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Tracey Gaudet at Consumer Centric Health, Models for Change '11


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

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Tracey Gaudet at Consumer Centric Health, Models for Change '11

  1. 1. Consumer-Centric HealthModels for Change ‘11
  2. 2. A Critical Momentin the History of Medicine Tracy W. Gaudet, M.D., DirectorVHA Office of Patient Centered Care and Cultural Transformation
  3. 3. VHA Mission Honor America’s Veterans by providing exceptional health care that improves their health and well-being. 10/19/2011 3
  4. 4. In 2010, the Department of Veterans Affairs (VA) treated 6 million Veterans.8,343,000 Enrollees450,000 85 years or older325,000 Women550,000 PTSD Patients75,600,000 Outpatient Visits679,600 Inpatient Admissions 4
  5. 5. 152 Hospitals965 Outpatient Clinics133 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. 5
  6. 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. 10/19/2011 6
  7. 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, MD10/19/2011 7
  8. 8. The Core IssueIndividuals do not fullyengage in their health orchange their behaviorsuntil it is driven bywhat matters tothem.8
  9. 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. 10/19/2011 9
  10. 10. Patient Centered CareSTEPS 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 10
  11. 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. 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
  13. 13. 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
  14. 14. Radical Departure, Rational Change How do we create a completely new framework for health? The Tools 10/19/2011 15
  15. 15. 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 10/19/2011 16
  16. 16. 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. 10/19/2011 17
  17. 17. An improved delivery system and showing greater empathy is not enough. Service Innovation andTech Innovation are essential for transformation.
  18. 18. The Values andCulture of Veterans19
  19. 19. Aligned with Veteran Values • Mission for Life and Health • A Personalized Health Plan • Training and Skill building • Team, trust, and support to succeed 20
  20. 20. 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.” 10/19/2011 21
  21. 21. Veterans committed their lives, health, and well-being to Mission Success in defense of our country.22
  22. 22. Now, we can help them be mission ready for theirlives, optimizing their health in service of whatmatters to them. How Will We Identify Success?23