CARE COORDINATION Home Telehealth

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CARE COORDINATIONHome Telehealth

• Pamela Canter, RN
• James H Quillen VA Medical Center

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Definition of Care Coordination

• The wider application of care and case management
  principles to the delivery of healthcare services
  using health informatics, disease management and
  telehealth to facilitate access to care and to
  improve the health of designated individuals and
  populations with the specific intent of providing
  the right care in the right place at the right
  time.

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GOALS OF CCHT

• Integration of healthcare environment to best
  meet the patients needs
• Proactive delivery of evidence-based care
  Establish continuous healing relationships
• Follow-up

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EXPECTED OUTCOMES

• Increased access and patient satisfaction
• Enhanced functional status and quality of life
• Increased Provider and CCHT staff satisfaction
• Reduced admissions and bed days of care
• Reduced clinic and ER visits
• Reduced nursing home admission rates
• Reduced overall costs for patients with history
  of frequent admissions and clinic visits.

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CCHT HISTORY
Established2004 National roll-out began for
CCHT. 1st enrollment for VISN 9 was February
2005. Mission To coordinate the right care, in
the right place, at the right time. Vision The
place of residence is the preferred place of care
to provide the just in time approach for both
the patient and caregiver. Goal Core
Values Maximize access to VHA system Patient
Centric Programming Integrity Evidenced Based
Practice Teamwork/Collaboration Flexibility/Sensib
ility Support for Congestive Heart Failure and
Diabetes
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ELIGIBILITY FOR CCHT

• Have at least one of the following chronic
  conditions congestive heart failure (CHF),
  diabetes mellitus (DM), hypertension (HTN) or
  chronic obstructive pulmonary disease (COPD) and
  may have conditions such that technology and care
  coordination could improve resource utilization
  and clinical outcomes.
• Requires more than one home-health visit per week
  due to severity of illness and need for
  monitoring, management or education.
• Patients will have had two (2) or more hospital
  admissions or emergency room visits in the
  preceding fiscal year.
• Will be enrolled in a Primary Care Clinic with
  greater than eight (8) outpatient visits in the
  preceding fiscal year.

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Cont. ELIGIBILITY CCHT

• Have greater than ten (10) active medication
  prescriptions.
• The home environment is such that daily care and
  medical problems can be managed in the home.
  Access to utilities and safety concerns are
  addressed for appropriate installation of
  equipment.
• The patient and caregiver accept the technology
  in the home.
• The patient and caregiver demonstrate competency
  in using and maintaining telehealth equipment.
• Other circumstances that may improve quality of
  life and improve clinical outcomes.

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VA Health Management Programs
Single Programs
COPD Cancer Care Acute General
Caregiver Palliative Care Depression Cancer
Care Maintenance Heart Failure Acute Polypharmacy
Diabetes CHF Maintenance Heart Failure
Maintenance Pre-Diabetes Heart Failure
Coagulation Management Hepatitis PROMISE Hyper
tension Coagulation Mgmt Main. HIV PTSD Bipola
r COPD Maintenance HTN Maintenance Schizophrenia
CAD Dementia Low ADL Senior Wellness CAD
Main. Diabetes Acute MI Substance Abuse Cancer
Care Diabetes Maintenance Pain
Management Weight Management
Co-Morbid Programs
Bipolar/Diabetes Depression/Pain
Mgmt. Diabetes/HTN Acute Pre-Diabetes/COPD Bipolar
/HTN Depression/HTN Diabetes/HTN
Maintenance Pre-Diabetes/Hypertension CAD/Diabetes
Depression/HTN/Diabetes HTN/Hyperlipidemia
PTSD/COPD Cancer Care/HTN Diabetes/CHF
MI/Diabetes PTSD/Diabetes Cancer Care HTN
Main. Diabetes/CHF Acute MI/Diabetes/CHF PTSD/HTN
CHF/COPD Diabetes/CHF Maintenance MI/CHF PTSD/HT
N/Diabetes CHF/HTN Diabetes/CHF/HTN Pain
Management/CHF Schizophrenia/Diabetes CHF/Hyperlip
idemia Diabetes/CHF/HTN Acute Pain
Management/Diabetes Schizophrenia/HTN COPD/HTN Di
abetes/CHF/HTN Main. Pain Management/HTN Schizophr
enia/HTN/Diabetes COPD/HTN Maintenance Diabetes/CO
PD Palliative Care/CHF Weight Management/CHF Depre
ssion/CHF Diabetes/COPD Main. Palliative
Care/COPD Weight Management/COPD Depression/COPD D
iabetes/COPD/CHF Palliative Care/Diabetes Weight
Management/Diabetes Depression/COPD/HTN Diabetes/C
OPD/HTN Palliative Care/HTN Weight
Management/HTN Depression/Diabetes Diabetes/HTN
Pre-Diabetes/CHF
Program available in Spanish
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Health Buddy 3 a Look Inside the Box
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Health Buddy 3
Power adapter
Phone ports, one to wall and one to the phone
DB-9 Serial Port
3 USB Ports
HB 3 must have ROM Build number 49714 or greater
to use Ethernet connection
InfraRed sensor
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What does the patient need

• 110V power outlet
• Standard single-line telephone
• Dial tone only (not pulse or VOIP)
• Analog line (not digital)
• No cellular connection
• One digit outside line access code
• DSL Filter - The Health Buddy appliance has a
  modem inside of the appliance that can interfere
  with telephone lines that also share a DSL
  connection. If a patient has a DSL line ask them
  to contact their DSL provider to install a
  filter. This picture is an example of a filter.

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Connecting the Health Buddy
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Connecting the Health Buddy and Phone
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Medical Devices
Visit www.healthbuddy.com for a complete list of
Medical Devices that can connect via a cable,
Blue Tooth or InfraRed to the Health Buddy 2 and
or Health Buddy 3
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The Patients First Experience

Once the patient has successfully set up the
Health Buddy and the green light is on, they
press start to begin. The patient will be
presented with a tutorial that guides them
through how to use the 4 blue buttons to answer
questions.
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Health Buddy System
Health Buddy Results are sent to a VA Secure
Data Center where the Care Coordinator can access
Health Buddy Patient Results on their computer.
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FY2009 1st quarter Bed Days of Care Cost
Avoidance
PreCCHT PreCCHT PreCCHT PostCCHT PostCCHT PostCCHT     Summary of Avoidance Summary of Avoidance Summary of Avoidance
Pts Dischs Cost Pts Dischs Cost   site Pts Dischs Cost
117 201 1,829,129.56 74 137 1,231,291.81     43 64 597,837.75
123 231 2,158,300.45 60 126 1,129,843.09     63 105 1,028,457.36
144 237 2,360,505.46 84 140 2,143,888.55     60 97 216,616.91
41 70 1,160,888.25 25 36 460,871.60     16 34 700,016.65
63 106 1,095,371.14 46 80 1,257,976.90     17 26 -162,605.76
152 257 3,171,639.81 89 161 1,735,614.38     63 96 1,436,025.43
640 1102 11,775,834.67 378 680 7,959,486.33   TOTALS 262 422 3,816,348.34
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FY2009 6 months follow up Cost Avoidance
Eligible for FY09 Outcomes Eligible for FY09 Outcomes Eligible for FY09 Outcomes Eligible for FY09 Outcomes Eligible for FY09 Outcomes Eligible for FY09 Outcomes Eligible for FY09 Outcomes
Patients Patients with Outcomes BDOC Baseline BDOC Followup BDOC Change Admission Baseline Admission Followup
40 40 61 52 -14.8 14.5 11
50 50 54.5 38 -30.3 16 13
32 31 81 29 -64.2 15 10
73 71 259 73 -71.8 21.5 18
45 45 144.5 63 -56.4 13 13
39 38 89 37 -58.4 16.5 11
279 275 689 292 -57.6 96.5 76

Calc BDOC Diff Cost per BDOC
9 2483 22,347.00
16.5 1626 26,829.00
52 2106 109,512.00
186 1689 314,154.00
81.5 1584 129,096.00
52 1452 75,504.00
677,442.00
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Emergency Room/Primary Care Visits
PreCCHT PreCCHT PreCCHT PostCCHT PostCCHT PostCCHT     Summary of Avoidance Summary of Avoidance Summary of Avoidance
Pts Encounter Cost Pts Encounter Cost   site Pts Encounter Cost
490 3226 585,240.52 457 2862 568,203.02     33 364 17,037.50
511 2463 564,165.76 421 1766 424,957.25     90 697 139,208.51
358 2022 472,575.80 319 1639 398,000.99     39 383 74,574.81
289 1247 254,048.26 245 942 198,541.26     44 305 55,507.00
440 2002 415,600.78 404 1671 362,590.02     36 331 53,010.76
756 3071 633,266.81 611 2362 468,994.46     145 709 164,272.35
2844 14031 2,924,897.93 2457 11242 2,421,287.00   TOTALS 387 2789 503,610.93
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DISCHARGE FROM CCHT

• Care Coordination/Home Telehealth may be
  terminated when
• 1) The patient is admitted to a nursing home
  setting as a long-term or permanent placement.
• 2) The patient/caregiver no longer wish to
  participate in the project.
• 3) The patient has permanently relocated outside
  of treatment area.
• 4) The patient has achieved clinical goals.

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Remote Education- FindingsCHF/DIABETES

• Enrolled patients had similar
• Achievement of behavior change goals
• Decreased unscheduled PC visits
• Improvement in HbA1c
• Improvements in quality of life
• High patient satisfaction

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Conclusions

• Telehealth is
• Feasible
• Acceptable to patients providers
• Can improve care