Friday, August 04, 2017

VA pilots programs to help rural veterans get care

Rural veterans often have difficulty getting to appointments if the nearest Department of Veterans Affairs medical treatment center is far away, so the VA is piloting programs to help. Rural areas already struggle with medical access for the general population, but the problem is worse for for the 24 percent of veterans who live in rural areas and are more likely to need medical care. "In recent years, the VA has set up more community-based clinics, and the Obama administration created a program, called Choice, that allows non-VA clinicians to serve rural veterans and receive reimbursement from the VA. But the problem persists," Jen Fifield reports for Stateline, the the nonpartisan, nonprofit news service of the Pew Charitable Trusts.

President Trump announced Aug. 3 that the VA is launching a telehealth program that will allow veterans to access medical care from a mobile-phone app. "This will significantly expand access to care for our veterans, especially for those who need help in the area of mental health, which is a bigger and bigger request, and also in suicide prevention," Trump said. "It will make a tremendous difference for the veterans in rural locations in particular."
Map by The Pew Charitable Trusts (click to enlarge)
Congress voted last week to fund the Choice program for another six months while it debates long-term solutions to the problem. But the program "has been plagued with problems from the start, including difficulty for veterans trying to make appointments, and long wait times for reimbursement," Fifield reports. In order to truly improve care for veterans, "the VA needs to expand both the services it provides and the services it pays others to provide," said Margaret Puccinelli, chairwoman of the Veterans Rural Health Advisory Committee, which makes recommendations to VA Secretary David Shulkin.

The task of figuring out new strategies for expanding services falls to the VA's Office of Rural Health, which distributes grants to local programs that show nationwide promise. Such programs include "using home-based rehabilitation for veterans who have heart attacks, and using telehealth for patients with HIV or multiple sclerosis," Fifield reports. Another promising initiative is the Volunteers of America North Louisiana program, which uses paid drivers to pick up rural veterans, including those in wheelchairs, from their homes and ferry them to appointments. Older VA programs to transport rural veterans didn't pick up patients from their homes and did not transport patients in wheelchairs. Another program is run by the Nebraska Association of Local Health Directors, which placed 10 coordinators in local health departments to get word out about services available to veterans and teach health-care workers how to identify veterans who need help.

Ultimately though, continued access to Medicaid may be one of the biggest factors in rural veterans' health. Most veterans rely on a mix of VA health insurance and either private insurance, Medicaid, or Medicare. According to a data analysis by Families USA, a health-care advocacy group, more than 1.75 million veterans use Medicaid, and 340,000 were able to enroll because of the Patient Protection and Affordable Care Act. Andrea Callow, associate director of Medicaid initiatives at Families USA, told Fifield that, for veterans in rural areas, "Medicaid could mean the difference between them getting care, and them not getting care."

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