Re-designing primary care: Implementation of patient-aligned care teams

Background: Primary care is the foundation of the Department of Veterans Affairs (VA) health care, but transformation efforts are necessary to meet the needs of Veterans and provide patient-centered care (PCC). Problem: The need to transform the VA from a problem/disease-based provider-driven system to a patient-centered, patient-driven health care system. Goals: Our project objective was to describe the implementation of the Patient-Aligned Care Team (PACT) model in the current Department of Veterans Affairs (VA) health care environment and to identify barriers and facilitators to implementing a new model of care that could apply more broadly to the implementation of large-scale changes in other large integrated health care systems. Strategy: We sought to learn through in-depth interviews with leaders and key informants at several stages of the PACT process, including planning, implementing, modifying where needed, and maintenance. Results: The PACT model offers PCC that is managed with high quality, safety, and effectiveness; provides optimal access; and integrates the Veterans' voice to respect their preferences, needs, and values toward achieving optimal health and well-being. Implications: This transformation in VA provides insight into the barriers and facilitators to implementing large-scale change in an integrated health care system. Implementation of a new model of care across a large integrated health care system requires continuous and highly visible engagement from leadership and staff, distribution of resources across initiatives, and alignment of program goals and performance measures, these lessons.