Behavioral Provider Uses ‘Trial by Fire’ to Turn Telehealth into Sustainable Long-Term Tool

Before the coronavirus, Turning Point Counseling Services admittedly had no experience with remote care models. But today, telehealth represents nearly all of the small Alaskan behavioral health provider’s business.

And going forward, virtual care delivery will remain an important part of the Fairbanks-based agency’s strategy, according to Nick Kraska, chief operating officer and CFO of Turning Point Counseling Services.

Kraska recently connected with Behavioral Health Business to discuss the company’s ‘trial-by-fire’ effort to make it all possible, as well as the administrative and payer burdens that have come with it.


You can find all that and more in the conversation below, edited for length and clarity.

BHB: How many patients do you serve and what services are most common for you guys?

Kraska: Turning Point is a full-service provider of behavioral health and substance abuse outpatient services. We offer everything from individual and family counseling to an intensive outpatient counseling program for substance abuse, and our counselors see patients with a wide array of diagnoses.

Currently, we are providing services to approximately 2,000 active patients each year. Our 13 counselors engage in upwards of 400 patient visits during our busiest weeks.


How much telehealth were you doing before the coronavirus hit?

None of our team had ever engaged with remote care models. It was a brand new undertaking for us and very much a trial-by-fire effort.

We had to rapidly make the transition once we realized it was the only way to ensure continuity of care for our patients with stay-at-home orders in place.

We were fortunate that our existing electronic health record (EHR) from InSync Healthcare Solutions offered telehealth functionality. So while many groups were scrambling to figure out how to make telehealth work, we simply consulted with our vendor partner and were up and running within less than 24 hours.

How much telehealth are you doing today?

We’ve been using the telehealth model for about six months now, and it still represents about 90% of our outpatient clients and 100% of our substance abuse intensive outpatient program clients. Some patients have returned to in-person care, but we are finding that other patients prefer the virtual sessions.

In particular, we have seen improvements with our higher-level care substance abuse program. Following the introduction of virtual sessions, that program has seen nearly 100% attendance and a very high graduation rate.

We are also finding that remote care works well for trauma patients because they feel safer participating in counseling from the comfort of their homes.

What was the biggest challenge you’ve had in adopting telehealth?

It was unchartered territory with a lot of unknowns. Turning Point is very focused on personalized care, and we had a lot of questions about how that would translate within a virtual counseling model.

Would counselors be able to engage with patients on the same level? Would patients respond in ways that would promote optimal outcomes?

Much of our concern was unfounded. Our patients were willing to do whatever it took to continue treatment, and staff and patients found the telehealth application very easy to use.

While there have been some minor technical issues, the overall technology experience has had very few hiccups. For example, there were cases where patients said they missed email reminders for sessions.

Reimbursement was another area of concern, as there were many unknowns in terms of payer expectations. We were afraid our practice would experience billing issues or claims denials as part of the learning curve.

To counter that, we have made it a priority to improve collaboration with our health plan partners and have found that each claim requires a very individualized approach as both providers and payers figure out these new care processes.

Administratively, I would say that our workload has doubled due to the individualized care each claim requires, depending on each insurance payer group.

Are there any areas telehealth hasn’t been able to help you with?

It has not made billing claims easier. In addition, networking with other agencies and making “warm hand-offs” of patients from agency to agency is more complicated. While patients have responded well to telehealth, it does not foster the same personal touch our agency prides itself on.

Being in Alaska, how do you deal with the issue of spotty connectivity in rural areas?

Most of our patients do not come from rural areas, but our experience working with the few we have has been a good one.

Honestly, we require clients to have internet connectivity sufficient for virtual sessions.

We have at times turned a spotty session into a phone session, but there have also been a few situations where we had to suggest an alternative such as in-person care. When a patient without sufficient connectivity lives too far for in-person care, we help them find another local provider.

How will telehealth factor into your care delivery model in the future?

We do believe that telehealth is a sustainable model for our practice and have made it part of our future strategy. Because we already had a HIPAA-compliant solution built into our EHR, we do not foresee the need to make any substantial adjustments to our offering.

In addition, patient notes integrate directly into the EHR, which keeps us from having to duplicate efforts.

With this infrastructure in place, we plan to evaluate the feasibility of expanding these services to more remote, underserved areas of our region.

What needs to happen to make sure telehealth remains a sustainable long-term tool for behavioral health providers?

The first thought that comes to my mind is to ensure that private insurance companies understand the need for telehealth, as well as its positive impact on care.

We have had a ton of private payer groups deny telehealth services, yet the work we are doing is the same work as if patients were sitting in front of us, face-to-face.

I think that if telehealth slowly dissolves, it will be because insurance companies stop paying for it. Otherwise, it is a sustainable long-term tool in our opinion.

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