Michael Ho, MD, PhD, a staff cardiologist at VA Eastern Colorado Health Care
DENVER — Michael Ho, MD, PhD, a staff cardiologist at VA Eastern Colorado Health Care, has spent much of his professional career studying how veterans access VA and the barriers that might stand in their way. That research has led directly to improvements in the department’s healthcare system, helping smooth the way for veterans in need and earning Ho a 2022 Health System Impact Award.
Today, Ho’s findings are being extended to VA’s community care program to help elucidate what challenges veterans might face when seeking care outside of the agency’s direct care system.
“My interest in access to care was born out of observations from practicing medicine, that there was a lot of variation in the care that we deliver and that we provide,” Ho explained. “And so I became interested in trying to understand that variation and trying to figure out ways to improve the care we provide to patients in general.”
That interest began back around 2010. At the time, VA’s Quality Enhancement Research Initiative (QUERI) had a funding opportunity where groups could work with the Office of Specialty Care to evaluate new programs. One initiative Ho helped evaluate was the then-new e-consultation program, which allowed VA providers to email specialists a question about a patient diagnosis.
“The hope of that program was to facilitate communication between primary providers and specialists and provide patients with answers quicker,” Ho explained.
One of the areas of the program, Ho and his fellows, evaluated was how specialists would be credited for the consultation.
“Does the specialist get credit for answering that consult? Depending on the level of question, sometimes they could take five minutes or half an hour or longer, because the specialist has to go into the electronic health record, look through a bunch of charts, a bunch of lab work, radiology and tests to provide an answer,” Ho explained. “We talked with providers, understood the issue, and worked with the Office of Specialty Care to provide different codes where the specialist could code the visit [depending on complexity].”
It was through that original grant program that the VA Collaborative Evaluation Center (VACE), of which Ho is a co-leader, was formed.
“We were multiple groups that were funded as part of that initiative, and we decided to all work together,” Ho said. “Even after that grant funding mechanism ended, we continued to work together.”
Today VACE is composed of MDs, PhDs, methodologists and program support personnel with bases in Denver and Aurora, CO, Seattle and Cleveland.
“We developed a good working relationship and are able to provide essentially a service to different VA program offices,” Ho said. “There are standard methodologies that we use, best practices. And we’re always trying to improve our methods and test new methods. But a lot of our approach depends on the needs of our partners. Ultimately, we want to provide information and data to them that helps them make decisions about improving the program.”
In recent years, one of those programs has been VA community care, which was consolidated and expanded by the MISSION Act, which was launched in 2019.
“Early on, it was just trying to understand which patients were going out to community care and in what specialties and in what areas of the country,” Ho explained. “As you can imagine, the needs for community care are very different in rural areas of the country versus veterans who live in more urban areas.”
Later on, Ho’s work began to focus more on how to better define “access” itself when it comes to community care.
“I think VA has defined it right now based on a specific time frame. That veterans should get primary care in a specific time frame—and for specialty care there’s a specific time frame—but that doesn’t take into account preferences of the veteran and their specific needs,” he explained. “If a patient has chest pain, they have to be seen today or tomorrow, rather than 14 days from now. But, if they have a chronic issue that needs ongoing care [and] they’ve been pretty stable, they may not need to be seen in that shorter time frame.”
“There’s a lot of nuance to patient needs, and I think it’s a challenge just to define it based on a time frame that a veteran needs to be seen,” he added. “There’s more work needed to better figure out how to define that. When you create these black-and-white metrics, then medical centers try to meet them. But it doesn’t allow for these nuances. Or allow for us to try to tailor care to whatever the patient needs.”
Ho and VACE’s research extends to evaluating virtual care, as well. One project that Ho is particularly excited about is the ATLAS program, which is placing virtual care pods at American Legion facilities and Walmart stores.
“The future of medicine is to provide care to patients where they are as best we can, and ATLAS is one way to do that,” Ho declared. “As an evaluation team, we’ve been trying to use data to help the ATLAS Team strategically place these pods.”
