Text Visits Could Shift Paradigm for Primary Care Providers

Patients enrolled in Anthem’s health insurance plans might soon have a new way to connect with their physicians: through text message. The company this month said it is partnering with app developer K Health to develop a co-branded app that will enable patients to chat with their providers for less than the cost of a typical office visit copay.

The deal is just the latest in a wave of partnerships and app launches that aim to facilitate text-based communication between providers and their patients. The moves could increase convenience for patients. However, it might represent a significant shift in the way physicians “see” patients.

James Ellzy, M.D., a family physician in Washington, D.C., told Inside Digital Health™ that text-message communication can be a win-win for patients and physicians, but it’s important that patients understand that text-based communication has its limits.

“I can’t tell you that you’re having a heart attack via a chat,” he said.

But text and chat can offer a meaningful way to provide advice and care, particularly when the physician already has a relationship with the patient or their family.

“I think that relationship between patient and provider being established ahead of time expands what we can do,” he said.

In some ways, text communication isn’t new for physicians. Ellzy said many family doctors already provide their cellphone numbers to patients with whom they have an established relationship, particularly if they are concerned about the patient. He said patients tend not to abuse the privilege.

“In general, most patients are very respectful because they say you are a physician and they’re not going to call you about every little thing,” he said.

However, Ellzy noted that providers aren’t compensated for such interactions. Thus, in case a tool like the Anthem/K Health app increases the number of doctor-patient text interactions, physicians need to know whether and how they will be paid for the consultations.

“I think one of the questions always is, ‘Am I getting reimbursed for that time?’ — especially if it’s part of the health plan,” he said. “Is the health plan going to reimburse me for that or not?”

If text visits are compensated — and if practices can reallocate resources to align overhead with a shift from 100% in-person visits to some mix of in-person and text “visits” — the change could work out well, he said.

In addition to allowing for text interactions with physicians, the K Health app will also allow Anthem patients to schedule appointments and ssee common diagnoses when patients present with similar symptoms.

Aside from the technological implications, the expansion of healthcare-by-text could affect the workflow of providers and continuity of care. Many patients who want quick answers turn to telemedicine providers or retail walk-in clinics.

“What I have seen over the years is that patients who are healthier and younger tend to want convenience over continuity (with their regular provider),” Ellzy said. “Older patients or patients with chronic conditions like to have that continuity because they have so much history to tell that they don’t want to tell that entire history every time they go in.”

When patients choose convenience, though, the records of those interactions often don’t make it back to the patient’s primary care physician.

Apps and services that make it easier to contact the patient’s regular provider might dissuade patients from going elsewhere, thereby keeping the records in house.

At larger practices like Ellzy’s, providers typically rotate “cellphone duty” in which they handle off-hours calls from patients. Such a system could be converted to “text message duty,” Ellzy said. But even if the patient interacts with a different provider at the same clinic, at least those records would still be in house, and the provider who chatted with the patient could personally communicate any pertinent information to the patient’s regular primary care doctor.

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