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The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
June 9, 2020
State Health Policy Leadership Telehealth The Center for Evidence-based Policy
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In the wake of COVID-19, states will face ongoing challenges related to emergency response and management of the global pandemic for many months—perhaps years—to come. While this work will continue to be critical, it will become even harder as state leaders confront COVID-19’s economic impacts and resulting budgetary crises. During these unprecedented times, policymakers will be looking for ways to spend less across the board and health care is likely to be a target for cuts as it accounts for such a large share of total state expenditures. A combination of creative and evidence-based solutions could add up to significant savings while also promoting better population health.
A new Milbank Memorial Fund report by the Center for Evidence-Based Policy (CEbP) presents a prime example of one potential solution for policymakers trying to maximize limited resources in a post-COVID-19 world: Electronic consultations or “eConsults,” a relatively new approach that connects clinicians over a secure electronic platform. Incorporating eConsults into programs like Medicaid and government employee health benefit programs could potentially make a difference in a very important, very expensive area: specialty care.
Access to specialty care is a persistent challenge for many patients and barriers like transportation, childcare, geography, and limited provider networks can make access to such care especially difficult for Medicaid beneficiaries. In addition to access challenges, the current system of referring patients for specialty care includes a number of inefficiencies, such as complicated referral processes, delayed response times, long waits, and patient no-shows. These inefficiencies not only lead to frustration among patients, they also have tangible costs for providers and payers. As a result of COVID-19, these challenges are likely to be compounded moving forward as people limit in-person contact.
In response to the access challenges and inefficiencies described above, eConsults were developed to facilitate secure, direct communication and coordination between clinicians. During an eConsult, the requesting clinician and the specialist share and discuss patient-specific information, reducing the need for face-to-face specialist visits. In their report—which summarizes findings from a report developed for the Medicaid Evidence-based Decisions (MED) Project at Oregon Health & Science University—CEbP researchers examined four systematic reviews and 36 individual studies that compared eConsults with a traditional referral process. The findings show that eConsults appear to be safe and are associated with:
While additional studies are needed to fully understand the effects of eConsults on important patient outcomes and care, these early results demonstrate strong promise. Beyond the tangible benefits described above, eConsults may also present an important opportunity to strengthen the primary care workforce through increased skills and knowledge related to specialty care.
EConsult programs are implemented and managed differently across health care systems, but there are case studies (including four highlighted in CEbP’s report) of the program in practice that interested states can refer to as examples. State Medicaid and public employee programs interested in eConsults will need to decide whether coverage should occur through fee-for-service or be incorporated into managed care contracts or other value-based payment models. Preliminary steps have already been taken to facilitate a pathway to reimbursement for eConsults, including the Center for Medicare and Medicaid Services’ establishment of eConsult-specific payment (CPT) codes.
As state leaders grapple with the new reality brought on by COVID-19, many tough decisions lie ahead. Budget reductions are never politically popular and can often lead to unintended consequences. Where possible, rather than broad sweeping cuts, leaders can start with more targeted approaches focused on cost-saving initiatives that maintain population health outcomes. EConsults may fit this bill as states begin adapting to the economic implications of COVID-19.
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An endowed operating foundation that engages in nonpartisan analysis, collaboration, and communication, with an emphasis on state health policy.