March 03, 2017

Examining the Science of Value and the Need for Care

By Nim Patel, MD, MPH

The importance of primary care.

As a physician, what matters to me most is providing high quality care. I care about helping those who are sick to get the care they need and get well.

Building a primary care foundation for our health system – while perhaps once seen as irrelevant – is recognized today as critical to decreasing healthcare costs and improving the health of the U.S. population. The demand for primary care is not only heightened by the expansion of coverage under the Affordable Care Act and our aging population in America, but it is also unbalanced with the shrinking supply of physicians.

If further proof is needed for the value of a primary care system, we can look at Europe and our Canadian neighbors who have well-developed primary care systems and subsequently much lower health care costs as a percent of GDP and overall healthier populations than the U.S.

The savings and value from primary care use are realized in the short term and grow over time.

The Teladoc value proposition – the science of providing value.

At Teladoc, as the largest provider of telehealth services in the U.S., we have long accepted the responsibility for measuring the value of our nascent, somewhat disruptive, new offering for our constituents by conducting high quality, thoughtful studies.

We have a team dedicated to gathering, reviewing and helping us make informed decisions with data. Between February 2015 and December 2016 we completed five analyses in partnership with Veracity Analytics and Dr. Niteesh Choudhry, a professor and researcher at Harvard Medical School. Collectively, the analyses were based on claims data spanning January 2011 through May 2016. These studies examine four different national U.S. populations covering 1.8 million beneficiaries and 22,000 Teladoc visits.

At Teladoc, we are uniquely able to conduct such rigorous studies because we have the large volume of visits that others lack and which inform these analyses and make them robust.

What has been found? Consistently the results show significant savings from the use of telehealth by replacing higher cost brick and mortar settings, while maintaining quality of care with a first visit resolution rate of greater than 90%.You can be confident in these results, because while medicine is rooted in science and precision, so too must be data analysis and study design. That’s why:

  1. We rigorously match our users with emergency room and physician office controls and study them as separate groups

  2. Our episode of care, including the initial day of visit, is 30 days in total and long enough to capture follow-up costs

  3. We look at impact on total healthcare spending including hospitalization costs

  4. Our studies have been repeated over time, in large populations and the findings are consistent

  5. We look at multiple diagnoses, rather than limiting the studies to a narrow set

The value of telehealth.

It has been proven, repeatedly, that there is cost avoidance from using telehealth.

So perhaps now it is time to mature the scope of the discussion and address the broader notion around the value of accessible, affordable episodic primary care.

Caring for our population absolutely requires us to do so cost effectively. However, cost savings is only part of the value that we must consider. We have a great responsibility to make sure everyone has access to quality care. And so we must begin to examine additional ways to not only measure the impact of improved access to care but also consider new ways of getting patients the healthcare they need.