Page 3 CaseStudiesinTelehealthAdoptionTheVATakingHomeTelehealthServicestoScaleNationally

The VeTerAns heAlTh AdminisTrATion: TAking home TeleheAlTh serVices To scAle nATionAlly 3

BACKGROUND a top-performing health care organization to a combi-
The Veterans Health Administration within the U.S. nation of factors, including a strategic vision and com-
Department of Veterans Affairs (VA) is regarded as a pelling case for system-level transformation; leadership
modern, responsive, efficient, and effective health care support and shared decision-making authority between
organization that many hold up as a model for deliver- officials in the central office and regional managers
ing cost-effective, quality outcomes. While it faces and key personnel at the local level; continuous and
similar financial and clinical challenges as other health accountable performance improvement processes tar-
care delivery organizations, the VHA is unique in geted toward incentivizing the delivery of interdisci-
terms of the health care needs it addresses among the plinary, team-based, patient-centered, quality care ser-
veteran population and in being directly accountable to vices at a reasonable cost; and a technology architec-
Congress and financed primarily from public budgets. ture that has served as the backbone for implementing
As one of the nation’s largest integrated health care enterprise-wide EHRs and health information systems
systems, the VHA’s primary and specialty care ser- and allowing the organization to align its mission with
vices serve approximately 6 million veterans with an quantifiable strategic goals and performance indica-
annual budget of more than $50 billion. It is organized tors. The potential value to the VA from investments in
around a service network model rather than hospitals. health information technology is just over $3 billion in
Each of the 21 Veterans Integrated Service Networks cumulative benefits (net of investment costs) through
(VISNs)—or shared systems of care—operates with reductions in unnecessary and redundant care, process
accountable clinical leadership responsible for mak- efficiencies, and improvements in care quality. 3
ing basic budgetary, planning, and operating decisions Reducing hospital readmissions has been an
(Exhibit 2). important performance improvement goal at the
The shift toward continuous, coordinated, and VHA. Higher readmission rates within the VHA have
comprehensive primary and specialist care services been generally associated with patients who are at
2
started in the mid-1990s. Observers have attributed an increased distance from the admitting facility and
4
the VHA’s successful transformation from a bottom- to experience higher comorbidity scores. In fiscal year
2009, the VHA reported that the 30-day unadjusted
all-cause readmission rate averaged 12.7 percent (with
Exhibit 2. Veterans Administration: a range of 0 to 17.7%) across the VHA health care sys-
Demographics and Health Care Utilization tem. During this period there were 485,774 acute medi-

Population cal/surgical discharges and 81,634 mental health hos-
Projected U.S. veterans population 22,328,000 pital discharges reported by the VHA. The unadjusted
Sex readmission rate for congestive heart failure was higher
Female 10% than the VHA national average (20.2%) at 12 facilities
Age
65 years or older 42.1% and significantly lower than the VHA national average
5
Race at 10 facilities. Structural and organizational interven-
White 83.0% tions using technology, like telehealth, are particularly
Black 11.9% promising in terms of offering improved access to
Hispanic 6.1%
Veterans Health Affairs health care and providing superior quality of care.
Total enrollees 8.57 million Care Coordination/Home Telehealth was
Total unique patients treated 6.17 million developed by the VHA to respond to the rising number
2011 appropriations (actual) $51.5 billion of elderly veterans with chronic care needs and reduce
Hospitals 152
Community-based outpatient clinics 817 their use of institutional care and its associated high

Source: National Center for Veterans Analysis and Statistics. costs. Group Health’s Chronic Care Model serves as
the conceptual framework for CCHT and has helped