Healthcare utilization and economic analysis of an internal on-demand telehealth service for upper respiratory infections.

Abstract

IntroductionOn-demand telehealth services are available to improve access and convenience of care, with some expectation that these visits may replace scheduled video visits and in-person visits. As on-demand telehealth becomes integrated into healthcare delivery models, there is a need to evaluate its impact on access, utilization, and charges.ObjectiveThis study evaluates an integrated, on-demand telehealth service (Express-Care) at an academic health center and how its availability and adoption influenced healthcare utilization and charges for patients seeking care for upper respiratory tract infections (URIs).MethodsA retrospective cohort study was conducted using electronic health record data from UC Davis Health between July 2018 and October 2024. A cohort of patients using Express-Care for URI was compared to patients receiving URI care via other modalities using a 1:2 propensity score match on sex, age, race/ethnicity, insurance, California Healthy Place Index, comorbidities, and household income. Patients who did not have URI visits both before and after the launch of Express-Care were excluded.ResultsAmong the 26,605 patients treated for URI, Express-Care users were more likely to be female (66.9% vs. 61.9%, p < 0.001) and commercially insured (84.6% vs. 78.5%, p < 0.001) than nonusers. In the matched patient cohort, Express-Care use replaced scheduled video visits and in-person visits 70% of the time, while 30.0% represented new utilization. Follow-up rates were higher after Express-Care visits than after compared to non-Express-Care visits (5.1% vs. 1.6%, p < 0.0001). Adjusted difference in mean charges was USD190 lower for Express-Care episodes than for non-Express-Care episodes (p < 0.0001).DiscussionAccess to Express-Care resulted in 42% more visits for URIs among users than among matched nonusers. Despite the increased visit frequency and follow-up rates for URIs, Express-Care was associated with lower mean healthcare charges.