Veterans
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VA’s Office of Rural Health, in partnership with VA's Quality Enhancement Research Initiative, is supporting the Telemedicine Outreach for PTSD (TOP) program to deliver therapy and other care through phone and interactive video contact.
“Our researchers have worked diligently in recent years to establish the safety and efficacy of PTSD psychotherapy delivered remotely, ensuring veterans will get the same quality of PTSD care as if they were in a doctor’s office at a VA medical center,” said VA Secretary David Shulkin. “We are excited to see this program help greater numbers of veterans living in rural areas and pleased that it will save them time and effort to get to a VA facility that is far from their homes.”
Dr. John Fortney, a research health scientist at the VA Puget Sound Health Care System in Seattle, Washington, is leading the project.
“Long travel distances to urban areas can be a major barrier to care for rural veterans,” Fortney said. “In a prior trial, we were able to use telehealth technologies successfully to engage veterans in evidence-based, trauma-focused therapy without their having to travel to a distant VA medical center.”
To date, more than 500 rural veterans who are not receiving specialty PTSD care have enrolled in the study.
The participants may choose between the two main forms of evidence-based, trauma-focused psychotherapy used in VA: cognitive processing therapy and prolonged exposure therapy.
Veterans participating in the program receive frequent phone calls from a care manager who helps them access services provided by off-site psychiatrists and psychologists.
The psychotherapy is delivered via interactive video from a VA medical center to a community-based outpatient clinic (CBOC) or to the veteran’s home.
The telephone care manager also monitors the Veterans’ progress and helps them overcome barriers to care.
The program includes 12 CBOCs across the nation in Charleston, South Carolina; Iowa City, Iowa; Little Rock, Arkansas; Denver, Colorado; San Diego, California; and Seattle.
The results, which will be available in 2020, will lay the groundwork for national implementation of the TOP program.
To learn more about VA research on PTSD, visit www.research.va.gov/topics/ptsd.cfm.
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“On behalf of the BVA Board of Directors and our members, we are excited to welcome Joe to the BVA family. Joe’s experience in the Army will prove largely beneficial as we continue ensuring the care of our blinded veterans therefore we look forward to his leadership,” said BVA President Joe Parker said.
As the executive director for the Blinded Veterans Association, Bogart serves as the association’s senior staff member and is responsible for outreach with stakeholders across the Nation, Field organizations, and VSOs.
“I am honored to join the BVA Team and be a part of an organization with a long and prestigious heritage of taking care of our blinded veterans,” said Bogart. “I look forward to ensuring that we continue to support our veterans and build an influential membership base so that everyone is aware of BVA’s programs, accomplishments, and mission.”
Bogart started out as an enlisted soldier as a combat engineer. Graduating from Officer Candidate School in 2005 as a 2nd Lieutenant in the U.S. Army Corps of Engineers he deployed to Iraq in 2006 taking over as platoon leader.
On his very last mission, while on a route clearance patrol, an improvised explosive device detonated on his armored Humvee. The blast and shrapnel resulted in the loss of his right eye and left him with glaucoma and legally blind in his left.
This did not stop him from remaining on active duty and returning to Iraq for a second time. He just recently retired from the Army as a major after more than 28 years of service. His wife will retire this summer from her job with the state of Missouri and join him in Virginia.
The Blinded Veterans Association is the only official voice for America’s veterans who are blind or visually impaired, successfully advocating for their needs since World War II.
For more information about BVA and its services, call toll-free 800-669-7079 or visit www.bva.org.
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The partnership will allow VA and CVN to work together to advance and improve veterans’ mental health and well-being and expand and promote community collaboration to increase veterans’ access to mental health resources.
“VA and CVN have a shared goal to improve veterans’ health and access to mental health services to reduce veteran suicide,” said VA Secretary David J. Shulkin. “With 14 out of the 20 veterans who take their own lives per day not engaging VA care, partnerships such as this help those veterans, as well as their families, receive care where they live.”
As part of the collaboration, VA and CVN will:
– Work together on potential mental health education initiatives, consumer marketing and public health messaging;
– Discuss potential locations for Cohen Clinics in regions believed to have underserved Veterans in need of mental health care services;
– Collaborate to share publicly available, VA-developed educational resources for health care providers, such as military culture training and suicide prevention training with CVN staff and clinic employees.
“This partnership will help us save lives by getting care to Veterans faster and, therefore, preventing suicides,” said Dr. Anthony Hassan, president and CEO of CVN. “We are excited about partnering with VA and advancing the field through innovative clinician training initiatives and public messaging. This partnership adds another layer of depth and quality to our robust network of Cohen Military Family Clinics.”
For more information about VA mental health services, visit www.mentalhealth.va.gov. Information about the Cohen Veterans Network may be found at https://www.cohenveteransnetwork.org.
Veterans in crisis or having thoughts of suicide – and those who know a veteran in crisis – should call the Veterans Crisis Line for confidential support 24 hours a day and 365 days a year. Call 800-273-8255 and press 1, chat online at www.VeteransCrisisLine.net/Chat, or text to 838255.
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“Our goal is to give transitioning service members one less thing to worry about,” said VA Secretary David J. Shulkin. “We know that more than a third of veterans who haven’t yet visited our facilities indicated they are not aware of VA health care benefits, while a quarter reported they do not know how to apply.”
As part of Concierge for Care, VA staff members are personally contacting recently separated service members to answer questions, process their health-care enrollment applications over the phone and help schedule eligible veterans’ first VA medical appointment, if needed.
Each week, VA receives a list of separating service members from the Department of Defense. The goal is to make contact with them within a month of discharge.
Certain veterans who served in a theater of combat operations are eligible to enroll and receive cost-free health care for medical conditions related to their military service during the five-year period after discharge.
Information about VA health care and the application process can be found at https://www.vets.gov/health-care/apply/ .
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The partnership will focus on analyzing patterns from approximately 700,000 historical, de-personalized health records to develop machine learning algorithms that will accurately identify risk factors for patient deterioration and predict its onset.
Initial work will be focused on identifying the most common signs of risk, like acute kidney injury, a problem that can lead to dialysis or death, but is preventable if detected early.
“Medicine is more than treating patients’ problems,” said VA Secretary David J. Shulkin. “Clinicians need to be able to identify risks to help prevent disease. This collaboration is an opportunity to advance the quality of care for our nation’s veterans by predicting deterioration and applying interventions early.”
Eventually, similar approaches will be applied to other signs of patient deterioration, leading to improved care for many more patients, with fewer people developing serious infections and conditions – ultimately saving lives.
“We are proud to partner with the Department of Veterans Affairs on this important challenge,” said Mustafa Suleyman, co-founder of DeepMind. “This project has great potential intelligently to detect and prevent deterioration before patients show serious signs of illness. Speed is vital when a patient is deteriorating: The sooner the right information reaches the right clinician, the sooner the patient can be given the right care.”
DeepMind is the world leader in artificial intelligence research. It has already partnered with leading hospitals in the United Kingdom to apply its innovative machine-learning algorithms to research projects looking at eye disease, head and neck cancer, and mammography.
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VA defines its low-performing facilities as those medical centers that receive the lowest score in its SAIL star rating system, or a one-star rating out of five.
VA currently has 15 such one-star facilities: Hampton (Virginia); Harlingen (Texas); Roseburg (Oregon); Washington (DC); Big Spring (Texas); Denver (Colorado); Dublin (Georgia); El Paso (Texas); Jackson, (Mississippi); Loma Linda (California); Memphis (Tennessee); Murfreesboro (Tennessee); Nashville (Tennessee); Phoenix (Arizona); and Walla Walla (Washington).
The steps VA is taking to produce rapid improvements at its low-performing facilities include:
– Central, national accountable leadership: VA has designated Dr. Peter Almenoff, Director of VA’s Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID) Healthcare Improvement Center, to oversee improvement at each of the centers. Dr. Almenoff reports directly to Dr. Carolyn Clancy, Executive in Charge of the Veterans Health Administration (VHA).
– Comprehensive analysis and identification of improvement targets: VA is employing a new initiative, known as Strategic Action Transformation (STAT), that uses a rigorous and formal approach based on clinical performance indicators to identify vulnerabilities in each low-performing facility and set specific targets for improvement.
– Provision of national resources for improvement: VA’s RAPID team of experts will use sophisticated statistical tools to track the progress of improvement against these targets, and, where warranted, will dispatch a team of expert improvement coaches quickly to the medical centers to assist them in meeting the goals.
– Accountability for results: VA’s Central Office will review each of the facilities quarterly, and if the facilities fail to make rapid substantial progress in their improvement plan, VA leadership will take prompt action, including changing the leadership of the medical center.
“President Trump has made it clear that our Veterans deserve only the best when it comes to their healthcare, and that’s why we are focusing on improving our lowest performing facilities nationwide,” said VA Secretary David Shulkin. “We will employ tight timelines for facilities to demonstrate improvement, and if low performance persists, we will make swift changes – including replacing facility leaders – until we achieve the rapid improvements that Veterans and taxpayers expect from VA.”
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By answering a few short questions, veterans will receive information on the specific armed services board to contact, the form or forms to fill out, special guidance applicable to their case, where to send their application and helpful tips for appealing their discharge.
“This new tool and partnership with DOD is one of many VA initiatives offered to veterans who believe they may have been unfairly discharged or received an unfair discharge characterization,” said VA Secretary Dr. David J. Shulkin. “Veterans who believe their discharge was unjust, erroneous or warrants an upgrade are encouraged to use the tool and then apply for review.”
DOD officials also praised the new innovative tool.
“We are thrilled to have partnered with the Department of Veterans Affairs in developing this wonderful and easily accessible tool,” said Mr. Robert Wilkie, Under Secretary of Defense for Personnel and Readiness. “We support our veterans, whether they served recently or long ago, and we are excited to introduce a tool that will individualize the guidance for those who desire an upgrade or change in their military discharge.”
The military has estimated that tens of thousands of veterans with less than honorable discharges are especially likely to have unjust discharges deserving of upgrades.
These are veterans who were discharged due to incidents relating to post-traumatic stress disorder, traumatic brain injury or sexual orientation.
Fragmented and confusing information has historically deterred veterans from obtaining crucial information and — in many cases — necessary benefits.
The discharge upgrade tool is available at https://www.vets.gov/discharge-upgrade-instructions.
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“In the past, the focus of TBI and PTSD brain research has primarily been based on male brains – without any active recruitment for women,” said Dr. Carolyn Clancy, executive in charge of VA’s Veterans Health Administration. “We have a lot to learn about how the female brain deals with TBI and PTSD, which makes this effort long overdue.”
Katherine Snedaker, founder and executive director of PINK Concussions, and a brain injury survivor, also applauded the collaboration.
“We are so grateful to partner with VA to launch the first active recruitment of female veterans, as well as active-duty members and civilian women to be a part of brain injury and PTSD research,” Snedaker said. “VA continues year after year to be one of our most valued partners in our ongoing mission to improve pre-injury education and post-injury care for women with brain injury.”
While there is postmortem brain tissue available for study of injury in men, there has been almost none for women. There is also a lack of research on Chronic Traumatic Encephalopathy, also known as CTE, in women. In all published literature on CTE, only two peer-reviewed journal articles (both published in the early 1990s) have focused on women.
Women veterans interested in participating in the brain bank may take the PINK Concussions pledge. Though tissue donation may occur many years or decades from now, enrollment will allow researchers to learn as much as possible about the health of an enrolled female participant and how things may change over the years.
For more information about the effort, visit www.pinkconcussions.com/. For more information about the VA’s National PTSD Brain Bank, visit www.research.va.gov/programs/tissue_banking/PTSD/default.cfm or call 800-762-6609.
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This newest partnership enhances ongoing efforts between the country’s two largest public-private health-care payment organizations to help America’s veterans by leveraging the gains made by CMS.
“The VA-HHS alliance represents the latest example of VA’s commitment to find partners to assist with identifying new and innovative ways to seek out fraud, waste and abuse and ensure every tax dollar given to VA supports veterans,” said VA Secretary Dr. David J. Shulkin. “This effort marks another step toward achieving President Trump’s 10-point plan to reform the VA by collaborating with our federal partners to improve VA’s ability to investigate fraud and wrongdoing in VA programs.”
CMS continues to focus on reducing and eliminating fraud, waste and abuse in Medicare, and in 2010, it established the Center for Program Integrity to help with this work.
CMS estimates that its program integrity activities saved Medicare operations $17 billion in fiscal 2015. Other HHS combined efforts – including law enforcement – contributed to greater program savings.
VA plans to capitalize on the advancements in analytics CMS has made by concentrating on its use of advanced technology, statistics and data analytics to improve fraud detection and prevention efforts.
Additionally, in November 2017, VA invited industry experts to provide information on the latest commercial sector tools and techniques to enhance VA’s fraud detection capabilities.
In April, VA will invite these industry experts to demonstrate their capabilities for detecting and preventing fraud, waste and abuse and recovering improper payments.
“We have a special obligation to keep America’s promise to those who have served our country and ensure that veterans receive high-quality and accessible health care,” said CMS Administrator Seema Verma. “CMS is sharing lessons learned and expertise to support VA to identify waste and fraud and eliminate these abuses of the public trust. Using state-of-the-art data analytics, CMS is partnering with VA to better detect and prevent wrongdoing in its programs.”
By using CMS’ successes in its program integrity protocols, VA will be able to close existing gaps in its own claims payment process.
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