Download - Telemedicine Programs
NASHP Denver, COOctober 15, 2007
GiGi GobleLead Liaison, Georgia Telemedicine Program
Telemedicine Programs
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• Largest publicly traded health benefits company in the nation 34 Million Members 42,000 Associates
• Brands: Blue Cross/Blue Shield in 13 states, including the
Anthem brand Blue Cross of California Health Link UniCare
WellPoint, Inc.
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• Nation’s largest Medicaid managed care company Serving the health care needs of over 2 million
members Offering Medicaid, S-CHIP, and other low income,
publicly funded programs Partner with approximately 50,000 healthcare
providers
• 1994: Business unit established as pilot project in Sacramento, CA
• Early in the program, access to specialty care was identified as a challenge
State Sponsored Business
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• “AMA sees physician supply tightening in specialty areas”
amednews.com, American Medical Association, July 2005
• “US likely to Face a Physician Shortage in 2020”COGME, Association of American Medical Colleges, April 2006
• “America is Running out of physicians”Merritt, Hawkins & Associates, Association of American Medical Colleges, April 2006
Physician Supply -Current Issues in the US
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Telemedicine – The Solution
What is Telemedicine? The use of
• High speed phone lines• Medical cameras/devices • Computer technology
To examine, diagnose, treat and/or educate patients from a distance
Applications• Live Video - synchronized encounter• Store and Forward - data/image exchange
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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
* **
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Improves “Access to Care” in rural settings: Earlier diagnosis and treatment Earlier intervention and management of chronic
conditions Avoidance of escalation of chronic conditions
leading to high cost procedures Fewer repeated tests, labs, and exams as care is
managed locally Access to care without traveling great distances
and losing days at work or school Provides access to top academic Specialty
Locations in State Helps to retain rural providers due to peer
consults and continuous learning
Telemedicine Program - Benefits
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Program created to meet the challenges of “access to specialty care” for the S-CHIP population in CA In 1998, Managed Risk Medical Insurance Board
(MRMIB) provided grants for technology and support
Contracted with other self-funded telemedicine programs in the state
Blue Cross of California (BCC) State Sponsored Business unit develops, funds, and continues to manage the Blue Cross of California Telemedicine Program
BCC Telemedicine Program – History
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• Founded as a result of the Anthem and WellPoint merger (Dec. 2004) and in partnership with the GA Commissioner of Insurance
• Program Goal - Provide all rural Georgians with access to specialty care within 30 miles of their homes, and install 40 units in 18 months.
• Specific Objectives
Implement program to realize Telemedicine’s full
potential
Support rural healthcare and rural facilities in
Georgia
Georgia Telemedicine Program –History
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Georgia Telemedicine ProgramBCC Telemedicine Program
Telemedicine Programs – Network Maps
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BCC Telemedicine Program - Status
• 62 Presentation Sites Local, rural locations where patient is “presented” via
telemedicine to a specialist
• 8 Specialty Centers Cedars Sinai Medical Center University of California, Davis University of California, San Francisco, Dermatology Dept. Loma Linda University 2 Independent Dermatologists 1 Independent Podiatrist 1 Independent Psychotherapist
• Continued Expansion Underway Multi-specialty medical groups Other independent specialists
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BCC Telemedicine – Clinical Utilization
California Telemedicine
0
500
1,000
1,500
2,000
2,500
3,000
1999 2000 2001 2002 2003 2004 2005 2006 2007
Enc
ount
ers
*
* Projected
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BCC Telemedicine Program
Other Specialties• Cardiology• ENT• Gastroenterology• General Surgery• Genetics• Hematology• Hepatology• HIV/AIDS• Infectious Disease• Internal Medicine• Nephrology• Oncology• Ophthalmology• Orthopedics• Pain Management• Pulmonology• Rheumatology• Urology
Psychiatry34%
Endocrinology9%
Neurology Peds5%
Nutrition Services
4%
Other19%
Dermatology29%
Overall Utilization By Specialty
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• 37 Presentation Sites• 11 Specialty Centers
– 83 specialists credentialed in 45 specialties e.g. Dermatology, Endocrinology, Neurology, Cardiology, Wound Care, Diabetic Education, Psychiatry, Pediatric sub-specialties, etc
• 15 Teleradiology sites funded by WLP Foundation • Introduced an Appointment Scheduling system
– Improved efficiency for patient and specialist
Georgia Telemedicine Program – Status
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Georgia Telemedicine – Clinical Utilization
0
50
100
150
200
250
300
350
1/06 2 3 4 5 6 7 8 9 10 11 12 1/07 2 3 4 5
Encounters
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Georgia Telemedicine Program
Other Specialties• Cardiology• Child Psychiatry• ENT• Geriatric Psychiatry• Infectious Disease• Neurology• Nutrition• Pediatric Nephrology• Pediatric Endo• Pediatric Urology• Perinatology • Podiatry• Pulmonology• Reproductive Endo• Rheumatology• Vascular Surgery
Wound Care 16%
Diabetes Ed.15%
Adult Psych 5%
Endocrinology 6%
Other32%
Dermatology21%
Overall Utilization By Specialty
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• WellPoint is committed to increasing access to care for its members 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.
Surveys have shown over 90% satisfaction results with Telemedicine for our members, physicians, and specialists.
Summary
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• An 18 month old with a mysterious skin rash over her entire body• Parents without a solution to stop the itching and crying• Closest Dermatologist is over 100 miles away • Wait time to be seen in person - 6 months
Telemedicine Makes a Difference
The Impact of Telemedicine