How eConsults Improve Health System Revenue Strategy by Optimizing Referral Management

By Mark Cittadino

For fee-for-service (FFS) health systems, it’s imperative to support network optimization strategies in order to solidify revenue flow and efficiency. eConsults provide a secure and documented messaging platform that directly benefits FFS health systems by supporting their revenue strategy in several ways.  

Improve patient retention

Improving patient retention, or reducing leakage, is a vitally important goal for optimizing revenue. The reason for this is clear: patient leakage is expensive. 

Adopting an eConsult platform can assist with retaining patients for specialty care and related services, both increasing FFS revenue and improving performance under value-based care arrangements. 

1. Patients needing specialty care that may have gone without are still in-network, being treated by their primary care provider. 
2. Patients in need of a face-to-face specialist appointment will funnel into in-network health system specialists, who may have already weighed in on the patient case via eConsult. Improved information regarding in-network specialists can help avoid a third of out-of-network referrals, greatly reducing the chance of patient leakage and thus improving FFS revenue reimbursement.

Maximize specialist visit revenue 

eConsults can increase efficiency within specialist queues by better equipping primary care settings with necessary resources to handle low-acuity cases. Over 70% of eConsults enable PCPs to manage their patients within the primary care setting, expediting care and freeing face-to-face specialist appointments for higher-acuity and higher-billing patients. 

eConsults also allow PCPs to receive complete workup guidance, including diagnostics and testing. Patients properly prepped for specialist visits help optimize FFS specialist revenue and ancillary service revenue.

Reduce readmissions

Hospital readmissions account for another vital metric by which health systems are evaluated. eConsults allow patients to get the care they need, faster. Lower-acuity patients will be less likely to resort to emergency and hospital settings for care that could otherwise be handled within primary care.  

By improving coordination and better equipping primary care to handle post-treatment follow-up visits, eConsults can help health systems reduce hospital readmissions by up to 17.1%. This helps FFS systems curtail readmission penalties and improve quality of care for admitted patients—during and after their hospital stay.

Minimize uncompensated care to increase capacity for compensated care

Many hospitals, particularly those in rural areas, struggle to maintain their operating margin, in large part due to uncompensated care. When primary care lacks adequate resources to treat patients, they often wind up in emergency settings, but lack the financial resources to cover the cost. This creates a profit loss while utilizing health system resources.

FFS systems can leverage eConsults to better provide “right time, right place, right provider” care in a care more affordable setting, both reducing uncompensated visits and freeing up hospital resources for higher-acuity patients. 

Capture additional patients in-network

As a method of increasing health system patient flow, primary care expansion has fallen out of favor in recent years. There are several costly components of acquiring primary care practices, including hiring, onboarding, and overall revenue flow of primary care versus specialty practices. By contrast, creating clinically integrated networks (CINs) of independent providers aligned with an organization’s own network offers an alternative strategy.

In this scenario, eConsults can be leveraged as a means of capturing specialty care referrals from local primary care practices. These visits are reliably higher-acuity, while lower-acuity (and lower-billing) patients not in need of a face-to-face referral are efficiently (and more effectively) managed within primary care.

Conclusion

For FFS health systems aiming to more efficiently manage healthcare resources, eConsults provide a technology-based option that addresses, both directly and indirectly, some of the most pressing concerns when it comes to optimizing health system revenue strategy—and, importantly, bettering patient outcomes. eConsults can help optimize specialist patient queues, granting higher-acuity patients efficient access to the face-to-face care they need, thereby improving quality of care and revenue. eConsults provide a clear method for FFS health systems to improve resource allocation, supporting better delivery of care for health organizations, doctors, and patients alike.

Mark Cittadino is Head of Health Systems Sales at AristaMD.