Accelerating toward veteran-centered health care at the Department of Veterans Affairs

I was honored (truly) to represent The Permanente Federation as a guest last week at a summit held by Veterans Health Administration Primary Care in Washington, DC, to review work done to date inside and outside of VHA, for the purpose of continuing to provide the best overall care for our veterans.

The summit included a review of the latest efforts of the Patient Centered Medical Home, given personally by Paul Grundy, MD, from IBM, and Michael Barr, MD, from the American College of Physicians, as well as information given by VHA experts in primary care leadership operations, quality, and across disciplines, including physicians and nurses.

The day and a half-summit included a healthy (in my opinion) amount of introspection that included the best results for our veterans, as well as areas for improvement. As I expected, this group of nursing and physician leaders are incredibly bright and committed to understanding the strengths and weakness of the system they support, to a humbling degree.

This is impressive to see in a system (VHA) that is regarded by many in health care as an example to others as what world class health care should be, and at the same time what I am familiar with in systems like this – an ongoing, healthy dissatisfaction with the status quo.

What I could also relate to in my role is the serious interest, especially in a highly-regarded system, in making sure that primary care is all that it can be, not just in medical offices but wherever patients/people/veterans live, work, and play (and I learned about the existence of the care coordination services – telehealth program). And, as at Kaiser Permanente, the VHA has a commitment to a robust internet portal for veterans, MyHealtheVet. I think the era of the personal health record is a great one for primary care, and vice versa.

In terms of connection to the patient centered medical home, I really liked how this concept was used not so much as a bar to reach, but as a guide and stimulus to create a whole new bar. Systems like VHA and Kaiser Permanente by virtue of their emphases on whole-body, total care, may be more likely to experience challenges faced by primary care across our profession(s) (nursing and medicine) sooner than the rest of health care and therefore be faced with the urgency of solving those challenges sooner as well. Both systems also support multi-specialty care, so there’s good understanding that great specialty care goes hand in hand with great primary care – both are necessary.

My hope is that the solutions they create for veterans will support strong primary care for all Americans, and I am confident that they will. Thanks to the primary care leadership, physicians and nurses alike, for allowing me to observe their work on behalf of our veterans.

Ted Eytan, MD