Improving Safety Net Specialty Care Access using Web-Based Platform: eConsult

The Problem

The US health care delivery system has historically been characterized by a fragmented, poorly integrated approach to delivering care that often falls short when it comes to managing patients with complex health conditions. Of particular concern is access to specialty care, especially for uninsured or under-insured patients relying on safety net services.

Studies on safety net patients in Los Angeles County show that significant barriers exist for access to specialty care, including long wait times, unreliable referral systems, and poor communication between primary care providers (PCPs) and specialists. In a study conducted by California HealthCare Foundation and Kaiser Permanente Community Benefit Programs, 85% of clinic medical directors from California’s federally funded health clinics reported that patients “often” or “almost always” had trouble accessing specialty care. On average, the wait time for patients referred from safety net clinics is 1-3 months to see a specialty physician, and it can often be much longer for high-volume specialties like dermatology and neurology.

The Solution

Recognizing the flaws with the current system, COPE Health Solutions partnered with a network of community clinics and a county hospital to develop eConsult as an innovative solution to improve coordination, appropriate access, and quality of care for patients. eConsult is a web-based, HIPAA-compliant physician messaging platform that allows PCPs and specialists to exchange provider notes, diagnostic findings, lab results, and informal conversations (or “curbside consults”).

Benefits of eConsult:

• Improves coordination of care and co-management of patients
• Case-based learning that enables primary care providers to make treatment decisions and avert unnecessary specialty referrals
• Decreases demand for specialty services, thus increasing access for patients for whom specialty care is appropriate
• Facilitates a culture of trust, confidence and communication between PCPs and specialists, which is the foundation for quality care coordination.
• Aligns Accountable Care Organizations, insurance plans and Delivery System Reform Incentive Payment programs with new payment and incentive models that require organizations to decrease costs and enhance quality and patient experience
• Enables identification of process improvement opportunities through tracking of utilization data such as diagnosis codes, wait times for message responses and common uses of the program.

Results

Nearly 50% of eConsults have resulted in the avoidance of a specialty visit. In addition, eConsult enables the ability to track and monitor utilization and increase patient satisfaction. eConsult is a transformative coordination system that maximizes specialty care access and efficiency for patients and system users.