Coalition to Transform Advanced Care (C-TAC) Summit

Leonard Schaeffer, thanks for that kind introduction, and for the great research you’re leading out at the University of Southern California.

Let me also acknowledge CTAC co-founders Bill Novelli and Tom Koutsoumpas. Thanks to you and all your people for doing the hard work of bringing us together for this truly important event.

And to everyone who has worked to make this advanced care summit possible—thank you. It’s important for Veterans, and it’s important for all Americans. It’s inspiring to see such a diverse group of leaders and world-class innovators so committed to improving care for those with advanced illnesses.

Three days ago, I was in Togus, Maine, for the 150th Anniversary of our very first facility. Let me tell you what Togus was about back in 1866, a year after the end of the Civil War.

First, it was about giving an immediate safe haven to Veterans who had survived four years of vicious fighting. Given the brutality of the fight, it’s not surprising that many simply could not care for themselves, and many families and communities were ill-equipped.

Second, Togus was about establishing a framework for what most everyone knew was coming as hundreds of thousands of Veterans aged and would need specialized care for injuries unique to warfare, and injuries unique to that very particular war. Amputations. The loss of one arm and one leg. The loss of both arms. The loss of both legs. Diseases like dysentery and typhoid Soldiers contracted in camps and in trenches.

The federal government knew these Veterans could be suffering for the rest of their lives. And they knew that if those Veterans weren’t suffering yet, then in five, ten, 15, 20 years down the road, they would be.

So that first National Soldiers Home was about something more than taking care of the disabled at the end of the war. It was about getting ready for the wave of disabled that would be coming. You see, Togus was the cornerstone of the network of National Homes that in 1930 would become the Veterans Administration.

Here’s why all of that is so important. Everyone knows that we age. Everyone knows that we get sicker and need more care as we age. But it’s visionary people who do something about it. It was the visionary people who conceived of the National Homes—the first of their kind anywhere in the world—who did something about it for those Union Veterans.

How’d that vision turn out? Those visionaries gave generations of Veterans to come—indeed, all Americans—the Department of Veterans Affairs, the largest integrated health care system in the United States, with over nine million Veterans enrolled.

How’d that vision turn out? Three hundred and fifty thousand people working to care for Veterans at over 1,200 health care facilities across the country.

How’d that vision turn out? Today, VA invests nearly $2 billion annually on research that serves today’s Veterans, and prepares us for the Veterans to come. Let me highlight some of the returns on those investments.

  • The nicotine patch
  • Electronic medical records
  • Patients with total paralysis using their minds to control robotic arms
  • The implantable cardiac pacemaker
  • The first successful liver transplants
  • Proving an aspirin a day reduces risk in heart patients
  • And identifying genetic risk factors for schizophrenia, for Alzheimer’s, and for Werner’s syndrome.

Who would have thought 10 or 15 years ago that we could identify risk factors for Werner’s syndrome by mapping the genome? I wouldn’t have. But a lot of smart people did. That’s the power of vision, and that’s the power of research.

Breakthroughs like those serve Veterans, but they serve all Americans. And that is why were are here today. We’re going to elevate the conversation on advanced illness care to the highest levels so we can get way beyond the things we already know and get to those breakthroughs we’ve never even imagined.

And we’re doing that by bringing together a diverse group of some of the best minds in social work, psychology, caregiving, and medical research. It’s diversity that sparks innovation. Here’s how James Burke, the great science historian, said it: “Change almost always comes as a surprise because things don’t happen it straight lines. Connections are made by accident.”

We need to have a few of those accidents of innovation. And we need to have them pretty quickly. By 2020, Americans aged 65 and over will have grown from 15% to 22% of the population. The population of Americans 85 and older will grow from about 6 million to nearly 12 million by 2035.

There’s a wave of aging Americans coming, and we have to get ready. The Department of Veterans Affairs—and the Veterans Administration before that, and the Veterans Bureau before that, and the National Homes before that—has always served as a “canary in the coal mine” for emerging healthcare issues. If you want to know what’s going to happen to your patient population in 10, 15, 20 years, look at what’s happening to Veterans right now.

What we’re seeing among our younger Veterans, who’ve been at war for the last 15 years, is just a sample of what we’re going to see in 2020, 2030, and 2040. They’re battling injuries we’ve never seen before, and we don’t know exactly how those wounds will affect Veterans as they age. But we intend to.

Remember the wave of aging Americans I mentioned? VA’s already endured our own tsunami, and it was called the access crisis. That crisis was about aging Vietnam Veterans turning to VA for healthcare at a rate we should have anticipated and prepared for, but we didn’t.

In 1960, only 2.2 million Veterans were 65 years old or older—7.5 percent of the population. By 2020 Americans aged 65 and over will grow to 22 percent of the population, while 47 percent of Veterans will be 65 or older, or 9.8 million Veterans. Between 2000 and 2015, the US population over age 85 increased about 60 percent while the Veteran population over age 85 tripled.

So here we are in 2016. We’ve learned some hard lessons. But we’ve benefited from some important accidents of innovation, and we’re applying those lessons learned.

Let me highlight a few of the initiatives we’re excited about.

In 2011, we launched our Million Veteran Program, or MVP. The MVP database is already the largest genetics database in the United States. More than 400,000 Veterans have enrolled. And we expect an enrollment of one million Veterans over the next five to seven years. Here’s what the Million Veteran Program is about. It’s a partnership between Veteran-volunteers and VA so we can learn more about how genes affect health. We’re working to apply the medical potential of genetic mapping to develop safer, more effective treatments based on new knowledge about the elemental role of genes in health and disease. By identifying gene-health connections, MVP stands to significantly advance disease screening, diagnosis, prognosis, and point the way toward more effective, personalized therapies. The MVP will be invaluable for future research on diseases like diabetes, cancer, PTSD, Alzheimer’s, and Parkinson’s.

In 2000, we started a pilot called VA Medical Foster Homes: Where Heroes Meet Angels. The Medical Foster Home program connects people willing to welcome a Veteran into their home with Veterans who would otherwise need nursing home care. Our VA Home based Primary Care teams provide care, oversight, and support and education for the caregiver directly in these homes.

In 2008, we had Medical Foster Homes in 3 cities. Today, we have Medical Foster Homes in 121 locations across 42 states, providing loving homes for 1000 Veterans every day. Our goal is to serve 5000 Veterans every day. Let me add that our Medical Foster Home program was recognized in The Wall Street Journal as one of the top 10 Health Care innovations in the US.

In collaboration with many of our national partners here today, we’ve made enormous advances in hospice and palliative care. In 2000, barely a third of VA hospitals had recognizable palliative care programs. Today, we now have palliative care programs in every VA hospital. The location of care is shifting, to honor Veterans’ preferences. In response to the wishes of Veterans, we are working to establish hospice beds in every VA hospital, too.

We’re getting close. We’re having conversations with Veterans and letting them play even larger roles in development of a treatment plan that’s right for them. That Veteran-centric approach is the catalyst of our Goals of Care Initiative, which will be replacing traditional advanced directives. The Goals of Care will be immediately accessible in all VA care settings across the nation—whether the Veteran is at home, in a VA medical center, or in a clinic.

This is truly personalized, proactive, patient-driven care for every Veteran. We’ve piloted Goals of Care in Chicago, Illinois; in Madison, Wisconsin; in Black Hills, South Dakota; and in Salt Lake City, Utah. National implementation is coming in the next months.

The last point I’d like to make is about the importance of caregiving. We all know that caregiving is critical to the comfort and welfare of our aging Veterans. What we also know is that caregiving is not easy. It’s hard work—physically and emotionally exhausting, and too often caregivers feel lonely and isolated.

So we’re offering caregivers peer support, using the world-wide web to bring them together in virtual environments so they can share information and support each other in the nuanced ways only they can understand.

That may not sound too important, but it is to them. Since we opened our National Caregiver Support Line in 2011, we’ve received over 190,000 calls and initiated over 33,000 referrals. That’s over 100 calls a day, and nearly 20 referrals a day.

The Caregiver Support Line is licensed social workers answering calls, helping caregivers find the resources they need in their local area, or just providing counseling. Next week, we’ll be kicking off some new caregiving initiatives with Elizabeth Dole and Tom Hanks.

VA depends so much on the work of others to accomplish our mission. We depend on your research, your expertise, and your insight. Let’s work together to identify other opportunities. I know that together, we’ll build more effective clinical programs in geriatric care.

For almost two years, I have been blessed to work on behalf of our Veterans. I take great pride in leading an organization that has the noblest mission in government.

On behalf of the entire VA, thank you for all you’re doing to better serve our Veterans. God bless all of you, our Veterans, and our great Nation. I look forward to your questions.

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