Research in Progress (RIP): "Addressing the needs of high-risk, high-cost Veterans Affairs patients"



Donna Zulman, General Medical Disciplines
Steven M. Asch, General Medical Disciplines

Date and Time

March 4, 2015 4:00 PM - 5:00 PM

FSI Contact

Nicole Feldman

All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.


Nearly half of total health care expenditures in the Veterans Affairs (VA) system are generated by 5% of its patients. These patients generally have complex health and health care needs, including multiple chronic conditions, comorbid mental health conditions, and social stressors, all of which contribute to high rates of hospitalization, urgent care visits, and outpatient encounters. In recent years, a number of intensive primary care models have emerged outside the VA that focus on health systems’ high-risk, high-cost patients. Early evaluations suggest that these models have the potential to improve quality of care and enhance patients’ care experience, while simultaneously keeping utilization in check and using resources more wisely. However, there are few rigorous evaluations of these programs, and studies of their applicability inside the VA are lacking. In 2013, the Palo Alto VA launched a quality improvement (QI) program for high-risk, high-cost patients to augment the VA’s patient centered medical home (Patient Aligned Care Team, or PACT) with Intensive management (ImPACT). ImPACT’s multidisciplinary team offers patients enhanced access, chronic disease management, support during health deteriorations, and social work and recreation therapy. Although ImPACT was designed as a QI program, Palo Alto VA leadership chose to enroll a random sample of eligible patients, providing an opportunity for a randomized controlled evaluation. We will describe this unique QI/research partnership, as well as early findings from the ImPACT pilot study, and discuss implications for future services for high-risk, high-cost patients within the VA system.