Client selection, intake, and assessment in Telemental Health
Using Telemental Health to Extend VA Integrated Care to ...
Transcript of Using Telemental Health to Extend VA Integrated Care to ...
USING TELEMENTAL HEALTH TO EXTEND VA INTEGRATED CARE TO COMMUNITY
SETTINGS: (A WORK IN PROGRESS)
Andrew Pomerantz, MD
Chief, Mental Health and Behavioral Sciences
White River Junction VA Medical Center
White River Junction, Vermont
VA National Office of Primary Care-Mental Health Integration
Eastern Region Rural Health Resource Center
Associate Professor of Psychiatry, Dartmouth Medical School
Some Definitions
• What is Telehealth?
• Varieties in VA:– Home Telehealth
• Health buddies
• IVR
– Store Forward• Retinology, radiology, dermatology
– General Telehealth
The Evidence Base
If you want randomized controlled trials you may have to wait a little longer
VA database
Where are the limits?
PAST AS PROLOGUE
• “WRJ model” of integrated care – APA Gold Achievement Award 2005– VA Advanced Clinical Access National Champion award 2007– Mandated in all VAMCs 2009
• TELEMENTAL HEALTH– Integrated Care to Bennington via Tele implemented 2004– QI study confirms Evidence Based care improved– Berlin, NH Vet Center and second CBOC began 2009
• VT Mental Health VA/National Guard partnership– 2005-present– 2008/9 plans for TMH
INTEGRATION OF WHAT?
• Mental Health/Substance abuse/Primary Care (extending the WRJ model)
• Telemental Health and Primary Care
• VA and rural veterans/families
• VA and Community– Community Mental Health Center– Federally Qualified Health Center
RATIONALE
• Rural Veterans have difficulty accessing MH care, despite its ready access in WRJ VA and 4 CBOCs
• Veterans and NG troops often resist specialized MH care at VA or CMHC
• Evidence suggests that veterans in community treatment may be sicker (more ED visits, higher incarceration rates)
and
• To accomplish several tasks:– Provide integrated care for veterans and
families using other medical homes but in need of “special” understanding (why VA exists)
– Leverage VA funding to catalyze development of integrated care and telehealth as part of the Vermont Healthcare
THUS
• The need to integrate the care, rather than build a stand alone VA system in a foreign land.
• And to take VA employees out of their comfort zone
SITES
CMHCs:Clara Martin Center, Randolph, VT
FQHCs:Richford Health Center (NOTCH), Richford, VT
Little Rivers Health Center, Bradford, VTIndian Stream Health Center, Colebrook, NHCoos Family Services, Berlin, NHMidstate Health Center, Plymouth, NH
FUNDING
• VA Office of Rural Health & Office of Mental Health Services
• VA/National Guard Sharing agreement
Current issues
• Technology– ISDN point to point
• Lowest setup expense
• Highest per-call expense
– T1 line• Higher setup
• Low monthly subscription
• Privacy, security• Waiting for NETC
Implementation Issues
• Cross Sector contract issues
• Credentialling, licensing
• Medical Records
• Fee for service
• Provider motivation and training
• Information sharing
• Infrastructure
• Ethical concerns
Program issues
• Patient Preparation
• Room – lighting, noise, comfort
• What to wear??
• Patient satisfaction
• Choosing patients
• Choosing providers
• Contingency planning
Tasks completed to date
• Engaged with NOTCH 8/08• Mobilizing the internal WRJ facility 10/08• Conference with NOTCH/VA IT 12/08
– Contract prepared 6/09• IT issues addressed• Motivational interviews• Preliminary budget developed• Contracting contracting contracting 11/08-6/09• Planning meetings (X2) with Bradford sites• ORH grant funded (5/09)• Identification of other FQHC sites (ongoing)
Cost per visit?
• So far: About $100,000
• Engineering a prototype costs more than the last product off the assembly line.
WHY DO YOU WANT TO DO TELE?
(or do you?)