As a federally qualified health center, Vista Community Clinic is a safety net for its neighborhood, managing an uninsured or underinsured patient population – in this case, 58 percent Medicaid, 2 percent Medicare and 32 percent uninsured.

THE PROBLEM

Access to specialty care is tough for these patients for several reasons, including transportation, child care, challenges with missing work and prolonged waiting lists for appointments.

"For our clinicians, it is hard to provide comprehensive primary care to our patients with complex or comorbid conditions in a 15- to 20-minute appointment," said Dr. Kevin Ronan, manager of quality assurance and a pediatrician at Vista Community Clinic. "And sometimes, what we needed was more of a curbside consult for recommendations on tests to order, a way forward or a sanity check on our current treatment plan, while awaiting a face-to-face appointment."

PROPOSAL

The clinic decided on a telehealth system from vendor AristaMD called e-consult Platform, which is designed to provide timely access to specialists for guiding patient care.

"This greatly increases access to quality specialty care for our patients, allowing primary care physicians to more efficiently manage patients," Ronan said. "The solution is seamlessly integrated into our physician referral workflows, so clinicians do not have to spend any additional time creating a separate e-consult."

The platform, the proposal said, would significantly reduce the need for face-to-face visits, improve coordination of care, and enhance both patient and provider satisfaction.

MARKETPLACE

There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services, Tellus and Tyto Care.

MEETING THE CHALLENGE

With the new telemedicine technology, the clinic's clinicians are able to leverage hundreds of AristaMD's board certified specialists for care planning advice and recommendations, usually within 24 hours and fully documented within the clinic's NextGen electronic health record.

"The platform is integrated into our existing referral workflow, interacting with Valer referral management and NextGen," Ronan explained. "Our providers enter referral orders, and those referrals appropriate for an e-consult are converted into e-consult requests by AristaMD. Providers then receive a task via NextGen to review the specialist response and correspond with any follow-up questions before completing."

Access to specialty guidance enables the primary care physicians to manage more complex patients, improving outcomes and reducing excess healthcare spending, he added.

"In a resource-scarce environment, we often co-manage patients in consultation with our AristaMD colleagues, until or unless a local specialist can be accessed," he explained. "Care teams receive answers to questions in a timely fashion, frequently obviating the need for a face-to-face visit, which saves our patients time and expense. Photos to dermatologists and EKGs to cardiologists provide a reassuring oversight of patient care."

"Care teams receive answers to questions in a timely fashion, frequently obviating the need for a face-to-face visit, which saves our patients time and expense."

Dr. Kevin Ronan, Vista Community Clinic

As an NCQA-certified patient-centered medical home, Vista Community Clinic is required to document resource stewardship measures undertaken to help hold down healthcare costs. Demonstrating that 71 percent of the clinic's referrals could be completed by an e-consult, saving the clinic more than $1 million in 2018, was strong evidence of fiscal responsibility in the clinic's patient-centered medical home recertification, Ronan said.

"The implementation process ensures involvement from Vista Community Clinic's providers, clinical champion, IT department and referral coordination team to work cohesively to manage the flow," he added.

RESULTS

According to the clinic's ROI calculations, numerous positive impacts on healthcare costs have resulted from using the telehealth platform.

"More than 1,800 e-consults to date have replaced specialist visits," Ronan explained. "We can estimate the total annual referral costs saved are $2,019,600 based on 1,800 e-consults replacing a visit, and this number is growing every day. Our total program savings – 1,800 e-consults at the current e-consult fee – equate to $1,794,600."

Being able to use telemedicine for consults has been a game-changer for the organization's clinicians and patients, said Dr. Kelly Motadel, chief medical officer at Vista Community Clinic.

"Clinicians have enhanced their knowledge to maximize their skill set as a primary care physician while saving patients the time and inconvenience it takes to go to a specialist's office," Motadel said. "Even in those cases where a face-to-face with the specialist is still necessary, our clinicians can often initiate some treatments or order additional tests prior to the specialist visit based on the e-consultant's recommendations."

ADVICE FOR OTHERS

E-consults no longer are just the solution to geographically remote medical clinics, Ronan said.

"They are the perfect answer to every hard-working, under-resourced primary care clinic whose clinicians seek a little guidance and whose patients benefit from one fewer trip to an unfamiliar office," he said. "Within the time constraints of a visit, if I'm not completely clear on the direction to go, it is a comfort to have telemedicine in my back pocket."

Patients are happy to wait a day while physicians ask the advice of a specialist, rather than needing to seek out a remote location for a stranger's care, he added. The service pays for itself both monetarily and in patient and provider satisfaction, he concluded.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com