Hello, we're going to talk about the VA health care system and Veterans Health Administration's contribution to medical education. We really wanna understand in this segment the relationship between Academic Medical Center and the Veteran's Health Administration. It was Lincoln that had the generous of the idea of a VA. However, you have to understand that the Veteran's Affairs, Department of Veteran's Affairs is one of the newest cabinet level positions reporting to the President. However, it was Lincoln who had this idea that we must care for him who shall have borne the battle for his widow and orphans. It was Lincoln after the Civil War who said, we as a country must care for the veterans who have served for us, and who have instilled this sense of respect and have fought for our freedom. When we think about the Department of Veteran Affairs, it's actually much more than just a health system. It is three different administrative units. One is the Veterans Benefits Administration or the VBA. The second is the Veterans Health Administration, or the VHA, and the third is the National Cemetery Administration. It's important to realize that the entire Department of Veteran Affairs is made up of these three organizations. What really capsulize the relationship between the VA and academic medical centers is the famous Memorandum Two. In 1946, there was a realization that there were veterans coming home who were gonna need long-term health care support after World War II. There were academic medical centers and new medical schools who needed the patient population and the experience of caring for patients, and Memorandum Two was this great idea that we wanted to address the national shortage of physicians and the limited capacity of VA hospitals by joining with the Academic Medical Center to jointly provide patient care, education, and research. And here's a great video that represents what's best about this collaboration in terms of training the future healthcare providers and the skills and the benefits that the academic enterprise brings to veterans. >> This is a story of a remarkable partnership. After World War II, the VA didn't have enough doctors. And American medical schools didn't have enough patients. So they joined forces. VA provides the training, America's best and brightest provide the care, and all of us reap the rewards. [MUSIC] >> This relationship continues today. In 2014, there was a blue ribbon panel on the VA and medical school affiliations that has gone on to recapsulize the importance of this relationship, and to further articulate the need for a closer working relationship, where both partners are here to care for today's veterans and assume the responsibility and accountability for the VAs academic mission, which includes the quality of its academic partnerships. The important thing to realize about the VA healthcare administration is that, in most of its healthcare facilities throughout the country, there's some type of learner. There's medical students, residents, fellows, nurses and various associate health professionals who have received some type of training in the VA healthcare system. The White House established the Joining Forces Initiative, where they were asking U.S. medical schools to train future physicians to foster an appreciation for veteran healthcare needs, to focus on veteran centered care, and understanding the challenges presented to military and veteran families. This video gives you an idea about the importance of focusing on the Joining Forces initiative. >> Today the nation's medical colleges are committing to create a new generation of doctors, medical schools, and research facilities that will make sure that our heroes receive care that is worthy of their service. I want to be very clear today. These mental health challenges are not a sign of weakness. They are not a sign of weakness. PTSD, TBI, depression, and any other combat related mental health issue should never again be a source of shame. Never. And right here at VCU, they're leading a ground breaking project to provide resources and training to health care providers, to volunteers, to community members, throughout the state of Virginia, who can help ease the transition home for veterans with TBI and PTSD. >> Partnerships between medical schools and the Veterans Administration medical centers have been absolutely critical to advancing care for TBI and PTSD. VCU is fortunate to be affiliated with the Hunter Holmes McGuire VA Medical Center. And with our VA colleagues, our research faculty conducts ground breaking investigations into TBI, spinal cord injury, return to work for people with disabilities, pain management, and PTSD. >> Academic medicine combines the very best of education, clinical care and research to focus on this most important segment of the population. And with men and women returning from war with both physical injuries and with the invisible wounds of PTSD and TBI, there is no time like the present to be sure that those who have sacrificed so much get the care that they need now and into the future. [APPLAUSE] [MUSIC] The Joining Forces Initiative is really a call to the US medical schools to transform their training to ensure that they impart an appreciation and approach to veteran healthcare needs and challenges in the future. There are multiple healthcare options for active duty military personnel, and we'll go over some of those so that you understand the difference between those options for active duty personnel, and those options that are available for veterans. Those who were active duty, the Department of Defense, operates a large integrated healthcare system that serves the needs of active duty personnel actually globally, and they have over 65 hospitals and hundreds of medical and dental care facilities worldwide to care for our active duty troops. And then the insurance that is provided as part of that is called Tricare, and it's the government provided insurance plan that provides healthcare to active duty military personnel and their families so that they can receive care in civilian facilities. The important thing to understand is that the VA healthcare system as part of the Department of Veteran Affairs is separate from the Department of Defense system, and the VA healthcare system primarily serves persons who are no longer in service. That being said, occasionally you will see active duty personnel at our VA facilities who are either on leave and need to to interact with the healthcare system, who are visiting, who find themselves in a situation where the VA hospital is available to them, and there's a mechanism for them to receive care within the VA system. Again, we just want to reiterate that only 30% of veterans receive some portion of their health care through the Veteran's Health Administration. That's approximately 9 million people overall. And about 6 million people use the VA as their regular care provider. And the majority of veterans who use civilian health care services use a variety of various different health care insurance, be it public and or private insurance carriers for the other 70% of veterans. If you wanna think about what encompasses the Veterans Health Administration, it is the largest single provider of health care in the country, it's an integrated health care system. It provides training, it's the largest training center in the United States, and it encompasses not only medical centers, but nursing home or community living facilities. CBOCS or Community Based Outpatient Clinics which provides healthcare, primary care and mental health services closer to the veteran and other types of care, which includes veteran center to rehabilitation and various types of home care programs. The thing that those who work in the VA healthcare system are most excited about is the ability to provide high quality care to today's veterans. When you look at the data, overall the VA constantly performs better in quality managers for chronic medical conditions. Provide high level of use of preventative care services across cancer, cardiovascular disease, and diabetes, and patients satisfaction scores are comparable, if not higher, than those in the US hospital industry. It is important to understand how one becomes eligible for VA healthcare, and enrollment is a systematized process that looks at a veteran's eligibility, not only in terms of healthcare status, but income and age. Since the amount of money that is given to the VA healthcare system by Congress is alloted, it is alloted in priority groups with a range from one to eight, with one clearly being those who receive the highest priorities in terms of getting care through the VA healthcare system. There's an online tool in order for veterans to apply in attempt to make this process of enrollment as easy as possible. It's quite easy to navigate this and ask several questions about who is eligible for VA healthcare benefits. The Veteran's Health Administration prioritizes veteran eligibility for health care services through eight priority groups, and those priority groups give a definition of whether a veteran service connected or not. A service connected veteran is one who is disabled due to injury or illness related to military service. That range of service connectedness can be from 0 to 100%, where a 0% rating may have a service connected illness, but it does not interfere with normal function. And a veteran with 100% rating is one who has one or more disabilities that significantly interfere with the ability to have a normal life and function. As you can see over the next two slides, the definition of who is eligible for various priority groups, so Group 1, again, is the top priority and that is where we place veterans with a 50% or greater Service Connected Illness. Where those veterans who are unemployable at the top of our priority list in terms of being eligible for services, and as you can see there's a combination of both military service related issues, Group 3 being a prisoner of war or a Purple Heart recipient, but also importantly issues around income eligibility in Group 4, where a veteran might by housebound or catastrophically disabled such that they really need the care services provided by the VA. And again when you get down to the bottom category, which would be Group 8, those are the ability for the VA to provide services and those veterans are typically are asked to pay the co-pay as related to the services incurred through the VA healthcare system. So as we think about the 30% of veterans who seek care at the Veterans Health Administration, the things that we want to think about for that population is that those veterans tend to be more likely to be impoverished from an economic point of view, they often report lower quality of life measures, they have multiple comorbitities that affect the ability to navigate the health care system. They have limited access to other forms of insurance. It's unclear what they would do often if the VA healthcare system wasn't available to them. And they often have less experience with a formalized doctor patient relationship. In this segment, we hope to have provided you the historical background as to why there is a inherent close relationship between Veterans Healthcare Administration services and academic medical centers. We hope to cover why and who those veterans are, who are prioritized to seek care at the VA hospital. And when we think about the veterans such as Mister Sims, who's a 31 year old Army veteran who served in Iraq ans Afghanistan, we want you to think of the discussion board how, looking at these photographs, might color your initial impression of Mister Sims, both as a veteran, and also who might be seeking care from you for the first time. Really focusing on looking at these photographs and thinking about your time on the discussion board, or when you fill out the quiz materials and the reflection questions on the quiz materials. These are your opportunities to reflect on the material covered in each of the segments and provide you with an opportunity to discuss, have discussions with other in the course.
