PACT Act Update: VHA’s ‘People, Process, Technology’ Supporting the Legislation

The Veterans Health Administration (VHA) is on track to meet its robust hiring goals and plans to launch new patient scheduling tools to support the influx of veterans applying for benefits and using health services following the passage of the PACT Act, Department of Veterans Affairs Undersecretary for Health Shereef Elnahal told reporters Monday.

Since President Biden signed the PACT Act into law in August 2022, more than 360,000 veterans have applied for benefits, 2.8 million veterans have been screened for toxic exposures, and more than 185,000 veterans have enrolled in VA health care.

VA’s “people, process, technology” approach is enabling the agency to deliver on its promise to veterans.

People

VHA’s total workforce grew by 9,590 employees in the first five months of fiscal year 2023. This marks the highest hiring growth rate in more than 20 years, Elnahal noted.

“The most important thing that VA health care system can do to prepare for the influx of veterans benefiting from the PACT Act is to staff our clinics and health care settings appropriately to meet that need,” Elnahal said. “We are hiring at a record pace and retaining employees better than in the immediate previous years.”

At the end of last year, VHA reported it needs to hire about 52,000 employees per year over the next five years. In fiscal year 2022, VHA hired more than 48,000 new clinical and administrative staff.

“Across the fiscal year thus far, we remain above our projected trend line to meet that goal, and so that means I hope that we will continue this momentum we are very likely to exceed that 52,000 goal,” Elnahal said.

VHA made 23,759 external hires as of the end of February of this fiscal year, the highest ever number of new hires recorded and onboarded within that timeframe.

“The bottom line is that we had a 3% overall employee onboard growth target this year. We’re already at 2.5% growth, and we haven’t even reached the halfway point in the fiscal year,” Elnahal said.

Process

Elnahal told GovCIO Media & Research that process is “the most important thing” to hold providers accountable for thresholds and expectations for clinical productivity. VHA’s process improvements are motivated by improving access to care and ensuring health care and provider responsibilities are distributed equitably.

“That’s been an endeavor that started since the beginning of last of last calendar year — setting standard clinic appointment duration lengths for every clinical specialty for both followups and new patients, and then holding clinicians accountable for filling at least 80% of their schedule across the board,” Elnahal said. “Almost every clinician will be held accountable for that based on their clinical specialty. That work is ongoing. We want to get to 80% of clinics across the country to meeting that standard. In my view, that is the most important way that access to the direct care system within VA can be improved.”

Technology

At the end of last year, VA launched a new screening tool to identify veterans with toxic exposures, help them develop a long-term health plan and connect them to follow up resources. The tool has also helped VA streamline its claims and benefits processing.

“We are now at 2.8 million toxic exposure screenings of veterans across the country. This is the existing base of veterans, whom we see in our primary care clinics and specialty care clinics every day. We have a goal of reaching 4.5 million screenings by the end of the fiscal year,” Elnahal said.

VA’s Office of Information and Technology also launched the VA PACT Act Performance Dashboard at the beginning of the month to measure the implementation of this legislation and showcase its impact on veterans.

Published every other Friday, the dashboard provides updates on key statistics like veterans who have applied for PACT Act-related benefits, received toxic exposure screenings, enrolled in VA health care and more. This tool will improve transparency and maximize accountability.

To add to the suite of new tools, Elnahal said VHA is now targeting patient scheduling systems to improve access to veterans.

“We are pursuing two different scheduling systems that will, I think, enhance the workflow of our medical support assistants,” Elnahal told GovCIO Media & Research.

First, VHA is pursuing the Internal Scheduling System (ISS), which was developed internally by VA OIT. This system consolidates all interfaces around VA’s scheduling platforms for providers into a single interface to improve usability for medical support assistants and efficiency of the scheduling process.

“A key element of that new scheduling system will be to see all of the appointment availability for a particular provider, which is really how patients think and clinicians think — what’s the next clinic slot available for the doctor I need to see or the provider I need to see — and right now, we don’t have a system that allows for that,” Elnahal added.

Elnahal said the system should be ready to pilot by summer 2023.

Additionally, VHA has released a request for information (RFI) for a commercial-off-the-shelf scheduling system that will aid in community care scheduling. With the RFI, Elnahal said he hopes to see products that can “see into community providers’ schedules” and scheduling grids, meet veterans where they’re at and provide seamless interoperability.

“We think that it needs to be a different scheduling system because we want to have a platform by which we can integrate with our highest volume community providers. And in as many cases as possible, see directly into the scheduling grids of those providers so that we can deliver that confirmed appointment to the veteran sooner,” Elnahal said.