Integration of Telehealth Into Managed CareDr. William Alexander

Chief Medical Officer, Amerigroup Georgia March 19, 2013

Who We Are: Amerigroup

• We have 17 years of experience providingaccess to health care for 2.7 million members in 13 states, focusing solely on federal and state programs

• We’re one of the first companies to integrate coordination of physical, behavioral and social needs while emphasizing community-based care

• We offer real solutions to address the health care needs of the financially vulnerable, seniors and people with disabilities

• Our Foundation has provided more than $16.7 million to community organizations since 2001

Amerigroup-WellPoint State Activity

As a wholly owned subsidiary of WellPoint, together with its affiliated health plans, the combined organizations serve 4.5 million members in 20 states, making us the largest provider of health care solutions to public programs.

• We serve 288,000 members— Medicaid— Planning for Healthy Babies— Children’s Health Insurance Program— Medicare Advantage

• We have 193 employees, including 62 doctors, nurses and social workers

• We have 18,096 providers and 125 hospitals

• We have donated 4,655 in volunteer hours and $210,600

• National Committee Quality Assurance accreditation: Excellent

• Extra Benefits— 24-hour HelpLine— Adult vision and dental care— Certain approved over-the-counter

medications prescribed by a doctor— Free Boys & Girls Club membership

About Amerigroup Georgia

— Cellular phone service, health-related text messages and extra minutes for those who qualify through SafeLink

— Free transportation to doctor’s appointments for PeachCare for Kids members

1. Rural Assistance Center, Georgia, http://www.raconline.org/states/georgia.php.

Why We Innovate

• Result of both the pressures of economic recession and recovery – and the continuing high unemployment rate – but, also, the scope of health care reform

• U.S. health system at 30,000 feet in 2019: majority of health spending will be public (51.9 percent) versus private (48.1 percent)

• With total expenditures on health slated to hit $4.5 trillion by the end of the decade, innovative solutions to lower costs and promote system efficiency will be key

Source: Congressional Budget Office, Mar. 2010; U.S. Census Bureau, Aug. 2008; Centers for Medicare & Medicaid Services, Feb. 2010; MedPAC Data Book, June 2009.

innovatethe gap

to fill

Rural Georgia

• The poverty rate in rural Georgia is 23.5 percent, compared to 16.7 percent in urban areas of the state — a 25 increase from the U.S. rate in rural America (17.8 percent) and 11 percent increase from the rate in urban America (14.8 percent), respectively1

• Georgia has 118 rural counties: Poverty rates for rural counties exceed those in urban counties by 58 percent. The rural counties have approximately half as many physicians and dramatic shortages of nurses, therapists and nutritionists (per capita) as the metro counties2

1. Rural Assistance Center, Georgia, http://www.raconline.org/states/georgia.php; Rural Assistance Center, United States, http://www.raconline.org/states/unitedstates.php; 2. Georgia Health Equity Initiative, Health Disparities Report 2008: A County-Level Look at Health Outcomes for Minorities in Georgia, http://health.state.ga.us/pdfs/ohip/Georgia%20Health%20Equity%20Initiative.pdf

Rural Georgia, cont’d.

• In Georgia, 24 percent of the rural population has not completed high school, compared to 16.7 percent of urban populations — a 26.6 percent increase from that of rural America (17.6 percent) and an 11.9 percent increase from that of urban America (14.7 percent), respectively1

• 22 percent of Georgians are uninsured; a 27 percent increase over the national average (16 percent)2

1. Rural Assistance Center, Georgia, http://www.raconline.org/states/georgia.php; Rural Assistance Center, United States, http://www.raconline.org/states/unitedstates.php; 2. Ibid.

Health Care Priorities in Rural Georgia

Amerigroup members in rural Georgia face three significant challenges, which we are working to address:

• Inadequate access to care

• Reduced access to specialty care

• Timely access to behavioral health and specialty consultations

Georgia Telemedicine Program

Solution• First Care Management Organization (CMO) to become a

partner with GPT, the statewide telemedicine network leader (140 specialists, 40 sites) in August 2011

• Population- and geographic-based targeting strategy for future presentation site deployment (i.e., highest Medicaid eligibles, greatest specialist deficiencies)

• Incorporation into internal case management rounds as a resource to improve access for members with greatest needs

• Targeted provider and member marketing and external communications in counties with existing sites

• Ongoing collaboration with GPT to address policy hurdles, analytics and future innovation

Problem• Inadequate access to specialty care in select rural and underserved

counties in Georgia

Funding Our Telemedicine Initiative

Supporting GPT and the targeted deployment of presentation sites to improve access to underserved rural populations:

2011 grant to add presentationsites: $20,000

• Evans Memorial Hospital — Evans County

• Meadows Regional — Toombs County

1. Includes full presentation capabilities; available to students and community on a year-round basis. 2. Expected to come online within GPT’s network by Q2-2013.

2012 grant for school-based health clinic programs: $50,0001

• Jenkins County High School and Middle School• Optim Medical Center Jenkins• Optim Medical Center Tattnall2

• Optim Medical Center Screven2

Patient-Centered Medical Home Update

Solution• In 2012, collaborated with a GPT partner to provide on-site

presentation capabilities for four PCMH groups• Practices now have the ability to provide same-day, same-

week access to specialist behavioral health consultations• Approximately 9,000 members have improved access to

address behavioral health issues• 30–40 consultations per week across all groups• Improved member and provider satisfaction, reduction in

time/cost away from work, lengthy gaps in appointment times

• Enhances the ability of the primary care physician to coordinate the patient’s care

Problem• Timely access to behavioral health consultations for select high-volume

Patient-Centered Medical Home (PCMH) and primary care groups

Telehealth by the Numbers

Greater focus on building and communicating the benefits of telemedicine has seen a rapid increase in the number of unique members, providers and geographic areas accessing telemedicine services.

Utilization Observations and Early Trends

* All results are specific to a sample population of 501 members that: (a) utilized telemedicine services in 2012, (b) had at least 1 claim in 2011 and 2012.

• Greater than 90% of total utilization is encompassed by the top 10 procedure codes

• Of those top 10 procedure codes, behavioral health services are currently the overall key driver in utilization

• The percentage of utilization occurring in the top 10 counties is steadily decreasing, indicating greater access in a growing number of counties

Q-and-ADr. William Alexander

William.Alexander@amerigroup.com