Bradley Hospital launched the REACH program in 2020, when the COVID-19 pandemic forced outpatient care online. The virtual partial hospitalization program provides intensive treatment for children stepping down from inpatient treatment, or stepping up from outpatient therapy.
Ellen Hallsworth, director of the REACH program at Bradley Hospital, told Becker’s that REACH hopes to expand its geographic footprint in the future. Though reimbursement challenges remain for virtual programs, more insurers and state Medicaid programs are expressing interest in virtual partial hospitalization, she said.
Ms. Hallsworth explained the benefits of virtual partial hospitalization and the future outlook for this program to Becker’s.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What are the challenges in virtual partial hospitalization programs? How do you mitigate those?
Ellen Hallsworth: When we started doing this work as a result of the COVID pandemic, everything but our inpatient services went virtual. A lot of stuff didn’t work virtually, but one of the things that did was our partial hospitalization program. We saw a lot of advantages in terms of seeing kids participating who wouldn’t have been able to drive to the hospital every day, which is a huge win. We saw parents engaging more. Our clinicians really like treating kids in their home environment. When they come to the hospital for an in-person program, it’s an artificial environment, whereas we’re seeing their bedrooms with their pets, and it helps us help them with their problems in real time.
I think the challenges are, when people start the program, they generally really like our staff. We have some really talented behavioral health specialists, and they do a great job keeping kids engaged. But parents are often quite skeptical of kids being home all the time, missing school. Once they start, they see how engaging the program is, and see the benefits. But it can be a push to get them on the red line to start engaging.
One of the barriers we saw initially was that families have been scarred by virtual schools, or had a bad experience with virtual school, and thought this would be similar. We’ve heard again and again that it’s not like virtual school. It’s much more engaging. Kids really form bonds. The first year, people kept saying, “I didn’t think virtual would work, but it was great.” Then, the feedback really ceased to mention virtual. There’s a lot more focus on therapists, on connecting with people with the same kinds of problems. I think the virtual piece is fading into the background, and it’s the quality of the treatment that stands out.
Q: What are the regulatory issues you’re watching?
EH: For us, [Drug Enforcement Administration] teleprescribing is something we’re watching closely as a system, and in the Bradley REACH program in particular, because we do prescribe controlled substances, mainly stimulants, to kids. The program in Florida is based in an area where there’s a really high shortage of child and adolescent psychiatry. The great thing about telehealth, because we’re Brown University Health, a lot of child psychiatrists want to work here. They want our name on their CV, even if they don’t want to move to Rhode Island. That means we’re able to connect really talented psychiatrists, psychologists and social workers with kids in Florida who just wouldn’t have access to this level of specialist care otherwise. Telehealth prescribing has a long period of uncertainty around it. We feel there are ways we can work around it, by working with primary care providers. But for some of the more disadvantaged kids in Florida, they don’t have access to primary care. If they don’t increase the level of flexibility from what they’re proposing, there’s going to be a decrease in access to care, which is unfortunate.
The other thing is reimbursement. In some states, Medicaid doesn’t reimburse virtual partial hospitalization, which limits how we can expand the program, and again, limits access to care. There are some payers who said they would stop reimbursing virtual partial hospitalization. There’s ongoing uncertainty around virtual PHP and virtual intensive outpatient too, which is unfortunate, because there’s a growing interest in them. There’s growing recognition they can play a really important role in keeping kids out of the hospital, the ER, and making sure they get treatment close to home.
Q: What’s the path forward for reimbursement for intensive virtual programs?
EH: Data is going to be key. Mental health often lags other areas of healthcare in terms of data. We’re working on this on our team, and others are too, building really solid outcomes data to show we’re helping kids get better, and longitudinally, we’re helping them stay out of the hospital, and even helping with things like school attendance. That’s a challenge, but it’s also a really big opportunity for people in this field. Anecdotally, we know we’re helping kids in this way, but to convince insurers, we’re going to have to provide the data.
