A 2017 telehealth study found higher spending, not savings, as ASC investment rises

Direct-to-consumer telehealth has been sold to employers and health plans for a decade on a simple promise: swap expensive office and emergency department visits for a cheaper virtual visit. The best-cited public claims benchmark says that swap often doesn’t happen.

In an analysis published by Health Affairs, researchers used commercial claims data covering more than 300,000 patients across 2011–2013 and focused on acute respiratory illnesses. They estimated that 12% of direct-to-consumer telehealth visits replaced visits to other providers, while 88% represented new utilization. Net annual spending on acute respiratory illness increased by $45 per telehealth user, according to the Health Affairs abstract.

The number operators can actually plan around: 12% substitution

For benefit and network leaders, the most actionable part of the Health Affairs result is not the $45 figure, it’s the substitution math behind it. A virtual channel that replaces 12% of visits behaves very differently in forecasting than one that replaces 50%.

That distinction matters because many internal dashboards still treat telehealth success as “adoption,” measured by registrations, utilization, or member satisfaction. According to Health Affairs, increased convenience may tap into unmet demand for health care, and new utilization may increase overall health care spending. In 2011–2013 claims data on acute respiratory illnesses, Health Affairs estimated that 12 percent of direct-to-consumer telehealth visits replaced visits to other providers and 88 percent represented new utilization, with net annual spending increasing $45 per telehealth user.

ASC investment is rising, and it changes what “downstream” means

MobiHealthNews reported on August 31, 2026, via a HIMSSCast episode, that Erik Tellefson of Capital One said ambulatory surgery centers “represent one of the clearest growth structures in American healthcare.”

For operators, the connection is practical. As outpatient capacity expands, virtual front doors increasingly act as the routing layer: who gets scheduled where, in what timeframe, and under which benefit incentives. Telehealth ROI can hinge on whether the virtual workflow is wired into the ASC network’s scheduling, prior authorization checks, and referral management, instead of simply creating a new entry point that generates more appointments.

What to change in benefit design and vendor scorecards

The Health Affairs findings don’t say direct-to-consumer telehealth is “bad.” According to Health Affairs, increased convenience may tap into unmet demand for health care, and new utilization may increase overall health care spending. The operational job is to decide when incremental care is a feature, improved access, and when it’s leakage that should be redirected or deflected.

Where this lands in 2027 planning for payers and large employers

• Use substitution versus new utilization as the core measure when evaluating direct-to-consumer telehealth. Health Affairs estimated that 12% of direct-to-consumer telehealth visits replaced visits to other providers and 88% represented new utilization in an acute respiratory illness claims analysis.
• Align incentives to the channel’s job. If telehealth is intended to replace physician office, urgent care, or emergency department visits, confirm the benefit differential, after-hours coverage, and triage pathways that make substitution plausible, not just convenient.
• If your network strategy includes ASCs, map the referral and scheduling handoff from virtual visits into your preferred outpatient sites. MobiHealthNews’ reporting on ambulatory surgery center investment is a reminder that outpatient capacity and competition can shape where care flows.
• Track utilization and spending, not just per-visit prices. Health Affairs reported net annual spending on acute respiratory illness increased $45 per telehealth user in its analysis, which can be missed if results are only reviewed in overall averages.