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How Veterans Affairs Healthcare Services Are Like Accountable Care Organizations


 

According to the Centers for Medicare and Medicaid Services, an accountable care organization (ACO) is defined as a “group of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.” The goal of an ACO is “to ensure that patients, especially chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.”

In many ways, the Department of Veterans Affairs (VA) is similar to an ACO. While some of the veterans have Medicare, not all of them do. Across the nation, the VA has the infrastructure to deliver high quality care to our patients. Large medical centers that are affiliated with medical schools and academic teaching hospitals teach medical students and resident physicians to provide excellent care to our patients. To meet the needs of our patients in smaller cities or rural areas, community-based outpatient clinics (CBOCs) deliver quality care to patients.

Our electronic medical record, called the Computerized Personal Record System (CPRS), links veterans nationally. A patient can be seen at the CBOC in Mansfield, Ohio, the Palo Alto VA medical center in California, and the Washington, D.C., VA medical center, and not have to worry about the physicians not having access to his medical information. This prevents physicians from ordering unnecessary radiographic studies, and it can decrease the chance of medication errors and polypharmacy.

The use of electronic consults, also known as eConsults, allows for faster access to specialists. After the PCP orders the patient’s chart, the specialist will review the information, provide recommendations to the PCP, and determine how quickly the patient needs to be seen by the specialist. This is important for our rural population, who will then have to make fewer trips to medical centers.

The Specialty Care Access Network-Extension of Community Healthcare Outcomes (SCAN-ECHO) project is another tool designed to assist our rural population. The program targets those who have diabetes, heart failure, and/or chronic pain. Patients travel to their CBOC and interact via the internet with the VA specialist located at a larger medical center, thereby reducing the number of long trips they must make to the medical center and the long waits they would normally have to endure to be seen by specialists.

Telehealth is another way the VA is coordinating high quality care for our veterans. In the comfort of their own homes, veterans upload weight, vitals, and blood glucose levels to assist physicians in monitoring and treating chronic medical conditions.

The VA also delivers highly quality care through its pharmacies. Electronic ordering of outpatient medications for patients is extremely easy; these medications can either be mailed home or made available for same day pick-up. Certain medications are restricted and require approval by specialists; however, when patients fulfill criteria for a nonformulary medication, it is easily accessible. In addition, the approval process is evidence-based, limiting the effect of pharmaceutical companies on patient care.

As a result of using the formulary process for medications, patients share in the savings through lower co-pays. Pharmacists participate in both antibiotic stewardship, as with inpatient vancomycin dosing, and in managing inpatient anticoagulation, which is often more reliable and less expensive than using physicians.

Through these and other programs, the VA ensures that patients receive the services they need in a thoughtful, evidence-based, and timely way.


Dr. Nemeth is a hospitalist at Louis Stokes VA Medical Center in Cleveland, Ohio, and assistant professor of medicine at Case Western Reserve University School of Medicine. He is a member of SHM’s Veterans Affairs Task Force.

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