By Annette M. Boyle

Paul Coupaud, public affairs officer at the Phoenix VA

PHOENIX — When CVS Health became an authorized provider under the Veterans Choice Program, several VAMCs considered using the company’s retail medical clinic, MinuteClinic, to help relieve long waits and offer routine medical services nearer to veterans’ homes.

This spring, the Phoenix VA Health System followed VA Palo Alto, CA, Health System in piloting a partnership with the pharmacy and TriWest Healthcare Alliance to provide more convenient care for veterans. The clinics are in some CVS pharmacies.

“At the Phoenix VA, we are always looking for ways we can better serve our veterans, and we see this pilot program as a great opportunity to ensure veterans receive the care they need in a timely manner,” explained Paul Coupaud, public affairs officer at the Phoenix VA.

Under the partnership arrangement, VA nurses can refer veterans to MinuteClinics in the metropolitan Phoenix area.

“I’ve long believed that veterans in need of routine health care services should not have to wait in line for weeks to get an appointment when they can visit community health centers like MinuteClinic to receive timely and convenient care,” pointed out Sen. John McCain (R-AZ), who supported the initiative.

Long waits for appointments and delays in treatment at the Phoenix VA were central issues in the scandal that rocked the VA in 2014. To address some of the issues identified in subsequent investigations, Congress authorized the Veterans Choice Program that year.

“Our No. 1 priority is getting veterans access to care when and where they need it,” said Baligh Yehia, MD, MPP, MSc, the VA’s deputy undersecretary for Health for Community Care. The partnership allows VA nurses to refer any of the Phoenix VA’s 120,000 veterans who call in to the helpline with appropriate conditions to the 24 MinuteClinics in the metropolitan area.

Coupaud said he expects that most veterans referred to MinuteClinic locations will have minor illnesses or injuries that fall within the clinic’s usual scope of care. Nurse practitioners at MinuteClinics diagnose, treat and provide prescriptions as needed to address common conditions including strep throat, minor respiratory and genitourinary infections, nausea and vomiting, diarrhea, minor wounds, skin conditions and muscle strains and sprains. They also provide common vaccinations, including those for influenza, pneumonia, hepatitis A and B, and shingles.

Patients may receive walk-in care seven days a week to monitor some chronic conditions, such as diabetes, hypertension and hypercholesterolemia as well as assistance with smoking cessation, contraception and other common issues.

The Phoenix program launched on April 17. In the first two weeks, 62 veterans had been referred to a MinuteClinic for care, primarily for cough, cold or allergy-related sinus and respiratory concerns.

“From the feedback we’re received thus far, the response has been positive. Veterans seem to appreciate the option as the Minute Clinic provides a timely option for them to receive the care they need,” Coupaud told U.S. Medicine.

While “increasing access and availability of care is crucial,” noted Maureen McCarthy, MD, Phoenix VA chief of staff, “in sending veterans out into the community, however, we are always conscious of providing the best care coordination we can.”

Care Coordination

Following the example of the Palo Alto VAMC, which launched a similar program last year, the Phoenix VAHCS and CVS will share electronic health information to facilitate care coordination and quality. After a veteran’s visit to a MinuteClinic, encounter summaries are forwarded to his or her primary care physician at the VA with the veteran’s consent. Patients who require more comprehensive follow-up are directed to contact their primary care team.

“All in all, the digital process has gone rather smoothly so far,” Coupaud said.

The Palo Alto VAMC’s program provided the 60,000 veterans served by the Palo Alto, Menlo Park and Livermore hospitals and the clinics in San Jose, Fremont, Capitola, Monterey, Stockton, Modesto and Sonora the option to receive care at one of 14 local MinuteClinic locations or at the VA. Veterans seen at a MinuteClinic could also fill prescriptions written at that visit at the associated CVS pharmacy.

More than 500 veterans took advantage of the MinuteClinic option last year.

“The partnership with CVS allows veterans to get care outside of regular business hours and on weekends and allows them to avoid traveling a long distance or having to use an emergency room,” according to the Palo Alto VAMC’s healthcare services group. In addition, referring some patients to MinuteClinics freed up slots within the VA for patients who preferred to receive care from their usual team.

When the program launched in California, it was promoted as a way to overcome some of the Palo Alto area’s geographic issues that can make getting to a VA facility challenging for some veterans. The program terminated after just a year.

The pilot helped the Palo Alto team better understand the challenges of providing a “seamless and comprehensive system of care that involves community partners,” said a spokesperson. Ultimately, however, “we felt it necessary to continue looking for and offering ways for veterans to get care when they want it, how they want it, and where they want it,” Damian McGee, Pablo Alto VA Public affairs officer, told U.S. Medicine.

Coupaud said he could not speak to the length of time Phoenix would continue the partnership with CVS, but he did note that programs that engage community providers in care for veterans are critical to providing the quick access to care veterans expect.

Yehia stressed that point as well, saying “partnerships between VA and private providers are essential to delivering care in the diverse geographies where veterans live.” Yehia’s operational brief is to build a robust network of federal and community providers to better meet the changing needs of veterans.