BOSTON – With health benefit manager Benemax now offering online second opinions, will similar Web-based services soon be offered by self-funded employers and traditional health plans?

Not so fast, says Bradford Holmes, research director for Cambridge, Mass.-based IT consulting firm Forrester Research: Who's paying for the nascent service and whether such a service is economical have yet to be determined.

Holmes said online second opinions are a good idea but lack economies of scale. Boston-based Partners Telemedicine, which provides the service to Medfield, Mass.-based Benemax as well as to Massachusetts General Hospital, Dana Farber Cancer Institute and Brigham and Women's Hospital, charges $600 to $700 per consultation.

"It's fundamentally about making good medicine available without buying a plane ticket," said Holmes. "It levels the playing field, and is beginning to catch on with self-funded employers in cities that don't have world-class healthcare."

Still, Holmes said, "this service is popular with sheiks. It's a ways off from being a medically necessary service or becoming an insured benefit."

Holmes disputes claims made by David Cowles, executive vice president of Benemax, who said, "Employers can provide this exceptional service without increasing premiums... We believe this program will improve healthcare efficiency, thereby reducing employers' health benefit costs over time."

While Holmes said offering online second opinions is the right thing to do, somebody's got to pay for the service. And if employers and health plans are going to pick up the tab, a strong body of ROI benefits will be required.

"If it reverses a deadly diagnosis, recommends a different course of treatment or finds something that wasn't there before, it's a big win and it may save lives," said Holmes, "but if the amended treatment is expensive, the argument that this benefit saves money may not sway employers or health plans."

Dr. Joseph Kvedar, director of Partners Telemedicine and president-elect of the Washington, D.C.-based American Telemedic Association, said that while the concept of online second opinions may seem foreign, he believes the service will eventually get adopted into the mainstream.

"Employers want employees to take ownership of their healthcare," he argued.

Kvedar believes online second opinions have already demonstrated their value: 90 percent of Partners Telemedicine consultations have resulted in a significant change to an individual's care plan.

Harvard's 4,000-member medical faculty provides deep knowledge in any given subject, Kvedar said, raising the quality of care.

"One has to believe that if you get patients to the right therapy sooner, you save money in the long term," said Kvedar, whose firm is in the process of gathering data to demonstrate real ROI.

With a 27 percent growth over 2002 and a predicted 50 percent growth over 2003, Partners Telemedicine has at least demonstrated that people are willing to pay out of pocket. But the question remains whether self-insured employers and health plans will eventually feel the same way.