As we come to the close of 2018, I was looking back at some of the issues where we have seen the needle move significantly in health and human services this year. My big takeaways? Fee-for-service is slowly but steadily being replaced by value-based forms of reimbursement (see Preparing For The Very Glacial VBR Rollout In Some Markets). “Therapy” (of many types) will be largely virtual (see First Telehealth-Now Virtual Health). “Primary care” will look very different in just a few years (see The Primary Care Reinvention). And, technology is one of the few viable solutions to the health and human service staffing issues.
What are the implications? I think the two most critical strategic skills for provider organization executive teams in 2019 fall in two areas—building the skills of management team in performance monitoring/management/optimization using metrics; and developing “digital dexterity” with the ability to integrate virtual health, starting with telehealth, into their service delivery continuum.
The latter—the making telehealth technologies work from a strategic perspective—was the focus of a great session at The 2018 OPEN MINDS Technology & Informatics Institute session, A Guide To Building A Sustainable Telehealth Program: From Billing & Scheduling To Staffing & Training, led by my colleague and OPEN MINDS Senior Associate David Young, and featuring case studies by Jeffrey Steigman, Psy.D., Chief Administrative Officer, Family Service League; and Krista Lewis, MHR, LPC, Chief Program Officer, Medical & Crisis Services, Family & Children’s Services, Inc. Mr. Young opened the session with a recap of those essential strategic issues—telehealth as potential solution to staffing, access, integration, and cost issues.
And he provided a great checklist for bringing expanded telehealth capacity to a delivery system. He emphasized the importance of considering some key issues before going ahead with an expanded telehealth strategy—the buy versus build decision, telehealth vendor selection, and measuring return-on-investment.
The case studies were great examples of how two management teams have made this happen. Dr. Steigman shared his work at Huntington, New York-based Family Service League, where they are planning to open a 24/7/365 crisis stabilization program in 2019. The program will be supported by mobile crisis teams, a crisis hotline, and telehealth services for consumers in crisis. Family Service League hopes to reroute 30% of emergency department visits by utilizing telehealth when and where appropriate. Family Service League’s strategy is to use telehealth to fill gaps in prescriber capacity so that they can better utilize their 30 prescribers on staff and to assist in the adoption of their new models of care.
Dr. Steigman explained that it takes approximately two months to start up telehealth services at a site, which includes the time required to apply with the relevant regulatory agency and receive approval. Each set-up costs approximately $2,000. Telehealth services are currently deployed in each of Family Service League’s 10 clinics. His advice from this experience?
- Receiving licensing agency approval is a process—Be prepared.
- Know the reimbursement landscape for service delivered through this medium—Medicaid is not an issue in NYS, but commercial payers can present challenges in terms of coverage and amount of coverage (some may discount)
- Adopt change management processes—This is like adopting an electronic health record. There will be resistance to change.
- Standardize procedures—Prescribers, for instance, will see consumers at multiple sites, and the experience must be the same.
- Vendor relationships are important—Vendors need to support the provider organizations, and provide the requisite training and coordination, while learning how your internal systems work.
Ms. Lewis then shared her experience. In 2015, Family & Children’s Services (F&CS), based in Tulsa, Oklahoma, began piloting telepsychiatry services through their outpatient medication clinic. Because of the pilot’s success, F&CS expanded this service into other clinical services—intake, on-demand medication clinic, Urgent Recovery Center warm handoffs, and outpatient services—and now contract with a third-party vendor, InnovaTel, to provide additional telepsychiatry providers. In 2019, F&CS will begin offering telepsychiatry to F&CS’s Crisis Mobile Response teams. Ms. Lewis’s advice?
- Set a budget—A fundamental part of your tech strategy needs to be how much you can spend and what you need in return for the investment.
- Set a time-frame—Implementation isn’t something that happens when you have the time. You need to set a deadline to adopt and take into consideration the time it will take to support the service line.
- Make sure operations and the tech are in sync—F&CS modifies operations to adapt to the tech they adopted.
- Bring in help (if needed) —Programs will fall apart without the internal support necessary to keep them staffed and funded. If you bring in help, make sure the partner staff is included as an integrated member of the team.
Now is not only the time for executive teams to look at how wider adoption of telehealth could affect organizational competitive edge and sustainability, it’s time to look at what a successful adoption will look like.
For more on the strategy it will take to find, assess and adopt telehealth, join Senior Associate Joseph P. Naughton-Travers on February 13, 2019 in Clearwater Beach, Florida for his 2019 OPEN MINDS Performance Management Institute executive seminar, “Making The Right Tech Investments For Your Organization: An Executive Seminar On Technology Budgeting & Planning.”