How eConsults Could Transform Care Coordination and Access

In an industry constantly looking for innovative ways to lower costs, improve communication and expand access, eConsult programs have emerged as a viable tool for improving care coordination for hard-to-reach Medicaid patients. 

These telemedicine platforms accelerate the traditional process of patient referrals by leveraging online messaging to help primary care doctors determine if specialist referrals are necessary. 

Typically, a referral coordinator would link Medicaid patients in need of a specialty consult with specialists - but that can be a challenging task, industry experts pointed out during a panel session at Xtelligent Healthcare Media’s Fourth Annual Value-Based Care Summit in Boston.

“One in three patients is referred to a specialist each year, and that number is even higher for Medicaid patients – closer to one in two,” said Danielle Carder, a clinical and access innovations specialist at the Association of American Medical Colleges (AAMC). “So access is a challenge across the board for all our members, even those at non-academic health systems.” 

Specialists are also difficult to find, and often have few open spots for appointments. Many specialists are limiting new appointments, or they only have available spots several months distant for Medicaid patients. 

“For Medicaid members, it takes a very long time to get in to see specialists,” said Jacob Reider, MD, FAAFP, CEO of the Alliance for Better Health. “Specialty practices will always say yes. But it might be three months, it might be six months.”

“The eConsult, for us, has been a way to say, ‘OK primary care, here's a system through which you can get assistance from someone who's fellowship-trained, and keep that patient in your practice while getting them service, often within 24 hours instead of 24 days, weeks, or months,’” Reider continued. 

In addition to expanding patients’ access to care and boosting care coordination, eConsult platforms have the potential to significantly lower healthcare costs. 

“I like to say we started out trying to solve an access issue and ended up solving a big chunk of a shared savings problem,” said Daren Anderson, director of the Connecticut-based Weitzman Institute and one of the first providers to secure Medicaid reimbursement for the service. “As a primary care practice looking to take on risk and beginning to embrace value-based opportunities, there aren't that many levers we haven't already pulled. We're already working on 30-day readmissions, ambulatory sensitive admissions, and we have complex care coordination.”

“But the most expensive thing that a primary care provider does, day in and day out, is send patients into the specialty system for a specialty consult,” he added. “And we’ve seen lots of evidence about how that can, and often does, lead to higher costs of care.”

eConsults can allow primary care doctors to treat patients mainly in the primary care space, reducing unnecessary consults that can lead to more tests and procedures, Anderson said.

“One of the papers that we published last year in the American Journal of Managed Care showed that cardiology consults, when sent as an eConsult first, saved about $500 per patient in the entire study,” he said. “And the majority of those savings came from increased costs of tests and procedures in the patients that got sent directly for face-to-face appointments rather than having an eConsult.”

While there are several benefits to using eConsult platforms, the panelists acknowledged what seems to be a persistent barrier to innovation in healthcare: resistance to change.

“This is a new skill,” Carder said. “It's something new for PCPs, and it's new for specialists. There needs to be outreach, training and familiarization around that tool. It helps to have a team to introduce this new skill to your primary care providers and to tell them what are good, quality sample eConsult questions in a specific specialty.” 

“You hear from PCPs that a lot of times in the beginning, they're scared to submit a question,” she added. “But understanding the types of questions that could be answered and asked by an eConsult is important. And we found by really engaging primary care providers and specialists, we have 85 percent of PCPs at our institutions using the eConsult tool completely voluntarily.”

Rather than think of eConsults as a technology, organizations should focus on the platform in terms of provider workflows and productivity.

“The success of your implementation is inversely proportional to the number of extra clicks you require of your primary care provider,” Anderson said. “And it ends at one.”

“You really need workflow engineers to map this out, and to capitalize on existing workflows to make it work as efficiently as possible,” he added.

Bringing specialists and primary care providers together on a connected health platform to discuss new methods of care will also benefit organizations.

“We believe that you need to have conversations with your PCPs and your specialists, because developing your institution’s standards of care and adapting methods to your local norms is where you're going to get increased usage,” Carder said.

Ultimately, organizations will succeed in shifting to innovative models of communication if they take a slow and steady approach.

“We're talking about change. And change, as they say, moves at the speed of trust,” Reider said. “What we always try and do is pull rather than push. We create something, and then we educate folks about the opportunity to try a new path.” 

Join us in Austin June 3-5, 2020 for the Value-Based Care Summit & Telehealth20!