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Provider Support Helping Members

The Telehealth Advantage

Telehealth in Action watch video

Introduction to Telehealth

In 1998, Anthem Blue Cross partnered with the Managed Risk Medical Insurance Board (MRMIB) to form the first statewide Telehealth Program in California. This program was developed, managed, and comprehensively supported by the health plan.

The program was developed to:

  • Increase access to specialty care in rural areas
  • Improve timeliness of diagnosis and treatment planning
  • Improve quality of care
The Benefits of Telehealth

Bringing Specialty Care Closer to Home

Telehealth is a unique health care delivery method designed to examine, diagnose, treat, and educate patients at remote locations by using:

  • High-speed telecommunications systems
  • Computer technology
  • Specialized medical cameras and peripheral equipment

For example, through a Telehealth encounter, a patient living in the Central Valley of California may receive medical treatment from a specialist located in Los Angeles or San Francisco without spending the time or money to travel to those locations for diagnosis and treatment.

Telehealth Improves the Patient's Experience

Telehealth improves the patient's experience because:

  • The patient can continue to be cared for by their local provider.
  • The patient has local access to the specialists in the state.
  • The local provider is able to treat the patient locally with the specialist recommendations.
  • The patient may receive a faster appointment, diagnosis and treatment vs. waiting to schedule an in-person visit.

Two technologies available

The two methods of telehealth consults available in the Anthem Blue Cross Telehealth Program are:

  • Live Video (synchronized): Connects patient, rural provider, and specialist via videoconferencing equipment to discuss, diagnose, and develop a treatment plan to be carried out locally.
  • Store and Forward (asynchronous): Uses encrypted HIPAA compliant software to send patient’s history, images, and data electronically to a specialist for evaluation and treatment which will be carried out locally.
Conducting a Live Video Consultation

Telehealth encounters are coordinated via Live Video conferencing and require the participation of three entities: the patient, the presentation site, and the remote specialist. A Live Video telehealth encounter should be treated with the same professional courtesy as a traditional office visit.

Scheduling the Telehealth consult

  1. The primary care provider (PCP) will refer the patient to the appropriate, closest presentation site.
  2. A Telehealth presentation site coordinator will schedule the telehealth encounter, which includes the presentation site, specialty center, and the patient.
  3. The telehealth presentation site coordinator will send over all required patient medical information and test results to the specialty center. (The site coordinator has been provided with all specialty center contact information.) When applicable, please remember:
    • Include a copy of the patient’s Anthem Blue Cross ID card (front and back), so the specialty center knows where to send claims.
    • If the patient cancels the appointment, immediately contact the specialty center and cancel the appointment with the telehealth site coordinator. This courtesy ensures that the specialist can accommodate as many appointments as possible.

One day prior to the scheduled appointment

The telehealth presentation site coordinator will:

  1. Confirm the appointment date and time with the patient.
  2. Remind the patient to arrive early enough to prepare for the telehealth consult, answer any questions, and complete the required forms. Remember: The appointment time is the time when the specialist will see the patient – this is when the videoconference call will be placed. It is important that the patient, PCP, and equipment are ready on time.
  3. Confirm that the specialty center has received the patient medical information, as well as any additional information needed by the specialty center.

Immediately before the scheduled appointment

The telehealth presentation site coordinator will:

  1. Obtain consent from the patient.
  2. Answer all questions that the patient may have about the telehealth process.
  3. Gather the necessary telehealth materials (e.g., clinical data, patient information, and medical records).
  4. Confirm that the telehealth workstation and medical instruments are working properly.
  5. Confirm the telecommunications link by calling the specialty center a few minutes before the scheduled appointment time. When the link is confirmed, mute the audio and the video until the patient and PCP/presenter are ready.
  6. Situate the patient in the telehealth room – being mindful of patient privacy and confidentiality.

During the live telehealth consult

The telehealth presentation site coordinator will:

  1. Maintain a professional environment that respects the patient’s privacy and confidentiality.
    • Indicate the presence of, and introduce, all persons participating in the consult at both locations.
    • Limit distractions by eliminating background noise as much as possible.
    • Prevent unknown people from entering the room during the consultation.
  2. Introduce the patient to the specialist.
  3. If the patient has an assigned PCP outside of the presentation site, introduce the patient this way: “This is (patient’s name). I am presenting (Mr., Ms., Mrs., patient’s name) for his or her PCP, Dr. (name).”
  4. Present medical history, previous treatments, and goal(s) for the consult (e.g., second opinion, diagnosis, medication recommendation).
  5. Save images and information shared with the specialist as part of the patient’s medical record.

After the live telehealth consult

The telehealth presentation site coordinator will:

  1. Mute the audio. Disconnect the session on screen.
  2. Address any patient questions or concerns.
  3. If the patient has another PCP outside of the presentation site, explain that the specialist’s recommendations will be sent to the assigned PCP for treatment management and prescription needs. The patient should be referred to this PCP for any follow-up.
  4. Coordinate the communication of the patient’s treatment/management plan and follow-up needs to the appropriate PCP.
  5. Maintain all images and information from the telehealth consult as part of the patient’s medical record. Back up the files in accordance with clinic policies and procedures.
Conducting a Store and Forward Consultation

Store and Forward (S & F) encounters are done during a regularly scheduled patient appointment. They can be applied to those referrals that do not require extensive specialist and patient interaction. During the encounter, information and appropriate medical images are transmitted via secure email from the primary care site to the specialist for review.

Because S & F encounters do not require the specialist, the presenter, and the patient to be available simultaneously, the burden of coordinating schedules is removed.

The availability of specialists accepting S & F encounters varies by location. Click here to view a list of specialty centers that participate in the Telehealth Program.

During the patient’s appointment

Once it is determined that the specialist referral can be addressed using S & F, the presentation site coordinator:

  • Obtains consent from the patient
  • Confirms availability of S & F services with the specialty center
  • Creates the electronic patient S & F session using the appropriate software, scopes, and cameras to capture the pertinent images and medical information
  • Thoroughly completes the demographics form in the S & F software to include:
    • The referring site information – name of the PCP, phone number, etc.
    • The patient information – identification and health plan. If necessary, fax a copy of the patient’s ID card (front and back) to the specialist center
  • Thoroughly completes the referral form in the S & F software to include:
    • Medical history
    • Chief complaint
    • History of current condition
    • Specific questions to be answered
  • Includes the telephone number that the specialist can call to verify receipt of the S & F session or to discuss the consultation with the PCP. (If you are a presenting site only, identify your site as “presenting only” and provide the name and telephone number of the patient’s assigned PCP.)
  • Emails the S & F session to the desired specialist

After Sending the Store and Forward Consult Request

If the specialist has not replied within a reasonable time frame, follow up with a courtesy phone call to confirm receipt and discuss the response timeline.

After receiving the S & F consultation form via email from the specialist, forward the consultation to the appropriate PCP to implement.

The presentation site coordinator also creates and maintains the medical records by:

  • Making a copy of the request for consultation
  • Making a copy of the specialist’s second opinion report
  • Documenting any actions taken concerning the patient’s care
Reimbursement

Please note that Anthem Blue Cross facilitates access to telehealth services, facilities and technology through this program. The benefits available, if any, for telehealth services, and the terms, conditions and limitations on those benefits will depend on the terms of the member's particular coverage.

To learn more about reimbursement for a telehealth encounter specific to some of the programs administered by Anthem Blue Cross or an affiliate for which reimbursement may be available, please visit the following links:

Providing Reimbursement

To support the long-term sustainability of the telehealth network, Anthem Blue Cross:

  • Provides comprehensive reimbursement for telehealth encounters for Anthem Blue Cross members enrolled in the following:
    • Medi-Cal Managed Care Program
    • California Public Employees' Retirement System (CalPERS) Basic Plan
    • Butte Schools Self-funded Program Plans
    • California's Valued Trust (CVT)
    • Self Insured Schools of California (SISC)
    • University of California (UC)

To inquire if you are eligible for telehealth reimbursement, please contact the Telehealth department at 1-866-855-2271.

Network Sites/Locations
Resources
Contact Info

Contact Provider Relations:
1-866-465-2272 - Southern CA
1-877-811-3113 - Central CA
1-888-252-6331 - Northern CA
Fax: 1-805-987-0736
Address: 120 S. Via Merida
              Mailstop: CAT201-N002
              Thousand Oaks, CA 91362

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The Anthem Telehealth Program