Commentary
Is VA health care really “all that different” from what veterans would find in the private sector?
As someone who spent more than 25 years managing private sector health care organizations and recently joined VA as its under secretary for health, I’ve had the unique opportunity to compare the health care systems. Over the past several months, I’ve met with veterans and their families, veterans service organizations, VA clinicians, facility staff, and veteran employees at all levels. Through these meetings and travel to dozens of facilities, I’ve come to realize that many of the essential services provided by the VA cannot be found in or even replicated in the private sector.
Over time and in partnership with successive generations of veterans, the VA has evolved into an interconnected, institutionalized system of care and services. And while many of these services aren’t unique to the VA, ours is the only health care organization that combines these services “under one roof” and integrates them in a way that is veteran-centric.
Further, as our country continues to struggle with improving health outcomes and unsustainable increases in health care costs, the VA can play a crucial role. As a long-standing, highly integrated, and patient-focused provider of care, the VA can lead the way in advancing the nation’s health care. This is the appropriate role for government: Do what the private sector cannot or will not do, given the nature of its enterprise.
The VA has 3 core strengths that distinguish its services from those of the private sector in caring for veterans: (1) systemwide clinical expertise regarding service-connected conditions and disorders; (2) a team approach to primary care that is veteran-centric; and (3) a holistic view of the veteran that includes physical, psychosocial, and economic determinants of health, as well as critical support services for family members and caregivers.
First, the VA brings together comprehensive expertise on service-connected health issues in a single health care system. Our clinicians are trained to identify, assess, and treat a wide spectrum of health issues, such as spinal cord injury and limb loss, conditions arising from environmentalexposures, and traumatic brain injury. Additionally, VA specialists have expertise in the treatment of mental health issues, substance abuse, suicide prevention, and posttraumatic stress disorder (PTSD). Further, the VA has a long track record that includes national programs in audiology and speech pathology, blind rehabilitation, chiropractic care, physical med-icine and rehabilitation, prostheticand sensory aids services, recreation therapy, and polytrauma care.
In contrast, knowledge of and expertise in these crucially important health care issues are not nearly as widespread in the private sector. For example, less than 50% of private practice primary care providers (PCPs) regularly perform screening tests for PTSD and depression.1 In addition, only 15% of community-based mental health providers are proficient in treating military and deployment-related issues such as PTSD, and less than 20% of PCPs have sufficient military culture competence to take a veteran’s military history.1
The VA’s second core strength is its team-based, veteran-centric model of primary care that focuses on patient-driven, proactive, and personalized care. This patient aligned care team (PACT) addresses not only disease management, but also disease prevention, wellness, and health promotion. The PACT model often includes PCPs, nurse care managers, social workers, pharmacists, nutritionists, behavioral health professionals, administrative clerks, as well as the veteran, family members, and caregivers. Through PACT, veterans can attend group clinics and educational seminars, access web-based information via a personalized patient portal, and directly communicate with their care team by phone, secure messaging, or telehealth. The PACT approach has proven effective: Several studies examined its impact on reducing avoidable hospitalizations, emergency department visits, and behavioral health issues and on improving communication among health care professionals.2-4
The VA’s third core strength—a holistic approach to patient care— also is not uniformly seen in the private sector. All too often the private sector health care system addresses only the patient’s chief complaint, focusing on the physical manifestation of an illness or the patient’s psychological condition. Ensuring a patient’s well-being requires the integration of the physical, psychological, social, and economic aspects of health and a thorough understanding of how these factors impact treatment compliance. As any health care professional knows, even the best treatment plan cannot succeed without patient compliance. In this regard, the ability to address nonmedical issues is as important as the treatment plan.
By taking a holistic view of health and inviting veterans to do the same, the VA addresses these and other compliance issues head-on. The VA is positioned to provide help, as appropriate, with transportation; caregiver support; homelessness; pharmaceutical benefits; clothing allowances; counseling in readjustment centers; and a full range of physical, psychological, dental, and social services.
