Providing Access to Pediatric Specialty Expertise by Extending eConsult Offerings to Internal and External Requesting Providers

eConsult Value Proposition

Heather Meyers, Director, Virtual Care Innovation & Digital Health Accelerator at Boston Children’s Hospital
Patricia Hanrahan, Sr. Product Manager, Virtual Care at 
Boston Children’s Hospital

So as we were thinking about launching off our e-consult program, we, we had a historic e-consult program at Boston Children’s that  kind of lived for many years, and was  actually had great successes. There were great pub publications, but it wasn’t an enterprise effort. And it was really important for us to, if we’re going to get behind this and kind of put our IDHA team, our digital health resources into that to think about how do we partner and is this a value and is the time, right? It was really important for us to understand what the, what the value proposition is, not just for Boston Children’s, but also for all stakeholders involved. We thought about this across five stakeholder groups. The first is from our BCH enterprise, and does this allow us to increase our complexity care, which again, we’re more of a complex and rare destination hospital, as well as reduce some of the appointment lag times.

I know it’s, a big struggle that everyone has capacity constraints. Just kind of thinking through how do we really optimize our provider time  from our specialist. Our specialist often gave us kind of insights that there’s a lot of curbside consults that are coming to them, whether through email, phone call, and is there the opportunity to streamline these and also ensure that there’s kind of net new revenue based and kind of reduces some of the liability concerns that they might have by sharing and extending too much for patient care as well as for our primary care providers. And Trish will go into kind of what our primary care makeup is at Boston Children’s, but also being able to have kind of enhanced education, more expedited access to specialists for patient families on avoiding travel that they could just receive right in their community PCP office.

Then also from the payer perspective on are we able to reduce cost of care delivery by reducing visits or more adverse events from that perspective. So this was kind of the focal point for our why. and then in parallel to this, we also got engaged by one of the largest Massachusetts commercial payers on doing a collaboration that would look at quality outcomes and cost outcomes. So a lot of those partnerships also kind of drove us to wanting to scale and be more enterprise-wide focus from that.

Evaluate Practice Performance Metrics for eConsult Programs - Measuring Access to Specialty Care

Evaluate Practice Performance Metrics for eConsult Programs:

Measuring Patient Access to Specialty Care

With considerable time and effort, at-risk practices identify patients at high risk of serious health events. We want to use this same information to develop an eConsult strategy.

To increase patient access to specialty care, consider which specialties have long appointment wait times, higher costs, conditions easily manage by the PCP, or do not require a face-to-face specialist visit. Using eConsults in these situations will drive cost savings, improve outcomes and decrease the risk of:

  • ED use – a costly alternative to a specialist visit.
  • Unscheduled or canceled specialty care appointments.
  • Boomerang appointments to primary care.

Increasing access to specialty care is the goal. Together, we can track and communicate which specialties are most:

  • Needed by the patients you serve
  • Likely to improve outcomes
  • Appropriate for eConsult
  • Valuable to your practice

Identify Specialties with Long Appointment Wait Times

There are many reasons why patients must wait too long to get an appointment with a specialist.

  • Not all specialists accept Medicare and Medicaid.
  • Doctors in many specialty areas are unevenly distributed across the country.
  • Patient referrals are often scheduled by the urgency of the condition.
  • Current patients are prioritized for appointments.

Merritt Hawkins reports that the nationwide average wait time to see an orthopedic surgeon is relatively short – just 16.9 days. However, looking at the average can be misleading.

  • This average is a 48% increase when compared to 2017
  • Getting an appointment with an orthopedist varies tremendously by location – San Diego averages 55 days!

Several factors impact appointment wait times. Not all specialists accept Medicare and Medicaid. Specialists are often clustered in metropolitan areas and unevenly distributed across the county.

Patient’s are less likely to schedule and attend a specialist appointment:

  • When the wait time is extended.
  • Travel distance to the specialist is significant.
  • Cost of the appointment is high — the patient has high-deductible insurance, or the specialist is out-of-network.

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