A Critical Moment in the History of Medicine. VHA Office of Patient Centered Care and Cultural Transformation

1. Consumer-Centric Health
Models for Change ‘11

2. A Critical Moment
in the History of Medicine
Tracy W. Gaudet, M.D., Director
VHA Office of Patient Centered Care and
Cultural Transformation

3. VHA Mission
Honor America’s Veterans by
providing exceptional health care that
improves their health and well-being.
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4. In 2010, the Department of Veterans Affairs (VA)
treated 6 million Veterans.
8,343,000 Enrollees
450,000 85 years or older
325,000 Women
550,000 PTSD Patients
75,600,000 Outpatient Visits
679,600 Inpatient Admissions
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5. 152 Hospitals
965 Outpatient Clinics
133 Community Living Centers
96 Domiciliaries*
278 Vet Centers**
*Residential Rehabilitation
1624 Points of Care Treatment Programs
**Walk-in support centers,
providing counseling and
connection to local social
services.
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6. Cultural Transformation
VHA is innovating the way health care
is delivered by shifting the current
health care system which is
problem based disease care
to one that is
patient centered health care.
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7. A Transformative Model
Contemporary Patient Centered
• Focused on disease • Focused on the person
• Physician-directed • Partnership with team
• Disease management • Health optimization
• Find it, fix it • Identify risk, minimize it
• Proactive
• Reactive
• Lifelong planning
• Sporadic
• Whole person approaches
• Biomedical interventions
• Resources & tools for
• Individual left to enact implementation
Adapted from Ralph Snyderman, MD
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8. The Core Issue
Individuals do not fully
engage in their health or
change their behaviors
until it is driven by
what matters to
them.
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9. Patient Centered Care
This transformation requires a change in
both the PRACTICE of healthcare,
and the EXPERIENCE of healthcare.
We need the technology to
hard wire this change.
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10. Patient Centered Care
STEPS IN THE PRACTICE
• Mission and vision of life and
health
• Exploring values and goals
• Clinician visit
• Creating a Personalized Health
Plan
• Teaching skills to achieve it
– Mindfulness, nutrition, stress
reduction, movement and exercise
• Support and behavior change that
works
– Integrative Health Coaching,
Buddies, Groups
• Team/Clinician follow-up
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11. RCT: At Risk for Heart Attack/Stroke
• Test of this concept and process
• Initial visit with integrative physician
• Experiential education and skill
building in domains of the health
plan
• Ten months with in-person
Personalized Health Plan Coaching,
group and individual

12. Domains of the Duke Health Plan
• Self Care
– Nutrition
– Movement, exercise and rest
– Mind-Body connection
– Spirituality
– Relationships and communication
– Physical environment
– Personal and professional development
• Professional Care
– Spanning prevention to intervention, using
conventional and complementary approaches

14. Key Findings
• Significantly reduced the risk of heart
attack or stroke in the next ten years
• People’s lives changed dramatically,
health changes were a “by-product”
Journal of General Internal Medicine 2006

15. Radical Departure, Rational Change
How do we create a completely
new framework for health?
The Tools
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16. The Clinical Tools
Current Future
• Chief complaint, history • Vision of health and
and physical integrative intake
• Disease-based medical • Whole person health record
record
• Problem list • Integrative health risk
assessment
• Assessment and plan for • Health profile and
the problem personalized health plan
for the individual
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17. The One Aim: The Veteran
• When we put the patient at the center -
their life and what matters to them - and
build our health care around them,
• Then we will achieve increased quality,
decreased costs, and improved experience
of our patients and ourselves.
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18. An improved delivery system
and showing greater empathy
is not enough.
Service Innovation and
Tech Innovation are essential for
transformation.

19. The Values and
Culture of Veterans
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20. Aligned with Veteran Values
• Mission for Life and
Health
• A Personalized
Health Plan
• Training and Skill
building
• Team, trust, and
support to succeed
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21. Future of VA Health Care
How can we help How can we help
What can you live your life
what’s wrong
I fix? with you? fully?
VA Past
VA
Current
VA
Future
Clinical Team Veteran, Family, Community
Physician
and Health Care Team
Paper Disease-Based Electronic Personalized Health Plan and
Medical Record Medical Record Whole Person Health Record
“Thanks for driving 5 hours “You have a medical problem, “We design your personalized
to get here, come back if please follow this treatment health plan to meet your
you don’t feel better.” plan to improve by your next
goals.”
visit.”
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22. Veterans committed their
lives, health, and
well-being to Mission
Success in defense of our
country.
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23. Now, we can help them be mission ready for their
lives, optimizing their health in service of what
matters to them.
How Will We Identify Success?
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