Telemedicine helps SSM Health triple the volume of psychiatric care
SSM Health Cardinal Glennon Children’s Hospital is an inpatient and outpatient pediatric medical center located in St. Louis, Missouri. And Missouri has a serious health care problem: a massive shortage of behavioral health providers.
THE PROBLEM
The demand for behavioral health care services is overwhelming across the country, but is especially acute in Missouri, where approximately only 200 of the 1,000 licensed psychiatrists actually reside in the state to serve a population of approximately 6 million people.
This shortage began to intensify even before the COVID-19 pandemic, and demand has not diminished since. Cardinal Glennon Children’s Hospital has experienced the impact firsthand: Emergency departments became overrun with behavioral patients, sometimes held in the emergency department for weeks without proper beds, awaiting psychiatric evaluation and/or placement.
What makes this crisis particularly challenging is its pervasiveness. Unlike many other health problems that can disproportionately affect certain demographic groups or regions, behavioral health care needs are truly universal, affecting urban, suburban, and rural populations across all socioeconomic backgrounds.
As a children’s hospital with an extensive geographic reach, Cardinal Glennon Children’s Hospital serves patients from Missouri, Illinois, Arkansas and beyond. Growing wait lists and extended appointment turnaround times forced families to seek crisis care through emergency departments, creating a cycle that served no one well – neither the behavioral health patients nor the acute care and trauma patients.
These issues have helped Cardinal Glennon Children’s Hospital recognize the urgent need to expand its psychiatric capacity through virtual behavioral health care.
PROPOSAL
While exploring solutions to the challenges of accessing behavioral health care, the organization quickly realized that telepsychiatry was ideally suited to its needs.
“Unlike many other specialties, behavioral health rarely requires a physical examination – making it perhaps the purest, most perfect use case for telemedicine services,” said Chris DiGiusto, vice president of outpatient services at SSM Health Cardinal Glennon. “With this in mind, we looked for providers who could provide dedicated psychiatric support while understanding the unique needs of a children’s hospital.
“After evaluating several options, Iris Telehealth stood out for two main reasons: its consistent track record of delivering on promises at other institutions and its willingness to grow with us in a true partnership that was relationship-oriented rather than transactional .”
The proposal is intentionally designed to scale incrementally. The organization would start with one full-time dedicated psychiatrist who would focus exclusively on Cardinal Glennon’s patients, with the understanding that Iris Telehealth would provide additional psychiatric capacity as needed.
“This thoughtful approach allowed us to establish and refine our workflows before expanding,” DiGiusto explains. “The proposal also addressed the complex requirements of our multi-state service area, ensuring that Iris Telehealth psychiatrists would be licensed to treat patients in Missouri, Illinois, Arkansas and neighboring states – a critical factor given the extensive geographic reach of our hospital.”
MEETING THE CHALLENGE
Cardinal Glennon built its telemedicine program around its existing Epic EHR platform, which serves as the single source of truth for patient care. The telepsychiatrists connect with patients through Epic’s integrated video platform, ensuring a seamless experience for providers and patients.
“This integration was critical because it allows our Iris Telehealth psychiatrists to work within the same system as our in-house teams, maintaining continuity of care and streamlining documentation,” said DiGiusto.
“The success of our program relies heavily on what we call our ‘wraparound services,’” he continued. “Before each visit, our team handles everything from registration and insurance authorization to patient readiness assessment. We focus primarily on patient engagement and ensuring they are prepared and committed to participating in their care.”
Following a psychiatric evaluation, the extended care team – including graduate students, psychologists, licensed clinical social workers, and nurse navigators – follows the psychiatrist’s treatment guidelines and provides ongoing therapeutic support.
“It takes about three months to get new Iris psychiatrists up and running in our system,” DiGiusto noted. “This includes epic training, hospital privileges, multi-state licensing and payer enrollment.
“While the technical aspects are important, what really makes this work is treating it as an integrated care program rather than just a technology implementation,” he added. “The psychiatrists become true extensions of our team, fully embedded in our workflows and culture.”
RESULTS
Virtual behavioral health has delivered significant improvements across several key metrics.
“Most notably, we have tripled the volume of our psychiatric operations, dramatically increasing access to care,” DiGiusto reported. “The percentage of new patients scheduled within 14 days has increased from 14% to more than 60%, meaning more children are getting the care they need, when they need it.
“Through our focus on patient engagement and extensive pre-visit preparation, we have reduced the no-show and same-day cancellation rate from 21% to just 7%, ensuring we are making the most of our psychiatric resources,” he says. continued.
Perhaps the most impactful achievement occurred in the emergency department, where the organization reduced the average wait time for behavioral patients awaiting evaluation and placement by 50%. This improvement is especially crucial because these cases often involve crisis situations where timely intervention can be lifesaving, DiGiusto noted.
“Many of these patients are now being identified and treated through our outpatient clinics before their condition escalates to a state of emergency,” he explained. “As Missouri’s largest provider of behavioral health care, these numbers represent real progress in addressing the significant psychiatric care needs in our region, although we recognize that there is still more work to be done.”
ADVICE FOR OTHERS
For organizations considering telemedicine for behavioral health, DiGiusto encourages them to approach it as a relationship-building opportunity, rather than just a technology implementation or contractual arrangement.
Success comes from finding providers who understand one’s specific needs and are willing to grow with the healthcare organization – and look beyond the technology itself to know how the program will integrate with one’s existing workflows and support services, he continued .
“Building a successful behavioral health program requires a comprehensive approach,” he advised. “Focus on creating robust comprehensive services that support both healthcare providers and patients throughout the care journey. This approach includes everything from streamlined registration and scheduling processes to committed care teams that ensure patient preparation and follow-up.
“While technology makes services possible, it is the human elements – the care coordinators, social workers, psychologists and support staff – that truly make these programs successful,” he concluded. “Consider starting small and scaling up incrementally as you refine your processes and build trust in the program.”
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