va office of rural health gina l. capra, mpa director, office of rural health (orh) office of the...

VA Office of Rural Health

Gina L. Capra, MPADirector, Offi ce of Rural Health (ORH)Offi ce of the Assistant Deputy Under Secretary for Health (ADUSH) for Policy and PlanningVeterans Health Administrati on (VHA)/Department of Veterans Aff airs (VA)

VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 2

Today’s Presentation

• Mission and Overview

• Demographics and Needs

• Focus and Resources

• Environment and Collaborations


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


Department of Veteran Affairs (VA)Mission, Core Values & Characteristics

VA Mission: “…to care for him who shall have borne the battle andfor his widow and orphan…”

VA Core Values:“I CARE” - Integrity, Commitment, Advocacy, Respect & Excellence

VA Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile and Integrated


What is the Department of Veterans Affairs (VA)?

• Established in 1930• Elevated to Cabinet level in 1989• Federal government’s 2nd largest department after the

Department of Defense• Three components:

– Veterans Health Administration (VHA)– Veterans Benefits Administration (VBA)– National Cemetery Administration (NCA)


Improve Health and Well-being

Provide Exceptional Health Care

Honor America’s Veterans

Veterans Health Administration (VHA) Mission


VHA is the Largest Integrated Health Care Systemin the United States

151 Hospitals

995 Outpatient Clinics (Hospitals, Community,

Independent and Mobile )

135 Community Living Centers

300 Readjustment Counseling Centers Vet Centers

103 Domiciliary Resident Rehabilitation Treatment Programs


21 Veterans Integrated Service Networks

I J 2002

N ANUARY

W ERE INTEGRATED AND

RENAMED

VISN 13 14

VISN 23

S AND


Eligibility for VHA Healthcare

• Eligibility for VHA health care services depends on a number of qualifying factors, including:– The nature of a veteran’s discharge from military service (e.g.,

honorable, other than honorable, dishonorable)– Length of service– VA adjudicated disabilities (commonly referred to as “service-

connected disabilities”)– Income level– Available VA resources


Who is eligible for VHA Healthcare?

Veteran eligibility for VA healthcare is based on category group (“Priority Enrollment Group”) • Category Group 1

Veterans with service-connected disabilities rated 50% or more disabling • Category Group 2

Veterans with service-connected disabilities rated 30% or 40% disabling • Category Group 3

POWs, Purple Heart recipients, those rated 10% or 20% disabled, or those eligible under Title 38, U.S.C., Section 1151

• Category Group 4Veterans who receive aid and attendance or housebound benefits or are catastrophically disabled

• Category Group 5Veterans whose income and net worth are below established VA thresholds of $31K - $46K annually,(depending on family size), those on VA pension and/or are eligible for Medicaid benefits

• Category Group 6 WW I, Mexican Border War Veterans, disorders associated with exposure to herbicides (Agent Orange) while serving in

Vietnam, exposure to ionizing radiation in Hiroshima and Nagasaki, Gulf War illness. • Category Group 7

Veterans who pay co-payments with income and/or net worth above the VA threshold• Category Group 8

Veterans who agree to pay specified co-payments with income and/or net worth above the VA threshold and HUD geographic index who were enrolled before January 2003. Income requirements may change

from year to year.


Population Served

• Of 8.3 million enrolled Veterans, 3.1 million enrolled Veterans live in rural/highly rural areas• 22 million Veterans nationwide6.1 million Veterans living in rural areas• 36% of total enrolled Veteran population live in rural/highly rural areas• About one-third (31 percent) of Operation Enduring Freedom and Operation

Iraqi Freedom (OEF/OIF) users of the VA Health Care System in FY12 reside in rural or highly rural areas.

11

Enrolled VeteranPopulation Density, FY 2010


How are rural communities (and Rural Veterans) unique?

• Status/Health Equity – Older, sicker, and poorer population

• Options for integrated health care and coordination– Primary and Specialty Care– Mental Health Care– Healthcare Workforce

• Geography/Transportation – Longer travel distances to receive care– Lack of public transportation

• Limited internet/broadband connectivity


Rural Veterans’ Most Common Outpatient Diagnoses

• High Blood Pressure• Post-Traumatic Stress Disorder

(PTSD)• Type II Diabetes • Depressive Disorder• High Blood Cholesterol• At least 1 service-connected disability


VHA Office of Rural Health (ORH)

• The VHA Office of Rural Health (ORH) was created by Congress in 2007 under Public Law 109-461, Sec 212

• Mandated to work across VA to develop policies, best practices and lessons learned to improve care and services for enrolled rural and highly rural Veterans

• ORH falls under the VHA Assistant Deputy Under Secretary for Health (ADUSH)for Policy and Planning

14


Office of Rural Health (ORH) Mission

Improve access and quality of care for enrolled rural and highly rural Veterans by developing evidence-based policies and innovative practices to support their unique needs.

3-Pronged Approach:1. Promote best practices for maximum impact: Innovative pilots

study and analyze spread best practices.2. Build parternships and collaborations: Engage with VA program

offices, Federal and state partners, Veteran Service Organizations and rural health communities to effectively utilize resources.

3. Bridge operations and policy: Leverage lessons learned to inform policy and contribute to measurable impacts.

15

VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 16 16

Office of Rural Health (ORH)

ORH DirectorSecretary’s Veterans’

Rural HealthAdvisory Committee

(VRHAC)Veterans Rural Health Resource Centers

(VRHRCs)

VRHRCEastern Region

VRHRCCentral Region

Staff Assistant

BudgetAnalyst

ORH Deputy Director

VRHRCWestern Region

VRHAC Program Analyst

Full-Time10 Positions Funded

VISNs 6, 7, 9, 11, 12, 15, 16, 17, 19, 21

Part-Time/Collateral Duties

11 Positions

VISNs 1, 2, 3, 4, 5, 8, 10, 17, 18, 20, 22, 23

VISN Rural Consultants(VRCs) 4 Program

AnalystsHealth Systems

SpecialistStaff

Assistant

VHA Assistant Deputy Under Secretary for Health for Policy and Planning

VHA Assistant Deputy Under Secretary for Health for Policy and Planning


Office of Rural Health Components

• Veterans’ Rural Health Advisory Committee (VRHAC)• Federal advisory committee to advise the Secretary of Veterans Affairs on health care issues affecting

enrolled Veterans residing in rural areas

• Veterans Rural Health Resource Centers (VRHRCs)• Three regional centers: Gainesville, FL; Iowa City, IA; Salt Lake City, UT• Serve as rural health experts• Field-based clinical and education laboratories for VA demonstration projects/pilot projects• Provide programmatic support and technical assistance to funded VA partners

• Veterans Integrated Service Network (VISN) Rural Consultants (VRCs)• Serve as primary interface between ORH and VISN rural activities and projects• Develop rural health service plans based on VISN-wide needs assessments• Facilitate information sharing across the 21 VISNs• Perform outreach to develop community relationships

• Office of Rural Health (ORH) Central Office• Provides national leadership on issues pertaining to rural veterans • Administer special purpose appropriation and resources• Provides technical assistance, project monitoring and performance analysis functions• Coordinates IHS-VA MOU to promote access for American Indian/Alaska Native Veterans

17


Central Region

Iowa

City, IA

Eastern Region,

Gainesville,

FL

ORH Washington, DC

Western Region Salt

Lake City, UT

Location of ORH Veterans Rural Health Resource Centers

• Eastern Region Resource Center’s focus

– Clinical Telehealth, workforce development, GIS

• Central Region Resource Center’s focus

– Big Data Analysis, Women’s Health, Treatment adherence

• Western Region Resource Center’s focus

– Native American Veterans, Geriatric Care VA and Community Outreach


Collaborate to increase service

optionsMeasure, evaluate, and document impact of best

practices

Identify, recruit and retain rural health care professionals

Use emerging studies and analyses to

improve careUse emerging

health information technologies

ORH STRATEGIC FOCUS AREAS

Educate and train VA and non-VA providers


ORH Priorities – FY 2013

Category

Project ARCH - Public Law 110-387, Section 403

VA must conduct a pilot program to provide non-VA care for eligible, highly rural enrolled Veterans in five VISNs (VISNs 1,6,15, 18 & 19)

SCAN-ECHO RFP Specialty Care Access Network-Extension for Community Healthcare Outcomes

Rural Health Training and Education Initiative (RHTI)

Inter-professional, team-based models of training to deliver care to rural Veterans at 7 sites

New, sustained/existing, and expansion projects for FY13

Approved projects address many VHA and ORH priorities such as Telehealth, Women veterans, Mental Health, Homelessness, and Access & Quality


Project Focus Areas – FY 2013

Category # of ORH ProjectsRural Telehealth, including Home Telemonitoring, Store and Forward Image Transmission, and Clinic Based Video Telemedicine 30Rural Primary Care / Patient Aligned Care Teams (PCMH) 16Rural Specialty Care: Cardiology, Audiology, Prosthetics, Optometry, Radiology, Dermatology 69Rural Community Based Outpatient Clinics, Outreach Clinics, Mobile Clinics 57Rural Education Initiatives 14Rural Facilities Improvement 3Rural Home Based Primary Care 50Rural Homelessness 5Rural Mental Health, including Post Traumatic Stress Disorder 35Other Categories 21Rural Outreach Activities 15

Projects Focused on Rural Special Populations, including Women, American Indians/Alaska Natives, and Asian American/Pacific Islanders 31Rural Veteran Transportation Programs, including ground and air transportation 15

TOTAL 361


ORH Communications

ORH Publications• “The Rural Connection” Quarterly Newsletter• Research Briefs• Monthly Fact Sheets• Website, www.ruralhealth.va.gov

Dissemination Strategies• “Push” dissemination to email contacts (> 3,000 internal and external to VA)• Publish articles in VA, Veteran Service Organizations (VSO), and other rural health

publications (ex. National Rural Health Association e-newsletter and Rural Roads magazine)• Leverage the VA social media channels and VAntage Point blog• Present at national meetings• Conduct ORH-sponsored webinars and broadcasts through My VeHU

(VA eHealth University)

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


FY14: Eye on the Environment

• Population Migration, Demographics and Definitions

• Affordable Care Act Implementation

• Rural Economies and Service Markets

• Outreach, Coordination and Collaboration

• Workforce Development

• Technology Impact

• Effective Use of Resources

23


Affordable Care Act and VA

• Since the Affordable Care Act’s (ACA) enactment, VA has been proactive in working to understand the law’s impact on Veterans, other beneficiaries, and VA’s health care system and in preparing for implementation of the law.

• The most significant provisions of the ACA are the individual mandate requirement, which requires most individuals to have health insurance coverage and the Medicaid expansion provision, which expands Medicaid eligibility to up to 138% of the Federal Poverty Level.

• The individual mandate is a provision that requires all individuals to have minimum essential insurance coverage or face a tax penalty.

– Enrollment in VA health care, CHAMPVA or Spina Bifida programs meet the minimum essential coverage requirement.

• Veterans or other beneficiaries currently enrolled in VA health care do not have to take any additional steps to comply with the health insurance requirement outlined in ACA.

• Veterans and other eligible beneficiaries not currently enrolled in VA health care can apply for enrollment at any time.


Collaboration and Communication

Leverage collaborations, communications and coordinated efforts to seize strategic opportunities and improve

efficiencies in service to rural Veterans and their families.


Additional Resources:ORH Website

www.ruralhealth.va.gov


Thank You for Your Service


Questions? Ideas? Contact Information

For additional information, please contact:

Gina L. Capra, MPADirector, Office of Rural Health

[email protected](202) 461-1884 (direct)(202) 461-1681 (main line)

• VHA Office of Rural Health1722 Eye St, NW, Suite GL16Washington, DC 20006-3710

mailto:[email protected]

va office of rural health gina l. capra, mpa director, office of rural health (orh) office of the...

Documents

enrolled veterans

rural veterans unique

health adush

va office of rural health

veterans discharge

vha health care services

va health care system

rural communities