Advancing High Performance in Veterans Healthcare

Transcription

1 Carolyn M. Clancy, MD Executive In Charge, Veterans Health Administration (VHA) Advancing High Performance in Veterans Healthcare January 11, 2018

2 Resources Dedicated to Advancing the Largest Integrated Healthcare System VHA employs over 306,000 full-time staff, plus: o More than 15,000 affiliated medical faculty o More than 73,000 volunteers o More than 127,000 health professions trainees VHA operates 1,700+ points of care, including: o More than 160 VA medical centers o More than 1,000 outpatient sites of care, e.g., community clinics o More than 300 Vet centers (including mobile units and support) VHA staff also includes over 100,000 Veterans

3 VA Healthcare Ratings Are Speaking For Themselves Academic Affiliates ( ) VA Hospitals Rate 13.8% Better

4 VA Healthcare Clinical Outcomes Are Some of the Best in the U.S. VA Hospitals (n=129) were compared with academic and community hospitals (n=4010) on various areas of clinical outcomes and patient experience. VA performed better for most measures including: Lower rates of inpatient safety events o pressure ulcer o iatrogenic pneumothorax o central line-associated blood stream infection

5 Improving Mortality Rates via Effective Care Delivery Recent study of VA vs. Community Care for Veterans found Veterans seeking high quality care with low mortality and readmission rates are well served by VA oveterans who underwent PCI within VA hospitals also had lower mortality rates than in-community (1.5% vs. 0.65%).

6 Quality Measures Are Improving Across the Entire VHA System VA outpatient care outperformed non-va outpatient care on quality. In addition: VA has ~40% higher screening rates for colon cancer (82% vs. national average in 60% range). VA reduced methicillin-resistant staphylococcus infections: ICU infections declined by 72% (from 1.64 to 0.46/1000 patient-days, ) VA had lower 30-day mortality for patients over 65 years of age, who were hospitalized with either acute MI or heart failure. Out of 47 Outpatient Quality Measures: VA IS BETTER 45 VA IS SAME 2 VA IS WORSE 0

7 We Are Seeing Patients Faster, Compared to the Private Sector Average Physician Appointment Wait Times in the Private Sector According to the 2017 Merritt Hawkins (MH) Survey of Appointment Wait Times, average wait times in the private sector grew by 30% (since 2014) in large markets. VA maintained shorter wait times in all specialties measured by MH survey. In cases, VA is 40% better. VA wait times across all appointment types have also improved by > 10% since 2014! Specialty VA NATIONAL MH Large Markets MH Mid-Sized Markets Cardiology 18.3 days 21.1 days 32.3 days Dermatology 18.1 days 32.3 days 35.1 days Obstetrics/Gynecology 23.0 days (Gyn only in VA) 26.4 days 23.1 days Orthopedics 20.8 days 11.4 days 15.0 days Family Practice 17.0 days (VA Prim Care) 24.1 days 32.0 days

8 VHA is Meeting The Urgent Medical Needs of Our Veterans VA achieved Same Day Services in Primary Care and Mental Health in 100% of 1,000+ Community Based Outpatient Clinics (CBOCs). It now takes less than 2 days for an urgent referral to a specialist to be completed across the VA system. >100,000 appointments have been completed. 94% are now being completed no later than the provider recommended follow-up date

9 Making Advances in Access For Our Veterans in Idaho BOISE, IDAHO o Achieved Same Day Services for urgent needs in Primary Care and Mental Health at ALL clinic locations. o From FY17 to FY18, wait times for new patients at Boise VA Medical Center improved as much as 9%. Mental Health improved from 9.5 to 8.9 days. Primary Care improved from 18.7 to 18.1 days. Specialty Care improved from 22.6 to 20.5 days. o Time for completion of urgent referrals to a specialist has improved 60% from FY14 to FY17 (from 19.3 days to 7.6 days) and was as low as 2.5 days in December of 2017! o In Dec. 2016, VA implemented a new process to ensure Veterans with timely follow-up needs are seen in a timely manner. In FYI, Boise completed 524 (96% within the clinician recommended date; in FY18 (through 1/3/18), 116 of 117 (99%+) were completed.

10 Some Factors Contributing to VA Improved Outcomes & Quality VA made investments in electronic health records (EHR). o Since the 1970s, VA has collected system-wide data from EHRs to advance patient care, facilitate research, and enhance overall patient-physician communication. EHR supports performance measures & drives improvement. VA implements coordinated programs and clear organizational goals, empowering improvement at the local level. VA employs an embedded research program that contributed to national programs such as: o Primary care-mental health integration o Tele-mental health o New models to care for women veterans. (From Article: Advancing High Performance in Veterans Affairs Health Care, featured in the JAMA Internal Medicine section of JAMA Nov. 21, 2017)

11 Next Phase: Working to Improve Overall Patient Experience As a public health system coupled with increasing transparency and visibility VA does not perform as well in patient experience (vs. the private sector). However, this may be the result of several other factors, such as: VA is measured at the minute level where private sector hospitals are rarely assessed, in a similar fashion, and are not measured on all of the same measures/results. VA operates an older physical and capital infrastructure, which may create a perception problem. VA tends to serve larger patient populations with more physical and mental health problems who generally provide lower scores in surveys of healthcare experiences. The number of patients receiving care increases yearly.

12 VA Healthcare Is Seeing A Growing # of Patients, with Changing Needs 48% (9.7 million out of 20.4 million) of all Veterans used at least one VA benefit or service in FY 2016 o 10 percentage point increase (38%) since FY % used multiple benefits, up from 31% in Percent of female Veterans who used VA benefits increased from 35% in 2007 to 47% in 2016; rate for male Veterans (2007 & 2016) was 39% & 48%. 70% of Veterans receiving Disability Compensation used VA Health Care in FY 2016, up from 59% in FY Veterans between ages of 25 and 34 and > age 65 are more likely to use VA benefits compared to Veterans of other ages. Service-connected disabled Veterans using VA Health Care increased from 59% in 2007 to 70% in o Over 93% of service-connected disabled Veterans were enrolled in VHA Health Care system in 2016.

13 Likelihood of Veterans Seeking VA Health Care is Increasing Veterans Receiving Compensation and VA Health Care Use by Service-connected Disability Rating: FY 2016 (in percent)

14 Improving Experience: Online Veteran Driven Tools Veteran Appointment Request Self-schedule primary care appointments and request assistance in booking other appointment types. See details for pending, confirmed, and upcoming appointments. Communicate with schedulers receive updates and more. >100 VA Medical Centers finalizing integration w/ MyHealtheVet

15 Improving Engagement and Usability with Innovative Tools mobile.va.gov/appstore 36 VA mobile apps o National Release 23 o Field Testing - 13 Links to commercial app store and direct links to mobile apps Training materials App user feedback

16 VA Anywhere to Anywhere Tele- Health is Expanding VHA Reach > 9 Million episodes of Telehealth > 700,000 Veterans using Telehealth > 336,000 Tele-Mental health visits > 5000 Tele-ICU patients NOW Our VHA Providers can care for our VA patients, across state lines!

17 In 2017, We Improved our Quality and Care Transparency and Accountability Launched in April of 2017: Over 4 million site hits during the first 20 weeks of operation

18 We Are Putting a Focus on Improving Patient Outcomes with Whole Health Reasons referred: Pain 55% Metabolic 24% Autoimmune 13% Quantifiable benefits at 12 months Rx use (narcotics, BP Rx, and diabetes Rx) Weight / BMI at 12 months Biomarkers improved Hemoglobin a1c 11.3% HDL cholesterol 13.9% Triglyceride/HDL-cholesterol Ratio 21.1% ( insulin-sensitivity) Homocysteine 5.2% Vitamin D 57% Changing the Conversation

19 We Continue to Modernize Across the Entire VHA System of Care EMR/EHR interoperability Advancements in Real Time Monitoring of the Network Mobile Tools and Solutions

20 We Are Now Leading the Way with Real Time Monitoring & Results Data Inputs (Monitoring and evaluation) Action (Intervention determined by vulnerability H, M, L) high Impact low high Severity low Probability Occurrence high high Go-Teams Specialty based, assessment and intervention support short term oaccess/scheduling o Budget/Finance o Community Care o Environment of Care o Inpatient Quality o Organization Development o Nursing o Patient Safety o Staffing/HR Support o Sterile Processing Deploy/coordinate resources o Other teams (e.g. Office of Medical Inspector) o Best Practice dissemination o OSI-VERC (complex implementation support) o Other virtual support Incident Command Center

21 We Are Working to Make VHA Better Every Day THANK YOU