ACOs leveraging telehealth see more patient visits down the road

Virtual visits are touted as complementary services for fee-for-service providers, but accountable care organizations (ACOs) are leveraging telehealth to replace in-person visits—and the payoff might not be there.

The use of virtual visits within a Massachusetts-based ACO reduced in-person visits 33 percent over a period of three years, but total visits, including both virtual and in-person visits, increased 80 percent over 1.5 years, according to a recent study published in Health Affairs.

The findings reveal unanswered questions about the long-term benefit of utilizing virtual visits with patients, particularly if they supplant in-person visits. The study, which was conducted by Massachusetts and California researchers, also throws into question whether virtual visits truly improve care access while lowering costs if more visits occur in the future.

“Hopes of an innovative, lower-cost alternative to in-person specialty care have been tempered by early analyses suggesting that virtual visit programs may decrease in-person visits but also increase total health care utilization,” wrote study authors led by Sachin Shah, MD, MPH, assistant professor of medicine at the University of California, San Francisco.

The study examined data from more than 35,000 patients from 2014 to 2017 within the Massachusetts General Physicians Organization (MGPO), a Medicare Pioneer ACO. Patients who registered for virtual visits were more likely to be younger, white, English speaking and live further from the clinic, in addition to being commercially insured. Before registering with the virtual visit program, users had the same in-person visit frequency as those who did not use the program.

The use of virtual visits was associated with a 33 percent drop in in-person visits, but was also associated with an 80 percent increase in combined visits. However, for every 3.5 virtual visits performed, an in-person visit was avoided, according to the study.

Furthermore, the rate of in-person care among users of the virtual visit program returned to baseline after one year.

“This study provides ACO administrators with an estimate of the potential gains attainable through shared savings from reduced in-person visit billing that could offset the necessary investment,” Shah et. al wrote. “However, the diminishing effectiveness over time observed in this study cautions against assuming a long-lasting reduction in in-person visits, absent a change in program design.”