Behavioral health integration is not a new idea. It started to garner mainstream traction in the 1970s, and as we sit here in 2024, nobody disputes the idea that we should integrate mental and physical health. It is unquestionably the right thing for patient care, and for total cost of care.

The last fifty years have brought amazing ideas, pilots, and learnings — but as an industry, we have yet to drive widespread adoption and success. At Iris Telehealth, we think that is about 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 the industry is 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 we all need to take to find success is no different. By integrating the right resources into a patient’s care team, we can drive better outcomes and better total cost of care.  

However, the biggest challenge with the industry approaches 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, the ability to algorithmically identify the patients that need care the most, and the development of care models that are financially sustainable. Let’s talk about each.

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 resources are being used efficiently so that smaller populations can still receive great care.  So, virtual care has to be part of the story. But, again, 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 also unlocked our ability to determine who should receive care 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 situation. And, there must be collaboration with the broader team and community providers to ensure patients are receiving continuous, quality, whole-person care.

If we do all of 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 Bridge Care Services is the answer to Behavioral Health Integration.

Bridge Care Services 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.

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 the services here and read our case study to learn what Bridge Care Services looks like in action.

For health systems seeking to provide high-quality inpatient psychiatric care, it’s essential to prioritize learning what patients need, how best to support them on their care journey, and how to connect with patients. While in-person care remains the gold standard, giving patients a virtual option can help reduce no-shows and ensure patients aren’t seeking behavioral health care in the ED.     

In a webinar hosted by Becker’s Hospital Review, healthcare leaders from Carilion Clinic and Bassett Health Network came together to discuss how they’re leveraging partnerships with telehealth organizations to overcome hiring challenges and help their communities get the best care possible. 

They were also joined by two providers, Dr. Tisa Ayuso and Dr. Ghazanfar Khan, who shared their experience providing virtual behavioral health care in an inpatient setting. 

How Carilion Clinic overcame staffing challenges during COVID-19 and beyond 

Laura Taylor, the Program Director of Psychiatry at Carilion Clinic spoke to the organization’s challenges navigating call outs during the COVID-19 pandemic. At one point, the organization had to shut down the unit and then reopen. Taylor said, “It took a lot of time to navigate scheduling to make sure that we were staffed appropriately to meet the patient needs on the unit.”  

From the hiring perspective, it took months for physicians to complete their credentialing. However, after partnering with Iris, Carilion was able to attain a reliable provider.  

Reflecting on this time, Taylor said, “To have an established Iris Telehealth provider was incredibly important because it created reliability on the unit. We knew exactly what we were working with when we had the physician. She was very reliable, and it created continuity of care.”  

Bassett Health Network’s approach to staffing providers in rural New York  

Bassett Health Network is in upstate New York, where its patients are geographically dispersed across the region.  

Amid cross-departmental changes, Bassett found itself with a shortage of clinicians on the inpatient side.  

While they were in the recruitment process, they couldn’t hire clinicians fast enough. They had leveraged locums to help run their inpatient unit, but they needed a long-term solution that would almost exclusively provide physician oversight on the inpatient unit. Dr. James Anderson, Chief of the Department of Psychiatry at Basset, said they wanted to expand their approach to virtual care. 

Anderson said, “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.” 

The provider experience facilitating virtual care  

While Dr. Tisa Ayuso has been with Bassett for a short time, she says her role as Virtual Medical Director has been going well. 

“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.” 

Along with working with patients, Dr. Ayuso also works with Bassett’s medical students to demonstrate best practices for delivering effective inpatient psychiatric care. 

Before working with Iris, Dr. Ghazanfar Khan started to experience the stress of the provider shortage and knew he wanted to make a change for his mental health. Since beginning his virtual inpatient role, Dr. Kahn enjoys focusing more on patients than commuting. 

“I’ve been able to focus more on my patients. I have charts pulled out when I’m seeing patients so that I can see their labs and medications and the nursing and social work notes. It has been working great for me. The hospital staff made it more convenient for me to transition from in-person to virtual.” 

The benefits and challenges of virtual care  

Virtual behavioral health makes it easier for patients to attend appointments and helps improve satisfaction overall. At Carilion, Taylor says that having a blended model has enhanced patient care. 

Reflecting on her observations, she said, “I had an opportunity to round with our telehealth psychiatrist, and rarely would I hear patients request a different provider. This provider was very good at building rapport quickly; they exchanged a wealth of information back and forth. I think patients felt very comfortable with that provider in a telehealth setting.”   

Besides a few technical glitches and finding the right place to take the video calls, Taylor says telehealth has been “almost seamless.” 

At Bassett, Anderson says they’ve heard almost zero patient complaints about virtual care. He said the challenges they faced were mainly on the front end. 

He said, “I wouldn’t say it was a challenge, so much as there were legitimate questions and concerns from staff on the unit about how we were going to operate on a daily basis. There were concerns about how we would get Dr. Ayuso in the room. It turns out that wasn’t as big of a deal as some anticipated.” 

Anderson also expanded on the benefits, noting, “I just got an email today from our clerkship director who is in charge of the medical student’s psychiatry rotation. He said the students are having a fantastic experience, and they love Dr. Ayuso. 

In some ways, there’s some suspicion that there’s even more contact with Dr. Ayuso than there might be if the psychiatrist was there on the unit. It’s been a surprise to some of the staff members on the unit about how non-disruptive it has been.” 

Advice on finding the right telehealth partner  

At Bassett, Anderson said they considered several things when searching for a behavioral health partner. “First,” he said, was “the ability to become impaneled with our various insurers. We absolutely want people that are willing and able to accept Medicare and Medicaid.” 

Next, Anderson said Bassett was looking for a partner who could serve as a collaborating physician for their nurse practitioners. After talking with multiple telehealth companies, Basset landed on Iris Telehealth because of their ability to meet their needs. 

Anderson said, “It was really strong communication and project management. To help us, we came in, and we sort of knew where we wanted to get to, but we didn’t know how to get there. Iris had this combination of knowledge and commitment to clear and confident communication. They had willingness to collaborate, but also had proven ideas that worked before – that was a big plus. 

They also had a clear commitment to quality services. When Iris is presenting a clinician to us, we know that clinician has already been well vetted by Iris. By the time we’re talking to the clinician, there’s a little bit of a halo effect because of the trust we’ve built. 

It’s not sign unseen. We build the partnership, and we see that things are working in other areas – it made it a pretty easy choice to go with Iris, and we’ve been happy so far.” 

The importance of collaboration and quality support  

For Carilion, Taylor said relationships and communication are incredibly important to finding the right behavioral health partner. 

“Working with well-informed individuals who know exactly what to do, have had that experience, and can offer solutions while listening to needs. That’s what I’ve enjoyed so much about my relationship with Shannon.” 

Shannon works as a Client Alignment Executive (CAE) at Carilion. Taylor says she’s enjoyed working with her CAE, who helps figure out what Carilion needs, how Iris can meet those needs, and the creativity of thinking outside the box. 

“The ease of transitioning a provider into the Carilion system is flawless,” said Taylor. “Every need is thought of. Every detail is considered when it comes to invoicing and general backend operations.  

Everything is very streamlined. It’s predictable, and there are no surprises. It’s been a wonderful experience. It’s meant to support Carilion and Carilion’s needs and not create barriers.” 

Figure out your next steps  

We’re so grateful for the time Laura Taylor, Dr. James Anderson, Dr. Ayuso, and Dr. Ghazanfar Khan generously shared with us. Thank you for your partnership and for all you do to help expand access to quality behavioral health care in your communities!  

Weren’t able to make it to the webinar? You can watch the full video here.  

If you’d like to learn more about integrating quality behavioral health programs into your organization, contact us today to get started! 

Access to high-quality substance-use disorder treatment has never been more important. The opioid epidemic continues to grow and impact more and more lives, families, and communities across the country. And, healthcare organizations must include some form of medication-assisted treatment (MAT) services for patients with substance use disorders and those seeking addiction treatment.

However, building an effective MAT program at your organization doesn’t have to involve a massive overhaul of your organization’s services. Working with a dedicated telepsychiatry or behavioral health partner can help if you’re just getting started and enable you to better expand your program to meet the growing needs of your community.

Note: This piece will focus on building a standard Office-Based Opioid Treatment program (OBOT) rather than a more intensive Opioid Treatment Program (OTP). If you’re hoping to learn more about providing OTP services, including methadone clinics, check out our full whitepaper on building an MAT program.

We will also share some insights from Iris Telehealth’s Chief Medical Officer, Dr. Thomas Milam throughout this piece for further insights into substance-use disorder and treatment.

Building an MAT program from scratch

Generally speaking, you’ll want to build out an OBOT program if you’re planning on prescribing Suboxone to treat patients with opioid-use disorders (OUDs). An OBOT program will allow prescribers with an X waiver to prescribe schedule III, IV, and V controlled substances to help treat those patients.

If that kind of treatment would be a good fit for your patients, make sure to keep in mind these key considerations when building your program:

• Any providers participating in your OBOT program (i.e., prescribing these controlled substances, including Suboxone/buprenorphine) will need an X waiver. If your current providers don’t have their X waiver, they can undergo training from the DEA and apply for their waiver.
• While your provider is receiving the appropriate training for their X waiver, your organization can start building what your OBOT program would look like. Alternatively, you can hire a provider who has their X waiver and specialized experience working with patients experiencing OUD who can help support your program. Remember, working with a strategic behavioral health partner can expand your access to highly qualified providers for your program.
• To have a Suboxone program, you need to be able to refer patients to a counselor. If you don’t have internal counseling services available, you should have a formalized referral relationship with another provider or organization in your community that does.
• Plan on having clinic staff available on-site to monitor patients when they start their first day of Suboxone.
• When starting patients on Suboxone, you may initially have them come in once a week. Then you will likely see them once every three months for maintenance.
• Your OBOT program will have record-keeping requirements that your organization must meet. You’ll need to comply with 42 CFR, a federal regulation requiring an additional standard of privacy than typical HIPAA requirements. You will need to keep a log of all patients currently (or previously) prescribed Suboxone. Generally, you can keep these records in your standard EMR.

Dr. Thomas Milam, Chief Medical Officer

Generally, the harm reduction model for dealing with substance use disorders has gained much more traction as we’ve been working through the opioid crisis. The introduction of buprenorphine into the prescribing armamentarium of healthcare providers has been more lifesaving than any drug known in terms of helping with opiate addictions.

From a social level, there is much more acceptance of harm reduction strategies, and evidence shows they are very lifesaving.

Challenges and opportunities you might face

The number one challenge your healthcare organization will likely face is dealing with stigma. People with substance use disorders are often the victims of stigma, stereotypes, negative portrayals in the media, and preconceived notions around what those disorders look like.

However, there are steps you can take to overcome that challenge, and it all starts with education:

1. Educate your staff: Provide comprehensive education to your team. Include an overview of medications (including medications like naltrexone, which doesn’t require any special licensing or certifications for prescribers). An MAT program doesn’t have to mean a methadone clinic. MAT services can be easily and seamlessly incorporated into the work your team is already doing.
2. Educate your community: It will be essential to educate your community on what substance use disorders are (and what they aren’t) and that they do not discriminate based on social status, economic status, race, or background.
3. Educate your patients: Spread the word. Let your patients know about the value of your MAT services, regardless of whether they have a documented SUD. Current patients may serve as an excellent referral source for community members in need of treatment.

Remember, the most significant benefit of building an MAT program is providing a valuable service to your community that will save lives.

Dr. Thomas Milam, Chief Medical Officer

I’ve known of organizations that wanted to expand into serving people with substance use disorders, but whose physical location was opposed by businesses or neighborhoods around them. That shows the reality of stigma faced by patients and families as they enter into the journey of recovery.

I think the strongest stigma is the one people hold against themselves for finding themselves in the world of addictions without knowing how they got there. So being around people who understand addiction from both a recovery and neurological basis is important.

It’s important to help people reduce shame and promote a positive self-image and self-awareness in the recovery journey.

Finding the right provider for your program

As you build out your program, it’s important to ensure you hire the right provider for your patient population, the kind of substance use disorders you treat, and your organization’s culture.

Here are some best practices for finding the right provider for your MAT program:

• Make sure your provider has dedicated experience treating substance use disorders and is familiar with a wide range of treatment options.
• If your organization serves patients experiencing opioid use disorders and plans on prescribing Suboxone, you should only consider providers with their X waiver or willing to get their X waiver.
• Look for providers who have worked with patients like yours and understand the particular challenges they face.
• If your organization is in a rural or underserved community, consider utilizing a strategic behavioral health partner to open up your provider pool.

Dr. Thomas Milam, Chief Medical Officer

There are populations of patients in psychiatry that some people love working with and others prefer not to. And that’s the case with working with people with addictions. Some providers can prescribe medicines and offer therapies to patients to help them, but you really have to have a heart for the work for the people and families involved. You also have to have the knowledge of the challenges faced by folks struggling with addictions

It’s challenging work, but also very rewarding work to help people step away from addictions and rebuild their lives. It’s not easy at all, and I have a lot of admiration for those who are going through that process or who have left their addictions behind. Honestly, not many people really understand how hard that work is.

Leverage partners to support telehealth MAT program offerings

Fortunately, you don’t have to build out your MAT program by yourself. Behavioral health partners like Iris Telehealth can be valuable resources to help your healthcare organization source and vet potential behavioral health providers for your program.

Here are some benefits to using a partner to develop an effective MAT telehealth program:

• Leveraging partnerships that utilize telepsychiatry or virtual care will allow you to access high-quality providers from across the country who have their X waiver and can prescribe Suboxone.
• Through a dedicated partner relationship, your organization can draw on the expertise and experience of organizations and providers who have been through this exact process and have seen effective MAT programs in action.
• A behavioral health partner will be able to support the long-term, sustainable growth of your telehealth MAT program. This support will decrease the burden of recruitment and program implementation on your team.

If you’ve encountered challenges finding highly qualified providers in your area, we strongly recommend considering telehealth as an option to help you better serve your community.

Dr. Thomas Milam, Chief Medical Officer

Telehealth provides many avenues for people to get the proper medication, treatment, therapy group support,  and even digital health applications to support them in the journey.

I am so proud of the clinics and healthcare organizations, Iris partners with, who take the need for compassionate and effective recovery treatment seriously, and work together with communities to support those who are struggling with addictions.

Some key resources to get started

Countless clinics and healthcare organizations have successfully navigated this process, and you will be able to benefit from their guidance and experience. You can also on some helpful resources in the early stages of building your program.

Some resources to start with include:

• The Substance Abuse and Mental Health Services Administration (SAMHSA)
• The American Society of Addiction Medicine (ASAM)
• Providers Clinical Support System (PCSS)

Then, if you’re planning on utilizing strategic partnerships or telepsychiatry to build up your program or source highly qualified providers, Iris Telehealth can help your organization through that process. If you want to learn more about getting started, contact us today or download our comprehensive whitepaper on building an effective MAT program for more information.

Iris clinicians are at the heart of what makes our organization such a special place to work. That’s why we’re turning the spotlight on the amazing work they’re doing every day. This month, we’re sitting down to talk with Elaina Najera, one of our incredible LCSWs.   

Q. How did you find Iris and decide you wanted to be an Iris provider?

A. I was looking at all the available online positions at different job hosting sites. I located Iris and thought, “Telehealth, I could do that. I’ve done that already.”

Then, when I did the initial meeting with Iris, and they started telling me about the organization, I was immediately sold on the ability to work from home and to work for some of the most disenfranchised folks. That’s a huge issue for me. Serving communities that aren’t normally served appealed to me.

Another thing that was huge was the competitive pay. That was another factor in considering this job. When I thought through the first couple of interviews, I realized this job was what I wanted. 

Q. How does teletherapy compare to in-person care?

A. I have been a social worker for at least 15 years and did in-person care. Then, with the advent of COVID-19 and a public health emergency, the state allowed for telehealth and expanded the ability. Initially, at the start of the pandemic, I was in case management work, not direct client service therapy.

Then, I switched mid-pandemic to doing therapy full-time, and it was all by telephone. I couldn’t even use Zoom at that location. It was very different. Comparing the two, no matter where I am, who I am, and where I’m at, I’m always the same person. I’m authentic, and I will be the same caring provider that I am, whether in person or using telehealth.

Telehealth has expanded my ability to provide care to people I usually wouldn’t have been able to reach as an in-person provider.

I’m a huge advocate for telehealth because I feel like the relationships can be just as deep and meaningful. In a therapeutic setting, the relationship is huge. It’s a huge part of the change cycle and folks’ ability to grow and build health in their life.

Even through telehealth, I can build those same strong relationships with my clients that I had while I was an in-person provider as well.

Q. How do you foster connection with patients virtually?

A. In person, you can see more of their environment. Sometimes, you can latch on to different things. Fostering a virtual connection means being authentic and genuine with what you are and who you are and acknowledging that sometimes there will be technology issues. Sometimes, there will be connectivity issues, and rolling with that when that happens.

By doing telehealth, I can see into people’s homes, which you’re not typically able to see, and see how people function in their homes in a traditional setting as a therapist. I can see pictures in the background and say, “Oh, that’s interesting.” Or they might say, “My room is super messy right now – ‘this’ is what’s going on.”

That fosters a relationship to say, “Okay, so what’s going on emotionally, mentally, that your room is in this state?” Virtually, it’s about being authentic. That’s one thing I will always come back to.

I am open to questions because sometimes your patients do not see your office. For example, they see my blurred virtual background. They’re not seeing all the things that tell them about me that they might see in an in-person setting. That’s why I’ll wear fun earrings, and then they’ll ask about it, and we joke about things and share. For me, engagement is huge for fostering that connection.

Q. As a healthcare professional, how do you manage work-life balance?

A. Since joining Iris, my work-life balance has been so much better. Getting rid of a commute has transformed my life and being home when I’m done with work. Managing a work-life balance for me is important because I am also a caregiver to my sister, who has some health issues.

So, being available to take her where she needs to go and do those things after work is important to me. One of the ways I manage my work-life balance is when my computer is off, I’m not working. I don’t have Zoom on my phone; I don’t check my emails when I’m off work. I’m grateful to be in a setting without being on call or having things to worry about.

That was a huge selling point for me with Iris – it’s more like traditional therapy. You are a therapy provider because you’re not on call or responding to crises and emergencies. I have a history of working in residential treatment. When you’re working in residential, it’s always a crisis.

As I’ve grown with Iris in the last six or seven months, I’ve had a new sense of calm and peace about my work life. That’s wonderful for me. I also make sure to schedule time off, be proactive about that time off, and make that a priority for myself and my family. I also make sure I take my breaks.

Someone asked me, “How do you do it when you have four or five sessions back-to-back?” I say, “I do the 50-minute therapeutic hour, and then I have 10 minutes to write a note or pet one of my cats, make a cup of tea, take a break, walk around in my living room, and listen to a song.”

One of my life passions is K-Pop, which has been for about 20 years. To manage and enjoy my life, I’ll listen to a K-pop song and find peace between sessions so I can show up and be the best person for my clients.

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

A. The most rewarding part of my job is being able to serve folks who usually wouldn’t be able to access care. I have a caseload of at least five or six folks who are unhoused right now and are struggling to meet their basic needs. The rewarding part is meeting them where they’re at – if they are in a parking lot, parked in their car because that’s where they’re sleeping for the night. I can meet them there and provide therapy to them that way.

It’s rewarding to see a slight change. The way I look at it is there’s a spectrum of suffering, and if we can move that needle a little bit, we’re not going make huge changes overnight, especially when folks’ basic needs aren’t being met. Reducing that suffering for that day, week, or month is rewarding.

The rewarding part is there’s a social justice issue mixed in all of it. Some people would not be able to access care because of either being unhoused, being disabled, having mobility issues, or having transportation issues; being able to serve those populations and give back to a community is so rewarding.

Q. What does providing teletherapy to the unhoused community look like in practice?

A. Most folks in California, where I practice, have a government phone. The government phone allows them access for free for maybe a dollar a month. It’s very affordable. So, usually, they also have data, and we can do a Zoom call. If we can’t do a Zoom call, we do it by telephone.

I still provide the same care, compassion, and connection. I have some of the greatest relationships with folks who we only meet by phone, but they trust me, talk to me, and it’s a wonderful experience.

If they don’t have a private place to meet, say they’re in shared housing right now in the shelter, they go to the local behavioral health office in Nevada County where I work, and we set them up in a room with a Zoom or Team’s link. I have one patient right now who does it that way, so they’re afforded privacy in an office space.

Q. What do you love about working with Iris?

A. I love everything, but I particularly love the amount of support that I have. I have my Clinical Operations Manager, Katelyn Deckert, shout out to her. She was recently on maternity leave, so bless her for having her baby. Melissa Kennedy was able to cover during that time. I never felt like I didn’t have support. I always had support.

The other thing is that Iris has fostered such a good relationship with my clinic that my clinic trusts me. They trust Iris, and I feel like a valued professional. I have beautiful equipment that works wonderfully for the job. I have wonderful pay and benefits that are huge to me.

Medical benefits are another issue in our country for people who need medical coverage. To have it as part of my job is wonderful, too. I love telling folks, I work from home, and I get to provide therapy to people.” I love sharing that. I love telling people I’m a Licensed Clinical Social Worker and do clinical social work every day from my own home.

That’s huge for me. That’s what I love about Iris. I got one of my close friends and confidants a position with Iris. She’s been on for three or four months now, and I’m working on getting as many other of my LCSW friends to come over.

Q. Why do you think teletherapy is important to the future of mental healthcare?

A. With the advent of the public health emergency of COVID, which we are still experiencing, COVID is still very existent. We saw that it is possible for folks to access care from home and access care in other ways than traditionally going into an office. You’re talking about travel time to an office, being in the office, waiting for the appointment, making the next appointment, leaving the office, and traveling back home.

For some folks, it’s a disability justice issue as well. Another area that I’m very passionate about is disability advocacy. We’re finding that more and more folks have been disabled by virtue of having COVID-19 infections. There’s a lot of long COVID happening, but disabled people have always existed, and they’re suddenly realizing that things do not have to be in person to have the same quality, care, and impact.

For me, it’s the future because it’s the most inclusive. It’s the option that will allow us to serve the most people. Some people have never been able to see a psychiatrist, but now they can because they can see one through telehealth from an Iris provider. To me, that’s amazing. That is the future.

Folks like me who are highly skilled in this field for a reason can reach more people via telehealth. It reduces barriers to getting treatment. That’s the future.

Q. What advice would you give someone new to telehealth?

A. My advice for someone new to telehealth is to be yourself. Practice with your equipment on someone else who’s not a client so you can get familiar with your equipment. Thankfully, Iris does that with you. You get to practice with IT when they set you up, and then you get to practice with your COM.

And remember, don’t ever think that telehealth is “less than.” There’s a stigma or a judgment that happens in the psychiatry and therapy community that somehow telehealth is less than. If you feel that as a provider, your clients and patients will feel that, too. Starting in telehealth, you need to honor telehealth for the sacred connection that it is and just as equal and valuable as an in-person session.

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

In the U.S., 14.1 million people have a serious mental illness, making behavioral health treatment critical. However, significant barriers keep people from the care they need, including the provider shortage and lack of specialty care, leading people to seek treatment in the ED.

Building a financially sustainable behavioral health program at scale can help these patients get quality care and reduce the total spend on their medical conditions (for both the patients and the health systems providing treatment). Partnering with an organization that can facilitate efficient care models can help your organization scale services and meet quality measures that enable your health system to thrive.

In this blog, we’ll share the keys to building a financially sustainable behavioral health program and insights from our Chief Marketing & Strategy Officer, Dan Ferris, on the benefits and impact on total cost of care.

The benefits of achieving a financially sustainable behavioral health program

Every health system faces a hierarchy of needs regarding patient care – from those who need immediate care in the ED to those stuck in referral queues to those who need proactive outreach in the community.

Let’s take a look at the six ways achieving financial sustainability can benefit your patients and overall organization:

• Increased revenue: In outpatient settings, many health systems are foregoing revenue by not having timely access available – driving unnecessarily high leakage and no-show rates. By having scalable care models that provide high-quality care, you can see and retain more patients.
• Sustainable margins: To drive sustainable margins in outpatient behavioral healthcare, health systems must leverage a multidisciplinary care team that works top-of-license and deliberately ensures patients are navigated to the right resource at the right time in the right way.
• Increased ED throughput: By augmenting your on-site care with a multidisciplinary team of behavioral health providers available 24/7/365, you can ensure every patient receives timely access to quality care and is not taking up valuable space in the ED longer than is clinically appropriate.
• Reduced admissions: By having access to a variety of virtual providers, like licensed counselors, PMHNPs, and MDs, on your team, patients are more likely to get to the right level of care and help ensure only the most critical are admitted, and those who might be more effectively treated in a lower level of care get the help they need. Ultimately, this approach can help decrease long-term costs.
• Limited revisit rates: By providing the most effective care possible, and ensuring every patient has an optimal discharge plan to manage their mental health, patients are less likely to come back to your hospital. At the same time, it can also better position your organization to retain patients within your network.
• Improved total cost of care: By treating behavioral health, you get the benefits of integrated behavioral health care. That’s because alongside physical conditions, you’re helping total cost of care over time, and increasing key metrics like pharmacy cost, reducing length of stay, and improving patient outcomes.

All six of these benefits combined help create a behavioral health program that’s both efficient and successful. Next, we’ll review the quality care models that help make financial sustainability in behavioral health care possible.

Dan Ferris, Chief Marketing & Strategy Officer

By integrating behavioral health, you are providing the care patients need and want, creating market differentiation while driving better economics. It’s a win-win.

Care models that build a financially sustainable future

At Iris, we design programs that seamlessly integrate into a health system and connect organizations with the highest quality behavioral health specialists. These services have helped organizations reduce their referral backlog by 83%, divert 36% of psych referrals to a lower level of care, and improve depression symptoms by 38% over eight weeks of care. You can read the full story here.

Dan Ferris, Chief Marketing & Strategy Officer

Our programs are designed for both clinical quality and financial sustainability. We bring expertise on driving top of license care, navigating patients to the right level of care, and billing appropriately to get paid for the care that’s provided. We’re not just providing access – we’re delivering a program with the know-how to drive clinical and financial success.

Here’s a look inside how our services work

Bridge Care Services: A Behavioral Health Integration model backed by clinical and operational expertise to solve ambulatory care at scale and deliver long-term clinical and financial outcomes for hospitals and health systems. We ensure the patients who need care first get care first – while being efficiently directed to an appropriate care plan. Our cross-functional care team of psychiatrists, therapists, and psychiatric mental health nurse practitioners will fully integrate into your health system. When clinically appropriate, our team will facilitate collaborative transitions to additional ambulatory services, primary care, and community partners as needed.

Key takeaway: Bridge Care Services hits target metrics such as expanding and accelerating access to care and achieving critical financial results like increasing revenue, driving sustainable margins, and improving total cost of care.

On-Demand Services: These services leverage a team of providers to help support ED and MedSurg units with on-demand consults 24/7 – ensuring your health system is never without a behavioral health specialist. On-Demand Services provides access to providers who are experts in assessing and managing risk to help patients get triaged and evaluated as quickly as possible.

Key takeaway: On-Demand Services leads to increased ED throughput, decreased inpatient admissions, and reduced revisit rates.

Scheduled Services: This approach provides a predictable coverage model for organizations, meaning your virtual providers are available on a regular schedule each week. Most importantly, it means your providers are never without a behavioral health provider to lean on for their expertise.

Key takeaway: Scheduled Services expands patient access to behavioral health care, increases revenue, and improves total cost of care.

Laying the foundation for whole-person care

Physical and behavioral health are intrinsically linked. For example, research from the National Library of Medicine shows that 74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24.

If you’re managing total cost of care and population health, behavioral health integration is essential.

Dan Ferris, Chief Marketing & Strategy Officer

There’s an opportunity to use behavioral health as a weapon to drive competitive differentiation for health systems. We believe providing quality behavioral health is a strategic advantage and can be financially sustainable. If an organization can offer integrated behavioral health at-scale, they can attract more patients, reduce leakage and the total cost of care.

According to a behavioral health analysis by Evernorth Health Services, treating behavioral health conditions in outpatient care is directly tied with a reduction in medical and pharmacy costs. In their analysis, they highlight savings up to $2,565 per person over the 15 months following a diagnosis and up to $3,321 per person over the 27 months following a diagnosis.

Where Iris Telehealth fits in

Iris Telehealth delivers high-quality behavioral health services via telehealth all across the country. From our rigorous provider vetting process to our in-depth knowledge and expertise, we help ensure your organization has a thriving, financially stable behavioral health program.

Contact us today to learn more about our care models and how we can help your organization increase ED throughput and provide short-term care to your patient population.

Iris clinicians are at the heart of what makes our organization such a special place to work. That’s why we’re turning the spotlight on the amazing work they’re doing every day. This month, we’re sitting down to talk with Dr. Mariela Fuenmayor.

Q. How did you find Iris and decide you wanted to be an Iris provider?

A. I found Iris online. I worked for the VA, and the stress level was too high. I started looking for another job that would give me more balance in my life. Then, I found Iris.

Q. How does Telehealth compare to in-person care?

A: There’s no doubt in psychiatry and therapy being able to see someone in person has an impact on people. But the whole world has changed. The amount of reach telehealth can have is amazing.

My school did not approve of telehealth. Now, I see its power, and then the pandemic showed us what we couldn’t see before.

I had been working in telehealth for five years because the VA hired me for telehealth. I was working with high-intensity patients. I already knew how it was, but many people didn’t know.

However, when the pandemic hit, it was a very easy transition to do it. Telehealth has a lot to offer nowadays, especially with the difficulties people have trying to be seen by a psychiatrist. So right now, I see the power, and I don’t think I would go back to the other way.

Q. How do you foster connections with your patients in a virtual environment?

A. My background has an art piece that I’m very connected to. Another thing I use is when talking to the patient, and then I say, “I want to introduce myself. I’m Dr. Fuenmayor. I’m a psychiatrist working for this place. I’m in my office, and it’s my home office, but this is a floor where no one is around. I have four screens in front of me. Sometimes, my dogs are here, and if they are, I will ask you if you want to see them. And sometimes they’re not. So, this is totally private, and the conversation is HIPAA compliant.”

I frame it like that and make sure I move my hands a lot. I’ve read a lot about nonverbal communication, so I practice that, make sure I’m keeping eye contact, and try not to talk when I’m talking to patients, so they feel that they are my priority.

Right now, there is an on-site team member with the patient – often either a nurse, case manager or therapist. So, I explain this to the patient on the call and say, “so-and-so is here.” Before I meet the patient, the on-site team presents everything to me and explains to the patient what will happen. That process has worked out well for me.

Very few patients say, “I want an in-person psychiatrist.” I would say 95% of the patients are okay with telehealth. Some of the patients told me they wanted to see a face-to-face psychiatrist, and they did. Then, they come back to virtual.

Q. How do you manage work-life balance?

A: I live in Arkansas in Central Time and work for California in Pacific Time. I start working at 10:00 a.m. my time and 8:00 a.m. their time. I work an eight-hour shift, and I make sure that my life before my job is the time when I walk and where I do my exercise. I’m a yoga practitioner, and I have time to do it every morning.

I don’t have to drive anywhere. So, I’m just home. I make sure that my office is on the second floor, and I’m never here. This room is just for the office.

It has worked out well for me. I don’t think about work after that. I think about my connection with my family and doing what I want. I do feel like I have achieved that work-life balance. It’s priceless.

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

A. When I can witness, with the team’s help, that I can change a person’s life for good, I’ve gone full circle since I graduated 30-something years ago. Many times, I felt like it was just running and running and not seeing the effect. When I was in private practice, the effect took years to happen.

Today, I work for Community Solutions, a non-profit organization in San Jose and Morgan Hill, California. There is a large transient population – we deal with the social problems they’re going through.

In two or three months they go one month in crisis, residential, then a three-month residential treatment program. In that time, I can see the change, and it is so fulfilling. I am super excited about this. Sometimes, you lose someone, but most of the time, I can see the effect of the team and the work we do in the patient’s life. That is the reason I went to psychiatry. I feel like I completed the whole circle and am back to where I wanted to be.

Q. What do you love about working with Iris?

A. I love it because, technology-wise, whenever I’m having hiccups, someone jumps in, and I feel respected. I have all the support I need. Iris Telehealth and the IT team are amazing. I don’t know them in person, but I’m super grateful. When I cannot connect, someone will jump on in minutes. Technical issues cause the biggest level of stress for a telehealth provider.

Of course, you have that responsibility of the patient. But the big stress is what happens if I cannot connect? What happens if something doesn’t work, and I cannot provide a service? Iris has been amazing at helping me with that.

Melissa Kennedy has also been amazing – she’s an amazing human being. When I have any problems in my personal life that I need to take, she’s very helpful in facilitating that. I feel super supported by Iris, and when I come to work, I want to come to work.

I’m not stressed. I am happy with what I’m going to do. And I know that if something goes wrong, I can text someone, call them, and they can jump on in minutes. That’s what I love about working with Iris.

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

A. There are not enough psychiatrists for the number of patients we have. I remember when I used to work in person, no matter what you do or if you try to buy a house close to your office, you still have the commute time. There is a lot of stress about commuting and parking.

Now, we can reach more people and we’re developing more effective ways to communicate. The world is used to video conferences, and there is no question that I can see more people through video than I could see in person. For example, if I have ten patients scheduled today and someone cancels, my team can add someone else to my schedule because I work in telehealth.

When I was working in the office, a no-show was a no-show – and the rate at that time was 30%. From and efficacy standpoint, there’s no question that we can see more patients. I think telemedicine offered a huge step forward in healthcare and telepsychiatry. It’s been a step forward.

New generations are going to ask you for that. I can also see people in person in my private practice when I used to have it, and your people feel comfortable doing video, and they’ll say, “No, let’s do video. I can do it. I can attend your appointment because I just finished working and can do it now. I don’t have to commute.” So, that’s why it’s the future — it makes the service more available to everyone.

Q. What advice would you give to someone who’s new to telehealth?

A. The taxing thing about telehealth is sitting at the desk and in an office. I have overcome that by ensuring I do my outdoor things before I go to work and doing physical exercise.

My advice is to separate your work from your life somehow. I put my office on the floor of my house where no one goes. That way, you have that break. Then, also make sure that you do physical exercise or whatever you do to keep your mind balanced.

Some people do meditation, and I do yoga, but make sure that you do something like that because now, when you walk, you cannot walk in an office. I do have a standing desk, but sitting here is taxing on the body. However, if you make sure that you do that, everything will be okay.

Q. Is there anything else you would like to add about your experience in telehealth?

A. I’m super grateful and happy. I’m proud to work for Iris. Telepsychiatry is a very effective tool. And from the provider’s standpoint, it can allow you to have a work-life balance, which can be very fulfilling. If you had asked me 30 years ago, I would never have told you I would still be so happy doing this. I am so glad and I’m helping people. If someone is going to try telehealth, give yourself a year of this experience, and if you’re like me, you will have a great opportunity to help people. And that’s the reason you went to medical school in the first place.

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

At Iris, we’re proud to offer a top-notch experience for our clinicians and partners by helping ensure excellent, long-term provider matches. This process, called The Iris Match, helps clinicians find an organization that aligns with their values and needs and enables our partners to secure a provider their patients and providers will love. 

Leading this effort is our incredible clinical hiring team. In this blog, we’re excited to share more about this team’s mission, their approach to hiring behavioral health providers, and how they go above and beyond to help ensure our providers are set up for success. 

The mission of the clinical hiring team 

The clinical hiring team comprises Clinical Hiring Managers (CHMs), Clinical Talent Consultants (CTCs), and Clinical Recruitment Coordinators (CRCs). This team revolves around collaboration, starting with the CRCs, who process provider applications through interviews with the CTCs and placements with the CHMs. 

On the organizational side, this team talks with partner groups to learn about their culture, patient population, and all the soft and hard skills providers will need to succeed. From start to finish, everyone is laser-focused on longitudinal matches with quality providers.

Life in clinical hiring is different each day. Whether they’re talking with providers and potential partners or attending meet and greets between the two, they’re invigorated by finding the best matches for each party. 

When zooming out, what sets this team apart is the dedication to their mission. The clinical hiring team is keenly aware of what patients must endure when there are gaps in coverage. That’s why they ensure they’re not just filling a role but making a mindful, high-quality, long-term match. This mission helps organizations with provider retention amid a shortage of behavioral health providers. 

So, what does our clinical hiring team look for when finding that perfect match? Let’s take a closer look.

What makes an excellent Iris provider

At Iris, we pride ourselves on working with the best of the best providers. While so many healthcare organizations need excellent providers, there are a few key components that we’ve found in making quality, long-term matches. 

In community mental health, an excellent provider understands the patient population, the complexities of delivering care to that population, and the demand it can have on them. We’re proud to give voice to the voiceless, and it requires a provider with compassion, understanding, and someone free from judgment.

Additionally, continuity of care is a significant focus for our organization, and we look for that shared value in our providers, too. Resilience is another tool we look for in our providers. By having something in place to help them avoid compassion fatigue and the secondary trauma that comes with these roles is essential.

For our providers, we help ensure they have the operational support they need in their daily work. For example, our Clinical Operation Managers (COMs) help ensure our providers have things like administrative and operational hurdles taken care of so they can focus on patient care. 

To learn more about our Clinical Operation Managers, check out their spotlight here. 

Providers also benefit from our mindful matches. At Iris, we don’t take a plug-and-play approach. Instead, we consider many components of the job to help ensure it matches what our providers want. For instance, we look at the community where they’ll be placed, ask if they’re comfortable seeing a particular patient population, and make sure their skill set is a match for the organization. 

The matchmaking process 

To help assist with making the best long-term match possible, there are a few considerations our clinical hiring team must learn about the providers. For example, do they have a specific prescribing or therapeutic approach they adhere to? Is there a specific population they want to work with? This team also assesses things like personality and communication style to ensure they’d be a good fit for our partners. 

From our partners, we might ask them any of the following questions:

• What are you looking for in a clinician? 
• Do you need someone who is more independent or who wants to be a part of the team? 
• Do you need someone with specific soft skills? 
• What kind of support do you have on the ground? 

As part of our rigorous vetting process, the clinical hiring team also does multiple interviews with the providers. This thorough process helps ensure that we’re not just filling slots, but making intentional matches. 

When working to make a match, the clinical hiring team asks themselves, “Would I trust someone I love with this provider?” And if the answer is no, then they may not be the best fit. 

Learn more about the support Team Iris provides

If you’d like to learn how our clinical hiring team can help your organization find the best provider fit for your population, contact us today! 

Additionally, if you’d like to learn more about the other pillars of support our teams provide, check out our other spotlights here:

• Telepsychiatry Services  in Action: Meet our CAE Team!
• Telepsychiatry Services  in Action: Meet our COMs Team!
• Telepsychiatry Services in Action: Meet the Medical Staff Services Team!

At Iris, we’re proud to provide quality support to all our partners so they can help their patient population get the quality behavioral health care they need. 

Lack of access to proper psychiatric care in the United States is a major challenge for our healthcare system. However, virtual solutions make psychiatric care more accessible, effective, and patient-centered.

The benefits of virtual care for patients are significant. In fact, a study by the American Medical Association demonstrated 79% patient satisfaction with telehealth. For patients, virtual care opens up access to behavioral health services, facilitates shorter wait times, and cuts out the commute to the doctor’s office.

While these benefits are essential, let’s take a closer look at all the ways virtual care boosts patient satisfaction. 

State of virtual behavioral health care

During the COVID-19 pandemic, many people found themselves relying on telehealth to get care. In fact, during the first four months of COVID-19, telehealth visits accounted for 23.6% of all interactions. Today, telehealth continues to provide care to those who cannot reach behavioral health services as easily.

Following the COVID-19 pandemic, many hospitals and health systems continue to experience challenges meeting patient volume and needs with limited behavioral health resources.

Additionally, the ongoing provider shortage underscores the importance of leveraging virtual care as patients still struggle to receive timely care. Thankfully, telepsychiatry can ensure patients receive quality, timely, and sustainable care by connecting them to providers regardless of geographic location.

Patient satisfaction by the numbers

Convenience is an essential factor that contributes to patient satisfaction. According to the American Medical Association, 62% of physicians feel like their patients have higher satisfaction since they’ve started offering virtual care as an option.

At Iris, our clinicians have a similar experience with patient satisfaction. Dr. Kavita Vasu, one of our psychiatrists, says virtual care gives her patients flexibility, allowing them to access care from wherever they are – whether at home or work. Dr. Vasu also notes that no-show rates are significantly lower.

Additionally, research shows that virtual care is an effective way to increase patient access. According to the 2022 CVS Health Care insights, 59% of patients said that accessing virtual telehealth services was essential to their health.

Overall, the data is clear – patient satisfaction with virtual care is high. 

The J.D. Power 2022 U.S. Telehealth Satisfaction Study says that a growing number of patients prefer telehealth visits for various types of care, including routine care, prescription refills, and regular mental health visits. The survey also says 94% of patients and their families who have used telehealth in the past “definitely will” or “probably will” continue to utilize it.

Virtual care reaches those who need care most

In a database released by the Health Resources & Services Administration, numbers show that 157 million people live in a mental health professional shortage area (HPSA). Virtual care makes access to specialty behavioral health providers more easily available to those who live far from care.

Here are just a few of the populations that benefit from telepsychiatry access:

• LGBTQIA+: For LGBTQIA+ youth, access to mental health can be difficult due to inadequate mental health care, fear of discussing mental health concerns, and stigma. Utilizing virtual care can help LGBTQIA+ youth overcome some of these barriers by promoting a safe and accessible method for the delivery of care.
  
• Youth: Child psychiatry is more important than ever, with the American Academy of Pediatrics, the American Hospital Association, and the American Academy of Child Adolescent Psychiatry declaring a mental health emergency for youth in October 2021. With virtual care, children can be screened for mental health conditions, and have a psychiatrist ready to support and treat them. Additionally, parents no longer have to take time out of their day to bring their children to their mental health appointments, making care more convenient for both families and children.
  
• Geriatric populations: Early intervention, collaborative care, and a holistic approach are both vital when it comes to addressing the health of the geriatric population in your community. Virtual care can be an essential tool for older adults to receive care from the comfort of their own homes while maintaining a sense of autonomy.
  
• Rural populations: Barriers like limited health literacy, transportation challenges, and privacy are just a few challenges that rural populations face when they’re trying to get the care they need. However, virtual care provides an opportunity for rural communities to connect to a high-quality mental health provider without a long commute and fear of stigma.
  
• Underserved populations: Social determinants of health create and exacerbate mental illness by making access to mental health care more difficult. Access to providers that are culturally competent can allow minorities to connect with a provider who can better relate to their experiences.

How virtual care boosts patient satisfaction in the ED

In the emergency department (ED), virtual care can allow patients faster access to behavioral health care through a virtual visit. This improved access means patients don’t have to wait hours to receive treatment and can have a shorter stay in the ED – leading to an improved patient experience overall. 

Avoiding ED boarding is crucial to patient satisfaction, as there are many downstream harms that can come with it. The Joint Commission (TJC) recently shared how boarding is a patient safety risk that leads to increased medical errors, compromised patient privacy, and increased mortality, especially if it exceeds four hours. With the help of virtual care, organizations can  increase throughput in the ED and decrease the need for patient boarding.

How Iris can help

At Iris Telehealth, we envision a better world through healthy minds. If you’re looking to meet the behavioral needs of your community and help your patients achieve better health outcomes, telepsychiatry is the perfect solution. Contact us today if you’d like to learn more about implementing telepsychiatry into your organization. 

Iris clinicians are at the heart of what makes our organization such a special place to work. That’s why we’re turning the spotlight on the amazing work they’re doing every day. This month, we’re sitting down to talk with Dr. Jean Oelschlager.

Q. How did you find Iris and decide you wanted to be an Iris provider?

A. I retired from my position in Wisconsin with community mental health in 2020 amid the pandemic. We moved to Arizona, and I planned to volunteer out here. During the pandemic, no one was accepting volunteers, particularly older volunteers. I thought I couldn’t just sit at home all the time. I needed to do something productive and useful. I thought about doing locums work again because I had done that work in the past, and I reached out to a couple of the companies I worked with, and they didn’t have anything that worked for me.

I wasn’t looking for a full-time job. I was looking for something where I could work two or three days a week because I wanted to retire or semi-retire. That didn’t pan out. I thought maybe I should check into telehealth.

I found Iris listed and read more about it. The more I learned about Iris, the more it seemed like it was a good fit for me because they were willing to be flexible with part-time hours, with the possibility that I might want to return to Wisconsin in the summers.

I like the mission to provide services to underserved areas. I like that Iris was started by a psychiatrist who saw this need and stepped up by starting the company. All those things were appealing, and the people I talked to were lovely, helpful people. It seemed like a really good fit. The process started at the beginning of 2021, and by September 2021, I started with the clinic in Missouri.

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

A. I’ve learned how to communicate better in the virtual world with patients. You have to be more tuned into eye contact and be more verbal about what you’re doing when you’re looking away so they know what you’re doing if you work with two screens.

I have one screen for the Zoom call and the other for the medical record. I’ll tell them if I’m doing something else, like ordering medications. They can see that when you’re in an office setting, but they can’t when you’re virtual. You have to be more mindful to let patients know when you’re not looking at them what’s happening. You give them time for them to answer.

The other thing that has worked well with my setup with Iris and the clinic in Missouri is that patients come into the clinic.

I don’t do virtual visits in their homes. They come in and get their vitals. We do PHQ-9s and AIMs, and then the nurse scans it so that I can see everything. I have a designated nurse that I’ve worked with throughout my time at the clinic. She knows my routine. She’s that physical presence for me, an extension of me. And that has worked really well.

Because sometimes she can see things that I can’t necessarily see and can alert me to that. I know not every situation with telehealth works that way, but I’m really happy that’s how it worked out. I value that team approach and that she’s there in person to connect with patients and see things that I might not catch virtually.

Q. How do you foster connection with patients virtually?

A. Eye contact is probably the biggest thing. Also, using the staff that’s physically present in the clinic to reach out to patients. For example, we had a patient who had postpartum depression, and I was concerned about her. We connected her with one of our therapists, who contacted her between my visits to see how she was doing.

The other thing that’s really nice about my setup is that it’s a primary care clinic. So most of the providers in the clinic are primary care, and then they have a behavioral health and substance use department, too. It’s happened more than once that a patient comes in to see me, and they are medically ill. They either have an upper respiratory infection or a UTI, or something needs to be addressed.

My nurse will try to get them in to see one of the primary care providers around our appointment. That way, the patient (particularly if it’s a more acute situation where we’re really concerned about them) can be seen and get their issue addressed either right before I see them or right after. That holistic approach creates a good relationship with patients that they appreciate. I appreciate it, too, because I know they’re getting their needs met in other areas.

Q. As a healthcare professional, how do you manage work-life balance?

A. The biggest thing is that at my stage now, I can say I’m only going to work two days a week. That was really an important part of coming back to work. I had been doing this for 30+ years and wanted to do other things, not just work full-time. That was one of the things with doing telehealth and joining Iris, was Iris being flexible enough to say, “Yes, we can find something where you can just work two days a week.”

I wasn’t interested in doing call anymore. I did that for years – been there, done that. I put my time in doing call. I wanted something where I could do outpatient work a few days a week without worrying about the call.

Not to say that I never would get a call. There have been instances where a question came up on a patient, and the clinic would call me on my non-work days. But that’s extremely rare. It may only have happened a couple of times in the two years I’ve been working.

Being able to do just the two days a week has worked really well because it’s allowed me to do other things. One of the things we enjoy doing out here is hiking. We’ve got a hiking group that we do regularly—staying active. The climate here is conducive to that, except in the middle of July.

Even then, you have to get up really early. I still do that and walk at least two miles daily every morning. I just get up really early when it’s hot. I think what we tell our patients is to stay healthy. Work is important, and I think that it helps me to stay mentally active, feel productive, and like I’m still contributing.

I’m volunteering at a couple of places, which has been great meeting the people in the community, making new friends, and staying active socially. All those things are important.

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

A. I would say seeing patients get better or having that “aha moment” where they connect how they can change their thinking or behavior that will make life better for them.

Q. What do you love about working with Iris?

A. The flexibility. The staff I’ve worked with have been wonderful and helpful—for example, the IT folks. I’ve had a couple of times where stuff didn’t work, and I was sending texts because of the time difference between Missouri and Arizona. I was texting them early in the morning, “This isn’t working, and I have patients starting at this time. I need help right away.” Then, within minutes I was getting help.

That’s been consistent because it’s happened several times. I’m not a tech guru by any means, and that’s probably my greatest anxiety is wondering, “What’s going to happen with the computer? Or, is there going to be some upgrade or downgrade?” The IT staff have been wonderful. The supervisory folks, like Melissa Kennedy are wonderful.

I had an accident where I was hit by a car while I was out walking last year, and I broke my back, leg, and pelvis. I was in a wheelchair for six weeks. Iris was very understanding, and the clinic understood that I had to get better. After three weeks of not working, I was so bored because I was wheelchair-bound.

The clinic and Iris helped me figure out a schedule where I would work just a few hours a day. I’d work a couple of hours, then I’d rest a couple of hours, and then I started seeing patients again after three weeks, even though I was still in the wheelchair. That’s another example of the flexibility that I value both with the clinic and with Iris. That was wonderful.

I’ve had a miraculous recovery, and that’s amazing. I feel very blessed, but that was being able to just work a little bit for probably a month to six weeks until I was more ambulatory. That was good for my mental health, too. Because I was homebound, unless my husband would load me up with a wheelchair to take me somewhere, which was a big to do, that flexibility was very important and helpful.

Q. What advice would you give someone new to telehealth?

A. I would say find the right company that will support you. It’s important to have a team behind you to help with credentialing and vetting potential clinics that you might be working for. The IT component – Iris has been great about providing the equipment and helping with getting licensing and malpractice coverage. I think that’s probably my biggest thing is just finding the right fit with a company that can give you that support and help getting started.

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

Over the last several years, it’s become clear that telehealth is here to stay. According to the American Psychiatric Association, nearly 60% of Americans would use telehealth for mental healthcare, and 43% currently want to continue using telehealth services when the pandemic is over.

With that data — and telehealth’s ability to expand access to high-quality providers — it’s no surprise that organizations are thinking through how to start a telemental health practice and leverage it as a long-term solution.

But, if your organization is wondering how to build a telepsychiatry practice in-house, you should consider some important first steps, limitations, and potential alternatives (like formal behavioral health vendor partnerships).

1. Building a telehealth program in-house won’t solve any recruitment challenges

As a medical group dedicated to providing virtual care services to healthcare organizations across the country, Iris Telehealth has access to a provider pool that spans all 50 states. However, individual organizations just starting to transition to telehealth as a long-term solution will likely be limited to the same provider pool they’d use for in-person providers.

And that’s not the only challenge you might encounter. For example, if you have an in-person provider who you think might transition to telehealth on a full-time or part-time basis, they may decide they don’t like telepsychiatry after all. Or they may get scooped up by another organization because they’re not limited by geographical location anymore.

At Iris, however, we not only assess their clinical skills, but their technical skills and screen presence as well. We have an intensive vetting process to make sure telepsychiatry is a good fit for that individual provider.

2. A formal telehealth program requires specific technological considerations

As you’re learning how to start a telepsychiatry practice in-house, you should ask yourself these questions:

• Do we have the right video platform?
• Do we have the right security in place (i.e. VPNs)?
• Will our platform work for our current staff and patients?
• Is our program HIPAA compliant?
• Do we have sufficient IT support for handling technological difficulties or glitches?

If you’re uncertain about the answers to any of these questions, a vendor partner like Iris Telehealth might benefit you and your team as you navigate this process. (And, even if we’re not an official partner of yours, we’d be happy to talk through your needs with you.)

3. The telehealth landscape is constantly changing (and may be hard to navigate on your own)

Policies in the behavioral health space continue to evolve. Whether it’s around HIPAA compliance, reimbursements for audio-only appointments, or billing and coding — things continue to change as more states pass legislation that permanently expands telehealth services.

It can be challenging to stay on top of all the relevant changes as just one healthcare organization. No matter your size or approach to telehealth, the organization needed to manage telehealth-specific policies will likely be a big lift for your team.

That’s where a vendor partner may come in handy to offer perspectives on how similar organizations are navigating this space right now.

4. You’ll need dedicated, telehealth-specific policies for your providers

There’s a lot of information and “what ifs” to consider if you’re trying to build your own telehealth program.

Here are just a few of the policies you might want to put into place:

• A standard 90-day grace period for providers leaving your organization. If you don’t tell your provider when they start that they have to give you 90 days’ notice, you may not have time to find a replacement provider when they leave. 90-day policies protect clinics, providers, and patients.
• A strong policy around computer usage. You don’t want someone accidentally putting a virus on your network if they’re using their computer for other things or are engaging with spammy content.
• No-show policies and policies for telehealth, specifically around remote patients (not in your clinic).
• Policies around when the telehealth provider should end a session or not have a session with a particular patient.
• A billing policy for patients who show up late to appointments.
• Standard prescribing rules and protocols.

5. Your EMR may not be set up for behavioral health or telehealth right now

If you’re determined to build your telehealth program in-house, the first thing you need to look at is the capabilities and limitations of your EMR.

Make sure you have it set up for behavioral health before you do anything else. A common mistake organizations (particularly FQHCs and CHCs beginning psych services for the first time) make is trying to run their virtual behavioral health program the same way they run their primary care. When that happens, they often end up overbooking providers. But behavioral health is a different paradigm.

Remember, ideally, you want your EMR to be able to encompass your scheduling, patient records, e-prescribing, and video in one system.

A formal behavioral health partner could help support you and your organization

One of the unique benefits of telepsychiatry and a partnership with Iris is our Clinical Operations Managers (COMs). We’re a concierge service whose number one goal is making sure you and your patients are getting the care and support you need. If, for example, there’s a scheduling issue or a provider conflict we can help resolve it using solutions we have seen and used at clinics across the country.

Every day, we help mediate and advocate for clinics and clinicians to ensure there’s efficient and effective patient care.

Here’s what that would mean for your organization:

• Our 24/7 IT support can interface with your organization’s IT to solve problems and can often independently solve them for our providers.
• We have support for billing and scheduling issues.
• We are Joint Commission accredited — which means we can assist with provider credentialing and paneling (we have some partners who do credentialing by proxy with us).
• We match your organization with a top-quality provider who specializes in the areas you need (and who we’ve already vetted to ensure virtual care is a good fit for them).
• After we’ve matched a provider with your organization, we help make sure they have the right technology and that the doctor knows what they need to know to evaluate your patients.
• We assume all of the expenses of the benefits and PTO.
• We are a true partner dedicated to long-term care and service. We make sure our providers are an extension of your team and do everything in our power to ensure continuity of care for your patients.

Whether you’re interested in learning how to make your own program a success or creating a formal partnership with Iris, we’re here to help. Contact us today to get the conversation started.

Integrating behavioral health across all patient journeys can transform a health system and how it delivers care for its community.

As Chief Strategy & Marketing Officer at Iris Telehealth, I’ve seen first-hand the impact effective behavioral health integration can have on a health system and its patients. Whether through better clinical outcomes and access, increased revenue, or positive margins – our health system partners sustainably leverage and integrate scalable behavioral health services seamlessly across their ecosystem.

Learn how our partners are finding success by integrating behavioral health services across their health systems, what the patient journey looks like through a virtual lens, and the financial impact virtual services can have on a health system.

The tangible impact of integrating behavioral health services

Experiencing the tangible impacts of integrated behavioral health services starts by providing timely access to quality care – and making sure that care is financially sustainable.

Once the need for behavioral health care is met, health systems may experience the following benefits:

• Better access
• Better patient outcomes
• Improved financials
• Reduced total cost of care
• A patient and provider community that feels supported

Helping health systems take back control of a fragmented healthcare landscape

Today, health systems are being disaggregated by a myriad of competitors – both new and old. This trend is contributing to lower health system revenue, but also to a further fragmentation of the patient journey. At Iris, we want to help health systems take back control of this fragmentation to ensure patients are getting integrated, whole-person care.

We believe providing integrated behavioral healthcare is a critical component to patient care. The reality is – behavioral healthcare should be infused into every journey. Whether a patient just received a cancer diagnosis, is an expecting mother, or is experiencing escalating anxiety at a primary care appointment, integrating behavioral health care will drive better patient care and eliminate the need for a patient to look elsewhere to fill gaps in their care needs.

At the end of the day, our goal is to help health systems deliver on their ultimate promise of delivering whole-person, integrated care.

How to integrate virtual services across a health system

The mistake many health systems make is believing that integrating virtual care into their health system is as simple as having virtual providers available to see patients. In practice, it is much more nuanced. We believe in the concept of “integrating virtual care locally” – whereby the referring provider knows and trusts the behavioral health care team they are relying on, and the virtual team truly knows the local dynamics. This approach is really the only way to build trust and create true continuity of care.

Additionally, the care experience has to be the same whether a patient is part of an Iris program or not. That is why our entire patient journey is built with the idea of integrating into, and leveraging, the health system technology already in place. The Iris provider is integrated seamlessly into the health system and the patient journey feels no different than it would if they were seeing an in-person provider.

The financial impact of integrating behavioral health services

The financial realities of providing behavioral healthcare are undoubtedly a challenge. But, in our experience, it is possible to deliver high-quality behavioral health care and have it be financially sustainable.

We have helped health systems double their behavioral health revenue while delivering a 10% program operating margin. And, study after study shows that providing outpatient behavioral healthcare reduces the total cost of care.

How is this impact possible? It comes down to the disciplined execution of a few key tenets:

• First, ensure you’re driving top-of-license care from a true care team approach. Yes, it is essential to have psychiatrists available for high acuity patients, but from our experience, we’ve seen psychiatrists relied on too heavily for patient care than what is clinically appropriate. That is why we leverage industry-leading navigation assessments, with a true care team approach to make sure every patient is seen by their optimal provider with a tailored care plan.
• Second, be sure to optimize the operational complexities of care delivery. Patient no-show rates, provider turnover, full provider panels, and consultation with referring providers are all critical to ensuring the program is sustainable.
• Finally, revenue cycle optimization is critical. Many health systems are not getting paid optimally for the care they provide and that has to change. Revenue cycle optimization means ensuring the optimal codes are being billed, providers are documenting appropriately, and payers are approving claims. Constant measurement, continuous improvement and dialogue with payers are critical, and can make a significant difference.

It is a reality that if there is “no money, there is no mission,” and therefore we are dedicated to ensuring our programs deliver on high clinical quality and financial sustainability.

The spirit of partnership with Iris Telehealth

At Iris, one of our core values is to suck less every day, which speaks to our commitment to continuous improvement and our journey to excellence. No health system has behavioral health figured out, and no health system expects to be perfect tomorrow. Everyone’s on a journey to be better than they were yesterday. If together we commit to continual improvement, we will make a lot of progress and deliver better care for our communities.

If you’d like to learn more about how we can work together, don’t hesitate to contact us today!

As Chief Strategy & Marketing Officer, Dan Ferris drives strategy and revenue growth acceleration by identifying market opportunities and increasing awareness of how Iris can uniquely solve customer needs. Dan brings twenty years of healthcare experience in various marketing, product and strategy roles at Hillrom, CIGNA, Abbott, and Putnam Associates, a healthcare strategy consultancy.

Striking the right balance between prioritizing quality patient care and managing everyday leadership tasks is pivotal for healthcare organizations. But it’s not always easy. Hospitals and clinics have safety and quality metrics they must report on, and sometimes it’s unclear who’s responsible and whether they have the training and skills to do that type of work.

During my years at Iris, I’ve seen many clinics promote staff members into leadership positions based on seniority rather than on that person having experience in leadership or administration. That’s where leveraging an Iris provider as a virtual medical director for a behavioral health program can be a great move.

Our providers are integrated into the organizations in which they see patients. They know the staff, the patients, and the clinical challenges that the organization faces, but they can also be involved in higher-level discussions and the administrative decision-making and leadership required for clinics to maintain safety and quality reporting.

In this article, I’ll share some of my insights into how leveraging a virtual medical director works, the benefits they can bring to an organization, and how on-site teams can build trust with a virtual medical director.

How leveraging a virtual medical director works

In many places across the country, our providers serve as virtual medical directors as well as behavioral health providers. Generally, the hours are divided so the providers and staff can know which hat is being worn when.

For example, we carve out administrative time with regular meeting cadences to meet with staff and go over things like policy reviews, safety incidences, and quality metrics – and perform supervisory services when needed. That provider will also have clinical hours where they deliver psychiatric services to patients through regular appointments.

It’s important to delineate how the provider uses their hours each day to prevent confusion. There are always a lot of patients to see, so the medical director may not have the time to do the administrative work if it’s not scheduled. Setting goals, having a solid job description and expectations, and protecting time for weekly administrative and leadership meetings are essential to success in the medical director’s role.

How to build trust between an on-site staff and virtual medical director

The way humans interact is really changing. While the gold standard in healthcare has been in-person care, on-site behavioral health services aren’t always available — this became painfully apparent during the pandemic. Not only did clinics and hospitals need more providers to serve the surge of patients seeking behavioral healthcare, they needed new leadership models and staffing structures.

Telemedicine enabled us to serve so many clinics and hospitals around the country, but coming out of the pandemic, we also knew that being an organization that clinics and hospitals could trust to do virtual care well was important. We were able to demonstrate that finding a virtual behavioral health provider who can be a leader and who truly cares about your community and your clinic helps build that trust – even if they’re three or four states away.

At Iris, we’ve found the key to building that trust is open, honest, and transparent communication — it’s at the core of everything we do. We get to know the on-site team members on a first-name basis and become comfortable with each other clinically, professionally, and personally. Our goal is for our virtual behavioral health providers to be as accessible as any on-site provider might be — that’s one of the ways to build trust.

As a provider, I’ve also found making yourself available online, just as you would in person, is helpful for building trust and engagement with an on-site team.

For example, leaving your office door cracked is the universal sign that you’re available to staff when you’re not with a patient. With virtual care, leaving your video on between patients or meetings allows staff to virtually pop in and say “hi” or ask a question related to patient care. So even if you’re on a screen, the on-site staff feel like you’re present. That’s the quality and integrity of the interactions we strive for at Iris.

How to set your virtual medical director up for success

Setting up your medical director for success involves developing clear goals and objectives as well as clear boundaries.

A few questions we’ve found helpful to ask in this process are:

• How many hours will your medical director need for the administrative function?
• Who held this role before? What were their challenges? Why did they leave?
• What are the expectations of this role?
• What meetings, supervision, and oversight are required in this role?
• What would success in this role look like to your team?

We’ve helped many organizations develop job descriptions to help them answer these questions as they pertain to their unique clinical workflow and staffing matrix.

For example, a remote medical director might be responsible for working with the Chief Financial Officer or operations team. They might need to put together presentations to demonstrate the safety and quality initiatives your organization is tracking and how your organization responds to – and measures the success of – new initiatives.

Additionally, there are financial metrics, quality reports, coding, and all sorts of things a virtual medical director is regularly reviewing.

Breaking down the responsibilities of a virtual medical director

A medical director’s role is really focused on directing the clinical delivery of care and the quality, safety, and integrity of that care so patients get the help they need and providers get the support they need. This can be done through virtual leadership just as easily as through traditional on-site leadership.

In my experience, supporting teams of providers – including doctors, nurse practitioners, nurses, and therapists –is very meaningful whether it is done in person or virtually.

Medical directors can be a sounding board for providers to bounce ideas off of as well as a resource for dealing with challenging clinical cases. Behavioral health patients can have high levels of acuity and sometimes have needs that providers can’t meet, so supporting colleagues and staff in their efforts to deal with dissatisfied patients can be very helpful.

Again, such support can be offered virtually by a medical director just as it might be done in person.

Where Iris Telehealth fits in

By working with a virtual care provider like Iris, your organization has a larger pool of providers to draw from. Whether you have a small office or a large clinic that needs help finding a medical director, we can help you find one that your staff and patients will enjoy working with.

If you’d like to learn more about our experience matching organizations with a virtual medical director, be sure to read through our case study from Chesapeake Integrated Behavioral Healthcare in Virginia. You can read the full piece here.

If you‘d like to talk to someone about potentially hiring a medical director, be sure to contact us today. We’d be happy to talk through the process and learn more about your needs.

Dr. Tom Milam manages our team of clinicians and guides them in telemedicine and industry best practices. He received his undergraduate degree from WVU in Anthropology, graduating summa cum laude, and received his M.D. from the University of Virginia. His residency training in psychiatry took place at Duke and UVA. Dr. Milam has served in a leadership role throughout his psychiatric career and spearheaded the telepsychiatry initiative at his previous hospital.