Impact of VA's Clinical Resource Hub Primary Care Telehealth Program on Health Care Use and Costs

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.

Evaluate the utilization and cost impacts of VA's Clinical Resource Hub program for primary care (CRH-PC), a hub-and-spoke-model.

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.

CRH-PC sites: 164 sites and 1,546,892 patients; Non-CRH-PC sites: 704 sites and 4,062,797 patients.

Costs and number of VA-provided and VA-purchased primary, emergency, and acute inpatient care visits.

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.

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.