A common service in all value-based clinical care organizations is consultation with subspecialists. Let's take a common complaint - chest pain. When a patient tells their primary doctor or healthcare provider that they have chest pains, several things are triggered. The healthcare provider evaluates and asks pertinent questions in an attempt to characterize whether the complaint is cardiac related or not. Once the healthcare provider completes the basic work and determines it’s not an acute problem that might need an ER evaluation, the healthcare provider then makes the determination (based on that individual’s medical history, ECG results, cardiovascular risk assessment etc.) on if to send the patient to be evaluated by a cardiologist. Often the higher the age and risk factors determine if the member/patient will be sent for a subspecialist consultation.
Most of the time this means that the patient will be given a referral to a cardiologist. This costs the patient time and money, and is also contingent on authorization by the Health Insurer for cardiologists based in the United States. Many times, the authorization is not immediate and the patient needs to be re-scheduled. With these obstacles in mind, telehealth or telemedicine is seen as a promising alternative for many subspecialty consults.
A unique opportunity and frequent example of how telehealth can revolutionize care, particularly in Medicare Advantage member clinic systems, is the sub-specialty consultation of their members. Conventionally these Advantage clinic systems provide sub-specialty consultation for their members by one of two care models:
- The first is having the required subspecialty provider, i.e., cardiology, lung specialist, nephrologist, etc. be hired by the clinic owners to provide the service in-house.
- The second is sending their members requiring subspecialty consults outside of the clinic to the subspecialist office locations.
The differences:
Sending the members out of the clinic comes with the inherent costs of transport, time delays on care, transportation risks, and the inconvenience of the patient having to go to a different location. Polling tells us members do not like doing this and is the main reason why many Medicare Advantage members change clinics. The members would rather have all the health requirements delivered at the clinic location only. Having the subspecialist in-house works very well and shows that member satisfaction is higher with this model. However, it saddles the clinic owners with the significant cost of hiring the subspecialists, which is higher than their own primary specialists' salaries. Also, by using the in-house model, the choice of options for subspecialists available to consult in-house is shorter for the members, limited to the total number of cardiologists on payroll. The second option, sending the member out, is what most Advantage clinic systems are doing. Exporting the subspecialty consultation addresses the cost savings for the clinic owner, but saddles the members with something they don’t want or like - threatening retention and affecting customer satisfaction.
Gal3n solves this problem with its telehealth system. Consider the following example: Ms. Rodriguez has an appointment with her cardiologist today at 10:30am. She, as many members do, goes almost daily to the clinic to benefit from their activity center, group exercises, food and games with other members, etc.
But today is different. Ms. Rodriguez is simply placed in an examination room at 10:30am where the Gal3n telehealth system is present, along with an MA. The cardiology consultation happens with the cardiologist remotely and Ms. Rodriguez comfortably in the clinic. No transportation costs or inconvenience to the member. Ms. Rodriguez can be referred to any number of specialists this way. This saves the inconvenience to the member of having to be sent out to a different location. It also saves the clinic the money associated with transport, liability, risk of falls, and most of all the cost of hiring subspecialists. The subspecialist on the other hand sees no significant difference in patient flow since they use their own computer to access the Gal3n system from any location, including their office. The specialist's documentation of the visit is exactly the same as an in-person consultation that is sent to the members EHR (or printed at the POS), and the encounter is saved for future reference. The subspecialist keeps the consultation document and bills for the encounter. The results are increased member satisfaction and retention while addressing the cost of subspecialty services.
