Mr. Chairman and distinguished Members of the Committee, we are grateful for the opportunity to provide testimony on Overcoming Rural Health Care Barriers: Use of Innovative Wireless Health Technology Solutions. My name is Dan Frank and I am the Managing Partner of Three Wire Systems, LLC (Three Wire). I am joined by my colleague, Dr. Ian Shaffer. Dr. Shaffer is the Chief Medical Officer for MHN. Three Wire is the prime contractor and MHN provides clinical support for the VetAdvisor® Support Program which is the topic of our testimony.
We will provide an overview and results to date of the VetAdvisor Support Program (VetAdvisor), an innovative evidence-based program that provides mental health outreach and health coaching services to Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans and their families, in both urban and rural areas. VetAdvisor uses non-traditional telehealth/virtual health delivery platforms to reach out to, and improve Veteran awareness of, and access to, the mental health support for which they are eligible.
What Is VetAdvisor?:
Telehealth is the underpinning of this ongoing program to ensure Veterans who have enrolled in VA and who may have mental health issues do not fall through the cracks. VetAdvisor is a two-part program - sponsored during the past three years by Veterans Integrated Service Network (VISN) 12, which augments and supports existing VA behavioral health care services, and assists Veterans with challenges they face during reintegration into civilian life. Using a call center that makes outgoing calls to conduct VA-approved behavioral health screenings, VetAdvisor identifies and refers to VA Veterans who may be in need of clinical behavioral health assistance. In addition, health coaching is a newer component of the program, which provides Veterans with an opportunity to participate in individual or group health coaching sessions using a virtual room on a computer, or by phone, if the computer is not an option. For example, a Veteran may work with a health coach on issues such as tobacco cessation, weight management, or understanding Post Traumatic Stress Disorder (PTSD) management.
VetAdvisor assists Veterans and their families, providing complementary, non-clinical support to Veterans identified and referred to the program by VA. Telehealth platforms allow enrolled OIF/OEF Veterans to stay connected and focus on areas of concern to them without leaving their homes. VetAdvisor’s trained health coaches (i.e., Licensed Clinical Social Workers) who conduct these sessions are critical to the popularity and growing success of this innovative VISN 12 initiative.
VetAdvisor, as an extender of VA face-to-face clinical services, focuses on identifying and working with Veterans who have, or are at risk for, PTSD, depression, substance abuse, suicide and homelessness. This telehealth approach to outreach, screening and coaching helps eliminate the stigma Veterans often associate with seeking mental health services and assists them in getting treatment.
From Wired Broadband to Mobile Wireless Health Platforms
In the past, Veterans who opted to use the virtual world health coaching program required wired broadband internet connectivity for their desktop or laptop computers to access a 3D collaboration environment to work with their health coach as depicted below.
However, Veterans who reside in rural areas can face challenges acquiring such wired services. Recognizing this limitation, VetAdvisor worked with our technology partners to leverage the most ubiquitous of consumer electronic devices: the mobile phone. In the United States, there are over 285 million mobile phones in use, which equates to a 91 percent market penetration. The use of mobile devices to wirelessly provide highly mobile or rural populations direct access to a healthcare system is an important component in VA’s transition to the Patient Centered Medical Home model. VetAdvisor will launch a virtual world smartphone capability (i.e., iPhone) in the fall of 2010. By extending the virtual world to smartphones, we can significantly increase the Veteran user base in rural areas where broadband service is not available but cellular service is. Additionally, please note that if Veterans opt to not to use the virtual world, they can simply use their cell phones to obtain health coaching services.
Today’s Veterans are increasingly reliant on mobile devices for communication and entertainment. VetAdvisor allows Veterans to access their health coach/virtual room on their own terms at a time and place that is most advantageous to them. The image below is an example of the VetAdvisor Virtual Room (VVR) as hosted by an Apple iPhone. We envision Veterans using these mobile devices anywhere and anytime they desire to work with their health coach within the virtual world. The scene below depicts a Veteran working with his medical team in the VVR to discuss the loss of a limb.
Leveraging the latest wireless technology employing telephonic and virtual world platforms, this program provides a cost-effective, appropriate and popular expansion of VA’s telehealth capability to allow for convenient follow-up with Veterans in urban and especially rural communities that VA identifies as at risk. Without this program, many of these Veterans might not return to VA to get the help they need or have as successful a return to their jobs, school and families.
The Evolution of VetAdvisor
VetAdvisor was initiated as a competitively awarded contract in 2007 by VISN 12, to Three Wire Systems, LLC (Three Wire), a Service Disabled Veteran Owned Small Business, and MHN, a Health Net behavioral health company.
Veterans who enroll in VA after returning home do not always seek clinical help until their mental health needs are critical. This may be due to a lack of understanding of symptoms, denial that a problem exists, lack of awareness of available mental health support, or stigma. VetAdvisor overcomes these barriers through its telephonic/virtual approach to identifying behavioral health care issues and virtual health coaching. VetAdvisor contacts those Veterans who may not take the initiative to get involved in mental health care before a tragedy or issues occur. VetAdvisor does this by using a proactive outreach approach:
- Using Computerized Patient Records provided by VA, VetAdvisor representatives call Veterans to thank them for their service
- During the phone call or at a scheduled date/time that is convenient to the Veteran, the health coach assesses the Veteran through a series of VA-approved screenings. The screenings cover both medical and behavioral health conditions associated with serving in combat to include: PTSD, Traumatic Brain Injury (TBI), suicide risk. substance abuse, depression and common medical disorders.
- If needed, a referral is made (and followed up on) to a VA mental health clinician.
- The VA medical facility is provided with the results of these screenings. The VA uses the results for follow-up and further evaluation. Once Veterans with behavioral issues are identified, they are encouraged to enroll in the VetAdvisor Health Coaching Program.
- The Health Coaching Program facilitates and supports Veteran involvement in existing VA services. A health coach is assigned to the Veteran for regular contact, advocacy, skill building, support and to provide motivation to seek treatment.
- Coordination continues with the Veteran, health coach, and primary care physician for as long as necessary.
Health coaching services are provided to Veterans through telephonic communication and/or virtual collaboration technology—the VetAdvisor Virtual Room (VVR). In the VVR, the Veteran and the coach interact as avatars. This highly immersive virtual environment provides strong feedback that enhances collaboration and communication. Virtual technology assists Veterans in their reintegration efforts in a number of ways. One of the major advantages is that it allows for the Veteran to discuss personal issues from the privacy of his or her own home or private setting of choice. Veterans maybe more willing to acknowledge the magnitude of their issues in this private environment. Secondly, it saves the veteran time and travel costs associated with office visits. For today’s Internet savvy generation of Veterans and their families, this form of communication feels more natural than traditional communication methods.
VetAdvisor Coaching Groups
During the 18 month pilot period, Vet Advisor engaged over 10,000 Veterans from VISN 12. As a result of the program, over 1,100 Veterans were directed to VA medical facilities for follow up on positive screening results. The statistics support the program’s success: when a Veteran was successfully contacted, there was a 95 percent acceptance for health coach screening appointments. The types of issues discussed in health coaching sessions cover a wide range. The top issues are occupational, anxiety, health lifestyle management and depression.
The figure below illustrates the range of issues addressed in the sessions.
VetAdvisor’s proactive outreach and screening for behavioral issues has proven to be an effective tool in assisting Veterans ability to access services to treat or prevent potential issues such PTSD, depression, or substance abuse that can lead to a downward spiral in their life and even result in homelessness. It is designed to provide support when and where the veteran chooses, and to motivate those who realize they may benefit from assistance to access services. It augments existing VA services by being pro-active rather than just waiting for the Veteran to seek care. The VetAdvisor program is a successfully demonstrated approach to increase and improve the VA’s involvement and assistance to OEF/OIF Veterans. The VetAdvisor program can be offered throughout VHA to ensure that Veterans do not fall through the cracks following their initial visit to and enrollment in VA. VetAdvisor provides the VA a mechanism to overcome access to care challenges for Veterans living in rural areas by using technology, including wireless technology, and solutions to provide outreach and ongoing support to Veterans, regardless of where they live.
On behalf of Three Wire Systems and MHN/Health Net, we would like to thank you again for your interest in ways telehealth solutions like the VetAdvisor program can help our Veterans and their families in geographically remote areas receive the care and services they have earned through service to our country. We are grateful to the Subcommittee for its leadership and commitment to identifying innovative programs to improve access to and promote quality of care that can support the unique needs of enrolled Veterans residing in geographically remote areas.