Providing appropriate and consistent access to VHA care has gotten more challenging as demand for care has increased and VHA’s access issues have become highly publicized. Several reports by the U.S. Government Accountability Office (GAO), the VA Office of the Inspector General (OIG) and Independent Assessments have documented opportunities to improve VA’s scheduling processes and systems. Congress passed the VA Access, Choice and Accountability Act of 2014 (Public Law 113-146, Choice Act) to address the high demand and VA’s access challenges. More recent activity in the Choice Act continues to support Veterans getting timely and coordinated care both at VHA and in the community. Coordinating access with IVC, other program offices and VA Medical Centers (VAMCs) poses even greater challenges.
IVC achieves organizational change by developing and maintaining communications with VA facilities; providing training and education; defining and implementing business process improvements, policy development and resource material development such as toolkits; promoting initiatives through proactive project management and strategic vision; and supporting data analysis, mapping, conversion and remediation. To be able to provide and sponsor these separate but interdependent activities, IVC needs robust and integrated program management support.
VHA partnered with Aptive HTG to provide program/project management support that requires expertise in project planning, systems management and facilitation with knowledge of clinical access issues and medical scheduling practices across VAMCs. In addition to comprehensive program and change management support, Aptive provides communications, strategy and health care operations subject matter expertise to help VHA fulfill its commitment to providing Veterans timely access to high-quality care. The Aptive team develops and leads key access evaluation and improvement initiatives in executive and administrative support, communications, data analysis, clinic practice management, field support and special projects.
Aptive provides the executive team with strategic guidance and collaborates with VHA program offices, Veterans Integrated Services Networks (VISNs) and VAMC leadership. We brief senior VHA and VA officials and offices, create and coordinate integrated project teams and provide ad hoc special project support. Our team also manages action-tracking, fielding and responding to urgent inquiries from VA officials, Congress and the media; and drafts responses, briefings and reports for the OIG, GAO and Inspector General.
Our experienced communications and change management experts develop proactive outreach and engagement strategies within the communications workstream. We create fact sheets, talking points, response to queries, one pagers, newsletters, website content, graphics, templates, press releases, media responses and video scripts to communicate messages to internal and external audiences. Our team recently led an effort among several VHA program offices to overhaul the public-facing Access to Care website to showcase more transparent and plain-language access features.
The Aptive team is working to adjust primary access measures used across VHA to ensure access data provides an accurate picture of the state of health care timeliness, accessibility and experience. We facilitated the Access Data Council across key operations and clinical services program offices to identify the most pertinent measures across operations, Veteran experience, care coordination and equity to establish a new set of core access measures. We are also coordinating with the Office of Healthcare Transformation and the Healthcare Operations Center to update reporting and accountability mechanisms, refine the selection of regularly reviewed experience measures and update tracking and reporting tools.
VHA’s overall goal is to provide Veterans with timely, well-coordinated access to services and support by managing clinic supply and demand and implementing standardized processes and systems for scheduling and tracking care. Toward that end, Aptive helps set policy, train staff and provide field guidance for clinic practice across VHA. We focus on outpatient clinic appointment scheduling, consult and referral processes and procedures, minimum scheduling effort, scheduling documentation, clinic profile management, e-consult management and online scheduling. We also facilitate scheduler training; communities of practice for schedulers, clinic profile managers and group practice managers at VAMCs and VISNs; and ad hoc working groups to develop standard operating procedures (SOPs) and identify/implement scheduling solutions.
To ensure VISNs, VAMCs and individual clinics adopt the policies and practices, our team helps Field Support with stakeholder engagement, data analysis, training and coaching and site visits. Our Field Support team also helps with ad hoc projects for relevant legislative requirements by managing project plans, conducting evaluations and drafting congressional mandated reports. We help test the effectiveness of using medical scribes, develop designation criteria and implement access improvements at facilities in medically underserved communities (for the MISSION Act); and ensure VAMC compliance with scheduling and consult management processes (for the Megabus Act).
Lastly, our team manages high-priority special projects that require expertise in strategy development, stakeholder engagement, project planning and initiation, workgroup management, project management and oversight, field coordination, progress reporting and sustainment planning. Specific projects include the Care Optimization in the Emergency Department (CO-ED) initiative focused on delivering optimized value-based care through increasing care coordination and preventive services; data analysis and reporting; transfers from community hospitals to VA for admissions; communication and education; and expanding innovative solutions (e.g., HealthChat, Tele-ED). The Aptive team also assists the National Emergency Medicine Office, which includes supporting the metrics development project and Tele-Emergency CARE implementation for VISNs; facilitating conversations with VA Health Connect partners on standardizing profile naming conventions; and facilitating conversations with SMEs on Oracle Health impact on implementation.
Optimizing the Request Process
With an influx of ad hoc requests from OIG and GAO, VHA had no sufficient process for receiving, tracking and closing incoming requests. Staff spent extra time searching for and understanding the status of requests, were confused by steps needed to fulfill the requests and risked delays in addressing them. In response, Aptive developed a master tracker to aggregate all requests with respective reports, milestone dates and request owners. We also developed knowledge management systems to ensure materials are readily accessible and that processes are streamlined for archiving finished requests and ensuring maintenance of the master tracker and associated materials. These artifacts and associated processes were well-received and adopted by the client. The direct result of these efforts is that managing incoming requests is now streamlined and transparent.
Tracking and Coordinating Artifacts
As the creation and revision of directives, SOPs and guidebooks increased, so did the need for reliable tracking and coordination of artifacts to ensure smooth communication of guidance and changes to the field. The Aptive team developed a policy catalog to track all directives, SOPs and guidebooks. The team is also currently developing a policy review and concurrence process to standardize policy development and create triggers for reviews and updates. Together, these items will create a centralized structure for clearly and concisely tracking and developing policy artifacts and ensuring timely delivery of quality products.
Developing an Implementation Guide
Since interest in the Community Embedded Staff Program was growing, the Aptive team began developing a comprehensive implementation guide. The program physically or virtually places a nurse or social worker in a community hospital to identify Veterans on their arrival and assist in coordinating their care.
Communicating COMPACT Act Benefits
The Aptive HTG team and VHA communications team implemented communications to expand awareness among Veterans and their families, external organizations, and VAMC staff about the COMPACT Act health care benefit for Veterans experiencing an emergent suicidal crisis. We also pursued a potential opportunity to collaborate with newly launched mobile medical units (MMUs). Our team reached out to MMU points of contact and successfully expanded communications outreach via the homeless care team.
Communicating with Third-Party Administrators (TPAs)
The Aptive HTG team maintains valuable visibility with VA’s TPAs and community providers through a monthly newsletter distributed to numerous external stakeholders. The newsletter delivers content on VA’s high-priority areas including suicide prevention, mental health, opioid safety training, whole health and the PACT and COMPACT Acts. The Aptive team received positive feedback on the monthly newsletter from a wide variety of stakeholders.
Staying Ahead of Schedule
The Aptive team routinely submits reports ahead of schedule and takes charge of implementing process improvements to keep on or ahead of project timelines. During Option Year 2, we submitted over half (7 out of 12) of the monthly reports early.
Creating a Communications Filing System
The Aptive team saw an opportunity to streamline artifacts and the organization of the communications SharePoint site. Working with leadership, we developed and implemented a new filing system. The new system has led to greater operational efficiency by organizing communications materials, making it easier to find and retrieve resources and establishing a set knowledge management process.
