Adding telehealth services becomes an attractive solution as provider organizations are held to access-to-care metrics in value-based reimbursement contracts (see Telehealth Gains Popularity—Telehealth Budgets Don’t). And since the feds have now added new telehealth benefits for Medicare Advantage, we expect to see more health and human service organization executives investing in this platform (see CMS Finalizes Expanded Medicare Advantage Telehealth Benefit Policies).
The challenge that telehealth addresses: “One in five Americans will experience a mental health issue at some time, yet 75% of the counties in the country are underserved by psychiatrists, and 40% of practicing psychiatrists do not take insurance,” which affects access, said Sandy Hall, president of Lighthouse Telehealth, during the “Improving Access To Care: The Benefits, Best Practices & Lessons Learned Implementing Telehealth Services” session at The 2019 OPEN MINDS Technology & Informatics Institute.
But how to add telehealth to a traditional service system is an operational challenge for many executives. According to Ms. Hall, key issues for successful implementation include support for change from leadership, an understanding of rules and regulations, and a customizable electronic health record (EHR) that supports new workflows and communication.
Adding Telehealth Requires Leadership
Planning for this type of change requires executives to identify which board members, consumers, and staff are most skeptical of telehealth and why, and then address those concerns directly. “All departments must be on board if telehealth is to be implemented successfully,” cautions Ms. Hall. “They have to know the what and the why.”
In Ohio, the why was that consumers were waiting 90 to 120 days to see psychiatrists at Lighthouse before telehealth services were introduced. And while Lighthouse execs believed telehealth was the best option to expand access to care, the organization recommends “easing” into it (see Virtual Health As Strategy—Starting With Telehealth) to ensure success.
That slow approach is what we’re seeing across the health and human service system. There has been a 12% increase in adoption of the technology from 2018 to 2019, though specialty provider organizations lag behind primary care providers with technology adoption, according to The Tech-Enabled Provider Organization: The 2019 OPEN MINDS Health & Human Services Technology Survey. Across the board, telehealth was one of the top 10 technologies adopted by specialty provider organizations with a 59% adoption rate.
Making Sense Of Many (New) Regulations
Telehealth regulations differ by state. The big issue is professional licensure requirements. But there is variability in mandates for offering and paying for telehealth. All state Medicaid programs, except Massachusetts, Iowa, and Rhode Island offer some reimbursement for telehealth though some have rules about distance. For example, in some states there are restrictions on miles between consumers and access to care at a physical location.
Also, some states require specific documentation of client appropriateness for telehealth services and there are many with specific place of service codes required for payment. Ms. Hall speculates – rightfully – that payers, state auditors, and accrediting bodies will continue to pay close to attention to detail and documentation.
Expanding EHR Capabilities To Support Telehealth
In addition, to make telehealth work, provider organization managers need to make sure that their EHRs have some specific capabilities. The following four EHR capabilities were essential to Lighthouse’s success:
- An appointment search function that allows team members to fill-in staff details, preferences, and categories that highlight telehealth professionals
- The ability to schedule a physical room in a different facility or office for a professional and or consumer to conduct the telehealth sessions, a process that is different than traditional scheduling, with 15- and 30-minute time frames for the telehealth sessions
- Group check-in notification allows team members to select different locations for the service (depending on whether the consumer or practitioner is remote), a notification list to make sure that team members address all medical issues, and consent reminders to facilitate better communication and coordination among team members who interact with the consumer
Management of crisis situations for appropriate intervention to support team members and improve health outcomes
Scheduling is more challenging for telehealth services, Ms. Hall emphasized, because a practitioner and consumer might need a physical space for the session, which can be conducted by phone or computer, and organizations need to pilot different approaches to find what works for them and then work with EHR vendors to make tweaks to their systems. Ms. Hall warned her colleagues that they might go through multiple iterations before they find what works best. Lighthouse made changes to appointments, booking tele-patient rooms and equipment, documenting consumer consent, treatment and follow up tracking, alerts to staff, and how insurance claims were submitted to support the scheduling process (see Virtual Health As Strategy—Starting With Telehealth).
Arguably the most important takeaway for provider organizations considering telehealth: It’s possible to survive, even thrive in a telehealth environment with careful planning, dedicated resources and investment, a commitment from the organization’s leadership, and effective change management. Ms. Hall and her team have turned impatient, unhappy consumers into those who are more likely to show up and less likely to relapse. Furthermore, the team has improved HEDIS measures and reduced the cost of service delivery per consumer.
For more on leveraging technology and implementing telehealth to improve access to care, check out these resources in the OPEN MINDS Circle Library:
- Engaging Consumers Was The Topic Of The Week
- Six Functions For Moving EHRs To The Next Level
- Virtual Health As Strategy—Starting With Telehealth
- What Are Health Plans Doing About Access?
- Overcoming The Virtual Health Paradox
- The Top Health Plan Digital Health Tools
- The Inescapability Of Your Virtual Presence
- 4 Market Realities Hindering A Telehealth Future
- Making Telehealth Work—Reimbursement & Great Execution Required
- What Are Health Plans Actually Doing?
And join us on February 14 for The 2020 OPEN MINDS Performance Management Institute for the session, “The Future Of Residential Treatment: How Technology & Innovative Program Models Are Redefining Service Delivery Models” with OPEN MINDS Senior Associate John F. Talbot, Ph.D., vice president of corporate strategy, Jefferson Center for Mental Health, and Dyann Roth, president and chief executive officer, Inglis.