Virtual Emergency Behavioral Health Services Virtual Footprint Currently
Virtual Emergency Behavioral Health Services
Virtual Footprint Currently providing telepsychiatry consults in Atrium ED’s and IP units BHPP places patients from 23 ED’s as well as any IP unit we provide CL coverage (8) Charlotte BHPP currently manages beds for 9 AH BH units in Charlotte and surrounding areas VPN covers Acute care ED’s, 12 hours a day Patient Placement: 11. 5 FTE Telepsychiatry: 12. 9 FTE Provider: ~13 FTE To serve a large geographical area 24 hours a day 2
Process The Model The Team Tele-psychiatry Clinician • LCSW/LPC Tele-psychiatry Provider • Adult Psychiatrist • Child and Adolescent Psychiatrist • Nurse Practitioner Patient Placement Nurse BH Patient. • Registered Nurse . Patient Placement Admission Transfer Coordinator • Bachelor level with psychiatry related experience. Patient Navigators • LCSW/LPC Virtual BH Support Team Email questions to Quiana. Smith@carolinashealthcare. org 3
Process BH Provider completes consults and determines inpatient BH need Inpatient BH Treatment Emergency Department (ED) BH placement searches for inpatient bed and arranges transport ED initiates consult and BH clinician collects collateral Navigator Initiates Patient BH Patient Email questions to Quiana. Smith@carolinashealthcare. org Virtual BH Support Team 4 Discharged to home, treatment facility, or community
Patient Placement and Bed Management Total Placements 12000 10396 10000 8944 9207 Bachelor Level Admission Transfer Coordinators/ RNs work 24/7 8227 8000 Placements based on clinical and exclusionary criteria 6000 4355 4000 2000 0 2014 2015 2016 2017 2018 Total Placements 5 Scope focused on locating and allocating appropriate Psych Beds
Virtual Patient Navigation Program Goals Program Elements Introduction to the patient follow-up process prior to ED discharge Decrease Admissions Reduce Readmissions Increase Discharges Follow-up evaluation within 72 hours by phone Reduce Unnecessary ED Visits Follow-Up Compliance Weekly contact includes: (1) C-SSRS Reassessment; (2) Identifying & assisting with barriers to appointments/medications; (3) Providing appropriate referrals; (4) Supportive listening 6
Return on Investment Clinical Outcomes ▲ Patient Experience of Care Healthcare Utilization ▲ Bed Occupancy Cost of Care ▼ Sitter Expense ▲ Timeliness to appropriate care ▼ ED&Psychiatry LOS ▲ ED Capacity ▲ Teammate/Provider Satisfaction ▲ ED/Psychiatry Discharge Rates ▼ LWBS ▲ Maximizes BH resources throughout the state ▲ Teammate/Provider Satisfaction ▲Increased Contribution Margin ▲ Continuity of care through IT ▲ Access to Timely Treatment Email questions to Quiana. Smith@carolinashealthcare. org 7
Virtual Behavioral Health Integration
Overview The Collaborative Care Model The Team Behavioral Health Professional PCP LCSW/LPC, Psych RN Health Coach Consulting Psychiatrist BHP/Care Manager Patient Other Behavioral Health Clinicians Provider Additional Clinic Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources Outside Resources Adult Psychiatrist Child and Adolescent Psychiatrist Nurse Practitioner Pharmacy Virtual BH Support Team Email questions to Quiana. Smith@carolinashealthcare. org Bachelor level with two years’ experience Obtain Health Coach Certification within 1 year of hire date 9 Board Certified Psychiatric Pharmacist (BCPP)
Process PCP consults BH Provider for curb side chart review Elevated PHQ-9 Scores Captured in BH Patient Registry PCP Office PCP Appointment PCP Office Administers PHQ-9 BH Patient Email questions to Quiana. Smith@carolinashealthcare. org Virtual BH Support Team 10 PCP initiates in office virtual visit if needed Post Appointment Call Back Protocol
v. BHI Current State v. BHI by the Numbers (2018) True Demographics • Average Age: 42 • Majority Women: 68% • Majority Caucasian: 78% • 95% Primary Care Attribution Prevalence of BH Disorders • 80% of the patients with elevated PHQ-9 scores, 66% with elevated GAD-7 scores, 35% with suicide ideations • 80 -90% of patients prescribed at least one psychotropic medication prior to enrollment in BHI • Mood and Anxiety disorders were the two most prevalent behavioral health conditions seen by our BHI team Prevalence of Comorbidities • 77% of the program participants had at least one chronic diagnosis • 90% had at least one chronic behavioral health diagnosis • Higher prevalence of other chronic diseases Email questions to Quiana. Smith@carolinashealthcare. org 15, 601 Unique Patients 86, 428 Patient Encounters 1, 006 Patients Active Patients 25 Primary Care Practices 7 Pediatric Practices 70+ Care Management Clinics 11
Outcomes-Disease Severity Depression 60. 2% of patients receiving BHI services demonstrated 50% reduction in PHQ-9 score Anxiety 65. 9% of patients receiving BHI services demonstrated 50% reduction in GAD-7 score Remission 44. 1% of patients receiving BHI services achieved remission Suicidal Ideations 88. 0% of patients receiving BHI services endorsed absence of suicidal ideations upon completion of Health Coaching
Outcomes-Clinical 13
Outcomes-Healthcare Utilization 14
Case Study: Anson County
Anson Patient Trajectory Anson patient enrolled in Behavioral Health Integration Patient referred to integrated Anson Primary Care clinic Criteria for virtual rural clinics: 1. Treatment resistant MDD 2. Psychosis 3. BPAD 4. Multiple inpatient or ED stays related to BH illness Patient referred back to Anson BHI once “stable” Provider in Charlotte
Measures of Success Reduction of ED utilization Reduction of inpatient utilization Increased virtual OMS utilization Reduced wait time for new patient visits Reduction 45 -day acute care utilization Cost savings
Virtual Primary Care
Why Virtual Primary Care? The Goals Reduce Costs Coordinated Care Enhance Engagement Improved Access for Patients Improve Quality
Care Options and Platforms Urgent Care Chronic Care PCP Visits Video Visits e. Visits Wearables MODALITIES EXAMPLE SERVICES What and How Electronic Health Records
Virtual Primary Care At Atrium Health My. Atrium. Health e. Visits Virtual Visits
Virtual Primary Care Our Experience Year-over-Year Volume 4. 7/5 Flu season: Pt Safety Hurricane Florence: Maintain Access Overall Care 4. 9/5 Provider Rating
Virtual Primary Care Ensuring Quality Care Stick to THE GOAL: Care is Care Consistent, physician driven protocols and goals Physician oversight and supervision Reliable technical platforms and support 1. Regular review 1. Documentation adherence 2. Antibiotic prescription rates 3. Protocol adherence 4. Care coordination 2. Ongoing education 1. Case reviews 2. 1: 1 3. Structured protocol development process 1. Yearly standard review 2. Monthly physician Advisory Council
Virtual Primary Care Drivers Regulatory Policy Telehealth/virtual health legislation significantly impacts supply and demand Cost Adoption Technology and Workflows Technology and workflows must “fit” within the patients' needs and capabilities Accessibility
- Slides: 24