On the Role of Teletriage in Healthcare Demand Management

Abstract

Problem definition: Many healthcare providers and payers offer teletriage, a telemedicine service where concerned patients can get advice about their health condition. In theory, teletriage should help patients with an acute illness choose an appropriate provider, reducing unnecessary and duplicate provider visits, yet no study has assessed the overall costs and benefits of teletriage at a system level. Academic/practical relevance: We model the use of teletriage in managing healthcare demand and determine in which cases teletriage is efficient and effective. Our model extends the academic literature on service operations and provides practical suggestions for healthcare payers. Methodology: We use a Markov decision process to model a patient’s choices during an acute illness episode, where the illness severity is partially observable to the patient and triage is subject to errors. We parameterize the model using data from the literature and provide both structural and numerical results. Results: Patients with high uncertainty about their state would use the teletriage service, which may improve their cost outcomes. However, when teletriage is added, the rate of arrivals to the emergency department (ED) may increase when the overtriage rate is above 5%, the lowest value observed in the literature. Patient’s choices and the copayment of other services affect the cost-effectiveness of teletriage. Managerial implications: There are several reasons why adding teletriage to the healthcare system could produce a negative cost outcome. Teletriage should not necessarily be free, which would encourage use by patients with low levels of uncertainty and actually increase the payer’s total cost. The overtriage rate is a key driver of performance and must be managed carefully.