Telehealth scenario: Primary care visits


The American Medical Association "Return on Health" framework is a holistic value framework designed to guide clinicians, virtual care leaders, payers and other health care stakeholders in assessing value created for patients and for themselves. 

The entity (Viridian Family Practice) referenced in this illustrative case is fictional. Individuals, businesses, events and scenarios referenced are influenced by interviews and review of publicly available literature. Any resemblance to actual individuals, entities or events is purely coincidental.

Viridian Family Practice is a small, independent primary care practice located in a suburban area. With many primary care-focused digital health companies starting to offer primary care services via telehealth, the practice has decided to start offering patients the option of scheduling a video visit to address low-acuity clinical issues.

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The practice’s annual patient volume is approximately 7,000. The office is staffed by a physician, two nurse practitioners, two medical assistants and office staff. The practice has decided to organize telehealth alongside in-person service delivery by scheduling “telehealth-only days” wherein the physicians and nurse practitioners alternate days when they conduct only video visits or in-person appointments. To determine which cases should be triaged for a video visit, the practice will utilize a clinical appropriateness protocol that provides a decision matrix to help office staff determine the types of patient issues for which a video visit may be offered to the patient as an alternative to an in-person appointment.

For example, the protocol permits the initiation of video visits to conduct medication adjustments, chronic disease management and counseling, and assessment of select conditions where a physical exam is not necessarily required, such as nonurgent behavioral health care. Ambiguous cases are reviewed by the practice’s nurse practitioners.

Viridian Family Practice has decided to adopt primary care video visits in order to:

  • Attract/acquire new patients.
  • Improve patient access and timeliness of care.

Clinical quality and safety outcomes

  • Relevant measures
    Number of visits to correct diagnosis
  • Impact goals
    Maintain the same number of visits to correct diagnosis as in-person care

Access to care

Availability of care

  • Relevant measures
    Median travel time per patient
  • Impact goals
    Reduce travel time per patient by 30 minutes

Patient, family and caregiver experience

Clinical and/or technology experience

  • Relevant measures
    • Patient-reported comfort and ease of use
    • Net Promoter Score (NPS)
  • Impact goals
    • Achieve total patient reported comfort with effectively using the video visit platform of at least 85%
    • Increase NPS scores by 10%

Clinician experience

Technology experience

  • Relevant measures
    Ease of use
  • Impact goals
    Ensure that 90% of Viridian’s clinicians find the video visit platform easy to use

Work experience

  • Relevant measures
    Engagement and satisfaction with work
  • Impact goals
    Improve engagement and satisfaction with work by 30%

Direct revenue

  • Relevant measures
    Direct contribution margin
  • Impact goals
    Maintain existing contribution margin

Indirect revenue

  • Relevant measures
    New patient acquisition
  • Impact goals
    Increase new patient growth by 15%

Operational efficiencies

  • Relevant measures
    No-show rate
  • Impact goals
    Decrease no-show rate by 25%

Health equity

Equity in patient, family and caregiver experience

  • Relevant measures
    Relative improvement in satisfaction with care for older adults
  • Impact goals
    Improve patient satisfaction rates among individuals over age 65 by 10%

Walmart: Walmart’s Doctor on Demand program has offered medical and behavioral health visits to patients in Colorado, Minnesota and Wisconsin since 2019.

Aledade: In March 2020, Aledade and partner Updox launched a comprehensive telehealth solution to Aledade’s national network of physician-led ACOs. Teladoc Founded in 2002, Teladoc offers virtual primary care services to members across the United States and other countries.

Kaiser Permanente: Kaiser began offering telehealth in 2016. Target conditions include cold and flu symptoms, minor injuries, and follow-up care for chronic conditions.

OneMedical: OneMedical offers subscribers 24/7 access to video chat and the ability to digitally renew prescriptions and communicate with clinicians via app.

Doctor on Demand: Founded in 2012, the company provides access to virtual appointments to address primary, behavioral and urgent care needs.

Clinical outcomes, quality and safety

  • The NCQA Taskforce on Telehealth Policy found that nonurgent complaints in primary care settings, diagnostic accuracy and the likelihood of diagnostic error appear to be roughly comparable in telediagnosis versus face-to-face encounters.
  • A 2014 study found that patients who used virtual primary care services were less likely to have a follow-up visit to any setting, compared with those patients who visited a physician’s office or ED.

Patient, family and caregiver experience

A 2019 study found that 90% of patients were confident in the care they received through video visits.

Financial and operational impact

A 2019 study found that virtual primary care generated cost savings without an associated increase in overall follow-up rates or antibiotic use when compared with in-person urgent or primary care.

Download the scenario (PDF) and read other Return on Health telehealth case studies and scenarios.

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Using Return on Health to review primary care video visits. Read the report and relevant tables.