Building eConsult Programs Aligned to Quality Initiatives for More Effective Value-Based Care 

As primary care providers and health systems transition from traditional fee-for-service models to value-based care (VBC), eConsults are a scalable, strategic tool to provide rapid specialist insights, minimize costs, and enhance patient-centered care. When eConsult programs are implemented in alignment with VBC quality initiatives, the standardized use of virtual specialist consultations can optimize care delivery. 

1. eConsults Enhance Care Accessibility

One of the fundamental goals of VBC is ensuring timely access to high-quality, patient-centered care. eConsults minimize barriers to specialty care by eliminating the logistical and financial burdens associated with traditional referrals. Aligning eConsults with accessibility-focused quality initiatives ensures that patients receive the right level of care at the right time, supporting performance metrics such as timely access to specialists and reducing disparities in care.

Value Based Care Benefits:

• Reduction in unnecessary specialist visits
• Expedited clinical guidance for complex cases
• Decreased patient wait times and travel costs
• Improved patient-centered care

Impact Data:

• Up to 70% of eConsults prevent the need for an in-person specialist visit
• Average RubiconMD eConsult response time: 3.5 hours, compared to a traditional referral wait time of 25 days

2. eConsults Improve Quality in Primary Care

PCPs serve as the frontline of healthcare delivery, and their ability to provide patient-centered care is enhanced by eConsults. Virtual specialist support ensures that care plans align with best practices while considering individual patient needs, including medication regimens, comorbidities, and social determinants of health. 

Integrating eConsults into quality initiatives, such as chronic disease management programs and patient safety programs, enhances adherence to evidence-based guidelines and improves patient outcomes. By proactively submitting eConsults for at-risk patients, primary care practices can streamline care delivery and ensure timely interventions. Here are some key areas where eConsults improve quality:

Chronic Disease Management

Building eConsult workflows that support the management of high-prevalence diseases helps to promote population health, lower risks, and costs.  Some examples of eConsult programs we’ve built with primary care clients are:

Diabetes Management: Primary care providers use standardized eConsult workflows when patients meet specific criteria, for example, an A1C over 9 with one or more comorbidities. This proactive approach to using virtual endocrinologists allows for timely adjustments to treatment plans, improvements in glycemic control, and prevention of complications for Diabetic patients. 

Heart Failure Management: Utilizing eConsults, primary care practices can coordinate care with specialists to determine a monitoring and treatment program for patients in various stages of Congestive Heart Failure (CHF). By submitting eConsults for treatment guidance, medication management, and lifestyle recommendations, providers can enhance adherence and reduce hospital readmissions.

Chronic Obstructive Pulmonary Disease (COPD) Management: eConsults can help providers treating patients in the earlier stages of COPD by facilitating collaboration with pulmonologists to optimize medication regimens and implement pulmonary rehabilitation programs. This proactive engagement helps improve respiratory function and enhances the quality of life for patients with COPD.

Preventive Care

Dementia Screening Programs: Primary care providers can share cognitive screening results, comorbidities, meds and behavioral observations with a virtual neurologist or psychiatrist for guidance on screening result interpretation and accurate diagnosis. This proactive approach aids in early disease detection and improves overall patient outcomes.

Substance Use Disorder Prevention: eConsults can be utilized to connect primary care providers with addiction specialists, enabling the development of tailored prevention programs. By proactively addressing SUDs through education and counseling, practices can support patients in making healthier choices.

Care Coordination

Care Transitions: eConsults can facilitate smooth transitions between different healthcare settings, such as from hospital to home or rehabilitation. By submitting eConsults during these transitions, primary care providers can ensure that patients receive the necessary follow-up care and support.

Specialist Coordination: Establishing clear communication through eConsults enhances collaboration between primary care physicians and specialists. This coordinated approach happens much more rapidly with an eConsult workflow versus a traditional referral.  It also ensures that all members of the healthcare team are aligned on patient care plans, leading to improved health outcomes.

Value Based Care Benefits:

• PCPs receive real-time clinical guidance from specialists
• Improved adherence to evidence-based care guidelines
• Enhanced patient safety through multidisciplinary collaboration

Impact Data:

• 90% of eConsults improve patient care plans, leading to better health outcomes
• 70% avoided referrals and services

3. eConsults Optimize Healthcare Resource Utilization

Efficient resource allocation is critical to VBC success. eConsults enable PCPs to manage a greater proportion of patient cases independently, reserving specialist visits for complex conditions that require in-person evaluation. By integrating eConsults into resource management initiatives, such as utilization review and cost-containment programs, healthcare organizations can ensure that specialist referrals are used judiciously, diagnostic testing is streamlined, and unnecessary procedures are minimized.

Value Based Care Benefits:

• Reduced demand for unnecessary specialist appointments
• Streamlined use of diagnostic testing and imaging
• Enhanced efficiency in specialist time allocation
• Lower healthcare costs for patients and providers

Impact Data:

• Total cost of care reduction: up to 20% through decreased medical and transportation expenses

4. eConsults Improve Continuous Care Coordination

Seamless care coordination is a cornerstone of VBC, ensuring that patients receive holistic, uninterrupted care. eConsults establish a structured communication framework between PCPs and specialists, fostering continuity and reducing medical errors. Aligning eConsults with care coordination programs, such as patient-centered medical homes and accountable care organizations, can enhance documentation, promote multidisciplinary collaboration, and improve transitions of care.

Value Based Care Benefits:

• Creation of a documented trail of specialist recommendations
• Strengthened communication between primary and specialty care providers
• Support for comprehensive, longitudinal patient management
• Reduction in medical errors due to clear, documented recommendations

Conclusion

eConsults are a strategic clinical tool for ensuring an effective VBC strategy. By enhancing accessibility, improving care quality, optimizing resource utilization, and strengthening care coordination, eConsults help healthcare organizations achieve patient-centered care, improved population health, and reduced costs. Aligning eConsults with existing clinical programs and quality initiatives ensures that primary care practices can maximize their impact on VBC delivery.