Category: Blog

Behavioral health integration is not a new idea. It started to garner mainstream traction in the 1970s, and in 2024, nobody disputes the impact of integrating mental and physical health.

It is unquestionably the right thing for patients and total cost of care.

The last fifty years have brought innovative ideas, pilots, and learnings — but as an industry, we have yet to drive widespread adoption and success. At Iris Telehealth, we believe that’s going to change. The data, care models, and technology have evolved to make driving scalable and sustainable clinical and financial outcomes possible. 

Let’s talk about what we’ve learned as an industry, where we’re going, and why the time is now to drive widespread adoption of behavioral health integration. 

Why hasn’t behavioral health integration lived up to the hype yet?

In entrepreneurship, there is a maxim that the success of any business comes down to 5% having the right strategy and 95% having great execution.

With behavioral health integration (BHI), the strategy needed to find success is no different. By integrating the right resources into a patient’s care team, we can drive better outcomes and total cost of care. 

However, the biggest challenge to date is scalability. There are no doubt great experiences, data, and outcomes. But results have been difficult to scale across patients of higher acuities, within rural geographies, and with financials that incentivize their organizations to invest over the long haul.

From our conversations with customers, too many have given up, or have stopped scaling their programs because they run into operational or financial roadblocks that prevent them from achieving their ultimate mission. 

So, how can we overcome this challenge to solve behavioral health integration?

There are a few key evolutions in the market that have changed the game: the ability to integrate virtual care locally, to algorithmically identify the patients that need care the most, and the development of care models that are financially sustainable.

Virtual care in behavioral health is a game changer. The unfortunate reality is that 70% of counties in our country do not have a licensed child psychiatrist and 60% do not have a licensed psychiatrist.

Additionally, virtual care allows you to leverage resources across geographies to ensure they’re being used efficiently so smaller populations can still receive great care. 

Virtual care has to be part of the story, but it comes down to the “how.”  

The answer is dedicated virtual care teams with local integration. There must be trust between virtual and in-person teams with shared goals, technology platforms, and communication mechanisms.  

The on-site teams must truly see the virtual providers as an extension of their teams – something that can only be established if the virtual providers know the local culture, are operating on the same technology platforms, communicate constantly, and have aligned goals.  

The second critical ingredient is utilization of data to measure and drive success. Data has unlocked our ability to determine “who should receive care” and “when.”

The reality is some patients are at higher risk of escalating than others, and the data exists within EMRs to intelligently prioritize who should get care first.

This process could mean prioritizing the referral queue to ensure patients in highest need care first or it could mean proactively identifying patients that need care, even if they have not been referred.

The data, algorithms, and technology are all there, we just have to do the work.

Finally, we have decades of learning around the optimal care model that we should apply going forward. Navigation assessments must be part of the story to ensure each patient is getting clinically appropriate care from a provider working top-of-license.

We need to incorporate short-term care models as clinically appropriate.

There must be a care team approach to ensure patients of all acuities can receive the best care for their specific needs. And, a need to collaborate with the broader team, and community providers, to ensure patients are receiving continuous, quality, whole-person care. 

If we do all these things, the financials follow – both on a fee-for-service basis and from a total cost of care perspective. We have proven that it is possible to deliver great clinical care while delivering a positive operating margin for our partner health systems. 

So, what’s next for behavioral health integration?

We cannot give up on the idea of behavioral health integration.

If we take the learnings we’ve had as an industry over the last few decades and apply them, we can absolutely scale BHI across entire populations in a way that delivers sustainable financials and fantastic clinical outcomes — all while increasing patient and provider satisfaction. 

We believe Virtual Clinic is the answer to behavioral health integration.

Our Virtual Clinic approach leverages a cross-functional care team to ensure patients who need help first, get seen first. They’re able to get the appropriate care plan for their needs and are supported throughout their care journey. Virtual Clinic integrates behavioral health services into unique patient journeys to ensure their mental health is always supported.

If you want to learn more about this service and how we can help your organization address behavioral health needs in a financially sustainable way, feel free to contact us today.

You can also learn more about our services here and read our case study to see them in action.

On November 1, the Centers for Medicare & Medicaid Services (CMS) released their 2025 Medicare Physician Fee Schedule through a comprehensive fact sheet that breaks down all the planned changes across the health care system.  

Here’s a look at how these changes will affect the behavioral health and telehealth landscape as we turn the corner into 2025 along with some insights from our Chief Medical Officer, Dr. Thomas Milam, on how we can interpret these changes.

Average payment rates under the PFS will be reduced by 2.93% in CY 2025

While the new ruling contains several positive updates, the PFS reduction in payment rates by 2.93% may have cascading impacts across your organization that you may have to prepare for.

While a decrease wasn’t unexpected, it still may present challenges for those affected as this reduction will put less money in the hands of healthcare workers and their organizations.

“Everything we do in medicine has a relative value unit (RVU) assigned to it – every procedure and every patient encounter – so even an incremental decrease is less money going to doctors, hospitals, and facilities during a time where there’s a lot more patients and higher acuity.”

Dr. Thomas Milam, Chief Medical Officer

CMS will preserve and expand the scope of and access to telehealth services

Without congressional action, the pre-COVID-19 statutory limitations in place for Medicare telehealth services will resume, including geographic restrictions and service limitations in which practitioners can provide telehealth services.

CMS has expressed intentions to preserve important flexibilities in their authority and expand the scope of, and access to, telehealth services. However, we’re still waiting on the supportive data and legislative updates that will be critical to such efforts.

“The CMS Behavioral Health Strategy has a lot of important initiatives where telehealth could play a major role in keeping patients well and out of hospitals and emergency departments. We have every reason to believe CMS, patients, and providers want to continue leveraging telehealth in patient care–we’ve been doing it, and we should keep doing it.”

Dr. Thomas Milam, Chief Medical Officer

CMS is leaning into greater suicide prevention and flexibilities for OUD treatment

To expand access to behavioral health care, CMS is taking action towards safety planning. When properly executed, this planning can go a long way towards preventing suicide.

CMS is currently finalizing separate coding and payment under the PFS describing safety planning interventions for patients in crisis, including those with suicidal ideation and those at risk of suicide or overdose.

“CMS is leaning in more to support efforts to identify people at risk for suicide, and they plan to have additional reimbursement modeling for services to move towards a zero-suicide policy. Suicide rates remain high in all age groups, and among veterans as well, so we should all be doing everything we can to screen, intervene, and prevent such loss of life — telehealth will continue to play a big role in such efforts.

There will be additional G-codes in the system that will cover some additional services for suicide screening, assessment, and management in keeping with the success of the 988-suicide hotline.”

Dr. Thomas Milam, Chief Medical Officer

CMS is also finalizing telecommunication technology flexibilities for Opioid Use Disorders treatment services – allowing people to receive care without an in-person visit.

“I was pleased to see there are still a lot of flexibilities around opiate treatment programs in the 2025 PFS. The high risk of intentional and accidental deaths associated with opiates and the fentanyl crisis warrant continued efforts in early screening, management and prevention strategies.

The opiate epidemic is still a major concern for CMS and among health care providers, so allowing flexibilities to  se telehealth and other technologies to keep patients engaged in ongoing treatment is imperative.”

Dr. Thomas Milam, Chief Medical Officer

Prior to the COVID-19 PHE, if someone needed buprenorphine to stay well and avoid withdrawal and relapse, they had to go to a clinic in person, attend to their appointments for med management and therapy, and get drug screens – everything had to be done in person. 

Now, a lot of this process takes place over the phone and helps lower the risk that someone might relapse or overdose. As policies around this patient population evolve, it’s critical that CMS and SAMSHA continue working together to recognize the vulnerability and importance of people struggling with opiate use disorder.

New G-codes can help promote provider collaboration

CMS is finalizing six G-codes that will be billed by people who have limitations in their statute to services for diagnosis and treatment, mental illness, psychologists, social workers and management. These codes will mirror current interprofessional consultation and CBT codes.

There’s also more recognition in healthcare that provider communication around patient care is of high importance.

For example, eConsults weren’t previously paid for, but now there’s recognition that collaboration is real work and adds value for patients and providers. Reimbursing healthcare providers for their interprofessional communication and identifying the work that different care teams are engaged in together to keep patients well is an important step in the right direction.

CMS also shared they are finalizing a policy to continue allowing direct supervision via interactive, real-time audio-visual platforms to extend various types of supervision for providers who may require it such as like nurse practitioners, therapists, physician’s assistants.

While there seems to be hesitancy around using audio-only modalities for supervision and care delivery, they will hopefully still be viable options given the rural locations of so many patients and providers in the US.

Where Iris fits in

At Iris, we believe in a future that helps more people get the high-quality behavioral health they need and deserve – regardless of where they live. Virtual care is an important part of the future of healthcare and will continue to increase access to care for those who need it most.

Want to learn more about what the final rule means for your organization? Reach out to talk to someone today – you can contact us here!

You can also get more information and read more about the new CMS rule here.  

Behavioral health integration is a crucial part of ensuring holistic care in women’s service lines. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), among women with mental health conditions, 27% have a serious mental illness and 20% suffer from mood or anxiety disorders during pregnancy.

In a webinar hosted by Becker’s Hospital Review, healthcare leaders from Carilion Clinic dove into how they’re approaching behavioral health in their women’s service lines, shared best practices for integration, and offered strategies for better patient outcomes.

Carilion Clinic has taken steps to integrate behavioral health services into their women’s health service lines, and Dr. Jennifer Wells, reproductive psychiatrist and Director of Women’s Mental Health Services, and Dr. Jaclyn Nunziato, OBGYN and Executive Director of Huddle Up Moms, shared how they think about ensuring all patients have access to care that’s trauma informed and culturally sensitive. Please read below for a breakdown of the key insights they shared during that conversation.

Untreated behavioral health conditions can have negative ramifications on clinical outcomes

As an OBGYN, Dr. Nunziato shared that mental health was never in her training, yet behavioral health conditions are more commonly found in women than other common illnesses covered in regular screenings.

“I found patients I was seeing for years were sitting on these mental health issues, everyday struggles, and transitions throughout their reproductive journey. I would hear time and time again [patients saying], ‘Nobody’s ever asked me how I’m doing […] mentally.’ I found screening them even at a routine visit has really opened my eyes to the need and to the lack of resources.”

Dr. Jaclyn Nunziato, OBGYN, Executive Director of Huddle Up Moms

Dr. Nunziato went on to say that untreated behavioral health conditions have negative ramifications on clinical outcomes and that gaining a better level of expertise in mental health has made her a better provider.

Reproductive psychiatrist Dr. Jennifer Wells, Carilion Clinic’s Director of Women’s Mental Health Services shared that she has witnessed mental health stigma decreasing, a credit to Carilion Clinic and having providers who are more open to behavioral health.

In previous times, Dr. Wells said people would show up and talk about their depression, but not mention things like substance use.

“As we’ve grown in our ability to talk about diseases and provide education to the people around us, it’s allowed this great evolution of how we think about mental illness. And now I think some of that is happening in the perinatal space.”

Dr. Jennifer Wells, Director of Women’s Mental Health Services at Carilion Clinic

She says persons of reproductive age and parenting women are more comfortable sharing their fears and concerns about being a parent. Dr. Wells also shared that the ability to express these fears and concerns opens the opportunity to educate, listen, and find better ways to help people manage their anxiety and depression.

Acknowledging that hormonal shifts are important markers of a women’s health journey can help reframe the way we approach conversations about behavioral health

When defining the difference between “women’s health” and “women’s mental health,” Dr. Wells shares that they’re intimately connected.

“Women’s health has come to the forefront because we recognize the journey of a woman through her life is characterized by significant hormonal changes. Hormonal shifts are responsible for many downstream effects like mood disorders.”

Dr. Jennifer Wells, Director of Women’s Mental Health Services at Carilion Clinic

Dr. Wells also shares that a woman’s life takes a dramatic shift every 10, 15, and 20 years, which can create a shifting of mental health. This journey starts during adolescence, matriculating through middle school to high school, where someone might experience premenstrual dysphoric disorder. Then in fertile years, a woman might experience perinatal mood and anxiety disorders.

If a woman undergoes fertility treatment or infertility, they might experience depression or anxiety. Then, there’s the postpartum period that brings a greater risk for mood and anxiety disorders. Then, there’s menopause.

When discussing hormonal shifts, there are also important considerations around stigma. Dr. Nunziato shared that acknowledging hormonal shifts places value on where a woman is in her journey, where in another time, it was seen as something that was “all in someone’s head.”

Dr. Wells said that would like to see the conversation move beyond a woman being histrionic and can’t control their hormones to the idea that hormones are neuroactive steroids that change the biochemistry and neuroreceptors of someone’s brain, making mood disorders more common.

“Hormones are very real, and we need to talk about them – it’s a part of a woman’s life. Women live their lives through connection and emotional ties to other people. As these connections change through life, it’s no surprise that it happens concurrently with hormonal changes that exacerbate and ameliorate mood disorders.”

Dr. Jennifer Wells, Director of Women’s Mental Health Services at Carilion Clinic

How to integrate behavioral health into women’s health

Dr. Nunziato said the first thing a provider can do to integrate behavioral health is to become more comfortable in the mental health space and talking about mental health with your patients, noting, “You are somebody that values mental health and is willing to ask about it, provide screenings, be more educated about it. The more you do it, the more you gain a network and find the resources available in your area.”

When considering at what point a provider should refer to a specialist, Dr. Wells says it depends on provider comfort, sharing that each provider comes from a different training background with varying familiarity on certain conditions, like PMDD or major depressive disorder.

For providers, she recommends getting more comfortable talking about mental health and increasing their knowledge base. Dr. Wells also shared that most people are comfortable prescribing an SSRI, but if it goes beyond their scope and level of comfortability, they can reach out for an e-consult.

“The high prevalence of mental illness and substance use disorders in America can be co-occurring, including conditions like anxiety and depression, ADHD, bipolar, and schizophrenia. We know that primary care providers, family doctors, and pediatricians are at the frontlines, but often need support from mental health experts for medication management, therapy, or substance use issues.”

Dr. Thomas Milam, Chief Medical Officer, Iris Telehealth

At Carilion Clinic, they have e-consult services built into their systems, and providers can reach Dr. Wells via calling, texting, or a referral to her clinic. There are also perinatal mental health lines where providers can get connected to a specialist within 30 minutes.

In Virginia, Dr. Wells and Dr. Nunziato are heading their state’s perinatal mental health line called “VMAP for Moms+,” designed to help providers caring for pregnant persons or those contemplating pregnancy. These lines help create networks of good information that’s evidence-based and data driven.

Dr. Nunziato shared that she was seeing wait lists from six months to a year and to help increase access, they leveraged a risk-stratification approach. She noted that not everyone needs to see a psychiatrist and might do great with a peer support group or rely on their own OBGYN.

Addressing gender in women’s healthcare

When discussing women’s health, it’s important to consider all facets of the female experience, including transgender care.

For Dr. Wells, who often works with transgender patients, she shared that her practice is intentional about using the right terminology and understand this population faces higher rates of substance use disorder, abuse, and intimate partner violence.

Dr. Nunziato added for transgender patients trying to get pregnant or going through menopause, they’re also dealing with physiologic changes and stressors that need to be addressed and often aren’t recognized.

“It’s up to us to implore our teams to be accountable, respectful, and as open as possible. When I have transgender patients who are getting pregnant, it’s a great way to remind my staff (from the front desk all the way to the person doing their transvaginal ultrasound) that we need to be mindful and respectful of everyone’s individual needs.”

Dr. Jaclyn Nunziato, OBGYN, Executive Director of Huddle Up Moms

Dr. Wells shared that as the Director of Women’s Health she understands that “women” doesn’t always apply and it’s important to find alternatives. Dr. Wells goes onto say that she tries to elevate her own vocabulary, be sensitive to the person in front of her (however they identify) and educate herself on how best to meet their needs.

Get started with behavioral health integration

We are so grateful for the time Dr. Wells and Dr. Nunziato shared with us. Thank you for your partnership and for all the incredible work you are all doing to expand behavioral health to your community!

Weren’t able to make it to the webinar? You can catch the full video here. If you’d like to learn more and figure out the next steps to integrating behavioral health into your women’s health service lines, you can contact us here.

When integrating virtual providers into your organization to augment your behavioral health strategy it’s critical to ensure the onboarding of those virtual providers is as seamless as possible. Successful onboarding sets the tone for the entire relationship and working with an experienced partner that manages the process can be a major benefit.

In this blog, we’ll review tried and true strategies our partners have leveraged to effectively onboard providers for long-term success.

1. Assess your resources and lean on your partner

Before bringing on virtual providers, it can be helpful to assess your current onboarding resources and workflows. It might also be helpful to talk with your on-site providers about what to expect and discuss how your new providers will benefit your organization overall.

“We thought in the long term, it was going to create a situation where we could offer more flexibility when looking at full-time staff members. Even if they weren’t working full-time in a virtual capacity, they would have that tool as part of their tool belt. 

So, whether it was because of illness or convenience, it’s an important arrow in our quiver to be able to expand virtual health to include providing services on the inpatient end.”

Dr. James Anderson, Chief of the Department of Psychiatry at Basset

Partnering with a behavioral health organization that takes care of logistical steps in your onboarding process can save you a lot of time and resources. For instance, at Iris Telehealth, our Practice Managers (PMs) help manage the entire onboarding process and the day-to-day logistics after onboarding completes.

Our PMs ensure providers feel supported throughout their onboarding process and have resources they need, whether that’s the right equipment, or assistance with things like the EMR, or general support.

2. Check all your credentialing boxes to ensure desired start date

Onboarding the right provider types and specialists might mean working with a provider who lives in another state. When that happens, you may need to allocate more time to that provider’s licensing and credentialing processes. In some circumstances, credentialing can take months and delay a provider’s start time, so it’s best to get started as soon as possible to avoid any road bumps.

When we’re working to onboard providers, our credentialing team stays in close contact with clinicians, providing follow-up and retrieving documentation to ensure the process moves forward as efficiently as possible.

Our Medical Staff Services (MSS) team can estimate the length of time credentialing  will take based on your state’s requirements and provide an accurate start date.

 

 

At Iris, we’ve achieved 96% of on-time start dates, ensuring clinicians can start providing care as soon as possible.

3. Conduct a tech check to ensure everything runs smoothly

Working in a virtual environment versus an in-person one comes with unique considerations. For example, virtual providers may require special equipment or you may need to ensure they have seamless access to your EMR. For successful onboarding, it’s crucial to conduct tech checks and have trial run throughs. While many providers are familiar with virtual care, some may need assistance.

When you’re working with patients virtually, it’s important to ensure everything goes smoothly. For example, providers should confirm their audio is working properly, their backgrounds are appropriate, and there aren’t any interruptions.

“We have our systems in place in terms of our morning rounds. We have the computer system up and running. We recently just got a fish-eye lens camera, so I have better visibility of seeing everyone in the morning meetings, which has been fantastic.”

Dr. Tisa Ayuso, Virtual Medical Director, Basset Health Network

Ensuring your processes are thorough is extremely important and partnering with an organization that values quality is crucial. At Iris, we run all tech checks for providers and deliver 24/7 IT support during onboarding and beyond – your virtual provider is never left alone to deal with technical snags and your on-site team’s resources aren’t eaten up by troubleshooting technology.

Along with technical checks, confirming familiarity with the EMR is also important. Our PMs ensure they know as much about your EMR as the provider does – that way they can be of assistance if ever needed.

4. Create a trusted training plan and prep for necessary steps

Upon your provider’s first day, there will be a lot for them to learn, and having a structured plan in place can be incredibly useful. Whether that looks like scheduling intro meetings for them with on-site providers or letting them explore the EMR before they see their first patient, giving them tools to settle to their new role can be a huge help.

It’s also helpful to think of your provider as you would as an on-site team member – ensuring they understand the workflows and inviting them to meetings.

When creating your onboarding plan, here are a few trainings you might consider:

• IT orientation
• HR orientation
• Support staff introductions
• EMR training
• Conducting a dry run

At Iris,  we account for these trainings and considerations when we help onboard a new provider. We also go over important trainings like crisis overview, data entry, appointment scheduling, emergency protocols, and much more.

Want some extra help with onboarding? Here’s where Iris fits in.

With all the logistical considerations that come along with onboarding a virtual provider, having a partner that’s been there before can serve as a huge advantage.

Want to learn more about how Iris can help your organization make provider onboarding seamless? Contact us today!

Iris clinicians facilitate top-quality behavioral health care – averaging 2.3M patient encounters every year. We are proud of the work our providers do every day to fill care gaps and support healthcare organizations across the country by providing their communities with timely access to exceptional care.

Every month, we sit down with one of our providers to spotlight the amazing work they’re doing every day and the impact they’re making on the communities they serve. This month, we’re sitting down to talk with Dr. Sean Hawkins!

Q. How does telehealth compare to in-person work?

A. The first thing on the top of the list is the contrast from where I was over a year ago – which was commuting probably an hour and a half a day. Then, there’s the extra 20 or 30 minutes you tack on to either end to make sure you’re not going to be late – accounting for traffic and accidents.

I really don’t miss the commute and I’m grateful to have more control over my day. I can customize more of my day and have more flexibility with my schedule. If I start my day an hour or two before my workday starts, I know exactly when I can sit down and when I can be there for my family. All those things are nice.

Q. How does telehealth support holistic care?

A. I have a nurse that’s present 90% of the time and a medical assistant that’s available other times. We see them at the beginning of every shift and in between every patient. We keep in regular contact. We also develop relationships with most of the employees.

There are behavioral health techs or care assistants present 24 hours a day. There are certainly people that I haven’t met that are overnight, but I do get to meet a large majority of the day shift employees, and I have some amount of communication with different people, even if I haven’t met them.

We review notes together. It feels like being part of a team with eight therapists – our nurse, a few medical assistants, and the leadership team. We have regular communication with that whole team, which I really enjoy.

At the top of the list is the other Iris psychiatrist – I get to see them face-to-face in a team meeting each week. We’re frequently talking on this side about different issues that come up.

Q. How does telehealth foster connection with patients virtually?

A. Telehealth helps patients in expected and unexpected ways. We do some outpatient visits – I think everybody learned a bit about that during the COVID-19 pandemic. But for me, it’s always a surprise when I’m introduced to somebody’s significant other, their family, dogs or the area where they live in a way that I never would’ve seen previously.

Additionally there are a lot of people who have been through traumatic events with men where they wouldn’t want to be in a closed room with a male practitioner and would not feel comfortable.

In fact, a lot of people I worked with in-person, would come in for a first visit and then back out the door and say, “I didn’t realize you were going to be a man. I can’t do this.”

I think that has been a lot better virtually to the extent that part of my first conversation with people is letting them know about boundaries, and if they’re not feeling safe or comfortable, I let them know they can always leave the room, and I’ll disappear. But if they’re not comfortable doing that, they could close the laptop.

There’s always that level of comfort for some people who have been through really difficult things like abuse and don’t feel as comfortable sharing a physical space with someone.

People who receive dialectical behavioral therapy can struggle with boundaries. It can be uncomfortable being a male provider in a small, closed room with no windows with a client who may have trouble with boundaries. There’s comfort on both ends knowing there’s no concern about some of the obvious things – where I might otherwise feel the need to have a chaperone present just for everybody’s comfort.

Q. What is the most rewarding part of your job?

A. The most rewarding parts are the same things that would be rewarding in person – seeing people make changes in their lives that are important to them over time. And feeling like I have some part of that is always nice. It’s mostly about an overwhelming sense of gratitude that someone opens up a part of their life where they’re vulnerable and where they’re trying to change or can change while I’m present.

Q. Why do you think telehealth is the future of mental health care?

A. The first thing that occurs to me is the geographical barriers. There are parts of the country where it’s hard to recruit psychiatrists and other mental health professionals. Telehealth helps cut out a two-hour commute or help patients overcome cost prohibitive transportation.

A lot of patients are working long days, and the last thing I want to do is tack my visit onto the to the end of that and have them drive an unsafe two hours. I think for some people it’s safety in a literal sense.

Telehealth creates greater comfort than patients would have if they came into a public setting. There’s also stigma and shame that can come along with in-person care. I think it’s a lower energy barrier for people and there’s a ton of reasons why telehealth is here to stay and I’m glad to be a part of it.

Q. Anything you’d like to share about your experience with Iris?

A. I’m really glad to be here. This is a dream job for me in a lot of ways.

At Iris, we believe our providers should be respected, valued, and applauded for the work they do, and we couldn’t be prouder to say, “thank you” to our very own Dr. Hawkins. If you’d like to learn more about working for Iris Telehealth, contact us today.