Deploying Telehealth to 1.2 M Users - LA County Case Study
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Innovating Equitable Telehealth for LA County The Los Angeles County Department of Mental Health (LACDMH) is the largest county-operated mental health department in the United States, directly operating 85+ programs and contracting with close to 1,000 organizations and individual practitioners. It’s goal is to reach 1.2M of its 10M residents who are in need of mental health services.
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Deploying Telehealth to 1.2 M Users - LA County Case Study
- 1. Telehealth Use in The Los Angeles County Department of Mental Health Marc Heiser MD, PhD Racheal Burgess Los Angeles County Department of Mental Health
- 2. LAC Department of Mental Health Race/Ethnicity Average Monthly Unduplicated Medi-Cal Beneficiaries Percentage of Medi-Cal Beneficiaries Unduplicated Annual Count of Beneficiaries Served by the MHP Percentage of Beneficiaries Served by the MHP White 499,886 13.0% 34,467 15.6% Latino/Hispanic 2,270,000 59.1% 117,531 53.1% African-American 387,547 10.1% 40,669 18.4% Asian/Pacific Islander 370,343 9.6% 9,430 4.3% Native American 4,765 0.1% 581 0.3% Other 314,957 8.2% 18,458 8.3% Total 3,840,000 100% 221,136 100% The total for Average Monthly Unduplicated Medi-Cal Enrollees is not a direct sum of the averages above it. The averages are calculated independently. Los Angeles MHP • Largest mental health system in the country • Covers a population of ~10 million • Over 80 directly operated (DO) programs (~40k clients/month) • 700 contract providers
- 3. LAC DMH Telepsychiatry Prior to COVID-19 • Telemental Health and Consultation Program • Small program providing medication support services for directly operated DMH clinics that were short-staffed • Clients would present to clinic in-person and see DMH psychiatrist located remotely • Remote psychiatric consultation also provided to DHS primary care clinics as part of Behavioral Health Integration/DMH Collaboration Program
- 4. Telepsychiatry Now: Rapid Pivot To Remote Care • Priority: Maintain client services, check in on health, ensure housing and food security • All disciplines have shifted to remote service delivery • Case management • Peer support and community health workers: Outreach and engagement, support groups • Therapy: Individual and groups • Nursing: Education, symptom screening, client management • Medication support: New evaluations and ongoing care
- 5. Opportunity and Innovation • Expand support for people residing in shelters • Deployed field-based teams with remote psychiatric support for people residing in emergency shelters and isolation and quarantine shelters • Improve access to care: Redistribution of psychiatric resources • Traditionally, psychiatrists are clustered in certain geographic areas of LA County, leaving other areas underserved • Using telehealth, we have been able to redeploy psychiatrists more equitably across the county • These psychiatrists no longer see clients in one clinic, but rather see clients throughout the system
- 6. LAC DMH Outpatient Services (DO Only): Jul 2019- Sept 2021 Telehealth Telephone Other COVID-19 Safer at Home • Client services increased during COVID-19 • Phone predominates
- 7. FY20-21 % Outpatient Services by Phone/TeleMH by DO vs LE 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 2020-07 2020-08 2020-09 2020-10 2020-11 2020-12 2021-01 2021-02 2021-03 2021-04 2021-05 2021-06 DO - TeleMH LE - TeleMH DO - Phone LE - Phone
- 8. 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 2020-21 DMH DO VSee Use (# of Visits) 2020 2021
- 9. Challenges with Telehealth • Access to technology: Individuals may not have smart phones and/or data capable of supporting audiovisual conferencing. They may not have enough minutes to use for telephone services • Comfort with technology: Varying levels of comfort with telehealth technology • Privacy: Individuals may be unhoused or they may not have private space where they reside
- 10. DO Clinic Efforts To Increase Video Visits • Quality Goal: Increase use of videoconferencing for mental health care • Video conferencing is equivalent to in-person care (Hilty et al. 2013) • Superior to telephone visits • To increase videoconferencing we have implemented the following: • Increased training sessions to twice a week • Trained “VSee Champions” to assist staff and clients • Implemented a clinic workflow to get clients online • Reviewing clinic VSee use at APEX meetings • Applied for federal funding for telehealth equipment • 6 month QI review of data
- 11. Result: Clinics With VSee Workflow Have More Video Appointments No Protocol
- 12. Future Directions: Expand Access And Improve Quality • Integration of telehealth software with DMH electronic medical record system • Leverage cultural capacity: Clients may be matched with providers in part based upon language and, if desired, cultural knowledge rather than geography • Use customer satisfaction survey and telehealth usage data to guide further expansion, understand unmet needs and barriers • Explore sources of funding for smart phones and data including government and public-private partnerships