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Study: Patients with Higher Out-Of-Pockets Costs More Likely to Use Online Patient Engagement Tools

December 29, 2015
by Heather Landi
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Patients with higher out-of-pocket costs for medical care are significantly more likely to choose email or other online patient engagement tools versus an in-office visit to contact their healthcare provider about health concerns, according to a study published in the American Journal of Managed Care (AJMC).

The study, which surveyed patients at an integrated healthcare delivery system with access to a patient portal to send secure email messages to providers, found that 46 percent of patients with a chronic health condition who contacted their healthcare provider via email through a patient portal reported that email was their first method of contact.

And, 85 percent of patients with higher cost-sharing for in-person visits reported choosing email as their first contact method compared with 63 percent of patients with lower cost-sharing, according to the study.

Also, more than 1 in 3 patients who sent an email to providers reported that it reduced their phone contacts or office visits, and a similar number, about 32 percent of patients, who sent an email to providers reported that it had improved their overall health.

The study authors wrote, “As more patients gain access to patient portal tools associated with an electronic health record, patient-provider emails may shift the way that healthcare is delivered and have the potential to impact efficiency, quality, and health outcomes.”

The study was conducted by the Kaiser Permanente's Division of Research, the University of Tennessee Health Science Center and the Mongan Institute for Health Policy at Massachusetts General Hospital. The study involved patients at Kaiser Permanente Northern California, an integrated delivery system based in Oakland, Calif. Health system members who register to use the password-protected patient portal website are able to exchange secure electronic messages directly with a provider in their healthcare team. Through the portal, which is offered at no charge, patients can view lab results, request medication refills, view portions of their health records and can schedule nonemergency office visits.

The study population consisted of adult patients who were in at least one of the health plan’s clinical chronic disease registries for asthma, coronary artery disease, congestive heart failure, diabetes or hypertension during 2010.

The study authors note that with the rapid growth of healthcare costs, health plan benefits that include high levels of patient cost-sharing (such as high deductibles) have been growing in popularity with policy makers and employers.

“In addition to the cost-sharing associated with a doctor’s office visit, patients often face additional barriers and costs to seeking in-person care, such as difficulty getting time off from work or arranging transportation or childcare. The convenience of e-mail may reduce these barriers to accessing care,” the study authors wrote. “Also, our finding of higher rates of patients using secure messaging as their first method of contact when facing higher out-of-pocket costs for in-person care may signal changes in patients’ care-seeking patterns that could become increasingly common as patient cost-sharing levels continue to grow and the ability to communicate with providers electronically becomes more widespread.”

“Additionally, although our study focused only on out-of-pocket charges for healthcare services such as co-payments and deductibles, patients may have also had other unmeasured personal expenses for transportation, lost wages, childcare, etc, associated with any healthcare encounter. Overall, the study data are cross-sectional; thus, these findings are not designed to establish causality. Future studies should continue to examine the impact of patient–provider email use on healthcare-seeking behavior, clinical care delivery work flow, and patient outcomes,” the study authors wrote.

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