This week, Blue Cross Blue Shield of Massachusetts (BCBSMA) introduced Telehealth, a program that will enable its 2.8 million members, which include many Islanders, to see a doctor for non-emergency health care, 24/7, via streaming video on a smartphone, computer, or tablet.
“Blue Cross defines Telehealth as the real-time video exchange between a clinician and a patient. It’s not a phone call, it’s not an email,” Greg LeGrow, senior director of Technology Engagement Solutions at BCBSMA, told The Times.
Telehealth is a collaboration between BCBSMA and Boston-based American Well, which provides the Amwell platform. Using the free Amwell app, a person can go online to see what doctors are available, check doctor credentials, and see how many people, if any, are waiting to see a specific doctor. According to an American Well spokesperson, the wait time for the first available doctor is 2 to 5 minutes on average. Essentially, a person feeling under the weather can find a doctor, make an appointment, fill out the paperwork, see the doctor, and have the prescription emailed to the local pharmacy.
Doctors are available around the clock. Not all America Well doctors are in Massachusetts, but all doctors available to Massachusetts residents are board-certified in Massachusetts.
If a person’s primary-care doctor in Massachusetts takes part in the Telehealth program, that doctor can be accessed from anywhere in the world. “Telehealth can improve access to a local doctor if he or she participates in the program,” Mr. LeGrow said. “If they don’t [participate], or it’s after hours or on the weekend, and you’ve got a migraine and really need to be seen, you will have access to a physician, no matter where you are, provided you can connect to the Internet.”
Mr. LeGrow said that the pilot program in Massachusetts, started a little over a year ago with 60 clinicians participating, has been very revealing. “We believe video can definitely enhance the doctor-patient connection,” he said. “If you spoke to an asthmatic over the phone, that would be one thing, but if you see an ashtray on the coffee table or a cat walking around, you’ll know a lot more about that person’s environment. It also enables family members to participate. If there’s a translation issue, it can be handled, and the doctor can see that the information is being received properly. A look says a lot.”
From a diagnostic standpoint, Mr. LeGrow said, video can enable doctors to evaluate rashes, and even a sore throat can be examined with a properly placed smartphone.
American Health provides telemedicine technology to 28 other independent Blue Cross/Blue Shield plans, and over 1,000 employers across the country.
A company spokesman told The Times on Monday that about 60 percent of Amwell users access the service from a mobile smartphone, about 30 percent from a desktop computer, and about 10 percent connect for non-video visits via telephone.
Telemedicine is catching on. A recent survey of 140 companies by the National Business Group on Health found that 74 percent of the nation’s largest employers are offering telemedicine services in 2016, up from 48 percent in 2015. The American Telemedicine Association estimates that 1.25 million online patient consults will take place this year.
Telehealth is not available to BCBSMA members until their plan’s renewal date — if a member’s employer renews annually in June, Telehealth won’t become available to that person until June.
Before a person sees the physician, he or she will fill out an online form that covers the same information requested in a brick-and-mortar office.
Medical records from a virtual visit with an American Well doctor can be downloaded and shared with that person’s local physician, but that decision rests with the patient.
“American Well uses Surescripts, which is connected to about 98 percent of the pharmacies in the United States,” Mr. LeGrow said. “The person chooses where they want their prescription sent electronically as part of the intake process.”
Payments will also be done electronically, in real time. “If the person is seeing someone through American Well, they will provide a credit card at the time of the visit,” Mr. LeGrow said. “If they have a benefit through their provider, they are charged their co-pay at the time of the visit. The consumer will know what the appointment will cost when they register for the visit.”
Telemedicine is not limited to BCBSMA members in the Telehealth program. Islanders who don’t want to get on a boat, get in their car, or leave their bed can access telemedicine through a number of providers. Even without BCBSMA coverage, an online visit with an Amwell doctor can still be cost-effective. According to the Amwell website, an urgent-care doctor consult will cost no more than $49, online therapy no more than $95, and a cyber-session with a nutritionist will cost $25 tops.
A boost for behavioral health
Telehealth also offers secure, live video access for mental health counseling, addiction counseling, smoking-cessation counseling, and dietary counseling.
Dr. Jennifer Gentile is a practicing physician and medical director of the Amwell Massachusetts Behavioral Health team. She is also a staff psychologist at Children’s Hospital Boston and instructor of psychology at Harvard Medical School.
Dr. Gentile said video can play a key role in enabling a therapist to evaluate a patient who may not be forthcoming, or who may be unaware of the severity of his or her problem.
“Take postpartum depression,” she said. “New moms can be in a bit of a fog, and they might not realize how troubled they are. We might be able to see her interaction with her infant, and see they are not engaging. Or we see she is still in her pajamas and unkempt, or she might not be making as much sense as she should be. That mom probably wouldn’t have been able to seek therapy because she wouldn’t have been able to organize herself enough to get out of the house. We see can also see signs of domestic violence. We can see bottles lying around with someone we’re treating for substance abuse. There’s so much shame with substance abuse; it allows them to be as private as they want to be while still getting the help that they need.”
Dr. Gentile said telemedicine can be particularly beneficial in small communities where people might not want to be seen going for counseling. “Stigma is a big reason why people don’t get mental health care,” she said. “This can be compounded in a small place like the Vineyard. People know who drives what car, where the therapist’s offices are, or maybe the receptionist knows their brother-in-law. I remember hearing a story on NPR a while ago about the high rate of suicides there, and thinking that Telehealth is the perfect answer for that.” Dr. Gentile also said telemedicine may be a good solution for younger patients who are more acclimated to interacting online.
Although there are no Massachusetts board-certified psychiatrists who can prescribe medications currently accessible through Amwell, there are plans to add them by the fall of this year. “In the meantime, online physicians in our group are able to prescribe medications like antidepressants as well,” she said.
Telemedicine can be a lifesaver. Dr. Gentile said there have been instances where a primary-care doctor has, in an online appointment, determined a person to be suicidal, and contacted local emergency responders, and also consulted with the emergency room physician prior to treatment.
“We do a lot of addiction counseling,” she said. “We can do everything but medical detoxification, like when someone in the acute phases of alcohol withdrawal needs a controlled substance; otherwise, we can absolutely help.”
Dr. Charles Silberstein, staff psychiatrist at Martha’s Vineyard Hospital, and one of three psychiatrists practicing on the Island, is not associated with American Well, but he does practice psychiatric telemedicine. He said initial visits are always in person, but that technology can compensate for geographical challenges.
“A lot can be done with videoconferencing,” he said. “I see a number of patients on the Cape and Nantucket that way. Some [seasonal residents] see me in person when they’re here, and we continue with teleconferencing when they go home, and it works well for them. It can be helpful to see people in their own environment. I prefer to see people in person; there’s a chemistry you get in the room that you can’t get on video. But anything that increases access to the people who want it is a good thing.”