We at AUSA Family Programs believe that the more knowledge our soldiers and their families have, the better able they are to make good choices and to address the challenges they may experience.We strive to assist them in gaining that knowledge by providing information about various programs.Unless you know about something you cannot take advantage of it and, therefore, you may be missing out on opportunities to request or access programs which best suit your needs.The following information is about a demonstration project for veterans requiring a specific health care service that is currently being piloted in select regions.The medical world is a mystery to most people, but if you are a military veteran patient, enrolled in the Department of Veterans Affairs (VA) medical system, and have been referred to the civilian community for specialty care or diagnostic tests it may truly become an ordeal.The patient must then go outside of the VA system to receive care from a community doctor.In 2006, Congress directed the VA to conduct a demonstration project designed to assist veterans in finding qualified doctors and making appointments. In response, Project HERO was born.Project HERO (Healthcare Effectiveness through Resource Optimization) is a congressionally-mandated five year demonstration project which was competitively awarded by the Veterans Health Administration (VHA) to Humana Veterans Healthcare Services, Inc. (Humana Veterans) in October 2007.The Project HERO contract covers medical/surgical services, mental health services, diagnostic services, and certain other services in four Veterans Integrated Service Networks (VISNs), which span 23 states: VISN 8 (Sunshine Healthcare Network); VISN 16 (South Central Healthcare Network); VISN 20 (Northwest Healthcare Network); and VISN 23 (Midwest Healthcare Network).If the VA exercises all contract option periods, the program will run through Sept. 30, 2012.VA facilities not under the contract continue to use the old system which means the patient has to find a doctor and make his or her own appointment.Project HERO has evolved since its inception and is now a veteran-centric program that provides personalized health care services directed to the individual needs of veterans when they are referred outside of the VA health care system for specialty or diagnostic care.Unfortunately, Project HERO was not made mandatory in the four VISNs. VA continues to run the old Fee Basis Program alongside the new system, which limits the effectiveness of the benefits described below.To begin the referral process under HERO, the patient’s Veterans Affairs Medical Center (VAMC) initiates the process by sending an authorization for outside care to Humana Veterans requesting specific specialty services.VAMC fee office staff may elect to utilize the Project HERO contract when specific medical or technological resources are not available inside the VA health care system.Project HERO supplements the VA health care system while maintaining Veterans Health Administration (VHA) quality and access to-care standards.The Humana Veterans Personalized Healthcare Solution (PHS) under the Project HERO contract offers substantial value compared to the traditional VHA Fee Basis Program.While the traditional VHA Fee Basis Program places full responsibility for care on the veteran, Humana Veterans guides the veteran through every phase of the process.After receiving an authorization from the VAMC, Humana Veterans contacts the veteran by phone to explain the process and to determine the best time for the medical appointment based on the veteran’s personal availability and specific needs.After this preliminary call, Humana Veterans then conducts a three-way appointment scheduling call with the veteran and a credentialed provider chosen from the Humana Veterans provider network based on location, availability and required expertise.In addition, Humana Veterans provides driving directions to the veteran if needed and conducts reminder calls to the veteran prior to the appointment date.As a condition for participation within the program, Humana Veterans’ network providers have agreed to schedule veteran appointments within 30 days and limit the veteran’s wait time to no longer than 20 minutes from the appointment time.This veteran-friendly appointment process has resulted in a veteran no-show rate of less than 7 percent, which compares very favorably to the community incidence of 20 percent or higher.Another significant benefit to the Veteran, and to VA, is the fact that Humana Veterans coordinates the transfer of any required pre-visit clinical information from the VA Medical Center to the Humana Veterans network provider.In addition, Humana Veterans ensures that the record (i.e., the specialist’s written Consult Report) is transferred to the VAMC in a timely manner in order to ensure continuity of care for the veteran.Humana Veterans returns these medical records to the VAMC in an electronic format within 16 days on average. After the Veteran’s appointment with the Humana Veterans network provider, the veteran returns to the VA primary provider for continuity of care.Humana Veterans is committed to a seamless "hand-off" of the veteran back into the VA system.The credentialing and accreditation requirements contained in the Project HERO contract ensure that veterans are treated by highly competent, qualified specialists.These pre-screened credentialed providers enhance the quality of the veteran’s health care experience. This quality cannot be guaranteed in the traditional VHA Fee Basis Program since veterans are responsible for finding their own provider without the benefit of any means to verify the qualifications of the specialist.Humana Veterans operates a Clinical Quality Management Program that investigates, monitors, tracks, and trends any potential quality issues, safety events, complaints, and grievances.A joint VA/Humana Veterans Clinical Quality Committee provides oversight to this program. In addition, veterans are provided access to a Humana veterans’ patient advocate and the Humana Veterans Customer Care Department throughout the entire experience.These benefits are substantial improvements to the traditional VHA Fee Basis Program.In addition to the significant benefits Project HERO provides to veterans, it also provides significant benefits to the Department of Veterans Affairs.Under Project HERO, providers submit their claims directly to Humana Veterans which pays providers directly within 30 days of receipt of the claim. Humana Veterans then bills the VAMCs based on the contractual rates established in the contract. This process greatly reduces errors and improper payments which are prevalent in the traditional VHA Fee Basis Program.The controls and processes established under the Project HERO Program enhance the efficient utilization of VA resources and taxpayer dollars in treating our nation’s veterans.An additional benefit provided by Humana Veterans to the Department of Veterans Affairs under the Project HERO Program is the Humana Veterans Data Mart system.The Data Mart system captures and maintains all data related to the healthcare service provided to the veteran. This system allows the local VA user to create management reports based on service type, timeliness, clinical data return, and claims information. This amount of data is simply not available within the traditional VHA Fee Basis Program.Humana Veterans through the Project HERO Program has demonstrated superior value to both Veterans and the Department of Veterans Affairs in terms of clinical quality, clinical information return, access to care, timeliness of care, convenience, customer service, patient advocacy, data availability, claims payment and financial controls.While these benefits are currently being realized in four VISNs, it seems they could certainly enhance the healthcare experience for our nation’s Veterans throughout the VHA health care system.