title: New Delivery Model for Rising-Risk Patients: The Forgotten Lot?
abstract: Shared-risk models encourage providers to engage young patients early. Telemedicine may be well suited for younger, healthier patients although it is unclear how best to incorporate telemedicine into routine clinical care.
  
  
  
  We test the assumptions surrounding the use of telemedicine, younger and rising-risk patients, and primary care in ClickWell Care (CWC), a care model developed at our institution for our own accountable care organization.
  
  
  
  CWC's team of physicians and wellness coaches work together to provide comprehensive primary care through in-person, phone, and video visits. This study examines usage of the clinic over its initial year in operation.
  
  
  
  1,464 unique patients conducted a total of 3,907 visits. 2,294 (58.7%) visits were completed virtually (1,382 [35.4%] by phone and 912 [23.3%] by video). Patients were more inclined to see the physician in-person for a new visit (1,065 visits [70.5%] vs. 362 [24%] phone and 83 [6%] video) and more likely to see the physician virtually for a return visit (606 [43.2%] phone and 249 [17.7%] video vs. 548 [39.1%] in-person), a statistically significant difference (X2= 306.7, p < 0.00001).
  
  
  
  This new care model successfully engaged a younger population of patients. However, our data suggest young patients may not be inclined to establish care with a primary care physician virtually and, in fact, choose an initial in-person touch point, although many are willing to conduct return visits virtually. This new model of care could have a large impact on how care is delivered to low- and rising-risk patients.
authors.affiliation: Department of Medicine, Stanford University School of Medicine and Stanford Center for Digital Health, Stanford Medicine, Stanford University , Stanford, California.
authors.forename: Lauren
authors.initials: L
authors.lastname: Cheung
authors.affiliation: Department of Medicine, Stanford University School of Medicine and Stanford Center for Digital Health, Stanford Medicine, Stanford University , Stanford, California.
authors.forename: Justin
authors.initials: J
authors.lastname: Norden
authors.affiliation: Department of Medicine, Stanford University School of Medicine and Stanford Center for Digital Health, Stanford Medicine, Stanford University , Stanford, California.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.affiliation: Department of Medicine, Stanford University School of Medicine and Stanford Center for Digital Health, Stanford Medicine, Stanford University , Stanford, California.
authors.forename: Sumbul A
authors.initials: SA
authors.lastname: Desai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D017216:Telemedicine / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
keywords: business administration/economics; e-Health; home health monitoring; m-Health; telemedicine