Increasing Access to Tele-psychiatry in Rural and Frontier Colorado Diana Hornung, MD, Medical Director Lilia Luna, PsyD, Behavioral Health Director

Disclosures No financial disclosures. Context of Presentation: Derived from the flows and processes of two Federally Qualified Health Centers

Road Map Who we are Why Tele-psych Our Model Data-Informed Results Key Components and Lessons Learned

Who We Are

INCREASES ACCESS INCREASES SUPPORT COST SAVINGS SAVES LIVES Why Tele-psychiatry? INCREASES ACCESS INCREASES SUPPORT COST SAVINGS Healthcare shortage areas…3 months on average to access psychiatry within community MH center OR an average of $150/visit for private psychiatric consultation - Lot of weight on out medical providers who’s days are full of MH/BH Concerns. per SIM data, 46% of adults will experience mental health illness or a substance abuse disorder at some point in their lifetime 20% of primary care office visits are directly mental health related and about 80% of visits involve behavioral concerns In Colorado, 40% of adults with low income qualifying them for Medicaid have a MH disorder. For these individuals, medical costs are increased by a factor of 2.24GET THEM ON RIGHT Tx PLAN. Frees up family medicine practitioners to see more patients and bring in more money to the clinic SAVES LIVES

Our Model In-House Referral to Tele-psych Consultation as Needed 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 Our Model

Key Components Evaluate Need Establish Initial Funding Promote Buy-In Establish and Communicate Flows with Teams Establish Tele-psych Provider who is Good Fit Train All Open and Regular Communication to Evaluate Optimal Level of Care Reliance on Team-based Care Contracting with Partners to Promote Revenue Development

Lessons Learned 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

Data-Informed Results 2018 Averages 31 tele-psych visits/month 11 new patients seen/month 161 Unduplicated Patients 20% Average No Show Rate Improved Satisfaction Quotes from Providers:  I like collaborating with psych NP on patients and making sure we are following same goals for pt.   I like having tele psych for taking immediate but stable pts with complex psych issues needing medications. 408 Total Encounters

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