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April 4, 2019
David Burda
Consumerism Innovation System Dynamics

Patients’ Growing Appetite for New Outpatient Care Models

If you believe in the adage “follow the money,” it would lead you to telemedicine. Analyzing billions of private health insurance claims, a new report said telemedicine is the fastest growing outpatient care delivery model in the U.S.

FAIR Health, the New York-based healthcare transparency advocacy group, released its second annual FH Healthcare Indicators report on April 1.  FAIR Health maintains a database of more than 28 billion private health insurance claims submitted by more than 150 million people (and their providers) to their health plans for payment.

Researchers from FAIR Health combed through its database to identify trends in where privately insured patients are getting their outpatient care.

From 2016 to 2017, the number of claims submitted for telemedicine visits jumped 53 percent and were up 1,202 percent over a six-year period, 2012 to 2017. By comparison:

  • The number of claims for visits to urgent-care centers rose 14 percent from 2016 to 2017 and were up 1,434 percent over a 10-year period, 2008 to 2017
  • The number of claims for visits to retail health clinics rose 7 percent from 2016 to 2017 and were up 674 percent over a six-year period, 2012 to 2017
  • The number of claims for visits to ambulatory surgery centers rose 6 percent from 2016 to 2017 and were up 97 percent over a 10-year period, 2008 to 2017
  • And the number of claims for visits to emergency rooms dropped 2 percent from 2016 to 2017 and were up just 194 percent over a 10-year period, 2008 to 2017

And what did patients go to those settings for? Other than outpatient surgeries at ASCs, the top non-surgical reason for visits to the other settings in 2017 was:

  • Acute respiratory infections for retail clinics
  • Acute respiratory infections for urgent care centers
  • Acute respiratory infections for telemedicine providers
  • Acute respiratory infections for hospital ERs

Repetition intended to make a point. Patients and their health plans don’t see much difference among the settings when it comes to their ability to diagnose, treat and be reimbursed for a common malady. Also, people seem to get a lot of upper respiratory infections.

The report adds to a growing body of research that shows that patients’ tastes in where they get their outpatient care services are changing dramatically.

What makes this report particularly credible is the fact that it’s based on claims. It’s not a survey or poll or sponsored by a telemedicine vendor or trade association. It’s based on where people went and what their health plans paid for.

Money talks, and it’s telling us loudly that traditional care models are on the way out thanks to things like consumerism, technology, engagement, transparency and convenience.

To learn more on this topic, read “Wither the Traditional Physician Office Visit” on 4sighthealth.com here.


David Burda is a columnist for 4sight Health and news editor of 4sight Friday, our weekly newsletter. Follow Burda on Twitter @DavidRBurda and on LinkedIn. Read his bio here

About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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