Industry Steps Up to Improve Veterans’ Access to Care
ST. LOUIS — The central focus of the VA over the past five years has been improving veteran access to care. Whether that means enabling veterans to receive care through community programs, expanding telehealth services to reach veterans in rural areas or moving care delivery to more convenient outpatient centers, the department has taken steps with community and industry partners to make it as easy as possible for veterans to receive the care they need when and where they want it.
In fact, the VA established an office specifically to facilitate public/private sector relationships in 2018. “The Secretary’s Center for Strategic Partnerships collaborates with industry and non-profit organizations to build programs together that further the VA Secretary’s highest priority initiatives to significantly improve veterans lives,” according to the agency.
The goal is to “find the sweet spot between the secretary’s most important priorities and industry’s most important priorities and together create big, bold, impactful partnerships around those missions,” explained Deborah Lafer Scher, executive adviser to the secretary and leader of the Center for Strategic Partnerships.
Those priorities have included reaching rural veterans and establishing a national telehealth system, two projects that industry and the VA have brought to fruition in record time.
When the department sought to cost-effectively expand access to care for the 33% of veterans in VA care who live in rural communities, it realized that many lived in areas that lacked broadband access. Others could not afford data plans to connect to the VA through telehealth services. Within months, partnerships developed with most major carriers enabled veterans to use the VA’s telehealth app at no charge and without using their personal data plans.
In researching how to expand the VA’s rural footprint without constructing new facilities, the VA discovered that 90% of veterans lived within 10 miles of a Walmart, Scher noted. Discussions with the retailer led to creation of rooms where veterans can use the store’s broadband service to connect to their providers via telehealth.
To reach more small towns in rural America, Philips stepped up to provide telehealth equipment to outfit Veterans of Foreign Wars and American Legion posts for telehealth in 2019. This year, the company partnered with the VA to expand the telecritical care (eICU) program, providing remote access to a centralized team of critical care specialists from any VA ICU bed.
Distributing Care to CBOCs
The support of industry partners extends to helping individual VAMCs remove barriers to care, as well. For instance, when veterans needed expanded access to treatment for alcohol use disorder, the St. Louis VAMC turned to its industry contacts for help, quickly training a broader pool of providers.
Recognizing that alcohol use disorder affects a significant percentage of the veteran population with negative impact on health and social well-being, the St. Louis VAMC increased its focus on alcohol use disorder treatment in 2019. It quickly became apparent that long trips to the two main VA hospitals created an obstacle to care for many veterans eligible for and interested in receiving long-acting injectable form of naltrexone, Vivitrol, to help them in recovery.
As the VA Criteria For Use for Vivitrol placed no restrictions on where treatment could be administered, a St. Louis VA mental health clinical pharmacist, Lauren Ash, PharmD, quickly identified two veterans who could benefit from receiving treatment at the more convenient CBOCs. One was referred to the St. Charles CBOC and the other to the North County CBOC for follow-up injections. Ash asked the Alkermes team to provide product and directions for use, in-service training and continuing education for the clinics’ primary care nursing team prior to the patients’ next injection.
With referrals picking up, it became clear that providing proactive training at primary care CBOCs would better enable seamless continuity of care without needlessly disrupting workflow. Linda Rogers, RN, a primary care clinic resource nurse, and her group of primary care nurse education coordinators set to work developing hands-on injection training and overall education on alcohol use disorder identification, stigma, diagnosis, treatment and counseling.
In late December 2019, Alkermes and the St. Louis VA team coordinated injection training for approximately 100 nurses throughout the St. Louis VA outpatient clinics and CBOCs. At the same time, the clinical pharmacy team provided in-service education on alcohol use disorder diagnosis and treatment to primary care providers.
Monitoring Diabetes From Home
The COVID-19 pandemic dramatically accelerated the delivery of healthcare to patients’ homes, for the VA and the other providers worldwide. The VA was well positioned to respond via telehealth, thanks to the partnerships launched in 2019 and the groundwork laid in previous years. Still, videochats from home do not always provide all the information needed to manage care.
That’s particularly true for diabetics. Without regular appointments to check A1c levels, clinicians faced new challenges in managing glucose levels for veterans, particularly those on insulin. At the same time, the increased risk of serious illness that SARS-CoV-2 poses for diabetics made bringing them in to clinics or hospitals for check-ins too fraught.
As it has throughout its quest to reach more veterans in their homes and communities, the VA turned to technology. Continuous glucose monitors (CGMs) are small, wearable devices that check blood glucose levels constantly throughout the day and night and alert the patient and caregiver of worrying trends or dangerous lows. The VA has steadily increased its use of CGMs for Type 1 diabetics and Type 2 diabetics who use insulin in recent years.
In November, the VA relaxed the criteria for use of CGM devices during the public health emergency. “The use of therapeutic continuous glucose monitors may allow patients to proactively treat their diabetes and prevent the need for hospital-based diabetic care,” the memorandum explained. “Practitioners will also have greater flexibility to allow more of their diabetic patients to better monitor their glucose and adjust insulin doses from home by using a therapeutic continuous glucose monitor.”
The Abbott FreeStyle Libre 2 system, an integrated CGM with high accuracy standards that make fingerstick confirmation typically unnecessary, comes with the LibreView cloud-based diabetes management software and a smartphone app (LibreLink) that simplifies sharing of data with healthcare providers. Clinicians can use the free and secure LibreView software to guide treatment decisions, regardless of the patient’s location.
Whether at the local or national level, the expertise of industry partners has enabled the VA to move further faster in its mission to reach veterans where they are and increase access to services and medications that improve their lives and health.