Clinician Corner: Dr. Jean Oelschlager on the Power of a Holistic Approach to Behavioral Healthcare

Iris clinicians are at the heart of what makes our organization such a special place to work. That’s why we’re turning the spotlight on the amazing work they’re doing every day. This month, we’re sitting down to talk with Dr. Jean Oelschlager.

Q. How did you find Iris and decide you wanted to be an Iris provider?

A. I retired from my position in Wisconsin with community mental health in 2020 amid the pandemic. We moved to Arizona, and I planned to volunteer out here. During the pandemic, no one was accepting volunteers, particularly older volunteers. I thought I couldn’t just sit at home all the time. I needed to do something productive and useful. I thought about doing locums work again because I had done that work in the past, and I reached out to a couple of the companies I worked with, and they didn’t have anything that worked for me.

I wasn’t looking for a full-time job. I was looking for something where I could work two or three days a week because I wanted to retire or semi-retire. That didn’t pan out. I thought maybe I should check into telehealth.

I found Iris listed and read more about it. The more I learned about Iris, the more it seemed like it was a good fit for me because they were willing to be flexible with part-time hours, with the possibility that I might want to return to Wisconsin in the summers.

I like the mission to provide services to underserved areas. I like that Iris was started by a psychiatrist who saw this need and stepped up by starting the company. All those things were appealing, and the people I talked to were lovely, helpful people. It seemed like a really good fit. The process started at the beginning of 2021, and by September 2021, I started with the clinic in Missouri.

Q. How does telehealth compare to in-person care?

A. I’ve learned how to communicate better in the virtual world with patients. You have to be more tuned into eye contact and be more verbal about what you’re doing when you’re looking away so they know what you’re doing if you work with two screens.

I have one screen for the Zoom call and the other for the medical record. I’ll tell them if I’m doing something else, like ordering medications. They can see that when you’re in an office setting, but they can’t when you’re virtual. You have to be more mindful to let patients know when you’re not looking at them what’s happening. You give them time for them to answer.

The other thing that has worked well with my setup with Iris and the clinic in Missouri is that patients come into the clinic.

I don’t do virtual visits in their homes. They come in and get their vitals. We do PHQ-9s and AIMs, and then the nurse scans it so that I can see everything. I have a designated nurse that I’ve worked with throughout my time at the clinic. She knows my routine. She’s that physical presence for me, an extension of me. And that has worked really well.

Because sometimes she can see things that I can’t necessarily see and can alert me to that. I know not every situation with telehealth works that way, but I’m really happy that’s how it worked out. I value that team approach and that she’s there in person to connect with patients and see things that I might not catch virtually.

Q. How do you foster connection with patients virtually?

A. Eye contact is probably the biggest thing. Also, using the staff that’s physically present in the clinic to reach out to patients. For example, we had a patient who had postpartum depression, and I was concerned about her. We connected her with one of our therapists, who contacted her between my visits to see how she was doing.

The other thing that’s really nice about my setup is that it’s a primary care clinic. So most of the providers in the clinic are primary care, and then they have a behavioral health and substance use department, too. It’s happened more than once that a patient comes in to see me, and they are medically ill. They either have an upper respiratory infection or a UTI, or something needs to be addressed.

My nurse will try to get them in to see one of the primary care providers around our appointment. That way, the patient (particularly if it’s a more acute situation where we’re really concerned about them) can be seen and get their issue addressed either right before I see them or right after. That holistic approach creates a good relationship with patients that they appreciate. I appreciate it, too, because I know they’re getting their needs met in other areas.

Q. As a healthcare professional, how do you manage work-life balance?

A. The biggest thing is that at my stage now, I can say I’m only going to work two days a week. That was really an important part of coming back to work. I had been doing this for 30+ years and wanted to do other things, not just work full-time. That was one of the things with doing telehealth and joining Iris, was Iris being flexible enough to say, “Yes, we can find something where you can just work two days a week.”

I wasn’t interested in doing call anymore. I did that for years – been there, done that. I put my time in doing call. I wanted something where I could do outpatient work a few days a week without worrying about the call.

Not to say that I never would get a call. There have been instances where a question came up on a patient, and the clinic would call me on my non-work days. But that’s extremely rare. It may only have happened a couple of times in the two years I’ve been working.

Being able to do just the two days a week has worked really well because it’s allowed me to do other things. One of the things we enjoy doing out here is hiking. We’ve got a hiking group that we do regularly—staying active. The climate here is conducive to that, except in the middle of July.

Even then, you have to get up really early. I still do that and walk at least two miles daily every morning. I just get up really early when it’s hot. I think what we tell our patients is to stay healthy. Work is important, and I think that it helps me to stay mentally active, feel productive, and like I’m still contributing.

I’m volunteering at a couple of places, which has been great meeting the people in the community, making new friends, and staying active socially. All those things are important.

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

A. I would say seeing patients get better or having that “aha moment” where they connect how they can change their thinking or behavior that will make life better for them.

Q. What do you love about working with Iris?

A. The flexibility. The staff I’ve worked with have been wonderful and helpful—for example, the IT folks. I’ve had a couple of times where stuff didn’t work, and I was sending texts because of the time difference between Missouri and Arizona. I was texting them early in the morning, “This isn’t working, and I have patients starting at this time. I need help right away.” Then, within minutes I was getting help.

That’s been consistent because it’s happened several times. I’m not a tech guru by any means, and that’s probably my greatest anxiety is wondering, “What’s going to happen with the computer? Or, is there going to be some upgrade or downgrade?” The IT staff have been wonderful. The supervisory folks, like Melissa Kennedy are wonderful.

I had an accident where I was hit by a car while I was out walking last year, and I broke my back, leg, and pelvis. I was in a wheelchair for six weeks. Iris was very understanding, and the clinic understood that I had to get better. After three weeks of not working, I was so bored because I was wheelchair-bound.

The clinic and Iris helped me figure out a schedule where I would work just a few hours a day. I’d work a couple of hours, then I’d rest a couple of hours, and then I started seeing patients again after three weeks, even though I was still in the wheelchair. That’s another example of the flexibility that I value both with the clinic and with Iris. That was wonderful.

I’ve had a miraculous recovery, and that’s amazing. I feel very blessed, but that was being able to just work a little bit for probably a month to six weeks until I was more ambulatory. That was good for my mental health, too. Because I was homebound, unless my husband would load me up with a wheelchair to take me somewhere, which was a big to do, that flexibility was very important and helpful.

Q. What advice would you give someone new to telehealth?

A. I would say find the right company that will support you. It’s important to have a team behind you to help with credentialing and vetting potential clinics that you might be working for. The IT component – Iris has been great about providing the equipment and helping with getting licensing and malpractice coverage. I think that’s probably my biggest thing is just finding the right fit with a company that can give you that support and help getting started.

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

Five Things You Should Know Before Building a Telehealth Program In-House

Over the last several years, it’s become clear that telehealth is here to stay. According to the American Psychiatric Association, nearly 60% of Americans would use telehealth for mental healthcare, and 43% currently want to continue using telehealth services when the pandemic is over.

With that data — and telehealth’s ability to expand access to high-quality providers — it’s no surprise that organizations are thinking through how to start a telemental health practice and leverage it as a long-term solution.

But, if your organization is wondering how to build a telepsychiatry practice in-house, you should consider some important first steps, limitations, and potential alternatives (like formal behavioral health vendor partnerships).

1. Building a telehealth program in-house won’t solve any recruitment challenges

As a medical group dedicated to providing virtual care services to healthcare organizations across the country, Iris Telehealth has access to a provider pool that spans all 50 states. However, individual organizations just starting to transition to telehealth as a long-term solution will likely be limited to the same provider pool they’d use for in-person providers.

And that’s not the only challenge you might encounter. For example, if you have an in-person provider who you think might transition to telehealth on a full-time or part-time basis, they may decide they don’t like telepsychiatry after all. Or they may get scooped up by another organization because they’re not limited by geographical location anymore.

At Iris, however, we not only assess their clinical skills, but their technical skills and screen presence as well. We have an intensive vetting process to make sure telepsychiatry is a good fit for that individual provider.

2. A formal telehealth program requires specific technological considerations

As you’re learning how to start a telepsychiatry practice in-house, you should ask yourself these questions:

  • Do we have the right video platform?
  • Do we have the right security in place (i.e. VPNs)?
  • Will our platform work for our current staff and patients?
  • Is our program HIPAA compliant?
  • Do we have sufficient IT support for handling technological difficulties or glitches?

If you’re uncertain about the answers to any of these questions, a vendor partner like Iris Telehealth might benefit you and your team as you navigate this process. (And, even if we’re not an official partner of yours, we’d be happy to talk through your needs with you.)

3. The telehealth landscape is constantly changing (and may be hard to navigate on your own)

Policies in the behavioral health space continue to evolve. Whether it’s around HIPAA compliance, reimbursements for audio-only appointments, or billing and coding — things continue to change as more states pass legislation that permanently expands telehealth services.

It can be challenging to stay on top of all the relevant changes as just one healthcare organization. No matter your size or approach to telehealth, the organization needed to manage telehealth-specific policies will likely be a big lift for your team.

That’s where a vendor partner may come in handy to offer perspectives on how similar organizations are navigating this space right now.

4. You’ll need dedicated, telehealth-specific policies for your providers

There’s a lot of information and “what ifs” to consider if you’re trying to build your own telehealth program.

Here are just a few of the policies you might want to put into place:

  • A standard 90-day grace period for providers leaving your organization. If you don’t tell your provider when they start that they have to give you 90 days’ notice, you may not have time to find a replacement provider when they leave. 90-day policies protect clinics, providers, and patients.
  • A strong policy around computer usage. You don’t want someone accidentally putting a virus on your network if they’re using their computer for other things or are engaging with spammy content.
  • No-show policies and policies for telehealth, specifically around remote patients (not in your clinic).
  • Policies around when the telehealth provider should end a session or not have a session with a particular patient.
  • A billing policy for patients who show up late to appointments.
  • Standard prescribing rules and protocols.

5. Your EMR may not be set up for behavioral health or telehealth right now

If you’re determined to build your telehealth program in-house, the first thing you need to look at is the capabilities and limitations of your EMR.

Make sure you have it set up for behavioral health before you do anything else. A common mistake organizations (particularly FQHCs and CHCs beginning psych services for the first time) make is trying to run their virtual behavioral health program the same way they run their primary care. When that happens, they often end up overbooking providers. But behavioral health is a different paradigm.

Remember, ideally, you want your EMR to be able to encompass your scheduling, patient records, e-prescribing, and video in one system.

A formal behavioral health partner could help support you and your organization

One of the unique benefits of telepsychiatry and a partnership with Iris is our Clinical Operations Managers (COMs). We’re a concierge service whose number one goal is making sure you and your patients are getting the care and support you need. If, for example, there’s a scheduling issue or a provider conflict we can help resolve it using solutions we have seen and used at clinics across the country.

Every day, we help mediate and advocate for clinics and clinicians to ensure there’s efficient and effective patient care.

Here’s what that would mean for your organization:

  • Our 24/7 IT support can interface with your organization’s IT to solve problems and can often independently solve them for our providers.
  • We have support for billing and scheduling issues.
  • We are Joint Commission accredited — which means we can assist with provider credentialing and paneling (we have some partners who do credentialing by proxy with us).
  • We match your organization with a top-quality provider who specializes in the areas you need (and who we’ve already vetted to ensure virtual care is a good fit for them).
  • After we’ve matched a provider with your organization, we help make sure they have the right technology and that the doctor knows what they need to know to evaluate your patients.
  • We assume all of the expenses of the benefits and PTO.
  • We are a true partner dedicated to long-term care and service. We make sure our providers are an extension of your team and do everything in our power to ensure continuity of care for your patients.

Whether you’re interested in learning how to make your own program a success or creating a formal partnership with Iris, we’re here to help. Contact us today to get the conversation started.

How Virtual Care Can Transform Your Health System’s Approach to Behavioral Health

Integrating behavioral health across all patient journeys can transform a health system and how it delivers care for its community.

As Chief Strategy & Marketing Officer at Iris Telehealth, I’ve seen first-hand the impact effective behavioral health integration can have on a health system and its patients. Whether through better clinical outcomes and access, increased revenue, or positive margins – our health system partners sustainably leverage and integrate scalable behavioral health services seamlessly across their ecosystem.

Learn how our partners are finding success by integrating behavioral health services across their health systems, what the patient journey looks like through a virtual lens, and the financial impact virtual services can have on a health system.

The tangible impact of integrating behavioral health services

Experiencing the tangible impacts of integrated behavioral health services starts by providing timely access to quality care – and making sure that care is financially sustainable.

Once the need for behavioral health care is met, health systems may experience the following benefits:

  • Better access
  • Better patient outcomes
  • Improved financials
  • Reduced total cost of care
  • A patient and provider community that feels supported

Helping health systems take back control of a fragmented healthcare landscape

Today, health systems are being disaggregated by a myriad of competitors – both new and old. This trend is contributing to lower health system revenue, but also to a further fragmentation of the patient journey. At Iris, we want to help health systems take back control of this fragmentation to ensure patients are getting integrated, whole-person care.

We believe providing integrated behavioral healthcare is a critical component to patient care. The reality is – behavioral healthcare should be infused into every journey. Whether a patient just received a cancer diagnosis, is an expecting mother, or is experiencing escalating anxiety at a primary care appointment, integrating behavioral health care will drive better patient care and eliminate the need for a patient to look elsewhere to fill gaps in their care needs.

At the end of the day, our goal is to help health systems deliver on their ultimate promise of delivering whole-person, integrated care.

How to integrate virtual services across a health system

The mistake many health systems make is believing that integrating virtual care into their health system is as simple as having virtual providers available to see patients. In practice, it is much more nuanced. We believe in the concept of “integrating virtual care locally” – whereby the referring provider knows and trusts the behavioral health care team they are relying on, and the virtual team truly knows the local dynamics. This approach is really the only way to build trust and create true continuity of care.

Additionally, the care experience has to be the same whether a patient is part of an Iris program or not. That is why our entire patient journey is built with the idea of integrating into, and leveraging, the health system technology already in place. The Iris provider is integrated seamlessly into the health system and the patient journey feels no different than it would if they were seeing an in-person provider.

The financial impact of integrating behavioral health services

The financial realities of providing behavioral healthcare are undoubtedly a challenge. But, in our experience, it is possible to deliver high-quality behavioral health care and have it be financially sustainable.

We have helped health systems double their behavioral health revenue while delivering a 10% program operating margin. And, study after study shows that providing outpatient behavioral healthcare reduces the total cost of care.

How is this impact possible? It comes down to the disciplined execution of a few key tenets:

  • First, ensure you’re driving top-of-license care from a true care team approach. Yes, it is essential to have psychiatrists available for high acuity patients, but from our experience, we’ve seen psychiatrists relied on too heavily for patient care than what is clinically appropriate. That is why we leverage industry-leading navigation assessments, with a true care team approach to make sure every patient is seen by their optimal provider with a tailored care plan.
  • Second, be sure to optimize the operational complexities of care delivery. Patient no-show rates, provider turnover, full provider panels, and consultation with referring providers are all critical to ensuring the program is sustainable.
  • Finally, revenue cycle optimization is critical. Many health systems are not getting paid optimally for the care they provide and that has to change. Revenue cycle optimization means ensuring the optimal codes are being billed, providers are documenting appropriately, and payers are approving claims. Constant measurement, continuous improvement and dialogue with payers are critical, and can make a significant difference.

It is a reality that if there is “no money, there is no mission,” and therefore we are dedicated to ensuring our programs deliver on high clinical quality and financial sustainability.

The spirit of partnership with Iris Telehealth

At Iris, one of our core values is to suck less every day, which speaks to our commitment to continuous improvement and our journey to excellence. No health system has behavioral health figured out, and no health system expects to be perfect tomorrow. Everyone’s on a journey to be better than they were yesterday. If together we commit to continual improvement, we will make a lot of progress and deliver better care for our communities.

If you’d like to learn more about how we can work together, don’t hesitate to contact us today!

As Chief Strategy & Marketing Officer, Dan Ferris drives strategy and revenue growth acceleration by identifying market opportunities and increasing awareness of how Iris can uniquely solve customer needs. Dan brings twenty years of healthcare experience in various marketing, product and strategy roles at Hillrom, CIGNA, Abbott, and Putnam Associates, a healthcare strategy consultancy.

Why (and When) You Should Consider a Virtual Medical Director

Striking the right balance between prioritizing quality patient care and managing everyday leadership tasks is pivotal for healthcare organizations. But it’s not always easy. Hospitals and clinics have safety and quality metrics they must report on, and sometimes it’s unclear who’s responsible and whether they have the training and skills to do that type of work.

During my years at Iris, I’ve seen many clinics promote staff members into leadership positions based on seniority rather than on that person having experience in leadership or administration. That’s where leveraging an Iris provider as a virtual medical director for a behavioral health program can be a great move.

Our providers are integrated into the organizations in which they see patients. They know the staff, the patients, and the clinical challenges that the organization faces, but they can also be involved in higher-level discussions and the administrative decision-making and leadership required for clinics to maintain safety and quality reporting.

In this article, I’ll share some of my insights into how leveraging a virtual medical director works, the benefits they can bring to an organization, and how on-site teams can build trust with a virtual medical director.

How leveraging a virtual medical director works

In many places across the country, our providers serve as virtual medical directors as well as behavioral health providers. Generally, the hours are divided so the providers and staff can know which hat is being worn when.

For example, we carve out administrative time with regular meeting cadences to meet with staff and go over things like policy reviews, safety incidences, and quality metrics – and perform supervisory services when needed. That provider will also have clinical hours where they deliver psychiatric services to patients through regular appointments.

It’s important to delineate how the provider uses their hours each day to prevent confusion. There are always a lot of patients to see, so the medical director may not have the time to do the administrative work if it’s not scheduled. Setting goals, having a solid job description and expectations, and protecting time for weekly administrative and leadership meetings are essential to success in the medical director’s role.

How to build trust between an on-site staff and virtual medical director

The way humans interact is really changing. While the gold standard in healthcare has been in-person care, on-site behavioral health services aren’t always available — this became painfully apparent during the pandemic. Not only did clinics and hospitals need more providers to serve the surge of patients seeking behavioral healthcare, they needed new leadership models and staffing structures.

Telemedicine enabled us to serve so many clinics and hospitals around the country, but coming out of the pandemic, we also knew that being an organization that clinics and hospitals could trust to do virtual care well was important. We were able to demonstrate that finding a virtual behavioral health provider who can be a leader and who truly cares about your community and your clinic helps build that trust – even if they’re three or four states away.

At Iris, we’ve found the key to building that trust is open, honest, and transparent communication — it’s at the core of everything we do. We get to know the on-site team members on a first-name basis and become comfortable with each other clinically, professionally, and personally. Our goal is for our virtual behavioral health providers to be as accessible as any on-site provider might be — that’s one of the ways to build trust.

As a provider, I’ve also found making yourself available online, just as you would in person, is helpful for building trust and engagement with an on-site team.

For example, leaving your office door cracked is the universal sign that you’re available to staff when you’re not with a patient. With virtual care, leaving your video on between patients or meetings allows staff to virtually pop in and say “hi” or ask a question related to patient care. So even if you’re on a screen, the on-site staff feel like you’re present. That’s the quality and integrity of the interactions we strive for at Iris.

How to set your virtual medical director up for success

Setting up your medical director for success involves developing clear goals and objectives as well as clear boundaries.

A few questions we’ve found helpful to ask in this process are:

  • How many hours will your medical director need for the administrative function?
  • Who held this role before? What were their challenges? Why did they leave?
  • What are the expectations of this role?
  • What meetings, supervision, and oversight are required in this role?
  • What would success in this role look like to your team?

We’ve helped many organizations develop job descriptions to help them answer these questions as they pertain to their unique clinical workflow and staffing matrix.

For example, a remote medical director might be responsible for working with the Chief Financial Officer or operations team. They might need to put together presentations to demonstrate the safety and quality initiatives your organization is tracking and how your organization responds to – and measures the success of – new initiatives.

Additionally, there are financial metrics, quality reports, coding, and all sorts of things a virtual medical director is regularly reviewing.

Breaking down the responsibilities of a virtual medical director

A medical director’s role is really focused on directing the clinical delivery of care and the quality, safety, and integrity of that care so patients get the help they need and providers get the support they need. This can be done through virtual leadership just as easily as through traditional on-site leadership.

In my experience, supporting teams of providers – including doctors, nurse practitioners, nurses, and therapists –is very meaningful whether it is done in person or virtually.

Medical directors can be a sounding board for providers to bounce ideas off of as well as a resource for dealing with challenging clinical cases. Behavioral health patients can have high levels of acuity and sometimes have needs that providers can’t meet, so supporting colleagues and staff in their efforts to deal with dissatisfied patients can be very helpful.

Again, such support can be offered virtually by a medical director just as it might be done in person.

Where Iris Telehealth fits in

By working with a virtual care provider like Iris, your organization has a larger pool of providers to draw from. Whether you have a small office or a large clinic that needs help finding a medical director, we can help you find one that your staff and patients will enjoy working with.

If you’d like to learn more about our experience matching organizations with a virtual medical director, be sure to read through our case study from Chesapeake Integrated Behavioral Healthcare in Virginia. You can read the full piece here.

If you‘d like to talk to someone about potentially hiring a medical director, be sure to contact us today. We’d be happy to talk through the process and learn more about your needs.

Dr. Tom Milam manages our team of clinicians and guides them in telemedicine and industry best practices. He received his undergraduate degree from WVU in Anthropology, graduating summa cum laude, and received his M.D. from the University of Virginia. His residency training in psychiatry took place at Duke and UVA. Dr. Milam has served in a leadership role throughout his psychiatric career and spearheaded the telepsychiatry initiative at his previous hospital.