February 2019

CT Post: Health center for the poor begets a telemedicine pioneer

Originally published by Dan Haar in the Connecticut Post

From a conference room in the just-opened building where Community eConsult Network is located, the business looks like any other medical startup. Dr. Daren Anderson, acting as CEO, convenes a daily video call with the firm’s dozen or so employees in three states across the country.

“Yesterday was really exciting,” chimes Maryann McGuire, hired late last year to head new products, as she reports on a “specialty review committee.”

Routine, except Community eConsult Network is a spinoff of Connecticut’s largest nonprofit health center for low-income patients.

The startup aims to radically change 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 business, itself a nonprofit, is among the pioneers of these electronic consultations — an emerging 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 CeCN, as the business is known, and is housed in the same new, ultramodern building just off Main Street in Middletown’s North End.

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 across 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 an urgent 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.

“That was the impetus for this entire work,” said Anderson, director of the Weitzman Institute and vice president and chief quality officer at CHC.

Years later, the platform is off the ground, not yet producing a surplus, but with paying customers in the ranks of Medicaid payers, private insurers and other institutions pushing for new ways to deliver health care.

“We’re the nationally recognized pioneer in this,” Anderson says matter-of-factly in his small corner office.

Connecticut innovation

If e-consults save money, and they do, they’re part of a disjointed effort in the health sector to cut into the national, $3.5 trillion health care bill. Connecticut’s Medicaid system, run by the state Department of Social Services, is among the leaders in cost containment and e-consults are part of that — although the reimbursement rates are not sustainable without outside subsidies.

Back in 2011, the Connecticut Health Foundation funded $150,000 toward the first study of effectiveness, then two years later, a follow-up grant of $25,000 for economic analysis. CHC has also funded much of the work for its Weitzman unit, which, broadly, aims to advance health delivery for underserved people.

In 2015, as a study showed that e-consults work safely, Connecticut became the first state in the nation to authorize e-consult reimbursement for Medicaid.

Now it’s starting to take off across the nation, though the unwieldy health payment systems, public and private, haven’t figured out the right levels of reimbursement for CeCN and its handful of competitors. The best customers across the country tend to be systems that are self-funded, or have payments based on overall population health management, rather than fee-for-service.

The Weitzman Institute was named in memory of Gerard “Gerry” Weitzman, an early supporter of CHC and innovation for underserved patients, who owned Pelton’s Pharmacy. He died in a car accident in 1999.

The institute and CeCN, along with two other health-related Weitzman businesses, have people in Denver and California in addition to Middletown.

UConn has been a partner in the research. And CHC’s vast base of primary care data on Medicaid patients, along with Connecticut state data, has proven a great trove.

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.

That’s garnering a lot of attention, including a prominently displayed feature story on Thursday in the American Medical Association’s publication.

“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.”

Two-day service, or faster

The consults on one level are a tech play, with lots of data and images 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.

In that way, it’s not about primary care docs handing off patients to specialists; rather, the specialists offer advice through the platform. There isn’t an elevated risk of errors and lawsuits, Anderson said

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, far sooner. And it prevents many hospital emergency room visits, the studies show.

Dr. Chris Norwood, a dermatologist at Starling Physicians in New Britain and Rocky Hill, handled 20 e-consults on a Thursday this month — all through CeCN, with patients from Washington state to Maine, many from Connecticut.

He could have seen perhaps 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 in the network send primary-care doctors their findings within two days, usually faster, and they can go back and forth with requests. Norwood sometimes asks for clearer pictures, or photos of a patient’s fingernails for certain conditions.

For this, he collects a modest, some would say meager, $35 per electronic consult.

“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.”

‘A powerful program’

Electronic consults started with the Veterans Administration, which has been doing them for decades, said Anderson, a former primary care director for the VA in Connecticut. It later spread to hospitals in San Francisco, no surprise there, then Los Angeles.

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 staff physician for the center.

“My goal had always been to work with the underserved,” Anderson said.

And he was the first to launch wide-scale 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 is preparing to 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 doctor 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.”