Legislature(2011 - 2012)CAPITOL 120
03/01/2012 01:00 PM House MILITARY & VETERANS' AFFAIRS
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska Veterans' Affairs - an Overview of the Alaska Va Healthcare System | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE SPECIAL COMMITTEE ON MILITARY AND VETERANS' AFFAIRS
March 1, 2012
1:10 p.m.
MEMBERS PRESENT
Representative Dan Saddler, Co-Chair
Representative Steve Thompson, Co-Chair
Representative Alan Austerman
Representative Bob Lynn
Representative Bob Miller
MEMBERS ABSENT
Representative Carl Gatto, Vice Chair
Representative Sharon Cissna
COMMITTEE CALENDAR
PRESENTATION: ALASKA VETERANS' AFFAIRS - AN OVERVIEW OF THE
ALASKA VA HEALTHCARE SYSTEM
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ALEX SPECTOR, Director
Alaska VA Healthcare System
U.S. Department of Veterans Affairs
Anchorage, Alaska
POSITION STATEMENT: Provided a PowerPoint presentation
entitled, "Alaska VA Healthcare System Military & Veterans
Affairs Committee Update," dated 3/1/12.
ACTION NARRATIVE
1:10:48 PM
CO-CHAIR DAN SADDLER called the House Special Committee on
Military and Veterans' Affairs meeting to order at 1:10 p.m.
Representatives Saddler, Thompson, Lynn, Austerman, and Miller
were present at the call to order.
^PRESENTATION: Alaska Veterans' Affairs - An Overview of the
Alaska VA Healthcare System
PRESENTATION: Alaska Veterans' Affairs - An Overview of the
Alaska VA Healthcare System
1:11:01 PM
CO-CHAIR SADDLER announced that the only order of business would
be an overview of the Alaska VA Healthcare System.
1:11:41 PM
ALEX SPECTOR, Director, Alaska VA Healthcare System, U.S.
Department of Veterans Affairs, said he would bring the
committee up to date on what the federal Department of Veterans
Affairs (VA) is doing in Alaska. The topics of his presentation
were: Demographics; Basic Eligibility; Alaska VA - Scope of
Clinical Services; Sites of Care; Joint Venture Relationship
with 673d Medical Group; Alaska Federal Healthcare Partnership;
Operation Enduring Freedom (OEF)/Operation Iraqi Freedom
(OIF)/Operation New Dawn (OND); Eliminating Homelessness; Rural
Health; Care Closer to Home; and Health Information Exchange.
Mr. Spector said there are 77,351 veterans in the state, which
means Alaska has the highest percentage per population in the
U.S. Of those, 30,022 enrolled in the VA Healthcare System, and
the number enrolled is also a very high percentage when compared
with other states. Further, 16,595 veterans received treatment
last year. Slide 2 entitled, "Alaska Veteran Population
Distribution," indicated that one-half of the veteran population
is located in the Anchorage and Matanuska-Susitna areas,
followed by Fairbanks. There are eight priority groups of basic
eligibility for VA medical care, from the highest priority of
Group 1, which are veterans who have a condition resulting from
their service, to priority Group 8, which are not service-
connected veterans, and who have high incomes. He explained
that copayments are required of some not service-connected
veterans, and the copayments are approximately equivalent to
those of Medicare. In addition, the healthcare system bills
third-party insurance when available. Mr. Spector observed that
VA medical services are very popular with veterans, and its
services have grown each year by 5 percent to 6 percent, which
indicates that the benefit package is very good for veterans,
and there is very good and respectful care.
1:16:40 PM
CO-CHAIR SADDLER asked for the factors that determine who signs
up and who does not.
MR. SPECTOR opined those who enroll may not have private
insurance and/or are returning veterans who are staying in
Alaska - perhaps due to its economic stability. However,
enrollment drops in areas distant from urban centers. He
stressed that enrollment is the key to receiving services, and
there is a focus on the local and national level to increase
enrollment, thus increasing funding from Congress. In response
to Co-Chair Saddler, he advised representatives of the
healthcare system attend many sessions held for returning
soldiers to explain benefits and enroll them. There are more
opportunities to enroll prior to discharge, and at required
follow-up health reviews held six months and one year after
discharge. Mr. Spector turned to the scope of the clinical
services delivered by the Alaska VA Healthcare System, noting
that it is mostly primary care delivered at several sites.
There is also a home-based primary care program available to
frail veterans living within a 20-mile radius of the Anchorage
facility. A small lab and pharmacy are also located at the
Anchorage Muldoon Clinic and limited dental care is available.
Mental health staff has been doubled in the last five years
because of issues with returning soldiers; for instance, there
is a suicide prevention coordinator, outreach to all returning
soldiers, and a military sexual trauma specialist. A mental
health staff member is integrated into primary care clinics, and
this aspect has been very successful.
1:21:36 PM
REPRESENTATIVE LYNN asked whether there is an increase in mental
health needs when compared to past wars, or if there is better
identification, and more prominence, of those needs.
MR. SPECTOR opined it is everything. He added that VA is
focusing on returning soldiers, but as services for
posttraumatic stress disorder (PTSD) become more public, older
veterans are coming in for treatment. Furthermore, Alaska's
population of older veterans is growing. Returning to the
clinical services, he said VA provides limited specialty care at
the clinic, however, major surgery is performed at the 673rd
Medical Group, including orthopedic surgery, podiatry, and
contract urology services. He described the home telehealth
(HTM) program that places devices in patient's homes to monitor
diabetes, blood pressure, depression, hypertension, and weight.
This service is effective in rural areas for those who have a
landline and, in certain cases, can save on travel and
hospitalization. Also at the Muldoon clinic, there are
rehabilitation services for physical, speech, and occupational
therapy, audiology, a traumatic brain injury (TBI) clinic, and a
small prosthetics program.
1:26:37 PM
MR. SPECTOR continued, listing the sites of care: Anchorage
Muldoon Clinic; 673rd VA/DOD Joint Venture Hospital Joint Base
Elmendorf-Richardson; Domiciliary Residential Rehabilitation
Treatment Program located at Benson and C Street; VA Community
Based Outpatient Clinic located at the Bassett Army Community
Hospital at Fort Wainwright; Mat-Su Community Based Outpatient
Clinic; Kenai Outpatient Clinic; Outreach Clinic at the South
Peninsula Hospital in Homer; and the Juneau Outreach Clinic. He
pointed out that during the last 10 years, clinics have been
located so that 89 percent of all veterans in Alaska live in a
borough with primary and mental health care, although there are
still challenges to provide rural health care.
1:29:09 PM
CO-CHAIR SADDLER asked whether future sites are planned.
MR. SPECTOR said there will be no more clinics, but VA seeks to
expand contract services in underserved areas. Community based
outpatient clinics (CBOCs) are funded by Congress and funding is
"on hold." He turned attention to the VA/DOD joint venture with
the Air Force, saying there are nine joint ventures between VA
and DOD, and the 673rd Medical Group is recognized as one of the
best. It is a VA and Air Force co-managed facility, commanded
by the Air Force and with 70 VA staff members. Pooled funds
from VA and DOD have been utilized to provide a sleep lab and a
sterile processing unit, to purchase an MRI machine, and to
improve cardiology services. This facility is the VA hospital
for Alaska and has received several awards. Regarding soldiers
returning from OEF, OIF, and OND, he advised that since [the
terrorist attacks of September 11, 2001], VA has registered
6,357 discharged soldiers. Of those enrolled, 2,696 - 42
percent - are receiving care at several sites. Approximately 40
percent are receiving mental health services, including
approximately 10 percent for new substance abuse problems, and
about 60 percent for combined PTSD/substance abuse problems. Of
the soldiers returning to Alaska, approximately 13.3 percent
test positive during the initial screening for TBI. Soldiers
suffering serious TBI injuries are not discharged in Alaska. As
veterans come into the VA healthcare system, they are assigned
to a Patient Aligned Care Team (PACT) where they are screened by
a social worker for alcohol use, depression, suicide prevention,
or PTSD/TBI on their first visit. Subsequently, they are
managed by the social worker - or referred to a specialty
service - with no delay of care.
1:34:18 PM
CO-CHAIR SADDLER gave a scenario of a returning veteran who
tests positive for alcohol or substance abuse, and asked whether
VA has a facility for his/her treatment, or if the patient would
be referred.
MR. SPECTOR responded that most of that type of care is
delivered on an outpatient basis; however, VA refers patients to
a Seattle facility for inpatient care or to Alaska Psychiatric
Institute (API) for acute psychiatric needs. In further
response to Co-Chair Saddler, he said, "Our average daily census
at API for mental health is probably two."
MR. SPECTOR directed attention to the topic of homelessness and
listed the services available to homeless veterans. Compensated
work therapy (CWT) is a program that pays veterans' salaries
while they gain skills with local employers - sixty veterans
participated in fiscal year 2011 (FY 11); twenty-one gained
employment, two are pursuing education, and some dropped out.
Incentive Therapy (IT) is a program that pays a small amount of
money to veterans working within the VA system. These two
programs paid $301,364.33 to veterans.
1:37:02 PM
CO-CHAIR SADDLER asked about other types of independent
employment possible through CWT.
MR. SPECTOR said veterans are working for the Municipality of
Anchorage, General Communications Inc. (GCI), and others. He
then described the Transitional Residence program which uses two
apartment buildings to house veterans transiting from in-patient
domiciliary treatment to the residential program. The Grant &
Per Diem program pays other homeless shelters - such as the
Salvation Army in Anchorage and the Rescue Mission in Fairbanks
- for housing for veterans. The Housing and Urban
Development/VA Supported Housing (HUD/VASH) voucher system
provides vouchers to veterans for rental apartments, and 42
veterans were housed in FY 11. This program works with the
Alaska Housing Finance Corporation (AHFC) to find housing, and
also partners with the Alaska Mental Health Trust Authority to
expand the program to rural areas and to keep veterans connected
with their case managers and social workers.
1:39:44 PM
CO-CHAIR SADDLER asked for the dollar value of the voucher.
MR. SPECTOR said the vouchers apply to eligible HUD housing, but
low vacancy rates make finding housing challenging in some
areas. The Domiciliary Care for Homeless Veterans (DCMV)
program has a 50 percent success rate, which is a common rate of
recidivism. In response to Co-Chair Saddler, he explained
success is measured by "stability in not being homeless for a
six-month period." In support of veterans' families, VA has
awarded Catholic Social Services a grant in the amount of
$350,000 to provide services for homeless veterans with
families. For unemployed veterans who do not have medical or
mental health problems, VA is working with employers through the
Homeless Veterans Supported Employment Program, and 24 veterans
have been placed in jobs. Mr. Spector advised that HUD's Point-
In-Time homeless survey determined in Alaska, the percentage of
homeless veterans has decreased by 49 percent in the last two
years, indicating that progress is being made toward ending
homelessness for veterans. In response to Co-Chair Saddler, he
said this rate is better than that of other states.
1:42:59 PM
CO-CHAIR SADDLER asked whether Mr. Spector holds a position on
the proposed "vet's village" in the Eagle River area.
MR. SPECTOR said he held no position; however, VA has been
working with Karluk Manor in Anchorage and some housing in
Fairbanks which are Housing First residences that place homeless
people in a safe environment without the requirement of
sobriety. In response to Representative Thompson, he said he
believed the Housing First house in Fairbanks opened this week.
Mr. Spector expressed VA's high interest in reaching out to
veterans in rural areas and to work better with the tribal
systems. A memorandum between VA and the Indian Health Service
(IHS), U.S. Department of Health and Human Services, created a
separate workgroup on Alaska issues, which is meeting with
tribal leaders in healthcare on how to get Native veterans'
healthcare through three tactics. The first tactic is to
increase access to the VA healthcare system through the
sponsorship of one of the forty Tribal Veteran Representatives
(TVR). In response to Co-Chair Saddler, he explained that a TVR
is not trained to the level of a Veteran Service Officer (VSO);
however, TVRs have increased the response from veterans living
in villages to VA outreach efforts many times over. This tactic
also includes using money from the VA Office of Rural Health to
redesign the intake process of Native organizations thus
increasing the identification of veterans. The second tactic is
to improve the coordination of care by entering into memorandums
of understanding with Native organizations to work together. In
response to Co-Chair Saddler, he explained VA and Native
organizations in various communities have agreed to work to co-
manage the healthcare of Native veterans by sharing information
and the responsibility that healthcare needs are met.
1:48:23 PM
REPRESENTATIVE AUSTERMAN asked whether VA is involved with the
National Guard effort to locate veterans living in villages.
MR. SPECTOR said yes; in fact, VA visited 120 villages during
its last outreach effort and will be doing that again. The
third tactic is to establish a sharing agreement template to be
utilized by VA and Alaska Native Tribal Health Consortium
members. Turning to the topic of care closer to home, Mr.
Spector said this subject originated with Alaska's U.S.
senators' concerns about sending veterans to Seattle for care.
In 2008, 750 veterans went to Seattle for care, which was "just
not right." National VA leadership advocated for oncology and
additional services in Alaska; as a result, since 2010, 221
oncology patients have stayed home for care. In response to Co-
Chair Saddler, he clarified that care purchased in Alaska is
more expensive than care provided at the VA facility in Puget
Sound. In July 2011, care in Alaska was expanded to other
specialty care, reducing the number of veterans traveling out of
state most years. Veterans that are still referred outside
include some post-surgical cases, highly complex cases, for
continuity of care, spinal cord injuries, trauma, transplants,
cardio-thoracic surgery, and at the request of the veteran.
Slide 24 was a list of cases referred for care in Alaska. He
warned of the possibility of not continuing local care due to
the increased cost. In response to Co-Chair Saddler, he said
most of the specialty care cases are handled in Anchorage or
Fairbanks, depending on the treatment plan. He pointed out that
VA cannot support research or procedures that are not approved
by the U.S. Food and Drug Administration.
1:56:06 PM
MR. SPECTOR, in response to Co-Chair Saddler, explained that the
Fisher House of Alaska is like a Ronald McDonald House for
active-duty and veteran families. It is located on the 673rd
Elmendorf campus and is also available to Coast Guard families.
There are 12 beds provided at no charge. The home was funded by
the Fisher House Foundation which has built homes in the U.S.
and Europe for military families. Directing attention to the
Health Information Exchange, Mr. Spector informed the committee
he represents VA and DOD on the board of directors for the
Alaska e-Health Network (AeHN). This organization will create
an exchange system in Alaska for sharing medical records between
providers electronically. The purpose is to improve patient
safety and decrease costs. The exchange is federally funded,
will save Medicaid money by eliminating duplicate tests, and
includes participation from the private sector in Alaska. In
response to Co-Chair Saddler, he said participation in the
exchange is optional, but there are incentives to join. He
observed that there are 2,000 doctors in Alaska, several major
hospitals, smaller hospitals, and the Alaska Native Health
Consortium, which can all be connected for an annual cost of
$2.5 million.
1:59:25 PM
CO-CHAIR THOMPSON assumed the system is sufficiently secure to
include Native and military health organizations, and to abide
by the Health Insurance Portability and Accountability Act of
1996 (HIPPA).
MR. SPECTOR stated the system is built to the highest military
security standards. As a matter of fact, to address the
concerns of citizens about their health information, patients
must opt-in and agree to be part of the network.
CO-CHAIR SADDLER asked whether the records contain basic
information, or include drugs, therapies, and appointments.
MR. SPECTOR explained that if a patient has an electronic
record, the network finds that information and creates a summary
of medications, problems, lab test results, and office visits.
2:00:56 PM
REPRESENTATIVE AUSTERMAN asked whether Alaska National Guard
members who do not do active duty service are included in the
Alaska VA Healthcare System.
MR. SPECTOR said no. He then referred to the federal system's
effort to work with the state veterans' affairs organization to
look for gaps where the state can help; in fact, his office is
working with TriWest Healthcare Alliance, the TRICARE managed
care contractor, the state, the National Guard, and all of the
federal partners to conduct an outreach focused on suicide
prevention. It is important to provide support for families
before the soldiers come home. All of these organizations are
doing an assessment of needs and will share the responsibility
of visiting villages to provide training to mental health
providers, to schools, and to the religious communities.
CO-CHAIR THOMPSON recalled his experience as mayor of Fairbanks
in 2001-2007, when many troops came home.
MR. SPECTOR said several screenings are done on alcohol use,
PTSD, suicide prevention, and TBI to prevent domestic abuse.
2:04:33 PM
CO-CHAIR SADDLER asked whether VA is represented on the
Statewide Suicide Prevention Council, Department of Health and
Social Services.
MR. SPECTOR was unsure. In response to Representative Lynn, he
said two years ago DOD began predeployment mental health
screening for research purposes. He opined the intent was to
look for a predisposition of depression, which military service
can aggravate. This type of situation is difficult to measure
by a healthcare system that only sees those veterans who are in
need, and not veterans who have adjusted well. He restated 40
percent of those seeking care need mental health intervention.
2:07:58 PM
REPRESENTATIVE LYNN suggested that a volunteer military force
has a different demographic than did the drafted soldiers in
earlier wars.
CO-CHAIR THOMPSON, as mayor of Fairbanks, ensured that the
Fairbanks police force was trained to be sensitive to returning
veterans.
2:09:18 PM
MR. SPECTOR stated that in Anchorage the system has reached out
to police, and to village police, with information on the signs
and symptoms of PTSD, suicide prevention, and appropriate
reactions to startle reflexes.
CO-CHAIR SADDLER mentioned pending legislation that would put a
veteran designation on driver licenses to provide "early warning
to a traffic stop situation." He then asked if Mr. Spector had
heard any indications of funding cuts in healthcare for
veterans.
MR. SPECTOR said he has not received concrete information about
budget cuts for FY 13 or FY 14.
CO-CHAIR SADDLER asked whether there are gaps in healthcare
services that need to be addressed.
2:11:14 PM
MR. SPECTOR acknowledged that in Alaska it is a challenge to
cover the great distances to rural areas, and to ensure that
veterans receive all the services to which they are entitled.
As a result of this, the travel budget is stretched. In further
response to Co-Chair Saddler, he advised all veterans to enroll
in the VA system, even those who have private health insurance.
This can be done at many locations such as through service
officers, the Military Order of the Purple Heart, the Veterans
of Foreign Wars (VFW), the Disabled American Veterans (DAV), the
American Legion, and at the healthcare sites.
2:13:30 PM
ADJOURNMENT
There being no further business before the committee, the House
Special Committee on Military and Veterans' Affairs meeting was
adjourned at 2:13 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 2012 Mar 1, State Military & Veterans Affairs Cmte, as of 23 Feb 12.ppt |
HMLV 3/1/2012 1:00:00 PM |
Alaska VA Healthcare System |