1. Standardizing Business Processes within an Integrated Health Care System
Derrick Markel – Deputy Associate Director/Program Manager
Lindsay Hall – Program Manager
Anthony Pak – Project Manager/Industrial Engineer

2. Introduction
A Chief Business Office Purchased Care (CBOPC) Initiative in Partnership with the VA – Center for Applied Systems Engineering (VA-CASE)

3. Learning Objectives
High-level overview of Veterans Health Administration (VHA)
High-level overview of Non-VA Medical Care (NVC)
Application of Systems Engineering principles to large scale problems

4. 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

5. 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)

6. Rapid Deployment Model

7. 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

8. 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

9. 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

10. Benefits of Standardization
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

11. Current State Evaluation
Conducted site visits and collected the current state:
Pre-site visit survey
Current state flow-mapping
Observations
Strong practice documentation

12. Documentation

13. Waste Identification

14. Gap Anaylsis
A gap analysis was conducted to identify variation within the current state as well as proposed future state changes

15. Historical Data
Claims processing data was pulled across the VA enterprise from October through September

16. Strong Practices
Collaborated with SMEs to identify and validate strong practices using flow maps, gap analysis, historical data and other documentation

17. Roles & Responsibilities
Roles and responsibilities under NVC vary from site-to-site
e.g. Claims Processor vs. Voucher Examiner
Position descriptions
Separation of Duties

18. 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

19. Future State

20. Next Steps
Training materials
Metric Plan
Testing and Implementation

21. Q&A/Feedback

22. References Veterans Health Administration: http://www.va.gov/health/
Chief Business Office Purchased Care (CBOPC):
Office of Budget:
Veterans Access, Choice and Accountability Act of 2014:
VA-Center for Applied Systems Engineering (VA-CASE):
Links to Social Media: