Building the VA Healthcare System of the Future

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By Robert A. Petzel, M.D., Under Secretary for Health, Department of Veterans Affairs

The Affordable Care Act has ushered in a new era of choice in healthcare coverage for many Americans, including the men and women who’ve served our nation in uniform. That has brought renewed emphasis on the VA healthcare system’s efforts to transform into one which delivers personalized, proactive, patient-driven healthcare to veterans.

Over the past five years, we have been laying the groundwork by expanding access, improving health outcomes and implementing Patient Aligned Care Teams — VA’s version of the Patient Centered Medical Home model — at our primary care sites. During the next five years, we want to ensure that we are the provider of choice for veterans by making the experience of care as high-quality as the care itself.

A critical challenge is that the current model is focused on disease care — which is an essential aspect of optimizing health and well-being — but it’s incomplete. The approach we are taking addresses the health and well-being of our patients more fully, and it will have a broader impact on the quality of their lives.

The first question we ask patients shouldn’t be, “What’s the matter with you?” It should be, “What matters to you?”

That is not to say we no longer will manage diseases or provide acute care. The difference will be in where we start our conversation with patients. Instead of asking them what their main problem is, we will ask them questions to better understand what their health and wellness goals are, and then build a personalized health and treatment plan around those goals.

When we see our patients, we will no longer focus solely on what is ailing them that day or what chronic conditions they are battling. We will talk with them about how their health status affects their ability to live the life they want to live over the long term.

We already know that we excel at managing disease and delivering quality health care. Now we are going to do that in the context of helping veterans achieve individual goals for health and well-being at all ages and stages of life.

To understand how this approach will work, imagine if your provider began an appointment with you not by telling you what you need to do to be healthy or prescribing a new medication but by asking you what you wanted to address. What if your provider listened to you, allowed you to set the agenda and created a true partnership with you, instead of concentrating on finding and fixing a problem?

We will help patients create an optimal vision of health based on individual needs, not what the provider thinks the patient needs. We will help patients explore options and the steps they can take to realize that vision. And we will help patients take action to achieve and sustain their health goals and work toward personal accountability.

This approach to healthcare delivery will allow us to treat the whole person, not only the disease. After all, healthcare delivery in the modern age needs to go beyond pills and surgery. And since no one knows you better than you, shouldn’t you be at the center of your healthcare?

As the nation’s largest integrated healthcare delivery system, with more than 1,700 sites of care, the Veterans Health Administration is uniquely positioned to lead the country in making these types of positive changes in the way healthcare is delivered not only for veterans but for all Americans.

We have an unprecedented opportunity to enhance the health and well-being of veterans and help transform American healthcare.

This year, U.S. Medicine marks 50 years as the voice of federal medicine. Over that half-century, the publication has chronicled the many changes that have taken place in how we deliver healthcare to the citizens we serve.

In the VA healthcare system, we will continue our own 21st-century transformation in earnest this year. It is the most significant transformation in how we deliver care since the 1990s, when we reengineered the VA healthcare system to respond to the changes taking place in healthcare delivery at that time, such as incorporating electronic health records and placing a priority on primary care.

We plan to be a national leader in population health, connected health, improvement strategies, personalized care and maximizing health outcomes in a cost-effective and sustainable manner. It will take time, but with the support of our patients, staff and our many federal and community partners, we will get there.

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