Virtual specialist consultations for patients with heart troubles could save payors more than $400 and provide greater access, timeliness and coordination of care to underserved communities.

Researchers at Community Health Center Inc. and the University of Connecticut Health Center found that so-called eConsults for cardiology reduced expenses associated with in-person consultations by $466 per patient while eliminating waiting time for patients looking to see specialists. The findings are the first randomized study for eConsults to be published and can be found in the January edition of the American Journal of Managed Care.

“eConsults provide rapid answers to clinical questions and allow physicians to implement treatment plans and help their patients get the care they need much more rapidly,” Dr. Daren Anderson, vice-president and chief quality officer for Community Health Center, and the lead author of the study, told HCB News. “In addition, eConsults provide a powerful educational tool that helps PCPs stay current with the latest medical knowledge.”

The current system for in-person consultations can suffer from delays, imbalances between supply and demand and poor information exchange.

eConsults are virtual consultations by specialists who review clinical information delivered electronically over a secure platform by primary care physicians. Based on the information, specialists can provide recommendations to physicians, eliminating the need for in-person visits and long waiting times.

Researchers conducted their study using 369 Medicaid patients referred by primary care givers for cardiology consultations, randomly assigning participants to use either eConsults or face-to-face referrals.

Information on those using eConsults was transferred to specialists through a secure peer-to-peer communication platform in the electronic health record with intention-to-treat analysis used to assess total cost of care, as well as cost in the categories of inpatient, outpatient, emergency department, pharmacy, labs, cardiac procedures and "all other".

Patients in the eConsult group were found to have significantly lower mean unadjusted total costs at $655 per patient, six months following consultations, compared to the face-to-face group. When taking into account non-normality, this amount was adjusted to $466. eConsult patients in the outpatient cardiac procedures group experienced reductions in cost of $81 per patient.

“eConsults are relatively easy to implement and utilize,” Anderson said. “The intervention is inherently scalable. The main limitation is simply the barriers that are always faced when seeking to change behaviors and long-established workflows. In addition, reimbursement is a challenge. Entities that are at risk for the total cost of care should find value in eConsults and be willing to bear the cost of the intervention.”

The findings credit savings, partially, to reductions in the cost of cardiac outpatient procedures, and suggest that changes in reimbursement policy supporting the use of eConsults could provide Medicaid programs with significant savings in relatively short periods of time.

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