Speaker 2: Hello everybody. Welcome to Health chatter. Today's interesting show will be on Veterans health, which is, you know, a whole population that um, deserves our attention really. And we have a great guest with us get to him in just a moment. As always, I like to recognize our excellent crew. Maddie Laine Wolf, Erin Collins, Deondra Howard, and and Sheridan Nygard and also Matthew Campbell, all do a variety of different things but it centers around research, marketing and and also production. Without them, health chatter would not be as successful as it is. So you guys are dear colleagues and thank you so much. We also have Dr. Barry Bane who couldn't be with us today, but he's our medical advisor. often is on our shows to provide a little bit of a medical perspective. And then of course there's Clarence Jones. We have a lot of fun doing these shows. We uh we like to engage in conversations around health and hopefully it's interesting for you, the listening audience. Human Partnership is our sponsor, HUEE M A N partnership, great community health organization that does very, very innovative things out in the community to help a variety of different people with health related issues from a prevention standpoint and intervention. Check them out at Human Partnership.org. check us out at healthchatterpodcast.com. You can see all the background information that we have for our shows. If you have questions, we check out the website every once in a while, uh to to get back to you uh on questions that you may have. So we hope you enjoy health chatter and today's show. Today's show is with Dr. Stephen Foo from uh Veteran's Health Administration. Dr. Foo, Stephen, I hope that's okay.
Speaker 3: Yes.
Speaker 2: is uh interested in smoking cessation and tobacco related disparities. His research is focused on identified best practices for improving the delivery and utilization of tobacco dependent treatments among diverse populations. He's a professor of Medicine at the University of Minnesota and director of the VA Center for Care delivery and Outcomes Research, graduate of Jefferson Medical College and the University of Pennsylvania. It's really wonderful having you. Um, it it it's actually I I'm really hoping to get some really insights some insights into uh VA care. Um, and I'm going to pass it over to my great colleague, Clarence Jones.
Speaker 4: All right, thank you Stan. Um, I want to just uh, you know, um, affirm the fact that we're very glad to have you uh Dr. Foo. Uh, it it's been interesting because you've been on our on our radar screen for a while. Uh, you know, Stan, I mean, Stan has has said that we wanted to to learn more about veteran's health. He's asked me that I know anybody. And I remember the fact that you and I were on a uh a University of Minnesota board, uh, I think it's CTSA, uh, and uh, uh I used to be intrigued by listening to what you were doing uh with the VA and I know that you were working with Mayo and some other organizations and so what I thought we would like to do is just talk a little bit about who you are and about your work at the VA. You can start off like that.
Speaker 3: That sounds great. Uh, thank you Stan, thanks Clarence. I'm really very grateful for the opportunity to be with you here all this morning. Um, a little bit about myself. Uh, I'm a primary care physician at the Minneapolis VA. Uh, I am also a researcher. Uh, I am what they call a health systems researcher. So we study and try and figure out what are the best practice, what are the best practices for improving the delivery of evidence-based care or care that we know uh are proven to uh be effective and how do we get those treatments to the patients um, who need them. Um, and we have here at the Minneapolis VA uh a center for care delivery and outcomes research, uh, which is a health systems research Center of innovation. And we have a a number of investigators um, over 30 investigators and I am fortunate to have been the director uh for nearly 12 years now for for that center.
Speaker 4: So you so you know, the uh the thing for me uh in terms of of listening or or being inquisitive, I know that we have a lot of veterans in our community. And you know, and what are some of the some of the uh the issues that the uh the VA helped them with? I mean, that's that's one of the things is like, you know, veterans come to you, what are some of the primary uh issues that they are facing?
Speaker 3: Sure. Yeah, so there are, you know, there are a number of what I would describe as common conditions. So, um, as a primary care doctor, um, I take care of, you know, of adult veterans, um, and you know, a lot of the conditions are like any old primary care doctor would see, um, things like high blood pressure, uh, diabetes, um, chronic obstructive pulmonary disease. Um, but I think what's uh, I guess a little bit I I don't know if it's unique but is that uh veteran a lot of veterans have a history of what we describe as military toxic exposures. Um, and so some of those chronic conditions are related to those toxic exposure. So, uh for example, um, some of the patients we see from the Vietnam War era were exposed to agent orange and they have high blood pressure or diabetes. Uh and those are those are agent orange connected conditions. Um, so we we would see a higher prevalence of diabetes and high blood pressure uh among veterans. So those common conditions, um, we see but they're more uh prevalent and then also they run together. So um, uh a lot of the veterans have we would describe as complex chronic conditions, they have multiple conditions. Um, so one of the nice things about being a primary care doctor at the VA is that we actually get more time to spend with our veterans um because um a lot of them have complex conditions where um, other health systems don't get to spend as much time with their patients. So I mean we're busy but I will say that is a very nice thing in terms of how the VA has structured its care is to uh allow us the time. And then the other thing, you know, in terms of how we've improved the way we deliver our care, um, VA primary care has implemented what's called pact teams or patient allied care teams. Uh another name for that is the patient Center Medical home. And what that is is that we take a team based approach to the care of our veterans in in primary care. Um, so it's an interdisciplinary team that consists of primary care provider like myself, uh an RN care manager and RN care manager, um, we then have uh nursing assistants, medical support assistance, um, um, and then also we have embedded uh clinical psychologist uh in case we need to do primary care mental health integration or connect folks to uh VA mental health care. Uh we also have um uh alongside with us co-located uh pharmacist, which is very helpful, um to help us with chronic disease management. So we and then of course social work uh to connect uh veterans to social services if if needed. So it's a very uh nice setup and that we have a lot of resources and as a primary care provider, I'm very fortunate that I have access to those services. So if I have a veteran who has kind of different needs, I know who I can go to to connect um them to appropriate services.
Speaker 4: You know what's interesting I I'm really glad that we're having this conversation because I I think as you probably have stated is that uh many times veterans have uh a higher rate of chronic illnesses and diseases than other people and and sometimes uh, you know, uh it's helpful for families to understand that. You know what I mean? Because part of what what what what we know is that there are a lot of things that are happening in in in veterans and so the more we can make our community aware of these issues, uh, hopefully it it just makes the life more peaceful for them uh because they've already done a great they've already done a great service, you know, in terms of uh protection uh and so we this is one of the reasons why we wanted to to to bring this out so that we can talk about this because like I said, I was always intrigued when you would talk about what was happening with veterans and things like that. And I always thought it was important to have a just very candid conversation about the issues that they might be confronted with and so that our our communities could know more. Stan, you had a question?
Speaker 2: Yeah, you know, I I I I'm trying to put on you know, a a um a thinking cap from a um a public perspective. It's kind of like, okay, what distinguishes the key thing that distinguishes access to care in a VA. So for instance, you know, you kind of think that, oh, these are combat soldiers that are coming back from, you know, serving you know, in in combat from in an acute situation. On the other hand, um, I I think and clarify if if I'm if I'm wrong, where yes, we could be dealing with them, but we'll be dealing with them ongoing. Okay, they have access to the care for theoretically the rest of their life. I I I assume, maybe you can clarify that. But not everybody is comes from combat, you know, in other words, you know, you can serve but not serve in that type of capacity. So, um, can you make a distinction for us between uh the type of care that you give for what I would maybe call acute, given you know, somebody's coming back from combat and they might be injured or or whatever versus more uh chronic and ongoing care.
Speaker 3: Yeah, I think so what I would just say is maybe what I would describe it is, you know, so when they're in the military, um, they're getting uh their health care from um DHA or the Defense Health Agency. Um Right, okay. Then when they are when they are when a a military service member is discharged um, then they they can become eligible for for VA care. Um, um, I I actually am not too familiar with actually what are the eligibility rules. Uh I I you know, I just see them when you know, I I see all those veterans who are eligible for care. Um, but what I do know is that I think there are roughly approximately 18 um million veterans in the armed Services, uh and the VA serves about 9 million uh veterans. Here in Minneapolis, um, we saw over 100,000 unique veterans uh in our our healthcare system. And and what's what when a a military service member is being discharged from uh, you know, back to civilian life, as part of that process, they're informed about their VA eligibility benefits and how to connect with the VA. Um, and we also, um, I know that we're pretty proactive, particularly when the veterans were returning from from the Gulf War, we had social workers who were doing direct outreach to veterans uh who were soon discharged and getting them in and getting them connected to we had a what we call a post deployment clinic, um, that, you know, that was was set up. I think it's still active. Um, and initially the that post deployment clinic is um taking care of them uh and then once they've been around for a little while, then they get actually transferred some of them over into our regular primary care clinic. It's something that I remember happening. And so because so because there has to be um, there's a there's a a number of things that uh we're being checked out for example, you know, veterans are being screened for traumatic brain injury, they're being screened for all sorts of conditions in the post-deployment clinic. Um, and then being connected to the appropriate research depending upon the results of that screening. But you know, once a veteran, you know, we we have a different perspective in the VA. We we we we we're we're responsible for their entire life. You know, when they come into our system, um, they're ours, you know, forever, you know, um for their entire life. and we have uh, you know, electronic medical record, uh, we have access to the Department of Defense electronic medical record. So we we can kind of see everything and um, and so that's also another really cool thing about the VA is you could be here in Minneapolis and then go to Hawaii and if you go to a VA in Hawaii, they see what's your medical records that are held in Minneapolis. so um, and so we can you know, promote that continuity of care and have that information. And so, um, for a veteran they can rest assure that anywhere in the country and VA in the country and we have their entire medical record in the VA, uh, um that we can access and uh and um and maintain that continuity of care.
Speaker 2: Yeah. So Dr., uh let me ask this question I we've talked a lot about health and and but what other kind of benefits uh do veterans get, you know, besides the besides the VA hospital, uh that also impacts their health because I'm thinking about things like housing and I'm thinking, you know, about jobs and stuff like that. Uh is that something also that the uh the VA is uh and again I know that you are, you know, you're talking more about the health aspect of it. but there are other things that veterans have access to that also enhances their health.
Speaker 3: Yes, yes. So so for example, you know, that's one of the nice things about working here at the VA is we have a excellent social work department. So if I have a veteran who may have some social service needs, uh I can connect them to our social workers and they um so if there's a veteran who's experiencing homeless or a risk for homelessness, the social worker, we my understanding is we have vouchers and so um, I, you know, or we um, yeah, so like there's there's vouchers for housing that can be given to veterans. Um, and I my understanding is that we're making some really good strides to uh reducing um of veterans homelessness here in Minnesota. Um, uh um, I can't remember exactly what the new story was but I remember some of our director talking about that we've really made some great strive in terms of reducing homelessness here in Minnesota. Um, similarly, we have a vocational work program, um, and we do vocational training to help veterans find a job. I've had a number of my veteran patients of mine who have uh participated in that program and and it helps them to to get a job. Um, so that's it's vocational training. Um, and yeah, or let's say for example veterans are uh experiencing food insecurity. Uh, we did a survey, um, back in like 2012, 2015 of veterans who were returning from the wars in Iraq and Afghanistan. we we found that over one about one over one and four veterans were experiencing food insecurity. Uh, and our social services will provide resources to help connect them to programs. The Minneapolis VA we do a regular food pantry, um, to help veterans with food insecurity. So, um, those are some of the benefits, um, besides just delivering health care because addressing some of those social determinants of health is is very important because not just physical health but but mental health, having a job is um, you know, Right. is important for actually suicide prevention, which is, you know, the number one concern uh of of the VA, uh, which are, you know, just trying to make things better to reduce the rate of suicide in the.
Speaker 4: Yeah. So let me ask another question real quick. Yeah. How did you how did you pivot during COVID? That's a that's a great question. especially given all the mental health issues associated.
Speaker 3: Yeah, I know that that was a that was a real challenge, you know, we um, oh, you know, we we pivoted. Um, we set up, um, something called an arc, an acute respiratory clinic on the first floor uh to screen patients, um, who were having respiratory symptoms. Uh, but we were we were open and we were open for business. I mean, you know, um, so I mean for a little while, things were moved to um, telehealth, you know, um, but um, you know, as soon as pretty, you know, I can't remember the exact timing but you know, when when we were able to, we were bringing patients back pretty quickly, you know, uh we just had to put the the masking policies and have kind of that triage system that as people were walking in if anybody was having respiratory symptoms, they got directed first to the uh acute respiratory clinic to get that evaluated and make sure that, you know, they weren't having COVID. Um, and then we and then then they could get in to the VA. So it was kind of figuring out, you know, a a triage system really to kind of handle that situation. Yeah, Tele health was it to increased dramatically the use of telehealth and uh and we're still um, um, you know, it's still an important uh modality by which we can deliver care. So we deliver in person care, uh, we do deliver telehealth care, um, you know, we have something called VA video connect by which we can do uh tele video or telehealth care. We can do, um, we we sometimes have veteran groups where they, we have group sessions on telehealth. Um, for example, some of the smoking tion groups that we um, do is is done on telehealth. We also have an in-person group as well. Um, and uh and mental health care is done both ways as well. Uh there's telehealth, um mental health care, um, as well as in person care. So it it's particularly helpful for veterans who have to travel a long distance um, but need to get care and so we can we can deliver that care, um, and you know, kind of save them that drive so to speak, you know, um, which is helpful.
Speaker 2: You know, I've got um, I've got a personal trainer that I that I work with and he's a veteran. And um, I remember talking to Tim during um, open enrollment on the other side of this equation, okay? You know, where where you know, people like Clarence and I or are frankly just about everybody on a yearly basis, you know, you got to, oh God, you got to go through this whole assessment of determining which health plan you're going to sign up for and and whether you have to change or or whatever. Okay. Tim said to me, it was really interesting when when we were just chatting about that as I was lifting weights and sweating to death. Um, he he said to me, I never worry about that. You know, so, you know, which is really interesting. You know, so if you're a veteran and you you know, you're accessing, you know, care through the veteran through the VA, you just you have it. It's yeah, you're you're a veteran, you're sign up for VA care and you're eligible, you know, you're eligible for VA care, you know, for the rest of your life, right? For the rest of your life, right? 24/7 full service. Right. So you know, to a certain extent for for for veterans, it's kind of like a single payer. We don't have to worry about it. We go in, we get the we get the uh the care we need. So it's it's an interesting um model actually to you know, to look at. Yeah.
Speaker 4: And and what's interesting I I'm really excited and glad that you know, we have had the opportunity to talk with you and to learn more about the uh the VA system and and what you're doing and and you know, for me it was the idea that, you know, inviting families who may really need the services to be able to access because so many times information is given out and unless you know, uh, unless the right person gets it, uh, then then then things don't happen. and I know that in in many of our communities, you know, because I come from a community perspective, uh, many people in our community need to understand more about how to access and to uh, uh, to work uh, you know, in terms of of of making their their family member healthier, but also it also makes the community healthier. And so I think the things that that we're talking about today are just very, very important uh because I didn't know, you know, like I said, uh uh Dr., when I when I when I would hear you talk about it, you, um, and others I'm like, okay, okay, okay. So what else can we know? What else can we learn, do or how can we present this information to the community? So I'm really glad that you, you know, that you uh uh you and your colleagues spend the time to uh to meet with us.
Speaker 2: Yeah, I I just want to comment, you know, families are very important and you know, the VA we do a variety of outreach events to try and connect with veterans and make them aware of our services and resources available. One great resource that's out there is uh what's called the county Veteran Service officer. Uh every county has one and a veteran can call up their county veteran service officer and you just Google, you know, whatever county, like County veteran Service officer and a phone number and a name will show up and you can contact them and uh those those they they are awesome because they they are a wealth of information. Also our veteran service organizations, uh they're they're very helpful. Um, uh disabled American veterans, the American Legion, um, veterans of foreign wars, um, and and and there's even more than that. Um, but um, but so yeah, so trying to just get the word out and just letting veterans know that hey, the VA's here. The VA here in Minnesota is is a great VA. In fact, we're a five-star uh quality, um, hospital. Uh, actually our our our VA was actually recognized by the government as being, I think the best hospital in Minnesota, not just VA hospital but of all hospitals. Um, so that's something that we were able to toot our horn about um, to to get that recognition. So we're we're pleased with that.
Speaker 4: Now, that's great.
Speaker 2: Very nice.
Speaker 1: Stephen, thank you so much. This has been enlightening. I've I've I've learned a lot and I appreciate the work that you and your colleagues do. Thanks for being with us. Thank you. Well, you know, Clarence you got the last thought. So on behalf of all the the folks out there. I will say so long and keep health chatting away.
