The Impact of Direct-to-Consumer, Video Telemedicine

项目摘要/摘要 46%的雇主目前为远程医疗服务提供保险，高于2013年的28%。 这是对历史模式的重大转变，在历史模式中，远程医疗护理服务在很大程度上是在 服务不足的市中心和农村地区，以改善获得专科护理的机会。随着网络的扩展， 互联网、更快的连接速度、更高的带宽和更多的移动设备使用，更多的患者 有办法从家中通过远程医疗访问提供商，潜在地改善了访问和 更广泛的便利性。了解视频远程医疗在广泛普及后将如何改变 患者-提供者接口对于了解如何更高效地提供护理至关重要。 -- 在广泛的基础上扩展远程医疗的两个障碍是：1)缺乏远程医疗 患者可以通过该平台从自己的家中访问范围广泛的医生；2)缺乏 寻求服务提供者咨询时的保险覆盖范围。最近，这些障碍被克服了 美国最大的健康保险公司之一，提供直接面向消费者的视频远程医疗工具。工具 使1900万成年人能够通过计算机或移动设备全天候与医生联系，改善了 便利性和消除因出行时间、需要离开工作或需要 托儿所。这种形式的远程医疗不同于针对疾病的程序和电子医疗 以前研究过的远程医疗访问(“电子访问”)。患者对这种形式的直接面向消费者的视频的反应 远程医疗还没有被很好地理解。 我们的多年研究将利用保险公司引入 通过直接面向消费者的远程医疗工具进行虚拟访问，以研究该工具对患者访问的影响 护理，2)护理质量，3)跨替代来源的常见条件的利用率和支出 医疗服务(零售诊所、初级保健办公室、急诊室)。这项研究的创新之处在于它对一个独特的 自然实验，为参保人使用视频远程医疗创造了不同的财务激励 成人，其使用的独特数据，干预组的规模(1900万成人参与者)，其纵向 设计，以及与美国一家大型私营保险公司的合作。这项研究的结果将通知私营保险公司 政策，州远程医疗法律和法规，以及医疗保险和医疗补助覆盖政策，其中 覆盖范围在地理上受到限制或仅限于一组狭窄的服务，

Project Summary/Abstract Forty-six percent of employers offer insurance coverage for telemedicine services today, up from 28% in 2013. This is a significant shift from historical patterns where telemedicine care delivery was largely promoted in underserved inner city and rural areas in order to improve access to specialty care. With the expansion of the internet, faster connection speeds, improved bandwidth, and greater use of mobile devices, more patients have the means to access providers via telemedicine from their home, potentially improving access and convenience more broadly. Understanding how video telemedicine, when made widely accessible, changes the patient-provider interface is critical to understanding how to more efficiently and effectively deliver care.   Two barriers to the expansion of telemedicine on a broad basis have been 1) the lack of a telemedicine platform through which patients can access a wide range of physicians from their own home and 2) the lack of insurance coverage when provider consultation is sought. These barriers have recently been overcome by one of the largest US health insurers, which offers a direct-to-consumer, video telemedicine tool. The tool gives 19 million adults around-the-clock access to physicians via computer or mobile device, improving convenience and removing access barriers that arise from travel time, the need to leave work, or the need for child care. This form of telemedicine is distinct from disease-specific programs and from electronic telemedicine visits (“e-visits”) studied previously. Patient response to this form of direct-to-consumer, video telemedicine is not well understood. Our multi-year study will take advantage of a natural experiment provided by the insurer's introduction of the virtual visits through a direct-to-consumer telemedicine tool to study the effect of the tool on 1) patient access to care, 2) quality of care, and 3) utilization and expenditures for common conditions across alternative sources of care (retail clinics, primary care offices, emergency room). The study is innovative in its analysis of a unique natural experiment that created differential financial incentives for video telemedicine use among insured adults, its use of unique data, the size of the intervention group (19 million adult enrollees), its longitudinal design, and collaboration with a large US private insurer. Findings from this study will inform private insurer policies, state telemedicine laws and regulations, as well as Medicare and Medicaid coverage policy where coverage is geographically limited or restricted to a narrow set of services,