ArticleBMC health services research2025
An episode-based cost analysis of virtual-first versus in-person-first care to treat common acute conditions among members of a large national payor.
Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe potential of virtual care as an alternative to in-person visits is promising, yet its economic impact is insufficiently understood. This evaluation represents an episode-based, cost impact analysis of virtual-first (versus in-person first) care to treat the most prevalent primary care acute conditions among Medicare Advantage (MA) and commercial fully-insured (C-FI) members of a large national health plan in the United States.
methodsRetrospective episodes-of-care and medical claims analyses identified members (N = 366,195; MA: 126,363, C-FI: 239,832) with resolved, pre-specified, acute primary care episodes (N = 455,231; MA: 141,034, C-FI: 314,197) between 1/1/2022-6/30/2022. Propensity score weighting estimated % difference in healthcare expenditures between virtual-first episodes and an adjusted cohort of in-person-first episodes.
resultsWithin the MA cohort, 7.6% (range: 0.7-24.8%) of episodes utilized virtual-first care with observed cost-of-episode 10-24% lower than in-person-first care for 6 of 11 included conditions (all P < 0.05), including: otolaryngology disease (-24 ± 2%), rhinitis (-20 ± 4%), gastroenterology disease (-20 ± 7%), minor bacterial skin infections (-17 ± 7%), sinusitis (-14 ± 4%), and bronchitis (-11 ± 4%). Within the C-FI cohort, 12.6% (range: 2.8-40.4%) of episodes utilized virtual-first care with observed cost-of-episode 9-33% lower than in-person-first care (all P < 0.001) for 12 of 16 included conditions (all P < 0.001), including: urinary tract infection (-33 ± 5%), viral skin infection (-29 ± 6%), gastroenterology disease (-27 ± 5%), rhinitis (-28 ± 5%), otolaryngology disease (-25 ± 2%), sinusitis (-25 ± 2%), urological disease (-23 ± 9%), contact dermatitis (-19 ± 5%), viral pneumonia (-17 ± 12%), bronchitis (-15 ± 4%), fungal skin infection (-11 ± 6%), and minor bacterial skin infection (-9 ± 7%), and 4 ± 2% higher to treat exposure to infectious disease (P = 0.001). There were no between-group differences in cost-of-episode to treat: skin inflammation (MA & C-FI), urinary tract infection (MA), exposure to infectious disease (MA), fungal skin infection (MA), low back pain (C-FI), or migraine headache (C-FI) (all P > 0.081).
conclusionThis real-world study of a large national sample of geographically diverse members demonstrates the potential of virtual-first care to resolve acute conditions at lower cost compared to in-person-first care. The use of episode-based analytical tools enhances the significance of these findings by enabling a proxy for clinical outcomes.
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