Hospice-Veteran Partnership ProgramHospice-Veteran Partnership Program

ContentContent

• Overview of the Hospice-Veteran Partnership Program

• Making the case to form an HVP• Strategies for HVP success• Tips for Getting Started and

Succeeding• Examples• Resources

Message from Tom EdesDepartment of Veterans Affairs

Message from Tom EdesDepartment of Veterans Affairs• “We in the VA depend on you,

community hospice agencies to deliver home care for our terminally ill patients. The VA does not intend to replicate the excellent system that is already in place for home hospice care and we in the VA must learn to collaborate with and learn from you.”

National CollaborationNational Collaboration• VA Hospice and Palliative Care Program Office

– Dr. Scott Shreve, National Director– HPC program office staff– VISN Program Managers and Clinical Champions

• NHPCO We Honor Veterans campaign– Emil Zuberbueler, Director, National Veterans Program– WHV program staff

• Veterans Advisory Council• Council of States

Hospice-Veteran PartnershipsHospice-Veteran Partnerships• Home: State hospice organization,

coalition, VA VISN or facility• Leadership: Co-chairs, generally

representatives from community hospice and VA

• Structure: State-wide organization and coordination with local or regional HVPs around the catchment areas of VA faciities

HVP PartnersHVP Partners• State Hospice Organizations• End-of-Life Coalitions• Community hospice agencies• VISNs and VA facilities

– VA Medical Centers– Community Based Outpatient Clinics (CBOCs)– Vet Centers

• State Veterans Homes• Veterans Service Organizations (VSOs)• Community Veteran Organizations

Veterans Health Administration21 Veterans Integrated Service

Networks

Veterans Health Administration21 Veterans Integrated Service

Networks

www2.va.gov/directory/guide/division_flsh.asp?dnum=1

Why Are HVPs Important?Why Are HVPs Important?• More than 1,800 veterans are dying every day

– . . .but not much is known about end-of-life issues for this special population

• The vast majority of veterans do not receive their health care from VA– . . .but community healthcare providers and

organizations often don’t know who they are or how to reach out to them

• Significant barriers exist– . . .but they can be overcome through communication

and collaboration

Volume of Veteran Deaths Volume of Veteran Deaths • Number of veteran deaths reached an all-

time high in 2006 (664,842 projected Veterans deaths)

• At least 600,000 deaths a year through 2016

• Less than 4% Veteran deaths (about 21,000/yr) will occur in VA facilities

• HVPs are solving care coordination problems at the local, state and national levelswww.va.gov/vetdata/Veteran_Population.asp

Projected Veteran Deaths (2011)

n = 648,354

Projected Veteran Deaths (2011)

n = 648,354

<20 20-24

25-29

30-34

35-39

40-44

45-49

50-54

17 383 715 806 1,052 2,026 4,063 7,764

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

15,301 44,617 51,942 65,066 104,299

134,788

132,764

82,760

www.va.gov/vetdata/Veteran_Population.asp

Total Projected Veteran Deaths by State (2011)

Total Projected Veteran Deaths by State (2011)

Top 10 States represent50% of Veteran deaths

Highest #: 58,250 (CA)Lowest #: 1,060 (DC)

Top 10 States with highest number of Veteran Deaths

Top 10 States with highest number of Veteran Deaths

How Can HVPs Help VA?How Can HVPs Help VA?

• Honors veterans’ preferences• Expands the interdisciplinary team• Increases VA staff knowledge of the

Medicare Hospice Benefit• Frees up inpatient beds for incoming

veterans• Shares the job of caring for Veterans

with the community

How Can HVPs Help Community Hospices?How Can HVPs Help Community Hospices?• Clinical Care

– Honors veterans’ preferences – Improves communication and continuity– Expands understanding of veterans unique

end-of-life issues

• Administrative – Increases referrals– Improves payment for services– Clarifies interface between VA and community

hospice policies and procedures

How Can HVPs Help Veterans?How Can HVPs Help Veterans?• Honors Veterans’ preferences• Standardizes VA response to

community hospices• Informs community response to

Veterans’ unique end-of-life issues• Contributes to continuity and quality

of care• Eliminates “charity care” for Veterans

Getting Startedwith the HVP Toolkit Getting Startedwith the HVP Toolkit • Begin with a Planning Committee• Identify potential partners• Form a Leadership Committee• Conduct Needs Assessment• Develop strategic objectives and measure

outcomes• Plan educational, program development

and outreach activities• Work together to build solutions

(www.wehonorveterans.org)

Potential HVP ProjectsPotential HVP Projects

• Community Outreach• Legal and Regulatory Issues• Education and training for providers• Research and Evaluation• Member Recruitment• Fundraising

Strategies for SuccessStrategies for Success

• Strong support from VA leaders– Identify champion from each facility in

state– Invite staff from CBOCs, State Veterans

Homes, and VetCenters to participate– Secure support from VISN leadership– Include HVP in strategic planning efforts– Coordinate HVP activities within your

VISN and with adjacent VISNs

Strategies for SuccessStrategies for Success

• Equally strong support from the state hospice organization or coalition– Identify Community hospice champion– Invite all community hospices in state to

participate – Secure board of directors support and

appoint HVP community leader(s)– Establish an HVP standing committee or

workgroup

Strategies for SuccessStrategies for Success

• Acknowledge and respect all interest positions and cultural differences– WIIFM factor– Language of organization– Rules, regulations and SOP– Perceptions

Understanding DifferencesUnderstanding Differences

VA Hospice

Culture Quasi-military Community healthcare provider

Role Provider and

Payer

Provider

Funding Fixed appropriation and budget

Entitlement - Medicare/ Medicaid hospice benefit; 3rd party reimbursement

Accountability Congress Governing Body, CMS, Fiscal Intermediaries and State

HVP Outcome Measures – 1st TierHVP Outcome Measures – 1st Tier

Are we improving veterans’ access to hospice and palliative care?– # veterans being served by community

hospices– HVP has the name and contact

information of VA HPC liaison(s) at each facility in the state and makes this information available to all hospices in the state

– # educational sessions among providers of care for veterans in all settings

HVP Outcome Measures – 2nd TierHVP Outcome Measures – 2nd Tier• Are we meeting veterans needs?

– # education sessions/events for veterans and their families

– Post death family satisfaction survey data collected and shared among providers

– # referrals from community hospice to VA for assistance with care, benefits or services

– # and % of community hospices that have written agreements with VA facilities and State Veterans Homes

HVP Outcome Measures – 3rd TierHVP Outcome Measures – 3rd Tier• Are HVPs paying attention to the

strength and sustainability of their infrastructure?– Composition of HVP membership– # HVP projects ongoing and completed– # HVP meetings

HVP National Program - Local SolutionsHVP National Program - Local Solutions• State lines and VISN boundaries are

complex• Solution: form regional HVPs around

each VA Medical Center in the state– Region includes the VAMC’s service area– Coordinate activities with your State

HVP to ensure that everyone has the same information

– Many benefits!

Regional HVPsRegional HVPs

• HVP survey can identify perceptions and misunderstandings

• Roundtable sessions drill down and identify barriers and opportunities

• Solutions and best practices can be shared and “hard wired” into performance

• Relationships strengthened through routine meetings and collaboration on specific tasks and objectives

How to Start a Regional HVPHow to Start a Regional HVP• Establish a Regional or Local HVP

leaders• Hold regular meetings• Report back to the State HVP and

VISN palliative care leaders

Regional HVP Start-up ActivitiesRegional HVP Start-up Activities• Schedule initial “Round Table or Open House”

– Invite local VA facilities, community hospices, State Veteran Homes and others

– Develop agenda collaboratively– Plan logistics carefully

• Pay attention to local issues that affect the interface of VA with community providers in the region

• Understand the different perspectives of individual member groups

Regional HVP AgendaRegional HVP Agenda• VA Continuum of Health Care Services

– Eligibility & Burial Benefits– VA Palliative and End-of-Life Care:

Inpatient and Outpatient Services – VA Bereavement Program– Coordination of Care– MD orders for start of care– Medications and DME– Home Hospice Agency follow up– VA Purchased Home Hospice Care

• Agencies Description & Services• Open Discussion

Next Steps for Regional HVPsNext Steps for Regional HVPs• Establish ongoing relationship• Create an e-mail group and send

regular updates• Partner for training and education

activities• Identify ways to increase hospice

referrals• Improve coordination of clinical care

Resources for HVPsResources for HVPs

• We Honor Veterans website• Military History Check List• Military History Pocket Card• Peace at Last: Stories of Hope and

healing for Veterans and Their Families (Deborah Grassman, 2009)

• State Hospice Organization websites

VA Pocket Card Homepagewww.va.gov/oaa/pocketcard/

VA Pocket Card Homepagewww.va.gov/oaa/pocketcard/