3.1: Health Care
Provide high-quality, reliable, accessible, timely, and efficient health care that maximizes the health and functional status
for all enrolled veterans, with special focus on veterans with service-connected conditions, those unable to defray the cost,
and those statutorily eligible for care.
Other Information:
Purpose and Outcomes: The purpose of this objective is to provide health care for all veterans enrolled in the VA health care
system with priority access to veterans with service-connected disabilities rated 50 percent or more. VA’s health care system,
through the auspices of the Veterans Health Administration (VHA) and its network of 21 Veterans Integrated Service Networks
(VISNs), is organized to deliver a comprehensive spectrum of health care serving the needs of America’s veterans by providing
a full continuum of patientcentered medical, surgical, psychological and social services. The VA health care system is designed
to treat the “whole veteran.” These services are provided through preventive and outpatient care, inpatient care, specialized
care, and related medical and social support services. Examples of these services include programs such as primary care, the
full range of acute inpatient services, long-term care, hospitalbased home care, specialized care, adult day care, and respite
and hospice services. VA will work to guarantee that the needs of special populations of veterans are met, such as women,
minority, and Gulf War veterans. VA will assess the needs of special populations of veterans and promote the use of programs
and services to which they are entitled. The quality of these services is paramount to VA. VA will continue to drive toward
the highest quality health outcomes by using the best scientific evidence available in clinical practice. VA will also use
a comprehensive performance management system that aligns with the Department’s overall vision, mission, and strategic goals
and objectives. This management system will also measure progress in meeting those quantifiable objectives. VA has set national
benchmarks for the quality of preventive and therapeutic health care services that exceed U.S. Government Healthy People 2010
goals and private sector performance. It is projected that the number of veterans desiring enrollment in the VA health care
system will increase from 4.7 million veterans in FY 2000 to 8.3 million in FY 2008. To ensure VA has the capacity to care
for veterans for whom our Nation has the greatest obligation – those with military-related disabilities, lower-income veterans
or those needing specialized care such as blind or spinal cord injury rehabilitation – additional enrollments for veterans
with the lowest statutory priority, Priority 8, have been suspended. This suspension is subject to annual review. Priority
8 veterans already enrolled may continue use of the VA health care system. At the same time, VA will continue to diversify
its funding base. Through the VA + Choice initiative, VA health care will be made available to Medicare eligible veterans
with cost reimbursement provided by the Department of Health and Human Services. As VA’s more diversified funding base matures
and stabilizes, VA will be able to expand capacity to best serve all veterans. VA expects to continue to develop its national,
integrated health care delivery system. The future system will provide opportunities for VA to function together and, in concert,
with public and private health care facilities to meet the health care needs of the enrolled population and to minimize duplication
of services. This health care system will continue to promote satisfaction, efficiency, assure high quality care, and provide
optimal access for the veteran population. VA will strive to achieve a level of quality and access that sets a national standard
of excellence for the health care industry. Strategies and Processes: VA will pursue a number of strategies to achieve this
objective: VA will continuously improve the quality and safety of health care for veterans to be the benchmark for health
care outcomes. VA will lead the advancement of knowledge and the practice of quality and patient initiatives to include: (a)
using preventive medicine practices and guidelines for chronic disease management; (b) increasing the use of automated systems
to reduce the likelihood of errors; and (c) developing a culture of error reporting, analysis, and learning. We will identify
high-quality evidence-based medical care and continue to measure clinical processes and outcomes to assure and improve the
delivery of high quality care. The image of VA as our Nation’s premier health care system will continue to be enhanced. VA
will improve patients’ satisfaction with their VA health care by implementing “servicerecovery” with standardized patient
satisfaction surveys that provide real-time results and data aggregation and reporting. Information and other technologies
such as telehealth used in the HealtheVet initiative will be applied to streamline administrative, business, and care delivery
processes to improve care provider and patient interface, minimize wait times, and reduce the incidence of errors. HealtheVet
allows veterans to be partners and take a more active role in their own health care. VA providers will be able to track patient-centered
metrics such as blood pressure, blood glucose, weight, and pulse without having to wait and see the patient in person. This
will enable providers to avert problems more quickly. VA is working to improve access to clinic appointments and timeliness
of service. We continue efforts to develop ways to reduce waiting times for appointments in primary care and key specialty
clinics nationwide. Past experience in measuring access has led to the development of a number of new access measures that
will provide even more detail into waiting times for both specialty clinic appointments and new enrollees. VA will improve
access, convenience, and timeliness of VA health care services. VA will provide incentives for ongoing, continuous health
care system redesigns to streamline work, and to analyze, identify, and promulgate improved health care practices. VA will
work with state agencies, especially in long-term care services, to reduce the redundancies and gaps in veterans’ services.
Timely, accurate, and affordable access to prescription drugs is a critical element of patient safety, well-being, and satisfaction.
Access to prescription drug benefits is a rapidly growing area of demand for our enrolled veteran population. Through VA’s
Consolidated Mail Out Pharmacy (CMOP) program, veterans are able to conveniently refill prescriptions by mail. Availability
of this benefit has helped drive veteran enrollment in the VA health care system in the last 3 years. VA will create a health
care environment characterized by patient-centered services where individual health care decisions are made on the basis of
current medical knowledge, consistent with patients’ informed preferences and needs. We will implement initiatives to support
shared decision-making and patient empowerment. Interactive technology strategies will be implemented to provide care in the
least restrictive environments to allow patients and families maximum participation in disease management and health maintenance.
A large percentage of veterans enrolled in the VA health care system have one or more chronic diseases. As a means to improve
our management of chronic diseases, VA will follow nationally recognized clinical guidelines for treatment and care of patients
with one or more high-volume diagnoses. This will result in improved health outcomes for veterans. To assess our progress
and results associated with our treatment of patients with chronic diseases, VA will use the Clinical Practice Guidelines
Index. This is a composite measure comprised of seven evidence and outcomes-based indicators for highprevalence and high-risk
diseases that have significant impact on overall health status. The indicators within the Index include ischemic heart disease,
hypertension, chronic obstructive pulmonary disease, diabetes mellitus, major depressive disorder, schizophrenia, and tobacco
use cessation. VA will continue to implement a comprehensive program of education and outreach in the area of preventative
medicine. We will proactively reach out to veterans to ensure that they are informed about the importance of receiving screening
for illnesses such as influenza, Pneumococcal pneumonia, and various forms of cancer. We will also provide information and
counseling services regarding tobacco consumption, alcohol, and substance abuse. VA is also the leader in hepatitis C screening,
testing, treatment, research, and prevention. The VA National Hepatitis C Program works to ensure that patients with or at
risk for hepatitis C virus infection receive the highest quality health care services. VA will ensure the consistent delivery
of health care by implementing standard measures for the provision of preventive care. The prevention measure includes several
indicators that allow comparison of VA and private health care outcomes. VA will use the Prevention Index II described in
objective 1.1 to assess the results of our initiatives in the area of preventive medicine under this objective for all veterans
that participate in our health care system. Over the past 5 years, there has been greater focus on VA’s ability to meet the
increasing need for long-term care for aging veterans. Eligibility for extended, institutional benefits is prescribed by statute
and is increasingly reserved for the highest priority veterans. VA has responded to the need for long-term care through new
initiatives to invest in home and communitybased care, State Veterans Homes, and assisted living situations, as well as attempts
to revitalize the community nursing home program. VA will increasingly emphasize rehabilitation efforts after hospitalization,
where appropriate, as an alternative to institutionalization, in order to better facilitate patients returning to their community
and, if possible, to their own home environment. VA is currently enhancing the actuarial long-term care model to better capture
the latest trends of utilization and reliance for the full spectrum of services to meet the long-term care needs of the aging
veteran. The enhancement will reflect latest survey results, trended disability and use rates, an adjustment for marital status
and an analysis of the relationship between nursing home care and home and community-based care. The work is guided by a steering
committee and includes a workgroup (with representatives from the CARES Planning Office, VA Office of Actuary and long-term
care experts from the field). Deliverables are in two phases, preliminary estimates in July 2003 and final estimates by March
2004. Crosscutting Efforts in Health Care VA will continue its partnership with DoD to develop an interoperable VA/DoD medical
information system and ensure the availability of veterans’ active duty health records to VA care providers. VA will continue
working with DoD to implement clinical practice guidelines to assure continuity of health care and seamless transition for
a patient moving from active military duty to veteran status. Collaboration will continue on the development of joint guidelines
and policies for the delivery of high-quality care and assurance of patient safety; joint training in multiple disciplines
including ancillary services; and exploration of opportunities to enhance collaborative activities in Graduate Medical Education.
In addition, VA and DoD will identify and foster opportunities for sharing information and resources in the areas of deployment
health surveillance, assessment, follow-up care, and health risk communications. VA is working to improve medical linkages
through participation in the Joint Working Group on Telemedicine. VA collaborates with HHS to develop non-VA benchmarks for
bed-days of care that are obtained from the Centers for Medicare and Medicaid Services (CMS) database. VA is able to obtain
data on ambulatory procedures from the National Center for Health Statistics. To maximize resources available for direct patient
care, VA collaborates with many agencies (DoD, Department of Agriculture, GSA, Indian Health Service, National Park Service,
the Merchant Marine Academy, and others) to determine its facility infrastructure and real property utilization, allocation
of excess property, and acquisition of energy and utility services. External Factors: The strategy to ensure the consistent
delivery of health care by implementing standardized health practices depends upon both electronic and external reviews of
care by the External Peer Review Program (EPRP). The EPRP is a contracted, on-site review of clinical records and serves as
a functional component of VA’s quality management program. VA will continue to participate with DoD in the joint development
and implementation of clinical practice guidelines. These guidelines must have a longrange view toward assuring continuity
of care and seamless transition for a patient moving from one system to the other. Enactment of legislation authorizing VA
to bill Medicare for health care provided to certain veterans is considered essential.
Indicator(s):
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