The Challenge

Geographic barriers, cultural concerns

Building a strong care team to support community mental health is a top priority for Forest County Potawatomi. By turning to telepsychiatry, the community has overcome geographic and cultural barriers to make that vision a reality.

Located in Crandon, Wisconsin, Forest County Potawatomi provides healthcare, education and other services to families living on the reservation. Most staff live more than an hour’s drive away, making it difficult to recruit quality behavioral health professionals on-site. As a result, residents often had to travel up to three hours away to receive care, preventing many from receiving the treatment they needed.

The tribal community also needed mental health clinicians who would be sensitive to the residents’ challenges, from ongoing substance abuse issues to years of intergenerational trauma. After trying unsuccessfully for six months to hire an in-person clinician, Forest County Potawatomi recognized that telepsychiatry could connect the community to a broad range of clinically and culturally appropriate professionals.

The Solution

Establishing an effective team

Forest County Potawatomi partnered with Array Behavioral Care to expand access to behavioral health. As a leading provider of integrated telepsychiatry services, Array provides the high-quality clinicians, tools and support to improve mental health access for all, regardless of where they live.

From the start, the two organizations have shared a commitment to delivering services personalized for the tribal community’s residents. Array matched Forest County Potawatomi with a skilled telepsychiatrist and advanced practice nurse, and both Array staff and the clinicians visited the community in person to build rapport with the on-site staff. To help address substance abuse issues in the community, Array's clinicians and medical director collaborated with local care teams to prescribe controlled substances only when necessary.

That collaboration extends to all aspects of the program, with Array's clinicians charting directly into Forest County Potawatomi’s EHR and meeting with on-site staff to discuss specific patients and treatments. Patients see the same clinician weekly, helping to build trust and make treatment more effective. Potawatomi’s advanced practice nurse has even provided care on-site as the two organizations continue to strengthen their working relationship. Forest County Potawatomi also collects patient feedback directly through Array's AtHome videoconferencing platform, to monitor and continually improve its services.

 

“Hiring and retaining quality clinicians on-site was a tremendous challenge for us. Thanks to Array, we now have a team of professionals who are highly competent, culturally sensitive, and take the time to understand the needs of our community and our residents.”

Julie Beeney, Interim Director Health Division and Clinical Services Administrator, Forest County Potawatomi

The Results

A happier, healthier community

Through its partnership with Array, Forest County Potawatomi now has a strong integrated care team to meet its population’s significant mental health needs. Key benefits include:

  • A true clinical collaboration. Array's clinicians have become a seamless extension of Forest County Potawatomi's primary care team. The professional team works together closely to make day-to-day decisions, and Array's psychiatrist consults with Potawatomi's medical director to promote a collaborative approach to each patient's care.
  • The flexibility to grow. As patient needs change, Forest County Potawatomi can easily adjust its telepsychiatry services to match. While the community launched its telepsychiatry program with an advanced practice nurse and a psychiatrist, it soon added a licensed clinical social worker (LCSW) to meet additional demand. The reception was so positive, the LCSW’s services have expanded from 24 to 40 hours a week.
  • Convenient, effective care. With skilled, caring clinicians available instantly on-screen, the community is finally getting the mental health support it needs. Patients no longer have to travel for hours to see a psychiatrist or therapist, and program feedback has been overwhelmingly positive.

Communities across the nation face a shortage of behavioral health providers. Approximately 123 million Americans live in a mental health professional shortage area[1] and 96% of counties in the U.S. have an unmet need for psychiatric prescribers.[2]

In order to address the increasing number of individuals seeking mental health care from primary care practices, many organizations turn to behavioral health integration. Behavioral health integration brings mental health specialists into the primary care setting and creates teams of mental health and primary care providers working together with individuals and their families to provide the best possible treatment.

Fifty-five percent of counties in the United States currently have no psychiatrists available, according to a new report.[3] This severe shortage is impacting the country’s health care system, particularly for primary care providers and nurse practitioners, who increasingly have to treat and/or prescribe for mental or behavioral health conditions.

Moreover, the delivery of specialized mental healthcare can be out of the realm of expertise or exceed their comfort level for many primary care providers. When the scenario arises, it makes sense to refer care to a psychiatrist or other mental health provider. Yet, due to the current shortage of psychiatrists, patients often wait weeks—sometimes even months—to be seen by a local psychiatry provider.

In the U.S., one in four primary care visits are for mental health conditions. Primary care providers write 70% of antidepressant prescriptions, which is approximately 30 million prescriptions annually.[4]

Telepsychiatry allows primary care practices to connect with remote psychiatric providers, including specialists such as child and adolescent psychiatrists, and offer mental health care to individuals in their office. InSight + Regroup has several primary care integration programs. Highlighted here is an innovative collaborative care pilot program located in a health system.

Morris Hospital & Healthcare Center

Morris Hospital and Healthcare Centers has been serving the Chicago area since 1906. Located in Morris, Illinois, their 89-bed hospital serves residents in five counties. Along with their main hospital, they have offices in 25 other locations.

In 2018, they implemented a telepsychiatry program within their emergency department to serve individuals presenting with a mental health concern. The next year, they started a collaborative care pilot program after recognizing the mental health need in the primary care setting. This program was developed in collaboration with the AIMS Center at the University of Washington. During this time, Morris Hospital and Healthcare Centers also worked closely with the Collaborative Family Healthcare Organization (CFHA). This national integrated care association advocates for behavioral health integration in the primary care setting and has served as a mentor for Morris Hospital and Healthcare Centers. Through implementation coaching and support services, the collaborative care pilot program was launched in February 2019. A licensed social worker serves as a care manager and splits their time between two offices. The program utilizes a telepsychiatry provider to serve as a consultant on mental health cases.

The aim of this program is to improve behavioral healthcare services by placing social workers and mental health professionals in primary care offices. Morris Hospital and Healthcare Centers employs 37 primary care providers and has approximately 109,000 outpatient visits per year. With the mental health professional shortage, many individuals seek mental health services from their primary care providers. However, primary care providers are not adequately equipped to treat mental health disorders.

The collaborative care team addresses mental health concerns in the primary care setting as opposed to referring off-site for those services. They track a defined patient population in a registry to ensure patients do not fall through the cracks. The care manager discusses patient cases with a consulting psychiatrist on a weekly basis and the psychiatrist makes treatment recommendations. The telepsychiatry provider meets with the treatment team of primary care doctors and clinical social workers to do chart reviews for four hours each week via video. The telepsychiatry provider does not work with patients directly, but helps to advise and support primary care providers with their cases.

Then, the care manager relays the recommendations to the primary care provider and patient. The care manager also provides the patient with psychotherapy using techniques such as behavioral activation and problem-solving therapy, both of which have been shown to be effective in the primary care setting.

To date, Morris Hospital and Healthcare Centers has seen patients in the pilot program become more engaged in their treatment plans.  In order to determine success of the program, Morris Hospital and Healthcare Centers uses a caseload tracker to track information such as PHQ-9 scores, GAD-7 scores, weeks in treatment and number of sessions to see how a patient evolves over time and how involved they are in their care. Since implementation, patients are more involved and are more likely to follow through with appointments and treatment plans.

Patients have truly embraced this model and have commented that it helps to decrease the stigma associated with mental health issues. In addition to the patients, the primary care providers have embraced the Collaborative Care model as well. By having a team member who can help address mental health concerns, primary care providers are more comfortable learning to treat mental health concerns and manage medications that were previously outside of their comfort zones.

The main goal for this program was to serve patients visiting their primary care providers with mental health concerns. Eventually, Morris Hospital and Healthcare Centers would like to see Collaborative Care services available at all primary care sites. In Illinois, there was recently an exciting development. Gov. J.B. Pritzker signed into law a Senate bill that requires private insurance companies and Medicaid to reimburse for Collaborative Care services. This is a win for integrated care and supports the Collaborative Care programs that are ensuring individuals have access to mental health services. Morris Hospital and Healthcare Centers is excited to see Collaborative Care continue to grow and impact the lives of individuals in their communities.

In order to promote this program to encourage replication, Morris Hospital and Healthcare Centers has presented on their Collaborative Care model in a variety of settings including at a special telemental health workshop during the ATA2020 virtual conference and the Caravan Health’s ACO Symposium. Additionally, Becker’s Hospital Review recently interviewed Dr. Jennifer Thomas, a family medicine physician and Doctor of Integrated Care at Morris Hospital and Healthcare Centers, to learn more about their innovative program.

[1] Peterson-Kaiser Health System Tracker. (2019). Retrieved from https://www.healthsystemtracker.org/?sfid=4356&_sft_category=access-affordability,health-well-being,spending,quality-of-care

[2] Konrad, T., Ellis, A., Thomas, K., Holzer, C., & Morrissey, J. (2009). County-Level Estimates of Need for Mental Health Professionals in the United States. Psychiatric Services, 60(10). doi:10.1176/appi.ps.60.10.1307

[3] https://www.newamericaneconomy.org/press-release/new-study-shows-60-percent-of-u-s-counties-without-a-single-psychiatrist/

[4] Barkil-Oteo, A. (2013). Collaborative Care for Depression in Primary Care: How Psychiatry Could “Troubleshoot” Current Treatments and Practices. The Yale Journal Of Biology And Medicine, 86(2), 139. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670434/

Prior to COVID-19, regulatory and reimbursement challenges limited the use of telehealth. The COVID-19 crisis presented an opportunity for telehealth to demonstrate its value.  An FQHC in New Jersey, a COVID-19 hotspot, describes how telehealth allowed them to maintain patients’ access to care during the pandemic and advocates for keeping the telehealth-friendly regulations in place even after the crisis is over. 

In a recent interview, Lee Ruszczyk, Senior Director of Behavioral Health at Henry J. Austin Health Center (HJAHC), an FQHC in Trenton, New Jersey, shares how HJAHC responded to the COVID-19 pandemic by quickly converting from an in-office, clinic-based model of care delivery to an at-home virtual model in a matter of daysso that patients could continue to receive the care they need without having to physically come into the facility.  He explains how their organization was able to successfully pivot to telehealth, how patients have responded to the changes, and why it’s important that telehealth-friendly regulations remain even after the immediate threat of the coronavirus has passed. 

How have you used telehealth in order to maintain patients’ access to care during the COVID-19 crisis? 

To help reduce unnecessary exposure and contain the spread of the virus in our community, we closed 3 of our 4 locations and turned to telehealth as a solution to maintain patients’ access to care.  One of our sites remains open for necessary in-person visits or emergency medical or dental care.  All other services are noprovided virtually. 

It was an organization-wide, all-hands effort, but we were able to successfully switch to telehealth within one week. We quickly restructured existing workflows, designed new workflows, adopted new platforms for teleconferencing and telemedicine and shifted staff responsibilities to make this happen. We also had to convert our call center to a virtual operation so that inbound calls are automatically routed to the appropriate remote team member.  

We started using Doxy.me and Doximity Dialerto enable our patients and clinicians to connect virtually. Both Doxy.me and Doximity Dialer are free, secure and easy to use telemedicine solutions that allow patients to meet and communicate with their regular healthcare provider from the safety and comfort of home through their phone, tablet or any device that has internet access.  Both applications have been instrumental in allowing us to rapidly shift from clinic-based services to remote care during COVID-19. 

Fortunately, this was not our first foray into telehealth. About 2 years ago, we launched a telepsychiatry program in partnership with InSight + Regroup, to help address the growing need for mental health care in our community. This telepsychiatry program supplements the care provided by our onsite mental and behavioral health team and gives our adult patients access to a psychiatric nurse practitioner to help diagnose and treat anxiety, depression, addiction and other behavioral issues. Prior to COVID-19, patients receiving psychiatry services would come to the clinic at their scheduled appointment time to meet virtually with their telepsychiatry clinician.  However, in the wake of the coronavirus pandemic, we had to quickly shift these services from clinic-based to at-home care so patients can continue to get the behavioral health they need without having to come into the office. To help centralize scheduling and management of our medical and mental telehealth services, we moved our telepsychiatry clinician into Doxy.me as well. 

Since we are in an underserved area, not all our staff have access to internet services, or the technology and infrastructure needed to provide remote care and administrative services.  Therefore, we provided computers and Zoom phones for all staff members without access. 

There were a lot of moving pieces to juggle and a lot of new processes to put into place in a short period of time. However, we were able to make these changes with little to no interruption in patient care.  We are operating at 100% productivity even in this current environment. All our clinicians are still able to see their target number of patients per day, just virtually now instead of in-person. 

How have patients responded to telehealth? 

Patients have really embraced our new telehealth services. They appreciate the convenience and safety of being able to access care from home.  We’ve noticed that show rates are higher, and attendance is more stable with telehealth An HJAHC staff member reaches out to patients the day before a scheduled session to remind them of their upcoming appointment, educate them on telehealth, explain the process and what to expect  during a virtual visit and answer any questions. They also send patients a unique URL for their telehealth visit or a text invite with a link to join their virtual session. 

Patients without internet or technology that supports videoconferencing have the option to come into the clinic for services or receive care over the phone. 

How is your staff handling the COVID-19 crisis? How are they faring emotionally, physically and mentally?   

Our staff has certainly risen to the occasion during these challenging times.  Every member of our team has been extremely resilient and flexible in adapting to the operational changes that were quickly put into place in response to the COVID-19 crisis. Their commitment to the patients we serve has not wavered, even as they juggle unexpected changes and additional responsibilities in their own lives. 

It is worth noting that behavioral health clinicians may be experiencing many of the same mental health effects of COVID-19 as the patients they are treating.  That’s an unprecedented situation. For example, in the aftermath of September 11, behavioral health clinicians who were personally affected by the tragedy could excuse themselves if a patient’s story hit too close to home.  Similarly, our call center representatives are on the frontline answering calls from patients who are grieving the loss of a loved one due to COVID-19, while they, too, may have lost their own loved ones. This is unchartered territory for all of us. We’re unable to distance ourselves. We’re living it just as our patients are.    

People choose to work in an FQHC because they want to help vulnerable patientwho face significant health inequities.  From the security guard to the CEO, everyone here at HJAHC has the same purpose and  commitment to care.  That has become even more evident during all of this.  Our staff may be dealing with their own hardships and loss, but they show up, every day to continue to serve the underserved in our community. 

To what do you attribute your organization’s success in responding to COVID-19? 

The senior leadership at HJAHC has been extremely thoughtful, transparent, responsive, open-minded and inclusive.  All staff members have been invited to participate in the planning and execution of the operational changes that we put into place as a result of the pandemic.  It has been an all-hands, collaborative effort, not a siloed approach broken down by seniority, discipline (e.g., medical, dental, behavioral health) or job function (e.g., clinical versus administrative).   

We’re all in this together and we need each other to define new workflows, implement changes and continually refine our processes.  A problem or bottleneck in one area doesn’t just affect one person or department, it has a ripple effect.  To be effective and efficient, we recognized that we needed to brainstorm solutions and problem solve as a group.   

Early on, we met twice a day on Zoom to determine the most appropriate path forward and plan accordingly. Together we would create a daily to-do list, identify needs, assign responsibilities and discuss what was working and what needed to be improved. 

Now, we hold staff meetings three times a week to check in on each other and to collectively troubleshoot and resolve any problems that may have arisen since we last met.  We are constantly evaluating and refining our processes to make sure every patient has access to the care that they need when they need it.  It’s like we’re building the plane as we’re flying it. 

What do you think the future holds, post-COVID-19, in terms of healthcare delivery? 

Moving forward, I envision a hybrid model that includes at-home virtual care and in-person, clinic-based services. It will be driven by regulations, but my hope is that after COVID-19 the regulations would still allow the clinician to be at home and the patient to be at home rather than requiring one or both to be physically present onsite.   

Prior to COVID-19, telehealth was only a covered benefit for Medicare beneficiaries located in a rural or health professional shortage area and they had to travel to a local medical facility to receive services from a clinician in a remote location.  However, in response to COVID-19, CMS expanded access to telehealth services to waive the geographic and originating site requirements so Medicare beneficiaries could receive services in their own homes without having to travel to a health care facility. 

The pre-COVID-19 originating site requirement represents a significant barrier for our patientwho may lack transportation or cannot get to the clinic for care. With the currently relaxed telehealth regulations during COVID-19, these patients can now access the care that they need from home. 

What would it mean for your organization if the positive regulatory changes that were put in pace in response to COVID-19 were rolled back and we returned to the way things were prior to the pandemic? 

Given that we're considered an essential service, there was no other option for us. We either had to pivot to telehealth or close our doors. We are now seeing more patients each day through telehealth than we were previously able to see in-person at the clinic.  Telehealth has allowed us to serve more patients more efficiently.  

I don’t think you can put the genie back into the bottle now.  Our patients have enjoyed the flexibility of being able to access care at home. There are times when they cannot come to the clinic for a visit because they have a sick child or parent at homecannot take off from work or don’t have transportation; however, they still need care despite these logistical challenges.  There are also times when they may need care from a specialist who may not be immediately available.  For example, maybe there’s specialist in our community, but they aren’t accepting new patients or have extremely long wait times for an appointment. Or, maybe the closest specialist is in another city hundreds of miles away and our patients have limited ability to travel.  Telehealth is the ideal solution in both scenarios as it helps to expand access to care for underserved communities and populations. 

As an FQHC, our mission is to provide high-quality care to underserved populations, particularly those who are economically and medically vulnerable.  The relaxed telehealth regulations that were put into place in response to COVID-19 have allowed our patients to continue to have access to primary health care services.   

It would be unjust and unfair to take away the flexibility and access to care that telehealth affords once the pandemic is over.  At HJAHC, we serve an underserved and uninsured patient population. Our patients have enough to deal with.  They struggle with povertytransportation, food scarcity, and health disparities.  Can't we just give them a break? They have enough inequities and barriers to deal with, access to healthcare should not be one of them.

About Henry J. Austin Health Center 

Henry J. Austin Health Center is a private, non-profit, Federally Qualified Health Center (FQHC) in Trenton, New Jersey, that provides primary care, mental healthsubstance abuse treatment services and more to uninsured, underinsured and medically underserved individuals in the Greater Trenton community.  Established in 1969, their mission is to provide patient-centered, comprehensive, accessible, efficient, quality care to vulnerable patient populations with poor social determinants of health. HJAHC is the largest non-hospital based ambulatory care center in the city, serving approximately 13,000 individuals per year across their four locations. 

To maintain patients access to mental health care during the pandemic, an FQHC in Pennsylvania expands their clinic-based telepsychiatry program to include at-home services. No-show rates have dropped and patient satisfaction has improved as a result. 

River Valley Health & Dental is an independent, non-profit, Federally Qualified Health Center (FQHC) in Williamsport, PA that provides medical, dental and behavioral health care and social services to underserved residents in central Pennsylvania. In 2019, they introduced integrated telepsychiatry services to supplement their onsite behavioral health and social services team in order to help address the growing need for mental health care in their community. This telepsychiatry program gives patients access to an adult psychiatrist as well as a child and adolescent psychiatrist who specializes in ADHD and Autism Spectrum Disorder.

Prior to COVID-19, patients would come to the clinic to meet virtually with their telepsychiatry clinician. Now, in the wake of the coronavirus pandemic, patients have the ability to access these telepsychiatry services from home.  Medical providers at the clinic are now also using telehealth – phone and televideo – to provide care for patients.

In a recent interview, Susan King, LCSW, Program Coordinator at Community Services Group and behavioral health coordinator at River Valley Health & Dental, describes how River Valley swiftly implemented technology to allow for at-home telehealth visits in order to provide ongoing support for patients during the COVID-19 pandemic. This has allowed them to minimize patients’ exposure to the virus while continuing to meet their healthcare needs.  Medical and behavioral health care clinicians deliver care via telephone or web-enabled video for most patients.  If necessary, in-person visits are still an option and are scheduled appropriately to minimize traffic in the facility and maintain social distancing.

Please describe the impact that COVID-19 has had on your organization. 

We are a busy FQHC. We provide primary health care, including medical, dental, behavioral and reproductive health services to the most vulnerable members of our community. As such, we have been designated as essential for both medical and behavioral health services. Not taking care of our community is not an option. Continuing to deliver care was not a question of if, but rather of how.  While COVID-19 has had a frightening impact on the nation as whole, our team has risen to the occasion, moving quickly to telehealth visits, adjusting staffing patterns and schedules and working with patients and families to adapt to the new technology and new model of care deliveryWhile we certainly miss the day-to-day camaraderie of staff and patients interacting together in-personwe are grateful that technology allows us to connect virtually so that patients can continue to receive the medical and mental health care they need during this time. We’re proud that as a healthcare organization, we were able to adapt to the challenges posed by COVID-19 and make things work for the benefit of our patients.   

How has COVID-19 affected your patients and their access to care? 

Many of our patients have been flexible enough to adapt to the idea of a phone visit. Those who have access to smart phones and computers have been also able to utilize televideo visits through our portal. Since we are essential, our physical clinic space also remains open for visits for patients without access to technology. We have worked hard to ensure a variety of ways to meet patient needs.   

What changes have you had to make in your operations in response to COVID-19? 

Our clinic remains open for needed or emergent in-person visits for both physical and behavioral health care; however, we have adjusted provider and support staff schedules to reduce foot traffic in the building. Many clinical staff are working full- or half-time from home. Staffing changes have also helped conserve valuable personal protective equipment (PPE). We implemented physical health monitoring for staff for early detection of signs of illness. We also adapted our mobile dentistry RV to serve as a respiratory triage unit to ensure that patients with COVID-19 symptoms are safely assessed and tested while minimizing exposure of staff in the physical clinic space.   

Have you noticed a difference in your telepsychiatry program pre-COVID-19 and now? Are patients more receptive to the idea of virtual care?   

The biggest difference we have noticed is that patients who are unable to leave their home, for various reasons, or patients who work and for whom taking time off to come to the office for a visit, are better able to engage in services. Prior to COVID-19, we had a lot of no-shows. We’re finding that now, given the convenience of at-home virtual care, there are fewer missed appointments. Patients are more likely to attend their appointments and are logging in on time for their scheduled sessions. Patients' time investment in the visit is much shorter when they are able to access these services remotely. And, ware able to serve more people more efficiently. 

How have the relaxed telehealth regulations and expanded reimbursement options in response to COVID-19 benefited your organization? 

Simply put, people are able to continue accessing quality psychiatric care when chronic or persistent mental health needs are exacerbated by fear associated with the pandemic. The expanded allowance for telehealth has also allowed our medical staff to continue to take care of our patients during the pandemic without missing a beat.    

Why is telehealth important to your organization and how does it help your patient population, in particular?   

As is the case nationwide, psychiatry is a specialty in short supply in our area. The community we serve struggles with significant socioeconomic risk factors and is among the most physically unwell population in our state.  We implemented telepsychiatry in our clinic as part of our commitment to treating the whole person, mind and body.  Access to telehealth helps our center uphold that value. 

Can you describe a patient who has benefited from the change from clinic-based to at-home based telepsychiatry services during the pandemic? 

One of our existing patients is a gentleman who struggles with psychotic symptomsBecause of his diagnosis, he is extremely reluctant when it comes to technology, particularly phones and computer screens. We were worried about how he would respond to the switch to online care. However, he has been remarkably receptive to it since it allows him to access care at home, with his mom nearby to comfort and reassure him.  Our hope is that telepsychiatry will help keep him out of a long-term in-patient psychiatric hospital. 

What would it mean for your organization if the positive regulatory changes that were put in pace in response to COVID-19 were rolled back and we returned to the way things were prior to the pandemic? 

The addition of telepsychiatry has enhanced the behavioral health services that are available to our patients. Since psychiatrists are in short supply in our rural area, a return to requiring patients to physically present in our office for care amounts to putting a barrier back in place.  A rollback is akin to making work, transportation, symptom presentation, childcare responsibility etc. a barrier to specialty mental health care for our 17,000 medical patients.   

Our Health and Human Services Department recently put out a request for comments to learn what’s working and what’s not in terms of healthcare delivery. They are also seeking provider recommendations on what healthcare delivery should look like post-COVID-19. Telehealth has certainly proven its value in maintaining patients’ access to care during the pandemic; so hopefully it is here to stay. I cannot imagine that we’ll return to traditional service models after the pandemic ends. I envision some type of hybrid approach that blends the best of in-person and virtual care so patients can access the care they need how and when it works for them. 

As many clinics across the country have had to close or temporarily suspend services during the COVID-19 crisis, the Fauquier Free Clinic in rural Virginia was able to quickly convert to in-home virtual care so their patients could continue to receive much-needed mental health services. 

The Fauquier Free Clinic in Warrenton, Virginia, provides comprehensive medical, dental and mental health care to uninsured and under-insured residents in Fauquier and Rappahannock counties. Founded in 1993, their mission is to help local families who cannot afford health insurance or health care by creating a community where all individuals, regardless of income, have the resources they need to be healthy.

In 2017, with funding support from the PATH Foundation, the Fauquier Free Clinic launched a telepsychiatry program to help address the growing need for mental and behavioral health care in their community. This program supplements the care provided by the in-person volunteer therapists at the clinic as well as gives patients access to a Spanish-speaking psychiatrist, Dr. Alicia Azpiri.

According to Shannon Raybuck, LPC and mental health care coordinator at Fauquier Free Clinic, the clinic brings much needed care to underserved patients living in rural areas of Virginia. Raybuck explains, “we serve a vulnerable patient population with poor social determinants of health. Like many rural communities, we have a critical shortage of psychiatric and mental health providers and none of our local psychiatrists speaks Spanish fluently. Therefore, the value of this telepsychiatry program cannot be overstated. Not only does it increase access to behavioral health care in our area, but it also allows the Spanish-speaking residents of our community to have access to these important services. It’s amazing that through this program, our free clinic in rural Virginia is able to provide vulnerable patients access to a Harvard-trained, Spanish-speaking psychiatrist on the other side of the country in California.”

The team at Fauquier Free Clinic recognizes that patients’ mental health, physical health, and overall well-being are inseparable. Therefore, they screen all patients for depression. Approximately half of all patients receiving mental health services at the clinic are referred from these screenings; the remaining patients seek out mental health services directly. Through telepsychiatry and onsite behavioral health care services, the clinic is able to provide comprehensive mental health support for patients, including counseling and medication management. The onsite and remote mental health clinicians collaborate with the medical and dental teams for collaborative patient care, ensuring that all patients’ health needs are addressed.

Prior to COVID-19, patients receiving psychiatry services would come to the clinic at their scheduled appointment time to meet virtually with Dr. Azpiri in a private room using a computer equipped with a large monitor, camera and microphone. However, in the wake of the coronavirus pandemic, the clinic had to quickly shift to in-home virtual care in order to maintain patients’ access to behavioral health care while taking steps to help contain the spread of COVID-19 and comply with social distancing protocols. The entire team at Fauquier Free Clinic was able to swiftly and successfully pivot their operations and adapt their workflows to accommodate this new model of care. Now, patients can continue to get the behavioral health they need from Dr. Azpiri, a remote clinician with whom they are already familiar, without having to come into the office.

Patients who do not have access to a computer or fast or reliable internet service at home, are invited to come to the clinic for their scheduled session. Alternatively, if patients have a mobile device, but poor or no internet access, they can also visit mobile hotspots that have been set up around the community, such as the local high school or aquatic center parking lots. This allows them to receive the help they need from the safety and privacy of their vehicles. Given the limited availability of broadband service in this rural area, these mobile hotspots were established in response to the increased need to connect online rather than in-person for school, work and/or healthcare during the pandemic.

Raybuck admits that she was initially unsure how to reconcile the new direct-to-consumer model with the clinic’s collaborative approach to care. However, she and Dr. Azpiri developed a plan where instead of entering the room physically at the end of a session as she would have done previously when visits took place at the clinic, she now enters the room virtually by joining the online session at the end to discuss next steps and coordinate follow up care with the patient. And, although fortunately she has not had to do so, Raybuck notes if a behavioral health patient posed an imminent safety risk to himself or others, Dr. Azpiri could alert her and she could step into the room virtually to help intervene and connect the patient with local crisis resources.

Dr. Azpiri concurs that the shift to in-home virtual care has given her a unique and valuable perspective into patients’ lives and living spaces. “I am so grateful that patients have been so receptive to this new approach. They have been so welcoming and inviting and flexible, which is a big reason we’ve been able to pivot so quickly and successfully to in-home virtual care. Delivering care directly to patients in their homes gives me a glimpse inside their private worlds, without being overly intrusive. I can assess environmental cues such as the orderliness and cleanliness of their surroundings, appearance, food needs, etc. This allows me to really see how they are doing physically, emotionally and mentally and determine if additional support is needed.”

Dr. Azpiri shares a touching story from a recent session with a patient who was excited to finally be able to introduce her – albeit virtually – to his dog. “Previously we had discussed the emotional benefits of having a pet and, at my suggestion, he decided to adopt a dog. He has really benefited from the companionship and I am so glad I finally got to meet his dog and see firsthand the loving relationship they have developed!”

Although it’s too soon to quantitatively measure the effectiveness of the switch from clinic-based to in-home telebehavioral health care, Raybuck and Dr. Azpiri agree the transition has been successful as evidenced by fewer missed appointments and high patient satisfaction and engagement. According to Raybuck, patients appreciate the safety, convenience and cost savings associated with being able to access care online from home. During this time, patients can continue to get the care they need without having to worry about exposure to COVID-19 or having to find reliable transportation or incur travel expenses, such as gas money, to get to the clinic for their scheduled sessions. Raybuck adds, “there are fewer missed appointments now because we are able to reach out to patients who have not logged into their session at the appointed time and remind them of their visit. They can then join their online session, even if a few minutes late, to connect with Dr. Azpiri. Previously, a forgotten appointment would have to be re-scheduled for a later date due to the travel time needed to get to the clinic.”

While their primary focus is on patient care, Raybuck notes that they would be remiss if they did not consider the mental and physical wellness and resiliency of their staff during these challenging times as well. In addition to taking measures to reduce staff members’ exposure risk and to keep them safe, the Fauquier Free Clinic is offering all staff and volunteers access to their telebehavioral health services in what Raybuck describes as a “makeshift Employee Assistance Program (EAP).” "We’re more than coworkers here at Fauquier Free Clinic; we’re family. We support each other. We’ve found that we’re texting and connecting with each other a lot more outside of work hours. We’re checking in on each other to make sure our buckets are full. You can’t fill from an empty bucket,” says Raybuck quoting the metaphor from the popular book by author Tom Rath.

Raybuck concludes by sharing two poignant examples of patients who benefited from telepsychiatry during the pandemic. One is a gentleman with a variety of cardiac and pulmonary health conditions who has long suffered from extreme anxiety about doctors, having lab work done, and going to the hospital. With Dr. Azpiri’s help, he had made significant progress in controlling this anxiety. However, his anxiety resurfaced during the COVID-19 crisis, and was exacerbated by his job as a deliveryman for a popular local restaurant. Dr. Azpiri recognized the predicament he was in – his job put him at increased risk of exposure but he needed to work to support his family – so she spearheaded a joint effort with his medical and mental health care team to issue an out of work notice to temporarily excuse him from work to protect his health, while still allowing him to keep his job long-term. During this time, he also experienced some significant medical issues and, with the support of Dr. Azpiri, was able to manage his anxiety and go to the emergency room on his own to get the medical care he needed.

The second story is of a mother who is an established patient of Dr. Azpiri's who has a young child with health issues and a history of respiratory illness and had to be ventilated in the past. The COVID-19 crisis, particularly the pulmonary effects on vulnerable patients, has triggered the mother’s PTSD trauma. Through Fauquier Free Clinic’s now in-home telepsychiatry program, Dr. Azpiri has been able to continue to meet with her to help her cope with the anxiety and emotions that have reemerged as a result of the pandemic.

“Unfortunately, some community clinics have had to close their doors, or temporarily suspend services in order to develop an alternative service plan during the pandemic. It pains me to think of all of the interventions, like the ones I described above, that would have been missed had we not been able to convert to in-home telehealth services. Because of telehealth, we have been able to continue to serve some of the patients in greatest need during these critical times. I cannot emphasize enough how important telehealth is in general, but especially in rural communities like ours. If there is any silver lining to this, it’s that telehealth is finally getting the recognition it deserves; everyone is realizing what we’ve known to be true for some time – telehealth is instrumental in expanding access to care for underserved communities and populations,” Raybuck emphasized.

The Challenge

High Demand for Care, Limited Providers

Established in 2006, the Whiteside County Community Health Clinic (WCCHC) in Rock Falls, Illinois, was created to answer a long-standing need for medical, dental and behavioral healthcare among county residents. In 2018 alone, the clinic provided services to over 13,000 patients during more than 50,000 visits. As a federally qualified health center (FQHC), the clinic provides services to patients on a sliding fee scale, ensuring residents can access care regardless of their ability to pay.

By 2018, WCCHC’s behavioral healthcare team had grown to 11 therapists and one part-time psychiatrist, who served an ever-growing number of patients in need of specialized mental healthcare and medication management. Despite this high demand, the clinic’s psychiatrist stopped seeing patients, creating a pressing need to find a replacement. In-house staff were not equipped to handle complex patient needs, so the clinic was forced to refer patients elsewhere, losing thousands of dollars in patient billings to external providers.

WCCHC needed a clinician to fill a unique set of needs: someone young and energetic who could handle complex cases, engage easily with patients and staff, onboard quickly, and have the flexibility to adjust their hours as needed over time. After local recruitment efforts proved challenging, the clinic looked for an experienced telepsychiatry partner to help fill this tall order

The Solution

Quality Clinicians, Quality Support

WCCHC ultimately chose Regroup, a leading provider of integrated telepsychiatry services. Regroup’s broad clinician network gave WCCHC access to a large pool of highly specialized quality clinicians. In addition, the ability to provide comprehensive support services, including deployment, IT, reimbursement and regulatory insight, made Regroup an ideal partner.

Regroup identified a psychiatrist who met all of WCCHC’s criteria, helping the clinic launch its telepsych program in just two months. Once on board, the teleclinician quickly embedded herself in operations, working closely with the on-site care team to adapt to workflows and develop care plans for patients. She was an instant hit with patients and staff alike and has become a seamless part of clinic operations.

To maximize telepsych utilization, WCCHC focused on ways to reduce the patient no-show rate and improve access to care. Clinic staff identified potential barriers to patients in need and sought to address them in a variety of ways using funding from federal grants. If transportation is preventing patients from getting to appointments, the clinic offers them gas cards to pay for fuel. If affordability is preventing patients from taking needed medications, the clinic offers them pharmacy gift cards. To accommodate patient requests for same-day and soonest-available appointments, the clinic maintains a waitlist and contacts patients as time slots become available.

WCCHC uses RegroupConnect to ensure the best possible video quality for patient sessions, and has also used the platform to collect feedback through patient surveys to make sure it’s meeting patient needs. In addition to IT support, Regroup helps oversee all related program needs, including clinician management, compliance support and reimbursement.

The Results

Fostering Better Outcomes

Since implementing its telepsychiatry program with Regroup, WCCHC has been able to meet the behavioral healthcare needs of its community more efficiently and effectively. Key benefits include:

  • Operational efficiencies: Regroup is there to provide WCCHC with top-to-bottom program support, from technical questions to regulatory updates. Its ability to handle every aspect of clinician management eliminates the burden of recruitment, retention and administration for the organization.
  • Scalable services: The partnership with Regroup enables WCCHC to contract for only as much service as it needs, aligning telepsychiatrist hours with patient volume and providing the option to increase hours as needed over time. Within months of the program launch, the telepsychiatrist’s hours increased from 12 to 16 hours weekly due to high demand.
  • Clinical quality: With instant on-screen access to an experienced, caring clinician, WCCHC can now provide patients with convenient, quality behavioral healthcare. Regroup has helped facilitate seamless collaboration between the telepsychiatrist and the on-site care team, resulting in holistic, patient-centered care. Regroup also provides ongoing program support, monitoring any issues, clinician productivity and patient experiences for continuous improvement.

 

Problem

Prior to starting telepsychiatry, Mifflin County Correctional facility faced high cost of psychiatric medication for inmates.

Outcomes

Within the first month of partnering with Array for telepsychiatry services, Mifflin County Correctional Facility lowered their psychiatric medication cost by $1,503.42. A comparison of monthly pharmacy costs pre- and post-initiation of telepsychiatry services further demonstrates the cost savings they realized with telepsychiatry and proper formulary adherence.

Additional Benefits

Mifflin Country Correctional Facility found the transition to telepsychiatry seamless and easy and credits Array for the continued success of their program. They cite Array's ongoing support and commitment to quality care, timely communication and provider matching as reasons for their success. They consider their telepsychiatry providers a great fit for their organization and appreciate that these providers have been flexible, responsive, and willing to testify – even at the last minute – for mental health hearings.

Conclusions

Telepsychiatry offers access to corrections-specific psychiatrists who understand the nuances of treating incarcerated individuals while maintaining adherence to a strict formulary which leads to significant savings on psychiatry medication.

The Challenge

Efficient, effective whole-person care

The yoga sessions and health bingo nights you’ll find at an Oak Street Health center are the first sign that it’s not your typical healthcare facility. With a mission to “rebuild healthcare as it should be,” the network of primary care practices for Medicare patients focuses on caring for the whole person to keep patients healthy and promote their well-being.

For Oak Street Health, providing quality mental health services is key to its integrated care approach. Founded in Chicago in 2013, the organization now serves 40,000 Medicare patients across five states – one-third of whom experience a mental health condition. As a value-based care provider, Oak Street is also incentivized to keep total healthcare costs down for each patient by focusing on preventive care.

By delivering behavioral health services directly to patients,  Oak Street sought to help them get the care they need, improve their overall health and reduce expensive – and sometimes avoidable – hospital admissions. As a rapidly expanding network based in underserved neighborhoods, Oak Street also needed a way to access high-quality mental health providers and scale its services quickly. Recognizing that telepsychiatry aligned with its mission to provide efficient, effective whole-person care, Oak Street launched its mental health service program with Regroup in 2016.

The Partnership

A shared commitment to quality assurance

Through its leading integrated telepsychiatry services, Regroup empowers healthcare organizations to bring quality mental health care services directly to patients, regardless of where they live. Since beginning their partnership, Regroup has provided Oak Street with the clinicians, tools and flexible support it needs to make the program a success.

As Oak Street works to optimize mental health care delivery  and patient utilization, Regroup’s services have evolved alongside the organization’s needs. Over the past two years, Oak Street has added on-site behavioral health specialists at its locations   to support patient engagement, and Regroup’s clinicians work closely with in-person staff to develop individualized care plans for each patient. Regroup has also helped to establish effective telepsychiatry technology, with both Regroup clinicians and other Oak Street telepsychiatrists relying on the RegroupConnect™ videoconferencing platform for patient sessions.

The two telepsychiatrists currently serving Oak Street have established ongoing relationships with their own patient populations over time, ensuring continuity of care and regular follow-up, explains Katherine Suberlak, Oak Street’s VP of population health. The clinicians are experienced at working within primary care settings, are flexible in accommodating scheduling changes when needed, and are accessible to on-site primary care and behavioral health teams to ensure a collaborative approach to care. That hands-on support extends to the rest of the management team, Suberlak says, with Regroup working closely with Oak Street to assess the quality of care and workflow and to ensure continuous quality improvement in service delivery.

The Results

A program that meets patient and organizational needs

Since  implementing its telepsychiatry program with Regroup, Oak Street has been meeting its patients’ significant mental health needs with an effective, scalable program. Key benefits include:

Increasing patient utilization. Oak Street’s unique integrated approach is encouraging more patients to take advantage of behavioral health services and reducing no-show “A Regroup telepsychiatrist and the on-site behavioral health specialist now see certain high-risk patients together, helping to improve care collaboration and patient engagement, and ensuring follow-through on the psychiatrist’s recommendations,” population health specialist Lydia Vazquez says.

A financially stable program. As a value-based care provider, Oak Street is able to provide its Medicare patients with transportation to clinic Offering mental health services virtually on-site helps Oak Street ensure more patients are getting the care they need, resulting in healthier patients and fewer expensive acute care episodes.

A best practice-focused With support from Regroup, Oak Street has uncovered what works for its clinics and is applying those practices as it continues to expand. That includes establishing efficient patient check-in procedures, using e-prescribing for medications, using an electronic health record that different clinicians can access to provide collaborative care, and having a consistent clinician at each site to promote continuity of care.

 

“What we appreciate most about Regroup is their partnership and ongoing collaboration. As we work to optimize our delivery of mental health care services, they are always willing to work with us to find new ways to serve Oak Street and our patients effectively.”

Katherine Suberlak, VP of Population Health, Oak Street Health

Mercer County Jail Case Study

Problem: 125/150 inmates on medication before telepsychiatry
Outcomes: With proper pharamcology via telepsychiatry, this number was reduced to only 30 inmates on medication.
Conclusions: Proper pharamcology with appropriate care and medication solves problems of over or under treating inmates. It also reduces number of inmates who try to “work the system” and saves tax payer dollars.

Bucks County Jail Case Study

Problem: High cost of medication for inmates before telepsychiatry
Outcomes: With telepsychiatry and proper formulary adherence they were able to reduce pharmacy costs by almost 2/3 per month and nearly $480,000 annually.
Conclusions: Having access via telepsychiatry to psychiatric prescribers who are well-versed in correctional psychiatry and pharmaceutical options leads to major savings on psychiatric medication.

Array's telepsychiatry services address jail’s needs for routine care, medication management and immediate responses in times of psychiatric crisis.

Telepsychiatry has proven efficient and effective, as is evident by case studies of Array's customers and other clinical research data.

Prisoners with psychiatric emergencies are treated expeditiously reducing liability to the arresting agency. More importantly police officers are spending less time at health care facilities guarding prisoners and are available to protect and serve civilians.

Telepsychiatry also represents access to corrections- specific psychiatrists who are sensitive to the nuances of treating offenders while maintaining adherence to a strict formulary.

Direct Cost Benefits of Telepsychiatry for Jails:
- Lower transportation cost
- Reduce custody & overtime expense
- Reduce offsite (ED) expense
- Lower call obligation expense
- Improve formulary adherence
- Provider suicide watch release

Indirect Cost Benefits of Telepsychiatry in Jails:
- Reduce flight risk
- Improve public safety
- Improve relationships with community providers
- Provide proper inmate care and safety

Successful Shared Service For Middlesex County Law Enforcement

By: Chief Raymond J. Hayducka, MS, CPM, South Brunswick Police Department

The New Jersey Police Chief
Published: July/August 2009

Most law enforcement agencies throughout New Jersey and the United States are feeling the effects of the economy. This has compelled agencies to reduce costs and do more with less. Through a shared service program law enforcement officials in Middlesex County were able to find a cost effective solution to a problem that has impacted most agencies at one time.

Problem: Police Officers in Middlesex County are required to transport and guard prisoners that are experiencing a psychiatric emergency or threatening suicide prior to being lodged in the county jail on criminal charges.

  • Transportation Cost $ 300
  • Custody (2 x $35 x 6.5 hrs) $ 455
  • ED Bill $1,200
  • Total per Offsite $1,955

The prisoner would have to be medically cleared because the correctional facility is not set up to care for prisoners with psychiatric emergencies. Quite often police officers would end up guarding these prisoners at local hospitals for long periods of time due to mental health professionals being unavailable during off hours and weekends to diagnose them.

Meeting of the Minds:

During a monthly meeting of the Middlesex County Association of Chiefs of Police the issue of guarding prisoners with psychiatric emergencies was discussed.

Middlesex Borough Chief James Benson brought forth the problem after a particularly frustrating experience his agency recently dealt with.
Middlesex Borough Officers were required to spend the entire weekend guarding a prisoner that had a psychiatric emergency.

They had to assign two officers to guard the prisoner for a 48 hour period because of a delay in the psychiatric screening. Most of the time spent by the officers was on overtime. The cost was thousands of dollars from the police department budget.

Many Chiefs in attendance agreed they had experienced the same problem in the past and just one prolonged incident could strain an agency’s budget. During the meeting the Chiefs turned to Middlesex County Prosecutor Bruce Kaplan to help find a solution to this costly problem. Prosecutor Kaplan advised the County Chiefs he would discuss the issue with Middlesex County Jail Warden Edmund Chicci and see if a cost effective solution could be found.

Introducing Telepsychiarty:

At the next meeting Prosecutor Kaplan and Warden Chicci presented the idea of telepsychiatry. Telepsychiatry is a process that screens prisoners through a video conference. If the program could be implemented law enforcement agencies in Middlesex County would have the ability to have a prisoner with a psychiatric emergency examined by a psychiatric clinician 24 hours per day / 7 days a week / 365 days a year.

CFG Health Systems (sister company of Array), the current provider of medical services for the Middlesex County Jail, and numerous correctional facilities throughout New Jersey and Pennsylvania, was willing to work with the association and run a test pilot program for six months. A committee was formed consisting of law enforcement executives from the Middlesex County Chiefs of Police Association and county officials to study the possibility of implementing a telepsychiatry program.

Program Planning:

All the law enforcement executives on the committee agreed that in order for the program to succeed it would be important to minimize the number of trips to local hospitals for the purpose of having a prisoner evaluated.

It is common knowledge among criminals in Middlesex County that you could avoid or delay entry into the county jail by claiming you are suicidal or you are experiencing psychological issues.

Often prisoners would threaten suicide so they could spend time in the hospital instead of the jail. These trips are costly and present security risks. If the trips could be minimized the officers would be available to patrol the streets and the cost to guard these prisoners would be greatly reduced. This was the main goal of the program.

The Logistics:

The committee worked with County Jail officials to set up a procedure to have the prisoners screened. A prisoner experiencing a psychiatric emergency or threatening suicide that was set to be lodged in the county jail would be transported similar to a prisoner being lodged under normal conditions.

The only difference would be that the agency transporting the prisoner would be required to notify the jail prior to transport the need for a psychiatric screening. This would give the jail staff time to contact the on-call psychiatric technician and set up the video conference monitor. The officers transporting the prisoners would have to stay with the prisoner throughout the screening until the prisoner has been cleared for lodging at the county jail.

The psychiatric clinician could determine the prisoner is medically cleared to be lodged at the jail and recommend strategies to the jail staff to safely secure the prisoner. The clinician could also determine if the prisoner needed to be transported to a psychiatric hospital.

Outcomes:

During the six month test period the average waiting time the police officer has had to spend with the prisoner during the screening was 65 minutes. The time saved transporting the prisoner and waiting for treatment was drastically reduced.

Dunellen Police Chief Gerard Cappella stated “in my 23 years of law enforcement I have never seen a psychiatric screening at a hospital conducted in less than six hours. The time saved is worth participating in the program.”

The main goal of the program was achieved immediately. The amount of time local law enforcement officers were guarding prisoners at hospitals for psychiatric emergencies is almost non-existent.

Police officers can return to the streets faster to perform their normal patrol functions.

It is estimated that in less than six months the savings in overtime expenditures was approximately $75,000. The cost of the program is divided among 26 law enforcement agencies in the county. Each agency is charged per capita based on the population they serve.

The program is considered by many law enforcement executives a great insurance policy. If you use it one time you can recoup your cost by not paying officers overtime to guard prisoners at local hospitals. The total cost for the program will be $36,000 per year.

Monroe Township Police Department was the first agency to use the program. Their cost to participate in the program is $1,383 per year.

The officers brought the prisoner to the county jail on a Friday night. After the prisoner was assessed by the psychiatric clinician she was approved for clearance at the jail. The clinician recommended that the jail conduct a suicide watch for 24 hours which they are equipped and trained to do.

Monroe Police Chief John Kraviec stated “if this situation occurred prior to the implementation of the program my officers would have been stuck at the hospital all weekend guarding the prisoner. It would have cost thousands of dollars in overtime. The program pays for itself the first time you utilize it. My officers came back and told everyone how smooth the system ran. It’s a benefit to the taxpayer by reducing cost and it makes your agency more effective.”

There have been other benefits for law enforcement since the program has been implemented. Officer morale has improved because they now know what to expect when they have a prisoner with psychiatric issues.

Prior to the program being implemented the police officer did not know if they would be stuck guarding the prisoner for an hour or days on end.

This has also led to a better relationship with the jail staff. It is very clear now what the role of the police officer is and at what point the prisoner will become the responsibility of the jail staff.

The prisoner is assessed much sooner and the liability for everyone is reduced because of the faster diagnosis and prescribed treatment. Middlesex County Freeholder Mildred Scott, chair of the county Law and Public Safety Committee, a 28 year veteran and retired Chief Sheriff’s Officer of the Middlesex County Sheriff’s Department recalls being tied up for hours in hospitals with prisoners. “This program improves officer safety and saves the taxpayers money.”

Middlesex County Deputy Freeholder Director Christopher Rafano, who was part of the committee and instrumental in implementing the telepsychiatry program, stated “there will be no reduction in treatment for the prisoner. In fact the treatment would be better because the prisoner will be evaluated faster than if brought to a hospital.”

Les Paschall, CEO of CFG Health Systems emphasized that the program is designed to comply with the Standards for Healthcare Services in Correctional Facilities issued by the National Commission Correctional Healthcare.

It is also designed to meet all constitutional and regulatory requirements as well as the local community standards of healthcare. This innovative solution is an example of a shared service that has proven efficient and effective which is imperative
in these difficult economic times.

Conclusions:

Prisoners with psychiatric emergencies are treated expeditiously reducing liability to the arresting agency. More importantly police officers are spending less time at health care facilities guarding prisoners and are available to protect and serve the residents of Middlesex County.

Ray Hayducka is Chief of Police in South Brunswick Township. He currently serves as the 3rd Vice President of the NJ State Association of Chiefs of Police.

The Challenge

Growing demand magnifies care shortages

Many Americans in rural areas struggle to access high-quality mental health services due to a chronic shortage of providers, costs and time associated with care, and persistent stigmas surrounding seeing a behavioral health specialist. As the growing opioid crisis and other factors create a higher demand for care, this lack of access becomes even more urgent. That was the case at OSF HealthCare’s Saint Elizabeth Medical Center in rural Ottawa, Illinois, which faced an influx of patients with untreated mental health and substance use disorders.

Due to the compounding issues of provider shortages and rising demand, patients were at risk of subsequent psychiatric hospitalizations while OSF faced potential decompensation. Wait times for in-person psychiatric care and for services at the CHOICES outpatient department had ballooned to six months. In addition, some patients were reluctant to visit a psychiatrist because of stigmas surrounding mental illness, costs associated with treatment, and time required to travel to appointments away from their primary care facility, all impeding the ability to receive the care they needed.

Recognizing its challenges and facing the reality of long patient wait times, OSF aimed to erase barriers to care at Saint Elizabeth Medical Center through an innovative approach to these issues.

The Solution

The right level of care, every time

In 2017, OSF launched a telepsychiatry program featuring direct-to-patient care as well as eConsult services. To bring its telehealth and eConsult programs to life, OSF turned to Array Behavioral Care, a leading provider of integrated telepsychiatry services. Array's eConsults empower primary care providers to treat some issues themselves, ensuring mental health clinicians are available to treat more severe conditions.

“Array has been a tremendous partner to our organization as we roll out an array of telepsychiatry options, including innovative consultative and patient treatment approaches,” says Luke Raymond, manager of behavioral health at OSF HealthCare. “Array demonstrates a commitment to customer service, high-quality psychiatric care and effective communication.”

Before referring a patient for direct psychiatric care, OSF’s primary care providers leverage eConsults to contact a Array clinician and determine if a referral is clinically appropriate. Based on the telepsychiatrist’s responses, a primary care provider may prescribe medications directly to the patient or refer them for additional services as needed. Providers also use eConsults to help patients access treatment more quickly when appointment wait times are significant.

eConsults are helping to decrease psychiatric wait times by enhancing the capacity of primary care physicians to provide mental health services. In addition, eConsults can increase the likelihood of patients seeing a mental health clinician, since they can more easily navigate the social stigma of seeking treatment and are often more comfortable talking to their primary care providers. For patients who still need to see a behavioral health specialist, Array clinicians provide telepsychiatry services through the secure ArrayConnect™ platform.

The Results

Shorter waits, high satisfaction, expansion-ready

Through its partnership with Array, OSF is significantly expanding access to care while ensuring each patient receives the right level of services. The telehealth and eConsult programs have helped OSF:

Reduce patient wait times dramatically. By adding Array telehealth clinicians for direct-to-patient care and reducing unnecessary referrals through eConsults, OSF has slashed patient wait times from six months for in-person consultations to six weeks for telepsychiatry sessions, a 75 percent reduction in wait In total, Array has completed more than 1,000 direct patient sessions and provides about 25 eConsults monthly.

Deliver patient and provider satisfaction. More than 98 percent of telepsych patients give the experience high marks. Among OSF providers surveyed about the eConsult program, 88 percent are satisfied with the content and 91 percent are satisfied with Array's response times.

Drive continuous improvement. The HIPAA-compliant ArrayConnect platform, designed specifically for telepsychiatry, securely and effectively connects patients with Array clinicians while offering session data and reporting tools so OSF can monitor program success. Array's deep pool of clinicians also gives OSF the flexibility to grow, with the two organizations  already discussing expanding the program to new sites.

If you are in crisis, call the National Suicide Prevention Lifeline, a free, 24-hour hotline at 1.800.273.8255. If your issue is an emergency, call 911 or go to your nearest emergency room.