Telehealth Actually Makes Some Health Care More Expensive: Study
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on acute respiratory illnesses was $45 more per telehealth user than it was for patients who saw the doctor in-person, a study 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Virtual consultations can mean you don’t have to schlep across town, sit in the waiting room, and leaf through a year-old Time magazine article as prelude to a short visit with your doc.\u003c/p>\n\u003caside class=\"pullquote alignright\">'When you make services that are convenient, it’s an ‘If you build it, they will come' kind of thing.'\u003ccite> Lori Uscher-Pines,\u003cbr>\nRAND Corporation\u003c/cite>\u003c/aside>\n\u003cp>Telehealth appointments are less expensive because the companies offering these services contract with doctors who are paid by the visit, and the companies themselves have little of the overhead necessary in a typical medical office, says Lori Uscher-Pines, a health policy researcher with the RAND Corporation. That means telehealth should theoretically save money for patients, employers and insurance companies -- the entire health care ecosystem. At least this is what telehealth companies claim. But now a \u003ca href=\"http://content.healthaffairs.org/content/36/3/485.abstract\" target=\"_blank\">study\u003c/a> from RAND, published Monday in \u003cem>Health Affairs\u003c/em>, says this isn't the case.\u003c/p>\n\u003cp>The study found that using telehealth for treatment of acute respiratory illnesses increased total annual spending, which the researchers defined as costs to insurers and out-of-pocket payments by patients, by $45 per telehealth user.\u003c/p>\n\u003cp>That's because 88 percent of the telehealth visits represented people who would not have gone to a doctor otherwise -- what the industry calls new utilization. Just 12 percent of the telehealth sessions, the researchers concluded, amounted to a \u003cem>substitute\u003c/em> for going to see the doc.\u003c/p>\n\u003cp>Uscher-Pines, a co-author of the study, says she's not surprised.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“When you make services that are convenient, it’s an ‘If you build it, they will come' kind of thing.”\u003c/p>\n\u003cp>Uscher-Pines says patients using telehealth for respiratory infections would likely not have gone to a doctor if the service had not been available. Rather, they would self-treat.\u003c/p>\n\u003cp>\"You sit at home, you watch Netflix, you take Tylenol,\" Pines says. \"But now because of these kind of services that are so easy to access, you have a visit that would not have otherwise occurred.”\u003c/p>\n\u003cp>The study is the fourth on telehealth funded by the California Health Care Foundation. Researchers examined claims data from more than 300,000 enrollees in the Blue Shield of California HMO offered by CalPERS, the California Public Employees' Retirement System. In 2012, CalPERS began offering the telehealth appointments to selected members through Teladoc, a Texas-based public company that provides virtual appointments with licensed physicians 24 hours a day, 365 days a year.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You have to use [telehealth] as a more precise tool with particular populations in order to serve their needs. Don’t just go into it blindly.'\u003ccite>Melissa Buckley,\u003cbr>\nCalifornia Health Care Foundation\u003c/cite>\u003c/aside>\n\u003cp>The current study looked at 981 people who used the Teladoc service over 18 months in 2012-13, seeking help for acute respiratory infections like bronchitis, pneumonia or sinusitis. The researchers compared these users with patients who had their acute respiratory infections treated by a doctor in-person. The focus was on this type of illness because it is the most commonly treated by direct-to-consumer telehealth providers, the researchers said.\u003c/p>\n\u003cp>Teladoc, which \u003ca href=\"https://www.teladoc.com/businesses/save-money/\" target=\"_blank\">markets\u003c/a> its service as a cost reduction, says patient information it gathered at the time of care contradicts the findings. Courtney McLeod, the company’s director of public relations, said in an email that just 13 percent of appointments for more than 400,000 acute respiratory infection patients represented new health care utilization.\u003c/p>\n\u003cp>That is pretty much the reverse of the 88 percent new utilization that the RAND researchers found. The RAND study asserts that the discrepancies between its numbers and those of the telehealth companies on new-versus-replacement health care could be due to the companies' use of surveys, as opposed to actual utilization data. The surveyed telehealth patients, the researchers wrote, may have overestimated the likelihood of going to see a doctor as opposed to not acting at all.\u003c/p>\n\u003cp>The researchers did acknowledge that use of telehealth for different conditions might produce better results. One of the study’s limitations was that respiratory infections often resolve on their own. “In contrast, an increase in utilization for patients with diabetes or mental illness might be perceived as a net positive,\" the study reads. \"These are conditions that are often undertreated and for which there is clearer evidence that receiving treatment improves health.\"\u003c/p>\n\u003cp>Uscher-Pines also said there could be economic benefits from telehealth that the study didn’t capture. \"These services can be offering patients reassurance,” she said, which can positively impact employee productivity. Telehealth visits initiated from a patient's work site might also reduce absenteeism,\u003c/p>\n\u003cp>But, she said, “You have to take this with a grain of salt when a company says we’re going to prevent emergency department visits. It’s unclear whether that’s likely to happen given the fact that the literature on innovations in health care delivery frequently tells us that when you increase convenience you increase utilization.\"\u003c/p>\n\u003cp>David Cowling, a co-author of the paper and a research scientist at CalPERS, said the study revealed the tradeoff that telehealth presents.\u003c/p>\n\u003cp>\"We have increased access to our members, which is a good thing. Eighty-eight percent were new utilization, so they wouldn’t have gotten care previously. Our members were seeking care and I’m sure their satisfaction with their health plan was higher.\"\u003c/p>\n\u003cp>But Cowling said the issue could prompt a change in the benefit when CalPERS re-examines its benefit package. He said the organization could potentially limit telehealth access to rural areas, one of the original aims of introducing the service, or tailor it to specific conditions.\u003c/p>\n\u003cp>Melissa Buckley, the director of the California Health Care Foundation’s Innovation Fund, said that sort of strategic thinking may be the best bet when it comes to telehealth.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If you use it naively you can drive up utilization,\" she said. \"You have to use it as a more precise tool with particular populations in order to serve their needs. Don’t just go into it blindly.”\u003c/p>\n\n","blocks":[],"excerpt":"A new study finds annual spending on acute respiratory illnesses was more for telehealth users than it was for patients who saw the doctor in-person.","status":"publish","parent":0,"modified":1490992171,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":1110},"headData":{"title":"Telehealth Actually Makes Some Health Care More Expensive: Study | KQED","description":"A new study finds annual spending on acute respiratory illnesses was more for telehealth users than it was for patients who saw the doctor in-person.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Telehealth Actually Makes Some Health Care More Expensive: Study","datePublished":"2017-03-10T19:30:13.000Z","dateModified":"2017-03-31T20:29:31.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"349779 https://ww2.kqed.org/futureofyou/?p=349779","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/03/10/study-finds-telehealth-actually-makes-health-care-more-expensive/","disqusTitle":"Telehealth Actually Makes Some Health Care More Expensive: Study","source":"KQED Future of You","customPermalink":"2017/03/07/study-finds-telehealth-actually-makes-health-care-more-expensive/","path":"/futureofyou/349779/study-finds-telehealth-actually-makes-health-care-more-expensive","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Telehealth takes a lot of forms these days\u003cspan style=\"font-weight: 400\">—\u003c/span>consultations with a doctor by video, phone or text; an appointment through the web or a mobile app. The one commonality: You get to interact with a health care provider from anywhere\u003cspan style=\"font-weight: 400\">—\u003c/span>your home, the office, Starbucks. Virtual consultations can mean you don’t have to schlep across town, sit in the waiting room, and leaf through a year-old Time magazine article as prelude to a short visit with your doc.\u003c/p>\n\u003caside class=\"pullquote alignright\">'When you make services that are convenient, it’s an ‘If you build it, they will come' kind of thing.'\u003ccite> Lori Uscher-Pines,\u003cbr>\nRAND Corporation\u003c/cite>\u003c/aside>\n\u003cp>Telehealth appointments are less expensive because the companies offering these services contract with doctors who are paid by the visit, and the companies themselves have little of the overhead necessary in a typical medical office, says Lori Uscher-Pines, a health policy researcher with the RAND Corporation. That means telehealth should theoretically save money for patients, employers and insurance companies -- the entire health care ecosystem. At least this is what telehealth companies claim. But now a \u003ca href=\"http://content.healthaffairs.org/content/36/3/485.abstract\" target=\"_blank\">study\u003c/a> from RAND, published Monday in \u003cem>Health Affairs\u003c/em>, says this isn't the case.\u003c/p>\n\u003cp>The study found that using telehealth for treatment of acute respiratory illnesses increased total annual spending, which the researchers defined as costs to insurers and out-of-pocket payments by patients, by $45 per telehealth user.\u003c/p>\n\u003cp>That's because 88 percent of the telehealth visits represented people who would not have gone to a doctor otherwise -- what the industry calls new utilization. Just 12 percent of the telehealth sessions, the researchers concluded, amounted to a \u003cem>substitute\u003c/em> for going to see the doc.\u003c/p>\n\u003cp>Uscher-Pines, a co-author of the study, says she's not surprised.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“When you make services that are convenient, it’s an ‘If you build it, they will come' kind of thing.”\u003c/p>\n\u003cp>Uscher-Pines says patients using telehealth for respiratory infections would likely not have gone to a doctor if the service had not been available. Rather, they would self-treat.\u003c/p>\n\u003cp>\"You sit at home, you watch Netflix, you take Tylenol,\" Pines says. \"But now because of these kind of services that are so easy to access, you have a visit that would not have otherwise occurred.”\u003c/p>\n\u003cp>The study is the fourth on telehealth funded by the California Health Care Foundation. Researchers examined claims data from more than 300,000 enrollees in the Blue Shield of California HMO offered by CalPERS, the California Public Employees' Retirement System. In 2012, CalPERS began offering the telehealth appointments to selected members through Teladoc, a Texas-based public company that provides virtual appointments with licensed physicians 24 hours a day, 365 days a year.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You have to use [telehealth] as a more precise tool with particular populations in order to serve their needs. Don’t just go into it blindly.'\u003ccite>Melissa Buckley,\u003cbr>\nCalifornia Health Care Foundation\u003c/cite>\u003c/aside>\n\u003cp>The current study looked at 981 people who used the Teladoc service over 18 months in 2012-13, seeking help for acute respiratory infections like bronchitis, pneumonia or sinusitis. The researchers compared these users with patients who had their acute respiratory infections treated by a doctor in-person. The focus was on this type of illness because it is the most commonly treated by direct-to-consumer telehealth providers, the researchers said.\u003c/p>\n\u003cp>Teladoc, which \u003ca href=\"https://www.teladoc.com/businesses/save-money/\" target=\"_blank\">markets\u003c/a> its service as a cost reduction, says patient information it gathered at the time of care contradicts the findings. Courtney McLeod, the company’s director of public relations, said in an email that just 13 percent of appointments for more than 400,000 acute respiratory infection patients represented new health care utilization.\u003c/p>\n\u003cp>That is pretty much the reverse of the 88 percent new utilization that the RAND researchers found. The RAND study asserts that the discrepancies between its numbers and those of the telehealth companies on new-versus-replacement health care could be due to the companies' use of surveys, as opposed to actual utilization data. The surveyed telehealth patients, the researchers wrote, may have overestimated the likelihood of going to see a doctor as opposed to not acting at all.\u003c/p>\n\u003cp>The researchers did acknowledge that use of telehealth for different conditions might produce better results. One of the study’s limitations was that respiratory infections often resolve on their own. “In contrast, an increase in utilization for patients with diabetes or mental illness might be perceived as a net positive,\" the study reads. \"These are conditions that are often undertreated and for which there is clearer evidence that receiving treatment improves health.\"\u003c/p>\n\u003cp>Uscher-Pines also said there could be economic benefits from telehealth that the study didn’t capture. \"These services can be offering patients reassurance,” she said, which can positively impact employee productivity. Telehealth visits initiated from a patient's work site might also reduce absenteeism,\u003c/p>\n\u003cp>But, she said, “You have to take this with a grain of salt when a company says we’re going to prevent emergency department visits. It’s unclear whether that’s likely to happen given the fact that the literature on innovations in health care delivery frequently tells us that when you increase convenience you increase utilization.\"\u003c/p>\n\u003cp>David Cowling, a co-author of the paper and a research scientist at CalPERS, said the study revealed the tradeoff that telehealth presents.\u003c/p>\n\u003cp>\"We have increased access to our members, which is a good thing. Eighty-eight percent were new utilization, so they wouldn’t have gotten care previously. Our members were seeking care and I’m sure their satisfaction with their health plan was higher.\"\u003c/p>\n\u003cp>But Cowling said the issue could prompt a change in the benefit when CalPERS re-examines its benefit package. He said the organization could potentially limit telehealth access to rural areas, one of the original aims of introducing the service, or tailor it to specific conditions.\u003c/p>\n\u003cp>Melissa Buckley, the director of the California Health Care Foundation’s Innovation Fund, said that sort of strategic thinking may be the best bet when it comes to telehealth.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If you use it naively you can drive up utilization,\" she said. \"You have to use it as a more precise tool with particular populations in order to serve their needs. Don’t just go into it blindly.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/349779/study-finds-telehealth-actually-makes-health-care-more-expensive","authors":["80"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1200","futureofyou_1199"],"featImg":"futureofyou_350465","label":"source_futureofyou_349779"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. 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As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. 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Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. 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