Kenya Graham,
Women Veterans Outreach Coordinator
VA Mid-Atlantic Network (VISN 6)
April 2013
Since the Revolutionary War, America’s women
have earned America’s gratitude and respect
for their contributions to the military and to
the Nation. VA will continue to improve our
benefits and services for women Veterans as
we transform into a 21st century
organization.
Secretary of Veterans Affairs
Eric K. Shinseki
March 10, 2010
2/2013
3
Source: America’s Women Veterans: Military Service History and VA Benefits Utilization Statistics, Department of Veterans Affairs, National Center for Veterans Analysis
and Statistics, Nov. 23, 2011; http://www.va.gov/VETDATA/docs/SpecialReports/Final_Womens_Report_3_2_12_v_7.pdf
Sources: VetPOP 2007 and VetPOP 2011 ADUSH for Policy and Planning
2/2013
4
Sources: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Health Care Group. Sourcebook: Women Veterans in the Veterans Health
Administration V1: Sociodemographic Characteristics and Use of VHA Care, 2011. VHA Office of Finance Allocation Resource Center (ARC).
2/2013
5
12% of Operation Enduring Freedom/Operation Iraqi
Freedom/Operation New Dawn(OEF/OIF/OND) Veterans
18% of National Guard/Reserves
6% of VA health care users
Women Veteran enrollment outpacing that of men—21% increase since
2009
5 years’ free VA health care for OEF/OIF/OND Veterans
with service-related issues
57% of OEF/OIF/OND women Veterans have used VA care
2/2013
6
VISN
FEMALE
USERS
FEMALE
VETERANS
MKT
PENETRATION
(WOMEN)
MKT
PENETRATION
(MEN)
1
12,157
78,921
15.4%
26.1%
2
7,351
39,982
18.4%
29.7%
3
8,215
61,222
13.4%
23.2%
4
15,053
104,434
14.4%
24.8%
5
13,020
112,168
11.6%
19.8%
6
29,014
181,054
16.0%
24.7%
7
34,318
182,241
18.8%
26.4%
8
34,228
156,655
21.8%
36.3%
9
16,261
92,875
17.5%
29.2%
10
11,570
68,834
16.8%
26.6%
Sources: WATCH Briefing Book, VetPop 2011
VETERANS HEALTH ADMINISTRATION
7
VISN
FEMALE
USERS
FEMALE
VETERANS
MKT PENETRATION
(WOMEN)
MKT PENETRATION
(MEN)
11
14,073
89,917
15.7%
23.0%
12
13,247
80,909
16.4%
27.2%
15
12,757
82,308
15.5%
28.4%
16
33,544
181,737
18.5%
28.6%
17
25,577
129,790
19.7%
27.1%
18
18,284
96,722
18.9%
30.5%
19
13,386
75,858
17.6%
26.3%
20
20,325
119,361
17.0%
24.8%
21
16,080
97,079
16.6%
29.6%
22
21,033
126,839
16.6%
25.1%
23
14,881
81,622
18.2%
33.4%
TOTAL
361,895
2,240,529
16.2%
26.2%
VETERANS HEALTH ADMINISTRATION
Sources: WATCH Briefing Book, VetPop 2011
8
Facility
Female Users
Female Veterans
Mkt Penetration
Asheville
1,949
7,449
26.2%
Beckley
546
2,387
22.9%
Durham
5,217
22,355
23.3 %
Fayetteville
6,414
31,608
20.3%
Hampton
6,599
53,634
12.3%
Richmond
4,653
30,289
15.4 %
Salem
1,953
9,004
21.7%
Salisbury
5, 194
24, 329
21.3%
12,000
10,000
8,000
FY11
6,000
FY12
FY13-JAN
4,000
2,000
ASH
BEC
DUR
FAY
HAMP
RIC
SALEM
SLS
7,000
6,000
5,000
4,000
FY11
FY12
FY13-MAR
3,000
2,000
1,000
ASH
BEC
DUR
FAY
HAMP
RIC
SALEM
SLS



1 year after separating from service, 62% of
female OEF/OIF/OND Veterans and 56% of
male Veterans remain in VA care
5 years after separating from service, 52% of
female OEF/OIF/OND Veterans and 47% of
male Veterans remain in VA care
Research-funded CREATE Attrition Study—
examines factors related to staying in or
leaving VA care
Source: Leslie, Douglas. Women Veterans Cohort Study (2012 unpublished data).
2/2013
12
 Maternity Care
 Mental Health
 Service-Connected
Disabilities
 Privacy, safety,
convenience
2/2013
13
58% of women VA users are 45+
√ Menopausal Needs
Age distribution of women Veteran patients, FY01 and FY10
√ Geriatric Care
√ Inpatient/Extended
Stays
Next 20 years … more
intensive health care
services and support
as caregivers
Source: Women’s Health Evaluation Initiative and VHA Women’s Health Services.
Sourcebook: Women Veterans in the Veterans Health Administration. Volume 2.
Sociodemographics and Use of VHA and Non-VA Care Fee. 2012 (in press).
2/2013
14
Proportion of women and men Veteran outpatients by total primary care encounters, FY10
Source: Women’s Health Evaluation Initiative and VHA Women’s Health Services. Sourcebook: Women Veterans in the Veterans
Health Administration. Volume 2. Sociodemographics and Use of VHA and Non-VA Care Fee. 2012 (in press).
2/2013
15
Proportion of women and men Veteran outpatients by mental health/SUD encounters, FY10
Source: Women’s Health Evaluation Initiative and VHA Women’s Health Services. Sourcebook: Women Veterans in the Veterans
Health Administration. Volume 2. Sociodemographics and Use of VHA and Non-VA Care Fee. 2012 (in press).
2/2013
16
Service-connected disability status among Veteran patients, by gender, FY10
Source: Women’s Health Evaluation Initiative and VHA Women’s Health Services. Sourcebook: Women Veterans in the Veterans
Health Administration. Volume 2. Sociodemographics and Use of VHA and Non-VA Care Fee. 2012 (in press).
2/2013
17



Women Veterans: ~8% of homeless Veteran population; 2X more
likely to be homeless than non-Veteran women*
FY 2011: VA served ~198,908 homeless, at-risk, or formerly
homeless Veterans (7.7% or 15,303 women)
VA homeless programs include:
◦ HUD-VASH Program (permanent housing): 13% of recipients are women; 14%
of HUD-VASH vouchers go to homeless Veterans with children; among women
housed in HUD-VASH in FY12, 38.4% are housed with children
◦ Grant Per Diem Program (GPD): In 2012, 7% of Veteran recipients were women
◦ Supportive Services for Veterans Families (SSVF) Program: First year assisted
~21,000 Veteran households comprising over 35,000 adults and children; 15%
were women
◦ Homeless Veterans Support Employment Program (HVSEP): Approximately 25%
of hires are women Veterans
◦ Veterans Homeless Prevention Demonstration Program (VHPD): 3-year pilot to
prevent homelessness among recently discharged through early intervention;
22% served were women
*2010 Annual Homeless Assessment Report (AHAR)
18
Are We Ready?
2/2013
19
2/2013
20
Dr. Patty Hayes
Chief Consultant
Dr. Sally Haskell
Deputy Chief
Consultant
(Clinical)
Dr. Laure Veet
Director
Women’s Health
Education
Dr. Maggie
Czarnogorski
Acting Deputy Director
Women’s
Comprehensive Health
Dr. Laurie Zephyrin
Director
Reproductive Health
Women’s Health
Education TEAM
Comprehensive
Health TEAM
Reproductive Health
TEAM
2/2013
Melissa Lanzendorfer
Assoc. Chief
Consultant
(Operations)
Meri Mallard,
Peggy Mikelonis
Deputy Field
Directors
Operations Support
TEAM
WVPMs, WHMDs
Name
Facility
Email
Phone #
Shenekia Williams-Johnson
VISN 06
Shenekia.williamsjohnson@va.gov
919-956-5541
Sharon West
Asheville
Sharon.west2@va.gov
828-298-7911
x5434
Kimberly Nugen
Beckley
Kimberly.nugen@va.gov
304-2552121, x4842
Joan Galbraith
Durham
Joan.galbraith@va.gov
919-2860411, x5229
Sandra Smith
Fayetteville
Sandra.smith1e33ba@va.gov
910-4882120, x7479
Patrice Malena
Hampton
Patrice.malena@va.gov
757-7229961. x2398
Beverly Ross
Richmond
Beverly.ross@va.gov
804-675-5389
Suzette Hile
Salem
Suzette.hile@va.gov
540-9822463, x3830
Penny Greer-Link
Salisbury
Penny.greer-link@va.gov
704-6389000, x4949


Women Veteran Program Manager at all
Medical Centers
Women’s Clinic at every NC Facility
◦ Women have the option of being seen in the WH
clinic, but may be seen in other clinics


Interested and proficient women health
providers at each site
*WH services offered at most Community
Based Outpatient Clinics (CBOCs)




2/2013
Required full-time in every health care system;
must report to Facility Director or Chief of Staff
Linchpin for improved women's health services
Leader of facility women's program
Resource for women Veterans in the community
• Serves as clinical leader for facility women’s health
program
• Works with WVPM to form the foundation of the WH
team
• Establishes priority and direction for clinical quality
improvement
• Oversees WH educational initiatives for providers
and trainees
2/2013







Comprehensive Primary
Care
Expanded Tele-health
Cancer Screenings
Mental Health
◦ Depression
◦ Post Traumatic Stress
Disorder
◦ Military Sexual Trauma
Heart Disease
Diabetes
Nutrition Counseling






Mammograms
Pap Smears
Maternity Care
Reproductive Health
◦ Infertility Services
(excluding in vitro
fertilization)
◦ Tubal Ligation
◦ Menopause
New Born Care – up to 7
days Postpartum care
Substance Abuse treatment



Seeing more pregnant female veterans
Must be enrolled for healthcare to receive
benefits
Maternity care is not performed at the
Medical Center
◦ Veteran can choose local provider and VA will pay
as long as provider accepts VA insurance

Women can receive breast pumps through VA


On site mammography offered at following
VISN 6 sites: Durham, Fayetteville, Hampton,
Richmond, Salisbury
Mobile Mammography
◦ Will provide care to new Health Center Complex
(HCC) initially and will spread to CBOCs – van
available late summer 2014; implementation TBD




2/2013
FY13: 11 Women’s Health/Rural Health telehealth
projects funded after 8 launched in FY12; FY14
grant applications under way
Women’s health informational mobile applications
under development
IT Innovations maternity tracker (care coordination)
pilots selected
Many VISNs have not yet implemented WH
telehealth
29




2/2013
30
High-quality, equitable care on par with that
of men
Care delivered in a safe and healing
environment
Seamless coordination of services
Recognition as Veterans
Barriers to Care
2/2013
31
“We don’t know if it’s because they had
different roles, because they felt like they didn’t
do the same thing as some of our male
Veterans … whatever it is, they are still not selfidentifying.”
General Allison Hickey
VA Under Secretary for Benefits
9/27/12
2/2013
32



39% have zero or almost no knowledge of
needed information about VA
Misperceptions in all cohorts about who is
eligible for VA care
OEF/OIF/OND more knowledgeable than
other cohorts about available women’s health
and readjustment services
Source: 2010 National Survey of Women Veterans, (D. Washington)
2/2013
33




31% didn’t think they were eligible
21% didn’t know how to apply for benefits
20% said closest VA is too far from home
Other challenges:
◦ Difficulty getting time off for appointments
◦ Child/eldercare responsibilities
*Not mutually exclusive
2/2013
34
Source: 2010 National Survey of Women Veterans,
(D. Washington)
Major gaps prevent delivery of equitable health
care to all women Veterans (e.g., privacy, PACT,
GYN, etc.)
Needs:
 Leadership support essential to enhancing VA
health care for women Veterans
 High-functioning women’s health committees
with high-level involvement
 Succession planning for WVPMs and challenge
of institutional knowledge
2/2013
35

Free, drop-in childcare
pilots at three VA medical centers
◦ Northport, NY (Opened 4/2012)
◦ Buffalo, NY (Opened 10/2011)
◦ Tacoma, WA (Opened 12/2012)



2/2013
Open to eligible Veterans during
appointments
Pilots will run until September 30, 2013;
evaluation under way
No legal authority beyond this pilot
36


VA has significantly reduced
gender gaps and exceeds private
sector on most performance
measures for both men and
women
Gender Differences in
Performance Measures, VHA
2008-2011, identifies best
practices for eliminating gender
gaps based on success in VA
networks
2/2013
37
Gender-specific care to women Veterans in VHA
facilities substantially exceeds that in other
systems
Cervical Cancer screening
93.5%
VA average (2010-11)
Vs.
77% private sector (2010)
67% Medicaid (2010)
Breast Cancer screening
86%
VA average (2010-11)
Vs.
71% private sector (2010)
69% Medicare
51% Medicaid (2010)
Source: VA Office of Analytics and Business Intelligence 12-19-2011
2/2013
38
• Trained 1,500 VA providers in basic and advanced
women’s health care to enhance access
• Expanding large-scale provider/nursing education
programs
• Developing online training for core topics in
emergency women’s health, with virtual patient
platform, videos, traditional e-learning
 My VeHU Women’s Health Special Focus Topics February
through April: http://myvehu.com/
• Sponsoring grant program to develop/deliver in
traditional mini-residency format with virtual
components
2/2013
39

VISN 06 Women Veterans SharePoint site
https://v6infoshare.v06.med.va.gov/programs/wo
menshealth/default.aspx

Women Veterans Healthcare Site
http://www.womenshealth.va.gov