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NEJM Perspective: On VA Becoming a High-Performance Network

March 18, 2016

The March 17 issue of The New England Journal of Medicine features a Perspective article by VA's Under Secretary of Health David Shulkin, MD that discusses VA's continuing challenge around the "mismatch of demand and capacity," with the goal of reestablishing trust with Veterans by "expanding our methods of providing care, emphasizing the concept of 'whole health,' and adopting a Veteran-centric approach in everything we do." Despite the issues revolving around access, VA outperforms the private sector in several areas including, lower risk-adjusted mortality rates, better patient-safety statistics, and better performance on a number of other process measures.

Dr. Shulkin also discusses the plan VA delivered to Congress on October 30, 2015 to evolve "our current system into a high-performance network based on a foundation of timely access and the integration of private-sector providers to ensure the best achievable outcomes for all enrolled Veterans." Dr. Shulkin goes on to describe a network that would consist of three groupings of providers: 1) all VA facilities, 2) private-sector delivery systems, and 3) additional participating private-sector providers. VA "will also continue to use our health services outcomes research program and "lean" management techniques to improve the effectiveness of our delivery system." [For example, see VA HSR&D's Quality Enhancement Research Initiative's (QUERI) Lean Enterprise Transformation Evaluation Initiative.]

Dr. Shulkin's article is accompanied by an audio interview with VA physician and researcher, Dr. Ashish Jha on lessons learned from VA's access crisis, as well as future directions. Dr. Jha states that Dr. Shulkin's plan " offers more choice for Veterans, and it allows the VA to manage its capacity challenges by working more closely with private sector providers, many of whom see quite a few Veterans already."

Shulkin D. Beyond the VA crisis - Becoming a high-performance network. The New England Journal of Medicine. March 17, 2016;374:1003-1005.

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