Mr. Chairman and other Members of the Committee:  Thank you for giving me the opportunity to provide testimony to the Committee.  My name is Derek Newell and I am President of Robert Bosch Healthcare.  Bosch, which makes the Health Buddy and T-400 remote monitoring devices, has been providing remote patient monitoring in the Veterans Health Administration (VA) since 2003 and is the largest provider of in-home monitoring services to the VA.  Bosch serves over 30,000 veteran patients and accounts for approximately 70 percent of the remote monitoring devices used by the veteran population. 

The population we serve suffers from chronic illnesses like congestive heart failure, diabetes and lung disease, and most have more than one condition.  The Health Buddy and the T-400 Systems collect patient symptoms and vital signs, such as blood pressure or blood sugar levels, and provide education and self-support tools through a series of questions answered by patients. The responses are prioritized by risk and transmitted to care managers within the VA.  This risk stratified output then enables care managers to quickly determine what kind of intervention is necessary for each patient, preventing escalation of symptoms.

These technologies have demonstrated positive results in improving the health care of our nation’s veterans’ population and in reducing costs, for example, 25% reduction in inpatient days and 19% reduction in hospital admissions. The VA has been visionary in building upon the successes of this rapidly emerging segment of the health care delivery system.

Regarding improvements in the procurement process, first, we applaud the transition of procurement and purchasing of home monitoring devices to the Denver Acquisitions Center, which will integrate and mainstream procurement practices for home monitoring technologies, including the Health Buddy, and T-400. The purchasing was previously done through the prosthetics department, which is excellent at purchasing physical objects, but is not accustomed to purchasing devices that also have content, applications and services integrated with them. Our devices are required to be connected to our data centers and to be available to upload data from the veteran and download content and programs for the veteran. Moving the procurement to the Denver Acquisitions Center allows separate payment for materials, applications, content and services, which will be increasingly important as these elements become increasingly intertwined with physical devices.

While we compliment the VA’s innovation to date, we believe there are a number of ways that Congress could assist the agency in improving the contract and procurement process to expedite greater use of home-based remote health care and other innovative technologies.

Based on our experience, I suggest the following enhancements that would improve contract and procurement processes in the VA.

• Preferred Partners: The cost of some of the systems and technologies, as well as the cost of continual innovation, require vendors to have some reasonable sense that they will have a successful relationship with the VA. Currently, remote monitoring, vendors need to commit to installing hardware in a data center within the VA as well as within a backup data center within the VA. After this they are free to sell their technologies to the related VISN’s, but there is no guarantee on how many units the VA will buy or how many units any vendor would sell. Rather than have a broad spectrum of vendors (the current proposal is 6), we recommend a more limited number of vendors with a larger commitment to and from each vendor (maximum 3 vendors). This would meet the VA goals of ensuring adequate competition within the VA and avoiding major supply disruptions if one vendor has financial or production problems, but it would also ensure a viable market for each vendor within the VA. 

Targeted Innovation: Recently the VA has started communicating to partners about its vision of veterans’ health needs and priorities, however this could still be improved.  Better communication and funding targeted innovation with preferred partners would enable us to respond in a more timely manner to the needs of the VA and to be partners in finding solutions. At present, a majority of our information comes only when a solicitation is released. Only then do we have a concrete knowledge of the VA’s national perspective and the goals and priorities.  The short turnaround cycles for proposal submissions do not allow for the innovation that would be possible with longer planning cycles. The recent Innovation grants proposed and funded by the VA are a step in the right direction.

• Introduce continuity into the FSS contracting process by appointing a single point of contact for partners.  Currently we interact with a variety of FSS contract staff, which creates a constant learning curve for them.   We encourage a move back to FSS’s former process of a consistent point of contact, which would streamline information flow and trim down bottlenecks.
• Greater sharing of information between VHA and other federal health care agencies could expedite telehealth adoption rates by the VA and those agencies.  We believe poor information-sharing hampers agencies’ ability to make mid-course program corrections and, by keeping information “under wraps,” effectively limits adoption of emerging and known best practices.

Mr. Chairman and members of the Committee, we believe these few but concrete and specific actions would go a great distance to support the VA’s efforts to expand the use of telehealth technologies.  In this regard, we admire the VA’s efforts to date and hope that our years of experience in interacting with the agency as a private vendor will be of use to the Committee.

I appreciate this opportunity to testify and would be happy to answer any questions you might have.