The results show a promising performance of models predicting cost and hospitalization using outpatient EHR's diagnosis and medication data. More research is needed to evaluate the benefits of other EHR data types (eg, lab values and vital signs) for risk stratification.

"Optimal lifestyle," comprising abstinence from smoking, adequate physical activity, eating 5 servings of fruits and vegetables each day, and consuming limited or no alcohol, is associated with low risk of chronic disease when unselected populations are observed for long periods of time. It is unclear whether these same associations are present when observation is limited to employed individuals followed for a brief period of time. The purpose of this investigation was to study the association between adherence to optimal lifestyle and the incidence of chronic conditions among employees over a 2-year period. Logistic regression was used to assess the association between employees' (N  = 6848) adherence to optimal lifestyle and the incidence of diabetes, heart disease, cancer, hypertension, high cholesterol, and back pain during a 2-year period. All data were self-reported. Adherence to any 3 components of the optimal lifestyle was associated with a significantly lower near-term incidence of diabetes (odds ratio [OR] =  0.56; 95% confidence interval [CI] = 0.31-0.97) and back pain (OR = 0.69; 95% CI = 0.53-0.92). Adherence to all 4 optimal lifestyle components was significantly associated with lower near-term incidence of back pain (OR = 0.44; 95% CI = 0.26-0.76). Physical activity was associated with significantly lower near-term incidence risk of heart disease (OR = 0.60; 95% CI = 0.38-0.95), high cholesterol (OR = 0.80; 95% CI = 0.66-0.99), and diabetes (OR = 0.51; 95% CI = 0.30-0.86). Adherence to optimal lifestyle, in particular adequate physical activity, is associated with lower near-term risk of developing several chronic conditions. Employers and payers should consider this fact when formulating policy or allocating resources for health care and health promotion.

The delivery of health care online is relatively new. However, early indications suggest that it can improve the experience of care for patients and the health of populations, along with reducing per capita health care costs. HealthPartners in Minnesota launched an online clinic called virtuwell in late 2010. After more than 40,000 cases, we report an average $88 lower cost per episode compared with care received in traditional settings, strong indicators of clinical effectiveness, and a 98 percent "would recommend" rating from customers. The possibility of extrapolating such savings to larger volumes of cases is compelling. We suggest a need for regulatory reform, particularly around state-level statutes that create barriers to the expansion of online care delivery, such as those that require clinicians to be located in the same state as the patient and those requiring clinicians to have had a previous face-to-face visit with a patient. Such reforms would encourage further innovation and lead to cost reduction and improvements in access and convenience for consumers throughout the health care system. O nline health care delivery is a relatively new care option. Recent studies have compared quality between online and face-to-face clinical care, 1 e-visit use by physicians, 2 and cost comparisons between e-visits and care received in traditional settings. Within these studies, findings include comparable quality between online and face-to-face care for selected conditions and indications of cost savings. Other findings suggest less positive outcomes such as slow uptake by physicians and possible increased use of antibiotics.Several fundamental questions drive such investigations. Can online care be performed safely, securely, and in compliance with regulations? Will consumers accept care delivered via these new channels, and will they find their experiences satisfying? Can an online care business model deliver compelling cost savings? In short, can e-visits work?Our organization, HealthPartners, is a Minnesota-based, consumer-governed, nonprofit organization that provides health insurance through a health plan and care through a large integrated health system that includes four hospitals and more than seventy medical and dental clinics, as well as a network of contracted providers. In 2010 we launched an online clinic called virtuwell. Two years later, virtuwell's early results suggest that online care has the potential to meet the "Triple Aim" goals of a better health care experience for patients, improved population health, and more affordable health care 4 -especially for conditions typically associated with primary care.