Care Coordination/Home Telehealth For Veterans - Essay Example

Care Coordination / Home Telehealth for Veterans Executive Summary/Introduction The Veterans Health Administration (VHA) holds the role of ensuring that continuous, coordinated, and comprehensive primary and specialist care services for the veteran population. Among this provision is the use of telehealth program, which involves the use of information and communications technologies to deliver medical care remotely by connecting various users located in different areas. The use of telehelath among veterans involves three main areas, namely clinical video telehealth, store and forward telehealth, and care coordination / home telehealth (Broderick, 2013). The first one refers to the use of interactive video technologies for the real-time delivery of physician visits to distant clinics to make diagnoses, manage care, perform check-ups, and provide care in polytrauma, mental health, rehabilitation, and surgical consultations. The second aspect refers to acquisition, transmission and storage of prerecorded information through sound, data, and image, including X-rays, video clips, and photos, between providers and specialists in radiology, dermatology, and retinopathy. The third element is the focus of this policy recommendation. It involves the use of electronic monitoring devices to capture patient physiological data related to symptoms and vital signs in the home environment and transmit those data to health care providers for review and appropriate coordination of care. Telehealth opportunities is shown in literature as a probable way in which the VHA and supporting stakeholders can reach a larger number of patients nationally in a practical and cost effective means (Gellis, Kenaley, McGinty, Bardelli, Davitt, & Have, 2012). Telehealth will ensure accessibility to affordable and quality health care to many veterans that struggle with access. Context and importance of the problem. The policy responds to the question of whether home telehealth can provide care to patients with chronic diseases on a larger scale such as through the VHA and show a practical and cost effective means for caring for veterans. The approach need to be both acceptable to patients and clinicians. As Broderick (2013) notes, VHA developed home telehealth as a response to the rising number of the elderly veterans that need chronic care and as a way to reduce their use of institutional care and its associated high costs. The option has also helped provide care within the patient’s home setting as a preferred place. The VHA provides primary care to more than 5 million veterans annually and needs a system through which to ensure the patients have access to care within a cost effective way (Rosland, Nelson, Sun. Dolan, Maynard, Bryson, Stark, Shear, Fihn, and Schectman, 2013). The US veteran population is estimated at 22,328,000, among which 8.57 million have enrolled in VHA, and 6.17 million receive treatment for unique conditions (Broderick, 2013). Among the conditions treated are a range of 16 chronic conditions, including arthritis, asthma, cancer, chronic obstructive pulmonary disorder, dementia, depression, diabetes, drug and alcohol abuse, and heart conditions such as peripheral vascular disease and chronic heart failure (Yoon, Scott, Phibbs, & Wagner, 2011). Other conditions are hepatitis C, HIV/AIDS, hypertension, PTSD, renal failure, spinal cord injury, and stroke. The veterans are also at a higher risk of contracting these conditions compared to the general population. The different chronic illnesses present a possible increase in need for health care services including hospitalization, physician visits, prescriptions, and home-based health services (Zulman, Martins, Liu, Tu, Hoffman, Asch, & Goldstein, 2015). Moreover, as the veterans age they require ways that enable them retain dignity in illness, meaning that they can be able to self-manage the illness at their homes or with an assistance. Home telehealth is a non-institutional service with the capability to provide access to veterans with chronic illnesses at their home thus retaining dignity in care and ensuring that the individual retains the right to self-management as they age (Darkins, Ryan, Kobb, Foster, Edmonson, Wakefield, & Lancaster, 2008). Patients with chronic diseases provide a challenging group as people that require continued care, and whose treatment can be inaccessible due to cost and the inability of the patient to move to facilities. Therefore, obtaining a way to ensure that veterans can access quality care within their homes, provides a viable option based on considerations of affordability, availability, quality, and accessibility. The reason is that as mentioned by Gellies et al. (2012), telehealth care presents an acceptable option for patients and care providers. Having established the potential usefulness of home telehealth care, the next step is identifying policy options that can facilitate greater adoption of home telehealth care among veterans. Policy options will need to recognize the areas that home telehealth care is probable, such as the challenge of generalizability. Recognizably, home telehealth care may remain mainly applicable to patients with the cognitive capability to understand its functionality and uses (Gellis, Kenaley, and Have, 2015). Therefore, public health practitioners as well as care providers need a framework the safeguards patient exposure to home telehealth care based on potential for use. The subsequent analysis gives insight into policy options on expansion of home telehealth care among the veteran population. Evaluative Criteria As the U.S. veteran population increases, it is important to appreciate the importance of telehealth as an approach to ensure access to care for people that would have otherwise found it challenging as it supports their complex health care needs by offering a way to present health information, track medication, and communicate with providers (Whealin, Jenchura, Wong, & Zulman, 2016). The system provides the stakeholders with support, access to information, coordination of care, and a way for patients and coordinators to communicate and share information. This makes access to health care easier and faster irrespective of whether the patient is in a rural place. Case studies provided by Broderick (2013) provide insight into how home telehealth care among veterans can achieve a national standard. The author notes that the VHA remains the largest individual purchaser of home telehealth technology internationally, which will continue to grow as the veterans population grows. The process shows three critical areas on which the policy recommendations arise, namely development of a supporting information technology infrastructure, commitment to training, cost efficiency, and integrated of models. Critique of Policy Options Part of the development of policy option of home telehealth is understanding the goals and targets of the approach. An audit conducted by the Office of the Inspectorate General regarding VHA application of home telehealth program established the following goals: The policy recommendations include IT infrastructure, training of various agencies involved in provision of care, cost efficiency, and development of integrated models. The applications of these recommendations need to be within meeting the overall mandate of the VHA home telehealth programs. The program presents alternatives to traditional care models to ensure greater access for many, and thus these recommendations need to support accessibility, affordability, and quality of care. The demonstrated application also remains within the VHA opportunities in maintaining high quality of care. Efficiency and sustainability The US faces an increase in healthcare dependence as the population continues to age, people live longer, and the rates of chronic diseases rise; amongst all of these vulnerable groups are aging veterans. The public health problem associated with the changing population dynamics is an increase in the need for services such as hospitalization, physician visits, and prescriptions as well as a need for home-based health services (Zulman, Martins, Liu, Tu, Hoffman, Asch, & Goldstein, 2015). Veterans represent a complex group among the aging population with chronic diseases and as such, require the establishment of ways to promote both self-management and assistant-based management that promotes a timely response to any arising health concern. Darkins, Ryan, Kobb, Foster, Edmonson, Wakefield, and Lancaster (2008) suggest the use of the telehealth program, which is a non-institutional service that supports the care for veterans with chronic conditions in their home as they age. Scope/Context and Challenges The U.S. Veterans Health Administration (VHA) provides primary care to more than 5 million veterans in 16.4 million encounters annually (Rosland, Nelson, Sun. Dolan, Maynard, Bryson, Stark, Shear, Fihn, and Schectman, 2013). The VHA faces the challenge of how to redesign its system of care to ensure it delivers services both across diverse communities and among people with different chronic illnesses and socio-economic vulnerabilities. Telehealth presents a possible response with the capability of reaching a large number of patients with chronic diseases nationally while maintaining a practical and cost-effective means of care acceptable to patients and care providers (Gellis, Kenaley, McGinty, Bardelli, Davitt, & Have, 2012). However, the use of telehealth faces the challenge of generalizability. A study by Gellis, Kenaley, and Have (2015) showed the various benefits of telehealth, but noted that the system may not be generalizable to all patients as some may require assistance with their activities of daily living. Meaning telehealth will work mainly for cognitively able patients who retain a certain level of functionality. This nonetheless does not exclude patients with depression. Based on its applicability, home telehealth care offers the benefit of home telehealth and disease management technology and augments the VHA existing health information technology infrastructure (Darkin et al., 2008). The program further covers the predefined nature of patient services but extends to acute care management, health promotion, and disease prevention. The CCHT program further provides veterans with support to care as needed and within rural areas, which has been a challenge for the VHA. Analysis and Recommendations. Policy Recommendations for population health informatics solution. Development of the IT infrastructure signifies the need to have an algorithm that matches the needs of the patients such as video-phones, messaging devices, biometric devices, digital cameras, and telemonitoring devices, and then ensuring that the care providers and other stakeholders are aware of the ways in which to use the technology (Broderick, 2013). Application at the national level further requires development of similar facilities nationally, in which the system must be able to accommodate a wider group of users, which implies the need for local centers to act as support systems. This implies the need for additional support staff with training to ensure competency in working with veterans and in execution of the system. Training therefore comprises of a way to ensure that different stakeholders at the public health level and health care levels understand the ways to support home telehealth services. These include installation, monitoring and evaluation, and response. The cost of home telehealth care per patient is about $1,600 per year, which presents a favorable option compared to the VHA home based primary care service that costs $13,121 per patient annually, or nursing homes that cost $77,745 per patient every year (Broderick, 2013). Data from the Office of the Inspectorate General however place the costs in VHA at less than $2,400 per patient when using home telehealth care, versus home based care estimated at $22,200 annually per patient, and $92,300 annually in using nursing home facility (Office of Audits and Evaluations, 2015). Although these numbers are higher, home telehealth care remains comparably low when considered against the other two options. Therefore, a well implemented home telehealth care system will lead to reduced cost of care within the VHA, which in turn opens up funding for other veterans. Furthermore, the approach ensures continued monitoring without requiring the patients to attend hospital days of stays, which would translate to reduction in health care resource utilization. Another policy area in the use of home telehealth is advanced integrated models of care, referring to collaborative efforts in provision of care. The stakeholders involved in the execution of home telehealth care include social workers, public health workers, and care providers including people tasked with system support and monitoring (Darkins et al., 2008). Policy response need to reflect collaborative efforts across the different groups involved in the provision of home telehealth care. Limitations Among the limitations today found in the telehealth care system is the lack of a well determined demand for the product, as the VHA is the customer and supplier and fails to show the demand and supply aspect of the technology. Agreeably, the VHA identifies the groups that need the program, but a supply and demand curve would show where to concentrate. As the U.S. veteran population increases, it is important to appreciate the importance of telehealth as an approach to ensure access to care for people that would have otherwise found it challenging as it supports their complex health care needs by offering a way to present health information, track medication, and communicate with providers (Whealin, Jenchura, Wong, & Zulman, 2016). The system provides the stakeholders with support, access to information, coordination of care, and a way for patients and coordinators to communicate and share information. This makes access to health care easier and faster irrespective of whether the patient is in a rural place. Conclusions Home telehelath care provides the veteran health care system with a model that can easily promote quick reach of the patient. However, in the application of the model it is recommended that service providers adequately examine the capability of the patient to utilize the program. Policy options will need to recognize the areas that home telehealth care is probable, such as the challenge of generalizability. Recognizably, home telehealth care may remain mainly applicable to patients with the cognitive capability to understand its functionality and uses. Therefore, public health practitioners as well as care providers need a framework the safeguards patient exposure to home telehealth care based on potential for use. The subsequent analysis gives insight into policy options on expansion of home telehealth care among the veteran population.The policy recommendations include IT infrastructure, training of various agencies involved in provision of care, cost efficiency, and development of integrated models. The application of these recommendations needs to be within meeting the overall mandate of the VHA home telehealth programs. The program presents alternatives to traditional care models to ensure greater access for many, and thus these recommendations need to support accessibility, affordability, and quality of care. The demonstrated application also remains within the VHA opportunities in maintaining high quality of care. References Broderick, A. (2013). The Veterans Health Administration: Taking home health services to scale nationally. Case Studies in Telehealth Adoption. The Commonwealth Fun, 4: 1-12. Darkins, A., Ryan, P., Kobb, R., Foster, L., Edmonson, E., Wakefield, B., & Lancaster, A. E. (2008). Care coordination/home telehealth: The systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemedicine and e-Health, 1118-1126. DOI 10.1089/tmj.2008.0021 Gellis, Z. D., Kenaley, B. L., & Have, T. T. (2014). Integrated telehealth care for chronic illness and depression in geriatric home care patients: The integrated telehealth education and activation of mood (I-TEAM) study. J. AM. Geriatr. Soc. 62: 889-895. Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Have, T. T. (2012).Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: A randomized controlled trial.The Gerontologist, 52(4): 541-552. DOI10.1093/geront/gnr134 Rosland, A., Nelson, K., Sun, H., Dolan, E. D., Maynard, C., Bryson, C., Stark, R., Shear, J. M., Kerr, E., Fihn, S. D., &Schectman, G. (2013). The patient-centered medical home in the Veterans Health Administration.Am. J Manag Care, 19(7): e263-e272. Whealm, J. M., Jenchura, E. C., Wong, A. C., &Zulman, D. M. (2016). How veterans with post-traumatic stress disorder and comorbid health conditions utilize eHealth to manage their health care needs: A mixed-methods analysis. J. Med. Internet res, 18(10): e280. DOI 10.2196/jmir.5594 Yoon, J., Scott, J. Y., Phibbs, C. S., & Wagner, T. H. (2011). Recent trends in veterans affairs chronic condition spending. Population Health Management, 14(x), 1-6. Zulman, D. M., Martins, S. B., Liu, Y., Tu, S. W., Hoffman, B. B., Asch, S. M., & Goldstein, M. K. (2015). Using a clinical knowledge based to assess comorbidity interrelatedness among patients with multiple chronic conditions. AMIA Annual Symp. Proc.: 1381-1389. Read More