Health System Cost Reduction Through the Use of a Telehealth Emergency Medicine Service for Patients Treated in an Urgent Care Setting

Health systems across the United States may wish to implement high-acuity telehealth services to support urgent care (UC) providers and divert avoidable emergency department (ED) referrals. Intermountain Health implemented a Telehealth Emergency Medicine Service (TeleEM), enabling board-certified emergency physicians to evaluate UC patients via teleconsultation, arrange outpatient laboratory and imaging studies, and longitudinally follow patients with escalation to the ED or specialty care when indicated. This model aims to safely manage UC patients with conditions such as chest pain, abdominal pain, and neurologic symptoms while reducing unnecessary ED use and lowering health system costs.

TeleEM was implemented across Intermountain Health in Utah on July 1, 2022. We conducted a retrospective analysis of all UC patients evaluated through the TeleEM program from July 1, 2022, to September 1, 2025. Cost data included all healthcare expenditures within 30 days of the UC encounter: TeleEM encounters, ED visits, hospital admissions, and outpatient testing. Patients managed through TeleEM were compared with UC patients who did not receive TeleEM consultation using propensity score matching based on demographic detail (age, sex, ethnicity) and prior amounts paid. Outcomes included 30-day ED presentation and 30-day total cost of care.

During the 38-month study period, 1,325 patients were managed through TeleEM after an urgent care visit while 14,742 UC patients did not involve TeleEM consultation. Overall, 60.6% of included patients were female and 74.87% self-identified as White non-Hispanic. After propensity-score matching, 1,325 TeleEM patients were compared with matched non-TeleEM controls. Among TeleEM-managed patients, 58 patients (4%) presented to an ED within 30 days of the UC visit, compared with 1,296 patients (98%) in the matched non-TeleEM group (p < 0.01). The mean 30-day cost of care for TeleEM-managed patients was $2,835 versus $5,747 for matched controls, representing a 51% reduction in costs (absolute reduction: $2,912; p < 0.01).

Health systems may wish to implement high-acuity telehealth services to support UC providers and divert avoidable ED referrals. This model appears to safely support UC providers by managing high-risk clinical presentation without an ED visit while reducing downstream spending.