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
Diana Hornung, MD, Medical Director Lilia Luna, PsyD, Behavioral Health Director
Centers
Total 6781 Medical 5468 BH 1504 Dental 2692
Number of Active Patients (seen in last 18 months)
Medicaid, 29% Uninsured, 34% Private, 27% Medicare, 9%
Patients by Medical Insurance Type
Standard Care by PCP and Team Tele-Psychiatric Care Stabilization on Medication Management Plan Referral back to PCP or to Specialty Psychiatry In-House Referral to Tele-psych Consultation as Needed
Evaluate Need Establish Initial Funding Promote Buy-In Establish and Communica te Flows with Teams Establish Tele-psych Provider who is Good Fit Train All Open and Regular Communica tion to Evaluate Optimal Level of Care Reliance on Team-based Care Contracting with Partners to Promote Revenue Developme nt
Establish and Communicate Flows with Team
Important to Develop Flows that Include Risk Assessment Pre-Screening, Diagnostic Imaging, and Labs Developing Flows that Take Into Consideration Part-time Tele-psych Provider Operationally- Tele-psych requires 2 rooms, 1-2 MAs, a HIPPA-compliant IS System that Allows this work to be done, and a team that views the importance
Establish Tele- psych Provider who is Good Fit
Outpatient Providers v. In-pt providers seem to have standards of practice that fit this model Invitation for On-site Visits and Engagement in Team Meetings Importance of Partnership being Flexible and Having Shared Mission
Open and Regular Communication to Evaluate Optimal Level of Care
Care Coordination Notes and Telephonic Access between Providers Is Important Empowering Medical Providers to Communicate Early if Unwilling to Manage Medication Management Plan so Patient Can Be Referred to Specialty Psychiatry
Reliance on Team- based Care
Every Team Role is Important in Making this work Having Designated MAs working with the Tele-psych Provider and Helping with Scheduling In Person Reminder Calls to Decrease No Show Rate Proactive Use of Care Coordination to Help Patients Navigate Around Barriers to Accessing Care
Contracting with Partners to Promote Revenue Development
Tele-psych not covered under State Medicaid within FQHCs Need to Negotiate coverage into contract with RAE Develop Sliding Scale Fee before establishing services
Ethical Dilemmas Requiring Evaluation of Best-Practice
Challenges that Arise with Limited Access Evaluating Need to Increase Tele-psych Clinics
10 14 10 11 13 15 34 31 26 37 33 27 16 33 31 34 33 8 6 6 5 4 8 14 10 9 12 10 13 3 15 15 11 12 5 10 15 20 25 30 35 40 July August September October November December January February March April May June July August September October November 2017 2018
Telepsych Utilization
Telepsych Visits Patients New to Telepsych Services Dec: Added additional 4 hours/week in Routt Clinic July: Began with 4 hours/week in Moffat Clinic
408 Total Encounters
2018 Averages
31 tele-psych visits/month 11 new patients seen/month
161 Unduplicated Patients
20% Average No Show Rate
Improved Satisfaction