Patient Aligned Care Teams (PACT): VA’s Journey to Implement Patient-Centered Medical Homes

Abstract

In 2010, the US Department of Veterans Affairs (VA) launched national implementation of patient-centered medical homes (PCMH) through the Patient Aligned Care Teams (PACT) initiative, as described by Gordon Schectman and Richard Stark, the chief architects of PACT, in their commentary to this Supplement. Concurrently, the PACT initiative aimed to incorporate rigorous formative and summative evaluation of PACT implementation and to promote PACT-related innovation development and testing. To accomplish these goals, the initiative established a national evaluation team (based in Seattle) and competitively funded five PACT Demonstration Laboratories (in Ann Arbor, Los Angeles, Iowa City, Philadelphia, and Portland). In addition, embedded health services researchers and clinical leader partners from outside the Demonstration Laboratories undertook relevant studies. Together, the implementation and evaluation components of PACT as reported in this Supplement’s articles document opportunities and challenges in implementing a PCMH in integrated healthcare systems that are both specifically relevant to VA and informative to other managed care or Accountable Care Organizations (ACOs) engaged in implementing PCMH models. In addition, as highlighted in the Reid and Wagner commentary in this Supplement, the articles have implementation science implications as they delve into components of the Chronic Illness Care Model. Rather than a demonstration project, VA’s implementation of PACT represents a national rollout of PCMH to all VA primary care practices in more than 150 medical centers and over 800 community-based outpatient clinics. The articles in this Supplement therefore reflect realistic transformation on a national scale during its first 2 to 3 years. Funded by the VA Office of Patient Care Services’ Primary Care Program Office, this Journal of General Internal Medicine (JGIM) Supplement shares the lessons learned by researchers and their clinical and policy partners during early stages of PACT implementation. The 19 published articles underwent rigorous JGIM peer review along with nearly 50 additional manuscripts that were submitted in response to the supplement’s Call for Papers but not selected for the Supplement. The published articles touch upon virtually all facets of medical homes, including implementation strategies, performance measurement, care transitions, team development, mental health and pharmacy integration, quality improvement, and medical home neighborhood development. We organized the PACT Supplement to reflect different stages and levels of medical home implementation, starting with pre-implementation PACT challenges and insights about implementation strategies, closer examination of organizational structures, strengths and challenges of implementing team-based care, and ending with implications for specialty care relationships and addressing the needs of special populations.