By Brooke LeVasseur, CEO of AristaMD, July 2018.
An estimated 209,0001 primary care physicians (PCPs) are caring for a population that is fast approaching 325 million2. As America’s baby boomers age, PCPs have steadily increased the volume of cases referred to specialist care by having more than doubled since 19993. However, the country is also projecting a deficit of 95,000 specialty physicians by 20254. The rising tide of demand and waning supply of physicians has resulted in a less effective and more costly specialty referral process. Referrals often lack complete medical workups, are sent to the wrong specialist, or are inappropriate for specialist attention. Long delays for PCPs to receive the results from specialist visits decrease a PCP’s ability to optimize the patients’ care. Most importantly, referral issues may delay necessary patient treatment and decrease satisfaction with the care process.
One solution to overcoming the specialist shortage is to increase the breadth of capabilities maintained by PCPs. To do so, PCPs must embrace tools that extend their clinical domain without delegating patient care to specialists, essentially becoming “Super PCPs.” This expansion of capabilities is consistent with the evolution of the Patient-Centered Medical Home (PCMH) model of care that strengthens relationships between patients and their clinical care teams. In line with PCMH principles, the ability of PCPs to grow their medical reach supports reduction of care fragmentation associated with higher costs, lower quality, and higher rates of preventable hospitalizations. More Integrated care can help patients avoid costly complications and produce better outcomes.
The move toward increased care capacities within primary practice is supported by evolving telehealth solutions including eConsult platforms that guide clinical decision making. Without delegating patient care to a specialist, the PCP can use AristaMD eConsults to gain immediate access to board-certified specialists covering >70 specialty areas via a secure, HIPAA-compliant communication platform. Clinical workup checklists and specialist eConsults work together to empower PCPs with immediate access to specialist insights leading to operational, financial, and clinical benefits for all healthcare stakeholders.
“When embraced, eConsults became a tool for providers to help them become a ‘Super PCP’,” said Dr. Christopher Dodd, former Regional Medical Director and current Chief Care Transformation Officer of ConcertoHealth. “eConsults help PCPs to serve as the sole provider to the patient.”
Primary care enhanced by specialist eConsult solutions, benefits health insurers, patients, and providers. Health insurers benefit from delivering more timely access to specialist consultation, thus improving member satisfaction, and expediting necessary treatment. Secondarily, by keeping a higher percentage of patients within the primary care setting, health plans significantly reduce unnecessary expenditure by eliminating unnecessary specialist visits. Furthermore, freeing up limited specialist appointments ensures timely access to care when it is needed, thereby reducing unnecessary ED visits and the need for hospitalization.
By retaining patients within the primary care setting, there is less opportunity for care coordination to break down. There are fewer appointments, less travel, less transfer of medical information, and more rapid progression from diagnosis to treatment. Patients benefit from consistent follow-up from the provider with whom they have a longstanding relationship. When a specialist visit is necessary, appointments can be available sooner as eConsults prevent low acuity patients who can safely be treated by the PCP from filling the specialist’s schedule. Additionally, patients who could not otherwise access or afford specialist care receive consultation and treatment plans.
Super PCPs benefit in many ways. eConsults enable physicians to expand their care capabilities and increase their own medical knowledge. Clinical workup checklists help guide PCPs in the assessment and treatment of conditions commonly presented to primary care, but previously transferred into specialist care. Fewer inappropriate referrals and more complete information sharing translate to higher patient satisfaction and retention. At a higher level, health systems benefit by using eConsults to improve access to specialty care, better manage population health initiatives, streamline care coordination, improve patient satisfaction scores, and support quality metric initiatives.
Dr. Dara Richards, CMO of Southwest Health, who championed the implementation within her organization noted that, “With knowledge gained from the eConsult reports, providers are better able to manage more patient conditions on their own. With the education provided from specialist recommendations, they were realizing that if presented with the same problem in the future, a referral would not be necessary.”
The AristaMD Smart Care Platform is a tool designed to encourage the evolution of Super PCPs and support PCMH principles. Equipped with clinical workup checklists and specialist eConsults, frontline Super PCPs are able to improve the patient’s ability to access timely specialist care while simultaneously expanding and securing their own practice, reducing the cost of care, and increasing patient satisfaction.
We encourage you to learn more about how the AristaMD Smart Care platform enables PCPs to extend the capacity of primary care through timely access to specialist expertise.
 AHRQ. The Number of Practicing Primary Care Physicians in the United States: Primary Care Workforce Facts and Stats No. 1. https://www.ahrq.gov/research/findings/factsheets/primary/pcwork1/index.html
 US Census Bureau. https://www.census.gov/popclock/
 Barnett ML, Song Z, Landon BE. Trends in Physician Referrals in the United States, 1999-2009. Arch Intern Med. 2012;172(2):163–170.
 The Complexities of Physician Supply and Demand: Projections from 2013 to 2025. Association of American Medical Colleges. 2015.