34th Annual Rural Health Policy Institute

Thank you, Leslie, for the warm introduction. And thanks to the team at the National Rural Health Association for bringing us all together today for this important cause. I’m thrilled to join so many great leaders who are committed to improving health outcomes across rural America.

Our military, the strongest ever on the face of the planet, draws on the strength evident in all corners of our great country. Among the great sources of strength for our Active Duty Forces are rural communities. And when it’s time for our troops to hang up their uniform for the final time, 5 million Veterans—a little over one-quarter of the entire Veteran population—settle down in rural America. Vets put down roots, build families, and thrive in those communities. At a time when health care is in increasingly short supply in rural areas, VA is fighting like hell to expand access for Vets who call rural America home.

And I’m proud to say—since President Biden took office—VA has delivered more care to more Veterans than any time in our nation’s history. This is especially true for rural Veterans, who enroll in VA healthcare at much higher rates than their urban counterparts.

You know, to me, this all comes back to that promise our nation makes to anyone who signs up for military service. If you take care of us, we will take care of you. If you fight for us, we will fight for you. If you have our backs, we will have your backs when you leave the service. Our country as a whole makes that promise. But it’s our job at VA to keep it—for rural Veterans, and for all Veterans. And that’s what I want to talk about today—how we’re keeping that promise.

First, let me talk about some of the ways we’re investing in rural facilities and innovating to ensure Veterans have improved access to in-person care. We’re working with our federal partners, including the Department of Health and Human Services, to fund community health centers in rural and remote areas. We delivered 15 major leases for Community Based Outpatient Clinics in 2022, and the PACT Act authorized 31 new leases in the years to come. Overall, that puts us at over 1,300 outpatient sites in communities across the country. We’re also continuing to employ innovative in-person care models, such as our Veterans Transportation Service, which ensures rural Veterans have adequate transportation to attend in-person medical appointments. Lastly, we provide options for Home-Based Primary Care, where a VA medical team travels directly to a rural Veterans home.

This commitment to rural Veterans allows them to receive the highest quality care, from the comfort of their homes. It also builds important relationships between Veterans and their providers. Providers like Nicole Lewis, a Registered Nurse in Clarksburg, West Virginia. She called a Veteran the day before she was scheduled to see him for a home visit. Nicole had gotten to know this Veteran extremely well—she said she considered him like family—so when he didn’t answer her calls, she realized something might be wrong. She immediately drove to his house and knocked at his front and back doors. She wasn’t sure, but thought she might have heard a muffled yell. So she called the police to conduct a wellness check, where they found the Veteran had become so tangled in his oxygen cord that they had to cut him out. Nicole stayed after the police left, to conduct a thorough medical assessment. She also showed the Veteran how to use a guardian alert system, which he previously felt he did not need. Nicole went above and beyond the call of duty for this Veteran, as she and so many of our providers do every single day.

Still, there is a lot of work left to be done. Rural Veterans often have to travel further to reach their nearest medical facility. This is more than a minor inconvenience; delayed treatments and screenings can result in life-threatening challenges, significantly increasing the risk of poor health outcomes. As a result, we’re continuing to expand the use of telemedicine and other virtual tools to reach Vets wherever they are. Telehealth tools are particularly important for our Vets in rural communities, who might have to drive for hours to reach their nearest clinic.

We have long been the largest provider of telehealth services in the country, but the entire medical profession has seen an exponential growth in this technology throughout the course of the pandemic. Here at VA, we’ve conducted 23 million virtual home visits over the past three years—a staggering 3000% increase since 2020. In the past year, over 38% of enrolled Veterans received a portion of their care by telehealth. For rural Veterans who have limited access to broadband connectivity, we’re working hard to bridge the digital divide to ensure that all Vets have access to VA telehealth care.

Telehealth has also opened up new and interesting opportunities to expand access to clinical trials for rural Veterans. For far too long, you couldn’t participate in these studies unless you lived in urban areas. But VA recently launched a pilot program to change that. We are ensuring local VA Medical Centers serving rural communities have adequate infrastructure and training to participate as clinical research sites, while using TeleOncology to bring VA’s best-in-class cancer studies and treatment directly into a rural Veteran’s home.

Any Veteran who qualifies to receive VA health care and lives in the US or a US territory is eligible to connect with their VA providers through telehealth. No matter the distance. Telehealth care is not just making appointments more convenient—they’re saving lives.

Let me tell you a quick story about one Veteran who gets his care through the VA whose life was saved by a routine telehealth appointment. This Veteran lives in a rural part of Alabama, near a pristine river where he can go out fishing almost every weekend—he’s on a first name basis with most of his fellow residents. He counts himself lucky to have access to a great Community-Based Outpatient Clinic at Fort Rucker. But if he needs specialized medical services, like eye care, he has to drive over three hours to the nearest VA medical center in Birmingham. One way. This Veteran had been having some vision problems and decided to set up a virtual eye appointment, through a VA program meant to bring remote eye screening services to rural or underserved Veterans who might otherwise have problems getting glasses or gaining access to an eye exam. During his eye exam, he was diagnosed with a pale optic nerve and the provider ordered him to undergo additional testing. This eventually revealed that his vision impairment was the result of a previously undiagnosed brain aneurysm. That eye screening, from the comfort of this Vets’ home, probably saved his life.

Let me say that again.

Telehealth saved that Veteran’s life.

Of course, telehealth on its own isn’t enough. Nothing is more critical to our success than the people we hire and retain here at VA, the people we need to serve America’s Veterans as well as they have served all of us. When it comes to providing care to Veterans and their families, study after study shows that we’re delivering better health outcomes for Veterans than the private sector. Veteran trust scores for outpatient VA care have averaged over 90% during the past year.

This is in no small part because of the incredible team of dedicated health care workers we have at VA. Like the rest of the medical field, however, one of our greatest challenges in rural health settings is a shortage of providers. That’s why hiring and retention are priorities. We must ensure we’re attracting and keeping great, caring medical professionals to serve rural Vets.

We are aggressively hiring health providers in rural communities and across the country. And we’re incentivizing our rural-based providers to stay rural. We are focused on better training and mentorship programs for providers and academic faculty serving in rural areas. Through our Office of Rural Health, we have provided training for 33,000 rural providers in specialty care areas such as geriatrics, gynecology, and psychiatry. We have funded five Veterans Rural Health Resource Centers across the country, in Iowa City, Salt Lake City, White River Junction, Gainesville, and Portland. Each Center has its own specific rural focus—from addressing the opioids epidemic to studying rural geriatric care—developing real-world, practical interventions to benefit Veterans in rural communities. Lastly, we are hosting a number of fellowships and financial award programs for researchers focused on rural Veteran health care challenges, in order to spark innovation and drive leadership.

Dr. Jessica Alva is one such fellow, a neuropsychologist out of the Central Virginia VA Health Care System. All of us have older relatives who struggle with technology—maybe some of us in this room do, occasionally, too. Dr. Alva saw this affecting access for older rural Veterans, including 75% of her older patients who were unable to complete their telehealth visits. So, what did Dr. Alva do? Motivated by a recent training she took, funded in part by the VA Office of Rural Health, she decided to make a change. She launched a project to help older Veterans, using focused intake questions to proactively determine if they might have an issue using technology and then addressing those problems prior to the appointment.

As simple as that. Within two months, 100% of telehealth appointments her team conducted with elderly Vets were successful. Her work became a model for providers across the country. So, we’re going to keep working on this, and make sure that we’re delivering world-class health care to all Vets.

I’d be remiss not to reiterate the fact that we are very aggressively hiring for the most passionate, highest-performing health care workers in the country who want to make a difference. If you are selected, you’ll be joining one of the best teams of professional, devoted public servants in government. It’ll mean a strong starting salary. It’ll mean opportunity for professional growth with superb colleagues, colleagues like Nicole Lewis and Dr. Jessica Alva. It’ll mean good benefits and other rewards for your hard work. But the greatest reward—the greatest reward—will be helping VA serve Veterans, and all their families and survivors.

Finally, I want to touch on mental health in rural Veteran communities. According to one study, 93% of rural counties in the nation do not have access to a single licensed psychologist. With this in mind, we have developed a peer specialist program to support Veterans, including rural Vets, across the continuum of mental health needs. We have brought on over 1,300 peer specialists, all fellow Veterans. We’ve given them professional training on how to use their personal experiences to inspire hope and serve as relatable role models for the mental health recovery of other Veterans—sharing similar military experiences and post-military personal struggles. They use a host of recovery tools to help fellow Veterans develop and enhance healthy coping strategies and manage mental health conditions. They are not clinicians—but the support they provide is invaluable in helping struggling Veterans reconnect with others, find a sense of belonging in their communities, and access available resources in and out of VA.

Veterans helping Veterans. The camaraderie they experienced in the military, extending long after they took off the uniform. There’s nothing better than that.

In closing, I want to reflect on something President Biden often says about serving Veterans. He says, “It’s our nation’s most sacred obligation to prepare and equip the troops we send into harm’s way, and to care for them and their families when they return home.” The second part of that sacred obligation is ours to fulfill at VA, and we will stop at nothing to serve Veterans, their families, caregivers, and survivors every bit as well as they have served us. All Veterans—regardless of who they are, who they love, what gender they are—or where they live. Here at VA, we will continue to help rural Veterans, to help all Veterans, thrive.

Thank you for listening. I look forward to your questions.