About eight years ago, Joe Club joined Allina Health, a nonprofit health system serving Minnesota and western Wisconsin. Today he is the Vice President of Operations for Mental Health and Addiction Services. we will discuss how With Behavioral Health tele Allina reduced her stay by half a day.
the problem
At the time, what he had heard from many hospital chiefs — most of them in greater Minnesota — was that they would have patients with mental health needs within their hospitals and no one would meet those needs. Of course, the shortage of psychiatrists is not only a problem in Minnesota, but nationwide.
“When we investigated this more deeply, we saw that the number of psychiatrists was particularly low in some of our regional hospitals,” Clapp recalled. “We found that for patients who arrive in a medical-surgical unit or an intensive care unit, they have a mental health need without the necessary expertise to assess, evaluate and initiate treatment. As a result, patients who get stuck within those beds will end up unable to move forward.
He continued, “The second problem we faced was the difficulty in providing psychiatrists to cover our emergency departments, which were facing a variety of patients coming in with mental health needs or who were in a mental health crisis.”
Allina Health has been inconsistent in how it provides that psychiatric coverage. The staff knew that the virtual behavioral health care provider could act as an aide to the psychiatrists who were inside the emergency departments to be able to provide 24/7 coverage for those psychological needs. These would be individuals who come into the emergency department in a psychiatric crisis.
“Start where your greatest needs or chances for success are.”
Go Club, Alina Health
He noted, “The third problem we were trying to solve was the ability to cover psychiatrists when they go on vacation or take continuing medical education training.” “When they’re gone, we’ll be short of psychiatrists for inpatient mental health units and won’t be able to adequately staff that family and won’t even have the capacity to admit patients into that family.”
an offer
To get out of their predicament, Allina Health chose Iris Telehealth, a company that provides telepsychiatry services to health systems and community health centers across the United States.
“We have collected an RFP and sent it to a small number of vendors who have identified that they offer virtual behavioral health services,” Klopp said. “Our goal was to provide timely access to quality care in our emergency departments, medical and surgical floors and inpatient psychiatric units. The need was greatest in our regional hospitals.
“We also knew we needed assistance 24/7 on an ‘on demand’ basis to ensure timely care,” he continued. “We quantified the need and went through the process of selecting a company we felt could partner with us and integrate into our existing care teams. We needed someone who our teams and patients could trust and provide the highest quality of care.”
the shop
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Face the challenge
There is a department within Allina Health that is responsible for the development of telehealth technology in general, so Allina built this model. In addition to deploying virtual behavioral health vans to regional locations and training employees to properly operate and manage equipment logistics, employees have certified all Iris Telehealth virtual providers to become Allina Health Premium Providers.
“With that said, the providers were set up as if we were going to have a psychiatrist work in person and provide that care,” Klopp explained. “We then trained the providers on our electronic medical record and documentation system because the goal was to have them not only see the patient remotely, but also to document within the record as if they were an Allina Health provider.
“It also meant relying on all the health plans that we contracted with, but it was really a matter of determining the need for the equipment and then training staff to use it to bring it to the patient,” he added. .
results
There are a few key metrics that Clubb is most proud of as they relate to improving patient care.
“First, across our regional hospitals, the partnership with Iris has helped reduce the length of stay on the MedSurg and ICU floors by half a day,” he said. “Timely access to available behavioral health care has helped ensure that patient care progresses in a timely manner and ensures that we have beds available for patients in need.
He continued, “Secondly, in our emergency department, we work diligently to provide brief treatment and intervention, including assessments, initiation of medication, and discharge considerations.” “In 2015, across our 12 emergency departments where we see approximately 22,000 patients walk through our doors, we were about 55% outpatient discharges.”
As a result of working with Iris Telehealth and a team-based approach to EDs, in 2022 Allina Health discharged approximately 63% of patients to an outpatient plan. Having behavioral health providers as part of the team, whether in person or virtually, creates confidence in decision-making, Klopp said, and he helped drive that direction into the outpatient plan.
“Finally, as it relates to all-time ED, virtual care has helped us reduce the time our behavioral health patients spend in the ED department,” he reports. “Prior to our partnership, the patients who stayed the longest in our emergency departments were our behavioral health patients. We launched a full value stream approach and, with the help of Iris, saw length of stay drop from 12 hours to nine hours. This 25% improvement had a huge impact on ED productivity rate.”
Advice to others
There is no doubt that there are many hospitals and health systems across the country facing provider shortages like Alina’s.
“Psychiatry is a valuable and hard-to-find resource, but when you get into subspecialties like communication counseling, ED psychiatry, and child and adolescent care, it’s even more challenging,” Klopp noted.
“Start where your greatest needs or chances of success are,” he advised. “We delivered virtual behavioral care in waves; not everything was done upfront. We started by supporting our regional hospitals in Minnesota first, because they needed it most, and followed that up with a phased approach over the course of a year to cover all of our hospitals within the system.”
Allina Health rolled out medical and surgical consultations first, followed by virtual behavioral care in the emergency department, and then added vacation coverage as a third phase. Now it is being tuned by advances in subspecialty areas, and Klopp said hospital chiefs are very satisfied with the approach and are no longer talking about a lack of service or presence in psychiatry.
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Email: bsiwicki@himss.org
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