Part 3: Combine eConsults and referral tracking for successful value-based care
Health plan administrators, ACO leadership teams, physicians and practice staff often comment that the pandemic highlighted challenges that already existed. Staff turnover increased patient care delivery demands and changing reimbursement models are putting pressure on stretched resources at every level of the healthcare system. As a result, providing appropriate care requires all of us to rethink specialty referral workflows.
The healthcare staffing shortages are impacting patients, practices and the entire healthcare delivery system. Nearly 1.7 million healthcare workers have quit this year. The remaining 76% of healthcare workers say they are burned out and exhausted.
AristaMD offers a solution to gaps in the specialty workflow. Our platform combines eConsults with referral tracking and management to:
- Reduce the impact of staff turnover and provider shortages.
- Optimize the selection and direction of in-network referrals.
- Improve specialty care coordination and outcomes.
- Manage wait times for specialty care.
In this 3-part series, we will discuss how implementing the AristaMD platform can support the transition to value-based care payment models.
- Part 1: How is the VBC payment model changing?
- Part 2: What challenges are driven by the value-based care transition?
- Part 3: How to combine eConsults and referral tracking for successful value-based care?
Reduce the impact of staff turnover and provider shortages.
Using a platform that offers both eConsults and specialty referral management enhances care consistency and avoids gaps in patient care when staff leave. By deploying a unified approach that allows staff to track both eConsults and face-to-face referrals in a sinclue location, health care providers ensure patients don’t fall through the cracks. In addition, the provider team, whether consisting of new employees or tenured team members, can easily identify the optimal specialty care setting for a patient and the status of that patient in the eConsult or referral process.
eConsults replace more than 70% of face-to-face specialty care visits. While there are other eConsult vendors out there, AristaMD is one of the only vendors deploying a documented eConsult (vs. curbside consultation) where evidence based care guidance and responding specialist biographies are shared with providers.
For primary care providers, eConsults lower or eliminate risks associated with transferring care to a specialist, which include:
- Long wait times – in some markets patients are experiencing appointment wait times of over 100 days for common specialties like cardiology, rheumatology, endocrinology, and dermatology. In one state, we recently heard wait times for several key specialties were up to 12 months.
- Care delays or inappropriate ED use – More than half of patients that are referred to specialists will not go to the appointment. Then when their symptoms escalate they will go to the ED to seek care.
Reducing the burden of coordinating specialist referrals can be a huge time saver for the office staff.
Optimize the selection and direction of in-network referrals
Sending a referral should only take a few minutes. It should not require standing at the fax machine, calling the specialist’s office, and checking which insurance a specialty care practice accepts. A referral should never result in a rejected referral because the patient was referred to the wrong sub-specialty, the insurance is not accepted, or the patient information is incomplete.
Using a simple wizard to help the referral coordinator send a complete referral to the best specialist for your patient, AristaMD is able to:
- Automatically verify that the patient’s insurance is accepted.
- Match the requested specialty and sub-specialty needed.
- Find the nearest provider to the patient.
- Sort the nearby specialists based on whether they accept the patient’s insurance.
AristaMD also enable the referral coordinator to attach the patient’s chart, imaging, lab work or whatever the specialist might need to make a diagnosis to the referral. Once a specialist is selected, specialty-specific questions are asked to confirm that the patient is being routed to the appropriate provider. The referral coordinator can quickly indicate:
- Whether this is a routine or urgent visit. A patient with escalating systems or lab work that indicates a more serious condition can be easily flagged so that the receiving office can prioritize the patient. It’s all about improving patient care and accelerating care for the patients that need it the most.
- Provide a brief description of the patient’s condition.
- Include details that lower the cost of care and help the specialty care practice understand the patient’s specific needs.
For example, when a patient is referred to an orthopedist, the referral coordinator can indicate that the patient has received imaging, make a note that the patient has completed physical therapy and communicate that the patient is open to surgery. For patients that are reluctant to receive surgery, the specialist office may want to route the patient to an advanced practitioner or recommend a particular orthopedist within the practice.
Technology that matches the patient to an in-network provider, verifies insurance and confirms specialty-specific details can play a huge role in supporting value-based care. Specialists are notified when patient care is urgently needed to avoid symptom escalation. In addition, keeping a patient in-network saves the primary care practice time and money. Avoid patient calls to request an in-network provider and the higher cost of out-of-network specialty care.
Benefits of Referral Tracking plus eConsults to Value-Based Care Providers
Improve specialty care coordination and outcomes
Use eConsults to improve patient compliance
Primary care providers request eConsults to save time and money for the practice and the patient. However, they also request an eConsult when a patient is unable or unlikely to visit the specialist. There are lots of reasons why patients do not follow through with a specialty care referral:
- No transportation
- Lack of childcare
- Inability to take time off work
- No funds to pay an additional copay
eConsults mitigate these social determinants of health that reduce patient outcomes by providing specialty care advice at the primary care office. In addition, eConsult specialists are trained to offer follow-up actions if the initial recommendation has limited success. If the specialist recommends a specific test, the eConsult will include what results to expect and treatment options based on the results. The specialist may sometimes recommend an eConsult in an additional specialty. These situations allow the PCP to coordinate care across multiple specialties efficiently. For example, a diabetic patient requires input from an endocrinologist and a wound care specialist.
This step-based process for diagnosing and treating patients improves care coordination because the PCP receives and records all of the diagnostic and treatment recommendations. Outcomes are improved when patients that are unable to coordinate a face-to-face visit receive needed specialty care.
Use referral management to improve patient compliance.
In-network utilization and reduced travel through optimized specialist selection also increase patient compliance, which leads to better outcomes. This information increases the likelihood that the patient will complete the referral and lowers the cost of care for the patient. For PCPs operating under a value-based payment model, selecting a specialist in-network will also reduce the cost of caring for this patient.
Most importantly, we want the patient to complete the referral so that the patient avoids higher-cost alternatives like the ED or escalating symptoms that lead to poor outcomes.
In addition, the referral tracking software allows staff to set reminders to follow up with the specialist to confirm the appointment was booked and document the treatment plan. All of this information can be gathered via email directly from the application.
Manage wait times for specialty care
Referral tracking combined with eConsults help your practice and the entire health system manage wait times for specialty care. Let’s review a few of the ways that wait times are minimized:
- eConsults replace more than 70% of face-to-face specialty visits.
- eConsults support obtaining appropriate diagnostics prior to a face-to-face specialty visit.
- More than 40% of eConsults result in a new diagnosis which means that the PCP can route the patient to the appropriate specialist – reducing unnecessary specialty care visits that limit the number of available appointments.
- Referral management tools that verify the patient’s insurance and route the patient to an in-network specialist help avoid cancellations that also decrease the number of available appointments.
- Urgency notifications help specialist’s prioritize patients that need a face-to-face visit immediately.
Combining eConsults with referral tracking and management support value-based care by lowering costs and increasing efficiency.