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

2. 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

3. 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

4. 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…

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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.

11. 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

12. 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

13. Questions