A new trend in health care is to shift away from volume of services delivered toward a focus on medical value. Harvard Business School Professor Michael E. Porter is one of the originators of the medical value concept, which states that if value improves, patients, payers, providers, and suppliers can all benefit while the economic sustainability of the health care system increases.
One way to increase health care value is through a melding of medical care and technology, and Viasat innovation is helping take on this challenge by connecting patients via telemedicine. A pilot program serving veterans in 29 counties and parishes in rural Louisiana, Arkansas, and Texas (aka Ark-La-Tex) is a first step in a broader telehealth vision of using technology to extend medical services to improve outcomes, decrease costs, and save lives.
Connecting Mostly Rural Vets to VA Health Services
According to Trulia, most veterans live outside major metro areas, making up only 6.4% of the civilian adult population in large cities. The Veterans Administration (VA) estimates that 43,000 veterans live in rural areas within the region served by the Overton Brooks VA Medical Center in Shreveport, Louisiana. That presents an obstacle to providing access to VA health services that virtually all veterans require.
To connect widely-dispersed vets to the services they need, Volunteers of America (VoA) North Louisiana initiated the Rural Vets Health Outreach program, working though the Office of Rural Health at the Overton Brooks VA. Brian Byrd, regional vice president of VoA North Louisiana says the program is part of a larger innovation project of the national VoA organization. Byrd said the plan is to look at lessons learned and then determine how to scale the service nationally.
“We’re paying now for outcomes instead of treatment,” said Byrd. “It’s fine to treat patients, but are they getting better? It’s about prevention, not just treatment. Right now 80% of health care dollars are spent on 20% of patients and we want to shift that balance.”
Searching for the right communications system to add value to their health care initiatives, they learned about Viasat enterprise satellite services. Dean Jordan and Bill Sullivan have carried the ball for Viasat since then, but Sullivan says it is VoA that has been driving the project.
The VoA won a $2 million rural health grant to fund development of a prototype mobile clinic. The design of the clinic follows the blueprint of Viasat satellite newsgathering vans, using a RAM 2500 Promaster as a base. Along with Viasat gear inside the van is a seating area where a nurse can consult with patients and gather vital signs. A videoconference area at the rear of the van, featuring a large high definition (HD) flat screen TV, is made private through a soundproof pocket door that separates it from the rest of the space. The Exede network beams data to and from a self-pointing dish on the roof to provide a high-speed, two-way video teleconference between doctor and patient.
“It works really well. You just press a button and you’ve got instant internet access,” said Sullivan.
The VoA cites the high-bandwidth connection from Viasat as the key to making the remote clinic feasible and effective. Using HD video, doctors can have a virtual face-to-face appointment, including the ability to read facial expressions and clearly hear what vets are saying.
“We’re able to deliver very high-speed video at economics that are sustainable in a mobile clinic environment like this,” Sullivan continued. “With previous generations of satellite technology it would just be really expensive.”
Though plans to add primary care are in the works, the mobile clinic is initially focused on mental healthcare. In fact, according to the Department of Veterans Affairs, of the 2.6 million veterans of the wars in Iraq and Afghanistan, 33% believe their mental or emotional health is worse than it was prior to deployment. Also, in any given fiscal year, nearly half a million veterans with a primary or secondary diagnosis of post-traumatic stress disorder received treatment from VA medical centers.
With questions still surrounding the VA about the effectiveness and quality of the care it provides, the health outreach van is a positive step forward for both veterans and VA medical centers for a few reasons:
- Less need to use the physical facilities of the VA, reducing both operational costs and wait times through fewer patients on site.
- Dramatically reduces the typical 50% no-show rates for these mandated mental health visits.
- Eliminates the time and costs to drive – sometimes hours –to get to the VA.
- Enables proactive care for patients, which has been shown to reduce healthcare costs in the long run by avoiding future issues and illness.
- Improve measurement and tracking of outcomes through more frequent patient contact.
The program is in a pilot stage. Viasat is helping create an article for peer review medical journals to quantify and promote the positive patient outcomes and cost savings.
Sullivan is excited by the potential for telemedicine to make a difference for veterans. He concluded, “This is really using Viasat’s power for good. I can see a fleet of 200 of these mobile clinics serving veterans full time. It saves money and provides better outcomes. We’re truly creating value with our technology.”