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ACP: Let's Step Up Efforts to Support the VHA

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New position paper advocates for funding and support to help the Veterans Health Administration meet the health care needs of veterans

Oct. 15, 2021 (ACP) – The American College of Physicians is calling for funding and support to ensure the Veterans Health Administration (VHA) can weather current challenges and fulfill its important health care mission.

The VHA, an agency under the Department of Veterans Affairs (VA), is the largest U.S. integrated health care delivery system, serving more than 9 million veterans at nearly 1,300 health care facilities. “In addition to its health care mission, the VHA has robust research and development programs; trains thousands of medical residents and other health care professionals, helping the U.S. sustain our health care workforce; and conducts emergency preparedness and response activities in support of federal and nonfederal entities,” said Dr. Thomas G. Cooney, chair of the ACP Board of Regents.

“Given the crucial role the VHA has in American health care, ACP recognized that it needed to update its policies to provide evidence-based input to policymakers to ensure the VHA continues to fulfill its core missions,” he added.

Cooney, a VHA-employed physician, was instrumental in developing a new ACP position paper on the issue, which was published Oct. 5, 2021, in Annals of Internal Medicine.

The VHA currently faces many challenges, including aging infrastructure and achieving access and care continuity with non-VHA clinicians, Cooney said. The new position paper provides a roadmap for how to shore up these gaps.

For starters, ample funding is needed to sustain the VHA health professions education, emergency preparedness, and research and development programs. The VHA should also act to accelerate the clinical implementation of research findings into real-world settings, Cooney noted.

A major challenge for the VHA has been the implementation of the Veterans Community Care Program (VCCP). Established as part of the VA MISSION Act of 2018, the VCCP is a network of community physicians and other health professionals through which veterans could access care. The VCCP should act as a safety valve to ensure that veterans can receive timely, local and appropriate care if it is not available to them through the VHA, according to the new position paper. VCCP clinicians should closely coordinate patient care with the VHA, but the VCCP should not replace the VHA, the paper states.

Additionally, ACP recommends that the VHA works to ensure seamless care coordination between non-VHA health care professionals and the VHA so that enrollees have access to a broad network of physicians and other health care professionals. The VHA should provide full coverage for higher-income veterans without service-connected disabilities and reduce or eliminate cost-sharing for high-value services.

The VHA patient-aligned care team medical home model needs to be continued to better provide patient-centered, coordinated care outside the VHA, Cooney said.

In particular, the VHA has demonstrated the value of embedding mental health services within primary care teams. Most recently, the VHA has been pioneering systemwide a patient-centered care model through the implementation of its “Whole Health” initiative, where patients' goals and priorities are incorporated into health care decisions, with peer-led support, personalized health planning, Whole Health coaches and well-being classes.

This is just the beginning. Going forward, the VHA also needs to prioritize models that identify, diagnose and treat veterans with specific care needs, including women and veterans with suicide risk, depression, military sexual trauma and substance use disorders, Cooney said.

The VHA has also experienced challenges with recruiting and retaining physicians and other health care professionals, Cooney said. “Some VA facilities, due to their location, have more vacancies than others, and some positions are more difficult to fill in specific locations,” he said. “Similar to the private sector, VHA faces a shortage of primary care physicians and psychiatrists.”

There is an onus on medical schools and residency programs to provide veteran-specific training to prepare physicians to deliver care to veterans in the community and the VHA, the position paper states.

“Ensuring that the VHA is able to continue providing top-quality, specialized care to our patients is critical to caring for our nation's veterans who have sacrificed so much for all of us,” Cooney said.

More Information

The position paper, “Health Care for Our Nation's Veterans: A Policy Paper From the American College of Physicians,” is available on the Annals of Internal Medicine website.

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Back to the October 15, 2021 issue of ACP Advocate