- A telemedicine consult platform for cardiology cases saved almost $500 per patient in Medicaid costs over in-person treatments, according to a newly released study.
In what’s being billed as the first published randomized study of the eConsult platform, researchers at Community Health Center and the University of Connecticut Health Center found that the telemedicine platform, which facilitates virtual consults with a specialist, yielded lower mean adjusted total costs of $655 per patient, or lower mean costs of $466 when adjusted for non-normality, compared to those using face-to-face consults over a six-month span.
In addition, the eConsult group reported reduced costs of $81 per patient for outpatient cardiac procedures, as well as improving access to care for underserved patients and reducing the rate of no-shows for providers.
“The results of our analysis show for the first time that when [primary care providers] are given an option to use eConsults for Medicaid beneficiaries, the total costs and the cost of outpatient cardiac tests and procedures at 6 months are significantly lower, by $466 and $81, respectively, compared with the traditional [face-to-face] approach,” the study, highlighted in the January issue of the American Journal of Managed Care, reported.
The study was conducted by a team led by Daren Anderson, MD, CHC’s vice president and chief quality officer and director of the Weitzman Institute, CHC’s research and innovation arm, both based in Middletown, Conn.
“The important findings from this research are that a relatively simple intervention, the use of eConsults to communicate with cardiologists, can improve access to care and reduce the need for face to face consults, all while saving the system money – a win-win for patients and payers,” Anderson said in a press release announcing the study’s results. “The $466 saved per cardiology eConsult demonstrates the economic benefit, while patients who commonly endure long waits for specialists receive timely, high quality care.”
CHC and the Weitzman Institute launched one of the first eConsult pilots in 2015, working with Safety Net Connect, a California-based developer of online care coordination services. Working at first with cardiac care patients, the program routed all specialist referrals from CHC providers through an online system that allows the specialist to review the case online. This includes access to the patient’s medical record and any questions the primary care doctor may have about his/her diagnosis and treatment so far.
Based on that success, CHC and the Weitzman Institute created the Community eConsult Network, a non-profit to manage and run the program, which now includes eConsult services in several states across the country. In 2016, the Centers for Medicare & Medicaid Services approved the program for Medicaid reimbursement.
“With limited specialty providers available to treat Medicaid patients, appointment wait times can be as long as a year, leading to healthcare disparities, higher rates of disability and complications in chronic diseases,” CMS officials said in a 2016 press release. “SNC’s eConsult system has been proven to increase access to timely, cost-effective specialty services for underinsured and underserved patients, many of whom live in rural areas with limited access to specialty care.”
Now those savings are coming into focus.
For their study, Anderson and his colleagues drew data from 235 Medicaid patients receiving face-to-face cardiac care treatment and 134 involved in the eConsult program.
In the eConsult group, 59 were referred for face-to-face consults due to the urgency of their condition or an established relationship with a cardiologist. Of the rest, which were referred to a reviewing cardiologist on the virtual care platform, 54, or 72 percent, didn’t require a specialty consult and were treated by the PCP, who received some guidance through the eConsult platform.
In the control group, 196 of the 235 patients, or 83 percent, had a face-to-face visit with a cardiologist; of the other 39 patients, 24 were no-shows.
Anderson and his colleagues said the eConsult platform proved itself by enabling PCPs to manage and coordinate care for more of their own patients rather than pass them off to a specialist, while also reducing referral waiting times for those in need of a consult. The primary source of savings, they said, was in a reduction in unnecessary and costly treatments.
Others savings, they said, included transportation and administrative costs incurred by safety-net health centers, some of which “invest significant resources not only in scheduling specialty visits for their patients, but also in providing extra support to help patients overcome financial, transportation, and other logistical barriers to reduce the likelihood of a no-show.”
Not included in the study was the impact on patients. Anderson and his colleagues noted one study undertaken in Canada that found significant costs savings in avoided transportation and lost productivity and wages from taking time off from work.
“These potential benefits associated with the eConsult represent unmeasured but potentially important cost savings that accrued to patients in this study,” they said.
While pointing out the value of the eConsult platform to healthcare providers and their patients, the study also noted that changes need to be made for the program to continue its success.
Anderson and his fellow researchers concluded that the eConsult platform can be valuable to state Medicaid agencies and health systems seeking ways to improve healthcare access for the underserved while reducing costs.
“Policy changes that support the use of eConsults as a new service modality could result in significant savings to the Medicaid program in a relatively short time frame,” they noted. “However, sustaining eConsult programs will require changes in reimbursement policies, either by authorizing payments for eConsults on a fee-for-service basis or by increasing the opportunities for primary care and specialty providers to share in the savings that accrue from more efficient and effective care.”