Impact of VA's Clinical Resource Hub Primary Care Telehealth Program on health care use and costs

Abstract: BACKGROUND: Telehealth can improve health care access in underserved areas. Hub-and-spoke-models, wherein providers in regional hubs deliver care through telehealth to patients visiting local "spoke" clinics, can improve access. However, cost impacts of this model are unknown. OBJECTIVE: Evaluate the utilization and cost impacts of VA's Clinical Resource Hub program for primary care (CRH-PC), a hub-and-spoke-model. DESIGN: Adjusted difference-in-difference and event study analyses comparing patients at program-sites who used CRH-PC services with patients who never used CRH-PC services, prepost program adoption, fiscal years 2018-2021. We also compared all patients at CRH-PC sites versus at non-CRH-PC sites to assess site-wide impacts. PARTICIPANTS: CRH-PC sites: 164 sites and 1,546,892 patients; Non-CRH-PC sites: 704 sites and 4,062,797 patients. MEASURES: Costs and number of VA-provided and VA-purchased primary, emergency, and acute inpatient care visits. RESULTS: At CRH-PC sites, 64,973 patients (4%) used CRH-PC services. Rural patients, African-American patients, and patients with greater comorbidities had higher odds of receiving program services. Program exposure was associated with an 18% increase in primary care visits (+0.7) and $612 per program-user per year. Comparing all patients (users and nonusers) at program-sites versus nonprogram sites, we found no impact, except video-based care more often replaced in-person services at program-sites. CONCLUSIONS: Among program-users, VA's CRH-PC increased mean primary care visits and VA costs, but as only 4% of patients at program-clinics were program-users, there were no differences in overall cost or utilization between program and nonprogram clinics. Findings suggest clinics can offer primary care telehealth services to high-need populations without affecting clinic-level costs, but costs should be monitored upon wider adoption.