E-Consult Sustainability

Expanding timely access to specialty care for the underserved through the improvement of the policy environment governing the use of and financial support for eConsult in California.

Timely access to specialty care is a serious issue, particularly for the state’s rural and underserved.  With 3.4 million newly insured, this issue has worsened.

The use of electronically delivered services is one way to help alleviate demand and improve quality.  eConsult is a web-based system that allows one provider, usually a primary care physician (PCP), to securely share health information and discuss patient care with another provider, often a specialist. This physician-to-physician electronic consultation reduces the need for unnecessary referrals as patient’s needs are addressed by the first provider. Additionally, the time saved reduces costs and the first provider is also able to build capacity and directly treat patients who often are referred to a specialist for common conditions. 

Blue Shield of California Foundation (BSCF) launched an electronic consult initiative among several California safety-net providers.  To assist the clinics in adopting these new technologies at scale, BSCF and the California Health Care Foundation engaged CCHP to provide a  comprehensive assessment of federal and state policies, including reimbursement, privacy and security, access, quality and other performance thresholds.  Working with BluePath Health, CCHP developed a comprehensive plan that outlines regulatory and policy barriers and provided recommendations to accelerate the expansion of eConsult throughout the state. Since that time of the project, reimbursement policy for eConsult has moved forward on the state and federal levels with Medicare and some Medicaid programs as well as commercial payers providing coverage. However, in some of these programs, eConsult may not be included under the umbrella of “telehealth” and instead placed in a category called technology-based services or communications-based services.

In March of 2018 an E-Consult Toolkit, created as a part of this initiative, became live and is now available online.  This toolkit is a comprehensive collection of e-consult tools, best practices, and case studies to assist health care administrative professionals, physicians, and specialists with implementing e-consult.  It contains case studies, policy work, and publications, in addition to the implementation model, to be used for educational purposes and to further guide stakeholders. Included are evaluations on access, cost, efficiency, quality, and satisfaction.  Visit the E-Consult Toolkit website for more information.