Study Shows Veterans Participating in a VA National Telehealth Tablet Initiative Save Both Time and Money
BACKGROUND:
While there is increasing evidence highlighting the impact of including the patient perspective in telehealth cost analyses, there has been less emphasis on the patient characteristics that are associated with monetary and time savings. In 2016, VA initiated a program to distribute video-enabled tablets to Veterans with geographic, clinical, and/or social access barriers to in-person care so that they could receive services in their homes or other convenient locations (Zulman et al., 2019). As part of a national evaluation of this initiative, a patient experience survey was conducted with a subset of tablet recipients (n=764). Investigators in this study sought to determine patient-reported monetary and time savings, as well as characteristics associated with those savings [594 Veterans responded to questions about money, and 399 Veterans responded to questions about time]. Patients were asked to consider transportation, gas, lodging, and food costs and to quantify how much money they saved per appointment; responses were categorized as <$25, $25-50, and >$50. For time savings, Veterans were asked to report whether they avoided missing work due to the tablets and whether the time saved was “paid” or “unpaid.”
FINDINGS:
- Of the study cohort, 92% of respondents reported that the tablets saved them money or time; 89% reported saving money, and 71% reported saving time. Among those who reported monetary savings, 41% reported saving $25-50 and 31% reported saving >$50 per appointment.
- Monetary savings were most pronounced among Veterans living a greater distance from VA or experiencing travel barriers and those without mental health conditions. For example, relative to Veterans who lived within 15 miles of a VA facility, those who lived more than 40 miles away were more likely to indicate that tablets saved them $25-50 and >$50, as opposed to <$25. Time savings were most pronounced among both younger and older Veterans (compared to middle-aged Veterans), employed Veterans, and those with greater technological experience. Among employed Veterans, no predictors were significantly associated with taking paid versus unpaid leave.
IMPLICATIONS:
- Findings may inform policy decisions regarding patient targeting and training as VA aims to expand its use of video telehealth technology. Also, authors suggest that future studies consider how rural residence may impact telecommunications connectivity.
LIMITATIONS:
- Investigators did not include savings associated with patients' visit copays.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by VA/HSR&D’s Quality Enhancement Research Initiative (QUERI). Dr. Jacobs is part of HSR&D’s Health Economics Resource Center (HERC); all other authors are with HSR&D’s Center for Innovation to Implementation (Ci2i). Dr. Zulman also is PI for QUERI’s Enhancing Veterans’ Access to Care through Video Telehealth Tablets Partnered Evaluation Initiative.
Jacobs J, Hu J, Slightam C, Gregory A, and Zulman D. Virtual Savings: Patient-Reported Time and Money Savings from a VA National Telehealth Tablet Initiative. Telemedicine and e-Health. December 26, 2019; Epub ahead of print.
