eConsults Can Lower Costs and Improve Access to Specialty Care

Mathematica recently released findings from a pilot study demonstrating the potential for eConsults to expand access to specialty care and reduce costs by an average of $195 per person within a commercial beneficiary population. eConsults enable primary care providers to asynchronously seek input from specialists on specific clinical questions rather than having to refer patients for a face-to-face visit. Although study findings suggest eConsults are a promising intervention, primary care physician uptake was lower than expected, with most utilization concentrated in a small number of practices.  

Overreliance on specialty care contributes to increased costs and limits access to care due to provider shortages and health insurance restrictions. Further, many services that are typically referred to specialists could be provided in primary care settings with sufficient support. The Peterson Center on Healthcare, in collaboration with Arkansas Blue Cross Blue Shield, conducted a pilot, which took place from February 2021 to July 2022, (Project Arkansas eConsultations (PARC)) to test the ability of eConsults to expedite care, reduce costs, and enhance accessibility for patients covered by commercial health insurance. Mathematica conducted a formative evaluation to learn from the pilot’s implementation and a summative evaluation to determine the impact of eConsults on cost and utilization.

“Although there is no one silver bullet, eConsults represent a feasible and promising intervention for coordinating care for patients with complex health care needs, enhancing the use of health information technology, improving access to care for people living in resource-limited communities, and providing comprehensive primary care—all of which are tactics for improving the quality of care while reducing costs,” wrote Mathematica’s Suzanne Felt-Lisk, Genna Cohen, and Eric Dehus in the formative report.

In the month of the eConsult, the study found an average reduction in expenditures for key services of $195 per person, driven primarily by lower costs of specialist care. Within the pilot, endocrinology, dermatology, and neurology were the specialties for which eConsults were most frequently used.

Primary care providers who used eConsults reported that they were motivated by the perceived benefits to their patients, which included more timely access to specialty care, reduced out-of-pocket costs, and reduced travel time. However, uptake of eConsults among primary care providers remained a challenge, with most providers making limited use of the intervention. The providers who frequently used eConsults cited strong leadership engagement and clear goal setting as key factors in their ability to make broader use of the intervention. The findings suggest that to optimize uptake and realize the full benefits of eConsults, sponsoring healthcare organizations should be prepared to invest resources in provider and specialist training, built-in reminders, and practice change management.

In the context of rising health care costs, affordability of specialist services, and limited specialty care access, findings from this research can inform decisions by commercial and public health insurance systems as they seek cost-effective approaches to providing integrated care for patients with chronic health conditions. The Centers for Medicare & Medicaid Services has included eConsults as a tool in its latest multi-payer model, Making Care Primary, which seeks to improve the delivery of advanced primary care services.

Learn more about the evaluation of Project Arkansas eConsultations here.