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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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