Quality Catalyst: eConsult Care Impact
Julia Jezmir, MD, MBA, Chief Medical Officer at AristaMD
We asked PCPs to rate the eConsult care impact—whether the consult they submitted and the response they received significantly impacted the patient’s care plan. For us, 90% say yes. Again, it’s critical to track this, especially if it drops, to figure out what may be happening there. I have a couple of examples of what that looks like here.
What is the significant impact on a patient’s care plan?
So the first one is for neurology, and this was a 65-year-old gentleman with a history of multiple strokes, and he developed worsening upper extremity tremors. The PCP submitted a consult for support with diagnosis and treatment. This was a great consult.
The PCP did a very nice job describing the tremor so the neurologist knew what was happening. The neurologist evaluated the case and suggested that this was most likely a case of either vascular parkinsonism or myoclonic jerking. The neurologist then indicated that the PCP should order an MRI and start a trial of Keppra for the patient.
What I love about this case is that the PCP and the specialists went back and forth, exchanging messages and updates, tracking the progress, and making modifications until the patient’s symptoms were better controlled. This was a case where the patient’s symptoms improved. They didn’t need to wait for a neurology appointment. They built greater trust with the PCP. This was just an overall excellent case.
The next one that I wanted to share with you is about rheumatology. So this was a 65-year-old lady who had a history of rheumatoid arthritis, and she had developed new nodules that were bursting and draining. It’s a little concerning. The rheumatologist reviewed the case and said rheumatoid arthritis nodules typically don’t burst. However, gout often mimics a similar presentation to rheumatoid arthritis. And so, again, the specialist suggested a complete workup. By the end of the case, the patient was diagnosed correctly and was started on the right therapy. Again, this is the rheumatologist, and the PCP went back and forth several times. Here, the consults are open for unlimited interaction because the goal is to get the provider the correct information and the patients the proper care.
Measuring eConsult Patient Benefits
eConsults deliver so many patient benefits. Patients save money with fewer copays, less travel expenses and reduced time off work.
Patient satisfaction improves when diagnosis and treatment are delivered quickly. Equal access to specialty care increases because social and geographic challenges related to care are reduced. Outcomes also improve when patients receive treatment fast, avoid expensive emergency care, and experience better care continuity.
eConsults Save Patients Money
Visiting a specialist is expensive. And not visiting the specialist can be catastrophic for the patient. The patient saves at least $120 per avoided referral — $40 per visit over the 3 visits typically needed to receive a diagnosis and treatment. Primary care accounts for only 5% of total healthcare costs. Specialty care contributes to 16.5% of healthcare costs. Treatment in the primary care setting avoids copays and care delays that increase costs.
The trick is to provide the right amount of specialty care in the right setting.
Healthcare Finance News reports that $200 billion, or 25% of healthcare costs, are for unnecessary tests and treatments. This figure doesn’t include unnecessary emergency room visits, multiple visits to the clinic because a patient can’t get an appointment quickly, or increased costs due to untreated conditions.
Let’s eliminate these unnecessary costs by consulting with an eConsult specialist to determine exactly what tests are needed and reduce duplicate tests at the ER or specialist’s office by avoiding these high-cost care settings whenever possible.
Copays aren’t the only cost to the patient that can impact access to specialty care. Will the patient need additional time off work, childcare, or travel a great distance to see a specialist? eConsults can minimize these costs as well.
Julia Jezmir
Chief Medical Officer at AristaMD
Julia Jezmir, MD, MBA, is a primary care physician with a background in value-based care and digital health. Dr. Jezmir has dedicated her career to addressing access to care and improving care delivery. She joined AristaMD following its merger with Sitka, where she was Chief Medical Officer. Prior to Sitka, she served in a dual role as the VP of ACO REACH & GPC Growth and as the NY market Associate Medical Director with ConcertoCare, an in-home value-based primary care provider for seniors and adults with complex care needs.
Dr. Jezmir has expertise in value-based care performance and digital health, working with health plans and provider groups, including Blue Shield of California, Devoted Health, Atrius Health, and Lyra Health. She also currently serves as an advisor with a number of healthcare startups. Dr. Jezmir started her career in international health, working in operations with Partners In Health and AMPATH.
She is a board-certified internal medicine physician, completed her medical degree and Master of Business Administration at Stanford University, and trained in internal medicine primary care at Brigham and Women’s Hospital and Atrius Health. Most importantly, ask her about Kansas City BBQ!