Outpatient Health Care Services for Veterans
Veterans Health Administration, Department of Veterans Affairs
The Veterans Health Administration, in partnership with the VA’s centralized Veterans Experience Office, continues to pave the way as a leader in the federal government in using customer research and human-centered design to improve services.
The investment in customer experience helps the agency meet the health care needs of veterans, adapt to new health care delivery models in response to the pandemic, and to raise trust in the VA overall.
Using in-depth customer research, customer journey mapping and other tools and methods, the agency continues to root out challenges veterans experience when receiving health care. For example, the agency is making it easier for veterans to refill prescriptions and improving the discharge experience for veterans who receive services at a VHA hospital.
increase in trust in the VA among veterans between 2016 and 2020.
of veterans said they got their appointment on a date and time that worked for them in the first half of fiscal year 2021.
Customer Experience Insights
Improvement from last year
Room for improvement
Veterans gave high marks to all aspects of their outpatient health care experience. They were particularly pleased with their interactions with VA health care providers, whom they felt listened carefully and explained things in ways they could understand.
Trust in the VA and VHA outpatient services has been rising since 2016 and continued to rise in 2020. Men reported slightly higher trust scores with outpatient services (89.4%) than women (85.7%) in fiscal year 2020. Increasing trust has been a key focus of the VHA’s customer experience efforts, as the agency recognizes that higher levels of trust will lead more veterans to access health care services, potentially improving health care outcomes.
The VHA is focusing on how to maintain trusted relationships with veterans in a virtual environment, anticipating that telehealth will continue as an option for care for the rest of 2021 and beyond. For example, the agency adapted its “Own the Moment” customer experience principles for telehealth and created a training session for clinical contact center staff that focuses on building trust with veterans during telehealth phone calls. This program has been piloted in two of the agency’s regional health care systems, known as Veterans Integrated Service Networks, and the VHA is planning to expand the training to all its clinical contact centers.
With the onset of COVID-19 in early 2020, most outpatient appointments for veterans shifted from in-person to telephone or video call, resulting in a more than 1,000% increase in telehealth visits over the previous year.4 This increase helped veterans to safely access care during the pandemic, with many appreciating the convenience of attending appointments from home.
While the shift to telehealth appointments allowed many veterans to access care from the safety of their own homes, in some instances it also made it more difficult to access care. For example, some of the previously scheduled in-person appointments that were cancelled at the beginning of the pandemic were never rescheduled or rescheduled much later, leading to delays in veterans seeing health care providers.5
Telehealth has been a component of VHA outpatient services for several years, and the pandemic further demonstrated both the possibilities of expanding telehealth and the issues that prevent some veterans from accessing these services. For example, more than 40% of rural veterans enrolled in the VA health care system lack a sufficiently strong internet connection to access telehealth.6 Anticipating sustained demand for telehealth services, the VA is tackling this issue through partnerships with the private sector to bring internet access to rural veterans and by establishing remote clinics where veterans can access telehealth services closer to their homes.
Making appointments on VA Video Connect, the VA’s primary video telehealth platform, also requires the coordination of two different scheduling systems—a complicated process that limited some veterans’ ability to make or reschedule appointments.7
Not knowing when to expect their prescriptions has been a common concern for veterans, especially because there are different processes and timelines for filling prescriptions, depending on medication type and whether the VHA or a private pharmacy is involved. To address this concern, the VHA created an online tool that allows veterans to track their prescriptions, rather than requiring them to contact the agency for updates. With this improvement the percentage of customers surveyed who cited this as a challenge dropped to 9% in the first half of 2021 from 21% in 2019.
The VHA is continuing to develop tools to streamline the process of receiving and refilling prescriptions. For example, in May 2021 VHA launched a new prescription-ordering capability within the MyHealtheVet app. VA prescription labels included a code that veterans can scan with their phone to quickly renew prescriptions within the app. VHA also began sending automatic alerts via the app to remind veterans when to refill prescriptions or visit a provider to have a new prescription written.
When discharged from a VA hospital, veterans receive information and equipment to help them continue their care at home but can sometimes feel overwhelmed trying to absorb everything they are told they need to do. Getting the discharge experience right is essential to ensuring that veterans stay healthy and to minimize the risk that they will need to quickly return to the hospital.
The VA conducted in-depth customer research to understand the hospital discharge experience and created a journey map that outlines the process, bright spots, problem areas and most impactful parts of the discharge experience. They learned veterans can feel overwhelmed by the amount of information relayed during discharge and worried they will be unable to remember everything. The timing of the process can also be confusing—leaving veterans wondering exactly when they will be going home or worried about arranging transportation.8
To address these issues, the VHA is developing a discharge checklist—a document that will lay out all the steps involved in discharge, which veterans and VA staff members can go through together. The VHA is also working to develop a booklet on the discharge process that veterans can use to write down and organize important information to remember at home. These resources will be designed around the needs of veterans and caregivers to ensure that information is available and easy to understand at discharge and beyond.9
Leading Customer Experience Practices
The Partnership and Accenture developed the following list of practices to understand how agencies prioritize the customer experience, and steps they can take to improve. The list is based on research about effective customer experience practices in both government and the private sector, and aligns with practices in a customer experience maturity self-assessment for agencies developed by the Office of Management and Budget.
A strong commitment and plan from agency leaders to prioritize customer experience is essential for sustained progress.
1. Includes high-quality customer experience in its strategic goals.
Customer service is one of the priorities listed in the agency’s strategic plan and is included in several of its strategic goals.
2. Specifies customer feedback as a key measure of the organization’s performance.
The percent of veterans who agree with the statement, “I trust VA to fulfill our country’s commitment to Veterans,” is a key performance measure.
3. Has a senior executive with the responsibility and authority to lead efforts to improve the customer experience across the organization.
The VA has a chief veterans’ experience officer who leads the agency’s customer experience efforts and strategy.
Ease of Customer Interactions
Interactions with the federal government should be easy, transparent and designed around user needs.
For the most common services provided, customers can:
1. Complete common transactions using the service delivery channel of their choice.
Veterans can apply for care, schedule appointments and manage prescriptions online or over the phone. Both in-person and telehealth options are available for outpatient care.
2. Obtain status updates through online self-service.
For example, veterans can track the status of health care claims or prescription medication shipments online.
3. Receive a response to feedback or answers to questions over social media.
The Veterans Health Administration responds to some of the feedback on Facebook, but regularly receives questions that are not addressed. VHA does not respond to customer feedback on Twitter.
4. Access online information and support in languages other than English.
In addition to English, some website content is available in Spanish and Tagalog. Interpretation services are available over the phone and at VA health facilities.
Listening to Customers and Acting on Feedback
To understand and prioritize customer needs, agencies should collect, publish, analyze and act on feedback.
1. Collects meaningful customer experience data across interactions and service delivery channels and shares it with the public.
The Veterans Health Administration collects and publicly shares customer experience data for its outpatient services in line with OMB guidance.
2. Collects and analyzes customer feedback to understand customers’ experiences based on their own words.
3. Aggregates and analyzes customer feedback across channels and programs, and shares feedback with relevant staff members so they can act on it.