Community Care Overview

Kameron Matthews, MD, JD, FAAFPDeputy Under Secretary for Health for Community Care

Community Care Overview

Kameron Matthews, MD, JD, FAAFP

Deputy Under Secretary for Health for Community Care

March 29, 2019

NACHC P&I Forum

Agenda

• Community Care Overview

• Current Roles & Responsibilities

• Community Care Programs

• Community Care Vision

• Community Care Major Initiatives

• Community Care Under VA MISSION Act of 2018

• TriWest Expansion

• Community Care Network

2

VA Office of Community Care – Current Roles

Our Goal for Community Care: Deliver a program that is

easy to understand, simple to administer, and meets the

needs of Veterans and their families, community providers,

and VA staff

Key Functions and Activities:

• Operate Veteran and Family Member Community Care

Programs:

Operate Veterans Choice Program and other community care programs to purchase care outside of VA

Operate claims processing and customer service operations for community care programs

Contract with vendors to maintain a network of community providers

• Bring Revenue to VA

Revenue cycle management - billing of private health

insurance and Veteran copayments

• Manage Fraud, Waste & Abuse

Programs for Veterans

• Veterans Choice Program (VCP)

• Veterans Choice Program Provider Agreements

• Traditional Community Care

• State Home Per Diem Program

• Indian Health Service / Tribal Health Program

(IHS/THP) Reimbursement Agreements Program

• Foreign Medical Program

Family Member Programs

• CHAMPVA

• CHAMPVA In-house Treatment Initiative (CITI)

• Children of Women Vietnam Veterans

• Spina Bifida Health Care Benefits

• Camp Lejeune Family Member

• Caregiver Support Program

3

“Achieving personalized, integrated, and high-quality care for our Veterans”

Vision

• Consolidated Community Care Program

• Support VA’s vision of a single, high performing network

• Seamless extension of VA’s network of facilities

• Authorities provided in the VA MISSION Act of 2018

• Meet the needs of all stakeholders

4

Community Care Major Initiatives

Veterans

Community Providers

Staff

Decision Support Tool

CCN/VCAsPC3 - TriWest

eCAMS/Community Care Reimbursement

System

Enrollment systemHealth Share

Referral Manager

Provider ProfileManagement System

Master database of community providers and facilities

Industry standard claims processing

Established robust community provider network

Helps identify eligible Veterans and schedule care with the Veteran’s preferred provider

Provides information on Veterans enrolled in the VA and whether they meet certain eligibility criteria for community care

Referral and Authorization Management Tool with online services for community partners

• Completed approximately 29.6 million appointments in the community for Veterans in FY 2018, an increase of 56% from FY 2014

• Major transformation initiatives for Community Care underway to keep up with the robust growth

5

Community Care under VA Mission Act

• The MISSION Act of 2018 signed into law by the President on June 6, 2018. The Act includes four main pillars:

• Consolidating VA’s community care programs

• Expanding the Program of Comprehensive Assistance for Family Caregivers to eligible Veterans of all eras

• Strengthening VA’s ability to recruit and retain quality healthcare professionals

• Providing VA the necessary flexibility to align its infrastructure footprint with the needs of our Nation’s Veterans

• Authorizes access to urgent care (walk-in) community clinics for enrolled Veterans

• Creates standards for timely payment to community care providers

• Strengthens the process for VA and partnering health care providers who prescribe opioids to Veterans

• Ensures providers removed or suspended from VA practice do not treat veterans in the community

6

Eligibility Criteria under MISSION Act

The MISSION Act establishes six different eligibility criteria for community care:

• VA does not offer the care or services the Veteran requires

• VA does not operate a full-service medical facility in the State in which the Veteran resides

• Veteran was eligible to receive care under the Veterans Choice Program and is eligible to receive care under certain grandfathering provisions

• VA is not able to furnish care or services to a Veteran in a manner that complies with VA’s designated access standards

• Veteran and the Veteran’s referring clinician determine it is in the best medical interest of the Veteran to receive care or services from an eligible entity or provider based on consideration of certain criteria that VA would establish; or

• Veteran is seeking care or services from a VA medical service line that VA has determined is not providing care that complies with VA’s standards for quality

7

TriWest Expansion

• In early October 2018, the VA reached an agreement with TriWest Health Care Alliance (TriWest) to:

• Extend its current coverage for one year

• Expand its services to all regions across the country, to include former Health Net Regions

• Ensures access to community care where needed until the CCN contracts are fully implemented.

• Community Health Centers can sign up directly with TriWest: https://joinournetwork.triwest.com

From VA Secretary Wilkie:

“TriWest has worked collaboratively

with VA from the start of the Veterans

Choice Program to address

implementation challenges and to

improve the program to better serve

Veterans. Extending the time and

reach of our partnership with TriWest

will ensure Veterans get the care they

need while the department transitions

to delivering care under the MISSION

Act next year.”

8

Community Care Network (CCN)

Benefits of the CCN:

• Gives VA control of Veteran care and experience

• VA is taking back scheduling, care coordination, and customer service functions

• Gives VA convenient access to a network of qualified, credentialed providers

• by having a provider network accredited by a nationally recognized accrediting body

• Gives VA a streamlined community care processes

• by including more services under CCN

• by no longer adjudicating claims

The Community Care Network (CCN) is a new set of region-based contracts to provide health care services in the community through a

contractor who builds and credentials the associated network and processes claims.

Community Health Centers (Region 1) looking to join the CCN

network can contact Optum at:

VACCNProviderContracting@optum.com

Achieved in Partnership

VACO ContractorVAMCRegion/

VISN

9

Questions

10

Health Centers and VeteransNACHC Policy and Issues Forum

March 29, 2019

Jennifer Joseph, PhD, MSEdDirector, Office of Policy and Program Development

Bureau of Primary Health Care (BPHC)

Health Resources and Services Administration (HRSA)

HRSA – VHA Partnership

• Support quality of care at health centers partnering with the VA

• Promote coordination of care between health centers and VHA medical facilities

• Support the use of EHR and data sharing

• Provide technical assistance and training for providers serving veterans

• Support data exchange on HRSA grantees and VHA sites

• Assignment of NHSC participants at VA medical facilities or other sites

• Collaborate on VA MISSION Act

• Explore opportunities to pilot new activities

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Veterans Served at Health Centers, 2008-2017

100

150

200

250

300

350

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Tho

usa

nd

s

2008 2011 2014 2017Growth from 2008-2017

(% Increase)

Veterans 213,841 249,548 289,391 355,648 66.3%

Source: Uniform Data System, 2008-2017

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Health Centers Serving VeteransOther 2017 UDS Highlights

95% of health centers served

veteran patients

54% of veterans receive services from rural health

centers

Public housing grantees served 9%

of all veteran patients served

Healthcare for the Homeless grantees served 26% of all veteran patients

served

The top veteran-serving states are

ME, AK, MT, VT, and ID

Source: Uniform Data System, 2017

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Thank You!

Jennifer Joseph, PhD, MSEd

Director, Office of Policy and Program Development

Bureau of Primary Health Care (BPHC)

Health Resources and Services Administration (HRSA)

jjoseph@hrsa.gov

(301) 594-4300

bphc.hrsa.gov

Sign up for the Primary Health Care Digest

15

Connect with HRSA

To learn more about our agency, visit

www.HRSA.gov

Sign up for the HRSA eNews

FOLLOW US:

16

FEDERAL VETERANS POLICY UPDATE

POLICY AND ISSUES FORUM

3/29/19

Oliver Spurgeon IIIDeputy Director of Federal Affairs

National Association of Community Health Centers

New Year,

New Congress,

Same Issues

June 2018

Veterans Community Care Program

March 2019

• Vets meet 1/6 conditions exist for outside care

• Some CHOICE Program regs. will remain after June 2019 (payment rates, etc.)

• New flexibility for vets w/ no full-service VA/low density states

• Focus on distance from home to care, not VA site

• VA MISSION Act signed

• VA coordinate care/scheduling

• Replace 30-day/40 mile standard*

• June 2019 deadline for VCCP regs. & strat. plans

Already completed:

VCCP proposed rule released on 2/22/19

Congressional Activity

Congressional Oversight Focused on VCCP Rollout:

55 MoCs express concern over access standards on 3/25• “trigger a massive shift of care to private

sector.”• “arbitrary and one-size-fits-all approach...”

We urge the VA to:

• Re-evaluate number/type of access standards• Review estimate of budgetary impact of change

“The Department should remain the primary coordinator of

care for all veterans, instead of setting up a system where

it’s possible a subset of vets will never see a VA doctor.”

What’s Next?

• House hearing on MISSION Act IT

implementation on 4/2

• House hearing on FY20 VA budget

request on 4/3:

• $220.2 billion (+9.6% over FY19)

• $8.9 billion for MISSION Act rollout

• $1.6 billion for EHR modernization

“We need to do more to ensure our veterans get the care they earned and

deserve...this proposed budget puts that care and support at risk.” – Chairman Takano

Questions?

Oliver Spurgeon IIIDeputy Director of Federal Affairs

ospurgeon@nachc.org202-604-9134

www.nachc.org

Promising Practice Spotlight: Identifying Veterans in the FQHC and Linking

them to VA via the Iowa VHA-FQHC Pilot Program

Ted Boesen -Iowa Primary Care Association (PCA)

Dr. M. Bryant Howren - Department of Veterans Affairs Office of Rural Health

Ron Kemp - Community Health Centers of Southeastern Iowa (CHC/SEIA)

NACHC Policy & Issues Forum, March 29, 2019

VHA-FQHC Pilot Program Background

• Partners & Background

• Project goals

• Screen all patients presenting for care at CHC/SEIA for veteran status using a standardized methodology;

• Screen all adult patients to identify behavioral health issues, including depression, anxiety, substance use disorder and Post Traumatic Stress Disorder (PTSD);

• Identify and assist interested, eligible veteran patients with assessing VA care enrollment and services; and

• Ensure veteran patients screening positive for behavioral health issues receive timely behavioral health care at a VA facility or the CHC/SEIA.

Project timeline (to-date)

• 2014-2015: Discussions between Veterans Rural Health Resource Center and the Iowa Primary Care Association

• 2016: Funding secured for project management and a part time RN Care Coordinator, partnerships formalized

• 2016: Screening for veteran status established at CHC/SEIA

• 2016 - 2018: Pilot project underway

• 2018-Present: Expansion of screening for veteran status to additional Iowa FQHCs underway, part time RN Care Coordinator goes full time, new site started with additional RH Care Coordinator

Pilot Program Phase 1:Screening for veteran status at CHC/SEIA

• The screening question was revised and added to the EMR as a required field

• Staff were informed, trained, and rollout occurred at all sites

• Reliable data was then available and the number of identified veteran patients at CHC/SEIA increased dramatically

Have you served in the military or armed forces?

This includes: Air Force, Army, Coast Guard, Marines, Navy, National Guard, or Reserves?

Yes_____ No_____

Pilot Project Phase 2: Implementation of behavioral health screening and establishing referral processes

• Single site implementation for veterans only

• VA Program Care Coordinator

• Establishing new VA behavioral health screening and treatment workflows

• Establishing and starting the referral processes

• Expansion of implementation for veterans only to additional sites

Health Center Marketing Flyers

Upcoming Program Implementation Phases

• Adding a provider on site that can perform VA eligible services

• Eventual expansion of behavioral health screening to all adult patients (single site to all sites)

• Introducing telehealth services to the pilot program

• Expansion to additional FQHCs

• Studying processes and procedures for project duplications efforts, capturing best practices, and internal/external reform recommendations

Overcoming Barriers

• VHA-FQHC Pilot Program toolkit

• Without Compensation (WOC) process

• Project tracking

• Conflicting priorities and time dedication

• Internal marketing

• Start a conversation

Discussion and Thank You

• Speaker Contact Info

• M. Bryant Howren, PhD, Matthew.Howren@va.gov

• Ted Boesen, tboesen@iowapca.org

• Ron Kemp, rkemp@chcseia.com

Serving the Veteran Population in Health Centers

NACHC Training and Technical Assistance Resources

March 2019

Providing Care for Veterans in CHCs Fact Sheet

You Can Access

This Resource on the

Health Center

Resource Clearinghouse:

https://www.healthcenteri

nfo.org/details/?id=1887

Or use the Search

function at

www.healthcenterinfo.org

Fact Sheet –Updated January 2019

www.healthcenterinfo.org

Veterans Choice/Mission Act Toolkit

You Can Access

This Resource on the

Health Center

Resource Clearinghouse:

https://www.healthcenteri

nfo.org/details/?id=1888

Or use the Search

function at

www.healthcenterinfo.org

Veterans Services Toolkit – Updated March 2019

www.healthcenterinfo.org

Other Resources

• Join the NACHC Veterans Interest Group – open to all health center stakeholders as a forum for information exchange and updates via mail group

• Contact NACHC’s lead staff for Veterans Programs - Gina Capra or Dick Bohrer trainings@nachc.org

• Check our website Veterans Page regularly for updates

www.nachc.org Health Center Operations Special and Vulnerable Populations

• See NACHC’s Formal Comment Submission (March 18, 2019) in response to VA’s Proposed Rule on the Community Care Network Program Access Standards