Dr. Teresa Myers, a family practice physician in Copley, Ohio, describes what she can see on her computer screen during a telehealth conference. "You know what HD television looks like. You can actually see the pimples on the actors' faces," she says. "I had a patient who was able to shine her iPhone flashlight to the back of her throat. I could see the exudates [pus-like fluid]. If you see that, you can be pretty sure." A few more questions, as well as having the patient take her temperature and feel and describe her lymph nodes, and Myers felt confident diagnosing strep throat and prescribing an antibiotic.
The consultation started less than five minutes after the patient logged in, cost $49 and lasted 10 minutes. The patient never left home, learned a few things about examining her own body and, two days later, said she felt much better when Myers followed up.
Myers is with American Well, a telehealth service which, for seven years, has employed physicians like her for e-visits, or virtual computer consultations, for patients within specific insurance plans or physician practices.
But now the service, joining a growing trend toward medical care based on patient convenience rather than physician schedules, is available directly to consumers—whether insured or uninsured, and whether they have a primary care physician or haven't seen a doctor in years. Anyone can download an app at americanwell.com, enroll, choose from a panel of physicians and talk to a doctor nearly immediately. Using smart phones, tablets or web browsers, people with common symptoms like sore throats, or who need quick advice in ongoing care for chronic conditions, or even those looking for support in kicking the cigarette habit can have a virtual face-to-face with the board certified primary care physician of their choice.
Just a few years ago, when patients had symptoms, they could either call their doctors, go to emergency rooms, or tough it out at home. Now options for care designed for consumer convenience are mounting.
The most common alternatives to a scheduled doctor's office visit include urgent care in free-standing clinics staffed by physicians, employer-based clinics offering a range of care from diagnosing infections to full primary care, and retail clinics within drug stores or big box stores like Walmart, usually staffed by nurse practitioners or physician assistants and often limited to common conditions like colds, flu and urinary tract infections. This direct-to-consumer app adds one more possibility to the growing field of convenience medical care.
The demand for quick and convenient consultation with doctors has produced other options such as TeleDoc, in which patients with a limited set of symptoms can get a call back within an hour from the first available doctor. White Glove is a company that offers, in four states, a clinic in a car. The half million White Glove users can call in and receive a home visit from a physician or nurse practitioner whose black bag might contain a rapid test for strep throat or some of the most commonly used prescription drugs.
Americans seem to like convenience care. Visits to retail clinics, for example, grew four-fold between 2007 and 2009, with nearly 6 million visits to such clinics in 2009 at an average cost of $78 per visit.
In fact, says Dr. Ateev Mehrotra , an associate professor of health care policy at the Harvard Medical School who has studied alternatives to brick-and-mortar doctor visits, convenience ranks high among the benefits of those alternatives. "One aspect of health care costs we don't talk about much is patient time," he says. That includes time in the car, time away from work, time in the waiting room, as well as time with the doctor. "When you start counting up all those hours, it turns into a huge amount of time, which adds up to a huge amount of money," says Mehrotra.
Options in convenience care, including virtual doctor visits via technology, may become even more popular as the new health care law goes into effect. Formerly uninsured people will be trying to make appointments with doctors—perhaps for the first time in their lives. "With the Affordable Care Act, millions of Americans are going to be hitting the healthcare system. Access is going to be more challenging," says Roy Schoenberg, CEO of American Well. "This form of care stretches the health care system, making it available to more people, without an intermediary."