Blue Button is not the only Innovation at the Veterans Administration

By Alice Borrelli, director of Health Policy for Intel

All of us in healthcare are united by the same goal: better care at a lower cost. The Health Affairs session, Early Evidence, Future Promise of Connected Health last week told a compelling story about programs that are working to bring low cost solutions for chronic patients, while highlighting the continued legislative and regulatory barriers that are preventing wide spread use of telehealth for chronic disease. remote care pictureSuccess stories came from all around the country — Chicago, New York, Montana, Boston, Arkansas and California, but the Veterans Administration (VA) continues to lead not only the U.S., but the world in the volume of patients treated through telehealth and they are getting dramatic results. Through programs set to daily monitor blood pressure, weight and glucose levels, the VA is improving the health of its patients. The Care Coordination Home Telehealth Program (CCHT) started in 2003 and reached 132,000 vets in 2012. Data from a cohort of 17,025 CCHT patients showed: 1) a 25% reduction in numbers of bed days of care; and 2) a 19% reduction in numbers of hospital admissions. Plus the patients report that they like the care, showing an 85% satisfaction rate. 

With these amazing results, why haven’t we heard more about the VA’s telehealth success than their Blue Button phenomenon when in fact, the program is significantly lowering costs? Add to these numbers, the additional vets treated through clinical video telehealth, store and forward telehealth and eConsults, and the number totals 800,000 annually.  

In policy circles, the VA results are often dismissed since it is a closed system, too different to be used in the private pay and Medicare marketplaces. Yet, the veterans receive 50% of their care outside of the VA facilities in the same hospitals and doctor’s offices that the rest of us use. The difference: the VA has focused on Connected Health using Patient Aligned Care Teams and standardized telehealth approaches to daily monitor their patients with chronic heart failure, COPD, diabetes and other chronic diseases. The VA uses standards of care, communications protocols and reporting systems that are driving improvements with measureable outcomes for our veterans. At the same time, they are inserting this patient generated data into their electronic health records to give a complete picture of the veteran’s health based upon daily data.  

By introducing the daily data feeds from patients, the VA has been able to target the chronically ill patients where telehealth will supplement and even improve face to face visits by providing a longitudinal view of the patient. As 30 million more patients move into the insured markets, this is the time to rethink how care is delivered and integrate Health IT to extend the reach of clinicians and care givers. 

The next time you hear VA Blue Button, also think remote care. Not as catchy, but certainly as powerful. We can learn from the VA’s experience as Medicare and private insurers move to integrated care through ACO’s and bundled payments, much like the VA system. We urge CMS, CMMI and others to take another best practice from the VA to encourage patient engagement and provide measureable improvement in patient health outcomes.

 

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