Tackling Health Care’s Scheduling Problem

Sometimes someone really hits the nail on the head. And I think Roy Schoenberg, M.D., CEO of American Well, did when I recently spoke with him about consumer disconnect.

The timing was perfect because I had recently suffered that disconnect. I had a horrific sinus infection, the same one I get every spring, and called my primary care doctor. A nurse got back to me, listened to my litany of complaints and told me that I couldn’t get a prescription over the phone. By that time I saw a doctor three days later and got my diagnosis confirmed I already had an ear infection. And to add to my misery I was away from my job, this job I so dearly love, for a half-day.

The way Roy sees it, and I wholeheartedly agree, is that we don’t so much have a technology or expertise problem when it comes to providing care; we have a chronic scheduling problem. Proving the most timely and high-impact so often hinges on everyone--providers, technicians, patients, families--being in the right place at the right time. And, let’s be honest, that takes a miracle and the whole process is so often unnecessary. I as a consumer have a lot of technology at my fingertips, as do doctors and nurses. No reason it shouldn’t be put to good use when I have a sinus infection and no car, and a doc has an hour of free time to check in online.

 “People disregard how much scheduling gets in the way of care … if the doctor, patient and everyone else can’t get together at a certain appointed time and place, then the care system breaks down,” according to Schoenberg. That’s painfully obvious if you think about your experiences as a consumer, not a provider, of care. And it’s especially true, Roy says, for people with chronic diseases who have a good idea what kind of specialists they need to speak with, but don’t have the time to go see multiple caregivers during the small window of time they really need help.

American Well has come up with an elegantly simple solution. It works with big insurers and hybrid health systems/health plans to create online meeting places for patients and physicians. Physicians within a payer or provider network log onto the network to announce their availability for online consults. Patients pick a physician and then exchange messages to get to the root of the problem. If necessary, such in the case of the chronically ill, multiple specialists can be brought into the conversation. American Well’s clients use the service in different ways  … some charge for a regular office visit, others make patients pay an out-of-pocket fee for an online consult.  Some even take patients “off the street” and have them pay full freight for the services.

There are a couple of innovative twists that make this work. Many docs are leery of treating via the Internet because of the threat of malpractice suits. American Well solves that problem with an agreement with the Lexington division of insurance giant AIG. For each online individual consult, AIG issues a malpractice policy for the physician. In addition, the company and its clients ensure patients and physicians aren’t having a “blind date” by interfacing the online system to payer/provider data repositories or with patient personal health records stored in the HealthVault service from Microsoft Corp. Patients also fill out standardized questionnaires before they connect to a caregiver.

This and similar services can go a long way to take care of the low-hanging fruit that's clogging up the system and making it difficult for providers to focus on the patients who really need hands-on services at a care facility, services rendered by physicians not mentally harried from churning through a string of patients with minor complaints (who are in no mood to be thankful since they had to haul their carcass to the doctor's office). 

 Roy says that American Well’s clients are finding that the online service is a market differentiator. “Let’s face it, the differences between what health insurers are offering employers in terms of coverage, price, etc., are really very minimal,” he says. “But when an insurer can tell an employer ‘we can offer a service that can connect your employees to a doctor in 30 seconds,’ that really gets peoples’ attention.”

That may be true, but it’s also sad … I’m not really sure why more insurers and physicians (including mine) aren't making better use of the Internet and make health care a lot more convenient on both sides of the equation.