VHA INNOVATION PROGRAMInnovation #391 Phonak TeleaudiologyVHA ISB Business Case

September 25, 2013

VETERANS HEALTH ADMINISTRATION

Project Background

Problem Statement • Within audiology there is a need to make hearing aid aftercare services more accessible. The

two biggest barriers to accessibility are (1) travel burden and (2) lengthy wait times– On average, it is 93 miles roundtrip to the nearest care facility with an average of 2.8

hours lost to travel and $104 in travel-related expenses– Due to high demand, wait times for most new patients to receive audiology services are

lengthy, with most Veterans waiting 31-60 days

Description of Proposed Solution• Enable Veterans to receive hearing aid adjustments in their home environment using

telehealth technologies will reduce travel burden on Veterans and reduce wait times by improving the operational efficiency with which care is delivered

– Focused on Phonak brand hearing aid because 49% of hearing aids issued by VA are Phonak brand

– Used Android smartphones for delivery as it is the most popular smartphone operating system but have plans to expand to iOS (approximately 53% of Americans own a iPhone or Android smartphone)

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VETERANS HEALTH ADMINISTRATION

Execution Status

• Project initiated in October 2012 with a targeted completion date of December 2013

• Prototype has been successfully developed• Initial field testing of the prototype on 12 Veterans was successful

– Prototype was well received by Veterans and audiology staff: both indicated they would be interested and willing to use it in the future for hearing aid adjustments

• Three month pilot scheduled to begin in October 2013 at the Cleveland VA Medical Center

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VETERANS HEALTH ADMINISTRATION

ISB Selection Criteria

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Criteria See… Self-Assigned Score

Compliance Slide 4 1

Five-Year Net Operational Cost Change Slide 5 2

Implementation Cost Slide 6 -6

Clinical Impact (Broadness) Slide 7 10

Clinical Impact (Degree) Slide 7 10

Business Impact (Broadness) Slide 8 10

Business Impact (Degree) Slide 8 10

Patient Safety Slide 9 3

Patient Value Slide 10 15

Healthcare Disparity Slide 11 3

Value = 1 * (16+41) = 57

Business Value = 2 + (-6) + 10 +10= 16

Clinical Value = 10 + 10 + 15 + 3 + 3= 41

VETERANS HEALTH ADMINISTRATION

Business Case – Compliance

• As a mobile application, the innovation will need to undergo the mobile application certification process developed by the Office of Web and Mobile Solutions

• At a minimum, the certification process will include review by the following certifying bodies

– Software quality assurance– Patient safety assessment– 508 accessibility – Code review– Usability testing– User interface– VA branding – Sustainment plan

• At this time, no issues or concerns identified that would prevent successful completion of the certification process

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Self Assigned Score: 1

VETERANS HEALTH ADMINISTRATION

Business Case – 5 Year Net Operational Cost Change

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With a cumulative investment of $1.4 million (excluding implementation costs), this innovation will generate $19.7 million in benefits for a net benefit of $18.3 million

Self Assigned Score: 2

Five Year Investment and Benefit Profile

LegendCumulative CostCumulative BenefitCumulative Net Benefit

VETERANS HEALTH ADMINISTRATION

Business Case - Implementation Costs

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Self Assigned Score: -6

Implementation Component Unit Cost Y1

QuantityY2

QuantityY3

QuantityY4

QuantityY5

Quantity Total

Develop iOS version $215,000 1 0 0 0 0 $215,000Pilots, 6 months each $104,000 10 0 0 0 0 $1,040,000Installation costs $7,400 0 1 1 1 0 $22,200Knowledge transfer $5,000 1 0 0 0 0 $5,000Total - $1,260,000 $7,400 $7,400 $7,400 0 $1,282,200

An estimated $1.3 million investment is needed over a four year period for national rollout

VETERANS HEALTH ADMINISTRATION

Business Case – Clinical Impact

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Self Assigned Score, Broadness: 10Self Assigned Score, Degree: 10

Clinical Performance Metric Degree of Impact

Provider Wait Time – 20 Minutes or Less 10%C&P Timeliness 10%Access List 14 Days, Specialty Care 10%Getting Care Quickly, Outpatient 10%Rating of Healthcare, Outpatient 10%

This innovation will positively and significantly impact five clinical performance measures

VETERANS HEALTH ADMINISTRATION

Business Case – Business Impact

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Self Assigned Score, Broadness: 10Self Assigned Score, Degree: 10

Business Performance Metric Degree of Impact

Reduces Costs (Improves Staff Efficiency or Workflow) 10%

Improves Access to Benefits (Improves Veteran Experience) 10%

This innovation will positively and significantly impact two business performance measures

VETERANS HEALTH ADMINISTRATION

Business Case - Patient Safety

• Inability to detect auditory cues that signal danger (smoke alarm, sound of a car coming down the street) and the inability to use the phone create hazards

• This innovation will improve patient safety by decreasing the amount of time Veterans spend with broken or unusable hearing aids

Evaluation CriteriaScored -10 to 10 where -10 is severe decrease in patient safety, 0 is no change in patient safety and +10 is very strong impact in patient safety

1. Demonstratively reduces preventative harm in this population: 82. Reduces mortality and morbidity in this population: 03. Improves patient safety by demonstratively reducing the chance of human error: 0

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Self Assigned Score: 3

VETERANS HEALTH ADMINISTRATION

Business Case – Patient Value

• Veterans that participate in the innovation will save an average of 158 miles, 4.76 hours and $177 in expenses as a result of reduced travel to VA care facilities

• Veterans consistently rate their experience with telehealth technologies as being as go as or better than traditional face-to-face service delivery, highlighting the value of telehealth solutions

• Veterans that utilize audiology services but do not participate in the innovation will also benefit from the innovation because it will reduce demand on clinical audiology services

• Reduce wait times for both walk in services and scheduled appointments

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Self Assigned Score: 15

VETERANS HEALTH ADMINISTRATION

Business Case – Healthcare Disparity

• This project will address healthcare disparities related to access

– Make hearing aid services more accessible to Veterans in rural and highly rural areas, where the travel burden is particularly cumbersome

– Make hearing aid services more accessible to Veterans with limited mobility

– Reduce disparities created by regional differences in wait times for hearing aid aftercare services

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Self Assigned Score: 3

VETERANS HEALTH ADMINISTRATION

Questions?

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For additional information, please refer to the full business case (391_Busines Case.docx)