Presentation on theme: "VA Office of Rural Health"— Presentation transcript:
1 VA Office of Rural Health Gina L. Capra, MPADirector, Office of Rural Health (ORH)Office of the Assistant Deputy Under Secretary for Health (ADUSH) for Policy and PlanningVeterans Health Administration (VHA)/Department of Veterans Affairs (VA)
2 Today’s Presentation Mission and Overview Demographics and Needs Focus and ResourcesEnvironment and Collaborations
3 Mission of the Department of Veterans Affairs (VA) “…to care for him who shall have borne the battle andfor his widow and orphan…”- Abraham Lincoln, 1865Photo by Jeff Kubina
4 Department of Veteran Affairs (VA) Mission, Core Values & Characteristics “…to care for him who shall have borne the battle andfor his widow and orphan…”VA Core Values:“I CARE” - Integrity, Commitment,Advocacy, Respect & ExcellenceVA Characteristics:Trustworthy, Accessible, Quality, Innovative, Agile and Integrated
5 What is the Department of Veterans Affairs (VA)? Established in 1930Elevated to Cabinet level in 1989Federal government’s 2nd largest department after the Department of DefenseThree components:Veterans Health Administration (VHA)Veterans Benefits Administration (VBA)National Cemetery Administration (NCA)
6 Veterans Health Administration (VHA) Mission Honor America’s VeteransProvide Exceptional Health CareVETERANS HEALTH ADMINISTRATION (VHA) MISSION STATEMENT Honor America’s Veterans by providing exceptional health care that improves the their health and well-being.VETERANS HEALTH ADMINISTRATION VISION STATEMENT VHA will continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that are both patient-centered and evidence-based. This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement. It will emphasize prevention and population health and contribute to the Nation’s well-being through education, research and service in national emergencies.Improve Health and Well-being
7 VHA is the Largest Integrated Health Care System in the United States 151 Hospitals995 Outpatient Clinics (Hospitals, Community, Independent and Mobile )135 Community Living Centers300 Readjustment Counseling Centers Vet Centers103 Domiciliary Resident Rehabilitation Treatment Programs
9 Eligibility for VHA Healthcare Eligibility for VHA health care services depends on a number of qualifying factors, including:The nature of a veteran’s discharge from military service (e.g., honorable, other than honorable, dishonorable)Length of serviceVA adjudicated disabilities (commonly referred to as “service-connected disabilities”)Income levelAvailable VA resources
10 Who is eligible for VHA Healthcare? Veteran eligibility for VA healthcare is based on category group (“Priority Enrollment Group”)Category Group 1Veterans with service-connected disabilities rated 50% or more disablingCategory Group 2Veterans with service-connected disabilities rated 30% or 40% disablingCategory Group 3POWs, Purple Heart recipients, those rated 10% or 20% disabled, or those eligible under Title 38, U.S.C., Section 1151Category Group 4Veterans who receive aid and attendance or housebound benefits or are catastrophically disabledCategory Group 5Veterans 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 benefitsCategory Group 6WW 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 thresholdCategory 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 changefrom year to year.
11 Population ServedU.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.Of 8.3 million enrolled Veterans, 3.1 million enrolled Veterans live in rural/highly rural areas22 million Veterans nationwide6.1 million Veterans living in rural areas36% of total enrolled Veteran population live in rural/highly rural areasAbout 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.Enrolled VeteranPopulation Density, FY 2010While 84% of U.S. inhabitants live in suburban and urban areas, cities occupy only 10% of the country and rural areas occupy the remaining 90%.19% of Americans live in rural areas 9% of physicians practice in rural areasReflections on User Demographics: enrolled vs non-enrolled; cultural competency in all dimensions; ancillary and support needs/social determinants of health; service delivery modelsProviders: recruitment and retention; multidisciplinary teams/PACT; use of technology/telehealth; quality and care coordination; collaboration with non-VADiagnosis: disability support and related ancillary services vs general primary/specialty care; age bands and related health care needsHealth Outcomes: quality indicators; goals and benchmarks; impact on overall health of individual, family, community
12 How are rural communities (and Rural Veterans) unique? Status/Health EquityOlder, sicker, and poorer populationOptions for integrated health care and coordinationPrimary and Specialty CareMental Health CareHealthcare WorkforceGeography/TransportationLonger travel distances to receive careLack of public transportationLimited internet/broadband connectivityAccording to a Health and Human Services report, half of the adults living in rural areas suffer from a chronic health condition.While many rural Veterans receive their Primary Care at one of over 400 rural community-based outpatient clinics (CBOCs) in the VA health care system, they have fewer options for local VA specialty care such as:Audiology, Neurology, Cardiology, Oncology, and SurgeryANDMental health servicesLong distance travel can be difficult, especially for Veterans with mobility issues.Travel can be complicated by a lack of transportation.Rural health care options are also limited by the difficulty in recruitment and retention of health care providers to rural areas.
13 Rural Veterans’ Most Common Outpatient Diagnoses High Blood PressurePost-Traumatic Stress Disorder (PTSD)Type II DiabetesDepressive DisorderHigh Blood CholesterolAt least 1 service-connecteddisabilityThe five most common diagnosis in rural Veterans seen as an outpatient include:High Blood PressurePTSDType II DiabetesDepressive DisorderHigh Blood CholesterolDiabetes, Arthritis, Hearing Loss, Hypertension, Mental Health Disorders (?)Source: VA National Center for Veterans Analysis and Statistics
14 VHA Office of Rural Health (ORH) The VHA Office of Rural Health (ORH) was created by Congress in 2007 under Public Law , Sec 212Mandated to work across VA to develop policies, best practices and lessons learned to improve care and services for enrolled rural and highly rural VeteransORH falls under the VHA Assistant Deputy Under Secretary for Health (ADUSH)for Policy and Planning
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:Promote best practices for maximum impact: Innovative pilots study and analyze spread best practices.Build parternships and collaborations: Engage with VA program offices, Federal and state partners, Veteran Service Organizations and rural health communities to effectively utilize resources.Bridge operations and policy: Leverage lessons learned to inform policy and contribute to measurable impacts.
16 Office of Rural Health (ORH) VHA Assistant Deputy Under Secretary for Healthfor Policy and PlanningORH DirectorSecretary’s Veterans’ Rural HealthAdvisory Committee(VRHAC)Veterans Rural Health Resource Centers(VRHRCs)ORH Deputy DirectorBudgetAnalystVRHAC Program AnalystStaff AssistantVRHRCWestern RegionVRHRCCentral RegionVRHRCEastern RegionOffice of Rural Health (ORH) Central OfficeProvides coordination, monitoring, analysis and national leadershipVeterans’ 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.Function as field-based clinical laboratories for demonstration projects/pilot projects.Serve as rural health experts.Act as educational and clinical repositories.Provide programmatic support to ORH.Veterans Integrated Service Network (VISN) Rural Consultants (VRCs)Serve as primary interface between ORH and VISN rural activities.Develop rural health service plans based on VISN-wide needs assessmentsFacilitate information sharing across the VISNs.Perform outreach to develop community relationships.VISN Rural Consultants(VRCs)4 Program AnalystsHealth SystemsSpecialistStaffAssistantFull-Time10 Positions FundedVISNs 6, 7, 9, 11, 12, 15, 16, 17, 19, 21Part-Time/ Collateral Duties11 PositionsVISNs 1, 2, 3, 4, 5, 8, 10, 17, 18, 20, 22, 2316
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 areasVeterans Rural Health Resource Centers (VRHRCs)Three regional centers: Gainesville, FL; Iowa City, IA; Salt Lake City, UTServe as rural health expertsField-based clinical and education laboratories for VA demonstration projects/pilot projectsProvide programmatic support and technical assistance to funded VA partnersVeterans Integrated Service Network (VISN) Rural Consultants (VRCs)Serve as primary interface between ORH and VISN rural activities and projectsDevelop rural health service plans based on VISN-wide needs assessmentsFacilitate information sharing across the 21 VISNsPerform outreach to develop community relationshipsOffice of Rural Health (ORH) Central OfficeProvides national leadership on issues pertaining to rural veteransAdminister special purpose appropriation and resourcesProvides technical assistance, project monitoring and performance analysis functionsCoordinates IHS-VA MOU to promote access for American Indian/Alaska Native Veterans
18 Location of ORH Veterans Rural Health Resource Centers Eastern Region Resource Center’s focusClinical Telehealth, workforce development, GISCentral Region Resource Center’s focusBig Data Analysis, Women’s Health, Treatment adherenceWestern Region Resource Center’s focusNative American Veterans, Geriatric Care VA and Community Outreach321Central Region Iowa City, IAEastern Region, Gainesville, FLORH Washington, DCWestern Region Salt Lake City, UTRegion 1 (East): VISN 1-10Region 2 (Central): VISN 11-12, 15-17, 23Region 3 (West): VISN 18-22
19 ORH STRATEGIC FOCUS AREAS Collaborate to increase service optionsMeasure, evaluate, and document impact of best practicesIdentify, recruit and retain rural health care professionalsUse emerging studies and analyses to improve careEducate and train VA and non-VA providersImprove access and quality of care through measurement, evaluation, & documenting impact of best practices in rural health.Optimize use of available and emerging health information technologies.Maximize use of existing and emerging studies and analyses to improve care delivered to rural Veterans.Improve availability of education and training for VA and non-VA providers by increasing distance learning and developing new education resources for health care professionals.Enhance existing and implement new strategies to improve and begin new collaborations and increase service options for rural Veterans.Develop innovative methods to identify, recruit and retain health care professionals and expertise in rural communitiesUse emerging health information technologiesORH STRATEGIC FOCUS AREAS
20 ORH Priorities – FY 2013 Category Project ARCH - Public Law , Section 403VA 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 OutcomesRural Health Training and Education Initiative (RHTI)Inter-professional, team-based models of training to deliver care to rural Veterans at 7 sitesNew, sustained/existing, and expansion projects for FY13Approved projects address many VHA and ORH priorities such as Telehealth, Women veterans, Mental Health, Homelessness, and Access & Quality
21 Project Focus Areas – FY 2013 Category# of ORH ProjectsRural Telehealth, including Home Telemonitoring, Store and Forward Image Transmission, and Clinic Based Video Telemedicine30Rural Primary Care / Patient Aligned Care Teams (PCMH)16Rural Specialty Care: Cardiology, Audiology, Prosthetics, Optometry, Radiology, Dermatology69Rural Community Based Outpatient Clinics, Outreach Clinics, Mobile Clinics57Rural Education Initiatives14Rural Facilities Improvement3Rural Home Based Primary Care50Rural Homelessness5Rural Mental Health, including Post Traumatic Stress Disorder35Other Categories21Rural Outreach Activities15Projects Focused on Rural Special Populations, including Women, American Indians/Alaska Natives, and Asian American/Pacific Islanders31Rural Veteran Transportation Programs, including ground and air transportationTOTAL361
22 ORH Communications ORH Publications Dissemination Strategies “The Rural Connection” Quarterly NewsletterResearch BriefsMonthly Fact SheetsWebsite,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 blogPresent at national meetingsConduct ORH-sponsored webinars and broadcasts through My VeHU (VA eHealth University)
23 FY14: Eye on the Environment Population Migration, Demographics and DefinitionsAffordable Care Act ImplementationRural Economies and Service MarketsOutreach, Coordination and CollaborationWorkforce DevelopmentTechnology ImpactEffective Use of Resources
24 Affordable Care Act and VA Since the Affordable Care Act’s (ACA) enactment, VA has been proactive in working to understand the law’s impact on Veterans, other beneficiaries, and VA’s 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 Collaboration and Communication Leverage collaborations, communications and coordinated efforts to seize strategic opportunities and improve efficiencies in service to rural Veterans and their families.
27 Thank You for Your Service Upon their discharge from active duty, many OEF/OIF and Operation New Dawn (OND) Veterans are returning to their rural communities.
28 Gina L. Capra, MPA Director, Office of Rural Health Questions? Ideas? Contact InformationFor 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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