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VA Office of Rural Health Gina L. Capra, MPA Director, Office of Rural Health (ORH) Office of the Assistant Deputy Under Secretary for Health (ADUSH) for.

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Presentation on theme: "VA Office of Rural Health Gina L. Capra, MPA Director, Office of Rural Health (ORH) Office of the Assistant Deputy Under Secretary for Health (ADUSH) for."— Presentation transcript:

1 VA Office of Rural Health Gina L. Capra, MPA Director, Office of Rural Health (ORH) Office of the Assistant Deputy Under Secretary for Health (ADUSH) for Policy and Planning Veterans Health Administration (VHA)/Department of Veterans Affairs (VA)

2 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 2 Todays Presentation Mission and Overview Demographics and Needs Focus and Resources Environment and Collaborations

3 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 3 Mission of the Department of Veterans Affairs (VA) …to care for him who shall have borne the battle and for his widow and orphan… - Abraham Lincoln, 1865 Photo by Jeff Kubina

4 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 4 Department of Veteran Affairs (VA) Mission, Core Values & Characteristics VA Mission: …to care for him who shall have borne the battle and for his widow and orphan… VA Core Values: I CARE - Integrity, Commitment, Advocacy, Respect & Excellence VA Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile and Integrated

5 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 5 What is the Department of Veterans Affairs (VA)? Established in 1930 Elevated to Cabinet level in 1989 Federal governments 2 nd largest department after the Department of Defense Three components: – Veterans Health Administration (VHA) – Veterans Benefits Administration (VBA) – National Cemetery Administration (NCA)

6 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 6 Improve Health and Well-being Provide Exceptional Health Care Honor Americas Veterans Veterans Health Administration (VHA) Mission

7 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 7 VHA is the Largest Integrated Health Care System in the United States 151 Hospitals 995 Outpatient Clinics (Hospitals, Community, Independent and Mobile ) 135 Community Living Centers 300 Readjustment Counseling Centers Vet Centers 103 Domiciliary Resident Rehabilitation Treatment Programs

8 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) Veterans Integrated Service Networks

9 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 9 Eligibility for VHA Healthcare Eligibility for VHA health care services depends on a number of qualifying factors, including: – The nature of a veterans discharge from military service (e.g., honorable, other than honorable, dishonorable) – Length of service – VA adjudicated disabilities (commonly referred to as service- connected disabilities) – Income level – Available VA resources

10 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 10 Who is eligible for VHA Healthcare? Veteran eligibility for VA healthcare is based on category group (Priority Enrollment Group) Category Group 1 Veterans with service-connected disabilities rated 50% or more disabling Category Group 2 Veterans with service-connected disabilities rated 30% or 40% disabling Category Group 3 POWs, Purple Heart recipients, those rated 10% or 20% disabled, or those eligible under Title 38, U.S.C., Section 1151 Category Group 4 Veterans who receive aid and attendance or housebound benefits or are catastrophically disabled Category Group 5 Veterans whose income and net worth are below established VA thresholds of $31K - $46K annually, (depending on family size), those on VA pension and/or are eligible for Medicaid benefits Category Group 6 WW I, Mexican Border War Veterans, disorders associated with exposure to herbicides (Agent Orange) while serving in Vietnam, exposure to ionizing radiation in Hiroshima and Nagasaki, Gulf War illness. Category Group 7 Veterans who pay co-payments with income and/or net worth above the VA threshold Category Group 8 Veterans who agree to pay specified co-payments with income and/or net worth above the VA threshold and HUD geographic index who were enrolled before January Income requirements may change from year to year.

11 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 11 Population Served Of 8.3 million enrolled Veterans, 3.1 million enrolled Veterans live in rural/highly rural areas 22 million Veterans nationwide 6.1 million Veterans living in rural areas 36% of total enrolled Veteran population live in rural/highly rural areas About one-third (31 percent) of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) users of the VA Health Care System in FY12 reside in rural or highly rural areas. 11 U.S. Population Density, 2011 Rural Area: Any non-urban or non-highly rural area. Highly Rural Area: Any areas in counties having < 7 civilians per square mile. Enrolled Veteran Population Density, FY 2010

12 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 12 How are rural communities (and Rural Veterans) unique? Status/Health Equity – Older, sicker, and poorer population Options for integrated health care and coordination – Primary and Specialty Care – Mental Health Care – Healthcare Workforce Geography/Transportation – Longer travel distances to receive care – Lack of public transportation Limited internet/broadband connectivity

13 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 13 Rural Veterans Most Common Outpatient Diagnoses High Blood Pressure Post-Traumatic Stress Disorder (PTSD) Type II Diabetes Depressive Disorder High Blood Cholesterol At least 1 service-connected disability

14 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 14 VHA Office of Rural Health (ORH) The VHA Office of Rural Health (ORH) was created by Congress in 2007 under Public Law , Sec 212 Mandated to work across VA to develop policies, best practices and lessons learned to improve care and services for enrolled rural and highly rural Veterans ORH falls under the VHA Assistant Deputy Under Secretary for Health (ADUSH)for Policy and Planning 14

15 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 15 Office of Rural Health (ORH) Mission Improve access and quality of care for enrolled rural and highly rural Veterans by developing evidence-based policies and innovative practices to support their unique needs. 3-Pronged Approach: 1.Promote best practices for maximum impact: Innovative pilots study and analyze spread best practices. 2.Build parternships and collaborations: Engage with VA program offices, Federal and state partners, Veteran Service Organizations and rural health communities to effectively utilize resources. 3.Bridge operations and policy: Leverage lessons learned to inform policy and contribute to measurable impacts. 15

16 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) Office of Rural Health (ORH) ORH Director Secretarys Veterans Rural Health Advisory Committee (VRHAC) Secretarys Veterans Rural Health Advisory Committee (VRHAC) Veterans Rural Health Resource Centers (VRHRCs) Veterans Rural Health Resource Centers (VRHRCs) VRHRC Eastern Region VRHRC Eastern Region VRHRC Central Region VRHRC Central Region Staff Assistant Budget Analyst Budget Analyst ORH Deputy Director VRHRC Western Region VRHRC Western Region VRHAC Program Analyst Full-Time 10 Positions Funded VISNs 6, 7, 9, 11, 12, 15, 16, 17, 19, 21 Full-Time 10 Positions Funded VISNs 6, 7, 9, 11, 12, 15, 16, 17, 19, 21 Part-Time/ Collateral Duties 11 Positions VISNs 1, 2, 3, 4, 5, 8, 10, 17, 18, 20, 22, 23 Part-Time/ Collateral Duties 11 Positions VISNs 1, 2, 3, 4, 5, 8, 10, 17, 18, 20, 22, 23 VISN Rural Consultants (VRCs) VISN Rural Consultants (VRCs) 4 Program Analysts Health Systems Specialist Health Systems Specialist Staff Assistant Staff Assistant VHA Assistant Deputy Under Secretary for Health for Policy and Planning VHA Assistant Deputy Under Secretary for Health for Policy and Planning

17 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 17 Office of Rural Health Components Veterans Rural Health Advisory Committee (VRHAC) Federal advisory committee to advise the Secretary of Veterans Affairs on health care issues affecting enrolled Veterans residing in rural areas Veterans Rural Health Resource Centers (VRHRCs) Three regional centers: Gainesville, FL; Iowa City, IA; Salt Lake City, UT Serve as rural health experts Field-based clinical and education laboratories for VA demonstration projects/pilot projects Provide programmatic support and technical assistance to funded VA partners Veterans Integrated Service Network (VISN) Rural Consultants (VRCs) Serve as primary interface between ORH and VISN rural activities and projects Develop rural health service plans based on VISN-wide needs assessments Facilitate information sharing across the 21 VISNs Perform outreach to develop community relationships Office of Rural Health (ORH) Central Office Provides national leadership on issues pertaining to rural veterans Administer special purpose appropriation and resources Provides technical assistance, project monitoring and performance analysis functions Coordinates IHS-VA MOU to promote access for American Indian/Alaska Native Veterans 17

18 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 18 Central Region Iowa City, IA Eastern Region, Gainesville, FL ORH Washin gton, DC Western Region Salt Lake City, UT Location of ORH Veterans Rural Health Resource Centers Eastern Region Resource Centers focus – Clinical Telehealth, workforce development, GIS Central Region Resource Centers focus – Big Data Analysis, Womens Health, Treatment adherence Western Region Resource Centers focus – Native American Veterans, Geriatric Care VA and Community Outreach

19 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 19 Collaborate to increase service options Measure, evaluate, and document impact of best practices Identify, recruit and retain rural health care professionals Use emerging studies and analyses to improve care Use emerging health information technologies ORH STRATEGIC FOCUS AREAS Educate and train VA and non-VA providers

20 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 20 ORH Priorities – FY 2013 Category Project ARCH - Public Law , Section 403 VA must conduct a pilot program to provide non-VA care for eligible, highly rural enrolled Veterans in five VISNs (VISNs 1,6,15, 18 & 19) SCAN-ECHO RFPSpecialty Care Access Network-Extension for Community Healthcare Outcomes Rural Health Training and Education Initiative (RHTI) Inter-professional, team-based models of training to deliver care to rural Veterans at 7 sites New, sustained/existing, and expansion projects for FY13 Approved projects address many VHA and ORH priorities such as Telehealth, Women veterans, Mental Health, Homelessness, and Access & Quality

21 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 21 Project Focus Areas – FY 2013 Category# of ORH Projects Rural Telehealth, including Home Telemonitoring, Store and Forward Image Transmission, and Clinic Based Video Telemedicine30 Rural Primary Care / Patient Aligned Care Teams (PCMH)16 Rural Specialty Care: Cardiology, Audiology, Prosthetics, Optometry, Radiology, Dermatology69 Rural Community Based Outpatient Clinics, Outreach Clinics, Mobile Clinics57 Rural Education Initiatives14 Rural Facilities Improvement3 Rural Home Based Primary Care50 Rural Homelessness5 Rural Mental Health, including Post Traumatic Stress Disorder35 Other Categories21 Rural Outreach Activities15 Projects Focused on Rural Special Populations, including Women, American Indians/Alaska Natives, and Asian American/Pacific Islanders31 Rural Veteran Transportation Programs, including ground and air transportation15 TOTAL361

22 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 22 ORH Communications ORH Publications The Rural Connection Quarterly Newsletter Research Briefs Monthly Fact Sheets Website, Dissemination Strategies Push dissemination to contacts (> 3,000 internal and external to VA) Publish articles in VA, Veteran Service Organizations (VSO), and other rural health publications (ex. National Rural Health Association e-newsletter and Rural Roads magazine) Leverage the VA social media channels and VAntage Point blog Present at national meetings Conduct ORH-sponsored webinars and broadcasts through My VeHU (VA eHealth University)

23 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 23 FY14: Eye on the Environment Population Migration, Demographics and Definitions Affordable Care Act Implementation Rural Economies and Service Markets Outreach, Coordination and Collaboration Workforce Development Technology Impact Effective Use of Resources 23

24 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 24 Affordable Care Act and VA Since the Affordable Care Acts (ACA) enactment, VA has been proactive in working to understand the laws impact on Veterans, other beneficiaries, and VAs health care system and in preparing for implementation of the law. The most significant provisions of the ACA are the individual mandate requirement, which requires most individuals to have health insurance coverage and the Medicaid expansion provision, which expands Medicaid eligibility to up to 138% of the Federal Poverty Level. The individual mandate is a provision that requires all individuals to have minimum essential insurance coverage or face a tax penalty. – Enrollment in VA health care, CHAMPVA or Spina Bifida programs meet the minimum essential coverage requirement. Veterans or other beneficiaries currently enrolled in VA health care do not have to take any additional steps to comply with the health insurance requirement outlined in ACA. Veterans and other eligible beneficiaries not currently enrolled in VA health care can apply for enrollment at any time.

25 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 25 Collaboration and Communication Leverage collaborations, communications and coordinated efforts to seize strategic opportunities and improve efficiencies in service to rural Veterans and their families.

26 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 26 Additional Resources: ORH Website

27 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 27 Thank You for Your Service

28 VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 28 Questions? Ideas? Contact Information For additional information, please contact: Gina L. Capra, MPA Director, Office of Rural Health (202) (direct) (202) (main line) VHA Office of Rural Health 1722 Eye St, NW, Suite GL16 Washington, DC


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