Integrated Telepsychiatry

Integrated Telepsychiatry in the Medical Home and ACO: Perform Like a Champion

First off, a huge congratulations to the U.S. Women's Soccer Team on their capture of the World Cup. It is particularly satisfying to see a group of individuals who have worked most of their lives to perfect a skillset come together as a group to achieve at such a high level.

Now, the U.S. healthcare system can learn something from the Women's Soccer Team. In team sports, it's not only the skill of the individual that prevails, it is also the extent to which the Team has a system and a plan, and the degree to which the players buy into and execute that system and plan.

At least two "systems" appear to bring promise of organizing skilled clinicians into health care teams that can produce at a high level and reasonable cost: Patient Centered Medical Homes and Value Based Contracting. As an example, the Boston Consulting Group analyzed recent claims data from 3 million Medicare members in either traditional fee-for-service Medicare or in Medicare Advantage (value based payment) environments.

As displayed below, using three widely accepted measures of health care success, their analysis demonstrated clear performance superiority for the MA programs.

As noted by the Robert Graham Center for Policy Studies in Primary Care and Family Medicine, as well as by many other health care analysts, in order for Medical Homes (and, by extension, clinics in value based contracts) to achieve their goals, they must have behavioral health services readily available and fully integrated. Where behavioral health specialists are not readily and timely available - significant swaths of the U.S. landmass - telemedicine and telehealth linkages serve an essential purpose.

While fee-for-service Medicare pays for telemedicine only in certain rural and similar locations, CMS has made it clear that Medicare Advantage programs are free to pay for these services in any setting in which they deem it to be clinically and fiscally prudent - urban or rural. Abundant data demonstrate the clinical and cost value of widespread and integrated availability of these behavioral health services (see, e.g., Chiles et al, Blount et. al, Cummings, et. al) and, thereby, their central place in realization of the Triple Aim.

If you are in a Medical Home setting, a value based contract, or are a health plan offering pay for performance incentives, we hope you are already cognizant of the foregoing and have taken steps to make behavioral health services readily and timely available for your patient base. Perform like a champion!