VHA INNOVATION PROGRAMInnovation #655 Sepulveda Meditation and Relaxation ProgramVHA ISB Business Case

September 25, 2013

VETERANS HEALTH ADMINISTRATION

Project Background

• Problem Statement – According to the National Center for PTSD, about 7-8% of the general population will have PTSD at some point in their lives. In the Veteran population, that number increases.• Roughly 11-20% of Veterans of the Iraq and Afghanistan wars, as many as 10% of Gulf War Veterans

and approximately 30% of Vietnam Veterans suffer from PTSD. While often in the limelight, PTSD is only one mental health/lifelong condition Veterans are suffering from. Suicidal ideation, depression, anxiety, chronic pain, and sleep disorders are also common in the Veteran population. While VA has made strides to increase the availability of mental health care, high demand for care , lack of individual appointments with mental health, and access & wait times are still an issue. Available appointments are often turned down because of the stigma of psychiatric care.

• Description of Proposed Solution – The idea combines holistic therapies and mind-body practices with primary and mental health care. While holistic medicine and mind-body practices aren’t innovative in themselves, the specific program designed and used by this innovation staff is both comprehensive and innovative.

• The Sepulveda Meditation and Relaxation Innovation Program (SMRP) combines five mind-body practices into a integrated care program.: 1) progressive muscle relaxation; 2) healing touch/guided imagery; 3) mindful meditation (iRest); and 4) meditative movement.

• Patients are referred to the SMRP by either a mental health or primary care provider. • Patients start with a 4-week intro group to all the practices. They can then choose to attend groups

that they find most beneficial to their needs. • Patients also receive MP3 players with pre-downloaded meditation tracks for home use.

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VETERANS HEALTH ADMINISTRATION

Execution Status

• Approach to Solution and Major Objectives – SMRP addresses the backlog and demand for mental health treatment. It also achieves the following objectives:

– Increases Patient Centered Care & Patient Empowerment: Mental health and primary care providers collaborate to address the whole patient

– Improves Access & Efficiency: Skills are effective for variety of presenting problems & free to use, thus avoid medication costs/individual primary care & mental health visits.

– Improves Quality of Care & Patient Physical and Emotional Health

• Execution Status –SMRP was a 2012 Employee Competition winner. The official Program ended in July 2013. The local site has picked up the cost of the SMRP to continue the current schedule. If they had not, hundreds of Veterans would not have had the opportunity to partake in the groups.

– Before the innovation funding, the staff offered 2 groups/week= 217 unique patient encounters from 12/11-6/12.

– As part of the innovation program, the staff held 12 groups/week= 3,607 unique patient encounters from 7/12-6/13. To compare with before the innovation funding (6 months), the post-innovation encounters would still be ~1,500 which is roughly 7Xs the number of encounters prior to the innovation. That is 7Xs the number of Veterans receiving access to mental health care at just one VA facility.

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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 10

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 10

Patient Value Slide 10 10

Healthcare Disparity Slide 11 1

Summary Value = 1 * (24+41) = 65

Business Value = 10 + (-6) + 10 + 10 = 24

Clinical Value = 10 + 10 + 10 + 1 + 10 = 41

VETERANS HEALTH ADMINISTRATION

Business Case – Compliance

• The solution is compliant with the following regulations:– Patient safety (patients are referred to the program by PCP or mental health)– Privacy

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Self Assigned Score: 1

VETERANS HEALTH ADMINISTRATION

Business Case- 5 Year Net Cost Change

• Financial: The VA has budgeted $6.2 billion in FY13 for mental health care. This includes staffing, inpatient and outpatient care, substance abuse treatment and medications (roughly $385 million was spent on mental health, pain and sleep outpatient medication in FY12). The current treatments are expensive and this is without all Veterans being seen and treated in a timely manner. This innovation was awarded $305,730.68 for 1 calendar year. ~90% of the funds were spent on staffing- the entire backfill salary of a psychologist (1FTE) and 2 RNs (.5FTE/each). The other 10% was spent on upgrades to the mind-body “studio”. It was a complete transformation and a 1-time only expense. For ~$270,000/year you can reach thousands of Veterans, while cutting cost for more expensive treatments and medications. $289,902,973.70 decrease in Rx over 1 year (w/national participation) Xs 5=$1,449,514,868.5

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Self Assigned Score: 10

VETERANS HEALTH ADMINISTRATION

Business Case - Implementation Costs

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Year 1 Year 2 Year 3 Year 4 Year 5

Pilot Phase $0 $0 $0 $0 $0

Deployment Phase $1.16M $1.12M $1.8M $1.8M $1.8M

Cumulative Costs $1.16M $1.12M $1.8M $1.8M $1.8M

Self Assigned Score: -6

VETERANS HEALTH ADMINISTRATION

Business Case- Clinical Impact

• Clinical: Improving quality of care, providing a comprehensive mental and primary care solution.

• Much of the clinical impact is intangible:• The increased quality of life, based on first-hand Veteran feedback, should not be discounted. While

not every quote can be backed with financial statistics, the results these Veterans have seen by participating in the SMRP should be recognized. 93% of patients said that after the groups, they had at least one new strategy to help them cope with the concern that led them to join the groups.

– “I feel more relaxed in here than anywhere else.”– “I’m able to go to the park with my wife and kids now.”– “I wish this was available at all the VAMCs in every state.” – “It’s been a lifesaver for me.”– “I’m walking without a cane for the first time in 3 years because of this program.”– “It’s an hour I’m not in my own head.”– “I’m grateful it’s available.”

• Other clinical benefits can be seen in the financial analysis

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

VETERANS HEALTH ADMINISTRATION

Business Case – Business Impact

Operational: As previously stated, access to mental health therapies often takes longer than Veterans need. In FY12, more than 1.2 million Veterans received mental health care from VA. In May 2013, VA met its goal of hiring an additional 1,600 mental health care workers by the end of 2013. The cost of these additional workers is high and they are still only able to see a limited number of patients at a time (1 to maybe a small group of 8). This innovation allows 15-20 patients to receive treatment 2-3 times a day. No mental health professional can reach 60 patients a day in traditional therapy.

Operational (cont’d): In 2012, VHA met a mental health milestone by fully evaluating patients within 14 days; however only about 49% of the time. The remaining 51% waited an average of 50 days for full evaluations (though situations considered mental health emergencies are handled differently). For follow-up treatments, the report indicated an appointment is scheduled within 14 days about 88% of the time. In the SMRP, patients are accepted into the introductory group every 4 weeks (it is a 4 week program) and welcomed into any of the groups at any time. A patient can be referred on a Monday and attend a group on Tuesday.

• In FY12, 26% of the patient population was seen by a mental health provider. By expanding this program, more than a quarter of the VA’s Veterans could be impacted and that is just including those already undergoing mental health treatment with strained staff and limited resources.

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

VETERANS HEALTH ADMINISTRATION

Business Case - Patient Safety

• This solution demonstratively improves patient safety

– Decreases suicidal ideation, depression, anxiety, anger, and stress– By including blood pressure and participation data into CPRS, patients health record is more complete

and progress is traceable

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: 92. Reduces mortality and morbidity in this population: 93. Improves patient safety by demonstratively reducing the chance of human error:

N/A

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Self Assigned Score: 10

VETERANS HEALTH ADMINISTRATION

Business Case – Patient Value

• This solution significantly increases patient satisfaction– Provides an alternative/non-evasive setting for Veterans to receive mental health

treatment– Improves quality of life– Patients’ families reports of positive behavior changes– Veterans are comfortable receiving treatment with other Veterans, peer support

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Self Assigned Score: 10

VETERANS HEALTH ADMINISTRATION

Business Case – Healthcare Disparity

• This solution does not address a healthcare disparity

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Self Assigned Score: 1