As the Department of Veterans Affairs works to reform its health system, the agency continues to struggle with how it tracks improvements, agency officials said Thursday at a government technology forum.
“Sometimes, as the data resource for the organization, I feel like a crack dealer,” said Stephan Fihn, the Veterans Health Administration’s director of analytics and business intelligence. “Information is empowering, but it can also motivate behaviors that may not necessarily move the organization in the right way.”
He added, “It always comes with the caveat … is this the right information to make the decision I need to make now?”
For example, using too few data points can pose a problem.
Before the last year’s waitlist scandal — when VA managers allegedly manipulated the department’s health care scheduling system, which officials said resulted in the mistreatment and death of dozens of veterans — Fihn said data showed wait times to be relatively low. Focusing too much on a few positive data trends in facility access, the VA failed to realize patient satisfaction was low and continually plummeting. Had they incorporated the low satisfaction data, they might have realized what was really happening, he said.
“Ultimately, what happened in Phoenix now seems in retrospect blatantly like ‘Why didn’t we see that?'” he said. “We were looking at the wrong metric. We did not connect the dots … I think sometimes we get lost in the numbers, and it’s easy to lose our way.”
But, at the same time, VA Chief Medical Officer Carolyn Clancy said the department is at a turning point.
It’s moving from “buying in volume — the more stuff you do, the more we pay you — to actually rewarding people on value,” she said. “Everything we do … is shaped by fee for service. It affects our mindset. … What we’re now developing is an enterprise path that frankly gives us the opportunities to focus on what does VHA do really well, and where is it that it’s just cheaper to buy it” from private industry?”
The VA knows what the indicators of success should be — DeAnn Farr, VHA director of enrollment and forecasting, put it simply as, “Are we getting what we want for our veterans?” — but defining and quantifying it is the struggle. (This is also a major focus in a new report published by the event’s sponsoring organization, ACT-IAC.)
“The difficulty as we go into value-based care is: How do we define value?” Fihn said. He joked that the person with the answer should win the Nobel Prize for medicine.
And things aren’t going to get any easier. The VA already has an ocean of data — petabytes of it, Fihn said — to sift through and analyze, and soon, like every other enterprise in and out of government, it’s going to be hit by a wave of data from new devices, technologies and means of care, like telehealth.
“We are on the verge of a tsunami of data,” Fihn said. The solution could lie within private industry, but he hopes the help is better than what the VA has received up to now, he said. “The help we’ve gotten so far has not been what I had hoped it would be.”