TELEHEALTH
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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.
II.
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 |
N/A |
N/A |
14.5% |
Mar-08
|
21% |
Mar-09 |
30% |
14.5% |
2011:
30% |
34.1 |
Percent
of TNGP grantees that continue to offer services
after the TNGP funding has ended. (Baseline:
2006) |
|
100% |
|
|
|
|
|
|
2012:
95% |
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.b |
463 |
489 |
892 |
Mar-08 |
943 |
Mar-09 |
968 |
1,371 |
|
# |
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 |
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 $ |
|
Appropriated
Amount
($
Million) |
$3.9 |
$3.9 |
|
$6.8 |
|
$6.8 |
$6.7 |
$6.8 |
|
Notes:
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 09 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 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 grantees commences a
new three-year cycle of grant supported activities,
gradually expanding sites and services per dollar
invested. With each new cohort, there is 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.
INTRODUCTION
The Telehealth Network Grant Program’s
(TNGP) performance measures allow the Program to track
progress in achieving its objectives of improving
access to quality health care services, particularly
to rural and other underserved populations, and promoting
the implementation of evidence-based technologies
and best practices. Strategies used that support
efforts to meet performance targets include sharing
best practices, offering technical assistance to grantees,
and encouraging grantees to offer specific types of
services to address their communities’ needs.
DISCUSSION OF RESULTS AND TARGETS
Long-Term Objective: Expand
the availability of health care, particularly to underserved,
vulnerable, and special needs populations.
34.II.A.I. 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%).
At the end of FY 06, HRSA began
to fund a new three-year cohort of grantees under
the Telehealth Network Grant Program (TNGP). It is
estimated that in this new cohort 10 % of the patients
enter a telehealth diabetes case management program
had 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.
Data for this first year will be available in March
2008. With funding in FY 07, this cohort of programs
is expected to achieve 21% of their patients under
control (data available in March 2009) and those funded
in FY 08 will have 30% of their patients under ideal
glycemic control. In FY 09, 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. A major challenge to
achieving these targets has been the heterogeneity
of the projects funded, many of which involve diabetic
education primarily, with little direct link to clinical
services that measure hemoglobin A1c. We are currently
working with the grantees to obtain the necessary
data from affiliated clinical providers.
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.
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