Collaborative care plans reduce subspecialty consults: the experience from a safety net hospital

Several strategies have been proposed to improve referrals and communication between primary care providers (PCPs) and specialists. In this article, we describe the effectiveness of collaborative care plans (CCPs) in reducing utilization of specialist resources in a capitated health plan based in a safety net hospital. To operationalize individual care plans, a single clinic called the Total Care Clinic (TCC) was launched. Midlevel providers were assigned to subspecialties and trained in specific algorithms of care that they were responsible for. Midlevel providers in the TCC were invited to attend in-house education opportunities. These interventions resulted in an overall 33.6-percentage-point reduction in the referral rate over 7 years of observation. The largest decrease in referrals was observed in gastroenterology, which resulted mostly from colon cancer screening with fecal immunochemical tests in place of colonoscopies. No increase in emergency department (ED) visits or hospital admissions accompanied the decreased referrals to specialists. Combining CCPs with provider education and placing select specialists in proximity of the PCPs resulted in significant referral reductions to specialists without increases in ED visits or hospital admissions.