Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Amendment to the Agreement with Stanford Health Care, a California Nonprofit Public Benefit Corporation to Provide E-Consult Services
RECOMMENDATION:
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Adopt a resolution authorizing a first amendment to the agreement with Stanford Health Care, a California nonprofit public benefit organization, to provide e-consult services for the term of March 18, 2026 through March 17, 2028, and increase the amount of the agreement by $472,316, to an amount not to exceed $616,000.
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BACKGROUND:
Effective March 18, 2026, the County and Stanford Health Care (SHC) commenced an electronic consultation (e-consult) program and participation agreement with a limit of 540 completed e-consults each contract year and with a provision that would allow a roll-over of unused e-consults to contract year two, not to exceed 1,080 over the two-year term, in an amount not to exceed $143,684.
The e-consult program allows the County’s primary care and specialty physicians to use Stanford’s licensed AristaMD platform to send e-consults to Stanford physicians while caring for County patients within San Mateo Medical Center (SMMC) and offsite clinics. E-consults are completed when Stanford’s specialists review the patient information sent over the platform and document their response to the County’s physician in the platform. Over the past two months, 91% of the e-consults were made from County primary care physicians to Stanford dermatologists, with the remaining 9% being directed to Stanford’s neurologists. SMMC expects growing consultations in pediatric care and miscellaneous other specialties as the program matures.
SHC provides the AristaMD platform and its physicians to the County at a rate of $96 per completed e-consult, a rate determined to be commercially reasonable and within fair market value. First, according to SHC, the $96 per completed e-consult rate is the same program rate SHC charges to all other health systems without exception. Second, also according to SHC, the $96 per completed e-consult rate incorporates all of SHC’s actual overhead expense for the AristaMD platform license, administrative and technical support, and physician time. It therefore does not appear that the rate was set as an inducement for SHC to gain patient referrals from the County. The program is resulting in a savings of $39 per consult in the specialty of dermatology compared to the County’s previous dermatology coverage agreement.
DISCUSSION:
This proposed amendment would increase the annual 540 completed e-consult cap to 3000, with a total cap over the two-year term of 6000. The amendment scales the existing $96 per completed e-consult rate over the term to arrive at an amount not to exceed $616,000 over the term of the agreement. The amendment also adds SHC’s sister hospital, Lucile Salter Packard Children’s Hospital at Stanford, within the scope of the agreement.
The County Attorney has reviewed and approved the resolution and agreement as to form.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that SHC shall have a resolution time of 6 hours for severe impact downtime support.
PERFORMANCE MEASURE:
|
Measure |
FY 2025-26 Actual |
FY 2026-27 Estimated |
|
Resolution time SHC shall have for severe impact downtime support |
6 hours |
6 hours |
COMMUNITY IMPACT:
County participation in SHC’s e-consult program impacts equitable health outcomes for County patients because the program facilitates providing care in the right place at the right time within the County’s health care facilities and obviates unnecessary referrals outside of the County for specialty care. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities. Since November 1, 2024, half of the patients at SMMC were female and half were male, the largest cohort of patients were Hispanic or Latino (58%), and a plurality were primarily Spanish speaking (48%).
FISCAL IMPACT:
The term of the agreement is March 18, 2026 through March 17, 2028. The amendment increases the amount payable under the agreement by $472,316 to an amount not to exceed $616,000 for the two-year term. The cost of the agreement is funded in part through a $159,000 Health Plan of San Mateo grant to seed the ramp-up of the program. Of the remaining $457,000 in expected cost, funds in the amount of $243,338 are included in the SMMC FY 2026-27 Recommended Budget. The remaining amount of $213,662 will be included in the SMMC FY 2027-28 Recommended Budget.
Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The portion of expenses for services provided to the medically indigent or to those covered by programs that do not meet the full costs of care is covered by the County’s General Fund contribution to SMMC and is within the existing annual appropriation.