The national discussion on health care reform has raised awareness of these dual challenges: costs are soaring, but more Americans need help from publicly-funded programs. With state budgets at the breaking point, it can be hard to see how to alleviate these conditions.That is what an innovative, valuable company should be able to do. Economic pressures create opportunities for innovation and advancement, and that remains the case today. Amerigroup provides innovative solutions to modern health system challenges, by doing things like engaging communities, partnering with providers and providing coordinated care. The results we’ve experience are improved health outcomes and lower costs.We do not operate like what you might think of as traditional insurance company – we do things like have case managers who visit our members’ homes to help them organize their care, we provide free cell phone minutes to members who need to call their doctors, and even help our members with household items like pest control, allergy bedding, and installing grab bars for people who might be at risk of falling.Because of our specialized population, we have to fight for programs and solutions that work best for our members. So, when a solution doesn’t readily exist to alleviate their health care problems, we innovate to fill the gap.
Medicaid beneficiaries living in small towns and isolated rural areas have decreased geographic access to health care providers – particularly specialists – and rely heavily on generalists for the majority of their care. When the state of Georgia asked Amerigroup to expand our service area to include several rural counties, we recognized our delivery system in these new counties would be different from the one we created in Atlanta. That is why we contracted with the Georgia Partnership for TeleHealth (GPT) to increase access to specialty care through the innovative use of technology, including telemedicine, health information exchange and telehealth. When Amerigroup members living in a remote area need to see a specialist not available in their community, their primary care doctor can refer them to one of GPT’s “presentation sites” located throughout the state, often within 30 miles of a member’s home. From the presentation site, using real-time video conferencing and other devices that support remote consults, the member can be examined by a specialist in GPT’s broadband-enabled network of more than 175 specialists, representing 40 physical and behavioral health specialties. Through GPT’s tracking of open appointments for panel specialists anywhere in the state, specialist consults via telehealth now can be requested by Amerigroup PCPs and scheduled statewide in a matter of days or even hours, instead of weeks or months. Hundreds of Amerigroup members have accessed specialty care through GPT’s network since the program started in 2011. Access to specialty services via telehealth has not only reduced delays in receiving specialty consults and follow-up appointments in areas that have poor access to specialty care, it also has reduced transportation expenses and missed days from work.
4.gpt ppt dr alexandervfor cmap_rtg_final
Integration of Telehealth Into Managed Care Dr. William AlexanderChief Medical Officer, Amerigroup Georgia March 19, 2013
Who We Are: Amerigroup• We have 17 years of experience providing access to health care for 2.7 million members in 13 states, focusing solely on federal and state programs• We’re one of the first companies to integrate coordination of physical, behavioral and social needs while emphasizing community-based care• We offer real solutions to address the health care needs of the financially vulnerable, seniors and people with disabilities• Our Foundation has provided more than $16.7 million to community organizations since 2001
Amerigroup-WellPoint State ActivityAs a wholly owned subsidiary of WellPoint, together with its affiliatedhealth plans, the combined organizations serve 4.5 million members in20 states, making us the largest provider of health care solutions topublic programs.
About Amerigroup Georgia • We serve 288,000 members — Medicaid — Planning for Healthy Babies — Children’s Health Insurance Program — Medicare Advantage • We have 193 employees, including 62 doctors, nurses and social workers • We have 18,096 providers and 125 hospitals • We have donated 4,655 in volunteer hours and $210,600 • National Committee Quality Assurance accreditation: Excellent • Extra Benefits — 24-hour HelpLine — Cellular phone service, health- — Adult vision and dental care related text messages and extra — Certain approved over-the-counter minutes for those who qualify medications prescribed by a doctor through SafeLink — Free Boys & Girls Club membership — Free transportation to doctor’s appointments for PeachCare for Kids1. Rural Assistance Center, Georgia, http://www.raconline.org/states/georgia.php. members
Why We Innovate • Result of both the pressures of economic recession and recovery – and the continuing high unemployment rate – but, also, the scope of health care reform • U.S. health system at 30,000 feet in 2019: majority of health spending will be public (51.9 percent) versus private (48.1 percent) • With total expenditures on health slated to hit $4.5 trillion by the end of the decade, innovative solutions to lower costs and promote system efficiency will be keyinnovateto fill the gapSource: Congressional Budget Office, Mar. 2010; U.S. Census Bureau, Aug. 2008; Centers forMedicare & Medicaid Services, Feb. 2010; MedPAC Data Book, June 2009.
Rural Georgia • The poverty rate in rural Georgia is 23.5 percent, compared to 16.7 percent in urban areas of the state — a 25 increase from the U.S. rate in rural America (17.8 percent) and 11 percent increase from the rate in urban America (14.8 percent), respectively1 • Georgia has 118 rural counties: Poverty rates for rural counties exceed those in urban counties by 58 percent. The rural counties have approximately half as many physicians and dramatic shortages of nurses, therapists and nutritionists (per capita) as the metro counties21. Rural Assistance Center, Georgia, http://www.raconline.org/states/georgia.php; Rural Assistance Center, United States, http://www.raconline.org/states/unitedstates.php; 2. Georgia Health EquityInitiative, Health Disparities Report 2008: A County-Level Look at Health Outcomes for Minorities in Georgia, http://health.state.ga.us/pdfs/ohip/Georgia%20Health%20Equity%20Initiative.pdf
Rural Georgia, cont’d. • In Georgia, 24 percent of the rural population has not completed high school, compared to 16.7 percent of urban populations — a 26.6 percent increase from that of rural America (17.6 percent) and an 11.9 percent increase from that of urban America (14.7 percent), respectively1 • 22 percent of Georgians are uninsured; a 27 percent increase over the national average (16 percent)21. Rural Assistance Center, Georgia, http://www.raconline.org/states/georgia.php; Rural Assistance Center, United States, http://www.raconline.org/states/unitedstates.php; 2. Ibid.
Health Care Priorities in Rural GeorgiaAmerigroup members in rural Georgia face three significantchallenges, which we are working to address:• Inadequate access to care• Reduced access to specialty care• Timely access to behavioral health and specialty consultations
Georgia Telemedicine ProgramProblem• Inadequate access to specialty care in select rural and underserved counties in Georgia Solution • First Care Management Organization (CMO) to become a partner with GPT, the statewide telemedicine network leader (140 specialists, 40 sites) in August 2011 • Population- and geographic-based targeting strategy for future presentation site deployment (i.e., highest Medicaid eligibles, greatest specialist deficiencies) • Incorporation into internal case management rounds as a resource to improve access for members with greatest needs • Targeted provider and member marketing and external communications in counties with existing sites • Ongoing collaboration with GPT to address policy hurdles, analytics and future innovation
Funding Our Telemedicine Initiative Supporting GPT and the targeted deployment of presentation sites to improve access to underserved rural populations: 2011 grant to add presentation sites: $20,000 • Evans Memorial Hospital — Evans County • Meadows Regional — Toombs County 2012 grant for school-based health clinic programs: $50,0001 • Jenkins County High School and Middle School • Optim Medical Center Jenkins • Optim Medical Center Tattnall2 • Optim Medical Center Screven21. Includes full presentation capabilities; available to students and community on a year-round basis.2. Expected to come online within GPT’s network by Q2-2013.
Patient-Centered Medical Home UpdateProblem • Timely access to behavioral health consultations for select high-volume Patient-Centered Medical Home (PCMH) and primary care groups Solution • In 2012, collaborated with a GPT partner to provide on-site presentation capabilities for four PCMH groups • Practices now have the ability to provide same-day, same- week access to specialist behavioral health consultations • Approximately 9,000 members have improved access to address behavioral health issues • 30–40 consultations per week across all groups • Improved member and provider satisfaction, reduction in time/cost away from work, lengthy gaps in appointment times • Enhances the ability of the primary care physician to coordinate the patient’s care
Telehealth by the NumbersGreater focus on building and communicating the benefits oftelemedicine has seen a rapid increase in the number of uniquemembers, providers and geographic areas accessing telemedicineservices.
Utilization Observations and Early Trends • Greater than 90% of total utilization is encompassed by the top 10 procedure codes • Of those top 10 procedure codes, behavioral health services are currently the overall key driver in utilization • The percentage of utilization occurring in the top 10 counties is steadily decreasing, indicating greater access in a growing number of counties* All results are specific to a sample population of 501 members that: (a) utilized telemedicine services in 2012, (b) had at least 1 claim in 2011 and 2012.
Q-and-A Dr. William AlexanderWilliam.Alexander@amerigroup.com