Supporting Veterans’ Health: Community Care Referral and Authorization Program (CCR&A)

The Context 

The Department of Veterans Affairs (VA) aims to provide eligible Veterans the care they need at the right time, from the right provider in the right place. The right place may mean care is provided by a member of VA’s Community Care Network (CCN).

Community care benefits Veterans by offering quicker access to quality care closer to their homes. The VA partnership with community care providers ensures Veterans receive the care they earned and deserve.

The Challenge

Prior to Cognosante’s CCR&A project, referring Veterans to community care was a time-consuming task for VA staff. Data gathered from multiple systems involved manual processes and once referrals were scheduled, community providers lacked information for follow-up treatment, and reimbursement procedures made it difficult to participate in the program.

Our Innovative Solution

Cognosante created a turnkey solution to streamline the referral process. CCR&A also gives community providers and VA staff access to information through a single interface. The user-friendly interface addresses VA’s intent to deliver the full spectrum of care to Veterans in the shortest time possible.

A key component of CCR&A, known as HealthShare Referral Manager (HSRM), automatically generates referrals and authorizations for Veterans receiving care in the community. This secure, cloud-based solution—developed in partnership with InterSystems—operates on Amazon Web Services (AWS) GovCloud to integrate bi-directional exchange of appointment data between community providers, VA‘s electronic health record, and other VA systems. As the first VA project to receive an Authorization to Operate (ATO) for cloud deployment, the CCR&A system is rated at FedRAMP FISMA High and optimized regularly to be as responsive as possible to requested changes.

Additionally, the solution consolidates more than 25 other VA systems into one interface to allow faster financial and clinical processing. Workflow automation simplifies the referral process, standardizes it to align with industry standards and creates a unified platform for VA and community providers. Most importantly, it decreases the administrative burden on VA staff so they can focus on the patient. CCR&A improves Veteran access to care by reducing turnaround time for appointments and streamlines care coordination. The solution is now an integral component of the VA Community Care information technology architecture.

Our Tangible Results

Since its launch in 2019, one of the CCR&A system’s major milestones was its generation of more than ten million community referrals and authorizations for more than three million Veterans, and reduced wait times of 75 percent. It has since generated more than sixteen million referrals and authorizations. The automation of the overall process is also less costly for the Veteran and VA.

The success of CCR&A has Cognosante engaged with the upgrade and development of a modernized system for VA’s Emergency Care Reporting (ECR). Like the CCR&A system, ECR makes it easier and faster for Veterans to get authorizations for prior care, specifically for emergency healthcare services. This modern, web-based portal replaces an antiquated method that relied on paper, fax, email and Sharepoint.

Cognosante’s work on the CCR&A program was recognized in 2021 by FedHealthIT as an Innovation Award winner and by WashingtonExec as a Pinnacle Award winner for Government Team Project of the Year.

Learn more about how Cognosante designs, develops and delivers innovative Enterprise IT solutions that are robust functional, scalable, secure, and independently validated—so government agencies can focus on their mission.