Home Telehealth Reporting Standardized on the VHA Decision Support System (DSS) Measures Program Cost Avoidance Jeanie Lowe VHA Rocky Mountain Network DSS Manager

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Home Telehealth Reporting Standardized on the
VHADecision Support System (DSS)Measures
Program Cost AvoidanceJeanie LoweVHA Rocky
Mountain Network DSS Manager
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VISN 19 Home Telehealth Care Pilot Objectives

• Develop methodology utilizing DSS to identify
  potential Home Telehealth Care patients
• Document clinical and usage outcomes utilizing
  DSS in chronic disease patient
  populations
• Develop functional deployment models for
  Home Telehealth Care Coordination in VISN 19
• Provide Care Coordination services (as
  appropriate)

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Care Coordination
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Rocky Mountain Network Program Fundamentals

• Incorporate care coordination model
• Emphasis on Disease Management
• Focus on
• Management of chronic illness
• Utilizing DSS, select frequent flyers
  patients with high utilization of services

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VISN 19 Pilot Sites / Emphasis

• Pilot programs at four facilities
• Cheyenne VAMC
• Eastern Colorado Health Care System
  (ECHCS)
• Sheridan VAMC
• Salt Lake City Health Care System (SLCHCS)

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Expected Home Telehealth Care Coordination Results
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Home Telehealth Care Coordination Results
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Patient Results
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VISN 19 Operational Lessons Learned

• Technology must be integrated into an effective
  care model (Care Coordination)
• Objective (DSS) utilization data should be used
  to prescreen patients for referral to program

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VALUE to Top Managementwhen DSS is Utilized

• Identification of patients appropriate for the
  program -- frequent flyers
• Tracks Costs of Patient cases before and after
  Home Telehealth intervention
• Standardized reporting of Home Telehealth
  Programs, allows identification of best practices
  
• Prospectively, by using DSS Home Telehealth
  measures, aids management in cost control
  documenting success.

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Specific Application After IdentifyingHigh
Volume / High Cost DRGs

• Select DRG Population COPD CHF
  Hypertension Diabetes MH DRGs Depression
  PTSD Substance Abuse Bipolar Disorder
• Select Care Coordination and/or Intervention
  for selected populations

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Original High Volume / High Cost DRG Patient
Population

• Found outlier costs in Facility A for Congestive
  Heart Failure (CHF) and Chronic Obstructive
  Pulmonary Disease (COPD) cases.
• Applied care coordination protocol, which
  resulted in major cost avoidance and QM
  improvement.
• Facility B did not prescreen potential patients
  utilizing DSS RESULT cost avoidance did not
  occur.

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COPD/CHF Inpatient Study
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V19 Facility Comparison of Inpt CostPre Post
TM Intervention
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WHY USE DSS TO SELECT YOUR POPULATION?
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AVG Inpatient Costs Per Quarter Pre/Post in
Facility A
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AVG Inpatient Costs Per Quarter Pre/Post in
Facility B
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Utilization Analysis
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Expected Results
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Cost Data Studies Summary

• Post care coordination in CHF/COPD patients
  shared lower costs than before
• DSS is key in selecting group and pre/post cost
  measures
• Using DSS to select population, brings
  technology to most brittle patients who use
  Inpatient and other expensive services the
  most
• Results greater cost avoidance/better health for
  patients for center