By Dr. Ron Moody, Chief Medical Officer, Accenture Federal Services

With more than 2.1 million virtual health encounters last year, VA is becoming a national leader in the use of telehealth services. Moving toward an accountable Healthcare model –  where telehealth is an integral part of services –  a change in performance metrics is needed to reach a place where virtual care and support rapidly become equally as important as traditional, in-person, Healthcare delivery.

The U.S. Department of Veterans Affairs recently transformed their expansion telehealth services to improve and expand their use among Veterans. The transformation includes VA Video Connect which provides efficient and ubiquitous video to home capabilities that can be used across multiple scenarios, and the Veteran Online Scheduling App, which allows patients to book appointments from their phones. The success of these technology modernization efforts depends not only the technology but also the change in policy, process, and practices around their use. Ultimately, success is defined by the improvement in Healthcare services for Veterans.

VA conducted more than 2.1 million virtual Healthcare interactions last year. The VA’s goal is to dramatically increase those numbers, with most of the increase coming from the use of video to home. If telehealth efforts like this can improve access to care and shorten wait times – two of VA’s most pressing issues – it could help solidify Veterans Health Administration (VHA) as the national leader in telehealth services.

Ensuring that access needs are met for an evolving Veteran population is an ongoing VA issue. There is also a move to value-based care and continued transition to patient-centered care. Simply hiring staff or building/acquiring new facilities is not an immediate solution. Available technology and the use of mobile devices across all patient demographics provides an opportunity for VA to expand access and lead Healthcare transformation with a different model.

For several years, Healthcare organizations like VA have worked to achieve improved outcomes, enhance patient satisfaction, and lower costs. Recently, the discussion has shifted to focus on becoming an Accountable Care Organization. Combining both goals enables VA to become both a performance-based and an accountable care organization.

The focus on accountability and being patient-centric, is partly fueled by new technology. These technologies allow quality care to be delivered outside of traditional brick and mortar facilities and require a new look at how performance is measured. The number of office visits or ambulatory care out-patient visits are no more a sufficient measure of success than is determining how many pills were dispensed without assessing the 5 R’s of medication administration.

Patient-doctor office visits should no longer be considered the primary commodity of Healthcare delivery. Better health outcomes remain the objective, and options available to achieve them are expanding. With planning, VA can move to maximize efficiency (outcome/cost) by changing how prevention, care delivery, health support, and other services are provided.

In addition to what is being measured, we need to reassess “who” is being measured. Just measuring a provider’s “productivity” by visits per day is not an accurate reflection of cost, value, or efficiency. It does not account for whether the visit was needed, if the visit achieved the desired outcome, whether the right type of engagement occurred, or even the true cost of the care.  To accomplish the goal of moving toward accountable Healthcare, changes in performance metrics must also occur.

With the rise of connected mobile devices and social media, most technical barriers to virtual services have been removed. Legal and policy changes are expanding virtual/telehealth use so that it becomes part of the standard process of Healthcare delivery. Virtual care and support should rapidly become equally as important as traditional, in-person, Healthcare delivery.

Healthcare organizations can immediately begin increasing capacity and lowering cost today by incorporating virtual services. This change involves even greater improvements to technology, scheduling/appointment processes, policies, and culture. Immediate value can be achieved by targeting ambulatory care and expanding access to high quality specialty care providers. By doing so, I believe we could significantly raise ambulatory capacity.

Fortunately, VA has positioned itself through investments to take immediate advantage of expanding virtual care services. Faced with resource and physical facility limitations, and mounting pressure for greater use of commercial Healthcare, VA can and should prioritize virtual care in a targeted manner. It can increase access and services without requiring additional staff. Currently, staffing costs account for about 50 percent of U.S Healthcare expenditures.

Virtual solutions provide not only a method to reach underserved groups, but to change the very nature of the demand/capacity equation. Simply put, virtual health can enable more care services for Veterans by means other than expanding the workforce. However, there is no optimal combination of traditional in-person and virtual encounters yet determined that will provide for best outcomes based on condition.

The value of integrating virtual care models is clear, proven by VA’s increased use of telehealth. The next step is moving to a new model of care across everyday clinical practice that brings productive change throughout the VA for our nation’s Veterans.


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