VA Testimony of Patricia Vandenberg before Congress on July 19, 2010

United States Department of Veterans Affairs

HOUSE COMMITTEE ON VETERANS’ AFFAIRS
FULL COMMITTEE
JULY 19, 2010
STATEMENT OF PATRICIA VANDENBERG, MHA, BS
ASSISTANT DEPUTY UNDER SECRETARY FOR HEALTH FOR POLICY AND PLANNING,
VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

July 19, 2010

Good Morning, Mr. Chairman and Members of the Committee. Thank you for inviting us here today to discuss the progress the Department of Veterans Affairs (VA) has made in implementing section 403 of Public Law (PL) 110-387, as well as VA’s efforts to increase access to quality health care for Veterans living in rural and highly rural counties in Virginia. I am accompanied today by Mr. Daniel Hoffmann, Network Director for the VA Mid-Atlantic Health Care Network (Veterans Integrated Service Network, or VISN 6), and Ms. Carol Bogedain, Interim Director for the Salem VA Medical Center. My testimony today will discuss VA’s work in implementing the pilot program required by section 403 of PL 110-387 and our local efforts in the area.

Section 403 of Public Law 110-387

Public Law 110-387, Section 403 requires VA to conduct a pilot program to provide health care services to eligible Veterans through contractual arrangements with non-VA providers. The statute directs that the pilot program be conducted in at least five VISNs. VA has determined that VISNs 1, 6, 15, 18 and 19 meet the statute’s requirements. This program will explore opportunities for collaboration with non-VA providers to examine innovative ways to provide health care for Veterans in remote areas.

Immediately after Public Law 110-387 was enacted, VA established a cross-functional workgroup with a wide range of representatives from various offices, as well as VISN representatives, to identify issues and develop an implementation plan. VA soon realized that the pilot program could not be responsibly commenced within 120 days of the law’s enactment, as required. In March and June 2009, VA officials briefed Congressional staff on these implementation issues.

VA has made notable strides in implementing section 403 of PL 110-387, with the goal of having the pilot program operational in late 2010 or early 2011. Specifically, VA has:

Developed an Implementation Plan, which contains recommendations made by the Workgroup on implementing the pilot program;
Analyzed driving distances for each enrollee to identify eligible Veterans and re-configured its data systems;
Provided eligible enrollee distribution maps to each participating VISN to aid in planning for potential pilot sites;
Developed an internal Request for Proposals that was disseminated to the five VISNs asking for proposals on potential pilot sites;
Developed an application form that will be used for Veterans participating in the pilot program; and
Taken action to leverage lessons learned from the Healthcare Effectiveness through Resource Optimization pilot program (Project HERO) and adapt it for purposes of this pilot program.
VA has assembled an evaluation team of subject matter experts to review the proposals from the five VISNs regarding potential pilot sites. This team will then recommend specific locations for approval by the Under Secretary for Health. We anticipate this process will be complete this summer. After sites have been selected, VA will begin the acquisitions process. Since this process depends to some degree on the willingness of non-VA providers to participate, VA is unable to provide a definitive timeline for completion, but VA is making every effort to have these contracts in place by the fall. This would allow VA to begin the pilot program in late 2010 or early 2011.

VA is developing information materials for Veterans participating in the pilot program, for non-VA providers, for VA employees, and for other affected populations so that, when the pilot is implemented, all parties will have the information they need to fully utilize these services. VA is committed to implementing the program directed by Congress and to maintaining the quality of care Veterans receive. Other issues, such as securing the exchange of medical information, verifying Veterans’ eligibility for this pilot program, coordinating care, and evaluating the success of the pilot program, are also important priorities and VA is working to ensure their appropriate implementation in the pilot program.

VA notes that section 308 of Public Law 111-163, which was signed by the President on May 5, 2010, amends the requirements of Public Law 110-387 section 403 regarding the “hardship” eligibility exception and the mileage standard.

Local Initiatives

As noted previously, VISN 6 was selected as one of the Networks that will participate in the pilot program required by section 403 of PL 110-387. VISN 6 has identified potential locations for consideration for the pilot program.

Separately, in fiscal year (FY) 2009, VISN 6 received approval and funding from VA’s Office of Rural Health for three programs to improve access for Veterans in rural Virginia. These included a program to improve effective communication and improving health literacy; a rural women Veterans health care program; and additional mental health substance abuse coordination. VISN 6 immediately began implementing these efforts in the summer of 2009, and all VA medical centers in VISN 6, including the Salem VA Medical Center, are benefiting from this continuing process. The programs are specifically targeted to assist Veterans residing in rural and highly rural counties.

The first project is designed to help VA conduct outreach to Veterans living in rural and highly rural areas and improve health literacy. We will accomplish this through several strategies. First, we are identifying Veterans with common characteristics or conditions, such as chronic obstructive pulmonary disease, diabetes, or congestive heart failure, and we are providing personal or group education on their health care needs in areas easily accessible to our Veterans. This may occur in a Veterans Service Organization facility, a Vet Center, or a community-based outpatient clinic (CBOC). Second, we are conducting patient prescription reviews with the aim of improving communication and coordination between each Veteran and his or her clinical pharmacist and provider. When Veterans better understand the health care decisions their providers are making, they can be a more effective partner in making those decisions. We are also expanding the use of VA’s online personal health record, My HealtheVet and enhancing self-care programs for chronic disease. To better support these initiatives, VISN 6 recently established rural health teams, which consist of rural health coordinators, clinical pharmacists, registered nurses, social workers, medical support assistants, program support assistants, and drivers. The hiring process for unfilled positions in the VISN 6 rural health teams is almost complete; all positions have been recruited and are pending final personnel actions. The teams are providing regular updates to VISN leadership and are implementing 90 day action plans they developed in May. Each VA medical center in the VISN has received funding to support these outreach and access efforts. In total, VISN 6 received $4.89 million for this project.

The second project supported by VA’s Office of Rural Health is a rural women Veterans health program. This program is designed to help increase the number of providers in rural or highly rural areas who are proficient, skilled and knowledgeable in caring for women Veterans. We have trained at least one provider in this program at each VISN 6 CBOC and medical center; as of the beginning of July 2010, 150 providers total have already been trained, and 150 more will be trained before the end of this fiscal year. The program will also focus on improving health literacy and the overall health education of women Veterans. VISN 6 received $1.92 million for this effort.

The final project supported by VA’s Office of Rural Health is a new effort to support additional mental health substance abuse coordination. This program is designed to provide mental health services including substance abuse treatment for Veterans in rural or highly rural areas through contracts with community partners to increase access to these services. Our contracting officials are finalizing this proposal and we expect to begin obligating funds by the end of the fiscal year. VISN 6 received approximately $2 million for this program.

Last month, between June 15 and 17, 2010, VISN 6 held a Network-wide meeting that provided our rural health teams with goals, objectives and strategic direction. The meeting allowed the teams to learn more about tele-medicine, home-based primary care programs, women’s health programs, the impact of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) on Veterans and their families, and the various partner programs offered by local governments in North Carolina and Virginia. This information sharing is critical to effective implementation of our outreach and access strategies for Veterans in this area.

In summary, these efforts are part of a larger plan by VISN 6 to improve access to quality health care for Veterans in rural and highly rural areas. The principles of this approach include engaging community providers and leaders; VA is here to complement their programs, not compete. Indeed, in fiscal year (FY) 2010 through June, the Salem VA Medical Center has disbursed more than $15 million for fee-basis appointments, while the Richmond VAMC has disbursed just under $15 million for fee-basis appointments; across all of VISN 6, more than $178 million has been disbursed through fee-basis care.

We also need to educate and engage Veterans and their families, and focus on common health issues among our Veterans. Finally, quality health care and positive health outcomes are strongly associated with improved screening and health maintenance and compliance. These programs support the strategic goals of the Office of Rural Health. By improving health literacy and empowering our Veterans to become full partners in their health care decisions, we can deliver the quality care our Veterans have earned.

Conclusion

Thank you again for the opportunity to discuss the status of the pilot program required by section 403 of PL 110-387 and the work VA is doing to improve access for Veterans in rural Virginia. My staff and I look forward to answering your questions.