“Like Manna from Heaven”:

How a Rutgers Program Is Bridging Gaps and Improving Health Care Access for N.J. Veterans

NEW BRUNSWICK, NJ—A U.S. Army veteran who served in Vietnam from 1966 to 1968, Richard Gola has had his fair share of dealings with the U.S. Department of Veterans Affairs (VA) and the challenges that obtaining health care services can present. So when, at a meeting early this year with other Vietnam War veterans, someone spoke about an upcoming program that promised shorter waits for appointments, integrated care, and no impact on his VA benefits—all at no cost—he was intrigued…and a bit skeptical.

“Free health care? It didn’t sound like something that could be true,” recalls Gola. “But I decided to give it a shot, and I can’t be more pleased. They cared, were considerate, treated you with respect. It was a big difference. I look back at my experience and can’t say enough good things about this program.”

Dubbed the Veterans Total Care Initiative (VTCI), the program—a joint effort by Robert Wood Johnson Medical School’s Department of Family Medicine and Community Health, Rutgers University Behavioral Health Care (UBHC), and Rutgers New Jersey Medical School—is the first of its kind to provide expedited, integrated medical and behavioral health care and peer support to veterans, regardless of branch or type of military service.

VTCI debuted in January 2016, less than one month after Robert Wood Johnson Medical School received word that $1.5 million in state funding had been approved for a six-month pilot program, says Barbara Jo McGarry, MD, associate professor of family medicine and community health, Robert Wood Johnson Medical School (pictured, far right). Family Medicine at Monument Square provides the clinical services for the New Brunswick–based health care, while UBHC administers the program, and New Jersey Medical School provides clinical care for veterans in the Newark area.

“There’s no long waiting period. You call on Monday and by the end of the week, you’ll have seen somebody—sometimes even the same day,” Gola says, noting that it could take months for him to get an appointment with the VA, only to “waste half a day” to learn the doctor was not available and the visit needed to be re-scheduled, with another lengthy wait. “This is a much more convenient and easy program to deal with. I tell everybody how great it is.”

In fact, in the months since his first visit, the Manville resident—and VTCI’s first patient at Monument Square—has become one of the most outspoken advocates for the program, spreading the word about its benefits to fellow veterans and encouraging them to give the program a try. It’s not unusual for a new patient to come in and tell George Wilson, LPN, patient care coordinator for VTCI at the Monument Square site (pictured, left), “Rich sent me here!”

Wilson, whom Gola emphatically calls “a great guy,” is one of the program’s major assets, says Dr. McGarry: “Because of his own background, it makes it so much better for the patients. He’s very knowledgeable and is a veteran who knows and understands their issues.”

A retired staff sergeant with the U.S. Army, Wilson served for 22½  years on active duty, 11½ of which were spent in nursing. Today, that experience has proven invaluable in his new role. “We speak the same language,” he says.

A Perfect Fit

When the program was being developed, the Monument Square practice was a natural for several reasons, Dr. McGarry says, not the least of which was its experience providing coordinated care for patients who have complex conditions, a common issue for veterans.

“In looking at the veteran population, we knew we needed to do more than just provide services, so we adapted our model of care coordinators to the VTCI program,” Dr. McGarry explains, noting that care coordinators help look at the bigger picture when it comes to patients’ needs. For example, if patients require a prescription but won’t be able to afford the cost, their care and subsequent health suffer. “The care coordinators and physicians will look at that to say, ‘How can we make sure that if we give the patient a prescription, they will actually be able to get it filled?’ Follow-through is a huge part of the program’s advantages. Our patients get exceptional care because they’re being followed aggressively.”

The program also is a good fit because of the capabilities of the family medicine practitioners in general, Dr. McGarry adds: “In addition to primary care, within the office there are physicians who specialize in women’s health, geriatrics, sports medicine, and acupuncture, which has become very popular with the veterans participating in the program.”

As part of Robert Wood Johnson Medical Group, the Monument Square practice also offers access to the vast scope of services that can be provided by other specialists within the group, although that is not part of the grant funding, she adds. VTCI program patients also can take advantage of other grant-funded programs in which the practice is involved, including one for individuals who are at risk of substance abuse.

Moreover, the medical school’s focus on improved care for veterans is reflected in the practice’s services, with faculty members from Monument Square participating in school-sponsored interprofessional training designed to help improve the provision of culturally sensitive care to veterans.

Accessing Services

Program participants get involved initially through a call to the helpline at 866-838-7654, which goes to one of the individuals at the New Jersey Vet2Vet—or Vets4Warriors, if the NJ Vet2Vet operators are occupied; both helplines are administered by UBHC. If the individual needs health care services in the New Brunswick area, the helpline staffers stay on the line while they transfer the individual to Wilson, who provides more details about the program. If the individual is seeking medical and behavioral help, Wilson works to coordinate the times of both appointments at Monument Square—primary care needs with family medicine physicians and behavioral health needs with a UBHC specialist—so that it’s most convenient for the patient, he says.

During the patient’s first visit, he or she receives a packet with additional information about the program, giveaways with veteran-related helpline numbers, and brochures about veteran-specific programs and resources in the area, Wilson says, noting that each patient in the program also is paired with a peer veteran who helps the patient through the process and handles the exterior support services essential to that person’s needs.

One of those peers is Miriam Soto-Quinones, who served in the U.S. Army for 26 years before retiring in 2001. She has worked as a peer veteran for Vets4Warriors for the past four years and is also pleased to be able to provide peer-to-peer support in person in her role with VTCI.

As the “first and last person they see,” the peer greets VTCI patients at the front desk, helps them with paperwork—a process Wilson says can take about a half hour—and assists with their transition to clinical services, Soto-Quinones explains. When the appointment is over, the peer makes sure the veteran has everything needed before leaving the office.

“There’s a bigger comfort level for patients,” she says. “When I introduce myself and say, ‘I’m here to help you,’ right away it reduces their anxiety, and you can see the sense of relief. Having a fellow veteran here to speak with them and assist, the patient can relate. That’s the real connection—they feel at home, special.”

But the involvement doesn’t stop there, Soto-Quinones stresses.

“What makes this program unique is that we follow up, not just as a representative of the clinic but as a peer,” she says. “We talk to each patient about a week after the appointment to find out how it went, if they have any questions, if there’s any other issue they need to discuss or take care of. A lot are in need of housing, of jobs. We’ve helped quite a few with those issues.”

Building Relationships

It’s that type of personal touch that several program patients say make a significant difference in the care, notes Douglas J. Boyle, JD, PhD, program director and clinical psychologist at UBHC, who is the evaluator for the VTCI program. Dr. Boyle moderated focus group discussions with the patients, designed to assess their overall experience with the program; their level of satisfaction with access, clinical services, and staff; any barriers to using services; and recommendations for improvements.

“They said they felt respected and that the care was excellent. The doctors and staff took the time to get to know them and learn about their problems. Some individuals even said it was the best care they ever received,” Dr. Boyle says. In fact, one focus group participant stated that the program was like “manna from heaven.”

Overall, Dr. Boyle says, veterans in the focus groups gave the program the highest rankings in all areas on a five-point scale. “In every case, it was unanimous. It’s rather unique that there was such positivity and unanimity among all the focus group participants,” he says.

“The personal aspects of this one-on-one, the human contact, is amazing,” one focus group participant reports. “These people here are personable. From day one, they make you feel like they know you and they care.” Another veteran agrees: “The staff actually has a connection with the patients, greeting them as they come in, saying things like, ‘I remember when I saw you so long ago, and your hair has grown.’ … It’s a personal touch. People need that personal touch with their doctors. It’s very important, especially if you want to keep that vet coming.”

Bridging Gaps with VA Services

While many of the veterans served through VTCI are already established patients with the VA, the program can be a boon for individuals who have had difficulties navigating the VA system, says Wilson.

For years, the VA has been plagued with significant backlogs, lost records, and red tape. Despite a concerted effort to overhaul the system, problems remain. More than a half-million individuals nationally are unable to get an appointment scheduled with a physician within 30 days, while an additional 34,656 veterans are on the “electronic wait list” (EWL) and cannot get an appointment in fewer than 90 days, according to an August 2016 report by the VA. And while the average wait times for appointments are significantly shorter in New Jersey than national averages, it can still be a challenge for veterans in the state to get services. The August report showed that more than two-thirds of New Jersey veterans on the EWL had been waiting for more than 120 days to be scheduled for an appointment.

“The VA is overwhelmed. It can be so hard to get an appointment, and they can’t do same-day visits. Veterans call here, and they can get an appointment right away. It’s better for the veterans, and access to care is much faster,” says Wilson.

In addition, VTCI provides services for anyone who ever served in the military—including those in the National Guard and the Reserves who might not be eligible for VA services, Wilson says.

“We want to provide the broadest reach possible,” Dr. McGarry explains, adding that all physicians in the practice participate in the initiative. “Our goal is to provide care when it’s needed, and to do that, everyone in the practice is involved.”

Looking at the Future

Initially, the practice’s mission was to have 125 VTCI patient encounters, including initial visits for new patients and any follow-up visits—a goal it has surpassed easily. By the end of August, practitioners at the Monument Square site had recorded a total of 275 office visits through the program, with as many as 13 appointments per week, and had 41 future appointments already scheduled.

Most of the growth has been because of word of mouth from the veterans who participate, as well as Wilson’s unflagging efforts to help spread the word via avenues such as social media, posting on Facebook pages for veterans groups and more.

Though initially slated to end its run in June, VTCI did so well, coming in under budget and benefiting so many individuals, the state extended funding through the end of November. Program advocates—providers as well as patients—say more time is needed to continue what has become an essential service for area veterans.

“I’ve become a big believer in this program,” says Dr. Boyle. “It will be a huge disappointment to the veterans if the state does not continue funding it. All focus group participants expressed concern that the program would soon be ending.”

In the meantime, the practice is laying the groundwork for future physicians to become more aware of the needs of the veteran population, educating residents and medical students who are exposed to this type of culturally sensitive care, Dr. McGarry says.

“Understanding the cultural differences that exist for a veteran population is a blind spot for most doctors,” she says. “The veteran experience is very different from the civilian experience, and that needs to be recognized and reflected in the medical care and services provided.

“That all people who serve [in the military] don’t have access to health care doesn’t seem right,” Dr. McGarry continues. “Being involved with a program like this one feels like we’re on the right side somehow.”

PHOTO CAPTION:

Pictured, l-r: George Wilson, LPN, patient care coordinator for the Veterans Total Care Initiative at Family Medicine at Monument Square, with the program's peer veteran, Miriam Soto-Quinones, and Barbara Jo McGarry, MD, associate professor of family medicine and community health at Rutgers Robert Wood Johnson Medical School.

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