Unlocking a Sustainable Model to Impact More Patients

Shantanu Nundy, M.D., Director of the Human Diagnosis Project Nonprofit

Several months ago, our team set out to identify how to improve our approach to providing more accurate, affordable, and high-quality care for the underserved through a national electronic consult (eConsult) system.

Speaking to doctors, patients, policymakers, top researchers, and technology experts nationwide about the Human Dx eConsult system, we heard a similar refrain: “This could save the U.S. health system hundreds of millions of dollars. There ought to be a way to financially support it.” Couched in the framing from Management Systems International — that the easiest pilots to scale are those that involve a clear and replicable technology and self-generate the financial resources needed for expansion — many were convinced by the transformative capabilities of our technology, which can scale at near-zero marginal cost. The only question was our ability to self-generate the financial resources.

Then came our Eureka moment: speaking with leading policymakers, we learned there is a nascent but quickly expanding reimbursement model that payers — from insurers to the federal government — use to compensate doctors who use eConsult. What’s more, because our eConsult is more advanced than existing systems, payers would be more likely to recognize how our eConsults can save money by preventing unnecessary hospital visits, services, tests, and procedures — while simultaneously improving patients’ overall health. While we could only get eConsults covered for insured patients, Human Dx’s low-cost model means we can use the revenue from insured patients to later expand specialty access for all patients.

These insights dramatically shifted our original proposal, enabling us to:

  1. Reach more clinics and patients than we had previously thought possible;
  2. Provide loan repayment for specialists who commit to contributing to our eConsult system (similar to lawyers, businesspeople, and other professionals who receive loan repayment for working in the public sector); and
  3. Sustain our national system beyond the MacArthur Foundation’s five-year grant period.

Over the last few months, we’ve partnered with the Association of American Medical Colleges, which has launched eConsult programs in more than a half-dozen academic medical centers around the country. We have also engaged the American Medical Association in ongoing discussions around program integrity and payment reform, and structured a payment model in our pilot with Louisiana Department of Health’s Medicaid program.

Together, we can unlock the value of better care for the nation’s underserved and use it to sustain our project for current and future generations, here in the U.S. and abroad.

We support creative people and effective institutions committed to building a more just, verdant, and peaceful world. ⚖🌿☮🌎

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