hospice-veteran partnership program
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Hospice-Veteran Partnership ProgramHospice-Veteran Partnership Program
ContentContent
• Overview of the Hospice-Veteran Partnership Program
• Making the case to form an HVP• Strategies for HVP success• Tips for Getting Started and
Succeeding• Examples• Resources
Message from Tom EdesDepartment of Veterans Affairs
Message from Tom EdesDepartment of Veterans Affairs• “We in the VA depend on you,
community hospice agencies to deliver home care for our terminally ill patients. The VA does not intend to replicate the excellent system that is already in place for home hospice care and we in the VA must learn to collaborate with and learn from you.”
National CollaborationNational Collaboration• VA Hospice and Palliative Care Program Office
– Dr. Scott Shreve, National Director– HPC program office staff– VISN Program Managers and Clinical Champions
• NHPCO We Honor Veterans campaign– Emil Zuberbueler, Director, National Veterans Program– WHV program staff
• Veterans Advisory Council• Council of States
Hospice-Veteran PartnershipsHospice-Veteran Partnerships• Home: State hospice organization,
coalition, VA VISN or facility• Leadership: Co-chairs, generally
representatives from community hospice and VA
• Structure: State-wide organization and coordination with local or regional HVPs around the catchment areas of VA faciities
HVP PartnersHVP Partners• State Hospice Organizations• End-of-Life Coalitions• Community hospice agencies• VISNs and VA facilities
– VA Medical Centers– Community Based Outpatient Clinics (CBOCs)– Vet Centers
• State Veterans Homes• Veterans Service Organizations (VSOs)• Community Veteran Organizations
Veterans Health Administration21 Veterans Integrated Service
Networks
Veterans Health Administration21 Veterans Integrated Service
Networks
www2.va.gov/directory/guide/division_flsh.asp?dnum=1
Why Are HVPs Important?Why Are HVPs Important?• More than 1,800 veterans are dying every day
– . . .but not much is known about end-of-life issues for this special population
• The vast majority of veterans do not receive their health care from VA– . . .but community healthcare providers and
organizations often don’t know who they are or how to reach out to them
• Significant barriers exist– . . .but they can be overcome through communication
and collaboration
Volume of Veteran Deaths Volume of Veteran Deaths • Number of veteran deaths reached an all-
time high in 2006 (664,842 projected Veterans deaths)
• At least 600,000 deaths a year through 2016
• Less than 4% Veteran deaths (about 21,000/yr) will occur in VA facilities
• HVPs are solving care coordination problems at the local, state and national levelswww.va.gov/vetdata/Veteran_Population.asp
Projected Veteran Deaths (2011)
n = 648,354
Projected Veteran Deaths (2011)
n = 648,354
<20 20-24
25-29
30-34
35-39
40-44
45-49
50-54
17 383 715 806 1,052 2,026 4,063 7,764
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
15,301 44,617 51,942 65,066 104,299
134,788
132,764
82,760
www.va.gov/vetdata/Veteran_Population.asp
Total Projected Veteran Deaths by State (2011)
Total Projected Veteran Deaths by State (2011)
Top 10 States represent50% of Veteran deaths
Highest #: 58,250 (CA)Lowest #: 1,060 (DC)
Top 10 States with highest number of Veteran Deaths
Top 10 States with highest number of Veteran Deaths
How Can HVPs Help VA?How Can HVPs Help VA?
• Honors veterans’ preferences• Expands the interdisciplinary team• Increases VA staff knowledge of the
Medicare Hospice Benefit• Frees up inpatient beds for incoming
veterans• Shares the job of caring for Veterans
with the community
How Can HVPs Help Community Hospices?How Can HVPs Help Community Hospices?• Clinical Care
– Honors veterans’ preferences – Improves communication and continuity– Expands understanding of veterans unique
end-of-life issues
• Administrative – Increases referrals– Improves payment for services– Clarifies interface between VA and community
hospice policies and procedures
How Can HVPs Help Veterans?How Can HVPs Help Veterans?• Honors Veterans’ preferences• Standardizes VA response to
community hospices• Informs community response to
Veterans’ unique end-of-life issues• Contributes to continuity and quality
of care• Eliminates “charity care” for Veterans
Getting Startedwith the HVP Toolkit Getting Startedwith the HVP Toolkit • Begin with a Planning Committee• Identify potential partners• Form a Leadership Committee• Conduct Needs Assessment• Develop strategic objectives and measure
outcomes• Plan educational, program development
and outreach activities• Work together to build solutions
(www.wehonorveterans.org)
Potential HVP ProjectsPotential HVP Projects
• Community Outreach• Legal and Regulatory Issues• Education and training for providers• Research and Evaluation• Member Recruitment• Fundraising
Strategies for SuccessStrategies for Success
• Strong support from VA leaders– Identify champion from each facility in
state– Invite staff from CBOCs, State Veterans
Homes, and VetCenters to participate– Secure support from VISN leadership– Include HVP in strategic planning efforts– Coordinate HVP activities within your
VISN and with adjacent VISNs
Strategies for SuccessStrategies for Success
• Equally strong support from the state hospice organization or coalition– Identify Community hospice champion– Invite all community hospices in state to
participate – Secure board of directors support and
appoint HVP community leader(s)– Establish an HVP standing committee or
workgroup
Strategies for SuccessStrategies for Success
• Acknowledge and respect all interest positions and cultural differences– WIIFM factor– Language of organization– Rules, regulations and SOP– Perceptions
Understanding DifferencesUnderstanding Differences
VA Hospice
Culture Quasi-military Community healthcare provider
Role Provider and
Payer
Provider
Funding Fixed appropriation and budget
Entitlement - Medicare/ Medicaid hospice benefit; 3rd party reimbursement
Accountability Congress Governing Body, CMS, Fiscal Intermediaries and State
HVP Outcome Measures – 1st TierHVP Outcome Measures – 1st Tier
Are we improving veterans’ access to hospice and palliative care?– # veterans being served by community
hospices– HVP has the name and contact
information of VA HPC liaison(s) at each facility in the state and makes this information available to all hospices in the state
– # educational sessions among providers of care for veterans in all settings
HVP Outcome Measures – 2nd TierHVP Outcome Measures – 2nd Tier• Are we meeting veterans needs?
– # education sessions/events for veterans and their families
– Post death family satisfaction survey data collected and shared among providers
– # referrals from community hospice to VA for assistance with care, benefits or services
– # and % of community hospices that have written agreements with VA facilities and State Veterans Homes
HVP Outcome Measures – 3rd TierHVP Outcome Measures – 3rd Tier• Are HVPs paying attention to the
strength and sustainability of their infrastructure?– Composition of HVP membership– # HVP projects ongoing and completed– # HVP meetings
HVP National Program - Local SolutionsHVP National Program - Local Solutions• State lines and VISN boundaries are
complex• Solution: form regional HVPs around
each VA Medical Center in the state– Region includes the VAMC’s service area– Coordinate activities with your State
HVP to ensure that everyone has the same information
– Many benefits!
Regional HVPsRegional HVPs
• HVP survey can identify perceptions and misunderstandings
• Roundtable sessions drill down and identify barriers and opportunities
• Solutions and best practices can be shared and “hard wired” into performance
• Relationships strengthened through routine meetings and collaboration on specific tasks and objectives
How to Start a Regional HVPHow to Start a Regional HVP• Establish a Regional or Local HVP
leaders• Hold regular meetings• Report back to the State HVP and
VISN palliative care leaders
Regional HVP Start-up ActivitiesRegional HVP Start-up Activities• Schedule initial “Round Table or Open House”
– Invite local VA facilities, community hospices, State Veteran Homes and others
– Develop agenda collaboratively– Plan logistics carefully
• Pay attention to local issues that affect the interface of VA with community providers in the region
• Understand the different perspectives of individual member groups
Regional HVP AgendaRegional HVP Agenda• VA Continuum of Health Care Services
– Eligibility & Burial Benefits– VA Palliative and End-of-Life Care:
Inpatient and Outpatient Services – VA Bereavement Program– Coordination of Care– MD orders for start of care– Medications and DME– Home Hospice Agency follow up– VA Purchased Home Hospice Care
• Agencies Description & Services• Open Discussion
Next Steps for Regional HVPsNext Steps for Regional HVPs• Establish ongoing relationship• Create an e-mail group and send
regular updates• Partner for training and education
activities• Identify ways to increase hospice
referrals• Improve coordination of clinical care
Resources for HVPsResources for HVPs
• We Honor Veterans website• Military History Check List• Military History Pocket Card• Peace at Last: Stories of Hope and
healing for Veterans and Their Families (Deborah Grassman, 2009)
• State Hospice Organization websites
VA Pocket Card Homepagewww.va.gov/oaa/pocketcard/
VA Pocket Card Homepagewww.va.gov/oaa/pocketcard/
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