Expanding Access to Rural Veterans

1. Expanding Access to Rural Veterans Presented to USSOCOM Care Coalition Sean C. McCoy, PhD Veterans Rural Health Resource Center-Eastern Region December 10, 2013

2. VHA Office of Rural Health (ORH) • The Veterans Health Administration (VHA) Office of Rural Health (ORH) was created by Congress in 2007 under Public Law 109-461, Sec 212 • Mandated to work across the Department of Veterans Affairs (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

3. 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: • 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.

4. 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) ORH Deputy Director VRHAC Program Analyst Staff Assistant Budget Analyst VRHRC Western Region VRHRC Central Region VRHRC Eastern Region Program Analysts Health Systems Specialists Staff Assistant VISN Rural Consultants (VRCs)

5. 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

6. Project Focus Areas – FY 2013

7. Location of ORH Veterans Rural Health Resource Centers Central Region Iowa City, IA Western Region Salt Lake City, UT 1 2 3 ORH Washington, DC Eastern Region, Gainesville, FL

8. Spotlight: Veterans Rural Health Resource Center, Eastern Region (VRHRC-ER) The Eastern Region Resource Center’s focus is on: • Home and clinical use of telehealth and distance technology • Workforce development and rural provider trainingand education • Geographic needs assessments and Veteransaccess to care Paul M. Hoffman, MD, Director • Located in Gainesville, Florida; Lewiston, Maine; and White River Junction, Vermont • Serves VISNs 1 through 10

9. Spotlight: Eastern Region FY 2013 Projects • Multiple Sclerosis (MS) CVT Neurology Follow-up • Multiple Sclerosis (MS) CVT Rehabilitation • GAP Program

10. Spotlighted Projects: Patient Population • SCI/D - >120 patients • 40% rural or highly rural • 45% MS, majority progressive • 47 NF/SG Amyotrophic Lateral Sclerosis

11. Care Coordination Rural Health Mobility Evaluation Clinic • Evaluation and comprehensive care for rural veterans withALS, MS, SCI, PD, andneurodegenerative disorders • Maximize independence andsafety in the home and community • Provide VA specialty care closest to the Veterans’ home

12. MS Clinic ‘National Multiple Sclerosis Society Affiliated Center of Comprehensive Care’ at Lake City, FL VAMC • Neurology • Medicine • Physical Therapy • Occupational Therapy • Speech, Swallowing • Social Work Hospital Referrals • Psychiatry • Neuropsychology • Urology • Nutrition

16. Rural Veteran TeleRehabilitation Initiative (RVTRI) • The RVTRI: • Completed 205 initial evaluations • Enrolled 127 veterans for ongoing care • Generated a workload of 2134 encounters • Reached Veterans in 30% (40/137) of our rural zip codes(Veterans served lived an average of 93 miles from the medical center) VHA Systems Redesign Champion Award - Outpatient Category 2011

17. Home CVT VisitsRehab/Wellness

18. Home CVT Visits

19. Expansion of RVTRI

20. GAP PROGRAM • Enroll Access Limited Veterans in Transitional Care Program: • Enrolled prior to transfer to Home Based Primary Care (HBPC) • Established Home Telehealth and Clinical Video Telehealth • Medication Reconciliation • Dementia Screening • Care Coordination • Home Safety Evaluations and Durable Medical Equipment

21. GAP PROGRAM • Team Members: • Nurse Practitioner • Social Worker • Occupational Therapist • FY 2013 • Enrolled 90 Veterans • 38 No Dementia, 15 Newly Dx Dementia, 35 Prior Dementia, 2 Unable to Screen • Mental Status and Depression Screenings • Caregiver Burden

22. Distribution of Veteran and non-Veteran MS patients in North Central Florida MS Patients Self-Reported to NFNMSS

23. Primary Road Travel

24. Secondary Road Travel

25. Combined Driving Routes

26. Collaboration and Communication Leverage collaborations, communications and coordinated efforts to seize strategic opportunities and improve efficiencies in service to rural Veterans and their families.

27. Additional Resources:ORH Website www.ruralhealth.va.gov

28. Thank You for Your Service