By CHRIS JAEGER MD, MBA
The Primary Cares Initiative provides new value-based payment models aiming to enhance the delivery of primary care to promote efficiency and quality while decreasing healthcare costs. In the second part of this two-part series, we explore how eConsults directly support this new initiative across several key metrics.
The Primary Cares Initiative aims to enhance the delivery of primary care through value-based payment models. In Part One of this two-part series, we broke down the five payment models offered through this initiative, including two performance-based models (Primary Care First) and three risk-sharing plans (Direct Contracting). Alongside previous programs such as Patient-Centered Medical Home (PCMH), the Comprehensive Primary Care (CPC+) program, and the Medicare Advantage Value-based Insurance Design (VBID), the Primary Cares Initiative represents the most recent push for enhancing primary care within health care systems.
Yet, as programs such as these continue to emphasize primary care providers as a locus of optimal care, the question becomes: how can primary care providers (PCPs) best work within initiatives such as these to enhance care delivery efficiency and effectiveness, and what kinds of services and technologies can support this?
eConsults represent a particularly promising way forward for PCPs to meet performance metrics. An eConsult is an asynchronous peer-to-peer telehealth platform through which PCPs can consult with a network of specialists. The PCP enters relevant patient information and a clinical question through a secure portal, and a specialist responds (often within a day) with a diagnosis, treatment recommendations, and other resources if necessary. This enables PCPs to treat patients directly and promptly, supporting primary care capabilities and improving healthcare outcomes for low- and high-acuity patients alike.
A continuing challenge in maximizing the efficiency and effectiveness of primary care relates to specialist referrals. As more health systems look toward creating PCMH models and consider adopting new value-based payment models under the Primary Cares Initiative, eConsult platforms will be instrumental in improving team-based care coordination and communication. eConsults directly support the Primary Cares Initiatives by maximizing primary care’s value in healthcare delivery, having demonstrated direct benefits in terms of costs, outcomes, and both patient and provider satisfaction
When it comes to increasing efficiency under the Primary Cares Initiative, a crucial aim is to reduce costs—for both healthcare organizations and patients—without sacrificing quality of care. Empowering primary care clinics to retain patients and treat them within the offices of PCPs yields greater savings for all stakeholders. An eConsult cost savings analysis demonstrated that $75 billion is spent annually on specialist referrals in the U.S. based on the following data:
- 9% of ambulatory visits result in a specialist referral; one in three hospital discharges result in referrals to other care providers
- The average referral results in 3.4 specialist visits
- $965 is the average total downstream specialist costs resulting from one referral
On average, more than 70% of eConsults have shown to replace routine specialist referrals. This drastically reduces costs associated with unnecessary specialist visits, labs and diagnostics, as well as downstream avoidable ED and office visits associated with waiting for specialist availability.
According to PCMH FQHC Vista Community Clinic’s ROI calculations, numerous positive impacts on healthcare costs have resulted from using the eConsult asynchronous telehealth platform. “We can estimate the total annual referral costs saved are $2,019,600 based on 1,800 eConsults replacing a visit. […] Our total program savings—1,800 e-consults at the current eConsult fee—equate to $1,794,600.”
Immediate access to necessary care through eConsult-supported primary care leads to improved patient outcomes by increasing access to appropriate levels of specialist care.
Several studies on eConsult outcomes have corroborated this:
- In a subset survey from 1,743 eConsults, surgery yield (percent of ambulatory visits resulting in a scheduled surgical case) increased by 11% (p=0.07) compared to standard care in a one-year retrospective study
- eConsults led to statistically significant reduction in avoidable surgical follow-ups in a two-year prospective pre-post survey analysis
- eConsults led to modified diagnosis in 15% of cases, and treatment plan change in 24% of cases in a one-year prospective data review of pediatric eConsults
- In terms of clinical care outcomes, one study found eConsults reduced time to complete a hematuria workup by more than 50%.
Increased provider and patient satisfaction
Access and outcome benefits of eConsult use directly ties into metrics such as CMS Star ratings indicative of patient satisfaction.
eConsult use directly and positively impacts the following STAR measures:
- Star Measures C22 (Getting Needed Care) and C23 (Getting Appointments and Care Quickly)
- Star Measure C27 (Care Coordination (CAHPS))
- Star Measure C21 (Plan All-Cause Readmissions Healthcare Effectiveness Data and Information Set (HEDIS))
Dr. Denise Gomez, Internal Medicine physician and Medical Director at San Diego FQHC North County Health Services (NCHS), comments on how platform usage strengthens the provider-patient relationship; “Patient satisfaction and provider satisfaction are coupled. When patients feel they have received quality treatment, mission-driven providers feel more satisfaction in their work.” By offering physicians more control over patient outcomes and restoring PCP confidence in delivering the most meaningful care to patients, physicians realize overall satisfaction benefits through eConsult use.
In addition, eConsults have shown to provide relief from specific factors contributing to provider burnout. “Quality time with patients increases PCP satisfaction,” says Gomez. “Immediate specialty recommendations allow the physician to be more efficient, allowing for more time with patients and improved overall satisfaction.”
Primary care has increasingly been recognized as the key to addressing many lingering issues within the United States patient population, and the Primary Cares Initiative offers new models to support leveraging primary care physicians to improve performance in terms of health care costs, efficiency of care, patient outcomes, and overall satisfaction. By implementing innovative asynchronous telehealth technologies such as eConsults–aimed to overcome access, quality, cost and satisfaction challenges stemming from the specialist referral system–PCPs gain a means to play an even more integral and active role in patient outcomes. eConsults facilitate right care at the right time in the right place thereby expediting treatment and drastically reduce costs, resulting in significantly better outcomes and satisfaction. This enables PCPs to improve on metrics vital to succeeding under such programs as the Primary Cares Initiative—and other such primary care-focused initiatives that are inevitably around the corner.
Chris Jaeger is the Advisor for ACO and Health System Strategy at AristaMD.