Benjamin C. Gonzales, operations manager II, virtual care, at Geisinger, said the prominent health system has faced a problem that is the biggest problem in behavioral healthcare: access. And while Geisinger’s population certainly has experienced its own challenges with behavioral health access like other communities, the problem has been significantly compounded by three things.

THE PROBLEM

"First and most obvious, the pandemic," Gonzales stated. "Unsurprisingly, we experienced a surge in demand much like other specialties in our system. Before the pandemic, it was common for our department to have a couple hundred outstanding referrals.

"We quickly saw that increase to a maximum of 19,000 outstanding referrals," he continued. "It's important to remember these are people who have been brave enough to ask for help and are perhaps facing some of the most challenging days of their lives. As a department, we were at a point where it would take close to six months for patients to get in to see one of our providers."

The team knew they needed to do something about it.

"Second, another significant piece is our location," Gonzales noted. "We're a rural health system, and it's not as easy for us to recruit people as it is for more urban health systems.

"And last, in my opinion, we simultaneously saw a lessening of stigma in the community surrounding behavioral health – and so more people were willing to raise their hand and say, 'I need help,'" he continued. "Ultimately, that resulted in us seeing about 180 referrals per day. We even have days where we're getting close to 400 referrals."

So Geisinger needed to create surge access, and it needed to consider ways to easily get the patient the right service the first time rather than elongating their wait.

PROPOSAL

Geisinger began looking for a vendor in the summer of 2020 to help the health system stand up a few services: adult and pediatric psychiatry consult services; outpatient intake assessment to take the guesswork out of matching patients to services; and longitudinal outpatient coverage to supplement existing services, including physicians, CRNPs and LCSWs.

"We wanted a team that could not only help us build surge access in a timely manner, but also lean in and co-develop solutions together," Gonzales said. "We pride ourselves on being an innovative health system, and we felt that vendor Iris Telehealth not only had a strong reputation, high-quality providers and strong recruitment, but they were also in a much more innovative, co-development posture.

"We got 20 or so highly talented, very bright and motivated providers on our team in a matter of months."

Benjamin C. Gonzales, Geisinger

"As a result, we were able to create an intake assessment in a timely, collaborative manner," he continued. "And now, moving into phase two, working on an integrated care project, we feel an innovative solution is much more possible with Iris Telehealth."

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MEETING THE CHALLENGE

Ultimately, it was the behavioral health leadership team that helped the IT team make progress – taking the leadership role in the development and management of the partnership.

But, in the development phase, it was both teams that came together to vet candidates, design services, determine scale and implement these services as well as a new intake service.

"One of the biggest advantages was gaining access to a national pipeline," Gonzales explained. "It can be tough to recruit in a rural market, and now we can get talented providers in the door much quicker than before. As a result, we got 20 or so highly talented, very bright and motivated providers on our team in a matter of months.

"Again, the other piece is that co-development posture," he added. "This was most apparent in the development of the intake assessment and onboarding of clinical talent. Their expertise in setting that up was invaluable."

RESULTS

The result Gonzales is proudest of is reducing the referral queue from 19,000 patients to 3,000.

"That is astounding," he stated. "We owe a lot of that to the surge capacity created by our vendor team and the addition of the intake to help route patients to the right service the first time.

"The second key result is the growth of our team," he added. "We were able to add 20 high-quality providers to our team in a very short amount of time. I can't stress how much of an impact it makes when you're able to leverage a national pipeline to find talent. As a result, we're able to get people into psychiatry usually within ten days. Before this, it was probably several months."

And finally, Geisinger learned a lot from the development of its intake assessment.

"We've completed more than 4,000 intakes, and Iris Telehealth has helped us work through quite a bit of volume," Gonzales reported. "But I think the greatest value has come from what we've learned along the way.

"For example, what key information do we need to determine what service our patients need?" he asked. "What can we use to eliminate extra steps for the patients? Which conditions should bypass intake and have direct access to services offered by some of our sub-specialists? Our success and ability to learn was largely possible due to the collaborative nature of our partnership with the vendor."

ADVICE FOR OTHERS

At the end of the day, one cannot have quality of care without access to care, Gonzales stated.

"It's just not possible," he said. "We've had to be very creative about how we create access for the communities we serve, and we would encourage others to do the same.

"Given the shortage of behavioral health providers, we recognized that scaling access virtually would be the best and quickest pathway forward for us," he continued. "For us, it was incredibly helpful to have a strong partner that could help us supplement our already strong, but perhaps undersized, team. That's really what it was about for us – recognizing the value that high quality and timely access can bring to the communities you serve."

Healthcare provider organizations also should consider the other values a virtual care partnership can bring, Gonzales advised.

"One is a nationwide pipeline of candidates that don't necessarily have to move to your community," he noted. "They can stay close to their families and loved ones. Second, virtual care offers a great deal of flexibility and autonomy for our team. I can't tell you how often I've heard from our providers, both internal and those from Iris Telehealth, how much they've benefitted from the flexibility of a virtual environment.

"We have fantastic providers who can do things like start a family, care for their loved ones or go back to school while still being able to care for our patients," he concluded. "Being able to offer that to our providers – to work in a flexible environment – is a big deal."

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Email the writer: bsiwicki@himss.org
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