Standardizing Business Processes within an Integrated Health Care SystemDerrick Markel – Deputy Associate Director/Program ManagerLindsay Hall – Program ManagerAnthony Pak – Project Manager/Industrial Engineer

Introduction

A Chief Business Office Purchased Care (CBOPC) Initiative in Partnership with the VA – Center for

Applied Systems Engineering (VA-CASE)

Learning Objectives

1. High-level overview of Veterans Health Administration (VHA)

2. High-level overview of Non-VA Medical Care (NVC)

3. Application of Systems Engineering principles to large scale problems

VHA Overview

• Largest integrated health care system consisting of over 1,700 sites of care– Sites are grouped in

to 21 Veteran Integrated Service Networks (VISNs)

– VISNs are grouped in to 5 regions

• Funding of $6.7 billion for FY2015• Serving 8.76 million Veterans each year

VA-CASE

• Interdisciplinary Veterans Engineering Resource Center (VERC)

• Built on philosophy of partnering Healthcare Systems Engineers with VHA administrative and clinical management staff

• Comprised of eight Program Offices: – Clinical Partnerships in Healthcare Transformation (CPHT)– Smart Service Systems– VHA Engineering Technical Assistance Program (VE-TAP)– Professional Development Program – VISN11 Program– Transactional Systems Program (TSP)– Program Management Office (PMO)– Data Engineering Resources (DER)

Rapid Deployment Model

Non-VA Medical Care

• Non-VA Medical Care (NVC) is provided to eligible Veterans by community-based providers when those services are not "feasibly" available from a Department of Veterans Affairs (VA) medical facility

• The use of NVC is governed by federal laws • An authorization for treatment in the community is

required for NVC – unless the medical event is an emergency

NVC Current State

• Significant growth in enrollees and expenditures– The VA-enrolled veteran population has increased by 78%

from FY2001 to FY2014• Highly decentralized with significant variability in

delivery and outcomes• As directed by the Veterans’ Access, Choice, and

Accountability Act of 2014 (VACAA), VHA is in the process of fully implementing the Veterans Choice Program

Non-VA Medical Care National Standardization

• The overarching goal of NVNS is to develop standardized business processes for all Non-VA Medical Care programs and functional areas

• Consistent service experiences for Veterans and Non-VA providers

• Consistency among staff members performing the work

• Increased efficiency and reporting consistency

• Effective utilization of technology, tools, and all resources

• Reduced variability and improper payments

Benefits of Standardization

Current State Evaluation

• Conducted site visits and collected the current state:– Pre-site visit survey– Current state

flow-mapping– Observations – Strong practice documentation

Documentation

Waste Identification

Gap Anaylsis

• A gap analysis was conducted to identify variation within the current state as well as proposed future state changes

• Claims processing data was pulled across the VA enterprise from October 2012 through September 2013

Historical Data

Strong Practices

• Collaborated with SMEs to identify and validate strong practices using flow maps, gap analysis, historical data and other documentation

Roles & Responsibilities

• Roles and responsibilities under NVC vary from site-to-site– e.g. Claims Processor vs. Voucher Examiner

• Position descriptions

• Separation of Duties

Hand-Offs

• Under VACAA, NVC authority transferred to CBO Purchased Care– Consolidation of claims processing functions, not

centrally located

• Hand-offs crucial due to geographic limitations

Future State

Next Steps

• Training materials• Metric Plan• Testing and Implementation

Q&A/Feedback

References

• Veterans Health Administration:– http://www.va.gov/health/

• Chief Business Office Purchased Care (CBOPC):– http://www.va.gov/purchasedcare/

• Office of Budget:– http://www.va.gov/budget/products.asp

• Veterans Access, Choice and Accountability Act of 2014:– https://

veterans.house.gov/the-veterans-access-choice-and-accountability-act-of-2014-highlights

• VA-Center for Applied Systems Engineering (VA-CASE):– http://www.indianapolis.va.gov/VERC/index.asp

• Links to Social Media: https://www.linkedin.com/groups/Veterans-Engineering-Resource-Centers-3740095 https://www.facebook.com/VeteransAffairs https://twitter.com/veteranshealth