About eight years ago, Joe Clubb arrived at Allina Health, a nonprofit health system serving Minnesota and western Wisconsin. Today he is vice president of operations in mental health and addiction services.
Back then, what he heard from many of the hospital presidents – mostly in Greater Minnesota – was they would have patients who had mental health needs within their hospitals and no one to address those needs. Of course, psychiatrist shortages are not just a problem in Minnesota, but nationwide.
“As we investigated this deeper, we saw the number of psychiatrists was particularly low in some of our regional hospitals,” Clubb recalled. “We found that for patients who land in a medical-surgical unit or an ICU, they had a mental health need without the expertise to assess, evaluate and initiate treatment. As a result, the patients would end up getting stuck within those beds and not being able to move forward.
“The second issue we faced was our difficulty in providing psychiatrists to cover our emergency departments that were facing a variety of patients coming in with mental health needs or who were in a mental health crisis,” he continued.
Allina Health was inconsistent in how it provided that psychiatric coverage. Staff knew a virtual behavioral healthcare service provider could serve as an adjunct to existing psychiatrists within the emergency departments to be able to provide 24/7 coverage to meet those psychiatric needs. Those would be individuals coming into the emergency department in a psychiatric crisis.
“Start out with where your greatest needs or opportunities for success exist.”
Joe Clubb, Allina Health
“The third problem we were trying to solve was the ability to cover for psychiatrists when they go on vacation or have continuing medical education training,” he noted. “When they were gone, we’d be short psychiatrists for inpatient mental health units and wouldn’t be able to properly staff those beds nor would we have the capacity to even admit patients to those beds.”
To get out of their predicament, Allina Health chose Iris Telehealth, a company that provides telepsychiatry services for health systems and community health centers across the U.S.
“We put together an RFP and sent it out to a small number of vendors who identified that they provide virtual behavioral health services,” Clubb said. “Our goal was to provide timely access to quality care in our emergency departments, our medical-surgical floors and our inpatient psychiatric units. The need was greatest in our regional hospitals.
“We also knew we needed help 24/7 in an ‘on-demand’ basis to ensure care was available in a timely fashion,” he continued. “We sized up the need and went through a process to pick a company we felt could be a partner to us and integrate into our existing care teams. We needed somebody that our teams, and patients, would trust and that would provide the highest quality of care.”
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MEETING THE CHALLENGE
There is a division within Allina Health responsible for advancing the technology of telehealth in general, so Allina built off that model. In addition to deploying virtual behavioral health carts at regional sites and training staff to properly operate and manage the logistics of the equipment, staff credentialed all of the Iris Telehealth virtual providers to become Allina Health privileged providers.
“With that, the providers were onboarded as if we were to onboard a psychiatrist to work in-person and provide that care,” Clubb explained. “We then trained the providers in our electronic medical record and the 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 credentialing with all the health plans we have contracts with, but it was really the identification of the need for the equipment and then the training of the staff to be able to use it to bring it to the patient,” he added.
There are a few key metrics Clubb is most proud of as it relates to improving patient care.
“First, across our regional hospitals, the partnership with Iris has helped decrease length of stay in our MedSurg and ICU floors by half a day,” he reported. “Having timely access to behavioral healthcare available has helped us ensure we progress patients’ care in a timely manner and ensure we have beds available for patients in need.
“Second, in our emergency department, we work diligently to provide brief treatment and intervention, including assessments, the initiation of medications and discharge considerations,” he continued. “In 2015, across our 12 emergency departments where we see approximately 22,000 patients pass through our doors, we were discharging about 55% to an outpatient plan.”
As a result of the work with Iris Telehealth and the team-based approach in the EDs, in 2022 Allina Health discharged nearly 63% of patients to an outpatient plan. Having behavioral health providers as a part of the team, whether it’s in-person or virtual, creates confidence in decision-making, and it’s helped drive that direction to an outpatient plan, Clubb said.
“Finally, as it relates to ED throughout, virtual care has helped us reduce the time our behavioral health patients spend in the ED,” he reported. “Before our partnership, the patients who had the longest length of stay in our emergency departments were our behavioral health patients. We launched a whole value stream approach, and with help from Iris, we’ve seen the length of stay decrease from 12 hours to nine hours. This 25% improvement has had a big impact on our ED throughput.”
ADVICE FOR OTHERS
No doubt there are many hospitals and health systems nationwide facing provider shortages like what Allina was experiencing.
“Psychiatry is a valuable resource and hard to find, but when you get into sub-specialties like consult liaison, ED psychiatry, and child and adolescent care, it’s even more challenging,” Clubb noted.
“Start out with where your greatest needs or opportunities for success exist,” he advised. “We brought in virtual behavioral care in waves; not everything was done upfront. We started with supporting our Minnesota regional hospitals first, because they had the greatest need, and we followed that up with a phased approach over the course of a year to cover all our hospitals within the system.”
Allina Health rolled out medical-surgical consulting liaisons first followed by ED virtual behavioral care and then added vacation coverage as the third phase. Now it’s fine-tuning by advancing into subspecialty areas, and Clubb said hospital presidents are very satisfied with the approach and no longer speak of a lack of psychiatry service or presence.
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