Congressional Affairs VHA Mission Honor America’s Veterans by providing exceptional health care that improves their health and well-being. VA Portland Health Care System (VAPORHCS) MOAA April 2017 Dan Herrigstad Chief of Public & Congressional Affairs Integrity Commitment Advocacy Respect Excellence VA attendees: VBA / Town Hall Co-Host - Chris Marshall, Director, Portland Regional Benefit Office, Veterans Benefits Administration Representing COS Office – Dr. Curl Patient Advocates – Sylvia Gawthorne, Kelly Williams Public Affairs – Dan Herrigstad & Kelli Roesch

VA Portland Health Care System To fulfill President Lincoln's promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans. VA Mission Statement

Guiding Principles… Our Values… Our Mission Our Vision Honor America’s veterans by providing exceptional health care that improves their health and well-being. Our Vision To be a patient-centered integrated health care organization for veterans providing excellent health care, research, and education; an organization where people choose to work; an active community partner; and a back-up for National emergencies. Vision VHA will continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that are both patient centered and evidence based.   This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement. It will emphasize prevention and population health and contribute to the nation's well-being through education, research and service in national emergencies. Values Integrity - Act with high moral principle. Adhere to the highest professional standards. Maintain the trust and confidence of all with whom I engage. Commitment - Work diligently to serve Veterans and other beneficiaries. Be driven by an earnest belief in VA’s mission. Fulfill my individual responsibilities and organizational responsibilities. Advocacy - Be truly Veteran-centric by identifying, fully considering, and appropriately advancing the interests of Veterans and other beneficiaries. Respect - Treat all those I serve and with whom I work with dignity and respect. Show respect to earn it. Excellence - Strive for the highest quality and continuous improvement. Be thoughtful and decisive in leadership, accountable for my actions, willing to admit mistakes, and rigorous in correcting them. Our Values… Integrity, Commitment, Advocacy, Respect, Excellence

Organization VA Portland Health Care System (VAPORHCS) President of the United States United States Department of Veterans Affairs Veterans Benefits Administration (VBA) Veterans Health Administration (VHA) Veterans Integrated Service Network 20 (VISN 20) VA Portland Health Care System (VAPORHCS) National Cemetery Administration (NCA) The VA is a cabinet-level department, reporting to the President of the United States. The Department of Veterans Affairs consists of three entities: The Veterans Benefits Administration (VBA) is where Veterans receive loans, support for education, and enroll for health benefits; the VA owns 131 cemeteries; And the third entity is us—healthcare. Healthcare is divided into 21 geographic regions, called Veterans Integrated Service Networks, or VISNs. We, along with seven other medical centers are part of VISN 20 – the Pacific Northwest VISN.

21* Veterans Integrated Service Networks (VISNs) *VISN 13 & VISN 14 were consolidated into VISN 23 As indicated previously, Portland is part of VISN 20, which also includes Alaska, Washington, and Idaho. If the map were to scale, you would see that VISN 20 covers 1/3 of the land mass of the United States. Many areas are rural and geographically remote, which provides challenges with access and the provision of health care. VISN 20 has eight VA facilities. Portland and Seattle are the two tertiary referral hospitals.

VA Portland Health Care System FY2016 Visits (Out-patient) PC Patients Assigned Portland 570,500 3,013 Vancouver 148,700 12,300 Hillsboro 44,700 11,748 Bend 37, 500 6,480 Fairview 33,000 Salem 62,000 7,842 West. Linn 24,000 8,833 CRRC 8,100 800 N. Coast 8,500 2,100 The Dalles 6,200 2,340 Newport 3,200 1,277 Lincoln City 657 143 North Coast CBOC Vancouver Division The Dalles CBOC CRRC Hillsboro CBOC East CBOC West Linn CBOC Portland Division Lincoln City CBOC Salem CBOC Newport CBOC The VA Portland Health Care System (VAPORHCS) is two-division, Joint Commission accredited 1A facility that administers care to Veterans throughout Oregon and Southwestern Washington. In addition to two main divisions located in Portland, Oregon and Vancouver, Washington, VAPORHCS operates nine Community Based Outpatient/Outreach Clinics (CBOCs) located in Newport, Lincoln City, Warrenton, Bend, Salem, East and Downtown Portland, West Linn, Hillsboro, and The Dalles. The VAPORHCS catchment area covers more than 30,000 square miles and 26 counties. In addition to these clinics, VAPORHCS also operates a Community Resource & Referral Center (CRRC) which serves homeless Veterans in downtown Portland. Bend CBOC

VA Portland Health Care System Provides full range of primary, emergency, specialty, tertiary, and long-term care Portland Division includes 167 Medical/Surgical, locked Mental Health, and Intensive Care Unit (ICU) beds. Vancouver Division has a 72-bed Community Living Center, a 35-bed Residential Rehab Treatment Program, and a transitional Transplant Lodging Unit.

VA Portland Health Care System Budget = $750 million 5,000+ employees, residents, fellows interns and volunteers Approximate numbers = 3,150+FTE, 675 Part time employees (440 Physicians, 1,020 Nurses, 173 Social Workers, 44 Psychologists) 815+ volunteers; Approximately 31% of employees are Veterans; approximately 145 are currently serving in the National Guard or Reserve forces. 198 academic affiliations Residents Trained Annually- 631 Students Trained Annually- 964 Nurses Trained Annually- 251 Fellows- 40

VA Portland Health Care System National Centers of Excellence Hosts a $33 million annual research program 150 active research investigators 500+ active protocols National Centers of Excellence Mental Illness Research Education & Clinical Center (MIRECC Agency for Healthcare Research & Quality (AHRQ) Evidence-based Practice Center National Research for Rehabilitative Auditory Research (NCRAR) Research Enhancement Awards Program (REAP) in Multiple Sclerosis Parkinson’s Disease Research Education & Clinical Center (PADRECC) Center for the Study of Chronic, Comorbid Mental & Physical Disorders Multiple Sclerosis Center for Excellence NIH – Funded Methamphetamine Research Center Hepatitis C Virus Resource Center Epilepsy Center of Excellence NIH – Funded Alcohol Research Patient Safety Center of Inquiry “500 active protocols” = (a document describing the procedures of a research study). » NIH-funded Alcohol Research Center » National Center for Rehabilitative Auditory Research (NCRAR, an RR&Dfunded Center of Excellence) » Mental Illness Research Education and Clinical Center (MIRECC) » Parkinson’s Disease Research Education and Clinical Center (PADRECC) » Multiple Sclerosis Center of Excellence » Epilepsy Center of Excellence » NIH-funded Methamphetamine Research Center » Center to Improve Veterans’ Involvement in Care (CIVIC, an HSR&D-funded Center of Innovation) » Agency for Healthcare Research and Quality (AHRQ) Evidence Based Practice Center

10 Priorities for SECVA Accountability Legislation Extend the Choice Deadline Past August Choice 2.0 Legislation: Eliminate the 40/30 Rule Infrastructure Improvements and Consolidations Enhance Foundational Services in VA VA/DOD/Federal Coordination EMR Interoperability and Modernization Breakthrough in Suicide Prevention Appeals Modernization Accelerating VBA Performance on Claims The Blueprint is VHA’s framework to rebuild the Veterans’ trust and become a truly Veteran-centric health system. It sets high expectations for health care innovation and a positive culture of service. Intent: The four themes and ten essential strategies contained in the Blueprint for Excellence frame a set of activities that simultaneously address improving the performance of VHA healthcare now, developing a positive service culture, transitioning from “sick care” to “health care” in the broadest sense, and developing agile business systems and management processes that are efficient, transparent and accountable. The Blueprint for Excellence is our organization’s way forward. This plan has ten strategies, the goals of which align with the Road to Veterans Day and VA’s strategic plan by delivering personalized, proactive, and patient driven care. The Blueprint also describes actions, required by law, in the Veterans Choice Act, in addition to strategies in the VHA Modernization Study, that will lead us to being a more open, innovative, high-performing, and collaborative culture. the Blueprint was finalized it was discussed with leaders across the Department as well as many of our stakeholders. Their feedback was incorporated into the document, and they will support us as we implement the Blueprint’s ten strategies. The Blueprint is available externally at www.va.gov/health. Now that this is a public document, supported by the legislative and executive branches and VSOs, I ask you to join me in faithfully implementing the Blueprint. The Blueprint for Excellence is our operational guide for implementing goals set forth in both the VA and VHA Strategic Plans. It’s how we will Honor the Service and Empowering the Health of enrolled Veterans. Visit: http://www.va.gov/HEALTH/docs/VHA_Blueprint_for_Excellence.pdf

Veterans Access, Choice, and Accountability Act (VACAA) of 2014 UPDATE: The Veteran Choice Program is part of the Veterans Access, Choice, and Accountability Act of 2014 (VACAA) signed into law Aug. 7, 2014. The Choice Program is a new, temporary benefit (up to 3 years) that allows some Veterans to receive health care in their communities rather than waiting for a VA appointment or traveling to a VA facility. This Web site has all the information one needs; how to get started, fact sheets, an on-line questionnaire to check your eligibility. This hotline 866-606-8198 is exclusively for making sure you are eligible for the Choice Program and setting up a non-VA care appointment. www.va.gov/opa/choiceact/ Want to get started? Call 866-606-8198

UDPATE: Veterans Choice Program Effective of April 19, 2017, The President signed a law that removes the August 7, 2017 expiration date and allows VA to utilize funding dedicated to the Veterans Choice Program (VCP) until it is exhausted. No Change to eligibility requirements ****Veteran residence is more than 40 miles from the closest VA health care facility by way of driving distance. Veteran has been told they will need to wait more than 30 days from the preferred date or the date medically determined by their physician. Veteran needs to travel by plane or boat to the VA medical facility closest to their home. Veteran faces a geographic challenge

UDPATE: Veterans Choice Program 90,484 cumulative patients have been eligible and offered Choice since the start of the program 41,867 Veterans have elected the Choice Program resulting in 71,943 authorizations and 42,782 appointments Approx. 46% of those eligible choose Choice Best estimate of what we know to have outsourced as of March 18, 2017

Primary Care Staffing Update CLINIC PCP Vacancies (MD/DO/NP) PCP Selections Support Staff Vacancies (RN, LPN, MSA, HT) Support Staff Selections Bend 2 6 3 CRRC Fairview 1 The Dalles Hillsboro 5 North Coast Resident Clinic 4 Women’s Health Salem 3.5 Lincoln City Newport Vancouver 9 West Linn TOTALS 11.5 39 14 As of April 20, 2017

New VA Web Site www.accesstocare.va.gov

New VA Web Site www.accesstocare.va.gov

Vancouver Primary Care Clinic To open July 2017 VAPORHCS Expansion Vancouver Primary Care Clinic To open July 2017 Parking improvement projects on Vancouver Campus – - 46 additional spaces planned at new Primary Care - 43 additional spaces planned for south access road (2016 bid was too high, re-bidding in FY 2017)

Chief of Public & Congressional Affairs Questions and Dialogue Dan Herrigstad Chief of Public & Congressional Affairs Daniel.Herrigstad@va.gov 503-402-2975