Veteran Coordinator programs are a new initiative to reach veterans. The first site in Michigan, and fourth in the nation, began at Baraga County Memorial Hospital (BCMH) in 2023. Michigan sites now include Helen Newberry Joy Hospital in Newberry, Schoolcraft Memorial Hospital in Manistique, Mackinac Straits Health System in St. Ignace, and soon Munising Memorial Hospital in Munising. The program’s objective is to help Veterans connect with benefits and resources. Given the success of the program, we continue to add sites.
Before implementing the program, BCMH estimated serving about 60 Veterans. Since 2023, BCMH has identified and served over 870 veterans. About half of these indicated a need to meet with the onsite Veterans Services Coordinator; for BCMH this role is filled by a Registered Nurse at the hospital. The BCMH data is from a continued pilot funded by the VA Office of Rural Health.
In December 2023, then VA Secretary at the time, Denis McDonough, Congressman Jack Bergman, and many other community leaders, including tribal leaders, and the Director of Michigan’s Veterans Affairs Agency, attended a roundtable regarding BCMH’s Veteran Coordinator program, speaking to local Veterans about pertinent issues. It is the first time a Secretary of the VA has ever visited the area. Dr. Carolyn Turvey, Iowa City Veterans Rural Health Resource Center, is the lead on the VA’s Veteran Coordinator model.
Left to Right: BCMH Dir. of Provider Services, Tom VanEss; BCMH CEO, Rob Stowe; I-REACH Project Mgr., Jim Yates; Clinical Dir. of Veterans Rural Health Resource Center, Iowa City, Dr. Carolyn Turvey; Congressman Bergman; Secretary McDonough; Dir of MVAA, Brian Love; BCMH Chief M.O., Dr. Todd Ingram. Not pictured: BCMH Case Mngr and Clinic Sup., Sue Ingram, RN; BCMH VA Coord. Lori Karvonen; Baraga Cnty VSO, Doug Gray; Keweenaw Bay Indian Community Pres., Doreen Blaker; tribal council member, Rodney Loonsfoot; I-REACH Principal Investigator & Dean of Research Univ. of Texas El Paso, and Veterans Wellbeing Lab, Dr. Emre Umucu.
Each Veteran Coordinator site is unique. The program is flexible, allowing the host site to use methods that best fit their needs and Veteran patients.
Sites identify a staff member, or two, who will dedicate time to assisting patients who are Veterans. This includes referrals for Veteran benefits; referral and enrollment assistance for VA healthcare and/or community care (based on Veteran preference and eligibility); address social drivers of health (SDOH); track progress and effectiveness of referrals; and provide reports and data.
The Michigan Center for Rural Health (MCRH) partners with the site to provide funding for one year. Funding is intended to cover costs associated with the program such as salary, modifications to intake screening, and outreach/ marketing, etc.
Situation
Michigan’s Veteran population is one of the largest in the US, with more than 500,000 Veterans. Of these less than half are connected to all their earned benefits. Awareness and how to get started are the largest barriers.
Community providers play a vital role in ensuring Veterans receive the care they’ve earned. Most Veterans, especially in rural areas, receive care in the community, and not at a VA facility. We’re asking community providers to help Veterans get connected to their earned benefits. Healthcare providers, given their professional skills and existing screening and referral procedures, are in the best position to assist in this effort.
Facility and the Veteran Coordinator support is provided by MCRH and the I-REACH Rural Veterans Program, local VA Medical Center Community Care Specialists, local VA clinics aka Community-Based Outpatient Clinics (CBOC), and local County Veterans Service Officers (CVSOs).
Mission
The Veteran Coordinator site will ensure each Veteran patient is identified and given an opportunity to connect with all their earned benefits. This is accomplished by providing a ‘warm hand-over’ (referral) to the local County Veteran Service Officer (CVSO), and by using a closed-looped referral approach for follow-on assistance, information and quality assurance.
Execution
The facility must screen all patients for military service at all intake points. The preferred screening question is, “Have you, a family member, or anyone close to you ever served in the military?” Guidance for next steps when the answer is “Yes” can be found in the I-REACH Veteran Connector Toolkit.
We emphasize the positive impact properly screening for military service can have on the veteran, their family, and the facility.
- Increased enrollment leads to increased utilization.
- Benefits providers to know patient background due to the unique culture, possible exposures, and common medical conditions of military service.
- Providers can identify trends in Veteran health conditions, which could impact future legislation, such as the recently introduced PACT Act.
- Identify SDOH and implications associated with Veterans.
- Facilities can recoup funds by billing the VA.
- Improve facility needs assessment efforts.
- Improve accuracy of patient characteristic report to Uniform Data System.
- Reduces readmission rates via care coordination (including social needs).
How much assistance, and with what aspects of Veteran benefits and health care the Veteran Coordinator provides, would need to be discussed with the CVSO. Also, this will continually evolve based on the Veteran Coordinator’s experience and time allotted, the Veteran’s specific issue at the time, and other nuances.
The facility should be in the VA Community Care Network, CHAMPVA system and Tricare’s Humana East network.
Administration & Logistics
The process of data collection and reporting will be discussed with each site; it should not be burdensome. Consideration should be made for reports showing program impact, as well as capturing success stories for shared learning, and qualitative outcomes.
Preferably the facility would set up reports off their existing reporting mechanism to reduce unnecessary work and eliminate duplication. An alternative could be a simple spreadsheet.
We request that CVSOs also track these referrals and provide feedback and reports. In some cases, CVSOs may be able to estimate a dollar value going back into the community from the benefits received by Veterans.
Communication and Support:
Communication and Support
Monthly virtual meetings with Michigan Veteran Coordinators are currently scheduled. Also, we understand, and anticipate, the coordinators and facility’s need for additional support while implementing the program, and during its early stages.
A Few Success Stories
- A woman Veteran presented, she has a 10% service-connected disability but was not enrolled in VA healthcare and should have been. She had several financial and legal issues relating to divorce. The facility’s Veteran Coordinator assisted with VA healthcare enrollment, connection her with VA’s Women Veterans Program Managers (WVPMs) and Veterans Justice Outreach and the County VSO.
- Before meeting with the Veteran Coordinator, a social worker employed by the hospital for 14 years, was unaware of VA benefits for surviving spouses & children. Another staff member was unaware of the VA caregiver programs.
- A Veteran rated at 100% disability was referred to the Veteran Coordinator by a social worker. The Veteran was unaware of CHAMPVA (low-cost health coverage for spouses and children.) He was also unaware of property tax exemption.
- A Veteran called the facility requesting assistance with medication payments (over $500/month). It was prescribed by a non-VHA provider. The Veteran Coordinator switched the Veteran’s primary care to their facility, enabling care and prescriptions to be reimbursed by VA.
- Following the Secretary of the VA’s visit, the Undersecretary of VA started his congressional testimony to the Veterans Affairs Oversight Committee by sharing this success story: A Veteran’s CPAP machine’s limited power back up restricted a Veteran from traveling and engaging in activities. VA CPAP machines don’t include batteries. The Veteran has to purchase a battery, and they are very expensive. The Veteran Coordinator stepped up and helped find a solution. It wasn’t a heavy task, as the Coordinator said, “I really didn't do anything, except [find information] and refer him to the CVSO who used County funds to buy him a battery. I just made a couple phone calls and got back to the Vet right away. I don't think he was used to people actually doing what they said they would and following through.”
Helping a Veteran can be as simple as that. Let us help you better serve those who have served us. Contact Jim Yates, I*REACH Project Manager at yatesja1@msu.edu for more information.