Telemedicine Programs

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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Gigi Goble

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  • Telemedicine Programs

    1. 1. NASHP Denver, CO October 15, 2007 GiGi Goble Lead Liaison, Georgia Telemedicine Program Telemedicine Programs
    2. 2. <ul><li>Largest publicly traded health benefits company in the nation </li></ul><ul><ul><li>34 Million Members </li></ul></ul><ul><ul><li>42,000 Associates </li></ul></ul><ul><li>Brands: </li></ul><ul><ul><li>Blue Cross/Blue Shield in 13 states, including the Anthem brand </li></ul></ul><ul><ul><li>Blue Cross of California </li></ul></ul><ul><ul><li>Health Link </li></ul></ul><ul><ul><li>UniCare </li></ul></ul>WellPoint, Inc.
    3. 3. <ul><li>Nation’s largest Medicaid managed care company </li></ul><ul><ul><li>Serving the health care needs of over 2 million members </li></ul></ul><ul><ul><li>Offering Medicaid, S-CHIP, and other low income, publicly funded programs </li></ul></ul><ul><ul><li>Partner with approximately 50,000 healthcare providers </li></ul></ul><ul><li>1994: Business unit established as pilot project in Sacramento, CA </li></ul><ul><li>Early in the program, access to specialty care was identified as a challenge </li></ul>State Sponsored Business
    4. 4. <ul><li>“ AMA sees physician supply tightening in specialty areas” </li></ul><ul><li>amednews.com, American Medical Association, July 2005 </li></ul><ul><li>“ US likely to Face a Physician Shortage in 2020” </li></ul><ul><li>COGME, Association of American Medical Colleges, April 2006 </li></ul><ul><li>“ America is Running out of physicians” </li></ul><ul><li>Merritt, Hawkins & Associates, Association of American Medical Colleges, April 2006 </li></ul>Physician Supply - Current Issues in the US
    5. 5. Telemedicine – The Solution <ul><li>What is Telemedicine? </li></ul><ul><ul><li>The use of </li></ul></ul><ul><ul><ul><li>High speed phone lines </li></ul></ul></ul><ul><ul><ul><li>Medical cameras/devices </li></ul></ul></ul><ul><ul><ul><li>Computer technology </li></ul></ul></ul><ul><ul><li>To examine, diagnose, </li></ul></ul><ul><ul><li>treat and/or educate patients </li></ul></ul><ul><ul><li>from a distance </li></ul></ul><ul><ul><li>Applications </li></ul></ul><ul><ul><ul><li>Live Video - synchronized encounter </li></ul></ul></ul><ul><ul><ul><li>Store and Forward - data/image exchange </li></ul></ul></ul>
    6. 6. Telemedicine Program – Reimbursement Enhanced * ** MEDICARE MEDICAID WELLPOINT OFFICE VISIT (MID-LEVEL OR HIGHER) X X SITE FEE X X TELEPHONE CHARGES X CONSULTATION X X X SITE FEE X TELEPHONE CHARGES OFFICE VISIT (MID-LEVEL OR HIGHER) X SITE FEE X SECOND OPINION X SITE FEE * ONLY IN FEDERALLY FUNDED DEMONSTRATION PROJECTS IN ALASKA AND HAWAII ** CALIFORNIA WILL BEGIN PAYING FOR S&F DERMATOLOGY AND OPTOLOMOGY EFFECTIVE 7/1/06 PRESENTATION SITE SPECIALTY CENTER LIVE VIDEO STORE AND FORWARD (S&F) PRESENTATION SITE SPECIALTY CENTER
    7. 7. <ul><li>Improves “Access to Care” in rural settings: </li></ul><ul><ul><li>Earlier diagnosis and treatment </li></ul></ul><ul><ul><li>Earlier intervention and management of chronic conditions </li></ul></ul><ul><ul><li>Avoidance of escalation of chronic conditions leading to high cost procedures </li></ul></ul><ul><ul><li>Fewer repeated tests, labs, and exams as care is managed locally </li></ul></ul><ul><ul><li>Access to care without traveling great distances and losing days at work or school </li></ul></ul><ul><ul><li>Provides access to top academic Specialty Locations in State </li></ul></ul><ul><ul><li>Helps to retain rural providers due to peer consults and continuous learning </li></ul></ul>Telemedicine Program - Benefits
    8. 8. <ul><li>Program created to meet the challenges of “access to specialty care” for the S-CHIP population in CA </li></ul><ul><ul><li>In 1998, Managed Risk Medical Insurance Board (MRMIB) provided grants for technology and support </li></ul></ul><ul><ul><li>Contracted with other self-funded telemedicine programs in the state </li></ul></ul><ul><ul><li>Blue Cross of California (BCC) State Sponsored Business unit develops, funds, and continues to manage the Blue Cross of California Telemedicine Program </li></ul></ul>BCC Telemedicine Program – History
    9. 9. <ul><li>Founded as a result of the Anthem and WellPoint merger (Dec. 2004) and in partnership with the GA Commissioner of Insurance </li></ul><ul><li>Program Goal - Provide all rural Georgians with access to specialty care within 30 miles of their homes, and install 40 units in 18 months. </li></ul><ul><li>Specific Objectives </li></ul><ul><ul><li>Implement program to realize Telemedicine’s full potential </li></ul></ul><ul><ul><li>Support rural healthcare and rural facilities in Georgia </li></ul></ul>Georgia Telemedicine Program – History
    10. 10. Telemedicine Programs – Network Maps Georgia Telemedicine Program BCC Telemedicine Program
    11. 11. BCC Telemedicine Program - Status <ul><li>62 Presentation Sites </li></ul><ul><ul><li>Local, rural locations where patient is “presented” via telemedicine to a specialist </li></ul></ul><ul><li>8 Specialty Centers </li></ul><ul><ul><li>Cedars Sinai Medical Center </li></ul></ul><ul><ul><li>University of California, Davis </li></ul></ul><ul><ul><li>University of California, San Francisco, Dermatology Dept. </li></ul></ul><ul><ul><li>Loma Linda University </li></ul></ul><ul><ul><li>2 Independent Dermatologists </li></ul></ul><ul><ul><li>1 Independent Podiatrist </li></ul></ul><ul><ul><li>1 Independent Psychotherapist </li></ul></ul><ul><li>Continued Expansion Underway </li></ul><ul><ul><li>Multi-specialty medical groups </li></ul></ul><ul><ul><li>Other independent specialists </li></ul></ul>
    12. 12. BCC Telemedicine – Clinical Utilization * * Projected
    13. 13. BCC Telemedicine Program <ul><li>Other Specialties </li></ul><ul><li>Cardiology </li></ul><ul><li>ENT </li></ul><ul><li>Gastroenterology </li></ul><ul><li>General Surgery </li></ul><ul><li>Genetics </li></ul><ul><li>Hematology </li></ul><ul><li>Hepatology </li></ul><ul><li>HIV/AIDS </li></ul><ul><li>Infectious Disease </li></ul><ul><li>Internal Medicine </li></ul><ul><li>Nephrology </li></ul><ul><li>Oncology </li></ul><ul><li>Ophthalmology </li></ul><ul><li>Orthopedics </li></ul><ul><li>Pain Management </li></ul><ul><li>Pulmonology </li></ul><ul><li>Rheumatology </li></ul><ul><li>Urology </li></ul>Overall Utilization By Specialty
    14. 14. <ul><li>37 Presentation Sites </li></ul><ul><li>11 Specialty Centers </li></ul><ul><ul><ul><li>83 specialists credentialed in 45 specialties e.g. Dermatology, Endocrinology, Neurology, Cardiology, Wound Care, Diabetic Education, Psychiatry, Pediatric sub-specialties, etc </li></ul></ul></ul><ul><li>15 Teleradiology sites funded by WLP Foundation </li></ul><ul><li>Introduced an Appointment Scheduling system </li></ul><ul><ul><ul><li>Improved efficiency for patient and specialist </li></ul></ul></ul>Georgia Telemedicine Program – Status
    15. 15. Georgia Telemedicine – Clinical Utilization
    16. 16. Georgia Telemedicine Program <ul><li>Other Specialties </li></ul><ul><li>Cardiology </li></ul><ul><li>Child Psychiatry </li></ul><ul><li>ENT </li></ul><ul><li>Geriatric Psychiatry </li></ul><ul><li>Infectious Disease </li></ul><ul><li>Neurology </li></ul><ul><li>Nutrition </li></ul><ul><li>Pediatric Nephrology </li></ul><ul><li>Pediatric Endo </li></ul><ul><li>Pediatric Urology </li></ul><ul><li>Perinatology </li></ul><ul><li>Podiatry </li></ul><ul><li>Pulmonology </li></ul><ul><li>Reproductive Endo </li></ul><ul><li>Rheumatology </li></ul><ul><li>Vascular Surgery </li></ul>Overall Utilization By Specialty
    17. 17. <ul><li>WellPoint is committed to increasing access to care for its members </li></ul><ul><ul><li>Telemedicine and Teleradiology are excellent examples of how WellPoint will support adoption of new and innovative technologies, to bridge the gap between rural and urban healthcare delivery. </li></ul></ul><ul><ul><li>Surveys have shown over 90% satisfaction results with Telemedicine for our members, physicians, and specialists. </li></ul></ul>Summary
    18. 18. <ul><ul><li>An 18 month old with a mysterious skin rash over her entire body </li></ul></ul><ul><ul><li>Parents without a solution to stop the itching and crying </li></ul></ul><ul><ul><li>Closest Dermatologist is over 100 miles away </li></ul></ul><ul><ul><li>Wait time to be seen in person - 6 months </li></ul></ul>Telemedicine Makes a Difference The Impact of Telemedicine

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