Integrated Telebehavioral Health Part 1 Jonathan Neufeld, PhD - - PowerPoint PPT Presentation
Integrated Telebehavioral Health Part 1 Jonathan Neufeld, PhD Mary DeVany, MA July 17, 2020 This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number G22RH30357. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
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www.gptrac.org
○ Specialists see and manage patients remotely
○ Specialists (often MH) integrate services into primary care environment
○ Physiological and behavioral monitoring to maintain best function in least restrictive, least expensive, or most preferred environment
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Convenient access to needed/desired services; popular among younger, busier, and generally healthier patients, or homebound patients/populations
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www.gptrac.org
telehealth
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www.gptrac.org
○ In person visit required before prescribing controlled substances (or consultation model) ○ Telemedicine exemption
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www.gptrac.org
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“Virtual Check-ins”
prior week or next available
at the time of service
“eVisits” “Telehealth”
messages, providing Rx
at the time of service
*any video platform
anywhere (homes)
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*New during PHE
○ Generate revenue through billing (private practice, specialty care) ○ Meet population access and service needs
○ Improve quality and/or outcomes (ancillary services in hospitals and clinics)
○ Manage chronic diseases to avoid complications, decrease unnecessary or adverse utilization (chronic and team-based care)
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○ Expanded codes, originating sites, providers, and methods
○ Vary by plan, but most following Medicare
○ HIPAA not being enforced ○ Audio-only OK (when necessary)
○ Verbal consent at time of first visit ○ Cost sharing waivers
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Collaborative Care Model
(concept, movement, reimbursement programs)
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Collaborative Care Model articulated the concept of care that is: 1) team-driven 2) population-focused 3) measurement-guided 4) evidence-based
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MAIN IDEA: All providers/services are readily available on site and provide coordinated services, based on a plan the patient helps create, under the direction of the primary care physician.
H&B Codes (9615x)
increments
Assessments
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Integrated BH (9083x)
+ Handoffs/Intros
Assessments Team-based Care (CoCM)
member with formal BH training
Interviewing and Behavioral Activation (care components or techniques)
facilitator role is key
○ Make initial connection ○ Introduce others ○ Pass call to/among providers
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to refer to BH; messages BHC pool
introduction
completes brief intake and schedules follow up
joins call and checks patient out
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Behavioral Health
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Psychotherapy Clinic
scheduled sessions
Most programs are site specific - use available staff to see presenting patients
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Brief Supportive Tx
individual sessions
re-evals (PHQ/GAD)
More structure provides more control over caseload and process Team-based Care (CoCM)
don’t pay (including ND/SD)
popularity, especially if standard TBH is at all restricted
Screening/Referral
referrals for positive screening scores
number of sessions, set expectations
colleagues
TBH (the “tele” part)
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Disciplined Reporting
intake note from BH clinician to PCP - intake/first session completed, findings, plan
no-shows, and closing/re-starting notes Ask Patient Preferences
telehealth now
Handoffs/Referrals
clinician” (or staff) - designated and available by video
make comfortable, collect information, talk up clinician (script), make video appointment
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Front Desk
pre-training for pt
check-in by phone (day before appt)
connection, confirm consent, and present patient to doctor Virtual Huddle Report
huddle virtually
Outcomes
Forum Domains
○ Access ○ Cost ○ Experience ○ Effectiveness ○ (Sub-domains)
apply for usual care
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Satisfaction
instruments are applicable
(multiple items are usually highly correlated) Technical Quality
technical issues (Y/N)
○ Audio ○ Video ○ Clinician issue ○ Other ○ (Free response)
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