VHA iEX Day 2 – Main Stage

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VHA iEX Day 2 – Main Stage

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Test Testing for captioning Testing for captioning. Testing for captioning. Test Testing for captioning >> Hello I’m Robert Wilkie, secretary of the

department of Veterans Affairs If you read about a new technology there’s a good chance VA is already using it. We’re living in an era of communications miracles and tele-health is a tool VA uses to consult remotely with rural patient We’re consulting to prepare veterans employment outside of the armed forces The tele-health is not just a high tech phonecall We’re also diagnoseing patients remotely. For example, diabetes is a disease that makes it harder for the body to deliver blood to the extremityies which can lead to sores and painful us users in the foot. They cause temperature variations in the foot. Today VA can monitor temperature variations by using a floor mat embedded with sensors that veterans can use at home VA doctors can detectd variations remotely with the tele-health connection It’s a monumental breakthrough Last year VA spent 3 3.2 billion dollars treating buy diabetic foot users — ulcers. In the first decade of this new century, VA unveiled the first powered ankle foot prosthetic, ushering in a new era of increased mobility tour veterans and other disabled Americans. And our robot exo skeletons have brought mobility to the lives of thousands of American warriors Today we’re talking that expertise to the next live level level level We launched a pilot program with the exo skeletons and seeing promiseing results Instead of the exo skeleton moving the patient around, the patient can increasing increasingly control the device as their own muscles are reactivated. With further research, we’re hoping to turn it from a mobility device for something thats injured to walk again under their own power. VA is finding ways to use artificial intelligence to care for our veterans more efficiently efficiently. We developed an AI system to forecast a life threatening kidney disease in patient. AI is also helping us keep the books One of the pharmacists in Chicago created a program to sort out the billing of medications dispensed to veterans. It can make sure medications are build to the right parties more efficiently than

any human can. That means money saved on more time spent with patients At VA we’re making sure every technological advance means better lives for America’s veterans ♪ ♪ >> Joe Grace: Good morning. Or actually good afternoon depending on where you are in the nation. I would like to welcome you to day two of the Innovation Experience. What an incredible opportunity to hear from great leaders to experience their passion for the veteran, for the service member, for the mission of the VA. As a veteran, as a knaveity captain knave navy captain retired as a submariner there’s no higher calling than to our veterans and those who take care of them. Special thanks to the 4REU7 leadership and those involved in the process. Today we have a great lineup for you. We’re going to flare a keynote speaker , Mark Johnson who is going to talk about disruption during the pandemic and how do you keep things going Nello Nell Fellow 1/2al Academy grad. We’re going to hear from Dr. Tom Klobucar He’s going to talk about rural veterans Mexico are outside of the boundaries of hospitals and taking care of them during the pandemic and every day is a critical mission for the VA We’re going to have the i iEX talks which is industry and a chance for industry to share what they are doing in the middle of the the shark Shark Tank, the VHA Shark Tank It’s the opportunity for us to reach out to the folks on the front lines, here what they are doing, see their innovations, get involved I’ll talk to Blake Henderson and see how that came out, learn how you can play and all the innovations going on. First of all I would like it turned over to the Executive Director of rural health, Dr. Tom Klobucar who will say some words to let us know how it’s going in his neck of the woods woods. Tom? s so much. Good afternoon, everyone. I would like to thank our friends and colleagues and partners in the VHA innovation ecosystem We’ve been partners since the beginning of that office and their consideration of innovation in rural space has been exceptional. It’s resulted in practices created at rural hospitals and clinics One of extraordinary things about the VHA is that there are so many after news for innovation at so many levels. As you’ll see, we work with the innovation eco system partners in the innovation space. We also provide our unique paths for the guestation guest innovation in the rural space The office of rural health was mandated through the efforts of a few very splieted officials and important Senators from rural states. With the language in the legislation that created the office, Congress basically tells us to do three things, all focused on innovation and the dissemination of best practice They tell us to do research, to innovate and disseminate best practices and innovate ino vailtive policies across the system They went so far as to amend the legislation in 2012 and recognize the office of rural health field satellite offices, veterans re source center and formal formalized by the legislative act. The office of rural health has five of these resource centers in portland, Oregon, Salt Lake City , Utah, Iowa city Iowa Iowa, Gainesville, Florida and white river jurchtion, Vermont They are charged with conducting the search, developing innovations to address rural access to care areas and disseminateing rural practices systemwide We created the approach and that gives us flexibility but we also require account ability from field teams We wee we rerye on the field teams to identify and develop and manage a nationwide portfolio programs trusting them to make good decisions and report accurate results about their ino ations. So basically if you wanted to distill the

office office of rural health’s philosophy, the fundamental idea is to keep the research, innovation programs on schedule, on target and on budget. We have a proven approach that has five elements that empower real innovation to deliver lasting results. First element is understanding what innovation is not. We don’t expect innovation to be more of the same. But some of our successful successful programs began by asking a simple question: How can we do more with the same? One of our researchers said it best when he said we take existing practices, break them and put them back together in new and interesting ways ways. The end result is a creation of cost effective, impactful initiatives that serve as force multiplyiers Training clinicians employed by VA in clinical practices specific to elderly and women rural veterans veterans. That represents one of the innovateive partnerships that have come out of this process. The second element is setting the tone. To create a truly innovateive environment requires developing a culture that doesn’t just reward awk S but success but holds them accountable for the performance It’s important to give innovate ors a sand box in which they can create new things The third element making the case. At the same time we need our innovateors to make the case to management before manage management Before we allocate a single doll ar to the program we make sure the scope is significant and surmontable This helps us reserve our time, money and effort to solveing the biggest and most feasible changes. Re Reflectively the cycle of research, innovate, disseminate. The is around defineing success from the beginning, of the most critical are defineing performance measure from the outset. Metrics need be measureable and a direct reflection of the challenge at hand. And our last but possibly our most important element in innovation is failing fast. We like — we have created a culture and process which allows program managers the ability and safety to flag emergeing issues to help organization avoid chaseing after some costs, three throeing throe throwing good money after bad if you will. Failing fast. We believe managers need be re rewarded for highlighting risks and offering solutions solutions. We have a few examples of existing innovation programs that are different stages of development. We have a brand new innovation out there there, the rural veteran navigator program. Evidence showed there was a need that required an approach to connecting native Alaska American veterans to their healthcare benefits. This used an evidence-based to increase rural native access to healthcare and benefit benefits and subsequently im proving their health outcomes. It connects native American veterans to enhanced healthcare options available to the mission act, VA, VHA and veterans programs promoting access to all the benefits and resources It’s national in scope with a local focus adapt ing to needs of individual tribes, villages, islands, communities and the environments of rural native veterans. It’s in the formative stages right now developed 234 consult consultation with tribes and local VA medical centers and in consultation with leaders and stakeholders in the riewcialg native American veteran community That’s just one in the initial stage to Give you 507B example of a rural programsing practice, this is a program that found success in significant way The remote home-based delivery of cardiac rehabilitation. You heard the secretary talking about the wonders tele-health can provide. This one uses this to connect with home-based counseling sessions and exercise on heart — they council them on heart health, tobacco cessation, stress management, medication adhereence and so on It provides a complete phase two cardiac program in a veterans home That’s a vitally important part of this. This program this year is at 26 sites — in 2020 that 26 sites in more next year It’s already been seat the at 508 sites across VA and now it’s adopted by non-VA

healthcare systems in the face of the COVID-19 pandemic A truly successful innovation that began as an idea of a researcher in Iowa city, Iowa. The second one I wanted to under underscore is this — we also around tele-health, clinical video tele-health to care for rural veterans with M.S. This used tele-health to deliver comprehensive rehabilitation care to rural veterans their homes. It connects them withists remote remotely from nearby clinics or VA medical centers to their homes. We’re at 12 sites now. High degree of patient satisfaction, decrease in missed appointments and truly successful that grew out of researcher asking a question. I’m proud of the fact that the VHA rural innovation cycle conduct ing research that re released the dissemination of these programs provides another avenue with concrete results and significant impacted on riewcialg access to care. I want to thank you for the opportunity to speak about innovation in the riewcialg 135EUS rural space >> Thank you, Tom This is Joe Grace. I’m your captain for this event of the veterans Innovation Experience. Tom, thank you The work you are doing for the veterans in the rural areas is amazing We appreciate those efforts It’s important to make sure they are covered just as well as any other group that we have. Not yet I gotta tell you, there’s some real excitement about the Shark Tank coming up. Our friend over here just seems 20 be to be a little anxious. We’re moving to a fellow naval academy grad Mark Johnson a senior partner and up with one of the founders of Innosite and he’s going to talk about keeping your organization moving during a pandemic. How do you succeed in that. As a small business CEO, I have experience with this. You want to make sure you have continuity of operations and seem to be able to live it Mark, are you with me? Yes >> What class do you have? >> 1986, proud of it >> We’re going with 80 first class with women at the naval academy. Welcome to the fellow boat school alumni. Go navy, beat Army I’ll turn it to you We’ll have a chance to sit down and answer questions in a round table even though you are virtual. Mark, over to you, sir , Joe. Real pleasure to be with everything. As Joe mentioned, you know, these are challenges times with covied You are co covied. You were COVID. My commendation to all of you. Half the time I’m asked to speak or do something it’s related to tele- health or remotor how do we think about the future That is kind of what gets us to the topic today. I co-founded Innosight with professor It’s about how do you think about createing new breakthrough innovations as Tom mentioned mentioned. You know, it wasn’t about the date to day innovation It is really about the bigger innovations that were transformative to the organization ? in the late 90s and early 2000s they were worried about disruptions and technologies that could cause them to tumble. The classic example were mini computer manufacturers worried about the personal computers coming on in the late 70s and 80s. As we worked as a firm or practice called Innosighted as sight, a consulting practice we quickly worried how to turn disruption as an opportunity. Me could be more innovateive inthrough sense and transform the organization and transform to different markets, create new business model, not just products. What weapon found was yes we the found was there was a commitment to the yoin vaition ideas idea to the innovation ideas commitment to form teams and hire a chief innovation officer, all of these things, but we found the efforts

falling short. When came time to truly allocate the resources, dollars, people, sustain the program, often times they — you know, the rug would be pulled out of the effort too soon, you know, there would be be — well, there are issues with the core organization. We can’t spend any time any more time time and effort in this skunk works model or doing things There would be issues around that the core bids was in trouble business was in trouble and the venture or effort wasn’t moving fast enough. What we found was that there wasn’t enough connection to vision, to developing that picture 5-10 years out of really where holeistically and systemically do you want to take the organization, more than just a vision statement, more than just saying we’re going to do a half day exercise and come up with a vision statement and mission statement is really about developing a true vision. It’s in particular relevant now. Of course, the instincts with COVID is to hunker down It’s true. We have to deal with the immediate actions actions. We have to deal with the Chris crisis and things have to happen today. We have to look past the horizon, past the two years or so when we’ll be — one year hopefully, dealing with this and get past that to say where is the north star, where do we want to take the organization? How do we think about it, almost like a portfolio of the future It’s important because as leaders, people in the organization wanted to be given direction. They want to have hope, inspiration and purpose and stability in a long-term of where things go upward and on ward. It’s a long way of saying our realization which is afternoonified in afternoon ampified in these times of crisis there’s not enough strategic thinking that goes beyond developing innovation, especially breakthrough innovation. If you can bring up the slides that led to the genesis of writing “Lead from the Future.” I published this in April. Are the slides up or should I put them up? Confirming from the team here. Anyone can answer there? I’m going to make a decision and share slides Okay,ly not share slide, I will not share slides then. Thank you That led to the book ” “Lead from the Future” which was published in April and as well as an article leader s do you have a clear vision for the post-crisis future to emphasize we need to deal with the scenarios and building a vision for how things are going to be in the post-crisis future that include the vision you may have been developing that could integrate together this idea of break breakthrough innovation with the right kind of vision narrative 5-10 years out typically for the organization and the strategy of how you’ll get there which I’ll talk about. I want to talk about which might be to many a familiar story in the sense that every time you think about innovation somebody has to bring up apple. There might be some eye rolling in the audience that once again we’re going to talk about apple as expected to innovation The reason I bring it up and having been in innovation for 20 years is the for story of Apple that most important is the part often overlooked. Yes, they were very good about design. Steve jobs a larger than life personality personal ity and enter (you entrepreneur, but really what came behind them when Steve Kopp Jobs took over in 199 8 but to at the turn of century had more to do with vision and more to with looking out ten years. You know to Steve Jobs when he came back in the late 90s having been gone almost 12 years from the company he co- founded he came. He came back and the personal computer was considered moving towards being a commodity believe it or not. Gateway said it’s inevitable that a personal computer will be

a commodity. There was a lot of pressure on Apple from others that it was too expenseive, too much of a niche computer and it was going to end up being commodity izeed by everything else. We started to have the dot com bubble and it burst in 2001. Steve Jobs and his top lieutenants looked out ten years. They looked out to 2010 and they said what can we do lever leverageing the personal computer and going beyond it What they envisioned was what they called the digital hub. Digital hub strategy as they called it. They said we have all of these device s coming out still and movie cameras, digital cameras, CD players, and MP3 players, you know, for holding music, personal hand handheld assistance. How could we leverage the computer to make them less clunk y? We can be the microprocessing, the power behind the devices, we can write elegant software and have the power reside in the hub called the personal computer that could enable and power and give the brains to all of the new emerge emerging consumer electronic devices. So they created a vision more than just simple statement that said how they could think about an adjacent business, a move beyond the core. This vision didn’t stop there. If you go to the next slide, what they didn’t share to the world in 2000 — because in 2,000 they shared the idea ten years out of the digital hub. What they didn’t share was that apple said they could to do these ourselves We could create an MP3 player called the ipod. We can get into tele-phony and a paradigm with the i iphone and then the iPad. So the key for thinking about this and we call this future back To give increased likelihood for success I would say the other thing that the VA appreciates is the systemic nature of what you need to do as an organization because you cover so many different services for veterans. It’s not just one simple thing, you know, between mental health and services that go beyond, you know, just typically traditional healthcare is thinking this systemic way to the future and how these pieces come together. Apple looked out to 2010 and these are more recent products we can create an adjacent move, the digital hub, we can create the white space move. We can get into the consumer electronics business. They envisioned this portfolio, system of things ten years out. It wasn’t with certainty but it did have clarity with their mind’s eye and it gave hope and purpose and inspiration for the organization more than just a simple sentence or two and they worked backwards They worked milestones in re verse from 2010 all the way back to initiatives that would start in 2001 with starting with software development and acquisitions of companies to build software that was going to be need needed to enable all of these consumer electronic devices. And then on the mile stone map they started with the iPad ipod and then two years later the itunes service, integrated that together and fully disrupted other MP3 companies you never heard of before because they integrated this new idea Then they moved in 2007 to the itoday iphone, 2010 to the iPad and the rest is history. Apple is the history of breakthrough innovation but the mechanism mek an mechanism that drove the innovateive things really was the power in of the vision in 20 2000 to work from the future backwards and develop the kinds of things moving and develop a whole new ecosystem and disrupt industries, not just an individual company It’s the case study that brings the portion of why we need to lead from the future, we need vision. If we want to succeed and break through innovation and transformation. If you go to the next slide, what is the essence he is essence of

this talk and the book lead from the fiewts the future? If you wanted to transform and continue to drive in this powerful way that I know the VA is try trying to do with very amazing laudable priorityies around customer service and the mission acted and what you are doing with electronic health records and what you are already doing with tele- health, you have to plan for the short-term. That’s 80 to 90% of your time, no doubt, to drive on innovation, run the organization and serve the customer, serve the veteran veteran. But it’s an and statement. And plan for the long term, get out to the 10 year horizon. If you are a software company maybe it’s four years but on average organizations are missing out and begin to bring it alive This is the next step, by developing an actionable vision, a vision that is not going to have certainty but clarity. It’s an impression ist painting not a photograph. It’s not a vision statement alone. It’s not just one sentence. That doesn’t inspire the organization. It’s a narrative about what is the system of future. How do we think like apple about digital hub not just computer and actually white spaces like i pod, iphone and iPad? What can we develop a vision of that kind of level of inspiration that can bring this future alive and get the organization excited and then translate that to a strategy which says how are we going to get there? What are the milestones? What kinds of choices do we need today in terms of initiatives today that get us to the intended future? And then the last bit of that is we have to think in the right way. I’ll talk about that. In order to have a vision that is not too much anchored in the orthodoxyies of today but can break through and be appropriate for what the future is going to hold based on con versioning technologies, knowledge, know how and things to anticipate, trends, saying this is the way it should be. It’s the Wayne get Gretzky analogy. He says I can skate to where the puck is going or shape where it should go. That’s the he is essence of leadership. The VA is not just anticipate anticipating what the future is but actually shapeing and defineing it and making it where it should be especially or for our veterans That gets to the thinking of future back and the process of going from the future back. So I’ll just take a couple words on each — a couple thoughts about each of those and then we can open up for Q&A. If you go to the next slide I wanted to start to talk about plan for the short term and long term. There’s a ton of bias we have to appreciate to plan for the long-term. People say of course, you know, long-term it’s incredible of how little really does go out Especially in the corporate world where I mostly work but I have worked in defense and joint forces command and other places in government as well. There’s so much bias though in general to the short term not because as companies but as human beings You can think about the ex existential crises crises we face. We’re wired as human beings with biases. An economist talked about a lot of these. We tend to deal with the fact that we’re bounded ration rationality. We tend to just deal with the information closest available to us. There’s a literal term called hyperbolic tis discounting that we tend to award the near term way more than we would ever value anything further out Sum costs. We talked about that earlier,, human doingle doing cognitive guy biases You add on that they create organizational awards and incentives. Whether it’s in the corporate world, you know, pension funds and investor s that and all those groups, is it any wonder that we end up in a system that really prioritizes the

short term and de deprioritizes and dismisses really the long term in serious. On the right hand side the tyranny of the urgent it’s — we are especially as senior executives but all of us across the board, we are crowded out in the opportunity to think in an a explorea active and envisioning way We have the tyranny of the urgent. We face more needs in the short term and ever before. A Harvard business review article and professor Michael porter said on average 7 72% of our time, executive time, CEO time is spent in meetings. Doesn’t give a lot of time to be able to step back and think about the art of the possible and future to begin to think about how can we not just operate and execute but how do we explore, envision and discover? We have this problem. We have to get to the long term and realize the long-term opens up the opportunity for the ability to think not just about what threats are on the or horizon but as much as with technologies convergeing on what are the opportunities on the horizon that we can take advantage of to continue to transform our organization through the disruptive and break through innovation initiatives we’re talking about If you go to the next slide, that’s the case for the long term. I want to share this. Clm is a Johnson & Johnson quest to intercept disease. It’s called the disease interception accelerateor. Bill Height was a practice practicing oncology He led a cancer center in New Jersey before becoming the head at January sen farm pharmaceuticals. By 2014 he wanted to take a personal vision that said why are we not in the future not just thinking about the treatment of diseases but we will have the technology to inter intercept disease and cure it at a level we could not do before. He had this vision of how could you take this large organization called January January Janssen pharmaceuticals, focuses on making drugs for treatment treatment, and disrupt and say we’re doing things about more about interception and prevention which would mean a news business model because the core model was getting paid for the research and development. Long story short they work to translate bill’s vision into J and J Janssen’s vision. And look looking to 2030 how do we think through a vision of what disease inter interception and perception looks like? Combining things with disease diagnosis with therapyies that could snrift one size fits all to personalizeation personalization. Biosensors, thinking about biometric biometrics. To come up with a check engine light It’s similar to what was described, Tom, you know the whole point about anticipateing diabetes, changes in the level of heat. It’s the same idea. Can we create the interception before the actual — you know, the actual manifestation of the disease. And it came by starting with a vision looking out 2030, bringing these together and saying, we’re going to create a disease interception accelerate or to be able to think about that. And then they walked it back to today and it’s been going on for about four years. They started with lung cancer It’s called the lung cancer initiative. They are making tremendous progress. How do you think about interception of the disease of long cancer before it manifests to stage one cancer? It wouldn’t have taken place and wouldn’t have gotten separated out from Janssen because it was so disruptive had it not started with a vision that was more than just a simple vision statement a vision of the architecture of a set of disciplines coming together to envision this disease interception accelerateors and how it could work with interception and acceleration Next slide, please, because we’re running out of time. I want to pin the

point that vision is different than strategy. Vision a discipline. It’s a Lange language and discipline we can embrace and build as a cape ability in our organization as leaders and — vision is about choices made longer term, five years out. Vision can be about playing a new game. Strategy is winning the game. Vision is finding the defendant defendant in addition destination. Talking about the means to get to the ends and how you would operationalize the vision. The vision is key if we’re going to figure out how to manage the five year to ten year horizon along with the short term and not dismiss it as something That is a fool’ser idea and fool’ser fool’s errand It’s talking about convergence of trends and what it means for the organization? How do you think systemicky systemically? The whole idea of the future work There’s going to be some people at home, some at work. It’s going to change policies. You have to think about technologies technologies all needs to come together a system. We know things are not as remote as they are now but we know they are a lot more remote than they were pre-COVID We have to start with the vision , almost the architecture of the system and put that into a way of thinking that walks back to the kind of initiatives you have today. If you go to the next slide we get to future back and how to think The thing we want to do whether we develop the vision, we don’t want to be as we’re trying to do something that is transformative We don’t want to be what we call present forward. We don’t want to take all the orthodoxyies of today with a new technology and say let’s implement that out to the future This is the picture of the first train in the 1820s You can see the inventerventor came up with the steam locomotive. What did they do? They strung the horse drawn coaches and behind it People on the top were given a full plume of smoke in their faces. It didn’t take long until the true train innovation and propel propellant of possibility that came from the technology became something of a different paradigm This is present forward thinking It’s to taking the orthodoxyies of the day and extrapolateing them forward in time as opposed to thinking future back. If you go to the next slide we want to think about things, yes president forward doing day to day prison operations That’s operate and execute We’re trying to make e efish efficiency improvements but future back we need think in a different way. We need think clean sheet. We need to think zero base as we talked before , we need to think zero based budget. We need to think imagine native imaginative. It’s getting comfortable with assumption assumptions because facts are in the day and rearview mirror and sometimes the facts are not going continue to form the way the future need it’s be. We have to work and get comfortable with assumptions and testing and management of Social Security assumptions. It’s really a way to get good about identifying, prioritizing, testing assumptions and learning which assumptions work and don’t work vis-a-vis through failing fast Plan from it on a Steve job’s example. If you go to the next slide, I want to share a picture with you. I think it’s important as you all talk a lot about being — continueing to drive customer service and thinking about the veteran and really getting behind what they need, and what they — and how best to innovate to address those needs. I think what we’ve learned, the innovation as part of future back and then so

we don’t want to ask needs in the sense of what do we need in terms of an existing service or product. We want to ask in terms of a deeper question which is what are you really trying to get done in your life arrest start there? What job are you hiring the VA to do? And not just from a functional point of view but maybe an an emotional and social point of view and get this deeper understanding of what we call jobs to be done as a part of looking to the future and innovateing This picture here. Normally I would ask what it is but since we’re virtual what this women has on her head in the left and carrying This is obviously in India in the more rural area This say refrigerateor. There’s companies coming in saying we can tap into the e mergeing middle class. All the big companies G.E. and pana sonic son pan Panasonic said we’re going to strip down the free ridge rate refrigerateor so they can afford it But they stripped it down and said what job are we try trying to get done as a mother in these emergeing areas areas, 234 this home as she was the one who was the one that was manageing the food and cooking and all of that. And this — the innovate ors what job are you try trying to get done as opposed to what do you need in a refrigerateor and show a classic large refrigerateor What they found quick quickly was there were only two jobs to be done. At the One job was they were guy buying because they didn’t have the means to buy and store If we could save our food for an extra day, leftovers, that would be smaw and if we awesome and if we could cool a couple beverages down 20 degrees, that would be amazing. By understanding — not by a paradigm of the existing product or service — but by deeping understanding deep deeply understanding what the mother needed. You didn’t need a refrigerateor You needed a cooler. It could be solar powered and powered by a battery and charged $69 instead of $400 and $300 and fit within the paradigm of the mobility that many of these families have among amongst their other folks in the village This is just the point that if you could tie vision to — and innovation to jobs to be done If you go to the next slide and think about it not just being future back if you go to the next slide but outside in in. Looking to see if we can get to that. How do we get really, truly outside in Don’t ask what they need from a service but ask what job are you trying to get done in your life. The job is the progress a customer or consumer is making in a circumstance There’s a famous article who said people don’t want to buy a quarter inch drill. They want a quarter inch hole. Focus on the job as opposed to the solution and focus on the way and the white what. My final message here is if you want to drive break through innovation. If you want to embrace disruptive innovation, you have to be more future back and more outside in and you have to start with those endureing principles of that especially in this type time of crisis and getting past the crisis With that I’ll give you a fun cartoon here. It’s about the process of being outside and future back developing this vision of the future 5-10 years old and figuring out how to get there by initiatives of today and deciding how you program and implement that the right way. That leads towards much more success in your innovation efforts from our experience of tying strategy and innovation along with being as outside in as you can be, you en able much greater opportunities for success. With that I’ll turn it over to you, Joe, for Q&A

>> Joe Grace: Thank you, Mark I really appreciate that. Mark, I can tell you’re an aerospace engineer because there were space suits If you were a submariner, there were fish or dolphins. We give you credit. I’m amazed that in innovation we forget that you still have to run the organization. When you look at the department of defense or the VA doing hundreds of thousands of encounters a day and suddenly people are not coming into the hospitals for routine exams or mammograms or colonoscopyies We talked to Tom Klobucar earlier. What does it mean for them. How do we do that createing for tele- health while doing innovation. You have the 50 meeter target and long- long-range targets. Tom is nodding his head. I can see him on the screen as well One of the questions that came up are what are the most common mistakes you see as organizations planning for its long term but they have to do the short term and going between those two. What are the pit falls that you see? a great question, Joe. The most common is trying to shoehorn long-term expanseive thinking into into — fitting it in and feeling good, you know, as we’re doing it, meaning this is not something you can just say okay we’re going to take half hour and talk about the long-term. The good news is in our experience the short term in the operation and execution including the one to three you’re out, year out, that is 80% to 90%, especially at the executive level, that’s 80-90% of what you do. The mistake we find is not carving out the 5% to 10% and really carving it out Meaning, for example, BMW is now taking once a quarter for a day — because of all the disruption in the transformation of automotive industry, electric wires, Uber and Lyft and all that stuff They are saying if we good to toteally electric it’s a change. They are taking one day a quarter and talking about the future They are recognizeing you have to carve out the time and have time be able to be in this mindsets of mind-set of explore and discover. It’s not just a half hour It’s a whole different way of thinking and discussing instead of it being about here is the data. That is appropriate for the President of Ford and the day to day. But this is about messy iness This is about iterateive. This is three steps forward and two backs. It’s about con vergeingverge con art and science. You have to get into the creative mode You have to be able to get into a mode to be able to say we’re going to explore and envision and discover. The mistake I would see is not carving out the time. The second mistake is when they do carve out the time, doing it present forward. Not doing it future back but saying are we stuck in the orthodoxes of the day >> Joe Grace: I love the fact that you tbawctd you still have to worry about what it is you are trying to solve. I laugh at the story we spent a couple million trying to find a pen that would write up and down in space and the Russians just used a pencil. Seemed like a good strategy well in New Orleans having Zeta, the now hurricane coming in, if you tried to cut a tree with a dull blade if #U stopped to sharpen it could you cut more but no time to stop and sharpen Within the healthcare space, this is a healthcare organization, what are the faint signals organizations need to be accounting for in that strategic plan? What are the underlying tenants there, maybe the subtle ones that you have that they ought to be thinking about in the strategic plan? Any thoughts on that? >> I think from our own work in healthcare, I think you have to keep an ongoing you have to keep a set of trends both healthcare and

related We have to be looking at what is happening in lifes and in disease diagnosis and technology , you know, to the point about tele- health and work from home, what is happening in trends around, you know that I think is big in the VA, of course, would be in the Rell nl of mental health realm of mental health. It’s made tremendous progress from a science point of view but societal point of view as well are the signals happening. We worked in the schizophrenia space with with a large company that makes a drug there. And realizeing that the injectable for schizophrenia is just a tiny piece of the problem What are the other trends that need to be looked upon to create really a new business model to effect to affect the kind of behavioral change needed to put those with schizophrenia on a regiment where it’s successful along with dealing with the stigma of folks that won’t even admit that they are — nobody wants to admit they are going to have schizophrenia because — >> Because of stigma. Mark, the other thought that comes to mind here and you didn’t address this but I know it’s in the days of being longer in the tooth and a grey beard we watched Demming and E6 sigma and how do I improve and revitalize the? In a government agency there’s no fund sitting there is for good ideas. The good idea fairy is not funded. You generally have to break something to apply funds to something else. I know Tom knows that and rhinos rhino Ryan knows that. How do you for somebody looking for metric based results on a future, the future is hard to get if you don’t put funds toward it What is the outcome and is the vetment worth it That is the question coming 234 funding? Dollars drive a lot of decisions Let me give you a quick analogy and we’ll see if it works for the VA. What we create as the impetus for doing this within corporations is the followinging which is called following following which is called the growth gap which basically says, okay, let’s be honest as leaders Let’s not just hold on to five Dom fifedoms and through trends and signals and all of this say what is going to happen to the core business over the next 5-10 years? And almost invaryibly when they look at it from an enter prides level not from an individual five feifdom, the overall mission, doing what we’re doing or keep doing is sustaining innovation We’re not going to get where we need go. That’s the growth gap. That’s the gap between the financial aspireation and what the core can different. deliver. In that gap is an opportunity, a set of opportunityies that you can make the case for at a high level for why you need to invest a little bit to learn a lot now. So I don’t know if that’s a good analogy — >> There’s another component of that I think we have to throw out. We have two minutes left here. That That is often time times particularly in the military side when you rotate every two years, when you plut in place is a budget cycle. You probably will not see the fruits of that labor. In senior leadership positions, they have a similar process that they put something in place innovateively that they won’t see that happen during their tenure as the money goes out whereas in industry it’s a cause and effect. I go out of business if I’m not successful. How do you see balancing that risk and focusing on the why and making that happen as opposed to planning for someone else to be able to do that because that is where we are in the scope of VA Your thoughts and then we’re going to wrap up there, Mark? >> I think the only way to answer that would be to come up with metrics of progress You know, building a change in culture that says we need to be good

Stuart stewards of the organization for the long term. And so how do we come up with in- process metrics and rewards that allow for planting seeds and trees that are going be — what do you call them seedlings before they become trees and being able to be measured to the progress to be handed to the next generation, if you will >> Joe Grace: Perfect. I want to thank you for your time today. You’ve given us a lot to think about going from Steve jobs to Wayne get Gretzky and I love Michael Jordan you miss all the shots you never took Thank thank you for what you are doing as well. We’re about to move to a new segment That is the iEX talks talks. It’s an exciting opportunity for industry partners to partners to tell us what they are doing and talk about their innovations. The words we have are that it’s going to — hey, littlea fella, not yet. Soon but not yet fell little fella not yet Soon but not yet. You have to love him We’re looking forward to eight minutes in kind ever a TED talk kind of environment that you’ll hear from the innovateors and partners bringing this to life along with the academic and VA partners This is how we make it happenel With that to the iEX talks In the VA, we’re really focused on the mission to serve veterans. We can up our think and perspective in the way to address challenges we stand a chance at solveing them and innovateive and exciting ways makes our work and partnership so exciting is the opportunity to make sure that we’re giving veteran veterans the best possible care VA leads the nation if not the world in using virtual care. We’re way ahead of curve >> Physicians have imagined the possible of bringing advanced imagery to the operating room. Holographic images animated that represent the anatomy of the patient and really improve the quality, safety and cost effectiveness of care We kind of see this as a dawn of an a new era It’s Verizon enableing 5G and low latency networks They are provideing infrastructure in being able to use spatial computing for misht patients, in this case, our veterans >> This is probably the most exciting time in healthcare, not just at the VA but in general. The deep mind Google relationship is exciting. We can predict a kidney injury 48 hours in advance. It’s ground breaking when you think about it. The VA is an exciting place right now because AI and a lot of other tools can be utilized to improve care in ways we haven’t done before >> I feel strongly that the VA and innovation program within the VA in particular should be the tip of the sphere in terms of proving out cost technologies and redesigned healthcare services in a digital world ♪ >> Hi, I’m Jon Bloom a physician and CEO of Podimetric Podimetrics. Diabetes is the number one cause of am pewation in the world, pew amputation in the world. We have the way to aim for complete e elimination of limb loss, it’s a problem that contributes to 3.2 billion doll ars in direct expenditures each year in the veterans health administration, a killer worse than most cancers and

considered one of greatest mark ers of health inequity we have in the United States. I want to share two stories today. The stories ever Robert and Walter They are all too common and represent the 501,000 veterans with high risk diabetes receiving care by the VHA every year. I’ll the story of Robert Robert is a Vietnam veteran who has had diabetes for many years. He has struggled to keep on top of it and has lost sensation sensation in his feet including multiple wounds called diabetic foot ulcers in his right foot He noticed discoloration under a callus on his foot It wasn’t enough to impact his life so he didn’t take action on it. It broke open revealing a small wound It turned into a bigger wound that got infected. It wasn’t until his son unless aid change in the smell around when he was visiting that somebody could be wrong. In fact, something was very wrong. He sought attention at the E.R. The doctor looks at the foot and notices the inhe have in inevitable he will lose the foot , probably at the knee. He was bound to a wheelchair un unable to go about the life he used to know. It’s too common and shouldn’t happen anymore. Now I want you to meet Walter, another Vietnam veteran. He has dealt with diabetes since he left the military in his 30s Like Robert Walter lost feeling in his feet and has had extenseive wound history to the left foot over the past several years. He is in en rolled in a program use the Podimetrics smart map is map. This allows clinician to detect 97 of ulcers five weeks before they present clinically. This time things were very different One day the system noticed a new occurrence of inflammation at the where he has had wounds veteran was called in to see the doctor. The clinician noticed the same thing Robert had seen previously callus with a with darkness underneath. It’s a wound that has not happened yet. After a clean up. The clinician made a cut out of the surface below the foot to relieve the appreciate shiewmple he sent him home It resolved and he has been ulcer free ever since That’s the story. Two patients almost identical except for one patient on his home own and didn’t know to seek care and one enrolled in a VHA program using latest in data science to monitor for issues before they become problems. It’s a huge difference. Like Walter and Robert one in four veterans have diabetes Yet too often we’re ignoreing one of most common and expenseive complicated the diabetic foot ulcer. The VA spends 3.2 million each year treating the complications despite the fact that they were largely preventable. I worked as an anesthesiologist and I saw the impact firsthand. It baffled me would would spend whole days doing nothing about amputations, essentially civil war medicine for something that shouldn’t happen anymore. We knew it was a problem that could be solved. It could have 5EU huge impact especially for the veteran population As I mentioned, diabetic foot complications are expenseive and cost one-third of treating it as a whole yet largely preventable. A third of the cost. But the real challenge is not the sign of detection, the real problem that had to be solved was one of long-term engagement. How do you make it so easy that patients overwhelmed with the care choose it every single day What we came up with the smart mat whether coupled with wrap around care support makes it easy for the patient to engage and here is how it works. Patients step on the mat for 20 seconds a day and good on with the rest of their life In that moment, we get a temperature scan of the feet which is sent wirelessly to the care team to use the great to work with VA providers to offer simple and in inexpenseive care if needed The device is connected meaning it requires no WiFi, no smart phone. We found find it’s critical as veterans lack access to the technology many of us take for granted. It turns out

to be one of single bestest drivers affecting outcomes outcomes, probably not surprise ing. In a multicenter trial, 86% of the patients use Podimetrics at a clinic clinically meaningful level on the study on average More exciting describing current useage within the VA 78% of veterans are fully engage d one full year after enrollment, a tremendous improve ment over any other im improvement study previously at least as we’re aware of. More important it will im pact of the veteran and healthcare system is dramatic A study found zero major amputations among a high risk population in the mid-atlanta region who used Podimetrics. It demonstrated a 40% drop in all cause E.R. visits a 3 5% reconstruction in all cause — for the six patients initially enrolled in the one year program we eliminated approximately one amputation, more than one E.R. visit and two hospitalize hospitalizations for every rough ly six patients As it season toishing. For them to engage when they needed to were able to drastically improve health while lessening the burden on the system. I’ll live you with leave with you this thought If we implement the technologies we can help veterans maintain independence and create value in the healthcare system by focusing on prevention as opposed to treatment we could have more cases like Walters and fewer cases like Robert’s. I want to come back to that number we talked about at the beginning. Zero the opportunity achieveable goal Partner with us whether you are a clinician, administrator the son or daughter of someone who love affected by diabetes. Let’ssure no veteran has to lose a limb due to diabetes. We have the opportunity to led lead the entire nation here. If you have questions reach out the VHA innovate ecosystem or Podimetrics to learn more. Thank you very much Hi, everyone. I’m glad to be witnessing the innovation this year and invited back to speak and I hope to give you a framework for which start-ups can accelerate VA’s healthcare mission and why the network of everybody attending needs to be engaged MIT hacking was founded and we’re proud of having injected best and bright est into VA’s healthcare innovation network Hacking medicine was founded on simple principles First new technologies, scale medicine and one of the only things that can accomplish the triple aim of healthcare of reduceing costs while increasing access and increasing quality This new technology though changes Claire, care models and business models. And the current large incumbents whether they are big pharma, big med-tech or healthcare systems adapt slowly Whether it’s enter entrepreneurs that can accelerate that and do in a capitalistic manner Whether the investors are thinking about redisking start-ups and funding those mile stones they think ever it with this simple framework science risk, there’s engineering risk and there’s execution risk. The risk they look to NIH and DOD for funding and this happens observe in academic research. Then you have to scale the technology and make sure that that technology can meet real world economics. That is the value of death This is where most start-ups die If you can get through, that you can get and access a multiple of the NIH and DOD funding in the private venture capital capital markets. We have a perfect example in Podimetrics They started at MIT and quickly turned to the VA to validate the technology and science. They were on the

science risk side but they raised millions of dollars and progressively moved and proven out their technologies. One of the big challenges was they didn’t know if putting these technologies into patient patients homes would actually work and would actually change outcomes and they have Because of that, they are now poised to be a major, major company that can impact not just VA healthcare patients but patients across the world. We’re so proud of them. Why are VC backed start-ups better than other types of partners? VA healthcare could partner with big companies but small start-ups are backed in 18 -24 month time frames That forces them to have an incredibly efficient use of funds and laser focus on which milestones and risks they are focused on. These are healthcare start-ups so of course they have safety and efficacy and clinical outcomes 20 prove but Podimetrics has shown you can do that efficiently The pandemic threatened to slow down funding. In fact what we’re seeing and this is the latest great from rock health including Q3 of 2020 that founding funding has accelerated. They are on pace to put $12 billion into digital health funding Most of this is consumer health and services. But the larger healthcare numbers are also looking similar So now what are the patterns that ren venture capitalists look for to choose what are start-ups? They love the technology. New sensors beget devices. They become knew biometrics. The new biometrics can replace decades old or 100 year old healthcare biometrics and the new biometrics #K prove out new therapeutics, new drugs And we’ve all seen how tele- medicine has accelerated in the pandemic and that only going continue There’s no turning back. Not only that we have Al gore rhythmic at gore rit Al gore RIT algorithmic care. They can spend more time face to face with patients and that creates more care redesign redesign, process redesign, and accelerate the unbund unbundleing of hospitals that was already happening You can take the services out of the hospitals into doctor’s offices or into patient s homes or into work places I started say saying this a decade ago but I feel it more strongly than ever This is the best time in the history of medicine to be doing what we’re doing to transform healthcare. Thank Thanks to last year’s event where I was at, I got to meet someone who would become my cofounder in a company we founded in May to tackle the most important problems during the pandemic which is cheap rapid test tests that don’t need lab equipment so you can have the results right there in front of you and act upon it. This is due to a new set of chemistryies called quantity quantum.labels we licenses and you can learn more about that from Ohio our CEO joe sf enreek enyez who is a med A venture capital group is — success is determined by the idea flow, the problem flow, the venture flow, and the solutions that people can propose to them. And so it’s incumbent on all of us present today to activate the healthcare network so they can focus on the biggest problems and the most im pactful solutions I’m so excited to see who they partner with and the start-ups that they enable Thank you for including me this year. And more importantly thank you for taking care of our veterans Thank you for being on the frontlines of healthcare and best of luck in this next wave of the pandemic. Hope to see you in person next year >> I was a see see zebra, not the horse that is striped and

lived on the Serengeti plane but in medical school they teach students that most patients they see in the lives have common diseases Those are the horses Very rarely would the patient come in with an unusual or exotic disease. Those are the zebras. If you spend your whole time for zeeb razz zebras you miss a lot of horses. When I was nine months old my mom thought my forehead looked funny and it turned out I was a zebra. If I wasn’t for the brave surgeon that worked on me I wouldn’t be alive today. I feel a compulsion to pay back that doctor that staffed me. I want to find ways of innovateing clinically to pay back that surgeon for the great work he did on me. I worked for a company called Cyti va we’re part of Danne Danneher life sciences platform We don’t make therapies but we help our customers to discover, design and manufacture therapies to treat patients, therapies like insulin to treat diabetes, antibodyies to treat rheumatoid arthritis, vaccines like one for COVID-19 and even teaching a patient’s immune cells to fight cancer. In the future the therapies we develop will be more personal than today We’ll help our customers diagnose and discover and treat patients in a very specific way. We all know that one size fits all means nothing ever fits It’s only by making a personal diagnosis and making a personal therapy and treating a personal disease in a way that most effectively treats that patient we’ll be truly able to help patients the most. My own father was a disabled veteran. He didn’t have this kind of personal care when he was alive so he spent the last 15 years of his life confined to an electric scooter We want to help the VA make care for their patients that treat the patient in the very best way. We want to help the VA to be able to diagnose and treatment patients personally so we can give the right patient the right treatment to treat the right disease at the right time. And do that through personalized medicine medicine. I want to tell you about John. John is a retired Army veteran. In his retirement he found full full fulfillment in driving a bus with a local elementary school. He could say hi to every kid on the bus and remember their name. He developed throat cancer. And the surgeons at the VA hospital in piewjent sound were piewg Puget Sound were able to treat it but they killed a portion of his jaw He couldn’t eat, drink, sip through a straw and he was in a lot of pain. He looked de formed and grow terrific and the students were afraid to get on the bus so he lost his job. The surgeons at the VA did an amazing surgery on him. It took two teams and a 14 hour surgery but they took a piece of bone from his leg and reshaped it to a piece of jaw for him. He wasn’t in pain. He could eat again, drink again and most importantly he didn’t look deformed and grow terrific so the kids weren’t afraid and he got his job back. But unfortunately that piece of bone in his leg was important and he will never walk normally again He had to trade one disease for another. You may remember Dr. Ripley who stood up here in 2018 and tomorrow you about a new way of treating patients like John. Instead of taking bone from his 14 and tying up two surgical teams and tradeing one disease for another another, we wanted to be able to precisely manufacture in a laboratory a new piece of bone to fix the jaw of patients like John. It was a crazy idea. We promised in 2-3 years we would be in the

first patients I want to tell you even with COVID-19 pandemic we’re on schedule to deliver on the promise. It’s more than printing plastic. It has to be the right shape. If I’m printing living bone it has to be right but also chemically and blajic biologically. The things we need to do all the way through the process are different than what we do to print a piece of plastic to Do this, we had to design a quhoal — so to do this we had to design a way to take them from scanning to surgery to manufacture the bone and control the quality of the process. An important part of that was the ability to present and expect and grow and expect and continually put this inspection process right in the middle of the development process for developing that bone. Well I’m here to tell you today that even with the pandemic we’ve done our first animal studies and the results are remarkable The bone grows. It vascularizes and gets a blood vessel, the way we hoped it would. Those are steps to help patients just like John. We’re not done. We can have the best invention invention. We can invent the best piece of bone, have the best surgeons to put it in place. But if we’re not able to implement it in a way that helps patients, we’ll never get there. It’s innovation times implementation. It’s not just inventors but we need everyone to take that invention and implement in a way that is innovateive and take cares care of patients. We need contract managers and pro curement experts and nurses and even janitors to help us get across the finish line. Here is our team Across the top we have Beth and Jeff and Zane and Monica and they all work for the VA and University of Washington in Seattle. The next row we have our friends from swrans swransed solutions solution advanced solutions life sciences , the incredible work they are done and we have me from Cytiva. This isn’t the whole team. There’s a critical person missing And that person is you. Won’t you join us? Won’t you help us innovate for veterans like John. Thank you >> Helloed to the VA community my name is Dr. Osamah C Choudhry and I’m a co-founder of mediivis. We speak about how we’re working with the VA to use augmented reality for safer surgery. So first I’d like to start with how my own journey has inspired the work we’re doing with Medivis. I trained 234 in neurosurgery at NYU It was a seven year program During all seven years of my training I had the privilege to take care of hundreds of veterans at the Manhattan VA. Our department would take care of any veteran who walked through the door who had a surge ically disorder of the the — surgical disorder of brain or Spain so it was really a privilege — or spine So it was really a privilege and an honor. One veteran whose surgical care really motivated most of this work. It was a young veteran. He came into our clinic with his family and he presented with what is known as aphasia which is losing the ability to speak. An MRI showed a large tumor pushing on the left side of his brain. It was pushing and invade invadeing into a network of arteries supplying his brain with blood This is something we needed to operate on before it affected his speech permanently His operation was one of the longest cases we had done as a team I. last lasted last. It lasted over ten years. A

delicate surgery We had to use microscopes and fine instruments to peel the tumor away from the blood vessels at the base of the brain. Imagine if you are operating for eight hours straight standing under a microscope and you get to the critical part of the case where you get to en encount the network of bloos vessels vessel blood vessels and you need to really understand what you are doing at that point All you had to rely on was the M RI scan up on the monitor in the corner of operating room. I clearly remember our lead surgeon We’re eight hours in and I’m scrolling through over and over for him to mental mentally recreate what he is seeing through the micro microscope It’s a frustrateing experience We kept thinking this itageing it imageing is such critical information there has to be a better way of seeing this and understanding this than just 2-D slices. The frustration my team felt that way is something surgeons feel over and over again when they are performing operations. The problem is very simple. It’s why are we using 2D imageing if we’re trying to understand and solve a 3-D problem If you take this problem and think of it in terms of how many operations we are perform around the world every year, hundreds of millions of them, all the surgeons and siz physicians using the same source of data, the same 2-D images to figure out what we’re doing 3- 3-dimensionally during the operation. Really for us the question was: Can we provide provide a technology that can allow for ak access to advance visualizeation for surgeons and if we can how much errors or complicate complication complications could you prevent with the technology? If you think about how images has evolved over the last century we started with x-rays. We moved to catskin cat scans and MRIs and the computeational power is incredible Since the last 50 years we’re looking at imageing in the same . looking on a monitor and scroll scrolling through slices So our focus at Medivis is how do you start taking this imageing datesa for patient dates imageing data and use augmented reality to re recreate the exact views surgeon need for an operation operation? We call this technology surgical AR. It was cleared by the FDA last year and the VA healthcare system will be among the first hospital systems in the country to have access to it We work very closely with Microsoft. We use the hallow lens augmented reality technology and this is Saul real all real imageing data of patients used to cree re create the holographicing renderings. It’s done in real- time and automatically so surgeons throughout the VA and any hospital can use it anywhere and at any time Beyond just surgeical use use, you know, our VA healthcare system ends up train training about 70% of our countries physicians. So, you know, we have a huge core mission on how do we use this same technology to advance our education as well so that when of this important concepts they need to learn about anatomy and physician physiology and not just train trainees but even our patients who need to understand their own anatomy and physiology how can we use this holographic rendering technology to improve and advance their understanding? So our partnership with the VA is something that has been a south source of honor for us. It’s a large nation agreement called project conversionance.version convergence. It involves micro softs and Microsoft and Verizon as well. This is the Dr. In Palo Alto, one of leaders in the initiative. It’s an honor to partner with the VA on this. Over the course of the next year year, there’s going to be fantastic research coming out of this collaboration. Like I mentioned before, the VA healthcare system will be among the first in the country to have access

so this technology. It’s first deployed at five VA starts to start. Palt Palo Alto VA, portland, Philadelphia VA and the center Si lirks mts mlearn center If your institution has surgeic al departments to use this technology, I encourage you to reach out to your VA innovation department to learn more about it. With that, it was really an hon to speak virtual before you all and, you know, we look forward to sharing details on how this collaboration will advance augment augmented reality for surgery in the coming years Thank you ♪ ♪ ♪ ♪ >> Hello, everyone. My name is Nial Darbey, I’m chief architect at Wellhive. We’re partnering with the VHA ecosystem to make the vision a reality. Allow me to introduce you to combat wounded veteran and department service officer for its marine corps league in Texas Jeremy Williams He was wounded protecting his fellow marines in an IED am Bush in are Ramadi. He suffered tra maltic brain injuries and lives with the psychological wounds of war. He shares his experience to help millions of other veteran have to do the same. He describes a community care appointment wait time going way beyond what was initially given to expect. On the day his appointment he was turned away because his consult was in incomplete. He subsequently had to make many phonecalls and share his original consult with offices in the VA Finally out of sheer us from us from frustration based on miscommunication he had to pay out of pocket for the care he received for his service -connected injury. As far as experiences go, Jeremy’s experience wasn’t so unusual. Many organizations struggle to keep up with the evolveing expectations of their customers. But let’s explore together an alternative really possible experience. Imagine a scenario in which Jeremy is referred to a community care provider most ideally suited to deliver the care he needs. Imagine a scheduling clerk engageing with Jeremy and finding the ideally suited providers based on the specialty, on the wait times and how well they’ve done in quality metrics. And then chooseing from among those short- short-listed providers based on how close they are to Jeremy’s home. Imagine in the moment of making the appointment Jeremy’s consult together with Liz clinical his clinical history are sent over in real time. Imagine subsequent to the encounter with the community care provider, their medical document ation is sent back to the primary care provider also in real-time and also electronically. Imagine finally prompt payments and collections between the VA, community care provider and Jeremy’s private health en surer with no burden placed on his shoulders. That’s the experience provided by the Wellhive partnership. We get the real experience was bad but are we able to describe in detail why it was bad? Or for that matter why the experience provided by wellH5N1 would wellhive would be good? Are we able to uncorp. rate the experiences in a way to build better software in the future I propose there’s only two core ingredients. Complete access to information and two easy access to services The more completely the VA answers veterans questions and easily delivers services to them the better the veteran It’s this complete and easy access to and services that define the almost daily experience with companies like Uber, companies

like Uber obsess about customer experience and they shaped what the modern digital world looks like. But — this a big but — Uber doesn’t merely answer his questions but it answers questions like he never would have asked Where is my driver? Where is he now? What time will he get here? How much will the ride cost? Can I trust my driver? All of these questions answered before Jeremy gets to his car and man, does Uber make it easy. Cashless rides, no need to carry a credit card. He can request a type of car and indicate to the driver his preference to re main quiet. Everything is easy. Even after the ride Jeremy can make a complaint, report a lot of item, barely a click or two in effort. All this begs the question, how does Uber do it and can the VA deliver similar top quality care to veterans? The answer lies in the implication of applications and systems and automate automation of business processes across organizations The chances are if a VA application cannot answer a question it’s because it’s not integrated with a system that has the answer. Orr if Or if a VA application can’t fully satisfy a request for a sfs it’s service a service it’s because it’s not updated for the business process This holds true regardless of whether the answer to the question or the delivery of service lies internal to the VA or outside in the community care provider organization. Application integration and cross organizational business process automation are exactly what the miss act has in mind when it spells out integrated outside networks While we haven’t realize realized the vision yet as Jeremy’s story clearly shows. The act places huge im emphasize on the two experiences I’ve been describing them here. In effect it demands the automation of the verification and discovery of OHI flshes coverage I insurance coverages. The automation of the scheduling of appointments including self service both within and outside of the VA that are the most timely, clinically appropriate and geographically accessible to veterans The automation of the exchange of clinical information between the VA and community care provider both before and afters they appointments and finally the continuous monitoring of the quality of care given by those providers. WellH5N1well hive in partnership with the VA ecosystem is responding to these demands. Our ask you to is that you pay attention to the innovateive work we’re doing at VISN 8. The VA has a long history of ground breaking innovations Light Lighthouse is say prime and recently example that. Well hive is working with the lighthouse team with the leadership of VISN 8 with the VA system and office community care. Our work encourages the establishment of a care navigation platform that enables high performing outside network the I often N of mission act When we’re successful, help us replicate that success across the VA. Today we can revolutionize the experience for our veterans Let’s give Jeremy and his fellow veterans the same premiere experience he gets from companies like Uber and can get from wellhive. Help us make the vision of the miss act a reality. We want to give the final words to Jeremy mim self- >> This tooth will vastly improve the way our healthcare services are delivered to service connected veterans like myself and those that I represent Having the ability to schedule an appointment in real realtime, share clinical information and understand where I live will help me focus on what matters, getting the care I need and representing marines >> Thank you so much for your time Thank you [off mic [inaudible] thank I Nial, and now we get to a chance to see what happens in live television which is

combined with a hybrid mode. My mic was off. My fault I hoped everybody would take a look at what is going on in VISN down south in Florida. Take a look at their activityies it’s great stuff. We were going to have a break here but instead we’re going to have a video. Take a look at great things happening across your VA we’ll be back for the second half of the iEX Talks. Over to you >> Everyone that works at the VA is on same page and we have the same mission which is to take care of veterans. Having that same mission coupled with the fact that we have researchers embedded in our hospitals, we have a culture of innovation, that allows us to do things that could never happen in the private sector >> We’re exploring new materials and new ways to provide better services more effectively. The recumbent bike is a relatively new thing for us. It works by activateing the paralyzed muscles with very small amounts of electric. And by timeing the activeation of those paralyzed muscles with the crank cycle, we can allow disabled vet s to add paralysis to exercise either on a trainer or actually progress to pedaling over ground. It allows them to be outside and members of the community, they feel engaged, a feeling of freedom, moving under their own power.-6- One of innovation programs that we have here is exo skeleton program It’s a robotic robotic suit that help veterans who acquired a spinal cord injury stand up and walk back on their feet. It make significant difference in the quality of life and achievement towards resteuer restoring some of the mobility. It’s a great honor that we’re helping people who risk their life for the entire country 3-D printing is say cool technology a way of making objects layer by layer. The beautiful thing is it works well with medical imageing data. When we image a person we take layers of images images, find the important anatomy within the heart Say it’s your heart. We can trace out the heart and send it to a 3D printer that re builds your heart in that exact space >> Patient have to understand the procedure they agreed. If you have a 3-D model of their assorta assorta, assort aorta they can understand and ask the proper questions >> We’re getting the materials that act or mimic real biological tissue so you can feel the muscle and course calcifications causing disease. It’s over the last year or two and it’s going to keep growing. I’m exciting excited to see what comes next >> with every generation of veterans they face unique challenges and ones we can’t possibly predict As the population changes we must be agile enough and innovateive enough to meet their needs quickly and in real-time >> Transcending therapy is a form of ingreat in ingreat in integrative cognitive therapy. It incorporates the spiritual beliefss have and develops a way to live in accordance with the belief systems >> It’s totally new to me Instead of focusing on the

12 steps it was on challengeing your thoughts and feelings. Are they true and helpful >> Yes, they have substance abuse issues. The opioid problems we’re experienceing in this country are horrible, but we’re seeing progress and the in innovation innovations we’re making here seems to be helping to address those. We try to help them understand thinking and behavior problems that lead to depression and substance abuse >> Thinking about in the long run what me and my family, fiancee and my stepson I gotta be able to take care of them >> You see patients coming back and saying this is my tenth rehab This is my fifth rehab. It finally clicked >> for some of our veterans being seen at a place comfortable for them is essential being able to provide the care that they need We have an innovation happening right now that we call mobile ops that stands for mobile or orthodics and prosthetic services. We’re breaking down barriers for care for some veterans having challenges coming to see us as at our VA facilities. As simple as it sounds it’s radical. Matthew is say gentleman who is a gentleman who has worn a prosthetic for years and not comfortably. We’re hopeful this is say really good fit >> I was refuseing to go into the VA and take care of my pros shet prosthetics. I was walking around on a leg that was broken. I was so scared to go out in public to have a panic. I feel privileged having them to come to the home and doing my prosthetic care. Seeing the VA taking a step forward to offer a service like this shows me they are listen together veterans feedback and they care legs is phenomenal and allowed me to do great things with my life >> the future of VHA innovation is an exciting one We’re partnering with ak deem academia, we’re partnering with industry to bring cutting edge solutions to the VA It’s not only that we get to innovate to help the veterans here but it’s spreading across the country >> Innovation is hard. It’s not easy. It’s a lot of hitting walls. It’s a lot of knows, it’s nos, failures and fraws fraws traitions frustrations. Why do we innovate? Because once we get it right we know we’re going to really change lives. That’s why we do it >> the diffusion of excellence program was created through a recognition by leadership that we don’t lack for creativity in our healthcare system but we do lack the ability to identify where excellence is happening We want to identify the best things that are being done across our system and norm alize them. One example for that is a de prescribeing methodology taking hold within the system called Vi onoe >> It’s quied widely increased by de-prescribeing medications causing more harm than help maybe we could improve patient safety. So far three years and we launched at more than 3-9D VA programs 39 VA programs across the nation More than 53,000 veterans have been impact ed and we have de-brie scribed more scribe- de-prescribed more than 11 5,000 prescriptions not essential and without adverse outcomes >> Hi, today I’m talking to you about a vet important

topic to veterans, post traumatic stress disorder

We’ll start with three stories you may relate to The first is Todd an elite special forces operator who had a high tempo career in and out of dangerous places before his life began to fall apart He was drinking heavily and his marriage was on the rocks and he was literally digging ditches. It took seven years before he realized it was . p r PTSD Next is siren who was sexually assaulted. She suffered alone in eye lens. It was December 25 in moas yul, Iraq, I was walking back from church with our new trauma surgeon, John. We had the same number of kids, the same ages. In the blink of an eye everything would change. A loud crashing sound. It hit myself and all around me was spoken con fusion, I was bleeding bleeding. Somebody grabbed me and hurryied me into a bunker. Others were hit but we didn’t know who, we didn’t know who. I was stuck in a bed the all too familiar sound of a trauma resuscitation on its other side. I heard a voice say it was John. Lying like a renew in my head all I could see hiss laughing when a car would pull up, officers in dressed uniform, a knock at the door The pain is visceral and the im images vivid of this freshly widowed spouse and the children whose lives would be changed forever by the loss of a parent. Christmas would never be the same for them or for me. But PTSD didn’t only affect veterans. Statistically speaking after half you will experience a significant trauma in your life. How many of could you relate to a story. It doesn’t have to be combat. You barely escape d a forest fire or escaped death from a car accident only to have a loved one die or were the victim of or sexual abuse abuse. Perhaps a pandemic, fear , isolation, loss of loved one. Everybody who experiences trauma expresses stress and that’s normal but for some the stress persists and it’s called PTSD Kilt wreak havoc on our body increeing risk for memory problems yark cardiac disease, liver dis disease, metabolic disorders even immune dysfunction to name a few. 25 million Americans will suffer from PTSD at some point in their lives. 25 million adults living in Florida and Utah combined Unfortunately, many go undiagnosed or untreated either because they didn’t recognize they need help or the stigma surrounding it was too great. Too many decide they will take their own lives. Veterans with PTSD are 14 times more likely to complete suicide than those without. A thing I tried to illustrate so far is what I like to call the four S’s. Silence, suffering, stigma and suicide. They interact and scas bailt each other Why is it that some people develop PTSD after a trawm idea and others do not? Are they weak? Are they less resilient? Is it in their head? If there’s one thing you take away from the talk I hope it’s this. It’s not just in our heads. It’s in our genes These code for your biology and that causes you to feel and react a certain way what can we as the healthcare team do to prevent the 4S’s. We represent a timeline in the life. With hypertension or diabetes we want to catch PTSD and treat it as early as possible to prevent suffering and negative copeing behaviors and long-term damage Sadly some will not get help until they made a desperate gesture. Others enter care after divorce, loss of parental rights, DUI DUI, something in crisis. The majority present mere near this red.when the suffers erode at home or at work and a boss or spouse forces them into care. The VA recognized the need for earlier intervention and took action by adding surveys to all patient visits to identify veterans even before they ask for help Imagine with me for a moment

what if we could use science to move the points of intervention even further upstream. What if a sample so small could answer the questions we hold What if we could tailor the treatments to the unique biology of Todd or biology of siren? We can. We can use the science of gee gee nom genomeic genomeics At true gee TruGenomix we look at trauma in order to get to the underlying biological and physiological problem. I wonder how Todd’s trajectory would have been different? Could we have saved 5-7 years of his life. We believe the science of gee nomism can Trump the other four This square showing who has Brown or blue eyes is what most remember. It’s not this Sim orm fixed. Each of us does inherit a fixed set of DNA but what is express is not locked. It’s nature plus nurture. If this helix represents a genome. We call this the epigenome epigenome. As we go through life our experiences leave marks or scars on the epi genome. We call them epigenetic markers. I represented them by band aids how, what, when and if this is expressed. You see a veteran in your office, you see a veteran, unique, compleesm, individual. No two are align. Todd is a unique puzzle made of up genomic information passed down and im pacted by experiences, exposures, tillness, coup could be toxins or hazards, positive nurtureing or lack there of. The food we eat could have an effect Understanding the interaction of genome with the environment within a specific individual is the crux of precision medicine. Our innovation is bringing the science of genomics and precision medicine to PTS drve We identify key genomic markers that when the expression is changed causes the symptoms. Just as in cancer care it’s time toll move away from one size fits all treatment for PT PTSD. The VA is leading the way in precision on oncology oncology They are partnering with the eco system to do the same for PTSD. Perhaps soon all behavioral health. Let’s work together using the science of genomics to move PT PTSD care and treatment and stamp out the suffering silence, stigma, suffering and and suicide. Thank you for your time time >> Hi, everyone, I’m Kaycee Coleman with Salesforce where I lead the public secretary York digital trans form trans transformation team. I’m taking a different tact in my story. I’m not talking about advances in science but in IT and I’m going to share with you equally amazing stories about how IT innovations are improving the lives of veterans. IT modernizeation has been a personal passion of mine for a long time. As a former government CIO too often I saw our systems were holding people back not empower ing them to do their best work. Let’s face it our IT systems are what we live with and depend on every day. You may very well feel like we did. Your systems ought to be work you but in fact , you are working for them. For instance,, do you ever find you have to enter the same information in multiple places because the systems don’t talk to each other? Or maybe you need a simple new IT feature but you are told it will be three years and millions of dollars to make it happen. All of that stuff is a drag on innovation and productivity and it interrupts the service to veterans in fulfilling the mission. I’m here to tell you it doesn’t have to be that way With modern digital Platt platforms it’s possible to create connected personal personalized intuitive services that are available any time, anywhere on any device So the question is How do we bring innovation to our IT systems for veterans and four r for our for

our mission? Or how do we stop work working for our IT systems and instead make them work for us? It’s an important question because we have all these amazing technologies advancing clinical innovation like PD 3D printing and artificial intelligence. We have to make the systems connected and easy to use or the customer experience for veteran veterans will suffer. My own modernizeation experience starts at the U.S. general services administration where I spent 12 years in the U.S. government as a senior executive and CI often We O we went through a transformation to equip everyone to tele-health using modern cloud platforms. It was a huge success Salesforce was one of the key partners in the initiative. We were able to develop new apps for our mission saving 90% of the time and 70% of the cost from traditional approaches Now at Salesforce, we’re helping other agencies do the same thing including the VA. I would like tomorrow you about the some of the amazing innovations that are making things better a at a time. Let’s start with the caregiver program. If you are a caregiver, all you want to is to make sure your loved one gets the support and resources he or she needs recently wasn’t easy. You had to go to different offices, different web sites, apply separate separately to multiple programs and stitch it all together yourself. The VA had tried twice before, un unsuccessfully to up grade the outdated and dysfunctional systems for caregivers and Congress was demanding action. So the office of IT selected a new team that included sales force as a replacement platform and this time it worked In less than a the first version was in operation in all 170 medical centers. that same caregivers has a single inter interface for the process and all the pieces are secretaryied secretary connected. To get information, sign up for benefits, connect with a specialist and apply for stipend payments. For a focus on human centric design what was full of complexity, delay and error is reliable and easy to use. It’s integrate d with the electronic health system so it’s working for caregivers, veterans and medical network not making them do the work instead. It continues to im prove. The VHA innovation ecosystem is working with front employees in VA medical centers to keep im proving and evolveing the system quickly It’s reached a new milestone of approval so veterans from pre-9/11 and caregivers can use its karma system the karma system and participate in the enhanced benefits program. The second story is about reduceing veteran homelessness which you know is a huge issue Tens of thousands of veterans live homeless every month. So it’s critical they get the full benefits they deserve. Until recent recently the VA had limited visibility until veterans up at local and community homeless shelters So there was no way to bring the full power of VA re resources to support them Imagine the challenge that they poses for veterans and for the volunteers and social workers at these shelters We were selected as at platform to address this challenge In February of last year, the squares program was launched. Squares is an app that connects over 700 service organizations to the VA and it’s the first time an external community has been connected to the master veteran index. Now, when a veteran shows up as a at a homeless shelter workers can quickly and easily look them up and determine their veteran status and benefit benefits eligibility like house ing vouchers health needs and other benefits and information. With squares on their smart phones and tablet’ses social workers are able to provide targeted, personalized care for veterans in need. They are not a faceless shelter occupant but an honored service veteran who has earned and deserved deserves our nation’s best standard of care. Both of these stories and many more at the VA and beyond are not just examples of making systems better. These are systems that work for the VHA, for veterans, for all of us unleash ing the best we have to offer for those in your care

If I leave you with just one thought, it’s that innovation is not just on the clinical side. It can be and must be on the IT side as well. Consider how much of your work is in service to old ways of doing things and imagine that it really can be better. And contact the VHA innovation ecosystem to learn more about partnership. Thank you >> afternoon, I would like to you jurn me on the journey of an injured soldier who went from suicidal to more stable because of three things courage, connection and care Let’s dive in. It’s 2005 and the military activated this soldier to serve in the Iraq war. They fall 11 feet and severely injury their back Two back surgeries later the soldier is lost in a wheelchair after being told they may never walk again, has no connection to individuals who understand and has no quick or easy access to care in the VA community. Now, show of hands, how many of could you see the soldier? The wheelchair ? How many of you feel felt the emotions? How many of you eimagined eimagined a female veteran? How many of you imagined me. My name is Zen Zenetta Adams. This is my story and I am that veteran veteran. You may be that veteran, too much there are three things I hope you take away today that. Is the three C’s of successfully reaching veterans courage, connection and care. They tiewch Courage is the first step a veteran needs to take to get the help they need and many women veterans struggle to overcome the fear and anxiety it takes to move on to the next chapter of life. Why don’t women identify as veterans? Maybe it’s because they’ve been traumatized in the military military Maybe they don’t feel like a real veteran because they didn’t serve in combat. I understand those feelings because I’m not a combat veteran and felt the same way way. While I struggled to coming to terms with my service, I dealt with feelings of aloneness and feelings that no one knew or understand my pain. I didn’t start to understand until I went to a women’s veteran retreat in as Aspen. It takes courage, like the courage his to attend the re treat to step out of un unknown for self care that. Is where courage and connection over lap. At re treats for women veterans I met those who with be part of sisterhood initiative In calls I receives saying thing s like I don’t want to live anymore. I’m a burden. I am alone. No one understands what I’ve been through. I am afraid and many more. It was hart hart heartbreaking but comforting to know I was not alone in my feelings and I could be trusted with their feelings Unfortunately, these were all thins I today is thin alls I once said to myself. In 2014 I started an organization WINC for all women veterans. It focused on offering peer support groups, retreats, studying the effects of military sexual trawm aa and trauma and we looked at events to honor women veterans For me it still wasn’t enough. Women were hesitant to participate as a veteran because of. Once they abandoned fear and connected to others they stayed connected. As we continue to reach the over two million women veterans in the United States which include the 7.5% of women vets who use the VA or the 43 ,000 women vets for connection, the number of cases across the country continue to rise. The question then became how can we connect women to one another in place where they felt safe? That is why where the military sisterhood initiative came in. It’s born out of a space where women veterans needed someone to talk to and understand them at any hour could reach another somewhere else and not feel like they were alone and feel like someone was listening I wanted it to be im impactful as well and reach as

many as possible so we connected and partnered with challenge America. They trusted our vision and did what I know they do best They’ve taken that vision and made it a reality for thousands of women veterans Why is the military sisterhood initiative important for you and me? Women veterans live it on connectivity with peers but don’t know they need it until they truly experience it Veterans hear connections and sometimes they hear group therapy That’s what I heard initially I needed something more hole istic, something that had control mekennisms in place but did not feel like a VA mental health study. Every veteran is different Some thrive on a structure group therapy That’s the beauty of MSI. With your help we can potentially is potentially is both on the platform. Since the January 2020 relaunch on the network. The MSI has members connecting with each other, self policeing one other and engageing with one another There’s opportunityied for structured and controlled chaos, if will you, on the platform. Furthermore the platform is doing its job of connecting women veterans and foftderring relations and learning as evidencedly the 49% 3% of active members and 93% returning to use the platform Your next question should be? How can I get more women connect ed to the program by use of military sisterhood sisterhood initiative program By integrateing your program into the non-traditional path pathway of cear. I knew you care about this. I believe that the VA and other stakeholders can partner and participate by offering educational, therapeutic and other opportunities for women veterans that want structure and support in a non- clinical setting Through a national, state and local effort, you can also enlist your sister organizations and partners to recognize that this is an out of the box way to en encourage women veterans to get connects to care while reduceing the rated rate of suicide among women veterans he note rates of suicide among veterans are rising which is why we must now I didn’t believe the VA was for me as I struggled with mental health issues. My connection to other women veterans in a non-VA setting led me to get the psychological help I needed in a VA setting. The MSI is a way for receipt ran women veterans to find the help I found and get care Ladies and gentlemen, you can be a part of connecting women through this platform Ultimately I put aside fear and connected with women as a severely disabled veteran who felt at one time suicide was the answer Since when I was injured, my journey to find connection and finally get the care I needed helped me to become the person I am today, a proud veteran, product family member, lawyer, founder, innovator and director of the Michigan Veterans Affairs. This is my story but you can pick wrup I left off with the MSI. The final question for you is: What actions will you take to help a veteran like me? >> Hi, I’m Rob Lieberthal a principle economist at the Mitre corporation. We have an exciting prototype we created call Cynthia that is building a better world How many of you know what Mitre does for veterans? Might Mi Mitre operates frly funded research and develop centers on behalf of government including the center for modernizeation cosponsored by the department of Veterans Affairs What does that mean? Many of you may think of Mier as IT Jedis in Bedford, Massachusetts and in McLean, Virginia. From my perspective we’re really in the business of building a better world, changeing and saving the lives of veterans Our forward-facing data driven analysis about how the world is changeing enable enables and supports the changes in the way VA employees are doing their work and improving their

performance. We develop and prototype new technology to experiment in a way that is currently not possible in the real world and provide those technologies to all the greater good. Today I want to tell you about a challenge that I face that we designed technology to solve, get begun access getting access to data perhaps you are thinking why do I need data access in I work at the. I have some of the best data in the world available at my fingertips. Let me ask: How many of you struggle with data when you want to collaborate with outside parters? Let me be specific how many of you spend countless hours reading data agreements or performing data risk for partner s? Wouldn’t you rather innovate instead of out forms? That’s why Cynthia comes In you can have the privacy protection needed to protect veterans, lower provider burden and solve the problems you may be facing as a medical center direct director or VA employee. Sintan a isan Cynthia is an open source platform. Some of you may have seen the articles in S Synthea to in the Wall Street journal or “New York Times”. In particular synthetic data can to the be answered with existing data sets at high. One great example is the COVID-19 pandemic. The VHA innovation ecosystem completed a precision F.D.A COVID-19 risk factor modeling challenge. The creation of COVID-19 data in Cynthia launch of the challenge, and evaluation of computeation models to predict COVID-19 related health outcomes in veterans involved participants from around the world and only took a month. Synthea can enable this because the data sets contain a representation of the course of illness, prevalence and burden of disease for populations to build that better world. Here say map of synthetic mass for the state of Massachusetts. She includes veterans modules for cancer, PTS D as well as self harm and substance abuse specifically experienced by veterans. The forward-facing aspects come from its use of emergeing and future facing healthcare data standard such as fire, fast healthcare inter interoperability resources This specification for exchangeing data will enable the development of applications, apps and allow VA providers time to discuss health data such as sensitive diagnosis with veteran before they see this data elsewhere. What ythea can allow us to build is a medical home that the mission act was designed to en courage. Better patient data and associated health records can represent a world where the VA continues to fulfill its promise as a nationwide healthcare system for veterans also will assist specific frustrations that VA medical center directors and likely experience every day when they want to collaborate with non-VA clinicians to deliver the best possible care to veterans. The environments include the economic re resources need for healthcare reimbursement meaning paying for carat VA clinics and beyond. It’s defined for designed for a world such as the one we have where veteran can choose from a wide array of providers. They’ve chosen to focus on veteran as a population with unique healthcare and personal needs This laws us to imagine what the future looks like for veteran, providers and the healthcare system. It also allows us to provide lesson s learned to improve the healthcare system for all Americans leverageing the veteran experience for the benefit of all. The potential for this to have an im pact can be seen across a range of issues in the VA. Those impact areas include matching supply and demand for care base based on external conditions that impact individuals Benefiting veteran based on representations of model patients like them, and respond ing to emergeing health, demographic and economic threats like COVID-19 in order to enhance veterans’ care While I started by talking about representing today ‘s healthcare system what we’re moving stoard a future based toward is based on so much porn more thch technology designed to solve this technical problem problem. We envision a world

where patient satisfaction is high and patient experience improved and transformed I see a fiewtd for Synthea in solveing the human problem of patient protest meeting patient-centered outcomes Owning our own health is likely to provide an outsized positive impact on all aspects for care for receipt veterans veteran veterans in the VA. Fulfilling demand for care by veterans and reduceing stress for providers will be the result of better world we can use together using Syntheea. That can include those of you working within the VA as well as collaborateors not currently of the VHA innovation ecosystem. I en courage you to stop by including the Mitre booth at the conference. I looked for to seeing you there ♪ Snoats >> Hello, I’m the Executive Director of challenge America. We’re a national nonprofit that leverages technology and the creative arts to improve the lives of veterans and their families I’m here today to talk to you about the maker movement This is what it looks like to be a maker. It’s not about products. It’s about people. As any experience maker will tell you, the key to making a good product is to learn about the user’s needs. I’m talking about the maker movement because I’m on a place to convert all of you into makers. If you are already a maker, I want you to join my crusade to grow the movement This is say big ask, I know, but if ever there was an audience receptive to this appeal it’s this one We’re all optimisms and we believe in the power of innovation to improve lives of veterans and their families. If ever there was a moment to encourage this it’s now. At challenge America we’re more recent recently converts to the maker movement yet we’re determined to make up for lost time. We took our first tentative steps in spring of 2018 when we led a group of secured veterans to sell tele-aveef tele- Tel Aviv. We decided on the plane ride home we were going all in on innovation. By the spring of 20 19, all of the polices were in place to launch our first makers for veterans program and it was an overwhelm ing success So much so that we decided to host a second program in the fall. Over the course of two programs we were successful in generateing 17 working prototype solution solutions four of which qualified for provisional pat patents. The formula was simple we asked veteran what’s they need and recruited people with skills to make solutions. As it turned out the veterans were the key to our successful success. Not only did they share the challenges but they joined the teams offering continuous feedback that proved helpful in keeping everyone on task and speeding up the design iteration process. As you see in the course of doing this work they forge a bond with the veterans and the veterans felt empowerment that was difficult to put into words Listen to a few storyies from maiksers ander storyies from makers and participants Mike, team Chris. Chris has pain and weakness on the left side. Walks with a cane right now and has a child on the way. He wants to be part of her life and being part of that life is down on the grown playing with her. We’re working on getting him down and back up safely and confidently In working with him, I made a friend. I thought we were going to get together and do this thing but really did make a friend and in talking to him it’s just the fact that people are here for them. He’s like I don’t care if anything happens, if we get anything out of this. 8 people show showed up and they care. [inaudible] If they are presented with the opportunity, go for it. These are incredible teams of people that come come together, volunteer their time to help them make, make their life better, give them

some hope and there’s no reason to tell them no >> Through all of this we learned a number of lessons not the least of which you S- have to be an engineer or software programmer to innovate. Many of our makers lacked any form formula training in the areas yet some of the non-technical folks mode the contributions to the teams that were most valuables These included administrative assistants, seam stresses and carpenters. We rolled into 2020 with big plans to build on our success but we quickly encounter encountered the hard and cold reality of COVID-19 Because of makers for veterans program included a significant number of in-person meetings with a vulnerable population it was hard a way forward. It’s at this moment our friends asked if we could join them in developing solutions for essential workers responding to COVID-19 The VA activated the fourth mission which allows to respond to civilian needs during a national crisis Within three weeks of deciding on this direction we launched our first program. Like everyone else we ed changeing from the important from in-person to virtual one. No long longer limited by geography we had an in of participants from every walk of life and several countries. More than 350 participants, in fact, have joined us over the course of five programs, virtually a program ever month every month. There were 25 prototypes many undergoing further development and 11 prototype prototypes are undergoing pilot programs across the country. And there are plans to test more. I see that the key to the success was the diversity of program participants Though many makers play traditional roles as engineers and designers, a significant minority hailed from less conventional backgrounds and for many of these the participation in the program was the first Innovation Experience. For example, our last challenge featured a team comprised entirement of women veterans all of whom were first time makers in every since tans they made valuable contribution and without exception all said they looked forward to participateing in future maker challenges If there’s one thing we learned through this experience it’s that we need the maker community now more than ever. However, this community is still too small and frankly too exhausted at this point to meet all of these challenges its. We need more make maker If you’ve never thought of yourself as a make maker, now is the time. Check out to find an opportunity near you. If you are already a maker, invite your friends or colleagues to join you in a maker challenge. If you are an employee employer encourage them to get involved and support them. The un uncertainty spanned by COVID-19 will not go away any time soon. We need all hands on deck if we’re going to remain resilient in the many challenges to come Thank you >> Joe Grace: Greetings V. these been some. Have these been great talk talks or what. This is the mute button you are experienceing on Zoom. We got a chance to see how it works This is the tech talks, TED talks, iEX talks and innovation going on and we’re getting ready for shark thank Shark Tank. We’re going to have a brain break that gives us a chance to work out. Because there’s Shark Tank coming on, hey, there little buddy it’s almost your time. Let’s get ready Everybody is going to take a brain break. We’ll see what is going on. I’m sure how we’re going to do it but I think we’ll get there It’s about that time. Take your break. Work out Get ready because it’s almost time for the favorite friend the shark. Let’s keep working on. Over to you you, let’s do it. Take it away to the brain break >> I’m Kenny and I’m an exercise physiologist for the program. It’s a cardio program

I’m going to show all three verses so try to pick which one is right for you and I hope you enjoy. Let’s get started now Start by marching in place Okay Try to find a pace that feels moderate for you. On a scale of 0-10 this should feel like a five or six out of ten. Doing a little bit of work. Okay? Just like this Forward and back, keep going ♪ ♪ ing one two, can you hear me? out and back in. Out, out, in, in , out, in, in. If it’s easy you can pick up the pace a little bit. Go wider with your steps. It’s occupy up to you. Find what is right for you. Keep it up Bounce on that tow. Come back to the middle. Find the pace that works for you Keep it up! Keep work working. Now switch to the right food, okay? Keep it up now step jacks Hands go up. Just like that Keep it up. Make it harder, go quicker begun take a longer step. Up to you Hand r hands over head just like that >> Hi, there shall everybody Doctors Ed Portillo and Molly here for the practice of COPD care >> Thank you Dr. This is an interprofessional program that stonds for chronic obstruct ive pulmonary obstructive obstructive obstructive obstruct ive pulmonary disease disease — >> This improves patient access to post discharge care while reduceing admission rates following the this — this uniquely positioned PACT teams to provide care to veterans who recently experience s a COPD evidence based on guideline What we’re doing is we’re implementing recommendation forces COPD management described in the global guidelines for COPD and provide ing additional opportunities for inhaler, med optimizeation, comorbid comorbidity assessment and this is provided to veteran veterans who have COPD. Which

bringses us to the brain break tiferity on breathe ing >> As we know, during can COPD care visits indicated patients are educated on so we invite everyone to get comfortable. Relax, loosen up shoulders and practice a bit of purse lipped breatheing Dr., layman why don’t you lead us off today >> Zactly exactly. Thank you >> Wait a second, can we have some music >> Were you going to say that? >> Absolutely. We’re going to add a little bit of calming music for dramatic effect and make everyone feel comfortable. Feel free to use this as a meditation exercise if you would like. We’ll go through the steps together First things first. Sit down, find a comfortable place to be in. Don’t have a barking dog in the background >> Or a screaming two month old >> Or a screaming two month old We might be people that need the believing [ Laughter ] Sit down in a care that is chair that is comfortable and focus on relampleing your next re lampleing your rei’m feeling great. We’ll gore ing to breathe in Slowly through your nose for two counts it’s a normal breath in. Count one, two Here we go. Now we’re going to pucker or purse your lips and let me — is this your part. Go ahead. Puck er, tell me >> Purse your lips as if you would whistle or like breathe “U.S. News & World Report”ing that puckered breath >> Awesome like blowing out a candle? Perfect, perfect breathe in the roses, breathe out the candle Awesome, awesome. Let’s do this for a couple of times I want to make sure this is playing while we do this >> with regular practice hopefully the tech Nick will to feel a little bit more natural to you These are techniques to help them catch their breath if they were doing something causing increases activity and frequency of breatheing They needed to take a pause to take that breath If you find yourself in a challengeing moment or a time where you need to take a breath, use these techniques to help yourself recenter and yeah relax a little bit Thank you so much for joining our team and do the COPD pursed lip breatheing >> Yeah, absolutely if your site is interested in learning more about COPD care, dare we put in a shame shameless plug. Email us at COPDcare @VA.gov Absolutely. Thank you so much for joining our IX brain break and enjoy the rest of your conference experience ♪ ♪ >> everyone, Joe Grace your captain here

We’ll take a quick break to give you a chance to run and grab a drink, do the bio break you’ve been needing and stand up and stretch and go to the resource tab on the social wall and Dave Vobora who was so gracious to give us that workout and different way of approaching things. He is our NFL veteran doing so much for our veterans go To the resource tab. It’s a longer video. The sharks are swimming around us. I haven’t seen that guy in the past few minutes. We worked out and to watch out for the sharks but Blake and are together at 16000 when the big hand is on the top and the four for Army folks listen ing. Be there at 1600 Check out the video from David and let’s have a great time this afternoon with the shark thank ♪ ♪ >> Shark! At least we got everybody attention

Welcome back. You’ve got to watch out for the sharks

in the water. We’ve got a whole of excite coming on today. The Shark Tank experience is what we’re looking forward to. This is a chance for innovators to come in and talk to us and show us what they’ve been doing. A little competition, I’m sure you’ve seen this across the age Shark Tank an exciting event. I’m here with Blake Henderson a long- long-time comploi employee if he VA who I med in New Orleans my hometown and Dr. Vega Wonderful for to you we here to tell us about shark Shark Tank Feels like a lifetime ago. The suit fits fighter >> [inaudible] got this put together. We’ve got Shark Tank Tank. What have you been doing over the COVID experience and what else you got on? >> Back in February we’re bringing the teams from last year’s Shark Tank together to create and replicate their plans. We left in first base with strong plans Less than a month later the world completely changed It was really neat to see this last group how resilient and adaptable they were. A lot of those practices went on high ateous for 30-90 days but really everybody came back online without fail and starting confronting the problems of the day. Many adapted and changed their practices incorporating a lot more virtual modalityies. It is a great thing to see actually did you find people were creative because they had more time. Did you find that at the were finding different experiences that made them think twice about how they were doing their business in day -to-day VA? I think lot of things post COVID it made people think why can’t I do this virtually especially Whether it’s training clinicians or working with group groups ever veterans. We have one practice doing in- in-person group visits with veterans for mental health issues and opioid abuse actually and they converted to a fully group model virtually on line with Zoom meetings and they are getting great engagement. It’s like a whole new world opened up for them >> I would say to. You’ve been doing this a long time time. Tell us how does Shark Tank work? What can we expect this afternoon? >> First of all 20920 2020 Shark Tank Competition began when VHA employees from across the systems submitted more than 400 things. We enlisted 10 0 VHA leaders to evaluate and score them bringing us to 15 finalists today >> That takes a lot of time. 10 0 leaders read the proposals and everything from minor to major transitions, I would imagine These are leader whroz volunteer their leaderser are leaders who volunteer their time. Most proposals got five reviews. The commit submitters take this seriously and we try to reciprocate

>> for folks that didn’t get a head start how would they get involved in Shark Tank Maybe next time We’ll rely on the audience today to help us pick one of Shark Tank winners Every attendee can cast a vote for their favorite practice This is like American idol here or the voice you vote for the person >> We want to hear from the community and from the people What inspires you the most? So under the polling menu option of the event app you can cast your one vote The population popular vote winner is one of continue winner s announced tomorrow >> This is your chance you see an innovation that makes your heart beat or think it’s great, you can bring that forward should we see in the actual application of it today What is the tactical? How does it look? He’ll walk you through it. Each one has a three minute pitch They the impacted as well as what it takes to successfully replicate the practice. Each pitch is followed by a two minute question and answer session with the moderator Devin Harrison who is joining us off. At the same time we have 38 VISN and medical center sharks joining us online. They manage healthcare systems that cover tens of thousands if not hundreds of thousands of veteran They take their work seriously thmple he know They know the things they need and tools employees need. It’s exciting to have so many leaders online with us right now They are bidding actual resources >> They are putting money where their mouth is They are making firm resource commitments of funding as well as FTE they are willing to invest to bring it to facility >> I here there’s great news from your family exciting coming out of pandemic >> I appreciate you going there My wife and I are our second baby girl in march >> Maybe found other things to innovate during the COVID experience. I’ve been looking for my buddy the shark. He has been jumping into every single meeting we’ve had. He the exercise thing with me. I don’t know where he is, Blake, but he has been pretty consistent >> Hard to miss >> Hard to miss that blue guy running around is a shark when you need it Always one when you don’t I got it from here. Don’t worry about it >> I’ll look and see if you could find a shark. If you can find another one that would be great. Over to you, sir Our finalists worked hard on the pitches and they are about to put their passion and pitches on the We have a special person online to deliver words of en encouragement to presenters Mark, are you with us? >> Hey, everybody this is mark Cuban. I want to be congratulations on being one of VHA Shark Tank final finalists. You have an amazing ideas and amazing business opportunity in front of you in a way that cannot only make the VHA better and more efficient and better serving for veterans set veterans but veteran vet lanes but lan vet lanes Congratulations on being amazing enter enter ( smiewr entrepreneurs This is your chance go For the Go for it and good luck >> Let’s go ahead and jump into the Shark Tank. All right First up we have acute re covery center program presented by Peter Chen >> How are you — Peter, can you hear me? Yes, yes. Can you hear me? — can you hear me? >> Yes, we can hear you, Peter Should I start? >> Yes, please, go ahead and start with your presentation. Thank you for your patience >> How are you? For the next few minutes notice your own emotions for insight. Use your excitement now to imagine — next slide it’s complete opposite a lack of excitement for anything Temporarily connect with

those you’ve known in mental health crisis, sadness, stress, lonelyiness, you might not want to go on You may want to fell different yet not stay in the hospital or wait for an appointment. What help might you choose. Next slide Veteran-centered help with near immediate access, learning mental health skill there’s a grownt community, its accused acute recovery center or ARC combines all the elements on the left with a humanistic group and individual program designed for mental health crisis. We connect with you before you leave, hear your goals and off you to start at the next Monday, Wednesday, Friday morning group. You arrive to welcomeing group of staffer other veterans dwoasm group psycho therapy and connect practical skills to your situation. We also carefully assess and treat risk with evidence based suicide specific strategies like CBT for suicide prevention The overall experience is one of connection, hope and empowerment. Over the last eight years, we’ve had consistently good outcomes, depression and quality of life each improve 80% of the time, veterans are almost universally satisfied and they stay in engaged in arc and the follow up treatment. Next slide. Three-quarters of veterans reduce their suicidality in the program Concretely they stop entending planning or thinking about dying. Veterans are hospitalized 60% less in the year following ARC and less veterans have needed in-patient hospitalization over time. Next slide. We teach veterans to match actions with values and our idea bid starts with a values match. A medical center who in risk, veteran-centered care and skill building at the point of crisis. A center willing to shift time for e efficient crisis clinical in incone United Fronter. At this moment instead of taking away freedom ARC empowers choice a tool use together Notice how you feel right now Assess. Do you value mental health recovery and see its role in suicide prevention? Choose. You make the choice whether to place a bid forRC. Next slide Try to identify with the veteran experience of being supported in group, of saying things you’ve been afraid to, of discovering skills to handle intense emotions steadily allowing to you engage back in your life. Crisis can sometimes be a teachable moment for change. These imoat quotes give a flavor of what I’ve witnessed, a meaningful impact on so many including myself. Thank you >> This is Devin Harrison? Can you hear me? >> Hi >> How are you today? Good >> Great presentation. I appreciate you doing what you do and what you do for the veteran. You talked about the veteran experience and one of the things you talked about was thinking about dying tying actions with values. Can you describe more about the practice from the veterans per perspective and more about what the experience would be? the primary outcome for me is the veteran experience. If you could just, you know, — what what I want to communicate the most 1 what it feels like. Every moment it feels like the right work. I know for eight years, almost 1 this, veterans we’ve been giving veterans a chance at a timing when a part of them really wants that and a part of them might not want it at all. But the vast majority really engage, learn and apply thes of their lives and better off. So an a of veterans really thrive in A RC The experience can be transformative for them. Why is that? What I tried do is say give a little flavor of the veteran experience and the way I structured my talk. There’s similarityies in the presentation and the way that we run group. Idea s ever balancing thoughts and emotion, values based choices, having moments of mindful awareness of you are in your inner experience If you got a glimless multiply that to 120 minutes a week and three times a week for veterans >> One more question I want to ask you is personally from your perspective, what does this practice mean to you and why did you — why is it so personal to you and meaningself in >> Well, meaning mean meaningful? >> Meaning pfl personal because

we want to give people a choice and think about mental health re covery. Our experience in Milwaukee is it works. The cost is not a lot because you are shifting F TE so there’s little risk and a lot of benefit Thank you. Excellent job Thank you >> Blake: [inaudible] thanks for sticking with us as we work out the process. Devin your questions are comeing in beautifully If could you talk louder or raise volume, that might help listeners hear that loud and clear This is the second pitch. Next up west Beta lack theum lack the lactam allergy assessments presented by Amanda at VISN 9 >> When iches little I went to the doctor and got a penicillin shot. On the way home my began to swell. We quickly went back to the from that day forward I was labeled penicillin allergin Next slide. Now penicillins are a type of antibiotic They are great drugs. Cheap and often considered the drug of choice for most infections. An internal study showed 50% of veterans received less preferred abtves based antibiotics based on having the allergy level. That’s not exactly true that an an allergy is an allergy. It’s not true. 10% state they have a penicillin allergy 90% of the time it may not be a true allergy or they may have grown out of it Having the false allergy label can cause treatment failures and the creation of supers. Next slide. Those super bugs can have a huge impact on both mortality and healthcare costs Next slide. So at the Memphis VA we thought what can we do about this Any clinical pharmacist could fill out the algorithm. Results in the chart. Many could be cleared from the assessment alone. Patients are referred to the pharmacist led allergy skin test clinic. The pharmacist places the skin test, breathes in and depending on the results they can say if the patient is safe to receive the penicillin antibiotics or not. 99% are able to take the betcha lactam antibiotic. We assumed it’s a cost savings of $1200 per assessment and improves anti microyoabal. You don’t need additional rehorses sources. We can help you train the increasing staff to fill out the algorithm For the skin test clinic you need a half FTE for the clinical pharmacist specialist, a physician physician champion, clinic space and pay for the testing supplies $155 a test. Could you have the cost avoidance of $1200 for every assessment that you. So you may not have the resources to implement the clinic right now and I understand that. But we can help you implement the beta lactam assessment assess ment which is effect as a stand alone program. Sharks, let’s get you set up to start saving lives at a time. Next slide is my team. thank you for your time and I’ll take questions >> Amanda, excellent job, can you hear me well? >> Can you hear me okay? >> . Thank you very much. One of the things you talked about was no new resource s but you did say for a portion of your implementation you did did need half FTE FTE. Is that correct? >> Yes >> Let’s talk about sustainment Can you take about implementing at a new facility and what are required and needed to be able to sustain this and spread it somewhere else? >> Yeah, so this is really kind

of a two part thing We mentioned the beta lactam allergy assessment. It could be standalone and no re sources needs because most VA have clinical pharmacy specialists on staff For the clinic it’s more involved. Sauce taining it may be a little more difficult Some of the barriers there is that you do need a physician champion Making sure that champion stays on staff, that you have somebody interested in helping the pharmacist with that that’s the integral part. We’re willing to implement in any combination Whether it’s just the assessment or maybe you are doing something similar so you just want the skin test clinic or maybe both and we can do wallAwesome, let’s talk about what the cost may be for that. Can you talk about the re source inputs and cost for implementing the practice>> the cost for the beta lactam assessment as mentioned is nothing. You have those pharmacists on staff. It take a little bit of time. But typically those assessments once you get everybody trained can be done in ten minutes or less Whether you are talking about the cost of clinic , about a half of an F FT for a clinical pharmacist specialist salary it’s ideal if you can hire someone to dedicate the time but you can use a pharmacist on staff. If you had pharmacist that could dedicate the time that is something could you do as well And as I mentioned the cost of skin test supplies are $155 a timeThank Amanda >> Thank you [ Applause ] >> Blake Henderson: : Great job Amanda and Devin Just so you know we’re hear you loud and clear now. Thank four making that adjustment. I’m proud to introduce drive-thru vaccination clinic presented by Kelli Crews of VISN 8. Welcome to the Shark Tank, Kelli >> Thank you. Next slide, please. Picture this your veteran does not have an appointment for a couple months. He or she may be dis abled. Maybe they — sorry can you hear me? My screen went — okay. I can’t see. I’m sorry I can’t see anything Bick tour this. Your veteran does not have an appointment for two months. It’s flu season He or she may be dis disabled. Maybe they wear oxygen. Maybe he or she is on a lunch break for work, circleing the parking lot trying to find a space to come in to get a flu vaccine vaccine. Wait, they don’t have to. They can go to the drive-thru vaccination clinic. All they have to do is roll down the window and roll up their sleeve That’s what we did at our facility. It’s critical that veterans receive their flu vaccines ait can release reduce risk of serious complications, prevent hospitalizations and death. We wanted to improve our vaccinations for veterans. This practice involved setting up a stafferd mobile station equipped with a lap laptop, refrigerated cart and allows veterans to veterans to thruf when convenient to them receive a vaccination without getting out of the vehicle This had a great impact It improved vaccination rates, provided access, convenient to the veteran, provided veteran satisfaction and enhances the veteran experience by offering a unique service not offered in the community. still is not today It is very relevant during COVID-19 because it decreases their exposure to a walk-up clinic and broad vaccination of veterans and employees is so to reduce the overall burden to healthcare systems during COVID-19 and the flu. As you can see, from the bar graphs, the

drive-thru contributed to an increase in flu vaccinations compared to previous seasons during the month of October. One medical center showed an im improvement of 11% in 2018 and another improvement of 6% in 2009. Another clinic showed an improvement of 3 3% in 2008 2018. We opened up the flu clinic to employee and the rates improved from 30% to during 2019, season to 3% during the 2020 flu season Next slide, please please. To implement this is not hard. It required two staff members that worked 25 hours each per week It was easily operated, not hard to replicate and no new hireing is required. Space to set up is all you need where cars can to drive-thru and not cause transportation congestion We a refrigerated cart $3200 stocked with vaccines, a labstop with WiFi connectivity for charting and CPRS. This would be ideaal for any medical facility or outpatient clinic or community- community-based outpatient. All you need is say covered carport, a drive-through area or cart. What are you waiting for, bid on this practice, increase the safety for veterans and vaccination rates. Thank you >> Kelli, can you hear me? >> Can I hear you >> What are people waiting for, right? What is the problem? >> That’s right [ Laughter ] >> So look, I want to talk to you about a couple of risks There’s been rumbles that COVID is going to be picking up again and right in the — on the cusp of going into flu season. So — faced while implementing this practice and what are the way you can mitigate the rifng? >> So there are of course always risk aassociateed with anyassociate associated with a project. One of riives could be someone having a reaction to a vaccine. I have not — in my 20 years of practice have not seen a reaction to a flu vaccine but it’s not to say it couldn’t happen. We take special precautions. If someone has never had one before they cannot get one in the clinic. They have to go to the facility to be observed There’s risk of someone having other health events during their time out there in the clinic. So we have special protocol set up where we call 911 or the emergency response team and of course there could be a car accident or pedestrian accident that we have to be prepared for >> Nrdz, thank you. understood, thank you. Let’s talk about the data a little bit. Talk about more about how collecting the data and how collecting that data actually impacts the practice >> of course. Because, you know , you wanted to be able to show that what your practice does has results So we have a team that we work with that collects the data they collect it for how many flu vaccines are given for veterans and employees and we keep that in a chart on an excel spreadsheet to make it readily available each year, each flu season for the leadership at your facility who are key stakeholders, how are they receptive to this practice so far >> They started this in 2018 as innovation grant They approved the flu cart for us to try them in two facilities and we continued in 2019 and then, of course again this year >> Nice. Lastly, personally how does this practice effect you in, you know, what do you want to say to that before we close? >> I like it. It’s nice hear our veteran they drive-by telling us this is the third year in the row They are glad we do this. It’s convenient to them With COVID-19 they don’t have to go in. There’s limit limited capacity. They can go to facilities They don’t have to worry and they can get vaccinated Thank you, I appreciate that >> Thank you Next up the practice we’re presenting is EMS clean covers presented by Robert banks bank Bankston Welcome to the shark Shark Tank >> Hello, all, you may be wonder ing what was removed from the camera. It was a small

prototype of EMS clean pras plastic cover, a lay er ever protection used to fight dust, debris, used to use [inaudible] the motivation was designed for my great brand great-grandmother who was diagnosed with Lupus in in a hospital acquired febltion infection in the 70 70s. At the young age of 8 I render wondered if it was a direct result of treatment or cleanliness of the treatment space. I felt helpless watching her treatment and struggle over the years. I promised to become a doctor to take care of her. My grandmother passed away in 1978 and thus made the dream of becoming a doctor seemed pointless. Although I promised to herself there was no way to save her life I carried that guilt for years One day pulling up to the medical center, hmmmm, I didn’t need become a doctor to save lives, EMS staff is instrumental in saving lives every day through cleaning and disinfect disinfecting but my heart knew we could do more. The medical center has patient beds, gurneys, medical equipment and clean Lynn yen that should have an extra layer of protection awaiting use This could be exposed without a layer of protection which could result in contamination wile in the designated areas while being trans for theed. Next slide. Regardless the free plastic cover provides free of contaminants while en storage or en route to the destination especially in COVID-19 it adds an amazing impact internal and external arrested for — sorry qualitative measures and standpoint. It was deemed beck praft by joint commission, OIG and leadership. All you need is $ 240 — 240 unit as the $ $1280 and .2FTE for a couple weeks at your center When it comes to the value benefit the it’s immeasure It ask you that consider makeing this medical center daily cleaning routine. Our goal is provide the best care to nation heroes with immediate impact. Sharks may wonder why would I need this cover. A year ago we did not need to wear a mask every day This is a chance be proactive instead of reactive Thank you for your time and consideration and have a great day >> Rob, how are you doing? >> I’m good, how are you? >> I’m good. Thank you for the presentation. So you kind of went a little fast over the cost of what is required. Can you circle back to that and talk a little bit more about what is required for the implementation? >> 250 units at $1280 >> Okay. Thank you are the stake soldier stakeholders saying. I’m you have to work with other people dealing #W the equipment and everything else with the equipment and everything else. How are they receiving the practice you are doing. Is it positive or negative? It’s positive. You know with fully prototype withfully with fully with any prototype you had to make adjustments. We had OIG coming back to back last year. There was a question about whether it was Crean clean or dirty or whatever. I ran and got the bag because we were not using it The joint commissioner was like this say best practice you need to use it everywhere >> Great. You talked a lot about, you know, the personal meaning to you so I’m not going to touch that but I appreciate you bringing up the fact that you were inspired by your grandmother to do something really important. I commend you on that. Let’s talk about the data. Have you seen a change in data in terms of implementing this practice and how can that effective or how can another facility using try to obtain data This senator qual Tate protection. As far as exact data but when patient are walking in and visiting when they could, they were impressed because we went to the level of doing an extraer of provide such as COVID-19 it’s a qualitative measure than quantitive

>> Thank you I appreciate that [ Applause ] is more qualitative instead of quantitive. To say we have great to show it’s decreased infections I >> Our next presenter is epic stress to improve the say we have great to show it’s decreased infections I >> Our next presenter is epic stress to improve the quality of cardic tank Presented by Nash Nishant Welcome >> Thank you, everybody, particularly the sharks. I would like to give you five reasons to invest in EPIQ stress. One number one it helps address a big problem problem. Pun lished Published data shows up to 20% one out of five cardiac stress tested performs within the VA may have been unnecessary. What does that mean? They have no or little to expected value in improving veterans cardio cardiovascular care and prolonged wait times waiting for tests that are necessary. Next slide, please. Reason number two shark s should invest in epic EPIQ-stress. The key ino innovation is the consult with all outpatient stress test orders this establishes a new avenue of care cord coo coordination that lieus for real-time auditing and personalized feedback independent of the phenomenon final test rowrt report. Next slide This is templateed to include the test ordered and overall assessment of the appropriateness and the rationale used for assessment As with all e-consults these must be generated within 48 hours and used for positive reinforcement and constructive criticism IT has been proven to be effective. After one year of implementation at the Providence VA EPIQ stress was associated associated with a reduction from 8% to 2%. A reduction from 26 to 21 days and a decrease in wait time s greater than 28 days from an overall percentage of 39 39% 3-9D% to just 20% Next slide, please. Reason number four the sharks should invest in EPIQ stress it has a great return on invest. The labor totaled $8 ,000. Soft savings from reduced quality achieved reduction in unnecessary stress test orders from $33,000 Therefore the financial return on investment in EPIQ stress was about $25. Now importantly the reduction in veteran wait times I mentioned to you achieved are an important customer benefit that should be qualitative qualitatively added to the quantitive ROI I just mentioned. Next slide, please The fifth and final reason to invest in EPIQ-stress is can it be yours or peanuts for single site spread I’m asking for less than an eighth of FTE. Why so low? Wove done the hard work of building the infrastructure structure. All you need to do is identify a champion to ensure buy why And I want to thank everyone who contributed to this work and my sincere thank to the , that the sharks for their team time and hopefully investment. How are you doing? >> Very good thank you, Devin >> No problem. Thank you for the presentation There’s a lot of good information in there. I want to circle back to the clinicians perspective though. As a clinician could you elaborate more on the clinician clinician’s experience using this practice? Yeah, so before we implemented this practice the approve, we did a lot of preempt implementation focus groups. They made it clear to us that parts of the reason that they ordered un necessary stress tests it was hard to keep up with all of new guidelines about what was necessary and what went So what we did with this inoation is really to make it — innovation office to make it simple for them. Part of this innovation is really provided provideing real-time clinic support so they know if they are ordering a theaft is necessary or unnecessary. In the post implementation

focus groups we’ve done they seem to really enjoy that that. The other thing this does is allow them to put in a consult without a test order which wasn’t before and really ask the question what is the rest test for this veteran? That is something they said they appreciate Sounds like one of the things that is going to define this success is communication for one S. that what you said Absolutely >> Thank you. There anything else in terms of you can give to the people bidding on this successful success factor? What do they need in terms for this to be successful? >> All I need is a clinical championship. I built the architecture in CPRS that’s done I need somebody to understand the nuances at a particular facility and if anything it’s be changed we’d we would be happy to modify it but it doesn’t necessarily need to be modified and can be implemented at a new facility >> Thank you very much >> Thank you, Devin >> We have increasing access using an innovateive recruitment approach, the MoRe concept. Welcome to the Shark Tank, Marcus >> Thank you Blake and thank you d to the members of the team our audience, sharks and most importantly our veterans. Thanks for the service. I’m Marcus Johnson I’m here to present on the work to improve veteran access to clinical research Next slide, please. We know going from the late tour and from the literature and meetings participation in research is challengeing for them They have to drive long dainses to hospitals, deal with traffic and parking and navigate facilityies to identify and locate clinical research examine rooms and suite and meet with study teams. These are significant barriers to participation in studies is a critical issue for our healthcare system because finding some clinical research are used to im improve healthcare delivery Therefore veteran participation in clinical trials directly contributed contributes to healthcare delivery in the VA or at large. Many are participating in various clinical trials underway to develop vaccines and treatments for COVID-19 and that’s important look at trials in the healthcare landscape today. To tackle this issue we developed the MoRe aproamp which used unit as a tool that is mobile. We want to bring the research to veterans as opposed to having them come to us to participate in research. Next slide, please Sharks I’m sure your next question is what is say mobile re recruitment unit It’s a unit set up and ready for a study visit. They include items such as a laptop, a stand, portable printer with scanning and copy ing functionality, insulated for biospecimen transport and smaller items To the left you can see the MoRe unit can be use easily packed up, similar to luggage and ready to be transported to the next to the stop as needed. Next slide For the pie will the we looked at the impact on the MoRe units on the MVP study high volume study. We utilized the units at seven different VA hospitals and we were able to deploy these units to 27 additional locations at those sites primarily the outpatient Collins and can community events to give options where they might access clinical research. We looked at enment and found enrollment increased by an average of 39% across seven site s. Next slide, please please. So our strategy is relatively inexpenseive with the cost of all the components totaling $2 No additional FTE is required for implementing the strategy. These units are simply a tool that the clinic research study teams that your facilityies can use to improve veteran access to studies. Next slide please. I want to thank my colleagues and the office of research and develop the Thank you to the sharks

for your time and I’m happy to answer questions Marcus, thank you. How are you doing today? >> Great, Devin. How are you? >> Great. I appreciate everything. Let me get this right. Ease Easy to break down and transport? >> Absolutely >> Cost is relatively low in terms of $2,000 per accurate unit, accurate? Accurate >> No FTE, right? Exactly >> Let’s dig into the data. Can you elaborate more on that and is there any other data elements that can be taken from this implementation? >> Again we looked at the impact of units on enroll enrollment in the MVP study offer over an 8 month period, three different time periods points, each six months in duration. We looked at enroll ment six months prior, the enrollment data and the subsequent six months and then we looked at the data in a posted intervention period to figure out whether or not any impact that we saw whether or not it could be sustain sustained. And, again, 234 total we in total we saw enroll ment increased 39% >> researcher I know everything is about the data and you are real analytical. Corrected me if I’m wrong but that’s what I’m gathering. Tell plea why this is so meaningful — tell why it’s meaningful to you for from a personal perspective >> It’s meaningful to me but really to us all There’s a number of VA facilities participateing in clinical research as it relates to COVID 19. We have to chip in and do our parts to make research easy for veterans to participate in if we want to address this pandemic in our healthcare system and the nation at large >> Great and before we go, do you have any perspective from a veteran who terms the experience that you want to discuss or talk about? >> Anecdotally they appreciate not comeing to the main facilities. They often long distances from homes >> They appreciate not haveing to deal with parking and they appreciate us comeing to them at the c-box and community events to meet them >> Awesome, awesome. I appreciate that. Convenient, packable, inexpenseive. Seems like the veterans like it it. Good deal. Thank Appreciate it, thank you [ Applause ] >> Thank you, great work. I want to give a shout out to the audience which is excited and active in the chat. Please keep adding comments. If you have questions for the finalists enter them in. If they don’t answer them live in chat, we’ll rely them to the finalists and they can get back to after the event Our next pitch is comeing from open house niche tifer initiative presented by Danielle demailo of VISN 22. Welcome to the Shark Tank Thank you and good afternoon. I would like to begin with a quick story about a Vietnam veteran Over his 30 year career he experienced severe trauma and for 18 years after his retirement he never sought mental health treatment. He is not alone. I have come to know many veterans under similar circumstances and I’m sure you have, too Next slide. In 2017 when we started this initiative over 6,000 veterans committed suicide, an average of 17 per day and it’s only getting worse with with a current data average of 20 veteran. Sadly those not engage d in VA healthcare are at greater risk, over 65% of veterans who commit suicide are not taking advantage of VHA services Here at the V SAVAHCS thousands are not getting care They are working to reduce the stigma associated with mental health. Next slide. Our initiative outlines the holistic and wrap around services offered in mental health as well as the whole health and home care programs. In addition to receiving presentations from subject matter experts, attendees have the opportunity to ask questions, gather resources and meet with a mental health clinician and or schedule an appointment within the mental health service. And in August of this year, we developed our very first virtual open house to adapt to the COVID-19 setting and we’re currently preparing for our second in November. Next slide. This mental health open house niche tifer is ideaal idea initiative is idea for any sites offering mental

health services. It’s adaptable and flexible for face to face and virtual settings and it’s scaleable based on local needs and circumstances and standard work is in place to assist. Next slide The results speak for themselves. We have so far experienced a 10% increase in veteran engagement Of those 10% over 90% have decided to engage in mental health services and nearly 33% have continued to actively participate But it isn’t just about the numbers. It’s about the veterans. As for veteran I mentioned earlier, he completed the in-patient PTSD program after months of individual and group psycho therapy. After 18 years after he retired from the Army No veteran have to wait this long for needed care and services We invite you to join us in making sure we leave no veteran behind. Thank you Danielle, excellent presentation , thank you >> Thank you >> How are you doing today, good ? >> Pretty good,>> Let’s dig in Let’s talk about sustainment Is this just at one facility? Multiple facilities? Can you break it down? >> We have this at this facility and one of our community based outpatient places in Yuma. We’re work working with VISN 22 to provide the services in our package and the program to all of VISN 22 because it’s been identify as a best practice and services and programs are voluntarily able to adopt the service and we presented over at VISN 5 This was about six months ago and sold our practice there, too Awesome, good deal >> So one of the things you had 234 in your slide was something along the lines of FTE E neutral neutral >> Neutral >> Can you explain that and is there a cost associated with this implementation? >> So the FTE neutral means that we need no additional staff to provide this service We recruit volunteers as an ancillary task because there’s a lot of clinicians particularly in mental health service interested in process improve ment and systems redesign redesign. So we recruit them and they meet weekly. They have additional responsibilities but it’s nothing that requires an additional staff member. As far as the cost, you know, there’s cost when we’ve had the face face-to-face open houses because we’ve offered food and door prizes all we’ve gotten those through donations because of our volunteer services allows for donations for veterans. And our virtual open house essentially is no cost because it’s through WebEx and really just the cost of the staff and, you know, PowerPoint and all of the technology that we already have in place at the VA Perfect. Thank you, Danielle >> Thank you very muchHave a good day [ Applause ] >> Outstanding work, Danielle We’re going to move right along. Next pitch is re mote temperature monitor monitoring and amputation prevention through tele- tele-health presented by Kyle of VISN 10. Welcome to the Shark Tank, Kyle >> Thank you, Blake. Hello, everyone. Sharks, I’d like to start off with a question: Would you — go the next slide, please. Would you stand on a mat like this for 20 a day if you could save your feet from amputation? Think about that. I imagine you are thinking, yes, of course, we’re finding many veterans who agree with you. We’re preventing amputation in as little as 20 seconds a day with remote temperature monitoring. Next lied. There ray huge number of veterans at risk for amputation 25% of veterans have diabetes and one-third of them will have a dye bettic bet diabetic foot problem. Finding this too late leads to devastateing consequences As you can see on the top right This is these problems dis dis proportionately affect our minority veterans and those would don’t have good transportation or the resources to make it for routine follow up care. You have heard secretary WiLkie talk about the cost as well and excess of $3 billion

annually It’s a huge problem What do we do? Send our highest risk veterans a smart mat they stand on for 20 a day in the home They take thousands of temperature readings in the feet, sends this data off to the cloud and the clinical team reviews it catch problems earlier The earlier we catch a die diabetic foot problem, the easier to treat. We’ve had multiple veterans rave about how easy it is to use We’re seeing a huge return on investment and prevention with ROIs the range of 3-4.5X. Next slide, please. In real world clinical use we saw complete elimination of all moderate to severe wounds with this practice. We saw complete elimination of all major amputations and near elimination of diabetic hospitalization for foot related. When you see the cost of a new diabetic foot ulcer is excess of $40,000 most of the cost from in- in-patient care. A study came out this month and estimated for every 100 veterans enrolled in the practice the net savings could be as high as $1.2 million a year. Next slide, please. The key thing to emphasize about this practice is how easy it is to implement. The clinical staff requires training but there’s no extra or FTE requirements This help you level the playing field for veterans that cannot easily follow up in clinic but bringing care to homes. This is especially relevant during the COVID-19 pandemic. No veteran shouldd have to lose their limb to diabetes. We have the technology to virtually eliminate major amputation. If you want to help your veterans prevent limb loss and get a high return on investment, go bid or the practice. Thank you food pad itself. It goes to the home. Did I get that correctly? >> It’s used in the home and has a built-in cell phone phone. It works just will everywhere. We joked there’s one cave in West Virginia >> It’s an asynchronous format? >> yes, we capture it, review it and re it to >> Good deal. What are you talking about in terms of cost of the footbad. are we talking about in terms of resources outside ever FTE you mentioned? >> Key thing, no space. No FTE The mat itself does cost $3500 revenue. The key thing to think about is, you know, for — with the return on investment of 3.5- 3.5-4X you are pay yourself back in the long run. We heard that mentioned by the panelists multiple times It’s worth shifting towards a preventative model versus the sick care Dean Kamen mentioned It’s important with a practice like this to focus on the preventative piece. There’s upfront cost to save money and limbs What are some of the commissions and stakeholders saying about this practice? >> sure. That’s one of things I like most about the practice There’s not one discipline that owns it. I have talked to some sites where PM and R runs the Aation program, A amputation program and other sites podiatrists run it I see multiple sites using this regardless of clinical team make up >> Awesome. I appreciate that Thank you for the words. Great presentation Have a good day, man Thank you, Devin, you, too >> All right [ Applause ] >> Thank you Kyle, great work our next practice is called Teleco individual presented by Gauri about a Behari Welcome to the Shark Tank Thank you. Hey, sharks, are you ready to hear how Phoenix had a cost avoidance of $500,000 within the first two months of COVID pandemic? Next slide, please. We are all we will aware of the crowded emergency rooms, increased overtime spending, overwhelmed call centers, PPE shortages and staff shortages due to COVID-19 relate d illness or expesh exposure

start of pandemic, Phoenix needed an alternative. Our solution Teleco individual. Next slide tele–COVID. Vet cans can call in and talk to a clinician in real-time regarding symptoms and concerns >> They triaged and managed patients by video or phone and conduct follow up visits over the next 7-10 days to ensure a resolution of symptoms In the first few months of going live we saw 1100 unique veterans. 95% were treated virtually. This led to a huge reduction in un necessary ED volume during a national healthcare crisis. 50% of our patients lived over 30 markets from market minutes from the closest VA sites. We were able to treat these veterans and avoid community care spending. 20% were rural. We were able to see them from the comfort of their homes We’ve seen over 6,000 unique veterans through over 10 10,000 encounters in the six months since the pandemic started. Next slide, please We received a lot of positive feedback from veterans One said I feel like they really cared about me Another they took care of me when #EU wasn’t well enough to drive into town. One Sid I said I feel like you made a house call when I needed it most. Veterans reported it took no more than 45 minutes to when they completed their testing or had the filled prescription in hand. Mark Cuban was impressed. It took two weeks from concept to implication. That must be a vafer record. It’s space and equipment neutral What if COVID is no longer an issue a year from now It’s an adaptable program that can be modified and can be prebranded to tele–flu or tele-cold as needed With minimum cost it’s a win for any network Sharks who is ready to make a splash with tele-COVID? >> Great job. $500,000 cost avoid is major At this point we’re probably close to millions Awesome to hear. Let’s talk about the key elements for this practice. What are some of the key elements and can you e elaborate more on those elements that really deem this as a success? >> So, a huge part of it was the multidiscipline multi- disciplinary effort. Scheduling operations, nurseing, tele-health and emergency department. That was definitely a major part of this. Another part of it is that we had help from our infectious disease department and heap helping to make sure that our team stayed up to date with COVID guidelines and testing protocols >> Awesome, awesome. Thank you We’ll talk about the resource. I know it’s a tele- practice. But are there any addition additional resource inputs people should know about, cost, FTE, anything else that is associated with this? So for tele-COVID we used exist ing staff so it’s FT FTE neutral for our facility We’ve been able to keep up with the surges in COVID demand and preparing — preparation for the current surge. In terms of imiment equipment most of staff is tele- work capeability. We used existing staff for that part. In terms of space we were space neutral because we used tele-working staff >> Awesome to hear. Last thing before we go, and you know, with COVID, the uptick that is allegedly about to happen, right?, what are some of the other risks associated with this practice? Its ability too forecast staffing needs they have a clinician and somebody to answer the phone in realtime to take care of the veterans not appropriately staffed you may need to create a way for patients to suspend the duel have callbacks that. Is not only modification if not able to provide adequate staffing >> Good deal. Thank you very much. Good Thank you, Devin [ Applause ] >> Thank you Gauri. Great work Our next present presentation is tele-lactation program presented by Cody Giovannetti. Welcome to the Shark Tank

>> [inaudible] >> Cody do you mind unmuteing your mic, please >> Am I unmuted? >> We’ve got you now. Thank you >> Okay. Thank you, Blake I’m excited and honors to be here on behalf of Memphis VA Next slide, please Close your eyes, imagine a new mom who went to regular appointments, received good prenatal care, went to the classes and she knew breastfeeding was the route they wanted to take. Shockingly no lack take was given lactation support was given. She had an energy crrch- c-section after 16 hours of labor. She was exhausted mental ly and physically Despite peeling feeling prepared breastfeeding was never a top topic She’s suffering from low milk supply and vomiting from pain medication with no support of maintaining her breastfeeding goal to home. You might be surprised to know this person was me. Three out of four moms try but quit before six months. As a result I wondered what we were doing to support our pregnant and lactate lactating veterans Unfortunately lactation services are not routinely offered by the VA. It’s estimated 8 85% of VAies are not provideing lactation services I developed the tele-health lactation program that has reached more than 250 veteran thus far. It showed that half of women veterans are child-bearing age Next slide, please, the total costs is $450 and,000 and we spread them to 8 VHA VA ies VA’s. I remember calling Cody with sciment about my baby latch ing because she en encouraged me and believed in me So here is the best part. In order to replicate services minimal supplyies are. The main component is .5FT E willing to become a lactation consultation I’ve been told you have it so we can all implement this program in a two- two-week time frame. Due to gap s care women veterans nationally are the not likely receiveing this support If every VA provided the service s could save $3 million to $4 million in just a year’s time. Let’s make an impact and start lack lactation services in your VA VA Cody horks you r, how are you? Good how >> Shout out to giving the personal story one. Sought shout out to you tour putting an emphasis on women’s health >> Thank you they are a deserve ing population >> No question about it. Let’s talk about sustainment a little bit more What are the elements people at a new facility should know before they implement this and what are some of the risks associated with that? >> sure, there’s no risk. The biggest thing is I give you initial steps and I — it’s a one and a half day training with me and then they — the who is identify will have to get lactation certification. And from there out I give you a tool kit that gives you step to step process for actually implementing and recreateing what I’ve done in people sis >> There is there any data that a person can glean to to say this is why it’s sktive effect ive and here is the EU8 impact and this is why you should have it? >> Sure, we have to VA data we don’t have lactation services routinely offered impact is we’re making an impact We’re provideing these services. We’re support ing these veterans. 90% of veterans are meeting their breastfeeding goals. We track them on a 3, 6, 9, 12- month basis to see how long they are breastfeeding We’re exceeding those rates compared to Tennessee >> You knocking down all type of walls >> Trying to>> Good deal Before we go, let me ask you, talk more about the feedback you received either from people at your facility, VISNs other stakeholders helping you

with the practice know, I’ve only had great feed back. Everyone very supportive and really, really wants to make an impact on the women population They are the largest growing, quickest, fasting growing population in the VA. Supporting them is just fabulous and, know, we’re excited to help anybody else that we can >> Awesome, Cody. Thank you >> Thank you [ Applause ] >> Great job, Cody. Moving right along love the chat chatter and feedback in the chat We’ve seen intentions to bid flying. You have as — as a remind reminder sharks have until 10:00 a.m. eastern tomorrow to submit your bids. We love it whether when you come to prepared shout out to David Ohio mare Ohio O’mira next presentation is presentation presentation embed ding physical therapy in PACT VISN 23 >> Cited excited to ber here Next be here. Thank you for the opportunity to share physical therapy and primary care with you today. I ask you to consider for a moment something you love to do. Walking our hiking, playing with children or grandchildren, or perhaps you are a weekend wearer of some favorite sport. Consider your person healthcare experience at a time when you were injured and sought care to continue doing what you loved to do. How does that care with your VA? Are your veterans satisfied and chooseing your VA? Next slide, please. If veterans satisfaction, wait, specialty care provider referral volumes, are areas you would like to improve we have a solution. By embedded physical therapists we able to sustain the lowest average wait time of any VISN, help reduce imageing and pain time referrals Most meaningful is the veteran satisfaction. One of many veteran testimonyies here shows you the value to the veteran when the integration of physical therapy with primary care allowed same day intervention to manage pain without opioids and returned to work the following day day. Next slide, please. VISN 23 has the lowest average new patient PT wait time of any VISN largely driven by the high volume of patients we’re able to serve same day. Have you walked down the hall at your VA, observed a veteran struggle ing to walk and been concerned for safety? At your VA, how long would that veteran need to wait to see a physical therapist? I think we can agree that in those scenarios what should and needs to happen is for the veteran to be able to go to a familiar clinic, see a therapist that same day and ideaally leave that clinic with the equipment they need without traveler delayed within the medical center This is the one of values ever imbedded this. The minimum requirements to do this are low. A standard primary care examine room is sufficient and there’s no large expenseive equipment to purchase. You may be achieve these results with careful realignment of re resources. We figured out how to successfully imbed P PT im in in this PACT. And 31 locations report they adopted the practice. The better question is will your site be next? Next slide please Thank you to everyone with making this project a success and thank you to the VISN 23 leadership for continuous sponsor sponsorship of this and others A special acknowledge to Brandon Peterson Dr. doctor of physical therapy and others. Dr. Peterson is available to answer questions through the virtual chat and I open the floor for questions. Thank you >> Amanda, awesome. How are you doing today? >> Good, thanks, a little nervous >> You are good. We’re just talking. It’s all good >> Let me — I wrote a couple of notes. I want to make sure I got them down correctly. No large equipment Does that mean no equipment at all. You talked about realigning existing resources also >> Really the physical therapist s em bredd in primary care they had need an appropriate exam table If you move a therapist working

out of a large gym spacing they probably they have a treatment table they are useing that could be moved into a primary care space >> Essentially no cost associate d with this practice is that accurate? >> It is possible to do this without additional cost Great. Is it in all of VISN 23? It’s throughout VISN 23 We’ve embedded 7 of our 8 medical centers and many others have this >> the you said 31 facilities are ready to queue this up? >> We asked which sites have embedded it and that was the response >> Major move, amanneddal Let’s talk about the veterans You said you get a high volume of new patients within your VISN is the feedback you are receive ing from veterans We’ll talk about that before we close up? >> They love it. We get great reviews When we we’ve done voice of the veteran surveys associated with implementing this initiative anding practice, they love the approach. They love they are able to do with the primary care clinic They love the scheduling process Really great re reviews from veterans. They are satisfied with this initiative >> Major moves, thank you very much. I appreciate it >> Thank you >> Thank you Amanda Outstanding work. Our next presentation is virtual integrated primary care mental health integration hub presented by Kevin Kelly a VISN for corporate Michael J.kressen ‘s VA >> Thank you so much to sharks and everyone watching Access to behavior al help can be difficult. Lack of space and wait times for behavioral. If so, we’ve created the solution for you The corporate Michael J.Crescenz VA medical center and our partners the virtual integrated PCMHI hub Next slide, please Deployable through a hub model it consolidates staffing and leverages existing technology like VA video connect for all PCHMI functions at the remote site. Recognize Recognized as a 2019 VISN 4 best practice it provides and provides rural veterans with equitable standards of behavior health including immediate same- same-day access, suicide prevention, early oid tiks identification of concerns and rapid initiative of care. Next slide, please. This model begins with the primary care provider initiate ing a virtual warm hand handoff by messageing the V.I.P hundred. This coordinates with an identified team member at the re remote site to begin an immediate 30 minute video appointment using an iPad. This assesses the problem, arranges follow up and provides brief feedback to the PCP about the plan. Those with mild to moderate symptoms can receive virtual follow up wile those while those with more severe symptoms are referred for specialty mental health at the remote site Resources needed at the hub site include PCMHI staff and at the remote site and a sharing of space for the 30 minute. Next slide, please. Since implement ation at Will inning Wilmington The hub has transferred veteran referrals successful improved access and referred to icals and PACT 21 rates At the north or Atlantic county CBOC the percent of primary patients who engaged in services increased from 09 p 3% in July 2019 to 4 79% in September 2020 And we’ve improved the PACT 21 rate for the entire

facility helping Wilmington move from 9th out of nine to fifth in VISN four 4 and they are quickly catching sites in fourth sites in third and fourth places They had limited PC PCHMI at their CBOCs but they are improving for veterans Sharks, we would be thrilled to partner with to you im improve access why the access at your sites. Thank you >> Thank you, how are you doing? >> Doing well. How are you, Devin? >> Good man, great job. I want to make sure I understood this will correctly in terms of implement implementation practice, okay? >> Okay >> It’s until Philly, in Philadelphia and also in Wilmington or no? is it anywhere else? >> Currently we use — so VISN 4 leadership developed this great idea to be to help an out reach to re remote and rural veterans. We use Philadelphia as the hub site because of the strong intrastructure r and current at all five CBOCs for Wilmington VA to grow veterans because were struggleing with staffing >> I am glad the risk associated with that. Can we talk about the rifnlg risks and how you mitigated them and talk about the risks you may have occurred during implementation? Absolutely Those are great questions and these are important things to think about. We know that potential barrier barriers can include at the re mote site, again it’s difficult toll staff and implement PCMHI and I know from personal experience at rural CBOC. A lack of experience or previous or in adequate implementation at smaller clinics that may make providers wary of change changing the referral process for mental health. The host facility should be aware this should be a significant change in referrals for mental health services. Of course, thinking about WiFi and — because we use iPads for virtual warm handoffs to make sure there’s adequate WiFi or being able to use CB CBT equipment >> Great >> Go ahead, sorry Keep, going, you got it >> Thinking through the process of how we handle e emergent referrals. If there’s a high-risk veteran thinking through the process of making sure the veteran is safe It’s processes they are working on for 18. We have the processes polished Our brilliant porter ins have helped us do that as wellI appreciate you. And thank you >> Thank you >> All right Kevin. Great work We’re on the home stretch with our last three pitches. Now up VISN 20 centralized lung cancer screening program presented by clis by Christopher slater >> Thanks. I’m a pulmonary physician at the VA port portland healthcare system I’ve been involved in lung cancer screening as co- director of the centralize centralized program for a decade now. I’m excited to tell but the current proposal Next slide,. To start you probably know lunger is bad but lung lung cancer is bad It’s the leading cause of death for veterans and they are likely to get lunsier because of higher rates of firsthand smoke exposure in the military. Scans low lowers the risk and is widely recommended Unfortunately the VA along with the U.S. in general has been slow to implement lung lung cancer screening so many access this service. This does not tell the whole story. I want to read the quote from one of veterans served by the current program. He said I want to thank the VA healthcare system. Recently I was schedule for lung cancer screening. They found it and removed the upper lobe of my right lung. I thank God it’s used to detect cancer early thmple patient and quote are the reasons we’ve worked so hard to provide high quality prevention for veterans. Based on VA’s experience in the lung cancer screening pilot program, they issued this memo in 2017 to clarify how lung cancer screenings should be

performed Port one of eight sites and developed the core components of a high quality program based on everything and collective experiences in the pilot The memo states only facilityies with these eight components should engage in the screening. We systematically worked to build capacity in our area so almost 70,000 veterans are assessed and offered screen screening that follows the 10N criteria our submission to provide a high quality service that minimizes the burden. We’ve achieved a program with a high level of adhereence and starting to see a lung cancer shift which is strongly associated with reduced mortality in Los Angeles lung cancer. Now weapon r we want we want to enable all veterans to have access to. We enable veterans to obtain their CAT scan at local facility. We utilize radiology and pull mon pulmonary expertise. The winning bidder supports the coordinator FTE necessary to run a program with a small amount to support pull mon nologists and radiologists as well. We work hand in glove to help implement the tools to systematically identify patient patients and coordinate with facilities. We aim to provide a high quality service that reduces veterans chances of dying from lung cancer while minimizeing the murder. If you want to make a dent in the huge burden of care, bid on us. Thank you for your time and a huge thank you to the part port land team. Partner and collaborateors and everybody committed to improving care for veterans. I wanted to acknowledge the hard work of other competitors today We’re work hard to improve care for veterans and I’m honored to be complu included with the you. Thank you so much >> Thank you for the present ation >> Thank you >> No problem. A couple questions. Can you we talk about data collecting for this practice and can you talk about will you it’s an im pact on the practice whielg you are implementing it? It’s part of what we do with implicateing the nurse coordinator and information technology tools is keeping track of how many veteran we so do the shared decision visit on. How many say yes, sir to screening yes to screening after being full fully inform and go to the low dose cat CAT scan and how do we keep people coming back year after year It’s something you have to get year after year wheel you are eligible. We have been able to offer this service to 70,000 veterans 234 our area. r in — in our area We’ve done 7,000 CT scans We showed we had over 80 % adhere adherence to follow up scans which is both high within VA programs and super-duper high compared to programs in the community community. We use data to inform what we do but to make sure we’re continually doing a great job Good deal. Let’s say on the implementation wave right now for this practice You talked about re resources being at FTE and then you said a small amount additional resources Can you dive eye little 2K50E7 deeper >> Based on what we’re able to do here in port We estimate that for every 40 ,000 veteran in the area for a facility that equals 1,000 that eventually say yes, sir to getting lung cancer screening. That takes a 1.0FTE nurse time to coordinate care for those folks folks We include .2FTE for a raid radiology to read the catscans cat CAT scans and supervise >> Good deal. One more question before we wrap up, any other cost associated with the practice or that’s just it that you mentioned? those are it. We’re trying to figure figure out how it’s going to work with Serna. It’s not a cost but we have to consider. VISN 201 oneis going to be one of first sites sites. One of things we commit ted to as a program is to work with that process to continue the high quality level of service >> It’s something to keep an eye on as people bid on this, correct? >> Correct >> I appreciate that. Thank you , Chris have a good day, man Thank you [ Applause ] >> Thank you you so much Chris and team there in port

portland. Great work. Our next practice out of VISN 41 tele–urgent care presented by Lori Conti of VISN 4 VA healthcare >> Good afternoon. Good evening Thank you all for the opportunity to present VISN 4’s tele-urgent care program. Next slide, please Community urgent care costs excited exceeded $1 million in VISN 4 this past year and then there I was I received a phonecall from Dr Timothy Burke VISN 4’s chief med Coll medical officer sharing his vision for increasing access to care, reduceing un unnecessary urgent care visits, reduce cost to the VA and im continuity of care for veterans in this system. We established an integrated project team within a week and gootd to work developing and got to work developing this program Referrals are Referrals are again ratesd by rates Referrals are generated by an RN triage. For on demand warm hand off for VA perlg Pittsburgh’s emergency providers. Next slide, please U.S. Army veteran Mr R. Moyer shared his experience He was so sick. His wife was at work with the only vehicle and he called the VA agreed to a tele-urgent care moment appointment. He said we were done in 10-15 minutes. They ordered the meds I needed to an noash pharmacy. nearby pharmacy. I felt better in a couple days I never needed to travel to the VA nor spend the gas I’m thankful this program exists Next slide, please We’ve been tracking successful utilization of this practice for all veterans like Mr. Moyer and we’re proud to share we served 2685 veterans in fiscal year 20 and when COVID-19 spiked in the region, we were ready. We concluded that since January 1950 of those veterans had their issues re solved from tele-urgent care or through a downed triage to the PACT team Saving the VA over $300,000 in community care payments to the urgent cares Next slide, please. You, too, can create a successful VISN urgent care. We participate partner partnered to create the national implementation guide We have resources, strategies, all the tools you need to get you started and this all aligns with the clinical contact center modern izeation effort Doing tele-health appointments just makes sense what he said. It saves our healthcare system, saves on you, saves gas protects yourself your health. It’s just so much easier. So bid on tele-urgent care and save the system. Thank you >> Thank you, Laurie, how are you doing today? >> Doing well. How are you, Devin? >> Good. Before we go on to any questions. Shout out to you with the natural light Major! Thank you I’m blessed here >> No problem I wanted you to know that. Let’s talk about user experience. You talked about the veteran experience which is tremendous Can we talk about the clinician experience, if will you. Can you elaborate on the clinician experience use ing this practice? Sure. We have such a great organization here in VISN 4. We have a clinical con text center full of nurses engaged to receive calls from veterans and get them directed to our energy department team. We have an awesome group of adviseition advise physician assistant staff who take the calls day by day. They’ve seen the tremendous im impact they can make keeping veterans at home, out of busy emergency departments un necessarily and making a huge difference They love seeing great and seeing the data and the impact they can make >> Let’s talk about data. Can you dive in deeper about the data and the impact You mentions it mention

mentioned it Let’s talk about it a little more >> We started in octs we had October we had a small portion operateing with one provider and we’ve grown to using this team and the emergency department. We’re seeing how visits many visits or veterans we can take care of every day. That number keeps growing and growing. We started out as a Monday through Friday 8 to 4:30 pie lot. I’m excited to share Sunday November 1 we’re expanding from 8:00 a.m. to 8:00 p.m. 365 day #-Zs a year We’re looking forward to see what we can accomplish on evenings, weekends and handleing holidays >> Great, one more question before you wrap up. Can you go back and reiterate the re sources needed for this practice in terms of FTEer finances? >> finance E E or finances >> Sure we used existing teams and existing staff Our netd work is supporting support in the dlets work is start Our network is standing expanding. These staff are expanding to emergency department and tele-urgent care. We’re utilizeing existing resources but making sure we have sample ample staffing as we gro grow and develop >> Thank you, good job >> Thank you [ Applause ] >> Out standing work, Laurie thank you all for sticking with us. We’re down to our last pitch of 2020 VHA Shark Tank Shark Tank Competition Welcome VA voluntary service curbside delivery Welcome to the Shark Tank, Sue >> Thanks so much, Blake. I want to make sure that you can hear me before we get started >> We hear you loud and clear Fantastic. Good afternoon, sharks. Before we start on the curbside delivery program voyage, I want to take a moment and ask you to consider one key question. What did you have for breakfast? Maybe it was something you grabbed from the fridge or maybe it was the same thing you have every day or maybe you don’t remember because so many things happened in the last eight hours and breakfast is not the most important thing on your. minds Well for a lot of our veterans food 19 only thing is the food is the only thing on their moondies A considerable number of veteran s are concerned with not having enough food. Nerl 2% of veterans who — nearly 2% of veterans who visit any VA medical center including yours experience food insecurity. We know COVID 19 made this worse. Many have made tough choice choices, chooses to eat or chooseing to pay bills Chooseing to stay home or choose ing to go to the grocery store and risk COVID exposure We launched curbside delivery as a way to minimize the choices. As a collaborative effort between voluntary service and multiple service lines this enhances other food programs that might be in place Our volunteer driver drivers drop off donated items directly to the veteran veteran’s doorstep to contract contactless delivery which minimum rises risk. We include other items and information about current happenings in their food bags. So to keep the program sustainable, we do that through strong community partnerships, donations and volunteer time. Our results prove that we’re breaking down barriers to care that food insecurity and isolation can create. Next slide, please. In fact, since launching in April, 2020 our program has met the needs of over 400 vulnerable veterans and have a staffing perspective, we used 12 volunteer volunteers and coordinators and our current voluntarily service specialists to make this program work. We’ve sourced almost 200,000 in donations and we’ve captures almost 670 600 volunteer hours from VTNs willing already register registered as VA volunteers Next slide, please. We know food insecurity an issue for many veterans which is why this program is perfect for you. All you need is a van, some volunteers and a willingness to tackle food insecurity. But we

want it to be easy so we can offer you a step by step implementation guide to make this a win/win situation your veterans and your sites. Sharks, take a out of food in insecurity issue and let’s bring curbside delivery to your facilities. Thank you >> Sue, Hank thank you. How are you? Great, how are you? Shout out to Charleston. I started my career as an engineer there >> Great place >> It’s near and deer to me You and about voluntary service being a strong ally in this obviously. But what about other stakeholders, have you spoken to food and nutrition , engineering, the transportation department? What are the other stakeholders saying 234 terms of in terms of implementation? >> It takes both to make this program work >> Speak on it. Let’s go >> from an internal perspective We’ve worked closely with nutrition and food service with social workers, with mental health department and of course, with transportation We gathered all of those stakeholders together. We had conversations and then we put together a very quick training to make sure that everybody was on board and understood how this program worked works. So from that perspective we’ve had great buy in. We couldn’t do it without the help of those functions. From an external perspective our community partners are really sort of bred bread and butter that makes this work. DV AV gave us vans. Volunteer drivers work injunction with DAV. Daughters of American revolution, American legion auxillary and American legion have given donations of food to keep the program going. So without those internal and external stakeholders we wouldn’t be as successful >> Good deal. And correct me if I’m wrong, you said that this really kicked off in April of 2020, correct? did. And here is why So volunteer voluntary service fills in the gaps. When COVID first hit our area, we had this idea. We were looking around and thinking what is needed? And so we spoke to all of those internal service lines and said, hey, what is needed? We realized that food was an issue and people leaving their home homes at a time when they were told to guarantee quarantine it was an issue. My team talked a little bit and this came out after this discussion >> What are some of the risks you encountered when you were getting this off the strong ? >> that’s the beauty of this program? We worked hard to minimize risk that. Is really risk. This That is why this exists. We’re minimizeing the risk of veterans who should not be going out and having potential to COVID. Our volunteer drivers they are VA volunteers gone through background check They are already in the system. We gave them back their purpose. Instead of standing them down, we stood back up in a different. We worked hard to minimize risk through PPE and practices in place. Good deal All after this is broken down >> Our step by step guide. The greatest part about this is there’s no additional FT Es and there’s no money because it’s through donated resources >> Good deal. I appreciate you Thank you very much >> Thank you [ Applause ] Wf a few great stories that came there Fins to the left, fins to the right. Might be dating myself with that. It’s a fantastic experience. Date two has been tremendous. I’m hoping Blake joins me. That was a long way from the other side >> Who puts the sets 100 yard as part >> We with the — we wanted to work on that. I haven’t seen our blue friend but a lot of great shark innovations in there >> It was our best Shark Tank The finalist presented presented. They brought passion

They communicated clearly. Appreciate the audience. You were great Very enthusiastic. Want to give a shout out to the Q&A facilitateor Devin Harrison >> Devin, you did a great job You kept it light and bright and a lot of great questions. Did you see anything that got you going? I know you can’t lean towards encourageing one or the other but what was the feeling? >> What highlights to me is how many the employees em empathize with the cut of customer, how much they are try ing to prevent problems and create a better experience, better outcome for the veteran We saw a lot ever that today and made me super excited >> I’m excited as a veteran when I look in and see the faces of employees and and and passion they are bringing forward as they talked about the pride of what they created at the VISN. Money savings, time savings, better veteran experience, preventing amputations, COVID, tele-health, all sorts of stuff that tends to lead towards a better veteran experience overall >> They are an extreme extremely talented great. They tied it together >> and how about your friend mark Cuban sending in a shout out. I thought it was a great note to let us know his reaction >> He has been a great supporter He loves how this translated to the healthcare environment and veterans and we really appreciated him joining us today >> Fabulous. You did a great job and thank you for including us in that >> Last bit get in your votes by 10:00 p.m. Polling closes at 10:00. We’ll announce the ten winners tomorrow afternoon at 4:45 p.m as part of the iEX awards ceremony >> Thank you, Blake. Big shout out to everyone who it possible To the atlas team and the folks here. Production crew, camera team, thank you so much much. And to the veterans who reached out to make this possible. I’m missing the shark. Special ciewdy ciewdies if you can figure outy kudos if can figure out who was the shark. Who was wearing the suit. The diffusion summit. The celebration of 12 promises practice of cohort five, the diffusion of excellence, virtual exhibit hall and awards presented later on tomorrow afternoon. I want to thank you. My name is Joe Grace, navy captain, your CapitalCaptain for this event and a veteran. Most of all for for all of you at the VA thank you for your service Thank you for your time we look forward to seeing you tomorrow at noon. Good Navy