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Remaking the toxic politics around veterans’ healthcare

From a two-part conversation about how politics shape veterans’ healthcare with Stephen Trynosky at the VHPI Blog: 

Trynosky: The thing is, the House Veterans’ Affairs Committee could be a platform for positive messaging and showcasing things, but it goes to the fracturing of veterans healthcare jurisdictionally in the House of Representatives. It has been ghettoized. It is overseen separately from the larger American healthcare system. The true experts on healthcare policy and financing in Congress, the Energy & Commerce and Ways and Means Committee staff, are not involved in oversight of the veterans’ healthcare system at all – and that’s a problem. 

This is the result of the historical iron triangle, the closed system between the VSOs, the VA, and the Veterans committees. That world doesn’t communicate much with the larger health policy community – certainly in Washington and I would say even nationwide. Recognizing that disconnect and trying to fix it should be a high priority for any leadership team of either party in either house of Congress.

VHPI: One of the things that has struck me in my work in healthcare, is that the VA is not considered part of the ecosystem of the American healthcare system. It’s the nation’s invisible healthcare system. It’s doing all these amazing things. Ironically, its very isolation from market driven healthcare and the fee-for-service imperatives may have allowed it to develop better models of care. The problem is that you have the largest healthcare system in the country and nobody knows about what they are.

The VA is really the only population health system in the country. The innovations it makes are available to everyone. You can see that in the COVID-19 crisis. But you see it in everything – in end-of-life care and homelessness, primary care – everything the American healthcare system does not do well the VA does well, and yet no one knows about it. 

Trynosky: Historically, that’s the nature of the Iron Triangle. The durability of the VA in the post WWII era meant that it never had to aggressively advocate for itself in that way. Broad bipartisan support was assumed and the imprimatur of the “Big 3” (VFW, DAV, and American Legion) was often enough to assure passage of sweeping legislation. In the middle of the Clinton impeachment when things were aflame in Washington, the Millennium bill – which was transformative for VA healthcare, was passed by unanimous consent in the Senate and was almost unanimous, if not unanimous, in the House. Massive bills have been passed with that kind of bipartisan durability. 

So VA never had to build an infrastructure or a culture of having to assess and justify, not only just requests for funding, but its continued existence. We’ve seen that need since the beginning of the 1980s in virtually all other Federal agencies with incredible scrutiny and advancement of privatization and outsourcing. So generations of bureaucrats (using that term in the best sense) at DOE, EPA, HHS, have grown up in their jobs having to constantly justify and put forth a compelling rationale to Congress and the American public for their continued existence. VA never had to do that. Read part one and part two.

The Veterans Healthcare Policy Institute’s team will discuss why the new Congress and administration needs to reconsider the current approach to veterans health issues which depends heavily on outsourcing veterans care to the private sector and eroding the VA’s robust models of veteran centric care. VHPI’s leaders, policy analysts, and fellows describe what needs to change within the VA MISSION Act and other initiatives to better serve veterans. They’ll offer their views on how veterans’ care can be expanded as the U.S. continues to battle COVID-19 and what role the VBA plays in the response.
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VA plans to outsource all Comp & Pen Exams

From Stars and Stripes:

The Department of Veterans Affairs is eliminating its in-house compensation and pension exam program and will outsource all of the exams, which are crucial to determining whether veterans are eligible for VA benefits.

In a letter to VA Secretary Robert Wilkie on Tuesday, Rep. Elaine Luria, D-Va., said the plan was developed with no notice to Congress. She's concerned the move could slow work to reduce a backlog of compensation and pension exams, commonly referred to as C&P exams, and she's worried about the VA's ability to oversee the contractors. Luria also criticized the department for cutting federal jobs during a pandemic.

Big Stories, Short Links

  • MyChesco: VA completes secure transfer of veteran data ahead of new Electronic Health Record launch
  • VA Press Release: VA recognizes Compensated Work Therapy Vocational Rehabilitation Week
  • Commonwealth Magazine: Families say problems are continuing at Holyoke State Soldiers’ Home ravaged by COVID-19
  • Becker’s Hospital Review: Reviewing the largest U.S. hospital systems
  • NWI.com: New $40M VA health clinic under construction in Terre Haute
  • MDedge: Is patient suicide in psychiatry a medical error?
  • VA Press Release: VA awards prime vendor status to Medline and Cardinal Health for healthcare supplies 
  • MDedge: Three digit national suicide hotline to launch in July 2022
  • Battle Borne: The Forever Wars outlive "At War"
  • CQ Researcher: How could COVID-19 transform the healthcare insurance system?

Training launched for women veterans transitioning from active duty to veteran status 

The Department of Veterans Affairs’ Women’s Health Services and the Department of the Air Force’s Women’s Initiative Team collaborated to establish training that provides information on health services available to women who are separating or retiring from the military. Read more at the Sixteenth Air Force Public Affairs.

“Inclusive care program to expand across VA”

From the VAntage Point Blog:

A program including caregivers into Veterans’ medical teams is expanding across all of VA, Secretary Robert Wilkie announced Oct. 19 during a virtual 5th annual VA-Elizabeth Dole Foundation Convening event.

The Campaign for Inclusive Care Academy equips doctors, nurses, social workers and frontline medical personnel with training to support Veterans and caregivers.

The training focuses on caregivers and Veterans receiving geriatric, polytrauma and traumatic brain injury care. Providers learn about three topics: the caregiver’s journey, the value of clear and mutual communication, and Veterans Health Administration privacy policies.

“We need to quickly and fully integrate you into the fabric of VA healthcare,” Wilkie told the audience. “Keeping you at the forefront is why we included caregivers in the design of the new electronic health record system we will launch Saturday. Keeping you at the forefront is why, under the MISSION Act, we’re expanding that caregiver program now to finally include the soldiers of World War II, Korea and Vietnam.”

Veteran eligibility includes those with a single or combined service-connected disability rating of 70% or higher. That eligibility includes Veterans whose disability is a result of an injury, an illness or a disease.

“We expect this first phase of expansion will let us enroll twice as many eligible Veterans and caregivers,” the secretary said.
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Previously, including caregivers into Veteran care wasn’t consistent. Under the new program, VA medical personnel will ask Veterans if they want a caregiver included in medical care.

The program started with three Veterans Integrated Service Networks, or VISNs. The three are VISN 10, headquartered in Ohio and covering parts of the Midwest; VISN 17, headquartered in Texas; and VISN 20, headquartered in Washington and covering the Pacific Northwest and Alaska.

More than 300 VA participants trained as champions of inclusive care, said Leah Christensen, national clinical program coordinator. She said they spread awareness across VA healthcare systems, encouraging colleagues to engage in the Academy. The champions also trained colleagues on the importance of including caregivers in care planning and how to support caregivers in their role.

Christensen said after completing the Academy for Inclusive Care, results showed increases on practicing inclusive care with Veterans and caregivers.

The Campaign for Inclusive Care Academy has several goals. One is helping VA identify caregivers and make them part of the team. Equipping caregivers to promote more positive clinical outcomes is another goal. The program also aims to enhance VA’s Choose Home program and improve care in the home. The last goal is to ensure that the information VA receives about caregivers is respected and remains private.

Research Roundup

  • Harnessing Collaborative Care to Meet Mental Health Demands in the Era of COVID-19 via the JAMA Network.
  • VHA’s Innovation Ecosystem: Operationalizing Innovation in Health Care: Innovation has been widely advocated as the solution to U.S. health care’s rising costs and unsatisfying outcomes, and an abundance of innovative health care products and practices have been developed in recent years. Most have neither produced dramatic improvements in care nor spread at the pace and scale needed to transform care or materially bend the health care cost curve. The authors believe that health systems lack a model for operationalizing and scaling innovations, which must be built on a foundation capable of embracing meaningful changes, whether incremental or dramatic. Four critical elements support development and deployment of innovation in a health system: (1) workforce capacity to actualize innovation; (2) an organizational infrastructure that supports integrated, systematic, repeatable pathways for change; (3) an innovation-nurturing culture; and (4) strategic external partnerships and collaborations. Although perhaps an unlikely source, the Veterans Health Administration’s Innovation Ecosystem (VHA IE) provides a demonstrably successful and replicable model for supporting the entire life cycle of innovation in a large and highly complex integrated health system. The authors discuss how to apply this model in any integrated health system. Read the full article here.
  • Mental health continues to deteriorate for many Americans during the pandemic. Read more at MDedge

VA’s $16 billion digital health project faces critical test

From Politico

An oft-delayed $16 billion system to overhaul veterans’ medical records will debut Saturday in Spokane, Wash., marking the first stage of a yearslong marathon.

Close observers of the project — initially pushed by President Donald Trump's senior advisor Jared Kushner — are cautiously optimistic, with one congressional aide predicting a “B-minus or C-plus” rollout.

Veterans’ Healthcare Verbatim: 

From the Op-Ed “Start focusing on veterans' health before they enlist” by Kelsey Baker. a former Marine Officer and a Uniformed Victim’s Advocate, in The Hill: 

Both campaigns laid out their plans for the military last week at a virtual convening with Military Times, a news outlet dedicated to covering service members and their lives, addressing what they would do for veterans. Formulating policies that exclusively focus on veterans is probably a necessary part of any presidential platform; a candidate wants a good portion if not all of the 17.4 million veterans in the country to support him. 

But to really help them, policy needs to utilize the time before they discharge from service. Actually, it has to focus on the time before they even enlist. 

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