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How eConsults Aid FQHC Reimbursement, Maintain NCQA guidelines, and Support the PCMH Model

Posted: Wednesday, September 19, 2018

How eConsults Aid FQHC Reimbursement, Maintain NCQA Guidelines, and Support the PCMH Model

A conversation with Dr. Kevin Ronan, Pediatrician and Senior Manager of Quality Assurance at Vista Community Clinic.

 

Can you provide an overview of your role as Senior Manager of Quality Assurance at Vista Community Clinic (VCC) and how you have become involved with AristaMD?

As the Senior Manager of Quality Assurance at VCC, I am responsible for NCQA’s Patient-Centered Medical Home (PCMH) program. One of their most important and highly scrutinized measures is how health systems are using data, in terms of quality improvement and assessment.

Our intention is to be good stewards of our resources and to identify which help us to achieve quality measures (taking care of diabetes etc.,), in a financially responsible way. One of the things that we have realized, after seeing the AristaMD data, is that leveraging the AristaMD telehealth platform helped us to bend the cost curve through significant avoidance of in-person specialty referrals.

Doctors tend to be pretty conservative and some find it hard to embrace change, even when clearly helpful. However, once clinicians started utilizing the platform to gain access to timely specialty care, it became hard to think of life without it.

 

How does PCMH fit within NCQA Guidelines?

NCQA oversees PCMH, recognizing health systems that meet specific measures of a patient-centered medical home. One of the things they look for is how well one is doing within these different metrics. One measure is trying to determine how the health system can help them financially. Can we help with their bottom line cost? Metrics are both patient-based quality of care, as well as bottom line cost.

 

Do you have any involvement with payer groups?

As a Federally Qualified Health Center (FQHC), our budget comes from federal and state funding, as well as the managed Medi-Cal plans. These funding parties follow HEDIS guidelines, which are quality metrics based on various measures. We, as the health system, gather guideline data and heavily liaison with plans to address gaps in care list that they identify.

 

Can you share the goals you are working on with VCC right now, and how is AristaMD’s eConsult platform involved?

Our biggest projects, currently, are diabetes-related and cancer screening, colorectal, cervical, and breast cancer. Our quality goal for the year related to these projects is to ensure the entire patient population has been looked at, and if issues arise, they are taken proactively managed.

For example, a patient with diabetes may have difficulty accessing specialty care- taking off work or traveling to San Diego city center to see a specialist. The ability of a primary care provider (PCP) to reach out and consult with a subspecialist is really helpful. Especially in areas with decreased resources, like the FQHCs often find themselves in, you may find it takes 6 months to see a neurologist. In contrast, a provider can submit an eConsult and obtain a documented eConsult from an experienced specialist within a couple of days. The availability of this service helps patients avoid an unnecessary trip and manage their health within the context of the primary care visit.

Another benefit of the eConsult is the ability to conduct diagnostics and blood work at the PCP office, prior to a necessary specialist visit. This saves the time of drawing necessary labs once at the specialist office, then having to return yet for yet another visit to follow up with the specialist.

 

Does recognition and level of recognition through these programs impact reimbursements?

Yes. Clinics with PCMH recognition are more likely to get a referral from health plans for patients.

Medi-Cal assigns lives to the plan, and the plans will distribute those lives to the clinics. The clinics that do better, in terms of scores, quality metrics, etc., improve health plan metrics and are therefore more likely to get extra patients. Success breeds upon itself and if you don’t do well, you have to prove you can do a better job before the plans will assign more patients to your clinic.

How would you describe the benefit the eConsult platform for care coordination and provider empowerment?

With transitions of care, it’s always hard to tell who has been hospitalized. However, payers certainly have this information. Our usual model consists of an eConsult being sent, a response received, and completion of the patient care at the given point in time.

As a pediatrician, I don’t treat a lot of chronic disease. But for my colleagues with adult patients, I know there are many cases where a provider is looking for just a little guidance, as opposed to sending a patient off to a specialist. We can do a lot in clinic with the backup of a trusted specialist to check in and ensure everything is going okay regarding a plan of care. In a hospital, that is easy. However, having this expertise available within a remote clinic, for instance a timely electronic consult, is a huge value added.

Learn More about Telehealth Resources to Support PCMH

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