The Group Practice Manager in the VHA: A View From the Field
The Veterans Health Administration implemented the group practice manager position at 5 diverse prototype sites to improve clinical practice management and increase access to care.
Cynthia LeRouge is an Associate Professor in the Department of Information Systems and Business Analytics at Florida International University in Miami. Savitha Sangameswaran is a Doctoral Student at the Department of Biomedical Informatics and Medical Education; Bianca Frogner is an Associate Professor, Director for the Center for Health Workforce Studies, and Deputy Director of the Primary Care Innovation Lab; and Cyndy Snyder is an Affiliate Assistant Professor, all at the University of Washington School of Medicine in Seattle. Lisa Rubenstein is Professor Emeritus at the University of California Los Angeles Schools of Medicine and Public Health and a Senior Scientist at the RAND Corporation. Susan Kirsh is the Acting Assistant Deputy Undersecretary for Access to Care at the Veterans Health Administration. George Sayre is a Health Services Researcher at the VA Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care and Clinical Assistant Professor in the Department of Health Services at the University of Washington. Correspondence: George Sayre (george.sayre@va.gov)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Limitations and Future Work
This study was based on a small initial sample of pilot sites of varying sizes and, as such, may not reflect the experience of all VHA GPMs. In addition, the use of snowball sampling, while facilitating identification of key stakeholders, may introduce bias in participant sampling. Nonetheless, the results from this study provide findings that informed the national VHA GPM initiative and can inform further studies of practice management roles outside of the VA.
Further study of the VHA GPM implementation and similar roles in other health care systems is needed. As the GPM position is fully implemented across the VHA, large scale evaluation is needed to gain a more representative picture and allow for comparison of the GPM role at various types of facilities (eg, size, rurality, complexity, ranking based on access performance metrics).
Conclusion
Improving access to care is a central goal for health care systems. The incorporation of the GPM role is an innovative approach to improve access management strategies. Early study of prototype sites provided VHA leadership with valuable insights used to influence further rollout of this initiative. Based on our findings, national and local support are important to ongoing success. National access mandates, training, and resources should focus on ensuring sufficient GPM authority, enabling GPMs to use data, and ensuring GPMs engage with frontline clinical and administrative staff to improve veteran access to care.
