Health Payers Tap Telehealth to Boost Pediatric Psychiatry Access

As both the managing director of behavioral health at Blue Cross Blue Shield Rhode Island (BCBSRI) and a licensed clinical social worker, Rena Sheehan knows the challenges parents face when searching for pediatric psychiatry services for their child.

“It is not uncommon for my colleagues who are not involved in behavioral health to approach me with questions about how to access care or navigate the behavioral health system,” she told HealthPayerIntelligence.com. “Some have even indicated they wonder what other people do when they don’t know someone who is familiar with the system.”

Behavioral and mental healthcare can be difficult landscapes to navigate even from within the system, much less as a patient. Payers who have connections and knowledge of the system still may struggle to expand their behavioral or mental healthcare pediatrician network because there simply are not enough child psychiatrists available.

“It's a known national problem,” Sheehan said. “Simply saying, ‘We're going to train more child psychiatrists’ or ‘more people are going to go into child psychiatry’ isn't necessarily going to solve the problem. We always talk in behavioral health about how there's a lot of different ways to get at a problem, and so we just need to keep thinking about different ways to approach things.”

BCBSRI used their strong relationship with Bradley Hospital and a telehealth option through PediPRN as their different way to approach the problem of pediatric psychiatrist shortages.

Bradley Hospital is a not-for-profit facility in the Lifespan health system in Rhode Island. It was the nation’s first pediatric psychiatry ward and today serves as a national center for childhood and adolescent psychiatric research. The hospital also hosts the PediPRN initiative, providing a consultation team of child psychiatrists to provide telehealth support to pediatric primary care providers.

From similar models in Massachusetts and other states, BCBSRI knew that the best solution was through care coordination.

“When you look across the healthcare industry with the patients that are medical-homed, it's really all about how we deliver care in a way that's less fragmented and more coordinated,” Sheehan explained.

To BCBSRI, PediPRN fit that description perfectly.

With PediPRN, if a child with a mental or behavioral healthcare condition comes to a provider who feels under-equipped to treat the condition, the provider can call the psychiatry experts at PediPRN. During the child’s appointment, the PediPRN team will walk through a diagnosis over the phone and support the pediatrician in discerning the best treatment or resources for the child.

Children do not have to be covered by BCBSRI or any particular provider to receive help through PediPRN.

“It's hard to have direct access to psychiatry and so having the PCP be the primary person who's asking the question of the psychiatry consultant and being able to work with the family themselves, is intended to make sure that the child gets the care that they need. There are some families who prefer to get their treatment with a pediatrician,” Sheehan said.

The coordinated care approach that BCBSRI sought is a strength of this program. Sheehan noted that since mental health problems can bleed into physical health problems and vice versa, the need for coordinated mental healthcare for children was natural and imperative.

By centralizing the information on the pediatrician through a phone call instead of a separate consultation with a specialist, PediPRN similarly works to remove any opportunity for mixed or missed messages on medications for their younger patients.

“With this consultation model, it's the pediatrician and the psychiatrist who are working together to be able to meet the person's needs.Then the pediatrician has all that information available to them,” Sheehan said. “Just like with any other chronic condition or acute condition, the primary care provider and, in this case, the pediatrician, really is the person who's pulling all of the patient’s care together and making sure that the patient gets what they need.It’s inevitably coordinated.”

Once the phone call occurs, there are multiple potential outcomes. The psychiatrist may address the primary care physician’s question on the phone, or they may recommend that the patient see the PediPRN physician or nurse practitioner for a face-to-face evaluation. They may alternatively direct the patient to a PediPRN therapist or refer the primary care physician to the PediPRN care coordinator to assist in accessing community resources.

BCBSRI provides PediPRN with resources available to BCBSRI members. These include urgent psychiatry care and behavioral health care coordinators who can assist.

Apart from working with Bradley Hospital’s medical director, BCBSRI and PediPRN crossed paths in other circles as well, a testament to the growing number of resources that payers can turn to for creative solutions.

BCBSRI participates in the State Innovation Model (SIM) and PediPRN is a SIM initiative. SIMs receive CMS funding to identify, test, and use projects tailored to the state’s healthcare needs. The program has become a strong resource for states: by mid-April 2019, 70 percent of states nationwide were pursuing SIM grants.

BCBSRI also crossed paths with PediPRN by funding the Care Transformation Collaborative of Rhode Island, which works toward an integrated health care system in Rhode Island. PediPRN was also an initiative in this organization.

With so many touchpoints between BCBSRI and PediPRN, it should come as no surprise that in 2018 over 30 percent of the patients that PediPRN served were from BCBSRI, a higher percentage than any other payer or stakeholder.

“We hope to see the utilization of the service continue to increase consistent with program leadership’s expectations,” Sheehan said. “In addition, through the training and resources the program is able to provide to the pediatricians on addressing behavioral health needs, we would hope to see members receive the treatment and resources they need before it reaches a crisis level and the family sees no other option than the ED which may not be the best experience for the family.”