The National Implementation of Care Coordination in VA

SPRY ConferenceSPRY ConferenceWashington DC 3Washington DC 3rdrd October 2003 October 2003

Adam Darkins MD, MPH,

Chief Consultant for Care Coordination

Department of Veterans Affairs

• Mortality rates decreasing by 1% p.a.

• Nursing home utilization 0.7% lower p.a.

• Disability rates decreasing by 2.2% p.a.

• Over 65’s increasing by 1.5% p.a

• Over 85’s increasing by 2.2% p.a

• 2% of patients 20-30% of costs

• Complex needs unmatched to service delivery

• Patients falling through the cracks in system

Changing National Trends in Long-term Care

Centers orOutpatient

HomeDoctor’sOffice

Health

Clinics

Rural andRegionalHospitals

ReferralHospitalsPrimary

Secondary

Tertiary A: The Existing Health Care System

Smart Home

Doctor’sOffice

B: The New Care Coordinated Health

Care System

Primary

Web Info

Telehealth

Community

Tertiary

RegionalRural and

Hospitals

HospitalsReferral

Outpatient

Health

Clinics

Secondary

Centers or

• Let technology lead services?

• Create financial incentives?

• Let a 1000 seeds bloom?

• Find a way to coordinate development?

Getting from A to B?:

“The ongoing monitoring and assessment of selected patients using telehealth technologies to proactively enable prevention, investigation, and treatment that enhances the health of patients and prevents unnecessary and inappropriate utilization of resources. Care Coordination uses best practices derived from scientific evidence to bring together health care resources from across the continuum of care in the most appropriate and effective manner to care for the patient”

Care Coordination: definition

• Patient and not provider centric• Designed to fill a gap in the system.• Contingent on collaboration with providers.• Manages chronic disease (DM, CCF, SCI, PTSD, DP WC)• Expands patient and provider relationship into the home

(home-telehealth technologies) • Expandable from current chronic disease

Model of Care Coordination

HCCSL 898 HCCSL Users Pre- and Post-Enrollment

0

100

200

300

400

500

600

700

800

900

1000

PRE 18 P RE 15 PRE 12 PRE 9 P RE 6 PRE 3 PST 3 PST 6 PST 9 PST 12 PST 15 PST 18

Quarter

# U

ser

s o

f S

ervi

ces/

Qtr

Rx HCCSL Users of 898 Enrollees Outpt. HCCSL Users of 898 Enrollees

Inpt. HCCSL Users of 898 Enrollees

En rolled In HCCSL

as of 7/6/2001

Care Coordination: outcomes

• Quality of life Quality of life • Patient satisfactionPatient satisfaction• Utilization:Utilization:

Define Model

Evaluate

Implement Critically Review

Care Coordination

Telecom server

Databases

Health data repository

Data is linked toIntranet and sent to VistA

HOMEHOMEVital sign data

Disease management data

E-health informationEthernet

56k

DSL

Cable

Intranet

Patient

Caregiver or

Care Provider takes measurements

VSB

HospitalInternet

Firewall

Encryption

PKI

National VHA CareNational VHA CareCoordination InfrastructureCoordination Infrastructure

National VHA CareNational VHA CareCoordination InfrastructureCoordination Infrastructure

• Phase 1 (1999) 1,500 Patients

• Phase 2 (2003) 2,500 Patients

• Phase 3 (2004) 10-25,000 Patients

• Phase 4 (2005) 50,000 Patients

Model of Care Coordination

Program Office

Technology Specifications

Performance Measures

Licensing and Quality Management

Care Coordination Implementation

• Reimbursement model

• Programs self-sustaining

• Interface care coordination and case management

• From management chronic diseases to ADL’s

Expansion Post October 2004

Clinical Settings

Clinical services

Care Coordination: Making the Connection

Provider

Patient at Home

Technology

00

1010

2020

3030

4040

5050

6060

19981998 19991999 20002000 20012001 20022002

NormalNormal MildMild HighHigh

Per

cent

Pat

ient

sP

erce

nt P

atie

nts

3,1333,133 6,5076,507 8,3578,357 9,4189,418 10,74510,745

P < .0001P < .0001

Improving HypertensivesImproving Hypertensives

• Multi-media record including data from home

• Outcomes measurement

• R&D

• Shared-decision making

Care Coordination

• Program office for care coordination roll out

• Clinical input into e-health to patients

• Clinical input into MyHealth-e-Vet

• R&D

Office of Care Coordination