A pilot program in Maine is proving the value of a telemedicine network that links remote primary care providers with specialists.
An eConsult program launched in Maine last December has improved care management and coordination for several small, rural primary care providers, while reducing expensive and time-consuming trips to a specialist.
The Maine eConsult Network, a one-year pilot program developed by the non-profit MCD Global Health, now encompasses eight primary care organizations across the predominantly rural state. More than 500 specialist consults have been conducted through the virtual network in the past six months, officials say, with 70% of those eConsults resulting in continued care by the patient's PCP, just 25% leading to an in-person visit with the specialist, and 5% needing more information.
The program addresses a care gap plaguing healthcare organizations across the country. Access to specialist consults is difficult owing to the declining numbers of specialists and high demand for their services. In rural areas those specialists are few and far between, requiring patients to travel long distances for in-person visits. Urban areas may have more specialists, but scheduling an appointment can often take months.
An eConsult platform enables a primary care provider to send patient information through a telemedicine portal to a specialist, who reviews the case and can ask for more information, request an in-person visit or determine that the PCP can handle the case, perhaps even offering clinical decision support. The platform is designed to reduce unnecessary in-person visits and the stress they put on patients, while speeding up the treatment process and improving clinical outcomes. It also helps PCPs treat more of their patients, a key business metric.
Since eConsults are relatively new, many payers don’t reimburse for the service. That includes CMS, which this year began offering Medicare and Medicaid coverage in specific circumstances and is seeking data on the overall value of the platform. MCD received funding from the state's Department of Health and Human Services to set up the program, and an evaluation will be done by the Maine Rural Health Research Center at the University of Southern Maine.
Daren Anderson, MD, was one of the first to explore the value of eConsults with the Connecticut-based Community Health Center and the Weitzman Institute, where he served as director. He's now president of ConferMED, an eConsult company serving federally qualified health centers (FQHCs) in several states and the platform for the Maine eConsult Network.
“With traditional specialty consultations, complicated logistics, and tracking combined with limited access, especially for patients in rural areas, can result in delays and worse clinical outcomes," he said in a press release issued by MCD. "As an alternative, eConsults provide advice and guidance from specialists quickly and easily and reduces the need for face-to-face visits. This results in better care for patients and a better process for everyone. For most cases, it takes far more work to coordinate and track face-to-face visits than simply getting an eConsult from a specialist, and the eConsult often provides all that is needed.”
In Maine, specialty consults can be especially challenging. At Mount Desert Island Hospital (MDI) in Bar Harbor, doctors treat patients on several nearby islands as well as small communities along the rugged coastline.
“I work on an island, but sometimes, it feels like I’m an island and I don’t have specialty resources,” Natasha Neal, DO, MPH, a family medicine provider at MDI, said in the MCD press release. “Knowing that I can place this consult and have this conversation with a specialist makes us less isolated and better equipped to serve patients, especially when they otherwise will wait months to learn more.”
“It is often possible, via eConsults, to get guidance on what tests to order, help interpret results, and recommend medication,” added Jennifer Monti, MD, a cardiologist based in southern Maine who is part of the Maine eConsult Network. “These three core functions reduce the amount of time it takes for care plans to be executed, which means more efficient, less expensive care for patients, and the face-to-face visit with the specialist, if needed, can be more nuanced and higher value because the patient will be present with relevant testing already performed.”
The value of eConsults is one of several topics that will be explored at the Northeast Telehealth Resource Center (NETRC) annual conference next week in Nashua, New Hampshire. The NETRC is one of 12 regional and two national resource centers that make up the National Consortium of Telehealth Resource Centers.
That event also comes at the beginning of Telehealth Awareness Week, which is coordinated by the American Telemedicine Association.
Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.
KEY TAKEAWAYS
eConsult platforms enable primary care providers to connect with specialists on a telemedicine platform to discuss patient care. The platform allows specialists to determine whether a patient needs an in-person consult or can be treated by the PCP.
In a pilot program now underway in Maine, 70% of the more than 500 eConsults conducted in the past six months have enabled PCPs to treat the patients themselves, while 25% were scheduled for in-person visits and the other 5% needed more information.
The program will be discussed during the Northeast Telehealth Resource Center's annual conference next week in Nashua, New Hampshire, which also takes place at the beginning of the American Telemedicine Association's Telehealth Awareness Week.