Managing Virtual Appointments in Chronic Care

Virtual appointments between patients and healthcare providers (through phone calls, e-mail and web based applications) can provide a cost-effective alternative to traditional office appointments for managing chronic conditions via regular monitoring, symptomatic treatment and education. Virtual appointments are intended to increase contact with the physician by either substituting or complementing office appointments, leading to improved health outcomes. It is important to design systems to integrate virtual and traditional office appointments. In this study, we introduce a capacity allocation model to study the use of virtual appointments in a chronic care setting. Specifically, we develop a finite horizon stochastic dynamic program to determine which patients to schedule for office and virtual appointments that maximizes aggregate health benefits across a cohort of patients. We find that under certain conditions, a simple myopic policy, where the sickest patients are scheduled for office appointments and the next sickest patients are scheduled for virtual appointments, is optimal. In more general settings, the myopic heuristic is found to be effective with an overall optimality gap of less than 3%. We demonstrate that virtual appointments may improve patients outcomes even if they provide only diagnosis. Our findings further show that virtual appointments serve a dual purpose: they may reduce the number of office appointments and may trigger follow-up office appointments by complementing and substituting for office appointments, if necessary.