The health care access benefits of telehealth—care provided remotely through virtual technologies—has prompted physicians and policymakers to examine how its use can be expanded to benefit patients. As providers and health systems experiment with new applications, a key question has emerged: How will telehealth impact health care spending?

To be sure, as a growing number of employers and insurers have turned to the technology in hopes of finding cost savings, prominent experts have sounded alarm bells, concerned that in fact telehealth could increase spending. Among them: Ateev Mehrotra, MD, associate professor at Harvard Medical School, who co-authored a study on the subject last year. His strong views made Dr. Mehrotra the ideal co-author of a new op-ed, recently published in the Annals of Internal Medicine in partnership with Adam Licurse, MD, MHS, Medical Director of Population Health at Partners HealthCare.

In the piece, Drs. Licurse and Mehrotra take a closer look at the key drivers of costs associated with telehealth, presenting a framework for telehealth’s use in the context of cost and value. They argue that three factors impact any telehealth intervention’s impact on spending, including: 

Dr. Licurse demonstrates the Virtual Visits app used at Partners.

• Whether interventions substitute for in-person visits, rather than add to them. By targeting telehealth interventions toward nondiscretionary and chronic conditions, employing patient cost-sharing, and utilizing telehealth in the context of value-based payments, providers can ensure telehealth is primarily substitutive—and thus does not drive up spending. 

• Whether the interventions are reimbursed at a lower rate than in-person visits, offsetting any increase in frequency of use. Though 13 states have passed laws requiring telehealth to be paid at the same level as in-person visits, lower reimbursement may be appropriate for telehealth since they’re often provided at lower cost—and this could help keep costs in check.

• Whether telehealth helps deter “downstream” care, preventing future costly events such as emergency department visits or hospital admissions by targeting high-risk patients with remote interventions. Additionally, these interventions can help reduce the cost of stay if patients can be discharged to the community and managed virtually.

“As telehealth moves from early adoption to common use…the reality in practice is that spending will decrease only in specific scenarios,” the co-authors assert. “Ignoring these factors [outlined above] may mean that telehealth expansion improves access, convenience, and patient experience—but at a price.”

Read more from Drs. Licurse and Mehrotra in the Annals of Internal Medicine.

Topics: Access to Care, Economic Impact, Legislation

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