Abstract: Interest in innovative health care delivery models has surged in recent years, partly owing to measures such as the Affordable Care Act which have expanded insurance coverage and spotlighted the need to contain health care costs. The goal of these innovations is to increase physician capacity without sacrificing quality of care. One innovation that has been proposed as a low-cost alternative to traditional office and phone visits is “e-visits,” or secure messaging between patients and physicians via patient portals. Using a panel dataset from a large primary care provider in the United States, we impact of patient adoption of e-visits on their subsequent frequency of office and phone visits, and also their subsequent health statuses. We study the 2008 to 2013 time period for our system which covers the first adoption of e-visits and their following promotion. The data enable a variety of difference-in-differences, matching, and instrumental variable analyses due to the variation in timing of both patient and physician adoption of e-visits, which allow us to carefully consider both observable and unobservable factors that drive patient e-visit adoption. Our study is the first to document strong evidence that contrary to current beliefs, e-visits serve to “trigger” additional office and phone visits without consistently measured improvements in patient health as measured by levels of blood cholesterol and blood glucose. The instrumental variable analysis provides suggestive evidence that patients on a healthy trajectory may be adopting e-visits at higher rates.

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