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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
8. Some Definitions What is Telehealth?
Varieties in VA:
Home Telehealth
Health buddies
IVR
Store Forward
Retinology, radiology, dermatology
General Telehealth
9. The Evidence Base
If you want randomized controlled trials you may have to wait a little longer
10. VA database
11. Where are the limits?
12. 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
13. 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
14. 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)
15. 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
16. 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
17. 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
18. FUNDING VA Office of Rural Health & Office of Mental Health Services
VA/National Guard Sharing agreement
19. 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
20. Implementation Issues Cross Sector contract issues
Credentialling, licensing
Medical Records
Fee for service
Provider motivation and training
Information sharing
Infrastructure
Ethical concerns
21. Program issues Patient Preparation
Room – lighting, noise, comfort
What to wear??
Patient satisfaction
Choosing patients
Choosing providers
Contingency planning
22. 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)
23. Cost per visit? So far: About $100,000
Engineering a prototype costs more than the last product off the assembly line.
24. WHY DO YOU WANT TO DO TELE?
(or do you?)