Virtuwell: The Goldilocks of e-consults

I've been watching the patient-clinician e-messaging field for 10 years. My firm helped webVisit pioneer Healinx (later renamed RelayHealth) develop its business model, and we've kept close tabs on other innovators such as American Well's live consultation program and MinuteClinic's in-store, nurse practitioner model.RelayHealth has the advantage of connecting patients and doctors who have an established relationship. The service is asynchronous, meaning a patient provides information, then receives a response from a doctor within a day, sometimes sooner. That helps the doctor fit webVisits into their available time and doesn't disrupt their workflow. Patients don't have to skip work to come to the office. It took a decade but health plan reimbursement for webVisits is now fairly routine.American Well represents an ambitious attempt at online health care. The idea is to make a physician available for an online consultation in real time. That's a challenge to operationalize, however, because you need a lot of docs ready to sign on at any given moment.MinuteClinic and other quick care clinics are good, too. They use nurse practitioners to diagnose and treat straightforward issues. They are convenient and cost effective but hard for their owners to profit from. They take selling space away from the front-store merchandisers at CVS and are hard to scale. Each site needs its own Nurse Practitioner, which is an expensive employee to sit idle. On the other hand, it defeats the purpose of MinuteClinic if it isn't staffed up sufficiently to handle walk-in patients.Now along comes Virtuwell from HealthPartners in Minnesota with a clever approach that addresses some of the weaknesses of each of the three models above. Patients answer a series of questions and their responses are sent to a HealthPartners Nurse Practitioner. Within 30 minutes the NP reviews the answers and responds to the patient. Thirty-one conditions --such as bladder infection, lice and yeast infection-- are within the scope for Virtuwell.Virtuwell uses a similar template to the RelayHealth webVisit. It provides answers reasonably fast (not quite as fast as American Well). And it utilizes NPs to handle routine conditions like MinuteClinic but without requiring a trip to the drugstore. This combination of attributes should make it quite compelling.There's still room for the other services, though. RelayHealth's advantage is that it works within the existing doctor/patient relationship. American Well can bring a specialist up quicker. And MinuteClinic has the in-person touch and quick access to prescriptions if needed.