The ongoing transformation of VHA reaches deeply into P&LO, one of the largest purchase and supply organizations in the federal government. P&LO provides VHA medical sites with everything from office supplies to advanced pharmaceuticals and medical instruments.

The team drew on its past success in helping federal agencies with business transformation. In just weeks, P&LO received detailed operational plans for its ILBT initiatives.

The team also gave P&LO a highlevel plan for internal integration of its two largest teams: purchasing and supply/logistics teams. This roadmap is designed to strongly align with the ILBT initiatives, while improving P&LO’s ability to support VHA’s achievement of desired health outcomes for Veterans. P&LO embraced this recommendation, and requested continued support for its new “One P&LO” vision.

The need is clear. Cyber and infrastructure attacks on government, business, education, and health care increased—again—in 2019. In May alone, a ransomware attack on Baltimore cost the city $18.5 million, the hack of a health care company exposed 11.9 million patient records, and an agency of the federal government saw confidential data stolen from a subcontractor. Nearly 1,000 other cyberattacks hit the U.S. during the year.

The White House publicly acknowledged in its 2018 government reform plan that “the federal government struggles to recruit and retain cybersecurity professionals.” The reform plan emphasized the need for innovative approaches to hiring cybersecurity talent and to deploying them more nimbly against emerging threats. That’s because cyber warfare is highly fluid and unpredictable, and traditional government service hiring rules have not been flexible enough to enable and incentivize unique and in-demand skillsets.

In 2019, Atlas brought its expertise to the nation’s fight against cyber and infrastructure threats by winning a major contract to help DHS’s Cybersecurity and Infrastructure Security Agency (CISA) develop a critical workforce of cybersecurity talent.

Faced with a need to add hundreds of people to their workforce efficiently and creatively, CISA’s Office of the Chief Human Capital Officer (OCHCO) tasked Atlas to support the full range of human capital functions, including:

• Policy, strategic planning, and workforce planning
• Recruiting, hiring, and training
• Human resources processing and data analytics
• Business process improvement
• Program management and administrative support

Atlas uses its extensive human capital expertise across the entire employment lifecycle, including the innovative use of data analytics to inform hiring strategies and practices and deep experience in improving organizational performance in the federal government. Atlas is currently executing on its full range of responsibilities with a blend of sophistication, speed, and sensitivity.

VHA P&LO originally engaged Atlas in 2016 to spearhead a fundamental shift: integrating equipment purchases that had long been decentralized in VA medical centers (VAMCs). Atlas continues to support P&LO with this transformation by working with clinicians, logistics managers, and biomedical engineers to deploy key parts of the operational model.

In 2019, Atlas worked across the VHA system to deploy the operational model by engaging stakeholders from the field and breaking down barriers to change. The team developed tools to gauge clinicians’ equipment preferences and championed a clinically driven strategic sourcing initiative to place these items on contract. Atlas engaged VHA stakeholders to organize a pilot project in the field for speeding and simplifying acquisition of high-tech medical equipment. With that capability, P&LO will be able to refine its acquisition processes for almost any requirement.

Beginning January 1, 2021, the U.S. will take a historic step toward ending health care industry practices that hide prices from patients. A powerful price transparency rule will go into full effect that requires hospitals to post the standard charges for its items, services, and procedures on the internet in a machine-readable format. Making hospital charges transparent and available to the public aims to bring market forces into play—increasing competition and reducing prices.

Well before this new era arrives, the Federally Funded Research and Development Center (FFRDC), operated by the MITRE Corporation in support of the Centers for Medicare & Medicaid Services (CMS), began helping the federal government and industry stakeholders prepare for it. As part of the MITRE FFRDC team supporting this effort, Atlas experts researched a range of policy and practical issues ahead of the policy development, contributing to detailed environmental scan reports that summarized price transparency literature and described the features of third-party, web-based tools and resources already available to consumers. Atlas personnel also structured and coordinated pivotal conversations with stakeholders, including patient advocates, electronic health record companies, and application developers.

To support CMS as they prepare for rule implementation, Atlas supported qualitative and quantitative research to assess hospitals’ readiness, understand the current price transparency environment, and help consumers understand how to use the new information to effectively compare prices. Atlas will continue to support the development of implementation guidance to ensure compliance.

Board certification is the gold standard of medical practice. While medical licenses set a minimum level of general competence, board certification demonstrates exceptional expertise in a specific field. That’s why patients and other health care providers look for a board-certified physician when they want assurance of excellence in a given specialty.

FDA increasingly relies on an emerging specialty known as clinical informatics, which applies information technology to health care data to improve patient outcomes—ideally at lower cost. Individual physicians use clinical informatics to assess patients, prescribe treatments, and monitor results. FDA multiplies those benefits by millions of patients, because the agency is applying clinical informatics to evaluate treatments and devices used by physicians across the health care spectrum.

In 2019, Atlas sped into action to put FDA physicians and supporting staff on a fast path to board certification in clinical informatics. Atlas instructional designers rapidly performed a gap analysis to identify the skills and knowledge FDA personnel needed to pass a demanding examination. Next, Atlas experts created a customized, high-intensity training course to help students absorb new knowledge quickly and sustainably. Then, when COVID-19 emerged, they pivoted quickly from live classes to video training to accommodate social distancing.

The U.S. freight railroad system moves more freight than any other in the world, with well over one million carloads in an average month. The FRA, within the Department of Transportation, is responsible primarily for keeping the railroad network safe for both goods and people—a mission that increasingly requires more advanced technology, tighter cross-functional collaboration, and systematic mitigation of retirement risk.

That’s why FRA selected Atlas to create a new five-year Strategic Human Capital Plan in 2019: Atlas experts bring deep human capital experience, technological sophistication, and proven ability to positively engage all types of employees in workforce planning. The Atlas team quickly dove into FRA’s workforce trends and challenges, conducting 33 in-depth focus groups with 15 percent of the organization’s employees from every level and geographic region.

Among the key findings: workers are hungry for tech training; past advances in recruiting and onboarding still need refinement; and with an aging workforce, FRA must improve succession planning and retain institutional knowledge. In the Strategic Human Capital Plan for 2020–2024, Atlas detailed employee perceptions regarding 11 high-priority issues and provided FRA with practical solutions for all of them. The entire project was completed in just six months.

Among active duty Service Members in the U.S. armed forces, approximately 14 percent receive diagnoses of psychological and behavioral health conditions, but a large proportion who have symptoms don’t seek care, get a diagnosis, or take advantage of the resources available to them. This limits overall mission readiness for military services.

Atlas began working with the DoD Psychological Health Center of Excellence in 2017 to simultaneously decrease the stigma associated with mental and behavioral health conditions while increasing the utilization of programs available to address them. Atlas experts helped plan and implement numerous changes, including:

• Systematically revising active duty Service Member communications that used language that stigmatizes mental or behavioral health conditions
• Identifying reasons why Service Members were not accessing mental health care
• Improving outreach and effectiveness of programs targeted to combat and operational stress control (COSC) in the military services

By 2019, Atlas conducted expert analysis of more than 200 mental health policies across the Services, helping to address and destigmatize psychological health care at the headquarters level. In addition to policy review, Atlas supports COSC programs through the standardization of data collection, program monitoring and evaluation, and recommendations for program improvement and sustainability.

After Congress passed the Appeals Modernization Act of 2017, the Board engaged Atlas to develop and deliver change management strategies to ensure timely implementation of the law. Less than a year later, the Office of Personnel Management identified the Board as a bottom performer in employee engagement and issued a memo requiring the Board to improve its employee engagement index (EEI) by 20 percent by June 2020. With just 18 months to achieve this goal, the Board again partnered with Atlas—this time to develop a strategic plan to dramatically improve its employee engagement scores.

After conducting a rigorous assessment, Atlas developed an approach that the National Center for Organizational Development praised as a shining example for the rest of VA. The strategy leveraged best practices and insights from Atlas’ previous work with the Board to develop a customized framework focused on improving trust in leadership, growth opportunities, proactive management, competence and training, work environment, and connection to the Board’s mission.

Atlas diffused employee engagement strategies, programs, and values across the Board, focusing on energizing employees’ collective commitment to serving Veterans. In June 2019, the Board achieved the highest increase in EEI among all Veterans Affairs Central Office (VACO) organizations— increasing its EEI by 23 points.

The Agency for Healthcare Research and Quality (AHRQ) is the nation’s leading federal agency charged with improving health care safety and quality. It funds research, creates education and training materials, and generates metrics and data that guide the nation in changing how health care is provided and how it is funded.

Over the past decades, AHRQ has developed rich repositories of data on patients, providers, expenditures, and more. Yet almost all of these data tools were built independently from each other, usually with customized software, resulting in a lack of a consistent user interface that brands them as all being from AHRQ. In addition, many of these data tools are tethered to outside vendors that maintain them.

In the short span of the contract, Atlas showed AHRQ how it could harmonize access to its various data tools by using a single portal, and also present the data visually to make each tool easier to understand. Once created, the working prototype Atlas proposed will demonstrate how AHRQ can remove control of its data tools from the various IT interfaces, making them less costly to expand and maintain, and more easily transferred between vendors.

On May 20, 2019, VA officially made the customer experience of U.S. Veterans a core principle that defines the department itself. This watershed moment highlighted the remarkable success of the Veteran’s Experience Office (VEO), which Atlas has served with distinction since 2016.

VA created VEO to address Veteran concerns. It was funded like a small start-up but given a huge mission: lead a major improvement in customer satisfaction across all administrations within VA. When VEO engaged Atlas for help with this massive task, Atlas experts responded with a mission-sized solution: using human-centered design to modernize VA’s legacy infrastructures and processes.

This strategy put the Veteran at the center of every VA function and communication. Atlas teams quickly demonstrated success in multiple projects, such as standardizing processes across VA’s 200 contact centers around the country and managing development of a VA-wide digital identity record for every Veteran. Atlas was also instrumental in creating Veteran Journey Maps and the VA Welcome Kit, which depicts the VA services applicable to each stage in the Veteran journey and provides information on accessing those services. The small start-up is now a big player, as Lead Agency Partner for the President’s Management Agenda (PMA) Cross-Agency Priority (CAP) Customer Experience (CX) Goal.

VHA is developing a living, thriving Innovation Ecosystem that can continually improve the lives of Veterans in measurable ways. Major milestones include:

• The Diffusion of Excellence program for replicating and scaling innovations systemwide
• The Innovators Network, which creates capacity for innovation through dedicated specialists at VHA sites across the country
• The Innovation Experience, which is an annual public event that brings hundreds of frontline employees together with VHA leaders, media, and academics to explore and celebrate new ideas at every stage of development

In 2019, surging participation in the VHA Innovation Ecosystem presented VHA with a welcome challenge: how to harness it. Atlas helped VHA develop a stable, repeatable, transparent structure for taking an innovation from concept to fruition. Atlas experts then developed an operational model that is simple yet powerful. It defines measurable target outcomes for innovations and provides guiding questions at every stage to help determine if an idea should continue to advance. New innovations are as welcome as ever; now they have a clearer path forward toward making a difference.

The world’s best-run organizations are exposed to the same set of risks as everyone else, but they establish internal control environments that proactively prevent surprises. This sets up their sustainable success: they can focus their attention on their missions rather than on recovering from missteps or oversights.

In 2019, Atlas performed several multi-year contracts with federal agencies seeking stronger, more effective internal control environments, including the National Science Foundation and VHA. Atlas experts draw on best practices, such as the “three lines of defense” model, to craft tailored solutions in the areas of internal controls governance; risk assessment; independent assurance; management oversight; internal controls policy and procedures establishment; and staff training.

A highlight during the year was completion of a contract with VHA’s Office of Community Care (OCC). The mission of OCC is to manage a popular option among Veterans: using their VHA-funded health care benefit with providers outside the VHA network. To minimize the inherent risk in paying for private care with public funds, Atlas designed and helped OCC implement a program for handling community care claims and disbursements consistently and transparently.

Since 2016, Atlas has been helping VA catch up to a demographic wave: the number of women Veterans is climbing even as the total Veteran population declines. This sparked recognition that one of VA’s most vital benefits is not gender-neutral. Women Veterans need and deserve health care aligned with their biology.

Atlas originally provided VHA with a detailed understanding of how VAMCs nationwide performed in providing health care to women. Atlas experts then developed a detailed methodology for achieving evidence-based quality improvement (EBQI) at sites with the greatest need and worked onsite with 21 of them to deliver measurable improvements. Examples include procurement and standardization of gender-specific medical supplies in exam rooms, access to designated providers with proficiency in women’s health, and more timely scheduling and follow up for preventive health screenings.

The model succeeded so well that other VAMCs are now requesting it. In partnership with PFS, Atlas experts are applying the road-tested EBQI methodology with a rapid process improvement approach. They first guide VAMC leaders, providers, and frontline employees to collaborate in identifying and prioritizing practical goals. Then, Atlas backs them up with implementation processes, technical assistance, and expertise in culture change, policy compliance, and data management. There’s still a long road ahead, but now it’s surely paved with progress.

In 2019, Atlas continued a five-year project that has convincingly demonstrated the effectiveness of the Youth Health Equity Model of Practice (YHEMOP)—expanding the pipeline of health professionals with the cultural, linguistic, and health equity competencies required for an increasingly diverse population. A shortage of such professionals led the Office of Minority Health (OMH) within HHS to launch the project in 2014.

The central strategy was to pair undergraduate, graduate, and doctoral students with health care and public health organizations, where they could engage in real-world health equity work. From inception, Atlas experts provided program management, recruiting, education, and research and evaluation support for YHEMOP while also documenting best practices and framing policy recommendations for OMH.

The five cohorts of Health Equity Fellows—as the participating students are known—performed their YHEMOP work in academic institutions, federal government offices, Regional Health Equity Councils, and professional associations around the country. During and after their tenures, Atlas connected them with mentors and other Fellows to help them build professional networks. Year after year, Fellows who came into YHEMOP with uncertainty about a health-related career gained the clarity and confidence to join the next generation of health professionals that our nation so urgently needs.

Atlas continues to help the nation take better care of young people. Since 2016, Atlas has been working with Emergency Medical Services for Children (EMSC), the only federal grant program focused specifically on improving emergency care for the nation’s 73.4 million people under 18. Atlas experts have contributed to EMSC’s national strategy, development of its current five-year roadmap, completion of milestone projects, and more.

EMSC, a program of the Maternal and Child Health Bureau within the Health Resources and Services Administration (HRSA), works with an impressive set of stakeholders. They include state EMS agencies; professional associations for doctors, nurses, and emergency medical service providers; a Family Advisory Network (FAN) that partners with state EMSC projects; quality improvement and data analysis resource centers; and federal agencies, including “HHS—home to HRSA—and the National Highway Traffic Safety Administration.

In 2019, Atlas leveraged its expertise in both health care and stakeholder engagement to help EMSC advance on three fronts simultaneously. The new Critical Crossroads toolkit helps emergency departments create a care pathway for pediatric patients who present with mental health crises. Atlas also launched a series of FAN webinar workshops and helped support the launch of a vital push toward greater pediatric readiness among prehospital EMS providers.

In less than five years, Atlas has built an industry-leading facilities activation practice that is helping VHA open new medical clinics, add mental health capacity, and step up services for its growing population of female Veterans. The Atlas team first proved itself with rapid-fire activations of large, high-visibility VAMCs in Denver and New Orleans. In 2019, Atlas has worked as a subcontractor to Strategic Medical Equipment Solutions, LLC (SMEs) on Service-Disabled Veteran-Owned Small Business contracts, such as multiple VHA facility activations in Arizona, Florida, Indiana, and Nebraska.

Activating a medical facility means turning a bare-bones building into a buzzing hive of modern medicine and human caregiving that’s furnished from wall to wall, served by high-tech infrastructure, and run with hundreds of precision operating policies. It’s like a race that a dozen teams all have to win—at exactly the same time.

The team brought to bear a combined 100 years of experience from helping guide activations at more than 30 health care facilities. Each member brings complementary domain expertise and a passion for overcoming challenges. The team collaborates internally and with clients at an extraordinarily high level in part because of its own specialized technology: the Atlas Facility Activation System (AFACTS™). AFACTS™ is an information management system so valuable that VA has vetted and now hosts it on its own web domain for managing activations.

VHA Facilities Activation Projects

• Omaha, Nebraska: Public/nonprofit partnership, Ambulatory Care Center addition to existing VAMC; includes dedicated women’s clinic
• Phoenix, Arizona: Four clinics become one super-clinic offering telehealth services, expanded specialty clinics, and mental health services
• Gainesville and Ocala, Florida: Two medical clinics and a mental health facility
• Terre Haute and West Indianapolis, Indiana: Outpatient and mental health clinics in two cities