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VA has developed policy and guidance required to implement CIH services that meet the definition of basic care as described in the standard Medical Benefits Package and are in accord with generally accepted standards of medical practice.
Alignment and integration of patient centered care within the organization, particularly surrounding roles, priorities and bureaucratic rules, remained major challenges. Conclusions: Transforming healthcare systems to focus on patient-centered care and better serve the "whole" patient is a complex endeavor.
In response, VA’s Office of Patient-Centered Care and Cultural Transformation formalized an approach to care called the Whole Health System of Care, incorporating patient-centered care and complementary and integrative health.
Veterans can find online Whole Health educational sessions on OPCC&CT’s website. In-person sessions and peer-led groups are offered by individual VA facilities, such as a group called “Introduction to Whole Health,” which is a one- to two-hour long session led by a trained facilitator or staff member.
Dr. Michelle Dorsey, senior clinical advisor for OPCC&CT and chief judge of this year’s Community Partnership Challenge, and Dr. Ben Kligler, acting executive director of OPCC&CT, shared the office’s “ Circle of Health ,” which illustrates the connections between a person’s health and other aspects of their life. There are eight categories in the Circle of Health that can affect the individual at the center of the circle: 1 Moving the body: Energy and flexibility 2 Surroundings: Physical and emotional 3 Personal development: Personal life and work life 4 Food and drink: Nourishing and fueling 5 Recharge: Sleep and refresh 6 Family, friends, and co-workers: Relationships 7 Spirit and soul: Growing and connecting 8 Power of the mind: Relaxing and healing
These are conditions in the environments in which Veterans live, learn, play, worship, and age. Six of these conditions are the theme of the 2020 VHA Community Partnership Challenge, led by VHA’s Office of Community Engagement (OCE): Employment, food security, housing, spiritual support, education, and transportation. When Veterans have access to positive SDOH such as these, they lead healthier lives.
The Whole Health model involves the consideration of many SDOH. Through its implementation of the model into Veterans’ health care, as well as its educational programming around Whole Health, OPCC&CT is helping Veterans access services to support their needs across SDOH.
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A report to OPCC&CT on these findings formed the foundation of VA's response to the CARA legislation requirements, culminating in the Congressionally Mandated report, titled “Pilot Program on the Integration of Complementary and Integrative Health and Well-Being Programs,” which was part of VA’s response to the legislation and was submitted by VA to the Chairman of the Senate Committee on Veterans’ Affairs. Findings also led to the approval of a VA Executive Decision Memo in support of the modernization LOE "Engaging Veterans in Lifelong Health, Well-Being, and Resilience," mandating the integration of Whole Health into Primary Care, Primary Care/Mental Health (PCMHI), and Mental Health across the VA healthcare system. EPCC's evaluation work has had widespread impact on the implementation of Whole Health at the VISN and site level, as their findings were presented to VA Central Office, VISN, and site leadership in support of Whole Health.
All 143 VA medical centers are advancing the Whole Health approach at varying levels. Therefore, studying implementation strategies for integrating Whole Health throughout the current system of care is essential to further WH spread. Barbara Bokhour, PhD, co-Director of HSR&D’s Center for Healthcare Organization and Implementation Research ( CHOIR ), leads the VA QUERI Center for Evaluating Patient-Centered Care ( EPCC-VA ), which works to generate evidence for VA’s transformation to a Whole Health System of Care. Partnering with VA’s Office of Patient-Centered Care & Cultural Transformation, EPCC-VA conducted an evaluation of the 18 flagship sites.
Findings also showed that in the 18 flagship sites 31% of Veterans with chronic pain (up to 55% at 1 flagship) engaged in some Whole Health services; 26% of Veterans with chronic pain used complementary and integrative health therapies; and although many of these services were delivered in the community, an increasing proportion are being delivered within VA due to hiring of CIH providers within VA at the pilot sites. Further, employees with more involvement in Whole Health had higher rates of identifying their facility as the best place to work, in addition to having lower turnover, lower burnout, and greater motivation.
In response, VA’s Office of Patient-Centered Care and Cultural Transformation formalized an approach to care called the Whole Health System of Care, incorporating patient-centered care and complementary and integrative health. In FY18, each Veterans Integrated Service Network (VISN) identified and funded a flagship site for a three-year pilot implementation of the Whole Health System (WHS) of Care (total of 18 flagship sites).
The Pathway introduces Veterans to WH concepts and facilitates their identification of personal life and health goals – and the development of a personal health plan.
The Modernization Lanes of Effort support the need for aligned, unambiguous policies, and consistent policy implementation.
VHA Directive 1137 - Provision of Complementary and Integrative Health (CIH) was approved by the Acting Under Secretary for Health on May 19, 2017 establishing policy regarding the provision of CIH approaches, representing a significant change in how care is to be delivered across the VHA system.
CIH is delivered within the context of the Whole Health System, a transformed model of care designed to empower and equip people to take charge of their health, well-being, and to live their life to the fullest.4
VA has developed policy and guidance required to implement CIH services that meet the definition of basic care as described in the standard Medical Benefits Package and are in accord with generally accepted standards of medical practice. A memorandum was signed by the Under Secretary for Health in May 2016 to approve the process for vetting CIH services deemed appropriate for use across VHA, and to recommend the formation of an IHCC Advisory Workgroup to serve as subject matter experts across program offices.