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Can Healthcare Leaders Learn From the VA’s Virtual Care Dilemma?

Analysis  |  By Eric Wicklund  
   October 04, 2024

Virtual care programs for veterans are seeing mixed results. That could help healthcare organizations better understand what works and what doesn’t.

Recent efforts to improve healthcare access for veterans offers insight into which virtual care strategies are working and which ones aren’t.

The success (or lack of) of programs launched by the Department of Veterans Affairs (VA) and the Veterans Health Administration (VHA) could help health systems and hospitals better understand the direct-to-consumer telehealth market.

For instance, the VA recently announced that its tele-emergency care (tele-EC) platform will now be available to veterans across the country, after the success of pilot programs in selected regions. The program, part of VA Health Connect, enables veterans to connect with care providers on-demand through a smartphone and associated app.

“Veterans can now be evaluated for possible emergencies from the comfort of their home,” VA Under Secretary for Health Shereef Elnahal, MD, said in a press release. “Sometimes, you’re not sure whether what you’re experiencing is a minor emergency or not — and tele-emergency care can help you resolve those questions. Veterans can get immediate, virtual triage with a VA medical provider who has direct access to their medical records. This avoids having to potentially drive to the nearest emergency department and wait to be evaluated, if appropriate.”

On the other hand, the VHA’s ATLAS (Accessing Telehealth through Local Area Stations) program, launched in 2019 in 24 non-VA locations (such as VFW posts and Walmart stores), isn’t doing so well. A recent report from the Government Accountability Office (GAO) found that 14 of those sites weren’t used at all by veterans in FY 2022 or 2023.

"I think it's a noble idea,” GAO Healthcare Director Alyssa Hundrup told a Virginia TV station in a recent interview.. “They've put in an effort but, unfortunately, it has yet to be used. VA really needs to be looking at the effectiveness of these sites, where they are, how they're using them, are they getting the word out to communicate with the veterans the availability of these? Otherwise, these sites are sitting there being unused and it's a real missed opportunity.”

So why is the tele-ICU program working but ATLAS is struggling? The issue may be similar to why so-called disruptors like Walmart, Walgreens and CVS Health are struggling to find a healthcare niche with retail clinics.

Tele-ICU is working because it gives veterans access to needed healthcare services from wherever they are, including and especially their homes. ATLAS, meanwhile, still requires veterans to travel to a specific site for healthcare.

That strategy works well for veterans in remote locations where broadband availability and even phone service is weak, and that does address a key barrier to care. According to the GAO report, those 10 ATLAS sites where veterans did access care were successful in helping those veterans and eliminating the need for long drives to the nearest VA center and long waits.

The VHA has responded to the GAO report by saying it will transition from a pilot to a grant program, adding financial sustainability to the equation, but the GAO is also asking the agency to develop benchmarks to measure the success of the ATLAS program on an ongoing basis, much like it does for other telehealth programs. Those benchmarks could help the VHA understand why veterans aren’t going to certain ATLAS sites and enable the agency to create sustainable virtual care programs that will attract veterans.

The examples set by the VA and VHA could also help healthcare leaders to understand how and where consumers want to access care. Consumers, like veterans, prefer on-demand virtual platforms for urgent care needs, while the success of retail clinics and stand-alone services is more nuanced, driven by factors that aren’t yet fully understood.

It’s clear that virtual care can address access challenges—the VA has conducted more than 9 million telehealth visits in each of the past two years—but simply putting together a virtual care platform doesn’t guarantee success. Providers need to understand how, when, where and why patients want to access care and create programs that address the needs and eliminate the barriers.

Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.


KEY TAKEAWAYS

The VA’s on-demand telehealth platform for veterans has been so successful, it’s being rolled out nationwide. The VHA’s program of putting virtual care clinics in select Walmarts and VFW posts, however, isn’t doing well.

Healthcare leaders should understand that simply setting up a virtual care platform doesn’t ensure that consumers will use it. They need to understand how, when, where and why people access care and develop programs that meet those preferences.


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