CCC Board of Directors Meeting Dates:
All Board meetings will be held at 2:00pm at 1111 E. Cesar Chavez St., Austin, TX 78702 and can be changed or added as needed.
- May 13, 2014
- June 10, 2014
- July 8, 2014
- August 12, 2014
- September 9, 2014
- October 14, 2014
* All meetings of the Board of Managers of Central Health and the Board of the CCC are open to the public.
* One of two monthly meetings of the BOM of Central Health is streamed live. Audio of Central Health Board meetings is available on www.CentralHealth.net
* The BOM of Central Health must approve budgets of the CCC in an open meeting.
Contact: Mark Hernandez
A Note from the CMO
|Mark Hernandez, MD|
Chief Medical Officer
One of the values of the CCC is innovation. Specifically, we say that "we encourage new ideas and creativity at every level of the organization". Our telemedecine DSRIP projects are certainly an area where that dedication to innovation is being seen. This month's newsletter provides an overview on what this service is and how it is being implemented locally to increase access to important services for our target population.
I want to highlight how this project exemplifies the concept of disruptive innovation. Disruptive innovation is a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors. There are numerous examples of disruptive innovations in business, such as the mass-produced automobile, the home computer, and the quick-service restaurant industry. Like these examples, telepsychiatry is changing the way we think about the delivery of healthcare services.
The most interesting opportunity with these telemedecine projects, however, is not the technology behind the provision of the service (although it is an innovation unto itself) but instead, continuing to explore new ways to make use of this technology to deliver healthcare now that it is available. In talking to our partners, these ideas have already begun flowing. I am looking forward to watching these ideas blossom.
Transforming Care - Implementing CCC 1115 Medicaid Waiver Projects
The 1115 Medicaid Waiver allows for funding of Delivery System Reform Incentive Program (DSRIP) projects that increase access to health care services, increase the quality and cost-effectiveness of care, and enhance the health of the patients and families served. In our on-going coverage of local DSRIP projects, this month we spotlight telemedicine programs in Travis County - 3 approved projects and 1 proposed project.
Transforming Care - Expanding Access to Care through Telemedicine
The American Telemedicine Association (ATA) defines telemedicine as the exchange of medical information from one site to another via electronic communications to improve a patient's clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, e-mail, smart phones, wireless tools and other forms of telecommunications technology. The use of telemedicine has spread rapidly and is becoming integrated into the ongoing operations of hospitals, specialty departments, home health agencies, health centers, private physician's offices as well as consumer's homes and workplaces.
This service option is especially useful for extending care to patients in remote areas and/or to patients in any location in which there is a shortage of providers. The 1115 Medicaid Waiver guidelines identify the following examples of ways in which these services are used -
- Specialist referral services typically involve a specialist assisting a general practitioner in rendering a diagnosis. This may involve a patient "seeing" a specialist over a live, remote consult or the transmission of diagnostic images and/or video along with patient data to a specialist for viewing at a later time.
- Patient consultation uses telecommunications to provide medical data, which may include audio, still or live images, between a patient and a health professional for use in rending a diagnosis and treatment plan. This might originate from a remote clinic to a physician's office using a direct transmission link or may include communicating over the Web.
- Remote patient monitoring uses technology devices to remotely collect and send data to a monitoring station for interpretation. Such "home telehealth" applications might include the reporting of a specific vital sign, such as blood sugar levels, or a variety of indicators for homebound patients. Such services can be used to supplement the use of visiting nurses.
- Medical education to provide continuing medical education opportunities for health professionals.
This innovative approach to care access has been embraced locally as it addresses a need for increased access to services, specifically behavioral health services and/or consultations, in a manner that is cost efficient, quality-focused, and customer-oriented.
There is a shortage of behavioral health providers nationally and in this region. The ideal ratio of psychiatrists in a community is 25.7 psychiatrists per 100,000 population. Travis County currently has 17.1 psychiatrists per 100,000 population. This translates into delayed access to care for individuals who need medication, coordination, and/or therapy services.
The specific DSRIP telemedicine projects detailed below allow for increased access to these critical services without any of the performing providers having to recruit individuals from other areas of the state or nation to move here to provide care.
Transforming Care - Travis County DSRIP Telemedicine Projects
Currently, three of the performing providers within the 1115 Medicaid Waiver Regional Healthcare Partnership (RHP) 7 that serve Travis County have received approval for telemedicine programs. A fourth performing provider has proposed a three-year telemedicine DSRIP project that is under review along with RHP 7's other proposed three-year DSRIP projects.
The approved projects include --
1. Austin Travis County Integral Care's Telemedicine Project
Austin Travis County Integral Care (Integral Care), the local mental health authority for Travis County, is increasing access and capacity to psychiatric assessments and medication services for the safety-net population in Travis County through deployment of psychiatric telemedicine services, currently at two of Integral Care's outpatient clinic sites.
- Integral Care's Psychiatric Emergency Services (PES) 24-hour walk-in clinic added Telemedicine services to existing psychiatrist assessment, referral, medication and psychiatric treatment services. Crisis telemedicine services increase prescriber access and reduce prescriber wait times.
- Telemedicine services are also offered at the Psychiatric Counseling Services clinic in Central Austin, the North Service Center, and the Dove Springs Clinic, based on identified consumer need, to allow individuals with serious mental illness to receive timely evaluation and/or medication management services.
2. Community Care Collaborative's Telepsychiatry in Community Health Clinics Project
The CCC's Telepsychiatry in Community Clinics Project, which began in March, brings telemental services to CCC patients with mental illness at CommUnityCare's North Central and South Austin locations. Specific services provided include:
- Initial assessments and continuing care to patients by behavioral specialists;
- Psychiatric consultations to primary care practitioners to assist with complex cases, medication management and reconciliation, triaging emergencies, addressing issues of co-morbidity; and
- Expanded opportunities for staff training and education.
Patients gain access to the telemedicine service through referral by their primary care provider following administration of the standardized psychiatric assessment Patient Health Questionnaire (PHQ-9) -- a screening tool for depression.
These technology-assisted services allow for timely access to behavioral health services for the patient in their primary care medical home, a familiar, non-threatening setting, decrease the need for patient's and caregivers to travel to an off-site location for care, and increase the provider's ability to treat the patient, via on-demand access to telepsychiatry services. It is anticipated that this project will ultimately serve 3,500 patients. 62 patients have received services through this project since its inception last month.
3. University Medical Center Brackenridge's Psychiatric Telemedicine Project
Patients who cannot access routine outpatient care often end up in emergency rooms or other crisis services (EMS, law enforcement) as their entry into the mental health system. This is especially true for those who have no mental health insurance coverage. This is less than ideal, for both patients and staff, as many patients remain in emergency rooms, without treatment (due to region's shortage of psychiatrists), while awaiting transfer to a psychiatric inpatient bed.
To address these concerns, University Medical Center Brackenridge's (UMCB) Psychiatric Telemedicine Project expands access to psychiatric consultation through implementation of telemedicine services. This project provides 24/7 access to psychiatric services at the region's Level I Trauma Center/safety net hospital, as well as Seton's other acute care facilities, alleviating the need for greater after-hours and on-site psychiatric consultations. All patients who present to the emergency department with a primary or secondary mental health diagnosis can be assessed by a psychiatrist via telemedicine for initiation of treatment and referral to the most appropriate level of care for on-going treatment. Admitted patients with co-morbid psychiatric disorders will also have access to psychiatric consultation through this project.
Typically, patients in psychiatric crisis presenting after-hours to the UMCB ED will wait until the next day for appropriate psychiatric assessment. Through implementation of telemedicine, patients receive a timely assessment, leading to earlier disposition at a less intense (and costly) level of care. Since October 2012, this project has provided more than 850 psychiatric consultations.
In addition to the three approved projects already underway, a fourth telemedicine project has been submitted as part of RHP 7's request for funding for three-year projects.
If approved, the St. David's Healthcare Partnership Telepsychiatry Project will expand access to psychiatric coverage in St. David's Emergency Department locations throughout RHP 7.
The availability of psychiatric consultation in the Emergency Department through the telepsychiatry model will expand care access and referrals to patients requiring psychiatric services to allow for 24/7 availability and provide needed guidance to Emergency Department physicians and social workers. This will enhance the quality and appropriateness of patient care, and lead to earlier and more appropriate pharmacologic interventions that can more quickly stabilize patients.
Sandra French, NP, is a board-certified psychiatric mental health nurse practitioner with Austin Travis County Integral Care. She has 31 years of healthcare experience, including eight dedicated to treating adults suffering from psychiatric disorders. She provides services in psychopharmacology, holistic psychotherapeutic interventions and solutions for individuals experiencing depression, anxiety, psychotic and affective mood disorders. She has specific experience treating Post-Traumatic Stress Disorder in forensic and military settings. Currently, she staffs the East Second Street Clinic for Integral Care, providing telemedicine services as part of Integral Care's Telemedicine DSRIP project.
Since it launched in August 2013, Ms. French has been a provider for Integral Care's Telemedicine DSRIP program.
According to French, telemedicine allows her to remotely provide all the services she can provide in a traditional clinic setting, including diagnostics, treatment, evaluation and management of acute and chronic mental health conditions or illnesses. So far, says French, the reviews have been positive.
"Sometimes it's hard to connect to people or providers in mental health, so this modality serves to reduce that emotional energy--transference or countertransference--that sometimes gets in the way of truly being open and honestly sharing," she says.
But, according to French, one of the most important benefits to telemedicine, other than helping Texans stay abreast of new healthcare systems, is that it allows people like her to provide care in all areas of medicine where people lack access.
"Critical shortages exist throughout health care, I am pleased to know that people are getting access in Travis County to mental health services that otherwise might not be available," says French. "Telemedicine is the electronic frontier of the 21st century in healthcare delivery at Austin Travis County Integral Care."
Dell Medical Center and New Seton Teaching Hospital
As you may already be aware with the closure of Red River Street between 15th Street and 18th street, work is beginning on the new Dell Medical School and Seton Healthcare Family's teaching hospital. Construction on the new hospital will begin in the fall of 2014. The $295 million Austin hospital will be built by Kansas City-based JE Dunn and is scheduled to open in 2017, roughly a year after the University of Texas Dell Medical School opens for classes across the street in 2016.