Sustainability of Home Telehealth Program

Veteran Health is described as an organization that has undergone a radical transformation from unresponsive and inefficient service provider to a high quality and responsive healthcare provider. By mid 1990s, VHA transformed its image to an organization that operates under affordable cost of care (Broderick, 2013). Currently, VHA is among the largest integrated healthcare systems that provides quality care to more than 1200 healthcare facilities (around 170 medical clinics and more than 1000 outpatient clinics) and more than 9 million Veterans (U.S Department of Veteran Affairs, 2018). According to U.S Department of Veteran Affairs (2018), VHA is financed using the public budget and is current approximated to be $ 129 billion per year. One of the challenges affecting VHA is the ability to integrate their ICT in the delivery of cost-effective and quality care to Veterans. Although the radical transformations reduced cost of care by about 50%, challenges emanating from non-institutionalized veterans who have constantly increased the total costs by more than 40%. The introduction of Home Telehealth (CCHT) program in the mid 1990s was geared towards realization of integrated service networks (Broderick, 2013).

Organizational Structure and Case Situation

Initially, VHA was focusing on shared care systems that entirely relied on the traditional bottom-to-top structure. The main issue was the need for VHA to organize their operations towards hospitals where patients could receive care. In order to address the issue, VHA had to strategic vision and overall organizational structure. Broderick (2013) states that the organizational structure of VHA was changed from the traditional ‘bottom-to-up’ to a more complex structure thereby paving way for system level transformation and adoption of the shared decision-making model. In addition, VHA there was a change in their leadership support and level of accountability thereby leading to constant improvement in organizational performance, increased quality of healthcare services, and managed costs.

 Introduction of the home telehealth model contributed to increased efficiency in processes, elimination of unnecessary or redundant care, and improvement in overall care thereby increasing the value of healthcare services that VHA provides to the veterans. According to Broderick (2013), the home telehealth model focused on self-management, encouraging patient activation, and early detection of complications. Through the integration of technologies in VHA’s organizational and structural operations, the organization was able improve quality of services and patients’ access to the services.

Key Problems and Issues

According to Broderick (2013), the main problem that VHA face is how they can utilize the pilot programs and theories in provision of services that can be beneficial within and outside VHA. Moreover, the issue of sustainability, cost containment, and the ever-evolving technology application in the clinical setting and other processes within the healthcare environment complicates the adoption of home telehealth services. The challenges bring more financial constraints to the organization. It is clear that home telehealth services can help in reducing the costs of care delivery, minimize hospital visits, thereby addressing the issue of health care costs.

Coordination in provision of patient care is a challenge given that veterans rely more on providers other than VHA. Therefore, successful management of care is greatly influenced by technological advancements that will enable real time data gathering and sharing among the various users of patient data. However, striking a balance between keeping up with the latest technologies and maintaining overall cost of care at manageable levels is a challenge. The use of remote care management helps in reducing the costs of care provision since it allows for the adoption of innovative techniques such as remote care delivery through mobile devices and social media platforms in ensuring patients get immediate care (Chumbler, Haggstrom & Saleem, 2011). However, the number of people to be reached by CCHT program is large thereby raising concerns on its sustainability and efficiency. Given the distance and number of people covered under the home telehealth program, technology implementation and scaling of the telehealth program to achieve the desired financial and care outcomes remains a key issue.

Organization’s Reponses to Technology and Leadership Issues

In order to respond to the issues and challenges facing VHA’s service delivery, they had to change their shared vision, organizational structure, and management teams. By appointing the right people (network leaders and performance directors), embracing shared decision making and formulating various performance metrics (measurable goals), VHA reduced the hospital visits by 40% while reducing the hospital admissions by 63% (Broderick, 2013). It is clear that technological changes and the different leadership approaches adopted made it possible to achieve the shared vision. Moreover, the new technologies not only addressed the patients’ needs but also helped in forming a pool of competent workforce who helped in scaling the program. Introduction of electronic health records and care coordination created room for home telehealth program to consistent and efficiently meet the healthcare needs of the veterans especially the non-institutionalized veterans. Moreover, the standardized care coordination was responsible for a robust technical health infrastructure.

Assessments

The case demonstrates the need to support telehealth services in healthcare delivery. First, VHA reduced hospital visits by 40%, hospital admissions by 63%, and overall operation costs by 50% while improving on efficiency, and highly responsive organization. From the case, it is clear that telehealth services brings healthcare providers and the community more closely hence promoting the provision of immediate care. Thus, the technology promotes consumption of affordable care. The fact that VHA innovates the already existing healthcare technology creates room for easy adoption of the home telehealth services since they do not completely abandon the old technology. By redefined their goals to focus on measurable outcomes and shared vision enabled their new leadership and management teams make useful decisions towards their success. The strong IT infrastructure and coordination of remote patient care are some of the key success factors for the adoption of affordable service delivery solution (Chumbler, Haggstrom & Saleem, 2011).

Review of Findings and Conclusion

The pilot has been very vital for various organizations’ success in adoption of home telehealth in their service deliveries. Remote care models used at local and national levels, in particular, have been very dependent on the findings presented by VHA. The need to provide efficient and affordable care promoted VHA to reorganize their organizational and leadership structure. Besides, the application of systematic approach and standardized care enabled the organization to scale the program while reaching large number of enrolled veterans across the board. Information and communication technologies are promoting the provision of immediate care to patients while promoting continuous patient monitoring and sharing or real time data. Care coordination among the various providers and VHA makes it possible to improve the quality of healthcare services hence contributing to the desired health outcomes. Some of the challenges that VHA may be interested in addressing at early stages are ethical issues revolving around patient data sharing and the evolving IT technologies. While the organization is keen on scaling their programs, handling patients’ data with the various care providers and employees remains a sensitive area that must be addressed. Besides, VHA may need formal certification of their home telehealth services.

The VHA remains as a leader in the implementation of cost effective and quality focused health care solutions to millions of patients across the U.S. Their adoption of home telehealth services and the ability to improve service quality, reduce costs, and eliminate unnecessary hospital visits and hospital admissions is a clear indication of the  hidden potential of technology in addressing healthcare needs. With the scaling up of coordinated care and provision of immediate care, various organizations outside will have to develop their own models in order to meet their needs.

References

Broderick, A. (2013). The Veterans Health Administration: Taking Home Telehealth Services to Scale Nationally. The Commonwealth Fund, 4, 1-11. Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2013/Jan/1657_Broderick_telehealth_adoption_VHA_case_study.pdf

Chumbler, N. R., Haggstrom, D., & Saleem, J. J. (2011). Implementation of health information technology in Veterans Health Administration to support transformational change: telehealth and personal health records. Medical Care, 49, S36-S42.

U.S Department of Veteran Affairs. (2018, May 31). Veteran Health Adminstration. Retreived from https://www.va.gov/health/