Transcript Veterans Health Administration Chief Business Office

Office of Rural Health (ORH)
NRHA Rural Health Policy Institute
January 24, 2011
Mary Beth Skupien, PhD, MS
Assistant Deputy Under Secretary for Health for Policy and Planning
Director, Office of Rural Health
Agenda
Office of Rural Health
Rural Veterans Demographics
Programs and Initiatives
Future Direction
2
ORH Mission
• Improve access and quality of care for enrolled rural
and highly rural Veterans by developing evidencebased policies and innovative practices to support
their unique needs
 Collaborate with VA program offices, other Federal and state
partners and rural health communities to build partnerships
 Engage in studies and analyses and promulgate best
practices
 Translate research and best practices into policy and
measurable impacts
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Areas of Focus
• Areas of Focus
 Access and Quality
 Technology and Telehealth
 Studies and Analyses
 Education and Training
 Building Collaborations
 Workforce Recruitment and Retention
ORH Organizational Structure
ORH Director (SES)
Mary Beth Skupien,
Ph.D., MS, RN
Veterans’ Rural Health
Advisory Committee
Chairman James Ahrens
ORH Deputy Director
Sheila Warren, MPH, RN
Program Analyst
Anthony Achampong,
MBA, MHSA
Program Analyst
Christina White
Program Analyst
Serena Chu, Ph.D.
Program Analyst
Nancy Maher, Ph.D.
Veterans Rural Health
Resource Centers
VRHRC-Western
Director
Byron Bair, M.D.
VRHRC-Central
Director
Peter Kaboli, M.D.
Budget Analyst
Mike Privman,
MHSA
Staff Assistant
Alta Jones
Clinical Liaison
Lynn McQueen,
DrPH, RN
VISN Rural
Consultants
VRHRC-Eastern
Acting Director
Paul Hoffman, M.D.
Contractor
Support
Part-Time /
Collateral Duties
13 Positions
Full-Time
8 Funded
1. Jackie Morales (V9)
1. Doug Edwards (V1)
2. Sherri Deloof (V11)
2. Christopher Petteys (V2) 10. Joseph Zimmerman
3. Mary O’Shea (V15)
3. Bertha Fertil (V3)
4. Deanna Jackson-Moore
4. Anthony Behm (V4)
(V16)
5. Alvis Hargrove (V5)
9. Joe Kohut (V10)
(V12)
11. Shenita Washington
(V17)
5. Ron Schmidt (V19)
6. Talbot Vivian (V6)
12. Kenneth Browne (V18)
6. Jodie Waters (V20)
7. Kristin Pettey (V7)
13.Laurie Traylor (V22)
7. Colette Alvarez (V21)
8. Pat Ryan (V8)
8. Katie Dziak (V23)
ORH Infrastructure
• Veterans Rural Health Resource Centers (VRHRCs)
 ORH has three regional VRHRCs. The VRHRCs:
 Provide programmatic support to ORH
 Conduct policy-oriented studies and analyses
 Operate as field-base clinical laboratories for demonstration
projects
 Serve as regional rural health experts
 Act as educational and clinical repositories of expertise
 The VRHRCs are located in:
 Eastern Region (White River Junction, Vermont)
 Central Region (Iowa City, Iowa)
 Western Region (Salt Lake City, Utah)
Map of VRHRCs and Veteran
Integrated Service Networks (VISNs)
Western
Region
Salt Lake City,
UT
Central Region
Iowa City, IA
Eastern Region,
White River Junction,
VT
ORH
Washington,
D.C.
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ORH Infrastructure (cont.)
• VISN Rural Consultants (VRCs)
 Serve as the primary interface between ORH and the VISN in
which they operate
 Meet semi-annually to discuss ORH programs and policies
that impact the provision of VA health care
 There are 8 full-time VRC positions and 13 part-time VRC
positions that have collateral responsibilities
 Responsible for executing a needs assessment, developing a
rural health service plan, facilitating information sharing
within and across VISNs and with ORH
 Perform outreach to develop strong relationships and
communications within the community at large and within VA
ORH Infrastructure (cont.)
• Veterans Rural Health Advisory Committee (VRHAC)
 VRHAC is a 12 member committee that advises the Secretary
of VA
 Has two ex officio members representing other Federal agencies,
to ensure coordination with other federal agencies involved with
rural health issues
 Meets semi-annually to discuss ORH programs and policies
that impact the provision of VA health care
 Examines ways to improve and enhance VA service for
Veterans residing in rural and highly rural areas by evaluating
current program activities and identifying barriers to
providing service
Agenda
Office of Rural Health
Rural Veterans Demographics
Programs and Initiatives
Future Direction
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Rural Veterans Demographics
• There are almost 8 million Veterans enrolled in the VA Health Care
System. Approximately 3 million live in rural and highly rural areas. (1)
(2)
• Rural:
3,414,983
• Highly Rural:
40%
120,334
Rural
Highly Rural
• Urban:
8,288,077
Urban
59%
1%
(1)
(2)
Definitions: Urban - areas defined by U.S. Census as urbanized areas; Rural - all other areas
excluded in U.S. Census defined as urbanized areas; Highly Rural - any rural area within a county
with less than 7.0 civilians per square mile.
FY 2010 data
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Agenda
Office of Rural Health
Rural Veterans Demographics
Programs and Initiatives
Future Direction
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Over 300 ORH Projects and Programs
• VA National Programs
• Rural CBOCs, Tele-health, Mental Health, Women Veterans Health, Homeless,
HBPC, Outreach Clinics, Behavioral Health, PACT, transportation, other.
• VISN/VRC Projects
• Tele-health, optometry, podiatry, diabetes, case management, mental health,
women’s health, homeless, transportation, communications improvement,
substance abuse treatment, social services, mobile clinics, etc.
• Rural Health Resource Center
• Projects
• HIV/AIDS, Rural Health Provider Training, Neuro-rehab consultation, Telerehab, VA Outreach clinic evaluation, Veteran’s Healthcare and Needs
Survey, Geographic access assessment, others.
• Studies
• Tobacco Cessation, Suicide-related mortality analysis, rural surgery needs
and strategies, transportation needs assessment, others.
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ORH Funding
• Fiscal Year (FY) 08
 ORH allocated $24 million to establish initial ORH
programs and projects
• FY 09
 Public Law 110-329 provided $250 million to support
service expansion and outreach:
 December 2008: ORH distributed $22 million to the VISNs as
seed money
 February 2009: ORH provided $215 million to 74 projects
across the VISNs and Program Offices
ORH Funding
• Fiscal Year 2009
Category
Funding
VISN Initiatives
$21,700,000
Telehealth/Telemedicine Expansion
$66,193,322
Home Based Primary Care Expansion
$36,323,645
Mental Health Programs
$11,340,480
Health Care Service Expansion
$14,011,988
Outreach Initiatives
$28,946,984
Education and Training
$9,093,375
Other
$12,794,488
Total:
$200,404,282
Funding as of August 31, 2010
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ORH Funding
• Fiscal Year 2010
Category
Funding
Telehealth/Telemedicine Expansion
Home Based Primary Care Expansion
Mental Health Programs
$4,718,846
$953,640
$1,124,514
Health Care Service Expansion
$10,395,908
Outreach Initiatives
$63,290,751
Education and Training
$3,374,694
Fee Care
$200,000,000
Other
$28,675,121
Total:
$312,533,474
Funding as of August 31, 2010
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Fiscal Year 2011 ORH Funding
Fiscal Year 2011-$250 Million-Operating Plan (Submitted for approval)
Category
Funding
Sustainment Projects
$109,500,000
Community-Based Outpatient Clinics
(CBOC)
$70,500,000
Public Law 110-387 Section 403
$70,000,000
Total:
$250,000,000
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Programs and Initiatives:
Access
• Outreach Clinic Expansion
 Provide primary care services, case management and mental
health services in rural and highly rural areas
 ORH has funded 40 Outreach Clinics
• Rural Mobile Health Clinics (RMHCs)
 Expand access to primary care, mental health, and specialty
referral into rural areas where it is not feasible to establish a
fixed access point and impacted Veterans are not able to
easily travel to fixed locations such as VA Medical Centers
and Community-Based Outpatient Clinics (CBOCs)
 ORH has four operational RMHCs serving rural counties in Maine,
West Virginia, Washington, Colorado, Nebraska and Wyoming
Programs and Initiatives:
Geriatrics and Extended Care
• Home Based Primary Care (HBPC) Expansion
 Provide comprehensive longitudinal primary care by an
interdisciplinary team in the homes of Veterans with complex
chronic disease and disability for whom routine clinic-based
care is no longer effective
• Medical Foster Home Expansion (MFH) Expansion
 Improve access and enhance delivery of health care to Veterans
residing in rural and highly rural areas
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Programs and Initiatives:
Geriatrics and Extended Care (cont.)
• Geri-Scholars Program
 Support geriatric health care providers in rural and
highly rural areas by aiding them in treating the
special needs of older Veterans
 Through intensive coursework and training, VA
disseminates the most current and effective methods in
rural and highly rural geriatric medicine to rural and highly
rural health care providers
Programs and Initiatives:
Mental Health
• South Central Illness Research Education and Clinical
Center (MIRECC) Pilot Studies
 The study will be used to develop clinical policy or
program that improve access, quality, and
outcomes of mental health and substance abuse
treatment services for rural and underserved
Veterans.
• Community-Based Mental Health Services for
Veterans in Rural Areas
 Expands intensive case management services for Veterans
with serious mental illness and outreach services and
expansion and integration of VA’s existing Rural Access
Network for Growth Enhancement (RANGE) program
Programs and Initiatives:
Women Veterans Health
• Delivery of Care to Women Veterans
 Improves the care for women Veterans by
enhancing the practice and culture of the VA to be
more inclusive of women Veterans
 Expand access for women Veterans
 Engage in outreach with women Veterans through
communication and advocacy
 Engage women to be partners in managing their health
Agenda
Office of Rural Health
Veteran Demographics
Initiatives
Future Direction
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Future Directions
• Improving knowledge base
 Continue improving ORH understanding of rural and highly
rural Veterans and their needs
 Implementing best practices and program evaluations of
current initiatives
 Implementing evidence-based strategies and innovative care
delivery models
• Improving capacity to care for rural and highly rural
Veterans
 Lessons learned from each year’s experience
 Growing infrastructure; emphasizing local innovation with
national focus
 Building community collaborations
 Working in partnership with other rural partners for policy
development
ORH Strategic Plan Refresh
“Refreshing”
the ORH Strategic Plan
• ORH has formed 6 workgroups to review and update programmatic
goals and objectives
1. Improve access and quality for rural Veterans
2. Optimize use of technology to enhance health care services
3. Maximize utilization of studies & analyses to impact health care
delivery
4. Improve availability of education and training for VA and nonVA service rural providers
5. Increase collaborations and increase service options for rural
Veterans (Top Priority)
6. Develop innovative methods to identify, recruit and retain
medical professionals in rural communities
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VRC & VRHRC Activities
• Geographic Assessments
• Health Need Assessments
• Objective Measures Development, Implementation
Reporting and Training
• Communication Improvement
• Alignment of VISN projects with National Programs
(e.g. VISN Telehealth projects with OTS measures and
standards).
• Identifying and establishing new partnerships
• Strategic Planning alignment, development and
implementation.
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Developing Relevant Measures
for ORH Programs and Projects
How we’ve established measures
• Through research and from literature review of national
rural health measures to identify evidence-based measures.
• Through evaluation and review of existing VA, non-rural
measures
• To compare VA rural and non-rural health care, service and outcomes
• To identify and work to prevent disparities
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What will be measured?
1. Access Measures – All ORH projects and Programs
will report:
• Number of rural veterans impacted
• Number of newly enrolled rural Veterans
• Number of rural women Veterans impacted
• Number of rural OEF/OIF Veterans impacted
• Number of rural homeless Veterans impacted
• Number of rural AI/AN Veterans impacted
2. All ORH projects related to established National
Programs (Tele-health, Mental Health, Other)
Will come into alignment with related National Program measures.
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What will be measured (continued)
3. Quality of Care and Service
• Hypertension recorded, Wait times, courtesy, move
(exercise) projects
4. Preventive Care
• Flu shots, Mammograms, Colorectal screening
5. Satisfaction/Perception
• Veteran, Staff and Provider
6. Outcome Measures: HB A1C, etc.
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How will Measures be collected and
tracked?
• Through the development and national deployment of an
electronic, web-based data collection, and tracking system.
• Through Passive and Active data collection methods
• Collaboration with VSSC and OQP
• Development of a Rural Health Briefing Book – in pilot now and target
release date 12/31/10.
• Rural Health Dashboard – target date for completion 3/2011.
• OQP is continuing to expand ability to pull out rural health data from
EPRP and SHEP 2/2011.
.
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Questions?
[email protected]
We look forward to partnering
in the future!
Thank you.
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