One of the VA's Health Priorities is "building a high-performance health care network." What does this mean?

Veterans will receive the highest level of coordinated care within VA or from participating providers and partners.

Which of the following is the largest provider of health professional training in the United States?

Veterans Affairs

What does the PACT stand for?

Patient Aligned Care Team

The VA Spinal Cord Injury/Disorders (SCI/D) program involves which system of care?

- Home and Community Support
- Acute and Sustaining Medical and Surgical Care
-Rehabilitation

All of the above

Combat Veterans from OEF/OIF/OND are screened for TBI only after having experienced a traumatic event and/or exhibit symptoms of TBI.

False

Which of the following is FALSE regarding Accessing VA Health Care for a Service Member transitioning to Veteran?

VA cannot schedule future appointments while the Service member is on Active Duty.

Match each Transition and Care Management (TCM) Team role with its associated description.

TCM Program Manager- Coordinates clinical care and oversees transition for OEF/OIF/OND Service members and Veterans.
TCM Case Manager- Partners with Service members, Veterans, and their families to assure the right health care and community services are provided when they need them.
Transition Patient Advocate- serves as an advocate to help navigate the VA health care system.

Any Veteran or active-duty Service member, including members of the National Guard and Reserve components, is eligible for Vet Center services.

False

VHA has successfully implemented comprehensive primary care for women Veterans at ___% of VHA health care systems.

100%

What health services do Veterans living in rural areas have access to?

- Telehealth Outreach Clinics
- Non-VA Medical Care
- Home-Based Telehealth
- A and C

All of the Above

Which of the following is NOT a VBA benefit for active duty Service members?

Financial Advising

Core values of the VA

Integrity
Commitment
Advocacy
Respect
Excellence

How is the VA funded

Federal government

VA Eligibility: Veteran Status

Served in active military for 24 continuous months or the full period for which they were called for active duty

VA Eligibility: Character of discharge

received a discharge under conditions other than dishonorable

VA Eligibility: Service Connected

Veterans who are determined by VA to be disabled d/t an injury or illness which was incurred or aggravated during active military service

VA Eligibility: Presumptive Conditions

Disabilities VA presumes to be caused by military service d/t exposure: Agent Orange, Prisoners of Ware, Radiation

VA Eligibility: VA Pension Benefits

Veteran must have served honorably with at least one day during a wartime period

What are VA priority groups

Determines who gets covered first based on condition/status

OT Services in VA

ADL assessment and training
Durable medical equipment assessment for ADLs
Home safety evaluation and training
IADL assessment and training
Return to work: Compensation/adaptation, stress/sleep management, Energy conservation
UE assessment & treatment (MMT, ROM, UE therapeutic exercise, UE edema management, modalities
Cognitive assessment and training
Vision Rehab
Ergonomics
Adaptive sports programs!

What does the VA cover for veterins?

-primary care
-specialty care
-acute care
-mental health
-pharmacy
-supplies

How is the VA funded?

-its a not-for profit government agency
-covered by income taxes
-funding distributed using capitation model called Veterans Equitable Resource Allocation (VERA)

What is VERA?

-veterans equitable resource allocation
-per capita distribution model based on number of veterans in an area
-veterans all have a primary facility they are linked to for care but they can seek specialty care at other VA facilities
-medical complexity is taken into account
-funded through advanced appropriations by congress
+pro = protection from government shutdowns/furloughs
+con = funding not realized for 3 years from date of service

Who qualifies for VA care?

-veterans that have served at least 2 years of full active duty
-spouses/dependents are generally not covered
-may be an income component for eligibility
-special situations that auto-qualify
+service-connected disability
+military exposure (agent orange, radiation, burn pits)
+purple heart recipients
+former POW

What does the veteran population look like?

-decreasing in coming years
-female population is increasing
-right now there is some GI generation (1901-1926), lots of silent generation (1927-1945), lots of baby boomers, some gen x, more millennials than gen x and some centennials
-will eventually be some silent gen, majority baby boomers an then the rest don't really change in coming years other than increase in centennials

What is critical to know when communicating with veterans?

-knowing the war era
-right now is a majority of vietnam era and gulf war era
-still have some WWIIs and korean conflict

What is the VA organizational structure?

1) secretary of veterans affairs (SecVa)
2)Veterans health administration (VHA) / veterans benefit administration (VBA) / National cemetery administration (NCA)

What is the VHA organizational structure?

-18 regional networks (VISNs)
-152 medical centers with varying complexity
-900 outpatient clinics

What are the pharmacy services that the VA has?

-Rx fulfillment
-mail order pharmacy
-emergency pharmacy
-care management
-medication management
-formulary management

What is prescription fulfillment?

-first fills and urgent meds are filled on site
-nationally integrated EMR
-prescriber order entry
-copays based on various eligibility rules
-3 teirs
-dispense meds in 90ds when possible
-tablet splitting
-follow federal pharmacy regulations not necessarily state laws
-pharmacists can be licensed in any state

What are the mail order pharmacy services?

-used for refills
-highly automated
-7 total locations
+Chicago and North Charleston SC
-can fill anything except C2s
-lower overhead costs due to economies of scale

What is emergency pharmacy services?

-emergency pharmacy cache (strategic national stockpile)
-disaster emergency medical personnel system (DEMPS)
-mobile pharmacy

What is care management?

-VA pharmacists practice in variety of different patient care settings
-basically mid-level practitioners
-credentialed through medical staff process, peer review and scopes of practice
-anticoag, hematology, oncology, HepC, home care, emergency medicine, infectious disease, intensive care, internal med, pain management, primary care, psych, seamless transition, spinal cord injury, surgery, telehealth, womens health

What is medication management?

-full review of all meds with each fill allowed by integrated medical record
-every veteran is counseled on new scripts prior to dispensing
-formulary substitutions and conversions allowed without MD approval
-quantities can be adjusted by pharmacists
-supply items provided by pharmacy (diapers, catheters, bandages ect)

How does the VA teach and train?

-more than 70% of docs in US had training in VA facility
-over 120000 health professional trainees annually
-significant research component
+first solid organ transplants, nicotine patch, shingles vaccine
-provides largest training of pharmacy residents in US

What does the Indi VA offer for PGY1 and PGY-2?

-internal medicine
-oncology
-administration
-ambulatory care
-psychiatry
-pharmacy practice

What is the VA national formulary?

-closed formulary
-searchable
-national P&T committee using evidence-based medicine
-national contracts to leverage cost containment
-pharmacy-managed therapeutic interchanges are common
-risk-sharing agreements
-copays are based on service connection and tiers
-moving away from terms like non formulary to formulary and PA

How are Copays decided for the VA?

-no copays for conditions directly linked to time in military
+diabetes, agent orange
-$5 for tier 1 (preferred generics) based on 30ds
+so cheap OTCs are a dilemma
-$8 for tier 2 (non-preferred generics)
-$11 for tier 3 (brand name/biologics)
-max out of pocket per year is $700

Does the VA act as provider or payer?

-both
-PA requests entered by doc, adjudicated by VA pharmacists and decision made
-used as cost-containment strategy
-significant involvement by pharmacists

What is the mission act?

-expanded and redefined circumstances in which vets can receive medical care outside of VA
-impact for pharmacy
+increased outside prescriptions
+only do urgent and emergent fills now
+workflow more akin to community pharmacy
-service not available at a VA medical facility
-veteran lives in place without full-service VA facility
-grandfather provision related to distance eligibility for VCP
-VA cannot provide care within certain designated access standards
+30min average drive for primary and mental health
+60min for specialty care
+20 days for primary care and mental health
+28 days for specialty care from date of request
-best medical interest of veteran
-service line does not meet certain quality standards

What is the risk sharing agreements?

-strategy to combat rising drug costs for drugs that have minimal benefit over existing therapies
-links payment for drugs to specific health outcomes
-not widely used in US due to administrative burden with data collection
-VA is currently operating 1 risk sharing agreement
+abiraterone for prostate cancer

What are the population health tools the VA uses?

-primary care almanac
+stratifies panel of pts based on various disease state outliers
+ex. diabetics with A1C>9% and recent dx: MI
-patient aligned care team (PACT) compass
+stratifies a panel of pts based on diagnosis
+ex. what percent of my pts have PTSD
-care assessment needs (CAN) score
+estimated probability of admission or death in a specified period of time
-Medication use evaluation trackers
+identifies target pts that meet pre-set criteria for intervention

What is the difference between private sector and VA HC?

-access to care
-medical record
-business model
-pharmacist career opportunities
-credentialing
-salary and benefits
-regulatory oversights

How many Veterans are in the VA System?

22 million Veterans ranging from: World War II, Korea, Vietnam, the Gulf War, Iraq, & Afghanistan War

VBA

Veterans Benefits Administration provides the following benefits to Veterans and their families: Compensation Benefits, Pension Benefits, Fiduciary Services, Educational Opportunities, Vocational Rehabilitation, Home Ownership Promotion, & Life Insurance Benefits

NCA

The National Cemetery Administration provides burial and memorial benefits to Veterans and their eligible family members.

VHA Budget

VHA has a budget of $ 60 billion. (Discussed anually)

How many veterans does the VHA serve?

VHA Serves 6.6 million unique veteran (5.8 million of whom are veterans)

Describe innovative discoveries rooted in the VA system?

(1) VHA is the largest single provider of heath care professional training in the country rotating more than 120,000 trainees each year

(2) 3 noble prizes, pioneering the first liver transplant, inventing the implantable cardiac pacemaker, developing the nicotine patch, the use of aspirin in heart attack death reduction, shingles vaccine effectiveness, VISTA, mail out pharmacy service.

List the programs in the VHA?

VHA Programs: Extended care service programs, sexual trauma counseling, grants and per diems for homeless Veterans, caregiver support, medical emergency preparedness center, geriatric research and clinical centers, education, centers of excellence for Parkinson's Disease, epilepsy and multiple sclerosis, centers for mental illness research, medical emergency preparedness.

What is the VHA'S mission statement?

1) to develop, maintain, and operate a national health care delivery system for eligible Veterans; 2) to administer a program of education and training for health care personnel; 3) to conduct health care research; and 4) provide contingency support for DoD and HHS during times of war or national emergency.

How many medical centers, community living centers, and regional offices does the VHA govern?

There are 160 medical centers
136 VA Community Living Centers
6 Independent Output Clinics
105 Domiciliary Residential Rehabilitation
56 Regional Office
227 National and State Cemeteries
830 Community Based Outpatient Centers
92,000,000 outpatient visits
707,000 inpatient admissions
271 million prescriptions filled each year
290,000 employees: 24,000 physicians, over 760,000 volunteers, and 63,000 nurses

What are the VA's 2014-2020 strategic goals?

Empower Veterans to improve their well-being
Enhance and develop trusted partnerships
Manage and improve VA operations to deliver seamless care & integrated support

Compensation Benefits:

The VBA compensation program provides
monthly payments and ancillary benefits to Veterans, in recognition of the average potential loss of earning capacity caused by a disability incurred in or aggravated during active military service. This program also provides monthly payments, as specified by law, to surviving spouses, dependent children, and dependent parents in recognition of the economic loss
caused by the Veteran's death during active military service or,subsequent to discharge from military service, as a result of a service connected
disability.

Pension Benefits:

The VBA Pension program provides needs-based monthly benefits payments, to eligible Veterans with nonservice connected disabilities, who served in a time of war. This program also provides monthly payments, as specified by law, to income-eligible surviving spouses and dependent children of deceased wartime Veterans who die as a result of a disability unrelated to military service.

Fiduciary Services:

The VBA Fiduciary services program provides
services to Veterans and beneficiaries who, because of injury, disease,infirmities or age, or because they are minor children, are unable to manage their financial affairs. This program appoints fiduciaries, generally
family members or caregivers, to manage the beneficiaries' VA benefits.

Educational Opportunities:

The VBA education programs provide eligible Veterans, Servicemembers, Reservists, surviving spouses, and dependent children the opportunity to achieve their educational or
vocational goals.

Vocational Rehabilitation and Employment Services:

The VBAVocational Rehabilitation and Employment (VR&E) program assists
Veterans with service-connected disabilities and employment handicap
impairment in substantial part from a service-connected disability) prepare
for, find, and maintain suitable employment.

Under the VACAA, what are the 12 areas of assessment?

Under the VACAA the VA is required to contract private sector entities (Grant Thornton, RAND, McKinsey, MITRE Corporation, CMS Alliance to Modernize Healthcare) to conduct an independent assessment of the care, services, and other healthcare furnished in medical facilities: (12 areas: demographics, health care capabilities, care authorities, access standards, workflow scheduling, workflow clinical, staffing/productivity, HIT, business processes, supplies, facilities, and leadership)

GI Bill:

refers to any Department of Veterans Affairs education benefit earned by members of Active Duty, Selected Reserve and National Guard Armed Forces and their families. The benefit is designed to help service members and eligible veterans cover the costs associated with getting an education or training.

Home Ownership Promotion

The VBA Loan Guaranty Program helps
eligible Veterans, active duty personnel, surviving spouses, and members
of the Reserve components and the National Guard by providing access
to favorable loan terms.

Life Insurance Benefits

The VBA Insurance Program provides all
Service members and their families with universally available life
insurance, which is automatically issued without underwriting.

VACAA

Veteran's Access, Choice,& Accountability Act: Bringing care closer to home

MyVA

1) Improving the Veteran experience

2) Improving the employee experience so they can better serve Veterans

3) Improving internal support services

4) Establishing a culture of continuous improvement, and

5) Enhancing strategic partnerships.

First established to provideCare for Civil War veterans who are disabled or indigent,System through to become one of the worlds largest health care delivery systems

Veterans health administration

Is the country's largest healthcare system and a significant component of Americas medical education system

Veterans health administration

38% of the total proposed VA budget, or 69.3 billion, Is dedicated to

Veterans health services

Because the VHA system has a long term relationship with its patients has access to

Each patient's complete medical record, and advantage over private medicine that, in theory, reduces both medical cost and errors

The department of defense military health system operates one of the largest healthcare organizations in the nation and provides both direct health care services and support for

US active-duty personnel, military retirees, survivors, and their dependents

Is a health insurance program available to those covered under the military health system and offers both managed care in fee for service options

TRICARE

Brings together healthcare resources of the uniform services and supplements them with networks of civilian healthcare professionals institutions pharmacies and other suppliers to provide access to high-quality healthcare services

TRICARE

Public Health

organized community effort to address the public interest in health applying scientific and technical knowledge to prevent disease and promote health.

What does public health address?

Individual, Community, Public Policy

Population Health

evidence based approach to analyze the determinants of health and disease as well as options for intervention and prevention to preserve and improve health

Assessment

obtaining data to define the health of populations and the nature of health problems

Assurance

includes the oversight responsibility for ensuring that essential components of an effective health system are in place

Policy Development

developing evidence based recommendations and analysis to guide public policy as it pertains to health

Essential Public Health Services

-monitor health status to identify community health problems

-diagnose and investigate health problems and hazards in the community

-inform, educate, and empower people about health issues

-mobilize community partnerships to identify and solve health problems

-develop policies and plans that support health efforts; enforce laws and regulations that protect health and ensure safety

-link people to needed personal health services & ensure provision of health care

-ensure competent workforce

-evaluate effectiveness, accessibility, and quality of personal and population-based health services

-research new insights and innovative solutions to health problems

Systems thinking

more comprehensive way of anticipating synergies and mitigating negative emergent behaviors with direct relevance to creating more system ready polices; incorporates advances in organizational behavior; emphasizes how everything fits into a larger social, cultural, economic and political system

Management

an interdisciplinary, rigorous, and valid endeavor that is integral to all human enterprise, including public health; necessary and sufficient condition to ensure the goals of public health programs are met

Seven Aspects to Administrative Role

Planning, Organizing, Staffing, Directing, Coordinating, Reporting and Budgeting

What is the Public Health Landscape shaped by?

Shaped by the confluence of public priorities, values, available health resources, financing mechanisms, politics, interests groups and environmental conditions

How do federal agencies receive their regulatory power?

through congressional legislation or presidential executive order

Categorical grant 1

targeted at specific public health services and population groups and allows feds more control over how funds are spent

Block Granting 1

allocate financial resources to broad domains of activities largely determined by the grant recipients

Categorical Grants 2

encourage PH organizations to operate in accordance with federal funding streams rather than in accordance with needs and priorities in population served

Block Grants

viewed as a strategy for preventing poorly targeted resource allocation but they remain an important part of federal health financing and include health and health services block grant

National Institutes of Health (NIH)

research leading to development of new clinical knowledge

AHRQ (Agency for Healthcare Research and Quality) & CDC

produces information about effective strategies for encouraging physicians to deliver clinical preventative services and for encouraging health care consumers to comply with screening recommendations

EPA (Environmental Protection Agency)

Maintains an array of industry partnerships to encourage voluntary compliance with strategies to reduce harmful pollution

Centers for Disease Control and Prevention (CDC)

Prevent and control specific disease, injury and disability risks on a national level through epidemiology surveillance and investigate research and program development and dissemination activities

Coordinating offices of the CDC

-Office of Surveillance, Epidemiology and Laboratory Services
-Office of Non-communicable diseases, Injury and Environmental Health
-Office of Infectious Diseases

HRSA (Health Resources and Services Administration)

Designed to expand public access to healthcare professionals and facilities, particularly undeserved areas

Bureau of Primary Health Care

Provide comprehensive primary care in medically undeserved areas including LHD and FQHC

NIH

Funds and Administers health research and demonstration initiatives ; academic health centers and medical schools depend heavily on NIH funding for most of their medical research

AHRQ (Agency for Healthcare Research and Quality)

Research focuses on:
-organization, delivery and financing of health services - including prevention with focus on medical care services
-Health care quality
-Access to care
-Clinical practice guidelines

FDA

largest consumer protection agency ensuring the safety of food, cosmetics, medicine, medical devices and radiation-emitting products

IHS

provides health services to federally recognized American Indian and Alaska Native tribes

SAMSHA

administers programs for the prevention, treatment and rehabilitation of substance abuse and mental illness

CMS

administers medical care financing programs that include the medicare program for the disabled and elderly individuals; Medicaid and SCHIP programs for low income families and children

Administration on Aging

offers programs to address the elderly health information and education needs, nutrition, social support, long term care needs, safety, injury prevention and violence prevention needs

OIG (Office of Inspector General)

investigates potential fraud and abuse cases

Office of Civil Rights

ensures equal access to programs and services for eligible population groups; also ensures health facilities funded by Hill Burton Act provides adequate access to free and reduced fee health services for uninsured and underinsured

Office of Management and Budget

presidents lead agency for overseeing programs and activities of the executive branch and for evaluating the effectiveness of agency programs, policies, and administrative procedures

Institute of Medicine

lies within the National Academy of Sciences;
Produced many influential studies of public health topics including infectious disease, vaccine safety, bio-terrorism and public health performance measurement

military and veteran's benefits

veterans health benefits have been in this country for a very long time and it is offered because of the the government's sense of responsibility to care for those who have served in the military

How does the eligibility for VA services work?

they are determined by priority groups
need: minimum of 2 years of service and an honerable discharge from the military
based on the level of needs and how much it will cost the VA to treat the vet

how much does it cost for VA services?

depends on the type of health care services and your priority group

Do vets pay for copayments?

veterans with service related injury or disability do not pay these costs

TRICARE

Department of defense health benefits for active military, eligible dependents, national guard and reserves members, and retired military members, and their families
are not part of the ACA rules
use the military health system and a network or civilian health care professionals, facilities, pharmacies and suppliers to provider services but the civilian providers need to be TRICARE certified

can you be eligible for both VA and TRICARE benefits?

yes!

active military get what type of TRICARE and how much do they pay?

-TRICARE Prime
-in-network care is provided at no cost
- annual out of pocket expenses- $1000

TRICARE prime

closed network HMP model with primary case management

can retired military enroll in TRICARE prime?

yes, they need to pay for an annual enrollment fee and pay other out-of-pocket costs

non-active duty memebers receive what kind of TRICARE and how much do they pay?

-TRICARE Select
-must use certain providers and pay deductibles and copayments
-annual amount of out-of-pocket expenses $3000

TRICARE Select

PPO model with contracted providers in the community

TRICARE for life

supplemental medicare plan for TRICARE beneficiaries to provide wrap around coverage

Indian health services are part of the ______

public health services

Indian health services

agency of federal government to provide health care to American Indians and Alaska Natives
-must be recognized as member of a federally-recognized tribe to receive health services
-comprehensive health services delivery system to improve the health status to the highest possible level
-is not an insurance program, it is a health delivery program

Indian Self-Determination and Education Assistance Act 1975

establish tribal self-determination

Tribal Self-Determination

Native American tribes to have greater autonomy and to have the opportunity to assume the responsibility for programs and services administered to them, including health care

global budgeting

payment mechanism for health care where a provider is given a lump sum of money to care for a population for a period of time- usually one year
- each year Congress determines how much money will be given to IHS to provide health care services

what services are provided with IHS?

inpatient
ambulatory
emergency
dental
public health nursing
preventive health care
-focuses on primary and preventative care like preventive screenings
- may be referred to private providers for care when the IHS facilities cannot provides the care, this is purchased referred care