Integrating Care in a Changing Policy Climate- Where Telehealth Fits In
The Center of Excellence for Integrated Care (COE) is committed to helping health systems integrate physical and behavioral healthcare services. They are a team of professional and licensed behavioral health clinicians who understand the value of and advocate for integrated care as a key component of whole-person health. As North Carolina slowly but surely moves the needle towards a more integrated healthcare delivery system, telehealth emerges as one tool to supplement this progress. Monica Harrison, Associate Director of COE, talks about the backdrop onto which telehealth joins the scene.
Within the past year, telehealth has assumed a greater spotlight in state level decision-making. COE currently consults on two task groups dedicated to the topic: one comprised of stakeholders from across the state and spearheaded by the NC Rural Health Leadership Alliance (link to NCRHLA article), and the other a regional group-the NC Healthcare Information & Communications Alliance, Inc. Telehealth Taskforce. This change is concurrent with new Department of Health and Human Services direction under the leadership of Secretary Mandy Cohen, a fellow advocate for whole-person approaches to care, especially in rural communities. But before change can be seen in implantation, change needs to be made at the policy level. The good news is that the North Carolina General Assembly continues to work towards a system in which physical health services will be included in all Medicaid managed care products. Currently under review in the House is HB967: Telemedicine Policy. In the current model, behavioral health services are managed through Primary Care Case Management (PCCM) programs, while behavioral health services are managed by local management entity-managed care organizations (LME-MCOs). If and when such changes are incorporated, new billing codes can be determined and implemented for services such as telehealth-rendered care and pathways to access can be determined for providers and patients alike. The DHHS estimates that this coordinated care plan stands to benefit nearly 1.8 million beneficiaries. COE supports these changes as progress towards a more integrated care model.
As a professional in health care, Monica perceives a hesitancy in some stakeholders when it comes to implementing virtual care—a concern that we may inadvertently be replacing traditional care and that face-to-face contact will always be important. It is also worrisome that easily implementable practices may 
continue to benefit those already plugged into the system, while substantial upfront costs will be required to bring the materials, training, and infrastructure required to more rural areas. Finally, as new systems are implemented into existing work flows, there may be fear that without well established guidelines, corporations may be able to cut corners. However, there is some comfort in bringing in exerts from states with similar health profiles to North Carolina on board to guide implementation. An excellent example of leveraging this expertise is Jay Ludlam, the Assistant Secretary for Medicaid Transformation for the Division of Medical Assistance who leads the transformation of the NC Medicaid and NC Health Choice programs. Ludlam was the former Missouri HealthNet Deputy Division Director, where he led the implementation of Medicaid expansion that benefitted more than 750,000. This experience is invaluable in enacting a vision of a more sustainable and progressive system here in North Carolina.
As change in healthcare management moves forward, policy and practice are two gears that push each other along. From their boots on the ground perspective in practice, COE continues to support policy change that supports their mission. At the end of the day, says, Monica, “It’s all about asking-how do we expand our reach and increase access, and be innovative about doing that?”.
Additional resources:
https://www2.ncleg.net/BillLookup/2017/H967
https://www.ncdhhs.gov/jay-ludlam