Women Veterans Health Care

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Women Veterans Health Care

• Kenya Graham,
• Women Veterans Outreach Coordinator
• VA Mid-Atlantic Network (VISN 6)
• April 2013

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• Since the Revolutionary War, Americas women have
  earned Americas gratitude and respect for their
  contributions to the military and to the Nation.
  VA will continue to improve our benefits and
  services for women Veterans as we transform into
  a 21st century organization.
• Secretary of Veterans Affairs
• Eric K. Shinseki
• March 10, 2010

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History of Women in the U.S. Military
Source Americas Women Veterans Military
Service History and VA Benefits Utilization
Statistics, Department of Veterans Affairs,
National Center for Veterans Analysis and
Statistics, Nov. 23, 2011 http//www.va.gov/VETDA
TA/docs/SpecialReports/Final_Womens_Report_3_2_12_
v_7.pdf
2/2013
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As Women Veteran Population Increases, Total Vet
Population Declines
Sources VetPOP 2007 and VetPOP 2011 ADUSH for
Policy and Planning
2/2013
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Women VA Users Doubled Since 2000
Sources Womens Health Evaluation Initiative
(WHEI) and the Women Veterans Health Strategic
Health Care Group. Sourcebook Women Veterans in
the Veterans Health Administration V1
Sociodemographic Characteristics and Use of VHA
Care, 2011. VHA Office of Finance Allocation
Resource Center (ARC).
2/2013
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Growth Expected to Double Again Soon

• 12 of Operation Enduring Freedom/Operation
  Iraqi Freedom/Operation New Dawn(OEF/OIF/OND)
  Veterans
• 18 of National Guard/Reserves
• 6 of VA health care users
• Women Veteran enrollment outpacing that of
  men21 increase since 2009

5 years free VA health care for OEF/OIF/OND
Veteranswith service-related issues 57 of
OEF/OIF/OND women Veterans have used VA care
2/2013
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FY12 Market Penetration VISNs 1 - 10
VISN FEMALE USERS FEMALE VETERANS MKT PENETRATION (WOMEN) MKT PENETRATION (MEN)
1 12,157 78,921 15.4 26.1
2 7,351 39,982 18.4 29.7
3 8,215 61,222 13.4 23.2
4 15,053 104,434 14.4 24.8
5 13,020 112,168 11.6 19.8
6 29,014 181,054 16.0 24.7
7 34,318 182,241 18.8 26.4
8 34,228 156,655 21.8 36.3
9 16,261 92,875 17.5 29.2
10 11,570 68,834 16.8 26.6
Sources WATCH Briefing Book, VetPop 2011
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FY12 Market Penetration VISNs 11 23
VISN FEMALE USERS FEMALE VETERANS MKT PENETRATION (WOMEN) MKT PENETRATION (MEN)
11 14,073 89,917 15.7 23.0
12 13,247 80,909 16.4 27.2
15 12,757 82,308 15.5 28.4
16 33,544 181,737 18.5 28.6
17 25,577 129,790 19.7 27.1
18 18,284 96,722 18.9 30.5
19 13,386 75,858 17.6 26.3
20 20,325 119,361 17.0 24.8
21 16,080 97,079 16.6 29.6
22 21,033 126,839 16.6 25.1
23 14,881 81,622 18.2 33.4
TOTAL 361,895 2,240,529 16.2 26.2
Sources WATCH Briefing Book, VetPop 2011
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FY12 Market Penetration VISN 06
Facility Female Users Female Veterans Mkt Penetration
Asheville 1,949 7,449 26.2
Beckley 546 2,387 22.9
Durham 5,217 22,355 23.3
Fayetteville 6,414 31,608 20.3
Hampton 6,599 53,634 12.3
Richmond 4,653 30,289 15.4
Salem 1,953 9,004 21.7
Salisbury 5, 194 24, 329 21.3
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VISN 6 Women Veteran Enrollees
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VISN 6 WOMEN VETERAN USERS
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Retention of Enrolled OEF/OIF/OND Veterans

• 1 year after separating from service, 62 of
  female OEF/OIF/OND Veterans and 56 of male
  Veterans remain in VA care
• 5 years after separating from service, 52 of
  female OEF/OIF/OND Veterans and 47 of male
  Veterans remain in VA care
• Research-funded CREATE Attrition Studyexamines
  factors related to staying in or leaving VA care

Source Leslie, Douglas. Women Veterans Cohort
Study (2012 unpublished data).
2/2013
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Younger Womens Needs

• Maternity Care
• Mental Health
• Service-Connected Disabilities
• Privacy, safety, convenience

2/2013
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Aging Population
58 of women VA users are 45
v Menopausal Needs v Geriatric Care v
Inpatient/Extended Stays
Age distribution of women Veteran patients, FY01
and FY10

• Next 20 years more intensive health care
  services and support as caregivers

Source Womens Health Evaluation Initiative and
VHA Womens Health Services. Sourcebook Women
Veterans in the Veterans Health Administration.
Volume 2. Sociodemographics and Use of VHA and
Non-VA Care Fee. 2012 (in press).
2/2013
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Women Average More Primary Care Visits than Men
Proportion of women and men Veteran outpatients
by total primary care encounters, FY10
Source Womens Health Evaluation Initiative and
VHA Womens Health Services. Sourcebook Women
Veterans in the Veterans Health Administration.
Volume 2. Sociodemographics and Use of VHA and
Non-VA Care Fee. 2012 (in press).
2/2013
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Women Use Mental Health Care More than Men
Proportion of women and men Veteran outpatients
by mental health/SUD encounters, FY10
Source Womens Health Evaluation Initiative and
VHA Womens Health Services. Sourcebook Women
Veterans in the Veterans Health Administration.
Volume 2. Sociodemographics and Use of VHA and
Non-VA Care Fee. 2012 (in press).
2/2013
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More Service-Connected Status among Women than
Men (VHA Patients)
Service-connected disability status among Veteran
patients, by gender, FY10
Source Womens Health Evaluation Initiative and
VHA Womens Health Services. Sourcebook Women
Veterans in the Veterans Health Administration.
Volume 2. Sociodemographics and Use of VHA and
Non-VA Care Fee. 2012 (in press).
2/2013
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Women Veterans and Homelessness

• Women Veterans 8 of homeless Veteran
  population 2X more likely to be homeless than
  non-Veteran women
• FY 2011 VA served 198,908 homeless, at-risk, or
  formerly homeless Veterans (7.7 or 15,303 women)
• VA homeless programs include
• HUD-VASH Program (permanent housing) 13 of
  recipients are women 14 of HUD-VASH vouchers go
  to homeless Veterans with children among women
  housed in HUD-VASH in FY12, 38.4 are housed with
  children
• Grant Per Diem Program (GPD) In 2012, 7 of
  Veteran recipients were women
• Supportive Services for Veterans Families (SSVF)
  Program  First year assisted 21,000 Veteran
  households comprising over 35,000 adults and
  children 15 were women
• Homeless Veterans Support Employment Program
  (HVSEP) Approximately 25 of hires are women
  Veterans
• Veterans Homeless Prevention Demonstration
  Program (VHPD) 3-year pilot to prevent
  homelessness among recently discharged through
  early intervention 22 served were women

2010 Annual Homeless Assessment Report (AHAR)
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• Are We Ready?

2/2013
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VHA Organization
2/2013
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Womens Health Services Organization
Dr. Patty Hayes Chief Consultant
Dr. Sally Haskell Deputy Chief Consultant
(Clinical)
Meri Mallard, Peggy Mikelonis Deputy Field
Directors
Melissa Lanzendorfer Assoc. Chief Consultant
(Operations)
Dr. Maggie Czarnogorski Acting Deputy Director
Womens Comprehensive Health
Dr. Laure Veet Director Womens Health Education
Dr. Laurie Zephyrin Director Reproductive Health
Operations Support TEAM
WVPMs, WHMDs
Womens Health Education TEAM
Comprehensive Health TEAM
Reproductive Health TEAM
2/2013
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VISN 06 Women Veteran Program Managers
Name Facility Email Phone
Shenekia Williams-Johnson VISN 06 Shenekia.williamsjohnson_at_va.gov 919-956-5541
Sharon West Asheville Sharon.west2_at_va.gov 828-298-7911 x5434
Kimberly Nugen Beckley Kimberly.nugen_at_va.gov 304-255-2121, x4842
Joan Galbraith Durham Joan.galbraith_at_va.gov 919-286-0411, x5229
Sandra Smith Fayetteville Sandra.smith1e33ba_at_va.gov 910-488-2120, x7479
Patrice Malena Hampton Patrice.malena_at_va.gov 757-722-9961. x2398
Beverly Ross Richmond Beverly.ross_at_va.gov 804-675-5389
Suzette Hile Salem Suzette.hile_at_va.gov 540-982-2463, x3830
Penny Greer-Link Salisbury Penny.greer-link_at_va.gov 704-638-9000, x4949
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Women Veterans Healthcare

• Women Veteran Program Manager at all Medical
  Centers
• Womens Clinic at every NC Facility
• Women have the option of being seen in the WH
  clinic, but may be seen in other clinics
• Interested and proficient women health providers
  at each site
• WH services offered at most Community Based
  Outpatient Clinics (CBOCs)

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Role of the WVPM

• Required full-time in every health care system
  must report to Facility Director or Chief of
  Staff
• Linchpin for improved women's health services
• Leader of facility women's program
• Resource for women Veterans in the community

2/2013
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Role of the WHMD

• Serves as clinical leader for facility womens
  health program
• Works with WVPM to form the foundation of the WH
  team
• Establishes priority and direction for clinical
  quality improvement
• Oversees WH educational initiatives for providers
  and trainees

2/2013
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Women Veterans Healthcare Services

• Comprehensive Primary Care
• Expanded Tele-health
• Cancer Screenings
• Mental Health
• Depression
• Post Traumatic Stress Disorder
• Military Sexual Trauma
• Heart Disease
• Diabetes
• Nutrition Counseling

• Mammograms
• Pap Smears
• Maternity Care
• Reproductive Health
• Infertility Services (excluding in vitro
  fertilization)
• Tubal Ligation
• Menopause
• New Born Care up to 7 days Postpartum care
• Substance Abuse treatment

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Maternity/OB care

• Seeing more pregnant female veterans
• Must be enrolled for healthcare to receive
  benefits
• Maternity care is not performed at the Medical
  Center
• Veteran can choose local provider and VA will pay
  as long as provider accepts VA insurance
• Women can receive breast pumps through VA

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Mammography (VISN 6)

• On site mammography offered at following VISN 6
  sites Durham, Fayetteville, Hampton, Richmond,
  Salisbury
• Mobile Mammography
• Will provide care to new Health Center Complex
  (HCC) initially and will spread to CBOCs van
  available late summer 2014 implementation TBD

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Telehealth and IT Projects

• FY13 11 Womens Health/Rural Health telehealth
  projects funded after 8 launched in FY12 FY14
  grant applications under way
• Womens health informational mobile applications
  under development
• IT Innovations maternity tracker (care
  coordination) pilots selected
• Many VISNs have not yet implemented WH telehealth

2/2013
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Ideal Women Veterans Experience of VA

• High-quality, equitable care on par with that of
  men
• Care delivered in a safe and healing environment
• Seamless coordination of services
• Recognition as Veterans

2/2013
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• Barriers to Care

2/2013
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Women Dont Identify Themselves as Veterans

• We dont know if its because they had different
  roles, because they felt like they didnt do the
  same thing as some of our male Veterans
  whatever it is, they are still not
  self-identifying.
• General Allison HickeyVA Under Secretary for
  Benefits 9/27/12

2/2013
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Lack of Knowledge of VA Services

• 39 have zero or almost no knowledge of needed
  information about VA
• Misperceptions in all cohorts about who is
  eligible for VA care
• OEF/OIF/OND more knowledgeable than other cohorts
  about available womens health and readjustment
  services

Source 2010 National Survey of Women Veterans,
(D. Washington)
2/2013
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Barriers to using VA health care among Women
Veterans who considered, but did not use, VA

• 31 didnt think they were eligible
• 21 didnt know how to apply for benefits
• 20 said closest VA is too far from home
• Other challenges
• Difficulty getting time off for appointments
• Child/eldercare responsibilities

Not mutually exclusiveSource 2010 National
Survey of Women Veterans, (D. Washington)
2/2013
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Overarching Challenges, Needs

• Major gaps prevent delivery of equitable health
  care to all women Veterans (e.g., privacy, PACT,
  GYN, etc.)
• Needs
• Leadership support essential to enhancing VA
  health care for women Veterans
• High-functioning womens health committees with
  high-level involvement
• Succession planning for WVPMs and challenge of
  institutional knowledge

2/2013
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Childcare Pilots

• Free, drop-in childcare pilots at three VA
  medical centers
• Northport, NY (Opened 4/2012)
• Buffalo, NY (Opened 10/2011)
• Tacoma, WA (Opened 12/2012)
• Open to eligible Veterans during appointments
• Pilots will run until September 30, 2013
  evaluation under way
• No legal authority beyond this pilot

2/2013
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Gender Disparities Progress!

• VA has significantly reduced gender gaps and
  exceeds private sector on most performance
  measures for both men and women
• Gender Differences in Performance Measures, VHA
  2008-2011, identifies best practices for
  eliminating gender gaps based on success in VA
  networks

2/2013
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Quality

• Gender-specific care to women Veterans in VHA
  facilities substantially exceeds that in other
  systems
• Cervical Cancer screening
• Breast Cancer screening

93.5 VA average (2010-11) Vs. 77 private sector (2010) 67 Medicaid (2010)
86 VA average (2010-11) Vs. 71 private sector (2010) 69 Medicare 51 Medicaid (2010)
Source VA Office of Analytics and Business
Intelligence 12-19-2011
2/2013
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Womens Health Education Progress

• Trained 1,500 VA providers in basic and advanced
  womens health care to enhance access
• Expanding large-scale provider/nursing education
  programs
• Developing online training for core topics in
  emergency womens health, with virtual patient
  platform, videos, traditional e-learning
• My VeHU Womens Health Special Focus Topics
  February through April http//myvehu.com/
• Sponsoring grant program to develop/deliver in
  traditional mini-residency format with virtual
  components

2/2013
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WH Resources

• VISN 06 Women Veterans SharePoint site
• https//v6infoshare.v06.med.va.gov/programs/women
  shealth/default.aspx
• Women Veterans Healthcare Site
• http//www.womenshealth.va.gov

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Wrapping Up