NASHP Denver, COOctober 15, 2007

GiGi GobleLead Liaison, Georgia Telemedicine Program

Telemedicine Programs

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• Largest publicly traded health benefits company in the nation 34 Million Members 42,000 Associates

• Brands: Blue Cross/Blue Shield in 13 states, including the

Anthem brand Blue Cross of California Health Link UniCare

WellPoint, Inc.

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• Nation’s largest Medicaid managed care company Serving the health care needs of over 2 million

members Offering Medicaid, S-CHIP, and other low income,

publicly funded programs Partner with approximately 50,000 healthcare

providers

• 1994: Business unit established as pilot project in Sacramento, CA

• Early in the program, access to specialty care was identified as a challenge

State Sponsored Business

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• “AMA sees physician supply tightening in specialty areas”

amednews.com, American Medical Association, July 2005

• “US likely to Face a Physician Shortage in 2020”COGME, Association of American Medical Colleges, April 2006

• “America is Running out of physicians”Merritt, Hawkins & Associates, Association of American Medical Colleges, April 2006

Physician Supply -Current Issues in the US

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Telemedicine – The Solution

What is Telemedicine? The use of

• High speed phone lines• Medical cameras/devices • Computer technology

To examine, diagnose, treat and/or educate patients from a distance

Applications• Live Video - synchronized encounter• Store and Forward - data/image exchange

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Telemedicine Program –Reimbursement Enhanced

MEDICARE MEDICAID WELLPOINT

OFFICE VISIT (MID-LEVEL OR HIGHER) X X

SITE FEE X X

TELEPHONE CHARGES X

CONSULTATION X X X

SITE FEE X

TELEPHONE CHARGES

OFFICE VISIT (MID-LEVEL OR HIGHER) X

SITE FEE X

SECOND OPINION X

SITE FEE

* ONLY IN FEDERALLY FUNDED DEMONSTRATION PROJECTS IN ALASKA AND HAWAII

** CALIFORNIA WILL BEGIN PAYING FOR S&F DERMATOLOGY AND OPTOLOMOGY EFFECTIVE 7/1/06

PRESENTATION SITE

SPECIALTY CENTER

LIVE VIDEO

STORE AND FORWARD (S&F)

PRESENTATION SITE

SPECIALTY CENTER

* **

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Improves “Access to Care” in rural settings: Earlier diagnosis and treatment Earlier intervention and management of chronic

conditions Avoidance of escalation of chronic conditions

leading to high cost procedures Fewer repeated tests, labs, and exams as care is

managed locally Access to care without traveling great distances

and losing days at work or school Provides access to top academic Specialty

Locations in State Helps to retain rural providers due to peer

consults and continuous learning

Telemedicine Program - Benefits

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Program created to meet the challenges of “access to specialty care” for the S-CHIP population in CA In 1998, Managed Risk Medical Insurance Board

(MRMIB) provided grants for technology and support

Contracted with other self-funded telemedicine programs in the state

Blue Cross of California (BCC) State Sponsored Business unit develops, funds, and continues to manage the Blue Cross of California Telemedicine Program

BCC Telemedicine Program – History

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• Founded as a result of the Anthem and WellPoint merger (Dec. 2004) and in partnership with the GA Commissioner of Insurance

• Program Goal - Provide all rural Georgians with access to specialty care within 30 miles of their homes, and install 40 units in 18 months.

• Specific Objectives

Implement program to realize Telemedicine’s full

potential

Support rural healthcare and rural facilities in

Georgia

Georgia Telemedicine Program –History

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Georgia Telemedicine ProgramBCC Telemedicine Program

Telemedicine Programs – Network Maps

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BCC Telemedicine Program - Status

• 62 Presentation Sites Local, rural locations where patient is “presented” via

telemedicine to a specialist

• 8 Specialty Centers Cedars Sinai Medical Center University of California, Davis University of California, San Francisco, Dermatology Dept. Loma Linda University 2 Independent Dermatologists 1 Independent Podiatrist 1 Independent Psychotherapist

• Continued Expansion Underway Multi-specialty medical groups Other independent specialists

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BCC Telemedicine – Clinical Utilization

California Telemedicine

0

500

1,000

1,500

2,000

2,500

3,000

1999 2000 2001 2002 2003 2004 2005 2006 2007

Enc

ount

ers

*

* Projected

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BCC Telemedicine Program

Other Specialties• Cardiology• ENT• Gastroenterology• General Surgery• Genetics• Hematology• Hepatology• HIV/AIDS• Infectious Disease• Internal Medicine• Nephrology• Oncology• Ophthalmology• Orthopedics• Pain Management• Pulmonology• Rheumatology• Urology

Psychiatry34%

Endocrinology9%

Neurology Peds5%

Nutrition Services

4%

Other19%

Dermatology29%

Overall Utilization By Specialty

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• 37 Presentation Sites• 11 Specialty Centers

– 83 specialists credentialed in 45 specialties e.g. Dermatology, Endocrinology, Neurology, Cardiology, Wound Care, Diabetic Education, Psychiatry, Pediatric sub-specialties, etc

• 15 Teleradiology sites funded by WLP Foundation • Introduced an Appointment Scheduling system

– Improved efficiency for patient and specialist

Georgia Telemedicine Program – Status

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Georgia Telemedicine – Clinical Utilization

0

50

100

150

200

250

300

350

1/06 2 3 4 5 6 7 8 9 10 11 12 1/07 2 3 4 5

Encounters

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Georgia Telemedicine Program

Other Specialties• Cardiology• Child Psychiatry• ENT• Geriatric Psychiatry• Infectious Disease• Neurology• Nutrition• Pediatric Nephrology• Pediatric Endo• Pediatric Urology• Perinatology • Podiatry• Pulmonology• Reproductive Endo• Rheumatology• Vascular Surgery

Wound Care 16%

Diabetes Ed.15%

Adult Psych 5%

Endocrinology 6%

Other32%

Dermatology21%

Overall Utilization By Specialty

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• WellPoint is committed to increasing access to care for its members Telemedicine and Teleradiology are excellent

examples of how WellPoint will support adoption of new and innovative technologies, to bridge the gap between rural and urban healthcare delivery.

Surveys have shown over 90% satisfaction results with Telemedicine for our members, physicians, and specialists.

Summary

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• An 18 month old with a mysterious skin rash over her entire body• Parents without a solution to stop the itching and crying• Closest Dermatologist is over 100 miles away • Wait time to be seen in person - 6 months

Telemedicine Makes a Difference

The Impact of Telemedicine