Ten years ago, helping healthcare organizations understand virtual workflows and virtual care pathways was much more complicated than it is today. Since the COVID-19 pandemic, the adoption of virtual care across all medical specialties and primary care has been critical, especially in behavioral health.
Today, behavioral health usage rates remain high. At Iris Telehealth, it’s not unusual for our partners to use telehealth 50-75% of the time for behavioral health care services. Everyone is used to telehealth.
That means, rather than primarily focusing on connecting and seeing patients (the core of virtual care), we’re now able to focus on emerging workflows that enable analytics that track no-show rates, billing and coding patterns, and patient engagement.
One area where we’ve seen a high opportunity for workflow improvement and high impact on patient outcomes is leveraging virtual care in the inpatient psychiatric unit.
The reality of behavioral health care in the health system
Behavioral health patients seeking care for urgent issues and experiencing long wait times in the health system is nothing new. That’s because many hospitals don’t have access to behavioral health resources. When they don’t have this access, they leverage social workers for care coordination, therapy, and patient support.
If a patient comes in with cardiac or lung issues, you want them to meet with a provider with the appropriate skill set and knowledge to assess them based on their presentation. Many emergency departments have excellent providers who have been able to treat behavioral health patients, but nowadays the acuity is much higher.
Access to inpatient treatment for patients who might be manic, psychotic, or experiencing withdrawal can be challenging – and it may not always be easy and efficient to direct them to the appropriate hospital bed or step-down unit.
That’s where we’re finding that, for many health systems, the emergency department is becoming like an inpatient unit. For organizations that partner with a telehealth solution like ours, patients can be seen by a psychiatrist or a Psychiatric Nurse Practitioner (PMHNP) in less than an hour of when they present to the ED.
From there, we can work with the ED staff on starting or restarting necessary medications or guiding the course of treatment – which makes for a better patient experience and smoother workflows for the on-site care teams.
In-person care verses virtual in inpatient psychiatric units
Through our partnerships with major hospitals and health systems across the country, we have found that hospitals and inpatient psychiatric units that have adopted workflows enable virtual care work very well.
When working with an organization, we like to learn about their culture around telehealth. We learn about their history and how they’ve embraced telehealth in the past.
It’s important for organizations to consider that the quality of an in-person provider isn’t necessarily better than that of a virtual care provider. We can get high-quality providers who want to work from their homes and virtually go into the inpatient psychiatry unit and ED, allowing patients to experience the high-quality care and professionalism they need and deserve.
Also, hospitals can have long-term virtual care providers seeing patients on inpatient units and engaging in rounding, team meetings, consults, and admitting/discharging patients.
A virtual behavioral health provider can be just as accessible throughout the day as an in-person provider. While you can’t knock on their door, you can send them a note through an instant messaging platform, text, or even call them on the phone just like an in-person provider.
There are many clinical duties on inpatient psychiatry units that require in-person support such as psych techs, nurses, and staff for things like lab draws and physical exams. However, in terms of behavioral health specialists, virtual providers can facilitate care that is as good as, or better than, in-person providers an organization might be able to recruit.
The key to integrating virtual and in-person providers
No matter the level of clinical care, trusting your team members is key, and that means spending time together. It’s important to note that being virtual doesn’t mean a provider is sitting at home doing nothing—it’s more like they’re in an office or a hospital next door. They may be 500 miles away, but they’re still available and responsive to patient and staff needs and questions.
For example, a nurse might have a question, or a patient might need to be seen twice or more during the day for something like an exacerbation of symptoms, possible side effects, or requesting to leave. In such cases a virtual provider would come back on video to see the patient and discuss concerns with the onsite team or even gather more collateral from family.
An on-site provider might be in a different location, stuck in traffic, and unavailable. However, a virtual provider can transcend those geographic barriers and see patients quickly with little if any delay.
Virtual care lends itself to collaboration and integration with on-site teams quite well. It allows for flexible, timely, and patient-centered care.
Virtual behavioral health programs and inpatient care
Continuity of care is critical to the patient experience. When you’re working with complex patients, it’s important to try and have continuity of care with the techs working around them and the nurses that can know and understand the nuances of their behavior.
With a solution like Scheduled Services, which is Iris’s approach to delivering virtual care, you have a provider working in the same units day after day — or being a part of the weeknight and weekend call teams and rounding team.
Building up the sense of continuity with the team and having that trust, consistency of care, and communication with patients in their behavioral health journey in the acute setting is very important.
Generally, our providers work on inpatient units just as an in-person provider would, though virtually. They have the same meetings, experiences with patients, and communication with the care team – all to help build that continuity.
The financial benefits of virtual behavioral health programs
There are also benefits of virtual behavioral health programs that lead to better financial outcomes. For example, by treating behavioral health, patients receive more holistic care that helps treat physical conditions in tandem, better improving total cost of care and reducing length of stay.
Additionally, having a virtual behavioral health solution in place can help improve ED throughput and ensure patients aren’t staying in the hospital longer than necessary.
There have also been recent policy shifts that have created major evolutions in how CMS and congress are working to look at virtual care reimbursement. It’s been more progressive than anything I’ve seen in my last 30 years of being in this field.
Change doesn’t happen a lot in medicine, but the recent changes to promote virtual access to care, particularly for people with mental health and substance use disorder issues, have been impressive and a huge win for patients and providers alike.
The future of behavioral health care
It’s important to challenge the myth that having someone on-site is better or necessary. Healthcare is moving away from care being solely driven by what happens in a brick and mortar facility.
In the future, not only will providers be working from home, but they’re also going to be seeing acute patients in the patient’s homes–patients who might otherwise have been hospitalized—in the emerging “hospital at home” and “remote patient monitoring” models that lend themselves quite naturally to virtual care.
Virtual care is helping the healthcare industry rethink our models and how we care for patients, both in acute care settings like inpatient units and partial hospital programs. Across the spectrum of care, virtual care continues to impact patients’ lives in ways that those of us in behavioral health care can really see.
If you’d like to learn more about how Iris Telehealth can integrate virtual behavioral health programs into your hospital or health system, please don’t hesitate to reach out. You can contact us here or check out this page to learn more about Scheduled Services.
