WGU D515 Assignment 2 | VHA Medical Home
Analysis Worksheet | 2 0 2 5 U p d a t e
Instructions:
Use this worksheet to analyze effective strategies for risk management and ethical
leadership in the Veterans Health Administration (VHA) Medical Home case.
Resources:
Use the following resources located in the course to complete this worksheet:
The Veterans Health Administration: Implementing Patient-Centered Medical
Homes in the Nation’s Largest Integrated Delivery System
Veteran Patient Perspectives and Experiences During Implementation of a
Patient-Centered Medical Home Model
Enterprise Risk Management: Issues and Cases
Note: This text investigates ERM case studies, both inside the healthcare industry and out. It
also explores the key issues for implementing ERM strategies.
HA Medical Home Case Questions
1. Address risks. Consider the risks from the case study concerning the
implementation of the patient-aligned care team (PACT) model. How could these risks
be addressed as part of an ERM plan?
Operational/Staffing: Implementing the PACT model was a new paradigm in care delivery
for the VHA; it involved restructuring staff into teams to provide care to a dedicated panel
of 1,200 patients (subject to adjustment to 900-1,500 depending upon the acuity of the
patients in the panel) (Klein, 2011). The teams consisted of a primary care provider, an RN,
an LPN or equivalent, and a medical clerk, with support staff: social workers, psychologists,
disease management coaches, nutritionists, and pharmacists. The care delivery mod el
changed to a collaborative team approach with all disciplines sharing responsibility; the
goals for changing to a medical home paradigm were to increase patient access to care and
improve clinical effectiveness by removing barriers to care.
Risks include the primary providers’ acceptance of this change. Without their buy -in, the
entire program’s operation would have failed. Each physician, nurse practitioner, and
physician’s assistant must be open to working collaboratively with other team members
who now have increasing responsibilities and input into patient care. The primary providers
need to be willing to consider the clinical opinions of the interdisciplinary team, and this
requires the development of professional trust and respect.
Non-provider staff must also be on board. Push-back by other staff, especially by nursing,
could lead to staff turnover, compromising the operation with a lack of qualified clinical
staff to ensure consistent, timely patient care. Additionally, any resistance by local union
leadership could exacerbate turnover (Klein, 2011).
Patient Care: A change this dramatic does not happen quickly; therefore, during the
workflow changes patients are at risk of being overlooked or temporarily lost in the shuffle
as the patient panels are formed and assigned to a team. There will also be a learning
, curve for all staff that may contribute to ineffective or insufficient patient care until the
program is better established.
Patient Satisfaction/Reputation: During the transition to a completely new workflow,
there may be delays, miscommunications, or other missed opportunities to deliver quality
patient care, which may create complaints or even loss of patients as they turn to other
providers in the private sector for the care they don’t feel they’re getting through the VHA.
There will be a learning curve of sorts for patients as well, and there is a risk that they may
not like the new interdisciplinary approach, causing them to seek care elsewhere. A large
percentage of patient (and/or staff) dissatisfaction could risk the VHA’s reputation, further
feeding into the loss of patients and potential staff.
Financial: In order to implement this model, the VA allocated over $227 million to cover
the hiring of additional staff and provide the required training (Klein, 2011). There is a
heavy financial risk that the program will not be cost-effective. And although it wasn’t
implemented for the purpose of saving money, the program needs to be financially sound
to ensure sustainability.
An ERM initiative would have identified and considered all of these risks, and any others
identified, with a thorough assessment facilitated by a risk management representative to
include members from all affected departments (physicians/providers, nursing, support
staff, finance, legal, etc.) prior to implementation (Louisot & Ketcham, 2014). The
initiative’s sponsor would be asked to develop a brief scope statement for review in the
assessment meeting. When agreed upon, the team would collectively identify and prioritize
the critical risks and their impact on the project from a multidimensional perspective. From
there, measures would be developed to address and mitigate the risks.
Measures to address the above risks would include a systematic rollout backed by a
thorough training program for all staff; clear and transparent communication to all affected
veterans of the upcoming changes to improve their access to care; ensuring that all newly
hired staff understand and embrace the PACT model of collaborative team care; qualitative
and quantitative audits in place to support the ERM process to monitor for risk issues,
identify them, evaluate, and implement mitigating measures (Louisot & Ketcham, 2014).
2. Identify strategies. What risk management strategies (e.g., ethical, legal,
regulatory, leadership, operational, etc.) were used? At what level and how was
leadership engaged in implementing those strategies?
Operational: To implement the medical home’s PACT model, the VHA received over $227
million to hire additional staff for the interdisciplinary teams and provide an intensive
training summit (Klein, 2011). Industry experts shared their expertise with a core group of
medical home teams. To support the model’s success, continued training support was
provided through a National PACT Collaborative Learning Session that met every three
months to learn of new practice methods, performance improvements, and the attendees
shared lessons learned from their own program implementations. To further support this
education, the VA hosted a weekly webinar on various topics. The VA also used an intranet
to report on teams’ performance, with each team required to post interventions they had
used and the results they achieved. Other teams were able to learn from them on
successful approaches that they might implement in their own teams. These strategies
supported the mitigation of risk by ensuring that the program was implemented by
knowledgeable and prepared teams that would continue to receive support to ensure
quality care and patient satisfaction with improved access to care.
Ethical: The medical home model was developed with an emphasis on the patient
Analysis Worksheet | 2 0 2 5 U p d a t e
Instructions:
Use this worksheet to analyze effective strategies for risk management and ethical
leadership in the Veterans Health Administration (VHA) Medical Home case.
Resources:
Use the following resources located in the course to complete this worksheet:
The Veterans Health Administration: Implementing Patient-Centered Medical
Homes in the Nation’s Largest Integrated Delivery System
Veteran Patient Perspectives and Experiences During Implementation of a
Patient-Centered Medical Home Model
Enterprise Risk Management: Issues and Cases
Note: This text investigates ERM case studies, both inside the healthcare industry and out. It
also explores the key issues for implementing ERM strategies.
HA Medical Home Case Questions
1. Address risks. Consider the risks from the case study concerning the
implementation of the patient-aligned care team (PACT) model. How could these risks
be addressed as part of an ERM plan?
Operational/Staffing: Implementing the PACT model was a new paradigm in care delivery
for the VHA; it involved restructuring staff into teams to provide care to a dedicated panel
of 1,200 patients (subject to adjustment to 900-1,500 depending upon the acuity of the
patients in the panel) (Klein, 2011). The teams consisted of a primary care provider, an RN,
an LPN or equivalent, and a medical clerk, with support staff: social workers, psychologists,
disease management coaches, nutritionists, and pharmacists. The care delivery mod el
changed to a collaborative team approach with all disciplines sharing responsibility; the
goals for changing to a medical home paradigm were to increase patient access to care and
improve clinical effectiveness by removing barriers to care.
Risks include the primary providers’ acceptance of this change. Without their buy -in, the
entire program’s operation would have failed. Each physician, nurse practitioner, and
physician’s assistant must be open to working collaboratively with other team members
who now have increasing responsibilities and input into patient care. The primary providers
need to be willing to consider the clinical opinions of the interdisciplinary team, and this
requires the development of professional trust and respect.
Non-provider staff must also be on board. Push-back by other staff, especially by nursing,
could lead to staff turnover, compromising the operation with a lack of qualified clinical
staff to ensure consistent, timely patient care. Additionally, any resistance by local union
leadership could exacerbate turnover (Klein, 2011).
Patient Care: A change this dramatic does not happen quickly; therefore, during the
workflow changes patients are at risk of being overlooked or temporarily lost in the shuffle
as the patient panels are formed and assigned to a team. There will also be a learning
, curve for all staff that may contribute to ineffective or insufficient patient care until the
program is better established.
Patient Satisfaction/Reputation: During the transition to a completely new workflow,
there may be delays, miscommunications, or other missed opportunities to deliver quality
patient care, which may create complaints or even loss of patients as they turn to other
providers in the private sector for the care they don’t feel they’re getting through the VHA.
There will be a learning curve of sorts for patients as well, and there is a risk that they may
not like the new interdisciplinary approach, causing them to seek care elsewhere. A large
percentage of patient (and/or staff) dissatisfaction could risk the VHA’s reputation, further
feeding into the loss of patients and potential staff.
Financial: In order to implement this model, the VA allocated over $227 million to cover
the hiring of additional staff and provide the required training (Klein, 2011). There is a
heavy financial risk that the program will not be cost-effective. And although it wasn’t
implemented for the purpose of saving money, the program needs to be financially sound
to ensure sustainability.
An ERM initiative would have identified and considered all of these risks, and any others
identified, with a thorough assessment facilitated by a risk management representative to
include members from all affected departments (physicians/providers, nursing, support
staff, finance, legal, etc.) prior to implementation (Louisot & Ketcham, 2014). The
initiative’s sponsor would be asked to develop a brief scope statement for review in the
assessment meeting. When agreed upon, the team would collectively identify and prioritize
the critical risks and their impact on the project from a multidimensional perspective. From
there, measures would be developed to address and mitigate the risks.
Measures to address the above risks would include a systematic rollout backed by a
thorough training program for all staff; clear and transparent communication to all affected
veterans of the upcoming changes to improve their access to care; ensuring that all newly
hired staff understand and embrace the PACT model of collaborative team care; qualitative
and quantitative audits in place to support the ERM process to monitor for risk issues,
identify them, evaluate, and implement mitigating measures (Louisot & Ketcham, 2014).
2. Identify strategies. What risk management strategies (e.g., ethical, legal,
regulatory, leadership, operational, etc.) were used? At what level and how was
leadership engaged in implementing those strategies?
Operational: To implement the medical home’s PACT model, the VHA received over $227
million to hire additional staff for the interdisciplinary teams and provide an intensive
training summit (Klein, 2011). Industry experts shared their expertise with a core group of
medical home teams. To support the model’s success, continued training support was
provided through a National PACT Collaborative Learning Session that met every three
months to learn of new practice methods, performance improvements, and the attendees
shared lessons learned from their own program implementations. To further support this
education, the VA hosted a weekly webinar on various topics. The VA also used an intranet
to report on teams’ performance, with each team required to post interventions they had
used and the results they achieved. Other teams were able to learn from them on
successful approaches that they might implement in their own teams. These strategies
supported the mitigation of risk by ensuring that the program was implemented by
knowledgeable and prepared teams that would continue to receive support to ensure
quality care and patient satisfaction with improved access to care.
Ethical: The medical home model was developed with an emphasis on the patient
