2017 News

Los Angeles County Scores An E-Success In Managing Specialist Care With Safety Net Connect's eConsult Solution

Los Angeles CA, March 2017

By Anna Gorman - This article originally appeared in Kaiser Health News, a nonprofit national health policy news service. KHN''s coverage in California is funded in part by Blue Shield of California Foundation.

An electronic program launched in 2012 by Los Angeles County''s health care system has reduced wait times for specialty care and eliminated the need for some safety-net patients to see specialists at all, according to a new study in the journal Health Affairs.

The program, eConsult, allows primary care doctors to get specialists'' advice for their patients and expedite referrals for those who need in-person appointments. About a quarter of the requests included in the study were resolved without patients needing to see an advanced-care doctor, though there was variation among the specialties.

"It completely changed how specialty care was delivered in a safety net system," said Michael Barnett, an assistant professor of health policy and management at Harvard T.H. Chan School of Public Health and lead author of the study.

The Los Angeles County Department of Health Services provides care for about 670,000 patients each year in a system that includes four hospitals, 19 health centers and dozens of community providers. The system serves a low-income population -- mostly uninsured or covered by Medi-Cal -- who traditionally have had difficulty getting access to specialty care.

The eConsult system handles over 17,000 requests each month. About 4,500 providers from more than 400 clinics use the system, according to the county. In 2016, the program served about 130,000 patients.

One of the major benefits of the eConsult system is that it centralizes requests for care from specialists such as cardiologists, neurologists or gynecologists, Barnett said.

Primary care doctors using eConsult have access to a secure, web-based portal to make requests for assistance from specialists. A specialist "reviewer" responds and helps the primary care physician decide how best to manage the patient''s condition.

That may mean giving advice, suggesting a specific treatment or recommending the patient see a specialist. If a patient needs a visit right away, the system allows for an expedited appointment.

In many cases, primary care doctors can resolve clinical issues with their patients simply by having a conversation, Barnett said. "Many referrals are for issues that could be resolved pretty easily if a primary care doctor could get a specialist''s attention," he said.

That means those patients wouldn''t need to take another day off work, figure out transportation across town and wait to see a specialist, said Paul Giboney, director of specialty care for the Los Angeles County Department of Health Services. Instead, the care could be delivered in the offices of their primary care doctors.

About 30 percent of patients who needed a face-to-face visit with a specialist in 2015 were able to get one within 30 days, up from 24 percent in 2014.

Difficulty getting appointments with specialists is a challenge for low-income patients across the United States. Without timely access, patients may get sicker and turn to the emergency room for care.

That was happening on a large scale in L.A. County before the implementation of the eConsult program. Some patients had to wait more than nine months for an appointment with a urologist or a gastroenterologist, for example, the study said.

The eConsult program started as an experiment to reduce the backlog, but Giboney said the county''s public health care system is now using it "day in and day out."

Despite the size and complexity of the Los Angeles County health care system, the eConsult program works efficiently, suggesting that "specialty access is not an intractable problem," the study said.

Giboney said the results show that electronic conversations between primary care doctors and specialists can improve the way business is done.

"Within a day, the specialist is already engaged and adding something to the patient''s care," he said. "We are a public system that is delivering a speed of specialty care that is really unmatched."

Since eConsult was rolled out in L.A. County, Giboney said he has talked to providers from Colorado, Illinois and Connecticut about starting similar programs.

Despite the efficiency of the system, Barnett said, there is still room for improvement on the wait times. The average amount of time it took for a patient to see a specialist in 2015 was still 52 days, though it had dropped about 17 percent from 63 days in 2014.

Patients who needed ear, nose and throat doctors and those who had kidney problems, cancer or blood diseases saw the most dramatic reductions in waiting time. The wait to see an ear, nose and throat specialist, for example, dropped from 72 to 44 days.

Wait times increased in only one of the dozen specialties examined: Patients had to wait on average 75 days in 2015 to see a podiatrist, up from 65 the previous year.

Barnett said the next step is to study the impact of the program on quality of care.

Giboney said he isn''t satisfied with the wait times either, despite the reduction, but he noted that sometimes doctors want patients to wait a few weeks to see if a treatment is working before going to see a specialist.

"It is not always about reducing the wait time," Giboney said. "It''s about delivering the right specialty care at the right time."



Safety Net Connect's eConsult System Lowers Wait Times for Access to Specialists

Boston MA, March 2017

Originally posted by the Harvard T.H. Chan School of Public Health

Low-income patients served by the Los Angeles County Department of Health Services (DHS) waited significantly less time to receive specialty care after DHS implemented an electronic system aimed at expediting access to specialists, according to a new study from Harvard T.H. Chan School of Public Health.

The findings provide some of the first evidence suggesting that using a web-based platform could improve access to specialists for underserved patients in any health system with significant constraints on specialty supply and access.

The study was published March 6, 2017 in the March issue of Health Affairs.

"In the Department of Health Services, primary care providers often had enormous difficulty getting timely specialty care for their low-income patients," said lead author Michael Barnett, assistant professor of health policy and management at Harvard Chan School. "We found that adoption of a centralized, electronic system for specialty care led to sustainable improvements in access to care."

In 2012, the Los Angeles County DHS rolled out the "eConsult" system - an electronic system that enabled primary care providers to request assistance from specialists via a web-based platform with rapid specialist review and triage. eConsult replaced the old system of phone calls, emails, and faxes, which often left patients waiting months for face-to-face appointments.

After three years of steady growth, the eConsult system was in use by over 3,000 primary care providers, and 12,082 consultations were taking place each month. By 2015, median time to an electronic response from a specialist was just one day, and one quarter of eConsults were resolved without a specialist visit.

In addition, the median wait time to see a specialist decreased 17.4%, from 63 to 52 days. And the percentage of appointments scheduled within 30 days of the initial request increased from 24% to 30.2%.

"eConsult has helped Los Angeles County transform itself from a health system characterized by fragmentation of care and long wait times into an integrated health system in which a community of connected providers works together to meet the needs of our patients," said Paul Giboney, director of specialty care at the LA County DHS and senior author of the study.

The study was supported by the California Health Care Foundation and the Blue Shield Foundation of California.

"Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists," Michael L. Barnett, Hal F. Yee Jr., Ateev Mehrotra, Paul Giboney, Health Affairs, March 6, 2017, doi: 10.1377/hlthaff.2016.1283

About Harvard T.H. Chan School of Public Health
Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people''s lives - not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America''s oldest professional training program in public health.



Sajid Ahmed, Prominent Expert in Health Information Technology and Innovation, Joins Safety Net Connect Advisory Board
Ahmed Will Offer Strategic Guidance and Real-World Insights to Advance the Expansion of Safety Net Connect's Health IT and Telehealth Solution Suite - Improving Health Equity for the Nation's Underserved

Newport Beach CA, February 2017

Safety Net Connect (SNC), a leading provider of innovative healthcare technology for organizations assisting underserved populations, is pleased to announce the appointment of Sajid Ahmed to the SNC Advisory Board. In this advisory role, Ahmed's expertise in the practical application of health information technology (Health IT) will ensure the continued alignment of SNC's health care product and service solutions with real-world needs and promote further expansion across the United States and globally.

Ahmed is Chief Information and Innovation Officer of Martin Luther King, Jr. Community Hospital in South Los Angeles, a new startup hospital that has championed the use of Health Innovations and Information technology combining clinical best practices to provide cost-effective, high quality, collaborative care. Ahmed's diligent work over the past four years brought the project to a successful launch in 2015, and the state-of-the-art facility now serves 1.35 million residents. Recently recognized by the Los Angeles Business Journal as Chief Technology Officer of the Year, Ahmed is a highly respected thought leader, speaker, consultant, and advocate for healthcare innovation. Ahmed holds credentials as a CHIME Certified Healthcare CIO (CHCIO) from the College of Healthcare Information Management Executives (CHIME), the leading professional organization for Chief Information Officers and other senior HIT leaders.

"In the growing field of healthcare technology, Sajid Ahmed is the one you want on your team," says Chris Cruttenden, CEO of SNC. "This is the man who led a multi-million Health IT initiative and planning for a community-based innovation hub on the MLK Medical Center Campus. His leadership makes a difference in the lives of millions. We are honored by the presence of this innovative pioneer on the SNC team."

Ahmed has had a longstanding interest in telehealth and care coordination going back to his prior position as Senior Director of Health IT and Innovation at L.A. Care Health Plan (L.A. Care), the nation's largest public plan serving more than one million Los Angeles County residents through free or low-cost health insurance programs. At L.A. Care, Mr. Ahmed worked with Los Angeles County Department of Health Services (LADHS), Community Clinic Association of Los Angeles, Healthcare LA IPA, and technology partner SNC to launch "eConsult," an innovative store-and-forward telehealth and care coordination system that facilitates virtual consultations and collaboration between primary care physicians and specialists. To date the LADHS eConsult system has completed over 600,000 eConsults - facilitating accessing to specialty care for low-income, underinsured LA residents, reducing waiting times and no show rates.

"Joining the SNC advisory board furthers my personal cause of improving health access across our nation," says Mr. Ahmed. "They are an organization to be respected - with their vast knowledge of HIT, the proven solutions they have developed, and their goal of making quality healthcare a reality for all individuals - SNC is clearly positioned for success. I look forward to the opportunity to contribute to the growth of this mission-driven healthcare technology company."



Improving Behavioral Care for Vulnerable Populations, L.A. Care Health Plan Expands eManagement System to Increase Access and Electronic Care Coordination between Community-based Physicians and the L.A. County Dept. of Mental Health
eManagement Enables Primary Care Physicians to Provide Behavioral Health Assessments in the Medical Home - Expediting Early Identification and Treatment

Newport Beach CA, January 2017

Safety Net Connect (SNC), a leading provider of innovative web-based healthcare solutions for organizations assisting underserved populations, is pleased to announce that L.A. Care Health Plan (L.A. Care) is expanding the eManagement system to connect community-based physicians with the Los Angeles County Department of Mental Health (LADMH).

L.A. Care will provide over 200 private practice physicians with direct, electronic communication to LADMH through the eManagement system developed by SNC. In addition to improving access and care coordination with behavioral health providers, the platform will facilitate early identification and triaging of patients with depression - the most prevalent mental health disorder in primary care.

"We are excited to expand and expedite access to quality mental health care for our members," shares L.A. Care CEO John Baackes. "Mental and physical health are inextricably linked - to be successful we must provide a holistic and closely coordinated approach to care management. With this technology we can help facilitate the communication necessary for better care, while reducing barriers for primary and specialty care physicians - and for their patients."

With this system, primary care physicians (PCPs) treating L.A. Care patients will be able to quickly access LADMH providers with electronic peer-to-peer consultations (eConsults) for inquiries on treatment guidelines or medication management. In addition, integrated assessments - including the Patient Health Questionnaire or "PHQ" - enable PCPs to screen patients for depression and other conditions during their appointment, in the trusted environment of their medical home.

If a referral for mental health services is appropriate, PCPs can simply and expeditiously connect patients with the right provider for their needs - and prioritize referral for patients who are at higher risk. The assessment scores and key elements of the patient history accompany the electronic referral - ensuring a more informed and effective first visit with the behavioral specialist.

"Mental health providers and primary care physicians have long recognized the need for more coordinated care - but the day-to-day barriers of our healthcare system have made that exceedingly difficult," shares Chris Cruttenden, President of SNC. "We're honored to partner in this unique public/private initiative that improves access and makes physician-to-physician communication truly scalable; it's exciting to see the potential of technology applied in such a meaningful area."

About L.A. Care
L.A. Care Health Plan (Local Initiative Health Authority of Los Angeles County) is a public entity and community-accountable health plan serving residents of Los Angeles County through a variety of health coverage programs including L.A. Care Covered™, Medi-Cal, L.A. Care Cal MediConnect Plan, L.A. Care's Healthy Kids and PASC-SEIU Homecare Workers Health Care Plan. L.A. Care is a leader in developing new programs through innovative partnerships designed to provide health coverage to vulnerable populations and to support the safety net. With more than 2 million members, L.A. Care is the nation's largest publicly operated health plan. http://www.lacare.org/

About Safety Net Connect
Since 2009, Safety Net Connect (SNC) has been a leading creator of healthcare technology that makes it easier for providers and institutions to increase access to care, streamline care coordination, promote evidence-based practices, and improve quality. With a mission to improve health equity, SNC has helped public and private healthcare organizations across the nation successfully reach over 5 million low-income, underserved individuals with affordable, effective patient-centered care. For more information, please visit www.safetynetconnect.com



L.A. Care Health Plan Links 21 Hospitals in Los Angeles County With Real-time Data Exchange and Care Coordination on eConnect Platform by Safety Net Connect

Newport Beach CA, January 2017

Safety Net Connect (SNC), a leading provider of innovative web-based healthcare solutions for organizations assisting underserved populations, is pleased to announce that 21 hospitals are now linked with real-time exchange of census data by the eConnect system sponsored by L.A. Care Health Plan (L.A. Care).

"Based on the outcomes of a successful pilot, we began rolling out the eConnect platform to the high-volume hospitals in our network in August of 2015," explains L.A. Care CEO John Baackes. "Engaging twenty-one institutions in just over a year is a true testament to the value of this kind of data in improving outcomes for our hospital providers. We're excited to be able to provide a meaningful solution that overcomes common connectivity barriers between systems."

Hospitals on the L.A. Care eConnect platform will send "real-time" alerts with Health Level-7 Admit Discharge Transfer (HL7 ADT) real-time data exchange. The eConnect platform developed by SNC provides L.A. Care the ability for immediate interaction and intervention along with concurrent review and better care coordination, particularly for post-discharge management - improving quality of care while reducing avoidable readmissions.

"Timely access to actionable data is the essential goal of most any health information technology - but a lack of interoperability between systems and organizations often makes that goal challenging, if not impossible," says Keith Matsutsuyu, CEO of SNC. "We're honored to be part of a solution that fully delivers on the promise of HIT - for the provider, the payer and most importantly, the patient."

About L.A. Care
L.A. Care Health Plan (Local Initiative Health Authority of Los Angeles County) is a public entity and community-accountable health plan serving residents of Los Angeles County through a variety of health coverage programs including L.A. Care Covered™, Medi-Cal, L.A. Care Cal MediConnect Plan, L.A. Care's Healthy Kids and PASC-SEIU Homecare Workers Health Care Plan. L.A. Care is a leader in developing new programs through innovative partnerships designed to provide health coverage to vulnerable populations and to support the safety net. With more than 2 million members, L.A. Care is the nation's largest publicly operated health plan. http://www.lacare.org/

About Safety Net Connect
Since 2009, Safety Net Connect (SNC) has been a leading creator of healthcare technology that makes it easier for providers and institutions to increase access to care, streamline care coordination, promote evidence-based practices, and improve quality. With a mission to improve health equity, SNC has helped public and private healthcare organizations across the nation successfully reach over 5 million low-income, underserved individuals with affordable, effective patient-centered care. For more information, please visit www.safetynetconnect.com