At the beginning of the COVID-19 pandemic, Geisinger’s Department of Psychiatry and Behavioral Health began experiencing a significant increase in demand for behavioral health services.
THE PROBLEM
The demand for services was most notable in adult psychotherapy services, with wait times of several months and several thousand outstanding orders. At the same time, the department began shifting much of its care to telemedicine, ultimately resulting in more than 80% of outpatient visits for behavioral health care services delivered virtually.
The department had several group therapy offerings at the time.
“Historically, these services have not been offered virtually due to the complexity of delivering groups via telemedicine,” said Benjamin C. Gonzales, operations manager II, virtual care, behavioral health, at Geisinger. “This posed a significant challenge given the important role that groups can play in treating mental illness and the access they create.
“The department, and Geisinger as a whole, did not have a solution for virtual groups,” he continued. “Geisinger’s service area is also rural. While in-person groups would be ideal, this would be difficult given the distance some patients must travel. Some groups even saw poorer utilization because they had multiple options when consolidation was needed.”
Additionally, Geisinger’s behavioral health team saw significant growth within the provider group, adding more than 70 providers to the team over the course of the pandemic. Much of this growth was achieved through telemedicine providers, including virtual psychotherapists.
Many of these providers are trained to offer therapy, but without a virtual group platform, this service could not be provided.
PROPOSAL
Virtual group therapy was intended to solve a number of problems. The most important thing was the continuity of services during the pandemic; With many in-person services on hold, it was not possible to lead groups in the clinic.
“Groups are an important component for many with mental health and substance use disorders, including some of Geisinger Behavioral Health’s sickest patients who often participate in the intensive outpatient program,” Gonzales explains. “At the same time, the department received an average of 180 referrals per day, approximately half of which were for adult psychotherapy.
“In many cases, patients could be supported in a group setting, but options were limited as most groups were offered in person,” he noted. “Many healthcare providers also transitioned to remote work, making it difficult to work with in-person groups. Virtual groups would allow our team to see patients remotely while utilizing our remote workforce. This would in turn help the department meet the overwhelming demand for services.”
Additionally, virtual groups were intended to provide a safe way to schedule patients for group sessions. For example, the department could not simply send out a Zoom invitation, as this would share the patient’s email with other invitees. The team also needed a way to seamlessly share content with patients before and after the group meeting to ensure patients could prepare for sessions.
MEETING THE CHALLENGE
Virtual groups were eventually implemented by the Center for Telemedicine at Geisinger. The system leveraged Microsoft Bookings for Groups for its ability to securely send group invitations without sharing patient emails.
The platform also allowed teams to create templates for groups, including providers/staff on the invite, the group name and time, as well as the maximum number of participants. The invite itself included a Teams invite without displaying contact information from other invites; Teams is also widely used at Geisinger for non-clinical purposes, which made implementation easy given the staff and provider comfort with the application.
“The platform was accessible to all departments at Geisinger,” Gonzales said. “In the behavioral health space, the platform was largely used by providers and staff to schedule and retain groups. Currently, planning groups and documentation are not integrated. Geisinger uses Booking for group scheduling, while patients are also scheduled in Epic.
“This allows healthcare providers to use Epic for clinical documentation, while using Microsoft Teams to actually connect with their patients,” he added.
RESULTS
The most important result of this work was the continuity of services.
“We were able to deliver nearly every group we offered in person via telemedicine, including our highest acuity intensive outpatient program,” Gonzales reported. “This was important to us given the important role the group process can play in recovery from mental and substance use disorders.
“We were also able to increase compared to individual psychotherapy,” he continued. “We currently offer 16 groups, creating capacity for 172 patients every week. With the same capacity we would only be able to care for 64 patients through individual psychotherapy. At one point we were unable to offer groups due to restrictions during the COVID-19 pandemic.”
Waiting times for groups are considerably shorter. Most groups can accommodate new patients within a week, while it can take several months for individual psychotherapy to gain access. This is largely due to the increased capacity created by groups.
“Along with the increased capacity, we are able to offer variation between group offerings, creating redundant offerings of the same service,” Gonzales explains. “This allows each patient to access services on the day and time of their preference, rather than being forced to choose from one option.
“Finally, we were able to add more than a dozen third-party providers to the group coverage,” he noted. “This could not have been achieved without telemedicine, given the geographic spread of our team. Ultimately, this will allow us to further scale the capacity created by groups.”
ADVICE FOR OTHERS
“I would encourage healthcare leaders to think about what services they can provide in a group setting and how they can do that supported through telemedicine,” Gonzales advised. “We have found that patients’ needs can often be met in a group setting, preserving individual therapy access for patients who need it most.
“I would also invite leaders to consider how this technology can enable them to leverage talent beyond their service area,” he continued. “We have been able to add several caregivers to our team, creating redundancy and more opportunities for patients to join a group, while at the same time scaling access.”
Finally, leaders must be aware of the operational need to support groups, he added.
“While we have created more capacity despite the geographic dispersion of our patients and staff, we have found that groups require more support from our staff,” he concluded. “Most of the additional comes in the form of managing referrals and scheduling groups, given the greater number of patients served within the same encounter.”
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