Virtual Consult Case Study
Emergency room usage rates and charges in a Medicaid population who received 24-hour, 7-days/week access to physicians on a telephone for urgent medical information requests, compared to a control group Medicaid population who was not enrolled in the program.
Location: Southern U.S. State
Design: Two regions, Region “A” and Region “B”, were selected for assessment based on similar Medicaid population demographics, socio-economic status, and health status. Total Medicaid claims and billings were measured in both regions for a period of 6 months prior to the intervention, from May through November. Claims and billings were again measured in both regions during the following period May through November, when the physician telephone access service was provided to beneficiaries in Region “A” but not in Region “B”. Medivo’s physician network provided the telephonic services and were scheduled in sufficient capacities to be available within 5 minutes of a patient calling an 800# with a special beneficiary code.
Significant Results: During the pre-intervention timeframe, claims volumes and total reimbursement levels were established as baselines in both regions. Changes were observed during the intervention timeframe. Region “A” experienced a 19.1% reduction in claim volumes for children under 2 (17.4% reduction in claims $), whereas Region “B” experienced a 5.4% increase in claims for children under 2 (2.2% increase in claims $) – representing a total difference in claims’ rates of 24.5% (19.6% difference in claims $). When summing all age categories, Region “A” experienced a 23.4% reduction in claim volumes (21.1% reduction in claims $) and Region “B” experienced a 9.5% reduction (10.6% reduction in claims $) – representing a total difference in claims’ rates of 13.9% (10.5% difference in claims $). See Chart 1 below.
Conclusions: Access to physicians for urgent medical information served to reduce both claims’ volumes and total dollars in this Medicaid population case study. The effect was larger on the segment of beneficiaries under age 2, ~20% reduction in ER visits and expenses, but also shown to have an ~10% reduction in services overall.
Chart 1: Region “A” vs. Region “B” – Vertical axis represents reductions in Medicaid claims and dollars from the Pre-intervention to the Intervention timeframes.
