econsults as an enabler for Comprehensive Primary Care Peter Meacher, MD - Callen Lorde, CMO Carlos Reines RubiconMD, COO

Transcription

1 econsults as an enabler for Comprehensive Primary Care Peter Meacher, MD - Callen Lorde, CMO Carlos Reines RubiconMD, COO 1

2 PRIMARY CARE MENTAL HEALTH DENTISTRY HOTT WOMEN S HEALTH TRANSGENDER CARE HIV CARE SEXUAL HEALTH ANAL HEALTH MOBILE HEALTH HEALTH EDUCATION PHARMACY LAB SERVICES CARE COORDINATION TRAINING RESEARCH EDUCATION

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5 Started in 2013 by two Harvard MBAs and a clinician on faculty at Harvard Medical School. With the mission to: Democratize Medical Expertise so that providers can offer every patient the care they deserve CLIENTS in 33 States: FQHCs Health plans Correctional Employer/onsite clinics Direct primary care Our diverse and mission-driven team is located in NYC

6 origins, frustrations, needs econsults and FQHCs complex cases isolation, lack of support new providers access communication and documentation

7 NYCeDC Pilot Grant

8 What is an econsult? An econsult is a remote consult between a community health center provider and a specialist. - Not Telemedicine. Not patient facing - Physician/NP/PA <> Specialist - Asynchronous - Text Based + Attachments (Photos, labs, imaging)

9 How it Works 1 COMMUNITY HEALTH CENTER PROVIDER Provider submits a patient econsult through the online platform 2 SPE CIALIST OPINION Assigned specialist shares his or her clinical opinion within hours 3 BETTER FOLL O W - UP Provider now can make more informed decision on patient s care

10 Policy Landscape FQHCs moving to Value based care and Capitation Health Plans and Providers need to meet timely access requirements Quality of Care and Patient Satisfaction more important than ever CMS, NYCEDC, Foundations, and Medicaid in other states are funding econsult implementations and starting to reimburse for it econsults are becoming an integral part of comprehensive primary care

11 The RubiconMD Platform

12 Access to Specialty Expertise Over 100 different specialties and sub-specialties are currently available on the RubiconMD platform. The select panel of specialists comes from academic medical institutions across the country. Allergy and Immunology Cardiology Clinical Pharmacy Dermatology Toxicology Endocrinology Geriatrics Neurosurgery Neurology Nephrology Med / Peds Infectious Diseases Hematology / Oncology Gastroenterolog y Obesity Medicine Obstetrics / Gynecology Occupational Medicine Ophthalmology General Dentistry Oral- Maxillofacial Surgery Orthopedic Surgery Pulmonology Psychiatry Physical Medicine / Rehab Pediatrics Palliative Care Pain Medicine Otolaryngology (ENT) Rheumatology Sleep Medicine Sports Medicine Surgical Oncology Urology Vascular Surgery Other

13 Value of econsults For Patients For Providers For Organizations + Improved access to highquality care within the community clinic setting Remove financial and social barriers to specialty care More comprehensive care which leads to better outcomes Providers continuously learning to practice at the top of their license Clear ROI from better care coordination Improved patient health outcomes

14 Insurance Type for Referrals at Callen-Lorde Uninsured Medicaid & QHP Private

15 Breakdown of 12,000 Annual Referrals Radiology Gastrenterology Ophthalmology Dermatology Urology Other

16 econsults at Callen-Lorde Community Health Center + Clinic enabled with econsult capabilities Providers share best cases to maximize learning ROI Impact study analyses shared with organization

17 econsult Case Study: Reproductive Endocrinology Male, 29

18 econsult Case Study: Reproductive Endocrinology (ctd) This endocrinologist trained at Harvard's Brigham and Women's Hospital and currently holds a teaching position at an academic medical center

19 Case Study: Allergy and Immunology Male, 25

20 Case Study: Allergy and Immunology (ctd) This allergy and immunology specialist trained at Johns Hopkins Hospital and currently holds a teaching position at an academic medical center.

21 Case Study: Psychiatry Addiction Medicine Male, 41

22 Case Study: Psychiatry Addiction Medicine (ctd) This psychiatrist trained at Tufts Medical Center and currently directs a department at an academic medical center

23 Case Study: Surgery Male, 22

24 Case Study: Surgery This surgical oncologist trained at Washington University in St. Louis and currently holds a teaching position at an academic medical center.

25 Strengths Provider Supporting Staff through learning opportunities New graduates Expanding scope Multiple consults Timeliness

26 Strengths Patient Time Cost & insurance Geography Unable/unwilling to attend in person

27 Strengths Improving Consult Quality Work up prior Necessity of consult Redirection to most appropriate specialist econsult feedback: Ratings

28 Impact Data from Rubicon DID THE OPINION : 1. Avoid a referral? 47% 2. Improve a referral? 3. Provide peace of mind? 4. Have no effect? 30% 21% 2%

29 Impact Data from Rubicon (2) Improved quality consult Prevented unnecessary consult Redirected consult Informed best next steps + Provider education Provider satisfaction Patient satisfaction

30 Challenges/Concerns

31 Challenges/Concerns Interoperability (or lack thereof)

32 Challenges/Concerns Interoperability (or lack thereof) Documentation

33 Challenges/Concerns Interoperability (or lack thereof) Documentation Cost

34 Challenges/Concerns Interoperability (or lack thereof) Documentation Cost Provider Engagement

35 Challenges/Concerns Interoperability (or lack thereof) Documentation Cost Provider Engagement Concerns ref medical malpractice and liability

36 Financing the RubiconMD model

37 Callen-Lorde & RubiconMD: Expanding the partnership Callen-Lorde transgender health specialists will be available through RubiconMD econsults

38 The Provider Experience

39 Busting econsult Myths

40 MYTH 1 econsults are just another form or telemedicine or second opinions.

41 FACT Telemedicine and second opinion services are mostly patient facing and address very particular use cases. econsults are one of the few provider facing innovations directed to taking quality of care to the next level.

42 MYTH 2 Providers can use curbside consults to safely consult specialists on difficult patient cases.

43 FACT Informal curbside consults are - not HIPAA-compliant - not properly documented - biased in many instances econsults are fully HIPAA compliant, properly documented and follow evidence based medicine.

44 MYTH 3 econsults put community health center providers at increased risk.

45 FACT Primary care providers are always responsible for their patient s care and that entails making decisions. econsults help providers make more informed decisions on their cases, leading to better care.

46 MYTH 4 econsults are time-consuming and place unnecessary administrative burdens on providers.

47 FACT econsults take a few minutes to submit and lead to better decisions, which ultimately result in avoidance of unnecessary administrative tasks for both the provider and the patient.

48 THANK YOU! Questions? Please contact callen-lorde.org rubiconmd.com