Seamless Transition of Returning Service Members Veterans Health Administration Michael J Kussman MD MS MACP Marianne Mathewson Chapman PhD ARNP

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Seamless Transition of Returning Service Members Veterans Health Administration Michael J Kussman MD MS MACP Marianne Mathewson Chapman PhD ARNP Powered By Docstoc
					    Seamless Transition of Returning
           Service Members

               Veterans Health Administration
        Michael J. Kussman, MD, MS, MACP
      Marianne Mathewson-Chapman PhD, ARNP

Nona Hall, BSN, MA, DoD/VA Program Coordination Office
 Lourie Moore, Maj, USAF, NC, TMA Case Management
                            VA Task Force

•   On August 28th, 2003, the Under Secretaries for
    Health & Benefits charged a VA Taskforce on the
    “Seamless Transition for Returning Service Members” to:
      •   Improve collaboration between VHA/VBA and DoD
      •   Improve communication and coordination
      •   Ensure VA staff is educated and appropriate policies and
          procedures are in place to enhance seamless transition of health
          care and disability services
•   Early efforts limited to VA & Army (specifically, Walter
    Reed AMC) in order to align VA, VHA & VBA interests
    and lay the foundation for follow on VA/DoD level
                            VA Task Force
                        Membership & Participation
           •   Co-chairs: Michael Kussman - VHA
                          Carolyn Hunt - VBA
• VA Subgroup chairs:
       VA/DoD Coordination: J. Wear (VBA)
       Program Office: S. McCready (VHA)
       Case Management, Workload: S. Perez (VBA)
       Communication/Outreach: B. Moseley Brown (VBA)
       Outreach Discharge Guard/Reserve: A. Batres (VHA)
                            M. Mathewson-Chapman (VHA)
       COL William Huleatt: Chief, Dept of Social Work
       LTC Joe Truelove: Chief, Care Continuum Management Service
       Jill Roark: Amputee Social Worker

•   Ensure coordinated and world class healthcare
    and disability services to those returning from
    combat theaters with service-related conditions.

•   Ensure “Seamless Transition” from DOD system
    to VA system.

•   Collaborate for transfer of medical information
    and separation physicals
     Seamless Transition Process
                          •   Medical

                          •   Medical records

                          •   Coordination of
 Injury                                         • VA specialty
               Medical                            centers
Deployment    Treatment       Lists of those    • Local VHA
or Training                   Disability        • VBA
Accident       Facility       System

                                                •   Follow-up
                                                •   Rehabilitation
                                                •   VA Disability
              VA Task Force
            Short Term Actions
•   Developed a joint management team concept

•   Developed a script for front line staff

•   Coordinated VA liaison contact and referral to
    VA facilities after discharge

•   Enrolled troops into VA system prior to leaving
    Walter Reed/Bethesda

•   Developed a video to highlight coordination issues
    and “best practices” in seamless transition
            VA Task Force
     Short Term VA/Army Actions
•   Placed a full time VA Social Worker and VBA
    representative at Walter Reed Army Medical
    Center and the National Naval Medical Center

•   Identified liaisons at other DoD (Army) sites –
    Brooke, Eisenhower, and Madigan Army Medical

•   Established a POC list at all VHA, VBA, and DoD
    (Army) sites

•   Obtained electronic “lists” of those entering
    disability process
            VA/Army Memorandum of
               Agreement (MOA)
•   Partnered with Disabled Soldier Liaison Team

•   Disability List – Medically Separated
                      Medically Retired

•   Long Term Consequences – cost

•   Coordination of services (healthcare and
    disability process) from DoD (Army) system to
         DoD Seamless Task Force Liaisons

•   November 2003 – DoD began participation with
    the task force
•   Program Office for Case Management at TMA
              POC:   Maj Lourie Moore
•   VA/DoD Program Coordination Office at TMA
              POC:   Nona Hall, GS
•   Guard/Reserve Affairs
              POC:   CAPT Bernard Winkel
•   Deployment Health Support Directorate
              POC:   Dr. Michael Kilpatrick
                 Task Force Subgroups Actions

•   VA/DoD Coordination:
    •   Confirm and relay applicable data needs to promote seamless
•   Joint (VA, VBA, VHA) Program Office:
    •   Establish a permanent, ongoing oversight committee
•   Case Management, Workload, and Website:
    •; consolidated workload reports
•   Communication and Outreach:
    •   Brochures/Posters, “Our Turn to Serve” video; 800 toll-free number
•   Outreach Discharge Services to Guard and Reserve:
    •   Availability of health care at VHA facilities for 2 years
    •   Guard case management for MED HOLDS at 15 sites
                    VA/DoD Task Force
                   Continuing Challenges

•   Stimulating a major cultural change in the
    implementation of “Seamless Transition”
    •   Immediate Focus: Operation Iraqi Freedom/Operation
        Enduring Freedom (OIF/OEF)
•   Enhancing coordination and communication
    •   Market and distribute information to all Services
           •   Brochures available at mobilization stations
           •   Website and links to other websites
           •   In-Flight video (CD ROM) highlighting services available
               from VA and DoD to take home
    •   POCs at each service level
               VA/DoD Task Force
              Continuing Challenges

• Finalize the MOA between the VA and Army
• Take efforts to the VA / DoD level
     •   Promote necessary DoD level requirements, commitments,
         and information exchanges
     •   Identify and/or streamline organizational involvement
     •   Assess and insert appropriate levels of authority and
•   Drawing on Taskforce experience to date,
    confirm specific data requirements and
    intended uses and users
     •   Service members deployed to OEF/OIF
     •   Lists of service members entering disability system who may
         need to transition to the VA
                   VA/DoD Task Force
                  Continuing Challenges
•   Formulate and finalize VA/DoD level MOA / authority

•   Establish HIPAA compliant process for obtaining
    relevant, data sensitive members lists
     •   Obtain and disseminate policy letters intended to guide actions
     •   Optimize central vs local sources to service data needs
     •   Institute secure electronic communications
     •   Establish relevant data management and storage practices

•   Determine what “shape” Taskforce should take to
    sustain valued best practices, optimally beyond
Time Now ...
For the -

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