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By Sarah C. Threnhauser

This has been a big year for telehealth, with lots of changes in payer and health plan policy regarding rules and reimbursement (see VA Finalizes Telehealth Rule Allowing Health Care Professionals To Practice Across State Lines; 29 States Adopt Multistate Compact For Nurses Permitting Cross-State Telehealth Services; 2018 Medicare Fee Schedule Expands The Telehealth & Remote Monitoring Code Sets; and For Health Plans, Technology = Improved Consumer Access), and a slow but steady increase in adoption by provider organizations (see Telehealth Billing – Easier Than You Think? and Telehealth Gains Popularity, Telehealth Budgets Don’t). What has been interesting to me is the shift in the discussion of “telehealth” as a stand-alone service line, to a discussion more about how best to integrate telehealth into current service delivery systems.

José Aponte

But, making telehealth a standard service for consumers requires changes on both sides of the equation—from both health plans and provider organizations. That dual perspective was the focus of The 2018 OPEN MINDS Management Best Practices Institute session, Cutting Edge Telepsychiatry: Sustainable Program Models In Practice, featuring José Aponte, Vice President, Product Innovation, Beacon Health Options, and John MacKenzie, RN Coordinator Psychiatric Telemedicine, Dignity Health.

Mr. Aponte presented the health plan perspective. Beacon’s interest in telehealth arose from the need to provide convenient access and consumer engagement. To achieve this, Beacon announced in August a partnership with MDLIVE to augment its behavioral health network. Beacon consumers will have access to MDLIVE’s network of psychiatrists, physicians, and therapists (see MDLIVE And Beacon Health Options Partner To Bring Clients Trusted And Comprehensive Virtual Behavioral Health Services).

The MDLive partnership is the result of a two-year initiative that included a needs-based network evaluation, market strategy including a plan synchronize existing services with telehealth services, analysis of 85 different technology vendors, and a pilot project to test the concept. Now that the program is going live, Beacon is making enhancements to its security systems and making changes to practices in how to match consumers to the most appropriate clinical services.

In response, Beacon laid out a market strategy, conducted a thorough need-based tech evaluation, and synchronizing knowledge from multiple telehealth pilots across their client portfolio. Finally, Beacon is now in the scale phase – operationalizing a efficient rollout of telehealth services to its members. Mr. Aponte shared his lessons learned from this process:

  1. Establishing a telehealth system requires intensive operational investment—Building back-end processes to support an optimal user experience and new modality of care requires time, iteration, and resources across the organization.
  2. Getting buy-in from your team is needed to build a new approach—Like any new service or program, implementing a telehealth program requires a culture shift and demands support at every level of the organization. Organization-wide buy-in will ensure commitment and prioritization across departments, leading to a successful launch.
  3. Monitoring changing payer requirements and regulations is necessary—Telehealth rules and regulations are still shifting at a fast pace, and it’s essential for your organization to continue an ongoing review of the regulatory variations and continuously evolving policies across payers and health plans.
  4. Educating consumers is key to adoption—Availability does not necessarily generate use and starting a program won’t do any good if consumers are unaware of its existence, or don’t understand how it works. Consumers have generally been positive about utilizing telehealth, but it’s important to make investments in smart marketing campaigns to educate users and generate higher levels of adoption.
John MacKenzie

Mr. MacKenzie presented the provider organization perspective on telehealth. Dignity Health is a health system with 39 hospitals that are currently delivering 1,000 telepsychiatry consults, delivered in three hospital systems, 23 hospitals, and 12 providers. It took a decade to get where Dignity is at today—starting in 2008 the system had one hospital with a grant-based, telehealth service for stroke. Currently, Dignity Health Telemedicine Network (DHTN) does 13,500 consults per year—staffed by specialty RN Coordinators. TeleBehavioral health includes 24/7 consultations for medication management, legal disposition decision support, medical necessity for transfer, minor behavioral treatment planning, and assistance with capacity determination.

Dignity averages a five-minute response time by telepsychiatrist; a 41-minute average time to bedside; and a 90-minute average time to consult note. His advice for keeping response time low? The number one barrier to have a successful program is getting the device from wherever it “collects dust”, to the consumer.

Echoing Mr. Aponte’s comments, Mr. MacKenzie explained that one of the most difficult aspects of telehealth is getting consumers to utilize the service, which demands continuous education and promotion of the program. Combined, the message from the speakers was clear—we can expect continuing acceptance and a push toward integrated services delivery, via telehealth. For more, check out these resources from the OPEN MINDS Industry Library:

  1. Telehealth Gains Popularity, Telehealth Budgets Don’t
  2. Telehealth Billing – Easier Than You Think?
  3. Getting Ready For The Era Of Telehealth
  4. Telemental Health Is Booming
  5. Telehealth Is Remaking More Than Therapy
  6. For Telehealth, The ROI Is Where You Plan For It
  7. Moving To The Flip Side – Telehealth, Urgent Care & Medical Homes
  8. The On-Demand, Direct-To-Consumer Online Therapy Market – A Glimpse
  9. Employer Health Plans Pushing Telehealth Adoption One Step Closer To ‘Ubiquity’
  10. The On-The-Ground Reality Of Making Telehealth Work

For more, join Sunil Budhrani, M.D., Chief Medical Officer & Chief Medical Informatics Officer at Innovation Health on October 23 at The 2018 OPEN MINDS Technology & Informatics Institute in Philadelphia, Pennsylvania, for his session, “A Guide To Building A Sustainable Telehealth Program: From Billing & Scheduling To Staffing & Training.”

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