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Veterans Health AdministrationOffice of Rural Health

VA Advisory Committee on Women Veterans

Office of Rural HealthOffice of the ADUSH for Policy and Planning

Veterans Health Administration

October 2009

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Agenda

Office of Rural Health (ORH)

Current Programs and Initiatives

Future Directions

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Public Law109 - 461

Establishment of Office of Rural Health

The Director of the Office of Rural Health shall perform functions to include:

1. Conducting, coordinating, promoting, and disseminating research into issues affecting Veterans living in rural areas, in cooperation with the medical, rehabilitation, health services, and cooperative studies research programs in the Office of Policy and the Office of Research and Development

2. To work with all personnel and offices to develop, refine, and promulgate policies, best practices, lessons learned, and innovative and successful programs to improve care and services for Veterans who reside in rural areas of the United States

10/07, Director

Office ofRuralHealth(ORH)

ADUSH Policy & Planning

ORH Legislative Requirements

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Office of Rural Health

PLANNING EXECUTION MANAGEMENT

OVERSIGHT and EVALUATION

COLLABORATIONOUTREACH, andDISSEMINATION

ORH Strategic Planning

• Policies and Guidance• Budget Execution Plans• Meeting ORH Strategic Goals

Project Planning

• Services/Programs Expansion• Pilots and Demonstrations• Technology Deployment

Studies and Analyses

• Establish Agenda/Guidance• Inform Policies/Programs• Congressional Responses

Collaboration and Outreach

• Develop Partnerships• Establish Outreach Strategies

Service Expansion Initiatives

• VISN Rural Health Funding• Outreach Clinics• Mobile Clinics• Travel Reimbursements

Pilots and Demonstrations

• National and Local Pilots• Funding VHA Program Offices

Studies and Analyses

• Conduct Studies and Analyses Collaboration and Outreach

• National ORH Meetings• ORH Website• Educational Symposia

Project Management

• Provide Guidance/Feedback• Coordinate Communications• Manage and Track Progress

Accountability

• Report on Progress• Evaluate Impacts/Outcomes

Knowledge Management System

• Monitor All ORH Activities• Organize/Manage Information

Dissemination Strategies

• Share Best Practices• Promulgate Lessons Learned• Utilize Dissemination Channels

Establish data-driven planning and evidence-based decision-making processes. Evaluate the impacts and outcomes of ORH funded initiatives and programs. Utilize rural health and veterans health expertise in VA and non-VA communities. Share findings with policy leaders, field units, and rural health communities.

Explore opportunities to innovate through collaboration and partnership. Develop outreach and educational resources and tools to help rural Veterans and providers. Establish collaborative networks in rural communities and among rural health organizations. Share best practices and lessons learned within VHA and with rural health partners.

ORH Core StaffORH Core Staff VRHRC Leaders/StaffVRHRC Leaders/Staff VISN Rural ConsultantsVISN Rural Consultants VRHAC MembersVRHAC Members ORH Working Groups VHA Program Offices VISN/VAMC Leadership Funded Project Leaders Collaboration Partners Outreach Partners Dissemination Partners

RESOURCES

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Agenda

Office of Rural Health

Current Programs and Initiatives

Future Directions

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ORH Appropriation

• FY08 $24 million to fund ORH initiatives

• FY 09 $24 million to continue to support FY08 ORH initiatives Public Law 110-329 provided $250 million to support

service expansion and outreach:• ORH provided $22 million to the Veterans Integrate Service Networks

(VISNs) in December 2008• Allocated in accordance with the proportion of rural and highly rural

Veterans in each VISN• ORH provided additional $215 million to VISNs and program offices in

February 2009• National, competitive process with 161 proposals reviewed; selected

74 projects and initiatives

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Funding DistributionPublic Law 110-329

• National Key Initiatives: $ 77.6M– National Telehealth Expansion $ 36.3M– Education and Training $ 1.8M– Mental Health Intensive Care Management $ 7.3M– Home Based Primary Care $ 26.4M– Other $ 4.7 M

• VISNs Key Initiatives: $136.9M – Outreach Clinic Expansion $ 19.6M– Local Telehealth Expansion $ 39.2M– Transportation Programs $ 5.6M– Health Care Services Expansion $ 15.7M– Community Outreach $ 15.9M– Home Based Primary Care $ 17.3M– Other $ 23.6M

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Outreach Clinics

• Outreach Clinics: To extend access to primary care and mental health services in rural and highly rural areas where there is not sufficient demand or it is otherwise not feasible to establish a full-time Community Based Outpatient Clinic (CBOC) by establishing a part-time clinic

• Funded 40 Outreach Clinics to date: Funded 10 Outreach Clinics in FY2008 Funded 30 Outreach Clinics in FY2009

• Impact: Potential Impact: 997,482 rural and highly rural enrollees live within the

service areas Impact to date: 2,250 patients have been seen to date

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Rural Mobile Health Clinics

• Rural Mobile Health Clinics: To extend access to primary care and mental health services in rural areas where it is not feasible to establish a fixed access point

• Currently all four Rural Mobile Health Clinics are operational: VISN 1 (ME) VISN 4 (WV) VISN 20 (WA) VISN 19 (CO, NE, WY)

• Impact: Vans serve 24 counties in six states Potential Impact: 13,359 projected rural/highly rural enrollees live within

the service areas Impact to date: 400+ patients have been seen to date (Puget Sound)

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Geriatrics and Extended Care

• Home Based Primary Care (HBPC) In FY08, 14 HBPC sites were provided In FY09, 2 major HBPC expansions:

CBOC and Community Collaboration (25 sites) Indian Health Service Collaboration (14 sites)

• Medical Foster Home FY 08: three rural sites FY 09: three rural sites

• GeriScholars Program: a joint initiative developed to engage and train rural clinicians in the care of older rural Veterans.

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Women Veterans

• As the proportion of enrolled rural and highly rural women Veterans increases with the enrollment of the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veteran population, more gender specific services will need to be provided. Current programs include:

• VISN 5: Women’s Veterans Health Program

• VISN 6: Rural Women Veterans Health Care Program

• VISN 16: Women’s Health: Improving Access to Care for Women Veterans Suffering from Chronic Pain Associated with Traumas and Depression

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Agenda

Office of Rural Health

Current Programs and Initiatives

Future Directions

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Future Directions

• Improving knowledge base– Continue improving ORH understanding of rural and highly rural Veterans

and their needs;

– Evaluate current initiatives and communicate best practices; and

– Implement evidence-based strategies and innovative care delivery models.

• Improving capacity to care for rural and highly rural Veterans– Apply lessons learned from each year’s experience;

– Grow infrastructure by emphasizing local innovation with national focus; and

– Build community collaborations and leverage technology.

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Future Directions

• Improving access and quality of care– Improve coordination both inside and outside VA;

– Operationalize best practices: nationalizing models that work; and

– Expand services and improve outreach

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Questions?