accessing patients’ private medical data electronically and putting it onscreen alongside all of the real-time communications. Not to mention creating an architecture that can exchange data with the vast mishmash of private databases and data warehouses maintained by health plans around the country, while respecting each plan’s unique authorization and accounting procedures.
Then, of course, there’s the problem of convincing physicians, never a particularly tech-friendly bunch, to make themselves available online—which means demonstrating, among other things, that the system will provide them with the patient data they need to make good medical decisions, that they’ll be compensated for their time appropriately, and that they aren’t exposing themselves to huge malpractice liability risk.
The problems, in short, seem insurmountable, which is probably why there aren’t a lot of companies attempting to surmount them. But now that a health plan as prominent as HMSA has bought into American Well’s service—and has committed to roll it out to hundreds of thousands of users in just over six months—the era of “Health 2.0,” when some of the best innovations from the consumer Web might be applied to the nation’s famously inefficient healthcare economy, suddenly seems a lot closer.
To hear Roy Schoenberg talk, the company has thought through many of the obvious obstacles. It has even arranged (with insurance company AIG) for malpractice insurance that protects doctors against liability that might arise from medical misjudgments during their online sessions. “The reason it took a year and a half to develop this is not just that we are marrying a real-time interactive component with a telephony infrastructure with three or four million dollars’ worth of server hardware,” he says. “It’s the fact that all of this has to tie into the way the healthcare system actually works—what makes a health plan cover or not cover a transaction, the huge mix of claims processing and predictive modeling and performance-based measurement systems that ends up allowing one patient to talk to one provider.” Now the company just needs to show that the whole system works, and that it brings real value to consumers, physicians, and insurers.
Partnering with Microsoft could help sell the idea to consumers. The Redmond, WA, company introduced its HealthVault consumer health information service last October; more than just a Google Health-style repository for personal health records, it’s designed to interface with dozens of independently-developed online health applications, such as GeneMedRx’s database of adverse drug interactions, and even with Web-enabled home medical devices such as blood pressure cuffs, scales, and glucometers. Just last week, Microsoft unveiled more than 40 new health applications and gadgets designed to work with the platform.
“HealthVault is going to give us three big things,” says Ido Schoenberg. “First, it’s going to create connectivity—my glucometer at home will now talk to HealthVault and we can upload that information directly into American Well, so that my blood sugar readings will be available directly to my primary care physician. The second thing is portability—it’s an independent domain completely controlled by the consumer, who decides when and how to share the data. The third thing is access—we are going to make the HealthVault service available from HMSA’s domain, and there will be other ports of entry. The integrated solution is going to premier first in Hawaii, which is a unique and wonderful place to start.”
Why Hawaii? It’s actually not hard to understand why a Web-based system like the one American Well and Microsoft are trying to build would appeal to HMSA administrators. “With the exception of one very large population center in Honolulu, we are essentially a very rural state,” says Michael Gold, HMSA’s chief operating officer. “So we’re experiencing the same problems that other rural areas have attracting and keeping physicians and supporting sophisticated practices. And we have an added problem, which is that often you can’t just drive over a mountain to get to the medical system that exists in Honolulu—you are separated by water. So we spend an enormous amount of money flying patients into Honolulu and flying physicians out to the other islands. This technology gives us the opportunity to stop moving bodies back and forth, and simply connect people over distances so they can get the kind of care they want.”
Come January, Hawaiians will get to see whether American Well’s system really can bring them that care. Ido Schoenberg, for one, is convinced that both patients and providers will see the benefits in the new technology. “The value that we bring to consumers is the convenience of being able to pick up a phone or go online and talk to a doctor; the immediacy of being able to get in front of that doctor in 20 seconds; choice in the number of providers they can reach; and affordability, since the system takes away a lot of the overhead costs that you see in normal care. The value to providers is also clear—the convenience of working anytime they choose and increasing their revenue while improving their lifestyle, without having to worry about co-pays, or claims processing, or even malpractice.”
It may still sound too good to be true—but Microsoft gives American Well a credible partner, and Hawaii gives it a viable proving ground.
