Impact of Telehealth on Pediatric Direct Primary Care: Is Virtually Showing Up Valuable?

Direct primary care (DPC) is a transformative alternative to the fee-for-service insurance-based model, offering unlimited patient access for a monthly fee. With growing interest in DPC within pediatrics, our primary objectives were to evaluate how increased access through DPC influences multimodal telehealth utilization and assess its potential to reduce in-person care encounters and costs, including office, urgent care, and emergency department (ED) visits.

A cross-sectional electronic member survey of a multi-physician pediatric DPC network was distributed in April 2023, which assessed the utilization and impact of telehealth modalities and their ability to avoid in-person healthcare visits. Data from the chargemaster of a nearby children's hospital were used as a proxy for the mean costs of pediatric office, urgent care, and ED visits to calculate cost savings for members.

There were 59 parent responses out of 155 for a response rate of 38%; 100% (59/59) reported texting questions to their doctor, 93% sent pictures to the doctor, 88% directly telephoned the doctor, and 22% used video chat. The minimum mean healthcare expenditure avoided by utilizing telehealth modalities is $1,171.13 per year per family. Patient satisfaction with the DPC model demonstrated a Net Promoter Score (NPS) of 98/100.

Our study demonstrates that utilization of telehealth modalities in DPC reduces the frequency of in-person office, urgent care, and ED visits and leads to family cost savings. These findings offer valuable insight for healthcare agencies and professional societies developing policies to support pediatric DPC as a sustainable model that delivers value to families, employers, and payers alike. Limitations include regional cost variations and unspecified total avoided visits, and the number of pediatric patients per family. This may result in an underestimation of family savings. Further research should include a larger sample size with clear specifications on the number of visits avoided and the number of pediatric patients treated.