Back in 2012, Longwood, Florida-based Impower was a small behavioral health agency that focused on home- and school-based care for individuals in the child welfare system.

THE PROBLEM

The behavioral health provider organization's services were limited, provider shortages were severe and wait times were over two months for new patients to receive initial treatment.

President and CEO Anna Baznik knew something had to change if the organization was going to survive. "I could not get providers," she said. "There just wasn't anyone."

So Baznik hired Amy-Erin Blakely, now vice president of behavioral health, as an emerging business consultant to develop and launch a telehealth program within Impower as an answer to the provider shortage.

PROPOSAL

By leveraging technology for remote virtual care, Impower would be able to deliver hard-to-locate providers into underserved areas and populations. In the initial incarnation, the patients would be able to present to a nearby facility or physician's office and connect via telemedicine without having to travel a considerable distance, and it was designed specifically for psychiatric treatment.

Over time, the vision evolved to allow the patients to remain at home to connect with the remote provider, and the services expanded to therapy, case management and more.

MARKETPLACE

There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services, Tellus and Tyto Care.

MEETING THE CHALLENGE

Impower is on its third telehealth platform and now uses telemedicine vendor Mend to provide electronic healthcare including scheduling, data entry into electronic health records, and the web-based video platform itself.

"Telehealth now connects patients and providers who are located anywhere within the state of Florida, soon to be national," Baznik explained. "It allows scheduling flexibility for providers and increased access to patients by offering a wider range of appointment times that aren't limited by geographic access."

Patients who were previously waiting weeks or months for appointments now access care in a few days or less, and they use the technology that they already have – most patients connect with their smartphones or tablets.

"With Mend, Impower patients can complete new patient paperwork electronically on the Impower website prior to their appointments which, through an integration, are immediately input into the patient chart at Impower," Blakely explained. "This has improved our referral process, increased patient onboarding, and reduced time between first contact and initial appointment."

The telemedicine technology ensures that patients are notified and on-time by also managing appointment reminders, she added.

"It allows scheduling flexibility for providers and increased access to patients by offering a wider range of appointment times that aren't limited by geographic access."

Impower President and CEO Anna Baznik

After referrals are received for patients, Impower contacts them to discuss with them the use of telehealth, assists in downloading the Mend app on their smart devices, and conducts testing on their devices, including a practice session prior to the appointment.

"This has been paramount in the successful paradigm shift to telehealth at Impower – ensuring patients understand that they can use the telehealth applications and they are simple and easy to access," Blakely said. "First impressions are everything."

Prior to the use of telehealth, Impower had front desk staff in its clinics who would check patients in, collect vitals, and show them back to their therapy rooms. Those staff members still support patients, but now work remotely from home and "follow" psychiatric practitioners throughout the day to ensure patients are checked in and are able to connect with their provider for their visits. They also schedule follow-up appointments.

"When Impower shifted to a direct-to-consumer model – seeing patients from home – the collection of biometric data became an obstacle," Blakely recalled. "As an innovative solution to this barrier, Impower has partnered with higi, a company that provides biometric stations in storefronts of many major grocery and drug stores."

Impower patients are given a unique ID they can use when going to their local store to have biometric data collected; for example, blood pressure, pulse and weight. When the patients check in at these stations and have their biometrics collected, their data is automatically uploaded every night directly into Impower's electronic health record. Then the data is there for the providers to see at their next appointment.

"Telehealth also has allowed Impower to provide true collaborative treatment with other practitioners, case managers, guardian ad litems, etc.," Blakely said. "Through Mend, multiple people are allowed to enter the virtual sessions simultaneously through the use of a secure URL that is sent to invited individuals."

For example, a psychiatrist, a patient and a neurologist can enter the same session and have a discussion regarding patients' treatment. Likewise, a patient may engage in family or group with multiple members all at different locations.

Impower now is entering into virtual primary care medical services to coincide with its behavioral health services.

RESULTS

The telemedicine technology has reduced patient no-shows by 50 percent, limited new patient wait times to less than 48 hours, and saved $150,000 in overhead in six months.

"By working with Mend and offering appointments within the patient home environment, we have reduced our no-show rate from 59% to 12%," Baznik stated. "This has had a massive impact on revenue and allows us to see more patients in shorter amounts of time. Additionally, we have closed down multiple brick-and-mortar locations and consolidated to one site."

The majority of staff now work remotely, and the administrative overhead for the organization dropped immensely. Within the first six months of the transition to fully virtual, Impower saved $150,000 on rent alone.

"Impower is able to initiate care faster because patients can be connected to a provider without travel or geographic restrictions," Baznik said. "This improves provider staffing overall and creates the ability to provide continuity of care for new patients. Impower has now conducted more than 200,000 telehealth visits, averaging around 1,000 per week."

And Impower no longer has any difficulty in recruiting providers. Some psychiatrists are closing down their own private practices, letting Impower take on the billing and health records of their patients while they are able to see their same patients, only from home, Baznik explained.

Investment money in telehealth at Impower came to about $460,000 within the first four years of implementation. That investment was returned within the first full year of implementation with reductions in no-show rates and overhead, Baznik said.

ADVICE FOR OTHERS

"Telehealth is a huge undertaking, but the benefits to the organization and patients far surpass the initial burdens," Baznik advised. "Work with providers who are eager to provide telemedicine and who understand the value of the technology. Telemedicine treatment has value for all patients, but it isn't a fit for all providers."

Work with payers to educate on the reduction in emergency treatment and overall cost of care by paying for telemedicine services in behavioral health, she added.

"Share with them the increased medication compliance rates, the access to family participation and the value for underserved populations," she concluded. "By educating providers, working with payers and dedicating your organization to innovative treatment delivery, you can reach more patients and provide expanded healthcare across the board."

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com