Reducing Healthcare Costs Through eConsults and Assessing Your ROI

Over the past decade, eConsults between primary care providers and specialists have proven to enhance care quality and access. Equally important, eConsults reduce medical costs for both patients and providers when compared with traditional referrals.  A 2019 study in the American Journal of Managed Care showed that eConsults can deliver a 20% reduction in costs related to specialty care.¹

Both incomplete referrals and unnecessary face-to-face referrals contribute to high costs

Patients who face access challenges, such as difficulty navigating the healthcare system, financial constraints, and lack of transportation, may be unable to complete a specialist referral. The short-term and long-term costs of incomplete referrals can only be estimated. Still, worsening patient conditions, medication safety issues, and ER visits result in higher healthcare costs. Simultaneously, unnecessary face-to-face referrals burden the healthcare system with longer wait times, drive higher costs for all, and further contribute to incomplete referrals.

By empowering primary care teams to treat patients with specialty needs within the primary care setting, eConsults ensure that patients receive the care they need while avoiding unnecessary referrals. Let’s dive into five key ways eConsults reduce costs and make healthcare more affordable:

1. Improve Access to Specialist Advice

Many patients face limited access to specialty care, particularly in underserved or rural areas. In fact, with 35-60% of traditional face-to-face referrals, the patient doesn’t complete the visit.^2-5 eConsults bridge this gap, enabling PCPs who serve populations with insufficient specialty care resources to obtain specialist input without the logistical and financial burdens of patient travel and long wait times.

For many specialties, wait times spanning anywhere from weeks to months are a major barrier to access. Several studies have shown that eConsults improve communication between PCPs and specialists,⁶ and reduce unnecessary face-to-face referrals⁴, thereby improving both average wait times and referral completeness rates.

2. Reduce Unnecessary Specialist Visits

Many face-to-face referrals result in unnecessary visits and escalated costs for patients. eConsults allow PCPs to seek specialists’ input electronically, managing many conditions effectively, and efficiently, at the primary care level. When unneeded referrals are eliminated, overall healthcare costs decline and in-person visits are accessible to the patients who need them most.

Several studies have demonstrated that eConsults dramatically reduce the number of in-person specialist visits needed by up to 70%.^7-8 This data is consistent with what we’ve seen in client data at RubiconMD. Primary care clinics treating Medicare/Medicaid populations save hundreds of dollars per eConsult on average, before factoring in any cost savings outside of avoided referral cost, which can double or triple that amount.

3. Optimize Resource Allocation

By shifting appropriate cases to primary care management, eConsults optimize specialists’ time and resource utilization. eConsults lower the cost of care for patients and also reduces the burden on the healthcare system as a whole by enabling specialists to focus on more complex cases in person.⁸

Years of research have confirmed that eConsults facilitate more efficient operations and better patient outcomes. Specialist availability for critical cases improves, enhancing overall care quality while also reducing costs.^9-10

4. Prevent Expensive Complications

Timely access to specialist advice allows PCPs to adopt a proactive approach to patient care, preventing minor issues from escalating into severe, costly complications that may require intensive treatment or hospitalization. Medication management and “watch and wait” plans are examples of the ways eConsults can prevent costly patient complications. Many studies have shown that eConsults result in PCPs adopting a new course of treatment, highlighting the efficacy of early specialist consultation.¹¹

According to research by Liddy et al. in Annals of Family Medicine, eConsults contribute to early interventions that curb the progression of disease, subsequently reducing hospital admissions and emergency department visits. This preventative measure is crucial in managing healthcare costs effectively.¹²

5. Enhance Care Coordination

eConsults foster collaboration and communication between healthcare providers. This integrated approach ensures that patients receive cohesive and coordinated care, reducing the likelihood of redundant tests and procedures.  Within the primary care team, delegation of eConsult submission to a medical assistant, scribe, nurse or referral coordinator empowers those team members to specialist insights, while preserving PCP time for patient care.

A review in the Journal of Medical Internet Research indicated that eConsults enhance care coordination and reduce duplication of services, which translates to significant cost savings. Patients who have complex cases or multiple conditions are more likely to experience communication challenges and confusion when navigating multiple specialties across the health system. Streamlined communication via eConsult also leads to better-informed decisions and more focused patient care.¹³

Determining your eConsult ROI

It is indisputable that eConsults improve quality and lower the cost of care. But what is the actual ROI of implementing an eConsult service and encouraging an eConsult-first approach? It is important to remember that an ROI calculation includes more than avoided referrals alone. A 3:1 ROI or greater can be achieved when factoring in patient population variations, soft ROI, eConsult policy, and programmatic uses of eConsults. 

To determine true ROI, you’ll need to assess the following costs:

• Cost of the eConsult service
• Implementation fees
• Training time and cost
• Cost of managing the eConsult vendor relationship 
• Time spent on policy, review, and reporting

Then calculate the following areas of savings:

• Avoided referrals (reduction in referrals per visit) by specialty
• Avoided diagnostics, tests, etc
• Avoided hospitalizations
• Reduction in patient wait times for specialty care
• Avoided complications from worsening conditions
• Effective interim care plans to keep patients stable
• Lower-cost treatment options based on specialist suggestions
• Ongoing provider education
• Improved provider satisfaction 
• Reduced provider churn
• Improved patient satisfaction

Savings further down the list may be more difficult to quantify and capture. If you are interested in working with RubiconMD to estimate your ROI, contact us.

Summary

In a world where healthcare costs are soaring, eConsults present a timely solution that leverages technology to foster efficiency, improve access, and ensure higher-quality care. As healthcare systems worldwide grapple with financial constraints, the adoption of eConsults will pave the way for a more sustainable and patient-centric future.

By embracing eConsults, we aren’t just cutting costs; we’re also bringing specialist expertise closer to home, enhancing patient experiences, and ultimately building a more efficient and equitable healthcare system.

References:

1. Newman, Eric D. MD, Simonelli, Paul F., MD, PhD, et al (2019). Impact of Primary and Specialty Care Integration via Asynchronous Communication. Am J Manag Care. 25(1):26-31.
2. RubiconMD client data (internal) prior to implementation of eConsults
3. Patel, M.P., Schettini, P., O’Leary, C.P. et al. Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System. J GEN INTERN MED 33, 715–721 (2018). https://doi.org/10.1007/s11606-018-4392-z
4. Mehrotra, A., Forrest, C. B., & Lin, C. Y. (2008). Dropping the baton: Specialty referrals in the United States.
5. Bodenheimer, T., & Fernandez, A. (2005). High and rising health care costs. Part 4: Can costs be controlled while preserving quality? Annals of Internal Medicine, 142(10), 842-846.
6. Russell, Anthony W., Adkins, Peter, et al. Electronic consultations (eConsults): a proof of concept trial in Australia. Intern Med J. 2022 Dec; 52(12):2150-2156. https://pubmed.ncbi.nlm.nih.gov/34432347/
7. Helmer-Smith, M., Fung, C., Afkham, A., Crowe, L., Gazarin, M., Keely, E., Moroz, I., & Liddy, C. (2020). The Feasibility of Using Electronic Consultation in Long-Term Care Homes. Journal of the American Medical Directors Association, 21(8), 1166–1170.e2. 
8. Caffrey, M. (2019). The Impact of Specialist Consults. *Journal of General Internal Medicine
9. Newman, Eric D. MD, Simonelli, Paul F., MD, PhD, et al (2019). Impact of Primary and Specialty Care Integration via Asynchronous Communication. Am J Manag Care. 25(1):26-31. https://www.ajmc.com/view/impact-of-primary-and-specialty-care-integration-via-asynchronous-communication
10. Anderson, D., Villagra, V., Coman, E. N., Zlateva, I., Hutchinson, A., Villagra, J., & Olayiwola, J. N. (2018). A cost-effectiveness analysis of cardiology eConsults for Medicaid patients. The American journal of managed care, 24(1), e9–e16.
11. Pun, Nicole, et al (2021). Comparing the content of traditional faxed consultations to eConsults within an academic endocrinology clinic. Journal of Clinical & Translational Endocrinology, Vol 24, 100260. https://doi.org/10.1016/j.jcte.2021.100260, https://www.sciencedirect.com/science/article/pii/S2214623721000120
12. Liddy, C., et al. (2016). The Role of eConsults in Healthcare. Annals of Family Medicine.
13. Vimalananda, V. G., et al. (2019). Care Coordination and Its Impact. Journal of Medical Internet Research.