybe by later this summer we will have a better sense of what we are seeing.

HLM: Is telemedicine different from an in-patient visit?

Daines: It reinforces and amplifies the things I should be doing during my general patient visits. Unfortunately, it's become a little bit of a cliché that the doctor is off in the corner during the exam looking at the computer and barely paying attention to the patient.

With telehealth you have to fight that urge even more. You have to make sure you are looking into the webcam so the patient gets a sense that you are looking at them and not looking at some screen.

You have to really listen. We know that about 80% of medical diagnoses can be made just from what the patient tells you. The physical exam is important for some medical conditions but there are many things we diagnose just by listening. A video visit really reinforces how important listening is in the doctor/patient relationship. 

HLM: How did you settle on $49 as the fee for telemedicine visits?

Daines: If you look at other organizations that are doing this around the country that is a pretty standard rate. It is much less expensive than an urgent care visit, much less expensive than an ER visit.

We are partnered with some insurance plans so that even that $49 can be reduced if you're covered. Insurance companies understand how important it is to do the right thing for the right patient in the right place at the right time.  

If someone calls with a medical complaint that is clearly not fit for telehealth, for example chest pains or stroke-like systems, what is best for them is to go to the ER and not to be charged for what is essentially a triage phone call.

We are not looking to extract $49 from a patient when they are already going to have to go to the ER and get a higher level of care.  

HLM: What metrics will you use to determine if Connect Care is working?

Daines: There are a couple of things. When somebody's finished a visit we ask them a few questions about their experience, what they thought of the provider and the total platform experience.

With some patients we follow up later on to make sure they actually get better. One of the most important things with any medical treatment is are we helping the patients feel better, stay healthy, be healthy.

We also want to be part of the solution to the healthcare expenditure problem, not part of the problem. We want to help lower the cost of care by helping patients get the care they need in the appropriate setting at the appropriate time.