Page 7 CaseStudiesinTelehealthAdoptionTheVATakingHomeTelehealthServicestoScaleNationally

The VeTerAns heAlTh AdminisTrATion: TAking home TeleheAlTh serVices To scAle nATionAlly 7

to expand access to care services and make the home
Exhibit 3. Outcomes: VHA Care the preferred place of care. The decision to imple-
Coordination/Home Telehealth 2004–07
ment telehealth received strong support from the VHA
Percent leadership, and a telehealth pilot involving the remote
Number of decrease in monitoring and patient self-management of nearly 900
Condition patients utilization patients was launched in 2000. The results of the pilot,
Diabetes 8,954 20.4 which demonstrated reductions in hospital admissions
Hypertension 7,447 30.3 and bed days of care as well as high levels of patient

Congestive heart 4,089 25.9 satisfaction, formed the basis for the model that has
failure become the national standard in the VHA since 2003.
Chronic obstructive 1,963 20.7 Although initial evidence for an innovation is
pulmonary disease
Post-traumatic stress 129 45.1 necessary, it is often not sufficient for widespread dif-
disorder fusion. Ongoing monitoring of the clinical outcomes
Depression 337 56.4 has demonstrated repeatedly high levels of patient

Other mental health 653 40.9 satisfaction and reduced resource utilization and has
supported the continued growth of telehealth within the
Single condition 10,885 24.8 VHA, validated the positive benefits, and strengthened
Multiple conditions 6,140 26.0 the program’s ability to spread home telehealth ser-

Source: A. Darkins, P. Ryan, R. Kobb et al., “Care Coordination/Home vices more broadly throughout the organization.
Telehealth: The Systematic Implementation of Health Informatics, Home The VHA’s experience with home telehealth
Telehealth, and Disease Management to Support the Care of Veteran
Patients with Chronic Conditions,” Telemedicine and e-Health, Dec. 2008 programs highlights the potential of alternatives to
14(10): 1118–26.
traditional care models to drive substantial benefits.
The experience also demonstrates that implementation
Leaders of other health care organizations at scale is possible and can yield substantial returns
have been dismissive of the applicability of the VHA’s across both time and geography. Successful implemen-
results, noting that the VHA is both payer and pro- tation was centered around reengineering of existing
vider and therefore has completely aligned incentives processes coupled with a strong IT infrastructure and a
and underlying systems for aggressive management commitment to training.
of chronic diseases. However, other programs—some The following are key factors that have led to
in highly fragmented environments—have been able the VHA’s ability to successfully pilot and implement
to achieve similar results to those of the VHA. For home telehealth at scale.
instance, the Health Buddy Project, a Medicare tele- Systematic evidence of targeted outcomes.
health demonstration project, was able to enroll more The pilot program validated the evidence initially
than 700 patients in two areas of the Pacific Northwest. found in the literature of small-scale interventions suc-
The program’s first phase, from 2006 to 2009, showed cessfully using home telehealth with chronic disease
a 240 percent return on investment for Medicare. 15 patients to support independent living and reduce

hospital admissions. The program has continued to
KEY SUCCESS FACTORS IN TAKING HOME demonstrate systematic evidence of targeted outcomes:
TELEHEALTH FROM PILOT TO SCALE reductions in bed days of care and hospital admissions,
The VHA first considered a role for telehealth in as well as high levels of patient satisfaction, all with-
noninstitutionalized care in the mid-1990s. Rather out diminishing the health status of participants. Such
than technology being the driver, the impetus for evidence has been important in expanding the scale of
introducing telehealth was the need to address the the program. As it has grown, the evidence has made a
care demands of chronically ill, aging veterans and