American College of Physicians: Internal Medicine — Doctors for Adults ®


How one health plan pays physicians for cybercare

From the September 2000 ACP-ASIM Observer, copyright 2000 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

While everyone talks about the Internet's potential to change medicine, a big question remains: Will physicians get paid for their time online?

While the answer to date has been a resounding "no," one health plan intends to change that. First Health Group Corp., a 10-million member preferred provider organization (PPO) based in Downers Grove, Ill., will begin paying its more than 280,000 physicians for Internet consults later this year.

First Health members can already build a personal health care Web page on the health plan's Web site to check up on claims and get personalized medical information. Members enrolled in a First Health Care Support disease management program for diabetes, asthma or hypertension will soon be able to communicate with their physician through their personal pages.

First Health will pay physicians $25 for electronic consults, the same rate it pays for preventive services. Because the consults are conducted through the health plan's Web site, physicians will be automatically paid without having to file a claim. The health plan hopes to expand the program to other disease management programs for congestive heart failure, high-risk pregnancies and HIV.

Scott P. Smith, FACP, First Health's vice president and national medical director, said data show that increasing office contact with physicians helps reduce hospital visits for chronic disease patients. He sees e-consults as an important way to expand that contact. Although First Health hasn't set a limit on how many cyberconsults it will pay for, Dr. Smith said that the health plan will be more generous than the current once-per-quarter maximum for chronic care encounters.

The health plan also anticipates growing consumer demand. "Research shows that 25% of the patients who use the Internet for health-related information would be interested in online physician encounters," Dr. Smith said. "That's a subset of the patient population—but it's a substantial number, and we want to start figuring out the best way to do it."

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