Virtual Visits Partially Replaced In-Person Visits In An ACO-Based Medical Specialty Practice.

Specialty care contributes significantly to total medical expenditures, for which accountable care organizations (ACOs) are responsible. ACOs have sought to replace costly in-person visits with lower-cost alternatives such as virtual visits (videoconferencing with physicians). In fee-for-service environments, virtual visits appear to add to in-person visits instead of replacing them. While this may be less of a problem within ACOs, whether virtual visits reduce in-person visits in an ACO is not known. Using data from over 35,000 patients in the period 2014-17 within a Massachusetts-based ACO, we found that the use of virtual visits reduced in-person visits by 33 percent but increased total visits (virtual plus in-person visits) by 80 percent over 1.5 years. While the use of virtual visits reduced in-person visits soon after registering with the program, the effect did not endure beyond a year. Whether and how virtual visits can substitute for in-person care in the long term are open questions.