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Telehealth
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FY
2007 Actual |
FY
2008
Enacted |
FY
2009
Estimate |
FY
2009 +/-
FY 2008 |
BA |
$6,819,000
|
$6,700,000 |
$6,819,000 |
+$119,000 |
Authorizing
Legislation: Section 330I of the Public Health Service
Act; as amended by Public Law 107-251, and 330L of
the Public Health Service Act; as amended by Public
Law 108-163.
FY
2009 Authorization |
Expired
|
Allocation
Method |
Competitive
Grant |
Program
Description and Accomplishments
Telehealth is the use of electronic information and
telecommunications technologies to support clinical
health care, patient and professional health-related
education, public health, and health administration.
Telemedicine, a subset of telehealth technologies
is defined as the use of telecommunications and information
technologies to provide or support long-distance clinical
care. Telemedicine and other telehealth technologies
are not things or ends in themselves, but the means
to provide services at a distance. Information may
be in various forms -- audio, video, data, or text.
In FY 2006, Congress expanded HRSA’s telehealth
programs beyond its Telehealth Network Grant Program
(TNGP) that provides grants to health care networks
to develop and evaluate the use of Telehealth technologies
to improve access to underserved communities. The
new funding allowed HRSA to add grants for: (a) pilot
projects examining the cost impact and value added
of tele-home care and tele-monitoring services (Telehealth
Networks-Telehomecare); (b) telehealth resource centers
to improve technical assistance to communities wishing
to establish telehealth services (Telehealth Resource
Center Grant Program); and (c) demonstrations to provide
incentives for licensure coordination among states
(Licensure Portability Grant Program). At the end
of FY 2006, 24 three-year grants were awarded as follows:
sixteen (16) grants for telehealth networks and telehomecare
networks, six (6) Telehealth Resource Center grants,
and two (2) grants to improve licensure coordination
among states. In FY 2007, funds were appropriated
to support continuation of these grants for their
second year.
A Program Assessment Rating Tool (PART) review of
the Telehealth Network Grant Program (TNGP) was conducted
in 2006. The program received a rating of “Moderately
Effective”, being cited for its success in expanding
access to services in underserved rural communities.
The assessment noted however that the impact on clinical
outcomes is unknown. The Office of Telehealth has
developed new annual performance measures and is tracking
performance against benchmarks. The program has started
collecting data on a new long-term measure to assess
the program’s impact on clinical outcomes in
diabetic patients served by the grantees of the TNGP
program, targeting control of hemoglobin A1C levels
in patients. As of August of 2007, TNGP grantees used
telehealth technologies to provide 39 different types
of clinical services, representing a total number
of 150 clinical services, across 339 sites in underserved
rural communities for a total of 489 sites and services.
For the baseline reporting period (FY 2005 funding),
101 communities had access to Pediatric and 72 had
access to Adult Mental Health services that otherwise
would not have had access in the absence of the Telehealth
grant. Data for FY 2006 and FY 2007 are anticipated
to be available in March 2008 and March 2009, respectively,
as grantees complete their activities for those funding
years. These data will be cumulative.
HRSA’s Office for the Advancement of Telehealth
(OAT) has started collecting data on a new long-term
care measure to assess the program’s impact
on clinical outcomes in diabetic patients served by
the grantees of the TNGP program, targeting control
of hemoglobin A1C levels in patients. For the majority
of TNGP grantees, OAT continues to track performance
against benchmarks mental health services, expansion
of sites and services, and sustainability.
To evaluate the performance of its tele-homecare/monitoring
grantees, OAT has developed common metrics and data
analysis strategies, based on data routinely collected
through the OASIS system, which is a nationally recognized
standardized data collection system of performance
measures. The measures focus on the impact of these
grants on the cost and effectiveness of the services
provided. Common metrics have been agreed upon and
a draft data analysis plan has been implemented. Data
are being collected and aggregated from all the programs,
with a report of the findings available at the end
of the 3-year grant cycle.
HRSA is also tracking performance of the Licensure
Portability Grant Program (LPGP) grantees. In FY 2006,
the Federation of State Medical Boards (FSMB) was
awarded a 3-year grant to reduce the legal and administrative
barriers to states sharing licensure information.
In its first year, FSMB established pilot projects
in two regions of the country to develop and maintain
a centralized interactive data management system.
FSMB also compiled state profiles of the technical
capabilities to electronically share licensure data
for each of the 14 states in the pilot regions, as
well as a policy analysis of each to determine legislative
and regulatory barriers to sharing data. A comprehensive
policy review of the 9 states that have specific telemedicine
licenses/registration programs also has been completed.
The National Council of State Boards of Nursing (NCSBN)
was awarded the second LPGP grant to identify and
implement enhancements to its current program for
cross-state recognition of licenses for nurses --
the Nurse Licensure Compact (NLC) and to support states
that are in the process of or considering adoption
of the NLC. In the first year, NCSBN developed a cost
analysis tool as a reference tool for States to address
misconceptions regarding the cost of adoption of the
NLC. To date, 23 states have implemented a NLC. A
summit of all nurse state licensing boards was held
to clearly identify the barriers to further expansion
of the NLC and selected states received funds to improve
their criminal background check systems, a significant
barrier to states implementing the NLC.
In FY 2006, six grants were awarded under the Telehealth
Resource Center (TRC) grant program. During their
first year, TRC’s provided individualized technical
assistance to groups developing Telehealth services
and have created web based tools to provide technical
assistance in the 24 states that they cover, including
US-Affiliated Pacific Islands.
Funding includes costs associated with grant reviews,
processing of grants through the Grants Administration
Tracking and Evaluation System (GATES) and HRSA’s
electronic handbook, and follow-up performance reviews.
Funding History
FY
2004 |
$3,949,000
|
FY
2005 |
$3,916,000
|
FY
2006 |
$6,814,000 |
FY
2007 |
$6,819,000
|
FY
2008 |
$6,700,000
|
Budget
Request
The FY 2009 Budget Request will facilitate a competition
for a new 3-year cycle of these grants at the FY 2007
level of activity. The FY 2009 Budget Request is $6,819,000,
an increase above the FY 2008 Enacted. The funds requested
will allow a new competition of the current Telehealth
Network Grant Program that supports consortia of health
providers to deploy telehealth technologies that:
(a) provide access to, coordinate, and improve the
quality of health care services; (b) improve the training
of health care providers; (c) improve the quality
of health information available to health care providers,
patients, and their families; and (d) evaluate the
impact of tele-home care and tele-monitoring services.
For 2009, HRSA has established a number of performance
targets for this program:
a) Increasing the proportion of diabetic patients
enrolled in a telehealth diabetes case management
program that have achieved ideal glycemic control
to 14.5% from a baseline of 10%;
b) Expanding the number of telehealth services (e.g.,
dermatology, cardiology) and the number of sites
where services are available as a result of the
TNGP program to 1,371 from 968 in 2008;
c) Increasing the number of communities that have
access to pediatric and adolescent, and adult mental
health services where access did not exist in the
community prior to the TNGP grant as a result of
the TNGP program to 207 for pediatric and 175 for
adult mental health services; and
d) Expanding the number of services and/or sites
that provide access to health care as a result of
the TNGP program per federal program dollar expended
to 106 per million federal dollars expended.
These funds will also support a new competition for
licensure portability grants that will allow:
(a) states to implement their plans for reducing the
barriers to cross state practice, and (2) HRSA to
expand licensure portability throughout the United
States and evaluate lessons learned from these grants.
The funds will also support a new competition for
the Telehealth Resource Center Grant Program, which
will allow the establishment of additional centers
of excellence in under served areas not presently
served with the resource centers funded in the 2006
- 2008, three -year grant cycle. This funding will
further allow HRSA to evaluate the effectiveness of
providing technical assistance and outreach services
through these additional regional centers. More specifically,
the funds will support 3 grant programs: 1) The Telehealth
Network Grant Program (including grants to specifically
examine the cost-effectiveness of telehomecare and
telemonitoring services) – $3,932,000; 2) The
Telehealth Resource Center Grant Program – $1,800,000;
and 3) The Licensure Portability Grant Program –
$700,000, as well as associated evaluation activities.
The remainder of FY 2009 appropriated funds ($387,000)
will support: (a) the mandatory administrative costs
of the grant competition, (2) evaluation of the progress
of these grants, and (3) other purposes to fulfill
the objectives of the telehealth programs, including
specialized technical assistance for grantees that
is unavailable from the resource centers, and implementation
of a uniform, electronic performance assessment system
that is consistent with the Department's evolving
Information Technology requirements.
#
|
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006
|
FY
2007 |
FY
2008 Target |
FY
2009 Target |
Out-Year
Target |
Target |
Actual
|
Target
|
Actual
|
Long-Term Objective: Expand
the availability of health care, particularly
to underserved, vulnerable, and special needs
populations. |
34.I I.A. 1 |
* Increase the proportion of
diabetic patients enrolled in a telehealth diabetes
case management program with ideal glycemic control
(defined as hemoglobin A1c at or below 7%). (Est.
Baseline for 2006 = 10%) a |
|
|
14.50% |
Mar-08 |
21% |
Mar-09 |
30% |
14.50% |
2011: 30% |
34.1 |
The percent of TNGP grantees
that continue to offer services after the TNGP
funding has ended. (Baseline: 2006) 100% |
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100% |
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2012: 95% |
Long-Term
Objective: Promote the implementation of evidence-based
methodologies and best practices. |
34.I II.D .2 |
Expand the number of telehealth
services (e.g., dermatology, cardiology) and the
number of sites where services are available as
a result of the TNGP program.b |
463 |
489 |
892 |
Mar-08 |
943 |
Mar-09 |
968 |
1,371 |
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# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long-Term Objective: Promote
the implementation of evidence-based methodologies
and best practices. |
34.III.D.1 |
Increase the number of communities
that have access to pediatric and adolescent,
and adult mental health services where access
did not exist in the community prior to the TNGP
grant. (Baseline – 2003: 79 Peds / 51 Adults)
c |
99 Peds / 62 Adults |
101 Peds / 72 Adults |
148 Peds/ 123 Adults |
Mar-08 |
160 Peds / 134 Adults |
Mar-09 |
160 Peds / 134 Adults |
207 Peds/ 175 Adults |
2011
219 Peds / 186 Adults |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Efficiency
Measure |
34 .E |
Expand the number of services
and/or sites that provide access to health care
as a result of the TNGP program per federal program
dollar expended (Baseline – 2003: 105/million)
d |
119
per million $ |
125
per million $ |
104
per million $ |
Mar-08 |
116
per million $ |
Mar-09 |
121
per million $ |
106
per million $ |
|
Other
Outputs |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target |
Actual |
Target |
Actual |
Telehealth Network Grants (Including
Tele-home Care/Monitoring). |
15 |
15 |
|
16 |
|
16 |
16 |
16 |
|
Evaluations |
1 |
1 |
|
1 |
|
1 |
1 |
1 |
|
Telehealth Resource Center Grants |
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|
|
6 |
|
6 |
6 |
6 |
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Licensure Grants |
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|
2 |
|
2 |
2 |
2 |
|
Appropriated Amount ($ Million) |
3.949 |
3.916 |
|
6.814 |
|
6.819 |
6.7 |
6.819 |
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a. |
It is estimated that
in the new cohort 10 % of the patients enter in
telehealth diabetes case management program with
ideal glycemic control (hemoglobin A1C at or below
7%) and, during the first year, this cohort will
achieve a 45% increase to 14.5 percent achieving
ideal control. With funding in FY 07, this cohort
of programs will achieve 21% of their patients
under control and those in the cohort funded in
FY 08 will have 30% of their patients under ideal
glycemic control. In 2009, the process begins
again with a new cohort of patients entering with
10% having ideal glycemic control, increasing
to 14.5% in the first year of the new cohort.
|
b. |
These targets are cumulative building
on the 489 Sites and Services achieved through
the 2003-2006 cohort. This cycle will begin again
in FY 2009 with the new cohort - annual targets
would be established based on the 2006-2008 cohort
experience. Current targets are ambitious in that
grantees continue to face significant barriers
to deploying telemedicine and with each new set
of grantees, the program funds grantees who add
more difficult services, as grantees explore the
boundaries of providing these services, e.g.,
innovative use of telehealth for physical therapy,
stroke assessment and post-treatment rehabilitation,
teledentistry, etc. |
c. |
Please note: Because this is a
demonstration program, every three years each
cohort of TNGP grantees "graduates"
from its three-year grant while a new cohort of
grantees commences a new three-year cycle of grant-supported
telehealth activities. The data are calculated
as a cumulative number. |
d. |
This measure provides the number
of sites and services made available to people
who otherwise would not have access to them per
million dollars of program funds spent. Every
three years, a new cohort of grantee commences
a new three-year cycle of grant supported activities,
gradually expanding sites and services per dollar
invested. With each cohort, there a start-up period
where services are being put in place but are
not yet implemented. Over the three years of the
grant, efficiency increases as grantees implement
sites and services. |
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