Q. What are the benefits to health plans for facilitating online or electronic visits?

A. Strategically, if the health plan can govern how care is rendered to any of its different members, the health plan would be in a much better position to manage medical costs. Health plans have a very keen interest in trying to make sure that consumption of services is going to take place in the least-expensive cost setting. Much of their interventions, whether it is utilization management or disease management or case management, is all about trying to coordinate care so that if it needs to take place, it is going to take place at the setting where it is least expensive. By introducing online care, they can essentially keep the interaction between consumers and the healthcare system to the least-expensive setting.

In addition, online care from a consumer's standpoint is a radical change in how health plans are positioning themselves from a competitive standpoint in terms of quality of service. If I'm a consumer of one health plan that offers me the ability to interact with physicians from home whenever I need to, versus a health plan that still requires me to schedule an appointment and walk or drive over in bad weather, then from a consumer standpoint, there is a very significant difference between the benefits that are offered by the health plans. That will, in turn, percolate into employers' choice of buying services from one health plan versus another. From a medical-cost standpoint as well as from a competitive standpoint, online care essentially rewrites the business.

A. I think that's very fair to say. Very intuitively, health plans have been competing between each other primarily on quality of care. What we see now, however, is that health plans are beginning to realize that there is this little other bucket that plans have notoriously not been embracing, which is the whole notion of quality of service.

Like every other industry, we know that in this age, the companies that succeed are the companies that deliver quality products at the level of convenience and quality of service that consumers are looking for. With the offering of bringing healthcare into people's living rooms, the health plans are making a significant shift into acknowledging the fact that quality of service is a huge differentiator.

Q. What's the risk to payers of not offering online care?

A. There is a two-pronged threat to the health plan. If you're not going to offer online care, not only will you lose your membership, you will begin to see issues that are going to surface with your provider pools, because you're not delivering to them [a service offering] that they can get from other health plans. By offering online care, the health plan also delivers a sense of freedom to its providers. It allows them to practice in a way that is much more tolerable. The health plan essentially gives its own providers a benefit.

And one other risk that I think health plans may want to consider is the fact that if online care is not going to be made available to consumers through the health plan, they are forcing those consumers to essentially turn away, and in a way forcing the market to create a new kind of product outside of the health plan. If payers are not going to introduce online care, someone in the market will quickly grasp the fact that there can be an alternative for it. And that is a very important consideration for health plans.