Acute Direct-To-Consumer Telehealth Leads To More Follow-Up Care

Patients who accessed care for upper respiratory infections through direct-to-consumer telemedicine platforms were more likely to have follow-up appointments than patients who had their initial visit in-person, according to a University of Michigan study that suggests potential setbacks of on-demand telemedicine.

The research, published in Health Affairs, questions whether shifting to direct-to-consumer telehealth services for initial care is successful in reducing acute care costs.

Researchers analyzed data from a large insurer for over 28,700 direct-to-consumer virtual visits and 57,400 in-person visits for acute respiratory infections from 2016 to 2019.

While most visits did not result in follow-up care, 10.3 percent of the patients first seen through a direct-to-consumer telehealth visit had a visit in the following week, compared to 5.9 percent of those whose first visit was in person.

Follow-up appointments included telemedicine visits and in-person visits to clinics, urgent care centers, and emergency departments. While the telemedicine group experienced fewer (0.5 percent versus 0.6 percent) emergency department visits, they had more follow-up office, urgent care, and telemedicine visits.

First author of the paper, Kathleen Li, MD, MS, noted in a press release that direct-to-consumer telehealth providers often lack access to a patient’s EHR, so they may not know the patient’s full care history, including underlying conditions. This could potentially lead to unnecessary healthcare spending.

However, direct-to-consumer telehealth models may help minimize emergency department visits by providing on-demand care to those who cannot access an appointment with their PCP right away. A recent National Poll on Healthy Aging report from IHPI co-authored by Li found that one in eight older adults had gone to the ED after not being able to schedule a timely visit with their PCP.

“If an appointment with a patient’s regular provider isn’t available right away, or the patient isn’t able to get to the clinic in person during standard business hours, on-demand virtual care does offer convenience,” said Li, an alumna of the IHPI Scholars program at the U-M Institute for Healthcare Policy and Innovation (IHPI).

However, with increasing numbers of providers offering primary-care based telehealth visits since the onset of COVID-19, patients are able to conveniently access virtual care for acute conditions with their regular provider. Therefore, further research is needed to examine how primary-care based telehealth visits may affect downstream care costs.

“Things have changed so much with the pandemic, and more primary care providers are now offering telehealth visits with themselves or members of their teams,” she explained. “It remains to be seen how primary care-based telehealth models will affect downstream use and cost of care.”

Chad Ellimoottil, MD, MS, senior author of the study and director of IHPI’s Telehealth Research Incubator, noted in a press release that insurance claims data may not be available for many direct-to-consumer telehealth providers, especially if a patient pays the up-front cost instead of using insurance.

“As more companies enter the marketplace of direct-to-consumer telehealth, it’s going to be important to understand the outcomes for patients, and the broader implications for the health care system,” said Ellimoottil, a telehealth researcher and urologist. “Data transparency is essential. We need to be able to directly compare outcomes of patients seen by direct-to-consumer telehealth companies with in-person care and with telemedicine provided by the patient’s own primary care provider.”

Employers that offer a direct-to-consumer telehealth option through their benefits package must carefully balance how the on-demand access could result in less time spent away from work and a potential reduction in unnecessary emergency department visits with how it could result in more follow-up appointments, Li noted.

“We need to optimize both the use of telehealth and of in-person emergency care,” she concluded.