Hospice-Veteran Partnership Program

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Hospice-Veteran Partnership Program
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Content

• Overview of the Hospice-Veteran Partnership
  Program
• Making the case to form an HVP
• Strategies for HVP success
• Tips for Getting Started and Succeeding
• Examples
• Resources

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Message from Tom EdesDepartment of Veterans
Affairs

• We in the VA depend on you, community hospice
  agencies to deliver home care for our terminally
  ill patients. The VA does not intend to
  replicate the excellent system that is already in
  place for home hospice care and we in the VA must
  learn to collaborate with and learn from you.

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National Collaboration

• VA Hospice and Palliative Care Program Office
• Dr. Scott Shreve, National Director
• HPC program office staff
• VISN Program Managers and Clinical Champions
• NHPCO We Honor Veterans campaign
• Emil Zuberbueler, Director, National Veterans
  Program
• WHV program staff
• Veterans Advisory Council
• Council of States

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Hospice-Veteran Partnerships

• Home State hospice organization, coalition, VA
  VISN or facility
• Leadership Co-chairs, generally representatives
  from community hospice and VA
• Structure State-wide organization and
  coordination with local or regional HVPs around
  the catchment areas of VA faciities

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HVP Partners

• State Hospice Organizations
• End-of-Life Coalitions
• Community hospice agencies
• VISNs and VA facilities
• VA Medical Centers
• Community Based Outpatient Clinics (CBOCs)
• Vet Centers
• State Veterans Homes
• Veterans Service Organizations (VSOs)
• Community Veteran Organizations

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Veterans Health Administration21 Veterans
Integrated Service Networks
www2.va.gov/directory/guide/division_flsh.asp?dnum
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Why Are HVPs Important?

• More than 1,800 veterans are dying every day
• . . .but not much is known about end-of-life
  issues for this special population
• The vast majority of veterans do not receive
  their health care from VA
• . . .but community healthcare providers and
  organizations often dont know who they are or
  how to reach out to them
• Significant barriers exist
• . . .but they can be overcome through
  communication and collaboration

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Volume of Veteran Deaths

• Number of veteran deaths reached an all-time high
  in 2006 (664,842 projected Veterans deaths)
• At least 600,000 deaths a year through 2016
• Less than 4 Veteran deaths (about 21,000/yr)
  will occur in VA facilities
• HVPs are solving care coordination problems at
  the local, state and national levels

www.va.gov/vetdata/Veteran_Population.asp
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Projected Veteran Deaths (2011)n 648,354
lt20 20-24 25-29 30-34 35-39 40-44 45-49 50-54
17 383 715 806 1,052 2,026 4,063 7,764

55-59 60-64 65-69 70-74 75-79 80-84 85-89 90
15,301 44,617 51,942 65,066 104,299 134,788 132,764 82,760
www.va.gov/vetdata/Veteran_Population.asp
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Total Projected Veteran Deaths by State (2011)
Top 10 States represent 50 of Veteran
deaths Highest 58,250 (CA) Lowest 1,060
(DC)
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Top 10 States with highest number of Veteran
Deaths
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How Can HVPs Help VA?

• Honors veterans preferences
• Expands the interdisciplinary team
• Increases VA staff knowledge of the Medicare
  Hospice Benefit
• Frees up inpatient beds for incoming veterans
• Shares the job of caring for Veterans with the
  community

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How Can HVPs Help Community Hospices?

• Clinical Care
• Honors veterans preferences
• Improves communication and continuity
• Expands understanding of veterans unique
  end-of-life issues
• Administrative
• Increases referrals
• Improves payment for services
• Clarifies interface between VA and community
  hospice policies and procedures

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How Can HVPs Help Veterans?

• Honors Veterans preferences
• Standardizes VA response to community hospices
• Informs community response to Veterans unique
  end-of-life issues
• Contributes to continuity and quality of care
• Eliminates charity care for Veterans

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Getting Startedwith the HVP Toolkit

• Begin with a Planning Committee
• Identify potential partners
• Form a Leadership Committee
• Conduct Needs Assessment
• Develop strategic objectives and measure outcomes
• Plan educational, program development and
  outreach activities
• Work together to build solutions
• (www.wehonorveterans.org)

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Potential HVP Projects

• Community Outreach
• Legal and Regulatory Issues
• Education and training for providers
• Research and Evaluation
• Member Recruitment
• Fundraising

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Strategies for Success

• Strong support from VA leaders
• Identify champion from each facility in state
• Invite staff from CBOCs, State Veterans Homes,
  and VetCenters to participate
• Secure support from VISN leadership
• Include HVP in strategic planning efforts
• Coordinate HVP activities within your VISN and
  with adjacent VISNs

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Strategies for Success

• Equally strong support from the state hospice
  organization or coalition
• Identify Community hospice champion
• Invite all community hospices in state to
  participate
• Secure board of directors support and appoint HVP
  community leader(s)
• Establish an HVP standing committee or workgroup

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Strategies for Success

• Acknowledge and respect all interest positions
  and cultural differences
• WIIFM factor
• Language of organization
• Rules, regulations and SOP
• Perceptions

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Understanding Differences
VA Hospice
Culture Quasi-military Community healthcare provider
Role Provider and Payer Provider
Funding Fixed appropriation and budget Entitlement - Medicare/ Medicaid hospice benefit 3rd party reimbursement
Accountability Congress Governing Body, CMS, Fiscal Intermediaries and State
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HVP Outcome Measures 1st Tier

• Are we improving veterans access to hospice and
  palliative care?
• veterans being served by community hospices
• HVP has the name and contact information of VA
  HPC liaison(s) at each facility in the state and
  makes this information available to all hospices
  in the state
• educational sessions among providers of care
  for veterans in all settings

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HVP Outcome Measures 2nd Tier

• Are we meeting veterans needs?
• education sessions/events for veterans and
  their families
• Post death family satisfaction survey data
  collected and shared among providers
• referrals from community hospice to VA for
  assistance with care, benefits or services
• and of community hospices that have written
  agreements with VA facilities and State Veterans
  Homes

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HVP Outcome Measures 3rd Tier

• Are HVPs paying attention to the strength and
  sustainability of their infrastructure?
• Composition of HVP membership
• HVP projects ongoing and completed
• HVP meetings

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HVP National Program - Local Solutions

• State lines and VISN boundaries are complex
• Solution form regional HVPs around each VA
  Medical Center in the state
• Region includes the VAMCs service area
• Coordinate activities with your State HVP to
  ensure that everyone has the same information
• Many benefits!

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Regional HVPs

• HVP survey can identify perceptions and
  misunderstandings
• Roundtable sessions drill down and identify
  barriers and opportunities
• Solutions and best practices can be shared and
  hard wired into performance
• Relationships strengthened through routine
  meetings and collaboration on specific tasks and
  objectives

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How to Start a Regional HVP

• Establish a Regional or Local HVP leaders
• Hold regular meetings
• Report back to the State HVP and VISN palliative
  care leaders

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Regional HVP Start-up Activities

• Schedule initial Round Table or Open House
• Invite local VA facilities, community hospices,
  State Veteran Homes and others
• Develop agenda collaboratively
• Plan logistics carefully
• Pay attention to local issues that affect the
  interface of VA with community providers in the
  region
• Understand the different perspectives of
  individual member groups

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Regional HVP Agenda

• VA Continuum of Health Care Services
• Eligibility Burial Benefits
• VA Palliative and End-of-Life Care Inpatient and
  Outpatient Services
• VA Bereavement Program
• Coordination of Care
• MD orders for start of care
• Medications and DME
• Home Hospice Agency follow up
• VA Purchased Home Hospice Care
• Agencies Description Services
• Open Discussion

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Next Steps for Regional HVPs

• Establish ongoing relationship
• Create an e-mail group and send regular updates
• Partner for training and education activities
• Identify ways to increase hospice referrals
• Improve coordination of clinical care

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Resources for HVPs

• We Honor Veterans website
• Military History Check List
• Military History Pocket Card
• Peace at Last Stories of Hope and healing for
  Veterans and Their Families (Deborah Grassman,
  2009)
• State Hospice Organization websites

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VA Pocket Card Homepagewww.va.gov/oaa/pocketcard/
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