Lessons learned from One Mental Health Provider’s Telehealth Trial by Fire

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DEK: Helpful tips to enhance service in time for the second half of the pandemic.

When COVID-19 began to spread in March of this year, Turning Point Counseling Services and thousands of other practices, faced a near-impossible predicament. Like many behavioral health providers and outpatient treatment programs, our business model prioritizes a personalized approach to care. But in the face of an unpredictable health challenge — one that seemingly shut down our entire country — we had to instead navigate a new care framework that minimizes in-person services.

We knew it wasn’t just our business model at stake. Patients with substance-use disorders need a high level of hands-on care. They are suffering both the physical ramifications of substance withdrawal (headaches, fever, chills) plus the emotional ones (family distancing and weaning off unhealthy social relationships).

Telehealth emerged as the safest potential solution – in truth, the only solution. But lingering questions remained. Would counselors be able to deliver the same level of engagement? Would patients respond to virtual care services in the same way? Could virtual care — a screen and a program — deliver outcomes that align with our expectations for individuals with substance-use disorders and mental health issues?

Overcoming the barriers to adoption

Our Fairbanks, Alaska-based practice experienced various forms of emergency situations. Yet none on our team could have foreseen the business and care-continuity challenge presented by the pandemic. As the virus spread, it became apparent that we needed to quickly embrace a new way of delivering therapies to ensure that patients enrolled in our individual, group and outpatient treatment programs would not experience interruptions in their care that could lead to a decline in wellbeing.

Admittedly, our practice was not familiar with the technology or remote models of care. Going virtual would entail a trial by fire we never anticipated. Fortunately, our existing electronic health record (EHR) partner—InSync Healthcare Solutions—had a telehealth offering, which is HIPAA compliant and designed for easy engagement with patients in on-one-one or group sessions.

In less than 24 hours, we were set up with a virtual care platform specifically built to interact and share data with mental-health practice EHRs. The user-friendly application allowed our counselors to easily launch virtual consultations and move from one program to another without skipping a beat. And because the telehealth solution syncs with our EHR practice notes, there’s no need to print out forms or other documentation or scan and re-upload information (and risk violating HIPAA).

As with any new technology implementation, staff and patients encountered minor issues — a few patients claimed they missed email reminders for sessions, for example. But overall the telehealth experience has been positive. As it turns out, most actively enrolled patients were willing to go to any lengths to recover even if that meant adapting to screens. And for providers, the ease of use and familiarity of the program has made overcoming the barriers to adoption worthwhile — and necessary — to continue providing the highest level of care.

Weathering the unexpected

For all that’s been discussed about telehealth in today’s care landscape, we’d be remiss if we didn’t admit our concern about revenue cycle and payment parity for virtual care. While the state of Alaska requires payers to cover telehealth, we feared that we would encounter billing issues such as lags in claims processing, denials or requests for information that would delay payment.

Thus, we are continually evaluating our processes to improve collaboration with health plans as telehealth reimbursement is unchartered territory on both sides of the isle. We have found that many insurers do not have streamlined processes in place to address every member, which necessitates that we take a very individualized approach with each patient claim. It has been resource intensive, although we believe that processes will improve over time.

Looking ahead: a stronger practice

It’s been nearly four months since our telehealth program launched. While a small percentage of our patients have returned to in-person care in tandem with new safety guidelines from the Centers for Disease Control and Prevention (CDC), our teletherapy program is still going strong, and we’re now looking at ways to expand to underserved populations.

According to one April 2020 study of 1,468 adults published in JAMA, 14 percent of people reported high levels of psychological stress, compared with four percent in April 2018. This and other studies suggest that the need for mental healthcare, including substance-use treatment, is only going to grow. Notably, our clinic is realizing perfect attendance across our substance abuse groups, and our work with trauma patients is improving as clients feel safer engaging in therapeutic work at their homes.

As we brace for a potential second wave of the pandemic, here are a few takeaways for practices in the process of implementing or expanding their telehealth program:

  1. Test drive workflows. Telehealth is not a stop-gap solution to use just during a pandemic. It’s the way of the future. Practices need to ensure patient encounters are easy to launch and document. Any workflow issues should ideally be resolved before clinicians see patients on screen.
  2. Communicate with payers. Making sure payers are on the same page as your practice is essential. One problem we ran into is that our top payers had pre-COVID limitations on what they would cover virtually. We’re still awaiting payments for services rendered in March and April.
  3. Check in with clinicians. Healthcare workers aren’t typically trained to use Zoom or other video-based communication tools as part of their regular work schedule, which can lead to burnout. Talk to clinical staff about what you can do to support them — such as spacing out group sessions. We have found that bringing staff into the office to conduct telehealth sessions improves internal collaboration and communication—an issue that was identified early on as therapists conducted sessions from home.
  4. Work with a vendor that has your back. What’s made the biggest difference in our program’s success is having a vendor partner that can support us when technical issues or questions arise. The right vendor is always looking for ways to improve its behavioral telehealth platform, the patient experience and clinician experience.

We take great pride in continuing to offer a personalized, caring approach to helping individuals with substance-use disorders and mental health issues. And while our telehealth trial by fire worked out, we strongly encourage other practices to plan ahead as much as possible to ensure they’re providing an optimal telehealth experience. The second wave of this pandemic is upon us: the time to start is now.

ABOUT THE AUTHOR

Nick Kraska, CDC 1, BHC 2, the COO of Turning Point Counseling Services,  has worked in the field of mental health for over seven years now and has been in a variety of roles, including direct care with patients, case management, intake coordination, administration and leadership.

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