The Neighborhood Care Partnership of Maine (CCPM) is utilizing a digital platform to attach rural clinics at 22 member organizations with specialists in real-time. Mary Butler Fleming, the chief working officer of CCPM, stated the initiative has helped to handle one in all rural healthcare’s most urgent challenges, which could be very restricted entry to specialist experience.
Talking throughout a current webinar hosted by the Northeast Telehealth Useful resource Middle, Butler Fleming mentioned the implementation of the PicassoMD platform, which connects major care suppliers (PCPs) with specialists in real-time.
CCPM is a clinically built-in community and accountable care group with a statewide presence. It has 22 member organizations in its community. Seventeen are Federally Certified Well being Facilities, and 5 are neighborhood and significant entry hospitals. They span 163 service places throughout the state. The community participates in 12 value-based cost preparations, together with the Medicare Shared Financial savings Program. They’ve generated about $100 million in gross financial savings in MSSP since 2016. They’ve about 350 major care suppliers and the members within the community collectively serve a few quarter of the state’s inhabitants on an annual foundation.
“As a company, we’re primarily targeted on implementing and scaling modern care supply fashions that enhance affected person outcomes and concentrate on efficient price administration,” Butler Fleming stated. To grasp why the digital curbside seek the advice of mannequin has been so impactful, she stated it’s good to perceive Maine’s distinctive healthcare panorama.
Maine is each the oldest and essentially the most rural state within the nation. A few quarter of its inhabitants is over the age of 65 and greater than 60% of its residents reside in rural areas.
“We’re going through a extremely dire lack of entry to specialists, notably cardiologists, rheumatologists, endocrinologists,” she stated. “Wait instances routinely exceed 9 to 12 months for these specialties specifically. Moreover, a lot of our clinician workforce consists of new-to-practice nurse practitioners and doctor assistants who’re typically working with out a medical director on website. And in contrast to numerous the big well being techniques, our community is comprised of principally major care-focused FQHCs, so they do not all the time have co-located specialist colleagues that they’ll do fast hallway consults with,” she defined.
These components create difficult circumstances for each suppliers and sufferers. Butler Fleming famous that it is properly documented within the literature that when there’s not sufficient entry to fulfill demand or when specialist care is delayed, it has fairly substantial adverse impacts, not solely on complete price of care, however extra importantly, on care high quality and well being outcomes.
The curbside consults are real-time, safe digital interactions that join major care suppliers immediately with specialists via a cell app, a laptop computer or an EMR interface. The platform CCPM makes use of is known as PicassoMD. Utilizing it, suppliers get entry to a specialist inside 30 seconds, she stated, and so they’re capable of have interaction in a synchronous dialog and get actionable steering and suggestions proper on the spot to assist them resolve difficult circumstances.
“After I describe the interface, it is so much like getting on a journey share app, like an Uber or Lyft, imagine it or not,” Butler Fleming stated. You choose the specialist that you simply’d prefer to seek the advice of with, and in seconds, you are pulled right into a synchronous HIPAA-compliant messaging platform. You’ve gotten the flexibility to ship images and do voice-to-text transcription. It is intuitive. It is fairly straightforward to make use of, and the suppliers have actually liked it.”
For his or her pilot with PicassoMD, they targeted first on ultra-rural websites. They’ve some FQHCs situated on an island an hour away from the mainland. They targeted on websites like that — practices that had a excessive proportion of new-to-practice NPs and PAs, websites with out co-located specialists and with out co-located medical administrators. “Three years into this work, we are likely to see that NPs and PAs are utilizing the device at a few price of two instances that of the medical administrators and MDs and DOs,” Butler Fleming stated, including that the utilization of the device does are typically increased at places with out a medical director on website.
By way of the use circumstances, a lot of them are utilizing the device on the level of care once they’re considering whether or not to ship a affected person to the emergency division or refer them to a specialist. Possibly they’re not sure about what labs or imaging to order or what drugs to prescribe. “We see the majority of the interactions taking place on the level of care, however they’re typically utilizing the device prematurely of or following a affected person go to, so it affords some flexibility for once they’re utilizing it,” she defined.
Butler Fleming listed among the advantages for a spread of stakeholders. “For sufferers, we’re seeing improved entry to specialist experience. Going to a specialist go to means driving two to a few hours every manner and infrequently incurring some important out-of-pocket prices. Sufferers are getting sooner diagnoses and extra optimized remedy. This interprets into improved well being outcomes and improve affected person security, she stated. “From a value perspective, we’re seeing important enhancements in avoidable referrals and emergency division visits, which has important monetary implications, notably of their value-based care fashions. Importantly, the PCPs, are sustaining their central position within the care coordination, which we really feel is absolutely vital. So this is not about changing the PCPs; it’s about empowering them with specialist experience once they want it essentially the most.”
ACOs like CCPM which can be in value-based cost preparations additionally profit, and state and federal governments profit via decreased Medicare and Medicaid spending. Butler Fleming stated that even specialists on and off the platform profit. “After I say specialists off the platform profit, I imply the circumstances that they’re seeing are screened out in the event that they’re pointless by that curbside seek the advice of, and so they’re extra appropriately labored up if they’re indicated. The PCPs are getting steering on what must be carried out prematurely of the specialist go to to make it most effective and efficient.”
Since launching in October of 2023, CCPM now has 100% utilization throughout its 22 member organizations. There are properly over 300 major care suppliers throughout the state utilizing utilizing the device, and so they have accomplished over 5,700 consultations in that timeframe. “Our supplier satisfaction price is fairly darn near 100% which is absolutely extraordinary,” Butler Fleming stated. “From a monetary perspective, we have generated about $1.25 million in estimated price financial savings via averted utilization, and that is largely attributed to avoiding about 2,000 pointless specialist referrals and about 168 emergency division visits.
She shared a testimonial from Dr. Megan Brewer, who practices within the Better Portland space, who stated it’s not an exaggeration that this device has saved affected person lives. The device is now getting used broadly as a recruitment and retention technique for lots of the FQHCs and hospital members.
The specialties which have the best quantity of consults correlate immediately with what CCMP is seeing because the longest wait instances for specialties. “So it has been a sport changer for PCPs to have the ability to seek the advice of with these specialists in actual time with out having to ship their affected person right into a 9-month queue,” she stated.
Who pays for this?
When she presents on this subject, Butler Fleming is commonly requested: Who pays for this? She defined that this isn’t one thing that the affected person pays for out of pocket; it’s free to affected person. At the start of this intervention, CCPM had an association the place it was paying per seek the advice of for members. As soon as it was profitable in demonstrating the worth of this device, a number of payers that it has value-based cost preparations with are masking the price of this service for his or her sufferers. “What we now have not been capable of cowl with payer help, we now have gotten grants to cowl, so there isn’t a price to sufferers and there’s no price to our members in our community,” she added. “That is one thing that we’re actually happy with. One other factor that we’re actually happy with is that this undertaking has actually been a springboard for extra collaboration alternatives to carry extra specialist experience into the state of Maine.”
This momentum is one thing that’s translated immediately into expanded partnerships and new initiatives, Butler Fleming stated. Looking forward to the remainder of 2026, CCMP is engaged on establishing longitudinal collaboration between PCPs and specialists on the platform. “We all know that typically one curbside seek the advice of does not do it, notably for sufferers with high-risk persistent circumstances, and having a way of continuity in these conversations between the PCP and the specialist might be vital.”
They’re additionally proactively figuring out high-risk and/or sub-optimally managed sufferers for focused short-term specialist enter, reasonably than ready for the PCPs to have interaction in a seek the advice of.
As a clinically built-in community, CCMP has EHR entry throughout the membership, in addition to entry to a statewide well being info change. “We’re capable of proactively determine and tee up the pertinent particulars of circumstances for evaluation,” Butler Fleming stated.
CCMP is also exploring probably combine AI scientific resolution help instruments into the workflow with a view to scale back lower-acuity specialist consults and to develop scientific resolution help instruments to assist optimize well timed, acceptable and prioritized specialist referrals.
Butler Fleming closed by saying the group is also working with PicassoMD to pilot direct telehealth visits by way of Picasso MD later this 12 months for among the specialties in highest demand. There are problems with licensing and credentialing and community standing with the payers to work via, she added, “nevertheless it’s definitely an thrilling proposition that might have a extremely significant influence on entry in our state.”
