Latest investment to address the growing need to align patient access to timely specialty advice in the appropriate care setting
AristaMD, a leading digital health company that provides eConsult solutions to connect primary care providers (PCPs) with timely, documented specialist insights, announces the acquisition of Preferral, a platform for referral management, analytics and document routing.
Combining virtual physician-to-specialist consultations, or eConsults, with a referral management platform that optimizes the selection of specialists for face-to-face referrals will help AristaMD in its mission of using technology to facilitate collaboration between healthcare providers. Both solutions are designed to expedite time to treatment, decrease costs and drive better patient outcomes.
“Today’s referral paradigm is broken. It is estimated that 20 million clinically inappropriate referrals are sent each year and that more than 20% of referrals are misdirected. In addition, up to 50% of referrals are often unfulfilled”, says Brooke LeVasseur, CEO of AristaMD. “All of these dynamics lead to patient frustration, inflated costs and poorer patient outcomes. Electronic referral management and eConsults are simple-to-implement tools that improves the quality of referrals, increase patient compliance, improve provider communication and reduce unnecessary spend.”
The combined company will provide a comprehensive, end-to-end referral solution to meet the needs of payers, health systems, Accountable Care Organizations (ACO), primary care providers and specialists. The integrated solution will provide the tools needed to ensure patients are being treated by the right provider, in the right setting – as quickly and cost-effectively as possible.
Reducing Complexity to Improve Outcomes and Access to Care
“COVID and long-standing physician shortages increase wait times for patients needing a specialist appointment,” says Jim Aylward, CEO of Preferral. “Long wait times increase the risk of avoidable complications. We want to eliminate patient visits to the emergency room because they were unable to get a timely appointment with a specialist. The union of AristaMD and Preferral solves this problem – improving care and lowering costs.”
Data released by athenahealth, an Electronic Health Record (EHR) company, indicates that the longer patients wait to schedule an appointment, the more likely they are to cancel that appointment. Scheduling a visit with a specialist often took weeks prior to COVID. The pandemic exacerbated the problem as patients postponed face-to-face visits with all types of physicians due to office closures and fear of exposure to the virus.
The complexity of our healthcare system also makes selecting a specialist for a patient difficult. In most practices, a primary care provider will select a specialist that they know. This process doesn’t consider the patient’s insurance or the amount of time the patient will wait to see a specialist.
“The selection of a specialist is made based on convenience,” says Jon Gautsch, Founder and Chief Technology Officer of Preferral. “The practice may have a cheat sheet listing specialists the practice has worked with in the past and who accepts each type of insurance. It’s not comprehensive. For office staff, selecting a specialist based on insurance, wait times and distance is insurmountable.”
The Preferral platform can quickly send a referral to a specialist and confirm receipt with both the originating practice and the patient. These features attracted the attention of busy primary care clinics using fax machines and follow-up calls to coordinate patient referrals. Cool Springs Internal Medicine & Pediatrics, PLLC, which has locations in Franklin and Brentwood, Tennessee, adopted the solution to relieve the time and effort required to coordinate specialist care.
“Referrals were often sent by fax, which was very time consuming and cumbersome,” says Patrick Stearns, Executive Director of Cool Springs Internal Medicine & Pediatrics, PLLC. “Preferral streamlined our process and enabled a single referral specialist to coordinate referrals for the 17 providers at our clinic.”
“Almost all of our referrals are sent electronically by digital fax or directly through the system,” continues Stearns. “About 80% of the specialists we work with also use Preferral, which means we receive confirmation that the specialist office received the referral. The patient is also notified automatically that the referral was sent to the specialist.”
The combination of virtual physician-to-specialist consultations, or eConsults, with a process to find a specialist and schedule an in-person visit allows the selection of the appropriate setting – electronic or in-person – and doctor for the patient. Providing patients with access to specialist advice in the right place, at the right time can reduce the cost of care as well as improve patient outcomes.
“With the growth of value-based care payment models, where providers are directly rewarded for cost effective and high-quality care, referrals are an important consideration for financial performance,” says LeVasseur. “Combining AristaMD’s contracted specialist panel of more than 300 eConsult providers across almost every imaginable specialty with the Preferral platform will vastly streamline the referral process, including peer-to-peer review for prior authorization, referral scheduling and interim care plan support.”
By helping healthcare providers automatically select the appropriate care setting, navigate insurance policies, specialist availability and patient needs, AristaMD also expects to:
Expedite testing, diagnosis and treatment. Offer low-cost access to specialist advice. Eliminate non-clinical issues that decrease the likelihood that the patient will see a specialist.
Lack of childcare, language barriers and distance are just some of the factors that diminish a patient’s ability to schedule a visit with a specialist. These non-clinical barriers to care are called Social Determinants of Health (SDoH). In recent years, The Centers for Medicare and Medicaid Services (CMS), health care plans and providers have paid more attention to how these factors impact patient outcomes and healthcare cost. For example, CMS expanded Medicare benefits to minimize SDoH in 2019.
The acquisition of Preferral by AristaMD will further reduce the effect of SDoH by allowing physicians to access eConsults, which eliminate the need for face-to-face specialty visits more than 70% of the time. eConsults empower the PCP to provide patient care informed by advice received from a U.S.-based, board-certified specialist. Avoiding unnecessary in-person specialist visits saves patients time and money while reducing the need to take time-off of work, travel long-distances, secure childcare or obtain translation services.
Preferral was founded in 2014 by now Chief Technology Officer, Jon Gautsch, while he was attending The University of Notre Dame. He noticed his father, an orthopedic surgeon, still received referrals from doctors by phone and fax machine, which prompted Gautsch to begin writing code for software that would allow primary care physicians to search for specialists, match insurance plans, set appointments and remind patients of those appointments.
Preferral hired Jim Aylward as CEO in May 2017 and officially launched in several local practices in September of the same year. “Before I became CEO, I went to demos out in the field and saw people’s reactions. They were blown away,” says Aylward. “I am equally impressed with the AristaMD eConsult solution. Together, Preferral and AristaMD will revolutionize the delivery of specialty care.”
Aylward will remain with the new entity during the transition period to ensure a seamless integration of the two companies. AristaMD will retain its current leadership and staff. Gautsch will assume the role of Sr. Vice President of AristaMD. In this new role, he will oversee the integration of the two platforms as well as support the rollout of new functionality to make it easier for patients to obtain access to specialists, and easier for specialists to market their availability.
“Many of the enhancements to the Preferral platform were developed based on customer requests and feedback,” says Gautsch. “Our peer-to-peer review and prior authorization functionality were a direct result of listening to the needs of our customers and their patients. I can tell that the AristaMD team has the same focus on designing solutions that meet the needs of its customers. We will continue to listen to customers to ensure new features address current and future challenges to patient care delivery.”
“Over the next few months, Jon [Gautsch] and the development team at AristaMD will integrate the two platforms without impacting current functionality,” says Neal Reizer, Chief Product Officer of AristaMD. “The result will be a single solution enabling primary care physicians to ensure their patients have appropriate and timely specialist input, whether via an eConsult or an in-person visit. The AristaMD integrated solution will continue to provide specialists with an easy way to promote their availability and expertise.”
“I am extremely excited to see these organizations come together and to work with a team that is transforming healthcare,” said LeVasseur. “We look forward to the evolution of our service offering and the industry. Our customers will have the benefit of state-of-the-art software, increased functionality and the innovation of the combined entities.”