Chasing the Curve: Program Description of the Geisinger Primary Care Behavioral Health Virtual First Response to COVID-19

In response to the COVID-19 pandemic, an initiative to rapidly transition to a telebehavioral health (TBH) service delivery model was developed to maintain access to primary care behavioral health (PCBH) services at Geisinger, a predominantly rural health system based in Central Pennsylvania. In line with the "Virtual First" approach employed by Geisinger's Department of Psychiatry and Behavioral Health, we describe how we transitioned to TBH services while facilitating communication and collaboration among PCBH providers, staff, and trainees, and supported our Geisinger colleagues during the initial months of the pandemic. We report outcomes of our Virtual First approach from March 2020 through June 2020, as well as provider surveys of acceptability and usability of the InTouch platform used for TBH. We found that we were able to attain or surpass comparable patient access and utilization by implementing TBH services compared with in-person services over the last 2 years while maintaining a training program. InTouch was found to be acceptable and usable overall based on provider ratings, although it does not include capabilities that would further enhance access such as group treatments or shared office visits with the BHP and primary care clinician. Our Virtual First approach enabled us to maintain access and utilization of PCBH services during a time of widespread uncertainty and behavioral health vulnerability in rural regions. We conclude with a discussion of the limitations of our approach and the next steps in navigating the "new normal" of behavioral healthcare in the age of COVID-19. Public Health Significance Statement This program description serves as a salient case example of successfully navigating the rapid transition to TBH services necessitated by the first wave of the COVID-19 pandemic in 2020. Planning and co-ordination of communication and task work among team members and an existing TBH platform capable of rapid scaling enabled rural access and utilization of PCBH services at Geisinger at comparable levels to the previous 2 years.