Transitions to VA care made easy with partnerships

The Veterans Health Administration (VHA) is committed to serving America’s Veterans, including Veterans who are eligible for VHA care but choose to receive care at facilities outside the VA health system.

VHA has established partnerships with the Marcus Institute for Brain Health and the Wounded Warrior Project to maintain seamless care for Veteran patients.

Both partnerships support Veterans who have received care outside VA and wish to return to VA care.

This January, VHA Care Management and Social Work Services entered into a continuity of care-focused partnership with the Marcus Institute for Brain Health (MIBH) in Aurora, Colorado.

“When Veterans choose to get care outside of VA, we are here when they are ready to return.”

During a three-week intensive outpatient program, MIBH provides services for complex medical and neuropsychiatric complications related to traumatic brain injury (TBI). MIBH also provides treatments for posttraumatic stress disorder (PTSD), substance misuse, depression, and related issues such as family functioning. The institute offers several nontraditional, holistic treatment options as well.

Transition to VA care made smooth as possible

For Veterans who independently elect to pursue MIBH health care services, the partnership will make sure the eventual transition to VHA care is coordinated and as smooth as possible.

When an eligible Veteran chooses to seek care with VHA after treatment at MIBH, VHA will assign a social worker or nurse, who will be located at MIBH, to serve as a liaison to coordinate follow-up and ongoing care at a VA medical center closest to the Veteran’s home.

These VA liaisons will help review Veterans’ medical records; collaborate with MIBH to plan for Veterans’ ongoing health care needs; educate Veterans about VHA health care; introduce Veterans to the Transition Care Management team at their home VA facility, and facilitate scheduling of Veterans’ health appointments.

Partnership with Wounded Warrior Project assists with transition

Nearly three years ago, the VA liaison role was introduced as part of the Warrior Care Network (WCN), a public-private partnership between VA, the Wounded Warrior Project®, and four academic medical centers that connect thousands of eligible Veterans with world-class care for PTSD and TBI.

Within WCN, VA liaisons educate Veterans about VA benefits and services, help enroll them in the VA health care system after treatment at a WCN site, ensure that individualized care for Veterans continues when they resume or begin care at their VA facility, and connect Veterans with the Care Management team at the home VA health care facility.

The VA Care Management team then ensures each Veteran receives ongoing case management as necessary.

The team also assists the Veteran with navigating the VA health care system, connects the Veteran with resources, and helps with access to care and readjustment to civilian life.

“Veterans have told us repeatedly that they prefer to get their care at VA,” said Kathy Dinegar, national program manager for the VA Liaison Program. “However, when Veterans choose to receive care outside of VA, we want them to know we are here for them when they are ready to return.”

Here’s more information on VHA Transition and Care Management Services.

And information on VHA’s public-private partnerships.

Tracy Weistreich, Ph.D., RN, is the Acting Director of the Office of Community Engagement.