Direct to Consumer
Insurance providers are increasingly offering coverage for quick-care options such as virtual visits (VVs), through which patients immediately have a real time video appointment with a physician over the internet to receive care for non-emergency conditions. This study seeks to:
1. Describe the care provided at VVs over a three-week episode compared to visits to a retail health clinic (RHC), urgent care center (UCC), ED, or primary care physician’s office (PCP) for similar conditions;
2. Describe the cost of VVs over a three-week episode of care compared to RHC, UCC, ED, or PCP for similar conditions;
3. Calculate potential cost savings of VVs for non-emergency conditions.
We identified virtual, RHC, UCC, ED, or PCP visits for conditions of interest (sinusitis, upper respiratory infection, urinary tract infection, conjunctivitis, bronchitis, pharyngitis, influenza, cough, dermatitis, digestive symptom, or ear pain) from Anthem medical claims, January 2014-May 2015. Patients were adult (under 65) or child commercial members without serious baseline health conditions. We assessed 4,635 VVs, and three visits in each of the four other locations matched to the VVs, totaling 55,310 non-virtual visits. We analyzed claims for three weeks following the visit to determine differences in lab tests, imaging, subsequent outpatient evaluation and management (follow-up) visits, subsequent ED and inpatient care, and total cost of all care during the episode (for initial visit and subsequent care, medical and pharmacy). A post-visit exit survey of VV participants asking where they would otherwise seek care was used in conjunction with cost data from claims to determine potential savings.
Total costs per episode were $36, $153, $1735, and $162 more expensive at RHC, UCC, ED, and PCP settings, respectively, compared with VVs. VVs had similar follow-up visit rates (28%) to RHC (29%;p=.54) and PCP (28%;p=.96), slightly higher than UCC (26%;p < .001), and lower than ED (34%;p < .001). Overall laboratory tests during the episode were lower for VV (13%) than others (RHC-37%; UCC-39%; ED-53%; PCP-37%; p < .001). Overall imaging rates during the episode were similar between VV (7%) and RHC (6%;p=.11), but lower than others (UCC-9%; ED-43%; PCP-11%; p < .001). The adjusted average cost of the initial visit was lowest for VV ($49) (RHC-$74; UCC-$134; ED-$1,404; PCP-$109; p < .001). Adjusted average subsequent medical costs were similar between VV ($200) and RHC ($204;p=.62) but lower than others (UCC-$266; ED-$584; PCP-$288; p < .001). Adjusted average pharmacy costs for VV episodes ($90) were similar to UCC ($92;p=.44) and ED ($86;p=.21), and somewhat lower than RHC ($97;p=.02) and PCP ($104;p < .001).
Virtual visit episodes were less costly than care at other locations for the same diagnoses, though they had similar follow-up visit rates, indicating a similar rate of problem resolution. We estimate that VVs resulted in savings of approximately $200 per three-week episode, including medical and pharmacy costs.
Staff Vice President
Wallace Adamson is the Staff Vice President for Anthem’s LiveHealth Online program. In this role, he is responsible for the LiveHealth Online provider collaboration strategy and the LHO Practice Edition product. Practice Edition allows physicians to deliver telehealth services to their own patients on the LHO platform. Also, he is responsible for identifying and implementing strategic partnerships that enhance the value of LiveHealth Online to physicians and consumers.
Prior to his current role, he was the Regional Vice President in Anthem’s Provider Engagement Strategy area, most recently leading R & D for Anthem’s Enterprise Cost of Care team.
He has served in various medical, network and cost of care capacities at Anthem since joining the company on a full time basis in 2000 after 15 years in private practice.
John F. Jesser serves as the vice president of Provider Engagement Strategy for Anthem, Inc., the nation’s largest health benefits company. In this capacity, Mr. Jesser manages a companywide process that looks at healthcare-related functions to improve the affordability of health care; the consumer experience and access to care. He leads the company’s telehealth strategy as the president of LiveHealth Online, an online care solution for consumers and providers being offered to Anthem’s customers. Mr. Jesser focuses on solutions and digital tools that improve the connection between doctors, hospitals, consumers and health plans. Previously, he served for more than 24 years in various management positions within the health care field.
Mr. Jesser earned his B.S. in mass communications from Miami University in Oxford, Ohio and an MBA from Cleveland State University.
He serves as chairman of the board of managers for Availity, LLC, a company that provides connectivity between health care payers and providers; and is chairman of the board of National TeleHealth Network (NTN), a telehealth physician management company founded as a joint venture between American Well and Anthem. He is also member of the board of Pursuant Health, a consumer health information and technology company.
Aliza Gordon is currently a Senior Researcher at HealthCore, Inc. In that role, she conducts health services and health outcomes research in a variety of topic areas with the goal of improving the quality and affordability of health care. She previously worked at the Center for Medicare and Medicaid Innovation, where she worked in the areas of program evaluation, program implementation, health policy development and analysis, and quality improvement.
Senior Director of Payer and Provider Research
Andrea DeVries is the Senior Director of Payer and Provider Research at HealthCore, Inc.