"We've been seeing that shift, as everyone has, from inpatient care to other points of care," said Lynn Simon, Community Health's president of clinical services and chief quality officer. "People are really moving towards convenience and easy access."

Initially, the companies are offering the Web visits in Oklahoma and Washington. They plan to expand them to parts of Arizona and Pennsylvania by the end of March, and to other areas later on.

Community Health, based in Franklin, Tennessee, is the second-largest U.S. chain of for-profit hospitals, with 30,000 beds. Simon said the Internet visits, which cost $39, won't shift patients from Community Health's emergency rooms and clinics, many of which serve rural communities.

Instead, the people who show up probably wouldn't have gone to see a doctor otherwise. The company figures that when Internet customers do need more care, they'll choose to go to Community Health's facilities, she said.

Roy Schoenberg, co-founder and chief executive officer of American Well, said urgent care is just the starting point.

The Boston-based company has a three-year deal with Community Health that can be extended for an additional year. Both firms declined to comment on the financial terms of the deal.

"The engagement between American Well and Community Health is a very significant engagement that gives them the infrastructure, the flexibility and all of the tools they need to be as aggressive as they can possibly be with telehealth," Schoenberg said. "This is a phased rollout, and that's the right way to do it." Closely held American Well competes against the publicly traded Teladoc Inc.

Community Health may expand its use of online visits to fields such as chronic disease management, behavioral health, and consultations with off-site specialists, depending on demand, according to a company spokeswoman.

Schoenberg said other uses can include taking care of homebound patients with cancer or lung disease, and following up with individuals after surgery.

"Most health systems that are entering the world of telehealth start by saying, 'We're going to do the simplest form of interaction,'" Schoenberg said. "The technology is built with the understanding that once you create the ability to deliver care online, its application extends to patients with a variety of conditions."

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