Nonprofit pioneers telemedicine
MIDDLETOWN — From a conference room in the just-opened research and technology building where Community eConsult Network is located, the firm looks like any other medical startup. Dr. Daren Anderson, acting as CEO at the fledgling company, convenes a daily video conference call with the firm’s dozen or so employees in four states across the country.
“Yesterday was really exciting,” chimes Maryann McGuire, hired three months ago to head new products, as she reports on a “specialty review committee.”
Routine, except Community eConsult Network is a spinoff of Connecticut’s largest network of nonprofit health centers for low-income patients.
The startup is radically changing the way specialists see patients — by creating a platform and a network for primary-care docs to send patient cases, complete with records, histories and photos, to cardiologists, dermatologists, orthopedists and other specialists electronically.
The firm, itself a nonprofit, is among the pioneers in electronic consultations — a form of telemedicine, which, according to research published in major medical journals, saves vast sums of money without compromising safety or quality.
That research? It was led by Anderson and others at the Weitzman Institute, which recently spun off Community eConsult and is housed in the same new, ultramodern building just off Main Street.
Weitzman is the research arm of Community Health Center Inc., based in a larger building a few feet away. CHC, far and away the state’s largest health center serving low-income people, was founded in the ’70s as a free clinic. It now has 15 hub clinics in Connecticut, 210 treatment locations and more than 140,000 patients with nearly 600,000 visits per year.
At first blush, a business like Community eConsult Network, backed by scientific studies, is not what you’d expect to find at a health center aimed at serving
people in poverty, with no university affiliation. But as Anderson explains it, the e-consult model arose naturally from a nagging problem: It’s not easy, to say the least, for people on Medicaid or without insurance at all, to get appointments with specialists.
And it’s not easy for working poor patients, perhaps without a car, to take a day off and somehow navigate their way to a medical specialty office far from home.
So, why not create a platform to make it happen?
If it saves money, and it does, that comes as the national health care bill is well past the crisis point. Connecticut’s Medicaid system, run by the state Department of Social Services, is among the leaders in cost containment and e-consuls are part of that — although the reimbursement rates are not sustainable.
Back in 2011, the Connecticut Health Foundation funded $150,000 toward the first study, then two years later, a follow-up grant of $25,000 helped implement the platform. CHC has also funded much of the work.
It all came together. In 2015, after a study showed success, “Connecticut became the first state in the nation to authorize e-consult reimbursement” for Medicaid, Anderson said.
Now it’s taking off across the nation, where Weitzman, and Community eConsult, have people in Denver and Los Angeles. The latest study, published in December in Health Affairs, showed that Medicaid patients who had e-consults in four specialties — dermatology, endocrinology, gastroenterology and orthopedics — saved Medicaid an average of $82 per patient, per month, compared with those went directly to specialists for face-to-face visits.
“Connecticut has become kind of a leading site for this sort of thing because of our work,” said Anderson, the lead author of the recent study. “We’re Connecticut based and we’re recruiting in Connecticut and so there’s a lot of e-consult work that’s being done in Connecticut.”
The consults on one level are a tech play, with lots of data and perhaps video moving from doc to doc, allowing specialists to ply their trades on laptops anywhere. But it’s really just an extension of the old, so-called curbside consult, Anderson explains — in which one physician asks another about a case.
As it turns out, that eliminates the need for a lot of in-person specialist visits. But, said Mark Masselli, CEO and co-founder of CHC, “It’s not trying to prevent the visit.”
Rather, the people involved say, it enables a specialist to see far more people.
Dr. Chris Norwood, a dermatologist at Starling Physicians in New Britain and Rocky Hill, recently handled 20 e-consults on a Thursday this month — all through Community eConsult, with patients from Washington state to Maine, many from Connecticut.
He could have seen maybe five patients in person in that same time, he said. Appointments can normally take weeks or months to set up, but if he sees a patient electronically who’s got a grave issue,” they can get in to see me sooner.”
Specialists send back a response within two days, usually faster, and they can go back and forth with requests. Norwood sometimes asks for clearer pictures, or pictures of a patient’s fingernails.
For this, he collects a modest, some would say meager, $35 per electronic consult. Payment systems across the country, for Community eConsult and competitors, are still evolving and the best tend to be the systems that pay flat rates for overall patient care, rather than fee-for-service.
“I wouldn’t call it profitable but it’s not an enormous money sink and I think it does help the community greatly,” Norwood said. “No one is buying a Ferrari with this.”
Electronic consults started with the Veterans Administration, which has been doing them for decades, Anderson said. Then it spread to San Francisco — no surprise there. Anderson, who has a Harvard undergrad degree in chemistry, his medical degree from Columbia University and his residency at Yale — where he later taught on the faculty — rejoined CHC in 2010 after an earlier stint as a doctor for the center.
He’s vice president and chief quality officer at CHC, and director of the Weitzman Institute, which was named in memory of the owner of Pelton’s Pharmacy, an early supporter of CHC.
“My goal had always been to work with the underserved,” Anderson said.
And he was the first to launch wide studies of the e-consult practice, soon after he rejoined CHC.
Patricia Baker, CEO of the Connecticut Health Foundation, said community health centers have long had trouble getting their patients in to see specialists, which is why electronic consultations advance the foundation’s goals.
“It is a powerful program for providing care and making that care cost effective, and improving access,” Baker said, but she added, rates need to be set to make that happen.
In a written statement, the state Department of Social Services said it’s committed to the technology and will soon issue new rates — after an increase on Jan. 1 that replaced a comically low rate.
It’s all part of lurching toward a future that uses technology for visits, not just treatment.
In 10 years, Anderson said, “Some of our consult needs will be met through artificial intelligence, some will get an e-consult, some will get telehealth visit where you talk directly by video-conference . ... What we say is, move knowledge, not people.”