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Factsheet HSV101 - Coordinated Veterans' Care Program

Purpose  

This Factsheet provides information about the Coordinated Veterans' Care (CVC) Program, and how you can participate.

What is the Coordinated Veterans' Care Program?

The CVC Program is a team-based program designed to increase support for Gold Card holders with one or more targeted chronic conditions. The CVC Program focuses on improving the management of chronic conditions and quality of life for eligible Gold Card holders who are most at risk of unplanned hospitalisation.

The Program aims to assist you to better understand your health and provide support in self-managing your conditions using a Comprehensive Care Plan (Care Plan). (The Care Plan is also referred to as a General Practitioner Management Plan (GPMP)).

This Care Plan is developed in consultation with you and you will receive a patient-friendly version.

Who is the CVC Program for?

The CVC Program is for Gold Card holders who meet the CVC Program criteria, including:

  • living in the community (not in a Residential Aged Care Facility)
  • have been diagnosed with one or more of the following chronic conditions:
    • congestive heart failure
    • coronary artery disease
    • pneumonia
    • chronic obstructive pulmonary disease
    • diabetes, or
    • some other chronic condition
  • have complex care needs, and/or
  • are at risk of unplanned hospitalisation.

How can I participate in the CVC Program?

Participation in the CVC program is voluntary. If you think you are eligible, talk to your General Practitioner (GP) about assessing your eligibility for enrolment in the CVC Program.

How does the CVC Program work?

After enrolling you in the CVC Program, your GP and nurse coordinator will develop a personalised Care Plan for coordinating and monitoring your ongoing health care.

Your Care Plan will include:

  • detailed information about your medical history
  • goals and strategies for managing your illness or injury
  • details of your medications including dosage, when and how often to take them and when they should be reviewed
  • symptoms you should watch out for, and
  • appointments to specialists and other allied health providers.

You (or your carer) will be given a patient-friendly version of your Care Plan.

The nurse coordinator will explain the Care Plan to you, coordinate ongoing health care and contact you regularly to:

  • help you make appointments with other health professionals involved in your care
  • remind you of appointments
  • monitor your conditions and address any concerns you may have
  • coach and assist you in achieving your health goals, and
  • provide feedback to the GP.

Your GP and nurse coordinator will regularly review your Care Plan, monitor your progress and, where necessary, take appropriate action.

The CVC Program also recognises the benefits of social inclusion in supporting good health. Your GP may identify a need for short-term assistance to encourage you to become involved in community or other social activities. If appropriate for you, your GP will refer you to a Veterans’ Home Care Assessment Agency for an assessment.

Are there any restrictions for entry into the CVC Program?

Yes, you cannot participate if you:

  • live in or are preparing to live in a Residential Aged Care Facility
  • have been diagnosed with a condition which is likely to be terminal within 12 months, or
  • are a participant or plan to participate in a similar Commonwealth coordinated care program.

How will I benefit from CVC?

The CVC Program aims to improve your general health and wellbeing by:

  • helping you to better understand and manage your health
  • helping your carers and family to understand your condition and how they can best help you, and
  • improving communication between you, your GP and your other health care providers.

Can I still go to hospital if I need to?

Yes. The CVC Program aims to improve your health and reduce the need to go to hospital, however you should always go to hospital if you need to.

Will there be any cost to me?

There is no cost to enrol in or remain a participant in the CVC Program. You will still be required to meet co-payments that exist for other DVA services that form part of your Care Plan.

Will the CVC Program affect my other DVA entitlements?

No, participation in the CVC Program will not affect your other DVA entitlements.

More Information

DVA General Enquiries

Phone: 1800 555 254 *

Email: GeneralEnquiries@dva.gov.au

DVA Website: www.dva.gov.au

Factsheet Website: www.dva.gov.au/factsheets

* Calls from mobile phones and pay phones may incur additional charges.

Additional Information

DVA Service Provider Enquiries

Phone: 1800 550 457*

Service Provider Website: www.dva.gov.au/providers

Transport Bookings

Phone 1800 550 455*

Veterans' Affairs Pharmaceutical Advisory Centre (VAPAC)

Phone: 1800 552 580*

Open Arms - Veterans & Families Counselling

Phone: 1800 011 046 *

Email: openarms.coord@dva.gov.au

Open Arms - Veterans & Families Counselling: www.openarms.gov.au

At Ease Website: www.at-ease.dva.gov.au

Related Factsheets

Disclaimer

The information contained in this Factsheet is general in nature and does not take into account individual circumstances. You should not make important decisions, such as those that affect your financial or lifestyle position on the basis of information contained in this Factsheet. Where you are required to lodge a written claim for a benefit, you must take full responsibility for your decisions prior to the written claim being determined. You should seek confirmation in writing of any oral advice you receive from DVA.

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6 April 2018