Abstract
Introduction
Claims data raises the possibility that on demand telemedicine programs might increase
new utilization, offsetting the cost benefits described in some retrospective analyses.
We prospectively evaluated the cost of a synchronous audio-video on-demand telemedicine
taking into account both what patients would have done instead of the telemedicine
visit as well as the care patients received after the visit.
Materials and methods
We conducted a prospective observational study of patients who received care from
an on-demand telemedicine program. At the time of the visit, we surveyed patients
about the alternative care that would have been requested, if they had not done the
telemedicine visit. We also obtained information following the visit about what further
care was received. Using cost data derived from the literature we performed a sensitivity
analysis to determine the cost impact of the on-demand telemedicine visit.
Results
There were 650 patients enrolled with a mean age of 37 who were 68% female; 74% had
their care concerns resolved on the telemedicine visit; only 16% would have “done
nothing” if they had not done the telemedicine visit, representing possible new utilization.
Net cost savings per telemedicine visit was calculated to range from $19–$121 per
visit.
Conclusions
In our on-demand telemedicine program, we found the majority of health concerns could
be resolved in a single consultation and new utilization was infrequent. Synchronous
audio-video telemedicine consults resulted in short-term cost savings by diverting
patients from more expensive care settings.
Keywords
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References
- State of Telehealth. Campion EW, ed.N Engl J Med. 2016; 375: 154-161https://doi.org/10.1056/NEJMra1601705
- Teladoc.Inc. Annual Report, Purchase, NY2016
- https://www.gpo.gov/fdsys/pkg/BILLS-115hr1892enr/html/BILLS-115hr1892enr.htmDate accessed: April 28, 2018
- Analysis of Teladoc use seems to indicate expanded access to care for patients without prior connection to a provider.Health Aff (Millwood). 2014; 33: 258-264https://doi.org/10.1377/hlthaff.2013.0989
- Urban telemedicine enables equity in access to acute illness care.Telemed. 2017; 23: 105-112https://doi.org/10.1089/tmj.2016.0098
Bryant M. Telehealth Vendors Getting Value Out of Partnerships. HealthcareDive.com. http://www.healthcaredive.com/news/payers-telehealth-vendors-getting-value-out-of-partnerships/421463/. Published June 23, 2016.
- HealthPartners' online clinic for simple conditions delivers savings of $88 per episode and high patient approval.Health Aff (Millwood). 2013; 32: 385-392https://doi.org/10.1377/hlthaff.2012.1157
- Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review.Telemed e-Health. 2015; 21: 81-85https://doi.org/10.1089/tmj.2014.0053
- Direct-to-consumer telehealth may increase access to care but does not decrease spending.Health Aff (Millwood). 2017; 36: 485-491https://doi.org/10.1377/hlthaff.2016.1130
- Virtual visits for acute, nonurgent care: a claims analysis of episode-level utilization.J Med Internet Res. 2017; 19https://doi.org/10.2196/jmir.6783
- Where Are Your Employee's[sic] receiving care?.
- Employer Best Practices in Telehealth.MA, Boston2015
- Telehealth framework to support measure development.
Article Info
Publication History
Published online: August 07, 2018
Accepted:
August 7,
2018
Received in revised form:
August 3,
2018
Received:
July 20,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
