1. Veterans Health Administration Office of Rural Health VA Advisory Committee on Women Veterans Office of Rural Health Office of the ADUSH for Policy and Planning Veterans Health Administration October 2009

2. 2 Agenda Office of Rural Health (ORH) Current Programs and Initiatives Future Directions

3. 3 Public Law 109 - 461 Establishment of Office of Rural Health The Director of the Office of Rural Health shall perform functions to include: 1. Conducting, coordinating, promoting, and disseminating research into issues affecting Veterans living in rural areas, in cooperation with the medical, rehabilitation, health services, and cooperative studies research programs in the Office of Policy and the Office of Research and Development 2. To work with all personnel and offices to develop, refine, and promulgate policies, best practices, lessons learned, and innovative and successful programs to improve care and services for Veterans who reside in rural areas of the United States 10/07, Director Office of Rural Health (ORH) ADUSH Policy & Planning ORH Legislative Requirements

4. 4 Office of Rural Health PLANNING EXECUTIONMANAGEMENT OVERSIGHT and EVALUATION COLLABORATION OUTREACH, and DISSEMINATION  ORH Strategic Planning Policies and Guidance Budget Execution Plans Meeting ORH Strategic Goals  Project Planning Services/Programs Expansion Pilots and Demonstrations Technology Deployment  Studies and Analyses Establish Agenda/Guidance Inform Policies/Programs Congressional Responses  Collaboration and Outreach Develop Partnerships Establish Outreach Strategies  Service Expansion Initiatives VISN Rural Health Funding Outreach Clinics Mobile Clinics Travel Reimbursements  Pilots and Demonstrations National and Local Pilots Funding VHA Program Offices  Studies and Analyses Conduct Studies and Analyses  Collaboration and Outreach National ORH Meetings ORH Website Educational Symposia  Project Management Provide Guidance/Feedback Coordinate Communications Manage and Track Progress  Accountability Report on Progress Evaluate Impacts/Outcomes  Knowledge Management System Monitor All ORH Activities Organize/Manage Information  Dissemination Strategies Share Best Practices Promulgate Lessons Learned Utilize Dissemination Channels  Establish data-driven planning and evidence-based decision-making processes.  Evaluate the impacts and outcomes of ORH funded initiatives and programs.  Utilize rural health and veterans health expertise in VA and non-VA communities.  Share findings with policy leaders, field units, and rural health communities.  Explore opportunities to innovate through collaboration and partnership.  Develop outreach and educational resources and tools to help rural Veterans and providers.  Establish collaborative networks in rural communities and among rural health organizations.  Share best practices and lessons learned within VHA and with rural health partners.  ORH Core Staff  VRHRC Leaders/Staff  VISN Rural Consultants  VRHAC Members  ORH Working Groups  VHA Program Offices  VISN/VAMC Leadership  Funded Project Leaders  Collaboration Partners  Outreach Partners  Dissemination Partners RESOURCES

5. 5 Agenda Office of Rural Health Current Programs and Initiatives Future Directions

6. 6 ORH Appropriation FY08  $24 million to fund ORH initiatives FY 09  $24 million to continue to support FY08 ORH initiatives  Public Law 110-329 provided $250 million to support service expansion and outreach: ORH provided $22 million to the Veterans Integrate Service Networks (VISNs) in December 2008 Allocated in accordance with the proportion of rural and highly rural Veterans in each VISN ORH provided additional $215 million to VISNs and program offices in February 2009 National, competitive process with 161 proposals reviewed; selected 74 projects and initiatives

7. 7 Funding Distribution Public Law 110-329 National Key Initiatives:$ 77.6M –National Telehealth Expansion$ 36.3M –Education and Training$ 1.8M –Mental Health Intensive Care Management $ 7.3M –Home Based Primary Care$ 26.4M –Other$ 4.7 M VISNs Key Initiatives:$136.9M –Outreach Clinic Expansion$ 19.6M –Local Telehealth Expansion$ 39.2M –Transportation Programs$ 5.6M –Health Care Services Expansion$ 15.7M –Community Outreach$ 15.9M –Home Based Primary Care$ 17.3M –Other$ 23.6M

8. 8 Outreach Clinics Outreach Clinics: To extend access to primary care and mental health services in rural and highly rural areas where there is not sufficient demand or it is otherwise not feasible to establish a full-time Community Based Outpatient Clinic (CBOC) by establishing a part- time clinic Funded 40 Outreach Clinics to date:  Funded 10 Outreach Clinics in FY2008  Funded 30 Outreach Clinics in FY2009 Impact:  Potential Impact: 997,482 rural and highly rural enrollees live within the service areas  Impact to date: 2,250 patients have been seen to date

9. 9 Rural Mobile Health Clinics Rural Mobile Health Clinics: To extend access to primary care and mental health services in rural areas where it is not feasible to establish a fixed access point Currently all four Rural Mobile Health Clinics are operational:  VISN 1 (ME)  VISN 4 (WV)  VISN 20 (WA)  VISN 19 (CO, NE, WY) Impact:  Vans serve 24 counties in six states  Potential Impact: 13,359 projected rural/highly rural enrollees live within the service areas  Impact to date: 400+ patients have been seen to date (Puget Sound)

10. 10 Geriatrics and Extended Care Home Based Primary Care (HBPC)  In FY08, 14 HBPC sites were provided  In FY09, 2 major HBPC expansions:  CBOC and Community Collaboration (25 sites)  Indian Health Service Collaboration (14 sites) Medical Foster Home  FY 08: three rural sites  FY 09: three rural sites GeriScholars Program: a joint initiative developed to engage and train rural clinicians in the care of older rural Veterans.

11. 11 Women Veterans As the proportion of enrolled rural and highly rural women Veterans increases with the enrollment of the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veteran population, more gender specific services will need to be provided. Current programs include: VISN 5: Women’s Veterans Health Program VISN 6: Rural Women Veterans Health Care Program VISN 16: Women’s Health: Improving Access to Care for Women Veterans Suffering from Chronic Pain Associated with Traumas and Depression

12. 12 Agenda Office of Rural Health Current Programs and Initiatives Future Directions

13. 13 Future Directions Improving knowledge base –Continue improving ORH understanding of rural and highly rural Veterans and their needs; –Evaluate current initiatives and communicate best practices; and –Implement evidence-based strategies and innovative care delivery models. Improving capacity to care for rural and highly rural Veterans –Apply lessons learned from each year’s experience; –Grow infrastructure by emphasizing local innovation with national focus; and –Build community collaborations and leverage technology. 13

14. 14 Future Directions Improving access and quality of care –Improve coordination both inside and outside VA; –Operationalize best practices: nationalizing models that work; and –Expand services and improve outreach 14

15. 15 Questions?