Lake Nona Impact Forum

Good afternoon and thank you for that warm welcome. Bruce Caswell, thank you for that kind introduction.

It seems like a long time ago, but it was just two years ago, the Spring of 2021, early in my time at Veterans Affairs. We were in the height of the COVID-19 pandemic. Our country, and everyone at VA, was laser-focused on saving American lives impacted by the ongoing health crisis.

I visited our Health Operations Center, or HOC. Low ceilinged room in our labyrinthine – and largely empty – Central Office in Washington DC. The room with about 25 people, carefully distanced, everyone masked, connected by Microsoft to more than 50 others across the country.

The VA health team in action.

And as the conversations came to an end, Dr. Richard Stone—then the Under Secretary of Health—began to call the roll among each of our 18 Network Directors. He knew, and each of them knew he knew, precisely how many of their vulnerable Veterans—those at risk of suicide—each Network Director had reached in the previous week, and he challenged to explain why they had not reached every single vulnerable Veteran, every vulnerable Veteran through a new and innovative VA program called the Recovery Engagement and Coordination for Health–Veterans Enhanced Treatment or REACH Vet.

Now I will talk about REACH Vet a little later but let me tell you what I saw in that room that day. What I saw that day was Veteran-centric care being paired with new innovations. VA clinicians recognizing that even in a pandemic—especially in a pandemic—we had to find solutions by putting ourselves in the shoes of the Veterans we serve—not waiting for problems to come to us but going out to preemptively find the problems before they manifested—so we could deliver solutions.

Again, I will explain REACH Vet more in a moment, but what struck me in that moment was not just the promise of that new innovation, but rather the unique strength of VA health care—tirelessly patient-centric care fueled by regular innovation.

I see that pairing every single day—Veteran-centric care combined with innovation and evaluation.

And the results speak for themselves.

Since President Biden took office, VA has provided more care—more innovative care to more Vets, in more settings than ever before.

We’re especially focused on shrinking the distances Vets have to travel to get care, particularly for rural Veterans, who enroll in VA healthcare at much higher rates than their urban counterparts.

At a time when health care is in increasingly short supply in rural areas, VA is fighting like hell to, and succeeding at, expanding access to care for Vets who call rural America home.

As we do this, as we pair innovation with Veteran-centric care, we have watched trust from our patients grow. Even as health care has become more complex and access to care has become more difficult in the broader economy, Vets trust us more—at more than 90 percent—trust on ease, effectiveness, and emotional support in outpatient care across our system this last year.

We’re evaluating ourselves from the perspective of our patients and holding ourselves to account when we fall short of their expectations.

We’re also constantly evaluating the delivery of outcomes for Veterans and doing research on these innovations to spread best practices across the health care industry.

Telehealth expansion was one of the most robust outcomes.

Now VA has long been the largest provider of telehealth services in the country, but we dramatically expanded telehealth use across clinical services. Telehealth tools are particularly important for our Vets in rural communities, who might have to drive for hours to reach their nearest clinic.

And the numbers tell the story. Here at VA, we’ve conducted 23 million virtual home visits over the past three years—a staggering 3000 percent increase in that time span.

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. 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.

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. So, we’re making sure that local VA Medical Centers serving rural communities have adequate infrastructure and training to participate as clinical research sites, while using tele-oncology to bring VA’s best-in-class cancer studies and treatment directly into a rural Veteran’s home.

And for the first time, tele-oncology allows us to include rural Vets, a huge segment of our population, in cutting edge clinical trials for the very first time.

That’s innovation—in what is the new reality—at its very best.

Another one of VA’s major investments in precision medicine is the Million Veterans Program, or MVP.

It’s the largest genetic database in the United States. And no one else has such a diverse genome databank as we do.

More than 930,000 Veterans have enrolled. 1 in 10 MVP participants are women. 1 in 5 MVP participants are black. MVP aims to be representative of all Vets—across race, ethnicity, gender, and age. So far, MVP demographics align with that of the Veteran population who receive their care at VA.

MVP is a partnership between Veteran volunteers and VA that allows researchers to learn more about how genes affect health.

Researchers study what puts Vets at risk—and what protects them—from different kinds of diseases by analyzing how genes, lifestyle, and military experiences affect health and illness. By identifying gene-health connections, MVP stands to significantly advance disease screening, diagnosis, prognosis, and point the way toward more effective, personalized therapies.

Already, this cutting-edge research has allowed us to build a new screening strategy for breast cancer using genetic and clinical markers.

It’s driven the evolution of safer, more effective treatments based on new knowledge about the elemental role of genes in health and disease, and it’s led to new findings for conditions such as anxiety, heart disease, suicide, kidney disease, cancer, and post-traumatic stress disorder (PTSD). In fact, an innovative study of more than 165,000 MVP participants identified several genes related to re-experiencing traumatic memories, which is one of the symptoms of PTSD. And what’s so promising about MVP and precision medicine is that we can move beyond general predictions to specific advances that influence the individual care of Vets.

And we’re pursuing and combining other innovations with research and new technologies. One example is VA leading the clinical implementation of Virtual Reality and defining a new healthcare delivery experience for Vets.

Right down the road at the Orlando VAMC, health care professionals are using virtual reality to provide evidence-based treatments for PTSD. This includes learning how to manage times of increased anxiety with relaxation techniques.

In response to his care, one Veteran said, “I had no idea that it was going to be so realistic that I could be instantly transported, for lack of a better word, to a place where instantly, I was at peace …. PTSD is hell, for lack of a better word, and it all just went away.”

So the use of VR provides an engaging, non-pharmacological tool that connects Vets to a whole health approach to mental, emotional, and physical well-being and healing. Nowhere is this more important than in our number one clinical priority, preventing Veteran suicide.

So for just a moment, let me circle back to REACH Vet.

Back in 2011, as part of VA’s commitment to reducing Veteran suicide, we launched Recovery Engagement and Coordination for Health–Veterans Enhanced Treatment or REACH Vet.

When Dr. Stone was challenging the Network Directors to reach their most vulnerable Vets, they were using REACH Vet—a validated suicide prediction algorithm that identifies Veterans who are at increased risk for suicide. They were using this tool to drive outreach to reach every Vet, at every facility, using the initial results of machine learning to save Veterans’ lives.

Last fall when we released our Suicide Prevention report, there was some really good news. For the second year in a row, suicide among Veterans has gone down. From 2018 to 2020, the Veteran suicide rate has decreased nearly 10%. Yet our work is not finished and we still have a long way to go.

But this report gave me hope because it made clear that while suicide is a human tragedy, it’s not an inevitable outcome. And our efforts, like REACH Vet, are focused on proving that. And simply put, it works.

Barry, a decorated Vietnam Vet who visited one of our clinics in the Bronx, New York, was one of several hundred VA patients nationwide who was deemed at an elevated risk of suicide based upon the predictive algorithm.

Now that news did not take him entirely off guard. Barry, who was 69 at that time, was badly wounded in the 1968 Tet offensive, and had already made two previous attempts on his life. But he was not totally comfortable with a computer recognizing this trait in him and finding him.

In his own words, Barry, said: “I don’t like this idea of a list, to tell you the truth—a computer telling me something like this but I thought about it and I decided, you know, OK — if it’s going to get me more support that I need, then I’m OK with it.”

And it did.

Program coordinators notified his clinicians who conducted outreach and collaboratively re-evaluated treatment strategies for Barry. They connected him to programs that promote health and wellness, healing and strength, and programs to intervene at the moment of crisis.

Not only did this work for Barry, but research studies show that REACH Vet results in increased treatment engagement, reductions in mental health inpatient hospital visits, and reduced suicide attempts.

Again, that’s using data to drive outreach using innovation to save Veterans’ lives because Vets need and deserve suicide prevention solutions that meet them where they are, rather than taking a one-size-fits-all approach.

And that’s why last May, we launched Mission Day Break, a $20 million-dollar grand challenge that will drive innovations to prevent Veteran suicide.

We invited a diverse group of solvers, including Veterans, researchers, technologists, advocates, clinicians, health innovators, and service members from across the country to help VA develop innovative concepts to reduce Veteran suicides.

And just a few weeks ago, we announced a final round of prizes through our Mission Daybreak challenge—totaling nearly $20 million across 40 teams—to build out proven new solutions developed by Americans in communities across the country.

These investments will help develop innovations that will save Veterans’ lives.

Let me tell you about the two first-place winners, who received $3 million dollars each. The first awardee was Stop Soldier Suicide’s “Black Box Project,” a technology solution that analyzes data from digital devices of Veterans who died by suicide to identify never-before-known risk patterns. And the second awardee was Televeda’s Project Hózhó, the first mental health app designed in partnership with Navajo Vets to reduce suicide in American Indian and Alaska Native populations using traditional healing practices.

But those awards are about more than just money. They’re about expanded partnerships—with health technology companies, universities, Veteran Service Organizations, Veterans, and other community groups—partnerships that hold promise for reducing Veteran suicide across the nation.

These partnerships and these people are using cutting-edge technologies to save Veterans’ lives. And at VA, that’s what Veteran-centric care and innovation are all about—saving and improving lives.

In closing, I want to reflect on something President Biden often says about serving Veterans. He says: “It’s our country’s most sacred obligation is 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 it comes back to the promise our country makes whenever someone signs up to serve in the military.

It’s a promise that’s as simple as it is fundamental. If you serve us, we’ll serve you when you come home. If you take care of us, we’ll take care of you. If you fight for us, we’ll fight for you. And in times like these keeping that promise to Vets has never been more important.

The technologies you will be talking about throughout this conference are a critical part of our ability to keep that promise, and I hope I have convinced you of that with these powerful examples. But all the technology in the world won’t keep that sacred obligation without the providers who keep Veterans at the heart of their care.

Providers like those at the Madison, Wisconsin VAMC, who set aside time at the start of every appointment to hear the story of their Veteran patients—a program which we’ve now expanded to VA hospitals across the country because they know that our Veterans are people—heroes—not a collection of symptoms.

And they are amazing people at that—and you can hear their stories by looking up “My Life, My Story” Whole Health program at the VA.gov website. Again, that’s My Life, My Story-Whole Health at VA.gov.

Or providers like our Chief of Staff in Seattle, the lead doc at that level one hospital, who at the peak of the pandemic was setting aside hours a day to call her panel of patients to get them to come in to get vaccinated. One Vet, frustrated that she had called him every day said, “how many times are you gonna call me to get vaccinated?” “Until you get the shot,” she said.

At the moment I thought to myself, how many patients in America right now are frustrated because their provider is calling them too often?

Or providers like a primary care doc in Fairbanks, who recently moved from Fairbanks to West Point, New York. She kept nearly all of her patients, because when those Veterans were told they could maintain access to her Vet-centered care by telehealth—even literally across the entire country—and in-person once a quarter, they jumped at the chance.

That—those Veterans, those providers, that VA—is care in a new reality. And I could not be prouder to be a small part of it.  

Thank you for listening. Have a great forum.