ROI Model and Program Budget We assume a 12% reduction in new patient office visits (by internal primary care population patients) to the 11 medicine subspecialties. At UCSF, the reduction in new-patient visit volume was greater than the eConsult adoption rate (8%), highlighting the importance of the decision support for standard referrals in addition to the eConsult option. In neurology, orthopedic surgery, and dermatology, we expect an eConsult adoption rate of 5% and reduction in internal new patient visit volume of 5%. These specialties are higher volume and are early in program development at UCSF. Referrals rates to each specialty are modeled on UCSF data that are based on 8 UCSF adult primary care sites. Savings per avoided specialty referral is estimated at $260. To be conservative, savings estimates include only the averted new-patient visit to the specialist. Subsequent followup visits, a reduction in ED use, and hospital admissions averted due to improved access are not included in the model—although preliminary analyses suggest a reduction in ED visits as well. Specialists receive a payment corresponding to 0.5 wRVU per completed eConsult and PCPs receive 0.5 RVU per eConsult. At UCSF, the PCP RVU value is credited toward annual productivity targets. eConsult clinical fee costs to the institution (1 wRVU total) are modeled at $100 per eConsult. To whom does the ROI accrue? The savings benefit to stakeholders depends upon current and future financial arrangements. For patients in managed care contracts, savings accrue to the Medical Group and Medical Center. For patients under fee-for- service contracts, where savings immediately benefit the commercial payers, the case can be made for reimbursement for the eConsult fees. The UC Office of the President will negotiate this point in UC-wide contracts. Improved access to specialty care has important implications not reflected in the model. Access is crucial to patient satisfaction. Secondly, while UCSF saw a decrease in referrals to specialties for internal UCSF primary care patients, the total new patient visit volume and and increased. A reduction in office visits to specialists by our primary care populations allows UC Health Centers to provide referral care to a greater total number of patients, strengthening referral relationships. Importantly, the reduction in internal new patient visits allows for greater access to higher complexity, external referrals to our specialty practices. Finally, the reduction in ED use and hospitalization within 120 days of referral seen at UCSF are not incorporated into the ROI model (to be conservative) but suggest that prompt access to specialty care leads to downstream savings. ROI for a Primary Care Population of 50,000 Averted visits eConsults Gross Savings eConsult Fee (Medical Center / Medical Plan) Net Saving ROI Year 1 (ramp up) 275 186 $70,695 Year 2 1378 931 $353,476 $19,893 $99,468 $50,802 3.55:1 $254,008 3.55:1 The UC Office of the President’s Center for Healthcare Quality and Innovation (CHQI) pledged substantial financial support for the implementation of the program. CHQI funds support for the implementation team at each site including a Physician-Lead, an Epic Analyst, and a Project Coordinator. The eConsult fees (0.5 wRVU to the specialist as well as the PCP) will be covered by the individual institutions (Medical Group or Medical Center). Projected costs per 50,000 primary care patients are shown in the ROI table.