Healthcare utilization and economic analysis of an internal on-demand telehealth service for upper respiratory infections

Introduction On-demand telehealth services are available to improve access and convenience of care, with some expectation that these visits may replace scheduled video visits and in-person visits. As on-demand telehealth becomes integrated into healthcare delivery models, there is a need to evaluate its impact on access, utilization, and charges. Objective This study evaluates an integrated, on-demand telehealth service (Express-Care) at an academic health center and how its availability and adoption influenced healthcare utilization and charges for patients seeking care for upper respiratory tract infections (URIs). Methods A retrospective cohort study was conducted using electronic health record data from UC Davis Health between July 2018 and October 2024. A cohort of patients using Express-Care for URI was compared to patients receiving URI care via other modalities using a 1:2 propensity score match on sex, age, race/ethnicity, insurance, California Healthy Place Index, comorbidities, and household income. Patients who did not have URI visits both before and after the launch of Express-Care were excluded. Results Among the 26,605 patients treated for URI, Express-Care users were more likely to be female (66.9% vs. 61.9%, p < 0.001) and commercially insured (84.6% vs. 78.5%, p < 0.001) than nonusers. In the matched patient cohort, Express-Care use replaced scheduled video visits and in-person visits 70% of the time, while 30.0% represented new utilization. Follow-up rates were higher after Express-Care visits than after compared to non-Express-Care visits (5.1% vs. 1.6%, p < 0.0001). Adjusted difference in mean charges was USD190 lower for Express-Care episodes than for non-Express-Care episodes ( p < 0.0001). Discussion Access to Express-Care resulted in 42% more visits for URIs among users than among matched nonusers. Despite the increased visit frequency and follow-up rates for URIs, Express-Care was associated with lower mean healthcare charges.