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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?

Breaking the Status Quo

In the wake of the global COVID-19 pandemic in 2020, the “Reimagining Veteran Healthcare” project set out to not only study what has changed about health care for Veterans during the pandemic, but also investigate what might change to better anticipate Veterans’ needs of the future. This inflection point was an opportunity for VA to drastically rethink how to meet evolving patient expectations and a changing population of Veterans.

This vision for the 20-year future of VA emerged from research with Veterans, Caregivers, front-line staff, healthcare experts, and VA leadership. Starting with the core users of VA services yielded a web of opportunities spanning from discovery and design to technical development, prototyping, piloting and implementation —utilizing the full range of Human-Centered Design (HCD) methodologies, tools, and approaches. 

While VA has several ongoing and near-future transformational programming in the works, there is a large gap when considering truly transformational future opportunities. This is where Reimagining Veteran Healthcare stepped in. Our team from Technical Assent and Deloitte had a goal of developing breakthrough, nonlinear innovations of service delivery models to create or capture markets, services, products, and customer segments that have yet to exist.

Putting Veterans at the Center

To keep Veterans at the center of our work, the team conducted ethnographic research with 100+ stakeholder interviews (virtually and in-person) with Veterans, clinical providers, familial caregivers, subject matter experts, and other key VA staff members. These helped the team ​​uncover pain points, bright spots, and/or validate our assumptions about the current state of Veteran healthcare, understand the post-pandemic priorities and behaviors of different populations of Veterans, and inform several transformational opportunity areas. 

“[I define health as] having the ability to accomplish all the things that I want to do in my life […] without any hindrance from medical or monetary or any of those things that naturally get in the way. The quality of things I am consuming in life. It’s the total of all those things.”

“If I could just visit one entity, one website, have everything available to me on ONE Dashboard or profile. If it was tailored to me and what I went through it would be so much more helpful.”

“It’s symptoms first, then based from symptoms, give prescriptions that alleviate those symptoms. The immediate question is always ‘What can I give you?’ Well, I don’t want a medication. I want to solve why it’s hurting in the first place.”

Developing Customer-Driven Solutions

Based on the insights that emerged from conversations with 250+ stakeholders –including Veterans, caregivers, and front-line staff, consensus was found around three critical priorities for VA’s future:

1. Redefine Veterans’ initial encounter with VA – VA has a critical opportunity to elevate health as a priority with Veterans during and following transition. Connecting proactively with personalized tools can create a seamless transition for Veterans to join the VA following active duty.
2. Deepen ongoing customer service efforts and engagement – Veterans feel the fragmented nature of the VA. By creating a backend system that puts Veteran health records, feedback, and preferences in one place, VHA can provide a more seamless front-end experience while empowering employees to own each individual interaction and overall health journey.
3. Extend the envelope of care – More than ever, Veterans expect care when, where, and how they want it. COVID-19 highlighted an opportunity for VA to extend care beyond its walls and broaden its definition of health and healthcare delivery.

Across these three central opportunities, 11 solution concepts were developed that allow VA to create transformational change for Veterans. These solution concepts are rooted in the Veteran experience, taking an outside-in look at what’s needed for VA healthcare delivery. Currently, the team is partnering with VAMCs to pilot and iterate on the solution concepts and help Veterans access VA care when and where they want it in the future.

How do you keep your customer at the center of your work? What opportunities are there to think outside the box to anticipate future customer needs?