Conflicting telehealth signals – is the VA or E Riding of Yorkshire CCG on the money?

Can there be two greater contrasts than the recent decisions by the Dept of Veteran Affairs in the US (VA) to award a five year $28.8m telehealth contract to AMC Health and that of the E Riding of Yorkshire CCG to “axe” its telehealth service?

The sheer size of the VA deal makes every recent deal in Europe seem very small in comparison. AMC’s CEO said: “AMC Health’s outcomes-based approach to telehealth and ability to actively engage patients to proactively self-manage their chronic conditions perfectly aligns with the VA’s telehealth goals. Both organizations focus on prevention and creating an environment in which people are motivated, engaged and feel responsible for their health”.  He might be a touch partial, although it all makes perfect sense, and suggests the VA has no doubts as to the efficacy of the technology.

Editor Donna notes: Our readers should also find it interesting that the services provided by AMC Health are near-turnkey for the VA except for the none-too-easy data integration. They span telehealth, case management and analytics,  PERS, interactive voice response (IVR), video consults and health coaching for VA outpatients. They are also providing an improved patient portal that meets FDA standards, integrates data with and adds functionality to VA’s VistA EHR (EHR Intelligence). I find it interesting that the release shies away from calling it telehealth, instead terming it ‘biometric remote patient monitoring’. (Hmmm…) Not disclosed is the care population size (VA cared for 8.8 million patients in FY 2012) or geographic footprint over the five year deal.

It is also not the first ‘big bet’ of the VA on telehealth. In 2011 (12 April) we covered VA granting six national contracts for telehealth totaling $1.38 billion over five years to: Cardiocom (now sold to Medtronic), Authentidate, American TeleCare (ATI), Bosch Healthcare, ViTelCare and Viterion (sold by Bayer in May). At the time, FierceMobileHealthcare estimated that individual contracts ranged from $150 million to $372 million over the five-year period.

Meanwhile back in the E Riding, EHI reports that the CCG has given GPs six-month’s notice to get other services in place; an evaluation of the programme did not demonstrate cost-effectiveness. They then quote from the letter: “The existing body of evidence on the cost effectiveness of telehealth is limited to a narrow range of conditions, and indicates that any cost benefit is conditional on the effective targeting of selected patient groups” which seems to be saying something different.

Perhaps those wholly-unrepresentative-of-telehealth cost effectiveness comparisons for the Whole System Demonstrator (WSD) are at it again so it’s nice to read Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis by Kaambwa et al of Flinders University in Australia that has just been pre-published online which demonstrates more attractive cosy/QALY figures from telemonitoring and self-management of hypertension.

Finally perhaps just worth mentioning that you can catch Adam Darkins of the VA at the Royal Society of Medicine’s Telemedicine conference on November 25 & 26 where he is giving one of the keynotes, alongside the likes of the DH’s Jon Rouse, Mary Baker, President of the European Brain Council and dementia expert Prof June Andrews.

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  1. Mike Clark


    The latest evaluation of the East Riding of Yorks telehealth service covering 2011/2012 by David Barrett of University of Hull is available at:

    This covers some of the primary/secondary care service costs and the patients groups involved.

  2. Duncan Chambers

    It is fallacious to compare the US VA with the UK NHS. The VA has centralised decision-making processes; serves a generally older and less healthy population; and most importantly has a high proportion of patients living in genuinely remote locations, who nobody disputes can benefit from telehealth.