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BRAVe Home Meds (Boxed, Reconciled, Assistance at Veterans Home for Medications)
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Our goal is to improve the quality of care for older Veterans while reducing costs. Currently, VA Eastern Colorado Health Care System spends more than $3 million dollars annually through Community Care for externally contracted home health RNs to fill medication pill boxes.
To address this, we’ve introduced BRAVe Home Meds, which leverages existing VA infrastructure by deploying VA-employed LPNs (Licensed Practical Nurses) to visit Veterans' homes. These visits include medication management, health assessments, med box filling, and video consultations with geriatricians. By shifting to this model, BRAVe is projected to reduce VA costs by 30-50% for the medication management service.
Origin:
September 2021, Rocky Mountain Regional VA Medical Center (Aurora Rocky Mountain)
Adoptions:
1 in-progress
Awards and Recognition:
GRECC Clinical Innovation
Partners:
Geriatric Research Education and Clinical Center, Geriatrics and Extended Care, Office of Community Care
Recent Updates
Overview
Problem
Medication Management for Veterans with multiple chronic conditions ensures they take the right medications while avoiding the wrong ones, reducing overprescribing and side effects. Appropriate medication usage helps prevent re-admissions and un-necessary hospitalizations. VA Eastern Colorado Health Care System spends over $3 million annually on contracted
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Medication Management for Veterans with multiple chronic conditions ensures they take the right medications while avoiding the wrong ones, reducing overprescribing and side effects. Appropriate medication usage helps prevent re-admissions and un-necessary hospitalizations. VA Eastern Colorado Health Care System spends over $3 million annually on contracted home health registered nurses (RNs) from community-based agencies to fill medication pill boxes for Veterans. The goal of BRAVe Home Meds (Boxed Reconciled Assistance At Veterans Home for Medications) is to insource this service, improving care quality for older Veterans while reducing community care expenditures.
VA Geriatricians identified challenges in continuity of care, particularly in coordinating VA medication orders with home health nurses. To address these issues, discussions began with Geriatric fellows, Office of Community Care (OCC), the Patient Aligned Care Team (PACT), Pharmacy, Nursing, and Systems Redesign. A chart review analyzed the characteristics of Veterans using home medication management. We found that these Veterans tend to be elderly, vulnerable, lacking support in the home, and often have symptoms of dementia. We also found that there was a significant amount of low yield administrative burden on VA staff for this service.
Our multidisciplinary team designed an effective solution within the VA system while establishing collaborative processes for cost reduction. This proactive approach can reduce overall healthcare costs for the VA by preventing the need for expensive acute care services. See more
VA Geriatricians identified challenges in continuity of care, particularly in coordinating VA medication orders with home health nurses. To address these issues, discussions began with Geriatric fellows, Office of Community Care (OCC), the Patient Aligned Care Team (PACT), Pharmacy, Nursing, and Systems Redesign. A chart review analyzed the characteristics of Veterans using home medication management. We found that these Veterans tend to be elderly, vulnerable, lacking support in the home, and often have symptoms of dementia. We also found that there was a significant amount of low yield administrative burden on VA staff for this service.
Our multidisciplinary team designed an effective solution within the VA system while establishing collaborative processes for cost reduction. This proactive approach can reduce overall healthcare costs for the VA by preventing the need for expensive acute care services. See more
Solution
BRAVe Home Meds addresses the problem by leveraging existing VA infrastructure to send a VA-employed LPN into Veterans' homes for medication management visits, brief health assessments, medication box filling, and video consultations with geriatricians. CPRS orders are updated in real time, ensuring timely and accurate medication reconciliation. BRAVe achiev
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BRAVe Home Meds addresses the problem by leveraging existing VA infrastructure to send a VA-employed LPN into Veterans' homes for medication management visits, brief health assessments, medication box filling, and video consultations with geriatricians. CPRS orders are updated in real time, ensuring timely and accurate medication reconciliation. BRAVe achieves comparable or better patient satisfaction scores than community care medication management at a lower cost to the VA.
How much do we spend on this service? Reconciling medication management costs with current financial data sources is difficult at best. We do not pay one amount for same service for every patient. To make this even more complex, home medication management consults are under the consult title “Community Care-GEC Skilled Home Care,” which lacks a stand-alone medication management category. This consult encompasses a range of services, including physical therapy, occupational therapy, speech therapy, wound management, and catheter care, making it difficult to isolate medication management alone. To address this, our team introduced the hashtag #MM# to specifically categorize medication management consults on the backend. This innovation led to the creation of a PowerBI dashboard, enabling VA staff to quickly locate Veterans with medication management consults and quantify the resources spent on this service. By implementing #MM#, we leverage the hashtags to correlate clinical information from the chart with the financial data resources, thus demonstrating the necessity of BRAVe. See more
How much do we spend on this service? Reconciling medication management costs with current financial data sources is difficult at best. We do not pay one amount for same service for every patient. To make this even more complex, home medication management consults are under the consult title “Community Care-GEC Skilled Home Care,” which lacks a stand-alone medication management category. This consult encompasses a range of services, including physical therapy, occupational therapy, speech therapy, wound management, and catheter care, making it difficult to isolate medication management alone. To address this, our team introduced the hashtag #MM# to specifically categorize medication management consults on the backend. This innovation led to the creation of a PowerBI dashboard, enabling VA staff to quickly locate Veterans with medication management consults and quantify the resources spent on this service. By implementing #MM#, we leverage the hashtags to correlate clinical information from the chart with the financial data resources, thus demonstrating the necessity of BRAVe. See more
Images
The HASHTAG Solution enables concise tracking of medication management consults (Image Credit - Dr. Audrey Yee)
Results
The BRAVe program has enrolled 7 Veterans to date, working through funding and staffing challenges. Despite these obstacles, the highly motivated team has demonstrated the huge potential to enhance care and reduce costs. A conservative financial analysis estimates that the BRAVe program costs 30-50% less per Veteran than community care outsourcing, after acc
...
The BRAVe program has enrolled 7 Veterans to date, working through funding and staffing challenges. Despite these obstacles, the highly motivated team has demonstrated the huge potential to enhance care and reduce costs. A conservative financial analysis estimates that the BRAVe program costs 30-50% less per Veteran than community care outsourcing, after accounting for VA clinician and administrative staff salaries, data analysis and travel costs associated with BRAVe implementation.
Most importantly, BRAVe brings VA staff directly into Veterans' homes for safe medication management. When one Veteran urgently needed to stop taking a medication before surgery, the VA nurse was able to schedule a home visit to ensure coordination and avoid cancellation. Another Veteran avoided an ER trip entirely thanks to outreach from the BRAVe team. The image below illustrates a situation where the BRAVe nurse was able to discard unsafe and expired medications from a Veteran’s home due to the trusting relationship that was established. These successes showcase how bringing VA staff into Veterans' homes can transform medication management and delivery of care. See more
Most importantly, BRAVe brings VA staff directly into Veterans' homes for safe medication management. When one Veteran urgently needed to stop taking a medication before surgery, the VA nurse was able to schedule a home visit to ensure coordination and avoid cancellation. Another Veteran avoided an ER trip entirely thanks to outreach from the BRAVe team. The image below illustrates a situation where the BRAVe nurse was able to discard unsafe and expired medications from a Veteran’s home due to the trusting relationship that was established. These successes showcase how bringing VA staff into Veterans' homes can transform medication management and delivery of care. See more
Images
BRAVe Home Meds improves patient safety (Image credit - Dr. Sarah Beck)
BRAVe vs. Home Health Program Cost Estimates for ~150 Veterans Enrollment (Image Credit: Robyn Moon, GRECC RN)
Metrics
- Number of Veterans served - ECHCS provides medication management services to over 600 unique Veterans annually
- Cost offset - BRAVe can provide medication management at lower cost to VA
- Patient satisfaction scores - increased with BRAVe providing medication management!
- Count and categories of Veteran connections to VA services
- Decreased administrative burden for VA staff
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
![The image shows several quotes from Veterans regarding the BRAVe program. Read below:
BRAVe LPN Feedback:
“Helpful for VA nurse to call in refills to medications, then I don’t have to, I forget sometimes.”
“Before Mercy there were 3-4 others coming and it was a disaster. They did not know if they were coming or going, Mercy is a jewel and 110% improvement. Mercy is thoughtful and mindful.”
BRAVe Program Feedback:
“Previously [I was] confused with pill box fills, great to be set up for a whole month.”
“Mercy has made my family feel secure and comfortable, this is “top notch” care that exceeds my expectations, and I appreciate it because I’ve had some “duds” that just didn’t show up or had disheveled appearance.”](https://prod-dm.s3.us-gov-west-1.amazonaws.com/practice_multimedia/attachments/000/000/410/thumb/Veteran_Quotes.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=ASIAR2ERFC2NEBR7ERXE%2F20241121%2Fus-gov-west-1%2Fs3%2Faws4_request&X-Amz-Date=20241121T080110Z&X-Amz-Expires=2700&X-Amz-Security-Token=FwoDYXdzEJ3%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaDFA6a3t5%2BToJB2l%2BrSLkBNxANHB5TQsxQ7%2B0CSO4JQ%2FeIw5raetXJtA8xWMnjQYxn3NY3sI7kvtfvN0ZBgELu3xSPcSegvnV62xpcVtLlbNssnpfITdll5QrmGyc6qTkILRnI2tffWUdMHCfCy%2FNdg7QARVgsH%2FYJqSGucUQzLNEd6n5xh0vnZzIAVizQKHgzvFV3M7nmxHEKuhkjkrMDPFB93qzmYOgML7oT8%2BbJpCYxyhP025nsvgSPU7zfgTg9vhZM1wV4T8ZcULl5dima3cCeK%2Bm9rga3TX7hrz4qEnnysBgiDtpBRRK%2FSlI%2Fq0ShcNnj8rBHxkIuNGwqCCTYbjQw%2Fx%2FxZHnmfdNFiDK9aPwe1Hdru9yZvtFpP%2BduSUIFDwLe10oepfhnDOTPIiQalUQilxDkY5Je8m9XDbglQuoUxwBsxDnJeP0kCuojNvEw9oF21DOHRmvxU4nozRY2ecTPsLIkA0jIItEIdMgIKzyg2uePVQosAFYDvypi1iKraNZc7d0SQWPQh8A9Bl2EHRyQpeoCgKk60pBc5HOghllXtfJgFsFBjp3uG2QqZP3m9iU%2B8NQorNX7jjMH2PHkae%2BCjgahhA5cFHQGh%2Fy%2Bjp2nX03nOS6GuWm5I0YbfsgGkxkMIlmsxAjqEEx9ZBe%2BK20XP4v6bLmu33IlY2lX1dgmvQW29n80WYlO3%2Bnmr7daWkXc5F8DQ8lgkEJABSLB3Ag72vaS8D91ZKW4rZmz%2Ftya%2BnfXMgV6wYxsg0zcqI1bdHizksw9R74xkdld15qFppl3kxsmpqUY5S5J4BGXmzYUDY1LYUlwYsDB5eznHGM8HZndyijofu5BjJBO2eTmsKY2RIW9NDFj0iSwlWFatNN2Cc5pyZC%2FTHyU5mDU5biYM1iqJkaC1d2JegSyG3x%2B0NgIEBIWgrBpufz%2BHo%3D&X-Amz-SignedHeaders=host&X-Amz-Signature=4370010058d60cce0aa04d24553674e1d97c8a1433eb7c3f85bc62c0d9a3b896)
Quotes from Veterans regarding BRAVe staff and services (Image Credit - Lynette Kelley, NP)
Veteran surveys show VA can do it better! (Image Credit - Lynette Kelley, NP)
Implementation
Timeline
-
1 month
Identify geriatrician medical director and field team (1 RN and 4 LPNs/ICTs) who will participate in the program (if you need to create new positions expect this step to take 6-9 months). -
1 month
Develop workflow for identifying eligible utilizers of medication management only and implement use of THE HASHTAG SOLUTION (#MM# in community care consult processing). -
1 month
Work with Clinical Application specialists to create consult and import electronic template notes and test for local usability. -
1-2 months
Conduct BRAVe orientation to include: home visit procedures, mandatory TMS modules, Prevention & Management of Disruptive Behavior (PMDB), and training home visit with experienced VA staff member. Complete tele-work agreements for field team and obtain necessary IT equipment and access (laptops, iPhones, remote printing). Order medical bags and collect supplies. We locally "nested" BRAVe adjacent to our Home Based Primary Care Service, this structure allowed for home safety and Joint Commission standards to be easily accommodated. -
1-3 months
Enroll Veterans and start doing home visits!
Departments
- Home Based Primary Care
- Community Care
- Geriatrics
- Nursing services
Core Resources
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Contact
About
Origin story
In 2021, we recognized that Medication Management as a long term service for Veterans was being utilized at a high cost. It started as a Quality Improvement project to review the Veterans within geriPACT that were using the service. We found that these older Veterans were isolated without supports in the home to help with medications.
We then gathered fro
...
In 2021, we recognized that Medication Management as a long term service for Veterans was being utilized at a high cost. It started as a Quality Improvement project to review the Veterans within geriPACT that were using the service. We found that these older Veterans were isolated without supports in the home to help with medications.
We then gathered front line staff from all different services to work through a design session on how we could insource this service within VA structures and BRAVe Home Meds was born!
Original team
Sarah Beck
Physician (GRECC & Medicine-Geriatrics)
Robyn Moon
GRECC, Clinical Innovation Nurse
Audrey Yee
Office of Community Care, Home Health Section Chief/Geriatric & Extended Care
Sandra Malakauskas
Former Section Chief-Office of Community Care, Home Health
Tamatha Anding
Office of Community Care, Home Health Asst. Nurse Manager/Geriatric & Extended Care
Mercy Tekle
Licensed Practical Nurse, GRECC Researcher
Lauren Abbate
Physician, (GRECC Associate Director for Clinical Innovations & Emergency Department)
Lynette Kelley
GRECC, Nurse Practitioner/Clinical Analyst
Comment
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