WellPoint State Sponsored Business Telemedicine - Increasing Patients’ Access to Care in CA & GA

Situation

There are great levels of disparity between the healthcare available to urban patients and that available to rural patients.

Many rural medical facilities are designated as Health Professional Shortage Areas (HPSA), having very limited, if any, access to specialty medical care. Rural residents requiring access to specialty healthcare often have no option but to wait months to receive an in-person appointment, and travel great distances to urban medical centers to wait to be seen. Unfortunately, for many rural patients this becomes a complete deterrent for them to seek care altogether, allowing their condition to escalate in severity.

With over 36 million residents, California is the most populous state. However, over 80% of the state’s land mass is designated as rural. Many of the counties throughout the state are predominately comprised of rural counties that are also designated as HPSA.

With almost 8.7 million residents, Georgia is the ninth most populous state in the nation, and has the sixth fastest growing population. However, Georgia ranks 38th in the nation in proportion of physicians to population. All or parts of most counties are designated as HPSA. While 38 counties have health centers, 66 do not; And 34 counties do not even have hospitals. One six-county area has only one board certified obstetrician and one board certified pediatrician. Overall, the number of Primary Care Physicians (PCPs) is inadequate, and the rate at which new ones are joining the workforce is declining.

Solution

Dedicated to improving the healthcare and health outcomes for rural Californians, in 1998 the parent company of Blue Cross of California, WellPoint Inc., partnered with the California Medical Risk Insurance Board (MRMIB) to form and fund the Blue Cross of California Telemedicine Program.

Telemedicine is a powerful health care delivery system that can significantly reduce healthcare disparities and service barriers. Telemedicine uses telecommunications technology, diagnostic equipment, and computers to exchange medical information from one location to another. This allows the patient the convenience of not having to travel great distances to seek care, take time off from work or school, maintain their relationship with their local PCP, and possibly receive a faster diagnosis and treatment plan. Additionally, this provides a learning opportunity for the local PCPs to learn how to better diagnose and treat specialty conditions from some of the state’s top specialists.

Currently the Blue Cross of California Telemedicine Program has 62 Presentation Sites (where the patient is presented to a remote specialist via computer) and 8 Specialty Centers (where the physician specialist resides and connects with the Presentation Site to review patient cases and suggest treatment). Our coverage extends to 29 of the 58 counties represented in the state where we offer approximately 25 specialties. The five most commonly used include Dermatology, Psychiatry, Endocrinology, Neurology, and Pediatrics.

Blue Cross supplies the equipment and software, conducts the trainings, provides marketing materials, and disseminates information on how to apply for grant funding and discounted phone services. All of these services are offered with the hope to help ease the financial responsibility incurred by the site, and to create program sustainability and longevity.

Based on the success of Blue Cross’ California Telemedicine Program, WellPoint’s Blue Cross Blue Shield of Georgia (BCBSGA) tailored the Georgia Telemedicine Program to the state’s current health system needs. The program allows a wide range of medical specialty activities to take place via Telemedicine technology, including radiology (Teleradiology), psychiatry (Telepsychiatry), and eventually emergency room medical assessments (TeleER) will be available.

In Georgia, Telemedicine units are currently installed at 48 sites; 88 specialists representing 44 different medical specialties are now part of the network. The Program enables all rural Georgians to access specialty care within 30 miles of their homes. To optimize specialty access, the Telemedicine program implemented the Internal Program Collaboration Website to centralize scheduling of specialist consultations. By tracking open appointment times for panel specialists anywhere in the state, specialist consults via Telemedicine can now be requested 24 hours a day, and scheduled statewide in a matter of days or even hours, instead of weeks or months.

Better Health Lower Costs

Better Health
Telemedicine allows patients to receive consultations from some of the top medical specialists in the state. Because Telemedicine is easily accessible, patients are more apt to use this resource to seek treatment, which may provide an earlier detection and diagnosis, thus preventing escalation of chronic conditions. Telemedicine is also used by PCP’s to get second opinions from specialists on difficult cases as to avoid misdiagnosis and prescribing ineffective medications. The learning opportunities that remote physicians receive by connecting with specialists can be immeasurable and truly help further their understanding and knowledge of specialized cases. To date, California Telemedicine sites have produced over 12,375 clinical consults (where patient cases were reviewed and treatment was suggested) and over 4,071 non-clinical consults (physicians utilizing equipment to conduct meetings and trainings). The acceptance and approval ratings for the program have been quite impressive across the board. A survey conducted reported the following results: over 90% of patients agreed that “Telemedicine made it easier for me to receive specialty services;” and over 89% of PCP’s agreed that “Telemedicine provided the information, advice, and expertise that I needed to diagnose, treat, and manage my patient’s condition.” Additionally, over 90% of physician specialists agreed that, “I would use Telemedicine again to review and diagnose patients.” Additionally, since its inception, Georgia Telemedicine has facilitated specialty consultations for over 500 patients and over 7,500 teleradiology services have taken place. Specialties consulted to date include dermatology, otolaryngology, endocrinology, rheumatology, cardiology, pulmonology, neurology, diabetic education, and nutrition services, in addition to radiology and psychiatry. Georgia Telemedicine patients indicate very high satisfaction with Telemedicine. Via a 2006 Patient Satisfaction Survey, 100% of patients “strongly agreed” that “Telemedicine made it easier for me to receive specialty services” and 91% “strongly agreed” with the statement “I would use Telemedicine again.”

Lower Costs
Telemedicine decreases patient travel time and reduces the amount of time they need to take off from work or school. Additionally, with Telemedicine, many serious medical conditions can typically be diagnosed and treated earlier than if the patient had to wait for a face-to-face specialist consultation. When certain medical conditions are diagnosed weeks or months after they are first suspected, treatment is usually more invasive, much costlier, and less successful. Consultation delays often result in greater risk of emergency medical care, intensive care hospitalization, and potentially poor outcomes for the patient. Ultimately, increased access to care means early identification and treatment of chronic conditions, resulting in savings for the entire healthcare system.