Veterans Health

“Answering the Call: Caring for Rural Veterans”
Virginia Rural Health Association 20th Anniversary
Annual Conference
Gina Capra, MPA
Director, Office of Rural Health (ORH)
Veterans Health Administration (VHA)
U.S. Department of Veterans Affairs (VA)
13/October 2015

VETERANS HEALTH ADMINISTRATION
Presentation topics
2
Organization Moderator/Presenter
Department of Veterans Affairs (VA), Veterans
Health Administration (VHA), Salem, Virginia VA
Medical Center (VAMC)
Brenda Hart, Rural Health Nurse Manager
Department of Veterans Affairs (VA), Veterans
Health Administration (VHA), Office of Rural
Health (ORH)
Gina Capra, Director
Topics
1. U.S. Department of Veterans Affairs Overview
2. Rural Veterans Snapshot
3. Community Collaborations & Strategic Drivers for Health Care Delivery
4. Veterans Choice Program Overview
5. Key Resources

OVERVIEW - 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
4

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:
5
Veterans
Health
Administration
National
Cemetery
Administration
Veterans
Benefits
Administration

VETERANS HEALTH ADMINISTRATION 6
U.S. Department of Veterans Affairs (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
7

Overview: which Veterans use the VA health care system?
8
~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
9
• 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 Defense
Military 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
749 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”
10
151 Medical Centers
(VAMC)
749 Community Based
Outpatient Clinics
(CBOC)
272 Other outpatient
and/or residential
service sites (includes
Mobile Medical and
Telehealth Units)
300 Readjustment
Counseling Centers
(Vet Centers)
70 mobile Vet Centers

FY16/October 2015: New
VISN realignment
underway
Regional Organization of Health Care Systems
21 Veterans Integrated Service Networks (VISNs)

VA Medical Centers (VAMC) Located in Virginia (3)
• Hampton VAMC, Hampton
– 100 Emancipation Drive, Hampton, Virginia 23667
– Phone: (757) 722-9961
– Toll-Free: (866) 544-9961
• Hunter Holmes McGuire VAMC, Richmond
– 1201 Broad Rock Boulevard, Richmond, Virginia 23249
– Phone: (804) 675-5000
– Toll-Free: (800) 784-8381
• Salem VAMC, Salem
– 1970 Roanoke Boulevard, Salem, Virginia 24153
– Phone: (540) 982-2463
– Toll-Free: (888) 982-2463
• VISNs 5, 6, 9
12

VA Community Based Outpatient Clinics (CBOC) Located
in Virginia (16)
• Charlottesville1
• Danville2
• Emporia1
• Fort Belvoir4
• Fredericksburg1
• Harrisonburg 5
• Jonesville6
• Lynchburg2
• Marion6
• Norton6
• Staunton2
• Tazewell2
• Vansant6
• Virginia Beach3
• Winchester5
• Wytheville 2
13
Parent Facilities: 1Richmond VAMC; 2Salem VAMC; 3Hampton VAMC; 4Washington DC VAMC; 5Martinsburg VAMC;
6Mountain Home VAMC
http://www.va.gov/directory/guide/state.asp?STATE=VA&dnum=ALL

VA Readjustment Counseling Centers (“Vet Centers”) in
Virginia (5)
• Alexandria
– 6940 South Kings Highway #204, Alexandria, VA 22310
– Phone: (703) 360-8633 or (877) 927-8387
• Norfolk
– 1711 Church Street, Suites A&B, Norfolk, VA 23504
– Phone: (757) 623-7584 or (877) 927-8387
• Richmond
– 4902 Fitzhugh Avenue, Richmond, VA 23230
– Phone: (804) 353-8958 or (877) 927-8387
• Roanoke
– 350 Albemarle Ave., SW, Roanoke, VA 24016
– Phone: (540) 342-9726 or (877) 927-8387
• Virginia Beach
– 324 Southport Circle, Suite 102, Virginia Beach, VA 23452
– Phone: (757) 248-3665 or (877) 927-8387
http://www.va.gov/directory/guide/state.asp?STATE=VA&dnum=ALL
14

SNAPSHOT of the Rural Veteran

Snapshot of the rural Veteran served by the U.S. Veterans
Health Administration
5% increase of enrolled rural
women Veterans since FY12
56% of VA-enrolled rural
Veterans are 65+ years old
12% of enrolled rural Veterans
served in Iraq or Afghanistan
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
33% of our 9.1M enrolled Veterans live
in rural or highly rural areas.
43% of rural Veterans earn an
annual income of less than $26,000
6% of enrolled rural Veterans are Women
8% of enrolled rural Veterans
are racial/ethnic minorities (African-
American, Asian, Native Hawaiian
or Pacific Islander, American Indian
or Alaska Native)
36% do not access the internet at
home

Snapshot of VA’s rural care delivery
17
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”
18
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

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
19
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

• Rural health care faces current and impending challenges:
− Healthcare workforce shortages and complex care coordination
− Primary care provider, mental health workers and specialist shortages
− Hospital closings due to financial instability
− Population health factors and social determinants of health
− Access to health and wellness promotion efforts
− Housing
− Education
− Employment
− Transportation
− Geographic, transportation and distance barriers
− Limited internet broadband coverage
• Health status and health equity matter!
20
Rural health care delivery: a challenging environment

Community Engagement & Collaborations

VA efforts to engage community providers
22
November 2014
VA launches Veterans
Choice Program (VCP)
February 1995
VA 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 2014
VA 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
23
Source: 2013 American Community Survey
Health Plan ACS 2013
VA 6,240,160
TRICARE 3,201,337
MEDICARE 11,278,162
Medicaid 1,955,348
Private 6,173,312
Uninsured 1,329,080
Total Veterans 23,077,645

Current use of the VA health care system
24Source: 2014 Survey of Enrollees
42%
45%
58%
39%
45%
50%
57%
33%
24% 24%
19%
33%
27%
22%
24%
30%
33%
31%
22%
26% 26% 27%
18%
36%
<30 30-49 50-64 65+ M F <$36,000 $36,000+
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
25

Virginia is answering the call
• Strong history of rural Virginia providers expanding care for Veterans in collaboration with the US
Department of Veterans Affairs
• November 2014: Governor’s Summit on Veterans Health
• First enrolled community providers under the Veterans Choice Program
Total Virginia Veterans 781,388 *
Total Virginia Veterans enrolled in VA Health System (FY14) 260,552 **
Rural enrollees 72,601
Highly Rural enrollees 4,628
Demographic Snapshot: 12% Female; 88% Male
Age 65+ 39%; Age 50-64 30%; Age 25-49 30%
White 46%; Black or African American 25%; Unknown 25%
Enrollment by Virginia Veterans in VHA increased +4.5% average annually FY10-14
*US Census Bureau, 2010, ** Veterans Health Administration Enrollment Files, FY14 26

OVERIVEW: Veterans Choice Program (VCP)

Overview: Veterans Choice Program (VCP)
*Veterans who were enrolled for VA medical care as of August 1, 2014 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,
• Reside in state without VA Medical facility, OR
• Unusual or excessive burden for travel to nearest health care facility
* In process of change due to new legislation
VCP allows eligible Veterans the choice to receive pre-authorized
health care in their communities from non-VA providers participating
in the VCP, 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
28

Veterans Choice Program (VCP): August 2014 provisions
29
• VA to furnish hospital care and medical services to eligible
Veterans through agreements with eligible entities or other laws
administered by the Secretary
− Agreements include contracts, provider agreements and
intergovernmental agreements
• $10 billion for a “Veterans Choice Fund” to pay for community
care authorized under the Veterans Choice Program
– VA contracted with two Third Party Administrators to
implement the provider networks, Veteran authorizations,
payment, etc.
• Authority sunsets in three years, or when the Veterans Choice
Fund is exhausted
• Pre-existing programs and initiatives were unchanged

Veterans Health Care Choice Improvement Act of 2015
• Sec. 4005. modifications of Veterans Choice Program
• Includes five provisions to enhance the Choice Act:
− Removes 60 day limit on episode of care
− Removes requirement for enrollment prior to 8/1/2014; Veteran must be enrolled in the VA
healthcare system
− Expands provider base by allowing VA Secretary to establish criteria
− Amends the wait time language that allows care at a non-department facility if Veteran cannot
get care in VA within the:
− Wait time goals set by VA (currently 30 days)
− Or within the clinically necessary time if shorter than wait time
− Changes requirement for distance from CBOCs related to full time physician availability
− Under review by OGC to determine exact interpretation
30

How does the Veterans Choice Program (VCP)
work?

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 in individual *60-day
episodes (Veteran may incur some cost if condition is non-service
connected) *changing per new legislation
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 (VCP)
providers
1
2
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

Veterans Choice Program Implementation
Secondary Authorizations and Pharmacy
• Secondary authorization requests (SARs) *beyond initial 60 days or for care not
included in initial authorization are submitted to and authorized by TPA (not VA)
*changing
• Pharmacy
1. An initial 14-day supply of medication that is an urgent and emergent needed
incident to an episode of care can be filled by community provider or local
pharmacies
2. That initial 14-day supply, must be initially paid for by the Veteran, but can be
reimbursed by VA
3. All other prescriptions must be filled by VA and are typically dispensed through
the mail order pharmacy, but can be in-person if Veteran desires
35

Third party administrator (TPA) geographic assignments
36
• Role
• Geographic Coverage - Health Net (yellow) and TriWest (blue)

How to become a VCP provider
• Health Net contact information:
– Provider customer service phone: 1-866-606-8198
– Email: HNFSProviderRelations@Healthnet.com
– Website: http://www.healthnetpc3provider.com/p3c/?register=tru
– Point of contact: Jim Jones, Director, Provider Network Management, Health Net Federal
Services, james.a.jones@healthnet.com
• TriWest contact information:
– Provider services contracting phone: 1-866-284-3743
– Email: TriWestDirectContracting@triwest.com
– Website: https://joinournetwork.triwest.com/
– Point of contact: Hal Blair, Deputy Program Manager, TriWest Healthcare Alliance,
hblair@triwest.com

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
38

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 VA
39

Veterans: Coverage into Care….How would you answer…
40
• Generally, rural clinicians and health care administrators…
A. Fully understand Veteran needs
B. Sometimes struggle to understand Veteran needs
C. Need more information on VA and Veteran resources
D. Know their patients’ military status
• Any response above points to continued engagement with multiple partners
in order to best serve our Veterans and their families in our communities,
across our State and across the Nation.

KEY RESOURCES

Key Resources
42
• Tom Grahek, Chief, Non-VA Purchased Care, Chief Business Office, VHA
– Tom.Grahek@va.gov 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/

Key Resources (continued)
Military Culture Training Course
Training for community providers on treating the unique Veteran
patient community
http://deploymentpsych.org/military-culture-course-modules
PTSD Consultation Program
Post-traumatic stress disorder training offered for health care
professionals who treat Veterans
www.ptsd.va.gov/professional/consult/index.asp
Veterans Choice Program Toolkit
Outreach materials (e.g., fact sheets, FAQs) designed to make it easy
to share information and spread awareness about VCP
http://www.va.gov/opa/toolkit/index.asp
43

Thank You! Questions? Ideas?
• Gina Capra, Director, Office of Rural Health, Veterans Health Administration (VHA)
– Gina.Capra@va.gov or 202-632-8615
• Brenda Hart, Nurse Manager for Rural Health, Salem VA Medical Center
– Brenda.Hart@va.gov or 540-982-2463 x4418
• Regan Crump, Director, Office of Strategic Planning & Analysis, VHA
– Regan.Crump@va.gov or 202-461-7096
• Lelia Jackson, Director, Office of Community Engagement, VHA
– Lelia.Jackson@va.gov or 202-461-5758
44

Veterans Health

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Veterans Health

Similar to Veterans Health (20)

More from Virginia Rural Health Association

More from Virginia Rural Health Association (20)

Recently uploaded

Recently uploaded (20)

Veterans Health

Editor's Notes