Quality Catalyst: eConsult Containment Rates
Julia Jezmir, Chief Medical Officer at AristaMD
eConsult containment means that the provider is equipped with the right recommendations to manage the patient’s care without referring the patient out.
You’ll see that, of course, this varies according to specialty. A specialty like endocrinology will have a high containment rate; in our case, we see a 96% referral avoidance rate or containment rate. And that’s because most cases don’t need an in-person evaluation. The PCP and specialists can co-manage the case together. In contrast, you can see something like ENT, which has a lower containment rate, and that’s to be expected because a specialty like ENT or urology tends to lend itself more toward procedures. In this case, a specialist is acting in a little bit more of a triage capacity and identifying the patients who need to be seen in person and how urgently versus ones whom the PCP can manage. Now, containment is a collaboration between your practice and your eConsult provider, and it’s really important to track containment across specialties over time while you’re running your clinical quality program. If your containment in each of the specialties or several of the specialties drops precipitously, then you know that something is going on, and it’s something to look into.
Measuring Clinical Quality
Multiple studies have shown that improved access to specialty advice and preventative care decreases the incidence of disease and patient mortality, resulting in better care outcomes. Preventive medicine proactively identifies and treats health issues before they develop into severe or chronic conditions.
By addressing health problems before they require emergency intervention, both patients and the health system save money and see better outcomes.
But how do you know the advice you receive from eConsults is working to prevent disease escalation? Using population health data, like hospitalization and readmission rates and emergency department discharges, can give you confidence that your program is effective.
For example, referral volume will decrease as the use of eConsults increases. Reporting from AristaMD offers quality metrics for your practice. Use internal and external metrics to confirm improvements in patient care and outcomes, including:
- Hospitalizations and Readmissions
- Emergency Department Discharges
- Referral Trends & eConsult Reporting
Hospitalizations and Readmissions
When participating in shared savings, partial or full capitation, controlling costs are closely related to hospitalization and readmission.
Monitoring trends in these areas after implementing an eConsult program can reveal the program’s greatest impact. eConsults support efforts to prevent hospitalization and readmission by allowing PCPs to build:
- More robust preventive care plans
- Address nuances related to chronic conditions
- Identify patients at risk for readmission and prioritize interventions
The average hospital stay cost is $11,700 – the most expensive type of care utilization. Preventing even one hospital stay delivers significant shared savings. For practices taking on capitation, avoiding a hospital stay will allow your practice to keep more of the per-person payment. While the amount of savings varies depending on the patient population and alternative payment model, keeping patients out of the hospital is critical to your revenue and time health of your patients.
Julia Jezmir
Chief Medical Officer at AristaMD
Julia Jezmir, MD, MBA, is a primary care physician with a background in value-based care and digital health. Dr. Jezmir has dedicated her career to addressing access to care and improving care delivery. She joined AristaMD following its merger with Sitka, where she was Chief Medical Officer. Prior to Sitka, she served in a dual role as the VP of ACO REACH & GPC Growth and as the NY market Associate Medical Director with ConcertoCare, an in-home value-based primary care provider for seniors and adults with complex care needs.
Dr. Jezmir has expertise in value-based care performance and digital health, working with health plans and provider groups, including Blue Shield of California, Devoted Health, Atrius Health, and Lyra Health. She also currently serves as an advisor with a number of healthcare startups. Dr. Jezmir started her career in international health, working in operations with Partners In Health and AMPATH.
She is a board-certified internal medicine physician, completed her medical degree and Master of Business Administration at Stanford University, and trained in internal medicine primary care at Brigham and Women’s Hospital and Atrius Health. Most importantly, ask her about Kansas City BBQ!