1. Sam Head Manager of Health Improvement Initiatives South Carolina Department of Health and Human Services The Role of Telemedicine in Expanding Prenatal Care

2. OB/GYN & Telemedicine Medicaid Accountability & Quality Improvement Initiative Designed to increase value and transparency in the current system, invest in hotspots of poor health, reduce per capita costs and improve health outcomes. Proviso divided into seven segments: Hospital & Clinic Innovations (sections A(1), C, D) Hospital Transparency (section A(2)) Disproportionate Share Hospital Accountability (section B) Graduate Medical Education (GME) Payments (section E(1)) Telemedicine & OB/GYN (section E(2)) Optional State Supplement (OSS) (section F) Reporting (section G) Proviso 33.34

3. OB/GYN & Telemedicine Section E(2): “The department shall develop a program to leverage the use of teaching hospitals to provide rural physician coverage, expand the use of telemedicine, and ensure targeted placement and support of OB/GYN services in at least four (4) counties with a demonstrated lack of adequate OB/GYN resources by July 1, 2014.” Telemedicine & OB/GYN

4. Selection Criteria: Primary OB/GYN Secondary OB/GYN Average distance to closest primary practice County Selection Data provided by the University of South Carolina, Institute for Families in Society, Division of Policy and Research on Medicaid and Medicare. Allendale, Bamberg, Barnwell, and Hampton

5. OB/GYN & Telemedicine

6. Project Elements Access Local family physicians to provide prenatal care Telemedicine Used as a tool to connect these underserved counties with more specialized services in other areas of the state Collaboration Regular communication between local providers, OB/GYN physicians in neighboring counties, and Maternal Fetal Medicine Specialists at USC and MUSC Care Management Partnering with Low Country Healthy Start for enhanced care coordination, case management, and patient outreach & education

7. OB/GYN & Telemedicine Family Physicians Provide low-risk prenatal care in county Recommended minimum of two (2) telemedicine encounters per patient Participate in MFM led collaboration sessions as scheduled Regular communication with delivering physician Refer patients to Low Country Healthy Start for enhanced care coordination & management services Participation in LCHS led Multidisciplinary Team meetings Continually educate patients on the use of telemedicine to build comfort and confidence level Project Roles

8. OB/GYN & Telemedicine MUSC/USC Maternal Fetal Medicine Lead on-site collaboration sessions with participating primary care providers. Regular communication with local prenatal care provider. Provide MFM telemedicine consults to FPs and OBs Unlimited use of medically necessary telemedicine consults for high-risk pregnancies Participation in LCHS led Multidisciplinary Team meetings. Continually educate patients on the use of telemedicine to build comfort and confidence level of patient. Project Roles

9. OB/GYN & Telemedicine How? Palmetto State Providers Network (PSPN) Current or upgraded internet connection Connectivity Who? Primary Care configured to USC, MUSC, and nearby OB/GYN sites. OB/GYN sites connected to USC, MUSC, and referring primary care sites. MUSC and USC will be available to all participating practices

10. Abbeville Edgefield McCormick Saluda Proviso 33.26 Counties (July 2015 – June 2016)