SSM Health Cardinal Glennon Children's Hospital is an inpatient and outpatient pediatric medical center based in St. Louis, Missouri. And Missouri has a serious healthcare problem – a massive behavioral health provider shortfall.

THE PROBLEM

The demand for behavioral health services is overwhelming across the country, but it's particularly acute in Missouri, where approximately only 200 of the state's 1,000 licensed psychiatrists actually reside in the state to serve a population of about 6 million.

This shortage began to intensify even before the COVID-19 pandemic, and the demand hasn't let up since. Cardinal Glennon Children's Hospital experienced the impact firsthand – its emergency departments were becoming inundated with behavioral health patients, who at times were being held for weeks in the ED without proper beds, awaiting psychiatric evaluation and/or placement.

What makes this crisis particularly challenging is its pervasiveness. Unlike many other health conditions that might disproportionately affect certain demographics or regions, behavioral health needs are truly universal – affecting urban, suburban and rural populations across all socioeconomic backgrounds.

As a pediatric hospital with an extensive geographic reach, Cardinal Glennon Children's Hospital serves patients from Missouri, Illinois, Arkansas and beyond. Its growing wait lists and extended appointment lead times were forcing families to seek crisis care through the ED, creating a cycle that wasn't serving anyone well – neither the behavioral health patients nor the acute care and trauma patients.

These issues helped Cardinal Glennon Children's Hospital recognize the urgent need to expand its psychiatric capacity through virtual behavioral healthcare.

PROPOSAL

When exploring solutions to its behavioral health access challenges, the organization quickly recognized that telepsychiatry was uniquely suited to its needs.

"Unlike many other specialties, behavioral health rarely requires physical examination – making it perhaps the purest, most perfect use case for telemedicine services," said Chris DiGiusto, vice president of ambulatory services at SSM Health Cardinal Glennon. "With this in mind, we sought vendors that could provide dedicated psychiatric support while understanding the unique needs of a pediatric hospital.

"After evaluating several options, Iris Telehealth stood out for two key reasons: Its consistent track record of delivering on promises at other institutions and its willingness to grow alongside us in a true partnership that was relationship-focused rather than transactional."

The proposal was intentionally designed to scale incrementally. The organization would start with one full-time dedicated psychiatrist who would focus exclusively on Cardinal Glennon's patients, with the understanding that Iris Telehealth would provide additional psychiatric capacity as needed.

"This measured approach allowed us to establish and refine our workflows before expanding," DiGiusto explained. "The proposal also addressed the complex requirements of our multi-state service area, ensuring Iris Telehealth psychiatrists would be licensed to treat patients across Missouri, Illinois, Arkansas and neighboring states – a critical factor given our hospital's extensive geographic reach."

MEETING THE CHALLENGE

Cardinal Glennon built its telemedicine program around its existing Epic EHR platform, which serves as the single source of truth for patient care. The telepsychiatrists connect with patients through Epic's integrated video platform, ensuring a seamless experience for providers and patients.

"This integration was crucial, as it allows our Iris Telehealth psychiatrists to work within the same system as our in-house teams, maintaining continuity of care and streamlining documentation," DiGiusto said.

"The success of our program relies heavily on what we call our 'wraparound services,'" he continued. "Before each visit, our team handles everything from registration and insurance authorization to patient readiness assessment. We focus particularly on patient engagement, ensuring they're prepared and committed to participating in their care."

After a psychiatric evaluation, the comprehensive care team – including PhD psychologists, counselors, licensed clinical social workers and nurse navigators – follows through on the psychiatrist's treatment directives, providing ongoing therapeutic support.

"Getting new Iris psychiatrists up and running in our system takes about three months," DiGiusto noted. "This includes Epic training, hospital privileging, multistate licensing and payer enrollment.

"While the technical aspects are important, what really makes this work is treating it as an integrated care program rather than just a technology implementation," he added. "The psychiatrists become true extensions of our team, fully embedded in our workflows and culture."

RESULTS

Behavioral health virtual care has delivered significant improvements across several key metrics.

"Most notably, we've tripled our psychiatric activity volume, dramatically increasing access to care," DiGiusto reported. "The percentage of new patients scheduled within 14 days has jumped from 14% to more than 60%, meaning more children are getting the care they need when they need it.

"Through our focus on patient engagement and comprehensive pre-visit preparation, we've reduced our no-show and same-day cancellation rate from 21% to just 7%, ensuring we're making the most of our psychiatric resources," he continued.

Perhaps the most impactful achievement has been in the emergency department, where the organization has cut the average hold time for behavioral health patients awaiting evaluation and placement by 50%. This improvement is particularly crucial as these cases often involve crisis situations where timely intervention can be lifesaving, DiGiusto noted.

"Many of these patients are now being identified and treated through our outpatient services before their conditions escalate to emergency status," he explained. "As Missouri's largest behavioral health provider, these metrics represent real progress in addressing the significant psychiatric care needs in our region, though we recognize there's still more work to be done."

ADVICE FOR OTHERS

For organizations considering telemedicine for behavioral health, DiGiusto encourages them to approach it as a relationship-building opportunity rather than just a technological implementation or contractual arrangement.

Success comes from finding vendors that understand one's specific needs and are willing to grow alongside the healthcare organization – and look beyond the technology itself to know how the program will integrate with one's existing workflows and support services, he continued.

"Building a successful behavioral health program requires a comprehensive approach," he advised. "Focus on creating robust wraparound services that support both providers and patients throughout the care journey. This approach includes everything from streamlined registration and scheduling processes to engaged care teams that ensure patient preparation and follow-through.

"While the technology enables service delivery, it's the human elements – the care coordinators, social workers, psychologists and support staff – that truly make these programs successful," he concluded. "Consider starting small and scaling incrementally as you refine your processes and build confidence in the program."

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