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E-Consult – Picking Up Speed

CTRC Summit 2019

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How did it start? Innovators paved the way

Blue Shield of California Foundation funded DPH and FQHC grantees across California in various stages of e-consult: Feasibility, Planning, Pilot, Spread and Scale, and CQI/Innovation. Leadership was provided by mature programs and SMEs from LADHS and SF General.

Active BSCF grantees include:• Alameda Health System• Community Health Partnership

of Santa Clara County• Inland Empire Health Plan• LADHS and LA Care Health Plan• San Joaquin General Hospital• San Mateo Medical Center• Ventura County Medical Center• Zuckerberg SF General and SFHN

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E-consult programs are revving up across the stateNCAL

SCAL

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Now…over one millione-consults in California

10.1377/hlthaff.2016.1283 HEALTH AFFAIRS 36, NO. 3 (2017): 492–499

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No longer “curbside consults” but mainstream care

https://www.nytimes.com/2019/03/18/upshot/when-email-comes-to-the-doctors-office-wait-times-decrease.html

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Efforts are accelerating with proposed changes to the DHCS Telehealth Provider Manual for 2019

CPT code 99451 will be used to capture e-consults performed by specialists. — This code reflects 5 or more minutes of time spent by the consulting (not treating)

provider.

Patients’ written or verbal consent (not informed consent) must be obtained for e-consult.

— This can be encompassed in a general consent agreement obtained by the provider organization and does not have to be captured with each encounter.

E-consult providers must be licensed in California and enrolled Medi-Cal providers, yet need not reside in California if they are affiliated with a billing organization located in California.

The E-Consult Workgroup appreciates DHCS’s acknowledgment of our group’s comments, many of which were reflected in the proposed code for e-consult in 2019. Additional information can be found on the DHCS web site under Telehealth:https://www.dhcs.ca.gov/provgovpart/pages/telehealth.aspx

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Programs are fueled by community-wide engagement

CHC/FQHCPCP-Specialist process

improvementsIncreased access to

specialty care for patientsExternal funding for

implementation?

PlanEase of capturing encounters for

reimbursementPotential to offer specialists

through remote network Means of addressing regulatory

access requirements

Health SystemProcess improvement

with community partner PCPs

Improve service and access to specialty care for patients

PRIME incentives for referral reply turnaround and closed loop

communications

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Sample considerations in community-wide engagement discussions

What are biggest specialty access

challenges?

How do PCPs incorporate e-consult into referral process?

Will there be e-consult platform or

integration fees?

Will e-consult integrate with my

EHR?

What are e-consult volume expectations

of PCPs?

What specialist capacity is available?

When/how quickly can specialists

respond?

Platform, integration fees, specialist and

staff time?

Will specialists have desktop and mobile

access?

What is needed for Waiver program

reporting?

What are biggest member pain points?

Will you engage both local and remote

specialists?

What e-consult volume is needed to address access gaps?

Will the plan provide implementation

assistance?

What is needed to demonstrate

improved access?

CHC Health System Plan

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What can you do to drive your e-consult program? Leverage CTRC resources

Participate in E-Consult Workgroup monthly webinars to discuss best practices in implementation and sustainability

Engage in discussions with State agencies to share e-consult accomplishments in improving network adequacy and timely access

Subscribe to the monthly E-Consult News, and use it to share your patient and provider stories, best practices and successes

Access econsulttoolkit.com for— Implementation tools— Policy news and events— E-Consult Workgroup and Newsletter

archives — New peer-reviewed publications on e-

consult

Join us on November 5 in Sacramento for the annual in-person E-Consult Workshop