Real-Time Access to Specialists for More Equitable Healthcare
Executive Summary
In a case study of two clinics that serve patient populations at opposite ends of the Social Determinants of Health (SDOH) spectrum, PicassoMD demonstrated how its on-demand virtual specialists service can level the playing field for healthcare access and improve health outcomes. PicassoMD’s Curbside consult platform was deployed simultaneously to primary care providers in a more affluent clinic and a more socially disadvantaged clinic. The result was that both patient sets gained rapid access to specialists, with a median connection time of 45 seconds or less (it usually takes a patient weeks to access specialist care). In 20% of the PicassoMD Curbside interactions, the provider was able to avoid an unnecessary patient visit to the specialist as a result of the encounter. These results indicate PicassoMD’s ability to provide better and more equitable health outcomes for patients and sustainable value for systems, payers, and at-risk providers.
PicassoMD’s platform enables primary care providers to access real-time clinical consultations from specialists across more than 30 disciplines. Traditionally, if a primary care provider needs to consult with a specialist on a patient’s treatment plan, they have three time consuming and expensive options: have the patient make an appointment to see a specialist, send the patient to the emergency room, or order testing. With PicassoMD, a primary care provider can share the patient’s case with a specialist through a PicassoMD Curbsides consult while their patient is still in the office. Within seconds, the primary care provider and specialist are connected and able to discuss the patient case and appropriate next steps.
Between March 1 and May 15, 2022, PicassoMD compared the access to care and health outcomes in two clinics where PicassoMD Curbsides is deployed, one in a less affluent1 area in southern Mississippi (n=202 curbsides) and one in a more affluent area in greater Washington, DC (n=200 curbsides). Despite large differences in social determinants of health between the two patient populations, the two clinics experienced similar outcomes as measured by:
- Access: Rapid connection to specialists
(median connection time = less than 45 seconds) - Outcomes: Avoidance of unnecessary visits to specialists (avoided unnecessary visits in 20% of the PicassoMD Curbsides consultations)
If we take these early results as an indication of the efficacy of PicassoMD, there is significant potential in providing better and more equitable health outcomes for patients as well as creating sustainable value for systems, payers, and at-risk providers. Done at scale, there’s an opportunity to improve healthcare access across populations – systematically improving health equity in a nation that has struggled to bridge the gap between low-income and high-income as well as rural and urban patients’ health access.
Introduction
Over the past decades, a growing2 body3 of research has confirmed that a person’s environment can greatly impact health outcomes. According to the Kaiser Family Foundation’s 2021 analysis, “studies suggest that health behaviors and social and economic factors, often referred to as social determinants of health, are the primary drivers of health outcomes and that social and economic factors shape individuals’ health behaviors.”4
Formed in 2019, PicassoMD aims to improve health outcomes across populations by providing primary care providers with real-time access to a network of specialists across all major disciplines. Through PicassoMD Curbside consultations with specialists, primary care providers are able to more confidently determine next steps for their patients while they are still in the office. PicassoMD operates in eight geographies across the U.S., with about 750 primary care physicians participating in PicassoMD Curbsides and 500 specialists from across more than 30 disciplines providing real-time consultations.
This is how PicassoMD Curbsides works in practice: if, while treating a patient, a primary care provider has a concern about their patient’s condition that extends beyond their expertise, the provider can immediately be connected with a specialist for an informal interprofessional consultation using their phone or another device (e.g., iPad, laptop) in less than one minute. The provider and specialist can collaborate in real-time using HIPAA-compliant texting with integrated documentation. The provider can share notes on their patient’s condition and seek the specialist’s guidance on next steps. If a patient needs a follow-up referral to a specialist, the provider can immediately refer the patient to a specialist, ensuring continuity of care.
Quantifying Social Determinants of Health
To examine how PicassoMD works across socio-economic regions, we used data from the Neighborhood Atlas5, a free tool funded in partnership by the National Institutes of Health.6
The Neighborhood Atlas quantifies the relative disadvantage of a community through the Area Deprivation Index (ADI), where high numbers are the most disadvantaged. Communities are defined using Census Block Groups - a standard unit of geography that is typically smaller than a zip code.
By looking at the ADI of Census Group Blocks that are within a 50-mile radius of our partners, we are able to quantify the degree to which their communities are traditionally underserved.
A Tale of Two Clinics – A Natural Experiment among Clinics in Different SDOH
Using ADI, we conducted a natural experiment between two of our partner clinics (Clinic A and Clinic B).
Clinics A and B are both independent, multi-site primary care clinics, and both participate in value-based contracts in which the clinics are financially incentivized to improve their patients’ health outcomes. The clinics have significant variation in the patients they serve and the communities they operate in:
- Clinic A is located in Southern Mississippi. Of the communities within 50-miles of this practice, 86% have an ADI higher (i.e., are more disadvantaged) than the national median. Clinic A’s average community ADI is 70 -- which places it in the top 70% of disadvantaged communities nationwide. Clinic A is located in a zip code in which more than 15% of people on average lack health insurance. Access to specialist care is also more limited, with 141 specialists per 100,000 people in this community.9
- Clinic B is located in Greater Washington, DC. Only 11% of the communities in a 50-mile radius have an ADI higher than the national median. Clinic B’s average community ADI is 26 - which means it is on average less disadvantaged than 74% of the communities in the country. Clinic B is located in a zip code in which, on average, less than 5% of people lack health insurance10, and there are 215 specialists per 100,000 people.11
Between March 1 and May 15, 2022, we observed the effects of each clinic using PicassoMD Curbsides (202 in Clinic A and 200 in Clinic B). We chose this timing because these clinics used PicassoMD Curbsides a similar amount over 2.5 months. Comparing the two clinics was of interest given the difference in resources and healthcare access in each community, which enabled us to understand the potential value in providing better technology and fast access to specialist care–across social health determinants.
By analyzing the PicassoMD Curbsides results, we could answer two questions:
- Question 1: Access Equity: With PicassoMD, are both clinics able to rapidly connect with specialists?
- Question 2: Outcomes Equity: With PicassoMD, are both clinics able to prevent unnecessary specialist utilization?
Results
The Impact of PicassoMD - Equalizing Access and Outcomes
Question 1: Access Equity: With PicassoMD, are both clinics able to rapidly connect with specialists?
Yes, with over 400 PicassoMD Curbsides in 2.5 months, the clinics were able to rapidly connect with specialists. The median time for connection with a specialist when using a PicassoMD Curbsides consultation was 27 seconds for Clinic A and 43.5 seconds for Clinic B (see chart below), especially notable because Clinic A is more disadvantaged and yet had even faster access to care. To contextualize this data, in a state-wide audit of 2017-2019, patients in Vermont waited on average over 100 days for a follow-up specialist appointment (and that was calculated before Covid, which exacerbated wait times and overwhelmed the healthcare system). To reduce this time to seconds–across populations of varying wealth and population density–is more than a statistically significant result.
Why is this important?
Access to the right care at the right time is a significant predictor of health outcomes. When patients have delayed care, 27% report that their conditions worsen, including 17% who report limitations in their ability to perform daily tasks13. These results indicate PicassoMD removes this delay in access to specialist care–from weeks to seconds–resulting in healthier patients.
Question 2: Outcomes Equity: With PicassoMD, are both clinics able to prevent unnecessary specialist utilization?
Yes, both clinics experienced similar reductions in unnecessary utilization. Without the real-time specialist counsel from PicassoMD Curbsides, the primary care providers across both Clinic A and B indicated they would have unnecessarily sent their patients to specialists (77 times) and emergency departments (7 times). (At Clinic A in Southern Mississippi, PicassoMD Curbsides prevented 37 unnecessary referrals and 4 unnecessary Emergency Department visits. At Clinic B in the Washington, DC area, PicassoMD Curbsides prevented 40 unnecessary referrals and 3 unnecessary Emergency Department visits.)
Why is this important?
Preventing unnecessary utilization is not only important on a system-wide level to prevent waste but also makes a meaningful difference for individual patients:
- Economic Costs: On average, a provider visit requires a patient to take 2 hours off work, often resulting in lost wages. Additionally, more than 40% of households do not have enough savings to cover insurance deductibles. As a result, 24% of Americans have medical bills that are past due15. Preventing unnecessary care is the first step in addressing the affordability crisis.
- Emotional Costs: Unresolved health issues have real emotional impacts for a patient that can lead to physical pain, worry, and sleepless nights. One nurse practitioner reported: “I have had more than one patient go into tears that we were able to do [PicassoMD Curbsides] because other medical primary care providers outside our system have told them that they would spend thousands to go get ‘checked out’ by various specialties.”
- Healthcare Costs: Every day that a patient is not on the right care plan increases the chance of deterioration or crisis events, leading to adverse outcomes for the patient and higher costs for the broader healthcare system.
These system and patient improvements–through PicassoMD Curbsides–are even more impactful in southern Mississippi (location of Clinic A) which has significantly fewer specialists per population than in the DC area (location of Clinic B) and a population that has a higher percentage of uninsured citizens.
Conclusion
In order to reduce the barriers to healthcare access across communities–agnostic of income level and across socio-economic lines–primary care providers (and the patients they serve) need real-time access to specialists who can advise them on whether their patients’ situations warrant further, specialized care. PicassoMD Curbsides provide this access across populations. Our early results indicate that PicassoMD Curbsides used at scale could give all communities–rural and urban, affluent and underserved– quick access to high-quality healthcare. In turn, reducing healthcare costs to patients and the healthcare system and providing equitable, better care for Americans.
To learn more about how PicassoMD can help you serve your communities, please contact our Co-CEO & founder, Dr. Reza Sanai (reza@picassomd.com) and Head of Business Development, Steven Cupps (steven@picassomd.com).
Footnotes:
1 Relative Disadvantage is measured by the Area Deprivation Index (ADI), a peer-reviewed standard that quantifies the relative socio-economic disadvantage of a geography. The ADI scale has been updated and mapped to census-block level detail by the Neighborhood Atlas with support by the NIH.
For more detail please see:
- University of Wisconsin School of Medicine and Public Health. 2019 Area Deprivation Index v3.1. Downloaded from https://www.neighborhoodatlas.medicine.wisc.edu/ May 15, 2022.
- Kind AJH, Buckingham W. Making Neighborhood Disadvantage Metrics Accessible: The Neighborhood Atlas. New England Journal of Medicine, 2018. 378: 2456-2458. DOI: 10.1056/NEJMp1802313. PMCID: PMC6051533.
- NIH: https://www.nia.nih.gov/research/blog/2019/11/neighborhood-atlas-free-social-determinants-health-data-all
2 Schroeder, Steven A. "We can do better—improving the health of the American people." New England Journal of Medicine 357.12 (2007): 1221-1228.
3 CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
4 Disparities in Health and Health Care” Kaiser Family Foundation, May 2021 Racial Equity and Health Policy
5 University of Wisconsin School of Medicine and Public Health. 2019 Area Deprivation Index v3.1. Downloaded from Neighborhood Atlas May 15, 2022.
6 Social determinants health, health.gov
7 For more detail on the ADI, please see:Kind AJH, Buckingham W. Making Neighborhood Disadvantage Metrics Accessible: The Neighborhood Atlas. New England Journal of Medicine, 2018. 378: 2456-2458. DOI: 10.1056/NEJMp1802313. PMCID: PMC6051533.
8 Source: US Census 2020 American Community Survey 5-Year Estimates
9 Dartmouth Atlas, 2011 data
10 Source: US Census 2020 American Community Survey 5-Year Estimates
11 Dartmouth Atlas, 2011 data
12 Vermont wait times pg. 2023
13 Delayed and forgone health care for nonelderly adults during the covid 19 pandemic
15 KFF Health Care Debt Survey, 2022