By Roy Schoenberg, MD, MPH, American Well Systems

After years of discussion and debate, health care reform has begun to unfold in the United States. Although reform’s arrival brings with it many unanswered questions, it is clear the central role of employers in managing employee health will not change.

If anything, it will grow in importance. This reality leaves employers with a tall order to fill: offer innovative health care services that help attract and retain employees, while also increasing productivity and controlling rising medical costs.

At the same time, employee expectations are rising. They are demanding convenient medical services that can fit into their busy schedules. After all, other tasks that touch them daily—banking, shopping, and booking travel—are readily available whenever needed, online, from their homes or desks.

A study from Euro RSCG showed 78 percent of Americans would like to visit with doctors online, too. Instead, all too often, employees take time off of work to travel to, and wait for doctor appointments, or simply lose productivity while worrying about their unaddressed health issues.

Introducing Online Care
To address these challenges, one solution increasingly adopted by employers is Online Care—a service offering employees the ability to come together with health care providers online for immediate, live conversations using video, secure text chat or phone. With Online Care, participating providers make themselves available for online and phone consultations at any time, for as long as they choose and from any location. Employees can log on whenever they have a health need, from their workplace or home (see Figure 1). They simply search for the provider who meets their needs (such as a female, Spanish-speaking PCP) and are connected immediately, without having to schedule an appointment or leave work or home.

During an Online Care visit, employees actually see and talk to a health care provider making the conversation feel very personal (see Figure 2). The provider is able to review the patient’s clinical information, discuss symptoms, diagnose, and prescribe medications as appropriate, for anything from common illnesses such as colds, flu, and sinus infections to chronic care management, behavioral health or nutrition. At the end of the consultation, the employee is encouraged to share a full record of the conversation with his or her primary care physician, maintaining continuity of care.

Online Care debuted in January of 2009, when Blue Cross Blue Shield of Hawaii made the service available to every resident in the state—members, non-members, and the uninsured. During the past two years, Online Care services have grown rapidly and now are offered through leading health plans, delivery networks, retail pharmacy chains and employers from coast to coast.

Figure 1: Online Care enables immediate access to employers
















Impact For Employers
Employers cite several motivations for offering employees Online Care services:
Productivity. With Online Care, employees gain an alternative to taking time off from work or waiting to be seen for a doctor’s appointment. Instead, they can address health concerns as soon as they arise. It allows employees to stay focused and less preoccupied at work or home.
Medical cost. Employers see Online Care as an option that helps employees avoid unnecessary, expensive visits to the ER, urgent care centers or provider offices and address their issues in the lower-cost settings of the home or workplace.
Employee satisfaction. Providing a differentiating service encouraging employees to manage their own health and the health of their families, in a convenient and affordable way, reflects the commitment of an employer to its staff’s well-being.

A growing amount of market experience illustrates how these goals are playing out for employers around the country. Three leading health care companies—Blue Cross and Blue Shield of Minnesota, OptumHealth, and Blue Cross Blue Shield of Western New York— who are working together with employers, provide a particularly valuable view of Online Care in action.

Figure 2: A live Online Care conversation















Blue Cross and Blue Shield of Minnesota
In late 2009, Blue Cross and Blue Shield of Minnesota (Blue Cross) became the first health plan in the continental U.S. to offer Online Care services.

“We saw the potential for Online Care AnywhereTM to improve the health and well-being of consumers across Minnesota, but felt it had a particularly compelling value for our employer partners,” said Sig Muller, VP business development for Blue Cross. “Employers were looking for a way to improve employee access to care and provide convenient options beyond the time and expense associated with traditional doctor visits.”

As a result, Blue Cross began its path toward a statewide consumer rollout by making Online Care Anywhere available to its own employees and their family members, from their homes or workplaces.

To facilitate access, Blue Cross also devised a further innovation—the “Virtual Employee Clinic”—a private, secure room in the office where employees can go to use Online Care Anywhere services. Blue Cross set up four Virtual Employee Clinics on its campus, each equipped with a computer, webcam, phone, and printer, as well as a biometric machine to record data such as weight, body mass index (BMI) and blood pressure.

The feedback from Blue Cross employees has been very positive. Ninety percent of employees reported they were very satisfied or satisfied with the Online Care Anywhere service. One employee shared, “My wife used the service twice and so did a few of my direct reports. All provided very positive feedback on the experience. This says a lot about the company and ‘walking the talk’ if you ask me.”

Another employee said, “I just had my first call to a physician for my eye infection problem. The doctor was outstanding and it was quick and very efficient. I will use this great service again—what a time saver.”

By mid-2010, due to strong employer demand, Online Care Anywhere was extended to additional employers, including global medical technology leader Medtronic and food manufacturer Schwan’s. Both companies began offering Online Care Anywhere to all employees and their families.

Similar to Blue Cross, Medtronic has set up three Virtual Employee Clinics around its facilities, and Schwan’s has created four. Based on the enthusiastic response, Blue Cross decided to expand availability of Online Care Anywhere to all residents of Minnesota.

What results have Minnesota employers seen? Blue Cross continuously conducts surveys among Online Care Anywhere users to understand their care experiences. They found the service is indeed impacting productivity. In terms of time-savings, 73 percent of users saved an hour or more by using Online Care Anywhere instead of goingto see a provider elsewhere—with many of those  hours reflecting paid work time.

In addition, 85 percent of employees completely resolved their health issues with Online Care Anywhere, eliminating the need for in-person visits and ensuring they could quickly return to work and family life. Finally, employees shared they used Online Care Anywhere instead of more expensive settings, including provider offices, retail clinics, and urgent care.

OptumHealth
OptumHealth, a business of UnitedHealth Group, was the first company to create an Online Care service that is national in scope: NowClinicSM online care.

“We are committed to offering all consumers access to convenient, affordable health care services,” said Rob Webb, CEO of OptumHealth. “However, NowClinic sees particularly strong demand from employers around the country who are looking to offer employees an innovative new service that also improves their family and work lives.”

With that in mind, OptumHealth joined forces early on with one of its most prominent employer partners: Delta Air Lines. Through OptumHealth’s NowClinic Online Care service, all Delta’s Minnesota-based employees and family members have real-time access to a network of physicians, around the clock. As NowClinic expands across new states, its “anytime, anywhere” ethos matches well with Delta’s busy, highly mobile workforce.

Following the Delta launch, OptumHealth announced the expansion of NowClinic to all consumers across all of Minnesota. Several additional employers, yet to be announced, also have begun working with OptumHealth to offer NowClinic to employees in multiple states. By choosing to leverage Online Care, OptumHealth is able to increase access to care for employees when they need it most—whether it occurs during work hours, in the middle of the night or on weekends.

Figure 3: Physician -Based "Reverse Practice"











Figure 4: Health & Wellnes-Based "Reversed Practice"

Blue Cross Blue Shield of Western New York
Blue Cross Blue Shield of Western New York (BCBSWNY) became the first company to offer Online Care on the East Coast with the introduction of its Online Care NYSM service. Although it has made this service broadly available to members throughout its home region of Buffalo, BCBSWNY has engaged local employers and made a special effort to drive awareness among its own employees.

This included an innovative way of introducing the service: commissioning a local theatre troupe to bring the Online Care concept to life through a series of performances for employees. A cast of professional actors, writers and directors created “Mouse Calls,” an interactive workshop illustrating the benefits of Online Care, when employees should use it, and the experience of interacting online with a local physician—all using reallife vignettes. Ten theatrical presentations took place over the course of four days at BCBSWNY’s headquarters.

“We felt it was appropriate to think out-of-the-box when bringing such an innovative
new service to our employees,” said Cindy Eberl, director of physician outreach at BCBSWNY.

In addition to Mouse Calls, BSBCWNY created a suite of four, state-of-the-art Virtual Employee Clinics at its headquarters, designed to provide employees with a private setting to consult with providers and keep Online Care top-of-mind. BCBSWNY also has begun working closely with its employer partners, who also have conducted events to inform employees about Online Care and opened Virtual Employee Clinics, on-site.

A-la-Carte Employer Practices
As employers increasingly adopt Online Care, efforts are under way to further enhance the service’s value to employees and their families. One new development is the “Reverse Practice”—the ability for employers to assemble a dynamic, constantly changing spectrum of health care professionals that accurately caters to the profile of employees and their needs (see Figures 3 and 4). Such practices that can morph based on employee traffic, is one of the unique advantages of Online Care. These have a significant potential to reduce the “trial and error” approach many employers reluctantly go through as they pay for health interventions for their employees.

They involve:
New provider types –
Employers are realizing Online Care services provide an opportunity to make a broad range of experts and specialists available online, from sleep specialists to fitness experts and pharmacists. These new provider types ensure employees turn to Online Care not only when they are sick, but when they want to improve their overall health and well-being.
Flexible and tailored services –
Employers also are looking to offer Online Care services reflecting the needs of various segments of their workforces and that can be adapted over time. For example, a retailer with young associates may value having a nutritionist and fitness coach available for consultations about healthy living, while an older, chronic population may benefit from a team of primary care providers, cardiologists, and nutritionists to help manage hypertension and high cholesterol.

As the health care system experiences great change, employers are taking extra strides to offer services that help entice and retain employees, all while managing productivity and rising health care costs. The experiences of employers across the country are illustrating the potential of Online Care to deliver on these needs.

Roy Schoenberg, MD, MPH is CEO of American Well Systems.