Inside UnitedHealth Group's national telemedicine initiative

The insurer hired an expert to advance telehealth across the company -- and across the country.

UnitedHealth Group, which serves more than 75 million people, is rolling out a telemedicine initiative. The insurer hired as its vice president and medical director for telehealth Dr. James Woodburn to advance telehealth across the company -- and across the country.

I spoke recently with Woodburn about Connected Care, which is described as "the first, national telehealth network that will connect patients to leading primary care physicians, specialists and hospitals, regardless of location."

How does Connected Care differ from other telemedicine efforts?

We've spent a lot of time over the last almost two years now looking at multiple areas. We have hardware, cameras, high-definition flat panel LCD screens, electronics that control the data input so pictures can go from one location to another. We've worked on clinical training. We've worked on marketing advice for the doctors. But most importantly, we spent a lot of time in the software programming to allow the system to function intuitively, effectively, confidentially. That's really the difference from other products that have been around for 20 or 30 years. It's really the full package of the training, oversight and software the drives everything in a very seamless and intuitive way.

Explain how the software works intuitively.

We've all learned from Apple computers that if you can just push a button, magic happens. We spent a lot of time with our graphical user interface, the actual screens that show up on the computer system. They describe in English the step that needs to happen. For example, we have a full scheduling system embedded into our platform. With some simple point and click and keyboard entry, appointments can be booked very easily.

Talk a bit about the system's hardware.

The hardware is an important part of the puzzle. We started out with a Cisco system, very high-definition, top of the line camera. A company in Boston is our supplier of stethoscopes, movable examination cameras that we can use to zoom in on a patient's skin rash. We can look down the throat or in the nose. Those are the two main components. One is the camera and TV screen, so the doctor can see the patient and the patient can see the doctor. Then there is the examination equipment, so the medical attendant or the nurse sitting next to the patient can be the hands and the eyes of the doctor who is sitting 10 miles or 1,000 miles away. That similar setup was what astronauts have used.

How do patients access the system?

The patients does have to go to a clinic where a medical attendant will be in an examination room. Our system will be in there and that attendant will have been trained to work on our system and to be the partner of the doctor during that clinical evaluation.

Do you have systems already operating?

We actually have had our own telemedicine clinic running here in Minnesota since last September. This is a clinic located in our headquarters where our employees can get a telemedicine evaluation by a doctor who is about 10 miles away. We're also involved in the Cisco systems San Jose clinic pilot which began almost two years ago. We've launched our clinical program in Colorado. That's going to be equipping three provider locations with four rural Colorado locations, so the doctors at Centura Health will be able to reach patients in four distant locations. We've also launched a mobile telehealth unit specifically for New Mexico.

How much does it cost to launch a system?

We have a variety of service agreement prices. Generally speaking, for a few thousand dollars a month, the clinic we're working with would pay us for that service that includes all the hardware costs, the software, the clinical education, the training, the marketing material, the connection fees, malpractice.

What's the reasoning behind launching and promoting system? Does it have to do with the doctor shortage?

Physician shortage certainly is critical and it's an element that we're addressing with our telemedicine program. But first and foremost, it's to speed the access to care for patients that are in need. It takes hours to get across the Rockies. Being able to provide much more convenient and much faster access to important clinical evaluation management by doctors on the other side of the Rockies, that improvement of access leads to greater satisfaction of the patient. It also improves the quality of care. If you can see your doctor to get your ailment treated quicker, chances are it's not going to get worse in the meantime. We improve access and we improve the quality of care. When you do those two things the cost of care will go down.

What are the problems with these systems? Isn't there a risk of misdiagnosis when the doctor isn't in the room with the patient?

In the hundreds of articles published over the last four decades, that is not a problem that is of major significance. What we learned along the way is that there are times when a patient should not be seen using telemedicine. The skill and the training of the practitioner who is there with the patient, the quality of the diagnostic, the implementation of electronic health records [are all] safety nets to make sure that potential scenario of a misdiagnosis is minimized.

What do you see in the future of telemedicine?

Part of the important and valuable elements of the health reform package includes direction to Medicare and Medicaid plans to increase their coverage for telemedicine services. We expect and anticipate that there will be more coverage for telemedicine services that will markedly accelerate the adoption of the technology. UnitedHealth Group, from a commercial payer perspective, made the decision to pay for a telemedicine visit at the same rate as face-to-face visits for the providers in our network and for beneficiaries covered under our plan. We believe that should [other] health plans provide more reimbursement for telemedicine that providers [would] be much more enthusiastic to get the system set up. The third thing that's working in everybody's behalf is the federal stimulus money that's going to pay for high bandwidth connectivity in rural locations around America. These are all fairly new and very significant changes in the landscape to where now the cusp of telemedicine application has been reached.

Image, top: Connected Care / Courtesy of United Health Group

Image, bottom: Dr. James Woodburn / Courtesy of UnitedHealth Group

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