Changes at the VA: Gaudet Exits, Kligler in New Role, Integrative Whole Health in 37 new Locations

Changes at the VA: Gaudet Exits, Kligler in New Role, Integrative Whole Health in 37 new Locations

Word began to break mid-summer of two developments at the Veteran’s Administration related to the giant agency’s integrative whole health effort. One was that Tracy Gaudet, MD, the charismatic founding director of the VA’s Office of Patient-Centered Care and Cultural Transformation that birthed the initiative was moving on. The immediate response of many is concern. Yet the news came concurrently with word that the VA’s initiative is expanding from the initial 18 to 37 new sites. Even with leadership change at the top of the VA, the initiative is secure and strongly supported. I connected with Ben Kligler, MD, MPH, Gaudet’s colleague who is presently acting director for an update.

First, Gaudet. The news is yet slim. She shared that she had been approached by an extremely well-funded philanthropist to lead what could be a huge roll out the VA’s whole health model in healthcare organizations and communities outside the VA national and potentially internationally. It was an offer she couldn’t refuse. Yet an anticipated announcement has not yet materialized. Gaudet left the VA in late August. More news when it arrives.

Meantime, I caught up with Kligler November 13, 2019 in the midst of a week in which he had not one but two trips between his New York office and the VA in Washington, DC. Gaudet had brought Kligler in to direct the Integrative Health Coordinating Committee that is driving the whole health initiative’s research, clinical and education agendas.

Gauder had ample evidence of Kligler’s capacity for leadership, and for work. He led one of the nation’s most significant integrative clinical care programs at Continuum Health Partners. His research with a focus on services to the underserved has included multiple papers based on a Patient Centered Outcomes Research Institute (PCORI) grant. His roles as educator-leader range from co-founding the integrative medicine section at the Society of Teachers of Family Medicine 20 years ago to an influential term a dozen years later as chair of the Academic Consortium for Integrative Medicine and Health. A piece of Kligler’s work there was in helping guide the Consortium’s successful petition to the Joint Commission to reconsider the science supporting non-pharmacologic approaches to treatment of people with pain that led to the revision of the pain standard.

Gaudet knew who she was hiring. Kligler, however, makes clear that he is not interested in moving from acting director to full time director of the VA’s Office of Patient-Centered Care and Cultural Transformation.

The Executive Director role is interesting and challenging work. But my passion is really for the work I have been leading in my regular role and I very much want to keep the momentum going there. That work focuses on educational programming, helping develop the VA research agenda for integrative health, and supporting VA clinicians in the field in building new clinical models that work. Al of  that really draws on the substance and expertise in my professional experience. Our team leads in those program areas are  doing a great job of stepping up as I’ve  taken on Tracy’s  role. I’m happy to step up into that role for as long as the office and the system need me to, but I’m looking forward to moving my focus back to those programs.

The timing of transition to the next director is not clear. Kligler notes that filling personnel vacancies at the top of large agencies throughout the federal government can be a long process. He notes that one unofficial member of the present team who is working from outside the VA is US Army Surgeon General Eric Schoomaker, MD, PhD. Schoomaker, who has played multiple key roles over the past decade in bridging integrative and military medicine, has helped particularly in communications with the DoD and Veterans’ services organizations.

Kligler can’t say enough about with the ample good news from the VA’s whole health initiative.  The VA leader Secretary Robert Wilkie is “100% behind” the whole health direction. Kigler and I reflected on how many times changes in conventional leadership in major institutions with integrative programs have proven problematic. That isn’t happening here. On the contrary, the whole health initiative that began being piloted in at least one facility in each of the 18 regions is now spreading into 37 new facilities – at least two more in each region.  The leaders for each new site met for a learning collaborative in September in Los Angeles to kick off their work. Kligler highlighted a few discipline-specific advances:

  • Acupuncturists There are now 60 licensed hired acupuncturists hired across the system and “it seems like we are hiring a new one every couple of weeks.”
  • Massage therapists Kligler notes that massage therapy “meets the evidence threshold for inclusion”  and is now part of  VA medical benefits. The services are typically available for pain-related conditions. At some VA sites this is offered at the facility and in other areas the services are available via community massage therapists. .
  • Naturopathic doctors A VA interdisciplinary working group is presently looking into this licensed discipline to make recommendations. (The American Association of Naturopathic Physicians has its own internal VA team also working on the issues.) Kligler notes a couple of abiding challenges. One is the lack of licensing in most states. A second is the clinical issue raised by the fact that naturopathic doctors often use many laboratory tests and supplements that are not covered by the VA.

Kligler then reflected broadly on how the developments in the VA’s whole health signal a maturation of the initiative even through the transition of Gaudet’s departure.

Tracy’s strong leadership was essential in getting us to where we are now with Whole Health. But we have so much momentum now that the effort really doesn’t depend any more on any one specific person. It’s being led from all over the system – from Central Office to the regional leadership and all the way into the field. The VA has really bought into whole health. And it’s not just in the 18 initial pilot sites or the next wave of 37—there are many initiatives in other sites, hiring health coaches, adding other integrative services.

It is remarkable that when one searches for the “VA Office of Patient-Centered Care and Cultural Transformation” the first link that first comes up is “www.va.gov>patientcenteredcare”. Click there, however, and one is sent to this site: www.va.gov/wholehealth/. What greets you there is a banner that connects “VA Benefits and Health Care” directly with “Whole Health”. Quite a message. The idea of the “cultural transformation” that Gaudet was hired to lead has gained an official and abiding name.