Presentation (CTI)

OBJECTIVES: Telemedicine offers convenience and expanded access, but its impact on care trajectories and healthcare costs remains understudied. We aimed to quantify elastic utilization, defined as additional outpatient visits triggered by digital access that would not have otherwise occurred in a fully in-person care system, and assess its implications under current reimbursement models.
METHODS: Using Penn Medicine EHR data, we applied a digital twin-based framework to construct matched in-person counterparts for patients with an index telemedicine visit. Matching accounted for demographics, clinical characteristics, and visit context. We compared total follow-up outpatient visits at one quarter and one year post-index to estimate utilization differences attributable to digital access.
RESULTS: Telemedicine significantly increased follow-up visit volume. At one quarter, telemedicine patients had 2.41 visits on average, compared to 1.98 among matched in-person counterparts (difference 0.43). At one year, the totals were 6.53 versus 5.71 (difference 0.82). Each additional encounter incurred reimbursement under current pricing structures.
CONCLUSIONS: Our findings challenge the prevailing assumption that telemedicine merely substitutes for in-person care. Instead, digital access drives a pattern of care expansion that may misalign with reimbursement strategies based on isolated encounters. These results highlight the need to reframe telemedicine reimbursement as part of longitudinal care planning, with implications for insurers, providers, and policy makers navigating the digital transformation of care.