Going for gold: Health care innovation increases Veteran access to care

“Our Veterans empower me to stay on top both access and innovation; same day access is the key piece of helping our Veterans receive care in an integrated way. Those are the things that keep me moving is how can we get to the patient who may otherwise say ‘no’ to mental health,” Rothschild said.

Rothschild started her career as a clinical health psychologist at VA Tennessee Valley Healthcare System (TVHS) in 2012 and later moved into her current role as Primary Care – Mental Health Integration Program Manager in 2019. Of the last three of five years under her leadership, the Primary Care – Mental Health Integration team has consistently ranked in the 90th percentile for timely mental health care access and climbed to the No. 1 spot among all VA medical centers during the months of July through September 2023. 

Most recently, Rothschild and her peers participated in the Veterans Health Administration’s Access Sprint: Mental Health Wave, an ongoing strategy with multiple, large-scale initiatives aimed at improving access for new patients and bringing back Veterans receiving care outside VA. The Access Sprint Waves focused on three types of care: primary care, specialty care, and mental health.

Rothschild and other VISN 9 mental health colleagues ranked in at first place for their remarkable access to care benchmarks. 

According to Rothschild, TVHS patients waited no more than five minutes for a same-day mental health appointment through the Primary Care – Mental Health Integration model. This accessibility metric continues to be sustained by the team. Additionally, by increasing staffing levels, the team conducted 1,985 more appointments compared to the year prior. Of that number, 660 Veterans had their first-ever mental health appointment.

Rothschild discussed the tools to increasing Veterans’ access to mental health care were teamwork, cross-team communication, putting the Veteran first, and using innovative modalities of care such as face-to-face, telephone, walk-in and same-day, virtual care, and even using the VA Mental Health App depending on what’s most important to the Veteran. 

“For me personally and for our staff at Tennessee Valley in PCMHI, it’s a critical mission that we serve our Veterans first,” she said. “We have, as I call it, very Veteran-centered scheduling. We want to give Veterans as many mental health care options. We all know no one wants to wait.”

Unlike most community hospitals, TVHS and other large, complex VA medical centers offer same-day mental health care access through the Primary Care – Mental Health Integration model. 

“One of the things I really love about our program is all Veterans can walk-in and talk to their primary care provider and see us [mental health] same day,” Rothschild explained. “That does not exist in the community. I, myself, as a civilian can’t get that done.”

To understand how Primary Care – Mental Health Integration works, it’s important to understand how VA’s model of primary care is built. 

VA Primary Care uses a patient-centered health care model called patient-aligned care teams. These teams consist of a primary care physician, nurse, social worker, Whole Health specialist, dietitian, and mental health experts. Particularly within Primary Care – Mental Health Integration, Veterans can be treated for depression, anxiety, post-traumatic stress disorder, and substance abuse services without needing a consult to another VA mental health care provider or moving to a different part of the hospital to receive their care. Primary Care – Mental Health Integration offers medication management, individual brief therapy, collaborative care management, and peer support offerings with regard to care.

“There’s a lot of people working around the patient to make sure that we’re providing not only same-day mental health care but same-day health services. We really want to drive home the point that this is your patient-centered medical home. In PCMHI, you can talk with your primary care doctor and say, ‘hey I’m having a problem.’ We’re going to be right there to talk through that. We want every Veteran to know that mental health is health.”

To enroll in VA health care, call TVHS at 615-225-2715 or apply online at www.va.gov/health-care/how-to-apply.