Audit of VHA's Home Telehealth Program

The goal of the Home Telehealth Program is to improve veterans’ access to care while reducing patient treatment costs. The program does this by remotely monitoring patients’ vital signs in the home and intervening early when adverse trends are detected. We determined how effectively the Veterans Health Administration (VHA) is managing its Home Telehealth Program. VHA missed opportunities to expand enrollment for Non-Institutional Care (NIC) patients in the Home Telehealth Program. NIC telehealth patients showed the best outcomes, in terms of reduced inpatient admissions and bed days of care (BDOC). In FY 2013, the number of NIC patients-served declined by 4 percent, while the number of Chronic Care Management (CCM) and Health Promotion/Disease Prevention (HPDP) patients-served grew 51 and 37 percent, respectively. The significant change in the mix of patients receiving care in this program occurred due to a change in the performance methodology. VHA began to measure program performance by the total number of patients-enrolled, rather than focusing on the increase in enrollment for NIC patients. This change in performance metrics encouraged VHA to enroll more HPDP participants. These participants would likely need less intervention from Primary Care physicians, because their health care needs would be less complex. VHA was successful in reaching its new performance metric. However, obtaining this goal did not result in more patients with the greatest medical needs receiving care under the program. As a result, VA missed opportunities to serve additional NIC patients that could have benefited from the Home Telehealth Program. VA could have potentially delayed the need for long-term institutional care for approximately 59,000 additional veterans in FY 2013. We recommended the Interim Under Secretary for Health implement mechanisms to identify demand for NIC patients and develop specific performance measures to promote enrollment of NIC patients. The Interim Under Secretary for Health concurred with our recommendations and provided an acceptable action plan. We will follow up on the implementation of the corrective actions.