STATEMENT OF
GLEN GRIPPEN
NETWORK DIRECTOR, VISN 19
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE
SENATE COMMITTEE ON VETERANS' AFFAIRS

July 21, 2007

        Good afternoon, Mr. Chairman and members of the Senate Committee on Veterans Affairs. Thank you for the opportunity to discuss the VA Rocky Mountain Network 19 and the health care services we offer to the veterans it is our privilege to serve. My remarks will briefly review current programs and collaborative efforts in Network 19 and our plans to increase services and access to care.

        The VA Rocky Mountain Network 19 covers a geographic area of 470,000 square miles across nine states and principally serves the states of Colorado, Montana, Utah, and Wyoming. Our service area also extends into portions of Idaho, Kansas, Nebraska, Nevada, and North Dakota. We are the second largest VA Network in terms of geographic area and deliver health care services to urban, rural and frontier locales. Distances between our medical centers, severe weather, secondary roads, and high mountain passes are significant factors to veterans' access to care.

        Network 19 has consequently focused on providing care closer to veterans both in their homes and in their communities. We have established Community Based Outpatient Clinics ( CBOCs) or Outreach Clinics as sites of care to provide high quality primary care and mental health care to veterans. Network 19 currently has 32 CBOCs and one Outreach Clinic: 10 CBOCs are located in Colorado, five in Wyoming, nine in Montana, five in Utah, two in Nevada-one of which is an outreach clinic-, one in Idaho, and one in Nebraska. Most of these CBOCs are located in rural areas. Network 19 will open six additional sites of care in FY 2007 and FY 2008. These new sites are planned for the West Valley of Salt Lake City; Lewistown, Montana; Cut Bank, Montana; Craig, Colorado; Burlington, Colorado and Elko, Nevada.

        Network 19 is a national leader in Care Coordination and Telehealth. We serve more than 1000 veterans in Care Coordination Home Telehealth programs. Fourteen care coordinators use disease management protocols and home telehealth technologies such as the Health Buddy. The Health Buddy is an in home messaging device that serves as a connection between patients at home and care providers, facilitating patient education and monitoring of chronic diseases. We have 26 other telehealth programs across the Network including primary care, home care, cardiology, dermatology, retinal screening, radiology, rehabilitation and polytrauma. We are also using tele-mental health to reach into the veterans' homes and into community clinics. This allows us to evaluate and follow patients without them having to travel long distances.

        Network 19 serves a large Native American population and through our Tribal Veterans Representative program, we have been successful in our outreach to the sovereign nations of Nevada, Idaho, Colorado, Wyoming, and Montana. Agreements with the Indian Health Service ( IHS) have allowed us to expand our tele-mental health program to the nations of the Crow, and Northern Cheyenne of Montana, and the Eastern Shoshone and Northern Arapahoe of Wyoming. We plan to bring tele-mental services to three reservations in Montana (Rocky Boy, Fort Belknap and Fort Peck) in the next six months. These agreements also open the door to establish referral patterns from IHS clinics to VA medical centers, and improve sharing of medical information.

        Access to mental health resources is one of the concerns facing veterans in rural areas. Therefore, comprehensive mental health care is one of the top priorities for Network 19. We have added 140 mental health positions. Some of these positions have been placed in CBOCs to add resources and greater mental health expertise in primary care clinics. Each medical center has a designated Suicide Prevention Coordinator. Their activities include identification of veterans at high risk for suicide and education of providers, veterans and families and members of the community. The Network has added staff to improve the coordination and delivery of care to the following programs: Post Traumatic Stress Disorder; Substance Abuse; Mental Health/Primary Care Integration; Homeless programs; and for the re-entry of incarcerated veterans.

        Network 19 is being called upon to deliver 21st century health care to 21st century combat veterans. They are young. Many have young families. Some have suffered traumatic injury on the battlefield. Our mission is to ensure continuity and improved coordination of healthcare for seriously injured or ill service members returning from theaters of combat as they transition from DoD to VA.

        We have been aggressive with our outreach efforts to these soldiers by participating in out-briefings for returning soldiers and we make individual contact with soldiers identified by DoD as having an injury. Our medical centers actively collaborate with state national guard and reserve components to ensure that no returning soldier slips through the cracks.

        Network 19 has enhanced their Operation Enduring Freedom / Operation Iraqi Freedom program staff to provide intensive case management in every state for seriously injured soldiers. Transition Patient Advocates serve as personal advocates for seriously injured returning veterans by traveling to Walter Reed, meeting with the families, and helping the veteran navigate the VA system.

        We have established a Polytrauma System of Care for veterans and active duty personnel with lasting disabilities due to Polytrauma and Traumatic Brain Injury. This system of care consists of teams of doctors, therapists, nurses, case workers and other health care experts who work closely with our patients and their families to provide top-quality individualized care. Our goal is to help veterans and service members achieve their highest possible level of recovery and functioning. The Denver VA Medical Center has been designated as the VISN 19 Polytrauma Site working directly with the Palo Alto VAMC as our Polytrauma Rehabilitation Center. The Grand Junction VAMC and the Salt Lake City Medical Center have Polytrauma Support Clinics and the Sheridan, Cheyenne and Montana VA Medical Centers have designated Polytrauma points of contact. The goal of this system of care is to ensure that important specialty care can still be provided to veterans as close to home as possible.

        Also, the Vet Center program provides quality readjustment counseling and community outreach to combat veterans and their families. There are several Vet Center sites throughout VISN 19's geographical area.

        The demand for Long Term Care has greatly increased due to the aging veteran population. Network 19 has developed an array of home and community based care services. We have five Home Based Primary Care Programs in our VISN. In addition, VISN 19 has a unique program for non- VA, or fee basis care which includes a nurse-managed system of care authorization and review. Through this system we have supported home based care and community based outpatient care - devoting more than $28.5 million dollars to this program in FY 2007 to date, and almost $61 million dollars to care in the community.

        Contracts with community care providers also serve to improve access. As an example, in Montana, where advanced practice mental health providers have traditionally been scarce, we contract with three community mental health systems across the state to augment VA staff and provide treatment of severe mental illness, medication management, psychotherapy, and case management for veterans in their local communities.

        Transportation in the Rocky Mountain States is an unremitting challenge. Assistance from the Disabled American Veterans Transportation Network makes the journey to secondary care much easier for our patients. DAV has established a responsive, professional network and we cannot thank them enough. In the last six months in Montana alone, DAV has operated 46 vans, utilizing 246 volunteer drivers who have driven almost 400,000 miles and transported almost 9,000 veterans for VA care.

        Network 19 is committed to providing quality health care to veterans, regardless of where they live. New technologies allow us to provide that quality care in any location. We remain keenly aware of the importance and challenges of service in rural areas, and believe our current and planned efforts are addressing these concerns for our current and emerging veterans.

        This concludes my statement. At this time I would be pleased to answer any questions you may have.