How do eConsults Support Risk-based Payment Models?
In this video, Cindy Craddock, RN at AristaMD discusses how eConsults support risk-based payment models.
How does eConsults support VBC?
How do eConsults support value-based care? So as you all know, there’s unequal access to specialty care. There are significant inequalities in specialty care, especially when patients are minorities, low-income patients, limited English, and are in rural areas where there are not even specialties available. It requires a long commute to get to those specialties. So physicians have been seeking advice from their peers for centuries, whether it was in person, by letter, by phone, or a curbside consult, as you may have heard it called before, secure electronic communication. The specialist would call their buddy that they might; maybe a nephrologist who needs some advice. eConsults takes that concept and escalates it. So previously, if you were to call a friend, do a curbside consult, if the PCP was unable to resolve the issue, um, after speaking with the specialist, they would go, there were traditional route and order, um, a referral to a specialist.
eConsults combines that idea of providing specialists with access, but they also can give patients medical history instead of just trying to sum it up over the phone. Um, and then instead of transferring the patient, the patient, to the specialist, the PCP mainly maintains their patient’s care. So again, you can see that would keep costs down. The PCP is still in charge of the patient care. So an electronic request for advice from a specialist precludes transfer of care. So in most cases, as I said, the PCP is asking for advice from the specialist. And then based on that advice, they can then make the informed decision whether they want their patient to be seen in person by a specialist or not. Historically eConsults for us replace more than 70% of in-person visits.
Of those eligible referrals, 70%, and this is the efficacy that we get back from providers that use our service. 70% no longer need an in-person visit. So that’s, that’s huge. And then it allows, you know, the 30% that do to get into the door quicker. And the more we implement this across clinics, the more those spots in the specialist office will open up with eConsults. Longer appointment wait times due to covid and specialist shortages. eConsults are taking off and serving patients. In the beginning, it would be more, you know, very simple, and we still do that, you know, very simple from a dermatology eConsult for a rash. But as I said, with care being more and more, um, difficult to get for patients, we’re seeing that eConsults can treat a little bit more complex, um, cases such as, you know, hematology, rheumatology, infectious disease, things like that. And even if it takes a couple of eConsults, um, if the patient gets the care at the end of the day and they avoid the in-person visit, it’s definitely worth it.
Support for the Transition to Risk-based Payment
With the transition to value-based health come challenges. Primary care practices, particularly smaller ones, must significantly upgrade their technology. Both to be sure that when they are referring a patient, the patient stays in-network and that the specialist is available to provide care. With the ongoing shortage of specialists, this remains a challenge.
Interoperability
Interoperability has been a challenge in healthcare for many years. To control costs under a value-based payment model PCPs must communicate the appropriate patient information when referring to a specialist to:
- Ensure that an appropriate diagnosis is made.
- Prevent duplication of diagnostics that increase the cost.
Unfortunately, most EHRs do not ‘talk’ to each other, and even when two providers are on the same EHR, the ability to share information between two practices is often difficult. Appointment scheduling platforms are not always connected to the practice’s EHR and are rarely connected to the scheduling platform of a specialist receiving a referral.