2016 Montana Medical Association Annual Membership and Board of Trustees Meeting. Blue Cross Blue Shield of Montana Telemedicine Update

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1 2016 Montana Medical Association Annual Membership and Board of Trustees Meeting Blue Cross Blue Shield of Montana Telemedicine Update September 9, 2016 Presented by: Paul Pedersen Senior Director, Provider Network Management 1

2 Overview BCBSMT s virtual visit solution, powered by MDLIVE, provides the ability for members to virtually visit with a physician by online video for non-emergency medical and behavioral health needs. Topic VIRTUAL CARE, EVERYWHERE Home / Remote Site Self-Insured Employer School Rural Site Valuable Benefits Include: Improved Access 24/7 real-time clinical care Reduced wait and travel times Cost Savings Costs less than an in-person visit Redirection of unnecessary ER and Urgent Care visits Improved Health Additional care management opportunity Ability for providers to e-prescribe, when appropriate 94% Of member issues are resolved during the initial visit A $40 virtual visit costs on average: $85 LESS THAN a PCP visit $250 LESS THAN Urgent Care $950 LESS THAN an ER visit 1 MDLIVE Analytics Team, June BCBSIL Analytics Team, Oct

3 Product Details Recognizing the need to improve our ability to respond to the market need, BCBSMT is in the process of implementing an integrated solution for 1/1/2017. Our 2017 Offering Provides: Seamless access to the virtual visit portal from Blue Access for Members SM (BAM) and BAM Mobile app Integration with BCBSMT transparency products* Shared (BCBSMT and MDLIVE) customer service support Co-branded print communications and web portals Behavioral Health included** Standard billing and reporting with Medical BCBSMT manages the contract with MDLIVE * Please note: All enhancements are dependent upon the implementation and funding. *Access to certain transparency products may not be available for all plans. **Behavioral Health included for fully insured only; optional for ASO. 3

4 Conditions Non-Emergency Medical Conditions Allergies Cold and flu Diarrhea Earache Fever Headache Insect bites Nausea Pinkeye Sore throat Pediatric Care Cold and flu Earache Nausea Behavioral Health Depression and anxiety Marital problems Child behavior and learning issues Financial hardship Coping with loss and grief Stresses and challenges of everyday life * Fully Insured groups receive both Medical and Behavioral Health; whereas Behavioral Health is an option for ASO and Labor groups. 4

5 Communication Mode by State MDLIVE s call center, web portal and mobile app provide consults for non-emergency medical conditions as available in the state where the member is currently located. When a member is located in MT, they are limited to interactive audio/video only*. ME WA OR CA AK NV ID UT AZ MT WY CO NM ND SD NE KS TX OK MN WI IA IL MO AR MS LA MI OH IN KY TN NY PA WV VA NC SC AL GA FL RI VT CT NJ NH DE MA DC MD Full services online video & telephone Services limited to telephone only Services limited to online video only Services temporarily suspended HI *Non-emergency medical conditions only. Behavioral Health consults are available by online audio/video only. 5

6 Network Details BCBSMT currently reimburses local Blue providers for telehealth consults and will continue to do so where the state mandate applies. MDLIVE will be treated as another in-network provider / access point for members. MDLIVE will have responsibility of individual provider credentialing while BCBSMT will conduct Delegation Oversight for the MDLIVE provider network. MDLIVE is recruiting additional providers with licenses in MT to maintain adequate provider availability given the additional MT membership. Local Blue providers have the ability to join MDLIVE s network. They can learn more by going to Local Blue providers can also purchase MDLIVE s software to offer telehealth services themselves, if they do not currently have the technology available. Virtual Visits is available in all HMO and PPO networks, but will not be available in the POS networks due to it s narrow / exclusive provider agreements. 6