The National Telehealth Webinar Series October 12, 2017

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1 The National Telehealth Webinar Series October 12, 2017 Presented by The National Consortium of Telehealth Resource Centers

3 Webinar Tips & Notes Your phone &/or computer microphone has been muted Time is reserved at the end for Q&A Please fill out the post-webinar survey Webinar is being recorded Recordings will be posted to our YouTube Channel BSF3QK-yg

4 Three Perspectives on Telepsychiatry: Adult, Pediatric, and Direct-to-Consumer Scott Baker, MBA Business Innovations Manager, InSight Telepsychiatry Barb Johnston, MSN, MLN CEO and Co-Founder of HealthLinkNow

5 Telepsychiatry Direct to Consumer Barb Johnston, MSN, MLM

6 Telepsychiatry: Direct to Consumer Appropriate Benefits Challenges Questions

7 Appropriate Condition-NOT suicidal or homicidal Most mental health issues OK Patient has required TM equipment Private/safe environment Communication via /cell for back up Informed Consent Signed and Documented Observe State and/or International laws/regulations

8 Case Example: 35 yr Severe depression NOT suicidal or homicidal Nurse at local community hospital Wanted psychiatrist out of community Works till 3pm-school age children I didn t want people at work to know It felt more personal somehow Prefer video approach

9 Benefits for Patients Meets Standard of In Person Care Many Patients expect/request it More flexible appointment times Convenience-no travel (time/cost) Less stress-familiar surroundings Avoid taking time off work/school Vacation or business travelers Maintain privacy

Benefits for Providers Many Patients expect/request it More flexible schedule/appointment times Convenience-no travel (time/cost) Enjoy home

10 Benefits for Providers Many Patients expect/request it More flexible schedule/appointment times Convenience-no travel (time/cost) Enjoy home or office-familiar surroundings Opportunity to expand/improve practice Learning new way to work No extra overhead costs High patient satisfaction

private pay Rules/regulations-States and payers Professional standards-same as

11 Challenges Securing private location Patients changing technology Previous VC dropped sessions-resolved Getting buy in from PCPs Payment: Insurance payers, private pay Rules/regulations-States and payers Professional standards-same as in person Appropriate attire and background Sit up and remain center of screen

12 How to be a Telesuccess: Implementing and Utilizing a Successful Telepsychiatry Program Scott Baker, MBA

13 Agenda Telepsychiatry Overview Models of Telepsychiatry Special Populations Program Planning Implementation

14 Telepsychiatry A medium for delivering psychiatric care through videoconferencing technology

15 Outpatient clinics In-home Primary Care Offices Emergency Departments Hospital Medical Floors Inpatient Units Urgent Care Centers Mobile Health Clinics CMHCs FQHCs ACT Programs Residential Programs Schools Corrections Skilled Nursing Settings for Telepsychiatry

16 Telepsychiatry is Different Telepsychiatry Focus on conversation and collateral collection Long-term physician-patient relationship Other Branches of Telehealth Focus on physical observation Short-term encounters Typically 8-12 appointments Multiple types of appointments Single consultation Urgent care

17 Scheduled Services Model Remote providers can be used to complete most tasks that an onsite provider would Initial Assessments and Testing Treatment Team Meetings Medication Management Therapy and Counseling Group Sessions

18 On-Demand Model Rapid, on-demand access to a psychiatric professional Psychiatric Assessments Admission and Commitment Decisions Consults and Orders Rounding Referrals

19 Asynchronous Model Some organizations do this with store and forward or telepsychiatry Session is recorded (with permission) with a facilitator trained to ask certain questions The session is then reviewed by a psychiatrist at a later time

20 Direct-to-Consumer Model Convenient value-add for consumers Flexible hours for providers in private practice Great for night and weekend appointments Expand care almost anywhere (home, dorm room, hub site, etc.)

Consumer Telemental Health Provider Community Benefits Reduces time in hospital Provides access to

times High consumer and family satisfaction Increases time and efficiency Decreases transportation

consumer population Flexibility to work from home Increases access to specialists Reduces

21 Consumer Telemental Health Provider Community Benefits Reduces time in hospital Provides access to specialists Flexible hours for scheduling appointments Facilitates continuity of care Reduces wait times High consumer and family satisfaction Increases time and efficiency Decreases transportation costs Increases number of visits Improves communication and collaboration Ability to see a diverse consumer population Flexibility to work from home Increases access to specialists Reduces inappropriate admissions Connects siloed health care organizations Improves population health Reduces risks and liabilities

22 Challenges Programs Providers Complying with multiple state and federal regulations Getting buy in from a new program Licensure in multiple states Must make time to interact with onsite staff Designing efficient workflows Potential to feel isolated

23 Special Populations Refers to any group of consumers that present unique barriers to communicating or understanding that require adaptability in the approach to treatment Only provide services to consumers with whom you have the training to effectively work and communicate

24 Success depends on their ability to sustain attention A flexible approach is an asset Set firm boundaries Parents may need to be involved in sessions Children

25 Sound is very important Have someone else in the room to act as your hearing translator if needed Though there is a higher chance of having dementia, this population can still get a lot out of telepsychiatry Still able to talk, engage and demonstrate cognitive deficits Aging Adults

26 Other Populations Autism Spectrum Disorder English as a second language Indigent populations

27 Patient Appropriateness Educate the individual on telebehavioral health to determine if it s right for them Appropriate Individuals Are busy and struggle to find time in their schedule to get away Have limited mobility or access to transportation Work full time or have multiple jobs Are in school full or part time Would not otherwise bother to schedule a mental health appointment Need timely care and treatment Inappropriate Individuals Are In crisis or emergency situations such as being suicidal, psychotic or violent With no access to reliable internet or a smart device with a camera or microphone Who have been educated on telehealth, but are still very uncomfortable with the technology or refuse to use it Who are medication-seeking

29 Implementing a Telepsychiatry Program

30 Program Planning Consider Regulatory and Legal Environment Cultivate Stakeholder Buy-In Select Technology Design Workflows Provider Credentialing Training

31 Know State-Specific Regulation and Rules Licensure State Medical Board Reimbursement Medicaid Private Payers Physician-Patient Relationship & prescribing Telemedicine specific legislation or regulation Permitted services, professionals, sites, etc.

32 Cultivate Stakeholder Buy-ins Providers Executives IT Medical Affairs Community Payers

33 Select Your Providers

34 Medical Affairs Plan ahead! Provider credentialing is the largest roadblock to launching new programs Are your bylaws conducive to telepsychiatry? Will you accept credentialing by proxy? Licensing Credentialing Paneling Payer Enrollment Maintenance of Certification, Reappointments, CMEs

35 Design Workflows Proactively design a system that works for you Goal should be integration When will you use telepsychiatry? How? Who will take the records? How will they be sent? Who will be the facilitator? What will they do? How will they communicate with the remote provider? How will scheduling work?

36 Practice Guidelines The American Telemedicine Association and the American Psychiatric Association both have guidelines for the practice of telepsychiatry and are excellent resources.

37 Questions and Discussion

38 The National Telehealth Webinar Series 3 rd Thursday of every month Next Webinar: Topic: Increasing Connectivity for Rural Health Care Facilities Presenter: Karen Lee, VP of the Rural Health Care Program, USAC Host: The Upper Midwest Telehealth Resource Center Date: 11/16/17 Times: 8:000AM HST, 10:00AM AKDT, 11:00AM PDT, 12:00PM MDT, 1:00PM CDT, 2:00PM EDT

com/r/m7nl3f3 TRC activity is supported by grants from the Office for the

39 Your opinion of this webinar is valuable to us. Please participate in this brief perception survey: TRC activity is supported by grants from the Office for the Advancement of Telehealth, Federal Office of Rural Health Policy, Health Resources and Services Administration, DHHS

The National Telehealth Webinar Series November 10, Presented by The National Network of Telehealth Resource Centers

The National Telehealth Webinar Series November 10, 2016 Presented by The National Network of Telehealth Resource Centers Webinar Tips & Notes Your phone &/or computer microphone has been muted Time is