Michigan's Henry Ford Health System offers a 100% virtual care program for behavioral health integration that is delivered to patients either directly in a primary care clinic or the patient's home.

Therapists are located at either a central clinical location or their home office and are able to securely deliver care using real-time audio and video through various platforms.

This telemedicine approach allows a small number of therapists to care for patients across the health system, providing evidence-based treatment with proven clinical outcomes compared to care provided by a primary care physician alone.

Therapists are supported by a psychiatrist and a specialized behavioral health pharmacist. The team provides comprehensive behavioral healthcare to a wide range of patients.

Marie Lee, manager of access care technology at Henry Ford Health System, will be discussing this program and offering lessons learned in an in-depth educational session entitled "Integrated Behavioral Health Services via Virtual Care" at the HIMSS22 Global Conference and Exhibition next month in Orlando.

Healthcare IT News sat down with Lee for an interview that offers a sneak peek at her session.

Q. What are some of the requirements for setting up a real-time, audio/video therapy session where a provider is in a clinical setting and the patient is in a primary care clinic or in their home environment?

A. The keys to success of any virtual care program implementation are in the people, processes and technology.

Before a patient is seen, the most important program requirements involve the collaboration between primary care and behavioral health services. The need and intervention benefits are well-researched; however, having teams willing to work across service lines to care for patients in a novel way takes communication, trust and a willingness to try something new.

Our organization had very passionate champions from the primary care side who were dedicated to removing barriers and ensuring this form of behavioral health could be brought to their patients. Once the clinical champions established their vision, administrative leaders needed to commit the resources that would be required to deliver the care, both in terms of capital expenditures as well as staffing requirements.

Finally, staff and patient education was crucial to the success of the program. Not only did the clinical staff need to be comfortable operating the technology, but they also needed to develop a workflow where patients were being seen by a clinician not physically in the building.

It also was very important for the patients to understand they would not see a therapist who was physically at the same location, but would see that therapist via video. As patients were given the option to connect to therapists without coming to the clinic, various support was provided to ensure they were able to get successfully connected.

Training materials and videos were provided, as well as one-on-one support from clinic staff to assist patients who were particularly challenged with the technology.

The program was intended for a small number of therapists to serve almost 30 clinical locations spread across a large geographic area. Processes were implemented to identify patients in need through the use of clinical tools, educate the patients about the behavioral health-integration program and benefits, schedule the patients at a convenient and comfortable location (often their own home or PCP's office), and provide care through a series of appointments conducted over video.

This program was launched in 2017, before the pandemic and before virtual care was widely adopted. Exam rooms in clinics were equipped with web cameras and speakers, allowing patients to connect to video visits without having to navigate the technology on their own or worry about WiFi in their home.

As this method of care became accepted, more patients wanted to skip the trip to the clinic and conduct visits from a location of their choosing (home, work, etc.). The organization adopted new technology that easily allowed patients to connect to video visits on their own.

This technology rollout and program adoption prepared the organization to transition a majority of all outpatient visits to video visits in March 2020, when the pandemic closed many clinical offices.

Q. What are a couple of the opportunities to provide evidence-based behavior therapy to individuals where a lack of providers and patient comfort with seeking treatment are significant barriers to effective treatment?

A. Meeting people where they are and getting them the treatment they need is really what drives this behavioral health integration program. People often seek care from their PCP as that is their "go-to" for care.

In addition to physical health concerns, conversations often turn to mental health concerns. In the past, some PCPs have been hesitant to prescribe medications for things like depression and anxiety, as they do not have the periodic check-ins that typically are required to ensure prescriptions are having the intended effect.

By partnering with a behavioral health therapist who provides updates to the PCP, patients are directed to the appropriate care via a series of therapy sessions, where it is determined if medication is needed (or needs to be adjusted). Patients do not have to go to a "behavioral health" clinic, and are cared for in a location where they typically seek care – the PCP's office or in the comfort of their own home environment.

The pandemic helped drive acceptance for virtual care services. Additionally, the pandemic exacerbated mental health issues. The behavioral health integration program was able to add staff to accommodate more patients being referred from approximately 30 primary care offices spread across southeastern Michigan, even caring for patients who were further from home, such as students going to college in other parts of the state.

Patients have embraced video visits as an opportunity to skip the travel and wait time in a clinic. Even older patients who are sometimes skeptical of new technology have been able to use the service.

One example was a gentleman who was 86 and asked his therapist, "Isn't there a way for me to just do this on my phone?" When they were able to get connected, he was happy, and stated, "All I had to do was get dressed and sit on my couch to see you!" Getting to the clinic was difficult for him to arrange.

Q. What does a 100% virtual program that allows patients to participate, regardless of their access to and comfort with technology, look like?

A. At program inception, the intent of the virtual program was to handle the technology and connection for the patient. The patient experience was to remain functionally the same as seeing their PCP: Arrive at the clinic, be roomed by a medical assistant, and see the provider.

In this case, the "see the provider" was via a computer monitor, where the medical assistant would start a video call with the therapist for the patient and then leave the room during the session. As the organization adopted more sophisticated video technology, patients were given the option to have their follow-up appointments (after their initial appointment that was completed with the patient in the office) completed via video at their own location.

Initially, about half of the patients chose that option and would often complete visits from their house, their office and sometimes even their parked car. Eliminating the need to drive to a clinic greatly improved patient satisfaction, as well as increased compliance with the follow-up visits.

In March 2020, all visits, including the initial visit that had previously been required to be in a clinical setting, moved to remote video visits as clinics were closed due to the pandemic. Almost all patients were able to access a computer with a web camera or a mobile device (smartphone or tablet) that allowed them to get connected to video visits.

In rare occasions, some visits needed to be converted to telephone only until the person was either able to access a video-enabled device or the clinics re-opened to outpatient services.

Lee will explain more at her HIMSS22 session, "Integrated Behavioral Health Services via Virtual Care." It's scheduled for Tuesday, March 15, from 10:30-11:30 a.m. in room WF4 of the Orange County Convention Center.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.