Episode #165: The VA as a “test kitchen” for care transformation in US healthcare – with Dr. Cole Zanetti



This dialogue is a Master Class in Care Transformation – likely owing to our guest’s unique background, which includes preventive medicine, public health, and clinical informatics. It should be required listening for all healthcare executives and managers – both clinical and administrative – as well process/quality improvement professionals. Our guest, Dr. Cole Zanetti is an insightful and brilliant process improvement and care transformation expert. He has a broadly empathetic perspective and a practical humanistic vision that is the foundation for his work and his leadership. 

Dr. Zanetti currently serves as a Senior Advisor for the Veteran Affairs National Center for Care and Payment Innovation – focusing on value-based care delivery and payment innovation pilots as well as emerging technology innovation pilots. He also serves as the Chief Health Informatics Officer for the Ralph H. Johnson VA Medical Center in Charleston South Carolina, and as the Director for Digital Health at Rocky Vista University College of Osteopathic Medicine. Dr. Zanetti was trained in Family Medicine and Leadership Preventive Medicine at Dartmouth Hitchcock Medical Center. He is triple board certified in family medicine, preventive medicine, and clinical informatics – and has a Masters in Public Health from the Dartmouth Institute for Health Policy. He has also served on the National Quality Forum’s Physician Advisory Committee and as a technical expert for the Centers for Medicare & Medicaid Services.  

A few months prior to this interview I heard Dr. Zanetti speak about the cutting-edge, digital-tech innovations being deployed within the VA. My intention going into the interview was to do a deep dive on those care delivery innovations. But, this conversation went in an unexpected direction, which I’m truly grateful for. We ended up exploring the philosophical underpinnings of transformation and the approaches Dr. Zanetti has had to adopt in order to do this work. In short, we discussed the ‘why’ and the ‘how’ of care transformation.  

Some of the areas we covered include:


  • Why Dr. Zanetti firmly believes that a serious commitment to and more significant resourcing of care transformation and digital transformation is critical – for patients, for providers and their staff, and for the survival of the mission of Medicine. 
  • How the VA is uniquely positioned to be a transformation center – a “test kitchen” for care delivery – not only for Vets but for the entire American healthcare system. 
  • The approaches that Dr. Zanetti has learned and adopted as a leader in care transformation – with a particular focus on inquiry and positive deviance.

This interview uncovers another example of how the VA is one of the most innovative and transformational healthcare systems in the country. I continue to be astounded by the “hidden gems” – the forward-thinking, nationally leading expertise and initiatives within the VA, and the unique factors that make the VA ideal for ideating, piloting, deploying and studying care transformation.

Towards the end of our dialogue, I promised that I would follow up with a part 2, which I will – in which we’ll dive into the specific digital tech innovations being deployed in the VA.

In the meantime, I hope you have a chance to glean the wisdom and humanity of Dr. Cole Zanetti.

Until Next Time, Be Well
Zeev Neuwirth, MD