“answering the call: caring for rural veterans” national rural health day: devils lake, north...

“Answering the Call: Caring for Rural Veterans”

National Rural Health Day: Devils Lake, North Dakota

Thomas Klobucar, PhDDeputy Director, Office of Rural Health (ORH)Veterans Health Administration (VHA)U.S. Department of Veterans Affairs (VA)

19/November 2015

VETERANS HEALTH ADMINISTRATION 2

Presentation Topics

Topics1. U.S. Department of Veterans Affairs Overview2. Rural Veterans Snapshot 3. Community Collaborations & Strategic Drivers for Health Care Delivery4. Veterans Choice Program Overview5. Key Resources

VETERANS HEALTH ADMINISTRATION

Overview of the Department of Veterans Affairs


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

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What is the Department of Veterans Affairs?

• Established in 1930• Elevated to Cabinet level in 1989• Federal government’s 2nd largest department after the Department of Defense• Three components:

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Veterans Health

Administration

National Cemetery

Administration

Veterans Benefits

Administration


VA Strategic Goals

• Goal 1: Empower Veterans to Improve their Well-Being− Give Veterans more information and choices for health care

• Goal 2: Enhance and Develop Trusted Partnerships− Create relationships between VA and community partners to provide care for Veterans

• Goal 3: Manage and Improve VA Operations to Deliver Seamless and Integrated Support

− Improve the coordination of care between VA and community providers


Who is a Veteran?Definition of a Veteran for VA purposes

• Veteran is a person who:− Served in the active military, naval or air service− Was discharged or released under conditions other than dishonorable

• Former or current Reservists, if they served for the full period for which they were called (excludes training purposes)

• Former or current National Guard members if activated/mobilized by a federal order

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Overview: Which Veterans Use the VA Health Care System?

~22 million U.S. Veterans

~9 million enrolled in VA health care

~6 million VA Patients

Not every VA-enrolled Veteran receives VA health care services in a given year. Some Veterans opt to not seek care, and/or others receive care outside the VA system, paying for care using other health insurance, Medicare, Medicaid, TRICARE, private insurance or other means.

In order to receive VA health care benefits, a Veteran must be eligible for care (usually determined by the presence of a service-connected disability, period of military service, or income level).


DoD and VA Health Care Systems: Quick Look

• Provides care to those who serve in uniform (plus families and retirees) through the TRICARE program

• 57 hospitals and ~400 clinics worldwide• Fiscal year 2015 budget = $47.4 B

Department of DefenseMilitary Health System (MHS)

Department of Veterans Affairs Veterans Health Administration (VHA)

• Provides care to those who served in uniform• More than 1,500 sites of care, including 167

medical centers, 14 health care centers and 757 Community Based Outpatient Clinics

• Fiscal year 2015 budget = $59.5 B

~10 million MHS beneficiaries ~9 million VHA enrollees

~1 million dual-eligibles


Veterans Health Administration “Footprint”

167 VA medical centers (VAMC)

771 Community Based Outpatient Clinics

(CBOC) and health care centers

287 Other outpatient and/or residential

service sites (includes mobile medical and

telehealth units)

300 readjustment counseling centers

(Vet centers)

80 mobile Vet centers 10


Snapshot of the Rural Veteran


Snapshot of the Enrolled Rural Veteran

5% increase of enrolled rural women Veterans since fiscal year 2012

56% are 65+ years old

12% served in Iraq or Afghanistan and typically have multiple medical and combat-related issues

22M Veterans in the United States,5.3M live in rural areas (24%)

9.1M enrolled in VA health care (41%) 3M rural Veterans enrolled in the VA

health care system (57%)33% (of 9.1M) enrolled Veterans

live in rural areas

43% earn an annual income of less than $26,000

6% are women

8% are minorities (African-American, Asian, Native Hawaiian or Pacific Islander, American Indian or Alaska Native)

25% of rural Veterans live below the poverty line (fiscal year 2013)

36% do not access the Internet at home (fiscal year 2013)


57,395 Veterans (10% of 18+ population)

24,793 rural Veterans (43% of ND Veteran population)

28,511 Veterans enrolled in VHA for care (50% of ND Veterans); 5th in the U.S. for percent of Veterans enrolled

44% enrolled Veterans are rural

Highest percentage of highly rural Veterans in the U.S. (16%)

73% of enrolled Veterans 50+ years old, 51% are 65+ years old

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69% rural Veterans enrolled in VHA for health care (56% nationally)

35% urban Veterans enrolled in VHA for health care (36% nationally)

6% of ND Veterans are women

The number of ND Veterans enrolled in VHA for health care increased nearly 10% from 2009 to 2014, from 26,000 to 28,500

North Dakota Veterans


Snapshot of VA’s Rural Care Delivery

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322,000+ rural Veterans used telehealth to access VA health

care in FY 2014

414,000+ one-way trips provided for Veterans to receive VA care

41% of rural enrolled Veterans have at least one service

connected disability

80.4% of rural enrolled Veterans have other health insurance

(e.g. Medicare, Medicaid, Tricare, Private Insurance) in addition to

their VA benefits

$1+ billion increase in VHA spending on health care for rural Veterans between 2012 and 2014, from $17.4 billion in 2012 to $18.4 billion in 2014, which represents 32% of all VHA health care expenditures

43% of VA patients who received care via telehealth were rural

443 VA sites of care are located in rural areas of the country

35% VA Medical Centers have greater than 50% rural Veterans enrolled for VA health care


“Caring for Rural Veterans”

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ORH Video: Caring for Rural Veterans

The VA Office of Rural Health video Caring for Rural Veterans was filmed in a VA Community Based Outpatient Clinic in Cumberland, Maryland. Take a three-minute trip to Cumberland to learn how VA helps meet the needs of rural Veterans across the country.

Link: http://youtu.be/yyIjKAa-kv0

http://youtu.be/yyIjKAa-kv0

http://youtu.be/yyIjKAa-kv0


Does Veteran Status Impact Health Status?

• Rural health requires a community-based approach that provides health care and support services that foster Veterans’ and their families’ well-being

• Veterans and their families are assets in rural communities

The most common outpatient diagnoses among rural Veterans are:

High blood pressure Post-traumatic Stress Disorder Type II Diabetes Depressive Disorder High blood cholesterol At least one service-connected

disability


Traditional Challenges of Rural Health Care Delivery

• Health care delivery in a rural setting faces ongoing challenges:– Provider and specialist shortages– Hospital closings due to financial instability– Population health factors/“social determinants of health”

• Access to health care services and wellness promotion efforts• Housing• Education• Employment• Transportation

– Limited broadband coverage– Geographic and distance barriers

• Rural health requires a community-based approach that provides health care and support services that foster Veterans’ well-being


Community Engagement and Collaborations


VA Efforts to Engage Community Providers

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November 2014VA launches Veterans Choice Program (VCP)

February 1995VA begins to establish

Community Based Outpatient Clinics (CBOCs)

• CBOCs established to improve Veterans’ geographic access to and use of primary care services

• Shifts focus of care from inpatient to outpatient setting

• Most CBOCs owned and staffed by VA, but some contracted to private sector

• Lack of access for Veterans seeking specialist care• PC3 established to

expand care options for Veterans

• Barriers to accessing care due to long wait times and geographic distance

• Choice Act established the VCP to increase accessibility to care for eligible Veterans

January 2014VA establishes Patient

Centered Community Care (PC3) Contracts

• The VCP provides greater access to community health care for eligible Veterans • Coordinated Care• Choice

Improvement Act


Health Care Programs Used by Veterans

20Source: 2013 American Community Survey

Health Plan ACS 2013VA 6,240,160TRICARE 3,201,337MEDICARE 11,278,162Medicaid 1,955,348Private 6,173,312 Uninsured 1,329,080 Total Veterans 23,077,645


Current Use of the VA Health Care System

21Source: 2014 Survey of Enrollees

<30 30-49 50-64 65+ M F <$36,000 $36,000+

42%45%

58%

39%

45%

50%

57%

33%

24% 24%

19%

33%

27%

22%24%

30%33%

31%

22%

26% 26% 27%

18%

36%

All or Most of My Health Care Needs Some of My Health Care Needs

None of My Health Care Needs or I Have No Health Care Needs

I use VA services to meet ...

Age Gender Income


Veterans, Enrollees and Patients: Fiscal Years 2014-2034

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Overview of the Veterans Choice Program


Overview: Veterans Choice Program (VCP)

Veterans who are enrolled for VA medical care OR recently discharged combat Veterans (within the five-year enrollment window) AND: • Live >40 miles driving distance, • Wait time >30 days from medically appropriate date or clinically necessary • Reside in state without VA Medical facility, OR• Unusual or excessive burden for travel to nearest health care facility

VCP allows eligible Veterans the choice to receive pre-authorized health care in their communities from community VCP providers, rather than waiting an extended time for a VA appointment or traveling a significant distance to a VA medical facility

In order to be a VCP provider, you must be an approved provider through a third party administrator

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How does a Veteran Access Services via Veterans Choice Program?

Care in VCP is activated by the Veteran calling the Third Party Administrator (TPA) at the number on the Veterans Choice Card

Health care through the VCP is authorized (Veteran may incur some cost if condition is non-service connected)

Medical documentation return:1) 30-day requirement for both in and out patient care

2) New cancer diagnosis must be reported within 48 hours


Requirements for Veterans Choice Program Providers

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3

Accept Medicare rates and meet all Medicare conditions of participation and conditions for coverage

Be in full compliance with federal and state regulatory requirements

Have unrestricted license in state where services are delivered


Veterans Choice Program - Provider Participation

• Complete information on respective Third Party Administrator (TPA) website

• TPA sends authorization package for Veteran’s medical appointment

• Return medical documentation and claim to TPA

• Claims payment by TPA


Third Party Administrator (TPA) Geographic Assignments

• Role• Geographic Coverage - Health Net (yellow) and TriWest (blue)


What VCP Means for Rural Health Systems, Medical Practices and Providers

In line with mission to provide rural access

Provides a venue for connecting with Veterans in the

community

Additional source of revenue

Community impact and opportunity for

partnership with Veteran Service Organizations, Officers and nonprofits

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Take Aways

1. Sign up as a VCP provider—you have nothing to lose and lots to gain

2. Know your local Veterans and their needs– At the end of this presentation is a list of organizations that

can help with this3. Contact your local VA medical facility leadership and staff to

build a relationship that can evolve in service to vets As the VA evolves into its "future" state of closer community collaborations where regional health care planning and patient care coordination is paramount


Thank You!

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Photo credit: Jose Gil

“… to care for him who shall have borne the battle and for his widow and orphan…”- Abraham Lincoln, VA mission

Thomas KlobucarOffice of Rural [email protected]

Visit: ruralhealth.va.gov Watch: https://www.youtube.com/watch?v=yyIjKAa-kv0 Subscribe to The Rural Connection:http://www.ruralhealth.va.gov/news/

Photo credit: Jose Gil

mailto:[email protected]

http://www.ruralhealth.va.gov/

https://www.youtube.com/watch?v=yyIjKAa-kv0

https://www.youtube.com/watch?v=yyIjKAa-kv0

http://www.ruralhealth.va.gov/news/

http://www.ruralhealth.va.gov/news/


Key Resources


Key Resources

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• Tom Grahek, Chief, Non-VA Purchased Care, Chief Business Office, VHA

– [email protected] or 804-878-2754

• Veterans Choice Program overview

• http://www.va.gov/opa/choiceact/factsheets_and_details.asp• "How to Become a Veterans Choice Program and/or Patient-Centered Community

Provider" fact sheet– http://

www.va.gov/opa/choiceact/documents/FactSheets/VACAA_Provider_Fact_Sheet_Choice_Program_508c_Internet.pdf

• VHA Choice Locator PC3 Provider Map– http://www.va.gov/opa/apps/locator/


http://www.va.gov/opa/choiceact/factsheets_and_details.asp

http://www.va.gov/opa/choiceact/factsheets_and_details.asp

http://www.va.gov/opa/choiceact/documents/FactSheets/VACAA_Provider_Fact_Sheet_Choice_Program_508c_Internet.pdf




http://www.va.gov/opa/apps/locator/




How to Become a VCP Provider

• Health Net contact information:– Provider customer service phone: 1-866-606-8198

– Email: [email protected]

– Website: http://www.healthnetpc3provider.com/p3c/?register=tru

– Point of contact: Jim Jones, Director, Provider Network Management, Health Net Federal Services, [email protected]

• TriWest contact information:– Provider services contracting phone: 1-866-284-3743

– Email: [email protected]

– Website: https://joinournetwork.triwest.com/

– Point of contact: Hal Blair, Deputy Program Manager, TriWest Healthcare Alliance, [email protected]


http://www.healthnetpc3provider.com/p3c/?register=tru



https://joinournetwork.triwest.com/



Veterans Choice Program Providers: Making Yourself Known to Veterans in Your Community

Engage with Veteran Community

Marketing and Outreach

Partner with Community VSOs

Provide Fact Sheets

Partner with Nearest VA35


Key Resources (continued)

Military Culture Training Course Training for community providers on treating the unique Veteran patient communityhttp://deploymentpsych.org/military-culture-course-modules

PTSD Consultation ProgramPost-traumatic stress disorder training offered for health care professionals who treat Veteranswww.ptsd.va.gov/professional/consult/index.asp

Veterans Choice Program ToolkitOutreach materials (e.g., fact sheets, FAQs) designed to make it easy to share information and spread awareness about VCPhttp://www.va.gov/opa/toolkit/index.asp

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http://deploymentpsych.org/military-culture-course-modules

http://deploymentpsych.org/military-culture-course-modules

http://www.ptsd.va.gov/professional/consult/index.asp

http://www.va.gov/opa/toolkit/index.asp

http://www.va.gov/opa/toolkit/index.asp

“answering the call: caring for rural veterans” national rural health day: devils lake, north...

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