Transcript Care Coordination/Home Telehealth to Support the Care of

Care Coordination/Home Telehealth to Support the Care
of Veteran Patients with Chronic Conditions
Adam Darkins, Chief Consultant for Care
Coordination, The Department of Veterans
Affairs
December 17, 2008
Care Coordination/Home Telehealth
• Mission: To ensure the right patient receives the right
care in the right place at the right time.
• Vision: To change the location of care whenever safe,
appropriate and cost-effective with the intent of making
the home and local community the preferred place of
care for veteran patients if this is their preference.
TELEHEALTH IN VHA
General “Real-Time” Telehealth (CCGT)
Home Telehealth (CCHT)
Store-and-Forward (CCSF)
Veteran Population Age 85 and Over
2000-2020
All Veterans 85 and Older
1,400
1,000
800
600
400
200
0
20
0
20 0
01
20
0
20 2
0
20 3
0
20 4
0
20 5
06
20
0
20 7
0
20 8
09
20
1
20 0
1
20 1
1
20 2
1
20 3
1
20 4
1
20 5
1
20 6
1
20 7
1
20 8
1
20 9
20
(in thousands)
1,200
Source: 2004 Vet
Pop
AUTHORITY AND ELIGIBILITY
NON – INSTITUTIONAL CARE
 VA is authorized by statute (Eligibility Reform Act, Millennium Act)
and required by regulation (38CFR17.38(a)(1)) to provide noninstitutional home and community-based extended care as part of
the VA medical benefits package.
 VA policy is to provide non-institutional services to all enrolled
veterans who need them.
 Eligibility is not restricted by age.
 All enrolled veterans who need such services are entitled to have
access to them regardless of priority status
 VA policy is to provide care in the least restrictive setting that is
safe for the veteran.
 Some veterans may be required to pay a co-payment for
certain services.
Care Coordination/Home Telehealth
Vital sign data
HOME
Disease management data
E-health information
National VHA Care
Coordination Infrastructure
Ethernet
Patient
VSB
Caregiver or
Care Provider takes
measurements
56k
Telecom server
DSL
Databases
Cable
Health data repository
Firewall
Data is linked to
Intranet and sent to VistA
Encryption
PKI
Internet
Intranet
Hospital
Utilization Measure = Bed Days of Care
Utilization Measure = Bed Days of Care
Summary Outcomes
Program
Admissions
BDOC
Health Status
Satisfaction
Cost
CCHT
20%
25%
VR12
86%
$1,600 p.a
Outcomes data for a cohort of 17,025 CCHT patients comparing 6
months post entry into program with previous indices. Source routine
CCHT data for program management
SUPPORTING INFRASTRUCTURE
Program
Training
COPs
Dashboard
IT (Home)
IT (VHA)
CCHT
6,000 Staff
21 VISNs
21 VISNs
COTS
Enterprise
COLLABORATIONS
CCS
PCS
OQP
DSS
EES
ORH
ONS
OIT