Leaders at the Danville, Pennsylvania-based Geisinger health system, like leaders across the U.S. healthcare system, have ben working to improve access to and scheduling around their full range of inpatient, outpatient, and telehealth-based behavioral healthcare services.
In that context, Geisinger’s Behavioral Health and Psychiatry Department offers a full range of inpatient, outpatient and telehealth services and continues to expand services and access. In 2021, for example, Geisinger and Acadia Healthcare Company formed a joint venture that includes two new 96-bed, 73,000 square foot freestanding inpatient behavioral health facilities serving adult and pediatric patients beginning in 2022 and 2023, respectively.
Meanwhile, during the COVID-19 pandemic, Geisinger saw referrals for behavioral health services grow at a much faster rate than they were used to as their communities sought care in the face of not only the pandemic but the worsening mental health crisis as well. At times, this growth exceeded 300 referrals per day. Their team saw an opportunity to pursue a partnership that would help them manage the increased volume and improve patient outcomes and experiences. In that context, Geisinger’s leaders turned to the professionals at the Austin, Texas-based Iris Telehealth to help them to efficiently increase access at scale for their behavioral health patients across the care continuum. To date, Iris’s services are live in six of Geisinger’s 11 hospitals and across their ambulatory network.
The Geisinger care team faced challenges in effectively and efficiently triaging their referral queue, which comprised low and high acuity patients. It was a critical point for Geisinger that these patients not only receive care more rapidly but also receive the appropriate level of treatment – including ongoing treatment plans where needed. The health system’s leaders also wanted their clinicians to be able to practice at the top of their licenses. And they saw an opportunity for several roles (psychiatrists, psychiatric mental health nurse practitioners (PMHNPs), and licensed clinical social workers (LCSWs) to be involved at various stages of the process to ensure patients received the specific care they needed.
With Geisinger’s needs in mind, Iris developed a best-in-class care navigation assessment led by LCSWs to accurately triage the patients in Geisinger’s referral queue and deployed a customized care pod comprising psychiatrists, PMHNPs, and LCSWs to ensure each patient got the right level of care, by the right provider, in a timely manner. Additionally, Iris deployed providers delivering 24/7 consult-liaison services in Geisinger’s EDs as well as ongoing follow-up care for patients as needed. Together, all those involved have worked to deliver a consistent patient experience. For example, for each Iris provider, Geisinger worked to conduct training that would make an Iris provider indistinguishable from a Geisinger provider and would ensure they felt fully integrated into the Geisinger team.
Ben Gonzales, operations manager for virtual care in the Department of Psychiatry and Behavioral health at Geisinger, spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland, regarding this ongoing initiative. Gonzales has been working closely with Dan Ferris and his team at Irish Telehealth. Below are excerpts from that interview.
Can you share with us the origins of this initiative?
In some ways, I’m unique in that our service area was really obviously impacted by the pandemic. We had wave after wave of COVID cases coming into our EDs, communities shutting down, no high school sports, etc. We saw that initial wave; we also saw a second wave. On any given day, we received several dozen referrals for our services; we quickly saw that increase dramatically. Some days, even now, we’re seeing 300 referrals a day.
Our department had been much smaller, and had been focused on the Danville area. We quickly realized there was no way we could keep up with that demand ourselves. We had about 19,000 outstanding orders for services. And so, with 150 referrals per day, we were facing the potential for having to hire more psychiatrists and therapists. We knew we needed to act. And we looked at a host of vendors, and were looking for a partner that could help us expand and create surge access, and get patients to the right clinical access point the first time, and help us meet the needs of our patients, and create a better experience for patients and providers through telemedicine. We actually learned a lot about onboarding providers. The initial intention was getting ourselves out of the hole, and Iris has done that for us.
What are your capacity and volume numbers now compared to in 2019?
In tandem with Iris bringing us about 20 providers on the outpatient side, we also went on a hiring frenzy ourselves. In psychiatry, we went from about a dozen psychiatrists, to 43. In total, we’ll have added about 100 providers, for a total of about 200 providers outpatient.
And how does that break down into disciplines?
We have 30 psychiatrists, and about two dozen LCSWs and psychologists. In total, we have about 170 who are not psychiatrists—therapists, psychologists, or neuropsychologists. The headline in all this is that we were able to effectively staff.
And what about the backlog now?
As of this moment [the end of 2022], we have about 4,000 patients outstanding, down from 19,000. So we’re up now about 20,000 completed appointments per year. In 2021, we had about 70,000 unique visits, compared to more than 90,000 in 2022.
What were the biggest challenges in architecting this new system?
The biggest was how to get patients from point A to point B. That’s why we turned to Iris for the creation of a comprehensive intake service. If you think of the patient’s experience, it’s a really confusing and super-complex experience, with ridiculously long wait times. So it wouldn’t be uncommon for a patient to be referred to psychiatry by their primary care physician. It might even have been for the wrong service. So they get in front of a psychiatrist after six months and the psychiatrist says, oh, you want to talk to someone, and then there would be another wait.
So Dan and his team helped us create an intake program. That has meant six LCSWs doing 45-minute intake encounters all day long. And my team of intake workers would navigate them to the appropriate resources. So the appropriate tracking would be to intake someone and navigate them, and help the patient find the resource. So the most beautiful thing about it is that we’ve really taken the guesswork out of this and gotten to the clinical endpoint sooner. We’re getting patients plugged in for intakes.
What have been the biggest lessons learned so far?
We have to think about care delivery and localization. We run a lot of services out of our Danville hub. But that’s rural Pennsylvania. And per virtual care, now, we’re onboarding providers from across the country. So it’s how we bring down the scale and localize care, helping patients and providers to navigate the system more effectively. Especially if we’re leveraging providers from across the nation, we need to prepare them better and structure our services more effectively. The other biggest lesson is that you really have to create a strong onboarding approach, esp. for providers. So the operations managers from Iris were instrumental in helping us create effective onboard procedures. Even simple things like how you share your screen; how we help you prepare for your sessions. Strong onboarding experience and keeping providers engaged on the back end, making sure we’re keeping them engaged and providing them with all the resources they need.
And in the last couple of months, we’ve had comments from every provider that’s started with us, that we have the best onboarding process of anyone they’ve worked with; and we owe a lot of that Dan’s team.
What advice would you offer to our readers who might bethinking of following your path?
I would encourage them to start by thinking about the care model that they want to create, out of the gate. We were in such crisis that we didn’t have that luxury. We needed to get providers in the door immediately, to start seeing patients. Now, we’re playing catch-up. If you have the luxury of being able to start there, you’ll be in a position to do this effectively. The other thing is, do whatever you can to bring care as close to home as possible and localize it. Our intake team, some folks live in PA, but many never have been in Pennsylvania and never will be in Pennsylvania. So if you’re hiring virtually, you need to create functional agility on your care team.
Is there anything you’d like to add?
We could not have grown at the scale we did, and matured, without Iris. There’s been a lot of maturity out of the way we operate. But we also had access to some of the best talent in the nation. Telehealth partnering has been great in that regard, and has accelerated our maturity by at least a year.