USING TELEMENTAL HEALTH TO EXTEND
VA INTEGRATED CARE TO COMMUNITY
SETTINGS: (A WORK IN PROGRESS)
Andrew Pomerantz, MD
Chie...
Some Definitions
• What is Telehealth?
• Varieties in VA:
– Home Telehealth
• Health buddies
• IVR
– Store Forward
• Retin...
The Evidence Base
If you want randomized controlled trials you may have to wait a little longer
VA database
Where are the limits?
PAST AS PROLOGUE
• “WRJ model” of integrated care
– APA Gold Achievement Award 2005
– VA Advanced Clinical Access National...
INTEGRATION OF WHAT?
• Mental Health/Substance abuse/Primary
Care (extending the WRJ model)
• Telemental Health and Primar...
RATIONALE
• Rural Veterans have difficulty accessing
MH care, despite its ready access in WRJ
VA and 4 CBOCs
• Veterans an...
and
• To accomplish several tasks:
– Provide integrated care for veterans and
families using other medical homes but in ne...
THUS
• The need to integrate the care, rather than
build a stand alone VA system in a foreign
land.
• And to take VA emplo...
SITES
CMHCs:
Clara Martin Center, Randolph, VT
FQHCs:
Richford Health Center (NOTCH), Richford, VT
Little Rivers Health Ce...
FUNDING
• VA Office of Rural Health & Office of
Mental Health Services
• VA/National Guard Sharing agreement
Current issues
• Technology
– ISDN point to point
• Lowest setup expense
• Highest per-call expense
– T1 line
• Higher set...
Implementation Issues
• Cross Sector contract issues
• Credentialling, licensing
• Medical Records
• Fee for service
• Pro...
Program issues
• Patient Preparation
• Room – lighting, noise, comfort
• What to wear??
• Patient satisfaction
• Choosing ...
Tasks completed to date
• Engaged with NOTCH 8/08
• Mobilizing the internal WRJ facility 10/08
• Conference with NOTCH/VA ...
Cost per visit?
• So far: About $100,000
• Engineering a prototype costs more than the
last product off the assembly line.
WHY DO YOU WANT TO DO
TELE?
(or do you?)
Using Telemental Health to Extend VA Integrated Care to ...
Using Telemental Health to Extend VA Integrated Care to ...
Using Telemental Health to Extend VA Integrated Care to ...
Using Telemental Health to Extend VA Integrated Care to ...
Using Telemental Health to Extend VA Integrated Care to ...
Using Telemental Health to Extend VA Integrated Care to ...
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Using Telemental Health to Extend VA Integrated Care to ...

  1. 1. USING TELEMENTAL HEALTH TO EXTEND VA INTEGRATED CARE TO COMMUNITY SETTINGS: (A WORK IN PROGRESS) Andrew Pomerantz, MD Chief, Mental Health and Behavioral Sciences White River Junction VA Medical Center White River Junction, Vermont VA National Office of Primary Care-Mental Health Integration Eastern Region Rural Health Resource Center Associate Professor of Psychiatry, Dartmouth Medical School
  2. 2. Some Definitions • What is Telehealth? • Varieties in VA: – Home Telehealth • Health buddies • IVR – Store Forward • Retinology, radiology, dermatology – General Telehealth
  3. 3. The Evidence Base If you want randomized controlled trials you may have to wait a little longer
  4. 4. VA database
  5. 5. Where are the limits?
  6. 6. PAST AS PROLOGUE • “WRJ model” of integrated care – APA Gold Achievement Award 2005 – VA Advanced Clinical Access National Champion award 2007 – Mandated in all VAMCs 2009 • TELEMENTAL HEALTH – Integrated Care to Bennington via Tele implemented 2004 – QI study confirms Evidence Based care improved – Berlin, NH Vet Center and second CBOC began 2009 • VT Mental Health VA/National Guard partnership – 2005-present – 2008/9 plans for TMH
  7. 7. INTEGRATION OF WHAT? • Mental Health/Substance abuse/Primary Care (extending the WRJ model) • Telemental Health and Primary Care • VA and rural veterans/families • VA and Community – Community Mental Health Center – Federally Qualified Health Center
  8. 8. RATIONALE • Rural Veterans have difficulty accessing MH care, despite its ready access in WRJ VA and 4 CBOCs • Veterans and NG troops often resist specialized MH care at VA or CMHC • Evidence suggests that veterans in community treatment may be sicker (more ED visits, higher incarceration rates)
  9. 9. and • To accomplish several tasks: – Provide integrated care for veterans and families using other medical homes but in need of “special” understanding (why VA exists) – Leverage VA funding to catalyze development of integrated care and telehealth as part of the Vermont Healthcare
  10. 10. THUS • The need to integrate the care, rather than build a stand alone VA system in a foreign land. • And to take VA employees out of their comfort zone
  11. 11. SITES CMHCs: Clara Martin Center, Randolph, VT FQHCs: Richford Health Center (NOTCH), Richford, VT Little Rivers Health Center, Bradford, VT Indian Stream Health Center, Colebrook, NH Coos Family Services, Berlin, NH Midstate Health Center, Plymouth, NH
  12. 12. FUNDING • VA Office of Rural Health & Office of Mental Health Services • VA/National Guard Sharing agreement
  13. 13. Current issues • Technology – ISDN point to point • Lowest setup expense • Highest per-call expense – T1 line • Higher setup • Low monthly subscription • Privacy, security • Waiting for NETC
  14. 14. Implementation Issues • Cross Sector contract issues • Credentialling, licensing • Medical Records • Fee for service • Provider motivation and training • Information sharing • Infrastructure • Ethical concerns
  15. 15. Program issues • Patient Preparation • Room – lighting, noise, comfort • What to wear?? • Patient satisfaction • Choosing patients • Choosing providers • Contingency planning
  16. 16. Tasks completed to date • Engaged with NOTCH 8/08 • Mobilizing the internal WRJ facility 10/08 • Conference with NOTCH/VA IT 12/08 – Contract prepared 6/09 • IT issues addressed • Motivational interviews • Preliminary budget developed • Contracting contracting contracting 11/08-6/09 • Planning meetings (X2) with Bradford sites • ORH grant funded (5/09) • Identification of other FQHC sites (ongoing)
  17. 17. Cost per visit? • So far: About $100,000 • Engineering a prototype costs more than the last product off the assembly line.
  18. 18. WHY DO YOU WANT TO DO TELE? (or do you?)

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