Decades of research has firmly established that telemedicine
expands access to health services for individuals living in remote and rural
areas. Evidence is beginning to accumulate that telemedicine may be “especially appealing” for those “who are
infrequent users of health care and to those who are relatively resistant to
usual outreach methods and vulnerable to untreated chronic conditions in the long
run.” Equally important, development of telemedicine is now intersecting with
rapid and ongoing changes in the health care system’s organizational structure
toward provision of more integrated care models and toward payment protocols
that aim to shift reimbursement toward payment for value. These trends are
accelerating even as different forms of telemedicine are being used in a
complementary fashion; as electronic health records become mainstream;and as
shared electronic record systems are extended to independent practitioners,
community hospitals, and providers of various community-based services
Telehealth services surging despite questions about value - Modern Healthcare Modern Healthcare business news, research, data and events
Investors think consumers will find virtual visits—either by phone or online video connection—more convenient, cheaper and just as effective as in-person doctor visits, particularly for relatively minor urgent-care needs. Insurers increasingly are embracing telehealth. In December, Anthem, the nation's second-largest insurer, announced that it would begin offering telehealth visits with no copay to its Medicare Advantage members in 12 states, including California, Florida and New York.
Advocates of the virtual-visit model argue that expanding access to telehealth services would reduce costs by heading off more expensive urgent care and emergency department care, and that consumers increasingly will substitute virtual visits for in-person visits so that the total amount of services will not rise. But critics question that assumption, cautioning that consumers may use telehealth in addition to traditional in-person visits, thus boosting total spending. They also worry about the quality of video and phone visits compared with in-person visits, and whether virtual care will be coordinated with patients' regular care.
“This fits into a larger initiative we're seeing of trying to provide care in a more convenient way,” said Dr. Ateev Mehrotra, an associate professor of healthcare policy at Harvard Medical School who studies telehealth.
Analysis Of Teladoc Use Seems To Indicate Expanded Access To Care For Patients Without Prior Connection To A Provider
Despite the potential benefits of telehealth applications, little is known about their overall impact on care. This is critical because rising health care costs and a shortage of primary care providers make it likely that telehealth services will play an increasingly important role in health care delivery. To help fill this gap in knowledge, we describe early experiences with Teladoc, one of the largest telemedicine providers in the United States, which provides care directly to patients over the telephone or via the Internet. We analyzed claims data for a large California agency serving public employees that recently offered Teladoc as a covered service. The 3,701 Teladoc “visits” we studied were for a broad range of diagnostic categories, the most common of which were acute respiratory conditions, urinary tract infections, and skin problems. Compared to patients who visited a physician’s office for a similar condition, adult Teladoc users were younger and less likely to have used health care before the introduction of Teladoc. Patients who used Teladoc were less likely to have a follow-up visit to any setting, compared to those patients who visited a physician’s office or emergency department. Teladoc appears to be expanding access to patients who are not connected to other providers. Future research should assess the impact of Teladoc and other telehealth interventions on the quality and cost of care.
Access and Quality of Care in Direct-to-Consumer Telemedicine. - PubMed - NCBI
Access and Quality of Care in Direct-To-Consumer Telemedicine | RAND
BACKGROUND: Direct-to-consumer (DTC) telemedicine serves millions of patients; however, there is limited research on the care provided. This study compared the quality of care at Teladoc, a
large DTC telemedicine company, with that at physician offices and compared access to care for Teladoc users and nonusers.
MATERIALS AND METHODS: Claims from all enrollees 18–64 years of age in the California Public Employees' Retirement System health maintenance organization between April 2012 and October 2013 were analyzed. We compared the performance of Teladoc and physician offices on applicable Healthcare Effectiveness Data and Information Set measures. Using geographic information system analyses, we compared Teladoc users and nonusers with respect to rural location and available primary care physicians.
large DTC telemedicine company, with that at physician offices and compared access to care for Teladoc users and nonusers.
MATERIALS AND METHODS: Claims from all enrollees 18–64 years of age in the California Public Employees' Retirement System health maintenance organization between April 2012 and October 2013 were analyzed. We compared the performance of Teladoc and physician offices on applicable Healthcare Effectiveness Data and Information Set measures. Using geographic information system analyses, we compared Teladoc users and nonusers with respect to rural location and available primary care physicians.
RESULTS: Of enrollees offered Teladoc (n = 233,915), 3,043 adults had a total of 4,657 Teladoc visits. For the pharyngitis performance measure (ordering strep test), Teladoc performed worse than
physician offices (3% versus 50%, p < 0.01). For the back pain measure (not ordering imaging), Teladoc and physician offices had similar performance (88% versus 79%, p = 0.20). For the bronchitis measure (not ordering antibiotics), Teladoc performed worse than physician offices (16.7 versus 27.9%, p < 0.01). In adjusted models, Teladoc users were not more likely to be located within a healthcare professional shortage area (odds ratio = 1.12, p = 0.10) or rural location (odds ratio = 1.0, p = 0.10).
CONCLUSIONS: Teladoc providers were less likely to order diagnostic testing and had poorer performance on appropriate antibiotic prescribing for bronchitis. Teladoc users were not preferentially located in underserved communities. Short-term needs include ongoing monitoring of
quality and additional marketing and education to increase telemedicine use among underserved patients.
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