The Veterans Administration supports the movement towards a patient-centered model of care and has created five demonstration laboratories to develop evidence that will help implement the Patient Centered Medical Home (PCMH) throughout the VA.
The demo laboratories are grant funded and will receive $1 million a year for the next several years. Each laboratory works with the coordinating center to identify trends and system improvements. The purpose for the demonstration laboratory projects is to evaluate specific topics related to the medical home, to learn more about serving rural patient using telemedicine and secure messaging, and to find the best way to structure the care team.
The VA is also focusing on building and testing models to train students in patient-centered medical home practices. Five “Academic Centers of Excellence” are going to be established in Seattle, Boise, San Francisco, Cleveland, and Connecticut to work with academic affiliated organizations to develop training and practice models that will help promote the concept of patient medical homes.
Developing the Centers is beneficial for the VA. First, it enables the VA to train medical providers in the PCMH model of care and at the same time, encourages providers to promulgate the model in their community. In addition, the program will act as a recruitment tool so that the providers being trained will gain exposure and interest in working in the VA setting.
The VA realizes that technical assistance is needed to move forward which requires increasing the staff at primary care sites, training and educating providers to work as a team, and creating a mini-residency for primary care providers to become familiar with specialty care services. The objective is to create linkages between primary and specialty care professionals while emphasizing the use of the computerized patient record system and the MyHealtheVet patient portal
To resolve some of the problems and issues involved in establishing medical homes, the VA is also working with other federal and private PCMH collaborations:
• AHRQ convened a collaborative group of employees in federal agencies and departments that are currently doing work related on the PCMH to develop a common base of knowledge about the PCMH model
• The VA and DOD have been collaborating though a work group to develop guidelines on evidence-based practices critical to the function of a medical home. DOD and the VA are also working together on quality metrics and studying the VA’s data system.
• A new DOD-VA initiative is looking at existing architectural plans and building spaces for new facilities and determining what design changes will be needed to accommodate expanded PCMH teams
• The VA has been working with the “Patient Centered Primary Care Collaborative” (PCPCC) for several years. They have shared their work, met stakeholders, and learned from the work of others involved in PCMH implementation
• The VA is using the American College of Physicians medical home builder to evaluate what is needed as they begin their transition to a PCMH model