• Melanie D Whittington, P Michael Ho, Susan R Kirsh, Rachael R Kenney, Jeffrey Todd-Stenberg, David H Au, and Joseph Simonetti.
• Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO 80045. Email: Melanie.whittington3@gmail.com.
• Am J Manag Care. 2021 Jan 1; 27 (1): e16-e23.

ObjectivesElectronic consultations, or e-consults, between primary care providers and specialists have been shown to improve access to specialty care, shorten wait times, and reduce outpatient visits. The objective of this study was to evaluate differences in health care costs between patients who received an electronic specialty consultation and patients who received a face-to-face specialty consultation.Study DesignRetrospective cohort evaluation of patients who received a specialty consultation in the Veterans Health Administration during 2016.MethodsPatients who received an e-consult were matched 1:1 to patients who received a face-to-face consultation using propensity scores. Total, outpatient, and inpatient health care costs over 3 and 6 months following the specialty consultation were compared using a generalized linear model with a gamma distribution and log link.Resultse-Consults accounted for 1.8% (urology) to 9.6% (hematology) of specialty consultations, on average. Across 11 specialties, patients receiving an e-consult had significantly lower health care costs compared with patients receiving a face-to-face consultation, ranging from 3.6% (cardiology) to 30.7% (hematology) lower. This was largely driven by differences in outpatient costs. Patients receiving an e-consult had significantly lower outpatient costs for all specialties except cardiology, ranging from 6.9% (endocrinology) to 31.2% (hematology) lower. Three-month inpatient costs among those who received an e-consult were significantly lower only in cardiology (5.2%), nephrology (9.3%), pulmonary (13.0%), and gastroenterology (14.3%).ConclusionsElectronic specialty consultations are a potential mechanism to reduce health care costs and promote the efficient use of health care resources.

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