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. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 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. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 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: 1.Promote best practices for maximum impact: Innovative pilots  study and analyze  spread best practices. 2.Build parternships and collaborations: Engage with VA program offices, Federal and state partners, Veteran Service Organizations and rural health communities to effectively utilize resources. 3.Bridge operations and policy: Leverage lessons learned to inform policy and contribute to measurable impacts.

4. VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 4 Office of Rural Health (ORH) ORH Director Secretary’s Veterans’ Rural Health Advisory Committee (VRHAC) Secretary’s Veterans’ Rural Health Advisory Committee (VRHAC) Veterans Rural Health Resource Centers (VRHRCs) Veterans Rural Health Resource Centers (VRHRCs) VRHRC Eastern Region VRHRC Eastern Region VRHRC Central Region VRHRC Central Region Staff Assistant Budget Analyst Budget Analyst ORH Deputy Director VRHRC Western Region VRHRC Western Region VRHAC Program Analyst VISN Rural Consultants (VRCs) VISN Rural Consultants (VRCs) Program Analysts Health Systems Specialists Health Systems Specialists Staff Assistant Staff Assistant VHA Assistant Deputy Under Secretary for Health for Policy and Planning VHA Assistant Deputy Under Secretary for Health for Policy and Planning

5. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 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. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 6 Project Focus Areas – FY 2013 Category# of ORH Projects Rural Telehealth, including Home Telemonitoring, Store and Forward Image Transmission, and Clinic Based Video Telemedicine30 Rural Primary Care / Patient Aligned Care Teams (PCMH)16 Rural Specialty Care: Cardiology, Audiology, Prosthetics, Optometry, Radiology, Dermatology69 Rural Community Based Outpatient Clinics, Outreach Clinics, Mobile Clinics57 Rural Education Initiatives14 Rural Facilities Improvement3 Rural Home Based Primary Care50 Rural Homelessness5 Rural Mental Health, including Post Traumatic Stress Disorder35 Other Categories21 Rural Outreach Activities15 Projects Focused on Rural Special Populations, including Women, American Indians/Alaska Natives, and Asian American/Pacific Islanders31 Rural Veteran Transportation Programs, including ground and air transportation15 TOTAL361

7. VETERANS HEALTH ADMINISTRATION (VHA) OFFICE OF RURAL HEALTH (ORH) - 7 Central Region Iowa City, IA Eastern Region, Gainesville, FL ORH Washington, DC Western Region Salt Lake City, UT Location of ORH Veterans Rural Health Resource Centers

8. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 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 training and education Geographic needs assessments and Veterans access to care Paul M. Hoffman, MD, Director Located in Gainesville, Florida; Lewiston, Maine; and White River Junction, Vermont Serves VISNs 1 through 10

9. VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 9 Spotlight: Eastern Region FY 2013 Projects Multiple Sclerosis (MS) CVT Neurology Follow-up Multiple Sclerosis (MS) CVT Rehabilitation GAP Program

10. VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 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. VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 11 Care Coordination Rural Health Mobility Evaluation Clinic Evaluation and comprehensive care for rural veterans with ALS, MS, SCI, PD, and neurodegenerative disorders Maximize independence and safety in the home and community Provide VA specialty care closest to the Veterans’ home

12. VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 12 Neurology Medicine Physical Therapy Occupational Therapy Speech, Swallowing Social Work Hospital Referrals Psychiatry Neuropsychology Urology Nutrition MS Clinic ‘National Multiple Sclerosis Society Affiliated Center of Comprehensive Care’ at Lake City, FL VAMC

13. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 13

14. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 14

15. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 15

16. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 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. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 17 Home CVT Visits Rehab/Wellness

18. VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 18 Home CVT Visits

19. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 19 Expansion of RVTRI

20. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 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. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 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. VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 22 Distribution of Veteran and non-Veteran MS patients in North Central Florida MS Patients Self-Reported to NFNMSS

23. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 23 Primary Road Travel

24. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 24 Secondary Road Travel

25. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 25 Combined Driving Routes

26. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 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. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 27 Additional Resources: ORH Website www.ruralhealth.va.gov

28. VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 28 Thank You for Your Service