The presentation Dr. James Peake gave in the Healthcare Executive Circle 2014 -seminar in 6th of February, 2014. http://hec2014.fi/

1. Healthcare
Executive
Circle
6 February
2014
Health Quality Journey US
Department of Veterans
Affairs
James B. Peake, M.D.
Lieutenant General, USA (Ret)
6th Secretary of Veterans Affairs
President, CGI Federal
CGI

2. LONG & WINDING
THE ROAD TO A QUALITY HEALTH SYSTEM

4. VA Major Business Lines
FY12 Total VA Funding: $127 Billion
National Cemetery
Administration
(NCA)
•Memorials & Burials
• Headstones &
Markers
• National Shrines
• State Grants
4
Veterans Benefits
Administration
(VBA)
•
•
•
•
•
•
Life Insurance
Home Mortgage
Education (G.I. Bill)
Comp & Pension
Vocational Rehab
Employment Services
Veterans Health
Administration
(VHA)
•
•
•
•
•
•
•
Primary/Specialty Care
Long-Term Care
Rehabilitative Care
Health Promotion
Mental Health Services
Prosthetics Services
Medical Research

6. Two GREAT Systems
Two GREAT Missions
HEALTH &
FIT
RETURN
TO
DUTY
SPECIALIZED
RECOVERY
LONG
TERM
REHAB
MILITARY HEALTH SYSTEM
DEPT OF DEFENSE
VETERANS HEALTH ADMIN
DEPT OF VETERANS AFFAIRS

7. FY 2012 End-of-Year Totals
Enrollees…………………………….…..…8.76 Million
Unique Patients Treated……………........6.33 Million
Outpatient Visits…………………………................83.6 Million
Outpatient Surgeries…………………………………….292,500
Inpatient Admissions………………………………….…703,500
Lab Tests (Inpatient & Outpatient)…………....…268.3 Million
Prescriptions Dispensed (30-Day Equivalent)…..266.2 Million
Source: FY 2012 End-of-Year Pocket Card
Prosthetic Services Performed………..…………..14.5 Million
7

8. VA’s Health Care Expertise
VA is one of the largest civilian employers in the federal
government and one of the largest health care employers in
the world.
277,000+ Total VHA Employees
84,000+ Veteran Employees
21,000+ Physicians
67,000+ Nurses*
8
*Includes registered nurses, licensed practical
nurses and licensed vocational nurses.

9. Academic Affiliations

10. May 1970

12. HARVARD . . . TO . . . CBO
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION
January 2007

14. Hospital System to
Health System
In 1996, VA began the creation of
Veterans Integrated Service Networks
(VISNs).
• 152 Medical Centers
•990 Outpatient Clinics
821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
• 300 Vet Centers
• 70 Mobile Vet Centers
• 102 Domiciliary Residential
Rehabilitation Programs
• 134 Community Living
Centers
14
Source: FY 2012 End-of-Year Pocket Card

15. N Engl J Med 2003; 348:2218-2227, May 29, 2003

17. Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary CareWith Mental HealthAugmented With Telemedicine
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama, Georgia, and South Carolina.

18. HOM
E
T O WN
S

19. WOMEN’S HEALTH CLINIC

20. Better Access, Better Care
Before
After
Hospital System
Health System
“Kizer had cut more than half
of the 52,000 hospital beds in
order to open 300 new
community clinics, helping the
agency treat 700,000 more
Only patients.”
Hospitals
Vet Centers
Hospitals
Outpatient Clinics
Mobile Clinics
20
Mobile Vet
Centers
My HealtheVet

21. PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership

22. Patient Centered Medical Home
Patient Aligned Care Teams

24. The Evolution of VistA
• 1977 – ANSI Standardization of MUMPS
• 1977-78 – CASS – Computer Assisted System Staff
• 1979-81 – Underground in the VA
• 1981-82 Becoming
“Legal”
• Decentralized Hospital Computer Program – DHCP ‘82
VistA ‘94
24

25. VistA Value .
Open Source
Confidential
25

26. 2009 VHA Quality and Safety Metrics
Metric
2009
2008
Benchmark
Unadjusted Mortality Acute Care
2.3%
3.0%
No national benchmark;
2008 Kaiser-P study = 4.5%
Unadjusted Mortality ICU
8.0%
8.0%
No national number- 2008
Kaiser-P study = 8.9% (other studies up
to 20% mortality)
Catheter Line Associated Bacteremia
(CLAB)
1.7/ 1000
Line days
2.15/ 1000
line days
No national benchmark; recent
Nosocomial Infections Survey.
Rate approx. 1.8-2%
Ventilator Associated Pneumonia (VAP)
2.46/1000
Vent days
3.42/ 1000
Vent days
No benchmark; in Q1 2004, VHA =
8.8/1000 vent days (72% decrease)
MRSA infections – Acute Care
0.37/ 1000
Bed days
No Data
No benchmark; in Oct 2007,
VHA=0.53/1000 days (32% decrease)
MRSA Infections – ICU
0.61/ 1000
Bed days
No Data
No benchmark; in Oct 2007,
VHA=1.82/1000 days (67% decrease)
MRSA Screening – ICU/ Acute Care
94%/ 93%
No Data
None
68%
57%
Literature: approx 30-40%
76.3%
68.0%
Literature: approx 30-40%
4.21 days
4.39 days
DVT prevention (high risk, nonoperative, acute care)
ICU non-operative DVT prevention
Acute care Length of Stay
Medicare average approx 4.9 days
Areas in Green highlight substantial improvement
26

28. The Value Continues 2012
VA Average Percent (1)
Clinical Indicator
DELTA
HEDIS 2011 (2)
Commercial Medicare Medicaid
2012 (6) 2011 (6)
2010 (6)
(7)
(7)
Breast Cancer Screening
87
85
87
71
69
50
Cervical Cancer Screening
93
93
94
77
n/a
67
Cholesterol Management for Patients with Cardiovascular
Conditions:
LDL-C Control (<100 mg/dL)
70
71
69
59
57
42
Cholesterol Management for Patients with Cardiovascular
Conditions:
LDL-C Screening
96
96
96
88
89
82
Colorectal Cancer Screening
82
82
82
62
60
n/a
Comprehensive Diabetes Care - Blood Pressure Control
(<140/90)
80
81
82
66
63
61
Comprehensive Diabetes Care - Eye Exams
90
90
91
57
66
53
98
99
90
91
83
Comprehensive Diabetes Care - HbA1c Testing
Comprehensive Diabetes Care - LDL-C Controlled (LDL-C<100
mg/dL)
68
69
70
48
53
35
Comprehensive Diabetes Care - LDL-C Screening
97
97
97
85
88
75
Comprehensive Diabetes Care - Medical Attention for
Nephropathy
95
95
96
84
90
78
Comprehensive Diabetes Care - Poor HbA1c Control (8)
19
17
15
28
27
43
Controlling High Blood Pressure - Total
77
78
79
65
64
57
Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3
96
97
97
77
n/a
76
94
94
94
53
n/a
44
96
97
97
48
n/a
40
Flu Shots for Adults (50-64) 3
65
65
71
53
na
n/a
Flu Shots for Adults (65 and older) 3, 4, 5
76
79
82
n/a
69
n/a
Immunizations: Pneumococcal 3,4, 5
93
94
95
n/a
69
n/a
Medical Assistance with Smoking Cessation - Discussing
Medications
Medical Assistance with Smoking Cessation - Discussing
Strategies 3
SOURCE: Office of Analytics and Business Intelligence Updated 11/28/2012
RAW
%
16
16
23%
21%
11
19%
8
9%
20
14
33
8
32%
21%
58%
9%
20
42%
12
11
(9)
12
14%
13%
-32%
18%
19
25%
41
77%
48
12
7
24
100%
23%
10%
35%
(7)

29. Power of
Information
Knowledge
Data
Act Decisively
TIME
What we don’t know WILL hurt us!

30. State of the Union Address
“…By computerizing health
records, we can avoid dangerous
medical mistakes, reduce costs,
and improve care”

31. The award cites VA's
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments.
American Council For Technology . . .
Excellence.Gov Award

32. System of Systems
System of Systems
PARADIGM SHIFT
NTE GRAT ED FR O M C ON US T O THE F OXH OLE . . .
INTEGRATED FROM FOX HOLE TO CONUS
TO& E
TO& E
TDA
TDA
Res erv ee
Res erv
JJOINT
OINT
CARE IN THE AIR
GERM ANY
VA
68W/ 18D
CO NU S B ASE
AO
In Theater Health
Services
Medical Centers,
Scientific Expertise
Forward
Surgical Tm

33. WW II / Korea
•Geriatric Care
•End Of Life
Vietnam Era
•End Professional Life
• Latent Medical Issues
OIF / OEF
•Early in
Professional Life
•Young Families
•Reintegrating

36. Rich 85-Year Research History
The groundbreaking achievements of VA researchers—
60% of whom also provide direct patient care—have
resulted in 3 Nobel Prizes, 6 Lasker Awards, and
numerous other distinctions.
36

37. Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information.
Over the next 5 to 7 years, the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases, including common illnesses such as heart
disease, diabetes, and cancer.
37

38. Veterans Give High Marks
to VA Pharmacies
J.D. Power and Associates, a firm specializing in
consumer surveys, recognized VA’s Consolidated Mail
Outpatient Pharmacy as “Among the Best” mail order
systems in the country in 2009, 2010, 2011 and 2012.
VA ships 460,000
prescriptions to
Veterans every
workday.
38

39. Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs.
Coyle GA, Heinen M.
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
Systems….Nurses have moved from manual to electronic
medication documentation … A marked decrease in medication
administration errors is a result of implementing BCMA.
Nurse Admin Q. 2005 Jan-Mar;29(1):32-8

40. PATIENT’S HOME
Adam Darkins

41. Increasing Access to Care via Telehealth
Since FY 2009, Telehealth funding has increased by 368% to
$334.8M.
In 2012, VA’s Telehealth programs:
• Provided care to half a million
Veterans
• Provided 1,429,424 episodes of care
• Supported 42,699 patients to live
independently in their own homes,
instead of long-term institutional care
41

44. My HealtheVet
A personal My HealtheVet account provides
Veterans with 24/7 online access to a variety
of tools to manage their health care.
Communicate
View
with Participating Appointments and
Patient Aligned Health Information
Care Team
Members
44
Refill
Prescriptions
Download and
Share Personal
Health Record

45. Expanding On-the-Go
Resources
The “PTSD Coach” mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance.
90,000 Downloads via
+ iTunes and Android
Market
45

47. Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment.
This provides practitioners the opportunity to master skills, practice
protocols, learn systems-based practices, apply critical decision
making, and promote improved team communications and function.
47

48. American College of Surgeons
2001
National Surgical
Quality Improvement
Program
(NSQIP)
1994
Today: 9 of VA top 10 of
1991 to 2006: thehospitals: America’s
• 47 percent drop World Report
U.S. News & in postoperative
mortality
Best Hospitals participate in ACS
• 43 percent drop in morbidity rates.
NSQIP
National VA Surgical Risk Study (NVASRS)
1991 - 1993

51. Recognition Continues
51
2012 The Joint Commission Accreditation & Top Performers Award. All VA
medical centers are accredited by The Joint Commission. In addition, The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures.
2012 ATA President’s Award for Innovation. The VA/DoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association.
2012 Fed Innovation of the Year Award. FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government.
2011 Innovations in American Government Award. Harvard University selected
VHA’s IntegratedEthics program, a program which handles ethic issues affecting
VHA patients, as one of the “Top 25 Programs” in the 2011 Innovations in
American Government Award competition.
2011 Global Vision Award. The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign.

52. JOURNEY
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity

53. The VA Quality Journey… Still
Evolving… Still Changing… It Must
..
And So Must YOURS

54. Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle