Telehealth Pilot Project. California Health & Wellness 6/9/2015. Region IX Leadership Institute

Transcription

1 Telehealth Pilot Project Region IX Leadership Institute 6/9/2015 California Health & Wellness California Health & Wellness is a managed care organization Established in 2013 Serves 170,000+ Members; 19 counties 170+ staff Headquartered in Sacramento Permanent satellite offices in: Chico (Butte County) El Centro (Imperial County) Placerville (El Dorado County) San Diego Subsidiary of Centene Corporation Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Tuolumne, and Yuba 2 1

2 California Health & Wellness Our Purpose Transform the health of the community, one person at a time Our Beliefs We believe in treating the whole person, not just the physical body. We believe treating people with kindness, respect and dignity empowers healthy decisions. We believe we have a responsibility to remove barriers and make it simple to get well, stay well and be well. We believe local partnerships enables meaningful, accessible healthcare. We believe healthier individuals create more vibrant families and communities. 3 Key Take-away Objectives 1) Define how telehealth, as a care delivery model, can optimize health outcomes. 2) Describe how telehealth can enhance primary care provider/specialist communications and facilitate more effective health care. 3) Identify aspects of telehealth that can better manage logistics and costs along the continuum of health care. 4 2

3 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. 5 Alignment with California s Triple Aim Initiative CH&W Telehealth Strategy Principles Redesigning the Health System Using live video and store and forward technologies to deliver 21 st century care. Providing timely access to specialty care Creating Healthy Communities Expanding role of PCP through knowledge transfer from specialist consultations Keeping care local by reducing member travel Managing chronic disease through medical home management Lowering Cost of Care Providing value-based care Capturing encounter data to track effect on ER visits 3

4 Building a Better System Three Pillars: High Quality High Tech High Touch 4

5 Three Core Objectives: Facilitated Communication Telehealth Enhanced Access Coordination Telehealth Pilot Project Sites Specialty Care Disciplines Proposed for Pilot Project Focus: Dermatology Endocrinology Mental Health Pain Management Rheumatology Pediatric Neurology Member Volume: (April 2015) Ampla: 18,743 Chapa De: 3,756 Clinicas: 18,445 Total = 40,

6 11 Anticipated Benefits Live Video/ Store and Forward Visit- Originating from Provider Site + Patient PCP Specialist Increased member and provider satisfaction Decreased wait times Lower costs Builds downstream capacity at clinic level Better outcomes/hedis Scores 6

7 Telehealth Provider Partners Specialty Provider Groups Cardiology, Dermatology, Endocrinology, Family Practice, Gastroenterology, General Surgery, Hematology/Oncology, Hepatology, Infectious Disease, Internal Medicine, Mental Health Counseling, Nephrology, Neurology, Neurosurgery, Oncological Surgery, Orthopedics, Otolaryngology, Pain Management, Physical Medicine and Rehab, Psychiatry, Pulmonology, Rheumatology, Sleep Medicine, Urology, Vascular Surgery Telemedicine readiness assessment for CH&W providers Telemedicine orientation training for provider staff econsult direct messaging platform Patient web based patient referral and scheduling platform Single sign on capability to use both tools Broadband assessments and services as appropriate based on provider needs CTN Connect web based video conferencing Clearing house of California telemedicine specialty care providers Coordinate telehealth training resources for CH&W 13 Reimbursement Strategy: California Health & Wellness is providing reimbursement for 12-month pilot-site clinics Provisions for CPT-4 code based reimbursement for care relative to telehealth activities. Both: delivered in the primary care clinic by the specialist Significant Investment of Resources Strategic Focus/Thoughtful Approach Addressing inefficiencies Investigating the overall downstream quality and financial impact of this model of care 7

8 Thank you! Mark Schweyer, BSN, MBA Director, Telehealth Programs Questions 8