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Using eConsults for more Equitable and Comprehensive Care

Advancing health equity for uninsured patients in rural communities by improving access to specialty care


eConsults have the potential to reduce health inequity for uninsured patients by improving access to specialty care. State and local health care payors, including Texas Medicaid and Central Health, see the benefit of eConsults in increasing access to specialty care and are exploring ways to expand this method of care delivery. While this initiative focuses on the uninsured, lack of access to needed specialty care is a significant barrier for many living in the rural areas in St. David’s Foundation’s five county region.

The Issue

Lack of access to specialty care significantly impacts the health and wellbeing of the uninsured and underinsured across Central Texas, particularly in our rural areas. Federally qualified health centers (FQHCs) and safety-net clinics provide access to primary care for uninsured patients—but without insurance, patients face major barriers to receiving needed, timely specialty care. Lack of access to specialty care to address complex health issues results in delayed or differed care, potentially leading to worse health outcomes and increased downstream health care costs.

eConsults are one method of addressing this inequity. eConsults allow primary care providers (PCP) and specialists to share clinical information and communicate electronically on specific cases, which creates an important opportunity for provider-to-provider collaboration. Armed with the specialist’s recommendations, the PCP can often continue to treat the patient. And even in cases where a direct referral to a specialist is needed, the referral process can happen more efficiently and effectively.

Research has demonstrated that eConsults reduce unnecessary visits and improve access to specialty care, but the impact on patients without insurance had not previously been studied. This research, funded by St. David’s Foundation, covers the results from a pilot eConsult program with Lone Star Circle of Care, a Central Texas FQHC, and ConferMED, an organization leading the way nationally to expand access to care, to explore the impact of eConsults on uninsured patients in rural Texas.

The Findings

Incorporating the low-cost process of eConsults significantly reduced uncompleted specialty referrals and the number of patients who needed to see a specialist. This is key for patients already facing barriers to accessing care, such as those without insurance or those living in rural areas, Prior to implementation of this program, 23% of uninsured patients referred to specialty care completed a visit with a specialist. After implementation of the program, 62% received a specialty consultation through an e-consult or face-to-face visit with a specialty provider. Additionally, wait times for referrals decreased from a median of 54 days to just seven.

Lone Star Circle of Care

Meet our Contributors


Amy Einhorn, MPP

Senior Program Officer


Abena Asante, MHA

Senior Program Officer