IMPROVING HEALTH ACCESS THROUGH TELEHEALTH : THE RURAL CALIFORNIA EXPERIENCE

1. IMPROVING HEALTH ACCESS THROUGH TELEHEALTH:THE RURAL CALIFORNIA EXPERIENCE Presented by Mario Gutierrez October 13, 2010

2. POPULATION DENSITY 13% OF CALIFORNIANS (400,000) LIVE IN RURAL COMMUNITIES

3. EARLY DEVELOPMENTS IN TELEHEALTH • 1996: TELEMEDICINE DEVELOPMENT ACT –FIRST OF ITS KIND IN THE COUNTRY • 1997: THE CALIF ENDOWMENT LAUNCHES $22M/ 10 YR INVESTMENT FOR TELEHEALTH CAPACITY BUILDING FOR SAFETY-NET PROVIDERS • 2006: CALIF EMERGING TECHNOLOGY FUND: $60M TO CLOSE THE BROADBAND DIGITAL DIVIDE • 2008:UC DAVIS MEDICAL SCHOOL LAUNCHES NEW 5-YR SPECIALTY RURAL PRACTITIONER TRACK

4. TELEHEALTH RESOURCES TODAY • 2009/10: CALIF RECEIVED OVER $214M IN STIMULUS FUNDS FOR HIGH SPEED BROADBAND EXPANSION: • $30M To Create The CalifTelehealth Network connecting 900 safety-net providers statewide • $81M To Calif Broadband Cooperative to build a 553 “Middle Miles” connection in Eastern Rural California • $59M to connect 19 rural counties in Central Valley • $7.9M for Model E-Health Communities for broadband sustainability

5. CENTER FOR CONNECTED HEALTH POLICY Supported by: The California Health Care Foundation Projects Include: Specialty Care Safety Net Initiative Model Telehealth Statute Development Telederm Utilization Research

6. SPECIALTY CARE SAFETY NET INITIATIVE • Policy, statutory, and practice pattern barriers prevent UC Schools of Medicine from providing specialty care consults to safety net patients. • Identifying and removing these barriers is essential to the long-term sustainability of UC based telehealth projects serving safety net patients. • Three year project running through early 2012 • Up to $1 million to 5 UC campuses • Up to $1 million to 45 community health centers • Vigorous assessment of challenges and benefits

7. Open Door – Del Norte Clinic K’ima:w Medical Center - 19 Phase 1 Sites - 16 Phase 2 Sites 9/1/10 - 12 Potential Partners Shasta Community Health Open Door Community Health Open Door – North Country Clinic Redwood Rural Health Plumas District Hospital Del Norte Clinics – Chico Family Health Oroville Hospital Western Sierra Medical Center Communicare Health Centers: Salud Clinic, Davis Community Clinic UC Davis Southern Inyo Community Health Centers UC San Francisco John C. Freemont – Northside Clinic Ridgecrest Regional Hospital Sierra Kings District Hospital Clinicas Del Camino Real - Fillmore Health Center Clinicas Del Camino Real - Newbury Park Clinicas Del Camino Real - Ojai Valley Health Center Clinicas Del Camino Real - Oxnard Health Center Clinicas Del Camino Real - Ventura Health Center Colusa Indian Community DBA: Colusa Indian Health Clinic Community Health Alliance of Pasadena Consolidated Tribal Health Project Inc Livingston Medical Group Sierra Family Medical Clinic St. Johns Well Child and Family Center - Compton Clinic St. Johns Well Child and Family Center - Dr. Louis C. Frayser Clinic St. Johns Well Child and Family Center - Magnolia Place Clinic Tarzana Treatment Centers Trinity Hospital Tulare Community Health Clinic Mountain Health and Community Clinic East Valley Community Health Center UC Los Angeles UC Irvine La Maestra Community Clinic

8. MODEL STATUTE DEVELOPMENT • POLICY GOALS: • Update the 1996 CA Telemedicine development Act • Provide national leadership in the use of telehealth tools to re-shape health care into patient-centered, accountable, and efficient system • Provide a framework for new legislation/regulatory change to advance the use and reimbursement of telehealth services • Identify related state and federal policy/practice barriers that inhibit full application of telehealth

9. CHALLENGES MOVING FORWARD: • State: • Massive State annual budget deficits • New Governor and legislative leaders • Federal Level: • Need fresh thinking to stimulate innovation and reimbursement policies for Medicaid and Medicare (CMS Center for Innovation) • Interstate Licensure & Scope of Practice Policy Review • Health Systems: • Change comes slowly-rural practices need to behave differently..Too Much Too Fast! • HIE-EMR-TELEHEALTH need to be in synch for systems to function efficiently

10. TELEHEALTH BENEFITS FOR RURAL • Strengthens Safety-Net as Patient-Centered Medical Home • E-visits, continuity of care, chronic care management • Gives Rural Hospitals New Life: eICU, LTC • Workforce: • Improves recruitment and CME access • Public Health • Home health care monitoring • Emergency Disaster Preparation • Monitoring Disparities • Building Healthy Communities! • Access to prevention & education information • One E-application for all health social benefits • Enhances overall quality of life-A life-line to the World