I see a number of old friends and associates in the audience. Rather than recognizing each of you individually, let me greet all of you by saying that I am honored to be here, once again, with the leadership of the National Guard.
In this season of thanksgiving, I always ask the Almighty’s blessings on all who serve and have served the cause of peace. I thank the men and women of the National Guard for your service and your sacrifice, and that of your families. As a Nation, we are much indebted to you.
President Lincoln’s charge, in his oft-quoted 2nd Inaugural Address, to “care for him who shall have borne the battle and for his widow, and his orphan...” adorns every VA facility and appears repeatedly in our publications. It has become our mantra, defining VA and what we do.
Care is the operative word in that quotation. As a result, most see us as a healthcare organization, and for the most part, that is true.
We operate 153 Medical Centers, which are affiliated with 122 of the top medical schools in the Nation, all of which are networked through VistA, our extensive electronic health record—the most comprehensive one in the country—networked to the 774 Community-Based Outpatient Clinics; 232 Vets Centers; and our other outreach and mobile clinics that extend even further into the rural countryside, where Veterans live. This extended network of capability and care makes VA the largest integrated healthcare system in the country.
Everyday, more than 298,000 people come to work in our three divisions to serve Veterans—our Veterans Health Administration, Veterans Benefits Administration, and National Cemeteries Administration—making VA the 2nd largest department in the Federal Government. But beyond healthcare, here’s what’s also true about VA:
Notwithstanding the breadth and depth of these capabilities and services, here’s what’s also true about our Veteran population: They number roughly 23 million, yet only about a third of them—7.9 million—are enrolled in VA. Five-and-half million of them see us at least once a year, and 3.5 million see us routinely—in some cases, weekly. In purely business terms, that means we enjoy about a 30 percent market penetration. Caring for Veterans and providing them the services and benefits they have earned is VA’s sole reason for existence, yet 70 percent of our market chooses to turn elsewhere for support—or, they go without.
Now, Veterans lead the Nation in homelessness, depression, substance abuse, suicides, and they rank right up there in joblessness, as well. We estimate that 131,000 Veterans live on the streets of this richest, most powerful country in the world—men and women, young and old, fully functioning and disabled, from every service, every component, and every war generation, even the current operations in Iraq and Afghanistan. While that estimate declined over the past 6 years and we seem headed in the right direction, the current economic troubles threaten to reverse that gain, increasing Veteran homelessness by 10-15 percent over the next 5 years. That is not going to happen.
Finally, 40,000 Veterans are released from prison each year—part of a turnstile system of re-institutionalization or homelessness.
These snapshots don’t come together very well for me. I don’t know why 15 million Veterans have chosen not to enroll in VA, especially during these difficult economic times. We want them to know that VA is here, and we are increasing our outreach to them. I need your help in getting that word out through your folks to Veterans in your communities.
President Obama has charged me with transforming VA into a 21st century organization. I’m not a clinician, and I didn’t grow up in VA. So, the past 10 months have been a time of learning as much as I can, as fast as I can. At VA, we advocate for Veterans—it is our overarching philosophy, and in time, it will become our culture. If anyone asks you what VA stands for, you tell them that VA advocates for Veterans.
Now, to do that well, we have to join the 21st century in all our myriad processes and programs. We must adapt to the demands and pace of the digital, mobile, and virtual world. Speed, precision, and quality drive those demands. While in the health administration, we enjoy the Nation’s (maybe the world’s) most comprehensive electronic health record, in the benefits administration we are paperbound—bogged down and decisively engaged. 11,450 claims adjusters currently do this for us everyday.
We are re-engineering our business processes—fundamentally challenging all our assumptions for why we process the way we do—and bringing latest technologies into our workspace in order to connect to all our Veterans, especially our youngest, with better, faster, higher-quality decisions and services. How fast is fast? I don’t know, but that is what we are going to find out.
In April, President Obama charged Secretary Gates and me to build a fully interoperable VA/DoD electronic records system that will provide serving members of our Armed Forces a Virtual Lifetime Electronic Record (VLER) that will track them from the day they first put on the uniform, through their time as Veterans, until the day they are laid to rest. Between VA and DoD, we have an opportunity to drive the improvement of healthcare through a fully interoperable electronic health record. I need your help to colonize the understanding that “uniform registration” of service personnel, yours included, and DoD/VA collaboration are crucial for a 21st century VA. We must do this better than we ever have before.
Most of what we deal with in VA doesn’t originate there; it originates in DoD—that’s where operational decisions are made, which have consequences. We have absolutely no role in any operational discussions, but we do need to better understand those decisions earlier in order to anticipate the kinds of requirements Veterans will need when they come to us.
For example, any possible healthcare issues involving injury or toxic exposures of RC formations is a time-sensitive issue. You and I know that where reserve component units are concerned, we have maybe six months following redeployment to capture individual-level detail governing any RC formation. Because of the way you fill units for deployment and your annual turnover rate, those units quickly become a shell of what they were following demob. If we are going to avoid the difficulties of Agent Orange and Gulf War illness, we must begin baselining the quality of health, maybe even including blood and tissue sampling, of each member of a formation that’s been exposed. This level of increased DoD/VA collaboration will be good for the services, good for Veterans, and good for the Nation.
Over the next five years, we are going to take 131,000 homeless Veterans off our streets. There are not many absolutes in life, and I know that making this commitment approaches an absolute. But, unless we set an ambitious target, we would not be working this issue hard enough. No one—no one—who has served this Nation, as we have, should ever find themselves living without care and without hope.
Homelessness is merely the last rung on the downward spiral of missed opportunities. We must offer education, jobs, treat depression, fight substance abuse, and offer safe housing. We have to do it all, simultaneously. Here’s how we are beginning to take that on:
Education: We’re implementing the Post 9-11 GI Bill—not without issues, but it’s getting done—a powerful option for qualified Veterans to pursue a fully funded degree-completion program at a state college or university of their choice—the largest program of educational benefits for Veterans since the original GI Bill of 1944.
By the time that original GI Bill expired in 1956, our Nation was richer by 450,000 trained engineers, 240,000 accountants, 238,000 teachers, 91,000 scientists, 67,000 doctors, 22,000 dentists—and by the early 1960’s, more than half the members of the United States Congress.
They and a million other college-educated Veterans went on to provide the leadership that catapulted our economy to the world’s largest, and our Nation to be leader of the free world and victor of the Cold War. With the new, Post 9-11 GI Bill, history is likely to repeat itself with this latest generation of Veterans. Let’s all help them make it to graduation day.
Next, jobs: VA puts Veterans first both in its hiring and in contracting. Thirty percent of our workforce are Veterans. We will improve on those numbers in the years ahead. Last year, in a survey conducted by the Society for Human Resource Management, over 90 percent of employers said they valued Veterans’ skills—especially their strong sense of responsibility and teamwork.
VA also puts Veterans first in its contracting awards. In FY 2008, $1.65 billion in VA contracts went to service-disabled Veteran-owned small businesses. We are collaborating with the Small Business Administration and the General Services Administration to certify Veteran-owned small businesses and service-disabled Veteran-owned small businesses for listing on the Federal Supply Register, improving their visibility and enhancing their competitiveness for federal supply contracts.
Why these initiatives? Because Veterans hire Veterans. They know what they’re getting. So, creating more Veteran-owned small businesses increases our opportunities for getting Veterans into the workforce.
Healthcare: VA will spend $3.2 billion this year to prevent and reduce homelessness among Veterans—$2.7 billion on medical services and $500 million on specific homeless programs. With 85 percent of homeless funding going to healthcare, the implication is that homelessness is very much a healthcare issue—heavily burdened by depression and substance abuse.
The psychological wounds of war affect every generation of Veterans. We must aggressively diagnose and treat these unseen wounds to address other portions of the downward spiral that often result in severe personal isolation; dysfunctional behaviors; losses of identity, confidence, and personal direction; shattered relationships; depression; and substance abuse. We know this cycle; we’ve watched it for years. We are not going to let this happen to this generation.
Last month, VA and DoD co-sponsored a national summit on mental health, attended by over 300 mental health professionals from across the country, as well as military and Veterans advocacy groups. Out of that summit will come a consensus report and a plan for better coordinating VA and DoD mental health efforts. VA now employs over 19,000 mental health professionals to address Veterans’ needs. We know, if we diagnose and treat, people usually get better. If we don’t, they won’t, and sometimes their problems become debilitating. We understand the stigma issue, but we will not be dissuaded from providing mental healthcare and returning hope to our homeless Veterans.
Housing: Healthcare alone will not end homelessness. We need additional housing to take in those who slip through our safety nets. We currently partner with more than 600 community organizations that manage roughly 16,000 transitional housing beds across the country.
Our collaboration with the Department of Housing and Urban Development has also grown in scale and measurable results. In 2008, HUD provided 10,150 HUD-VASH vouchers for homeless Veterans. HUD-VASH II, approved in 2009 for implementation in 2010, provides 10,290 more vouchers —each HUD-VASH voucher can house a single Veterans or Veterans with families.
So, education, jobs, treatment of depression and substance abuse, safe housing—we must do it all. This is about challenging all the assumptions, even those that go to the very heart of one’s organization.
I have asked why, 40 years after Agent Orange was last used in Vietnam, this secretary is still adjudicating claims for service-connected disabilities related to its toxic effects. And why 20 years after Desert Storm, we’re still debating the debilitating effects of whatever causes Gulf War illness. Left to our present processes, 20 or 40 years from now, some future secretary could be adjudicating service-connected disabilities from our ongoing conflicts. We have begun to review those processes, as well.
Challenging the assumptions includes reviewing how VA serves a Reserve Component that has been employed in ways not seen since World War II. We are looking for better ways to serve RC Veterans. We are being proactive in providing earned care and benefits, but is it enough? As a department, we are striving to be as responsive and flexible as you and your Soldiers and Airmen have had to be.
As most of you know, Guard and Reserve members returning from combat tours are entitled to five years of free VA healthcare and 180 days to obtain a one-time dental evaluation and treatment. This means we need to get them quickly enrolled in VA. With this generation, a letter in the mail doesn’t cut it anymore. There has to be personal contact for the message to get across, and we have designed an outreach office with a plan to do that.
Called the “Seven Touches of Outreach,” the goal of this program is to engage Guard and Reserve Veterans at least seven times during the deployment cycle, with targeted messages and face-to-face encounters with VA staff members.
Touch Point 1 is VA’s Reserve Component Demobilization Initiative to ensure RC Veterans returning from the combat zone are introduced to VA during out-processing at the 61 demob sites (61 total—15 Army, 36 AFR, 4 Navy Reserve, 3 Marine Reserve and 3 Coast Guard Reserve). They receive an overview on VA services and benefits and are enrolled in VA healthcare. Members are assigned an OEF/OIF program manager to contact, who will set up their initial health and dental appointments at the VA facility of their choice. We’re working with MG John Ellington, National Guard Chief of Chaplains, and with Family Readiness Coordinators to implement this demob program for both Soldiers and Airmen in the Guard.
Since May 2008, we have supported over 1,295 demob events, briefed over 73,000 Veterans, and enrolled over 70,000 of them, for a 95-percent enrollment rate.
Touch point 2 is VA’s Individual Ready Reserve Muster (IRR), initiated last May to inform IRR reservists of their enhanced VA health and dental benefits during their IRR muster. Over 5,200 reservists have attended IRR musters, and about 2,500 have enrolled.
Touch point 3 is VA’s Combat Veteran Call Center, which contacts oef/oif Veterans to ensure they are aware of VA services and benefits. Seriously injured or ill Veterans who have previously used the VA medical system and oef/oif Veterans discharged from the military, who have not accessed VA healthcare have been targeted as priorities. In its first year, the call center made over 700,000 phone calls and either contacted or left messages for 515,000 RC members.
Touch point 4 is DoD’s Yellow Ribbon Program (yrp), where VA staff provides “boots on the ground” for Yellow Ribbon events initiated in 2009 for each of the services during the 30-60-90 days post-deployment cycle. VA has supported over 665 events Nationwide, reaching over 80,000 service members and 54,000 family members.
Touch point 5 is DoD’s Post-Deployment Health Reassessment (pdhra). VA supports the health assessment conducted by DoD providers and is able to link RC Veterans with appointments to VA for mental health or other follow-up requirements. Of 298,000 RC Veterans screened, 107,000 have been referred for further evaluation. 61,500 members received appointments for healthcare and 25,000 to Vet Centers for readjustment counseling.
Touch point 6 is VA’s partnership with the National Guard and the training of Transition Assistance Advisors (taa’s), who work for the adjutant general in each state. TAAs have reached out to over 360,000 RC Veterans and referred over 76,000 to VA for services or benefits.
Touch point 7 is the new Internet Web page for oef/oif Veterans. The site uses blogs and other social media tools to engage this new generation of Veterans. There is also a section on the Web site for women Veterans and family members. John Brown serves as director of VA’s oef/oif Outreach Office.
In closing, I ask all of you to talk to your Soldiers and Airmen—stress the importance of registering with VA as soon as they are eligible. Many view VA as an organization for old men, but it will become important to them in 10, 15, 20, or 25 years.
Again, thanks for this invitation. I hope you have a productive conference. I wish you all well in your service to our Nation. God bless each of you, God bless our Veterans, and may God continue to bless our wonderful country. Thank you.