Overview
Organization: Keystone Community Health (KCH) – a 10-site Federally Qualified Health Center (FQHC) in Pennsylvania
Primary Care Staff: 35 Physicians, 10 Advanced Practice Nurses
Gazuntite Specialist Panel: 20 specialists across Cardiology, Endocrinology, Pulmonology, Gastroenterology, Neurology, Nephrology, Rheumatology, Dermatology, Psychiatry, Hematology, Oncology, Infectious Disease, Urology, OB/GYN, Allergy & Immunology, Ophthalmology, Orthopedics, Pediatrics, Geriatrics, and Palliative Care.
Patient Population: 42,000 active lives (predominantly Medicaid and Medicare)
Implementation Date: January 2025
Gazuntite’s Specialist e-consult platform was deployed to expand specialty access, reduce unnecessary referrals, and strengthen the 340B and value-based revenue base of the FQHC network.
1. Deployment Timeline and Growth Metrics
Phase 1 – Launch & Training (0–3 months)
• Credential 20 specialists; EMR integration (Athena DM & ECW P2P); onboarding 35 PCPs/10 APNs
• E-Consult Volume: 400
• 100% EMR-native workflow
• Avg response time: 22 hrs
• PCP satisfaction: 93%
Phase 2 – Early Adoption (3–6 months)
• Expand usage across all sites; first CPT billing; initiate pharmacy 340B tracking
• E-Consult Volume: 1,200
• 25% external referral reduction
• CPT 99452 compliance: 87%
• $180K downstream diagnostics
Phase 3 – Scale & Optimization (6–9 months)
• Chronic disease management expansion; pharmacy optimization; dashboard rollout
• E-Consult Volume: 2,400
• 68% PCPs report higher clinical confidence
• 18% drop in unnecessary referrals
• 340 avoidable ER visits prevented
Phase 4 – Full Integration (9–12 months)
• Mature into a “virtual multispecialty” network; optimize 340B and follow-up capture
• E-Consult Volume: 4,800
• 45% referral reduction
• 32% chronic disease improvement
• Full 340B and downstream ROI reporting
2. Financial & ROI Model (12-Month Impact)
A. Core E-Consult and Avoidance Benefits
• Avoided External Specialist Visits: $648,000 (2,160 avoided × $300 average cost differential)
• Avoided ER Visits: $510,000 (340 diversions × $1,500 per ER visit)
• CPT 99451/99452 Shared Billing: $168,000 (4,800 consults × $35 average)
• Downstream Diagnostics: $275,400 (labs, imaging, procedures retained)
B. 340B Program Contribution
• New/Adjusted Prescriptions: 1,680 medication actions (35% of e-consults)
• In-house 340B Capture: 70% of actions filled via FQHC pharmacy
• Net 340B Margin: $65 per fill, 2.0 refills avg → $229,320
Care coordination and decision support within the EMR drive medication optimization and adherence, key pillars of 340B program performance.
C. Follow-Up Visit Revenue
• Follow-up Rate: 0.6 per e-consult (2,880 total)
• Average Net Contribution: $80 per visit → $230,400
Improved transitions and communication increase continuity and follow-up adherence.
D. Total Year-1 Financial Summary
| Category | Value ($) |
|---|---|
| Avoided Specialist Costs | 648,000 |
| Avoided ER Costs | 510,000 |
| CPT Billing Revenue | 168,000 |
| Diagnostics Retained | 275,400 |
| 340B Contribution | 229,320 |
| Follow-Up Visits | 230,400 |
| Gross Savings + Revenue | 2,061,120 |
| Program Operating Cost | (250,000) |
| Net Annual Return | $1,811,120 |
| ROI (12-Month) | 4.2× |
3. Clinical and Patient Outcomes
| Metric | Baseline (Pre-Gazuntite) | 12-Month Outcome | Improvement |
|---|---|---|---|
| Avg Wait for Specialist | 68 days | 36 hours | ↓ 98% |
| PCP Referral Leakage | 37% | 15% | ↓ 60% |
| Chronic Disease Control (A1C/BP/LDL) | 58% | 76% | +18 points |
| Avoidable ER Visits | 8.2% | 4.5% | ↓ 45% |
| Medication Adherence | 68% | 84% | +16 points |
| PCP Confidence (Surveyed) | 61% | 91% | +30 points |
| Patient Satisfaction | 82% | 95% | +13 points |
4. 340B + Care Coordination Synergy
Drawing on AAACN’s Care Coordination and Transition Management (CCTM) model, Gazuntite embeds specialists and RNs directly within the PCP workflow:
• Person-Centered Care Planning: Shared plans and medication adjustments logged directly in the EMR.
• Cross-Setting Communication: Instant return of consults, updates, and labs across all 10 clinics.
• Support for Self-Management: RN coordinators educate patients on medication regimens and follow-up compliance.
• Population Health Management: Dashboards tracking A1C, BP, LDL, and 340B pharmacy utilization aligned with HRSA UDS metrics.
The workflow mirrors evidence-based chronic-disease management programs (CHF, diabetes, COPD).
5. Illustrative Patient Example
Patient: 58-year-old male, diabetes + COPD
Problem: 74-day average wait for endocrinology & pulmonology; A1C = 9.1
Gazuntite Intervention: Dual e-consult responses within 36 hours; medication titration; in-house 340B fill; 2-week RN follow-up
Result:
• A1C → 7.4 within 90 days
• Avoided hospital admission (est. $11,000 saved)
• 340B medication captured and refilled twice in-house
• Patient reported “best breathing in years” and fewer missed workdays
6. Multi-Year Projection (10 Similar FQHCs in Pennsylvania)
• Annual E-Consults: 48,000
• Avoided Specialist + ER Costs: $6.4M
• Downstream Diagnostics + 340B: $2.1M
• Follow-Up Revenue: $2.0M
• Net ROI: ~4×
• Chronic Disease Control Improvement: +25–30 points
7. Executive Summary
By Month 12, Keystone Community Health evolved into a digitally enabled multispecialty ecosystem where every PCP had 20 specialists behind them—within the same EMR, the same day.
• Financially, Gazuntite generated $1.8M in net value and a 4.2× ROI by capturing 340B prescriptions, local diagnostics, and high follow-up compliance while eliminating unnecessary referrals.
• Clinically, it reduced wait times from months to hours, improved chronic-disease control by 32%, and cut ER visits nearly in half.
• For patients, it restored access, affordability, and continuity of care—without adding staff or altering the PCP workflow.
Gazuntite turns every FQHC into a virtual multi-specialty center, converting care gaps into both better health and sustainable revenue.
