Department of Veterans Affairs and Department of Defense Collaboration for Transitioning Health Care

The Department of Defense and the Department of Veterans Affairs are united in a common mission to facilitate health care coordination, streamline benefits application processes, eliminate duplicative requirements, and correct other business practices that complicate the transition of Service members from active duty to veteran status. Emphasis on these programs has increased as Service members returning from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are being provided care for the physical and psychological injuries they have sustained. DoD and VA are committed to continually provide high quality continuum of care for each individual as their transition from combat to the next phases of their lives occurs. This article will explain three DoD-VA programs to inform our warriors about care and benefits from federal and state agencies and to assist them in accessing what they so richly deserve.

The VA Liaison Program, developed in August 2003, places social workers and nurses at Military Treatment Facilities (MTFs) to assist Service members (Active Duty, National Guard, and Reserves) who have been injured in OEF/OIF. These VA Liaisons then work closely with MTF social workers, case workers and discharge planners to transition follow-up care from DoD to VA. This program helps wounded Veterans transfer from acute care at MTFs to rehabilitative care at VA Medical Centers, and back if necessary. Patient care is also available for Service members on convalescent leave who choose to have follow-up care at their local VA facilities. VA Liaisons use a standardized referral form from the MTF Case Manager which outlines the health care needs of the Service member, and coordinates referrals with OEF/OIF Program Managers at the receiving VA Medical Center. VA Liaisons register Service members and enroll Veterans in VA to schedule appointments or secure inpatient beds prior to leaving the MTF.

Under this program, VA currently has 27 full-time social workers and nurses working as VA Liaisons in 13 MTFs. The program is nationally funded by the VA Central Office (VACO), and sites are determined in coordination with the Department of the Army and Department of the Navy (the Air Force contracts out this function). The VA Liaisons are programmatically assigned to Care Management and Social Work Service at the VACO, but administratively assigned to their local VA Medical Center. VA Liaisons are integrated with staff at the MTF to coordinate health care and provide onsite consultation/collaboration about VA resources and treatment options. Expectations of staff members are outlined in a Memorandum of Agreement between each MTF and corresponding VA Medical Center.

A second joint program geared towards continuum of care is the Federal Recovery Coordination Program (FRCP). The President’s Commission on Care for America’s Returning Wounded Warriors report (July 2007) recommended that the Departments create comprehensive, patient-centered recovery plans for every seriously wounded Service member, including those who may benefit that were wounded early in the OEF/OIF conflicts. The FRCP is operated as a joint VA/DoD program with VA serving as the administrative home. The goal of the FRCP is to provide assistance to recovering Service members, Veterans, and their families through recovery, rehabilitation, and reintegration.

Today, 15 Federal Recovery Coordinator (FRC) positions are located at six MTFs and two VA Medical Centers. All FRCs have a clinical background in nursing or social work, and prior experience in either the military or VA heath care system. All are Master’s level, and have specialized knowledge in one or more clinical areas; many have advanced practice degrees. They frequently consult with each other, bringing their collective knowledge and experience to bear for their patients.

FRCs develop a customized Federal Individual Recovery Plan for each client that is used to monitor and track the services, benefits, and resources needed to accomplish identified goals. The goals are those of the Service member or Veteran, with input from their family or caregiver, and the multidisciplinary team. The number and types of goals are related to the medical problems, the stage of recovery, and the holistic needs of the client and family.

Recovering Service members and Veterans are referred to the FRCP from a variety of sources, including the Service member’s command, members of the multidisciplinary treatment team, case managers, families already in the program, Veterans Service Organizations, and non-governmental organizations. Generally, those individuals whose recovery is likely to require a complex array of specialists, transfers to multiple facilities, and long periods of rehabilitation, are referred. When a referral is made, a FRC conducts an evaluation that serves as the basis for problem identification and determination of the appropriate level of service.

A third program was the development of a comprehensive, web-based National Resource Directory to provide recovering Service members, Veterans, families, care coordinators, care providers, and care partners with a single online reference, (www.nationalresourcedirectory.org), on the full array of programs and benefits available. The directory was activated in November 2008, and contains checklists for common processes and a section for frequently asked questions. It also provides information on services, and catalogues resources available through national, state, and local governmental agencies, organizations, and other related associations. Users are able to search for information by user type, geographic location, military affiliation, and specific service or resource. The directory is a joint development project by DoD, VA, and the Department of Labor, with content information provided by partners across the nation.

Joint initiatives between DoD and VA have shown the progress that can be accomplished/achieved in providing continuity of care for our soldiers through each segment of their transition. These initiatives are proof that with cooperation and a shared mission, we can ensure that our Service members and Veterans receive the care they’ve earned. Programs like these are evidence of a world-class partnership between the departments that delivers seamless, cost-effective, quality services to our beneficiaries who are of such value to our nation.

Michael E. Kilpatrick, M.D., is Director of Strategic Communications for the Military Health System in the Office of the Assistant Secretary of Defense for Health Affairs.

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