How Intermountain Lowers Costs Through Virtual Care

A study finds that the total costs for the health system's urgent care telehealth program are substantially less than care provided in urgent, primary, or emergency care settings.

While the practice of virtual care seems to hold the promise of lowering healthcare costs, few organizations have been able to back up that premise with data. Intermountain Healthcare has broken the mold.

The cost of virtual care at the Utah-based, nonprofit system with 24 hospitals in eight states, is significantly lower than care delivered in other settings. Total savings range from $232 to nearly $3,000 less than the equivalent cost of care in urgent care, primary care, and emergency department settings, according to published data.

A study to evaluate the effectiveness, efficiency, and value of virtual care visits, published July 25 in the Journal of Telemedicine and Telecare, found that the $429 total cost of virtual care for the most common telehealth diagnoses was $232 less than urgent care, $278 less than primary care, and $2,974 less than care delivered in the emergency department.

HealthLeaders takes a deeper look into how Intermountain's program operates and how it lowers costs through its virtual care initiative.

How Intermountain's Virtual Care Service Works
 

Launched 3.5 years ago, Connect Care is Intermountain's direct-to-consumer virtual urgent care service offering video visits 24/7/365 with nurse practitioners employed by Intermountain. The health system uses the American Well technology platform as well as the company's online care group of physicians to manage overflow calls or to handle patients who are located in a state where Intermountain's providers are not licensed.

Callers pay up to $59 per call ($49 during the period the study was conducted), although copays can be lower, depending on the individual's insurance plan.

Currently, Connect Care experiences about 25,000 visits a year, primarily from members of SelectHealth, Intermountain's insurance product. Of about 900,000 covered lives, about 10% have enrolled in Connect Care, and about 50,000 have used the service, says Jim Sheets, vice president of outreach services at Intermountain Healthcare.

Why Do a Study?
 

Intermountain has invested substantial resources in virtual care services, according to Sheets—not only through Connect Care—but also in Intermountain Connect Care Pro, which offers provider-to-provider telehealth services to other acute care, rural, and critical access hospitals and communities that might not have the specialty care that they need.

"We've invested a lot in this service, primarily as another access point to our patients, with the idea that we can reduce the overall cost of care and help people receive care in a more appropriate setting," says Sheets. The study, he says, "is our justification for the investment that we're making in this technology and service."

Intermountain's study examined SelectHealth claims data from April 1, 2016, through March 31, 2017, for the diagnostic categories commonly seen in virtual care settings: sinusitis, conjunctivitis, urinary tract infection, upper respiratory infection, influenza/pneumonia, bronchitis, dermatitis/eczema, ear pain, digestive symptoms, and cough. A secondary data source included survey data indicating how virtual visits redirect care.

To determine cost differences, the authors compared 1,531 virtual visit claims against 4,377 claims from urgent care, 4,388 claims from primary care, and 2,285 emergency department claims.

Study Findings: Virtual Care Is Less Expensive
 

The study indicates that virtual care was a less expensive option than a visit to a primary care physician, urgent care, or the emergency room, say Sheets.

According to the study, the total cost of virtual care was significantly lower than all other care settings. Total cost included the initial visit, as well as costs of related care within 21 days of that appointment, plus costs associated with laboratory and imaging services. The $429 total cost of virtual care was $232 less than urgent care ($661), $278 less than primary care ($707), and $2,974 less than care delivered in the emergency department ($3,403).

• Initial Visit Costs: Cost for the initial visit alone, which was included in the total cost calculation, was $45 for virtual care, versus $114 for primary care, $136 for urgent care, and $1,384 for a visit to the emergency department, based on the claims data.
   
• Follow-Up Costs: Follow-up costs for care related to the same condition provided within 21 days of the initial visit were about $288 for virtual care and urgent care, which was significantly lower than $490 following a visit with a primary care physician, or $1,782 when a patient visited the emergency department.
   
• Pharmacy Costs: Pharmacy costs of $111 were the same for virtual, urgent, and primary care, but slightly lower than the $153 spent on pharmaceuticals after visiting the emergency department.

Other key findings:

"This demonstrates that we can decrease the cost of healthcare, improve access, and treat patients in a more appropriate setting, and still achieve positive outcomes for them," says Sheets.

Bill Beninati, MD, senior medical director, Intermountain Connect Services at Intermountain Healthcare, acknowledges that other organizations may experience different results. Carefully defining what conditions can be treated via virtual care and integrating telehealth into the system's overall approach to care contribute to Intermountain's success, he says.

What's Next?
 

With a strategic goal to improve access for patients regardless of where they live and provide a lower cost care alternative closer to patients' homes, Sheets says, "We believe there's an opportunity to use this technology to bring specialty services to patients in more remote locations so that they can avoid unnecessary transfers to a higher level of care."

The health system is in the process of conducting additional studies to validate expansion of these types of services and build partnerships with outside organizations and facilities, says Sheets.

The study findings offer "a low-key, easy way for us to begin an affiliation discussion," says Beninati.

As a result of this study, Eric Liston, administrator, Intermountain Connect Services, says SelectHealth is lowering copays on some plans for use of Connect Care. In 2020, the virtual care visit copay will be free in some of the payer's plans. "We've tried to incentivize patients to use this lower cost care when appropriate," says Liston.

In addition, without marketing its program to outsiders, Intermountain's success is attracting the attention of other payers and employers.

Virtual care "increases access, it's convenient for the members, and it also creates a good outcome for them," says Sheets. As a result, he says, "we've had other organizations and markets approach us [about] doing Connect Care for them because they know it's helpful if you're managing a population that is covered by a risk plan."