1. ALTA Consulting Group, Inc., April 2003 Internet2 Spring 2003 Member Meeting HEALTH & DIGITAL DISPARITIES

2. ALTA Consulting Group, Inc., April 2003 HEALTH & DIGITAL DISPARITIES Overview ISSUE Whether the development of next generation technology can advance health care access? I. What has been our history? II. What is the status of current deployment? III. What is missing? IV. What has been tried? V. Challenges and Lessons Learned VI. Conclusions

3. ALTA Consulting Group, Inc., April 2003 HEALTH & DIGITAL DISPARITIES I.What has been our history? Technology  Today, most residential and business Internet users in rural and underserved low-income areas gain on-line access to the Internet over narrowband conventional phone lines at maximum speed of 53 thousand bits per second (kbps).  Business and residential users in urban and suburban areas are likely to gain access to the Internet at higher data transfer rates characterized by current generation capability at speeds of approximately 1.5 million bits per second (mbps) downstream and 200 Kbps as evidenced by the Bernstein and McKinsey study, (January 2000).

4. ALTA Consulting Group, Inc., April 2003 HEALTH & DIGITAL DISPARITIES I.What has been our history? (cont’d) Health  Approximately 20% of the US population resides in primary medical care Health Professional Shortage Areas.  In 2000, there were 40 million uninsured Americans.  Many low-income persons, especially those enrolled in Medicaid or who have no insurance, often have difficulty finding physicians who are willing to accept them as patients.

5. ALTA Consulting Group, Inc., April 2003 HEALTH & DIGITAL DISPARITIES II.What is the status of current deployment? Internet Access  Americans who have the greatest connectivity are typically high income households. NTIA research indicates that the least connected are generally: -low-income-unemployed -seniors -Hispanics -Native Americans-Blacks -single-parent - persons with limited-urban & households education rural dwellers

6. ALTA Consulting Group, Inc., April 2003 HEALTH & DIGITAL DISPARITIES II.What is the status of current deployment? (cont’d) Health Access  The Kaiser Commission on the Future of Medicaid found in its 1997 report: 1997-99: Increase in commercial plans exiting from state Medicaid markets (Exit rate-15-17% annually) Result of exodus: 1.2 million Medicaid enrollees impacted. (Best case: Burden of selecting new health care plan. Worst case: Discontinuity of care if change of provider required.)

7. ALTA Consulting Group, Inc., April 2003 HEALTH & DIGITAL DISPARITIES III.What is missing? Infrastructure development in urban centers and rural communities.

8. ALTA Consulting Group, Inc., April 2003 HEALTH & DIGITAL DISPARITIES IV.What has been tried? Do we have the elements of a solution or, at least, food for thought?  Universal Service Fund  Medicaid Managed Care  Smart Home Project/ Telemedicine

9. ALTA Consulting Group, Inc., April 2003 HEALTH & DIGITAL DISPARITIES IV. What has been tried? (cont’d) Smart Home Project /Telemedicine Goals  Prevention/ Primary Care linkage  Disease Management Strategies  Provide live primary health services.  Link other pediatric sub-specialties into the clinical and educational care delivery process.  Enlist the support and assistance of community leaders in the implementation of convenient and preventive health programs.  Build and expand the pediatric health care knowledge base of prevention and treatment of pediatric related illnesses.

10. ALTA Consulting Group, Inc., April 2003 HEALTH & DIGITAL DISPARITIES V.Challenges and Lessons Learned?  Community Readiness  Timing Is Everything  Financing Strategies

11. ALTA Consulting Group, Inc., April 2003 HEALTH & DIGITAL DISPARITIES VI.Conclusions  Financing Strategies  Incentives  Intangibles - Equity