Program Spotlight: Community Care and Authorizations (CCRA)

Susan Burke
Program Manager

We met with Susan Burke, Program Manager to discuss our CCRA project—why it’s valuable and how it impacts the lives of our nation’s Veterans. See why our Contracting Officer Representative refers to it as the Community Care “Crown Jewel Project.”

1. Can you briefly describe the CCRA project and why it is important?

HealthShare Referral Manager (HSRM) is a secure, enterprise-wide web-based system the Department of Veterans Affairs (VA) uses to generate and submit referrals and authorizations to community providers. HSRM allows community providers and the VA to better manage community care for Veterans—enabling seamless care at the following locations:

• VA medical centers (VAMCs)
• Outpatient clinics
• Community-based outpatient clinics (CBOCs)
• Veterans Integrated Service Network (VISN) offices

HSRM has allowed the VA to transition from what was a largely manual process to a more streamlined process that generates standardized referrals and authorizations in accordance with clinical and business rules. HSRM facilitates reduced turnaround time for processing referrals, providing care, submitting claims, and receiving payment. The CCRA component supports clinical and administrative processes that:

• Seamlessly provide eligible Veterans with prompt referrals to provider of choice
• Provide community providers with referrals and authorizations consistent with industry standards
• Decrease the administrative burden on VA clinical and community care staff members
• Facilitate communication between community care staff, third-party administrators (TPAs), and community providers via a unified platform that enables the secure exchange of medical information.​​​​​

2. What are the top three things employees should know about the CCRA project?

When a Veteran needs care in the community, our system is used to process the referral—it reduces Veteran wait times to receive care and schedule appointments. We are deployed nationwide, and our system is used at every VA Medical Center in the country. We are working to expand our presence with community providers. While our referral and authorization system integrates with more than 20 different VA care coordination systems, our system doesn’t process claims for reimbursement. We only provide the referral and authorization portion.

3. What tangible results have you seen on account of our work?

To date, 1.5 million referrals have been processed through HSRM. Our infrastructure connects 9,000 users within the Department of Veteran’s Affairs community care network, giving veterans faster and more efficient access to medical care.

4. How have we provided value with this project?

We have provided a complete turnkey solution that includes development, deployment, training, and support for HRSM. The VA was so impressed with our work that we received a new three-year, sole-source contract. Our work helps the VA:

• Improve Veterans access to community care
• Streamline and accelerate health information exchange, enabling faster and better care coordination and communication
• Consolidate multiple systems into one easy-to-use and secure system, reducing disparate system use and administrative burden
• Standardize patient data inputs, tracks referral workflow, and generate reports to inform decision-making
• Use Standardized Episodes of Care (SEOC), or bundled services, to streamline referral information and reduce the need for Request for Services (RFS)

​​​​​​​5. What are you looking forward to most as a result of this project?

I am looking forward to continuing to grow and improve our current solution together with my team. We’re currently leveraging data analytics to identify HSRM utilization gaps at VA Medical Centers and looking at categories of care to gain a better understanding of how we can further reduce referral wait times. Everything we do is centered around improving access to healthcare for our Nation’s Veterans—the most rewarding part of my job.