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Veterans Crisis Line Badge

Office of Public and Intergovernmental Affairs

Remarks by Deputy Secretary Sloan Gibson

College of Health & Human Services, University of North Carolina Wilmington
Wilmington, North Carolina
January 30, 2015

American health care is ready for a change. Here’s why:

From 2000-2009, heart disease increased by 25 percent. Diabetes, by 32 percent. Strokes, 27 percent. In most states, obesity is at or more than 40 percent. We spend more per capita on health care than any industrialized Nation in the world, yet our average life expectancy is no better than countries that spend far less.

Look at health care outcomes. Take heart disease—the #1 killer of Americans. We spend over $100 billion annually on heart-related medical treatment. But compared to medical therapies, at least 90 percent of all heart disease could be prevented by making some simple changes in lifestyle—90 percent!

There’s a financial imperative for change as well. Health care consumes 18 percent of our GNP and it’s projected to account for one-fifth of our economy by 2021. The fact is, spending more is getting us less.

Taken together, these factors point to the need to reassess how we deliver health care in this country. Many in the health care community—to include the Institute of Medicine—have called for lessening our focus on disease-driven health care and adopting a more holistic approach that focuses on the patient, prevention, and “well-being.” In other words, move from “sick care” to “health care.”

To many experts, the issues we’re facing are rooted in the fact that we’ve made disease the focal point of health care, not the person. At VA, we’re working to change that dynamic—to make our care more personal, more patient-centric as we undertake what will perhaps be the most sweeping transformation in our 85-year history.

This evening I’d like to do three things: First, tell you some things about VA you probably didn’t know—about its scope and scale, and about its legacy of achievement in shaping American health care over the past six decades. Second, get you thinking about how VA is positioned to help institute a new model of health care for the decades ahead. And, third, invite you to be part of our transformation by joining the VA Team and encouraging others to join

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VA is the largest integrated health care system in the Nation:

  • Almost nine million enrolled for care.
  • 150 medical centers—you call them “hospitals”—and 819 community-based outpatient clinics located from Maine to Manila. The word “clinic” doesn’t really describe them because some of these facilities can be as large as 250,000 square feet.
  • We have 300 Vet Centers where we provide counseling and support for combat Veterans and their families.
  • 135 community living centers—you call them nursing homes.
  • 104 residential rehabilitation treatment facilities for our disabled Veterans.
  • And scores of outreach and mobile medical clinics to serve our most rural Veterans—each tethered to one of our medical centers.

We are a full service provider—serving Veterans with inpatient care, outpatient care, remote care, and care in the community. Our services range from primary care, to polytrauma care for those with catastrophic injuries, to complex specialized procedures such as organ transplants and neurosurgery.

After more than a decade of war, we’re focused squarely on the mental health needs of our patients because more than a third of our patients have had a mental health diagnosis within the past 12 months. We’re taking an integrated approach by including mental health care within our primary care services; including mental health specialists on our patient care teams; and by reaching out to those who need us by providing virtual telemental health care.

Our health care is delivered by 23,425 doctors and 61,237 nurses located in facilities from Maine to Manila. We also employ psychologists, physical therapists, pharmacists, recreation therapists, social workers, and a long list of other health care professionals.

But health care is just one of VA’s nine lines of business.

  • Last year, VA provided $58 billion in compensation benefits to four million Veterans.
  • We paid $1.1 billion in vocational rehabilitation and employment benefits to 100,000 disabled Veterans.
  • Since 2009, we’ve paid $47 billion in Post 9/11 GI Bill education benefits to 1.3 million Veterans and eligible family members.
  • We guarantee 2.1 million home loans and we’ve had the lowest foreclosure rate in the industry for the last 25 consecutive quarters.
  • As the Nation’s tenth largest life insurance enterprise, we administer nearly 6.5 million policies providing $1.3 trillion in coverage for Veterans, Servicemembers, and their families
  • .
  • VA maintains 3.4 million gravesites at 131 National Cemeteries and conducts over 125,000 interments annually.
  • Our network of programs and services are supported by 340,000 employees—over 290,000 of them working in health care—and a budget of $164 billion. Those statistics make us the second largest agency in the Federal government. If VA were operating in the private sector, we would be a Fortune 10 company. We’re a 21st century department, with an inspiring 19th century mandate, and a mission unlike any other organization, public or private.

Our history traces to the end of the Civil War, when President Lincoln called on America “to care for him who shall have borne the battle, and for his widow and his orphan.” Amazingly, today, VA still cares for an 84-year-old child of a Veteran of the Civil War. In fact, we still pay benefits to about 16 widows and children of Veterans of the 1898 Spanish-American War, and to over 4,000 widows and children of Veterans of World War I.

VA exists because the cost of war doesn’t end when the last bullet is fired.

We’re working to provide high-quality, evidence-based, and increasingly personalized health care. We’ve adopted non-traditional approaches—most notably care delivered by interdisciplinary teams of physicians and health care professionals responsive to the specific needs of our patients.

As part of our evolving model of care, we’ve incorporated nearly 1,000 Veteran Peer Support Specialists on our teams—combat Veterans trained to augment our care by providing ill and injured patients the one-on-one support and understanding that comes from the shared experience of war.

Who are our patients? Almost 6.5 million men and women ranging from the 90-year-old who crossed Omaha Beach on D-Day, to the 19-year-old who battled insurgents in Afghanistan’s Korengal Valley—each with vastly differing needs and expectations.

They fall into two groups. Roughly two-thirds are over age 65. They have higher rates of physical and mental illness, and are poorer than age-matched non-Veterans. Older, sicker, poorer.

Newer to VA are Veterans deployed after 9/11, who come to us with the signature injuries of physical and emotional trauma. To best treat them, VA is building its future on its legacy of cutting-edge innovation that is as broad and historically significant as it is profound—and generally unrecognized.

Much of that legacy has roots in our collaborations and partnerships. Long before crowdsourcing, VA knew the value of collective effort.

We recognize that we don’t have all the answers or all the means to address the challenges we face, and so we’re engaging the public and private sectors and academia like never before—1,800 academic affiliations alone, to include the University of North Carolina, here in Wilmington.

VA’s first foray outside government goes back to 1946 when it entered into partnership with the country’s premier medical and health science schools to deliver care for the 16 million troops being demobilized and the 670,000 casualties of World War II.

The credit goes to General Omar Bradley, then Administrator of the Veterans Administration. Bradley understood the magnitude of the problem he faced—providing care for record numbers of returning warfighters. There were waiting lists for admission at all VA hospitals, and both Army and Navy hospitals were taking in the overflow. So he came up with a simple, common sense solution. He struck up non-monetary alliances with the country’s medical schools to gain immediate access to physicians and residents to staff VA facilities, medical students, and research programs and prosthetics development, as well as other areas then in short supply at VA.

In return, medical schools were allowed full access and use of VA facilities, labs, equipment, and the infrastructure and patient populations of our 97 hospitals, to include the 25 new ones then under construction.

A point of interest—General Bradley did it all without a single computer.

Fast-forward 69 years. As a result of those first partnerships, today we spend over $650 million annually on our medical and nursing school alliances that include some of the top universities in the country—Harvard, Stanford, the University of Pennsylvania, and UNC.

Our ties are close and highly productive. Some examples. The Chief of Staff of our Boston VA Medical Center is one of the deans at Harvard Medical School. At the medical school of UCal San Francisco, the entire faculty is credentialed to practice in VA, and all our medical center physicians there are members of the University’s staff. These types of synergistic relationships advance the exchange of knowledge, create new and better treatment protocols, and result in improved medical care for both Veterans and the general public.

It’s estimated that 70 percent of all U.S. physicians received at least some part of their professional training in a VA hospital. Each year, our facilities train 62,000 medical students and residents, 23,000 nurses, and 33,000 in other health profession fields. Every one of them leaves the VA schoolhouse knowing about Veterans and the cutting-edge technologies, protocols, and alternative approaches used to treat them.

They know about Patient-Aligned Care Teams, where an array of specialized health care providers—to include mental health professionals—work together to customize care to a Veteran’s specific needs. And they know about the many follow-on support services a Veteran can access to advance recovery when discharged from a VA hospital.

There’s simply no other health care system that does as much to shape and influence how doctors and other health professionals think about, and deliver care. None.

We are research-driven—at the forefront in creating new knowledge thanks to hundreds of initiatives and research projects underway. There’s been a big payoff.

  • VA researchers have received three Nobel Prizes for research in Medicine or Physiology, and seven Lasker Awards for major contributions to medical science.
  • Just a few months ago, two VA scientists were awarded the prestigious Samuel J. Heyman Science and Environment Medal for their groundbreaking work on spinal cord injuries. They’ve spent nearly 25 years developing innovative approaches, effective interventions, and drug therapies to reduce complications and improve the quality of life in paralyzed patients. Most recently, they’ve been testing a new bionic assistance system to help patients not only stand, but walk and climb stairs. They’re making a huge difference.
  • Our work touches and improves lives every day. VA pioneered and developed the Nation’s flagship electronic medical records system as well as bar-code software for safely administering medications.
  • We developed the implantable cardiac pacemaker and conducted the first successful liver transplants.
  • VA created the nicotine patch, developed some of the first medications for hypertension, and, through a VA Cooperative Study, helped license the Shingles vaccine.
  • Our researchers identified the genetic risk factors for schizophrenia, Alzheimer’s, and Werner’s Syndrome, and conducted groundbreaking research into Post Traumatic Stress Disorder (PTSD) and traumatic brain injury.
  • We’re in the vanguard of research into artificial limbs that move naturally when controlled by electrical impulses from the brain.
  • And we’ve demonstrated that patients with total paralysis can control robotic arms using only their thoughts—a system called “Braingate” and the subject of a 2012 60 Minutes story.

We’re future-forward with our work in genomics. We’re advancing VA health care by making it not only preventive, but predictive. We’re working to apply the medical potential of genetic mapping and position VA as a leader in developing safer, more effective treatments based on new knowledge about the elemental role of genes in health and disease.

In 2011, we launched our Million Veteran Program, or MVP—a partnership between Veteran-volunteers and VA to learn more about how genes affect health. MVP is establishing one of the largest databases of genetic, military exposure, lifestyle, and health information for use in research on diseases like diabetes, cancer, and PTSD.

By identifying gene-health connections, our program stands to significantly advance disease screening, diagnosis, prognosis, and point the way toward more effective, personalized therapies. With an expected enrollment of one million Veterans over the next five to seven years—and 345,000 currently—MVP is already the largest database of its kind in the United States.

Let me turn to another area where VA is out in front—telehealth. We’ve extended our reach well beyond VA’s brick and mortar—not as a replacement for doctor-patient relationships, but to enhance them.

Telehealth is good medicine whether in VA primary care, specialty care, or mental health care. It increases access, decreases travel, improves efficiency, and adds to the quality of care. And it’s especially important to Veterans who live in rural or highly rural areas of the country—in fact, they comprise 45 percent of all our telehealth patients.

Last year, more than 700,000 Veterans chose telehealth for some aspect of their VA health care, and over 4,000 received secure video visits in their homes from their provider.

We’re using telemental health to deliver care in areas like pain management, therapy for insomnia, and PTSD. The results are impressive. Telemental health care has decreased, by about 25 percent, hospitalization rates in over 100,000 new patients within an average six months of starting treatment.

What do our patients think about their telehealth care? Our average national satisfaction scores range from 85 percent to 94 percent.

VA is taking telehealth technology into the ICU. At many locations, a “second set of eyes” now monitors our critical care patients with a bank of monitoring screens that show data and the patient simultaneously, and alert our clinicians of any change in patient status.

A live two-way audio-video feed links the patient, the provider, and the critical care nurse team. The video resolution is so fine, “intensivists” can see a patient’s pupils constrict in response to light. As important, TeleICU allows the medical staff to immediately get advice on a patient’s needs from VA’s ICU hub in Cincinnati. High-tech diagnostic equipment and cameras give clinicians there the ability to quickly assess the situation and collaborate with ICU staff on the ground to provide the best medical expertise and treatment available. Last year, approximately 5,000 Veterans received this type of cutting-edge care in our TeleICU beds.

There’s a compelling cost component to TeleICU as well. The demand for intensive care physicians in this country continues to be greater than the supply, driving up costs for critical care services. This is one strategy that’s proving effective in managing the shortage of intensive care physicians as well as the price of ICU care.

We are continuing to increase our investments in telehealth to reach Veterans and maintain our prominence in this promising field.

We’re always on the lookout for next generation technologies to improve patient care. Here’s an example. VA just launched a two-year pilot to study how we can accelerate evidence-based clinical decisions—say, by a doctor analyzing PTSD treatment options for a patient. We want our physicians to be able to quickly zero-in on the right information and right data so they can prescribe the right care targeted to the individual patient.

We believe that emerging technology holds promise in assisting with complex medical decisions that depend on dispersed, hard-to-organize information. So we’re looking at a computer-based Clinical Reasoning System to support our care by:

  • Extracting key information and knowledge from our electronic health records, and from the medical literature;
  • Presenting relevant findings to the physician in an organized manner;
  • All to support care delivery in real time.

It’s another example of how we’re working to make our care patient-personal while improving efficiency and outcomes. By any measure, VA’s record of discovery and innovation has contributed in a major way to health care in America. It has done a lot, and it’s prepared to do more.

While we still have too many Veterans waiting too long for care, Veterans are satisfied with the quality of care they receive at VA. And it’s not just me saying that. Since 2004, the American Customer Satisfaction Index, the ACSI, has shown that Veterans receiving VA health care give us higher satisfaction ratings than patients receiving care in private hospitals. Every year for the last five years, J.D. Power has scored VA’s Mail Order Pharmacy the highest in overall satisfaction. And last year, 24 VA medical facilities were recognized as “top performers” by The Joint Commission.

That recognition is because performance management is a big part of VA health care. You can’t manage—or manage well—what you don’t measure. You can’t improve without knowing what you need to improve. That’s why we use a web-based, balanced scorecard approach to continuously measure, evaluate, and benchmark the quality and efficiency of our care. It’s called SAIL, Strategic Analytics for Improvement and Learning.

SAIL is based on the simple premise that “what gets measured is what gets done.” The insights we get from its 26 measures drive our actions to translate performance at a moment in time into a sustained progression to deliver better health care outcomes. It goes beyond other industry-recognized measurement tools in that it doesn’t limit its assessment to the quality of inpatient and outpatient care. It looks at the bigger picture—including employee satisfaction, access to care, and efficiency.

And unlike most other industry report cards that are updated annually, SAIL is updated quarterly to allow our hospitals to more closely track performance and determine whether we’re achieving the Veteran outcomes we want, and how we compare to the performance of other health care providers.

The answer is that VA care compares favorably with our private sector counterparts. The most recent data from the National Committee on Quality Assurance show that, across many clinical indicators, we outperform the commercial sector, sometimes very significantly.

For instance, in prevention:

  • In prescribing Beta-Blockers after a heart attack, VA was rated 92 percent, the private sector, 84 percent.
  • In controlling high blood pressure in our patients, VA was rated 76 percent—the private sector, 64 percent
  • .
  • And in conducting colorectal cancer screening, VA, 81 percent—the private sector, 63 percent.

We also outperform in patient outcomes. In comparing mortality rates for congestive heart failure—even with adjustments for differences in risk—Veterans were found to have a 30 percent lower risk of dying of heart failure in a VA hospital than in a commercial hospital

And we outperform in patient safety. Hospital infections are among the most common sources of harm to patients. The rates of hospital-acquired infections in VA hospitals match or are better than in the best hospitals in the country. Since we undertook a major infection prevention initiative in 2007, hospital acquired infection rates have fallen by 72 percent in the ICU setting, and by 66 percent in non-ICU areas of our facilities

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VA operates with unmatched transparency in either the public or private sectors. We report and evaluate our errors to avoid repeating them in the future. More than that, we publish our health care results on our website, VA.gov, and on the government’s open data website, data.gov. Veterans and the public can track our performance in patient safety, care quality, and access to our care.

We believe in full disclosure and the power of metrics to drive better care, better health, and better value. I don’t know of any hospitals in the private sector that are as open about their performance.

Today, we’re moving forward to further improve the quality of our services, increase access to them, drive down the cost to deliver them, and drive up customer satisfaction. The problems that occurred in VA’s facilities in Phoenix and elsewhere have been well documented. We own them, and we’re fixing them.

Our first priority has been to accelerate access to care by getting Veterans off wait lists and into clinics. Because one of the biggest challenges we face is the shortage of medical staff, we’ve hired 1,600 more nurses, 700 more support staff, and 600 more physicians in the past six months.

We’re ramping up our recruiting to bring the best and brightest onto VA’s rolls. VA is actively recruiting to fill 35,000 vacancies for health care professionals and support staff—and we’re actively hiring from medical, nursing, and health sciences schools like the College of Health and Human Services. Yes, you heard right, 35,000 vacancies.

  • In just the period May through November of last year, we completed 33 million appointments for care—766,000 of them during extended clinic hours, on nights and weekends—that’s 1.3 million more appointments than in the same period in 2013.
  • Ninety-eight percent of those appointments were completed within 30 days of the Veteran’s preferred date or the medically-necessary date—92 percent within two weeks of the preferred date! And we estimate that roughly 20 percent of completed appointments reflect same day access for our Veterans.
  • And while we continue to build our internal capacity, during the period May 1st to December 31st last year, we authorized 1.9 million Veterans to receive care outside VA—a 46 percent increase in appointments for care in the community from the same period in 2013. Because each of those referrals results in an average of seven appointments, that translates into 13 million appointments for care in the community.

Purchased care is not new, nor is it a replacement for a strong, dedicated Veterans’ health care system. VA has always sponsored care in the community in extraordinary circumstances, like geography, where rural Veterans can’t easily get to a VA facility. Or technology, where it makes sense to refer Veterans elsewhere for highly specialized procedures. Or in instances where we need to cover temporary shortfalls in staffing and other resources.

Care in the community addresses some of VA’s current access problems, but, as important, it opens the door to other transformative aspects of patient care—in care coordination and interoperability, for instance.

Unlike a private health plan, we retain responsibility for the quality and continuity of care we deliver. A private plan will provide their participants a roster of physicians, and it will pay a specified amount of the cost of care, but it isn’t directly concerned with the quality of care an individual receives, or whether or not that patient requires follow-on or specialized care.

VA, on the other hand, is an integrated health care system—concerned with all aspects of a Veteran’s health care over the near-term and long-term. That’s why we track and monitor the effectiveness of the care in the community that we authorize—to ensure Veterans are receiving the care they need and that a record of that care is imported into our electronic medical records.

We have a vested interest in doing that. Where participants of private sector health plans may change their plans many times over the course of their lives—our patients are with us for the long term, most often a lifetime.

Let me give you one example—hepatitis C. VA leads the country in hepatitis screening, testing, treatment, research and prevention. One hundred seventy thousand Veterans are under our care. We provide the high-cost drugs to treat them—not only because it’s the right thing to do for Veterans, but because we know the cost benefit is in not having to do a liver transplant 10 or 20 years later. Private health care plans don’t always take that long view because their cost-benefit decisions are driven by shorter-term considerations.

I spoke about partnerships earlier. If VA and private providers are caring for the same Veteran-patient, we’re in a position to collaborate, to share information and knowledge. There’s a potential to leverage improvements in electronic health records by developing a public-private platform and infrastructure to generate new ways of using patient information and data, new ideas, and new solutions for better patient care.

Increasing the level of care delivered in the community also has the potential for increasing high-value care—particularly in reducing medical waste and redundancies. Because we’re working in tandem, there’s opportunity to ask ourselves, “How do we prevent costly redundancies in X-rays, MRIs, blood tests, and countless other tests?” More than that, asking, “How do we reduce unnecessary testing—period?” Public-private collaboration allows us to tackle these types of issues and develop answers and solutions that are important to keeping health care costs in check.

VA’s history of innovation, public-private partnerships, and leadership arguably makes it well suited to bridge the public-private “health care divide” in this country by serving as the model for 21st century health care. As a department of government that operates efficiently and effectively, on a par with the best-run companies in the private sector.

We’re positioning ourselves to do that.

VA has laid out its vision in its “Blueprint for Excellence,” the template for achieving long-term health care reform and preeminence. It answers the hard questions about how we organize, operate, and collaborate to serve Veterans.

It lays out our strategy for change—not just to repair the recent breakdowns in our system—but to establish a new health care operating model for VA. The plan identifies four main objectives:

First, improve the performance of our health care. We must not only excel in our specialty expertise—treating the seen and unseen wounds of war—but we must also ramp up our expertise in treating the more mainstream health problems found in the broader population of Veterans we serve. Problems also common to the non-Veteran population.

Our long-standing electronic health record system has given us the edge in having the ability to generate “big data” related to care and health and provide a “big picture” view of health care and emerging trends. And, as we do all that, we must ensure that our care continues to compare favorably to the best care in the private sector.

Second, re-set VA’s culture to focus on customer service and customer satisfaction. VA’s institutional values—Integrity, Commitment, Advocacy, Respect, and Excellence are attributes that go to the heart of our mission and can go a long way toward meeting the service goals we’ve set for ourselves.

Third, develop efficient, transparent, accountable, agile business and management processes so that we can operate more efficiently and be a responsible steward of taxpayer dollars.

And fourth, advance health care innovation for both Veterans and the country at large. VA must transition from “sick care” to “health care” in the broadest sense, and move to a patient-driven model of care. In short, VA needs to do more to help Veterans take charge of their own health.

We are committed to a “whole health” model of care—personalized, proactive, and patient-driven. That means advancing initiatives and systems designed around the needs of the patient, and tailoring care to a Veteran’s medical condition, genome, and personal needs, values, and circumstances.

It means using strategies that inspire Veterans to take greater control of their health.

It means partnering with them to consider all factors that can affect their well-being and target preventable diseases like heart disease and type 2 diabetes. And it means delivering care rooted in, and driven by, what matters most to that patient—in their life agenda, and health care goals—if we are to engage and inspire them to achieve their highest level of physical and mental well-being.

Personalized, proactive, and patient-driven—a model of service that operates around a Veteran’s needs, not our organization’s. An approach to care that is at once revolutionary, sensible, and compassionate.

In health care and across our other eight business lines, VA is changing the way we do business to better serve Veterans.

Our transformation is not about change for the sake of change. It is about customer service. It’s about delivering a seamless, superior “VA experience,” and putting Veterans first in everything we do

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We’re establishing a new operating platform to support our transformation. We call it MyVA, because that’s how we want Veterans to view us—as an organization that belongs to them, providing quality care in ways they need and want.

We’re organizing in their best interests by combining functions, simplifying operations, and rethinking our structures, processes, and relationships to become more Veteran-centric, productive, and efficient—not just in health care, but across our Department.

The approach to MyVA is both bottom up and top down. Top down in the sense that there are a few overarching features:

  • A VA-wide customer service organization to drive excellence.
  • A single regional framework to support and improve coordination, partnerships, and customer service. Just this week we announced we are realigning our 21 operating networks into five nationwide regions to enable Veterans to more easily navigate VA and all its services and benefits.
  • A national network of community Veteran advisory councils coordinating better service delivery with our partners and our employees.
  • And a shared services model for improved effectiveness, cost reduction, and increased productivity VA-wide.

At the same time, our transformation is being driven from the bottom up, by employees. Why? Because, coming from the private sector, I know that the best ideas for innovation and continuous improvement come from front-line employees. And no one knows better how to serve Veterans than our employees—a third of them Veterans themselves.

That’s why, over the past six months, Secretary Bob McDonald and I have been to more than 100 VA facilities from coast to coast, talking to Veterans, VA employees, union members, Veteran advocacy groups, and other stakeholders to get their perspectives on how to create a better VA for Veterans. We’re soliciting employee ideas and suggestions for improved VA services through our online portal, the MyVA Idea House, and we’re making good use of that input to develop the way forward.

People sometimes ask me, “Why do you think you can achieve the sweeping reforms and reach the goals you’ve set for VA?” I answer them with two words: “VA employees.” I’m immensely proud of the work they do. Veterans are, too. Here’s what one Veteran recently wrote:

“They pursued my issues with a determination that ensured there would be no leaving the facility without addressing my concerns . . . . [They] bring joy and enthusiasm … that’s contagious and must raise the spirits of all the patients, much like it does for me.

“They bring justifiable credit to the VA as employees . . . . I am always treated like a General!”

Overwhelmingly, that’s the type of employees we have. And that’s the type of VA experience we want to deliver consistently across our Department. We want every Veteran “treated like a General” every time they walk through our doors.

As VA sets its course for the long-term, I like to keep in mind a great Vince Lombardi quote: “Perfection is not attainable, but if we chase perfection we can catch excellence.” We understand, especially in health care, we’ll never be perfect—but we can pursue performance excellence.

VA is at a unique juncture in its history, and because it doesn’t carry out its mission in a vacuum, what VA does now will help set the course of American health care for decades to come. Last summer, I met with Harvey Fineberg, distinguished clinician and health care leader—former president of the Institute of Medicine. When I commented that VA could accomplish more in the next two-to-three years than we could have in two-to-three decades, Dr. Fineberg immediately corrected me: “No!” he said, “VA can accomplish things now it never could have accomplished!”

He’s right. We’re in an extraordinary position. First, we have an opportunity to change perceptions about VA by:

  • Lengthening our lead in areas where we’ve always excelled;
  • Taking the lead in service delivery areas that are lagging;
  • Charting new ground in emerging areas of health care, and
  • Optimizing, not simply maximizing, that care to responsibly spend taxpayer dollars—because while it is morally right to prevent suffering and illness, it is fiscally right to avoid unnecessary costs.

Second, we have an opportunity to improve our care by modeling a system that:

  • Leverages evidence-based, team-based, and patient-centric approaches to care;
  • Emphasizes “wellness” to short-circuit “illness”;
  • Uses technology and innovation to continuously improve outcomes, and metrics to continuously monitor and improve performance
  • ;
  • And welcomes new and complementary approaches such as meditation, Tai Chi, yoga, and health coaching based on integrative medicine.

Here in North Carolina, the Fayetteville VA Medical Center is a national leader in training and using Whole Health Coaches to help Veterans make good lifestyle choices—in exercise and nutrition for instance—that correlate to good health. Initially focusing on homeless Veterans, the medical center saw the remarkable impact coaching had on their lives and health and they have since moved to integrate coaching into their patient-aligned care teams.

Here again, we are moving rapidly from reactive disease management to proactive health care—it’s health care for the 21st century. VA’s changing model of care is not about creating a “new” system, but shaping the “right” system for Veterans—health care built on the cornerstones of disease prevention, personalized health management, innovation, and customer service.

We have a third opportunity—and responsibility—before us. And that’s to share our vision, knowledge, experience, and achievements to help frame and contribute to the evolving paradigm of health care in America.

VA is well-positioned to advance its legacy in American health care—once more, in the lead, and out in front. It all comes down to what Dr. Fineberg told me—VA has a unique opportunity to “accomplish things now [we] never could have accomplished”—and that means a lot for the Veterans we serve—and for all Americans.

Let me share one last thought. There’s no more inspiring mission than serving the men and women who have served and sacrificed for our country. There’s no better place to work, with locations across the Nation. And there’s no more exciting time than now as VA transforms itself for the decades ahead.

We’re looking for health care professionals like the graduates of the College of Health and Human Services—and we’ll work hard to help you work hard.

We offer:

  • Education debt reduction and student loan repayment plans.
  • Employee scholarships in select areas of health care.
  • Comprehensive pay and compensation packages commensurate with education, clinical experience, and market.
  • Recruitment, relocation, and retention incentives for working in rural and highly rural hospitals and clinics.
  • And we’ve recently increased our physician salary ranges to make us more competitive with other health care employers.

More than that, we have the greatest clients of any health care system in the world—the men and women who have “borne the battle” for America.

Thank you, all. Now, let’s open the floor to discussion, questions and answers.