1. VHA INNOVATION PROGRAM Innovation #391 Phonak Teleaudiology VHA ISB Business Case September 25, 2013

2. 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) 1

3. 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 2

4. VETERANS HEALTH ADMINISTRATION ISB Selection Criteria 3 CriteriaSee…Self-Assigned Score ComplianceSlide 41 Five-Year Net Operational Cost ChangeSlide 52 Implementation CostSlide 6-6 Clinical Impact (Broadness)Slide 710 Clinical Impact (Degree)Slide 710 Business Impact (Broadness)Slide 810 Business Impact (Degree)Slide 810 Patient SafetySlide 93 Patient ValueSlide 1015 Healthcare DisparitySlide 113 Value = 1 * (16+41) = 57 Business Value = 2 + (-6) + 10 +10= 16 Clinical Value = 10 + 10 + 15 + 3 + 3= 41

5. 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 4 Self Assigned Score: 1

6. VETERANS HEALTH ADMINISTRATION Business Case – 5 Year Net Operational Cost Change 5 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 Legend Cumulative Cost Cumulative Benefit Cumulative Net Benefit

7. VETERANS HEALTH ADMINISTRATION Business Case - Implementation Costs 6 Self Assigned Score: -6 Implementation Component Unit Cost Y1 Quantity Y2 Quantity Y3 Quantity Y4 Quantity Y5 Quantity Total Develop iOS version$215,00010000 Pilots, 6 months each$104,000100000$1,040,000 Installation costs$7,40001110$22,200 Knowledge transfer$5,00010000 Total-$1,260,000$7,400 0$1,282,200 An estimated $1.3 million investment is needed over a four year period for national rollout

8. VETERANS HEALTH ADMINISTRATION Business Case – Clinical Impact 7 Self Assigned Score, Broadness: 10 Self Assigned Score, Degree: 10 Clinical Performance MetricDegree 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

9. VETERANS HEALTH ADMINISTRATION Business Case – Business Impact 8 Self Assigned Score, Broadness: 10 Self Assigned Score, Degree: 10 Business Performance MetricDegree 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

10. 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 Criteria Scored -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: 8 2.Reduces mortality and morbidity in this population: 0 3.Improves patient safety by demonstratively reducing the chance of human error: 0 9 Self Assigned Score: 3

11. 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 10 Self Assigned Score: 15

12. 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 11 Self Assigned Score: 3

13. VETERANS HEALTH ADMINISTRATION Questions? 12 For additional information, please refer to the full business case (391_Busines Case.docx)