The Primary Cares Initiative: How Value-based Payment Models Strengthen Primary Care

December 3, 2019

Dr. Chris Jaeger - Primary Cares Initiative Value-Based Care

By: Chris Jaeger, Advisor for ACO and Health System Strategy

The CMS Primary Cares Initiative provides new value-based payment models to enhance primary care delivery to promote efficiency and quality while decreasing healthcare costs. In the second part of this two-part blog series, we explore how eConsults directly support this new initiative across several key metrics. It represents the most recent push for enhancing primary care within healthcare systems, alongside previous models such as Patient-Centered Medical Home (PCMH), the Comprehensive Primary Care (CPC+) program, and the Medicare Advantage Value-based Insurance Design (VBID).

Yet as programs continue to emphasize primary care providers as a locus of optimal care, the question becomes: how can PCPs best work within initiatives such as this to enhance care delivery efficiency and effectiveness and what kinds of services and technologies can support this? A clear answer lies within telehealth technologies, such as eConsults, which is an asynchronous peer-to-peer platform that directly supports primary care capabilities by improving appropriate access to specialist care and improving healthcare outcomes for low- and high-acuity patients alike.

eConsults directly support the Primary Cares Initiatives by maximizing primary care’s value in healthcare delivery, having demonstrated direct benefits in outcomes, costs, and patient and provider satisfaction.

A continuing challenge in maximizing the efficiency and effectiveness of primary care relates to specialist referrals. As more health systems look toward creating PCMH models and consider adopting new value-based payment models under the CMS Primary Cares Initiative, eConsult platforms will be instrumental in improving team-based care coordination and communication.

AristaMD and other leading telehealth companies have contributed to the growing body of evidence demonstrating the benefits of eConsults and other emerging technologies in healthcare. Various sources of data and testimonial showcase improved performance of hospitals and healthcare systems along several critical metrics as a result of implementing these technologies.

Reduced Costs

When it comes to increasing efficiency under the CMS Primary Cares Initiative, a crucial aim is to reduce costs—for both healthcare organizations and patients—without sacrificing the quality of care. Empowering primary care clinics to retain patients and treat them within the offices of PCPs yields greater savings for all stakeholders. An eConsult cost savings analysis demonstrated that $75 billion is spent annually on specialist referrals in the U.S. based on the following data:

  • 9% of ambulatory visits result in a specialist referral; one in three hospital discharges results in referrals to other care providers
  • The average referral results in 4 specialist visits
  • $965 is the average total downstream specialist costs resulting from one referral

On average, more than 70% of eConsults have been shown to replace routine specialist referrals. This drastically reduces costs associated with unnecessary specialist visits, labs and diagnostics, and downstream avoidable ED and office visits related to waiting for specialist availability.

According to PCMH FQHC Vista Community Clinic’s ROI calculations, numerous positive impacts on healthcare costs have resulted from using the eConsult asynchronous telehealth platform. “We can estimate the total annual referral costs saved are $2,019,600 based on 1,800 eConsults replacing a visit. […] Our total program savings—1,800 e-consults at the current eConsult fee—equate to $1,794,600.”

Improved Outcomes

Immediate access to necessary care through eConsult-supported primary care leads to improved patient outcomes by increasing access to appropriate levels of specialist care.

Several studies on eConsult outcomes have corroborated this:

  • In a subset survey from 1,743 eConsults, surgery yield (percent of ambulatory visits resulting in a scheduled surgical case) increased by 11% (p=0.07) compared to standard care in a one-year retrospective study
  • eConsults led to a statistically significant reduction in avoidable surgical follow-ups in a two-year prospective pre-post survey analysis
  • eConsults led to the modified diagnosis in 15% of cases and treatment plan change in 24% of patients in a one-year prospective data review of pediatric eConsults
  • In terms of clinical care outcomes, one study found eConsults reduced the time to complete a hematuria workup by more than 50%.

Increased Provider and Patient Satisfaction

Access and outcome benefits of eConsult use directly tie into metrics such as CMS Star ratings indicative of patient satisfaction. eConsult uses directly and positively impacts the following STAR measures:

  • Star Measures C22 (Getting Needed Care) and C23 (Getting Appointments and Care Quickly)
  • Star Measure C27 (Care Coordination (CAHPS))
  • Star Measure C21 (Plan All-Cause Readmissions Healthcare Effectiveness Data and Information Set (HEDIS))

Dr. Denise Gomez, Internal Medicine physician and Medical Director at San Diego FQHC, TrueCare, formerly North County Health Services, comments on how platform usage strengthens the provider-patient relationship; “Patient satisfaction and provider satisfaction are coupled. When patients feel they have received quality treatment, mission-driven providers feel more satisfaction in their work.” By offering physicians more control over patient outcomes and restoring PCP confidence in delivering the most meaningful care, physicians realize overall satisfaction benefits through eConsult use.

In addition, eConsults have provided relief from specific factors contributing to provider burnout. “Quality time with patients increases PCP satisfaction,” says Gomez. “Immediate specialty recommendations allow the physician to be more efficient, allowing for more time with patients and improved overall satisfaction.”


Primary care has increasingly been recognized as the key to addressing many lingering issues within the United States patient population, and the CMS Primary Cares Initiative offers new models to support leveraging primary care physicians to improve performance in terms of health care costs, efficiency of care, patient outcomes, and overall satisfaction. By implementing innovative asynchronous telehealth technologies such as eConsults–aimed to overcome access, quality, cost and satisfaction challenges stemming from the specialist referral system–PCPs gain a means to play an even more integral and active role in patient outcomes.

eConsults facilitate the right care at the right time in the right place, thereby expediting treatment and drastically reducing costs, resulting in significantly better outcomes and satisfaction. This enables PCPs to improve on metrics vital to succeeding under such programs as the Primary Cares Initiative—and other primary care-focused initiatives that are inevitably around the corner.CMS