March 24, 2016

E-Consults Quickly Connect Patients With Specialists

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Medicaid will reimburse some health centers in the state for providing patients with access to medical specialist through electronic consultations, which some providers believe will increase low-income patients’ access to care.

Community Health Center, Inc., and HealthyCT are both offering e-consults.

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Community Health Center, Inc., and HealthyCT are both offering e-consults.

“The impact is potentially huge,” said Dr. Daren Anderson, director of the Weitzman Institute, which is the research and quality improvement arm of Community Health Center Inc. (CHC). CHC is a Middletown-based network of 13 health centers that includes facilities in New Britain, Stamford, Norwalk, Clinton, and Old Saybrook.

An e-consult enables a primary care doctor to contact a specialist—for a second look at patient’s echocardiogram, for instance—and securely send part or all of a patient’s medical records electronically. The specialist then replies to the primary care doctor within a few days (but more typically within just a few hours), reducing the need for a patient visit to the specialist.

The e-consult is a valuable tool, said Nicole Seagriff, CHC’s Norwalk medical director and a nurse practitioner.

“It allows us to improve the care we give our patients,” Seagriff said. “With really busy schedules and the array of illnesses we see, it’s tremendously helpful to be able to quickly and efficiently collaborate with a specialist.”

Anderson, who studied e-consults for about a year, said he found the process increased access to specialty care for underserved populations, reduced the need for in-person care, streamlined specialty referrals and had the potential to reduce emergency department visits. The study Anderson coauthored appears in the March/April issue of the Annals of Family Medicine.

The study examined data from primary care clinicians who sought e-consults from cardiologists. It included 36 clinicians who referred 590 patients for e-consults. In 69 percent of cases, issues that warranted an e-consult were resolved without the patient having to visit a cardiologist, and those who received e-consults reported fewer emergency department visits in the following six months compared with those who did not have an e-consult, according to the study.

Spurred by his research, Anderson worked with the state Department of Social Services (DSS), which administers Connecticut’s Medicaid program, to pursue the Medicaid reimbursement. DSS submitted the request to the Centers for Medicare and Medicaid Services, which approved the plan.

So far, CHC is the only federally qualified health center in the state offering e-consults, and they are offered at all 13 CHC locations.

Seagriff said e-consulting with dermatologists has been particularly helpful, compared to a wait of six months or more for patients with Medicaid.

Patients appreciate having access to the e-consults, Seagriff said, “because it saves a lot of time and the stress of trying to get to yet another appointment.”

She also learns from the e-consults, she said, and is able to carry that knowledge to other patients.

The e-consults can greatly benefit low-income patients who struggle to find medical providers who accept Medicaid patients, according to Anderson. Some low-income patients are now waiting nine to 12 months to see a specialist because there aren’t enough that serve the population, he said.

“Inadequate access to care is a significant contributor to health care disparities, higher rates of disability and complications in chronic diseases,” he added.

Based on CHC’s study, DSS officials are optimistic about the impact e-consults can have in the state, said department spokesman David Dearborn.

“Our health specialists are very pleased with this innovation and the promise it offers to expand access to specialist services,” Dearborn said. “We hope to expand this service in other federally qualified health centers across the state.”

This week, HealthyCT, the state’s non-profit health insurance CO-OP, signed a contract with the Weitzman Institute to offer e-consults with specialists. “The program will allow PCPs to confer, and share charts and films securely with their colleagues in several specialties and receive answers to their questions within two business days,’’ according to a HealthyCT release. There is no cost to the patient.

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