Patients referred to specialists by Primary Care Physicians (PCP) often do not benefit from the visit, either because the visit is not medically necessary or because PCPs and specialists do not communicate effectively about the referred patient.
This problem tends to disproportionately affect low-income individuals, including the uninsured and those on Medicaid. Recent advances in communications and record-keeping technologies have the potential to address these problems but few referral systems take advantage of these advances.
L.A Care Health Plan, a public health plan service for Medicaid beneficiaries has developed a web-based software platform. The program called “eConsult” implemented in 2009 enables PCPs at FQHCs to consult electronically with specialist reviewers before referring patients to a specialist. A $200,000 grant to implement the service was provided by Blue Shield of California Foundation.
The “eConsult” system works by having the primary care doctor provide relevant information about the patient’s condition, including medical records and photographs and plus questions on treatment options. The specialist reviewer than responds typically within 48 hours answering the doctor’s questions and if necessary asks for additional information. After one or more exchanges, the specialist reviewer recommends whether a specialty visit is needed.
The “eConsult” system has reduced unnecessary specialty referrals with a meaningful percentage of cases being resolved without a face-to-face visit. The system is now being used in more than 40 ambulatory primary care clinic sites run by the LA County Department of Health Services and at more than 60 community-based clinic sites with contracts to care for uninsured and underinsured patients.
At the start of 2013, 85 specialist reviewers performed electronic consultations in 15 specialties and in three pediatric specialties. By the end of the year, it is anticipated that nearly 180 clinic sites and 160 specialist reviewers in 25 specialties will participate.
For more information, contact Len Rosenthal, at 213 -694-1250 extension 4712 or email lrosenthal@lacare.org or go to www.innovations.ahrq.gov.