Health Services Research & Development

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Commentary

During the last few years, the Department of Veterans Affairs (VA) has faced challenges meeting the evolving needs of Veterans and the growing demand for care. To address these challenges, VA is adopting modern healthcare models, including telemedicine, home-based care, and a stronger emphasis on building partnerships in the community. From fiscal year (FY) 2014 to FY 2015, community care appointments increased approximately 20 percent from 17.1 million to 21.3 million.1 With more Veterans receiving community care, VA needs to build a robust, integrated healthcare network of VA and community providers to improve healthcare outcomes, continuity of care, and care coordination.

Currently, VA's multiple community care programs—all with unique requirements—make it challenging for Veterans, community providers, and VA staff to navigate the system. Recently, VA has taken initial steps to consolidate its community care programs into one program that is easy to understand, simple to administer, and that meets the needs of Veterans, their families, community providers, and VA staff. In October 2015, VA submitted a report to Congress outlining a long-term strategy to consolidate community care programs, which are dependent on congressional action and funding. The consolidation plan lays the foundation for historic reforms to improve how VA delivers community care. The plan focuses on five touchpoints important to Veterans, including: 1) easy to understand eligibility requirements; 2) streamlined referral and authorization processes; 3) continued development of a Community Care Network; 4) internal and external care coordination; and 5) faster claims processing. A greater emphasis on customer service underlies these touchpoints. This transformation is being driven by the field, including physicians, nurses, social workers, care coordinators, Chief Medical Officers, customer service representatives, local VA Medical Center Business Office staff, and Community Care staff.

An essential component of VA's community care transformation is the establishment of a Community Care Network, which will leverage both local VA facilities and community providers. VA released a draft Community Care Network Request for Proposal in April 2016 to solicit feedback from industry and VA employees. This network will comprise federal partners, academic affiliates and external providers, and will start to identify highperforming providers based on quality, value, and commitment to Veterans' health. VA plans to align with industry standards by using common metrics and incentivizing providers for delivering high-quality outcomes.

These capabilities are critical as VA transitions from its traditional role as a healthcare provider to an integrated provider and payer of care. More importantly, few large integrated healthcare systems have the ability to evaluate the impact of healthcare both as a provider and payer. This ability positions VA to lead research that would drive innovation through examining the impact of outcomes and cost over a patient's lifespan. VA will also be able to monitor and analyze the development of an integrated healthcare network, the potential impacts on continuity of care, and patient outcomes.

Care coordination aims to improve health outcomes, prevent gaps during transitions, and support a positive and engaging patient experience. As more Veterans access care in their local community, VA has a unique opportunity to expand its care coordination capabilities across its network, and become the leader in care coordination. Input from the field, industry best practices, and a deeper understanding of stakeholder needs will help VA develop innovative care coordination models. These models aim to provide the appropriate levels of care coordination, a well-defined patient population, and responsibilities and expectations of patients and clinicians to improve the customer experience. To truly accomplish this, VA looks to researchers to: 1) support the development of care coordination models; 2) identify best practices and implementation strategies; 3) understand models and their impact on continuity of care and patient outcomes; and 4) share quantitative data (e.g., customer satisfaction) with the research community.

As VA continues to move forward with implementing the future vision of community care, we are excited about the new opportunities in healthcare research and ways VA can lead in healthcare delivery, reimbursement, and technology. Health researchers will play a significant role as VA transitions to a high-functioning, integrated health network. We look forward to developing a strong relationship with our researchers to support VA's efforts to build an integrated healthcare network.

1. "Building an Integrated Health Network," The Department of Veterans Affairs, Commission on Care, April 18, 2016. Available at https://commissiononcare.sites.usa.gov/files/2016/04/Building-an-Integrated-Health-Network-FINAL.pdf

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