• Am J Manag Care · Jun 2023

    Economics of a health system's direct-to-consumer telemedicine for its employees.

    • Krisda H Chaiyachati, Christopher K Snider, Nandita Mitra, Ann Marie Huffenberger, Susan McGinley, Regina Bristow, C William Hanson, Gregory Kruse, Shivan J Mehta, and David A Asch.
    • University of Pennsylvania, 423 Guardian Dr, 13th Floor, Blockley Hall, Philadelphia, PA 19104. Email: krisda.chaiyachati@pennmedicine.upenn.edu.
    • Am J Manag Care. 2023 Jun 1; 29 (6): 284290284-290.

    ObjectivesTo compare the mean per-episode unit cost for a direct-to-consumer (DTC) telemedicine service for medical center employees (OnDemand) with that of in-person care and to estimate whether the offered service increased the use of care.Study DesignPropensity score-matched retrospective cohort study of adult employees and dependents of a large academic health system between July 7, 2017, and December 31, 2019.MethodsTo estimate differences in per-episode unit costs within 7 days, we compared costs between OnDemand encounters and conventional in-person encounters (primary care, urgent care, and emergency department) for any similar condition using a generalized linear model. We used interrupted time series analyses limited to the top 10 clinical conditions managed by OnDemand to estimate the effect of OnDemand's availability on the trends for overall employee per-month encounters.ResultsA total of 10,826 encounters among 7793 beneficiaries were included (mean [SD] age, 38.5 [10.9] years; 81.6% were women). The mean (SE) 7-day per-episode cost among employees and beneficiaries was lower for OnDemand encounters at $379.76 ($19.83) relative to non-OnDemand encounters at $493.49 ($25.53), a mean per-episode savings of $113.73 (95% CI, $50.36-$177.10; P < .001). After the introduction of OnDemand, among employees with encounters for the top 10 clinical conditions managed by OnDemand, the trend for encounter rates per 100 employees per month increased marginally (0.03; 95% CI, 0.00-0.05; P = .03).ConclusionsThese results suggest that DTC telemedicine staffed by an academic health system and offered directly to employees reduced the per-episode unit costs and only marginally increased utilization, suggesting lower cost overall.

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