Direct to Consumer
Amidst an ever-changing clinical and political landscape, the reformation of healthcare policy and the expansion of Medicaid and the Affordable Care Act, has resulted in over 49% of Americans receiving benefits under government programs. Despite these recent gains, data analytics, both macro and micro in nature, have revealed that greater access to coverage is not synonymous with greater access to healthcare. In an effort to bridge that divide, Molina Healthcare of Washington (MHW) has partnered with Carena Medical Providers, a Seattle-based telemedicine provider organization, to launch a virtual urgent care program that concurrently provides a high-touch member experience, with 24/7 access to high quality, cost effective patient care. MHW is the first Managed Care Organization in Washington to provide statewide virtual urgent care at no cost to its over 650,000 Medicaid members.
MHWs Virtual Care program focuses on the immediate treatment and management of non-emergent conditions, many of which needlessly result in ED and inpatient visits, due to barriers of access and awareness. By using evidence-based telemedicine practices, Molina Virtual Care redirects our members to the appropriate primary care settings, and further supports the primary care team with case management and care coordination resources; identifies missing preventive and HEDIS-based services and coordinates follow-up care through shared documentation.
The challenge of meeting the complexity of Medicaid populations requires a coordination of services and collaboration between providers and heatlh plan, and a focus on such primary considerations as:
â€¢ The increasing overutilization of Emergency Departments for primary care
â€¢ Strategies to extend scarce primary and specialty care resources
â€¢ Increasing the availability of care management services for high risk members
â€¢ Ability to contact members who are in transition or homeless
â€¢ Dispelling the myths of low technological sophistication and adoption among Medicaid beneficiaries
â€¢ Overcoming cultural barriers to deliver needed services and improving population health
The purpose of this proposed session is to present MHW's application of telemedicine as a successful use case, and to highlight the broader lessons learned in the areas of member communication and engagement strategies including social media, provider engagement, clinical service accuracy, and cost effectiveness.
The session will also address ongoing challenges experienced by MHW, including rural access and provider contracting in the new world of payment parity, and to solicit feedback and encouraging dialogue across our healthcare peers, en route to fostering solutions within a constructive and collaborative forum.
Chief Medical Officer
Frances M. Gough, MD
Dr. Gough is the Chief Medical Officer for Molina Healthcare of Washington. Molina Healthcare is a managed healthcare organization that arranges the delivery of health care for members enrolled in government-funded programs. Molina Healthcare of Washington serves over 700,000 members enrolled in Medicaid, Marketplace and Medicare programs.
She oversees clinical strategy and development of clinical models of care delivery focused on quality and value, health outcomes, cost efficiency, and member safety, which meet the diverse needs of members across all Molina’s lines of business. Dr. Gough oversees all programs and activities related to telemedicine for the Washington heatlhplan, and consults and particiates in enterprise wide initiateves and best practices related to innovation and teleheatlh. She maintains external relationships with providers, community organizations, Managed Care Organizations, and State partners.
Dr. Gough provides clinical perspective to the senior leadership within the organization, and engages with network and community physicians, hospital leaders, and other partners regarding clinical care and services for enrollees, as well as issues related to Utilization Management and Prior Authorization, Pharmacy and Quality.
She is a graduate of the University of Washington School of Medicine; board certified in Internal Medicine. Her background includes clinical and academic medicine at University of Utah Medical Center and Scripps Clinics in San Diego. She is a physician entrepreneur with expertise in programs in high-risk patient management and virtual urgent care.
As a mmber of the American Telemedicine Association, Dr. Gough has served as co-chair of the Standards and Guidelines Committee for Primary Urgent Care and has co-authored the ATA Guidelines for Primary Urgent Care Telemedicine.
Monday, April 24
10:35 AM – 10:54 AM