34.1.  Percent of Telehealth Network Grant Program (TNGP) grantees that continue to offer services after the TNGP funding has ended.  

(Baseline – 2005: 100%; Target – 2012: 95%)

Sustainability of grant-funded programs resulting in increased access to health care for more Americans is a key objective of this program.  History suggests that 100% of grantees continue to provide some level of telehealth services.  It is reasonable to set a target of 95%, allowing for unforeseen events associated with a more heterogeneous program and changes in the healthcare environment over a period of six years. The Program does not anticipate significant challenges to achieving this target.

Long-Term Objective:  Promote the implementation of evidence-based methodologies and best practices.

34.III.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.

The first cohort of grantees in this program was funded in FY 03 and the second funded in FY 06. As grantees mature, learn best practices from other grantees, and learn of new needs in the communities they serve, grantees may make additional telehealth services and service locations available.  It is anticipated that the program will experience a slightly reduced rate of growth in the future, after adjustment for carrying over existing sites that continue into the second cohort, that began in FY 06.  Actual data for the first year of this cohort (FY 06) will be available in March 2008.  The targets for the second cohort of grantees reflect a slight reduction from the first cohort because beginning in FY 06, the program requires that grantees put greater emphasis on evaluating services rather than on expanding the number of sites where services are provided in accordance with Congressional directives.  The targets are cumulative, building on the 489 sites and services made available in the first cohort (2003-2005) through TNGP funding, and are calculated by adding the number of projected services offered by each grantee to the number of sites operated by the grantee’s networks in each year to the baseline (i.e., 489).  FY 09 begins a new cohort of grantees, and the target of 1,371 services and sites assumes a similar rate of growth as experienced in past cohorts. Achieving this target will be dependent on the FY 09 level of funding and whether past trends of gradual growth continue into the future.  Of particular note is the challenge of clinical and payer acceptance, which is influenced by the development of solid models of best practices.  HRSA’s Telehealth programs strive to glean solid models of best practices from the grants that then can support enhanced clinician and payer acceptance of Telehealth services.

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)

The cumulative targets and data include the first 3-year cohort whose funding began in FY 03, and whose project period ended in August 2006; the second 3-year cohort whose funding began

in FY 06 and whose project period will end in September 2009; the FY 09 target for the first year of the third cohort; and finally the long-term target for FY 11.

With funds awarded in FY 03, 79 communities had access to pediatric and adolescent mental health services and 51 communities had access to adult mental health services as a result of the TNGP grant.  With funds awarded in FY 04, 99 communities had access to pediatric and adolescent mental health services and 62 communities had access to adult mental health services.  Finally, with funds awarded in FY 05, 101 communities had access to pediatric and adolescent mental health services and 72 communities had access to adult mental health services as a result of the TNGP grant, demonstrating the significant impact of the program on expanding access.

The FY 09 cumulative targets of 207 and 175 communities gaining access to pediatric and adult mental health services, respectively, through telehealth networks are based on prior experience.  By FY 11, a total of 219 communities are expected to have gained access to pediatric and adolescent psychiatric services and 186 communities will have gained access to adult psychiatric services that otherwise would not have had them in the absence of the TNGP.  The FY 09 target reflects the beginning of a new cohort of grantees.

These targets take into account the environmental challenges experienced by grantees even when grant funds are available.  For example, difficulty in obtaining services due to the shortage in the supply of mental health specialists and continued low reimbursement for these services.  In the second cohort, 16 programs were funded, but three of the sixteen are required to focus on providing and evaluating tele-home care services in accordance with Congressional directives. Moreover, fewer programs are offering pediatric/mental health services in the second cohort compared to the first (6 programs vs. 10 programs), and the targets reflect this fact.  The number of programs offering these services is difficult to predict as the legislation authorizing the TNGP grants provides grantees with wide discretion as to what they propose to provide, based on community need.  Nevertheless, the Program will continue to encourage applicants in the guidance to propose these services and provide continuing technical assistance to those that do provide services.

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)

One measure of the Telehealth Network Grant Program’s (TNGP) efficiency is the number of sites + services that provide access to health care as a result of the TNGP grant per $1 million Federal program dollars. The Telehealth program’s efficiency measure captures the fundamental underlying mission of the program: namely to expand access to services in underserved communities at an affordable cost.  This is a consistent indicator that can be tracked over time.  For example, with funds awarded in FY 03, grantees were able to achieve an efficiency of 105 sites + services per million dollars appropriated ($3.9 million).  With FY 04 funding, the efficiency factor increased to 119 per million and to 125 per million with FY 05 funds.  In FY 06, a new set of programs was awarded telehealth grants, with slightly more funding ($4.55 million).  The targets for this second cohort of grantees reflect a slight reduction from the first cohort because beginning in FY 06, the program requires that grantees put greater emphasis on evaluating services rather than on expanding the number of sites where services are provided in accordance with Congressional directives. As a result, we anticipate these grantees to have a similar learning curve as the FY 03 cohort, but they will emphasize evaluation of the services provided, possibly resulting in slightly fewer services or sites per million dollars expended.  The target for FY 09 assumes a similar experience in the first year of a new cohort as experienced in previous cohorts, reflecting a decrease in sites and services offered in the first year of a new cohort, a continued increase in tele-home care/home monitoring and an emphasis on evaluation of the quality and cost of services rather than a simple increase in the sites and services provided. It is anticipated that the efficiency will rise each year in the cohort, similar to prior years, as new sites and services are implemented.