What are the Costs of Improving Access to Specialists through eConsultation? The Champlain BASE Experience

Excessive wait times and poor access to care are among the most significant problems facing health care service delivery in Canada and beyond. We implemented the Champlain BASE eConsult service in the region of Ottawa, Canada to increase access to specialist care. We have collected ongoing utilization data and provider surveys over a three year period, providing a unique opportunity to explore the economic aspects of this multispecialty eConsult service. This is an economic evaluation from the perspective of the payer: the Ministry of Health and Long-Term Care of Ontario. All eConsults submitted during April 1, 2011 to March 31, 2014 were included. We attributed cost savings only to those cases where an eConsult led to the avoidance of a face-to-face specialist visit. A total of 2606 eConsults directed to 27 different speciality groups were included. In 40.3% (n=1051) of cases processed, a face-to-face specialist visit was originally planned but avoided as a result of eConsult, while 29% led to a referral. The estimated cost per eConsult for Years 1, 2, and 3 were $131.05, $10.34, and $6.45 respectively. Results from a sensitivity analysis project that the eConsult service will break even once we reach 7818 eConsults. This is one of the first studies to examine costs across a multispecialty eConsult service. We saw a marked decrease in the cost per eConsult over each annual period. Future research is needed to identify and examine similar outcomes that may lead to cost savings.