O2177: Telehealth Modalities Are Key to the Value of Direct Pediatric Care

Background: Direct Pediatric Care (DPC) is a relatively new and transformative pediatric care model that replaces the high-volume fee-for-service (FFS) insurance-based practice model with unlimited patient access for a flat monthly membership fee. How does this increased access impact multimodal telehealth utilization? Does this different payment paradigm result in appropriately avoidable office, urgent care, or emergency department visits for families?

Methods: We performed an electronic member survey of a multi-physician direct pediatric care practice network to assess the utilization and impact of telehealth modalities within the DPC model, and the ability of these modalities to avoid in-person office visits, urgent care visits, or emergency department (ED) visits. Parents of members were sent an electronic survey link and one reminder via email.

We utilized standardized, published data from the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey and other published children’s hospital pricing to assign mean national costs to pediatric office ($169), urgent care ($250), and ED ($821) visits to calculate healthcare cost savings for members.

Results: There were 59 parent responses for a response rate of 38%. There were 100% (59/59) who reported texting questions to their doctor’s cell phone, 93% sent pictures to the doctor’s cell phone, 88% placed a direct telephone call to the doctor, and 22% used video chat (Fig 1). For families who had been members for less than six months, utilization patterns remained high: 100% reported texting, 88% sent photos, 69% placed a telephone call, and 13% had a video chat.

Families self-reported that these communication modalities prevented a doctor’s office visit for 98% (58/59) of members, an after-hours or weekend urgent care visit for 92% (54/59) of members, and an emergency department visit for 69% (40/59) of members.

Utilizing mean expenditure data and self-reported avoided visits, the minimum mean healthcare expenditure avoided by utilizing telehealth modalities is $1,240 per year per family.

Patient satisfaction with the DPC model demonstrated a Net Promotor Score of 98/100.

Conclusion: Telehealth communication modalities are widely utilized in DPC, lowering the utilization of in-person office, urgent care, and ED visits. While our data demonstrates family cost savings, there are limitations to this methodology including regional and system-based cost differences, and not specifying the total number of avoided visits, nor number of children, for whom a visit was avoided. This may result in our data underestimating family savings. For reference, the average annual membership cost per patient is $1,440 in our network. These savings substantially offset membership dues. The added convenience of avoided in-person visits due to these telehealth modalities further adds to the value of the DPC model. The ultimate result is exceedingly high family satisfaction as demonstrated by a Net Promotor Score of 98.