- An accountable care organization's use of virtual healthcare led to 33% fewer in-person visits, but increased overall visits by 80%, according to a new study in Health Affairs. It also shed light on the potential for virtual visit programs to increase disparities in access to care.
- Researchers reviewed data on 1,431 patients who registered with a virtual visit program at a Massachusetts-based ACO between October 2014 and February 2017. Of those, just over half (51%) completed at least one virtual visit.
- Virtual visits were highest immediately after registration and dropped off as time went on, returning to baseline by the end of the study. Participants tended to be younger, white, English-speaking, commercially insured and needed to travel farther to reach the clinic than nonparticipants.
Virtual visits are often used to supplement costly in-person care, but to be truly disruptive and help achieve value-based care goals they need to actually replace in-person visits. This study shows in-person visits were replaced with virtual visits but only for a short duration.
For every 3.5 virtual visits, one in-person visit was avoided, the study says. However, the benefits of the shift to virtual visits did not extend beyond a year, the study says.
"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," they write. "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."
To increase access for patients while reducing costs, the researchers recommend three focal points. ACO-based virtual care programs should be construed to impact all medical costs, not just ambulatory care, and be measured against that goal. ACOs must make demonstration of the value of these programs a priority. And organizations must monitor the potential of virtual visit programs to exacerbate disparities.
"Historically, new health interventions favor the well resourced, thereby widening socioeconomic disparities," the study says. "As virtual visit programs mature, special attention should be paid to promoting their use among traditionally marginalized patients such as members of racial and ethnic minority groups, the homebound, people with limited English proficiency, and those living in poverty."
There's another obstacle organizations need to overcome in implementing virtual care programs. According to Deloitte, 23% of consumers said they had used video visits and more than half expressed a willingness to try them, but just 14% of doctors reported having video capabilities and 18% of those planned to add it in the next year or two.