Veterans have unique needs and often complicated health histories. The 9 million enrolled with the U.S. Department of Veterans Affairs (VA) cross multiple generations from World War II to the current conflicts. With changes in demographics, technology and direction of healthcare, it is critically important that federal officials, with input from veterans and private industry, be proactive and innovative to shape the future of Veterans Health Administration (VHA) medicine. Such was the consensus in a May 2017 discussion led by AMSUS, the Society of Federal Health Professionals.
In its second public policy and strategy forum to address important topics in federal medicine, AMSUS gathered public and private sector leaders to discuss how VA can best deliver healthcare in the 21st Century. Congresswoman Julia Brownley D-Calif., delivered a passionate keynote is support of veterans and veteran health. The panelists likewise contributed engaging information that allowed listeners to learn first-hand how VA is addressing the ever changing needs of veterans. Panelists included Poonam Alaigh, MD and Acting Undersecretary for Health; Miguel LaPuz, MD and Acting Principal Deputy Undersecretary for Health; Grace Roddin, chief counsel and oversight director for the House Veterans Affairs Committee; and Sherman Gillums Jr., executive director, Paralyzed Veterans of America.
VHA is working on “bold changes” in how it delivers care. Expect increased operational transparency, more decision-making by veterans and more tools for VA to hire more efficiently, to reward high performers and to rid the agency of employees who do not put veterans first.
VHA is the largest integrated health care system in the country. It has been rebuilding the public’s trust since a 2015 VHA review found that hundreds of thousands of veterans died before their applications for care were processed. The most public demonstration was in Phoenix, Ariz., but investigators discovered widespread mismanagement. VA and Congress developed the Veterans Choice Program to respond to the crisis, which was implemented in 90 days. The program allows veterans to seek care outside of the VA system if they are more than 40 miles driving distance from a VA medical facility or have a 30 day or longer wait time.
Three years later, the Veterans Choice Program, VA, Congress and Veterans Service Organizations (VSOs) have had the time to identify the program’s shortcomings and are working to improve it. In fact, an anticipated revamped program – known on Capitol Hill as Choice 2.0 — is VA’s top priority.
As they work to improve the current Choice program, however, VA and Congress say they will not neglect the staffing and infrastructure needs inside the federal agency’s health program.
Funding must be provided to ensure services are adequately resourced so veterans can receive needed care. In addition, VA healthcare workers and facilities must be measured evenly against the private sector. For VA to be responsive, more doctors need to be hired and facilities improved. Besides healthcare, VA provides peer support, which can be critical in a veteran’s recovery of his or her physical, mental and emotional wounds.
But planned changes do not stop with Choice. The future of VA healthcare will:
- Empower veterans to choose where, when and how they obtain care at VA facilities;
- Allow healthcare providers to predict, prevent and give precision treatment for illnesses;
- Bring healthcare to veterans through greater use of telehealth and homecare, instead of requiring them to travel to VA locations.
Some of this already is visible. In April 2017, VA launched an online tool that provides veterans with much needed information that empowers them to make decisions about where they will receive care. They can learn what services are available at each VA facility, find out the average length of time it takes to receive those services, take a peek at patient satisfaction, and discover how VA hospital infection rates compare to civilian hospitals near them. With these tools, veterans can make more informed decisions regarding where to receive care. Found at www.accesstocare.va.gov, this tool allows a person to search by geographic region based on zip code. And soon VA will unveil a web-based tool that allows veterans to schedule their own appointments.
In the area of predictive modeling, VA recently launched an innovation aimed at preventing suicide. Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment or REACH VET – uses veterans’ healthcare records to identify those most at risk for suicide, so interventions can be launched via primary care and mental health providers. The goal is to prevent a challenge from becoming a crisis. Suicide prevention is VA’s highest clinical priority. Research suggests that 20 veterans die by suicide each day, yet the majority do not receive care in the VA system. Some speculate that the number of veteran suicides is really unknown because no law exists requiring coroners to notify VA of a veteran death, which is why access to care is critical for those needing psychosocial support.
VA has many partnerships with private industry and academic institutions in an effort to improve service. The web-based scheduling system is the result of a private industry partnership, and the agency also has a private sector partnership to develop an exoskeleton to improve ambulation and independence. With authority granted by Congress, VA has created nonprofit organizations to partner with pharmaceutical companies to ensure veterans have access to clinical trials. Approximately 84 currently exist across the country.
Research and innovation have long been important components of VA, which is exemplified by the world’s first liver transplant being performed at a VA facility. The agency has a research budget of $1.8 billion and more than 3,500 researchers publish 10,000 articles per year. One ongoing project is the Million Veterans Program, an initiative to collect data on veterans throughout a long period of time, similar to the Framingham Study. The goal is to discover how a vast array of chronic illnesses will act based on patient behavior, demographics and genetic makeup in order to better prevent and treat illnesses. More than 560,000 veterans are enrolled in this program, which creates a rich database of clinical, behavioral, work and other social histories, plus DNA analysis, that VA and its partners can use to improve health outcomes.
The backbone to all of this modernization, however, is in improvements to VA’s Information Technology. IT Systems assist in a wide range of improvements from letting providers know the best options to treat patients to tracking how long it takes to obtain an appointment. And, Electronic Health Records are vital to maintaining care regardless of where the patient receives care – in the military, veteran or private sector healthcare settings.
The United States has the most comprehensive system of assistance for Veterans of any nation in the world, with roots that trace back to 1636 when the Pilgrims of Plymouth Colony were at war with the Pequot Indians. The Pilgrims passed a law that stated disabled soldiers would be supported by the colony. Today’s VHA continually strives to meet veterans’ changing medical, surgical and quality-of-life needs. New programs provide treatment for TBI, PTSD, suicide prevention and women Veterans, and telemedicine is being established to accommodate the needs of a diverse veteran population. VA cultivates medical research and innovation to improve the lives of veterans and to benefit society-at-large. For example, VHA provides training for the majority of America’s medical, nursing and allied health professionals. As a result, roughly 60 percent of all medical residents obtain a portion of their training at VA hospitals.
