My 'interview' of Paul Costello, VP Sales and Marketing, on the history of Viterion, relationship with the VA and tech developments.

1. 1 Issue 2 | Telemedicine www.telemedmag.com 1
3 new healthcare
apps are bringing
the house call back
Some of the coolest
wearables won’t be
available in stores
A day in the lives of
five telemedicine
physicians
Game on: Who will
be telemedicine’s
next winning bet?
telemedicine
FEAR
HAPPINESS
SADNESS
SURPRISE
ANGER
OUTSIDE IN
How emotion-capture
technology could augment
telemedicine...starting with
the treatment of PTSD

2. www.telemedmag.com 15
veteran health
wounded, wired warriors
VA Deploys Targeted
Telemedicine Programs to
Improve Vet Services
While the Veterans Health Administration
might not be the first place you’d look for cutting
edge technology, the last decade has seen the VA
take bold steps in groundbreaking telemedicine
solutions. To learn more, we sat down with Paul
Costello, VP of Marketing at Viterion, which has
been at the center of the VA’s Telehealth program.
By Donna Cusano
Out of 2 million patient visits in 2014, the VA estimates that tele-
medicine has led to savings of nearly $2,000 per patient while main-
taining an 85 percent patient satisfaction rate. At the center of this
telehealth system is Viterion Digital Health, which has been an
authorized supplier to the Veterans Health Administration for its
Care Coordination/Home Telehealth (CCHT) program for more
than a decade. Paul Costello, Viterion’s VP of Sales and Marketing,
discusses the impact the VA Home Telehealth program has had on
the industry as a whole.
How did the VA’s telehealth program act as a proof of
concept for the industry?
TheVA’sVISN8regionalpilot(Florida,southGeorgia,PuertoRico
and the USVI), with 800 veterans during 2000-2003, demonstrated
the value of basic telehealth monitoring which reduced days of care,
hospital readmissions and hemoglobin A1c, maintaining high levels
of patient satisfaction. This became the model for the national Care
Coordination/Home Telehealth (CCHT) program starting in
2003, which targeted veteran patients at high risk of entering long-
term institutional care by focusing on in-home care management
assisted by monitoring technology. At the time, the VA’s major care
challenge was the growth of the aging veteran population; between
2000 and 2010, the number of 80+ veterans tripled.
We’ve heard that the VA’s telehealth program was suc-
cessful. Give us the straight numbers.
By any metric, the VA Telehealth Services program has succeeded
in expanding its scope and outcomes. 690,000 patients—12 percent
of the veteran population—experience 2,000,000 visits annually
(FY2014). They now receive services including Clinical Video Tele-
health (real time videoconferencing), Store & Forward (clinical im-
aging) and Home Telehealth (home-based acute and chronic care
BY THE
NUMBERS
690,000
Veterans
provided with
remote care
by VA in fiscal
year 2014
55%
Percentage of
veterans re-
ceiving remote
care who live
in rural areas
12%
Percentage
of veterans
receiving tele-
medicine care
in 2014
2 million+
Total number
of telehealth
visits in the
VA system in
2014
Home Tele-
health alone
has grown
from 43,000
patients in
FY 2010 to
156,000 in
FY2014
management via technology). About half of
veterans receiving telehealth services live in
rural areas with limited access to VA care.
Home Telehealth alone has grown from
43,000 patients in FY 2010 to 144,520 pa-
tients in FY2013 and 156,000 in FY2014,
as it becomes an increasingly attractive op-
tion for veterans.
Home Telehealth has improved patient
outcomes and saved money, results remark-
ably consistent since the VA’s first national
survey in 2007. By FY2014:
• Bed days were reduced by 42 percent
• Hospital admissions were reduced by 34
percent
• Patient satisfaction was maintained at 85
percent
• The VA also estimated that Home Tele-
health saved $1,999 per patient per year in
FY 2013.
Home Telehealth has also succeeded in
achieving the VA goal of keeping veterans
living independently in their communities.
During FY 2013, 41,430 patients—over 28
percent—were supported by Home Tele-
health to live independently in their homes,
versus being transferred to long-term insti-
tutional care.
Describe more specifically how
home telehealth developed with
the VA
It took time, but the VA and Viterion de-
veloped methods for their care teams to
utilize this newly-generated patient data in
optimizing care coordination of large pop-
ulations. These patients may have multiple
chronic conditions—hypertension, diabe-
tes, COPD, heart failure and obesity—or
be in transitional care. Telehealth assists not
only in clinician monitoring of patient vital
signs, patient self-management, health pro-
motion and disease prevention (HPDP),
but also in alerts to changes in condition,
reports, analysis and EHR integration. The
goals are to enhance patient health, prevent
decompensation and to reach the patient
with the right care at the right time.
Vital signs monitoring uses medical
devices to monitor blood glucose, blood
2010
2014

3. www.telemedmag.com 47
pressure, pulse, pulse oxygen, weight, tem-
perature, peak flow and pain level. These
connect directly to the current V100 desk-
top unit, or the patient or caregiver may
enter results manually. Patient answers
to customized health questions provide
qualitative information for the clinician.
Integrated into daily checks are medication
reminders and patient education tips pre-
set for their condition(s) which reinforce
healthy behaviors.
Clinicians can enroll patients, assign
DMPs, establish monitoring schedules
with reminders, easily set up vital sign risk
levels and alerts when patients are out of
range or measurements aren’t taken, and
can see their patient grouping with status
at a glance on their home page.
Viterion’s platform also facilitates individ-
ual patient and population reports, analysis
and risk stratification through a wide range
of queries and filters. Results are also inte-
grated into patient records in VistA, the
VA’s EHR.
How will a new, younger veteran
population change the VA’s tele-
health landscape?
Younger veterans—Cold War, Vietnam,
Gulf War, Bosnia/Kosovo, Iraq and Af-
ghanistan—are now part of or entering VA
care. These veterans are often substantially
more mobile and technologically sophis-
ticated. Viterion’s new tablet, the Vitacast
1000, was designed to meet their needs. A
7” touch screen tablet with its own plat-
form, it has wireless capability (3G/4G/
Wi-Fi), Bluetooth/USB-A medical device
connectivity and a rechargeable battery. Its
screens, menus and icons are large, bright
and intuitive; audio cues, text-to-speech
option and stylus assist those with motor,
hearing and visual impairments. The new
technology enhances not only vital signs
monitoring but also reminders for medica-
tion and appointments; patient education
and qualitative measurements such as pain
assessment; and indicators that help with
care for PTSD and brain injury patients.
What is next for the VA’s tele-
health program?
The VA is piloting a digital wound manage-
ment system, integrated with VISNET and
VistA, where patients or caregivers take
digital photos of their wounds at home,
wirelessly uploading them to their patient
record. Clinicians can instantly view and
assess images, then document patient prog-
ress over time, increasing access to care for
mobility-restricted or rural veterans.
How will the VA system’s lessons
impact the broader telemedicine
landscape?
Viterion Digital Health is now using the
lessons learned over 12 years with the VA
in new partnerships with ACOs, hospitals,
health systems, long term care organiza-
tions and health plans. A significant and
positive change for telehealth this year is
CMS’ introduction of a reimbursement
program for chronic care management
(CCM). Eligible for this are Medicare FFS
patients with two or more chronic condi-
tions, who are often the sickest and most
costly to manage. For providers imple-
menting CCM, meeting CMS’ rigorous
reimbursement requirements--successfully
establishing, coordinating and manag-
ing comprehensive care plans for these
patients, integrating non-face-to-face pa-
tient care, documentation through existing
practice/hospital EHRs and management
systems--can be extremely important to
their bottom line. It presents a new oppor-
tunity for private CCM/TCM providers
to integrate telehealth as part of remote
care, which can lead to improved patient
outcomes, convenience, satisfaction and
avoidance of unnecessary care costs, as
proven by our extensive history and experi-
ence with the VA.
V.A. LEADS THE WAY // FROM PAGE 15
cally ill patients and developing care
coordination plans utilizing telehealth.
The options are robust and capabilities
are truly remarkable with this newfound
ability to impact patients suffering from
chronic diseases. You can now take your
care to the home of patients you treat,
which has already shown many posi-
tive outcomes in managing chronic dis-
eases such as diabetes, while earning a
monthly reimbursement per patient. For
this type of program you need to deploy
the devices necessary to monitor the pa-
tients remotely. The options available on
the market are diverse and even though
they essentially all do the same things in
regards to collecting vital signs data, the
higher tiers of monitoring devices can do
much more. Devices can give you an up-
loaded customized series of survey ques-
tions to gauge the patient’s daily condi-
tion, medication adherence reminders,
educational materials such as exercise and
diet suggestions along with live video ca-
pability, all in one unit installed into the
home.
Provide Mobile Diagnostics
Mobile diagnostics or imaging is an av-
enue a provider can champion and build
a business off of as well. The global mo-
bile imaging services market was valued at
USD 10.7 billion in 2013 and is expected
to grow at a CAGR of 3.2% from 2014 to
2020, to reach an estimated value of USD
13.3 billion by 2020.
The telemedicine tools are now avail-
able, but the catalyst for massive change
will come from those with credentials,
with years of education, these vital knowl-
edgeable few who have been entrusted
to care for us. I dare you to embrace the
revolutionary journey of becoming a tele-
physician and shaping our clinical world
for centuries to come.