Extreme Makeover: Transformation of the Veterans Health Care System

Abstract

The veterans health care system administered by the U.S. Department of Veterans Affairs (VA) was established after World War I to provide health care for veterans who suffered from conditions related to their military service. It has grown to be the nation's largest integrated health care system.As the system grew, a number of factors contributed to its becoming increasingly dysfunctional. By the mid-1990s, VA health care was widely criticized for providing fragmented and disjointed care of unpredictable and irregular quality, which was expensive, difficult to access, and insensitive to individual needs.Between 1995 and 1999, the VA health care system was reengineered, focusing especially on management accountability, care coordination, quality improvement, resource allocation, and information management. Numerous systemic changes were implemented, producing dramatically improved quality, service, and operational efficiency. VA health care is now considered among the best in America, and the VA transformation is viewed as a model for health care reform.

Factors Underlying Quality Problems with Alcohol Screening Prompted by a Clinical Reminder in Primary Care: A Multi-site Qualitative Study

“…1), to be embedded in the electronic medical record. 13 While there is no "gold standard" for optimal use of the AUDIT-C clinical reminder, it was designed to: 1) prompt annual clinical screening; 2) guide clinical staff to perform screening in a validated, standardized, reproducible way; 3) automatically score and document results of screening; and 4) when positive, trigger a subsequent clinical reminder for brief intervention and other appropriate follow-up. The AUDIT-C clinical reminder was used 1.5 million times in its first year (2004), and over 24 million screens have been documented with the clinical reminder in the last five years.…”

Behavioral medicine translation in the Veterans Health Administration: editorial to the special section on the Department of Veterans Affairs

“…However, the VA as it exists today was shaped when Veterans' health and rehabilitation benefits were first established in 1917 for Veterans with World War I-related injuries and disabilities during a time when health insurance and community support for disability did not exist. The Veterans Administration was established in 1930 to provide more consolidated and comprehensive management of these benefits [1].…”

“…In the 1990s, Dr. Kenneth Kizer, VHA Undersecretary for Health, introduced initiatives that transformed the VHA from a highly centralized bureaucratic structure to a highly integrated system of regional networks with an electronic medical record, reducing fragmented and impersonal care and improving the quality and efficiency of services [6]. During the last decade, the VHA initiated quality programs and built informatics resources beyond those of other health care systems [1]. Especially with its emphasis on high quality, efficient care, and its national data resources, VHA today offers an unparalleled environment for clinical translation.…”

“…Based on these eligibility requirements, many Veterans cared for in the VHA are poor, have limited resources, and have lower levels of educational attainment [27]. However, the Veterans Health Care Eligibility Reform Act of 1996 freed the VHA to provide medical care to Veterans in any medically appropriate setting for any of a Veteran's health conditions allowing the VHA to serve a very broad group of Veterans and to provide high-quality care for all regardless of socioeconomic status [1]. In support of this aim, legislation has permitted VHA to collect reimbursement for services provided in VHA settings from private payers and Medicare and to pay for services in the community when services, particularly highly specialized services, are not readily available in VHA settings.…”

“…The VHA is the nation's largest fully integrated health care system and this organization makes the translation of evidencebased behavioral medicine possible on a national scale [1]. An early adopter of behavioral medicine almost from its inception in the 1970s, the VHA supported clinical practice and research targeting health risk factor reduction interventions for tobacco and obesity, psychological factors associated with cancer, and on integrated medical and behavioral treatment of pain [2].…”