Addressing Policy Barriers to E-Consult Adoption and Reimbursement in California

E-consult is a care delivery mode that significantly improves specialty care access for the safety net by enabling primary care providers to communicate directly with specialists about patient needs using telehealth technology. Studies, such as one recently publishing in Health Affairs about LA Country, show significant success in decreasing patient wait time to see specialists, such as cardiologists, neurologists and gynecologists. However, as with many new telehealth-based care delivery modes, despite the successes of e-consult barriers impeded its adoption.

To overcome these barriers and expand adoption of e-consult, the Center for Connected Health Policy partnered with the California Healthcare Foundation and the Blue Shield of California Foundation to form the Electronic Consult Workgroup. In March of 2016, CCHP partnered with BluePath Health to establish the Workgroup’s membership of providers, payers, policy makers and patient advocates, facilitate monthly meetings and support the implementation of e-consult by provider grantees. The Workgroup’s goal is to outline and address regulatory and policy barriers, as well as to provide recommendations for accelerating e-consult’s expansion throughout the state.

This ongoing work includes:

  • Setting agendas, facilitating and summarizing monthly webinar meetings of the Electronic Consult Workgroup.
  • Creating and leading Workgroup subcommittees on reimbursement policy, fiscal analysis of e-consult implementations and payers.

Results

E-consult is a store-and-forward, or asynchronous, telehealth mode that supports communication on patient care between primary care providers and specialists.

E-Consult Definition

In the early portion of this engagement, BluePath Health helped to create a clear and consistent definition for e-consult as a store-and-forward telehealth modality. The definition is as follows:

An electronic consultation is an asynchronous dialogue initiated by a physician or other qualified health care professional seeking a specialist consultant’s expert opinion without a face-to-face patient encounter with the consultant.

To capture the service rendered, the specialist will report a code for interprofessional consultation (e.g. 99446). Electronic consults provided by consultative physicians include written report to the patient’s treating/requesting physician/qualified health care professional.

Expansion of Medi-Cal Telehealth Policy 

BluePath Health has held meetings with officials in California Department of Health Care Services to discuss e-consult results with the goal of expanding Medi-Cal telehealth policy to include reimbursement for e-consult.