The three pillars of healthcare reform are to increase patient safety, improve healthcare quality, and bend the cost curve. Integration of behavioral health services in the primary care setting can substantially contribute to all three objectives. Yet despite efforts to recruit behavioral health specialists to rural America the number of mental health profession shortage areas in the U.S. has increased 97% during the past decade. This webinar will provide actionable information that practitioners and Health Center executives can rely on to evaluate and implement telebehavioral health services successfully and thereby realize their substantial value.

1. Value of telepsychiatry integration in the Medical Home Phil Hirsch PhD – CEO Access Psychiatry Solutions "Efforts to provide everyone a medical home will require inclusion of mental health care if they are to succeed in improving care and reducing costs."

3. Telepsychiatry 2011

4. Asynchronous Synchronous

5. Not your father’s telepsychiatry

6. Logistics

7. Integrated 2 telepsychiatry … YOURS

8. Rationale

9. Shortage vs. mal-distribution

10. Safety, Quality, Cost (BH vs. PC) PC PC Druss, BJ Miller, CL Rosenheck, RA Shih, SC Bost, JE (2002) .Mental health care quality under managed care in the United States: A view from the Health Employer Data Set (HEDIS). Am J Psychiat 2002; 159: 860-862. Dolnack DR, Treating patients for comorbid depression, anxiety disorders, and somatic illnesses. J Am Osteopath Assn. 2006 May; 106. Krupnick J, Sotsky S, Simmens S, Moyer J, Elkin I, Watkins J, Pilkonis P (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology l64(3): 532-539. Pingnone, MP, Gaynes, BN, Ruston, JL, Burchell, CM, Orleans, CT, Mulrow, DC & Lohr, KN (2002). . Screening for Depression in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force . Anals of Internal Medicine , 36(10), 7650776.

11. Evidence

12. A common first reaction … `

13. Center for IT Leadership – HealthPartners “ … great potential to improve access … adoption in routine health care has been slow … lack of clarity about the value of telehealth … slow adoption. “ The simulation predicted savings of $4.3 billion per year … “ Payers, providers and policy-makers should work together to remove the barriers to the adoption of telehealth in order to make it widely available to all.” SOURCE: The value proposition in the widespread use of telehealth . Cusick CM, et al.Journal of Telemedicine and Telecare . June 2008 vol. 14 no. 4 167-168.

14. E = MC2 Evidence … Systematic review of studies of patient satisfaction with telemedicine . Mair F & Whitten P. BMJ . 2000 June 3; 320(7248): 1517–1520. Sample Kennedy C & Yellowlees P. The effectiveness of telepsychiatry measured using the Health of the Nation Outcome Scale and the Mental Health Inventory. Journal of Telemedicine and Telecare 9:12–16, 2003. Evidence-Based Practice for Telemental Health. American Telemedicine Association: 2009. 2006 – 394 2009 – 146 2011 - 97

16. Demand and Sustainability

20. Medicaid SECTION 20 – TELEMEDICINE Use of an electronic media to link beneficiaries with health professionals Via a real-time Consultation; Office visits; Individual psychotherapy; Pharmacological management Face to face not required for TBH Prior auth. F4F vs County Health Plans (CHPs) and Medicaid Health Plans (MHPs) ORIGINATING SITES: 􀂃 County mental health clinic or publicly funded mental health facility 􀂃 Federally Qualified Health Center (FQHC) 􀂃 Hospital (inpatient, outpatient, or critical access hospital) 􀂃 Office of a physician or other practitioner (including medical clinics) 􀂃 Renal dialysis facility 􀂃 Rural health clinic 􀂃 Skilled nursing facility 􀂃 Tribal Health Center (THC) AUTHORIZED PRACTITIONERS The following health professionals may provide telemedicine services: 􀂃 Physician (MD, DO, DPM) 􀂃 Nurse Practitioner 􀂃 Nurse Midwife 􀂃 Physician’s Assistant (billed under the supervising physician) 􀂃 Psychologist∗ 􀂃 Social Worker∗ In-state providers are to be used whenever possible for distant site services.

21. Commercial health plans

22. Cost offset and value

27. Phil Hirsch, PhD Access Psychiatry Solutions 206.365.3096 [email_address]