Department of Veteran Affairs. Working Together for Improved Health

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1 Department of Veteran Affairs Working Together for Improved Health

2 Objectives of the Session Overview of VA and Veteran Population Veterans in Indiana Planning for Care for Indiana Vets Rural Health Focus in VA VA Rural Health Programs in Indiana VA and the Affordable Care Act Veterans Access, Choice and Accountability Act 2

3 DEPARTMENT OF VETERANS AFFAIRS OVERVIEW 3

4 Veteran Population Overview Approximately 476,000 Veterans live in Indiana 4

5 Veteran Population Overview 5

6 Indiana Veterans 476,000 Veterans 35,500 Women 340,000 Wartime 6

7 Department of Veterans Affairs Veterans Health Administration Veterans Benefits Administration National Cemetery System 7

8 VBA - Veterans Benefits Administration Mission VBA s Mission is to serve as a leading advocate for Servicemembers, Veterans, their families and Survivors, delivering with excellence Veteran-centered and personalized benefits and services that honor their service, assist in their readjustment, enhance their lives, and engender their full trust. 7 Business Lines Compensation Pension and Fiduciary Education Vocational Rehabilitation and Employment Life Insurance Loan Guaranty Benefits Assistance 8

9 VBA Veterans Benefits Administration Resources Serving Indiana Veterans Regional Benefits Office Counseling about benefit eligibility Assistance in application Indianapolis, IN Regional Loan Center Home Loan Guaranty Cleveland, OH

10 NCA National Cemetery Administration Mission NCA honors Veterans and their families with final resting places in national shrines and with lasting tributes that commemorate their service and sacrifice to the Nation Purpose Provide burial space for Veterans Maintain national cemeteries as national shrines Mark Veterans graves with a Governmentfurnished headstone, marker or medallion Provide Presidential Memorial Certificates in recognition of service to a grateful nation Grants for establishing and expanding state and tribal government Veterans cemeteries 10

11 NCA National Cemetery Administration Resources in Indiana Crown Hill Confederate Plot - Indianapolis Crown Hill National Cemetery - Indianapolis Marion National Cemetery New Albany National Cemetery Woodlawn Monument Site Terre Haute 11

12 VHA - Veterans Health Administration Mission Statement To honor America s Veterans by providing exceptional health care that improves their health and wellbeing. 1)National health care system for eligible Veterans 2) Education and training for health care personnel 3) Health care research 4) Contingency support for war and national emergencies 12

13 Who Provides VA Health Care to Indiana Veterans? 21 Veterans Integrated Service Networks (VISNs) VISNs 9, 10, 11 &15 I N J ANUARY 2002 VISN S 13 AND 14 WERE INTEGRATED AND RENAMED VISN 23 13

14 VISNS 9 (8%), 10 (3%), 11 (70%), 12 (13%) AND 15 (6%) SERVING INDIANA VETERANS 14

15 Serving Indiana VHA Sites of Care 3 Inpatient Sites 16 Outpatient Sites 5 Mental Health Store Fronts Vet Centers 15

16 VA Healthcare Sites in Indiana Health Systems Northern Indiana Health Care System Fort Wayne, IN Marion, IN Indianapolis Veterans Benefits Indianapolis Regional Benefit Office Vet Centers Crown Point Evansville Fort Wayne Indianapolis South Bend Outpatient Clinics (VISN) Bloomington (11) New Albany (9) Crown Point (12) Evansville (15) Goshen (11) Greendale (10) Indy West (11) Martinsville (11) Muncie (11) National Cemetery Indianapolis Marion New Albany Terre Haute Peru (11) Richmond (10) Scottsburg (9) South Bend (11) Terre Haute (11) Vincennes (15) W Lafayette (11) 16

17 Indiana Veterans Enrolled in VA for Healthcare 476,000 Veterans in Indiana Rurality of Enrollees 185,500 Veterans in Indiana are enrolled for VA Care almost 39% 60% 0% 40% 96,000 of those live in rural areas - 40% Highly Rural Rural Urban 17

18 Indiana Veterans Who Use VA for Healthcare Of the Veterans who are enrolled for VA healthcare, approximately 64% of them came to VA last year Of those, 42% were from rural areas Greater majority of rural enrollees (64%) are using us than urban enrollees (62%) 18 Photo Courtesy of Dennis Cluth, Michigan Vietnam Veteran

19 PLANNING FOR CARE FOR INDIANA VETERANS 19

20 Strategic Priorities More Care Closer to Veterans Meeting the Needs of the Newest Veterans Embedding a Culture of Improvement Meeting Corporate Responsibilities Systematically Just Do Its Honor America s Veterans by providing exceptional health care that improves their health and well-being 20

21 Bring Care Closer to Veterans Integrated Planning Plan for population health needs at a market systems level Considers health futures: connected health, non-capital, efficiency Matches assets to the population needs Informed Veteran-centric capital plans Anticipated Impacts New sites of care, re-routed referral patterns, and mission changes Future capital planning considerations 21

22 VA S RURAL HEALTH FOCUS 22

23 VHA Office of Rural Health The VHA Office of Rural Health (ORH) was created by Congress in 2007 under Public Law , 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 23

24 VA 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 24

25 RURAL HEALTH FOR VETERANS LIVING IN INDIANA 25

26 VHA Rural: Indiana Veteran population: 185,500 enrollees Veteran rurality: 96,000 enrollees are rural Gender: 97% are male Age: 62% are over age 60, 38% between ages 18 and 59 Rural facilities: Marion VA Medical Center and Peru Outpatient Clinic Top three diagnoses treated: diabetes, hyperlipidemia and other unspecified counseling 26

27 Indiana Rural Health Initiatives Rural Prosthetic Van Program Outpatient Clinics Transportation Programs Blind Rehab Program TeleHealth expansion Community Partnerships-ASPIN 27

28 Mobile Prosthetic Vans 2 Vans in Indiana Started 10/1/13 Visits outpatient clinics 2x month Provides wheelchair fits/adjustments, diabetic shoes, braces, orthotic adjustments 4,811 appointments 28

29 TeleHealth Expansion Easiest way to provide health care to rural patients Home TeleHealth, Clinical Video Conferencing, and Store and Forward Technology Patient in one location and a provider in another location Primary care, Specialty Care, TeleRetinal Screening, and Dermatology 29

30 TeleHealth Expansion Cont d FY14 VISN 11 held over 11,000 visits for Veterans receiving care in Indiana Provides increased Veteran satisfaction Improves access to care Cost effective with less travel for Veterans and staff 30

31 Rural Community Partnerships ASPIN/VA/IVBHN providing PTSD TX to rural Veterans in eight counties of IN Homeless Shelters-CVT to Homeless Shelters that house Veterans Working with the Indiana National Guard to expand access to Veterans 31

32 Additional Community Partnerships Military Family Research Institute of Purdue University-Education Symposium for local providers to assist Veterans New Food Bank coming for rural Veterans Indiana Department of Camp Atterbury-Veteran Community Re-entry Center for the Homeless South Bend 32

33 DEPARTMENT OF VETERANS AFFAIRS AND THE AFFORDABLE CARE ACT 33

34 What does ACA mean for Veterans? Enrollees in any VA health care program meet health care law coverage standards Veteran s health care program Civilian Health and Medical program (CHAMPUS) Spina bifida health care program ACA does not change VA health benefits or Veterans out-of-pocket costs Veterans can apply at any time Non-eligible Veterans and family members should visit the marketplace to obtain coverage 34

35 What happens if you don t have coverage? Veterans not enrolled in the VA healthcare system or who do not have qualifying insurance will be charged a fee if they do not have an exemption For 2015, the fee will be $325 or 2% of taxable income Exemption information can be found at VA will notify IRS beginning this tax year about coverage. They will also send a letter and IRS form 1095B 35 to Veterans and beneficiaries for filing

36 VA Reaching Out to Non-Enrolled Veterans Targeted Outreach Campaign Identified non-enrolled Veterans who would most likely meet our eligibility requirements for care and who would be most apt to use our services Selected the zip codes closest to our facilities where we know we have room for new patients Wrote letters and enclosed brochures about our services, inviting them to come 36 check us out

37 Anticipated Impact of ACA on VA in Indiana Early projections showed that VA could have an out-migration nearly equivalent to the in-migration of patients due to ACA. Over the next 3 years, we expect to see a growth in enrollees of close to 20,000 Veterans. About 7,800 are expected to be as a result of ACA. 37

38 DEPARTMENT OF VETERANS AFFAIRS AND THE VETERANS ACCESS, CHOICE AND ACCOUNTABILITY ACT 38

39 VACAA aka Choice Program Eligibility requirements for non-va care paid for by VA >30 day-wait from preferred date or the date medically indicated by the VA physician Residence > than 40 miles from the closest VA health care facility * Travel by plane or boat to the closest VA medical facility Unusual or excessive burden in traveling to a VA medical facility based on the presence of a body of water (including moving water and still water) or a geologic formation that cannot be crossed by road 39

40 Steps to Getting an Appointment Decide which non-va health care provider you would like to use. Search the list of approved care providers in your community. Make sure you have information on hand about any other health insurance coverage you may have. 40

41 Steps to Getting an Appointment Call to make sure you qualify + schedule an appointment. When you call, we will walk you through the following steps: You will be asked to enter your ZIP code, and first and last name. We will check to make sure you are eligible for this program. We will check which of your needs are covered by the VA. You will be asked for your address and the name of your preferred non-va provider. Unfortunately, not all providers will be covered so if your preferred provider is not available, we will recommend other providers in your area. We will then work with you to schedule an appointment 41

42 Choice Program Overview Video 42

43 Choice Care Contracts Patient-Centered Community Care (PC3) VA nationwide program for eligible Veterans to obtain specific care when local VA services are not available VA purchases care in the community The Choice Program allows coverage for more services and provides more flexibility in the choice for community-based care Contracts with Health Net Federal Services and TriWest Healthcare 43

44 PC3 Providers in Indiana? 44

45 Want to Become a Community Provider for VA? Two Options. Contract Agree on a reimbursement amount Provider agreement Accept Medicare rates Meet all Medicare Conditions of Participation and Conditions for Coverage as required by the U.S. Department of Health and Human Services Must not be on CMS exclusionary list Must have full, current and unrestricted license Must provide copies of medical records for VA electronic record 45

46 Contact Information for Health Net and TriWest Health Net Provider Customer Service Phone Number: , Option 2 HNFSProviderRelations@Healthnet.com Website: me/provider/options-for-providers.html TriWest Provider Customer Service Phone Number: TriWestDirectContracting@triwest.com Website: 46

47 VA Offers Military Culture Training Many community providers are not trained in treating Veterans, according to a 2014 RAND report. AMA issued guidelines for assessing a patient s military experience and duty assignments VA is providing a number of accredited training resources at not cost to all Veteran care providers Military Cultural Awareness ( Awareness-Course/M/wrap_menupage.htm) Military Culture: Core Competencies for Healthcare Professionals ( Dozens of other Veteran-care courses to be added this 47 year

48 More information of VA, ACA & VAACA ACA VA s ACA website: Call VETS (8387), Monday through Friday from 8 a.m. to 10 p.m. or Saturdays from 11 a.m. to 3 p.m., eastern. For information on the Marketplace, visit or call Veterans Choice Program VA s Choice Program web-site: 48

49 Resources for Veterans & Advocates General VA Web-site: Veteran Eligibility for Health Care: Apply for Healthcare On-Line: Applying for Other Benefits: Federal Benefits for Veterans, Dependents and Survivors: 49

50 Questions? VISN Contact Title 11 Sherri DeLoof Rural Health Coordinator 11 Sherry Moravy Strategic Planner 9 Jacquelyn Morales Rural Health Coordinator 9 Deborah Martin Strategic Planner 10 David Chmieleski Health Coordinator 10 Debbie Page Strategic Planner 12 Sandra Calenda Rural Health Coordinator 12 Joe Zimmerman Strategic Planner 15 Lisa Jones Rural Health Coordinator 15 Mark Zinser Strategic Planner 50