Collaborating to Improve Care for Veterans

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Specialty Pharmacy By the Numbers

Veterans face a unique set of health issues. In addition to serving our country longer than ever on active-duty deployments in dangerous hotspots around the globe, members of the military often deal with illnesses and injuries caused by the environmental and other hazards they are exposed to during their service.

The stresses of combat, coupled with extended absences from loved ones during long deployments can also lead to mental health problems, including posttraumatic stress disorder (PTSD), anxiety, depression and suicide. For many veterans, these mental and physical wounds of war linger long after they return to civilian life.

Yet only a small fraction of veterans receive their health care at Veterans Health Administration (VHA) facilities with expertise in treating the conditions associated with military service. The vast majority of veterans get either some or all of their care at civilian hospitals and facilities, many of which are unprepared to appropriately diagnose and treat them.

Lehigh Valley Health Network at the Forefront

Lehigh Valley Health Network (LVHN) in Allentown, Pennsylvania, is among the first U.S. health systems to recognize and attempt to address the specific health care needs of their veteran community. In 2011, LVHN helped launch a coalition of area health care facilities – the Lehigh Valley Military Affairs Council – and, with the assistance of an organization called Warrior Centric Health (WCH), began collecting and analyzing data on veterans within their service area.

“Lehigh Valley Health Network has done something very unique, innovative and commendable,” said Ronald J. Steptoe, CMR, DABDA, chief executive officer and cofounder of Warrior Centric Health, which provides healthcare facilities with veteran population data, statistics and tools to help them measure, coordinate and deliver high-quality care to veterans.

“By turning on the switch and beginning to collect this data, they were able to establish the baseline for better understanding and serving their veteran patient population,” added Steptoe, a West Point graduate and eighth-generation Army veteran whose family legacy of military service dates back to the Revolutionary War. “That’s the baseline that the rest of our health care facilities in America should get to – at a minimum.”

In October 2018, after seeing the effectiveness of the collaboration between LVHN and WCH, Vizient, a health care performance improvement organization that is also our parent company, published “Trends in Demographic Data Collection and Use in Healthcare: A Field Guide for Improving Care for Veterans.” The guide, developed by Vizient partner and equity champion Lisa Sloane and her team at MiH, focuses on the collection and use of veteran status while highlighting the commitment by LVHN and Warrior Centric Health to provide better care and services to those who served our country. It offers four best practices for collecting data about veterans.

Impact on Civilian Health Systems

LVHN’s analysis of the data it collected found that 7% of the population in the system’s service area – and 10% of their patients – were veterans. Additional analysis showed that 13% of LVHN’s revenue came from their veteran-patients, who – as a group – had higher readmission rates than non-veterans.

A common misperception among the public is that all veterans get their care at the VHA. Of the approximately 18-20 million veterans in the U.S., 70% are not registered with the VHA, according to Steptoe. “On an annual basis, the VHA sees 6 million veterans – only 30% of the total veteran-patient population,” he said.

And even among that 30%, the VHA is not the only provider they go to for their care. “In reality, it’s estimated that 90% of our veterans get at least some of their care from our civilian health care system,” said Evelyn Lewis, MD, the chief medical officer for WCH and a 25-year veteran of the Navy.

Military service, simply by its nature, has an impact on the health of those who serve. “If you were to apply OSHA regulations to the military, they couldn’t do their job,” noted Steptoe. “The things we do during training and deployment – for example, jumping in and out of vehicles, exposure to loud noises and toxins, never mind what the enemy may be directing at us during combat – have a consequential impact on our health. The data show that veterans have a higher propensity for various health conditions, such as cardiovascular disease, cancer, musculoskeletal and respiratory health issues.”

He added, “Veterans, just to qualify for service in the military, were among the healthiest Americans when they signed up to serve. There’s clearly something fundamental to the experience of the military that has an impact on veterans’ health.”

Best Practices – Asking the Right Questions

Based on the experiences of LVHN and WCH, the Vizient field guide is designed to help provider organizations identify health care disparities and gaps in delivery specific to their veteran community. The guide recommends that all adult patients be asked at registration if they have served on active duty in the U.S. Armed Forces, the U.S. National Guard or the U.S. Reserves so their veteran status can be determined at the point of care and integrated into their patient assessments.

Asking where and when the veteran served can also be key to diagnosing their condition. For example, Vietnam-era veterans could have been exposed to Agent Orange, while those who served during the two Gulf wars – or in Iraq and Afghanistan – might have had exposure to depleted uranium. Veterans of the Iraqi and Afghani battlefields also may have developed respiratory and other problems from breathing in toxic waste from burn pits or aerosolized metal from exploding vehicles.

“A physician or other caregiver treating a veteran who presents at a civilian hospital with a respiratory problem probably would not think to ask him or her where or when they served,” said Dr. Lewis. “Just asking whether a patient served is not enough. The provider needs to ask these additional questions so we can match the responses with the different environments and contaminants the veteran may have been exposed to.”

A 2016 American Hospital Association report found 57% of hospitals routinely asked patients whether they served in the military, but only 10% of them actually used the data they collected to assess gaps in health care delivery for veterans.

“Our dream as an organization is that every U.S. health system would at least to some degree have the level of information that’s in the field guide to help improve health care for our veterans,” said Steptoe.

Acentrus Specialty’s Support for LVHN’s Mission

Acentrus Specialty is proud to support not just LVHN’s specialty pharmacy program but also the health system’s overall mission of care.

LVHN was one of the first health systems to access Acentrus’ limited drug distribution agreement with Pfizer that offers qualified Acentrus hospital and health system clients access to certain Pfizer oral oncology products.

“Accessing the limited drug distribution agreement with Pfizer requires our clients to abide to clinical and operational standards,” said George Zula, vice president of Acentrus. “LVHN has demonstrated its ability to meet these standards, not just in specialty pharmacy, but as evidenced by the leading role they play in collecting and utilizing data to improve clinical care and outcomes for their veteran patient population. LVHN is recognized for the value-based care they provide to our veterans, and that resonates with Acentrus values and mission.”

Zula added: “LVHN is a leader in this area because they already abide by the standards included in our agreements. They are an example of a truly exemplary client and we support their and WCH’s outstanding efforts on behalf of the veterans community.”

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