iHT² CMIO Symposium Beverly Hills – eConsult: A Model for Integrated Care – Rob Bart, CMIO, Los Angeles County Department of Health Services

588 views

Published on

iHT² CMIO Symposium Beverly Hills – eConsult: A Model for Integrated Care – Rob Bart, CMIO, Los Angeles County Department of Health Services

Closing Presentation "eConsult: A Model for Integrated Care"

The rate of outpatient specialist referrals has nearly doubled over the past decade. Increased utilization, along with documented variation in referral rates, has raised concerns about worsening fragmentation of care and the appropriateness of referrals. Access to specialists by primary care providers representing their patients has always been a challenge within safety-net healthcare delivery; fulfilling the dual imperatives of timely access and rational triage drove the implementation of eConsult. eConsult links primary care providers and specialists, with the goals of increasing access to care, improving dialogue, optimizing the efficient use of specialty resources, and enhancing primary care capacity.

Learning Objectives:

∙ A new paradigm for primary care-specialty interface
∙ A technology tool supporting a move away from visit-based care

Rob Bart, MD
Chief Medical Information Officer
Los Angeles County Department of Health Services

Published in: Education, Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
588
On SlideShare
0
From Embeds
0
Number of Embeds
8
Actions
Shares
0
Downloads
5
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

iHT² CMIO Symposium Beverly Hills – eConsult: A Model for Integrated Care – Rob Bart, CMIO, Los Angeles County Department of Health Services

  1. 1. eConsult – a Model for Integrated Care - making it easier to behave like a system Rob Bart, MD Chief Medical Information Officer Los Angeles County Department of Health Services with contributions from Paul Giboney, MD & Hal Yee, MD
  2. 2. Background
  3. 3. Background – ACA & Work force  32 million Americans newly insured  10,000 Americans turn 65 daily through 2033  MD shortage of 91,500 by 2020  Underserved populations will bear the greatest burden of workforce shortage
  4. 4. Background – ACA & Work force  Projected physician shortages
  5. 5. Background – ACA & Work force  Projected first-year enrollment growth
  6. 6. Los Angeles County  Population >10 million  Largest homeless population in US @ > 48,000 (2010)  10% undocumented immigrants
  7. 7. Los Angeles County
  8. 8. Los Angeles County
  9. 9. Los Angeles County Department of Health Services  2nd largest municipal health system US after NYHHC  US$3.5 billion budget (17% county funded)  800,000 unique patients served 2012  Volume of Services  Ambulatory - >2.6 million  Emergency - >300,000  Inpatient - ~75,000  Healthy Way LA (LIHP) – 252,379 enrolled
  10. 10. Los Angeles County Department of Health Services
  11. 11. Goals for Today  3 Responses to Specialty Care Need  The use of Workgroups to bring together a fragmented specialty care delivery system.  The use of technology (eConsult) to transform the way we understand specialty care services.  The implementation of a centralized specialty appointment scheduling system to improve customer satisfaction and reduce no shows.
  12. 12. The Challenge  Mario receives primary care at CP or DHS 42 year old with Ulcerative Colitis  He has a flare in his condition  His PCP would like GI specialist input for the flare   The Problem Long wait time for GI clinic appointment  No good way for PCPs to communicate with specialists about possible consults or patients needing expedited attention 
  13. 13. The challenge • How does a large, historically fragmented health care system address the issues of: • Long wait times for specialty services – Lack of coordinated care between County and Community Providers – – High no-show rates to specialty clinics Large variation in care delivery processes
  14. 14. The “Black Hole”  350,000+ referrals to specialty care annually  Long Wait times for specialty clinic visits(2011) Gastroenterology – 162 days  Nephrology – 86 days  Podiatry – 222 days  Urology – 208 days  Cardiology – 140 days  Dermatology – 208 days  Gynecology – 109 days  Neurology – 225 days   Access to specialty care is consistently recognized as one of the top problems in the safety net.
  15. 15. Fragmented Care Hal Yee, 2013
  16. 16. Fragmented Care Hal Yee, 2013
  17. 17. Patient Centered Medical Neighborhood Hal Yee, 2013
  18. 18. Principles Effective Practice Practical “real world” improvement
  19. 19. Disruptive Innovation  Investment in Patient Centered Medical Neighborhood (PCPs and Specialists).   Specialty Primary Care Workgroups eConsult – in partnership with local Medicaid plan and FQHCs  Investment in Patient Centered Specialty Scheduling    Reduction in process variation Reduction in no-show rates Improved patient experience
  20. 20. Specialty Primary Care Workgroups  Effective Practices  Collaboration across facilities and disciplines  Triple Aim  Equity/Reduced variability
  21. 21. eConsult • HIPAA secure, web-based “clinical conversation” portal. • Advantages – PCP and Specialist collaboration • • • – – – Improved PCP clinical capability Relationship building Troubleshooting of system issues Improved responsiveness to requests for specialty assistance Reduction in avoidable specialty visits Improves effectiveness of specialty clinic visits (when they are indicated)
  22. 22. eConsult – Primary Care
  23. 23. eConsult – Primary Care
  24. 24. eConsult – Primary Care
  25. 25. eConsult – Primary Care
  26. 26. eConsult – Primary Care
  27. 27. eConsult – Primary Care
  28. 28. eConsult – Primary Care
  29. 29. eConsult – Specialty Care
  30. 30. eConsult – Specialty Care
  31. 31. eConsult – Specialty Care
  32. 32. Impact - eConsult  eConsult  14 Specialty Services    Cardiology, Dermatology, Diabetes, Endocrinology, Gastroenterology, Gynecology, Hematology, Hepatology, Nephrology, Neurology, Obstetrics, Ophthalmology, Podiatry, Urology 1,300+ PCPs using system 130 PCP Sites (40 DHS, 90 Community Partner)  110+ Specialty Reviewers  Average Time to Respond to Initial Request = 2.5 days  A primary measure of impact is that 100% of specialty requests are answered promptly by an expert who is able to provide assistance.
  33. 33. Impact - eConsult
  34. 34. DHS Appointment Service Center (ASC)  The old way – “Mail and Pray”  The new way - Patient Centered Specialty Scheduling  For patients identified through eConsult  ASC has the ability to schedule anywhere in the system  Appointments are scheduled only after personal patient contact  GOALS –  Improved patient experience  Quick scheduling turn around times  Less variation in process  Lower „no show‟ rate  More effective work, not just more efficient work
  35. 35. Impact - ASC  Patients Scheduled – 16,000+  Successfully Scheduled Rate – 84%  For unreached patients - phone message left, letter sent and PCP notified via eConsult  No show rate – 13.5% (historically 35 - 40%)
  36. 36. Overall Impact  Community Partner Medical Director –  “eConsult has been a blessing and the providers are thoroughly enjoying the opportunity to learn new patient management strategies from the specialty providers. The best part is our patients aren‟t waiting over 6 months for consultations!”
  37. 37. Summary  The power of collaboration to overcome the challenges of a large and fragmented system.  The power of conversation (via eConsult) to bring specialty services into the medical home.  The power of a scheduling process that focuses on effectiveness and patient engagement.
  38. 38. Future – DIRECT Project
  39. 39. Future – DIRECT Project
  40. 40. Thank you! rbart@dhs.lacounty.gov

×