The doctor is in – cyberspace.

Dr. Mia Finkelston resides in Maryland, about an hour from Washington, D.C., but she sees patients online from Maine and 18 other states.

Finkelston treats patients over the Internet, using a Skype-like system in which a patient and doctor can see each other on a smartphone, tablet or computer. Finkelston wears a white lab coat and sits in front of a partition screen in her home, so that patients “won’t be distracted by the sofa and the rocking chair.”

LiveHealth Online, the virtual doctor program that Finkelston works for, is expanding in Maine because it’s now a covered benefit through Anthem Blue Cross Blue Shield.

Finkelston gave up her brick-and-mortar practice after 20 years as a family doctor, and virtual health is now most of what she does.

She tends to get calls from people worried about symptoms they experienced overnight, or while on a trip.

“I get a lot of people asking things like, ‘Is this a tick bite?’ ” Finkelston said in a video chat with the Press Herald. “A lot of 7 a.m. calls from dads wondering whether their child has pinkeye.”

While LiveHealth Online has been available for about two years to anyone who downloads the mobile app, this summer it became a covered benefit for Anthem customers, and the company is now heavily promoting it. For Anthem patients, using LiveHealth Online is treated the same as a visit to the doctor, with typical co-pays of $5 or $10. Patients who don’t have Anthem but want to use LiveHealth can pay $49 for a 10- to 15-minute consultation.

No Maine doctors have signed up yet to work for LiveHealth, but patients in Maine have many online doctors to choose from who are licensed to practice in the state, Anthem officials said.

By making the service a covered benefit, Anthem should greatly expand its usage in Maine, said Mitchell Stein, a Cumberland-based independent health policy analyst.

Stein wouldn’t be surprised if other insurance companies quickly followed suit, either with LiveHealth or another “telemedicine” program.

“It seems like a natural extension of services and a useful way to keep costs down, so it would make sense for the other insurance companies to follow,” Stein said. “It also benefits the individual because it’s convenient.”

Rory Sheehan, an Anthem spokesman, said insurance company accountants calculated that for Anthem policyholders, every LiveHealth visit saves an average of $71 to the entire health care system, primarily because patients can avoid visiting more costly urgent care centers and will be less likely to go to hospital emergency rooms for non-emergency conditions.

Finkelston sees many people who need reassurance that their symptoms are not acute, or that only need to be prescribed antibiotics. She said a family once called while on a camping trip with a child who had an ear infection. Rather than cut short their trip, she advised them to get pain medication and prescribed antibiotics.

“These are relatively healthy people calling for advice about relatively easy things,” Finkelston said. “I get a lot of calls on Sunday night from people wondering whether they can go to work on Monday.”

Finkelston – who estimates she works about 30 hours per week – chose to give up her brick-and-mortar job for schedule flexibility that allows her to travel more often to see her children play lacrosse.

Some believe that telemedicine will explode in upcoming years. Dallas-based Parks Associates, a company that researches technology trends, predicts that doctor-patient video consultations will nearly triple in one year, from 5.7 million this year to more than 16 million in 2015.

Harry Wang, director of mobile and health product research for Parks Associates, wrote in an email response that it’s not only the convenience that will increase usage, but employers encouraging workers to use the service to “reduce work absenteeism and raise productivity.” Wang wrote that “health care providers will gradually accept this form of care” and that increasing reliance on virtual health will improve “access, quality and cost.”

Dr. Jeffrey Holmstrom, Anthem’s medical director and a primary care physician, said LiveHealth will not usurp primary care.

“This will not replace the primary care physician,” Holmstrom said. “This is an opportunity for enhanced access to doctors.”

With the patient’s permission, each LiveHealth visit is documented and sent to the family doctor.

Holmstrom said that although there are primary care doctors on call on weekends, some people may be reluctant to disrupt their doctor’s time off. In some cases, the LiveHealth appointment may save a primary care office visit later in the week.

Patients’ medical records are not available to LiveHealth doctors, although patients can fill out a questionnaire with their medical history.

Stein said that is one flaw he sees in the system. He said in the future it’s possible that similar telemedicine systems will be available, for example, across the MaineHealth network, for InterMed patients or for Eastern Maine Medical Center customers. That way, while patients may not be having a virtual chat with their family doctor, they could still talk to a doctor in Maine who is part of the same health network and can access their health records and medical history.

Stein said that would be a better situation for patients than having a virtual chat with a doctor in Texas.

Kevin Lewis, CEO of Maine Community Health Options, a cooperative insurer that competes with Anthem, said it has no plans to join LiveHealth, and he doesn’t see how it would benefit the state’s health care system because Maine doctors are not signed up.

“For us, the primary care doctor and patient relationship is paramount, and we will work to strengthen those ties,” Lewis said.

Stein expects virtual medicine will only expand in Maine.

“This is only a sign of things to come,” he said.


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