Page 4 CaseStudiesinTelehealthAdoptionTheVATakingHomeTelehealthServicestoScaleNationally

4 The commonweAlTh Fund

move toward the goal of making the patient’s home who oversees CCHT, adds that the basic care needs,
into the preferred place of care where possible and staffing, and use of technology to coordinate care,
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appropriate. Promoting patient activation and self- as well as design and operational details will vary to
management is fundamental in the CCHT model to accommodate differences in health care delivery orga-
prevent unnecessary hospital admissions or emergency nizational models.
department visits. The VHA’s experience indicates that The current program’s origins date back to
the messaging functionality within home telehealth ser- the mid-1990s, although the VHA’s involvement with
vices supports this goal through proactively identifying telemedicine dates back to 1977 when it piloted the
adverse symptoms, knowledge deficits, and negative use of telemedicine in Nebraska. Home telehealth
health-related behaviors. Reduced use of health care as discussed in this case study only came to the fore
resources for CCHT’s patient population is attributed in the mid-1990s, when it was introduced to address
to patient self-management, disease management, and patient need. The primary goals were to expand access,
the use of virtual visits. provide care as close as possible to the patient’s com-
munity, and make the home the preferred place of
HOME TELEHEALTH: TAKING A PROGRAM care when appropriate. The clinical leadership of the
FROM INITIAL PILOT TO SCALE regional VISN in South Florida and the Caribbean,
Today, the VHA is the largest individual purchaser of VISN 8, originally conceived the program with the
home telehealth technology worldwide and it plans goal of creating a cost-effective mode of avoiding
to increase the size of its program considerably. The higher-cost institutional care and supporting aging vet-
VHA’s history has made it the health care industry’s erans in their homes and communities. The initial pilot
test case for how to successfully plan and implement a focused on the 4 percent of the noninstitutionalized
program that has been embraced throughout the organi- veteran population in the network who were driving
zation from senior leadership to the patient population. approximately 40 percent of costs. 7
However, the VHA has faced many of the same chal- VISN 8 conducted a telehealth pilot from 2000
lenges as other health care organizations in implement- to 2003 in its integrated system of seven hospitals, 10
ing technology into care delivery practice. Namely, multispecialty outpatient clinics, and 28 community-
scaling a process that reproduces the financial and care based primary care clinics. With a population of
outcomes from pilots while ensuring sustainability of approximately 900 patients, the pilot included moni-
the clinical, technology, and business processes neces- toring along with patient self-management and use of
sary to support home telehealth. relatively simple home telehealth devices. The pilot
Implementation at the VHA has centered was associated with a 40 percent reduction in emer-
around reengineering existing processes, a strong IT gency room visits, a 63 percent reduction in hospital
infrastructure, and a commitment to training. The VHA admissions, and an 88 percent reduction in nursing
attributes the rapidity and robustness of its CCHT home bed days of care, as well as a high (94%) level
implementation to the systems approach taken to inte- of patient satisfaction. The pilot formed the basis for
grate the clinical, technology, and business elements the model that was implemented nationally in the VHA
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of the program based on its experience with pilot after 2003. The national model also achieved high
programs. For example, CCHT incorporated existing rates of patient satisfaction and reductions in resource
business processes wherever possible to reduce the utilization.
program’s overhead costs and increase efficiency. The When developing the national program, the
VHA experience demonstrates that implementation VHA’s senior leadership was committed to putting
at scale is possible and can yield substantial returns into place the necessary infrastructure. Core elements
across both time and geography. Dr. Adam Darkins, included developing algorithms for selecting patients