Dr. Daren Anderson, Chief Quality Officer of Community Health Center, discusses his promising research on eConsults and their potential to reduce health disparities.
What are some of the current problems within the healthcare system that the Community eConsult Network (CeCN) was designed to address?
The biggest problem is the antiquated way that information is passed between primary care providers and specialists. We’ve relied on paper, fax, or the patient to be the vehicle to transmit that information back and forth, which in many cases makes no sense. There are so many places where the knowledge and information transfer breaks down. By establishing an electronic linkage between a primary care provider and a specialist, you leap over many of those barriers and hurdles. The second main problem it addresses is the lack of access to specialty care, particularly for medically underserved patients such as those with Medicaid or without insurance. Most states have limited numbers of specialists accepting Medicaid or willing to see the uninsured and I think that’s probably the number one problem that our version of eConsults and our implementation of eConsults was intended to address.
Describe the journey of implementing the Community eConsult Network. What challenges did you face?
We knew about eConsults from work that was going on in the West Coast. Connecticut hasn't been a particularly innovative state when it comes to healthcare technology and we weren't sure such an approach would necessarily be well received in Connecticut. And so our journey started with a clinical trial to prove it could work. We actually got a small grant to test the idea of eConsults here in Community Health Center, Inc.. Working with UConn Health Center [University of Connecticut], we conducted a RCT [randomized control trial] and it demonstrated very impressive results: a substantial reduction in face-to-face visits and good clinical outcomes and cost-savings. And so after doing that trial for cardiology we were able to leverage the findings to get the attention of additional funders, in particular our Medicaid program. Subsequently, they came out with a payment model to fund eConsults. That was what allowed us to create the new entity CeCN, which is now a multi-specialty eConsult delivery platform which receives reimbursement from a number of payers with Connecticut Medicaid being the most important for us so far. After doing the pilot with Cardiology, we started adding multiple additional specialties, building up our platform and working with Safety Net Connect, our software platform.
“THE POTENTIAL TO IMPACT HEALTH DISPARITIES AND IMPROVE ACCESS FOR OUR PATIENTS IN THE SAFETY NET USING TECHNOLOGY IS VERY EXCITING.”
How do eConsults address barriers to care for underserved and low-income patients?
The biggest one is lack of access to specialists. We know that 20 to 30% of our patients to whom we refer to a specialist never make it or never get a visit. For a whole range of reasons. Even when we are able to get an appointment for them, the wait times are often enormous. I think in the safety net, the eConsult network specifically addresses the issue of access. A substantive percentage of the consults we send can be managed by the primary care provider effectively if they can get eConsult support from a specialist. So it is markedly improving access to specialty care. And we know from the evidence that lack of access to specialty care is one of the principal causes of health disparities. We believe that by implementing a model like this, we’re ultimately reducing health disparities.
What has your research shown on the impact of eConsults in improving access to care?
We’ve done two large research studies. And we have two others that are ongoing. The first one showed that eConsults improved access and timeliness of care for cardiology with equivalent clinical outcomes and about 59% of all eConsults could be resolved electronically with no need for face-to-face visit. The second study, which was a cost-effectiveness study, showed that that there was an average $466 per patient savings in the patients that got eConsults compared to the group that didn’t. That savings largely accrued from a reduction in cardiac testing and procedures. And that was at six months. We have several new studies going on now looking at the impact of dermatology eConsults and studying endocrine eConsults.
As a physician yourself, what do you find most exciting about eConsults?
It’s so elegantly simple. I think what I find most exciting about it is that it isn’t really more complicated than email. It’s taking a technology that everyone is using for all sorts of things and applying it to a challenging healthcare conundrum. It’s exciting for me to be able to see my patients get access to good specialty care that they otherwise wouldn’t be able to get. Otherwise we would be struggling. The potential to impact health disparities and improve access for our patients in the safety net using technology is very exciting. That’s why I love what we’re doing.
Dr. Daren Anderson is the Director of the Weitzman Institute and VP/Chief Quality Officer of Community Health Center, Inc. In this role, Dr. Anderson is responsible for ensuring that CHC delivers the highest possible quality of care to its patients, developing a strong quality improvement infrastructure across CHC, promoting research and development, and supporting CHC's mission to become a nationally-recognized center of world-class healthcare. Read more.