Healthcare Dive has an interesting telehealth story about my former employer:
The University of Pittsburgh Medical Center Health Plan Monday launched AnywhereCare, a mobile app that provides 24/7 access to emergency telehealth services to patients across Pennsylvania…
app users can access emergency clinicians at about half the cost of a health plan copay, ranging from $10 to $49 per visit
Wahoo — this is going to save a lot of money through diversion of low need, high cost emergency room visits!
Right?
Well……. maybe. It’s complicated.
There are three major effects that need to be evaluated.
The first is the positive story. Some people will use this app to determine that their immediate need does not require an emergency room visit that they otherwise would have used. They are better off as they don’t have the stress nor the expense of the ER. The system spends less money as aggregate ER demand declines and everyone is happy.
The next two stories are a bit more complicated. There will be some cases where a person will use the app. The tele-health specialist will look at the situation and send the patient to the ER. Here telehealth acts as a mobile triage unit. When my son was having bad asthma attacks, the nurse phone line performed this role and sent us to the ER. The difference is the patient is using a more expensive resource and then using the ER appropriately instead of just going to the ER.
The third story is a price response story. How many people who otherwise would have just grinned and beared it will use the more convienent and fairly low cost telehealth application? The worried well will drive up costs. We’ve seen this in other diversion efforts.
The Rand Corporation looked at how people responded to the proliferation of urgent care clinics. They found that there was a net increase in healthcare spending driven by urgent care centers. There was some minimal diversion but far more demand was now being satisified by the cheaper and lower hassle urgent care centers. People who had complaints that previously would have been a watch and wait situation before going to the ER were now showing up at urgent care centers:
Examining people who visited retail clinics for low-severity illnesses such as urinary tract infections and sinusitis, researchers found that in most cases people would have stayed home and not sought medical care if the retail clinic had not been available….the new study found that some people did trim spending by visiting retail clinics instead of costlier physician offices. However, such savings were overshadowed by the increased spending on new medical care.
There may be value in telehealth other than cost savings. Not worrying is valuable even if re-assurance adds to total net spend. But these stories are more complicated than diversion efforts are automatic cost savers.
Telehealth, diversion and demand responsePost + Comments (23)