We have turned a page to the next chapter in healthcare for the US. At its core is a new delivery system in which we leverage all available tools to allocate our precious resources, and the patient is at the center of it all.
We have a severe shortage of providers in the U.S. and must utilize the right tools at the right time to match patients to the right resources in the right place. In addition, healthcare needs to be more consumer-centric, as we are witnessing a rising demand of patients seeking options like telehealth that deliver high quality care faster, more conveniently, and affordably.
Lastly, as we adapt our care deliver models in the future, we need to keep an eye on reducing the stark inequities that have become glaringly apparent during this pandemic. Modalities like telehealth hold the promise to provide culturally and linguistically appropriate access to care through expanded networks and to help close gaps in care and address social determinants of health.
Telehealth solutions can be used to optimize the efficiency of healthcare delivery and ultimately improve patient experience. One mode of telehealth, eConsults, ensure that patients are treated by the right provider in the right setting, by facilitating effective peer collaboration that can support all providers to operate at the top of their license. What that means in practice is that primary care providers can get guidance from specialists to help design care plans, and that in-person visits to specialists can be reserved for those patients with more complex issues who cannot be treated virtually.
AristaMD, connecting primary care providers (PCPs) with timely, documented specialist insights, announced investments from Ascension Ventures, a strategic healthcare venture firm representing 13 of the nation’s leading non-for-profit health systems, and .406 Ventures, a venture capital firm investing in early-stage disruptive enterprise technology and digital health companies.
These investments top off the company’s Series B funding round, which was co-led by Cigna Ventures and MemorialCare Innovation Fund, at $24 million. The new capital will be used to accelerate commercial growth as well as continue the expansion of its proprietary eConsult platform supporting payors and health systems across the country.
“Delivering more timely care to patients has become even more crucial during the COVID-19 pandemic and will remain important in the future, as we must reserve precious in-person specialty appointments for those who critically need them,” said Brooke LeVasseur, CEO of AristaMD. “This additional funding will help us accelerate our vision and contribute to shaping a world where all patients have timely, cost-effective access to health care.”
Designed by practicing physicians, AristaMD’s eConsult solution empowers PCPs to expand their scope and collaborate on patient care with a world-class panel of on-demand specialists. AristaMD significantly increases access to appropriate and timely care to improve outcomes and reduce costs.
“With its innovative solution and industry-leading team, AristaMD is positioned to make a considerable improvement in the way health care is delivered,” said John Kuelper, managing director of Ascension Ventures. “AristaMD has built a highly scalable solution that continues to deliver tangible ROI for health systems and payors, and improves the level of care for all patients.”
The need for eConsults has never been more critical. According to recently published data, since the COVID-19 pandemic started, outpatient hospital visits declined by 31%. Additionally, preventative screenings for cervix, colon and breast cancer have dropped between 86% and 94%, compared to the last three years. With non-emergency, proactive care and elective procedures being canceled throughout the pandemic, there is a backlog of appointments. eConsults will be an effective triage tool now and moving forward to improve access and reduce healthcare strain.
“AristaMD enables patients to efficiently obtain the appropriate level of care when they need it most,” said Payal Divakaran, partner at .406 Ventures. “We’re excited to partner with Brooke, her team and a great group of co-investors to expand the reach of AristaMD’s enterprise-grade platform.”
The shortage of specialist physicians in the United States continues to receive a great deal of attention as an area of concern. However, a lesser-known compounding factor is the increase in referral rates. In a 2012 study, the National Ambulatory Medical Care Surveys found that between 1999 and 2009, the probability of receiving a specialist referral during an ambulatory patient visit increased from 4.8% to 9.3%, a 92% increase, nearly double. While this study is now several years old, we can surmise that this trend has continued due to the persistence of several factors contributing to the overall disparity between specialist referrals and the number of available specialist physicians.
The clear impact of these compounded problems is substantially increased wait times among patients with a physician referral for specialist appointment. In 15 major metro areas, a recent Merritt Hawkins study covering the medical specialties of cardiology, dermatology, orthopedic surgery, and obstetrics and gynecology, found appointment wait times increased 25% from 2014 to 2017. Wait times averaged 24.1 days across the study, with some extreme cases waiting 165 days for an appointment.
Long wait times impact patient outcomes and healthcare operations
On top of the anguish and emotional impact of waiting for care, diseases and illnesses can progress as patients sit in appointment queues for weeks or even months on end. As NEJM describes, “long waits before appointments, particularly specialist appointments, often contribute to the development of avoidable complications,” which cause more difficult health cases both for the patient and for the physicians caring for them.
There are notable effects on healthcare operations that add to the case for reducing patient wait times as a crucial avenue for improving healthcare overall. For example, long wait times for appointments increase the prevalence of no-shows, indicating that patients are either frustrated enough to not follow through on scheduled appointments or forget appointments altogether because of the long interim period. Sometimes appointments can even be moved around by specialist physicians at the last minute, leaving patients in limbo for even longer.
Additionally, long wait times frequently lead to patients receiving inefficient care. Firstly, extended waits often deter patients from seeking initial care. This shifts the healthcare industry away from proactive to reactive care, which is less effective and more costly for all parties involved. Secondly, the inability to access the care they need and when they need it, leads to patients seeking care within inappropriate settings. These patients are more likely to be admitted to EDs, as the 30-day rate of ED and inpatient usage was 8.7 times higher for patients awaiting a specialist appointment. A study by Truven Health Analytics noted that 71% emergency room visits are unnecessary and avoidable. Each of these issues alone make strong cases for reducing patient wait times; these issues combined suggest reducing patient wait times is a crucial goal that must be prioritized when it comes to streamlining healthcare delivery and improving quality of care.
In light of these concerning figures and effects, healthcare organization operations are turning their focus toward reducing wait times and improving patient outcomes. This fits well as part of an overall strategy to increase quality and efficiency of healthcare delivery. Below, we will focus on how telehealth platforms, specifically eConsults, combat multiple factors driving specialist appointment wait times, streamlining the physician referral process and thereby reducing patient wait times for happier and healthier patients.
Positive impacts of reducing patient wait times by accessing specialty care from within primary care
Increasingly, healthcare providers are entering into value-based payment arrangements. Telehealth solutions, and specifically eConsults, can support the drive toward more efficient care by increasing access to specialists while better optimizing time and place of care.
eConsults are is an electronic form of peer-to-peer collaboration, providing PCPs with a platform to consult with specialists on specific patient cases. eConsult interaction occurs using a secure, HIPAA-compliant messaging platform, where specialist guidance is received within 24 hours, drastically reducing the interim time between referral and treatment. eConsults can replace more than 70% of routine referrals with immediate, specialist-guided treatment from the PCP, without the wait and additional cost. Keeping lower acuity patients out of the specialist referral queue means faster access to face-to-face visits for the higher acuity patients, expediting care and improving outcomes for all.
One provider (and frequent user of AristaMD eConsults) at a Federally Qualified Healthcare Center describes the challenges of securing specialty care for the patients at her clinic: “Especially with MediCal patients, it usually takes at least four or five months for a patient to complete a referral. Very often, patients end up waiting three to five months, then receive notification their appointment has changed, the specialist has moved, or even that the specialist is no longer taking that patient’s insurance. Some of these patients are then in limbo for more than six to nine months. This is where the benefit of AristaMD’s eConsult platform comes in. AristaMD specialists provide guidance on patient care plans, for example diagnostic or medication recommendations, within 24 hours.”
Several studies have already noted demonstrable decreases in wait times once eConsults were introduced in large health systems. The San Francisco Department of Public Health saw dramatic improvements following the introduction of their eConsult program. The median wait time for a non-urgent appointment with a rheumatology specialist was drastically reduced from 126 days to 29 days. Additionally, patients visiting specialists needed fewer follow-up appointments as a result of a more extensive pre-visit workup made possible by this telehealth platform. Other similar successes have been observed in Los Angeles and the NYC Health + Hospitals System, with the latter finding that median wait times for high-urgency specialist visits decreased from 30 days to 16 days as a result of eConsult implementation.
eConsults are ideal for addressing the growing problem of lengthy patient wait times. They empower PCPs to deliver specialist-guided care to lower acuity patients in a timely manner while freeing up the capacity for in-person specialist visits for the more complex, higher acuity patients who need them most.
AristaMD is now available in the Epic App Orchard marketplace. AristaMD being accepted into App Orchard marks another cutting-edge innovation built upon AristaMD’s history of proven integration scalability.
Enabling PCP to specialist collaboration on care plans, AristaMD’s eConsult solution improves access to timely specialty care for patients who would have otherwise had to wait for a separate face-to-face visit. The AristaMD app makes this process even more streamlined for health system specialists using Epic. Providers can now quickly launch the eConsult platform directly through Epic’s electronic health record (EHR), creating a user-friendly experience for answering eConsults with minimal provider burden and workflow changes.
“We know providers are pressed for time and health systems are trying to streamline technology solutions, ideally with a single touchpoint,” said Brooke LeVasseur, CEO of AristaMD. “The AristaMD app in the App Orchard allows organizations to leverage our eConsult platform directly through their EHR with the benefits of baseline data, proven efficacy, full reporting, and platform management. It’s an important step and part of our continued innovation plan focused on helping providers reduce the challenges of change management and ultimately, provide better care for patients.”
LeVasseur continued, “Using the SMART on Fast Healthcare Interoperability Resources framework, AristaMD is able to leverage an integration with any Epic customer. We hope to work with other EHRs in order to help drive the future of interoperability that delivers new important capabilities along with enhanced provider experience.”
According to the Office of Coordination of National Health Information, 50 percent of healthcare dollars are wasted on inefficient processes. Transformative innovation must not only change the current way things are done, it must be disruptive by having a meaningful impact on time, quality, cost and operational effectiveness – it must dramatically simplify and accelerate the process it enables.
There are very exciting ways in which digital technology is creating transformation across the entire healthcare system in areas such as connected health, artificial intelligence (AI), blockchain, mobile data gathering, analytics, digital therapeutics and remote patient monitoring. All of these technological developments will improve healthcare efficiency, but more importantly they will drive the delivery of individualized care and dramatically improve patient outcomes as follows:
Access to Care
Connected health, or telehealth, is enabling the delivery of care to rural areas, where access is often nonexistent or very limited. It is also being used to address growing medical staff and physician shortages by providing access to timely care through collaborative tools such as eConsults. Telehealth delivers faster, less expensive and more convenient healthcare and in doing so significantly improves patient outcomes.
Conventional patient engagement systems display information at the hospital bedside, which is only one of many relevant ways to connect with patients. Companies are now integrating artificial intelligence or ‘virtual’ health coaches into interactive educational platforms, resulting in higher utilization and engagement, and delivering more robust, actionable content.
Remote Patient Monitoring (RPM)
A vast array of innovative wearables and sensors such as the biosensor bra patch, implantable glucose sensor, electronic tattoos and the cardiac mapping vest are revolutionizing remote monitoring capabilities. These remote monitoring systems have the potential to help achieve triple aim goals by leveraging the latest advancements to collect and analyze patient data beyond the bedside. Patients and providers can use smart phones, tablets and apps to remotely assess, diagnose and monitor their patients. Electronic monitoring can be an effective solution to identifying issues as they happen while also enabling more effective tracking of patients post-discharge, improving compliance and adherence, and reducing the number of re-admissions.