Page 4 Case Studies in Telehealth Adoption Scaling Telehealth Program sLessons from Early Adopters

4 The commonweALTh Fund

receiving home telehealth. The reduction in health care on an enterprise scale. With more than 70,000 patients
resource utilization (defined as hospital days of stay) receiving telehealth-supported care management in
from 2004 to 2007 is significant across eight primary 2012, the VHA’s experience demonstrates that imple-
conditions for patients monitored for either single or mentation at scale is possible and can yield substantial
multiple diagnoses (Exhibit 1). returns. Some of the VHA’s keys to success include:
The VHA’s national telehealth program has • Aligning telehealth strategy with organizational
been developed through strong leadership support, vision and mission. The VHA’s success with
articulation of a strategic vision and compelling telehealth is evidence of the organization’s ability
business case, and an underlying health information to connect vision, strategy, and technology in the
technology infrastructure. Coupled with a strong com- delivery of continuous, coordinated chronic care
mitment to standardized work processes, policies, and for targeted populations at risk for long-term insti-
training, the program has transformed care coordina- tutional care. The experience serves as a strategic
tion to successfully meet the chronic care needs of an and operational blueprint for other organizations
aging veteran population while reducing their utiliza- looking to implement telehealth at scale.
tion of and costs associated with institutional care.
Other integrated delivery networks or government- • Leveraging underlying human and social pro-
sponsored systems can benefit most from VHA’s cesses. The VHA has instilled an organizational
lessons learned. From the perspective of patient care culture and capacity for technology-led change.
coordination, the lessons may be most applicable to the This has resulted in the telehealth program being
Medicare–Medicaid dual-eligible population. embraced by the national and local leadership, as
The VHA attributes the rapidity and robustness well as by the population it is designed to serve.
of its CCHT implementation to the systems approach The staff that originally started the program has
taken to integrate the clinical, technology, and business since advanced to more senior positions through-
elements of the program based on experience gained out the organization, effectively becoming champi-
from piloting. For example, CCHT incorporated exist- ons for the program.
ing business processes wherever possible to reduce • Generating systematic evidence of targeted out-
the program’s overhead costs and increase efficiency comes. Targeted outcomes have been maintained

Exhibit 1. VHA Care Coordination/Home Telehealth Program Outcomes, 2004–07

Percent decrease
Condition Number of patients in utilization
Diabetes 8,954 20.4%
Hypertension 7,447 30.3
Congestive heart failure 4,089 25.9
Chronic obstructive pulmonary disease 1,963 20.7
Post-traumatic stress disorder 129 45.1
Depression 337 56.4
Other mental health 653 40.9
Single condition 10,885 24.8
Multiple conditions 6,140 26.0

Source: A. Darkins, P. Ryan, R. Kobb et al., “Care Coordination/Home Telehealth: The Sytematic Implementation of Health Informatics, Home Telehealth, and Disease
Management to Support the Care of Veteran Patients with Chronic Conditions,” Telemedicine and e-Health, Dec. 2008 14(10):1118–26.