Virtual "Urgent Care" may Lead to Higher Rates of Downstream Follow-Up Care

Even before the pandemic made telehealth a hot topic, people with minor urgent health needs had started to turn to companies that offer on-demand video chats with physicians that they don't normally see.

Insurers and employers even started buying access to this direct-to-consumer form of virtual care, hoping it might reduce in-person care, including emergency department visits.

But a new University of Michigan study casts some doubt on whether that will actually happen.

Published in the April issue of Health Affairs, the study finds that patients who had an on-demand virtual care visit for an upper respiratory infection in the three years before the pandemic began were slightly more likely to receive additional follow-up care than similar patients who had their first visit in person.

The study compared data from more than 28,700 virtual visits with data from more than 57,400 in-person visits for acute respiratory infections in 2016 through 2019. Those visits, and any follow-up care, were all covered by a large insurer. All the virtual visits were done through a direct-to-consumer telehealth company that the insurer had partnered with.

The authors say it's important to note that the vast majority of the patients did not require any further care for their infections, which included ear infections, bronchitis, laryngitis, sore throat and pneumonia.

But 10.3% of the patients first seen through a direct-to-consumer telehealth visit ended up having an in-person visit in the next week, compared with 5.9% of those who had their first visit in person. This includes second telemedicine visits or visits to clinics, urgent care centers and emergency rooms.

Less than 1% of all the patients in the study visited an emergency department after their initial visit, and the percentage was only slightly lower among people whose first visit was through a direct-to-consumer virtual provider compared with those who started with an in-person visit.

Kathleen Li, M.D., M.S., is the first author of the paper and an alumna of the IHPI Scholars program at the U-M Institute for Healthcare Policy and Innovation, and conducted the study as part of the institute's telehealth research effort.

She notes that direct-to-consumer telehealth providers usually don't have access to patients' electronic health records, so they may not know the patient's full medical history or underlying conditions.

As an emergency physician at Michigan Medicine, Li notes that often patients will come to the ED after trying to reach their primary care physician and not being able to get an appointment quickly.

Li was a co-author on a recent National Poll on Healthy Aging report from IHPI that found that 1 in 8 older adults had gone to the ED after not being able to get a timely appointment with their regular provider.

"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," she says. "But 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. It remains to be seen how primary care-based telehealth models will affect downstream use and cost of care."

Senior author Chad Ellimoottil, M.D., M.Sc., who directs IHPI's Telehealth Research Incubator, says that while the insurance claims data in the study were available to the IHPI team, that may not be the case for most direct-to-consumer telehealth, especially if the patient pays directly rather than 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," says Ellimoottil, a urologist and telehealth researcher. "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."

For employers that offer a direct-to-consumer telehealth option through their benefits package, Li says, the bottom line comes down to balancing how much the instant access may result in an increase in visits or additional follow-up care, against the benefit of less time spent away from work and a potential reduction in inappropriate emergency department visits.

"We need to optimize both the use of telehealth and of in-person emergency care," she says.

Kathleen Yinran Li, Ziwei Zhu, Sophia Ng, Chad Ellimoottil.
Direct-To-Consumer Telemedicine Visits For Acute Respiratory Infections Linked To More Downstream Visits.
Health Affairs 2021. doi: http://dx.doi.org/10.1377/hlthaff.2020.01741

Most Popular Now

Alcidion Acquires UK Patient Flow Softwa…

Smart health technology provider Alcidion Group has today announced the strategic acquisition of ExtraMed, a UK company which specialises in providing NHS trusts with software that helps frontline staff make...

New AI Tool Tracks Evolution of COVID-19…

A new machine-learning program accurately identifies COVID-19-related conspiracy theories on social media and models how they evolved over time - a tool that could someday help public health officials combat...

Siemens Healthineers Completes Acquisiti…

Siemens Healthineers AG (Frankfurt: SHL) announced that it has successfully completed the acquisition of Varian Medical Systems, Inc. ("Varian"). The acquisition was previously announced on August 2, 2020. "With Varian, Siemens...

Artificial Intelligence Model Predicts w…

The human immune defense is based on the ability of white blood cells to accurately identify disease-causing pathogens and to initiate a defense reaction against them. The immune defense is...

Commission Opens First European Innovati…

Following the launch of the European Innovation Council (EIC) and the announcement of the first funding opportunities, today the Commission opened the first EIC Accelerator calls. The funding worth over...

Talking Health Tech

Opinion Article by Andy Kinnear, Partnerships Director, Ethical Healthcare Consulting. Ethical is different. The guy who founded it, [chief executive] Thomas Webb, comes from an NHS background and he is very...

International Master in Digital Health i…

The Master of Digital Health, MDH (formerly - Master of Medical Informatics, MMI) at European Campus Rottal-Inn (ECRI) - a branch of the Deggendorf University of Applied Sciences (DIT) in Bavaria...

Call for Papers: DigiHealthDay-2021

12 November 2021 The DigiHealthDay 2021 is an International Symposium with the theme "Global Digital Health - Today, Tomorrow, and Beyond". The abstracts pertaining to the field of digital health and...

Proposal for a Regulation Laying Down Ha…

Artificial Intelligence (AI) is a fast evolving family of technologies that can bring a wide array of economic and societal benefits across the entire spectrum of industries and social activities...

Leeds Hospitals go Live with Agfa Health…

Leeds Teaching Hospitals NHS Trust (LTHT) has successfully implemented Agfa HealthCare's Enterprise Imaging (EI) solution, a unified platform complete with clinical tools, reporting and a workflow engine that will help...

Digital Mental Health Interventions for …

An increasing number of digital mental health interventions are designed for adolescents and young people with a range of mental health issues, but the evidence on their effectiveness is mixed...

CoolClinical.com has Developed the First…

Cool Clinical announced the release of the publication on the first Artificial Intelligence system for predicting outcomes of cancer treatment, using data from clinical trials. This is a breakthrough for...