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Online health care a growing trend among seniors

Jason Weston is a senior developer at Virtuwell,

Jason Weston is a senior developer at Virtuwell, which is headquartered in St. Paul, Minn. Credit: TNS / Jeff Carpenter / Health Partners

MINNEAPOLIS, Minn. — The nascent trend of patients getting health care online is coming to the Silver Sneakers crowd.

A growing number of Medicare health plans are introducing “virtual visits” as an option for seniors, with formats ranging from live video connections with doctors to online information exchanges with nurse practitioners for handling minor ailments.

For several years, the e-health trend has focused on the under-65 crowd, with online services marketed to busy parents and younger professionals accustomed to both the internet and mobile devices.

Aversion to technology and complicated health conditions likely make virtual visits virtually impossible for many with Medicare coverage. But there’s a growing number of “silver surfers” who are spending more time online and are likely willing to give virtual health care a try.

“I don’t sell seniors short on their ability to take up on this new model at all,” said Ezra Golberstein, a health policy researcher at the University of Minnesota. “It’s not going to be for everybody . . . but it is a useful addition.”

Service for Medicare plans

UnitedHealthcare, the nation’s largest insurer, based in Minnetonka, Minnesota, launched virtual visits in January for more than 1.1 million people enrolled in the company’s Medicare health plans.

“We’re seeing a lot of Medicare plans begin to add telehealth services,” said Dr. Sylvia Romm, a medical director with American Well, the Boston-based company that’s one of two outside vendors providing the UnitedHealthcare service. “And we’re seeing good uptake from older Americans.”

The coverage applies only to “Medicare Advantage” plans where seniors obtain benefits through a private health insurer, rather than the traditional Medicare program. Kentucky-based Humana, which along with UnitedHealthcare is one of the nation’s largest Medicare Advantage operators, started offering virtual visits in some states last year.

HealthPartners is launching Facebook ads this year — directed at seniors — touting its Virtuwell service, where nurse practitioners provide diagnosis, treatment and prescriptions for more than 60 common conditions like sinus or bladder infections and minor skin conditions.

HealthPartners has published studies documenting savings with the service, said Dr. Kevin Ronneberg, a vice president at the company, adding that Virtuwell lets patients get care at times they might otherwise go to costly care settings like urgent care and ERs.

Historically, seniors have been late adopters of technology, but many are making deeper dives into the online world, according to the Pew Research Center.

Among seniors, the Pew survey found two distinct groups. Younger, more highly educated or more affluent seniors tend to have “relatively substantial technology assets,” the report said, plus a positive attitude about the benefits of online life. Older and less affluent seniors, including those with significant health problems, often are cut off from the new technology tools.

There isn’t a lot of good evidence yet about the quality of care with virtual visits, said Dr. Ateev Mehrotra, a Harvard Medical School researcher who has published studies on the trend, which he calls “direct-to-consumer telemedicine.”

Testing rates among those receiving online care are lower, research has suggested, a finding that could be a good thing or a bad thing depending on the condition, Mehrotra said.

“These treatment options are very good for patients who are generally healthy, and this is just a problem that they have and they need to get it taken care of,” he said. “For patients who have a lot of chronic conditions, it gets a lot more complicated in terms of what medications can be chosen and also what could be going wrong with them.”

Seniors are more likely to have complicated health problems, so online care might not be as good an option, Mehrotra said. And many seniors have close relationships with their primary doctors, which also might make virtual visits a tough sell.

In the vast majority of cases, Mehrotra said, patients who talk with a doctor through online video are not talking with their regular physician.

Completement to doctor visits

In a study published in Health Affairs earlier this year, researchers estimated that just 12 percent of direct-to-consumer telemedicine visits replaced visits to doctor offices or emergency rooms, while 88 percent represented new use of medical services.

“There may be a dose response with respect to convenience and use — the more convenient the location, the lower the threshold for seeking care and the greater the use of medical services,” Lori Uscher-Pines, a policy researcher at Rand who worked with Mehrotra on the study, said in a statement.

The point isn’t to shut down telemedicine, Mehrotra said, but to get insurers to consider whether the visits add enough value to justify the cost, rather than rely on what he sees as the “erroneous argument that such visits save money.”

Susan Malley, 68, of Duluth, Minnesota, has worked for decades in health care IT and says she sees potential benefits for patients and the overall health care system with online care. Some seniors love using Skype or FaceTime, she notes, to talk with faraway grandkids.

But Malley also sees plenty of seniors who lack computer skills, particularly in her work as a volunteer instructor teaching classes for seniors who want to learn about the internet. Virtual visits won’t work for those Medicare beneficiaries, she says, adding that she fears the trend is being pushed to compensate for all the physicians who have left the profession out of frustration in recent years.

“We’re in a huge transition phase,” Malley said. “We still have a tremendous part of the population that says: ‘Huh? I don’t even want a cellphone.’ ”

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