Incr ncreasi sing g Ac Acce cess t ss to Tel ele- psychiatry - PowerPoint PPT Presentation

Incr ncreasi sing g Ac Acce cess t ss to Tel ele- psychiatry i in R Rural a and Frontier Colorado Diana Hornung, MD, Medical Director Lilia Luna, PsyD, Behavioral Health Director

Disclosures • No financial disclosures. • Context of Presentation: • Derived from the flows and processes of two Federally Qualified Health Centers

Road Map • Who we are • Why Tele-psych • Our Model • Data-Informed Results • Key Components and Lessons Learned

Who We Are Patients by Medical Insurance Type Number of Active Patients (seen in last 18 months) Total 6781 Private, 27% Medical 5468 BH 1504 Medicare, 9% Dental 2692 Uninsured, 34% Medicaid, 29%

Why Tele-psychiatry?

Our Model In-House Referral to Tele-psych Consultation as Referral back to Needed PCP or to Specialty Stabilization on Psychiatry Medication Management Tele-Psychiatric Plan Care Standard Care by PCP and Team

Key Components Open and Regular Contracting Communica with Establish tion to Partners to Tele-psych Evaluate Promote Provider Optimal Revenue Promote who is Good Level of Developme Evaluate Buy-In Fit Care nt Need Establish Establish Train All Reliance on Initial and Team-based Funding Communica Care te Flows with Teams

Lessons Learned Operationally- Tele-psych Establish and Important to Develop Flows requires 2 rooms, 1-2 MAs, that Include Risk Developing Flows that Take a HIPPA-compliant IS System Communicate Assessment Pre-Screening, Into Consideration Part-time that Allows this work to be Diagnostic Imaging, and Tele-psych Provider Flows with Team done, and a team that views Labs the importance Establish Tele- Outpatient Providers v. Invitation for On-site Visits Importance of Partnership psych Provider In-pt providers seem to and Engagement in Team being Flexible and Having have standards of practice Meetings Shared Mission who is Good Fit that fit this model Open and Regular Empowering Medical Providers to Communicate Care Coordination Notes Communication to Early if Unwilling to Manage and Telephonic Access Medication Management Evaluate Optimal between Providers Is Plan so Patient Can Be Important Referred to Specialty Level of Care Psychiatry Having Designated MAs Proactive Use of Care Reliance on Team- Every Team Role is In Person Reminder Calls to working with the Tele-psych Coordination to Help Important in Making this Provider and Helping with Decrease No Show Rate Patients Navigate Around based Care work Scheduling Barriers to Accessing Care Contracting with Partners to Tele-psych not covered Need to Negotiate coverage Develop Sliding Scale Fee under State Medicaid within Promote Revenue into contract with RAE before establishing services FQHCs Development Ethical Dilemmas Requiring Challenges that Arise with Evaluating Need to Increase Limited Access Tele-psych Clinics Evaluation of Best-Practice

Data-Informed Results 2018 Averages 161 31 tele-psych visits/month Unduplicated Patients 11 new patients seen/month Improved 20% Average No Satisfaction Show Rate Telepsych Utilization 40 37 34 34 33 33 33 35 31 31 Dec: Added July: Began with 4 additional 4 30 27 hours/week in 26 hours/week in Routt Moffat Clinic Telepsych Visits 25 Clinic 408 Total 20 16 15 15 15 Patients New to Telepsych 14 14 13 13 15 Encounters 12 12 Services 11 11 10 10 10 10 9 8 8 10 6 6 5 4 3 5 0 July August September October November December January February March April May June July August September October November 2017 2018

Questions