Office of Rural Health

1. Office of Rural Health Advisory Committee on Women Veterans October 26, 2010 Washington, DC Mary Beth Skupien, Ph.D., MS, RN Director, Office of Rural Health Office of the Assistant Deputy Under Secretary for Health for Policy and Planning Veterans Health Administration

2. VA Mission & Vision • VA Mission: To fulfill President Lincoln's promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans. • VA Vision: To provide Veterans the world-class benefits and services they have earned - and to do so by adhering to the highest standards of compassion, commitment, excellence, professionalism, integrity, accountability, and stewardship.

3. VHA Mission & Vision • VHA Mission: Honor America’s Veterans by providing exceptional health care that improves their health and well-being. • VHA Vision: VHA will continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that are both patient-centered and evidence-based. This care will be delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement. It will emphasize prevention and population health and contribute to the nation’s well-being through education, research, and service in National emergencies.

4. ORH Establishment 4 In 2006, Congress created Office of Rural Health (ORH) by enacting Public Law 109-461 (also known as the Veterans Benefits, Health Care, and Information Technology Act of 2006). By October 2007, ORH was established within the Office of the Assistant Deputy Under Secretary for Health (ADUSH) for Policy and Planning, Veterans Health Administration (VHA), Department of Veterans Affairs (VA).

5. Legislative Requirements Authority & Responsibility ADUSH Policy & Planning • Establishment of the Office of the Rural Health as mandated by Public Law 109-461: • The Office of Rural Health shall perform functions to include: • In cooperation with the medical, rehabilitation, health services, and cooperative studies research programs in the Office of Policy and the Office of Research and Development of the Veterans Health Administration, to assist the Under Secretary for Health in conducting, coordinating, promoting, and disseminating research into issues affecting veterans living in rural areas. • To work with all personnel and offices of the Department of Veterans Affairs (VA) to develop, refine, and promulgate policies, best practices, lessons learned, and innovative and successful programs to improve care and services for veterans who reside in rural areas of the United States. February 2007 Immediate Action on PL requirements & staff recruitment Public Law 109 - 461 October 2007 Office of Rural Health

6. ORH Mission & Major Goals • ORH Mission: Improve access and quality of care for enrolled rural and highly rural Veterans by developing evidence-based policies and innovative practices to support the unique needs of enrolled Veterans residing in geographically remote areas. • ORH Major Goals: • Improve access and quality of care for rural and highly rural Veterans. • Optimize the use of available and emerging technologies to enhance services to Veterans residing in rural and highly rural areas. • Maximize the utilization of existing and emerging studies and analyses to impact care delivered to rural and highly rural Veterans. • Improve availability of education and training for VA and non-VA service providers to rural and highly rural Veterans. • Enhance existing and implement new strategies to improve collaboration to increase service options for rural and highly rural Veterans. • Develop innovative methods to identify, recruit and retain medical professionals and requisite expertise in rural and highly rural communities.

7. ORH Organizational Structure ORH Director (SES) Mary Beth Skupien, Ph.D., MS, RN Veterans’ Rural Health Advisory Committee Chairman James Ahrens ORH Deputy Director Sheila Warren, MPH, RN Clinical Liaison Lynn McQueen, DrPH, RN ORH Working Groups Program Analyst Anthony Achampong, MBA, MHSA Program Analyst Christina White Program Analyst Serena Chu, Ph.D. Program Analyst Nancy Maher, Ph.D. Budget Analyst Sharon Howell, MBA (Acting) Staff Assistant Alta Jones Veterans Rural Health Resource Centers VISN Rural Consultants Full-Time 8 Funded Part-Time / Collateral Duties 13 Positions VRHRC-Western Director Byron Bair, M.D. VRHRC-Central Director Peter Kaboli, M.D. VRHRC-Eastern Acting Director Paul Hoffman, M.D. • 1. Gail Goza-MacMullan (V1) • 2. Christopher Petteys (V2) • 3. Bertha Fertil (V3) • 4. Anthony Behm (V4) • 5. Alvis Hargrove (V5) • 6. Talbot Vivian (V6) • 7. Allison Hawley (V7) • Pat Ryan (V8) • Joe Kohut (V10) • Joseph Zimmerman (V12) • Shenita Washington (V17) • Greg Kischuk (V18) • Laurie Traylor (V22) 1. Jackie Morales (V9) 2. John Paglione (V11) 3. Paula Fleming (V15) 4. Deanna Jackson-Moore (V16) 5. Ron Schmidt (V19) 6. Jodie Waters (V20) 7. Colette Alvarez (V21) 8. Katie Dziak (V23) Contractor Support 7

8. Office of Rural Health Resources • Veterans Rural Health Resource Centers (VRHRCs) • Three regional centers: White River Junction, VT; Iowa City; IA; Salt Lake City, UT. • Function as field-based clinical laboratories for demonstration projects/pilot projects. • Serve as rural health experts. • Act as educational and clinical repositories. • Provide programmatic support to ORH. • VISN Rural Consultants (VRCs) • Serve as primary interface between ORH and VISN rural activities. • Develop rural health service plans based on VISN-wide needs assessments. • Facilitate information sharing across the VISNs. • Perform outreach to develop community relationships. • Veterans’ Rural Health Advisory Committee (VRHAC) • Federal advisory committee to advise the Secretary of Veterans Affairs on health care issues affecting enrolled Veterans residing in rural areas. • Evaluate current program activities and identify barriers to providing rural health care services. • May adopt recommendations to enhance or improve VA rural health care services.

9. ORH Funding • Fiscal Year 2009 Funding as of August 31, 2010

10. ORH Funding • Fiscal Year 2010 Funding as of August 31, 2010

11. ORH Funding • Fiscal Year 2011-$250 Million-Operating Plan (Draft) As of September 17, 2010

12. 2010 Report of the Advisory Committee on Women Veterans • Recommendation 9: That VA ensures rural health mobile vans and clinics have standardized protocols for providing care to rural women Veterans that ensure access and availability of health care screenings, and treatment; are appropriately equipped and staffed with specially trained personnel to adequately address the gender-specific health care needs of women Veterans; and have standardized protocols to address issues that require follow-up or referral.

13. Rural Mobile Clinics • Funding 4 pilot project mobile clinics since 2008: Togus, Maine; Cheyenne, Wyoming; Puget Sound, Washington; Clarksburg, West Virginia • Togus, Maine – Full-time Nurse Practioner trained to provide comprehensive primary care according to VHA standardized protocols for Women Veterans. Services include breast & cervical cancer screening, gynecological care and maternity care. Licensed social worker available to provide mental health screening. • An executive summary with recommendations is in the process of being completed that will guide the planning and implementation of future mobile clinics.

14. Other Mobile Programs • Healthcare Empowerment Respect VA (HERVA) • G.V. Montgomery Medical Center (Jackson, Mississippi) - Mobile medical unit to provide primary care screening and outreach to Women Veterans. Will be staffed with nurses. • Mobile Medical Unit (MMU) • South Texas Veterans Health Care System (Kerrville Division) - Provide screening and education services for the detection of breast cancer.

15. Other Rural Women Initiatives • FY 2009-2010 • VISN 5 – Women Veterans Health Program – Conducted women-specific needs assessment. Hired 3 nurse practitioners to provide clinical, training, education, and outreach services to rural women Veterans. Evaluate new and expanded programs. • VISN 6 – Rural Women Veterans Health Care Program – Conducted women-specific needs assessment. Trained physicians and nurses to provide services to rural women Veterans. Purchased specialized OB/GYN equipment for CBOCs. • VISN 10 – Women’s Diagnostic Coordinator - Nurse coordinates Mammography and Pap tests for all Veterans utilizing the Chillicothe VAMC and its 5 CBOCs. Order, track, and follow-up with the community providers. • VISN 16 – Women’s Health Pilot – Use biofeedback to regulate pain and anxiety.

16. Other Rural Women Veteran Activities • Focus on Education activities: • Collaborate with The Women Veterans Health Strategic Health Care Group to provide Rural Women’s Health programs (e.g., presentation at Women Veteran Program Manager Conference). • Participate in regular conference calls with the Rural Women Veterans Steering Committee. • Partner with VA Health Services Research and Development to develop initiatives. Share data in order to develop policy recommendations.

17. Priorities of the Office of Rural Health • Web-based reporting system developed with all projects listed with access for all ORH staff • Monitoring and Tracking all ORH projects quarterly • Communications Plan developed for ORH • Strategic Plan Update in FY ‘11 with involvement of Stakeholders • Increase collaboration & communication with existing and new partners • Monitor and track the activities of the VA/IHS MOU Subgroups • Regular site visits to the field

18. Priorities of the Office of Rural Health • Complete a Comprehensive Needs Assessment of Veteran’s with VRCs & VRHRCs participation • Realignment of VRHRCs under ORH (Direct Supervision) • Collaboration and Education Symposia planned and managed by ORH staff (focus Women Veteran and Homeless Veterans) • Advocating for 3 new positions in ORH to meet infrastructure needs

19. Office of Rural Health Culture • ORH will be a "Veteran-Centered" Program with mission-driven staff“ -- It is all about the Veteran" • Open communication will be paramount • Teamwork and collaboration will occur at all levels and with many partners • Continuous improvement will be the norm with accountability and evaluation of programs/projects • Innovation will be encouraged and rewarded • Increased use of technology for all processes and activities • Decisions for change will be driven by data and evidence based practices • Celebrate successes for advocating and providing improved access to high quality care for rural Veterans

20. Questions? Thank you for your commitment to rural Women Veterans! 20

21. Contact Information For further information please contact: Mary Beth Skupien, Ph.D. MS. RN Director, Office of Rural Health MaryBeth.Skupien@va.gov (202) 461-7083 Sheila Warren, RN, MPH, CPHQ Deputy Director, Office of Rural Health Sheila.Warren@va.gov (202) 461-7105 Department of Veterans Affairs Veterans Health Administration 810 Vermont Avenue, NW Washington, DC 20420 21