Office of Rural Health (ORH)

Report
VA Office of Rural Health
Gina L. Capra, MPA
Director, Office of Rural Health (ORH)
Office of the Assistant Deputy Under Secretary for Health (ADUSH) for
Policy and Planning
Veterans Health Administration (VHA)/Department of Veterans Affairs (VA)
Today’s Presentation
• Mission and Overview
• Demographics and Needs
• Focus and Resources
• Environment and Collaborations
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 2
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
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 3
Department of Veteran Affairs (VA)
Mission, Core Values & Characteristics
VA Mission:
“…to care for him who shall have borne the battle and
for his widow and orphan…”
VA Core Values:
“I CARE” - Integrity, Commitment,
Advocacy, Respect & Excellence
VA Characteristics:
Trustworthy, Accessible, Quality, Innovative, Agile and Integrated
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 4
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)
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 5
Veterans Health Administration (VHA) Mission
Honor America’s Veterans
Provide Exceptional Health Care
Improve Health and Well-being
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 6
VHA is the Largest Integrated Health Care System
in 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
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 7
21 Veterans Integrated Service
Networks
IN J A N U A R Y 2 0 0 2
V IS N S 1 3 A N D 1 4
W E R E IN T E G R A T E D
RENAMED
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 8
AND
V IS N 2 3
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 “serviceconnected disabilities”)
– Income level
– Available VA resources
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 9
Who is eligible for VHA Healthcare?
Veteran eligibility for VA healthcare is based on category group (“Priority Enrollment Group”)
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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 4
Veterans who receive aid and attendance or housebound benefits or are catastrophically disabled
Category Group 5
Veterans 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.
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 10
Population Served
• Of 8.3 million enrolled Veterans, 3.1 million enrolled Veterans live in
rural/highly rural areas
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•
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22 million Veterans nationwide6.1 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.
Enrolled Veteran
Population Density, FY 2010
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 11
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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
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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
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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
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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.
2.
3.
Promote best practices for maximum impact: Innovative pilots 
study and analyze  spread best practices.
Build parternships and collaborations: Engage with VA program
offices, Federal and state partners, Veteran Service Organizations
and rural health communities to effectively utilize resources.
Bridge operations and policy: Leverage lessons learned to inform
policy and contribute to measurable impacts.
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 15
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Office of Rural Health (ORH)
VHA Assistant Deputy Under Secretary for Health
for Policy and Planning
Secretary’s Veterans’
Rural Health
Advisory Committee
(VRHAC)
ORH Director
Veterans Rural Health
Resource Centers
(VRHRCs)
VRHRC
Western Region
VRHRC
Central Region
ORH Deputy
Director
VRHRC
Eastern Region
VISN Rural Consultants
(VRCs)
Full-Time
10 Positions Funded
VISNs 6, 7, 9, 11, 12, 15,
16, 17, 19, 21
Budget
Analyst
4 Program
Analysts
VRHAC
Program
Analyst
Health Systems
Specialist
Staff
Assistant
Staff
Assistant
Part-Time/
Collateral Duties
11 Positions
VISNs 1, 2, 3, 4, 5, 8, 10,
17, 18, 20, 22, 23
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 16
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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)
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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)
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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
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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
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 17
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Location of ORH Veterans Rural Health Resource Centers
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Eastern Region Resource Center’s
focus
– Clinical Telehealth, workforce
development, GIS
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•
Central Region Resource Center’s
focus
Western
Region
Salt Lake
City, UT
Central
Region
Iowa
City, IA
– Big Data Analysis, Women’s
Health, Treatment adherence
ORH
Washin
gton,
Eastern
DC
Region,
Western Region Resource Center’s
focus
Gainesville,
FL
– Native American Veterans,
Geriatric Care VA and
Community Outreach
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 18
Measure, evaluate,
and document
impact of best
practices
Collaborate to
increase service
options
Identify, recruit
and retain rural
health care
professionals
Use emerging
studies and
analyses to
improve care
Educate and train VA
and non-VA providers
Use emerging
health information
technologies
ORH STRATEGIC FOCUS AREAS
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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
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 20
Project Focus Areas – FY 2013
Category
Rural Telehealth, including Home Telemonitoring, Store and
Forward Image Transmission, and Clinic Based Video Telemedicine
Rural Primary Care / Patient Aligned Care Teams (PCMH)
Rural Specialty Care: Cardiology, Audiology, Prosthetics, Optometry,
Radiology, Dermatology
Rural Community Based Outpatient Clinics, Outreach Clinics, Mobile
Clinics
Rural Education Initiatives
Rural Facilities Improvement
Rural Home Based Primary Care
Rural Homelessness
Rural Mental Health, including Post Traumatic Stress Disorder
Other Categories
Rural Outreach Activities
Projects Focused on Rural Special Populations, including Women,
American Indians/Alaska Natives, and Asian American/Pacific
Islanders
Rural Veteran Transportation Programs, including ground and air
transportation
TOTAL
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 21
# of ORH Projects
30
16
69
57
14
3
50
5
35
21
15
31
15
361
ORH Communications
ORH Publications
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“The Rural Connection” Quarterly Newsletter
Research Briefs
Monthly Fact Sheets
Website, www.ruralhealth.va.gov
Dissemination Strategies
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“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)
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 22
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
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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.
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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.
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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.
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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.
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Collaboration and Communication
Leverage collaborations, communications and coordinated
efforts to seize strategic opportunities and improve
efficiencies in service to rural Veterans and their families.
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Additional Resources:
ORH Website
www.ruralhealth.va.gov
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Thank You for Your Service
VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 27
Questions? Ideas? Contact Information
For additional information, please contact:
Gina L. Capra, MPA
Director, Office of Rural Health
[email protected]
(202) 461-1884 (direct)
(202) 461-1681 (main line)
• VHA Office of Rural Health
1722 Eye St, NW, Suite GL16
Washington, DC 20006-3710
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