Acting Undersecretary for Health, Richard Stone, MD
Editor’s note: This opinion piece was provided to U.S. Medicine last month by then-Acting Undersecretary for Health Richard Stone, MD.
The future of healthcare is often thought of in terms of digital technology – redefining the traditional doctor’s visit. Considering the speed with which technology is evolving, the healthcare sector needs to be responsive, versatile and integrated. VA demonstrated the benefits of being an integrated health care system when the COVID-19 pandemic hit. We were able to use our size as an advantage, pivoting quickly to provide care when, where and how it was needed.
VA medical facilities are geographically distributed across the United States but operate as a single enterprise with strength and agility. This integration is made possible by the establishment and maturation of our Healthcare Operations Center (HOC), which serves as a fusion center for collecting, analyzing, planning and disseminating data and information to all stakeholders. The HOC is a key enabler for VA’s ability to quickly cross-level staff and materiel between VA Medical Centers and to regions most in need. The HOC, which allows us to capture best practices in real time, also helps us to quickly propagate successful practices across the country. This kind of integration is the future of healthcare because what matters most, from a patient perspective, is what happens when they need care. Capturing and sharing the lessons from integrated healthcare activities is critical to supporting a further connected approach for healthcare design and delivery moving forward.
Understanding where VA is today requires us to look at our journey. Immediately after the Civil War, the number of disabled veterans in need was so great that Congress authorized the National Asylum for them, essentially building cities, the first of which was in Togus, ME. Post WWI, the approach to healthcare evolved into long-term, in-patient care and VA built sprawling medical center campuses in remote areas near the ocean or mountains so Veterans could recuperate in idyllic settings with fresh air. This approach changed radically after WWII, as 16 million American service members came home. Gen. Omar Bradley and Maj. Gen. Paul Hawley co-located VA hospitals near major academic medical centers and major medical schools in the country to ensure veterans received the care they needed and could go home. Today, VA educates about 70% of U.S. physicians and has, on any given day, about 124,000 residents and students who train in our institutions.
Evidence of VA’s approach to integrated care can be found throughout our history. We developed the first blind rehabilitation program in the world in 1947, performed the first liver transplant, the first pacemaker, developed the nicotine patch in the 1980s, and essentially eradicated hepatitis C from the veteran population utilizing medications that many of our researchers helped develop. We are also restoring the sense of touch via prosthetic technology, and our Community Living Centers are a model for elder care.
Today, VA is at the forefront of precision oncology, and we are the only healthcare system in the country that has virtually eliminated health disparities among minority prostate cancer patients. Our ability to deliver tele-oncology precision medicine offers Veterans in remote areas of the country the same benefits and outcomes as those who live near academic institutions. A kidney transplant performed in a VA hospital has about double the survival rate of a kidney transplant performed in a commercial hospital in America. All of this demonstrates the value of a highly integrated healthcare system.
COVID-19 forced each of us to personally reconsider or change our preferences about where, how and from whom we receive our health care – and because of that, it is changing the future landscape in the U.S. As we emerge from COVID-19, VA currently has an opportunity to help redefine the future of health care delivery by focusing on our infrastructure, technology, the type of care we provide and where we provide it. As we discuss the future of VA health care delivery, we are thinking about how we can best deliver high-quality care in ways that work for our veterans, whether that means providing care using telehealth, or in-patient care at a VAMC or local Community Based Outpatient Clinic, or a mixture of these options integrated together for a seamless experience. It is time for VA to fundamentally reexamine what is necessary to deliver care to veterans over the next 50 years. The current national discussion on infrastructure investment should drive this examination. This should not be a discussion on which of our oldest hospitals to replace. It should recognize the future trends in care delivery and what America’s veterans need.
As part of this effort, VA is conducting market assessments for each of our markets to drive design of high-performing networks of care. The networks will consist of a more flexible healthcare delivery platform that can provide quality, readily accessible, cost-effective care through VA and leverage the best of care provided by federal partners, academic affiliates and other private sector providers. These assessments are extremely valuable as we move forward with the potential of recapitalizing VA and deciding what kind of health facilities to build, and where.
VA is also continuing to move away from in-patient care at embedded facilities and toward providing efficient and effective care through more accessible ambulatory care facilities. Data has shown patients recover more quickly, costs of care are lower and health care facilities can free up capacity more swiftly with this approach. During the height of the COVID-19 pandemic, VA went from 2,000 virtual visits a day to 40,000, increasing access to care to Veterans nationwide. Outside of VA, this model of care, moving from in-person visits to virtual, exemplifies how accessibility can be increased while wait times and health care costs can be reduced. These changes will require purposeful, strong leadership and should be considered when VA is determining effective infrastructure changes, proper technology and the right delivery model to ensure time and money are spent effectively to improve patient and Veteran healthcare.
In our ongoing efforts to identify what processes work and which don’t, VA will continue to examine how our medical centers are designed and functioning and how they can be configured to function most efficiently. From what we’ve seen so far, we can be even more integrated by continuing to make care more accessible and building clinically driven processes that empower our healthcare providers. We will continue our drive to be an agile learning organization, utilizing lessons learned to build a better future for America’s heroes.
Dr. Stone was the acting under secretary for health for the Veterans Health Administration, overseeing the delivery of care to more than 9 million enrolled veterans at over 1,200 health care facilities. He is a retired Army major general and veteran of the war in Afghanistan.
