Setting the Stage for Transformation

1. Setting the Stage for Transformation Robert Jesse, MD, PhD Principal Deputy Under Secretary for Health National Planning Conference July 2010

2. Expectations of Healthcare Industry Changing • Patients participate as partners in their care • Care is convenient and local: • Walk in clinics, ZoomCare, Walmart, Employer Embedded PC • Alternative methods of care are available: • Non-institutional, home-like, complementary medicine • Health care information is readily accessible: • MHeV, WebMD, etc • Preventive health is a focus: • Chronic health issues (diabetes, obesity) are managed • Function is not bounded by age or injury

3. Expectations of Healthcare Industry Changing Public awareness of war and veterans issues. Younger Veterans often have families and jobs. Younger Veterans have grown up with different expectations for service. Younger Veterans prefer to communicate via email, text messaging, and online tools. Healthcare value is defined by access, patient expectations, economic realities, and outcomes. Veterans may have a unique perception of value

4. Veteran Centered Care Definition: A fully engaged partnership of veteran, family, and health care team, established through continuous healing relationships and provided in optimal healing environments, in order to improve health outcomes and the veteran’s experience of care Universal Services Task Force, 2009

5. Veteran Centered Care Definition: A fully engaged partnership of veteran, family, community and health care team, based on continuous healing relationships nurtured in user friendly, efficient and effective environments that promote optimal health outcomes. PDUSH, 2010

6. Principles of Veteran Centered Care • Provides safe, high quality, accessible care – first, foremost and always! • Enhances the quality of human interaction and therapeutic partnerships • Encourages the involvement of family and friends (community) • Solicits and respects the Veteran’s values, preferences, and needs • Systematizes the coordination, continuity, and efficiency of care • Supports and sustains a satisfied and engaged workforce • Empowers patients and families through information and education • Incorporates the nutritional, cultural, and nurturing aspects of food • Provides for physical comfort and pain management • Ensures emotional and spiritual support • Designs physical environments that are conducive to health and healing • Introduces creative arts into the healing environment

7. Care Designed Around the Patient • Medical Home Model • Comprehensive primary care model with patient and family as the hub • Prevention, health promotion, and chronic disease management • Coordination of care across the continuum (specialty and acute care) • Team based approach, all functioning at optimal level of competency • Physicians manage complex diagnostic problems and more difficult clinical management issues incorporating higher-level specialists as appropriate • Potentially more efficient in patient populations with chronic disease • Fewer ECU visits • Fewer hospitalizations • Better quality and satisfaction • More costly primary care

8. Team Care Designed Around the Patient • Care Platform (Specialty Care) • Work flow organized around the needs of patients • Anticipates patient’s needs and preferences • Integrated treatment plan • Coordinates care at point of service • Team approach to care • Competency levels raised where appropriate • Evidence-based care and use of registries to optimize chronic care • Many Oncology clinics are already organized around this model

9. What is Access ? Definition of Access in VHA: VHA will provide Veterans with timely access to quality health care in a veteran-centered and responsible manner, which meets or exceeds internal and community standards. Metric Based Redefine Access to VA: Veterans have earned certain benefits through dedicated service to their country. Those benefits are clear, and each Veteran is able to select and access those of their choosing in a facile manner when they want or need them. Trust Based Transforming Healthcare Access: Veteran centered care must restructure how patients interact with the healthcare system; moving from an historically episodic model to one of longitudinal engagement. Relationship Based

10. Improve Access To Care Transforming healthcare access: Patient centered care must redefine how patients interact with the healthcare system from an historically episodic model to one of longitudinal engagement • Expand Virtual Access to service through technology(Telephone Care, SM, Text Messaging, Social Networking Tools, Virtual Group Visits) • Improve Veteran access to information(Transparency, Patient facing enhancements to CPRS) • Support Primary Care providers with just in time consultative support(Shared Care Platforms, ECHO; P2P Communication Tools) • Improve our business processes to ensure timely access and effective communication and coordination (System Redesign, Continuous Improvement at the Point of Care, Reducing variation) 10

11. The Fundamentals • Delivering health care is different from healthcare delivery • Health care is what we provide individual patients • Healthcare is about the systems that enable this • You can’t have healthy patients without having healthy healthcare systems • In order to have evidence based care you have to have evidence-based management

12. VHA Initiatives for FY 2010 Improve Mental Health of Veterans Zero Homelessness VLER VRM Expand Access To Care 12

13. VHA Initiatives for FY 2010 Expand Access To Care Proactive Outreach Being Added in FY2011 Systems Redesign Specialty Care Rural Veterans Women’s Health Women’s Readjustment Counseling Medical Informatics Transportation For Veterans Improve Efficiency

14. If You Could Describe the “Transformed” VA… • What would it be? • The healthcare network is defined by patients and providers, and by their relationships, but not by bricks and mortar. • Patients come to us because they want to not because they have to. • Access is assessed by engagement and not by time-based metrics. • Engagement is based on trust, capability and caring, which are the hallmarks of the “new models of care” Page 14

15. Questions?