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

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

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

4. Who We Are

5. 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

6. 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

7. 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

8. 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

9. 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

10. Questions