eConsults Can Decrease Unnecessary Specialist Referrals by 70%, Saving $3M in Annual Referral Costs for Every 100K Members
By Brooke LeVasseur, CEO of AristaMD
Within the shift from fee-for-service payment models to value-based care, it has become increasingly important for healthcare providers to focus on optimizing the referral process, referring patients to the right place at the right time. Health plans are missing out on critical programs to support this transition. In addition to increasing access to quality specialty care, eConsult platforms significantly decrease healthcare costs that stem from unnecessary referrals, chronic disease management, and high-risk patients.
Context into the overall cost of care.
National health expenditure growth is expected to average 5.5 percent annually over 2017-2026, according to a report published today as an “Ahead Of Print” by Health Affairs and authored by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). Growth in national health spending is projected to be faster than projected growth in Gross Domestic Product (GDP) by 1.0 percentage point over 2017-2026. As a result, the report projects the health share of GDP to rise from 17.9% in 2016 to 19.7% by 2026.
- 9% of ambulatory PCP visits result in a specialist referral
- 20-30% of these referrals are for routine clinical issues that can be safely treated by PCPs *Source: AristaMD internal data, 2018
- The average referral results in 3.4 specialist visits
- Average total cost of downstream specialist costs resulting from one referral is $965
- About one in 10 ambulatory visits and one in three hospital discharges will result in referrals to other care providers
- Two out of every three Medicare beneficiaries have two or more chronic diseases, which often requires treatment from multiple providers in multiple specialties
eConsults reduce health plan costs and deliver increased access to specialty care.
Adoption of eConsults is fast, simple, and immediately gives PCPs support in order to avoid unnecessary referrals.
- Deliver more timely access to care
- Reduce costs associated with unnecessary specialist visits, labs, and diagnostics
- Improve patient satisfaction
- Minimize costs such as extra or unnecessary ED and office visits associated with waiting for specialist availability
“The immediate and tangible impact of eConsults for ConcertoHealth is the ability to avoid unnecessary referrals, while the long-term benefits include avoiding unnecessary admissions and readmissions.” Dr. Christopher Dodd, Chief Care Transformation Officer, ConcertoHealth
The Data is in: More than 70% of routine specialist referrals can be replaced by an eConsult.
- eConsult efficacy has been proven across diverse geographies, specialties, and patient demographics
- Launching an eConsult program can be done in <30 days and requires no IT integration
- eConsult programs have NO upfront costs and pay-per-consult pricing means no-risk and immediate ROI
“Our intention is to be good stewards of our resources and to identify which of those resources help us to achieve quality measures (managing diabetes etc,) in a financially responsible way. We’ve realized that leveraging the AristaMD telehealth platform helped us bend the cost curve through significant avoidance of in-person specialty referrals.” Dr. Kevin Ronan, Sr. Quality Assurance Manager, Vista Community Clinics