eConsults: A Technological Lifeline for Rural Providers
Over the past decade, health centers in rural settings have led the way in using eConsults to improve patients’ access to specialty care. Rural patients face challenges accessing health care specialists such as dermatologists, neurologists, and rheumatologists. eConsults allow primary care providers to seek advice from geographically distant medical specialists, and have become a key component of rural providers’ telehealth approaches. Consultations reduce or eliminate the need for many patients to travel for face-to-face visits with specialists. eConsults enable primary care providers to ask clinical questions of a network of specialists and get an answer within hours. Studies have shown that eConsults decrease wait times for specialist visits and prevent unnecessary referrals. California policy leaders removed barriers in eConsult adoption by making these encounters reimbursable by providers. eConsults now have widespread support from Medicaid managed care plans and are a telehealth strategy in many states’ Rural Health Transformation programs. Provider leaders like Joel Ramirez, MD, of Camerena Health Center, have incorporated eConsult into their referral workflows to address rural health care access challenges.
E-Consult Growth across the U.S. and Abroad
The Playbook
Provider Engagement and Leadership
A provider champion is key to engaging the care team to embrace a process change that will improve patient access and create a more efficient referral process.
Provider Engagement and Leadership in Action
Sharing Lessons Learned
Zuckerberg San Francisco General, a system with over 20 years of eConsult experience, has shared its expertise with clinics across California to emphasize the importance of collaboration among primary care providers and payers, San Francisco e-consult leaders are known experts in eConsult best practices and lessons learned. View the Central Valley eConsult Dashboard created by ZSFG and BluePath Health.
The Importance of a Provider Champion
Dr. Tuot, Clinical Advisor to the E-Consult Workgroup, is also a practicing nephrologist and an active e-consult/eReferral participant. In addition to leading provider engagement at ZSFG, Dr. Tuot created an evaluation process that has been leveraged across hospitals in California and Nationally.
Dr. Tuot continues to support successful e-consult programs across the country in leading by example.
How to Get Started
Contact the E-Consult Workgroup to learn more about readiness assessment and provider engagement.
Payer Value Proposition and Ownership
E-consult programs are fostered by payer collaboration and consistent reimbursement, making workflows the same for providers whether they are treating Medicaid or Commercial-covered patients.
Payer Value Proposition and Ownership in Action
Anthem Blue Cross Approach
Anthem Blue Cross realized their Central Valley, CA county-wide e-consult program required payer collaboration in order to support providers with one workflow for all Medicaid patients.
To do this, they formed the Central Valley E-Consult Coalition with other managed care plans, FQHCs, and independent practice associations at the table.
Hear payer leaders’ perspectives on e-consult collaboration.
Payer Collaboration Leaders
The plans engaged Fresno, Madera, Kings and Tulare county FQHCs and the local medical groups to support one workflow and reporting mechanism for primary care providers using e-consult. The plans hosts county-wide roundtable sessions to foster conversations around patient/member and provider needs and increase access to care across the Central Valley and neighboring counties.
Learn more about the Central Valley E-Consult Coalition.
How to Get Started
Contact BluePath Health to learn about the county-wide e-consult implementation approach.
Streamlined Provider Technology Workflow
Primary care providers need a simple e-consult workflow and “at-the-elbow” support in order to embrace a change that can dramatically improve the specialty referral process.
Streamlined Provider Technology Workflow in Action
What OSU Did
In response to the COVID-19 pandemic, Ohio State University Wexler Medical Center leveraged Clinical Transformation in Technology (CTT) implementation framework to transition to telehealth, and leveraged its existing e-consult program to enable providers to support remote care delivery, patient and provider safety.
CTT Implementation Leaders
OSU’s Department of Family and Community Medicine’s Telehealth Workgroup employed the CTT framework to accelerate telehealth use and develop clinician recommendations in providing remote virtual care during the pandemic.
In a few weeks, patient visits went from 5% to almost 93% telehealth while maintaining high levels of patient satisfaction.
How to Get Started
Contact the E-Consult Workgroup to learn more about e-consult provider workflow.
Patient/Member Education and Communications
E-consults are peer-to-peer communications that result in reduced wait times and expedited specialty advice for patients, however, patients need to understand that care is taking place behind the scenes.
Patient/Member Education and Communications in Action
AAMC Approach
The Association of American Medical Colleges (AAMC) set out to understand patient perspectives and preferences for use at 5 US academic medical centers in the process of adopting e-consult.
Although e-consults take place behind the scenes, when patients are engaged to receive specialist advice, they demonstrate increased satisfaction with the care they receive.
Read more about patient perspectives on e-consult.
AAMC Implementation Leaders
Based on the University of California, San Francisco model, AAMC launched Project CORE: Coordinating Optimal Referral Experiences in 2014 to improve the clinician and patient referral experience.
More than 30 AMCs across the country have successfully implemented e-consults and e-referrals, tools built into the electronic medical record, improving quality of care and access in a patient-centered way.
In this study, UCSF assessed patient acceptance of e-consult.
How to Get Started
Contact BluePath Health to learn more about patient engagement strategies.
Case Study - Kaiser Permanente, Colorado, Specialty Care Initiative
Kaiser Permanente (KP) Colorado launched a unique program allowing community safety net primary care providers to request advice through e‐consult with select KP specialists who offered their time to support uninsured patients. The program offered opportunities for medical education for participating primary care providers, coordinating responses to improve access to care and the overall health of the community. As a result, interest in e-consult spread and sparked policy leader interest. Today, the Colorado Medicaid E-Consult program supports clinics across the state.
How do we launch an e-consult program?
Contact BluePath Health to get started.
Implementation Examples
Primary Care Organization (FQHC or Independent Practice)
Community Health Centers, Inc. a federally qualified health center in Middletown Connecticut, engaged its primary care providers, clinic specialists, and State Medicaid to support its initial effort.
At CHC, Inc., clinical leadership prioritizes the right type of care at the right time — e-consult, ECHO (provider education) and/or live video telehealth specific to the patient need.
Health System (Hospital or Academic Medical Center)
The University of California at Irvine faces a growing aging population, a high cost of living and a shortage of physicians. UCI implemented e-consult to tackle lower-complexity referral problems that did not require an in-person evaluation, resulting in 80% of requests being resolved electronically.
View the webinar where Dr. Alpesh Amin, Chair, Department of Medicine, UC Irvine School of Medicine presented on their experience.
Health Plan (Medicaid or Commercial Payer)
Inland Empire Health Plan partnered with WISE Healthcare to pair primary care providers with specialists to ask questions, learn from his experiences and improve processes.
In its Multi-County E-Consult Initiative, IEHP held evening networking meetings allowing providers to share a meal and discuss how to strengthen their program.
View the webinar in which Dr. Priya Batra of IEHP speaks to specialty care access through telehealth.
E-Consult Technology Providers and COVID-19 Response
The COVID-19 pandemic had an immediate impact on primary care providers who were forced to limit in-person visits to ensure patient and provider safety. Delays in primary care visits exacerbated specialty care backlogs that were already months long. To address these unacceptable wait times, providers and technology vendors incorporated e-consult as a first step in their referral workflows. E-Consult technology vendors responded with free or low-cost programs for safety net providers. Providers have now expressed an increased level of acceptance of telehealth to improve their safety and optimize patient care.