People say digital health startups shouldn’t even try to work with the VA. But that’s totally wrong.
There’s a saying that many who work with the U.S. Department of Veterans Affairs (VA) have heard before: If you know one VA Medical Center, then you know one VA Medical Center. It’s a mantra born of the fact that the VA consists of more than 1,200 facilities that frequently operate in silos. It means you tend to find variation in policies, procedures, and operations from one facility to the next. The VA is also the largest health system in the United States, made up of more than 300,000 employees serving nine million veterans. It’s not the easiest federal department to navigate.
When speaking with health care entrepreneurs and investors early on in my career, many of them told me I shouldn’t even try the VA, that the juice isn’t worth the squeeze. Yes, there’s an enormous opportunity given the size of the VA’s patient population. But pitching the VA can be like selling door-to-door: making a deal with one facility doesn’t guarantee you’ll make a sale at the next. And if you can’t make multiple sales quickly to scale your business, they said, then it’s just not worth the trouble.
For many health care entrepreneurs, the complexity of the VA is a bridge too far. But in spite of the challenges, there are three key reasons the VA offers great potential.
First, since the VA is an integrated health care system that pays for its own services, it has built-in incentives to provide value. Most digital health solutions describe their value proposition as some version of making it easier for patients to maintain or monitor their health or receive care. This increased ability to monitor for problems or access care sooner prevents more acute problems and improves overall health, thereby driving down costs in the long run. However, most health care systems operate via a fee-for-service model, which means they perversely lose money by investing in preventive solutions. Value-based care providers like the VA are incentivized to jump at these solutions that both save costs and lead to better health outcomes.
Second, the VA has embraced innovative technology for years, but the challenges brought on by Covid-19 truly underscored the need to incorporate new ways of solving old problems. The VA has a “fourth mission,” meaning in times of national emergency it serves as a backup health system should the civilian system become overwhelmed. One way the VA keeps those beds open is by embracing virtual care. This frees up more clinicians to see more patients, and it keeps those with underlying conditions away from hospitals where they could potentially contract Covid-19.
Finally, while working with the VA has been great for business, that isn’t the only reason I value our partnership. I’m the son of a Vietnam War veteran, and I was even born on a military base. Our veterans, like my father, deserve nothing less than the best medical care we have to offer because of their service to our country. But it’s more than that: We owe veterans great care now because while we may have taught our men and women in uniform how to be fit, we didn’t always teach them how to stay healthy. Veterans tend to be more medically complex than their peers, for a variety of reasons. In addition to higher rates of mental health disorders and chronic pain, one-in-four VA patients have diabetes.
As a digital health company, it hasn’t always been easy to work with the VA but among the bureaucratic complexities lie innovative and dedicated clinicians, knowledgeable researchers, and true champions of veteran care. There is no health system better suited to adopting new technologies to better care for patients. In the long run, that’s what matters most.
The VHA Innovation Ecosystem has been an instrumental partner in helping us overcome barriers, as well as building the infrastructure needed to adopt new solutions. In the future, I hope to see more digital health solutions scaled to improve veteran care. The question isn’t why should innovative health care companies partner with the VA, it’s why shouldn’t they?