oia live and learn

OIA Live and Learn

Homelessness InitiativeLeveraged by VSSC

APRIL 25 2013

Betsy LancasterDeputy DirectorOIA∙OABI∙CAR∙VSSC Clinical Program Support501 265-0455

VETERANS HEALTH ADMINISTRATION Office of Informatics and Analytics

Homeless InitiativeIn 2009,

President Obama and VA Secretary Shinseki announced the goal of

ending Veteran homeless by the end of 2015.

75,609 Veterans were Homeless in 2009**Annual Veteran PIT Count (Point in Time - One Night in January)


Ending Veteran Homelessness Plan

Individualized Care• Housing Assistance

– HUD-VASH, Grant Per Diem, Safe Haven, Supportive Services for Veteran Families, Emergency Housing, Residential Housing

• Healthcare– Primary care (H-PACT), mental health, substance abuse, specialty, dental, vision

• Job Training– Compensated Work Therapy, VA employment opportunities

• Education– GI Bill

• VA Benefits– Claims processing, Foreclosures, Veterans Appeal Board


Supporting the Plan

“You cannot solve a problem you cannot see.”Secretary Shinseki

Homeless Initiative success required a robust and consistent data driven system – to track homeless Veterans, their needs, services and outcomes– to assess specific homeless programs and their effectiveness– to monitor progress in eliminating Veteran homelessness

The Homeless Office turned to VSSC


VSSC Support

VSSC ClinicalRegistry, Reporting and Analytics• Rodney Austin• Charlton “Butch” Fort*• David Jensen*• June Oliver

Homeless PACT Reporting• Deanna Bishop• Freddy Kirkland• Deborah Fullerton

• Betsy Lancaster

*Full-time devoted to Homeless Initiative

VSSC OperationsData Collection - HOMES and Legacy• Thomas Bricker• Suryapratap “SP” Thakur• Jeanne Weishar

VSSC BusinessFinancial Reporting• Regina McMillen

Management Reporting• Melinda Bishop


Homeless Services Registry• Provides a national snapshot of progress towards VA’s Five Year Plan to End

Homelessness Among Veterans.

• Incorporates data collected through Homeless Operations, Management and Evaluation System (HOMES), VBA benefits, VHA clinical and administrative records and external data from HUD and community providers to provide both a programmatic and veteran centric longitudinal perspective on the prevalence of Veteran homelessness.

• Includes data related to HUD-VASH that is derived from HOMES, most particularly data related to case management and housing status.

• In addition to patient demographics and enrollment, the registry provides clinical information related to mental health, primary care, urgent care and inpatient treatment activities and future appointments.


Homeless Registry Components

Homeless Registry

Homeless & At Risk Veterans Reporting Tools

V60.0 Lack of HousingVHA Homeless Svcs

Legacy Homeless DataVBA Homeless Flash

VHA Homeless ScreenerSupport Svc Vet Families

HUD/HMIS

Homeless Operations

Management & Evaluation

System(HOMES)

Homeless Services Cube

Performance Measurement,Case andManagementReporting

VHA & VBADatabases

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VBA Benefit Claims (C&P, VRE, Edu)Veteran DemographicsAddress and Contact

Military Service/OEFOIFONDHealth Eligibility/EnrollmentVeteran Identification Card

Primary Care TeamClinical Diagnoses

Future VHA AppointmentsClinical Utilization

Housing StatusEmployment Status

Future Data SourcesVBA Loan Guaranty

VBA Education BenefitsVeteran Appeals Board

Ancillary Information

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Homeless Services CubeThe Homeless Services cube and briefing book were developed as just one part of an integrated system of homeless and at risk programs and services, data capture, analysis and reporting.

• Used extensively by the Homeless Program Office to track workload and Homeless and At Risk Veterans

• Allows for aggregation, dissection, grid and graphical analysis of homeless programs, Veterans and metrics

• Includes approximately 568,000+ Veterans who are currently or formerly homeless and at risk for homelessness. Many are currently housed. Once a Veteran is placed in the registry, they are always in the registry so that we can adequately track Veteran outcomes and program effectiveness.

• Contains information on the 18 Homeless Program areas and over 300 metrics

• Includes Veteran Level detail and Homeless Veteran Profile (available only to those with NSSD access)

• Access the Homeless Services cube and Briefing book through the VSSC website


Homeless Service Cube


Homeless Services Cube


Homeless Veteran Profile

• Provides a one page CPRS-like summary of a homeless or at risk Veteran that includes information pertinent to his/her homelessness and housing status

• Lists key demographics , diagnostic categories related to homelessness, primary care team information, military service and eligibility, and contact information. Cube

• Has links to listings for Primary Care encounters, Mental Health care, VBA claims, Homeless Services, and future appointments.

• Can be accessed currently through a cell action on the Homeless Services cube• Access requires patient level SSN access within the NSSD database managed by

NDS. All access requests are automatically vetted and logged.• Enhancements in development:

– Enhanced and automated access to VIC Image– Direct Access to Homeless Veteran Profile to those with approved access.


Homeless Veteran Profile


Performance Measure Reporting

• HMLS1 - Percentage of Veterans Discharged to Independent Housing Arrangement• The VA’s Plan to End Veteran Homelessness calls for residential and transitional housing

programs to place a primary focus on discharging Veterans directly to independent housing in the community. This measure promotes and reinforces disposition practices and strategies that are consistent with this primary focus.

• HMLS3 - HUD-VASH Vouchers - Percentage of Veterans Housed (Point in Time)• The number of Homeless Veterans will decrease with each Veteran who obtains

permanent housing and case management through HUD-VASH. Permanent housing is critical to ending veteran Homelessness, and HUD-VASH is VHA’s primary resource for accessing permanent supportive housing.

• HMLS41 - Percentage of Veterans Served in HUD-VASH Who Meet Criteria for Chronic Homelessness

• This measure focuses on the percentage of chronically homeless Veterans entered into the HUD-VASH Program, which is a primary target population. Helps prioritize targeting the most needy and most vulnerable Veterans for permanent supportive housing.


Performance Measure Reporting• Percentage of Veterans Discharged to Independent Housing Arrangement• HUD-VASH Vouchers - Percentage of Veterans Housed (Point in Time)• Percentage of Veterans Served in HUD-VASH Who Meet Criteria for Chronic

Homelessness


HUD-VASH Voucher Monitoring


PACT and Homeless PACT Reporting

Of the approximately 568,00+ Veterans currently in the Homeless Registry, 383,166 or 67.3% are assigned to a Primary Care Provider (PCP) and PACT team.

Homeless PACT (Patient Align Care Team) is a specialized Primary Care team• Created to assist Homeless and At Risk Veterans with their primary care

needs as well as connecting them with resources to assist with their housing needs

• Includes currently 25 H-PACT teams with 5,378 Homeless Veterans assigned

• Reported to be highly effective at reducing ER/UR visits and transitioning to housing


Homeless PACT


Homeless Operations, Management & Evaluation System (HOMES)

HOMES is the Data Collection Tool used by VA Homeless Coordinators in the field• Assess Homeless & At Risk Veteran Needs• Collect Veteran and Family demographics and characters• Refer Veterans to Needed Homeless Services• Manage and track individual cases• Track housing status• Report case histories


HOMES

• Veteran History


HOMES

• Referral Form


HOMESHudVash Entry Form


Financial Reporting

Homeless Spending Reports were developed to assist facilities in managing dollars allocated and obligated for the Homeless Initiatives.

Data Sources:Automated Allotment Control System (AACS) – Used to track the Budget and Allocations to Program Offices and VHA Facilities.Status of Allowance (SOA) – Daily report of amount budgeted, obligated and unobligated balances by Account Classification Code (ACC).

Facilities receive allocations by Transfer of Disbursing Authority (TDA) via AACS. Mnemonic codes are used to designate what initiative the dollars are for. Allocations do not show up in Budgeted SOA until they are distributed to the ACC account assigned to that initiative.


Financial Reporting Homeless Spending Report

http://vssc.med.va.gov/tabreports/webrm/T21_HL_MonthlyMatrix.aspx


Financial Reporting Homeless Spending Report (cont’d)


Financial Reporting Homeless Spending Report (cont’d)

Partial screenshot of detail view. Information is at the Document ID level.


Financial ReportingHomeless EOM Spending Report

Homeless EOM Spending – data broken out by month from AACS and SOA

http://vssc.med.va.gov/tabreports/webrm/T21_HL_MonthlyMatrix.aspx


Homeless Products on the VSSC Website


Leveraging the Homeless Information

• Established a VSSC_Homeless database on the Corporate Data Warehouse (CDW)

• Refreshed Daily• Used by the Homeless Center and

Homeless Office for evaluation of programs and Veteran Outcomes

• Used to feed Homeless Unique data monthly to the VHA_NU database created by VA’s Deputy Asst Secretary for Data Governance and Analysis to track Veterans/Users across VA

• Will be used by VINCI in the future to provide Homeless data for approved researchers


Top Priorities• Continue to provide data, tools, and knowledge that will foster the operation of high-

value, high quality, safe, and patient-centered healthcare systems in the fight against Veteran Homelessness.

• Support frontline homeless coordinators in the collection and accuracy of data

• Improve and enhance our ability to provide a last known housing status for Veterans at-risk for homelessness using VHA Homeless Screener data (clinical reminder).

• Incorporate and develop internal and external reporting for the Supportive Services for Veteran Families program

• Transfer into production the Homeless Veteran Profile (stand alone and through Homeless Services Cube) with VIC interface

• Expand our reporting for Homeless PACTS, the providers and teams


Major milestones / projects within the next 6 months

Homeless Management Information System (HMIS)• The HMIS database contains the data for the Supportive Services for Veteran Families

(SSVF) program. With the inclusion of the SSVF data into the Homeless Registry and the Homeless Services cube, our section will be able to present a more accurate depiction of a Veteran’s housing status.

Homeless Screener Clinical Reminder into the Homeless Registry• Clinical reminders provide a current status as to how stable a Veteran’s housing outlook is

for the future. They can also answer questions as to the Veteran’s current housing status.Veteran Identification Card (VIC) pictures on the Veteran Profile.

• The inclusion of Veteran pictures on the Veteran Profile will enable social workers in the field to better identify and provide services to homeless Veterans.

Homeless PACT Reporting• Develop additional reporting to track program trends, team turnover, Veteran characteristics

HOMES• Version 1.8 phase I, II, & III which enhances the homeless experience with the

application facilitating data capture and accuracy


Major target audience for products/services

• VA Central Office• VA National Center on Homelessness among Veterans• VHA Homeless Program Office• Network, VISN and Facility Homeless Program Coordinators• Northeast Program Evaluation Center (NEPEC)• Department of Housing and Urban Development (HUD)• Community Solutions


Homeless Registry is Patient Centered

Homeless and At Risk Veterans are a very transient population. And, unfortunately they tend to move in and out of programs and housing.

• Focus on the characteristics of the Veteran, the services and benefits they received, the benefits they requested and the hurdles that are specific to the homeless (frost bite, depression, substance abuse). Established Homeless Veteran Profile provides a CPRS like detail for the Veteran across data domains, across facilities, across administrations

• Incorporated PACT team and provider into registry (75% of Homeless Veterans are assigned a PACT team)

• Provide Image of Veteran to encourage report between Homeless Coordinator and Veteran

• Provide Veteran level detail on reports where possible to assist facilities and providers in identifying individual patients for special focus. This is both as part of operational metrics and specific program area reports.

• Homeless Services Cube• Performance Metrics (HMLS1, HMLS3, HMLS41)• Homeless Veteran Profile• HUD-VASH Chronic/Vulnerable Veterans Report


Data DrivenThe Homeless Registry which incorporates multiple disparate data sources into one centralized database for Homeless Reporting. • VHA Data Sources

• CDW - Inpatient, Outpatient, Patient, Clinical Reminders, Encounters, PCMM, Provider• Health Eligibility Center Data

• VBA Data Sources• VBA Education, VRE and claims with Homeless Flash• Home loan defaults

• NEPEC Homeless Legacy data (pre-HOMES)• Homeless Operations, Management and Evaluation System (HOMES)

• Homeless Veteran Assessments• Service Referral• Case Management• Discharge Housing

• HMIS SSVF/HUD-VASH (external data)• Veteran Identification Card (is this CBO owned?)• Financial Data• Homeless HUD Voucher Data


VSSC is a Virtual, Collaborative Team

We use many tools to encourage collaboration between team members:• Hold weekly Team meetings using VANTS, Live Meeting, Lynx• Hold Bi-Weekly Project Lead Meeting• Hold Monthly All VSSC Meeting• Use OneNote to capture meeting summaries, checklists• Track project progress with Project Tracker• Use Office Communicator to encourage active communication.• Track Product Web Hits and Customer Satisfaction• Answer Customer Questions and Concerns via VSSC HELP Desk• Facilitated 2012 VSSC BI Boot Camp• Newsletter and ListServ

• Use Microsoft Team Foundation Services (TFS) to provides source code management, continuous unit testing, team collaboration, agile planning, and continuous integration.


Forward Thinking has Always been in Our Past

VSSC has been successful in creating useful business information in support of healthcare operations due to our:

– Strong collaborations with user groups & partners such as Central Office, VISNs, Systems Redesign, Nursing, DSS, OQP, PCS, Planners, Quality Managers, etc.

– Diverse staff blending strong technical and analysis skills with comprehensive content expertise

– Innovative technical tools and diverse/new data sources– Agile and flexible approach to getting the job done– “Yes, we can help you with that!”


Contacts with Other Offices

Aside from our main customers: The Homeless Office and Homeless Center• VA Central Office• Veteran Benefits Administration• Central Business Office• Office of Information & Technology/Corporate Data Warehouse• Finance• Veterans Board of Appeals• Housing and Urban Development (HUD)• Various Contracting Groups


Measuring Success

• Received recognition from Secretary during a briefing where he proclaimed after viewing the Homeless Registry, cube and Homeless Veteran Profile that he “felt like a kid at Christmas”

• Presented the Secretarial Coin last spring for work on registry and reporting

• Featured prominently in the National Center on Homelessness among Veterans 2012 Annual Report

• 1,500 users and 20,000 hits for FY13

Most importantly, it’s the bottom line…..


Ending Veteran HomelessnessVeterans PIT Trend 2009-2012

2009 2010 2011 20120

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Total VeteransSheltered VeteransUnsheltered Veterans

17% Decrease in the Number of Homeless Veterans Since 2009. Homeless Center


Questions

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Contact UsRegistry And Reporting:Butch Fort [email protected] (318) 990-5080David Jensen [email protected] (619) 500-2097Rodney Austin [email protected] (405) 286-4073Betsy Lancaster [email protected] (501) 265-0455

HOMES:SP Thakur [email protected] (919) 858-6544Tom Bricker [email protected] (208) 388-3511

Financial Reporting:Regina McMillen [email protected] (817) 633-0961

mailto:[email protected]







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