How Virtual Providers Benefit from Behavioral Health Integration

Iris clinicians facilitate top-quality behavioral health care – averaging 2.3M patient encounters every year. We are proud of the work our providers do every day to fill care gaps and support healthcare organizations across the country by providing their communities with timely access to exceptional care.

Every month, we sit down with one of our providers to spotlight the amazing work they’re doing every day and the impact they’re making on the communities they serve. This month, we’re sitting down to talk with Iris LCSW, Elizabeth McErlean!

Q. What do you love about being a telehealth provider?

A. I love being a telehealth provider because it feels like I have more hours in my day to live.  Going to an in-person job, there’s a lot of time that gets sucked into travel and having to get up and get ready.

I have my morning routine that I would normally go through if I was working outside the home, so I keep work and home separate. I have my office in a separate place that I use only for telehealth.

I really like the solemn serenity that I get working from home. I live by myself, so it’s quiet. It’s just me and the dog. I can take lunch whenever I want. I don’t have to worry about somebody else using the microwave.

I guess “freedom” sums it up. I like the freedom of working from home.

Q. What impact have you seen telehealth services make at the clinic where you serve?

A. I am working with a Federally Qualified Health Center. They provide almost all the same services of any healthcare provider. There are two sites – one in Machias and one in Eastport. They have pediatrics, dental, psychiatric medication prescribing, and general practitioners.

I am at one site a couple days and at the other site a couple other days. It’s very interesting because the other therapist who’s there is also from Iris — we both reside in North Carolina, and we’re both at this clinic.

They’re in Maine and very remote. I provide (and the other clinician provides) collaborative care with the psych med prescribers and general practitioners.

Therapy is very different than the medical side. Sometimes medical professionals don’t really understand the difference of therapy – our approach is different, and our perspective is different.

Working with primary care providers, pediatricians, and nurses has not only helped the clients have an in-house therapist referral, but it also helps educate them on what therapy can help with.

There are certain guidelines, and I can’t practice outside my scope. For example, I can’t see somebody who struggles with eating disorders – I’m not trained or have experience in eating disorders.

It’s helping the medical professionals understand how therapy is not an extension of them, but it’s in addition to them to provide wraparound care.

Q. How does telehealth support holistic care?

A. The team I work with is great – they’re very open to communication and want to collaborate. They’re very good at having meetings with the practitioner.

The organization is good and very open. They want the best for their clients, and everybody wants the best for their patients. So, everybody’s very respectful.

Q. How does telehealth foster connection with patients virtually?

A. It’s not the same because when I was in person, I could see a lot of body language. And one thing I could see was how they came from the waiting room back to my office. I could see how they were doing through their posture and their gait.

From the standpoint of telehealth, having art behind me has been helpful. I have a picture of a Van Gogh’s Starry Night and two smaller starry nights that my son painted when he was younger. So, I have three starry night paintings and people love that. It’s a great talking point.

If I was in a private practice, I may not be able to personalize my office quite as much because the business personalizes that. The other piece is my dog – she’s almost always there and I think it helps create a more relaxed atmosphere so that patients almost feel like they’re coming into my home.

Do we need to have boundaries to make sure that we don’t become friends? Yes, that’s my responsibility to be aware of that. And of course I am, but I think it gives the client a little bit of comfort. Especially when I work with kiddos – they like seeing the dog.

Q. What is the most rewarding part of your job?

A. The most rewarding part of my job is the flexibility and ability to learn about different places, cultures, and people without traveling or moving there.

I’m originally from Wisconsin, so the first placement I had was in a clinic in Iowa. It was very similar to Wisconsin. So, I felt comfortable with that.  I was very excited to go to Maine. It’s in the eastern-most part of the United States. It’s very remote.

It’s completely different – it’s a lobster fishing culture, so it’s very different from Wisconsin culture that I grew up with in the Midwest. And it’s very different from southern culture that I live in now – so only telehealth allows me that.

As social workers, we love to hear people’s stories, to hear where they come from, who they are, and what makes them tick.

Q. Why do you think telehealth is the future of mental health care?

A. Because you can reach people where they’re at. For example, at the clinic in Maine, I recently had a video call with someone in their child’s school parking lot because they were getting off work and they had to go to their child’s parent-teacher conference.

So, we were able to see each other through telehealth. It was obviously a private place and confidential.

I think telehealth relaxes people, too, to be in their home and be able to do therapy. There would be some clinicians that would say they’re not sure it’s appropriate for everyone struggling with mental health, but for the vast majority, I think telehealth can really be helpful.

We can reach so many people with telehealth in a shorter period of time because the transition from one client to another is much easier from our perspective – it’s just a couple clicks and you’re onto the next one – versus maybe you’re sharing office space with somebody, and you have to schedule things differently or you go out and get them.

Q. Anything you’d like to offer from your experience as a telehealth provider?

A. I came to social work later in life – it’s like a final career for me. I’ve only been doing it 10 to 15 years. I’ve worked at a lot of places – a court system, for example – some places have been supportive, and some places haven’t been.

I have a situation at Iris where they made me feel so supported and validated – I have never felt that way from any other employer. They get it – they’re supportive of their clinicians. I love the communication.

Everybody that I encounter is so warm and friendly, supportive and caring and they don’t expect us to sacrifice ourselves to help our clients.

We want to help the clients, but it’s important to have self-care and I take care of myself too. If I’m not in a good place, I can’t help the clients. And so, I really do get that feeling from Iris.

At Iris, we believe our providers should be respected, valued, and applauded for the work they do, and we couldn’t be prouder to say, “thank you” to our very own Elizabeth McErlean. If you’d like to learn more about working for Iris Telehealth, contact us today.

Why Leveraging Virtual Behavioral Health Services Drives Patient Satisfaction in the ED

Identifying ways to address behavioral health needs and improve patient satisfaction in the emergency department (ED) is not only beneficial for your health system, but it’s also the right thing to do for patients.

If there isn’t adequate access to behavioral health services across your organization and within your community, patients may feel they have no choice but to seek behavioral health care in the ED. When that happens, ensuring your ED has adequate behavioral health resources to meet that patient demand can be a substantial difference-maker for patient satisfaction, quality, and even length of stay.

Health systems have an opportunity to help patients get the quality, life-changing care they need and deserve.

By embracing the patient and leveraging virtual behavioral health services to ensure they’re well taken care of during their time in the ED and have a good plan after discharge, health systems are better positioned to retain patients and help them throughout their healthcare journey (even beyond the ED).

54% of U.S. hospitals have no psychiatrist available for ED and inpatient consultation services

In 2022, 6 million people sought care for mental, behavioral, or neurodevelopmental disorders in the ED.

A study from the Mayo Clinic on specialty psychiatric services in emergency departments found the following results:

  • 59% of hospitals say they transferred a psychiatric patient to a different hospital due to lack of available services
  • Only 27% of hospitals had consultation services available for psychiatric patients
  • 54% of U.S. hospitals had no psychiatrist available for medical ED and inpatient consultation services

With the high demand for behavioral health care in the hospital setting, it is critical your organization provides quick access to quality care.

 

“For many health systems, the emergency department is becoming like an inpatient unit. For organizations that partner with a telehealth solution like ours, patients can be seen by a psychiatrist or a Psychiatric Nurse Practitioner (PMHNP) in less than an hour of when they present to the ED.
From there, we can work with the ED staff on starting or restarting necessary medications or guiding the course of treatment – which makes for a better patient experience and smoother workflows for the on-site care teams.”
Dr. Thomas Milam, Chief Medical Officer

 

Across the board, patients report high satisfaction rates with telehealth.

For example, an article from the American Medical Association, cites 79% of patients were very satisfied with the care they received during their last telehealth visit, with 73% saying they would continue using virtual care in the future.

60% of patients said they waited 10+ hours to be seen by a mental health professional in the ED

Today, patients seeking behavioral health support in the ED spend a lot of time waiting and don’t always receive adequate information or resources to support them long-term and prevent them from returning to the ED.

A survey from the National Alliance on Mental Illness found that patients with psychiatric emergencies in the ED experienced the following:

  • 60% of patients waited 10+ hours to be seen by a mental health professional in the ED
  • 54% said there was no information given to them about prescribed medications
  • 65% were not given information about outpatient or community care

Anecdotally, patients also reported feeling very isolated and not taken seriously in their ED experience.

If you’re looking for ways to improve the patient experience, increasing access to dedicated behavioral health services and specialists in the ED is a positive step in the right direction to ensuring patient needs are being addressed.  

Virtual care helps reduce the amount of time patients spend in the ED

Patient satisfaction stems from the ability to address specific needs and track progress to ensure important metrics are being met.  

On the operational side, having insights into how your clinicians are performing can help optimize care, ensure quality treatment, and help keep patients safe.

Through our strategic approach to quality management, we’ve helped our partners reduce the length of stay in their MedSurg units by 0.5 days, increased ED discharge rates from 55% to 62%, and reduced their length of stay in the ED from 12 to 9 hours.

Overall, our partners have seen an 80% improvement in ED throughput by leveraging a strategy that ensures patients get to the right level of care and have the behavioral health care they need to address their specialty behavioral health needs.

Get started with behavioral health integration

Every hospital’s central value boils down to caring for patients and ensuring they’re well taken care of – body and mind. Whether your ED has leveraged virtual before or is looking for innovative solutions that will support patients long-term – there’s no bad place to start.

If you’d like to learn more about how Iris Telehealth can help integrate behavioral health into your organization, please contact us today.

2025 CMS Physician Fee Schedule Final Rule: Key Changes to Behavioral Health and Telehealth

On November 1, the Centers for Medicare & Medicaid Services (CMS) released their 2025 Medicare Physician Fee Schedule through a comprehensive fact sheet that breaks down all the planned changes across the health care system.  

Here’s a look at how these changes will affect the behavioral health and telehealth landscape as we turn the corner into 2025 along with some insights from our Chief Medical Officer, Dr. Thomas Milam, on how we can interpret these changes.

Average payment rates under the PFS will be reduced by 2.93% in CY 2025

While the new ruling contains several positive updates, the PFS reduction in payment rates by 2.93% may have cascading impacts across your organization that you may have to prepare for.

While a decrease wasn’t unexpected, it still may present challenges for those affected as this reduction will put less money in the hands of healthcare workers and their organizations.

“Everything we do in medicine has a relative value unit (RVU) assigned to it – every procedure and every patient encounter – so even an incremental decrease is less money going to doctors, hospitals, and facilities during a time where there’s a lot more patients and higher acuity.”
Dr. Thomas Milam, Chief Medical Officer

 

 

CMS will preserve and expand the scope of and access to telehealth services

Without congressional action, the pre-COVID-19 statutory limitations in place for Medicare telehealth services will resume, including geographic restrictions and service limitations in which practitioners can provide telehealth services.

CMS has expressed intentions to preserve important flexibilities in their authority and expand the scope of, and access to, telehealth services. However, we’re still waiting on the supportive data and legislative updates that will be critical to such efforts.

“The CMS Behavioral Health Strategy has a lot of important initiatives where telehealth could play a major role in keeping patients well and out of hospitals and emergency departments. We have every reason to believe CMS, patients, and providers want to continue leveraging telehealth in patient care–we’ve been doing it, and we should keep doing it.”
Dr. Thomas Milam, Chief Medical Officer

 

 

CMS is leaning into greater suicide prevention and flexibilities for OUD treatment

To expand access to behavioral health care, CMS is taking action towards safety planning. When properly executed, this planning can go a long way towards preventing suicide.

CMS is currently finalizing separate coding and payment under the PFS describing safety planning interventions for patients in crisis, including those with suicidal ideation and those at risk of suicide or overdose.

“CMS is leaning in more to support efforts to identify people at risk for suicide, and they plan to have additional reimbursement modeling for services to move towards a zero-suicide policy. Suicide rates remain high in all age groups, and among veterans as well, so we should all be doing everything we can to screen, intervene, and prevent such loss of life — telehealth will continue to play a big role in such efforts.
There will be additional G-codes in the system that will cover some additional services for suicide screening, assessment, and management in keeping with the success of the 988-suicide hotline.”
Dr. Thomas Milam, Chief Medical Officer

 

CMS is also finalizing telecommunication technology flexibilities for Opioid Use Disorders treatment services – allowing people to receive care without an in-person visit.

 

“I was pleased to see there are still a lot of flexibilities around opiate treatment programs in the 2025 PFS. The high risk of intentional and accidental deaths associated with opiates and the fentanyl crisis warrant continued efforts in early screening, management and prevention strategies.
The opiate epidemic is still a major concern for CMS and among health care providers, so allowing flexibilities to  se telehealth and other technologies to keep patients engaged in ongoing treatment is imperative.”
Dr. Thomas Milam, Chief Medical Officer

 

Prior to the COVID-19 PHE, if someone needed buprenorphine to stay well and avoid withdrawal and relapse, they had to go to a clinic in person, attend to their appointments for med management and therapy, and get drug screens – everything had to be done in person. 

Now, a lot of this process takes place over the phone and helps lower the risk that someone might relapse or overdose. As policies around this patient population evolve, it’s critical that CMS and SAMSHA continue working together to recognize the vulnerability and importance of people struggling with opiate use disorder.

New G-codes can help promote provider collaboration

CMS is finalizing six G-codes that will be billed by people who have limitations in their statute to services for diagnosis and treatment, mental illness, psychologists, social workers and management. These codes will mirror current interprofessional consultation and CBT codes.

There’s also more recognition in healthcare that provider communication around patient care is of high importance.

For example, eConsults weren’t previously paid for, but now there’s recognition that collaboration is real work and adds value for patients and providers. Reimbursing healthcare providers for their interprofessional communication and identifying the work that different care teams are engaged in together to keep patients well is an important step in the right direction.

CMS also shared they are finalizing a policy to continue allowing direct supervision via interactive, real-time audio-visual platforms to extend various types of supervision for providers who may require it such as like nurse practitioners, therapists, physician’s assistants.

While there seems to be hesitancy around using audio-only modalities for supervision and care delivery, they will hopefully still be viable options given the rural locations of so many patients and providers in the US.

Where Iris fits in

At Iris, we believe in a future that helps more people get the high-quality behavioral health they need and deserve – regardless of where they live. Virtual care is an important part of the future of healthcare and will continue to increase access to care for those who need it most.

Want to learn more about what the final rule means for your organization? Reach out to talk to someone today – you can contact us here!

You can also get more information and read more about the new CMS rule here.  

How Integrating Behavioral Health Can Improve Women’s Health Service Lines

Behavioral health integration is a crucial part of ensuring holistic care in women’s service lines. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), among women with mental health conditions, 27% have a serious mental illness and 20% suffer from mood or anxiety disorders during pregnancy.

In a webinar hosted by Becker’s Hospital Review, healthcare leaders from Carilion Clinic dove into how they’re approaching behavioral health in their women’s service lines, shared best practices for integration, and offered strategies for better patient outcomes.

Carilion Clinic has taken steps to integrate behavioral health services into their women’s health service lines, and Dr. Jennifer Wells, reproductive psychiatrist and Director of Women’s Mental Health Services, and Dr. Jaclyn Nunziato, OBGYN and Executive Director of Huddle Up Moms, shared how they think about ensuring all patients have access to care that’s trauma informed and culturally sensitive. Please read below for a breakdown of the key insights they shared during that conversation.

Untreated behavioral health conditions can have negative ramifications on clinical outcomes

As an OBGYN, Dr. Nunziato shared that mental health was never in her training, yet behavioral health conditions are more commonly found in women than other common illnesses covered in regular screenings.

“I found patients I was seeing for years were sitting on these mental health issues, everyday struggles, and transitions throughout their reproductive journey. I would hear time and time again [patients saying], ‘Nobody’s ever asked me how I’m doing […] mentally.’ I found screening them even at a routine visit has really opened my eyes to the need and to the lack of resources.”
Dr. Jaclyn Nunziato, OBGYN, Executive Director of Huddle Up Moms

 

Dr. Nunziato went on to say that untreated behavioral health conditions have negative ramifications on clinical outcomes and that gaining a better level of expertise in mental health has made her a better provider.

Reproductive psychiatrist Dr. Jennifer Wells, Carilion Clinic’s Director of Women’s Mental Health Services shared that she has witnessed mental health stigma decreasing, a credit to Carilion Clinic and having providers who are more open to behavioral health.

In previous times, Dr. Wells said people would show up and talk about their depression, but not mention things like substance use.

“As we’ve grown in our ability to talk about diseases and provide education to the people around us, it’s allowed this great evolution of how we think about mental illness. And now I think some of that is happening in the perinatal space.”
Dr. Jennifer Wells, Director of Women’s Mental Health Services at Carilion Clinic

 

She says persons of reproductive age and parenting women are more comfortable sharing their fears and concerns about being a parent. Dr. Wells also shared that the ability to express these fears and concerns opens the opportunity to educate, listen, and find better ways to help people manage their anxiety and depression.

Acknowledging that hormonal shifts are important markers of a women’s health journey can help reframe the way we approach conversations about behavioral health

When defining the difference between “women’s health” and “women’s mental health,” Dr. Wells shares that they’re intimately connected.

“Women’s health has come to the forefront because we recognize the journey of a woman through her life is characterized by significant hormonal changes. Hormonal shifts are responsible for many downstream effects like mood disorders.”
Dr. Jennifer Wells, Director of Women’s Mental Health Services at Carilion Clinic

 

Dr. Wells also shares that a woman’s life takes a dramatic shift every 10, 15, and 20 years, which can create a shifting of mental health. This journey starts during adolescence, matriculating through middle school to high school, where someone might experience premenstrual dysphoric disorder. Then in fertile years, a woman might experience perinatal mood and anxiety disorders.

If a woman undergoes fertility treatment or infertility, they might experience depression or anxiety. Then, there’s the postpartum period that brings a greater risk for mood and anxiety disorders. Then, there’s menopause.

When discussing hormonal shifts, there are also important considerations around stigma. Dr. Nunziato shared that acknowledging hormonal shifts places value on where a woman is in her journey, where in another time, it was seen as something that was “all in someone’s head.”

Dr. Wells said that would like to see the conversation move beyond a woman being histrionic and can’t control their hormones to the idea that hormones are neuroactive steroids that change the biochemistry and neuroreceptors of someone’s brain, making mood disorders more common.

“Hormones are very real, and we need to talk about them – it’s a part of a woman’s life. Women live their lives through connection and emotional ties to other people. As these connections change through life, it’s no surprise that it happens concurrently with hormonal changes that exacerbate and ameliorate mood disorders.”
Dr. Jennifer Wells, Director of Women’s Mental Health Services at Carilion Clinic

 

 

How to integrate behavioral health into women’s health

Dr. Nunziato said the first thing a provider can do to integrate behavioral health is to become more comfortable in the mental health space and talking about mental health with your patients, noting, “You are somebody that values mental health and is willing to ask about it, provide screenings, be more educated about it. The more you do it, the more you gain a network and find the resources available in your area.”

When considering at what point a provider should refer to a specialist, Dr. Wells says it depends on provider comfort, sharing that each provider comes from a different training background with varying familiarity on certain conditions, like PMDD or major depressive disorder.

For providers, she recommends getting more comfortable talking about mental health and increasing their knowledge base. Dr. Wells also shared that most people are comfortable prescribing an SSRI, but if it goes beyond their scope and level of comfortability, they can reach out for an e-consult.

“The high prevalence of mental illness and substance use disorders in America can be co-occurring, including conditions like anxiety and depression, ADHD, bipolar, and schizophrenia. We know that primary care providers, family doctors, and pediatricians are at the frontlines, but often need support from mental health experts for medication management, therapy, or substance use issues.”
Dr. Thomas Milam, Chief Medical Officer, Iris Telehealth

At Carilion Clinic, they have e-consult services built into their systems, and providers can reach Dr. Wells via calling, texting, or a referral to her clinic. There are also perinatal mental health lines where providers can get connected to a specialist within 30 minutes.

In Virginia, Dr. Wells and Dr. Nunziato are heading their state’s perinatal mental health line called “VMAP for Moms+,” designed to help providers caring for pregnant persons or those contemplating pregnancy. These lines help create networks of good information that’s evidence-based and data driven.

Dr. Nunziato shared that she was seeing wait lists from six months to a year and to help increase access, they leveraged a risk-stratification approach. She noted that not everyone needs to see a psychiatrist and might do great with a peer support group or rely on their own OBGYN.

Addressing gender in women’s healthcare

When discussing women’s health, it’s important to consider all facets of the female experience, including transgender care.

For Dr. Wells, who often works with transgender patients, she shared that her practice is intentional about using the right terminology and understand this population faces higher rates of substance use disorder, abuse, and intimate partner violence.

Dr. Nunziato added for transgender patients trying to get pregnant or going through menopause, they’re also dealing with physiologic changes and stressors that need to be addressed and often aren’t recognized.

“It’s up to us to implore our teams to be accountable, respectful, and as open as possible. When I have transgender patients who are getting pregnant, it’s a great way to remind my staff (from the front desk all the way to the person doing their transvaginal ultrasound) that we need to be mindful and respectful of everyone’s individual needs.”
Dr. Jaclyn Nunziato, OBGYN, Executive Director of Huddle Up Moms

 

Dr. Wells shared that as the Director of Women’s Health she understands that “women” doesn’t always apply and it’s important to find alternatives. Dr. Wells goes onto say that she tries to elevate her own vocabulary, be sensitive to the person in front of her (however they identify) and educate herself on how best to meet their needs.

Get started with behavioral health integration

We are so grateful for the time Dr. Wells and Dr. Nunziato shared with us. Thank you for your partnership and for all the incredible work you are all doing to expand behavioral health to your community!

Weren’t able to make it to the webinar? You can catch the full video here. If you’d like to learn more and figure out the next steps to integrating behavioral health into your women’s health service lines, you can contact us here.