1. Comprehensive Primary Care for Women Veterans Sally Haskell, MD Acting Director, Comprehensive Women’s Health Women Veterans Health Strategic Health Care Group, Patient Care Services, U.S. Department of Veterans Affairs Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia Session #A1 October 28, 2011 10:30 AM

2. Faculty Disclosure Please add the commercial interest disclosures that you reported on your signed Disclosure form: I have not had any relevant financial relationships during the past 12 months. 2 10/27/2011

3. Overview Describe Comprehensive Women Veterans Health Care Describe Models of Care for Women Veterans Describe how VA Women’s Health aligns with Patient Aligned Care Team Model (PACT Model) Give examples of Women’s Health PACT in Veterans Health Administration (VHA) 3 10/27/2011

4. Expected Outcome Participants will gain an understanding of Women Veterans Health Care 4 10/27/2011

5. Comprehensive Primary Care for Women Veterans 5 10/27/2011

6. Number of women Veteran VHA patients in each year, FY00-FY10 Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Health Care Group; Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characteristics and Use of VHA Care, 2011. Women Users Doubled since 2000 6 10/27/2011

7. Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Health Care Group; Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characteristics and Use of VHA Care, 2011. Age Distribution: Three Peaks 7 10/27/2011

8. Mission Ensure all women Veterans receive equitable, high- quality, and comprehensive health care services in a sensitive and safe environment at all VA facilities Be a national leader in the provision of health care for women Veterans, thereby raising the standard of care for all women 8 10/27/2011

9. Transforming Health Care Delivery for Women Veterans 9 10/27/2011

10. Revised Guidelines on “VHA Services for Women Veterans” Outlines specific services at facilities and Community Based Outpatient Clinics (CBOCs) Defines “Comprehensive Primary Care for Women Veterans” Requires women be seen by Women’s Health Primary Care Providers Offers three clinic models Details safety and security requirements Establishes systematic data collection process 10 10/27/2011

11. Complete primary care from one designated Women’s Health Primary Care Provider at one site (including CBOCs) Implementing Comprehensive Primary Care for Women Veterans Care for acute and chronic illness Gender-specific primary care Preventive services Mental health services Coordination of care Model for PACT Measured with Women’s Assessment Tool for Comprehensive Health (WATCH) 11 10/27/2011

12. VA Patient-Aligned Care Teams: PACT PACTs deliver primary care that is: Team-based Patient-centered Accessible Coordinated Comprehensive Continuous Focused on continuous improvement PACT Teamlets typically composed of Provider, Clerk, Registered Nurse, Health Technologist, extended team members 12 10/27/2011

13. Influx of younger women Reproductive health care Maternity care Mental health Musculoskeletal injuries Chronic pain Cardiovascular risk prevention Privacy, safety, convenience Women’s Health PACT: Unique Needs 13 10/27/2011

14. Women’s Health PACT: Unique Needs Older women (largest sub-population of female VA users) Menopausal needs Mental health Chronic pain Cardiovascular disease Osteoporosis Cancer Privacy, safety, convenience Geriatric Care 14 10/27/2011

15. Model 1: Integrated Primary Care Clinic—Comprehensive primary care is delivered by a designated women’s health provider in a gender neutral primary care clinic. Model 2: Separate but Shared Space—Comprehensive primary care is offered by a designated women’s health provider in a separate or shared space that may be located adjacent to or near primary care. Model 3: Comprehensive Women’s Clinic—VHA facilities with larger women’s populations are encouraged to create comprehensive women’s clinics in exclusive separate space, that co- locates primary care, gynecology, mental health and other services for women Veterans. Models of Care 15 10/27/2011

16. Women’s Health PACT Teamlets in all Models of Care Every care site should have Designated Women’s Health Providers (WH PCP) who are interested and proficient in women’s health To maintain proficiency, each designated WH PCP must be comprised of at least 10% female patients or site must have alternative plan to maintain proficiency 16 10/27/2011

17. Women’s Health PACT Teamlet Implementation Examples RN specific knowledge and skills: Mammogram tracking, coordination with breast surgeons, oncologists Gynecology procedures, assistance, and post-op patient follow up (for co-located GYN) Pap smear tracking and follow up Specific injections, Depo-Provera, Lupron, Gardasil Patient education-including contraception, pre- conception care and planning, pre-natal care, others. 17 10/27/2011

18. Women’s Health PACT Teamlet Implementation Examples Health Tech specific knowledge and skills: Act as Chaperone Assess environment for Privacy, Safety, Dignity Be familiar with issues such as MST Set-up and assist with GYN exam Deliver cultures, Paps, other samples to lab Review patients coming in each week, huddle with provider Communicate with patients—prior to visit and follow up as needed Have a role/responsibility for PACT team population management 18 10/27/2011

19. Women’s Health PACT Teamlet Extended Team Members Primary care mental health integration team (with Women’s Mental Health expertise) Military Sexual Trauma Coordinator Gynecologist Social Work Care Coordination and Fee Services Pharmacist with Women’s Health expertise: medications in women who may be pregnant or lactating Gender-specific medications such as OCPs and HT management of gender disparities in lipids, DM Nutritionist 19 10/27/2011

20. Reproductive Health Care Challenges Screening and care of common reproductive health issues provided by Designated Women’s Health Provider Must ensure daily access within PACT Teamlet to a Designated Women’s Health provider for urgent care needs More complex gynecological care provided by Gynecologist, ideally co-located with Women’s Health Teamlet, or by Fee Basis 20 10/27/2011

21. Developing a Population Perspective Eliminate gender disparities in screening and prevention Use population tools, tracking systems for Pap smears, Mammograms Track those at high risk of CVD or DM Screen for MST/IPV Offer preconception counseling Manage obesity/increase exercise Prevent development of Chronic Pain 21 10/27/2011

22. Women’s Health Transformation Initiative Implementing comprehensive primary care is one piece of VA Women’s Health Transformation Initiative. Other pieces include: Reaching out to Women Veterans through Call Center Improving Privacy and Environment of Care Ending Homelessness Improving care coordination 22 10/27/2011

23. Sub-Initiative of New Models of Care Improved Care Coordination Emergency room care Assessment tool development Ongoing provider/staff education Breast cancer Tracking of abnormal test results Breast Cancer Clinical Case Registry Teratogenic identification of drugs Women’s Health Transformation Initiative 23 10/27/2011

24. Women’s Health Education Recruiting and retraining providers interested and proficient in women’s health National Women’s Health Mini-Residency Program 1100+ primary care providers educated Flagship education model for VA SimLEARN partnership: Large mini-residency, ED-WH curriculum, task trainer dissemination Advanced Fellowships VA Cyber Seminar Spotlight on Women’s Health VA Women’s Health Research Conference 24 10/27/2011

25. Acquiring data on the population of women Veterans Producing key sociodemographic and VHA health care utilization data Goal: Understand the effects of military service on women’s lives Women’s Health Evaluation Initiative 25 10/27/2011

26. Questions? 26 10/27/2011

27. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you! 27 10/27/2011