eConsults: Telemedicine for our Neediest Populations

Two articles caught my eye today.  The first was an issue brief from the Commonwealth Fund, which focused on the strength of America’s premier primary care safety net: community health centers.  The article evaluated those health centers who had adopted the  Patient Centered Medical Home ( PCMH) model of care.  The study looks at the period from 2009 to 2013 and makes the observation that on almost all metrics, capability has improved dramatically  – except in providing access to specialty care. In particular for Medicaid and uninsured patients who make up 75% of the patient population, community health centers showed declines in obtaining specialist or subspecialist appointments and procedures.

s WSJ there was an article about Google’s investment in a health insurance startup.  The company will be giving free unlimited telemedicine services to their patients with phone access to a physician within 10 minutes.  A Google official noted “What we’re excited about is companies that can transform the cost curve through technology”.  There’s been lots of investment activity like this recently in telemedicine, mostly in the private sector.  Unfortunately, few of these investments are focused in on America’s most needy population, which is disappointing as change in this space has global implications.  Community Health Centers are often  left without financial capital, so we need to bring our intellectual capital to the table to see what we can accomplish.

At our Community Health Center, we’ve developed the Weitzman Institute, an organization dedicated to inspiring primary care innovation.  One of our initiatives is working on ways to use telemedicine to provide access to specialists for this population.  We are rolling out an eConsult network, initially in New England, and then across the country.  We start by sending the data and not the patient for the consultation. We’ve based this on the work of Dr. Mitch Katz, Director of the LA health county system.  Seven years ago, Dr. Mitch Katz spoke at our Weitzman Symposium about his pioneering work in San Francisco.

Soon after meeting Mitch we undertook a clinical trial with eConsults in Cardiology.  Our finding — that an initial specialist consultant screen provided substantial benefit to the patient, provider, and system — will be soon published in The Annals of Family Medicine. Most importantly our State Medicaid agency has recently agreed to reimburse us for the econsults.  Our hope is that their leadership will bring other state Medicaid agencies to the table.

We’d love to hear about your perspective on how to improve access to specialist care for those at community health centers – I can be reached at mark@chc1.com or reach out to Dr. Daren Anderson, head of the Weitzman Institute, at daren@chc1.com