Telehealth Pilot Project Mark Schweyer, BSN, MBA Director of Telehealth Programs

California Health & Wellness California Health & Wellness is a Medi-Cal managed care organization Established in 2013 19 Rural Counties Most providers and members are new to managed care concepts Subsidiary of Centene Corporation

ACA Impact on Medi-Cal Pre-ACA Medi-Cal Population Traditionally TANF (Women and Children) & SPDs Post ACA Medi-Cal Population Expanded Medi-Cal eligibility Added new populations Duals MCE 12.5 million enrollees 1 out of 3 Californians

Rural California Post ACA Provider Network in Rural Counties Heavy reliance on FQHCs and RHCs Continued access & availability challenges Historic low levels of providers that see Medi-Cal patients Alternate approaches required to meet the needs of the members Contracted outside of county Enhanced provider network to align with existing travel patterns Enhanced transportation benefit Promoted use of physician extenders and community health workers Telehealth Solutions Biggest Challenge --- Expanded Medi-cal but didn’t expand our provider options…still challenged in rural communities… Operational Challenge --- Relying on specialists to devote half a day to go see a patient in a rural community Geographical Challenge --- Some counties require members to travel 2 hours to see a specialist…creates unique barriers…

Three Core Objectives: Telehealth Facilitated Communication Care Coordination Enhanced Access Recognizing the historical barriers regarding lack of access, geographic isolation, and socio-economic disparities that exist in rural communities, California Health and Wellness has developed a strategic initiative to utilize telehealth technologies to: Enhance rural primary care access to specialists Facilitate communication between rural primary care practitioners Optimize care coordination

ELECTRONIC CONSULTATION Telehealth Solutions ELECTRONIC CONSULTATION STORE-AND-FORWARD LIVE VIDEO Electronic Consultation – will provide a HIPAA-compliant platform to facilitate primary care practitioner/specialist communication with very rapid turnaround Store-and-Forward Technology – (Specifically diabetic retinopathy and dermatology) will allow for efficient transfer of medical imaging to specialists with consultative reports diagnosis and treatment recommendations within 48 hours. Patient can remain in their own communities and home clinics. Live Video – will provide real-time consultations between our members and distant-site specialists and include their own primary care practitioners to achieve the most-optimal patient-centered medical-home based care

VIDEO REMOTE INTERPRETATION Telehealth Solutions Interpreters are challenging to find particularly when “face-to-face” services are required in remote communities. Exacerbated when travel is required over mountainous terrain in winter months. We are piloting “on-demand” and short-turnaround scheduled video-remote interpretation at clinical sites while studying member and provider satisfaction. We are developing models that ensure scalability across clinics of differing sizes and resources. Built-in economies of scale and cost-efficiencies. VIDEO REMOTE INTERPRETATION

Centralized Scheduling A single point of contact for our members, primary care practitioners, and multi-specialty provider groups Alignment with our extensive array specialty companies that offer assistance with coordination of transportation benefits, case-management, behavioral health services, and member connection services Scheduling coordination across multiple primary care sites and multi-specialty groups that enhancing care coordination and allows for opportunities to ensure that we are meeting our access and availability standards.

Centralized Scheduling Coordination of clinical documentation transfer from primary care sites to specialty providers Creates workflow efficiencies at both the primary care sites and for specialty groups Reduces incidence of member no-shows through timely and personalized scheduling that connects members with resources needed to attend appointments

Goals Increase provider and member satisfaction through the offering of easy, secure and efficient programs and services. Increase access to quality specialists and optimize face to face visits. Develop new models of care that build capacity within the community, reinforce existing programs and increase the ability of PCPs to manage basic specialty services. Improve the management of disease/chronic illness among high-risk members. Ensure that service offerings enhance the affordability of the network and do not increase care delivery costs. Reduction in ER utilization and long-distance travel expense.

Measuring and Ensuring Success Development of specific performance metrics Continuous quality oversight through data analysis Working closely with the State of California to ensure alignment of telehealth efforts with Medi-Cal payment models Starting with less complex service deliverables: Store-and-Forward technologies, video remote interpretation Developing new solutions based on historical lessons learned

A New World Health plan payer support Provider partnerships Thoughtfully designed pilot program Health plan support helps provide resources to rural health facilities to better position the planning, development and execution of telehealth programs. Promotes long-term financial solvency of clinical models Helps create synergy to achieve financial and operational success Strong partnerships allow us to develop operational norms through continuously testing the model. As we move forward these partnerships will enable us to share best practices and make timely thoughtful adjustments to the model that will allow for scalability to wider geographies

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