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September 19, 2019

What private health care can learn from VA, according to former secretary David Shulkin

Daily Briefing

    In a post on LinkedIn, former Veterans Affairs (VA) Secretary David Shulkin, who spent much of his career in the private sector, offers 12 tips the private health care sector can take from VA.

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    What the private sector can learn from VA

    As VA secretary, much of Shulkin's job involved working with private sector companies to help VA "address issues in a complex and difficult-to-maneuver system that needed reform and modernization," he writes. But at the same time, Shulkin also learned about practices that VA does "so well."

    Here are 12 practices private sector organizations should adopt from VA, according to Shulkin:

    1.  Leveraging advanced practice nurses and pharmacists. Beginning in 2016, VA allowed the majority of its advanced practice nurses to practice independently, which improved access to care and significantly reduced wait times, Shulkin notes. In addition, pharmacists can write prescriptions for medications, which "reduces the burden on primary care physicians," Shulkin writes.

    2. Prioritizing suicide prevention. At VA, suicide prevention is a top priority, according to Shulkin. Every VA medical center has at least one suicide prevention coordinator that supports high-risk patients, corresponds with community partners, and coordinates efforts between VA and outside organizations.  

    3. Integrating behavioral health. VA delivers more behavioral health care services in primary care than the majority of other health systems, according to Shulkin. "Without having to worry about the challenges of third party reimbursement, VA care can be provided without the fragmentation often seen in the private sector," Shulkin explains. "While the private sector does have this obstacle, it is still a worthwhile pursuit."

    4. Taking a holistic approach to health. "The true superpower of VA" is its ability to address the complete needs of a patient by addressing the "physical, psychological, spiritual, and economic elements of patients' health," Shulkin writes. By contrast, the private sector's reimbursement models often prevent providers from taking a holistic approach, Shulkin notes. "Specific health issues are difficult to tackle if a person lacks access to the right medications, transportation, housing, and economic support," Shulkin writes.

    5. Employing predictive analytics. By using the same EHR for more than two decades, VA established a lifetime record filled with data that allows the agency to identify patients in need.  "VA has developed predictive tools, such as ReachVet, which identifies veterans at highest risk for suicide and is working with Google DeepMind to identify risk factors for patient deterioration and predict onset," Shulkin writes. 

    6. Being transparent. At VA, "transparency is a strong motivator for quality improvement," Shulkin writes. VA was the first health system in the United States to make its wait times public, according to Shulkin. The agency has also published quality data and opioid prescribing rates, according to Shulkin. "It held us accountable and pushed us to do better," he says. 

    7. Utilizing telehealth. Employing telehealth for veterans nationwide allowed VA to provide health care services to veterans who lived in areas with medical shortages, according to Shulkin. "Improved access to patients, from the comfort of their own homes, is something that all Americans would benefit from," he writes.

    8. Offering adaptive sports and other therapies. Providing adaptive competitive sports can help veterans with disabilities to regain a sense of "power, hope, and well-being," as they navigate their conditions, according to Shulkin. "Other less conventional treatments like service animals, especially for emotional support, prove also to be powerful influences on health," he writes.

    9. Viewing veterans as a population. Viewing and treating the nine million veterans that receive health care through VA as a "defined cohort is a powerful way to influence their health status," Shulkin writes. For instance, by proactively identifying all patients with hepatitis C, VA was able to employ an outreach strategy offering all veterans definitive treatment. Since then, more than 100,000 veterans have been treated for the condition.

    10. Providing 'whole person' support. Through its "whole person" health care model, VA encourages self-care and peer support. "Training and supporting peer advocates is an effective strategy for addressing health conditions that require emotional support and behavioral change," according to Shulkin.  

    11. Identifying best practices. "Integrated systems need to transform to constantly improve and learn," so VA uses scientific methods to determine best practices, according to Shulkin. "Once identified, these best practices are then disseminated for others to adopt and implement," he writes.

    12. Establishing partnerships. Through partnerships, VA aims to go from being a "provider of care to a network coordinator of care," according to Shulkin. "Reaching and working with non-profit organizations, churches, mosques, and synagogues, as well as with companies in the community, has been an accelerator of change," he writes (Shulkin, LinkedIn, 8/29).

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