**Presented at the 2022 CMSA Annual Conference**
*** RN, CCM and SW credits ***
The Veterans Health Administration (VHA) cares for over 9 million Veterans nationwide. The increasing prevalence of chronic conditions escalates safety risks, resource utilization and cost of care (RAND, 2017). Specialized care and case management programs improved health equities and outcomes over the decades. However, the current enterprise-wide silo approach to care coordination service delivery across the care continuum creates a varying approach that may result in increased safety risks, inefficient capital management, inconsistent communication, gaps in access to quality care and Veteran frustrations. Fragmented care delivery is not unique to VHA and is experienced throughout the healthcare industry. A U.S. study estimated communication failures were responsible for at least 30% of all malpractice claims, resulting in over 1,700 deaths and $1.7 billion in malpractice costs over five years (CRICO Strategies, 2015). VHA developed a Care Coordination & Integrated Case Management (CC&ICM) framework that was tested in key VA Healthcare Systems from 2016 to 2019 (Singer, 2020). The national initiative establishes standard care coordination definitions, roles, processes, and tools that support clinical integration. Several facilities achieved a reduction in hospitalizations, ER visits and/or costs of care, while improving Veteran trust. In 2021, VHA endorsed the CC&ICM framework enterprise wide as the care coordination model for seamless care integration, enhancing the experience of the Veteran and employee. The framework embraces cultural transformation to provide a predictive analytical approach to population health management, relationship-based care strategies to foster trusting partnerships with a holistic and integrated approach to care planning and delivery. The national phased deployment is currently under way and projected to reach all VHA facilities by Spring 2023.
Objectives:
- Differentiate between the three levels of and roles for care coordination as defined by Veterans Health Administration.
- Distinguish components of the framework for systems and clinical integration.
- Demonstrate understanding of how VHA's Care Coordination & Integrated Case Management framework achieves value-based care for the patient and organization.