Collaboration among CAHs, State Flex Programs, and the ......– Flagstaff – Lake Havasu City –...

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9/June 2016

Tommy DriskillExecutive Assistant to Director, ORHRural Health Coordinator and Executive Assistant to Director, VA Pacific Islands Health Care System

Deborah AmdurDirector, Phoenix VA Health Care System

Collaboration among CAHs, State Flex Programs, and the Veterans Health Administration in Caring for Rural Veterans14th Annual Western Region FLEX Conference

VETERANS HEALTH ADMINISTRATION 2

• U.S. Department of Veterans Affairs (VA) Overview

• Today’s Veteran Choice Program

• The Future State Vision for Community Care for Veterans

• Conclusion

Session Objectives

VETERANS HEALTH ADMINISTRATION

Overview of the Department of Veterans Affairs


Photo by Jeff Kubina

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“…to care for him who shall have borne the battle and for

his widow and orphan…”- Abraham Lincoln, 1865

Today, we say to care for those “who shall have borne the

battle,” and for their families and survivors.

U.S. Department of Veterans Affairs (VA) Mission

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Veterans Health

Administration

National Cemetery

Administration

Veterans Benefits

Administration

• Established in 1930

• Elevated to Cabinet level in 1989

• Federal government’s second largest department after the Department of Defense

• Three components:

What is the Department of Veterans Affairs?

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• Veteran is a person who:

− Served in the active military, Coast Guard, Army, Navy, Marine and Air Force plus Commissioned Officers of the Public Health Svc and NOAA

− Was discharged or released under conditions other than dishonorable

• Former or current Reservists, if they served for the full period of active duty for which they were called (excludes training purposes)

• Former or current National Guard members if activated/mobilized by a federal order for active duty

Who is a Veteran?Definition of a Veteran for VA purposes


~10 million MHS beneficiaries ~9 million VHA enrollees

~1 million dual-eligibles

• Provides care to those who served in uniform• More than 1,500 sites of care, including 167

medical centers, 14 health care centers and 771 Community Based Outpatient Clinics

• Fiscal year 2015 budget = $59.5 B

Department of Veterans Affairs Veterans Health Administration (VHA)

• Provides care to those who serve in uniform (plus families and retirees) through the TRICARE program

• 57 hospitals and ~400 clinics worldwide• Fiscal year 2015 budget = $47.4 B

Department of DefenseMilitary Health System (MHS)

DoD and VA Health Care Systems: Quick Look

8Source: 2014 Survey of Enrollees

IncomeGenderAge

42%45%

58%

39%

45%

50%

57%

33%

24% 24%

19%

33%

27%

22% 24%

30%33%

31%

22%

26% 26% 27%

18%

36%

<30 30-49 50-64 65+ M F <$36,000 $36,000+

All or Most of My Health Care Needs

Some of My Health Care Needs

None of My Health Care Needs or I Have No Health Care Needs

I use VA services to meet ...

Current Use of the VA Health Care System

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Today’s Veterans Choice Program

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• The VCP provides greater access to community health care for eligible Veterans

• Coordinated Care• Choice

Improvement Act

• Barriers to accessing care due to long wait times and geographic distance

• Choice Act established the VCP to increase accessibility to care for eligible Veterans

• Lack of access for Veterans seeking specialist care

• PC3 established to expand care options for Veterans

• CBOCs established to improve Veterans’ geographic access to and use of primary care services

• Shifts focus of care from inpatient to outpatient setting

• Most CBOCs owned and staffed by VA, but some contracted to private sector

November 2014VA launches Veterans Choice Program (VCP)

January 2014VA establishes Patient Centered Community Care (PC3) Contracts

February 1995VA begins to establish

Community Based Outpatient Clinics (CBOCs)

VA Efforts to Engage Community Providers

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Veterans who are enrolled for VA medical care AND:• Live >40 miles driving distance, • Wait time >30 days from medically

appropriate date or clinically necessary • Reside in state without VA Medical

facility, OR• Unusual or excessive burden for travel to

nearest health care facility• Service is not available

VCP allows eligible Veterans the choice to receive pre-authorized health care in their communities from community VCP providers, rather than waiting an extended time for a VA appointment or traveling a significant distance to a VA medical facility

In order to be a VCP provider, you must be an approved provider through the VA’s contracted third party administrator (TPA)

Overview: Veterans Choice Program (VCP)

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• Requirement to develop an implementation plan to consolidate VA’s community care programs

– Waived requirement for enrollment prior to 8/1/2014; Veteran must be enrolled in the system of patient enrollment

– Expands provider base to include Medicaid providers, Aging and Disability Resource Centers and providers who meet criteria established by VA

– Allowance for appointments < 30 days where clinically indicated

– Expansion of the 60-day episode for referral care; replaced with one-year limit

– Choice benefit for VA sites with no VA full-time primary care physician

• Choice Improvement Act signed into law on July 31, 2015, which modified the original Veterans Choice Program

• Expanded Access to Non-VA Care through the Veterans Choice Program, on December 1, 2015:

The Choice Improvement Act of 2015

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• Geographic Coverage - Health Net (yellow) and TriWest (blue)

VA Contracted Third Party Administrator (TPA)


• States with primary representation at the 14th

Region Annual FLEX conference – Arizona

– California

– Hawaii

– Idaho

– Nevada

– New Mexico

– North Dakota

– Oregon

– Texas

– Utah

– Washington

– Wyoming

• Combined, more than 300 CAHs

Critical Access Hospitals: Answering the Call


Arizona’s Critical Access Hospitals


Care in VCP is activated by the Veteran calling the contract Third Party Administrator (TPA) at the number on the Veterans Choice Card

or by the contact TPA calling the Veteran

Health care through the VCP is authorized (Veteran may incur some cost if condition is non-service connected)

Medical documentation return:

1) 30-day goal for both in and out patient care

2) New cancer diagnosis must be reported within 48 hours

How does a Veteran Access Services via VeteransChoice Program?

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3

2

1

Maintain at least the same or similar credentials and licenses as VA providers

Be accessible to the Veteran and agree to accept rates as outlined in the Act

Participate in the Medicare Program or other similar program approved by VA

How does a Community Provider become a Veterans Choice Program Provider?


• Complete information on respective contract Third Party Administrator (TPA) website

• Contract TPA sends authorization package for Veteran’s medical appointment

• Return claim for care rendered to contract TPA -patient notes no longer required for payment, but still needed by VA

• Claims payment by contract TPA

How does a VCP Provider Receive Payment

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Community impact and opportunity for

partnership with Veteran Service Organizations, Officers and nonprofits

Additional source of revenue

Provides a venue for connecting with Veterans

in the communityIn line with mission to provide access for all

What VCP Means for Critical Access Hospitals

The Future State Vision for Community Care for Veterans

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Access to Community

Care (Referral)

Care Coordination

Provider Payment(Claims)

Veterans We Serve (Eligibility)

High-Performing Network

The New Veterans Choice Program consolidates VA’s

community care programs and addresses the following:

• The VA Budget and Choice Improvement Act calls for improving Veteran access to care by consolidating community programs into one, standardized New Veterans Choice Program (New VCP)

• The new program will standardize access to community care through a high-performing network with robust care coordination and timely provider payment

• Transformation of this scale and impact will require phased implementation and a systems approach

• VA submitted a proposal to Congress on October 30, 2015

Background: VA Budget and Choice Improvement Act

22* activities which are dependent on legislation for complete implementation

– VA will begin to consolidate and streamline

community care network access (via award

of contract) and improve relationships with

community providers and core partners*

– Veterans will be able to see a community

provider within 30 days of their referral*

– Community care claims (clean) will be

processed and paid within 30 days 85

percent of the time

– Claims backlog will be reduced to less than

10 percent of total inventory

– Referral and authorization time will

be reduced

• By December 2016, the goal is to begin improving Veterans’ experience with community care

Measureable Impact for Veterans in Calendar Year 2016

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• VHA is committed to purchasing care for Veterans in the community

• Critical Access Hospitals will be “trusted partners” in VHA's High Performing Network of the Future

• Quality of Care certification and Interoperability for Health Information Exchange will be essential credentials

• Stay with us – changes this significant will take 10-20 months to implement

What Does This is Mean for Critical Access Hospitals?

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• Non-VA Purchased Care Team, Chief Business Office, VHA

– [email protected] (804-878-2754); or [email protected] (202-437-3537)

• Veterans Choice Act website

– http://www.va.gov/opa/choiceact/

• VHA Choice Locator PC3 Provider Map

– http://www.va.gov/opa/apps/locator/

• Veterans Choice Program Toolkit (outreach materials to easily share information and spread awareness about VCP)

– http://www.va.gov/opa/toolkit/index.asp

• Military Culture Training Course (training for community providers on treating the unique Veteran patient community)

– http://deploymentpsych.org/military-culture-course-modules

Key Resources

mailto:[email protected]


http://www.va.gov/opa/choiceact/

http://www.va.gov/opa/apps/locator/

http://www.va.gov/opa/toolkit/index.asp

http://deploymentpsych.org/military-culture-course-modules

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• TriWest contact information:

– Provider services contracting phone: 1-866-284-3743

– Email: Email: [email protected]

– Website: https://joinournetwork.triwest.com/

– Website: Provider resources - http://www.triwest.com/en/ (select Provider)

– Point of contact: Hal R Blair Sr., Deputy Program Manager, TriWest Healthcare Alliance, [email protected]

• Health Net contact information:

– Provider customer service: 1-866-606-8198

– Email: [email protected]

– Website: www.healthnetpc3provider.com/p3c/?register=true

– Point of contact: Jim Jones, Director, Provider Network Management, Health Net Federal Services, [email protected]

• Ask to apply to be a Veterans Choice Program provider (different from PC3)

How to Become a VCP Provider


Overview of VA in Arizona


• Phoenix VA Health Care System650 E. Indian School RoadPhoenix, Arizona 85012(602) 604-3914

• Northern Arizona VA Health Care System500 HWY 89NPrescott, Arizona 86313(928) 445-4860

• Southern Arizona VA Health Care System3601 S. 6th AveTucson, Arizona 85723(520) 792-1450

• VISN 18 (VA Southwest Health Care Network) merged with VISN 22 under the MyVA Task Force initiative

Arizona VA Medical Centers


• Southern:

– Green Valley

– Safford

– Sierra Vista

– Tucson (northwest and southeast)

– Yuma

• Northern:

– Anthem

– Flagstaff

– Lake Havasu City

– Cottonwood

– Kingman

• Phoenix:

– Gilbert

– Globe

– Payson

– Phoenix

– Surprise

– Show Low

– Scottsdale

Arizona VA Community Based Outpatient Clinics (17)


https://joinournetwork.triwest.com/

http://www.triwest.com/en/



http://www.healthnetpc3provider.com/p3c/?register=true


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• Chinele Vet Center Outstation (Chinele, AZ)• Hopi Vet Center Outstation (Hotevilla, AZ)• Lake Havasu Vet Center (Lake Havasu, AZ)• Mesa Vet Center (Mesa, AZ)• Phoenix Vet Center (Phoenix, AZ)• Prescott Vet Center (Prescott, AZ)• Tucson Vet Center (Tucson, AZ)• West Valley Vet Center (Peoria, AZ)

http://www.va.gov/directory/guide/state.asp?State=AZ&dnum=ALL

Arizona VA Readjustment Counseling Centers (“Vet Centers”) (8)


• Increase access to care for Veterans• Stabilize leadership• Rebuild the workforce: culture change• Systems redesign: improve processes• Rebuild community trust • Foster community partnerships

Focus Areas of Leadership


• Staffing: hiring initiatives• Expanding space • Telehealth • Improved transportation• Community partners: the CHOICE Program

Fixing Access to Care


2400

2500

2600

2700

2800

2900

3000

3100

3200

3300

Oct

-14

No

v-14

De

c-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-15

May

-15

Jun

-15

Jul-

15

Au

g-15

Sep

-15

Oct

-15

No

v-15

De

c-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-16

May

-16

3193.22

Access: StaffingNet FTEE FY15 - Present

http://www.va.gov/directory/guide/state.asp?State=AZ&dnum=ALL

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643,462

688,447

757,665 773,911 779,197

799,631

896,401

957,019

500,000

550,000

600,000

650,000

700,000

750,000

800,000

850,000

900,000

950,000

1,000,000

FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15

Outpatient Visit Growth

Access: Growth


0%

5%

10%

15%

20%

25%

30%

35%

40%

ABQ AMA BIG ELP PHX PRE TUC VISN18 NATION

User Veteran Market Share

Access: Market Penetration


3.19

10.6

14.02

Access: Wait Times


16,743

21,011

29,379

54,981

25,481

0

10,000

20,000

30,000

40,000

50,000

60,000

FY12 FY13 FY14 FY15 FY16 TD

Community Care Consults

Access: Community Care

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$66,172,221 $71,445,000

$82,924,213

$104,033,942

$48,699,195

$-

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

FY12 FY13 FY14 FY15 FY16

Community Care Expenditures

Access: Community Care Expenditures


Choice Utilization


Access to Care: Expand Telehealth


• Emergent gaps in service:– Urology

– OR shutdowns

– Sleep studies

– Mental health services

– Home health services

– Address needs of rural Veterans

– Ability to flex as demand fluctuates (seasonal Veterans)

Collaboration through Choice Care

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• Care coordination • Multiple touch points• Veterans expectations vs. past practice• Timely payments• Lack of flexibility in regulations and resource programming

Current and Future Challenges


• Women Veterans Programming • Veterans Justice Outreach Program• Homeless Programs - HUD/VASH• Evidence Based Therapies for PTSD• Suicide Prevention Coordinator• Military Sexual Trauma Coordinator• Substance Abuse Residential Rehab & Treatment

Finding the Balance: Unique Programming in VA


• Ongoing dialogue/collaboration• Addressing issues together• Changing the dialogue with our Veterans• Improving VA provider acceptance of community referrals• Creative solutions to access challenges

Keys to Improvement


• Thomas Driskill, Executive Assistant to Director, Office of Rural Health and Rural Health Coordinator, Pacific Islands Health Care System– [email protected] or 808-433-0787

• Deborah Amdur, Director, Phoenix VA Hospital System

– [email protected] or 602-604-3914

• Visit the Phoenix VA Health Care System website

– http://www.phoenix.va.gov/

• Visit the ORH website

– www.ruralhealth.va.gov

Thank you!



http://www.phoenix.va.gov/

http://www.ruralhealth.va.gov/

Collaboration among CAHs, State Flex Programs, and the ......– Flagstaff – Lake Havasu City –...

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