THE HONORABLE ROBERT H. ROSWELL, M.D.
UNDER SECRETARY FOR HEALTH
DEPARTMENT OF VETERANS AFFAIRS
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
March 2, 2004
Mr. Chairman and Members of the Committee:
I am pleased to appear before the Committee to discuss the Department’s ongoing efforts with regard to CARES.
The CARES process has involved one of the most comprehensive evaluations of the VA health care system ever conducted. It is a data-driven planning process designed to project future demand for health care services in 2012 and 2022, compare them against the current supply, and identify the capital requirements and the asset realignments VA needs to improve access, quality, and the cost effectiveness of the VA health care system.
Last September, Secretary Principi and I appeared before this Committee to discuss both the CARES process and the VHA draft National CARES Plan. At that time, the CARES Commission, under the superb leadership of Everett Alvarez and John Vogel, was nearing the end of its site visits and public hearings and was preparing to begin the daunting task of writing its report. On February 12 of this year, the Commission presented its final report to the Secretary, with findings and recommendations.
In regards to Mental Health Programs, VHA is developing a comprehensive mental health strategic plan to transform its mental health programs consistent with the recommendations contained the President’s New Freedom Commission Report on Mental Health. This plan will recommend fundamental changes in the structure, policy, and culture of our mental health care delivery system. As part of the plan, VHA is creating a vision for delivery of care to veterans with mental illness and substance abuse within a system that places equal importance and emphasis on mental health and physical health, is integrated, veteran-centered, and based on recovery.
Developing a mental health demand model that accurately projects the full range of mental health services needed by veterans has been challenging. A revised model that is more detailed and improves on past efforts is currently being developed. The resulting options for mental health care will ensure that VHA maintains a robust system of coordinated, integrated, “state-of-the-art” care for veterans with mental health care needs.
We have conducted several studies of domiciliary programs over the past year. These studies highlighted --
Accordingly, I have instructed planners to assure that programs in domiciliary structures are focused on residential rehabilitation and that each patient have a clinical treatment plan. As each program (e.g. mental health, substance abuse, long term care) defines its discrete capacity for residential rehabilitation, VHA will have a more complete picture of the total capacity requirement for domiciliaries.
Mr. Chairman, we are also reviewing the ‘critical access hospital’ concept that was presented in the draft national plan and are developing a definition of what we now call ‘ rural access hospitals’ and how such facilities should function in our health care delivery system.
We believe that these facilities may be important in providing access to health care in certain rural markets where access to VA and/or community care is limited. Such facilities would need to be part of a network of health care that provides an established referral system for tertiary or other specialized care not available at the rural facility. The facility should also be part of a system of primary health care (such as a network of CBOCs). Such facilities would also need to be a critical component of providing access to timely, appropriate and cost-effective health care for the veteran population served.