GOVERNMENT FOR THE PEOPLE: PROFILES ON THE CUSTOMER EXPERIENCE

Outpatient Health Care Services for Veterans

Veterans Health Administration, Department of Veterans Affairs


Executive Summary

In 2019, the Veterans Health Administration continued a multiyear effort to improve the experience for veterans receiving health care services, including adopting customer experience principles as part of VA’s core values. Partnering with the VA’s Veteran’s Experience Office, the VHA continued to build a robust system for collecting and analyzing customer feedback, accelerated the use of techniques like human-centered design to understand veterans’ needs, and invested in staff training to improve the patient experience. The VHA also implemented new legislation that year, making it easier for veterans to access health care from providers outside the VA network.  

As the coronavirus spread throughout the country in 2020, the VHA greatly expanded its delivery of telehealth services. In late August, staff members were conducting more than 169,000 weekly health care video visits with veterans, more than a 1,000% increase since the crisis began.1

Over the past four years, veterans’ trust in the VA has increased substantially, rising from 59% in 2016 to 77% in April 2020. Veterans continued to praise the trusted relationships they have with their health care providers—stating they were treated with courtesy and respect when receiving care. After learning that many veterans were often unable to get care when they needed it, the VHA launched ongoing efforts to reduce the amount of time veterans had to wait to obtain an appointment, and has made progress over the past five years.

To further improve the outpatient experience, the VHA also now aims to provide veterans with better information and updates about the process and timing for receiving prescriptions—which vary depending on medication type and whether the VHA or a local pharmacy fills the prescription.

Service Overview

The VHA provides numerous medical and mental health services to veterans at more than 1,200 facilities across the country and served more than 7 million veterans in 2019.

Primary Customers

Veterans and their families, caregivers and surviving spouses. 

Key services

  • Assistance with applying for VHA health care.
  • Assistance with scheduling and viewing health care appointments.
  • Health care and telehealth services ranging from surgery and physical therapy to dental care, mental health and vision care.
  • Online systems to communicate securely with VHA health care professionals.
  • Assistance with refilling and tracking prescriptions and viewing lab and tests results.

Data at a Glance

increase in trust in the VA among veterans between 2016 and 2020 

of veterans surveyed said they got their appointment on a date and time that worked for them in fiscal 2019 

of veterans surveyed said they did not know when to expect their prescriptions 


People Interact With VHA By

(All data for fiscal year 2019)

CALLING OUTPATIENT SERVICES CONTACT CENTERS

>45 million

calls


(>41 million in fiscal 2018)

VISITING ONLINE

300.7 million

visits to VA.gov


(280.1 million in fiscal 2018)

AVERAGE WAIT TIME FOR CALLS

57 seconds


(56 seconds in fiscal 2018)

VISITING A VA HEALTH FACILITY

87.1 million

outpatient visits


(85.9 million in fiscal 2018)


Customer Experience Insights

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In a 2019 survey, 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 treated them with courtesy and respect.

Veterans Outpatient Health Care Experience, 20192

Transparency of process 94.4%
People and employees 94.3%
Overall satisfaction 92.5%3
Service effectiveness 92.2%
Ease of process 91.1%
Efficiency of process 89.9%
Trust in VA facilities 87.7%

These scores may be driven by customer-focused initiatives, such as “Take Five,” which launched in June 2019. Under this initiative, VA health care providers were trained to engage personally with patients in the first five minutes of a visit to help foster human connection and trust.

“Research shows that if providers spend the first five minutes sitting and talking with patients rather than checking charts or devices, the patient perceives that the provider has spent 40% longer with them by focusing on that initial person-to-person connection before going into medical care,” said Jennifer Purdy, executive director for patient experience in the Veterans Experience Office.

Veterans Customer Experience, Trust Scores (2016-2019)4

Jul 2016 Oct 2016 Jan 2017 Apr 2017 Jul 2017 Oct 2017 Jan 2018 Apr 2018 Jul 2018 Oct 2018 Jan 2019 Apr 2019 Jul 2019 Oct 2019 Jan 2020 Apr 2020
VA Trust 59% 60% 61% 65% 66% 69% 69% 70% 69% 70% 73% 72% 72% 74% 80% 77%
Outpatient Trust 85% 85% 86% 87% 87% 88% 88% 88% 88% 88% 88% 88%

Trust in the VA among veterans has been increasing since 2016. Men reported slightly higher trust scores with outpatient services (88.1%) than women (83.5%).

The VHA closely tracks appointment wait times across facilities and has begun offering veterans more options, including early morning and weekend appointments, to reduce the wait. A 2019 study noted that wait times for appointments at VA facilities were shorter on average than wait times for private sector health care appointments and had improved since 2014 when reports emerged that veterans were not receiving care within a reasonable amount of time.5

  • 86% of veterans said they got their appointment on a date and time that worked for them in fiscal 2019, according to the VA’s health care survey.
  • As of July 2020, 87% of VA health care appointments were scheduled within 30 days of the requested date, down slightly from 91% in February before the coronavirus struck.

In June 2019, the VA began to implement the MISSION Act of 2018, a law designed to give veterans increased access to care outside of the VA if they want it. Among other things, the law combined several different community care programs into one; simplified eligibility criteria; provided new urgent care benefits; and codified the ability of VHA physicians and other clinicians to provide telehealth services across state lines. In the first year of implementation, the VHA received positive feedback from veterans and veterans service organizations on these changes, according to agency staff.

There are different processes and timelines for filling prescriptions, depending on medication type and whether the VHA or a private pharmacy is involved. To make things easier, the department rolled out a VA Prescription Refill and Tracking tool in 2019.

21% of veterans said they did not know when to expect their prescriptions, according to VHA surveys, making it one of the most common concerns.

Selected VHA pages we reviewed received a C in our analysis. Webpages explaining what tests and services are covered under VA health care use clear language, and display topics and subtopics in a way that is easy to follow. However, pages related to receiving care outside of the VA are difficult to understand and impersonal, often referring to veterans in the third person.

Website Experience:
How easy is it to navigate and understand online information? 

Reviewers looked at the pages from the perspective of people seeking to answer two questions:

VHA Grade

C


Strengths

  • Pages that deal with what tests and services are covered are laid out well, nicely written and easy to navigate.
    • Webpages use a clear sidebar structure, which tracks with the information elsewhere on the page and uses question headings that are easy to skim.
    • Language is conversational and the page does not use jargon or difficult words.
    • Information about coverage is organized around a veteran’s situation, such as his or her disability status.

Opportunities to improve

  • Webpages that describe how to access care outside of the VA network, and what care is covered, are difficult to understand.
    • Writing is impersonal, with the veteran referred to in the third person.
    • In some cases, the site uses dense, complex legal language.
    • Busy pages present an overwhelming amount of information for users to digest.

Figure: Health care cover pages have a clear structure of topics and subtopics and use a conversational tone (https://www.va.gov/health-care/about-va-health-benefits/dental-care)
Figure: Pages describing access to care outside of the VA use impersonal language, with the veteran referred to in the third person (https://www.va.gov/COMMUNITYCARE/programs/veterans/General_Care.asp#Eligibility)

Key

Improvement from last year

Ongoing challenge


Connecting on Social Media

The VHA engages with veterans on Twitter, Facebook and YouTube. The agency collects and analyzes information and feedback from veterans’ social media posts, and combines it with information and feedback from other sources, for insights on what is working well and how VHA can improve services. Additionally, the VHA analyzes social media posts to identify and offer help to veterans who may be in crisis.     

As of September 2020, the Veteran’s Health Administration’s social media presence related to outpatient health care services for veterans included:


Twitter

(@VeteransHealth)

Joined: November 2008



Followers: 110,600



Total tweets: 33,900


Facebook

(@VeteransHealth)

Joined: October 2008 



Followers: 258,600 



Total likes: 257,500


YouTube

(Veterans Health Administration)

Joined: March 2008 



Subscribers: 46,300



Total views: 35.5 million

Social media practices

Posts almost daily?
Yes



Responds to customers?
Yes – occasionally



Includes multimedia content?
Yes

For background information on these metrics and our full methodology click here.

How VHA shifted health care services during the coronavirus

Like many health care systems, the VHA struggled with staff shortages and a lack of personal protective equipment as the number of coronavirus cases escalated. The agency had to innovate to treat veterans who were at risk or contracted the virus, while at the same time maintain routine health care services and keep employees and other patients safe.

The agency quickly expanded telehealth capabilities for both mental health and medical services so veterans could get treatment without risking exposure to the virus. About a month after the crisis reached the U.S., VHA health care video visits had increased seven-fold with more than 18,000 daily visits.6 After increasing agency bandwidth, VHA was conducting 169,000 video visits each week by late August, a more than 1,000% increase since the pandemic began.

To staff up, the VHA used newly granted hiring authorities and onboarded roughly 20,000 new employees between late March and July, reducing the time it took to hire a new employee from 94 days to 10-12 days, on average.7

The VHA also quickly adjusted how it handled an influx of questions and concerns from veterans, whether related to the virus or other issues. The VHA adopted a streamlined approach for its national MyVA311 line, which included screening callers for their inquiries to determine if they needed to be directed to a clinical call line. By doing this, myVA311 assisted over 38,000 callers with nonmedical related COVID-19 inquiries and prevented them from contacting specialized assistance, enabling people staffing those lines to focus on patient-specific needs.

Throughout these efforts, VHA leaders focused on supporting and nurturing front-line hospital employees who were under stress while risking their own health and safety to treat others. They launched new programs to help staff members focus on their well-being, and shared accolades from grateful veterans to show staff members the remarkable difference they were making. 


“Your use of telemedicine has been seamless and very convenient for me. I hope after the pandemic, the VA will continue to explore wider adoption of telemedicine for some appointments, as it’s super convenient, saves time and money, and would improve my overall experience with VA medicine.”
from a veteran seen at the Jamaica Plain VA Medical Center in Massachusetts.

“The VA is the best organization I have ever been a part of; the level of genuine care is above and beyond. Even in this time of pandemic chaos, you are there for all of us.”
from a veteran seen at the Tomball VA Clinic in Texas.

Indicators that the Customer Experience is a High Priority 

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Commitment to Customer Experience

The agency:

Includes high-quality customer experience in its strategic goals.


Specifies customer feedback as a key measure of the organization’s performance.


Has a senior executive with the responsibility and authority to lead efforts to improve customer experience across the organization.


Shares meaningful customer feedback data with the public.

Customer Service Basics 

For the most common services provided, customers can: 

Complete frequently used transactions online.


Easily find information to call an appropriate VHA representative.


Schedule in-person appointments.


Obtain status updates.


Find standardized and consistent information and guidance across channels.

Customer Feedback 

The agency collects and analyzes data and information on customer perceptions:   

Of specific interactions, including website visits, phone calls and in-person appointments. 


Of a customer journey through a series of interactions or multistage processes that build toward a specific goal.


Of the overall service the organization provides.


Through qualitative research, such as customer interviews, focus groups, analysis of social media comments or direct observation.


Through a structured analysis of comments about the service left on social media channels.

More details about our methodology

This customer experience profile was produced in collaboration with Accenture Federal Services.