This announcement solicits applications for the Telehealth Network Grant Program (TNGP). The primary objective of the TNGP as noted in Section 330I(D)(1) is to demonstrate how telehealth programs and networks can improve access to quality health care services in rural, frontier, and underserved communities. TNGP networks are used to: (a) expand access to, coordinate, and improve the quality of health care services; (b) improve and expand the training of health care providers; and/or (c) expand and improve the quality of health information available to health care providers, and patients and their families, for decision-making.
To further elaborate on the program’s statutory requirements noted above, applicants are encouraged to develop innovative applications that meet new and emerging needs in a changing health care delivery system with a focus on value and improved health care outcomes. For example, in terms of expanding access to care, applicants are strongly encouraged to demonstrate how they will improve access to health care services that would not otherwise be available without the use of telehealth technology. In responding to the charge to use this funding to better coordinate health care services, applicants are also encouraged to demonstrate how the use of the technology could improve health care transitions and reduce avoidable re-admissions. In responding to the call for improving the quality of health care services, applicants could note how they will use telehealth technology to support the broader efforts of the Department of Health and Human Services’ Partnership for Patients. Examples could include post-discharge coordination or identifying ways to use telehealth technologies within the taking part in new delivery models such as Accountable Care Organizations and Shared Savings programs.
In accordance with Section 330I(g)(8) of the Public Health Service Act [42 USC 254c-14(d)(1)], applicants are asked to explain how they are basing their project on established clinical evidence, in accordance with the President’s Improving Rural Health Care Initiative included in the Administration’s 2013 budget request. As part of this initiative, the Federal Office of Rural Health Policy (ORHP) grantees are encouraged to use an evidence-based approach to its funded activities. There is a nascent telehealth evidence base as noted in the recent Institute of Medicine (IOM) report, entitled "The Role of Telehealth in an evolving Health Care environment" (2012). To the extent practical, applicants are encouraged to cite how their proposed approach to using the grant funds are based on established practices. This could include citing telehealth-related journal articles that detail approaches that are being replicated in their applications. To the extent possible, applicants are encouraged to work with their nearest Telehealth Resource Center in identifying these promising practices. As noted below, and in keeping with the legislative requirements, grants activities must serve rural communities, although the grantees may be located in either urban or rural areas.
In addition, all applicants are required to identify which clinical areas of telehealth they will focus on in their project. In doing so, each applicant will be required to set a baseline of data for those conditions that are the focus of their projects and then measure how their use of telehealth services affects the health status of those patients who are recipients of telehealth services. For example, if projects focus on diabetes management, applicants would develop a baseline of blood sugar levels for their patient population and then assess how the improved access to care and the better coordination of that care through telehealth technology improved outcomes over the course of the grant funding.
TNGPs may provide services in any of a variety of settings includinglong-term care facilities, community health centers or clinics, physician offices, hospitals, schools, and assisted living facilities to demonstrate how telehealth networks can meet the goals of the program.
Important: Applicants should have a successful track record in implementing telehealth technology and have a network of partners in place and committed to the project as of the date of application. Signed Memorandum of Agreements (MOA) from those network partners committed to the proposed project must be included in the application. Applicants failing to submit verifiable information with respect to the commitment of network partners, including specific roles, responsibilities, and clinical services to be provided, will not be funded. TNGP funds are intended to fund network expansion and/or to increase the breadth of services of successful telehealth networks. Start-up projects with no demonstrable telehealth experience will be at a competitive disadvantage.
Important: Projects selected for funding must provide clinical services for which performance measures can be developed. In particular, we strongly recommend an emphasis on those clinical services that focus on one or more of the chronic disease states of high priority (i.e. congestive heart failure, cancer, stroke, chronic respiratory disease and/or diabetes). An applicant must provide evidence to show that it will be ready to begin to implement the project upon grant award (the project start date is September 1, 2013).
It should be emphasized that the TNGP will seek to select projects that have demonstrated skill in evaluation. In addition, applicants must evidence a successful track record in providing telehealth services and demonstrate how the proposed funds will expand services to new communities and/or populations. Applicants must provide an evaluation design to measure process and outcomes. Quantitative outcomes should be measured in the following areas: impact on quality of care; appropriateness of use of the technology; whether access was improved; whether clinical outcomes were improved; and, how the cost of service delivery was affected in terms of efficiency and effectiveness of care.
Of particular interest will be programs that can clearly measure how the use of telehealth services can save health care costs either for providers or the patients they serve. This could take the form of reducing travel costs for patients or reducing avoidable admissions or re-admissions by better managing patient health. or reducing hospitalization rates and emergency room visit rates per year for patients receiving disease management services for diabetes, congestive heart failure, cancer, stroke and chronic respiratory disease; 3) controlling blood glucose levels in diabetic patients; 4) improving the efficiency of health care; and 5) reducing medical errors; and 6) other clear outcome measures.
Grantees will be required to participate in the Office for the Advancement (OAT) of Telehealth’s data collection/evaluation efforts as a condition of accepting TNGP funding. Data collected will include 6-month progress reports [including reporting on annual Government Performance Results Act (GPRA)-related performance measures], annual reports, information for the grantee directory, and final grant project reports. All of the data will be used to inform the telehealth community to advance the field as well as to manage the program. Also, grantees benefit from having the data as it provides them with a systematic way (by establishing a benchmark) of comparing their program to similar programs funded by OAT. Grantees are provided a feedback report of their measures compared to averages across all OAT grantees.
Another key program emphasis is on projects that effectively integrate administrative and clinical information systems with the proposed telehealth system and integrate the proposed system into each provider’s normal healthcare practice, including moving toward achieving meaningful use of Electronic Health Records (EHRs). Projects will also be required to document steps taken to ensure the privacy of patients and clinicians using the system and the confidentiality of information transmitted via the system, including compliance with Federal and State privacy and confidentiality, including Health Insurance Portability and Accountability Act of 1996 ( HIPAA) regulations.
In addition, as part of the grant application process, each applicant is required to submit a sustainability plan that outlines its strategy on how the services proposed will be sustained after federal funding has ended.