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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
BluePath Health Inc.; Client Proprietary and Business Confidential 3
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