Service Design for Government
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Balancing Patient & Employee Experience to Improve Veteran Access to Care

Fostering a Veteran-Centric Experience

Veteran Affairs’ (VA) ability to prioritize the customer experience of our Veterans is crucial to meeting its objective of “serving and honoring the men and women who are America’s Veterans,” One of the key ways VA successfully achieves its mission is by providing timely access to specialty care services. However, the most significant challenge to providing timely access to care to Veterans is coordinating between primary and specialty care. This includes prerequisite appointment requirements and specialty care consults which are a major factor in guaranteeing patient safety and quality of care.

The VA’s Optimizing Healthcare Value Program (OHVP) was tasked with identifying pain points that affect access to care and evaluate best practice solutions. OHVP engaged Technical Assent to help bolster Veterans’ access to timely treatment by uncovering key institutional knowledge within VA, defining best practices, and sharing findings to other VA sites.

Dissecting Costly Failures in the Consult Referral Process

Our team supported OHVP in completing qualitative data gathering and quantitative data analysis through two key avenues: informational interviews and a Healthcare Failure Modes and Effects analysis (HFMEA). We also performed virtual site visits that consisted of information-gathering sessions with primary and specialty care providers. The same issues that surfaced during many of the information-gathering sessions with providers were further confirmed by the analysis of the consult referral process. Existing processes, policies, and procedures combined with staff-related challenges to complicate the overall case management process that led to delays to Veteran care, namely provider fatigue, burnout, and increased turnover.

We also discovered that primary care providers (PCPs) often send Veterans for specialty consultation without the prerequisite testing information necessary to diagnose or address the issue. This is due to inconsistently defined and applied business rules around which parties are responsible for completing what diagnostic testing required for specialty care consult referrals, staffing and resource constraints that result in overworked providers on both sides, and disagreement on who’s responsible for what diagnostic testing. This resulted in specialty care providers discontinuing or canceling consults due to the lack of necessary diagnostic information and completed prerequisite testing requirements. In fiscal year 2021, the VA saw 28% of nearly 12 million outpatient consults get canceled or discontinued – not only does this significantly impact the veteran experience, it creates a loop of wasted time and effort on all stakeholders that may result in Veterans ultimately losing trust in the process.

Developing an Enhanced Operating Model

Technical Assent partnered with the VA Pittsburgh Healthcare System (VAPHS) to develop an optimized operating model to address access issues while referring Veterans for specialty care services, now dubbed the Complex Case Management Hub (CCMH). Our project team designed an improved care team model, built a business case for the CCMH model by quantifying the value of its benefits, and generated the tools and resources that an interested site would need to roll out the CCMH.

The CCMH’s design focuses on improving the Veterans experience when transitioning care from primary care to specialty care by optimizing the consult referral process. The process now alleviates barriers that providers face when submitting, triaging, and completing specialty care consults. Instead of the PCP bearing the burden for completing the diagnostic testing required to submit a consult referral to specialty care, the CCMH team takes on the full responsibility for performing any prerequisite testing and delivers a complete care package with all of the information required for the specialty care service to accept the Veteran as a patient. This eliminates the administrative task of ordering, tracking, and coordinating diagnostic testing for PCPs, while also preventing specialty care services from receiving non-useful consults that take time away from providing direct care to Veterans in their clinics. This has resulted in improved clinic capacity, improved provider productivity, and shorter wait time for both primary and specialty care appointments. In short, there has been a reduction in volume – and the associated costs – of Veterans being unnecessarily sent outside of the VA system to receive care.

Creating a Win-Win for Veterans and VA Providers

Our work is centered around the ultimate user experience for all stakeholders and helping get to the root of the problem through human-centered design. By developing a solution primarily focused on creating an easier process for PCPs, it resulted in improved care for Veterans and an improved employee experience.

How do you balance both the experience of your customer and that of your employees when designing a solution?

About the Author
Liam Murphy is a Consultant with Technical Assent. He’s supported OHVP under the VHA’s Office of Quality and Patient Safety (QPS) in its effort to improve Veteran access to care for over two years. Prior to joining Technical Assent, Liam was a management consultant for financial services companies across a variety of practice areas.

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