To improve access to specialty care for uninsured and underinsured individuals, Anthem Blue Cross recently granted $50,000 to California E-Consult Coalitions, marking the second grant Anthem has released for this initiative since 2021.
The California E-Consult Coalitions are composed of Community Health Centers in the Central Valley, North rural, and Sacramento regions. The coalitions are distributing funds to Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Indian Health Centers (IHCs) in these regions.
Anthem released the latest funding of $50,000 for the uninsured portion of the coverage, and has spent significant amounts of grant dollars over the past few years to provide this time/distance saving, quality improving, patient satisfaction increasing service. This support helped over 40 clinics and several individual provider organizations across the program’s three regions to provide free e-consults to underserved individuals.
The coalitions engage stakeholders, including primary care provider organizations, Native health centers, managed care plans, and county agencies. The stakeholders come together on a monthly basis to conduct roundtable sessions for best practices on increasing e-consult access.
Kerina Mendoza, program manager at Anthem, explained how provider shortages continue across the state, and sometimes there aren’t as wide of a variety of specialists in rural areas when compared to more urban areas. When patients travel to a primary care provider, a health-related issue outside of the provider’s specialty may arise. Primary care providers frequently have to refer patients to specialists who are sometimes located far away from the patient, forcing them to wait for scheduling and availability.
To receive specialty care, patients in the Central Valley, North rural, and Sacramento regions have to travel over 25 miles on average, according to Mendoza, with travel sometimes being upwards of 50 miles. To tackle this issue, e-consults allow primary care physicians to consult asynchronously with specialists, at their convenience, with specialists who provide expert guidance on how to treat the patient’s needs. Issues are addressed timely, within several days, and without requiring patients to travel or schedule appointments with other providers.
“What we have seen through this program is that when an e-consult is submitted, 80% of the time, the primary care doctor is able to manage the patient’s care within the primary care setting,” Mendoza said.
The e-consult initiative provides timely access to care for routine referrals that are not urgent or do not involve surgery. While insurers, such as Anthem Blue Cross of California, cover these e-consult services for their members, many patients going into FQHCs, RHCs and IHCs are uninsured or underinsured.
When health centers use e-consults to treat their patients, they first see if their patient has insurance that can cover costs billed by specialists who are e-consulted. When patients do not have insurance to cover the specialty e-consult, the participating health centers draw funds disbursed by California E-Consult Coalitions. Anthem has also set up participating health centers with technology to perform e-consults, networks of specialists, and training.
“Since the start of this effort, we have seen more than 7,000 e-consults completed,” said Mendoza, who added that the most common specialty care needs for adults are gastroenterology, neurology, and cardiology.
Anthem plans to continue communicating the importance and success of e-consults to expand participation across additional organizations. “This effort is making tremendous strides in ensuring health equity across communities, so we would like to see it grow,” Mendoza said.
California E-Consult Coalitions and Anthem Blue Cross also continue to promote innovative change and address hurdles related to e-consults. Mendoza noted that while specialists are reimbursed for their services when participating in e-consults, the primary care providers are not, so more needs to be done to incentivize them to participate in the e-consult process.
“Our efforts have demonstrated that e-consults result in timely resolution to healthcare issues in 80% of cases, and for the other 20%, they help to better prepare clinicians and patients ahead of specialist visits, which can influence improved outcomes,” Mendoza said. “For these reasons, we really hope that California state agencies continue to work with us to reform payment mechanisms for primary care physicians to incentivize them to use e-consults, especially in FQHC, RHC and IHC settings.
Despite the need for payment reforms, we are most excited to see the positive overall use of e-consults, and the extension of these services to uninsured populations. In just two years, the $100,000 in grant funds that Anthem Blue Cross provided for uninsured coverage is almost gone. We expected it to last longer, but it serves as a demonstration of how great the need is, and we hope it draws additional advocacy for this health equity initiative to continue and expand.”