Page 6 CaseStudiesinTelehealthAdoptionTheVATakingHomeTelehealthServicestoScaleNationally

6 The commonweAlTh Fund

appropriate delegation and scope of practice) without system. The VHA also provides patients with the abil-
the patient having to be automatically seen by a pri- ity to authorize sharing of electronic patient record
mary care physician. data, such as prescriptions or lab results, through the
Ensuring the VHA has a competent telehealth “Blue Button” application. Blue Button is a convenient
workforce has been a critical component of its strategy and secure method for patients to retrieve information
to expand services nationwide. Standard professional in plain text via the Internet. In addition to the 6 mil-
training does not include telehealth. To remedy this lion veterans who receive care through the VHA, the
situation, the VHA has established a dedicated national VHA plans to also make the Blue Button application
CCHT training center. Formal telehealth certification available to the 17 million veterans who receive care at
does not exist, but the VHA ensures regular competency non-VHA health providers and hospitals. 14
assessments and requires that staff are trained as part of
its internal reviews of telehealth programs. Care coor- EVIDENCE OF OUTCOMES IN HOME
dinators undergo a three-to-five-week intensive train- TELEHEALTH
ing course in the requisite skills and competencies. The The VHA has found that an enterprise-wide home
center has trained over 5,000 staff members, to date. telehealth system is an appropriate and cost-effective
Eligible patients are offered the choice to means of managing chronic care patients in both urban
receive CCHT-based care or other noninstitutional care and rural settings. Studies that compared data from
services. Among those offered home telehealth, only the year before entering the program and six months
10 percent prefer to use the more traditional in-person postenrollment show a 25 percent reduction in bed
encounters. When a patient is enrolled, the care coor- days of care, a 20 percent reduction in number of
dinator selects the appropriate home health technol- admissions, and a mean satisfaction score rating of 86
ogy using an algorithm based on a patient’s needs, the percent. Decreases in health resource utilization were
complexity of the disease or condition, and the indi- largest in highly rural (50.1%) and urban (29.2%)
vidual’s ability to use technology. The algorithm helps areas, for mental health-related conditions, and for
determine which CCHT device (videophone, messag- patients with multiple conditions. Patients’ acceptance
ing device, biometric device, digital camera, or tele- of CCHT was high, with only 10 percent declining
monitoring device) is most suitable and cost-effective services. The cost for CCHT ($1,600 per patient per
for each patient’s use. Upon device selection, the care year) compared favorably with the direct cost of VHA’s
coordinator gives the patient and caregiver the required home-based primary care services ($13,121 per patient
13
training. per year) and market nursing home care rates (an aver-
On an ongoing basis, the coordinator reviews age of $77,745 per patient per year).
telehealth monitoring data and provides active care Exhibit 3 summarizes the reduction in health
or case management. Each patient is classified on the care resource utilization (defined as hospital days
basis of his or her risk level, which is assessed daily of stay) by the condition monitored and for patients
according to preset thresholds, with alerts if any signif- monitored for single or multiple diagnoses. There is
icant changes arise in the patient’s symptoms or behav- wide variation across conditions. Although the reasons
ior that require intervention and management. When accounting for such variation are not exactly clear,
alerts occur, care coordinators intervene as necessary. the most likely explanation is a reflection of the case
For instance, a coordinator may call a patient to verify mix in that disproportionate numbers of patients are
a potential exacerbation of their condition to prevent an involved for specific conditions as well as the fact that
emergency room visit or hospitalization. certain conditions affect patients more severely than
Care coordinators coordinate patients’ care others.
even when they receive care services outside the VHA