1. CARE COORDINATION Home Telehealth Pamela Canter, RN James H Quillen VA Medical Center

2. 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.

3. GOALS OF CCHT Integration of healthcare environment to best meet the patient’s needs Integration of healthcare environment to best meet the patient’s needs Proactive delivery of evidence-based care & Establish continuous healing relationships Proactive delivery of evidence-based care & Establish continuous healing relationships Follow-up Follow-up

4. 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.

5. CCHT HISTORY Established:2004 National roll-out began for CCHT. 1 st 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/Sensibility Support for Congestive Heart Failure and Diabetes

6. 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. 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. o Requires more than one home-health visit per week due to severity of illness and need for monitoring, management or education. o Patients will have had two (2) or more hospital admissions or emergency room visits in the preceding fiscal year. o Will be enrolled in a Primary Care Clinic with greater than eight (8) outpatient visits in the preceding fiscal year.

7. Cont. ELIGIBILITY CCHT o 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 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 accept the technology in the home. The patient and caregiver demonstrate competency in using and maintaining telehealth equipment. The patient and caregiver demonstrate competency in using and maintaining telehealth equipment. Other circumstances that may improve quality of life and improve clinical outcomes. Other circumstances that may improve quality of life and improve clinical outcomes.

8. VA Health Management Programs ** Program available in Spanish COPD **Cancer Care AcuteGeneral CaregiverPalliative Care Depression **Cancer Care MaintenanceHeart Failure AcutePolypharmacy Diabetes **CHF Maintenance **Heart Failure MaintenancePre-Diabetes Heart Failure **Coagulation ManagementHepatitisPROMISE Hypertension **Coagulation Mgmt Main.HIVPTSD BipolarCOPD MaintenanceHTN MaintenanceSchizophrenia CADDementiaLow ADLSenior Wellness CAD Main.Diabetes AcuteMISubstance Abuse Cancer CareDiabetes Maintenance **Pain ManagementWeight Management Bipolar/Diabetes Depression/Pain Mgmt.Diabetes/HTN AcutePre-Diabetes/COPD Bipolar/HTN Depression/HTN Diabetes/HTN MaintenancePre-Diabetes/Hypertension CAD/Diabetes Depression/HTN/DiabetesHTN/Hyperlipidemia **PTSD/COPD Cancer Care/HTN Diabetes/CHF **MI/DiabetesPTSD/Diabetes Cancer Care HTN Main.Diabetes/CHF AcuteMI/Diabetes/CHFPTSD/HTN CHF/COPDDiabetes/CHF MaintenanceMI/CHFPTSD/HTN/Diabetes CHF/HTN **Diabetes/CHF/HTN **Pain Management/CHFSchizophrenia/Diabetes CHF/Hyperlipidemia **Diabetes/CHF/HTN AcutePain Management/DiabetesSchizophrenia/HTN COPD/HTNDiabetes/CHF/HTN Main.Pain Management/HTNSchizophrenia/HTN/Diabetes COPD/HTN MaintenanceDiabetes/COPDPalliative Care/CHFWeight Management/CHF Depression/CHFDiabetes/COPD Main. Palliative Care/COPDWeight Management/COPD Depression/COPDDiabetes/COPD/CHFPalliative Care/DiabetesWeight Management/Diabetes Depression/COPD/HTNDiabetes/COPD/HTNPalliative Care/HTNWeight Management/HTN Depression/DiabetesDiabetes/HTN**Pre-Diabetes/CHF

10. Health Buddy 3 a Look Inside the Box

11. Health Buddy 3 HB 3 must have ROM Build number 49714 or greater to use Ethernet connection

12. 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. What does the patient need

13. Connecting the Health Buddy

14. Connecting the Health Buddy and Phone

16. Medical Devices 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

17. The Patient’s 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.

26. Health Buddy Results are sent to a VA Secure Data Center where the Care Coordinator can access Health Buddy Patient Results on their computer. Health Buddy ® System

28. FY2009 – 1 st quarter Bed Days of Care Cost Avoidance PreCCHTPostCCHT Summary of Avoidance Pt’s Disch’sCostPt’sDisch’sCost sitesitePt’sDisch’sCost 117 201$1,829,129.5674137$1,231,291.81 4364$597,837.75 123 231$2,158,300.4560126$1,129,843.09 63105$1,028,457.36 144 237$2,360,505.4684140$2,143,888.55 6097$216,616.91 41 70$1,160,888.252536$460,871.60 1634$700,016.65 63 106$1,095,371.144680$1,257,976.90 1726-$162,605.76 152 257$3,171,639.8189161$1,735,614.38 6396$1,436,025.43 640 1102$11,775,834.67378680$7,959,486.33 TOTALSTOTALS262422$3,816,348.34

29. FY2009 – 6 months follow up Cost Avoidance Eligible for FY09 Outcomes Patients Patients with Outcomes BDOC Baseline BDOC Followup BDOC % Change Admission Baseline Admission Followup 40 6152-14.8%14.511 50 54.538-30.3%1613 32318129-64.2%1510 737125973-71.8%21.518 45 144.563-56.4%13 39388937-58.4%16.511 279275689292-57.6%96.576 Calc BDOC DiffCost per BDOC 92483$22,347.00 16.51626$26,829.00 522106$109,512.00 1861689$314,154.00 81.51584$129,096.00 521452$75,504.00 $677,442.00

30. Emergency Room/Primary Care Visits PreCCHTPostCCHT Summary of Avoidance Pt’s EncounterCostPt’sEncounterCost sitesitePt’sEncounterCost 490 3226$585,240.524572862$568,203.02 33364$17,037.50 511 2463$564,165.764211766$424,957.25 90697$139,208.51 358 2022$472,575.803191639$398,000.99 39383$74,574.81 289 1247$254,048.26245942$198,541.26 44305$55,507.00 440 2002$415,600.784041671$362,590.02 36331$53,010.76 756 3071$633,266.816112362$468,994.46 145709$164,272.35 2844 14031$2,924,897.93245711242$2,421,287.00 TOTALSTOTALS3872789$503,610.93

31. DISCHARGE FROM CCHT Care Coordination/Home Telehealth may be terminated when: 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. 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. 2)The patient/caregiver no longer wish to participate in the project. 3)The patient has permanently relocated outside of treatment area. 3)The patient has permanently relocated outside of treatment area. 4)The patient has achieved clinical goals. 4)The patient has achieved clinical goals.

32. Remote Education- Findings CHF/DIABETES Enrolled patients had similar: Enrolled patients had similar: Achievement of behavior change goals Achievement of behavior change goals Decreased unscheduled PC visits Decreased unscheduled PC visits Improvement in HbA1c Improvement in HbA1c Improvements in quality of life Improvements in quality of life High patient satisfaction High patient satisfaction

33. Conclusions Telehealth is: Telehealth is: Feasible Feasible Acceptable to patients & providers Acceptable to patients & providers Can improve care Can improve care