1. 0 Veterans Health Administration Veterans Health Administration Overview Aging Network & Veterans Health Administration: Partnerships and Opportunities February 24, 2009 Joseph P. Zimmerman, FACHE Strategic Planner, VISN 12 Office

2. 1 Veterans Health Administration …. to care for him who shall have borne the battle and for his widow and his orphan

3. 2 Veterans Health Administration Federal Health Care Policy Context Data obtained from CMS, DoD MHS, DVA Enrollee Model, U.S Census Total Population: 300 million (2006) Total Expenditure: $2.1 Trillion (2006) 47 M *Population doesn’t add up to 300 million due to dual eligibility ** Other Gov’t Programs include IHS Programs, SCHIP, Research, Worker’s Compensation, Structures & Equipment, Public Health Activity, etc.

4. 3 Veterans Health Administration Source: VetPop2004 - VA Office of Policy and Planning

5. 4 Veterans Health Administration Source: Office of the VHA Assistant Deputy Under Secretary for Health for Policy and Planning

6. 5 Veterans Health Administration Veteran Enrollees and Patients by Selected Periods of Service SOURCE: Department of Veterans Affairs, Office of Policy and Planning, VetPop2004 Note: Numbers do not sum to total enrollment. Veterans may report multiple periods of service, and veterans who served only during peacetime are excluded.

7. 6 Veterans Health Administration OEF/OIF Veterans, Enrollees and Patients Data Sources: 2008 EHCPM Update (BY07): FY09 Enacted Current Policy + 10% GMT/VMT; BDGS6F0BED0R6C2M7SP June 2007 OEF/OIF Roster, VA Office of the Actuary Data Sets, End of Fiscal Year Enrollment Files. Note: OEF/OIF data do not include active duty service members treated by VA

8. 7 Veterans Health Administration Source: Decision Support System, “Geriatric Primary Care: Workload, Utilization, and Cost” for all veterans seen in Primary Care between July 1, 2007 and June 30, 2008.

9. 8 Veterans Health Administration Enrollees Location Definition of U/R/H based on the Census’s definition of rural. Urban - Areas defined by U.S. Census as an urbanized area (excludes urban clusters) Rural - All other areas excluded in U.S. Census defined urbanized areas Highly Rural - Any rural area within a county with less than 7.0 civilians per square mile Veteran Enrollees by U/R/H EOY 06 Source: VHA Office of the Assistant Deputy Under Secretary for Health for Planning and Policy, End of Year 2006 geo-coded Master Enrollment File

10. 9 Veterans Health Administration  VHA Mission: Honor America’s veterans by providing exceptional health care that improves their health and well- being.  VHA Vision: To be a patient-centered integrated health care organization for veterans providing excellence in health care, research, and education; an organization where people chose to work; an active community partner and a back-up for National emergencies.

11. 10 Veterans Health Administration Gen. Eric Shinseki Secretary of Veterans Affairs Veterans Health Administration Michael Kussman, MD Under Secretary for Health National Cemetery Administration Veterans Benefits Administration VISN 1 VISN 3 VISN 5 VISN 7 VISN 9 VISN 11 VISN 15 VISN 17 VISN 19 VISN 21 VISN 2 VISN 4 VISN 6 VISN 8 VISN 10 VISN 12 VISN 16 VISN 18 VISN 20 VISN 22 VISN 23 Cathy Rick Chief Officer, Nursing Services Joel Kupersmith, MD Chief Research and Development Officer Malcolm Cox, MD Chief Officer, Academic Affiliations Joy Hunter Chief, Employee Education Vacant Chief Officer, Social Work and Care Management Services Madhu Agarwal, MD Chief Officer, Patient Care Services Geriatric Programs Nursing Home Services Home and Community Care Services Medicine and Surgery Mental Health Rehabilitation Dentistry Primary Care James F. Burris, MD Chief Consultant Geriatrics and Extended Care Gerald Cross, MD Principal Deputy Under Secretary William Feeley, MSW Deputy Under Secretary for Operations and Management

12. 11 Veterans Health Administration 21 Veterans Integrated Service Networks

13. 12 Veterans Health Administration Current VHA Planning Challenges For Veterans OEF/OIFUrban/Rural Polytrauma Traumatic Brain Injury PTSD Mental HealthWomen Aging

14. 13 Veterans Health Administration Geriatrics & Extended Care  Institutional Care Programs  VA Operated Community Living Centers  State Veterans Nursing Homes  Community Nursing Homes  Non-Institutional Care Programs  VA Operated Home Based Primary Care, VA Adult Day Health Care  Purchased Skilled Home Care, Homemaker/Home Health Aide Services, Community Adult Day Health Care, Hospice, Respite

15. 14 Veterans Health Administration Source: VHA Office of Finance and Allocation Resource Center-Adjusted DSS costs

16. 15 Veterans Health Administration VHA Philosophy for Long-Term Care –Provide Care in the least restrictive environment –Whenever possible in home & community based settings –Nursing home care should be reserved for situations in which the veteran can no longer be safely maintained in the home

17. 16 Veterans Health Administration Source: VHA Long-Term Care Demand Model Version 3.1 Demand

18. 17 Veterans Health Administration Source: VHA Long-Term Care Demand Model Version 3.1

19. 18 Veterans Health Administration Source: Office of Geriatrics and Extended Care, FY08

20. 19 Veterans Health Administration A Unique Partnership for Exceptional Service