Safety Net Connect, a provider of web-based healthcare solutions aiding the underserved and safety net populations, has signed anew County-wide contract with the Los Angeles County Department of Health Services (DHS), which will expand the use of Safety Net Connect’s innovative eConsult system by primary care providers and specialists throughout the DHS system.

The eConsult system facilitates electronic consultations between primary care providers and specialists, which offers vulnerable people better, more efficient access to specialized care. The system enables providers to discuss relevant details of patients’ medical history prior to scheduling appointments, thereby reducing unnecessary referrals, limiting wait times and lowering administrative costs. In many cases, the increased communication between physicians results in patients receiving more immediate, specialist-guided care from their primary care physician, eliminating the need for a specialist appointment altogether.

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The US health care delivery system has historically been characterized by a fragmented, poorly integrated approach to delivering care that often falls short when it comes to managing patients with complex health conditions. Of particular concern is accessto specialty care, especially for uninsured or under-insured patients relying on safety net services.

Learn how COPE Health Solutions partnered with a network of communityclinics and a county hospital to develop eConsult as an innovative solution to improve coordination, appropriate access, and quality of care for patients, resulting in nearly 50% avoidance of specialty visits. Read the full case study on our website.

Read the full case study on COPE’s website.

L.A. Care Health Plan, the nation’s largest publicly operated health plan, announces that for its eConsult telehealth program, more than 50,000 electronic consultations between primary care providers (PCPs) and specialists have been initiated.

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By Paul Karon

Although the Medicaid program helps millions of low-income families and children get essential health care, patients with the government-sponsored coverage still face significant barriers when it comes to seeing doctors in the medical specialties.

But in an era when so much of everyday life takes place in the virtual realm of computers and digital communications, an evaluation study supported by the Southern California Clinical and Translational Science Institute (SC CTSI) showed how the same technologies can give Medicaid patients better access to medical specialists, with less hassle forthe patients and lower cost for the providers.

Called eConsult, for electronic consulting, the study used a combination of computer and digital communications tools to enable primary care providers to consult with specialist physicians when in-person meetings are difficult to schedule or, perhaps, unnecessary.

A cross-institutional team from USC, L.A. Care Health Plan, SynerMed and Partners in Care Foundation showed how an electronic consulting system provided Medicaid patients greater access to specialists like dermatologists, endocrinologists and nephrologists.

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eConsult celebrated its first anniversary in July and it has come a long way from that first month when it started with 2 specialties and 4 clinics. With the addition of new Specialty Services like Endocrinology, Diabetes and (going live on September 3rd) Hepatology and Echocardiograms, eConsult now offers 14 specialty services.

By the numbers:

• 14 Specialty Services (Cardiology, Dermatology, Diabetes, Echocardiograms, Endocrinology, Gastroenterology, Gynecology, Hepatology, Nephrology, Neurology, Obstetrics, Ophthalmology, Podiatry, Urology)
• 100 DHS Specialty Reviewers
• 2.3 days = Average Specialty Reviewer response time
• 120 sites (40 DHS and 80 Community Partner)
• 1,200+ Primary Care Providers using eConsult System

To highlight our emphasis on customer care and delivering responsive and appropriate specialty services, we have renamed the Central Referral Unit (CRU) as the DHS Appointment Service Center (DHS ASC). Our focus on Patient Centered Specialty Scheduling will remain the same as always.

The DHS ASC has been busy! They have now successfully scheduled almost 13,000 patients. A recent assessment of the patients scheduled showed an average No Show rate of only 15%! This is considerably less than the No Show rate of 25-40% in patients scheduled via other means.

Since the start of the project 18 months ago, L.A. Care Health Plan, the nations largest public health plan, has counted 15,000 electronic consultations between primary care doctors and specialists, connecting 1,300 providers in 108 community clinics and health centers across the county, the community health plan announced last week. The web-based system allows primary care doctors and specialists to share health information and discuss patient care. This reduces patient treatment times, improves clinical quality and lowers costs. This year, the program will be expanded to 76 additional sites to serve one million low-income Los Angelenos, the plan announced last week. This represents an exciting milestone in the effective delivery of specialty services to our patients, said Dr. Paul Giboney, director of specialty care for the Los Angeles Department of Health Services (DHS). L.A. Care Health Plan is a public entity and community-accountable health plan serving local residents through Medi-Cal, Healthy Families, L.A. Cares Healthy Kids and L.A. Care Health Plan Medicare Advantage HMO SNP, among other programs. The web-based eConsult is part of DHS and HealthCare L.A. Independent Physicians Association. Funding and management for eConsult is provided by MedPoint Management and Community Clinic Association of Los Angeles County and L.A. Care. L.A. Care provides major funding and management for the program.

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L.A. Care Health Plan, the nations largest publicly operated health plan, announces that for its eConsult telehealth program, more than 15,000 eConsults, which are electronic consultations between primary care providers (PCP) and specialists, have been initiated. The program is the largest rollout of its type in the nation, used by 1,300 PCPs in 108 community clinic/health center sites across L.A. County. L.A. Care plans to expand the program to an additional 76 sites throughout 2013 to serve close to one million low-income individuals and families. Fourteen different types of specialist physicians are available to review eConsults from PCPs.

The web-based eConsult system enables PCPs and specialists to securely share health information and discuss patient care, with the goal of providing the right treatment at the best place in the shortest time. The program is composed of the second largest public health care delivery system in the nation, Los Angeles County Department of Health Services (DHS), and one of the largest safety net clinic associations in the state, Health Care L.A. Independent Physicians Association (HCLA). Also playing central leadership roles are MedPOINT Management and Community Clinic Association of Los Angeles County. L.A. Care, provides major funding and management.

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More than 10,000 eConsults have been responded to in 9 specialties to date – Urology is new this month (Nephrology coming soon!). This represents an exciting milestone in the effective delivery of specialty services to our patients. We are grateful to our partners at LA Care for their sponsorship of the first 18 months of eConsult work. We also appreciate our committed specialty reviewers whose response to the initial request for assistance has averaged less than 2 days.

Measuring Impact

The fact that in each of these 10,000 situations, a PCP and a specialist were able to rapidly discuss the clinical needs of the patient and determine the best next steps is the one of the primary outcomes we seek in evaluating the impact of eConsult. We can also see the impact in the response from those using the system:

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L.A. Care Health Plan, the nation’s largest public health plan, is proud to announce that only six months since its launch, its safety net eConsult program has surpassed its target number of clinical sites, thus decreasing the number of inappropriate and unnecessary specialty referrals at those locations.

eConsult is a web-based platform that allows for primary care provider-to-specialist conversations aimed at speeding access to specialty care and better care coordination. The Safety Net eConsult Program is an initiative of L.A. Care reflecting its ongoing commitment to advancing health and health care using the latest in care coordination and communication technologies.

The Safety Net, the system that safeguards and provides care to the poor and uninsured, in Los Angeles County has long been overwhelmed with the volume of patients needing access to specialty care. L.A. Care is committed to promoting efforts to increase access to quality health care for low-income and vulnerable residents. Through innovative partnerships L.A. Care developed the Safety Net eConsult Program, a straightforward approach to overhaul the healthcare challenge faced in Los Angeles County using telehealth and care coordination solutions to address the growing need for access to information and access to care.

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With the growth of users and specialties, the volume of eConsults conducted has passed the 2,000 eConsults milestone and is growing rapidly. Thanks to all the Specialty Reviewers and PCPs who have put in so much effort to improve our responsiveness to our patients needs for specialty care. eConsult stats: 6 Specialties 39 Active Specialty Reviewers 61 locations (35 DHS and 26 Community Partners) 400+ Primary Care Providers 1,000+ System-wide Users (providers, nurses, clinic staff, referral center staff and others) 2,451 Patients (and providers) assisted through eConsult 57% assisted with Face to Face Specialty Visit 35% assisted by specialist support and education of PCPs (no face to face visit required) 8 % assisted by re-direction of the eConsult

Doctors called it the black hole.

If their low-income or uninsured patients needed specialty care, they put in a referral to the massive Los Angeles County health care bureaucracy and then waited – for weeks or even months. It could take eight months to see a neurologist, more than three to see a cardiologist.

With a million patients a year depending on Los Angeles County for health care, local officials decided they had to act. Hiring scores of costly specialists wasn’t an option. So in 2012 they created a program called eConsult, modeled after a system at San Francisco General Hospital, to streamline the referral process.

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Safety Net Connect (SNC), a leading provider of innovative web-based healthcare solutions for organizations assisting underserved populations, announced that it will collaborate with Partnership HealthPlan of California (PHC) to implement a six-month pilot of SNC’s eConsult system. The pilot will operate within federally qualified health centers across three upper northern California counties that serve a large Medicaid population with inadequate access to specialty care.

The eConsult pilot will enable select PHC-affiliated primary care physicians to consult with specialists in four distinct specialty fields. With a secure, structured exchange of information and peer-to-peer discussion of patient needs, SNC’s eConsult will facilitate the delivery of specialty care within the primary care office, providing timely services for members who may live hundreds of miles from a specialist.

“We are excited to be an integral part of PHC’s initiative to expand specialty care access,” said Chris Cruttenden, president of SNC. “Our eConsult technology will provide an avenue for high quality specialty care to reach PHC’s low-income, underinsured, and rural residents who are at an unfortunate disadvantage when it comes to specialty care access. We believe this partnership will have a positive impact on the health and wellbeing of many northern California residents.”

The PHC/SNC partnership was inspired by Los Angeles Department of Health Services’ pilot of the SNC eConsult system and its landmark 18-month outcomes – where 46% of eConsults were resolved in the primary care office, without the need for a face-to-face specialty appointment; and average wait times for specialty appointments decreased by 60%.

“PHC is a huge champion of innovative solutions for the advancement of patient-centered care,” said Dr. Robert Moore, the Chief Medical Officer for PHC. “The SNC eConsult system stands out in the expanding field of telehealth as a groundbreaking method for making specialty care readily available to underserved, rural populations. We are pleased to be working with an expert team steeped in real-world experience for serving the needs of organizations such as ours.”

About Partnership HealthPlan of California

Partnership HealthPlan of California (PHC) is a non-profit community based health care organization that contracts with the State to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care. PHC provides quality health care to over 514,000 members. Beginning in Solano County in 1994, PHC now provides services to 14 Northern California counties – Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Shasta, Siskiyou, Solano, Sonoma, Trinity and Yolo. For more information, visit www.partnershiphp.org

About Safety Net Connect

Since 2009, Safety Net Connect (SNC) has partnered with public and private organizations to provide a multitude of successful and nationally recognized web-based healthcare solutions for underserved and safety net populations. SNC’s innovative solutions have reached over 5 million patients from clients such as Los Angeles Department of Health Services (LADHS), MedPoint, LA Care, Orange County Healthcare Agency, CalOptima, San Diego Healthcare Agency, and Cook County MHN (an Illinois Medicaid Project). For more information, please visit Safety Net Connect (SNC),