DEPARTMENT OF VETERANS AFFAIRS Washington DC 20420   April 7, 2020 In Reply Refer To: 001B FOIA Request: 19-09094-F Austin R. Evers Executive Director American Oversight foia@americanoversight.org Dear Mr. Evers: This is the Seventh Partial Initial Agency Decision (IAD) to your Freedom of Information Act (FOIA) request to the Office of the Secretary, U.S. Dept. of Veterans Affairs (OSVA) dated July 11, 2019, referred to this FOIA office on July 2, 2019, and assigned FOIA tracking number 1909094-F. You requested, as you phrase it: “All emails sent or received by former Secretary David Shulkin or former Chief of Staff and Acting Secretary Peter O’Rourke on any personal, non-governmental, or nonofficial email account regarding official agency business. [...] Please provide all responsive records from November 9, 2016, through March 28, 2018.” Seventh Partial IAD & Reasonable Searches Dated 8/2/19 On August 2, 2019, OSVA received approximately twenty-two thousand (22,000) pages of emails from David Shulkin working on VA business on his aol.com and gmail.com email accounts, in which Mr. Shulkin did not copy a VA employee. OSVA now releases to you one thousand nine hundred seventy-nine (1,979) pages, Bates-numbered 20001-21985. OSVA releases partial email addresses of Laurie Perlmutter (lperl), Marc Sherman (mbs), Bruce Moskowitz (brucem), whereas redacting their email addresses would not identify them as the recipients or senders. OSVA releases the names of Marc Sherman’s associates Michael Zinner, Terry Fadem, Clifford Ko, and Kurt Heyssel, as well as Perlmutter associate Marisol Garcia. OSVA releases names of RFP panelists Amy Cooper, Stan Huff, Stephanie Reel, Jon Manis, Karson, Ed Marx, Frank Opelka, Aneesh Chopra, Cris Ross, Carla Smith, Ryan Howells, Paul Sutton, and Kenneth Mandi. VA elects to release the names and VA contact information of VA Senior Executives. VA also releases photographs of the VA Secretary, as well as public photographs. After reviewing the one thousand nine hundred seventy-nine (1,979) pages, Bates-numbered 20001-21985, OSVA redacts some information with FOIA Exemptions 4, 5, and 6. 5 U.S.C. § 552(b)(4) exempts from disclosure “trade secrets and commercial or financial information obtained from a person and privileged or confidential.” “Where commercial or financial information is both customarily and actually treated as private by its owner and provided to the government under an assurance of privacy, the information is “confidential” within Exemption 4’s meaning.” Food Marketing Inst. v. Argus Media, No. 18-481, at *2 (U.S. June 24, 2019). Redacted information includes details of multiple proposals (including from Apple), with proposed technical approaches, teaming or partnership agreements, assessment methodology, and labor rates, all of which the VA never accepted. Such information is marked confidential, A I A PVERSIGHT Austin Evers Page 2 April 7, 2020 and offerors (such as Apple) typically treat such as commercially private information or having received an assurance of privacy from the VA.   Exemption 5 protects interagency or intra-agency memorandums or letters that would not be available by law to a party other than an agency in litigation with the agency. The presidential communications privilege protects agency communications to or from the President or his advisers. On ten (10) pages, OSVA redacts communications between VA officials and the President or his advisers. Loving v. DOD, 550 F.3d 32, 37-38 (D.C. Cir. 2008) (Exemption 5 "incorporates" Presidential Communications Privilege, which protects "'communications directly involving and documents actually viewed by the President,' as well as documents 'solicited and received' by the President or his 'immediate White House advisers'" (internal citations omitted)); Berman v. CIA, 378 F. Supp. 2d 1209, 1219-20 (E.D. Cal. 2005) (same), aff'd on other grounds, 501 F.3d 1136 (9th Cir. 2007); Judicial Watch, Inc. v. DOJ, 365 F.3d 1108, 1110 n.1 (D.C. Cir. 2004) ("embrac[ing] the definitional analysis set forth" in In re Sealed Case, 121 F.3d 729, 74950, 752 (D.C. Cir. 1997), protecting documents covered by Presidential Communications Privilege); Amnesty Int'l USA v. CIA, 728 F. Supp. 2d 479, 522 (S.D.N.Y. 2010) ("all twenty documents reflect or memorialize communications between senior presidential advisers and other United States government officials and are therefore properly withheld"). Out of nine thousand nine hundred forty-seven (9,947) pages released to you, OSVA redacted information per the presidential communications privilege on only forty-three (43) pages.  FOIA Exemption 5 also permits an agency to withhold material reflecting the thoughts, opinions, and recommendations of federal officials reviewing an issue. Under the deliberative process privilege and FOIA Exemption 5, OSVA redacts internal government deliberations, thoughts, opinions, recommendations, and solutions from federal employees reviewing in their professional capacities: VA programs, potential responses to news or Congressional inquiries, talking points, a proposed Executive Order, and unsubstantiated allegations. The information contained in the responsive records is both predecisional and deliberative because it reflects preliminary opinions, proposed solutions, recommendations, potential responses to news or Congressional inquiries, talking points, a proposed Executive Order, unsubstantiated allegations, and a VA OIG complaint details, which do not reflect VA's final decision. Exposure of premature discussions before a final decision is made could create undue public confusion. The release of the redacted information would negatively impact the ability of federal employees to openly and frankly consider issues amongst themselves when deliberating, discussing, reviewing, proposing changes to, and making recommendations on: VA programs, potential responses to news inquiries, talking points, a proposed Executive Order, unsubstantiated allegations, and a VA OIG complaint details. The information reveals the thoughts, deliberations, and opinions that, if released, would have a chilling effect on the ability of federal officials to discuss, opine, recommend or be forthcoming about the agency’s issues which require full and frank assessment. Here, the disclosure of the withheld information is likely to compromise the integrity of this deliberative, decision-making, or investigation process. Moreover, the predecisional character of a document is not altered by the passage of time. Bruscino v. BOP, No. 94-1955, 1995 WL 444406 at *5 (D.D. C. May 15, 1995), aff’d in part, No. 95-5212, 1996 WL 393101 (D.C. Cir. June 24, 1996); Bruscino v. BOP, No. 94-1955, 1995 WL 444406 at *5 (D.D. C. May 15, 1995), aff’d in part, No. 95-5212, 1996 WL 393101 (D.C. Cir. June 24, 1996); Access Reports v. DOJ, 926 F.2d 1192, 1196-97 (D.C. Cir. 1991) ("talking points" memoranda are predecisional); ACLU v. DHS, 738 F. Supp. 2d 93, 112 (D.D.C. 2010) (“’talking points’ are predecisional . . . the document itself suggests that a public statement was anticipated at the time of its creation, and given that no official statement has yet been made, the talking points remain ripe recommendations that are ready for adoption or rejection by the A\11 ICA PVERSIGHT Austin Evers Page 3 April 7, 2020 Department"); Sec. Fin. Life Ins. Co., No. 03-102-SBC, 2005 WL 839543, at *11 (D.D.C. Apr. 12, 2005) ("The undisputed evidence establishes that these [talking points] are deliberative."); Judicial Watch, Inc. v. U.S. Dep't of Commerce, 337 F. Supp. 2d 146, 174 (D.D.C. 2004) (protecting "talking points" and recommendations on how to answer questions); St. Louis Sewer Dist., No. 10-2103, at *18 (E.D. Mo. Mar. 2, 2012) (protecting email communications, "press releases, talking points and 'Q & A,'" drafts, and briefing materials); Citizens for Responsibility & Ethics in Wash. v. DHS, 514 F. Supp. 2d 36, 44 (D.D.C. 2007) (protecting briefing materials concerning Hurricane Katrina response including proposed "solutions and approaches"); Judicial Watch, Inc. v. DOE, 310 F. Supp. 2d 271, 317 (D.D.C. 2004) (protecting briefing materials for Secretary of the Interior), aff'd in part, rev'd in part on other grounds & remanded, 412 F.3d 125, 133 (D.C. Cir. 2005); Klunzinger v. IRS, 27 F. Supp. 2d 1015, 1026 (W.D. 1998) (protecting paper to brief commissioner for meeting); Thompson v. Dep't of the Navy, No. 95-347, 1997 WL 527344, at *4 (D.D.C. Aug. 18, 1997) (protecting materials to brief senior officials responding to media inquiries, as "disclosure of materials reflecting the process by which the Navy formulates its policy concerning statements to and interactions with the press" could stifle frank communication within the agency), aff'd, No. 975292, 1998 WL 202253, at *1 (D.C. Cir. Mar. 11, 1998) (per curiam); Williams v. DOJ, 556 F. Supp. 63, 65 (D.D.C. 1982) (protecting "briefing papers prepared for the Attorney General prior to an appearance before a congressional committee"). 5 U.S.C. § 552(b)(6) exempts from required disclosure "personnel and medical files and similar files the disclosure of which would constitute a clearly unwarranted invasion of personal privacy." FOIA Exemption 6 permits VA to withhold a document or information within a document if disclosure of the information, either by itself or in conjunction with other information available to either the public or the FOIA requester, would result in an unwarranted invasion of an individual’s personal privacy without contributing significantly to the public’s understanding of the activities of the federal government. Specifically, the information being withheld, as indicated on the enclosed documents, under FOIA Exemption 6, consists of names, identities, photographs, email addresses, phone numbers, cellular numbers, facsimile numbers, unsuccessful resume application details, medical details, photographs, and personal details unrelated to the VA of: federal employees, federal contractors, veterans, private citizens, and their family members. Federal employees, federal contractors, veterans, private citizens, and their family members retain a significant privacy interest under certain circumstances, such as in instances where the release of their information could represent a threat to their well-being, harassment, or their ability to function within their sphere of employment. The federal employees, federal contractors, veterans, private citizens, and their family members whose information is at issue have a substantial privacy interest in their personal information. In weighing the private versus the public interest, we find that there is no public interest in knowing the names, identities, email addresses, phone numbers, cellular numbers, facsimile numbers, unsuccessful resume application details, medical details, photographs, and personal details unrelated to the VA of: federal employees, federal contractors, veterans, private citizens, and their family members. The coverage of FOIA Exemption 6 is absolute unless the FOIA requester can demonstrate a countervailing public interest in the requested information by demonstrating that the FOIA requester is in a position to provide the requested information to members of the general public and that the information requested contributes significantly to the public’s understanding of the activities of the Federal government. Additionally, the requester must demonstrate how the public’s need to understand the information significantly outweighs the privacy interest of the person to whom the information pertains. Upon consideration of the records, I have not been able to identify a countervailing public interest of sufficient magnitude to outweigh the privacy interest of the individuals whose names are redacted. The protected A\11 ICA PVERSIGHT Austin Evers Page 4 April 7, 2020 information has been redacted and (b)(6) inserted. “Withholding a telephone number or e-mail address, alone, is not sufficient to protect that [privacy] interest; alternate means of contacting and harassing these employees would be readily discoverable on the Internet if this court ordered their names disclosed.” Long v. Immigration & Customs Enf’t, 2017 U.S. Dist. LEXIS 160719 (D.C. Cir. 2017). Out of the twenty-two thousand (22,000) pages, OSVA has reviewed about sixteen thousand three hundred (16,300) pages and released nine thousand nine hundred forty-seven (9,947) pages, some redacted, to you. About six thousand five hundred (6,500) pages predate November 9, 2016 and, thus, are non-responsive to your FOIA request. Of the nine thousand nine hundred forty-seven (9,947) pages released to you, four thousand four hundred thirty-six (4,436) pages relate to three (3) informal advisors. On March 10, 2020, OSVA released you two thousand three hundred four (2,304) pages, nonconsecutively Bates-numbered 15140-19303, redacted with FOIA Exemptions 4, 5, and 6. One thousand eight hundred fifty-nine (1,859) pages between those Bates-numbers predated November 9, 2016 and were, thus, non-responsive to your FOIA request. On February 3, 2020, OSVA released one thousand nine hundred fifty-four (1,954) pages, Bates-numbered 1659-3638, redacted with FOIA Exemptions 4, 5, and 6. On January 14, 2020, OSVA released seven hundred six (706) pages, Bates-numbered 950-1658, redacted with FOIA Exemptions 5 and 6. On January 6, 2020, OSVA released to you five hundred forty-three (543) pages, nonconsecutively Bates-numbered 10033-11500, redacted with FOIA Exemptions 5 and 6. The other four thousand two hundred seventy-nine (4,279) pages, within pages Bates-numbered 10033-14999, predated November 9, 2016 and, thus, are non-responsive to your FOIA request. On January 6, 2020, OSVA also re-released to you nine hundred forty-nine (949) pages, Batesnumbered 1-949, previously released to you on November 21, 2019, but with fewer redactions. Approximate 30,800 Pages of Emails Received on or About 1/15/2020 On or about December 23, 2020, Mr. Shulkin submitted approximately thirty thousand eight hundred (30,800) pages of emails in which he copied a VA email address. From OSVA’s preliminary review, about sixteen thousand four hundred (16,400) pages predate November 9, 2016, and thus, are non-responsive to your FOIA request. From a sample size of four hundred thirty-five (435) emails totaling two thousand one hundred thirty-four (2,134) pages, Shulkin did not copy, forward, or send to his VA email address, two hundred two (202) emails totaling nine hundred seven (907) pages. We estimate eight thousand three hundred (8,300) pages in which Shulkin copied, forwarded, or sent to his VA email address, and six thousand one hundred (6,100) pages in which Shulkin did not copy, forward, or send to his VA email address. For your past FOIA request 18-07426-F, OSVA has released to you all of Shulkin’s aol and gmail emails, possibly redacted, in which Shulkin directly communicated with the three (3) informal advisors and copied, forwarded, or sent to his VA email address. For your FOIA request 18-11960-F, OSVA has produced and will continue to produce all of Shulkin’s aol and gmail emails referencing the three (3) informal advisors and copying or sending emails to VA email address. A\11 ICA PVERSIGHT Austin Evers Page 5 April 7, 2020 OSVA will process the six thousand one hundred (6,100) pages in which Shulkin did not copy, forward, or send to his VA email address as responsive to this FOIA request. FOIA Mediation As part of the 2007 FOIA amendments, the Office of Government Information Services (OGIS) was created to offer mediation services to resolve disputes between FOIA requesters and Federal agencies as a non-exclusive alternative to litigation. Using OGIS services does not affect your right to pursue litigation. Under the provisions of the FOIA Improvement Act of 2016, the following contact information is provided to assist FOIA requesters in resolving disputes: VA Central Office FOIA Public Liaison: Name: Doloras Johnson Email Address: vacofoiaservice@va.gov Office of Government Information Services (OGIS) Email Address: ogis@nara.gov Fax: 202-741-5769 Mailing address: National Archives and Records Administration 8601 Adelphi Road College Park, MD 20740-6001 FOIA Appeal This concludes OSVA’s Seventh Partial IAD to request 19-09094-F. Please be advised that should you desire to do so, you may appeal the determination made in this response to: Office of General Counsel (024) Department of Veterans Affairs 810 Vermont Avenue, NW Washington, DC 20420 If you should choose to file an appeal, please include a copy of this letter with your written appeal and clearly indicate the basis for your disagreement with the determination set forth in this response. Please be advised that in accordance with VA’s implementing FOIA regulations at 38 C.F.R. § 1.559, your appeal must be postmarked no later than ninety (90) days of the date of this letter. Sincerely, Richard Ha, JD, CIPP/G OSVA FOIA Officer Attachments – Redacted one thousand nine hundred seventy-nine (1,979) pages A\11 ICA PVERSIGHT not decades, of neglect and failure to modernize," Shulkin said. More flight from the VA health care system could eventually lead to its elimination - a disaster for the millions of veterans, many of them with meager means, who rely on services impossible to affordably achieve anywhere else. "It would put veterans with very difficult problems out into the community with nobody to stand up for them and to coordinate their care," Shulkin testified in June . As a first step toward making VA care more focused, Shulkin has ordered administrators to takes percent of their budget - $3.5 billion total - away from care cheaply available in the private sector, like eyeglasses and flu shots, and use that money to double down on core VA services, such as treating traumatic brain and spinal cord injury, PTSD and providing orthotics. 11 AMERICAN PVERSIGHT VA-19-0799-G-000001 DS 00020717 Message From: Sent : To; Subject: David-- L Perl (b) (6) @gmail.com] 8/30/2017 1:52:50 PM IP !1@frenchangel59. com]; Dr. David Shulkin [Secshulkin@gmail.com] ( Re:bTrump's most popular Cabinet secretary is Obama holdover - The VA's Shulkin has cut through red tape, made bfg)changes. ( 6 ) This article is terrific-- well deserved .....congrats! It's just the beginning---a ton of work ahead ....Bes t. ...L ( @frenchangel59.com> wrote: OnNlon, Aug 28, 2017 at 3 : 18 PNI, 1P <1 b ) I don ' t know if you saw this very interesting article praising Secretary Shulkin while describing the big ( problems he faces. 6) http://www. poli ti co.com/story/2017 /08/28/trump-shuklin-veterans-obama-holdover-24204 7 By ARTHlJR ALLE 08/28/2017 04 :57 A I EDT AMERICAN PVERSIGHT VA-19-0799-G-000002 DS_00020718 Secretary of Veterans Affairs David Shulkin secs his primary mission as reestablishing tnist among veterans. I Cliff Owen/AP Photo. VA Secretary David Shulkin has proved to be something unique in President Donald Trmnp's Washington: an Obama appointee nominated by Trump who is beloved by almost everyone and getting stuff done. By tweaking regulations, he has managed to fire hundreds of allegedly incompetent employees, publicized waiting times at Veterans Affairs clinics, gotten money to expand vets' treatment by private doctors, and expanded care for isolated vets through telemedicine and mobile phones, while promising to close 430 vacant VA buildings and speed up benefit awards. Shulkin also made a bold - and risky - decision to bypass contracting rules to buy a $16 billion digital health record system. AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000003 DS 00020719 "What motivates me and what motivates Dr. Shulkin is the same, to provide the best care to veterans," said Rep. Phil Roe (R-Tenn.), chairman of the Veterans Affairs Committee . "I don 't know whether he's a Republican or Democrat, and I could care less. " But there's a reason Shulkin was Trump's fourth choice for the VA job - or possibly the fifth , or the 10th , depending on whmn you ask. The VA, with 350,000 employees and 1,250 health care sites, is a political quagmire. Not many people want to clean up others ' messes with hundreds of people looking over their shoulder. The VA's conservative critics are holding their fire now that a GOP administration and Congre_ss control the agency . But savaging from both left and right is likely to start up again if Shulkin 's mission flags. That could easily happen. The administration and Congress must agree on a way to scrap or overcome budget caps to fund an ambitious Shulkin agenda that includes building up the $70 billion VA health system from within while simultaneously enabling veterans to get care outside its doors . Shulkin sees his primacy mission as reestablishing trust among veterans. After taking office, he got legislation passed that 1nakes it easier to fire poorly performing staff , and he quickly relieved several top officials , including Brian Hawkins , head of the Washington , D.C., VA Center. (The federal Merit Systems Protection Board ordered Hawkins reinstated, but Shulkin sidelined him in an administrative job.) AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000004 DS 00020720 In a bold stroke for transparency, he made the VA the first health care system in the country to publish waiting times at its clinics. With equal decisiveness, in June, he decided to scrap the VA's venerable IT system with a one-source contract. He got a Department of Justice ruling to help expand the ability of isolated veterans to see doctors remotely, through telemedicine and mobile apps. All the while, Shulkin has held at bay libertarian groups like the Concerned Veterans of America, who are inclined to allow vets to freely choose to see doctors outside the VA. Shulkin said recently that privatization of the VA "won't happen while I'm in office." In a reflection of Shulkin' s determination to bolster the VA's health care services even while expanding veterans' options, when Trump signed an emergency $2.1 billion measure to continue funding for the 2014 Veterans Choice Act, the bill also included $1.8 billion to strengthen 28 VA hospitals. But these steps only nibble at the edges of the main issue, which is how to satisfy the health needs of veterans vvithout breaking the VA system, whose costs have been climbing at 5 percent annually. With budget caps near bursting, Congress needs to develop legislation this fall that ¼ill keep the faith ¼ith veterans while staying under those caps. "It's not clear that Shulkin or the Hill have a complete grasp on how big their budget hole is, let alone the willingness to fill it," says Phillip Carter of the Center for a New American Security, a centrist think tank. AMERICAN PVERSIGHT VA-19-0799-G-000005 OS 00020721 "They can't build two parallel systems with no regard for cost and no guiding principles for how to allocate care. It's not politically viable or feasible." Tough decisions earn respect Shulkin has managed to get work done under an erratic president by "making sure he is not tapped to make decisions outside of Veterans Affairs," says one colleague . Shulkin, whose nomination was unanimously approved by the Senate in February, isn't registered with either party, and no one seems to know whether he leans Democratic or Republican. Former President Barack Obama appointed him to lead the VA's health system in 2015, but "my only party is the veteran's party," he told POLITICO in an interview at his office. Trump has had nothing but praise for Shulkin, and he enjoys great popularity in the Senate and House, where Roe says that Shulkin' s medical background gives him insights that his two predecessors, Eric Shinseki and Bob McDonald, didn't have. "We think alike - it's almost scary sometimes," said Roe, himself an obstetrician. "He'll say the same thing that I'd been thinking." Shulkin' s frankness and accessibility have won fans across the spectrum, even from those who question his actions - an irregularity in polarized Washington. "He's a very impressive person. He can drill down on the VA's problems, explain them and find solutions that draw on his private-sector AMERICAN PVERSIGHT VA-19-0799-G-000006 OS 00020722 knowledge," said Dan Caldwell, policy director for Koch Industries-backed Concerned Veterans of America, which, unlike Shulkin, wants to allow vets to freely seek care at private facilities. "So far in his tenure , he has shown leadership and ability to focus on veterans , to keep ideology out of the equation and work in a bipartisan way," said Julia Bro\\rnley of California, a senior Democrat on the House Veterans Conunittee. Shulkin has yet to nominate several senior deputies - including w1dersecretaries of health and benefits, and a chief information officer to oversee the acquisition of a new records system. Two VA IT workers who spoke on condition of anony1nity said the lack of high-level leadership had left them twiddling their thumbs. Although many IT specialist s in and out of th e VA question Shulkin 's decision to ditch the agency's 40-year-old digital record system, one official who opposed the decision said IT officials had resigned themselves to work on it - largely because they respect Shlil.kin as a leader. Welcome to the jungle Many of the problems Shulkin faces date .back decades. The VA has always struggled to handle the de1nand for health care from veterans. Before 1996, when health undersecretazy Ken Kizer began implementing an integrated care system, the VA treated veterans only for service-related conditions . AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000007 D8_00020723 The classic Catch-22 was the World War II amputee whose wound was frequently infected because of his diabetes. "He could get the stump cared for at the VA, but not his blood sugar problem," recalled Kizer. "It didn't make sense." Thousands of veterans struggled to get care for years while the Pentagon and VA tussled over whether exposures to the herbicide Agent Orange, during the Vietnam era, or a variety of other toxins used during Mideast wars, were responsible for their aihnents. Since the late 1990s, the VA has alternately rationed and increased care as it sought to do right by veterans while holding down costs. Yet it still can't meet the demand. The 2014 Phoenix VA scandal, which resulted from evidence that officials faked appointment calendars to obscure long wait times, prompted Congress to open its checkbook with the Veterans Choice Act, which authorized $10 billion over 3 years to care for veterans in the private sector. The Choice program, meant to be temporary, allowed vets to go outside the system if their care required more than a 30-day wait, or required them to travel more than 40 miles. Even so, the program ran out of money earlier this year as veteran demand was still surging. In June, Shulkin testified that 35 percent more veterans were seeking health care outside the VA each week than had done so a year earlier. The Choice program was blovving through cash without a clear idea of how much more would be needed. AMERICAN PVERSIGHT VA-19-0799-G-000008 OS 00020724 President Donald Trump, accompanied by VA Secretary David Shulkin (right), talks \\rith a patient during a Veterans Affairs Department "telehealth" event at the White House. Shulkin has accomplished much in his tenure , including expanding care for isolated ,ets through telemedicine and mobile phones . I Evan Vuee i/AP Photo. And while the program has improved over three years, some still call it a "train wreck" as Sen. Jon Tester (D-Mont .) referred to it recently . Montana veterans have had more, not less, trouble getting care because of red tape associated with the program, he said. It isn't clear vets are being treated better outside the VA system. Their records often aren't shared among private and VA doctors, leading to poor coordination. An insprector general report last month, for example , found that patients prescribed opioids in non-VA clinics received conflicting guidelines on how to use them . The VA also has no clear idea of how much it costs to care for patients within its walls. The agency hired PricewaterhouseCoopers to AMERICAr-... pVERSIGHT VA-19-0799-G-000009 DS 00020725 determine the demand for services at each VA facility, a Senate staffer said, but that report could take years to finish and, in the meantime, "when you don't know what demand is, it creates a problem for Congress." The move to expand veterans care in the private sector c01nes at a time when the U.S. health care syste1n is moving in the opposite direction, with health care systems seeking ever more tightly integrated care within their facilities . Shulkin, who as CEO of Morristown Medical Center in 2011 set up one of the country's first accountable care organizations - in which doctors are rewarded for lowering unnecessary costs - is well aware of this. "As a hospital administrator, which I [was] for 30 years in the private sector, you want to maximize your current fixed costs," he said in the interview. "Care in the community is not going to be cheaper." Shulkin hopes to create a rational balance of inside and outside care - "adjusting the hot and cold spigots," he says - that is based on patient need and predicated on good information sharing. Congress will take his ideas as it develops legislation this fall for "Choice 2.0, or whatever we call it," Roe said. Shulkin would ditch the "30 days/ 40 miles" rule in favor of a system based on the veteran's clinical needs. In his vision, veterans seeking care would first talk to a VA provider - in person, by phone or virtually - leading to a clinical assessment to decide whether their care would be met best ¼ithin or outside the VA. If a veteran were treated outside the A1v1L 1 11'-11'1 PVERSIGHT VA-19-0799-G-000010 OS 00020726 VA, information from the visit would flow back to his or her primary care team. Sharing that information is a problem, though. The pursuit of an IT system in which records flow smoothly among the VA, military and private health care systems motivated Shulkin's decision in June to ditch the VA's digital health record system - built in-house since the late 1970s - in favor of a Cerner Corp. system. But that transition will take five years at a bare minimum and could cost $16 billion, according to one estimate . "We haven't figured out how to pay for it yet," says Roe, who recently hired a staff IT expert to help oversee the undoubtedly difficult transition. "This is a huge project," Roe said. "It may be the biggest IT project in the country's history." Small steps Shulkin isn't ready to give veterans unfettered choice in health care because, he acknowledges, the VA's brand has been tattered so badly that free choice could lead to an exodus from the system that he estimates would add $20 billion a year to the VA's budget. "On a level field of competition, I do not believe that we would be treated fairly today, because I believe this agency has had years, if not decades, of neglect and failure to modernize," Shulkin said. More flight from the VA health care system could eventually lead to its elimination - a disaster for the millions of veterans, many of AMERICAN PVERSIGHT VA-19-0799-G-000011 OS 00020727 them with meager means, who rely on services impossible to affordably achieve anywhere else. "It would put veterans with very difficult problems out into the community with nobody to stand up for them and to coordinate their care," Shulkin testified in June. As a first step toward making VA care more focused, Shulkin has ordered administrators to take 5 percent of their budget - $3.5 billion total - away from care cheaply available in the private sector, like eyeglasses and flu shots, and use that money to double down on core VA services, such as treating traumatic brain and spinal cord injury, PTSD and providing orthotics. AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000012 DS 00020728 Message David Shulkin [secshulkin@gmail.com] 8/29/2017 2:58 :17 PM From: Sent : (b) (6) Poonam Alaigh ■-■@gmail.com] Re: Trump's most popular Cabinet secretary is Obama holdover - The VA's Shulkin has cut through red tape , made big changes. To : Subject: Nice note Sent from my iPhone (b) (6) On Aug 28, 2017, at 8:22 PM , Poonam Alaigh ~ wrote : Yes it 1s a great article- but the real kudos goes to all of you . David and I always know they we have your unconditional support, your strong backing and your confidence so that we are able to make these bold changes and take the 1isks we need to do. We are all a family and you provide so much of invaluable guidance and linkage to key community partnerships , all of which has resulted in this fast paced momentum of transformation . As you always say, a lot more work needs to be done and we know there are many many more problems and challenges. We are fortunate that we are a team wiith a shared commitment to build a system that delivers the highest quality of care to our nations heros . Again thank you to aJI of you- we need you to make this happen On Mon , Aug 28, 2017 at 3 : 19 PM IP wrote: b ) I don 't know if you saw this very interesting article praising Secretary Shulkin while describing ( the big problems he faces . 6) http://www .politico .com/story/2017/08/28/trump-shuklin-veterans-obama-holdover-242047 By ARTHUR A.LLE 08/28/20 l 7 04 :57 AM EDT AMERICAN PVERSIGHT VA-19-0799-G-000013 DS_00020729 Socrctaf)• ofVctcmn · ffairs Da\ id Sht1l11in sc1,;~h rirm1n rni i C'liffOw cntAP Photo t a f1,;C tnbli hrn~ t It am ng.1ctcr-m VA Secretary David Shulkin has proved to be son1ething unique in President Donald Tn1mp's Washington: an Obama appointee n01ninated by Tru1np who is beloved by almost everyone and getting stuff done. By tweaking regulations, he has managed to fire hundreds of allegedly incompetent employees ~ publicized waiting times at Veterans Affairs clinics, gotten money to expand vets' treatment by private doctors, and expanded care for isolated vets through tele1nedicine and 1nobile phones, while promising to close 430 vacant VA buildings and speed up AMERI-...,,. PVERSIGHT VA-19-0799-G-000014 DS 00020730 benefit awards. Shulkin also n1ade a bold - and risky- decision to bypass contracting rules to buy a $16 billion digital health record system .. "What motivates me and what motivates Dr. Shulkin is the same, to provide the best care to veterans," said Rep. Phil Roe (RTenn.), chairman of the Veterans Affairs Committee. "I don 't know whether he's a Republican or Democrat , and I could care less." But there 's a reason Shulkin was Trump 's fourth choice for the VA job - or possibly the fifth, or the 10th, depending on whom you ask. The VA, with 350,000 employees and 1,250 health care sites, is a political quagmire. Not 1nanypeople want to clean up others' 1nesses with hundreds of people looking over their shoulder. The VA's conservative critics are holding their fire now that a GOP adininistration and Congress control the agency. But savaging from both left and right is likely to start up again if Shulkin 's mission flags. That could easily happen . The administration and Congress must agree on a way to scrap or overcome budget caps to fund an ambitious Shulkin agenda that includes building up the $70 AMERICAr-... pVERSIGHT VA-19-0799-G-000015 DS 00020731 billion VA health system from within while simultaneously enabling veterans to get care outside its doors. Shtilkin sees his primary mission as reestablishing trust among veterans. After taking office, he got legislation passed that mal wrote: On Mon , Aug 28, 2017 at 3: 19 PM IP <11 b ) I don't know if you saw this very interesting article praising Secretary Shulkin while describing the big ( problems he faces . 6) http ://www .politico .com/story/2017/08/28/trump-shukJin-veterans-obama-holdover-242047 By ARTHUR ALLE 08/28/20 I 7 04 :57 M EDT AMERICAN PVERSIGHT VA-19-0799-G-000027 DS_00020743 Secretary f Veterans Affair· Da\ i wrote : b I don 't know if you saw this) very interesting article praising Secretary Shulkin while describihg the big problems he faces. ( 6) http://www .poli ti co.com/story/2017/08/28/trump-shukJ in-veterans-ob ama-hol dover-24 204 7 By ARTHUR ALLE 08/28/2017 04 :57 AM EDT Secretary or Veterans Affairs David Sliulkin sees his primary mission as reeslablishing trust among veterans. I CliffOwcn/AP Photo. VA Secretary David Shulkin has proved to be something unique in President Donald Tn1mp's Washington: an Oba1na appointee nominated by Trump who is beloved by almost everyone and getting stuff done. By tweaking regulations, he has managed to fire hundreds of allegedly inc0111petente111ployees, publicized waiting times at Veterans Affairs clinics, gotten money to expand vets' treatinent AMERICAN PVERSIGHT VA-19-0799-G-000038 DS_00020754 by private doctors, and expanded care for isolated vets through telemedicine and 1nobile phones , while promising to close 430 vacant VA buildings and speed up benefit awards. Shulkin also made a bold - and risky - decision to bypass contracting rules to buy a $16 billion digital health record system. "What motivates n1e and what motivate s Dr. Shulkin is the same, to provide the best care to veterans," said Rep . Phil Roe (RTenn.), chairman of the Veterans Affairs Committee . "I don 't know whether he's a Republican or Democrat, and I could care less. " But there 's a reason Shulkin was Tru111p's fourth choice for the VA job - or possibly the fifth , or the 10th , depending on whom you ask. The VA, with 350,000 employees and 1,250 health care sites, is a political quagmire. Not many peop le want to clean up others' messes with hundred s of people looking over their shoulder. The VXs conservative critics are holding their fire now that a GOP adn1inistration and Congres s control the agency. But savaging from both left and right is likely to start up again if Shulkin 's 1nission flags. That could easily happen. The administration and Congress must agree on a way to scrap or AMERl(lf\l\i pVERSIGHT VA-19-0799-G-000039 DS 00020755 overcome budget caps to fund an ambitious Shulkin agenda that includes building up the $70 billion VA health systen1 fr01n within while simultaneously enabling veterans to get care outside its doors. Shulkin sees his primary mission as reestablishing trust among veterans . After taking office, he got legislation passed that mal President Donald Tnunp. accompanied by VA Secretmy David Shnlkiu (right). talks with a paLientduring a Veterans Affairs Department "tclchcalth" event at the White House. Shulkin has accomplished tnltch in his tennre. it1ch1dinge:x.paHding care for isolated vets through telemedicine and mobile phones. I Evan Vucci/AP Photo. And while the program has improved over three years, some still call it a "train wreck" - as Sen. Jo n Tester CD-Mont.) referred to it recently. Montana veterans have had more , not less, trouble getting care because of red tape associated with the prograin, he said . AMERICAr-... pVERSIGHT VA-19-0799-G-000045 DS 00020761 It isn't clear vets are being treated better outside the VA system. Their records often aren 't shared among private and VA doctors, leadin g to poor coordination . An insprecto r general report last month, for examp le, found that patients prescribed opioids in 11011-V A clinics received conflicting guidelines on how to use them. The VA also has no clear idea of how much it costs to care for patients within its walls. The agency hired PricewaterhouseCoopers to determine the demand for services at each VA facility, a Senate staffer said, but that report could take years to finish and, in the meantime ~"when you don't lmow what de1nand is, it creates a problem for Congress." The move to expand veterans care in the private sector co1nes at a ti1ne when the U.S. health care system is moving in the opposite direction, with health care syste1ns seeking ever more tightly integrated care within their facilities. Shullcin, who as CEO of Morristown Medical Center in 2011 set up one of the country's first accountable care organizations - in which doctors are rewarded for lowering unnecessary costs - is well awar~ of this. AMEf pVERSIGHT VA-19-0799-G-000046 DS 00020762 "As a hospital administrator, which I [was] for 30 years in the private sector, you want to maximize your current fixed costs," he said in the interview. "Care in the community is not going to be cheaper." Shulkin hopes to create a rational balance of inside and outside care - "adjusting the hot and cold spigots," he says - that is based on patient need and predicated on good inforination sharing. Congress will take his ideas as it develops legislation this fall for "Choice 2.0, or whatever we call it," Roe said. Shulkin would ditch the "30 days/ 40 miles" rule in favor of a system based on the veteran's clinical needs. In his vision, veterans seeking care would first talk to a VA provider - in person, by phone or virtually - leading to a clinical assessment to decide whether their care would be met best vvithin or outside the VA. If a veteran were treated outside the VA, information from the visit would flow back to his or her primary care team. Sharing that information is a problem, though. The pursuit of an IT system in which records flow smoothly among the VA, military and private health care systems motivated Shulkin' s decision in June to ditch the VA's digital AMEF..~, . PVERSIGHT VA-19-0799-G-000047 OS 00020763 health record system - built inhouse since the late 1970s - in favor of a Cerner Corp. system. But that transition will take five years at a bare minimu1n and could cost $16 billion, according to one estimate. "We haven't figured out how to pay for it yet," says Roe, who recently hired a staff IT expert to help oversee the undoubtedly difficult transition. "This is a huge project," Roe said. "It may be the biggest IT project in the country's history." Small steps Shulkin isn't ready to give veterans unfettered choice in health care because, he acknowledges, the VA's brand has been tattered so badly that free choice could lead to an exodus from the system that he estimates would add $20 billion a year to the VA's budget. "On a level field of competition, I do not believe that we would be treated fairly today, because I believe this agency has had years, if not decades, of neglect and failure to modernize," Shulkin said. More flight from the VA health care system could eventually lead to its elimination - a disaster for the millions of veterans, many of them with meager means, who rely AMERICAN PVERSIGHT VA-19-0799-G-000048 OS 00020764 on services impossible to affordably achieve anywhere else. "It would put veterans with very difficult problems out into the community with nobody to stand up for them and to coordinate . their care," Shulkin testified in June. As a first step toward making VA care more focused, Shulkin ha.$ ordered administrators to take 5 percent of their budget - $3.5 billion total - away from care cheaply available in the private sector, like eyeglasses and flu shots, and use that money to double down on core VA services, such as treating traumatic brain and spinal cord injury, PTSD and providing orthotics. AMERICAr-... pVERSIGHT VA-19-0799-G-000049 DS 00020765 Message From: Sent: To: CC: Subject: (b IP a@frenchangel59.com] ) (6) 8/28/2017 7:18:37 PM (b) (6) (b) (6) @gmail.com; bruce (b) (6) @mac.com;mb (b) (6) @gmail.com lper-@gmail.com; Secshulkin@gmail.com Trump's most popular Cabinet secretary is Obama holdover - The VA's Shulkin has cut through red tape, made big changes. I don't know if you saw this very interesting article praising Secretary Shulkin while describing the big problems he faces. http://www .politico .com/story/2017/08/28/trump-shukJin-veterans-obama-holdover-242047 By ARTHUR ALLE 08/28/2017 04:57 AM EDT Secrclaty of Veterans Affairs David Shulkin secs his primaty mission as reestablishing lrnsl among veterans . I Cliff Owen/AP Photo . VA Secretary David Shulkin has proved to be something unique in President Donald Trump's Washington: an Obama appointee nominated by Trump who is beloved by almost everyone and getting stuff done. AMERICAN PVERSIGHT VA-19-0799-G-000050 OS 00020766 By tweaking regulations, he has managed to fire hundreds of allegedly incompetent employees, publicized waiting tilnes at Veterans Affairs clinics, gotten money to expand vets' treatment by private doctors, and expanded care for isolated vets through telemedicine and mobile phones, while promising to close 430 vacant VA buildings and speed up benefit awards. Shulkin also made a bold - and risky - decision to bypass contracting rules to buy a $16 billion digital health record system . ''What 1notivates 1ne and what motivates Dr . Shulkin is the same , to provide the best care to veterans," said Rep. Phil Roe (R-Tenn.) 1 chairman of the Veterans Affairs Conunittee. "I don't know whether he's a Republican or Democrat , and I could care less. " But there 's a reason Shulkin was Trump 's fourth choice for the VA job - or possibly the fifth, or the 10th, depending on whom you ask. The VA, with 350,000 employees and 1,250 health care sites, is a political quagmire. Not n1any people want to clean up others ' 1nesses with hundreds of people looking over their shoulder. The VA's conservative critics are holding their fire now that a GOP adininistration and Congress control the agency. But savaging from both left and right is likely to start up again if Shulkin 's mission flags. That could easily happen. The administration and Congress must agree on a way to scrap or overcome budget caps to fund an ambitious Shulkin agenda that includes building up the $70 billion VA health AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000051 D8_00020767 systen1 from within while simultaneously enabling veterans to get care outside its doors . Shulkin sees his primary mission as reestablishing trust among veterans. After taking office, he got legislation passed that 1nakes it easier to fire poorly perfonning staff, and he quickly relieved several top officials? inc1uding Brian Hawkins, head of the Washington , D.C., VA Center . (The federal Merit Systems Protection Board ordered Hawkins reinstated , but Shulkin sidelined him in an administrative job .) In a bold stroke for transparency , he made the VAthe first health care syste1n in ·the country to publish waiting times at its clinics. With equal decisiveness, in June , he decided to scrap th e VA's venerable IT systen1 with a onesource contract. He got a Department of .Justice ruling to help expand the ability of isolated vete ran s to see doctors re1notely, through telemedicin e and mobile apps. All the while, Shulkin has held at bay libertarian groups like the Concerned Veteran s of Alnerica, who are inclined to allow vets to freely choose to see doctors outside the VA. Shulkin said recently that privati zation of the VA "won't happen while I'm in office." In a reflection of Shulkin's determination to bolster the VA's health care services even while expanding veterans ' options, when Trump signed an emergency $2.1 billion measure to continue funding for the 2014 Veterans Choice Act, the bill also included $1.8 billion to strengthen 28 VA hospital s. But these steps only nibble at the edges of th e ·main issue , which is how to satisfy the health AMf:::RICA~ pVERSIGHT VA-19-0799-G-000052 DS 00020768 needs of veterans without breaking the VA system, whose costs have been climbing at 5 percent annually. With budget caps near bursting, Congress needs to develop legislation this fall that will keep the faith with veterans while staying under those caps. "It's not clear that Shulkin or the Hill have a complete grasp on how big their budget hole is, let alone the willingness to fill it," says Phillip Carter of the Center for a New American Security, a centrist think tank. "They can't build two parallel syste1ns with no regard for cost and no guiding principles for how to allocate care. It's not politically viable or feasible." Tough decisions earn respect Shulkin has managed to get work done under an erratic president by "making sure he is not tapped to make decisions outside of Veterans Affairs," says one colleague. Shulkin, whose nomination was unanimously approved by the Senate in February, isn't registered with either party, and no one seems to know whether he leans Democratic or Republican. Former President Barack Obama appointed hiin to lead the VA's health system in 2015, but "my only party is the veteran's party," he told POLITICO in an interview at his office. Trump has had nothing but praise for Shulkin, and he enjoys great popularity in the Senate and House, where Roe says that Shulkin' s medical background gives him insights that his two predecessors, Eric Shinseki and Bob McDonald, didn't have. "We think alike - it's almost scary sometimes," said Roe, himself an obstetrician. J 1¥11. I 11.._I I PVERSIGHT VA-19-0799-G-000053 OS 00020769 "He'll say the same thin g that I'd been thinking." Shulkin's frankness and accessibility have won fans across the spectrmn, even from those who question his actions - an irregularity in polarized Washington. "He's a very impressive person. He can drill down on the VA's problems, explain the1n and find solution s that draw on his private-sector knowledge," said Dan Caldwell, policy director for Koch Industries-backed Concerned Veterans of America, which , unlike Shulkin, wants to allow vets to freely seek care at private facilities. "So far in his tenure, he has shown leadership and ability to focus on veterans, to keep ideology out of the equation and work in a bipartisan way,'' said Julia Br ownley of California , a senior Democrat on the House Veterans Committee. Shulkin has yet to nominate several senior deputies - including undersecretaries of health and benefits, and a chief information officer to oversee the acquisition of a new records system. Two VA IT workers who spoke on condition of anonymity said the lack of high-level leadership had left them twiddling their thun1bs. Although many IT specialists in and out of the VA question Shulkin's decision to ditch the agency's 40-year-old digital record system, one official who opposed the decision said IT officials had resigned the1nselves to work on it - largely because they respect Shulkin as a leader. Welcome to thejungle A,v_ pVERSIGHT VA-19-0799-G-000054 DS 00020770 Many of the problems Shulkin faces date back decades. The VA has always struggled to handle the demand for health care from veterans. Before 1996, when health undersecretary Ken Kizer began implementing an integrated care system, the VA treated veterans only for service-related conditions. The classic Catch-22 was the World War II ainputee whose wound was frequently infected because of his diabetes. "He could get the stump cared for at the VA, but not his blood sugar problem," recalled Kizer. "It didn't make sense." Thousands of veterans struggled to get care for years while the Pentagon and VA tussled over whether exposures to the herbicide Agent Orange, during the Vietnam era, or a variety of other toxins used during Mideast wars, were responsible for their ailments. Since the late 1990s, the VA has alternately rationed and increased care as it sought to do right by veterans while holding down costs. Yet it still can't meet the demand. The 2014 Phoenix VA scandal, which resulted from evidence that officials faked appointment calendars to obscure long wait tiines, prompted Congress to open its checkbook with the Veterans Choice Act, which authorized $10 billion over 3 years to care for veterans in the private sector. The Choice program, meant to be temporary, allowed vets to go outside the system if their care required more than a 30-day wait, or required them to travel more than 40 miles. Even so, the program ran out of money earlier this year as veteran demand was still surging. AMERICAN PVERSIGHT VA-19-0799-G-000055 OS 00020771 In June, Shulkin testified that 35 percent more veterans were seeking health care outside the VA each week than had done so a year earlier . The Choice program was blowing through cash without a clear idea of how much more would be needed. President Donald Trump, accompanied by VA Secretary David Shulkin (right), talks with a patient during a Veterans Affairs Department "telebealth" event at the White House. Slmlkin has accomplished much in his tenure, including expanding care for isolated vets through telemedicine and mobile phones. I Evan Vucci/AP Photo. And while the program has improved over three years, some still call it a "train wreck'' as Sen. Jon Tester (D-Mont.) referred to it recently. Montana veterans have had more, not less, trouble getting care because of red tape associated with the program, he said. It isn't clear vets are being treated better outside the VA syste1n. Their records often aren't shared among private and VA doctors, leading to poor coordination. An insprector general report last month, for example, found that patients prescribed opioids in non-VA AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000056 DS 00020772 clinics received conflicting guidelines on how to use them. The VA also has no clear idea of how much it costs to care for patients within its walls. The agency hired PricewaterhouseCoopers to determine the de1nand for services at each VA facility, a Senate staffer said, but that report could take years to finish and, in the meantime, "when you don't know what demand is, it creates a problem for Congress." The move to expand veterans care in the private sector comes at a time when the U.S. health care system is moving in the opposite direction, with health care systems seeking ever more tightly integrated care within their facilities. Shulkin, who as CEO of Morristown Medical Center in 2011 set up one of the country's first accountable care organizations - in which doctors are rewarded for lowering unnecessary costs - is well aware of this. "As a hospital administrator, which I [was] for 30 years in the private sector, you want to maximize your current fixed costs," he said in the interview. "Care in the com1nunity is not going to be cheaper." Shulkin hopes to create a rational balance of inside and outside care - "adjusting the hot and cold spigots," he says - that is based on patient need and predicated on good information sharing. Congress will take his ideas as it develops legislation this fall for "Choice 2.0, or whatever we call it," Roe said. Shulkin would ditch the "30 days/ 40 miles" rule in favor of a system based on the veteran's clinical needs. In his vision, veterans seeking / 1¥11. I 11.._I I PVERSIGHT VA-19-0799-G-000057 OS 00020773 care would first talk to a VA provider - in person, by phone or virtually - leading to a clinical assessment to decide whether their care would be met best within or outside the VA. If a veteran were treated outside the VA, information from the visit would flow back to his or her primary care team. Sharing that information is a problem, though. The pursuit of an IT system in which records flow smoothly ainong the VA, military and private health care syste1ns motivated Shulkin's decision in June to ditch the VA's digital health record system - built in-house since the late 1970s - in favor of a Cerner Corp. system. But that transition vvilltake five years at a bare minimum and could cost $16 billion, according to one estimate. "We haven't figured out how to pay for it yet," says Roe, who recently hired a staff IT expert to help oversee the undoubtedly difficult transition. "This is a huge project," Roe said. "It may be the biggest IT project in the country's history." Small steps Shulkin isn't ready to give veterans unfettered choice in health care because, he acknowledges, the VA's brand has been tattered so badly that free choice could lead to an exodus from the system that he estimates would add $20 billion a year to the VA's budget. "On a level field of competition, I do not believe that we would be treated fairly today, because I believe this agency has had years, if not decades, of neglect and failure to modernize," Shulkin said. ) 1¥11. I 11.._I I PVERSIGHT VA-19-0799-G-000058 OS 00020774 More flight from the VA health care system could eventually lead to its elimination - a disaster for the millions of veterans, many of them with meager means, who rely on services impossible to affordably achieve anywhere else. "It would put veterans with very difficult problems out into the community with nobody to stand up for them and to coordinate their care," Shulkin testified in June. As a first step toward making VA care more focused, Shulkin has ordered administrators to take 5 percent of their budget - $3.5 billion total - away from care cheaply available in the private sector, like eyeglasses and flu shots, and use that money to double down on core VA services, such as treating traumatic brain and spinal cord injury, PTSD and providing orthotics . AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000059 DS 00020775 Message From: (b) (6) Sent : 8/14/201711:29:24 To : David Shu Ikin [drshulkin@aol.com] Re: Subject: (b) (6) @gmail.com] AM Yes I see no disagreement , viv usually gets a list of vacant 15 positions and those looking for detailees. She usually can find people a slot very quickly and could potentiaJly do it before Tom comes . On Aug 13, 2017 10:56 PM , ttDavid Shulkin" wrote : Wouldn't we rather detail him to something like the wh hotlit1e or Human Resources or the accountability office- why have him on the 10th floor Sent from my iPad On Aug 13, 2017 , at 7:34 PM, (b) (6) (b) (6) ail.com> wrote : On paper he is the EA to the Chief of Staff and collaterally aJso Chief of Mission Operations (travel) . However- is detailed into a non existent FTE as Special Advisor to the Deputy Secretary. Similar scenario as me . On Sun, Aug 13, 2017 at 7:32 PM David shulkin wrote: What is (b) (6) position ? Sent from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000060 DS 00020776 Message From: David Shulkin [drshulkrn@aol.com] Sent : 8/14/2017 2:56:01 AM To: (b) (6) Subject: Re: (b) (6) @gmail.c.om) Wouldn't we rather detail him to something like the wh hotline or Human Resources or the accountability office- why have him on the 10t h floor Sent from my iPad On Aug 13, 2017 , at 7:34 PM (b) (6) (b) (6) ail.com > wrote: On paper he is the EA to the Chief of Staff and collaterally also Chief of Mission Operations (travel). However- ,is detailed into a non existent FTE as Special Advisor to the Deput y Secretary. Similar scenario as me . On Sun, Aug 13, 2017 at 7 :32 PM David shulkin < Drshulkin@aol.com > wrote : What is (b) (6) position? Sent from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000061 DS 00020777 Message David shulkin LDrshulkin@aol.com] From: Sent : 8/14/2017 12 :16:03 AM To : (b) (6) Subject: Re: (b) (6) @gmail.com] Ok - whatever you think Sent from my iPhone On Aug 13, 2017, at 7:43 PM, (b) (6) (b) (6) mail.com> wrote: I know Vivieca wouldn't want him back as her EA for trust reasons . We wouldn't want him managing your travel for trust reasons, there's enough chatter without him there from other people . But this would be his fall back position ofrecord. He may have a relationship with Tom, I can't recall . Cannot speak to what he does, J'm not sure. Maybe there is another 15 in the organization he can do as a lawyer or whatever. On Sun, Aug 13, 2017 at 7:35 PM David shulkin wrote : Yes i dont think we should continue that detail - do you? Sent from my iPhone On Aug 13, 2017, at 7:34 PM, (b) (6) (b) (6) mail.com> wrote : On paper he is the EA to the Chief of Staff and collaterally also Chief of Mission Operations (travel). However - is detailed into a non existent FTE as Special Advisor to the Deputy Secretary. Similar scenario as me . On Sun, Aug 13, 2017 at 7:32 PM David shulkin wrote : What is (b) (6) position ? Sent from my iPhone Sent from Gmail Mobile Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000062 DS_00020778 Message From: (b) (6) Sent : 8/13/201711:43:25 To : David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) @gmail.com] PM I know Vivieca wouldn't want him back as her EA for trust reasons. We wouldn't want him managing your travel for trust reasons , there's enough chatter without him there from other people. But this would be his faJI back position of record . He may have a relationship with Tom , 1 can't recall. Cannot speak to what he does, rm not sure. Maybe there is another 15 in the organization he can do as a lawyer or whatever . On Sun, Aug 13, 2017 at 7:35 PM David shulkin wrote : Yes i dont think we shouJd continue that detail - do you? Sent from my iPhone On Aug 13, 2017 at 7:34 PNI (b) (6) (b) (6) 0 mail.com > wrote: On paper he is the EA to the Chief of Staff and collaterally also Chief of Mission Operations (travel). However - is detailed into a non existent FTE as Special Advisor to the Deputy Secretary . Similar scenario as me . On Sun, Aug 13, 2017 at 7:32 PM David shulkin wrote : What is (b) (6) position? Sent from my jP hone Sent from Gmail Mobile Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000063 DS 00020779 Message From: David shulkin LDrshulkin@aol.com] Sent : 8/13/201711:37:57 To: (b) (6) Subject: Re: PM (b) (6) @gmail.co mJ Better to start with a clean slate than continue bad habits Sent from my iPhone On Aug 13, 2017, at 7:34PM, (b) (6) (b) (6) On paper he is the EA to the Chief of Staff and collaterally also Chief of Mission Operations (travel). However - is detailed into a non existent FTE as Special Advisor to the Deputy Secretary. Similar scenario as me . On Sun, Aug 13, 2017 at 7:32 PM David sbulk:in wrote : What is.(b) (6) position? Sent from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000064 DS 00020780 Message From: David shulkin lDrshulkin@aol.com] Sent : 8/13/201711:35:40 To: (b) (6) Subject: Re: PM (b) (6) @gmail.co mJ Yes i dont think we should continue that detajl - do you? Sent from my iPhone On Aug 13, 2017, at 7:34PM, (b) (6) (b) (6) On paper he is the EA to the Chief of Staff and collaterally also Chief of Mission Operations (travel). However - is detailed into a non existent FTE as SpeciaJ Advisor to the Deputy Secretary. Similar scenario as me . On Sun, Aug 13, 2017 at 7:32 PM David sbulk:in wrote : What is.(b) (6) position? Sent from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000065 DS 00020781 Message From: (b) (6) (b) (6) Sent: 8/13/2017 11:34:29 PM To : David shulkin [Drshulkin@aol.com] Subject: Re: @gmall.com] On paper he is the EA to the Chief of Staff and collatera1ly also Chief of Mission Operations (travel). However - is detailed into a non existent FTE as Special Advisor to the Deputy Secretary. Similar scenario as me . Ot1 Sun, Aug 13,2017 at 7:32 PMDavld shulkjn wrote : What is (b) (6) position? Sent from my iPhone Sent from Gmail Mohi le AMERICAN PVERSIGHT VA-19-0799-G-000066 DS 00020782 Message David shu lkin [Drshulkin@ao l.com] From: Sent: 8/13/2017 11:32:27 PM To: (b) (6) what is (b) (6) (b) (6) @gmail.co m] position ? sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000067 DS_00020783 Message To: Davidshulkin [Drshulkin@aol.com] 8/7/2017 5:02:25 PM @gmail.com] (b) (6) (b) (6) Subject: Re: CHRO From: Sent: Peter - peter.shelby@va.gov (b) (6) Poonam -@hotmail.com Sent from my iPhone > On Aug 7, 2017, at 12:10 PM, -(b) (6) > (b) (6) <-@gmail > I would like to speak to Peter Shelby. > Thanks. . com> wrote : Also, can I get Poonam' s email or phone? > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000068 OS 00020784 Message From: David shulkin LDrshulkin@aol.com] Sent: To : 8/19/2017 7:10:09 PM Ike Perlmutter ll@frenchangel59 .com} ( Subject: Fwd: [EXTERNAL] b Follow lip undersecretary ) ( 6 Ike- this was the other candidate for the Undersecretary that as you can see just withdrew ) David (b) (6) (b) (b) (6) From:-~ (6) Sent: Friday, August 18, 2017 09:21 PM Eastern Standard Time To: DJS Subject: [EXTERNAL] Fo llow up David I appreciate the opportunity to be considered for the position of Under Secretary of Veterans Affairs Health . We ' ve received the diagnosis (b) (6), (b) (2) I wish you and your team the very best for the great work ou are doing . Sincerely (b) 1111 (6) On Aug 11, 2017, at 12:55 PM , DJS wrote: AMERICAN PVERSIGHT VA-19-0799-G-000069 DS 00020785 Got it Sent with Good (www .good.com ) -----Original Message----(b) (6) ~ From: -(b) (6) Sent: Frida y, August 11, 2017 01:15 PM Eas tern Standard Time To: ShuJkin, Davi d J., MD (b) (6) (b)(6) Cc:-(b) (6) [EXTERN AL] Thank you/ Te st Subject: David Timnkyou for ialkiug with me this momu1g.Twill update you in a few days , likely Wednesda y nt - the latest. Tilankyou again (b) (6) Sent from my iPhone AMERICAr-... pVERSIGHT VA-19-0799-G-000070 DS 00020786 Message From: David shulkin LDrshulkin@aol.com] Sent : 8/14/201710:57:08 To : Jennifer Lee (b) (6) @gmail.com] Re: Draft response Subject: AM Do you want to followup and push this? Sent from my iPhone On Aug 13, 2017, at 11 :21 PM , Jennifer Lee~ (b) (6) > wrote ; Yes , definitely . Will look into where we are with this- we were trying last year to get it off the ground . Thanks , Jen On Sun, Aug 13, 2017 at 8: 17 PM , David sbulk.in wrote : Jen- can you th1nk about this and see if you think we should do Sent from my iPhone Begin fo1warded message : (b) (6) From: (b) (6), (b) (2) ail. com> Date: August 13, 2017 at 7:50:21 PM EDT To: David shulkin < drshu1kin@aol.com > (b) (6) Cc: (b) (6), (b) (2) ail.com >, (b) (6), (b) (2) -DEKA (b) (6) Subject: Draft response David (b) (6), (b) I spoke with -(2) and some of his team. Herein are some draft responses. I believe this to be a great opportunity for VA to lead the nation and look forward to next steps Best • (b) (6), (b) (2) First the questions below relate to the clinical trial: Do we need fu11Ciing to pjlot? _Q AMERICAN PVERSIGHT we do not , we can fund the clinical trial. VA-19-0799-G-000071 DS_00020787 Do we need staff for data collection and home visits or do you guys have that? We would ideally like the VA to commit to data collection as they will be taking care of patients - and since the initial IDE as currently envisioned uses simulated home environment there should be no need for home visits. Note: that the machine has great abilities to send data directly to the cloud and we can work with VA to evolve many data intense systems in this direction. Ifwe amend the IDE to accommodate true home visits we can provide staff necessary to do the home visits and or supplement any VA needs, in most any situation. What are the regulatory hurdles? - there is an existing IDE so there should be no regulatory hurdles Is there an irb protocol? Yes, can modify to work with VA as necessary . Other logistic issues? - either directly or through a CRO. We can work with VA to manage delivery of materials, drugs, devices etc. Current VA CLCs would be feasible - and we can develop necessarytrainingfor the appropriatestaff dependingon who supportsand staffsthe CLC's. We may also wish to use home nursesto train in the CLC's potentiallyif Vets wish to receive treatmentsin home. AMERICAN PVERSIGHT VA-19-0799-G-000072 OS 00020788 Message From: Jennifer Lee (b) (6) @gmail.com] Sent : 8/14/2017 3:21:34 AM To : David shulkin [Drshulkin@aol.comJ Re: Draft response Subject: Yes, definitely. Will look into where we are with this- we were trying last year to get it off the ground. Thanks, Jen On Sun, Aug 13,2017 at 8:17 PM, David shulkin wrote : Jen- can you think about this and see if you think we should do Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6), (b) (2) ail.com > Date: August 13, 2017 at 7:50:21 PM EDT T : David hulkin (b) (6), (b) (2) (b) (6) , (b) (6), (b) (2) -DEKA (b) (6) dekaresearch.com > Subject: Draft response David (6), (b) I spoke with -(b) and some of his team. Herein are some draft responses. (2) I believe this to be a great opportunity for VA to lead the nation and look forward to next steps Best • (b) (6), (b) (2) First the questions below relate to the clinica l trial : Do we need ftmding to pilot? No we do not , we can fund the clinical trial. Do we need staff for data collection and home visits or do you guys have that? We would ideally Jike the VA to commit to data collection as they will be taking care of patients - and since the initial IDE as currently envisioned uses simulated home environment there should be no need for home visits . AMERICAN PVERSIGHT VA-19-0799-G-000074 DS 00020790 Note: that the machine has great abilities to send data directly to the cloud and we can work with VA to evolve many data intense systems in this direction. Ifwe amend the IDE to accommodate true home visits we can provide staff necessary to do the home visits and or supplement any VA needs, in most any situation. What are the regulatoiy hurdles? - there is an existing IDE so there should be no regulatory hurdles Is there an irb protocol? Yes, can modify to work with VA as necessaiy. Other logistic issues? - either directly or through a CRO. \Ve can work with VA to manage deliveiy of materials, drugs, devices etc. Current VA CLCs would be feasible - and we can develop necessary training for the appropriate staff depending on who supports and staffs the CLC's. We may also wish to use home nurses to train in the CLC's potentially if Vets wish to receive treatments in home. AMERICAN PVERSIGHT VA-19-0799-G-000075 OS 00020791 Message David shulkin LDrshulkin@aol.com] From: Sent : 8/14/201712:17:18 To : Jennifer Lee (b) (6) @gmail.com] Fwd: Draft response Subject: AM Jen- can you think about this and see if you think we should do Sent from my iPhone Begin fo.-warded message : (b) (6) From: (b) (6), (b) (2) · ail.com > Date: August 13 2017 at 7:50:21 PM EDT To: David shulkin (b) (6), (b) (2) (b) (6) Cc: (b) (6), (b) (2) (b) (6) dekaresearch .com> Subject: Draft response -DEKA David (6), (b) I spoke with -(b) and some of his team. Herein are some draft responses. (2) I believe this to be a great opportunity for VA to lead the nation and look forward to next steps Best (b) (6), (b) (2) First the questions below relate to the clinical trial : Do we need fundi1,g to pilot? No we do not, we can fund the clinical trial. Do we need staff for data collection and home visits or do you guys have that? We wouJd ideally like the VA to commit to data collection as they will be taking care of patients - and since the initial IDE as curren tly envisioned uses simulated home environment there should be no need for home visits . Note: that the machine has great abilities to send data directly to the cloud and we can work with VA to evolve many data intense systems in this direction . AMERICAN PVERSIGHT VA-19-0799-G-000076 DS 00020792 Ifwe amend the IDE to accommodate true home visits we can provide staff necessary to do the home visits and or supplement any VA needs, in most any situation. What are the regulatory hurdles? - there is an existing IDE so there should be no regulatory hurdles Is there an irb protocol? Yes, can modify to work with VA as necessary. Other logistic issues? - either directly or through a CRO. We can work with VA to manage delivery of materials, drugs, devices etc. Current VA CLCs would be feasible - and we can develop necessary training for the appropriate staff depending on who supports and staffs the CLC's. We may also wish to use home nurses to train in the CLC's potentially if Vets wish to receive treatments in home. AMERICAN PVERSIGHT VA-19-0799-G-000077 OS 00020793 Message David shulkin [Drshulkin@aol.com] 8/11/2017 12: 11 :54 AM Poonam Alaigh I(b) (6) @hotmail.com] Re: Close Call- Todays top CNN story From: Sent : To : Subject: Yup Sent from my iPhone On Aug 10, 2017, at 7:40 PM, Poonam Alaigh - (b) (6) >wr ote: http://www.cnn.com/20l 7/08/ 10/politics/kfiIe-sam-clovis-on-the-radia/index.html We have to be indebted to our Protection Team!! Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000078 DS_00020794 Message From: Sent : To ; Subject: Poonam Alaigh I(b) (6) @hotmail.com] 8/10/2017 11:40:08 PM David shulkin [Drshulkin@aol.comJ Close Call- Todays top CNN story http://www.cnn .com/2017 /08/10/poli tics/kfile-sam-clovis~on-the-radio/index .html We have to be indebted to our Protection Team I! Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000079 DS_00020795 Message Poonam Alaigh I(b) (6) @hotmail.com] 8/25/2017 7:31:57 PM David shulkin [Drshulkin@aol.comJ Re: Animal research update From: Sent : To : Subject: Agree Sent from my iPhone On Aug 25, 2017 , at 3 :23 PM, David shulkin wrote: Yup Not the time though to tackle - tom Will do Sent from my iPhone On Aug 25, 2017, at 2:43 PM, Poonam Alaigh - (b) (6) wrote : Of note- how John continues to include Jake unnecessarily and Darin even when he is no longer here Sent from my iPad Begin fmwarded message: From: "Alaigh , Poonam , M .D ." < Poonam .Alaigh@va .gov> Date: August 25, 20 17 at 2 :31 :51 PM EDT To: 1Poonam AJaigh' ~(b) (6) > Subject: FW: Animal research update Sent with Good (www .good .com) -----Original Message----From: Ull yot, John Sent: Friday, August 25 , 2017 02:30 PM Eastern Standard Time To: Tucker , Brooks; Alaigh, Poonam , M.D .; DJS Cc: Cashour , Curtis; Hutton, James; Pape , Lisa M .· Beck, Lucille R ; Jensen, Jon M .; Johnson., Glenn; Leinenkugel , Jake ; Selnick , Darin Subject: Re : Animal research update Thanks Brooks - adding Jake and Darin for awareness as the WH should help us block anything . JohnU. AMERICAN PVERSIGHT VA-19-0799-G-000080 DS_00020796 From: "Tucker, Brooks" Date: Friday, August 25, 2017 at 2:27 PM To: "Alaigh, Poonam, M.D." , DJS Cc: Department of Veterans Affairs Department of Veterans Affairs , Curt Cashour , "Hutton, James" , "Pape, Lisa M." , "Beck, Lucille B." , "Jensen, Jon M." , "Johnson, Glenn" Subject: RE:Animal research update Thank you, Dr. Alaigh. Please keep me and John Ullyot apprised on how you want to proceed and with whom from VHA. OCLAwi ll coordinate with Capitol Hill offices to ensure we have accurate and timely engagement that is synchronized. Adding Jon Jensen and Glenn Johnson for ongoing awareness. Brooks D. Tucker Assistant Secretary Office of Congressional and Legislative Affairs 0: (202) 461-6449 Department of Veterans Affairs 810 Vermont Ave, NW Washington, D.C. 20420 brooks.tucker@va.gov AMERICAN PVERSIGHT VA-19-0799-G-000081 OS 00020797 From: AlaighI Poonam,M.D. Sent : Friday, August 25, 2017 2:24 PM To: DJS;Tucker, Brooks Cc: Ullyot, John; Cashour,Curtis; Hutton, James; Pape, Lisa M.; Beck, LucilleB. Subject: RE: Animal research update Looping my team- I think-(b) (6) should also be engaged Sent with Good (www.good .com) -----Original Message----From: DJS Sent: F1iday, August 25, 2017 02:20 PM Eastern Standard Time To: Tucker , Brooks Cc : Ullyot, John; Cashour, Curtis; Hutton, James ; Alaigh, Poonam , M .D . Subject: RE: Animal research update Brooks- thanks for letting me know I think we are best at this point to have VHA engage directly at this point with staff- either the head of research or the acting ISH if she feels comfortable, I think keeping this fact based and not political is the next step- after that I can consider getting involved Sent with Good (www.good.com ) -----Original Message----From: Tucker, Brooks Sent: Friday , August 25, 2017 09:07 AM Eastern Standard Time To: DJS Cc: Ullyot, John; Cashour, Curtis; Hutton , James ; Alaigh , Poonam, M ,D . Subj ect : FW : Animal research update Mr. Secretary, See below -recotmuend we disc:ussat your earliest convenience with John UUyot and Dr. Alaigh in t11croom. Respectfully. Brooks D. Tucker Assistant Sccrctl:11) ' Office of Congressional and Legislative Affairs 0 : (202) 461-6449 AMERICAr-... pVERSIGHT VA-19-0799-G-000082 DS 00020798 Department of Veterans Affairs 810 Vennont Ave, NW Washington,D.C. 20420 brooks.tucker@va.gov -----OriginalMessa_ge----From: Cashour. Curtis Sent: Friday, August 25, 2017 8:25 AM To: Tucker. Brooks Cc: Ullyot. John: Hutton, James Subject: Animal research update I spoke with folks from PVA and DAV yesterday regarding animal research. They said the opponents of our cru1ineresearch program arc aggressively e House bill Lhat.would lobbying the Senate AppropriationsCommiltee to pass 1J1 gut our program. They said it's quite possible the Senate will simply pass the House bill with minimal changes. Would it be possible to have SECVA call the chair and ranking member regarding this issue? Sent with Good (www.good.com} AMERICAr-... pVERSIGHT VA-19-0799-G-000083 D8_00020799 Message David shulkin lDrshulkin@aol.com] 8/25/2017 7:22:03 PM Poonam Alaigh I(b) (6) @hotmail.com] Re: Animal research update From: Sent : To : Subject: Yup No t the time though to tackle - tom Will do Sent from my iPhone - Ou Aug 25, 20 17, at 2:43 PM, Poonaro AJaigh (b) (6) > wrote : Of note- how John continues to include Jake unnecessarily and Darin even when he is no longer here Sent from my iPad Begin forwarded message : From: "Alaigh, Poonam., MD ." (b) (6) va .oov> Date: August 25, 20 17 at 2 :31:51 PM EDT To: 'Poonam Alaigh 1 - (b) (6) Subject: FW: Animal resea.-ch update Sent with Good (www .good .com) -----Original Message----From: Ull yot, John Sent: Friday, August 25, 20 17 02:30 PM Eastern Standard Time To: Tucker , Brooks; Alaigh, Poonam, M .D .; DJS Cc: Cashour , Curtis ; Hutton , James; Pape , Lisa M .; Beck , Lucil1e B.; Jensen , Jon M. ; Johnson , Glenn ; Leinenkugel , Jake ; Selnick , Da1in Subject: Re : Animal research update Thanks Brooks - adding Jake and Darin for awareness as the WH shouJd help us block anything . John U. From: "Tucker, Brooks" Date: Friday, August 25, 2017 at 2:27 PM To: "Alaigh, Poonam, M.D." , DJS Cc: Department of Vet erans Affa irs Department of Veterans Affairs , Curt Cashour , "Hutton, James" , "Pape, Lisa M." , "Beck, Lucille B." AMERICAN PVERSIGHT VA-19-0799-G-000084 DS_ 00020800 , "Jensen, Jon M ." , "Johnson, Glenn" Subject: RE: Anima l research update Thank you, Dr. Alaigh. Please keep me and John Ullyot apprised on how you want to proceed and with whom from VHA. OCLAwill coordinate with Capitol Hill offices to ensure we have accurate and timely engagement that is synchronized . Adding Jon Jensen and Glenn Johnson for ongoing awareness . Brooks D. Tucker Assistant Secretary Office of Congressional and Legislative Affairs 0: (202) 461 -6449 Department of Veterans Affairs 810 Vermont Ave, NW Washington , D.C. 20420 brooks. tucker@va.gov From: Alaigh, Poonam, M.D. Sent: Friday, August 25, 2017 2:24 PM To: DJS;Tucker, Brooks Cc: Ullyot, John; Cashour,Curtis; Hutton, James; Pape, Lisa M.; Beck, Lucille B. Subject: RE: Animal researchupdate AMERICAN PVERSIGHT VA-19-0799-G-000085 OS 00020801 Looping my team- I think-(b) (6), (b) (2) should also be engage d Sent with Good (www .good .com ) -----Original Me ssage-- --From: DJ S Sent: Frida y, Augus t 25, 2017 02:20 PM Eas tern Standa rd Time To: Tucker , Brooks Cc: Ull yot, John ; Casho ur, Curtis; Hutton, Jame s; Alaigh, Poonam , M ,D. Subject: RE : Animal research update Brooks- thank s for letting me know I th ink we are best at thi s point to have VHA engage directly at thi s point with staff- either the head of researc h or the acting ISH if she feels comfortable , 1 think keeping thi s fact based and not political is the next step- after tl1at I can consider getting invo lved Sent with Good (www.good .com ) ----Original Mes sage ----From: Tucker, Bro oks Sent: Frida y, August 25,20 17 09:07 AM Easte rn Standard Time To: DJS Cc: Ullyot, John ; Cashour, Curti s; Hutt on, Jame s; Alaigh, Poonam . TvL D_ Subject: FW: Animal research update Mr. Secretary, See below -recommend we discuss at your earliest convenience with John Ull yot and Dr . Ala igh in tbe room . Respectfully , Brooks D. Tucker Assistan t Sec retary Office o r Co ngress ional and Leg isla tive Affairs 0 : (202) 461-6449 Departmentof Veterans Affairs 810 Vcm10nt Ave . NW WasbingLon. D.C. 20420 brooks .tuckcrta::va.gov -----Original Mcssagc----From: Cashour, Curt.is Sent: Friday, August 25. 2017 8:25 A1'vl To '.Tuck er, Broo ks Cc: ffi lyot, John: Hutton , James Subject Animal resea rch updat e AMERICAr-... pVERSIGHT VA-19-0799-G-000086 D8_00020802 l spoke witl.1folks from PY A and DAV yesterday regarding animal research. They said Lhe opponents of our canine research program are aggressivel y lobby ing the Senate Appropriations Committee to pass the House bill that would gut our program They said it's quit e possible Lhe Senate will simp ly pass ilie House bill witb minimal cha nges. Would it be possible to have SECY A call the chair and ranking member regarding this issue ? Sent wilh Good (www.good.com ) AMERICAr-... pVERSIGHT VA-19-0799-G-000087 D8_00020803 Message From: Sent : To ; Subject: Poonam Alaigh I(b) (6) @hotma il.com ] 8/25/2017 6:43 :17 PM David shulkin [Drshulkin@aol.comJ Fwd: Animal research update Of note- how John continues to include Jake unnecessarily and Darin even when he is no longer here Sent from my iPad Begin forwarded message : From: "Alaigb, Poonam , M.D ." Date: August 25, 2017 at 2:31:51 PNIEDT To: 'Poonam AJaigh1 ~(b) (6) > Subject: FW: Animal research update Sent with Good (www .good.com ) -----Origin al Message----From: Ullyot, John Sent: Friday, August 25, 20 17 02 :30 PM Eastern Standard Time To: Tucker , Brooks ; Alaigh , Poonam , M.D.; DJS Cc: Cashour , Curtis; Hutton , James ; Pape , Lisa M.; Beck, Lucille B.; Jensen , Jon M.- Johnson, Glenn ; Leinenkugel , Jake ; Selnick, Darin Subject: Re : Animal research update Thanks Brooks anything. adding Jake and Darin for awareness as the WH should help us block John U . From: "Tucker, Brooks" Date: Friday, August 25, 2017 at 2:27 PM To: ''Alaigh, Poonam, M.D ." , DJS Cc: Department of Veterans Affairs Department of Veterans Affairs , Curt Cashour , "Hutton, James" , "Pape, Lisa M." , "Beck, Lucille B." , "Jensen1 Jon M." , "Johnson, Glenn" Subject: RE: Animal research update Thank you, Dr. Alaigh. Please keep me and John Ullyot apprised on how you want to proceed and with whom from VHA. AMER11...,r\1 PVERSIGHT VA-19-0799-G-000088 OS 00020804 OCLAwill coordinate with Capitol Hill offices to ensure we have accurate and timely engagement that is synchronized . Adding Jon Jensen and Glenn Johnson for ongoing awareness. Brooks D. Tucker Assistant Secretary Office of Congressional and Legislative Affairs 0: (202) 461-6449 Department of Veterans Affairs 810 Vermont Ave, NW Washington , D.C. 20420 brooks .tucker@va .gov From: Alaigh, Poonam,M.D. Sent: Friday, August 25, 2017 2:24 PM To: DJS;Tucker, Brooks Cc: Ullyot, John; Cashour,Curtis; Hutton, James; Pape, Lisa M.; Beck, Lucille B. Subject: RE:Animal researchupdate Looping my team- I think-(b) (6) should also be engaged Sent with Good (www .good .com) -----Original Message----From: DJS Sent: Friday, August 25, 20 17 02:20 PM Eastern Standard Time To: Tucker , Brooks Cc: Ullyot, John ; Cashour , Curtis; Hutton, James ; Alaigh, Poonam , M .D . Subject: RE : Animal research update AMERICA! PVERSIGHT VA-19-0799-G-000089 OS 00020805 Brooks- thanks for letting me know I think we are best at this pojnt to have VHA engage directly at thi s point with staff- either the head of research or the acting ISH if she feels comfortable, I think keeping thi s fact based and not political is the next step- after that I can consider gettin g involved Sent with Good (www .good .com) -----Original Message---From: Tucker, Bro oks Sent: Friday, August 25, 20 17 09:07 AMEastern Standard Time To: DJS Cc: Ullyot, John ; Cashour, Curtis; Hutton , James; Alaigh , Poonam, M.D . Subject: FW: Animal research update Mr. Secretary. Sec below -recommend we discuss at your c.irliest convenience with John UUyot and Dr. Alaigh in the room. Respectfully. Brooks D. Tucker Assistant Secretary Office of Congressional and Legislative Affairs 0: (202) 46 1-6449 Department of VeternnsAffairs 810 Vermont Ave, NW Washington, D.C. 20420 brooks.tucker@,.va.gov --Origi nal Message-From: Cashour, Curtis Sent Friday, August 25. 2017 8:25 AM To: Tucker. Brooks Cc: Ullyot, John; Hutton, Jmnes Subject An.imalresearch update I spoke wiU1folks from PVA and DAV yesterday regarding animal research. Tl1ey said the opponents of our canine c bill Lhat would researchprogram arc aggressively lobbying the Senate Appropriations Committee to pass tJ1e f-{ous gut our program, TI1cy srud it's quite possible the Senate will simply pass the House bill with minimal changes. Would it be possible to have SECVA ca11the chair and ranking member regarding this issue? Sent wi th Good (www.good.com) AMERICAr-... pVERSIGHT VA-19-0799-G-000090 D8_00020806 Message Davidshulkin [Drshulkin@aol.com] 8/12/2017 6:38:04 PM Poonam AlaighI(b) (6) @hotmail.com] Re: What about From: Sent: To: Subject: Omg no Sent from my iPhone > on Aug 12, 2017, at 1:52 PM, Poonam Alaigh <-@hotmail.com> (b) (6) > > -(b) (6) strugg'i'ing for the adush role- better to thin k about a solution wrote: than having nobody and we can buy time to find the right leader - > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000091 OS 00020807 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 8/12/2017 5:52:35 PM To: DavidShulkin [drshulkin@aol.com] What about Subject: (b) (6) 11111111111111 for the adush role- better ~ng than having nobody and we can buy time to find the right leader - to think about a solution Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000092 OS 00020808 Message From: Sent : To : David Shulkin [drshulkin@aol.com] 8/2/201710:36 :49 AM Poonam Alaigh I(b) (6) @hotmail .com] https ://Iaw .stackexchange .com/ questions/7100/ can-the-president-veto-a-bi house l1-that-was-passed-by-2-3-of-each- Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000093 DS_ 00020809 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 8/4/20 17 1:33:55 PM To: (b) (6) (b) Bruce Moskowit z [bruce~@mac (6) Re: Geotagging Subject: .com] sounds great Thanks Bruce Sent from my iPhone (b) (6) > on Aug 4, 2017, at 7: 32 AM, Bruce Moskowitz wrote: (6) > This is the group that can get this done in a matter of weeks if I twist his arm! > https :// www.azavea.com / about / teammate / robert-cheetham / > > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000094 OS 00020810 Message From: Sent: To: Subject: Bruce Moskowi t z [brucem (b) (6) (b) @mac .com] 8/4/2017 11:32:11 AM (6) Poonam Alaigh I(b) (6) @hotmail.com]; David shul kin [drshulkin@aol .com]; (b) (6) Geot agging This is the group that can get this done in a matter https://www.azavea.com/about/teammate/robert-cheetham/ of weeks if I twist @aol.com his arm ! Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000095 OS 00020811 Message From: David shu lkin [Drshulkin@ao l.com] Sent: 8/5/20 17 7:35:40 PM To: Poonam Alaigh I(b) (6) @hot mail.com] Re: Did you know Subject: Wow Sent from my iPhone > on Aug 5, 2017, at 2:38 PM, Poonam Alaigh <-@hotmail.com> (b) (6) > (6) > -(b) (6), > has a -(b) (6) and is still wrote: recovering (b) (2) > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000096 OS 00020812 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 8/5/2017 6:38:44 PM To: David Shulkin [drshulkin@aol.com] Did you know Subject: (6) -(b) (6), has a -(b) (6) and is still recovering (b) (2) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000097 OS 00020813 Message From: Sent: To: Subject: David shu lkin [Drshulkin@ao l.com] 8/4/20 17 10 :27: 17 AM Poonam Alaigh I(b) (6) @hot mail.com] Re: Did the prednisone help No Sent from my iPhone > on Aug 4, 2017, at 5:32 AM, Poonam Alaigh o<-@hotmail.com> (b) (6) wrote: > > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000098 OS 00020814 Message From: Sent: To: Subject: sent Poonam Alaigh I(b) (6) @hotmail.com] 8/4/2017 9:32:59 AM David Shulkin [drshulkin@aol.com] Did the prednisone help from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000099 DS_ 00020815 Message Poonarn Alaigh I(b) (6) @hotmail.com] Sent : 8/12/2017 10 :29:08 PM To : David Shu Ikin [drshulkin@aol.com] Subject: Fwd: [EXTERNAL] Catch up Attachments : ACCV 2017 .doc; ATT00001.htm; (b) (6) From: Bio 2017.docx; ATT00002.htm Actually- on re-reading her note , she knows too much and has been a close friend of Joe and Karen- I would stay away . She is not operational, didn't run qualcare well, has a big mouth, name drops, and is looking for basically consulting and negotiating deals . We don't have that available Sent from my iPhone Begin forwarded message : - From: "Alaigh , Poonam, M .D." (b) (6) Date: August 12, 2017 at 6 :25 :08 p_M EDT To: 'Poonam Alaigh' (b) (6) Subject: FW: IEXTERNALI Catch up > Sent with Good (www .good .com ) -----Original Message----From: DJS Sent: Saturday , August 12, 2017 04:57 PM Eastern Standard Time To: Alaigh, Poonam, M .D. Subject: FW : [EXTERNAL] Catch up Should we consider her? Sent with Good (www .good .com ) -----Ori.gi nal Message----(b (b) (6) From: (b) (6) ~ Sent: Saturday , August )12, 2017 04:31 PM Eastern Standard Time (6 To: Shulkin , David J. , MD ) Subject: [EXTERNAL] Catch up David , I watched with pride the news conference today with the President. You did an outstanding job and congratulations on all the success with the VA and bringing some quality programs to our veterans . Since I left Cigna I have doing strategic and business development consulting for a couple of major health systems in the Northeast (not just NJ) . I have included my CV and Bio . If I can be of any help to you AMERICAN PVERSIGHT VA-19-0799-G-000100 DS 00020816 Either in the Northeast or Southwest (I have a second home in Scottsdale), please let me know. I think I could help if you need assistance negotiating deals with providers in the community. Share my CV with your team if appropriate and ifl can help don't hesitate to have someone on your team call. Keep up the good work. With the other events of the day I'm sure it didn't go as you had planned, but It was still very impactful. Thanks again - (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000101 OS 00020817 (b) (6) (b) (6) (b) (6) (b (b) (6) E-mnil: ■~coo, ) (6 ) (b) (b) (6), (6) (b) (2) EXPERIEN CE! (b) (6), (b) (2) 20(10- 4// t 7 8/93 - 4/1 7 2/M--f /17 BOARD APPOINTMENTS: • (b) (6), (b) (2) • • • CIVlC ASSOCIATIONS: . • (b) (6), (b) (2) PROFESSIONAL ASSOCIATIONS : • (b) (6), (b) (2) AMERICAr-... pVERSIGHT VA-19-0799-G-000102 DS_00020818 (b) (6) Page2 2016 2015 2014 2014 2013 2013 2013 2013 2012 2012 2012 2012 2011 2011 2011 (b) (6), (b) (2) 2011 2010 2010 2010 2009/10 2009 2009 2009 2009 2006 2005 2004 2004 2003 2002 2001 2000 AMERICAN PVERSIGHT VA-19-0799-G-000103 DS_ 00020819 o4 (b) (6) (b) (6), (b) (2) A Wholly-Owned Subsidiary of Cigna (b) (6), (b) (2) (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000105 DS_ 00020821 06 Message DavidShulkin [secshulkin@gmail.com] Sent: 8/18/2017 11:32:31 PM To: IP [ll@frenchangel59 .com] ( Subject: Re:bRE: ) ( 6 Thanks so much Ike. ) Sent from my iPhone From: > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > ( on Aug 18, 2017, at 6:38 PM, IP wrote: b David , ) ( good conversation. I spoke to Poonam and we had a very I am sure everything wi 77 be fi ne 6 I will discuss tomorrow. we need )more people like Poonam. All my Best, Ike -----original Message----From: David shulkin [mailto :secshulkin @gmail . com] sent : Friday, August 18 , 2017 4: 52 PM To: Ike Perlmutter subject: Ike- Poonam is getting really anxious about not hearing any decision on the undersecretary Nomination and is thinking its not going to happen and beginning to talk about leaving. If there is anyway we can get the White House office would help a lot. There may be nothing we can do at this it to you to reassure her- it point but i thought I would mention Thanks David sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000107 OS 00020823 Message From: IP ll@frenchangel59 .com] ( Sent: 8/18/2017 10:38:03 PM b To: 'David ) Shulkin' [secshulkin@gmail.com] RE:( 6 ) Subject: David, I spo ke to Poonam and we had a very good conversation wi 77 be fine I will discuss tomorrow . we need more people like . I am sure everything Poonam. All my Best, Ike - - - --Original Message-- --From: David shul kin [mailto:secshulkin @gmail . com] sent : Friday , August 18 , 2017 4 : 52 PM To: Ike Perlmutter subject: Ike- Poonam is getting really anxious about not hearing any decision on the undersecretary Nomination and is thinking its not going to happen and beginning to talk about leaving. If there is anyway we can get the White House office would help a lot. There may be nothing we can do at this it to you to reassure her- it point but i thought I would mention Thanks David sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000108 OS 00020824 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 8/18/2017 8:51:35 PM Ike Perlmutter [~frenchangel59.com] ( b ) ( Ike - Poonam is getting really anxious about not hearing any decision on the undersecretary 6 is thinking its not going to happen and beginning to talk about leaving. ) If there is anyway we can get the White House office to reassure her - it would help a lot. To: There may be nothing we can do at this point but i thought Nomination and I would mention it to you Thanks David sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000109 OS 00020825 Message Poonam Alaigh (b) (6) @gmail.com] 8/8/2017 12:52 :59 AM Marc Sherman [mbs~@gmail.com] (b) Secshulkin@gmail.com (6) Re: Coming weeks From: Sent : To : CC: Subject: Sounds good- look ing forward to it! On Mon, Aug 7, 2017 at 8:51 PM Marc Sherman <- (b) (6) > wrote : I am available next Thursday but not Wednesday . Let's just keep dinner for this Wednesday and I will endeavor to change my con.flict and come to DC. - On Mon , Aug 7, 2017 at 7:39 PM, Poonam Alaigh - (b) (6) Actually only Wednesday 8/16 dinner works for me next week > wrote : On JVfon,Aug 7, 201 7 at 7: 14 PM Poonam AJaigh (b) (6) wrote : Marc, I am traveling Thursday onwards this week and returning to de next week and available Wednesday 8/16 or Thursday 8/17 if it happens to work . Not sure if any of those days work for David though . On Mon, Aug 7. 2017 at 5:00 PM Marc Sherman wrote: 1 have a conflict for Wednesday dinner. I now can't be in DC that day . 1 am so sorry. fs there any chance that you could make Thursday work instead? Marc (b) (6) : On Fri, Aug 4, 2017 at 5:37 PM , Poonarn Alaigh -wrote Awesome- lets confirm 6 :30pm at your favorite restaurant- send me the name again . Have wonderful weekend to both of you . > wrote: On Fri, Aug 4, 2017 at 5:22 PM Marc Sherman <- (b) (5) Yes , looking forward to it. We can pick place and time that morning? Have a great weekend. Marc Sherman (b) (6) On Aug 3, 2017 6:02 PM, "Poonam Alaigh" - (b) (6) > wrote: Marc/- spoke to david , he is not sure of his schedule for next Wednesday with stuff influx/ the two of us can meet and hopefully David can join- does that still works for you? - On Wed , Aug 2, 2017 at 9:50 AM Poonam Alaigh (b) (6) 1 can make it work - hopefully David can too On Wed , Aug 2, 2017 at 8:38 AM Marc Sherman wrote : > wrote : VA-19-0799-G-000110 DS_ 00020826 Marc Sherman (b) (6) (b) (6) On Aug 2, 2017 6:34 AM, "Poonam Alaigb 1' ~ wrote : Marc- are you in town for a catch up di1mer with david and I ? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000111 DS 00020827 Message Marc Sherm,in (mb (b) (6) @.gmail.com] 8/8/2017 12:51 :57 AM (b) (6) Poonam Alaigh ■-■@gmail.com] Secshulkin@gmail.com Re: Coming weeks From: Sent : To : CC: Subject: lam available next Thursday, but not Wednesday . Let's just keep dinner for this Wednesday and [ will endeavor to change my conflict and come to DC. On Mon, Aug 7, 2017 at 7:39 PM, Poonam Alaigh - (b) (6) Actually only Wednesday 8/16 dinner works for me next week wrote: > wrote : On Mon, Aug 7, 2017 at 7: 14 PM Poonam AJaigh - (b) (6) Marc, lam traveling Thursday onwards this week and returning to de next week and available Wednesday 8/16 or Thursday 8/17 if it happens to work . Not sure if any of those days work for David though. On J\llon, Aug 7, 2017 at 5 :00 PM Marc She1man wrote : I have a conflict for Wednesday dinner . I now can't be in DC that day. lam so sorry. ls there any chance that you could make Thursday work instead? Marc On Fri, Aug 4, 2017 at 5:37 PM, Poonam Alaigh - (b) (6) > wrote: Awesome- lets confirm 6 :30pm at your favorite restaurant- send me the name again. Have wonderful weekend to both of you . On Fri, Aug 4, 2017 at 5:22 PM Marc Sherman <- (b) (6) > wrote: Yes, looking forward to it. We can pick place and time that morning? Have a great weekend. Marc Sherman (b) (6) - > On.Aug 3, 2017 6:02 PM, "Poonam Alaigh 11 (b) (6) wrote : Marc/- spoke to david, he is not sure of his schedule for next Wednesday with stuff influx/ the two ofus can meet and hopefully David can join- does that still works for you? On Wed, Aug 2, 2017 at 9:50 AM Poonam Alaigh - (b) (6) I can make it work- hopefully David can too On Wed, Aug 2, 2017 at 8:38 AM Marc Sherman wrote : > wrote: > wrote : VA-19-0799-G-000112 DS_00020828 Marc- are you in town for a catch up dinner with david and I? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000113 OS 00020829 Message Poonam Alaigh (b) (6) @gmail.com] 8/7/2017 11:39:29 PM Marc Sherman [mb-■l@gmail.com] (b) (6) Secshulkin@gmail.com Re: Coming weeks From: Sent : To : CC: Subject: - Actually only Wednesday 8/16 clinner works for me next week > On Mon . Aug 7. 2017 at 7:14 PM Poonam Alaigh (b) (6) wrote : Marc, I am traveling Thursday onwards this week andretuming to de next week and available Wednesday 8/16 or Thursday 8/17 if it happens to work. Not sure if any of those days work for David though . On Mon , Aug 7, 2017 at 5:00 PM Marc Sherman wrote: I have a conflict for Wednesday dinner . I now can't be in DC that day . I am so sorry. Is there any chance . that you could make Thursday work instead? Marc On Fri, Aug 4, 2017 at 5:37 PM, Poonam Alaigh - (b) (6) wrote : Awesome- lets confirm 6:30pm at your favorite restaurant- send me the name again . Have wondetful weekend to both of you . On Fri, Aug 4, 201 7 at 5:22 PM Marc Sherman <- (b) (6) > wrote : Yes, looking forward to it. We can pick place and time that morning? Have a great weekend. Marc Sherman (b) (6) > wrote : On Aug 3, 2017 6:02 PM, "Poonam Alaigh 11 - (b) (6) Marc/- spoke to david, he is not sure of his schedule for next Wednesday with stuff influx / the two of us can meet and hopefully David can join- does that still works for you? - On Wed, Aug 2, 2017 at 9:50 AM Poonam Alaigh (b) (6) I can make it work- hopefully David can too On Wed , Aug 2, 2017 at 8:38 AM Marc Sherman wrote : > wrote: Marc Sherman (b) (6) > wrote ; On Aug 2. 2017 6:34 AM, "Poonarn Alaigh 11 - (b) (6) Marc- are you in town for a catch up dinner with david and I? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000114 DS_00020830 Message From: Sent: To : CC: Subject: Poonam Alaigh (b) (6) @gmail.com] 8/7/2017 11:14:36 PM Marc Sherman [mb-■l@gmail.com] (b) (6) Secshulkin@gmail.com Re: Coming weeks Marc, I am traveling Thursday onwards this week and returning to de next week and available Wednesday 8/16 or Thursday 8/17 if it happens to work. Not sure if any of those days work for David though . OnMon, Aug 7, 2017 at 5:00 PMMarc Sherman wrote: I have a conflict for Wednesday dinner . I now can't be in DC that day. I am so sorry. Is there any chance that you could make Thursday work instead? Marc On F1i, Aug 4 2017 at 5:37 PM, Poonam Alaigh - (b) (6) > wrote : Awesome- lets confirm 6 :30pm at your favorite restaurant- send me the name again . Have wonderful weekend to both of you . On Fri , Aug 4, 2017 at 5:22 PM Marc Sherman <- (b) (6) > wrote : Yes, looking forward to it. We can pick place and time that morning? Have a great weekend . Marc Sherman (b) (6) wrote: On Aug 3, 2017 6:02 PM, "Poonam Alaigh 11 - (b) (6) Marc/- spoke to david, he is not sure of his schedule for next Wednesday with stuff influx/ the two of us can meet and hopefully David can join- does that still works for you? (b) (6) On Wed, Aug 2, 2017 at 9:50 AMPoonam Alaigh -wrote [ can make it work- hopefully David can too On Wed, Aug 2, 2017 at 8 :38 AM Marc Sherman wrote: > wrote : On Aug 2, 2017 6:34 AM, "Poonam Alaigh" (b) (6) Marc- are, you in town for a catch up dinner with david and I ? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000115 DS_00020831 Message David Shulkin [secshulkin@gmail.com] 8/7/201710:17:57 PM From: Sent : Marc Sherman [mb (b) (6) @gmail.com] Re: Coming weeks To : Subject: Marc- not a problem Unfortunately i am not available thursday evening David Sent from my iPhone On Aug 7, 2017, at 5:00 PM, Marc Sherman <- (b) (6) wrote : Poonam and David I have a conflict for Wednesday dinner . 1 now can't be in DC that day. I am so sorry. ls there any chance that you could make Thursday work instead? Marc - > wrote : On Fri, Aug 4, 2017 at 5:37 PM, Poona111Alaigh (b) (6) Awesome- lets confirm 6:30pm at your favorite restaurant- send me the name again. Have wonderful weekend to both of you . On F1i, Aug 4, 2017 at 5:22 PM Marc Sherman <- (b) (6) wrote: Yes, looking fo1ward to iL We can pick place and ti.me that morning? Have a great weekend. Marc Sherman (b) (6) - > - > wrote : On Aug 3, 20 I 7 6:02 PM, "Poona111Alaigh '' (b) (6) Marc/- spoke to david, he is not sure of his schedule for next Wednesday with stuff influx/ the two of us can meet and hopefully David can join- does that still works for you? On Wed , Aug 2~2017 at 9:50 AM Poonam Alaigh (b) (6) I can make it work- hopefully David can too On Wed , Aug 2, 2017 at 8:38 AM Marc Sherman On Aug 2, 2017 6:34 AM, "Poona111Alaigh 11 (b) (6) wrote : Marc- are you in town for a catch up dinner with david and I ? A Jot happening and would be good for us to meet AMERICAf PVERSIGHT VA-19-0799-G-000116 DS_00020832 17 Message Marc Sherman [mb (b) (6) @.gmail.com] 8/7/2017 9 :00:49 PM From: Sent : To : CC: Subject: (b) (6) Poonam Alaigh ■-■@gmail.com) Secshulkin@gmail.com Re: Coming weeks Poonam and David 1 have a conflict for Wednesday dinner . I now can't be in DC that day. I am so sorry. Is there any chance that you could make Thursday work instead? Marc On Fri, Aug 4, 2017 at 5:37 PM, Poonam Alaigh - (b) (6) wrote: Awesome- lets confirm 6 :30pm at your favorite restaurant- send me the name again. Have wonderful weekend to both of you. > wrote: On F1i, Aug 4, 2017 at 5:22 PM Marc Shennan <- (b) (6) Yes, looking forward to it. We can pick place and time that morning? Have a great weekend . Marc Sherman (b) (6) - > - > wrote ; On Aug 3, 2017 6:02 PM, "Poonam Alaigh" (b) (6) Marc/- spoke to david, he is not sure of his schedule for next Wednesday with stuff influx/ the two ofus can meet and hopefully David can join- does that still works for you? On Wed, Aug 2, 2017 at 9:50 AM Poonam Alaigh (b) (6) I can make it work- hopefully David can too On Wed, Aug 2, 2017 at 8:38 AM Marc Sherman wrote: Marc Sherman (b) (6) On Aug 2, 2017 6:34 AM, "Poonam Alaigh 1' - (b) (6) > wrote : Marc- are you in town for a catch up dinner with david and I ? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000118 DS_00020834 Message From: Sent : To : CC: Subject: Poonarn Alaigh (b) (6) @gmail.com] 8/4/2017 9 :37:46 PM Marc Sherman [mb-■l@gmail.com] (b) (6) Secshulkin@gmail.com Re: Coming weeks Awesome- lets confirm 6:30pm at your favorite restaurant- send me the name again. Have wonderful weekend to both of you. On Fri, Aug 4, 2017 at 5:22PMMarc Shennan <- (b) (6) > wrote: Yes, loolcing forward to it. We can pick place and time that morning? Have a great weekend. Marc Sherman (b) (6) On Aug 3, 2017 6:02 PM, "Poonam Alaigh" - (b) (6) > wrote : Marc/- spoke to david, he is not sure of his schedule for next Wednesday with stuffinflux/ the two ofus can meet and hopefully David can join-does that still works for you? - On Wed, Aug 2, 2017 at 9:50 AM Poonam Alaigh (b) (6) I can make it work- hopefully David can too On Wed, Aug 2, 2017 at 8:38 AM Marc Sherman wrote : > wrote: Marc Sherman (b) (6) On Aug 2, 2017 6:34 AM, "Poonam Alaigh" - (b) (6) > wrote: Marc- are you in town for a catch up dinner with david and I ? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000119 DS 00020835 Message From: Marc Sherman [mb (b) (6) @.gmail.com] Sent : To : 8/4/2017 9 :22:42 PM (b) (6) Poonam Alaigh ■-■@gmail.com) CC: Subject: Secshulkin@gmail.com Re: Coming weeks Yes, looking forward to it. We can pick place and time that morning? Have a great weekend. Marc Sherman (b) (6) On Aug 3, 2017 6:02 PM, "Poonam Alaigh" - (b) (6) wrote: Marc/- spoke to david, he is not sure of his schedule for next Wednesday with stuff influx/ the two ofus can meet and hopefully David can join- does that still works for you? On Wed , Aug 2, 2017 at 9:50 AM Poonam Alaigh - (b) (6) 1 can make it work- hopefully David can too On Wed, Aug 2, 2017 at 8 :38 AM Marc Sherman wrote : Marc Sherman (b) (6) wrote : On Aug 2, 2017 6:34 AM, "Poonarn Alaigh" - (b) (6) Marc- are you in town for a catch up dinner with david and I? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000120 DS 00020836 Message From: Sent : To : CC: Subject: Poonam Alaigh (b) (6) @gmail.com] 8/3/201710:02 :05 PM Marc Sherman [mb-■l@gmail.com] (b) (6) Secshulkin@gmail.com Re: Coming weeks - > Marc/- spoke to david, he is not sure of his schedule for next Wednesday with stuff influx/ the two of us can meet and hopefully David can join- does that still works for you? On Wed , Aug 2, 2017 at 9:50 AM Poonam Alaigh (b) (6) I can make it work- hopefully David can too On Wed, Aug 2, 2017 at 8:38 AM Marc Sherman wrote: Marc Shennan (b) (6) > wrote ; On Aug 2, 2017 6:34 AM , "Poonam Alaigh 11 - (b) (6) Marc- are you in town for a catch up dinner with david and l ? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000121 DS_ 00020837 Message David Shulkin [secshulkin@gmail.com] 8/2/2017 2:08:06 PM From: Sent: To : Poonam Alaigh (b) (6) Re: Coming weeks Subject: @gmail.com] Ill Im not scheduling anything due to my (b) (6) Sent from my iPhone but ifi feel better i would be glad to - On Aug 2, 20) 7, at 9 :51 AM, Poonam Alaigh (b) (6) > wrote : - Sony- meant Wednesday Aug 9th can work - david ? On Wed , Aug 2, 2017 at 9:50 AM Poonam Alaigh (b) (6) I can make it work- hopefully David cru1too On Wed , Aug 2, 2017 at 8:38 AM Marc Sherman Tuesday or Wednesday next week (August 8 or 9)? Marc Sherman (b) (6) - (b) (6) > wrote: wrote : > On Aug 2, 2017 6:34AM, "Poonam Alaigh 11 (b) (6) wrote : Marc- are you in town for a catch up dinner with david and I ? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000122 DS_00020838 Message From: Sent : To : CC: Subject: Poonarn Alaigh (b) (6) @gmail.com] 8/2/2017 1:51:58 PM (b) (6) @gmail.com] Marc Sherman [mtll■■ Secshulkin@gmail.com Re: Coming weeks - Sorry- meant Wednesday Aug 9th can work - david ? On Wed , Aug 2, 2017 at 9:50 AM Poonam Alaigh I can make it work- hopefully David can too (b) (6) On Wed, Aug 2, 2017 at 8:38 AM M.arc Sherman<- (b) (6) > wrote : > wrote: Tuesday or Wednesday next week (August 8 or 9)? Marc Sherman (b) (6) - > wrote ~ On Aug 2, 2017 6 :34 AM, "Poonam AJaigb 11 (b) (6) Marc- are you in town for a catch up dinner with david and I ? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000123 DS 00020839 Message From: Sent : To : CC: Subject: Poonam Alaigh (b) (6) @gmail.com] 8/2/2017 1:50:52 PM Marc Sherman [mb-■l@gmail.com] (b) (6) Secshulkin@gmail.com Re: Coming weeks J can make it work- hopefully David can too On Wed, Aug 2, 2017 at 8:38 AM Marc ShermanTuesday or Wednesday next week (August 8 or 9)? (b) (6) > wro1e: Marc Sherman (b) (6) wrote: On Aug 2, 2017 6:34 AM, "Poonam Alaigh 11 - (b) (6) Marc- are you in town for a catch up dinner with david and I? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000124 DS 00020840 Message From: Marc Sherman [mb (b) (6) @.gmall.com] Sent : To : (b) (6) CC: Subject: 8/2/2017 12:38 :16 PM @gmail.com Secshulkin@gmail .com Re: Coming weeks Tuesday or Wednesday next week (August 8 or 9)? Marc Sherman (b) (6) - > On Aug 2, 2017 6:34 AM, "Poonam Alaigb" (b) (6) wrote : Marc- are you in town for a catch up dinner with david and I ? A lot happening and would be good for us to mee1 AMERICAN PVERSIGHT VA-19-0799-G-000125 DS 00020841 Message From: Sent: To: CC: Subject: Poonam Alaigh (b) (6) 8/2/20 17 10:34:4 1 AM @gmail .com] (b) (6) mbsll■l@gmail.com David Shulkin [Secshulkin@gma il.com] Coming weeks Marc- are you in town for a catch up dinner with david and I? A lot happening and would be good for us to meet AMERICAN PVERSIGHT VA-19-0799-G-000126 OS 00020842 Message From: David shulkin lDrshulkin@aol.com] Sent : To : 8/5/2017 5 :54:29 PM (b) (6) Subject: Re: (b) (6) @gmail.com] Yes id like to change itSent from my iPhone Ot1 Aug 5, 2017 , at 8:34 AM, (b) (6) (b) (6) feels like the same place when I worked up there the last time . Being apart of the group , I felt wierd be I was able to think outside the box. Coming back to VHA was the best thing ever. On Aug 4, 2017 7 :17 AM, "David Shulkin" wrote : Ok- now I know I need to decide who I replace first that would increase the overall team IQ the most Sent from my iPad On Aug 4, 2017, at 7:10 AM, (b) (6) (b) (6) ail.com > wrote: I heard it was cancelled be the team said you wouldn't like it and those people said that it would take up too much room . People also complained that it would take too long to set up (Shours) which was not true. It would've taken 1hr or 1.5hr at most. It was made into one of those unnecessary big deals . It could've been set up and if you didn't like it, they would've came back to take it down. On Aug 4, 2017 6 :59 AM, "David shulkin" wrote : Do you know what ever happened to my stand up desk ? Sent from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000127 DS 00020843 Message From: (b) (6) Sent : 8/5/2017 12:34 :57 PM To : David Shu Ikin [drshulk in@aol.com] Re: Subject: (b) (6) @gmail.com] feels like the same place when I worked up there the last time. Being apart of the group, l felt wierd be l was able to think outside the box. Coming back to VHA was the best thing ever On Aug 4, 2017 7:17 AM, "David Shulkjn 11 wrote : Ok- now I know I need to decide who I replace first that would increase the overall team IQ the most Sent from my iPad On Aug 4, 2017 , at 7: 10 ANI, (b) (6) (b) (6) mail.com > wrote: I heard it was cancelled be the rnam said you wouldn't like it and those people said that it would take up too much room . People also complained that it would take too long to set up (5hours) which was not true. It would've taken 1hr or 1.5hr at most . It was made into one of those unnecessary big deals . It could've been set up and if you didn't like it, they would've came back to take it down. On Aug 4 2017 6:59 AM, "David shulkin" wrote : Do you know what ever happened to my stand up desk? Sent from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000128 DS 00020844 Message From: David Shulkin [drshulk rn@aol.com] Sent : 8/4/2017 11:16 :56 AM To : (b) (6) Subject: Re: (b) (6) @gmail.co mJ Ok- now I know 1 need to decide who I replace first that would increase the overall team IQ the most Sent from my iPad On Aug 4, 2017, at 7:10 AM, (b) (6) (b) (6) mail .com > wrote : I heard it was cancelled be the team said you wouldn't like it and tho se people said that it would take up too much room . People also complained that it would take too long to set up (Shours) which was not true. It would've taken 1hr or 1.5hr at most. It was made into one of those unnecessary big deals . ]t could've been set up and if you didn't like it, they would've came back to take it down. On Aug 4, 2017 6 :59 Alv1,"David sbulkin" wrote : Do you know what ever happened to my stand up desk? Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000129 DS 00020845 Message From: (b) (6) Sent : 8/4/201711:10 :00 AM To : David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) @gmail.com] I heard it was cancelled be the team srud you wouldn't like it and those people said that it would take up too much room .. People also complained that it would take too long to set up (5hollrs) which was not true. It would've taken I hr or 1.5hr at most. It was made into one of those unnecessary big deals. rt could've been set up and if you didn't like it, they would've came back to take it down . On Aug 4, 2017 6:59 AM, "David shuJkin" wrote: Do you know what ever happened to my stand up desk ? Sent from my iPbone AMERICAN PVERSIGHT VA-19-0799-G-000130 DS 00020846 Message Sent: David shu lkin [Drshulkin@ao l.com] 8/4/20 17 10:59: 10 AM To: (b) (6) From: (b) (6) @gmail.co m] Do you know what ever happened to my stand up desk ? Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000131 OS 00020847 Message Poonarn Alaigh I(b) (6) @hotmail.com] 8/5/2017 6 :03:20 PM David shulkin [Drshulkin@aol.com] Re: No more tantrums From: Sent : To : Subject: Stay off your feet as much as you can over the weekend and also in the office- try alternate cold and hot compressors jn addition to everything else you are doing So relieved that I at least heard from you -was hoping you didn 1t end up in the ER or something with the way you sout1ded yester da y. I know it will get better , but want it to be soon . Sent from my iPad On Aug 5, 2017, at 1:53 PM, David shulkin wrote : No - not any better- no - he is a surgeon and i want to hold off on surgery for a few more weeks if i can The airport walks yesterday real ly destroyed me- My support teams are idiots- why they could get me carts instead of me walking i dont know- surrounded by incompetent peopke Sent from my iPhone On Aug 5, 2017, at 1 :24 PM, Poonam Alaigh - (b) Pain any better- did you talk to thatllll (6), worried since I haven't heard from you Sent from my iPhone (b) (6) > wrote : person that Es. mentioned? Getting (b) (2) Begin forwarded message : From:-(b) (6) Date: August 4, 2017 at 7:04:06 PM EDT To: David Shulkin Subject: No more tantrums I will work on it, that is ny word to you- really bothered that I make your pain worse- apologies . Just call me this weekend if you can to discuss Bruce and Ike - don 1t call Ike before we speak . Let me know what I cando to be there for you . Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000132 DS 00020848 Message David shulkin lDrshulkin@aol.com] 8/5/2017 5 :53:23 PM Poonam Alaigh I(b) (6) @hotmail.com] Re: No more tantrums From: Sent: To : Subject: No - not any better- no - he is a surgeon and i want to hold off on surgery for a few more weeks if i can The airport walks yesterday really destroyed me- 1\!Iysuppmi teams are idiots- why they could get me cart s instead of me walking i dont know- surrounded by incompetent peopke Sent from my iPhone On Aug 5, 201 7, at 1:24 PM, Poonam Alaigh - (b) (6) (b) Pain any better- did you talk to thatllll (6), haven't heard from you Sent from my iPhone wrote : person that Es mentioned ? Getting worried since 1 (b) (2) Begin forwarded message : From:-(b) (6) Date: August 4 2017 at 7:04:06 PM EDT To: David Shulkin Subject: No more tantrums I will work on it, that is ny word to you- really bothered that I make your pain worse- apologies . Just call me this weekend if you can to discuss Bruce and Ike don't cal I Ike before we speak. Let me know what I can do to be there for you . Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000133 DS 00020849 Message From: Poonarn Alaigh I(b) (6) @hotmail.com] Sent : 8/5/2017 5 :24:58 PM To : David Shu Ikin (drshulkin@aol.com] Fwd: No more tantrums Subject: Pain any better- did you talk to that~(b) (6), you Sent from my iPhone person that Es mentioned? Getting worried since I haven 1t heard from (b) (2) Begin forwarded message : Frorn:-(b) (6) Date: August 4, 2017 at 7:04 :06 P I EDT To: David Shu\kjn Subject: No more tantrums I will work on it, that is ny word to you- realJy bothered that I make your prun worseapologies . Just call me this weekend if you can to discuss · Bruce and Ike - don 1t call Ike before we speak. Let me know what I can do to be there for you . Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000134 DS 00020850 Message From: David Shulkin [secshulkin@gmail.com] Sent : 8/4/201710:00 :12 PM - (b) (b) (6) ■--■hotmail.com] Fwd: Fox News (6) To: Subject: The derm part was the big hit Sent from my iPhone Begin forwarded message : From: Marc Sherman <- (b) (6) > Date: August 4, 2017 at 5:22:55 PM EDT To: IP (b t frenchan el59 .com>, L Perl_ (b) (6) , Bruce Moskowitz )(b) (6) (b) c mac .com>, Secshulkin@gmail.com , Poonam Alaigh (6) (b) (6) (6 mail.corn> ) Subject: Fox News I am not sure this is what was sent out last week , but this is a great piece that has tremendous benefits in many many regards . http ://video .foxnews.com/v/553 l 164928001/?#sp =show-clips Marc Marc Sherman (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000135 DS_00020851 Message David Shulkin [secshulkin@gmail.com] 8/4/2017 9 :59:53 PM Marc Sherman [mb (b) (6) @gmail.com] IP [1@frenchangel59.com]; L Perl ■■■ ( (b) (6) @gma il.com]; Bruce Moskowitz [bruce (b) (6) (b) @mac.com]; b (6) (b) (6) Poonam Alaigh ■-■@gmail.com] Re:)Fox News From: Sent : To : CC: Subject: ( 6 Thanks had not )seen Sent from my iPhone On Aug 4, 2017, at 5:22 PM, Marc Sherman <- (b) (6) > wrote : I am not sure this is what was sent out last week , but this is a great piece that has tremendous benefits in many many regards . http ://video. foxnews .com/v / 553 I 16492800 l /?#s p=show-cli ps Marc Marc Sherman (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000136 DS_ 00020852 Message From: Sent : To : Subject: Marc Sherman [mb (b) (6) @.gmail.com) 8/4/2017 9 :22:55 PM @gmail.com]; Bruce Moskowitz (bruce (b) (6) (b) @mac.comJ; IP !1@frenchangel59 .com]; l Perl (b) (6) ( Secshulkin@gmail.com; Poonam Alaigh (b) (6) @gmail.com] b (6) Fox) News ( 6 ) is what was sent out last week, but this is a great piece that has tremendous benefits in many lam not sure this many regards. http://video.foxnews .com/v/553 l 164928001/?#sp =show-clips Marc Marc Sherman (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000137 DS_00020853 Message CC: (b) (6), (b) (b) (6) --@va.gov] (2) 8/10/2017 6:25:36 PM Davidshulkin [Drshulkin@aol.com] (b) (6) (b) (6) [-@gmail.com] Subject: RE: From: Sent: To: Wi77 do (b) (6), (b) (2) -----original Message----From: David shulkin [mailto:Drshulkin@aol . com] sent· ust 10, 2017 2:21 PM To: (b) (6), (b) (2) Cc: (b) (6) subject: Lets tweet the cabinet member of the day video and tweet out the ny times article on de va sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000138 OS 00020854 Message From: David shu lkin [Drshulkin@ao l.com] Sent: 8/10/2017 6:20:44 PM To: (b) (6), (b) (2) (b) (6) CC: Lets tweet the cabinet (b) (6) (b) (6) @gmail.co m] member of the day video and tweet out the ny times article on de va Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000139 OS 00020855 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 7/29/2017 9:43:15 PM To: Drshul kin@aol .com South Korea Subject: told -(b) (6), sent from my iPad (b) (2) I am not going- AMERICAN I PVERSIGHT already VA-19-0799-G-000140 DS_00020856 Message From: Poonam AlaighI(b) (6) @hotmail.com] Sent: 8/14/2017 2:13:21 PM To: Davidshulkin [Drshulkin@aol.com] Re: Darin Subject: I joined the call early today and no one knew I was on- before you and V1v1eca got there and it was primarily Jake and the pin heads and Jake was the King Pin holding court with them and telling them what to do - as soon as the others arrived - there was drop dead silence as though nothing else happened Sent from my iPad > on Aug 14 , 2017, at 10:10 AM, David shulkin wrote: > > 18th > > sent from my iPhone > >> on Aug 14 , 2017 , at 8 :32 AM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : >> >> When is he leaving- he is monopolizing meetings still and wants to hear his own voice- he is obsessed with VHAand is purposefully developing a close relationship with the vsos in addition to the Hill - he is on a mission >> >> sent from my iPhone > AMERICAN PVERSIGHT VA-19-0799-G-000141 OS 00020857 Message From: Sent: To: Subject: David shu lkin [Drshulkin@ao l.com] 8/14/2017 2:10:27 PM Poonam Alaigh I(b) (6) @hot mail.com] Re: Darin 18th Sent from my iPhone (b) (6) > on Aug 14, 2017, at 8:32 AM, Poonam Alaigh <-@hotmail.com> wrote: > > When is he leaving- he is monopolizing meetings still and wants to hear his own voice- he is obsessed with VHA and is purposefully developing a close relationship with the vsos in addition to the Hill - he is on a mission > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000142 OS 00020858 Message From: Sent: To: Subject: Poonam Alaigh I(b) (6) @hotmail.com] 8/14/2017 12:32:49 PM David Shulkin [drshulkin@aol.com] Darin When is he leaving- he is monopolizing meetings with VHAand is purposefully developing a close is on a mission still and wants to hear his own voicerelationship with the vsos in addition he is obsessed to the Hill - he Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000143 OS 00020859 Message From: Sent: To: Subject: Attachments: Poonam Alaigh I(b) (6) @hotmail.com] 7/31/2017 2:48:56 PM David Shulkin [drshulkin@aol.com] Despite the pain IMG_0265.JPG; ATT0000l.txt I was ab 7 e to capt ure a parti a 7 but awesome smi 7 e ! ! Hope yo u fee 7 better! AMERICAN PVERSIGHT VA-19-0799-G-000144 OS 00020860 Sent from my iPhone Message From: Sent : To : Subject: Poonam Alaigh (b) (6) @gmail.com] 7/28/20171:59 :22 AM l@frencha ngel59 .com; lper-@gmail.com; ■@frencha ngel59 .com; brucem (b) (6) (b) @mac.com; ( (b) (b bmbtl■l@gmail.com; (6) ) (6) Secshulkin@gmail.com (b) (6) )Re: New email (6) ( 6 ) new email Adding David's too Thursday , July 27 2017 , Poonam Alaigh- (b) (6) >wr ote: Please note my new email for future communication amongst us . Looking forward to us connecting on 011 Sunday. Thanks AMERICAN PVERSIGHT VA-19-0799-G-000147 DS 00020863 Message David shulkin [Drshulkin@aol.com] 7/28/2017 1:55:36 AM Poonam Alaigh I(b) (6) @hotmail.com] Fwd: New email From: Sent : To ; Subject: Secshulkin@gmail.com is the new email for ike's communications in the future Sent from my iPhone Begin forwarded message : From: Poonam Alaigh - (b) (6) Date: July 27, 2017 at 9:54: 10 PM EDT (b) (6) To: 1(b @frenchange159.com , ~ com , ) (b) (b) (6) (b) ■@frenchangel59.com , b~ @mac .com , -· (6 (6) (6) Drshulkin@aol .com ) Subject: New email (b) (6) Please note my new email for future communication amongst us. Looking forward to us connecting on Sunday . Thanks AMERICAN PVERSIGHT VA-19-0799-G-000148 DS_00020864 Message From: Sent: Poonam Alaigh (b) (6) 7/28/2017 1:54:10 AM @gmail .com] ■@frenchangel59.com; bruce (b) (6) (b) @mac.com; (b bmb (b) (6) @gmail.com; Drshu (6) lkin@aol.com ) (6) Subject: )New email (6) ( 6 ) new email for future communication amongst us. Looking forward to us connecting on Sunday. Please note my To: l@frenchangel59 .com; lper-@gmail.com; ( (b) Thanks AMERICAN PVERSIGHT VA-19-0799-G-000149 OS 00020865 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 8/8/2017 11:21:16 AM Ike Perlmutter [ll@frenchangel59.com] ( Undersecretarybcandidates ) ( 6 I ke- The Commission on the) undersecretary forwarded 4 names to the White House for consideration Poonam Alaigh MD MD (b) (6) MD (b) (6) An a ourth doctor from caremoor in California To: Subject: They have indicated a preference for Dr Heyt Dr -(b) was supposed to visit with me this week but rescheduled due to personal issues this again delays (6) the process and im growing concerned about how long it will take to get a new person in and up to speed we have too much going on as you know Thanks David sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000150 OS 00020866 Message Sent : David shulkin lDrshulkin@aol.com] 7/30/2017 5:02 :07 PM To : (b) (6) Subject: Re: lnvictus From: (b) (6) @gmail.com] l think you are right Lets stick to the opening Sent from my iPhone On Jul 30, 2017 , at 12 :07 PM, (b) (6) (b) (6) ail.corn > wrote : I don't think this means potus is going : See he asks if you are leadjng the closing Presidentia l Delegation Itook that to mean are you leading for the US I'll verify but we don't get quick responses about potus schedule for events . On Sun, Jul 30, 2017 at 12:05 PM Dav id shulkin wrote: Does this mean flotus is opening and potus is closing? Sent from my iPhone Begin forwarded message : From: 11(b) (6), (b) (2) EOP/WHO 11 (b) (6) Date: July 30, 2017 at 11;58:32 AM EDT To: "(b) (6), (b) (2) EOP/WHO" (b) (6) (b) (6), (b) (2) (b) (6) (b) (b)(6) (6) Cc:" drshulk:in Subject: Re: Invktus Will the Secretary be there for the Opening Ceremonies on Sept 23? If so, I assume he would like to join the Presidential Delegation that is lead by FL OTUS . Or will he be going for the closing and leading the Presidential Delegation for those ceremonies? I met with our embassy staff and Invictus Games organizers last week in Toronto and will be presenting options to FLOTUS next week , so we can lay out her schedule . - Thanks (b) (6), (b) (2) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000151 DS_ 00020867 (b) (6), (b) (2) EOP/WHO (b) (6) Good Afternoon , So glad to hear the Secretary will be attending! Our operations team just returned from the pre-advance and we are still working on travel details since we have UNGA the previous week in NYC . We will keep you in the loop as we confirm travel plans in an attempt to coordinate . Have a lovely day, - (b) (6), (b) (2) Sent from my i Phone (b) (6), (b) (2) (b) (6) (b)(b) (6)(6) wrote : Good Morning Mrs. -(b) (6), (b) (2) We were excited to hear that the First Lady will be attending the Invictus Garnes this year in Toronto . Secretary Shulkin is also scheduled to be at the games . Do you believe there i s an opportunity for them to travel to the games together ? We would welcome the opportunity to coordinate some appearances together. - Best, (b) (6) (b) (6) Special Adv1sor to the Secreta ry Departmen t of Veterans Affai rs AMERICAN PVERSIGHT VA-19-0799-G-000152 DS 00020868 - (b) (6) (b) (6) -- Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000153 D8_00020869 Message From: (b) (6) Sent : 7/30/2017 4:07:59 PM To: David shulkin [Drshulkin@aol.comJ Re: lnv ictus Subject: (b) (6) @gmail.com] l don't think this means potus is going : See he asks if you are leading the closing Presidential Delegation 1 took that to mean are you leading for the US I'll verify but we don't get quick responses about potus schedule for events . On Sun, Jul 30, 2017 at 12:05 PM David shulkin wrote: Does this mean flohis is opening and µoh.is is closing? Sent from my iPhone Begin forwarded message ~ • EOP/WHO" (b) (6) From: 11(b) (6) Date: July 30, 2017 at 11:58:32 AM EDT To: "(b) (6) . EOP/WHO 11(b) (6) (b) (6) (b) (6) (b) (b)(6) (6) Cc:" Subject : Re: Invictus ov> Will the Secretary be there for the Opening Ceremonies on Sept 23? lf so, I assume he would like to join the Presidential Delegation that is lead by FLOTUS. Or will he be going for the closing and leading the Presidential Delegation for those ceremonies? I met with our embassy staff and Invictus Games organizers last week in Toronto and wiJl be presenting options to FLOTUS next week, so we can lay out her schedule . - Thanks (b) (6) Sent from my iPhone (b) (6) EOPIWHO (b) (6) Good Afternoon, AMERICAN PVERSIGHT VA-19-0799-G-000154 DS 00020870 So glad to hear the Secretary will be attending! Our operations team just returned from the pre-advance and we are still working on travel details since we have UNGA the previous week in NYC. We will keep you in the loop as we confirm travel plans in an attempt to coordinate . Have a lovely day , - (b) (6) Sent from my iPhone (b) (6) (b) (6) R (b) (b)(6) (6) Good Morning Mrs . -(b) (6) We were excited to hear that the First Lady will be attending the Invictus Games this year in Toronto . Secretary Shulkin is also scheduled to be at the games . Do you believe there is an opportunity for them to travel to the games together? We would welcome the opportunity to coordinate some appearances together , - Best , (b) (6) (b) (6) Special Advisor to the Secretary Department of Veterans Affairs - (b) (6) (b) (6) Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000155 DS 00020871 Message David shulkin [Drshulkin@aol.com] 8/5/2017 5 :58:32 PM Thomas Bowman (b) (6) Fwd: From: Sent : To ; Subject: @yahoo.com] Dont know if you caught the clip below Sent from my iPhone Begin forwarded message : From: DJS Date: August 5, 2017 at 1:47:02 PM EDT To: 'Shulkin 1 https ://m. youtube. com/watch ?feature=youtu. be& v= 150dTZI 9YU Sent with Good (www .good.com ) AMERICAN PVERSIGHT VA-19-0799-G-000156 DS_00020872 Message From: David shu lkin [Drshulkin@ao l.com ] Sent: 8/5/20 17 5:58:08 PM (b) (6) (b) @mac . com] Bruce Moskowitz [brucerrl■■■■ Ike Perlmutter ll@frenchangel59.com]; (6) Laurie Perlmutter (b) (6) ( b (b) (6) @gmail.com] [mbtl■■ To: CC: ) ( 6 ) Bruce- I wanted to make sure you saw our telehealth enjoyed it and got good press all around- the clip and loudest critics in the last few years Subject: > > > > > > @gmail.com]; Marc Sherman Fwd: https: // m.youtube.com / watch ?feature=youtu demo the other day with POTUS- it went well and he below is fun because the two guests were our biggest . be&v=150dTZl_ 9YU sent with Good (www.good.com) AMERICAN PVERSIGHT VA-19-0799-G-000157 OS 00020873 Message Marc Sherman [mb (b) (6) @.gmail.com) 7/30/2017 8:49 :33 PM Marisol Garcia .@frenchangel59 .comJ (b) Poonam Alaigh (6) (b) (6) @gmail.com]; Secshulkin@gmail.com; L Perl ■■■ (b) (6) @gmail.com]; Bruce Moskowitz. [brucentll-■ .com] (b) (6) (b) @mac.com];IP [l@frenchangel59 ( Re: REMINDER- VA Shulkin and Poonam Alargh - TODAY Sunday, July 30th - 5:15 PM to (6)- Follow-up with Secretary b 6:00 PM EST ) From: Sent : To : CC: Subject: ( 6 ) Proposed Agenda: • • • B1ing to date on current issues and plans Status of Choice o Program and funding o Action Plan AMC push back on starts and stops (or no starts) o Apple o Terry Fadem o Wha1ion o Donated research time • • PTSD • Suicide • Reduction of disability cJaims What is 11eeded(from us) (b) frenchangel59.com> wrote: On Sun, Jul 30, 2017 at l :35 PM , Marisol Garcia wrote: On Sun, Ju l 30, 20 17 at 1 :35 PM Marisol Garcia <111 (6) Sunday, July 30 th 5:15 PM- 6:00 PM EST Dial-in l11formation: US: 1-866-244- (b) (6) Passcode: (b) (6) Participants: Laurie Perlmutter, Poonam Alaigh, Secretary David Shulkin, Dr. Bruce Moskowitz, Marc Sherma11and Ike Thank you AMERICAN PVERSIGHT VA-19-0799-G-000160 DS 00020876 Mariso l Garcia (b) (6) Cell) (b) ■@frenchangel59 .com (6) AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000161 DS_00020877 Message From: Sent : To : Subject: Man·sol Garcia.@frenchangel59 .com] (b) 7/30/2017 5:35 (6) :07 PM 'Poonam Alaigh' (b) (6) @gmail.com); Secshulkin@gmail.com; lper-@gmail.com; (b) bruce (b) (6) (b) @mac.com; mb--@gmail .com; l@frenchangel59 (6) .com (b) (6) ( REMINDER- VA -(6) Follow -up with Secretary Shulldn and Poonam Alaigh - TODAY Sunday, July 30th - 5:15 PM to 6:00 b PM EST ) Sunday, July 30 th ( 6 ) 5:15 PM - 6:00 PM EST Dial-in Information: US: 1-866-244- (b) (6) Passcode:(b) (6) Participants: Laurie Perlmutter, Poonam Alaigh, Secretary David Shulkin, Dr. Bruce Moskowitz, Marc Sherman and Ike Thank you, Marisol Garcia (b) (6) Cell) (b) ■@frenchangel59.com (6) AMERICAN PVERSIGHT VA-19-0799-G-000162 DS_00020878 Message From: (b) (6) Sent : 8/2/2017 11:24:37 PM To ; David Shu Ikin (drshulkin@aol.com] Re: TMZ Subject: (b) (6) @gmail.com) Yea . And you look happy . On Aug 2, 2017 7:21 PM , "David Shulkin" wrote : Pretty funny Sent from my iPad On Aug 2,2017 , at 7:07 PM, (b) (6) (b) (6) mai I.com> wrote : http ://amp .tm.z.com/2017 /08/02/v-a-secretary-david-shulkin-transgenders-donald-trumpmlli tary-ban AMERICAN PVERSIGHT VA-19-0799-G-000163 DS_00020879 Message David Shulkin (drshulkin@aol.com) From: Sent : 8/2/2017 11:21 :43 PM To : (b) (6) Subject: Re: TMZ (b) (6) @gmail.com] Pretty funny Sent from my iPad On Aug 2, 2017 , at 7:07 PM , (b) (6) (b) (6) mail .com> wrote : http:!/am p.tmz .com/2017 /08/02/v-a-secretary-david-shu1kin-transgenders-dona1d-trum ban AMERICAN PVERSIGHT p-mi1itary- VA-19-0799-G-000164 OS 00020880 Message From: (b) (6) Sent: 8/2/2017 11:07 :13 PM To ; drshulk in@aol.com TMZ Subject: (b) (6) @gmail.com) http:IIamp.tmz.com/201 7/08I02lv-a-secretary-david-shulkin-transgenders-donald-trump-miIitary-ban AMERICAN PVERSIGHT VA-19-0799-G-000165 DS_00020881 Message I(b) (6) From: Vivieca Simpson Sent : 8/20/2017 2:50:22 PM To : David shulkin [drshulkin@aol.com] Subject: Re: @gmail.com] No, a lot of people were punished for following him and he was able to leave ahead of the heaL -(b) (6) around today because Phillip gave bad advice to the team regarding how to manage him . is On Aug 10, 2017 16:55, 11David Shulkin 11 wrote: Phillip matkovsk-y wants to come back to VA Thoughts? Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000166 DS 00020882 Message David Shulkin [drshulkin@aol.com] 8/10/2017 9:55:52 PM Vivieca Simpson I(b) (6) @gmail.com] From: Sent: To: Phillip matkovsky wants to come back to VA Thoughts? Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000167 OS 00020883 Message From: David shulkin [Drshulkin@aol.com] Sent: 8/1/2017 11:52:59 PM To: (b) (6) Subject: Re: Practice tmrw Im going without the slides (b) (6) @gmail.com] tommorow Sorry for the indecision Will you come? sent from my iPhone > On Aug 1, 2017, at 7:20 PM, (b) (6) (b) (6) <-r@gmail . com> wrote: > >Hi, in addition to Thursday morning, White House requested were on the hill until 5:30 another practice tmrw Afternoon. shared you > > sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000168 OS 00020884 Message From: (b) (6) Sent: 8/1/2017 11:20:01 PM To: David Shulkin [drshulkin@aol.com] Practice tmrw Subject: (b) (6) @gmail.com] Hi, in addition to Thursday morning, White House requested another practice tmrw Afternoon. Shared you were on the hill until 5:30 Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000169 OS 00020885 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 8/27/2017 10:18:35 PM (b) (6) Poonam Alaigh [-@hot mail.com] Re: Quick run down Thanks for the update Its a good idea as i should send to vba too because their homes and families are at risk too Sent from my iPhone > on Aug 27, 2017, at 6:02 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : > > Just got off a 1:1 call with a Skye - most important need now is difficulty in getting staff into the facilitythe current team has been there since the start of the hurricane . They will need food supply for the employees on Tuesday and patients will need additional supplies and food by midweek. They are coordinating with VACOI OC, National Guard and FEMA.The staff also have issues with flooding in their own homes and significant damage and childcare issues going on . > > Although the Houston facility is open, all with more likely to close soon . clinics there are closed. In addition 5 CBOCSare closed > > one Veteran who was at home had chest pain but could not get through 911 since that s ystem is tremendously overburdened and strained, our nursing staff helped the son perform CPR over the phone but died. > > > Do you want to send a message of encouragement out to the staff in Houston or should I ? Might be better if you did recognizing their heroic efforts , commitment and sacrifice > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000170 OS 00020886 Message David shulkin lDrshulkin@aol .com] 8/7/2017 8:50:39 PM Vivieca Simpson I(b) (6) E)gmail.com) Fwd: Update From : Sent: To : Subject : Not a complete surprize - He wont be coming Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6) ahoo .com> Date: August 7 20 17 at 4: 13 :05 PM EDT To: David Shulkin , David Shulkin Subject: Update Hope all is well with you and the family . As I now finish week four of my radiation treatments , I am exper iencing some radiat ion sickness and fatigue (probably in part due to the hormone therapy also) . I am taking multiple naps each day in spite of the eight hours of sleep I get each night . My two sisters and wife (with whom I share caretaking responsibi lities for our 4 parents) are concerned about my return to a full-time position. They are all in agreement that I neither have the energy levels nor enthus iasm to work as intensely as I have done throughout my career . As much as I relish the opportun ity to contribute to the turnaround at the VA , and more importantly , the chance to wor k with you aga in, I think the time has come for me to slow down. I am disappo inted for myself , and troubled if I have disappointed you. The balance of my career will consist of board seats and part-time consu lting/advisory engagements in the NYC market I apprec iate everything you have done for me and I apologize if this creates any problems for you. The realization and acceptance of my morbidity/mortality has been a very tough pill for me to swallow . I look forward to reading about all of the great things you will be achiev ing in the next few years . I am one of your biggest fans . Much good health and great success . - (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000171 DS 00020887 Message From: David shulkin lDrshulkin@aol.com] 8/10/2017 10 :24:53 AM Poonam Alaigh I(b) (6) @hotmail.com] Re: question Sent : To : Subject: Agree - Sent from my iPhone On Aug 10, 2017 , at 6:00 AM, Poonam Alaigh (b) (6) > wrote : Good response - don't like this email to you at all-would advice to stay away from her. Don 1t think she is a good fit for our team Sent from my iPhone On Aug 9 2017, at 6 :25 PM, David shulkin wrote : Sent from my iPhone Begin forwarded message : From.: David shulkin Date: August 9, 2017 at 6:24:55 PM EDT To:-(b) (6) Subject: Re: question ..(b) i dont really understand what your asking or the GSA process (6) or what fedramp high is Im really not sure though this is an appropriate request of a cabinet secretary so while i am sure it is all up and up- im going to be safe and respectfully decline Sent from my iPhone On Aug 9, 2017 , at 5:09 PM , -(b) (6) wrote: Hey David Congrats on the telehealth Whitehouse announcement. It was impressive I I am going outside the process to just ask a direct question - we need to get the IBM watson cloud to fedramp high, and to do so need endorsement of sorts (not commitment) from agencies and demonstrate to GSA that there is interest in our offerings ( watson for oncology, genomics , blue mix etc) . I'm hoping you or someone you designate would be willing to do so . I am hearing they are going to try to get AMERICAN PVERSIGHT VA-19-0799-G-000172 DS_00020888 John Kelly to reach out, so of course I'm trying to cut through the 'process' and just get it done. If you are amenable, I will send an email via work emails .... This is a huge barrier for us now, and finally have gotten corporate IBM to recognize the importance. There is a GSA process and I won't burden you with it - just want to send an email to the right person, if not you and officially ask. BTW - did you get to see any of the tennis matches? I'm so sorry we couldn't unbundle the IBM packages. Also Poonam had to cancel dinner with me Monday but will meet with her next week . Hopefully, she's had time to think about where I might fit and provide value . ;-) talk to you soon I hope. still working on your precision medicine team ) need to get comms to approve a narrative so we can get a post reporter to do a story . - thanks - (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000173 OS 00020889 Message From: Poonarn Alaigh I(b) (6) @hotmail.com] Sent : 8/10/201710:00:11 To : David shulkin [Drshulkin@aol.com] Re: question Subject: AM Good response - don't like this email to you at all-would advice to stay away from her. Don't think she is a good fit for our team Sent from my iPhone On Aug 9, 2017 , at 6:25 PM, David shu lkin wrote : Sent from my iPhone Begin forwarded message : Ft·om: David shulkin Date: August 9, 2017 at 6:24 :55 PM EDT To:-(b) (6) Subject: Re: question (b) 1111 i dont really understand what your asking or the GSA process or what (6) fedramp high is Im really not sure though this is an appropriate request of a cabinet secretary so while i am sure it is all up and up- im going to be safe and respectfully decline Sent from my iPhone (b) (6) On Aug 9, 2017, at 5:09 PM, -wrote: Hey David Congrats on the telehealth Whitehouse announcement. It was impressive! I am going outside the process to just ask a direct question - we need to get the IBM watson cloud to fed ramp high, and to do so need endorsement of sorts (not commitment) from agencies and demonstrate to GSA that there is interest in our offerings ( watson for oncology, genomics, blue mix etc) . I'm hoping you or someone you designate would be willing to do so. I am hearing they are going to try to get John Kelly to reach out, so of course I'm trying to cut through the 'process' and just get it done . If you are amenable, I will send an email via work emails .... This is a huge barrier for us now, and finally have gotten corporate IBM to recognize the importance . There is a GSA process and I won't burden you with it - just want to send an email to the right person, if not you and officially ask. AMERICAN PVERSIGHT VA-19-0799-G-000174 DS 00020890 BTW - did you get to see any of the tennis matches? I'm so sorry we couldn't unbundle the IBM packages. Also Poonam had to cancel dinner with me Monday but will meet with her next week. Hopefully, she's had time to think about where I might fit and provide value. ;-) talk to you soon I hope. still working on your precision medicine team -- :-) need to get comms to approve a narrative so we can get a post reporter to do a story. - thanks - (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000175 OS 00020891 Message From: David shulkin lDrshulkin@aol.com] 8/9/2017 10:25 :10 PM Poonam Alaigh I(b) (6) @hotmail .com J Fwd: question Sent : To : Subject: Se11tfrom my iPhone Begin forwarded message : From: David shuJkin Date: August 9 2017 at 6:24:55 P:NIEDT To:-(b) (6) Subject: Re: question (b) 1111 i dont really understand what your asking or the GSA process or what fedramp high is (6) Im rea lly not sure though this is an appropriate request of a cabinet secretary so while i am sure it is all up and up- im goin,g to be safe and respectfully decline Sent from my iPhone OnAug9,2017 (b) (6) at5 :09PM,-wrote: Hey David Congrats on the te lehealth Whitehouse announcement. It was impressive I I am going outside the process to just ask a direct question - we need to get the IBM wa{son cloud to fedramp high, and to do so need endorsement of sorts (not commitment) from agencies and demonstrate to GSA that there is interest in our offerings ( watson for oncology, genomics, blue mix etc) . I'm hoping you or someone you designate would be willing to do so. I am hearing they are going to try to get John Kelly to reach out, so of course I'm trying to cut through the 'process' and just get it done . If you are amenable , I will send an email via work emails .... This is a huge barrier for us now, and finally have gotten corporate IBM to recognize the importance . There is a GSA process and I won't burden you with it - just want to send an email to the right person , if not you and officially ask . BTW - did you get to see any of the tennis matches? I'm so sorry we couldn't unbundle the IBM packages . Also Poonam had to cancel dinner with me Monday but will meet with her next week . Hopefully, she's had time to think about where I might fit and provide value . ;-) talk to you soon I hope. still working on your precision medicine team -- :-) need to get comms to approve a narrative so we can get a post reporter to do a story . - thanks - (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000176 DS 00020892 Message From: Poonarn Alaigh I(b) (6) @hotmail .com] Sent: To : 7/30/2017 9:48:54 PM Subject: Re: Re: David shulkin [Drshu[kin@aol.com] Yes in the process From: David shulkin Sent: Sunday, July 30, 2017 5:03 PM To: Poonam Alaigh Subject: Fwd: Re: Do not share with others but this is a detailed update on cerner project Can we get windoms enpmotment engagement done? Sent from my iPhone Begin forwarded rnessage: (b) From: -(b) (6) <~ > Date: July 30, 2017 (6) at 1:44:07 PM EDT To: David shulkin Subject: Re: Hi David - we received the signed agreement on late Friday afternoon , Five FTEsworking exclusively on data continuity. Its a start. We be,ganwork "as if" last Monday, and three of us were in KansasCity this week (including me). Its early days and it is too soon to rnake any declarative statements, but here is my read so far : -good news The commitment is there. People are taking your decision seriously, and .are working toward coming up with a workabl .e solution, and fast. Jackie Wynn is a godsend, but she has her hands full too. (I was on the phone with her when your message arrived on an internal MITRE matter; we speak constantly). There are strong people in all three institutions: VA, MITRE,and Cerner. I've been impressed with the BAH team supporting the initiative (I know one of the guys there, very solid). John Windom has been professional, responsive, and supportive (did you know that he does not have an employment agreement with VA yet?) - not-so good news ConfidentialJy, the VA-IT team is not strong, and not strong enough to be a good partner in this process. Leadership is very status conscience, and they are more. concerned with posture than AMEr- pVERSIGHT VA-19-0799-G-000178 DS 00020894 delivery. (This is not big news, it is just true here too). There are two people who I know on the team - one is a subject matter expert who reported to me when I worked at VA - who are good (smart, responsive, mission oriented, clear answers). The rest seem less outcome/execution oriented. Process needs structure badly, and right away (John W needs someone to help him ask the right questions). Lots of "notional diagrams", a little light on system inventories and underlying (comprehensive) data models. - Cerner Too soon to tell. If you're going to go commercial, you definitely made the right choice. The kick-off meeting was so-so, more marketing than substance, but, again, they have some very good people on their side, including a few who are knowledgeable about (or worked on) the DHMSM project. So that's helpful. The discussions are superficial - like how important training is (without saying what training they'll do) and we've not gotten to the engineering issues as quickly as I would have expected or want. I've needed to hold fire until I was officially on board (I was only invited as an unpaid observer, and friend of the agency and MITRE). I am unclear on exactly what they are going to offer from a functionality perspective; I think they are too. (This is ordinary engineering stuff, but somebody has to drive it methodically ... and relentlessly). My three biggest questions at the moment (only the first is something you can actually help with): 1) When will Windom be officially appointed? 2) We need a for-real data inventory that is unencumbered by mishegas and "embedded" functionality; I can't get a straight answer on this yet. My path to solution at the moment is JLV (do you know what this is?), in part because it is the system I personally know the best, in part because it has the best documentation, and in part because both VA and DoD are signed on. Let's call that a lucky punch, but we need some luck here too. You've got to start somewhere, and this is a good place to start. Everything else I've seen so far is much less helpful (but, again, this is very early and a lot can change). 3) We need a very clear answer from Cerner about what will and will not be included in their Health -e-lntent data aggregation product. As I suspected, it is not in service yet at DoD (this was the trigger of my "heads up" memo to Jen in February). And their information architecture (think of this as just "what goes in, into what black box, and what comes out" all from a format and structure perspective) is meager so far. My intuition tells me that they have it, they just don't have it in a good form yet. But it is very high in my priority list: we need to know, exactly, what sockets are we going to plug into. It really is as simple as that. Some folks from DoD/Leidos were not thrilled with the questions on Health-e-lntent; they clearly did not do their homework with regards to the actual data flows prior to award. Its easy to turn on a system; harder to get validated and audited data feeds to it. They're not approaching this in a way that I recognize, yet. I certainly don't have the details (ie they could be farther along than they shared so far). All I've said so far is "we need to pay very close attention to that; there's no win here if a VA clinician does not have real-time access to the complete longitudinal record, period." You can imagine how that went over .... Very best regards, AMERICAN PVERSIGHT VA-19-0799-G-000179 OS 00020895 (b) 1111 (6) On Sun, Jul 30, 2017 at 12;51 PM, David shulkin wrote: -(b) (6) any update on how things are going? I have very little visib ilit y Sent from my iPhone AMERICAr-... pVERSIGHT VA-19-0799-G-000180 D8_00020896 Message From: David shulkin lDrshulkin@aol.com] Sent : 7/30/2017 9:03:08 PM To : Poonam Alaigh I(b) (6) @hotmail .com J Fwd: Re: Subject: Do not share with others but this is a detailed update on cemer project Can we get windoms enpmotment engageme11tdone? Sent from m.y iPhone Begin forwarded message : (b) (6) (b) (6) From:-~ > (6)1:44:07 PM EDT Date: July 30, 2017 at To: David shuJlcin Subject: Re: Hi David - we received the s1gned agreement on late Fr1day afternoon . Five FTEs working exclusively on data continuity . Its a start . We began work "as.if' last Monday , and three ofus were in Kansas City this week (including me). Its early days and itis too soon to make any declarative statements but here is my read so far: -good news The commitment is there. People are taking your decision seriously, and are working toward coming up with a workable solution, and fast. Jackie Wynn is a godsend , but she has her hands full too. (I was on the phone with her when your message arrived on an internal MITRE matter we speak constantly) . There are strong people in all three institutions : VA, MITRE , and Cerner. rve been impressed with the BAH team supporting tbe initiative (I know one oftbe guys there, very solid). John Windom has been professional , responsive, and supportive (did you know that he does not have an employment agreement with VA yet?) - not-so good news Confidentially , tbe VA-IT team is not strong, and not strong enough to be a good partner in this process . Leadership is.very status conscience, and they are more concerned with posture than deJivery. (This is not big news , it is just true here too) . There are two people who J know on the team - one is a subject matter expert who reported to me when I worked at VA - who are good (smart, responsive , mission oriented, clear answers). The rest seem less outcome/e xecution OJiented. Process needs structure badly, and right away (John W needs someone to help him ask the right questions) . Lots of "notional diagrams" , a little light on system inventories and underlying (comprehensive) data models . - Cerner Too soon to tell . If you're going to go commercia l, you definitely made the right choice . The kick-off meeting was so-so, more marketing than substance , but, again, they have. some very good people on their side, including a few who are knowledgeable about (or worked on) the AMEr- pVERSIGHT VA-19-0799-G-000181 DS 00020897 DHMSM project. So that's helpful. The cliscl.lssionsare superficial - like how important training is (without saying what training they'll do) and we've not gotten to the engineering issues as quickly as I would have expected or want. I've needed to hold fire until I was officially on board (I was only invited as an llllpaid observer , and friend of the agency and MITRE) . I am unclear on exactly what they are going to offer from a functionalit y perspective ; I think they are too. (This is ordinary engineering stuff, but somebody has to drive it methodically . . . and reJentless)y). My three biggest questions at the moment (only the first is something you can actually help with) : l) When will Windom be officially appointed ? 2) We need a for-real data inventory that is unencumbered by mishegas and "embedded" functionality; I can't get a straight answer on this yet. My path to solution at the moment is JLV (do you know what this is?), in part because it is the system I personally know the best, in part because it has the best documentation , and in part because both VA and DoD are signed on. Let's call that a lucky punch , but we need some luck here too. You've got to start somewhere , and this is a good place to start. Everything else l've seen so far is much less helpful (but, again , this is very early and a lot can change). 3) We need a very clear answer from Cerner about what will and will not be included in their Health-e-Intent data aggregation product. As I suspected, it is not in service yet at DoD (tl1iswas the trigger of my "heads up'' memo to Jen in February) . And their information architecture (think of this as just "what goes in, into what black box, and what comes out" all from a format and structure perspective) is meager so far. My intuition tell.s me that they have it. they just don't have it in a good fonn yet. But it is very high in my priority list: we need to know, exactly, what sockets are we going to plug into. It really is as simple as that. Some folks from DoD/Leidos were not thrilled with the questions on Heahh-e-lntent ; they clearly did not do their homework with regards to the actual data flows prior to award. Its easy to turn on a system; harder to get validated and audited data feeds to it. The y're not approaching this in a way that I recognize , yet. I certainly don't have the details (je they could be fa1ther along than they shared so far). All rve said so far is "we need to pay very close attention to that; there's no win here if a VA clinician does not have real-time access to the complete longitudinal record, period. 11 You can imagine how that went over .. Very best regards , (b) (6) On Sun, Jul 30, 2017 at 12:51 PM, David shulkin wrote : -(b) (6) any update on how things are going? I have very little visibility AMERl('Af\ pVERSIGHT VA-19-0799-G-000182 D8_00020898 83 Message To: Davidshulkin [Drshulkin@aol.com] 7/30/2017 5:01:37 PM (b) (6) Poonam Alaigh [-@hot mail.com] Subject: Re: Now? From: Sent: Nothing- know can ask you if need anything Thanks sent from my iPhone (b) (6) > on Jul 30, 2017 , at 12:11 PM, Poonam Alaigh <-@hotmail.com > wrote: > > what can I do for you > > sent from my iPhone > >> on Jul 30 , 2017, at 11 :48 AM, David shulkin >> wrote : >> No >> >> sent from my iPad >> >>> on Jul 30, 2017, at 11:18 AM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote : >>> »> Any better ? >>> >>> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000184 OS 00020900 Message To: Poonam AlaighI(b) (6) @hotmail.com] 7/30/2017 4:11:04 PM DavidShulkin [drshulkin@aol.com] Subject: Re: Now? From: Sent: What can I do for you Sent from my iPhone > on Jul 30, 2017, at 11:48 AM, David shulkin > > > wrote: No > sent from my iPad > (b) (6) >> on Jul 30, 2017, at 11 : 18 AM, Poonam Alaigh <-@hotmail.com >> » Any better? > wrote: >> >> sent fr om my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000185 OS 00020901 Message To: DavidShulkin [drshulkin@aol.com] 7/30/2017 3:48:04 PM (b) (6) Poonam Alaigh [-@hotmail.com] Subject: Re: Now? From: Sent: No Sent from my iPad (b) (6) > on Jul 30, 2017, at 11:18 AM, Poonam Alaigh <-@hotmail.com> wrote: > > Any better? > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000186 OS 00020902 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 7/30/2017 3:18:03 PM To: David Shulkin [drshulkin@aol.com] Subject: Now? Any better? sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000187 DS_00020903 Message From: Poonam Alaigh (b) (6) Sent : 8/3/2017 2!35:llPM To : brucent1••·@mac.com; l@frenchangel59 .com (b) (6) (b) ( David Shulkin [Secshulkin@gmail.com] (6) b Fwd: Update ) ( 6 ) CC: Subject: @gmail.com] ---------- Forwarded message--------From: Poonam. Alaigh- (b) (6) Date : Thu, Aug 3, 2017 at 10:33 AM Subject: Fwd : Update (b) (6) To:--(b) (6) > Sent from my iPhone Begin fmwarded message: From: Poonam Alaigh ~(b) (6) Date: August 3, 2017 at 10:32:59 AM EDT To: Bruce Moskowitz Bruce, just spoke to-(b) to send a message to all participants to freeze all Apple discussions until the 3 of us have(6)spoken today. Darin is officially out as of Monday so it's an important time to reset , We cannot move with that includes our governing board Sent from my iPhone On Aug 3, 2017, at 7:54 A.NL Bruce Moskowitz wrote: (6) The big issue for the choice program and the Apple project is to swiftly move to have a geotagged network of physicians and hospitals that can see Veterans on a timely basis, insure quality standards and practice cost containment Sent from my iPad Bruce Moskowitz M.D . OnAug3 AMERICAN PVERSIGHT (b) (6) 2017 at6 :12AM ~wrote: VA-19-0799-G-000188 DS_ 00020904 Good morning , I have prepared a brief bjgh level letter to update the governance group of the EHR component of our initiative. I sent to V AIT and Apple for comments before sending along to you. I expect to hear back from App le today and will forward as soon as I do. At that time we can discuss any additional edits and the dist1ibution . In order to maintain an up to date list of participants in this project , we added-(b) (6) to the work ing group at VA . This is the same resource we discussed earlier but wanted you to have the name. Also, Darin was work ing on getting a MOU set up with VA and Apple howe ver nothing had yet happened when he transitioned off the project. I will connect Apple with someone from our ofl:1.ceof genera l counse l and will participate in all calls and keep you apprised . I will be exploring further the purpose /s for this document today and will update you. Pat Wallace Sent from my iPhone On Aug 2, 2017, at 6:22 AM, Bruce Moskowitz wrote : (6) May have no signal this am if can't reach me try after 4 Sent from my iPad Bruce Moskowitz M .D. On Aug I, 20 17, at 5:05 PM, (b) (6) ~wrote: Thank you so much for your response . I will be avai lable at6:45am tomorrow to review updated information . I wi ll give you a call at the number you provided. Thank you, .(b) (6) Sent from my iPhone AMERICAr-... pVERSIGHT VA-19-0799-G-000189 D8_00020905 On Aug 1, 2017 , at 4 :33 PM, Bruce Moskowitz <- (b) (6) (b) (b) (6) wrote: (6) @ mac.com> Trymeat6 -(b) or (6) only time in am is 645 - Sent from my iPad Bruce Moskowit z M .D . On Aug 1, 2017 , at 3 :55 PM, • (b) (6) (b) (6) ol.com wrote: Hi Dr Mosko witz, lam hoping that you have some time today to discuss the status of our projec t with the five centers and Apple . AMERICAr-... pVERSIGHT VA-19-0799-G-000190 OS_ 00020906 lam availab le after 4:30p m. I am also availab le very early tomorr owif that is a better fit for your schedu le . T hank You . (b) (6) Sent from my iPhone 0 n J u 1 1 3 2 0 1 7 a t 9 0 6 A AMERICAN PVERSIGHT VA-19-0799-G-000191 DS_00020907 M B r u C e M 0 s k 0 w t z < Q r (b) (6) ( b ) ( m 6) a f .:. f 0 m > w r 0 t e N 0 AMERICAr-... pVERSIGHT VA-19-0799-G-000192 D8_00020908 0 n t 0 d a y w 0 u 1 d w 0 r k s e n t f r 0 m m y 1 p a d B r u C e M 0 s k 0 w t z M D AMERICAN PVERSIGHT VA-19-0799-G-000193 DS_00020909 0 n J u 3 ' 2 0 1 7 a t 8 5 6 A M (b) (6) ~ Q 1 .::. C Q m w r 0 t e G 0 0 d M AMERICAr-... pVERSIGHT VA-19-0799-G-000194 D8_00020910 0 r n n g D r M 0 s k 0 w t z T h e t e C h n 0 1 0 g y t e a m f r 0 m V A h a s b e e n m AMERICAN PVERSIGHT VA-19-0799-G-000195 DS_ 00020911 e e t n g w t h A p p 1 e t e a m t 0 d s C u s s k e y s s u e s a s s 0 C a t e d w t h t AMERICAN PVERSIGHT VA-19-0799-G-000196 DS_ 00020912 h e E H R a s f 0 1 1 0 w u p t 0 t h e 1 a r g e C 0 n f e r e n C e C a 1 1 h e 1 d n 1 a t e J u n AMERICAN PVERSIGHT VA-19-0799-G-000197 DS_ 00020913 e T h e s e s s u e s a n d p r 0 g r e s s h a V e n C 1 u d e d I ) u n d e r s t a AMERICAN PVERSIGHT VA-19-0799-G-000198 DS_ 00020914 n d n g t h e C u r r e n t s t a t u s 0 f V A u s e 0 f t h e F H I R s t a n d a r d s w h C h a AMERICAN PVERSIGHT VA-19-0799-G-000199 DS_ 00020915 r e e s s e n t a 1 f 0 r t h e V e t e r a n s d g t a 1 p 1 a t f 0 r m T h e V A h a s t e AMERICAN PVERSIGHT VA-19-0799-G-000200 DS_ 00020916 a m s w h 0 h a V e b e e n u s n g F H I R s t a n d a r d s f 0 r d 1 f f e r e n t a p p s a n d s AMERICAN PVERSIGHT VA-19-0799-G-000201 DS_ 00020917 0 m e 0 f t h e w 0 r k r e q u r e d f 0 r E H R h a s a 1 r e a d y s t a r t e d 2 ) t h e y p AMERICAN PVERSIGHT VA-19-0799-G-000202 DS_ 00020918 r 0 V d e d a d r a f t 0 f k e y m e s t 0 n e s a n d p r 0 J e C t e d t m e 1 n e t 0 s h AMERICAN PVERSIGHT VA-19-0799-G-000203 DS_ 00020919 a r e w t h t h e C I 0 s a n d g 0 V e r n a n C e g r 0 u p T h e r e a r e s 0 m e e d t s b AMERICAN PVERSIGHT VA-19-0799-G-000204 DS_00020920 e n g m a d e t 0 t h s d 0 C u m e n t b u t w s e n d a 1 0 n g V a s e p a r a t e e m a AMERICAN PVERSIGHT VA-19-0799-G-000205 DS_ 00020921 3 ) R e s 0 u r C e s n e e d e d d e n t f C a t 0 n 0 f a n a d d t 0 n a 1 AMERICAN PVERSIGHT VA-19-0799-G-000206 DS_00020922 r e s 0 u r C e f r 0 m V A t h a t h a d n 0 t b e e n p r e V 0 u s 1 y 1 d e n t 1 f e d T h AMERICAN PVERSIGHT VA-19-0799-G-000207 DS_00020923 s w 0 u 1 d b e p a r t t m e s u p p 0 r ■ (b) (6) t f 0 r t h s n t a t V e a n d w e a r e C u r AMERICAN PVERSIGHT VA-19-0799-G-000208 DS_00020924 r e n t 1 y a d d r e s s n g t h a t r e q u e s t A s y 0 u k n 0 w t h e d e V e 1 0 p m e n AMERICAN PVERSIGHT VA-19-0799-G-000209 DS_00020925 t 0 f t h s f u n C t 0 n a 1 t y s m 0 r e 0 f a m a r a t h 0 n p r 0 C e s s a n d t h e p r AMERICAN PVERSIGHT VA-19-0799-G-000210 DS_00020926 0 J e C t e d t m e 1 n e s M a r C h A p r 1 1 2 0 I 8 T h e a C t u a 1 w 0 r k h a s b e AMERICAN PVERSIGHT VA-19-0799-G-000211 DS_00020927 g u n a n d s m 0 V n g a 1 0 n g T h e II C a r e F n d e r II a p p w a s d s C u s s e d AMERICAN PVERSIGHT VA-19-0799-G-000212 DS_00020928 w t h (b) (6) A p p I e ) n a C a I I t h s w e e k T h e n e X t s t e p 1 AMERICAN PVERSIGHT VA-19-0799-G-000213 DS_00020929 s f 0 r y 0 u a n d I t 0 d s C u s s t h e s p e C f C f e a t u r e s t 0 b e n C 1 u d e d AMERICAN PVERSIGHT VA-19-0799-G-000214 DS_00020930 n t h s a p p r e V e w 0 n V A s d e a n d t h e n m 0 V e t 0 V e r t 0 A p p 1 e p e n d AMERICAN PVERSIGHT VA-19-0799-G-000215 DS_ 00020931 n g t h e r f e e d b a C k w e w 0 u 1 d 1 k e 1 y g 0 t h r u a s m 1 1 a r p r 0 C e s s a AMERICAN PVERSIGHT VA-19-0799-G-000216 DS_00020932 s u s e d w t h E H R b y h a V n g t e C h t e a m s w 0 r k n g t 0 g e t h e r t 0 s t a r t t AMERICAN PVERSIGHT VA-19-0799-G-000217 DS_00020933 0 d e n t 1 f y k e y s t e p s t m e 1 n e a n d r e s 0 u r C e s n e e d e d e t C T h s AMERICAN PVERSIGHT VA-19-0799-G-000218 DS_ 00020934 w 0 u 1 d b e b u t n a s m u 1 t a n e 0 u s ( n 0 t s e q u e n t a 1 ) t m e f r a m e t AMERICAN PVERSIGHT VA-19-0799-G-000219 DS_00020935 0 E H R a n d m 0 s t 1 1 k e 1 y h a V e a m u C h s h 0 r t e r t m e f r a m e s 0 m u C h 0 f AMERICAN PVERSIGHT VA-19-0799-G-000220 DS_00020936 t h e u n d e r p n n n g s f 0 r t h e C a r e F n d e r a r e a 1 r e a d y d 0 n e A s AMERICAN PVERSIGHT VA-19-0799-G-000221 DS_00020937 a n F y I I r e C e V e d a C a 1 1 f r 0 m D a r n 1 e t t n g m e k n 0 w t h a t h e w 0 u 1 AMERICAN PVERSIGHT VA-19-0799-G-000222 DS_00020938 d n 0 1 0 n g e r b e w 0 r k n g 0 n t h e p r 0 J e C t A V a a b 1 e f 0 r a d s C u AMERICAN PVERSIGHT VA-19-0799-G-000223 DS_00020939 s s 0 n w h e n C 0 n V e n e n t f 0 r y 0 u r s C h e d u I e (b) (6) s e n t f r AMERICAN PVERSIGHT VA-19-0799-G-000224 DS_00020940 Message From: Sent: To: CC: Subject: Bruce Moskowit z [bruce (b) (6) (b) @mac.com] 7/13/2017 1:06:29 PM (6) @aol.com (b) (6) Poonam AlaighMD I(b) (6) @hotmail.com]; DJS[drshulkin@aol.com] Re: Update Noon today would work Sent from my iPad Bruce Moskowitz M.D. > > > > > on Jul 13, 2017, at 8:56 AM, -(b) (6) @aol . com wrote : Good Morning Dr Moskowitz , The technology team from VA has been meeting with Apple team to discuss EHRas followup to the large conference call held in late June. > > > > These issues and progress key issues associated with the have included : 1) understanding the current status of VA use of the FHIR standards which are essential for the veterans digital platform. The VA has teams who have been using FHIR standards for different apps and some of the work re quired for EHRhas already started > > 2) they provided a draft of key milestones and projected timeline to share with the CIOs and governance group . There are some edits being made to this document but will send along via separate email. > > 3) Resources needed : identification of an additional identified. This would be part time support for this re quest resource initiative from VA that had not been previously and we are currently addressing that > > As you know, the development of this functionality is more of a marathon process and the projected timeline is March-April 2018. The actual work has begun and is moving along . > > (b) (6) The "care Finder" app was discussed with ........ (Apple) in a call this week. The next step is for you and I to discuss the specific featur~uded in this app ; review on VA side and then move it over to Apple. Pending their feedback, we would likely go thru a similar process as used with EHRby having tech teams working together to start to identify key steps , timeline and resources needed etc . This would be built in a simultaneous (not se quential ) timeframe to EHRand most likely have a much shorter timeframe. so much of the underpinnings for the care Finder are already done. > > As an FYI, I received project. > > > > > > > Available a call for a discussion from Darin letting when convenient me know that he would no longer be working on the for your schedule. (b) 1111 (6) sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000226 OS 00020942 Message @aol.com(b) (6) @aol.com] (b) (6) 7/13/2017 12:56:20 PM Bruce Moskowit z [bruce (b) (6) (b) @mac.com] Poonam AlaighMD I(b) (6) @hotmail. (6) com]; DJS [drshulkin@aol.com];-(b) Update (6) From: Sent: To: CC: Subject: @aol.com] (b) (6) Good Morning Dr Moskowitz, The technology team from VA has been meeting with Apple team to discuss EHRas followup to the large conference call held in late June. These issues and progress key issues associated with the have included: 1) understanding the current status of VA use of the FHIR standards which are essential for the veterans digital platform . The VA has teams who have been using FHIR standards for different apps and some of the work required for EHRhas already started 2) they provided a draft of key milestones and projected timeline to share with the CIOs and governance group . There are some edits being made to this document but will send along via separate email . 3) Resources needed: identification of an additional resource from VA that had not been previously identified. This would be part time support for this initiative and we are currently addressing that request As you know, the development of this functionality is more of a marathon process and the projected timeline is March-April 2018. The actual work has begun and is moving along . (b) (6) The "care Finder " app was discussed with ........ (Apple) in a call this week. The next step is for you and I to discuss the specific feat~cluded in this app ; review on VA side and then move it over to Apple . Pending their feedback, we would likely go thru a similar process as used with EHRby having tech teams working together to start to identify key steps, timeline and resources needed etc . This would be built in a simultaneous (not sequential ) timeframe to EHRand most likely have a much shorter timeframe. so much of the underpinnings for the care Finder are already done. As an FYI , I received project . Available a call for a discussion from Darin letting when convenient me know that he would no longer be working on the for your schedule. (b) 1111 (6) sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000227 OS 00020943 Message From: David shulkin LDrshulkin@aol.com] 8/2/2017 12:22:44 AM Vivieca Simpson I(b) (6) E)gmail.com); (b) (6) I(b) (6) (i)hotmail.com) Fwd: Sent : To : Subject: (b) (6) @gmail.com]; Poonam Alaigh If i ever complain about our committees see this https://m .youtube .com/watch?v=YEaeP6CK42o Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000228 DS 00020944 Message From: Poonarn Alaigh I(b) (6) @hotmail.com] Sent : 7/25/2017 2:38 :05 PM To : David Shu Ikin (drshulkin@aol.com] Fwd: I am not sure Subject: I need you to read this now'! This is evolving into a dictatorial culture- wHI harm us at VHA and your VA legacy of success - obviously my advice is not important to you anymore- you feel you can be alone in this journey and you are trusting the very people that are bringing you down!! Sent from my iPhone Begin forwarded message : From:-(b) (6) Date: July 24, 2017 at 7:04:30 PM EDT To: Drshulkin@aol.com Subject: I am oot sure I am completely clueless but we definitely are not in sync- I cant make change if your team continues to put roadblocks and I dont have your support- I cant tun VHA if I have to continue to do "MOther May [" and everything I commit to gets overturned and shot down- I have no credibility with my staff and team anymore . This is getting so frustrating- I want to help the facility with crisis mru1agement and I spoke to you about what I wanted to do, told you that I ca11t commit one way or the other on patient safety at this time but you keep repeating the same thing . Maybe we change the entire press release and just state that you heard from me and this is what you are directing me to do- maybe that will make you feel more comfortable . I dont care either ways, I just cant have my teain put all this hard work, and then lose all my crerubility . After this , no matter what you say, I really dont think that you trust me or my judgement- it is pretty obvious . I will stop all press releases from VHA moving forward- I dont have the energy or time to deal with it. YOu know everything about VHA , you just decide what we need to do, what press releases we need to put out and what actions we need to take . I will follow not leadthe good thing is that 1 am adaptable . Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000229 DS 00020945 Message Davidshulkin [Drshulkin@aol.com] 7/26/2017 11:08:03 AM (b) (6) Poonam Alaigh [-@hot mail.com] Re: How are you feeling now From: Sent: To: Subject: About 30 percent this am compression at 74 -75 showed tight Will start better physical therapy sent from my iPhone > on Jul 26, 2017 , at 4 : 14 AM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote: > > Now? What did the MRI show? > > sent from my iPhone > >> on Jul 25, 2017 , at 7 :44 PM, David shul kin wrote: >> >> Anesthesia wearing off >> >> Pain returning but may be a little better - ill have to see in am >> >> sent from my iPhone >> >>> on Jul 25, 2017, at 7 : 19 PM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote : >>> >>> >>> >>> sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000230 OS 00020946 Message From: Sent: To: Subject: Poonam AlaighI(b) (6) @hotmail.com] 7/26/201 7 8:14:36 AM Davidshulkin [Drshulkin@aol.com] Re: How are you feeling now Now? What did the MRI show? Sent from my iPhone > on Jul 25, 2017, at 7:44 PM, David shul kin wrote: > > Anesthesia wearin g off > > Pain returnin g but may be a little better- ill have to see in am > > sent from my iPhone > >> on Jul 25 , 2017, at 7 :19 PM, Poonam Alai gh <-(b) (6) @hotmail . com> wrote: >> >> >> >> sent from my iPa d AMERICAN PVERSIGHT VA-19-0799-G-000231 OS 00020947 Message Davidshulkin [Drshulkin@aol.com] 7/25/2017 11:43:56 PM (b) (6) Poonam Alaigh [-@hot mail.com] Re: How are you feeling now From: Sent: To: Subject: Anesthesia wearing off Pain returning but may be a little better- ill have to see in am Sent from my iPhone > on Jul 25 , 2017, at 7 :19 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : > > > > sent from my iPa d AMERICAN PVERSIGHT VA-19-0799-G-000232 OS 00020948 Message From: Sent: To: Subject: Poonam Alaigh I(b) (6) @hotmail.com] 7/25/2017 11:19:16 PM Drshul kin@aol .com How are you feeling now sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000233 DS_00020949 Message From: David Shulkin [secshulkin@gmail.com] Sent : 8/20/201710:10:08 PM @gmail.com] Poonam Alaigh (b) (6) Subject: Fwd: Priority List Attachments : Priority ToDo List 081817 1P.PDF; Untitled attachrrient 92695.htm To : Sent from my iPhoae Begin forwarded message : (b @frenchange159.com> From: 11IP" <1 Date: August ) 18, 2017 at 4:07:28 PNI l\IDT (6 To: '"David Shulkin"' ) Subject: Priority List AMERICAN PVERSIGHT VA-19-0799-G-000234 D8_00020950 Department of Veterans Affairs Proposed Priorities No. 1 Issue Regulatory Personnel reslrLICluring restrict ions 19, 2011 Risk Without a change in the ab ility of the Secretary lo make discretionary personnel changes at all levels the transformation will bellmited . Benefits Eligibillty There oontinues to be a backlog in application approvals for benefits. The program needs a system upgrade and restructuring. There are currently approximately 500,000 applications by veterans that are waiting approval. Many of those applicants have needs that a time delay will impact. Oloice 2.0 Olo ice 2.0 is the extension al the existing Choice program that a llow., Verterans to utilize private medical facilities for healthcare without the 30/40 limitations. The Oloice program is critical to the transformation of the VA because the VA medical facilites can not handle the volume, quality or connvenienoe. Choice requires a funding souroe and an efficient way to claim and distribute the payments. The program has not been approved by Congress and needs funding, the development of an effective managed care network that monitors access, cost and quality. Without the implementation (properly done) of the Choice 2.0 program, the VA >MIi be unable to properly serve the veterans healthcare needs in an efficient and quality manner. This could lead to a recurranoe of the scheduling and inability to deliver healthcare problems of the Obama Administration, Hiring Restriction and delays II takes way to long to go from hrl ng decision to a pprova I This process currently takes from 3 to more than 6 months. In the meantime, the transformation al the respective areas languish and set the entire process behind. There is a limited period of time in 'Mhichto effect a transformation and the delays ca used by the tliring approva I and start date delays are a great lmpediment to accom pllshing a tra nslorm ation in a reasonable period of time. This goes hand in hand with t he risk presented in number 1. Regulatory contracting restrictions Political reviews 7. Details The q uallty of personnel in the VA is mixed. Many of the personnel that have risen to management over time are complacent, unqualified for the role they occupy and do not view the goal of transformation and q ualtiy care delivery to be their first priority. The existi ng system does not allcm for effective restructuring of positions. leadership or management. resulting in an organization al unmotivated and misqua lltied "managment" August Licensing and IP Management There are not enough qualified leadership personnel at the VA (see number 1) to create a useful strategy throughout the Department in a II areas needing reform. Nor are there enough potentiaI hires in the short ti me available. even if the hiring impediments above are fixed. The marketplace has skills and ideas through available contractors, but engaging those contractors are subject to the 1cmbid procurement regulations. These skills are not t he same as buying a commodity and the system therefore forces the hriing of the lowest common denominator. Hcmever, the VA has paid enough for consultants who come in and submit a 150-300 page report on their views. The VA needs to be able to hire consultants who come in and fix !hi ngs and have the authority to do so. Currently, we are told that a consultant does not have any authority to di reel a VA employee and the employee can ignore that direction with impunity. The Secretary must be given the freedom to bring in C Level and other positions to fulfill his leadership team as he sees necessary achieve his goals. There seem to be way too many political roadblocks to that process. BiIlions of dollars are unprotected because the VA does not have the skill to do so. We have recommeded a solution to prevent this long term leakage, but the regulations are a deterrent to putting this solution in place. We have identffled a qualified IP management expert and got him to agree to create an IP management protocol and system for the VA. but after tremendous effort to identify the best person. the VA learned t hat there was no vehicle or mechanism to simply hire the specialist. Result • failure of Ira nslormation. This wilI result in an ineffective team, unable to accomplish a transformation. II won't get done. The VA wi 11end up giving way and not protecting BIiiions of dollars wonh of in1ellec1Ualpropeny . Facillty reallignment 1here are 1,200 VA facilities that are underutiliZed or unused. These facilities come at a significantcost and manpower waste. Congress needs to act . We met with Congressional leadership on this program and presented a viab le way to move it forward. VA Committee leadership was in agreement but this program seems to be stalled. Money that can be used for veterans' beneftts and care are being diverted unnessarily to useless facilities maintenance. These facilities could also be used to generate potential revenue or partnerships. This delay costs the VA $25 million per year . CIO The organization has tremendous IT and IT enhanoement needs. This cannot be done without a sophisticated and capable C 10 in leadership. It appears that a CIO is immenent but it took 7 months to acoompllsh tl1is. As systems get built, they will be inadequate for the needs of the organization and its strategic goals without the leadership al a CIO. This wilI cause great waste in time, money and quality of ca re. 1Q Medical Center Rating System CMS had agreed to implement their hos pitaI rating system this summer at the VA In order to qualify hospital quality or lack of quality. This is required to make certain operating and care delivery decisions. CMS now informs the VA that the Implementation will be signfflcantly delayed into 2018. This delay will prevent the identification of medical center quality problems and promote quality of care fai Iures for our veterans . 11 The VA will adopt the DOD Cerner system and append the EPIC system for a multi-functional system that wilI be interoperable with t he DOD and private care providers. The contract to move forward should have been submitted and approved by now . This system is the nervous system of the entire medical ca re delivery system and MUST be implemented as quickly as possible. The delay in contracting will have lasting effects. EMR replacement AMERICAN PVERSIGHT VA-19-0799-G-000235 OS 00020951 Message From: David Shulkin [secshu-lkin@gmail.com I Sent : To : 8{1'8/201710 :35:59 PM IP [l@frenchangel59 .com] ( Subject: Re:bPriority List ) ( This is excellent!6 ) Sent from my iPhone On Aug 18, 2017, at 6:07 PM , IP wrote : b ) ( AMERICAN PVERSIGHT VA-19-0799-G-000237 DS 00020953 Message From: Sent : To: Subject: Attachments : IP !1@frenchange l59.com ] ( 8/ 18/20 17 10:0 7:28 PM b 'David ) Shulkin' [secshulkin@gmail.com] ( Priority List 6 ToDo List 081817 lP.PDF Priority ) AMERICAN PVERSIGHT VA-19-0799-G-000238 DS 00020954 Department of Veterans Affairs Proposed Priorities No. 1 Issue Regulatory Personnel reslrLICluring restrict ions 19, 2011 Risk Without a change in the ab ility of the Secretary lo make discretionary personnel changes at all levels the transformation will bellmited . Benefits Eligibillty There oontinues to be a backlog in application approvals for benefits. The program needs a system upgrade and restructuring. There are currently approximately 500,000 applications by veterans that are waiting approval. Many of those applicants have needs that a time delay will impact. Oloice 2.0 Olo ice 2.0 is the extension al the existing Choice program that a llow., Verterans to utilize private medical facilities for healthcare without the 30/40 limitations. The Oloice program is critical to the transformation of the VA because the VA medical facilites can not handle the volume, quality or connvenienoe. Choice requires a funding souroe and an efficient way to claim and distribute the payments. The program has not been approved by Congress and needs funding, the development of an effective managed care network that monitors access, cost and quality. Without the implementation (properly done) of the Choice 2.0 program, the VA >MIi be unable to properly serve the veterans healthcare needs in an efficient and quality manner. This could lead to a recurranoe of the scheduling and inability to deliver healthcare problems of the Obama Administration, Hiring Restriction and delays II takes way to long to go from hrl ng decision to a pprova I This process currently takes from 3 to more than 6 months. In the meantime, the transformation al the respective areas languish and set the entire process behind. There is a limited period of time in 'Mhichto effect a transformation and the delays ca used by the tliring approva I and start date delays are a great lmpediment to accom pllshing a tra nslorm ation in a reasonable period of time. This goes hand in hand with t he risk presented in number 1. Regulatory contracting restrictions Political reviews 7. Details The q uallty of personnel in the VA is mixed. Many of the personnel that have risen to management over time are complacent, unqualified for the role they occupy and do not view the goal of transformation and q ualtiy care delivery to be their first priority. The existi ng system does not allcm for effective restructuring of positions. leadership or management. resulting in an organization al unmotivated and misqua lltied "managment" August Licensing and IP Management There are not enough qualified leadership personnel at the VA (see number 1) to create a useful strategy throughout the Department in a II areas needing reform. Nor are there enough potentiaI hires in the short ti me available. even if the hiring impediments above are fixed. The marketplace has skills and ideas through available contractors, but engaging those contractors are subject to the 1cmbid procurement regulations. These skills are not t he same as buying a commodity and the system therefore forces the hriing of the lowest common denominator. Hcmever, the VA has paid enough for consultants who come in and submit a 150-300 page report on their views. The VA needs to be able to hire consultants who come in and fix !hi ngs and have the authority to do so. Currently, we are told that a consultant does not have any authority to di reel a VA employee and the employee can ignore that direction with impunity. The Secretary must be given the freedom to bring in C Level and other positions to fulfill his leadership team as he sees necessary achieve his goals. There seem to be way too many political roadblocks to that process. BiIlions of dollars are unprotected because the VA does not have the skill to do so. We have recommeded a solution to prevent this long term leakage, but the regulations are a deterrent to putting this solution in place. We have identffled a qualified IP management expert and got him to agree to create an IP management protocol and system for the VA. but after tremendous effort to identify the best person. the VA learned t hat there was no vehicle or mechanism to simply hire the specialist. Result • failure of Ira nslormation. This wilI result in an ineffective team, unable to accomplish a transformation. II won't get done. The VA wi 11end up giving way and not protecting BIiiions of dollars wonh of in1ellec1Ualpropeny . Facillty reallignment 1here are 1,200 VA facilities that are underutiliZed or unused. These facilities come at a significantcost and manpower waste. Congress needs to act . We met with Congressional leadership on this program and presented a viab le way to move it forward. VA Committee leadership was in agreement but this program seems to be stalled. Money that can be used for veterans' beneftts and care are being diverted unnessarily to useless facilities maintenance. These facilities could also be used to generate potential revenue or partnerships. This delay costs the VA $25 million per year . CIO The organization has tremendous IT and IT enhanoement needs. This cannot be done without a sophisticated and capable C 10 in leadership. It appears that a CIO is immenent but it took 7 months to acoompllsh tl1is. As systems get built, they will be inadequate for the needs of the organization and its strategic goals without the leadership al a CIO. This wilI cause great waste in time, money and quality of ca re. 1Q Medical Center Rating System CMS had agreed to implement their hos pitaI rating system this summer at the VA In order to qualify hospital quality or lack of quality. This is required to make certain operating and care delivery decisions. CMS now informs the VA that the Implementation will be signfflcantly delayed into 2018. This delay will prevent the identification of medical center quality problems and promote quality of care fai Iures for our veterans . 11 The VA will adopt the DOD Cerner system and append the EPIC system for a multi-functional system that wilI be interoperable with t he DOD and private care providers. The contract to move forward should have been submitted and approved by now . This system is the nervous system of the entire medical ca re delivery system and MUST be implemented as quickly as possible. The delay in contracting will have lasting effects. EMR replacement AMERICAN PVERSIGHT VA-19-0799-G-000239 OS 00020955 Appointment From: Sent : To : Mar isol Garcia .@frenchangel59 .com] (b) 7/26/2017 3:11 (6) :53 PM L Perl (b) (6) @gmail.com]; (b) (6) @hotmail.com; David shulkin [Orshulkin@aol.comJ; Bruce Moskowitz [bruce (b) (6) (b) @maccom]; mb (b) (6) @gmail.com; l( @frnnchang,el59.com Subject : Location : ) VA - Follow-up with Secretary Shufkin and Poonam Alaigh - Sunday, July 30th - 5:15 PM to 6:00 PM EST ( Conference Call (6) 7/30/2017 9:15 :00 PM End: 7/30/2017 9:45:00 PM Show Time As: Tentative Start: Recurrence : b 6 ) (none) Sunday, July 30 th 5:15 PM -6:00 PM EST Dial-in Information: US: 1-866- -244- (b) (6) (b) (6) Passcode: Participants: Laurie Perlmutter, Poonam Alaigh, Secretary David Shulkin, Dr. Bruce Moskowitz, Marc Sherman and Ike Thank you, Marisol Garcia (b) (6) Office) (b) (6) Cell) (b) ■@frenchangel59.com (6) AMERICAN PVERSIGHT VA-19-0799-G-000240 DS 00020956 Message From: (b) (6) Sent : 7/27/2017 11:15:40 PM drshulkin@aol.com Art icle To ; Subject: (b) (6) @gmail.com) http://www.nydaiIynews.com/amp/newswires/news/business/new-deal-reached-fix-va-budget-crisis-vetsprotest-article-1.3362579 AMERICAN PVERSIGHT VA-19-0799-G-000241 DS_ 00020957 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 7/27/2017 11:21:37 AM (b) (6) Poonam Alaigh [-@hot mail.com] Re: Working the town sounds good Sent from my iPhone (b) (6) > on Jul 27, 2017, at 6:02 AM, Poonam Alaigh <-@hotmail.com> wrote: > > I thin k we have to use the strategy of working the town- forgot to tell you that I had dinner with Leah Binder yesterday - good networ king discussion and she wants to do a welcome re ception. Meeting with one of the staffers for dinner today - while you do the more formal meetings , I will do the more 1: 1 so we develo p both the breadth and depth that we need > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000242 OS 00020958 Message From: Sent: To: Subject: (b) (6) Poonam Alaigh [-@hotmail.com] 7/27/2017 10:02:45 AM DavidShulkin [drshulkin@aol.com] Working the town I think we have to use the strategy of working the town- forgot to tell you that I had dinner with Leah Binder yesterday- good networking disc ussion and she wants to do a welcome reception . Meeting with one of the staffers for dinner today - while you do the more formal meetings, I will do the more 1:1 so we develop both the breadth and depth that we need sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000243 OS 00020959 Message From: Sent: To: Subject: David shu lkin [Drshulkin@ao l.com] 7/26/2017 4:34: 19 PM Poonam Alaigh I(b) (6) @hot mail.com] Re: Didn't know if you knew Ok Sent from my iPhone > on Jul 26, 2017, at 11:56 AM, Poonam Alaigh <-@hotmail.com> (b) (6) wrote: > > But I just heard that Darin wanted to be secretary of the VA and has been pitching for it- it now all makes sense - there are booby traps being laid all around us with these pinheads- they know they can't touch VHAand thus you as long as I am here and I have made loyal team with me- we will speak to you when you come here later today > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000244 OS 00020960 Message From: Sent: To: Subject: (b) (6) Poonam Alaigh [-@hotmail.com] 7/26/2017 3:56:46 PM David Shulkin [drshulkin@aol.com] Didn't know if you knew But I just heard that Darin wanted to be secretary of the VA and has been pitching for it- it now all makes sense - there are booby traps being laid all around us with these pinheads- they know they can't touch VHAand thus you as long as I am here and I have made loyal team with me- we will speak to you when you come here later today sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000245 OS 00020961 Message David shulkin [Drshulki n@aol.com] 7/25/2017 7:06:40 PM Marisol Garcia .@ (b) fren changel59 .comJ Re: [EXTERNAL)(6) Call for Sunday, July 30th at 5:30 PM - Please reply to this ema il From: Sent : To : Subject : Marisol- ive been tied up Does Ike still need to speak to me? Sent from my iPhone (b) @frenchangel59 .com> wrote : On Jul 25 20 17, at I 0:34 AM, Marisol Garcia wrote : On Jul 25, 2017, at 10:34 AM, Marisol Garcia (b) (6) wrote: Yes- thanks Sent from my iPhone (b) @frenchangel59.com> wrote : On Jul 25, 2017, at 10:35 AM, Marisol Garcia wrote : On JuJ25 201 7, at 10:35 AM, Masi sol Garcia wrote : Here is what DAV posted on their facebook yesterday about the signing of the legislation : Despite the attempts of interest groups to push VA closer to privatization, the President moved to prov ide an integrated healthcare system that funds critical areas of VA and supports the Choice program." 11 What I think is more interesting are the comments from their members. Here are the first few you can check it out at https://www.facebook.com/DAV/ -(b) (6) VA doesn't need more money . They need to stop wasting the money they have . It's time to sta1i giving veterans a lot more choice in seeing the doctor of their choice and not one beholden to the VA. (b) (6) Little off topic, but how come the VA hospital can't have a smiling pie of the president on the wall? (b) (6) Do not let the VA go privatized. It will be terrible for Vets. (b) (6) I am using the fee basis service but the v,a . web site and secure messaging a totaJ failure . I can not use site at all, I like like 200 miles away from the v .a. I tried to work with the v.a. and go paperless saving the v.a. loads of money, however it stopped working and now everything goes to me like 10 bucks for an envelope that was free before. It is sent express mail now so you can see the cost involved . w .t.f.? (b) (6) this is fine and good if you live 50 miles or more from a VA clinjc or hospital..! live 43 miles from VA nashville soi cant use CHOICE program.I have to settle for 6 month apart appointments from VA.its BS . (b) (6) Mr Trump will they use it wisely?? Not on buildings or bonuses or such but veterans to get needed care im sure hoping (b) (6) The Choice Program send veterans to the lowest bidding doctor's office , which means the veterans get 1'cheap 11 heaJthcare, which means bad treatment from inexperienced doctors . Initially , the program was put in place as a last resort , in case the VA was overwhelmed . (b) - (6) THE VA REMAINS AS CORRUPT AS EVER. BUNCH OF DUMMIES TO BELIEVE THIS CRAP . (b) (6) Routine care for veterans .must be privatized . The VSOs opposing this are selling out the veterans they should be representing . Here is my favorite comment: rve been delighted to be using the "Choice Care 11 program for the last 3 years. The nearest CBOC for me was a 50-mile one-way drive . The only thing they offerred were standard labs and wellness visits . The closest V AMC is 70 miles for me . Many of our local vets are (b) (6), (b) (2) -(b) (6) AMERI JAi PVERSIGHT VA-19-0799-G-000256 DS 00020972 enrolled in Choice Care due to their distances from VA care. We even have a local Optometrist, Audiologist, and Podiatrist working directly with our VAMC" to provide services right here in our home towns. I've never seen this program as some evil shift towards privatization; rather, expansion of personal-care options for our millions of veterans is always one more step forward within the ever-expanding system. Darin AMERICAN PVERSIGHT VA-19-0799-G-000257 OS 00020973 Message From: Darin Selnick (b) (6) Sent : 8/13/2017 1:05:37 PM To : David shulkin [Drshulkin@aol.comJ DAV Comments on Yesterday Subject: @gmail.com] Here is what DAV posted on their facebook yesterday about the signing of the legislation : "Despite the attempts of interest groups to push VA closer to privatization , the President moved to provide an integrated healthcare system that funds critical areas of VA and supports the Choice program." What I think is more interesting are the comments from their members . Here are the first few you can check it out at https://www.facebook.com/DAV / (b) (6) -VA doesn't need more money. They need to stop wasting the money they have . It's time to start giving veterans a lot more choice in seeing the doctor of their choice and not one beholden to the VA. (b) (6) Little off topic , but how come the VA hospital can't have a smiling pie of the president on the wall? (b) (6) Do not let the VA go privatized . It will be terrible for Vets . (b) (6) I am using the fee basis service but the v .a. web site and secure messaging a total failure. I can not use site at all, I Jike like 200 miles away from the v.a. I tried to work with the v .a . and go paperless saving the v.a . loads of money, however it stopped working and now everything goes to me like 10 bucks for an envelope that was free before . It is sent express mail now so you can see the cost involved . w .t.f.? (b) (6) this is fine and good if you live 50 miles or more from a VA clinic or hospital..( live 43 miles from VA nashville soi cant use CHOICE program.I have to settle for 6 month apart appointments from VA.its BS. (b) (6) Mr Trump will they use it wise] y?? Not on buildings or bonuses or such but veterans to get (6) needed care im sure hoping (b) (6) The Choice Program send veterans to the lowest bidding doctor's office, which means the veterans get "cheap" healthcare, which means bad treatment from inexperienced doctors " Initially , the program was put in place as a last resort, jn case the VA was overwhelmed . (b) (6) -THE VA REMAINS AS CORRUPT AS EVER BUNCH OF DUMMIES TO BELIEVE THIS CRAP . (b) (b) (6) Routine care for veterans must be privatized . The VSOs opposing this are selling out the veterans (6) they should be representing. Here is my favorite comment: (b) (b)(6) (6) ~ I've been delighted to be using the "Choice Care" program for the last 3 years. The nearest CBOC for me was a 50-mile one-way drive. The only thing they offerred were standard labs and wellness visits. The closest VAMC is 70 miles for me . Many of our local vets are enrolled in Choice Care due to their distances from VA care. We even have a local Optometrist, Audiologist, and Podiatrist working directly with our VAMC" to provide services right here in our home towns. I've never seen this program as some evil shift towards privatization ; rather, expansion of personal-care options for our mill ions of veterans is always one more step forward within the ever-expanding system . (b) (6), (b) (2) Darin AMERICAN PVERSIGHT VA-19-0799-G-000258 DS 00020974 Message David shulkin LDrshulkin@aol.com] 8/11/2017 10:22:43 AM Poonam Alaigh I(b) (6) @hotmail.com] Re: See David's connections, activity and experience From: Sent : To : Subject: Agree Sent from my iPhone On Aug 10, 2017 , at 8:59PM , Poonam Alaigh- (b) (6) > wrote: No harm trying - if nothing else we have another connection . Sent from my iPad On Aug 10, 2017, at 8:58 PM, David shulkin wrote: Doubt he will leave medstar for us at this point- Steve thought he was unemployed Sent from my iPhone Begin forwarded message : From.: (b) (6) via Linkedln Date: August 10, 20 17 at 6:23:47 PM EDT To: David ShuJkin Subject: See David's connections, activity and experience Da id Slrnlkin (b) (6) C I§iEii£;. I has accepted your invitation . Let's start a conv ersation . (b) (6) President · COO Med tar Health P ans Baltimore . Ma~ land Area View profile I Message AMERICAN PVERSIGHT VA-19-0799-G-000260 DS_00020976 □ People you may know (b) (6) Editor-in-Chief at Health Affairs + CoWlccl □ (b) (6) □ (b) (6) , MD, MS-HQS Interrust at Premier Medical Associates Im.:. + Connect -t Specialist Leader at Deloitte + Connect Sec more Unsubscrib.! I : Help You arc receiving Accepted Im·italion emails TI1isemail was intent.ledfor David Shulkin ( Seereli:U)U.S. Department l)f Veterans Affairs). Learn why we inclucfoJtlus. Linked(m 1,-2017 J.rnkedJn Corporation. 1000 West Maude /\venue, Sunnyvale. CA 94085. J.mkeLIInand the Linlcdln logo are rcg1slcrcdtrademarks oflink.cdln. AMERICAr-... pVERSIGHT VA-19-0799-G-000261 D8_00020977 Message Poonam Alaigh I(b) (6) @hotmail.com] 8/11/2017 12:59:56 AM David shulkin [Drshulkin@aol.comJ Re: See David's connections, activity and experience From: Sent : To : Subject: No harm trying - if nothing else we have another connection. Sent from my iPad On Aug 10, 2017 , at '8:58 PM , David shulkin wrote: Doubt he will leave medstar for us at this point- Steve thought he was unemployed Sent from my iPhone Begin forwarded message : From: (b) (6) via Linkedln Date: August 10, 2017 at 6 :23:47 PM EDT To: David Shulkin Subject: See David's connections, activity and experience David Shulkin (b) (6) □ □ has accepted your invitation . Let's start a conversation . (b) (6) View profile led tar Health Plun. land Arca I Message C- People you may know (b) (6) Fditor-in-Ch1ef al ffe-;ilU1 A!Tair~ + Connect AMERICAN PVERSIGHT VA-19-0799-G-000262 DS_00020978 (b) (6) , MD,M S-HQS Internist at Premier Medical Associates [n1,; . + □ Connect (b) (6) Specmlist Leader al Del01tte + Connect I See more Urumbscnbc I Ilclp You are receiving /\ccepled Tnvilationemails. This email was intended for David Shullon { Secretary U .S. Department of Veterans Affairs) . Learn whv ,re 111cludedthrn. Linked(m •~ 2017 LinkcdJn Corpornlion, 1000 West.Maude Avenue , Sunnyvale, CA 94085. Linkcdin and the Linkedln logo are registered trademarks ofLinkedln , AMERICAr-... pVERSIGHT VA-19-0799-G-000263 DS_ 00020979 Message David shulkin [Drshulkin@aol.com] 8/11/2017 12:58:28 AM Poonam Alaigh I(b) (6) @hotmail.com] Fwd: See David's connections, activity and experience From: Sent : To : Subject: Doubt he will leave medstar for us at this point- Steve thought he was unemp loyed Sent from my iPhone Begin forwarded message : From: (b) (6) via Linkedln Date: August 10, 2017 at 6:23 :47 PM EDT To: David Shulkin Subject: See David's connections, activity and experience David Shulkin (b) (6) □ □ has accepted your invitation. Let's start a conversation. (b) (6) President & COO edStar Health Plan Bahimore, Mal} laud Area I View profile Message □ People you may know (b) (6) •ilitor-UL-C:h.icfat l lc:.illhAflaJJ~ + AMERICAN PVERSIGHT Connect VA-19-0799-G-000264 DS_00020980 □ (b) (6) □ (b) (6) ,MD,MS-HQS Internist at Premier Medical Associate:,;Inc + Co1u1cct Specialist Leader at Deloitte + Connect ... I Sec more Unsnbscribc I llclp You are rece1v111g /\ccepted Tnv1tat1one11101ls . 1 U .. fhis email was intt:ndcu for Duv1dShulkin ( Secn.:tar:, Dcpanmenl nr VeteransAffairs). Learn wh_ywe included this. Linked(m re,2017 Lmkcdln Corporalion.. IU00 West Maude Al'cnuc. SUJm)vale\ CA 9-1()85.LLOk.cdJn aud 1heLinkedln log,oare registered trademarksofLinkedln . AMERICAN PVERSIGHT VA-19-0799-G-000265 OS 00020981 Message From: thomas bowman (b) (6) Sent : 7/23/2017 9:41 :29 PM To: David Shulkin [drshulkin@aol.com] Fw: Senators call for quick confirmation of 6 VA appointees - News - Stripes Subject: @yahoo.com] Sent from Yahoo Mail on Android On Sun, Jul 23, 2017 at 12:23 PM, (b) (6) (b) (6) <~ mac.com> wrote: https ://www .stripes.com/news/senators-calI-for-quick-confirmation-of-6-va-appointees1.478872#.WXTNHMaZMkj Senators call for quick confirmation of 6 VA appointees • A\llERICAN PVERSIGHT VA-19-0799-G-000266 OS 00020982 STARS AND STRIPES WASHINGTON - The man slated to take the No. 2 spot at the Department of Veterans Affairs said the VA has a trust problem and he wants to fix it. "While there are significant challenges confronting the VA, I believe one of the most pervasive is regaining the trust of veterans, their families and the Ametican people," Thomas Bowman told senators Wednesday. "The Phoenix VA Medical Center scandal in 2014, and since then, other scandals associated with an inability to appropriately hold VA employees ... accountable for unsatisfactory performance or misconduct, seriously undermined the trust and confidence in the VA." Bowman, who now works as the staff director for the Senate Veterans' Affairs Committee, was nominated by Trump to the position of deputy secretary of the VA - a spot most recently held by Sloan Gibson during the administration of former President Barack Obama. If confirmed, he will work under VA Secretary David Shulkin to lead the 350,000-employee agency, the second-largest in the federal government. article continues below related articles "Modernizing the VA... working with Congress, [veterans service organizations] and other stakeholders to boldly and aggressively address needs highlighted by each of them will build upon what Trump, Shulkin and the Congress have already started, to hopefully regain that trust/' Bowman said. He and five other VA appointees were questioned Wednesday during a Senate veterans committee hearing. The committee intends to vote Thursday to send the nominations to the Senate floor for confirmation. "It's ve1y important we get these done now so they can get to work," said Sen. Johnny Isakson, R-Ga., chairman of the committee. "Every day they're not working, our veterans are not being served, and that's not good for our country." A\llERICAN PVERSIGHT VA-19-0799-G-000267 DS 00020983 Sen. Jon Tester, D-Mont., the ranking Democrat on the committee, agreed senators needed to expedite the nominations. "As the VAfaces debilitating workforce shortages and tough decisions about veterans' care and benefits, it's critically important that we thoroughly and quickly vet nominees to serve at the VA," he said. Before working in Congress, Bowman held leadership positions at the VA, including chief of staff. He was also a senior adviser to the director of VA health care in Florida and the Caribbean. He's a retired Marine Corps colonel and earned degrees from the University of Texas and Western New England Co1lege. "There needs to be some common sense coming out of the department, " Tester said. 'I hope you're the guy to provide that.'' Senators also heard from Brooks Tucker, nominated to be the assistant VA secretary of congressional and legislative affairs. Tucker worked on Trump's transition team and is now a senior adviser to Shulkin. He was previously a senior policy adviser to Sen. Richard Burr, R-N.C. He's a retired lieutenant colonel in the Marine Corps. James Byrne was nominated to be VA's general counsel He most recently worked as general counsel and the lead cyber and counterintelligence attorney at Lockheed Martin. (b) (6) Trump nominated-Allen, Amanda Meredith and Joseph Toth to the U.S. Court of Appeals for Veterans Claims, which hears cases from veterans who think their claims for VA benefits were denied unjustly. Allen is a law professor and director of the Veterans Law Institute at Stetson University in Gulfport, Florida. Meredith is the deputy staff director and general counsel for the Senate veterans committee and Toth served as a judge advocate in the Navy. In 2011, Toth partnered with prosecutors in Afghanistan to establish rule of law in the district where the Taliban was formed. The Senate committee is expected to vote on the six nominations Thursday at noon. iuentling.nikki& tripe . orn Ttuitter: @nikkiwentling A\llERll .. PVERSIGHT VA-19-0799-G-000268 DS 00020984 Message (b) (6) Darin Selnick-@gmail .com] 7/22/20 1710 :47:31 PM David shulkin [Drshulkin@aol.comJ Fwd: CVA Backs House Plan to Fix Choice Program Budget Shortfa 11 From: Sent : To : Subject: FYI Darin ---------- Forwarded message ---------From : CVA - Press Date : Sat, Jul 22 2017 at 3:2 1 PM Subject: CVA Backs House Plan to Fix Choice Program Budget Shortfall To: (b) (6) mail.com For Immediate Release: July 22, 2017 Press contact: press@cv4a.org CONCERNED FORAMERICA CVA BacksHouse Plan to Fix Choice Program Budget Shortfall On Friday, the House Veterans Affairs Committee (HVAC) released a legislative solution to the Veteran Choice Program budget shortfall. The bill would create additional funds for the choice program which would be offset by continuing existing fees within other VA programs and reforming certain VA pensions. Arlington, VA- Concerned Veterans for America (CVA) Policy Director Dan Caldwell issued the following statement: "We fully support the House VA Committee's bill to fix the budget shortfall within the Veteran Choice Program. Chairman Roe and his committee have put forward a practical solution that will address the problem quickly and in a fiscally responsible manner . This plan will ensure that the veterans who have been able to successfully use the choice program will not face any lapses in care due to the program runn ing out of money in the coming weeks. "We urge Congress to reject strawman arguments from defenders of the status quo who are using this moment to advance their anti-choice agenda instead of doing what's best for veterans. There is no reason to tie fixing the Veteran Choice Program to other unnecessary spending increases, especially considering that a VA appropriations bill with a near ly two billion dollar budget is already in the works. "This whole scenario underscores the need for a permanent choice reform that will remove the VA as the middleman standing between veterans and their health care, After the budget shortfall is addressed, legislato rs must work as quickly as possible to develop a solution that will give veterans real choice over whe re and when to see a doctor , inside or outside of the VA." AMERICAN PVERSIGHT VA-19-0799-G-000269 DS_00020985 The Veteran Choice Program, whict) was enacted under Veterans ' Access to Care through Choice, Accountability, and Transparency Act, was intended as a temporary solution to the wait list scandal of 2014. The Program was flawed - allowi ng veterans to only receive care at VA-approved facilities if they meet the "30-day, 40-mile " rule, for example - and has been implemented poorly ,. CVA has proposed the creation of a government-chartered non-profit to oversee the traditional VA medical system in addition to creating a veterans health insurance program that would offer all veterans at the VA the ability to access care in the private sector. These proposals would empower veterans to use these benefits at his or her own discretion - inside or outside of the VA. #-## If you Would rather not receive future communications from Concerned Veterans For America, let us know by dicking here. ·concerned Veterans For Amerfca , 2300 Wttson Blvd, Arlington, VA 22201 Unrted Slates AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000270 DS 00020986 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 8/2/20 17 11 :01:09 AM To: (b) (6) Poonam Alaigh [-@hot Subject: Re: If i need anything i know mail.com] can ask- thanks Sent from my iPhone (b) (6) > on Aug 2, 2017, at 6:54 AM, Poonam Alaigh <-@hotmail.com> wrote: > > I don't want you to ever re-live the Atlantic experience except with good memories. > > I really want to see you back to your normal statedoes with back ailments. it will happen I know, but will take time- always (b) (6) (b) (6) > > sent from my iPhone > >> >> >> >> >> >> >> >> on Aug 2, 2017 , at 5:5 1 AM, David shulkin Thats how i felt about atlantic- But as you know it usually turns Neither of us would be on this iilliiliii analgesia soi wrote: know how you feel out to be best journey now (b) (6) >> >> sent from my iPhone >> (b) (6) >>> on Aug 2, 2017 , at 3:13 AM, Poonam Alaigh <-@hotmail.com > wrote: >>> >>> I know I shouldn ' t, but I haven't been able to sleep much thinking of everything we spoke about - I know that all I can do is do my best and make a positive impact today , but if it doesn't happen , I know that we, especially you , gave it our best shot. But still so disturbingsomething so obvious , so needed , so perfect should not be so difficult and impossible. >>> >>> sent from my iPad >> AMERICAN PVERSIGHT VA-19-0799-G-000271 OS 00020987 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 8/2/20 17 10:54: 18 AM To: Davidshulkin [Drshulkin@aol.com] Subject: Re: I don ' t want you to ever re-live the Atlantic experience I really want to see you back to your normal statedoes with back ailments. except with good memories. it will happen I (b) (6) know, but will take time- always (b) (6) sent from my iPhone > on Aug 2, 2017, at 5: 51 AM, David shulkin wrote: > > Thats how i felt about atlantic- > > But as you know it usually > > Neither turns of us would be on this > llllllliiiliiiianalgesi (b) (6) soi know how you feel out to be best journey now (b) (6) > > sent from my iPhone > >> on Aug 2 , 2017, at 3: 13 AM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote: >> >> I know I shouldn't , but I haven't been able to sleep much thinking of everything we spoke about- I know that all I can do is do my best and make a positive impact today , but if it doesn't happen , I know that we, especially you, gave it our best shot . But still so disturbingsomething so obvious , so needed, so perfect should not be so difficult and impossible . >> >> sent from my iPad > AMERICAN PVERSIGHT VA-19-0799-G-000272 OS 00020988 Message To: David shu lkin [Drshulkin@ao l.com] 8/2/20 17 9:5 1:40 AM Poonam Alaigh I(b) (6) @hot mail.com] Subject: Re: From: Sent: Thats how i felt about atlantic- But as you know it usually turns Neither of us would be on this once the analgesia inflamed it wore off- soi know how you feel out to be best journey now the Pain is so bad all night could not sleep- the procedure really sent from my i Phone > on Aug 2, 2017 , at 3:13 AM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote: > > I know I shouldn ' t, but I haven't been able to sleep much thinking of everything we spoke about- I know that all I can do is do my best and make a positive impact today, but if it doesn't happen , I know that we, especially you , gave it our best shot . But still so disturbingsomething so obvious, so needed, so perfect should not be so difficult and impossible . > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000273 OS 00020989 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 8/2/20 17 7:13:49 AM To: Drshulkin@aol.com I know I shouldn't, but I haven't been able to sleep much thinking of everything we spoke about - I know that all I can do is do my best and make a positive impact today, but if it doesn ' t happen, I know that we, especially you, gave it our best shot. But still so disturbingsomething so obvious, so needed, so perfect should not be so difficult and impossible. Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000274 OS 00020990 Message From: Sent : To : Subject: Alaigh, Poonarn, M.D . (b) (6) @va.gov] 7/25/2017 2:29 :06 PM 'Mar isol Garcia'.@frenchangel59 .com]; 'David shulkin' [Drshul kin@aol.com) (b) RE: [EXTERNAL]Call (6) for Sunday, July 30th at 5:30 PM l can make it work but have to entertain compan y at 6pm - so can be available for 30min- David ? Sent wi th Good (www .good .com) -----Ori gj nal Message----From: Ma1isol Garcia. (b) @frenchange159.com ] Sent: Tuesday , July 25 ,(6) 20 17 10:26 AM Eastern Standard Time To: Alaigh , Poonam , M .D .; 'David shulkin' Subject: RE : [EXTERNAL ] Call for Sunday , July 30th at 5:30 PM Sorry - The only time that works .for Ike and the rest is 5:30 PM - so sorry That doesn 't work at all? From: Alaigh, Poonam, M.D. [mailto (b) (6) @va.gov] Sent: Tuesday, July 25, 2017 10:14 AM To: 'Marisol Garcia'; 'David shulkin' Subject: RE: [EXTERNAL] Call for Sunday, July 30th at 5:30 PM The early to mid morning works best for me either Saturday or Sunda y. Sent with Good (www.good .com ) -----Original Message----From: Marisol Garcia. (b) @frenchangel59 .com ] Sent: Tuesday, July 25,(6) 20 17 10: 12 AM Eastern Standard Time To: Alaigh , Poonam , M.D .; David shulkjn Subject: [EXTERNAL] Call for Sunday, July 30th at 5:30 PM Poonam and David, Ike would like to have a call with Laurie, Bruce, Ma rc and both of you . Please let me know if 5:30 PM works for you . Thank you, AMERICAN PVERSIGHT VA-19-0799-G-000275 DS_ 00020991 Marisol Message Poonarn Alaigh I(b) (6) @hotmail.com] From: Sent : 7/20/2017 5:31 :35 AM To : David shulkin [Drshulkin@aol.comJ Subject: Re: Statement on Manchester Third-Party Review No, I will take the sword for you- but I don't like the fact that everyone can speak for me- I am fine with the concept but not the words- anyway its water under the bridge but we shouJd try that this doesn't happen again agam Sent from my iPad On Jul 20, 2017, at 5:38 AM , David sbulkin \1/fOte; That was not the intent of anyone- it seemed that we were stating tl1eobvious If the USH is not overseeing this then who would? The only other persons possible would be the dep sec or secva . Since i am already taking all of the heat for this in the press - i will be glad to take this on And handle the oversight. That way you can stay out if it Sent from my iPhone On Jul 20, 2017 , at 12:58 AM, Poonam Alaigh - (b) (6) > wrote : It was not worded right by any means- it is. a setup- I am very concerned and not happy at aJI- how is there a commitment declared on my behalf without my approval or consent - and I was with you, you could've just walked over to me and had a quick discussion Sent from my iPhone On Jul 19, 2017, at I0:29 PM, David shulkin wrote : We had talked about it and agreed not to get cornered into a third party review Miguel is the one is interviewed with the globe and suggested the third party to them I dont know who suggested doing that he do the interview- this is too volatile to have him as a spokesperson The Department now is responding to the story and once again playing defense to a bad story , AMERICAN PVERSIGHT VA-19-0799-G-000277 DS 00020993 I cannot figure out how it puts you as a target- this was as is the role of the USh - youve delegated it for now - which is your perogative but the USH holds the responsibilit y Im not sure what you would have suggested we could have. done different. Sent from my iPhone On Jul 19. 2017, at 10:00 PM, Poonam Alaigb (b) (6) ~wrot e: David you have to talk to me about this before you work out an action plan with John for VHAMiguel or I were not involved and n get agreed to thisA this puts me in a vulnerab le position and boxes me terribly - I now become the direct target Sent from my iPhone Begin forwarded message : From : ''Alaigh, Poonam , M.D." Date: July 19. 2017 at 9:56 :58 PM GMT+ l To: 'Poonam Alaigb' (b) (6) ~ Subject: FW: Statement on Manchester Third-Party Review Sent with Good (www .good .com) -----Original Message---From: Wright , Vivieca (Simpson) Sent: Wednesday , July 19, 2017 04:48 PM Eastern Standard Time To: Ullyot, John; Blackburn , Scott R.; Leinenkugel , Jake ; Alaigh, Poonam , M .D. Subject: RE: Statement on Manchester Third-Party Review John adding Poonam because she was not aware of thi s Statement. AMERICAr-... pVERSIGHT VA-19-0799-G-000278 D8_00020994 -----Original Message----From: Ullyot, John Sent: Wednesday, July 19, 2017 03 :46 PM Eastern Standard Time To: Blackburn, Scott R.; Leinenkugel, Jake; Wright, Vivieca (Simpson) Subject: Statement on Manchester Third-Party Review FYI - good news - as discussed a number of outlets informed us they are writing pieces today with Manchester VAMC whistleblowers very skeptical about the original OMI report and OM l's ability to conduct a credible reinvestigation of the same facts at Manchester VAMC. We responded with the following after discussing with SecVA (this had been my recommendation at Tuesday's staff meeting): Secretary Shulkin has been clear that the top-to-bottom review he ordered following the Boston Globe article will be comprehensive, transparent, and brand new. The Undersecretary of Health will personally supervise the review, and we're also identifying a third-party panel of medical experts to be named shortly who will review the final report and provide input to the VA. Manchester Veterans deserve no less. -- Curt Cashour, Press Secretary, U.S. Department of Veterans Affairs Thanks, John U. AMERICAN PVERSIGHT VA-19-0799-G-000279 OS 00020995 Message David shulkin LDrshulkin@aol.com] 7/20/2017 4:38:42 AM Poonam Alaigh I(b) (6) @hotmail.com] Re: Statement on Manchester Third- Party Review From: Sent : To : Subject: That was not the intent of anyone- it seemed that we were stating the obvious lfthe USH is not overseeing this then who would? The only other persons possible would be the dep sec or secva. Since i am already taking all of the heat for this in the press - i will be glad to take this on And handle the oversight. That way you can stay out if it Sent from my iPhone On Jul 20, 2017, at 12:58 AM, Poonam Alaigh ~(b) (6) > wrote : It was not worded right by any means- it is a setup- I am very concerned and not happy at allhow is there a commitment declared on my behalf without my approval or consent - and I was with you, you could 1ve j ust walked over to me and had a quick discussion Sent from my iPhone On Jul 19, 2017, at 10:29 PM, David shulkin wrote : We had talked about it and agreed not to get cornered into a third party review Miguel is the one is interviewed with the globe and suggested the third party to them I dont know who suggested doing that he do the interview- this is too volatile to have him as a spokesperson The Department now is respond ing to the story and once again playing defense to a bad story. I cannot figure out how it puts you as a target- this was as is the role of the USh - youve delegated it for now - which is your perogative but the USH holds the responsibility Im not sure what you would have suggested we could have done different. Sent from my iPhone On Jul 19, 2017, at l 0:00 PM, Poonam Alaigh ~(b) (6) > wrote : David you have to talk to me about this before you work out an action plan with John for VHA - Miguel or I were not involved and AMERICAN PVERSIGHT VA-19-0799-G-000280 DS 00020996 n get agreed to thisA this puts me in a vuJnerab le position and boxes me terrib ly - I now become the direct target Sent from m y iPhone Begin fo1warded mes sage : From: '1Alai gh , Poonam, M .D .11 Date: Jul y 19, 20 17 at 9:56:58 PM GMT + 1 (b) (6) To: 'Poonam Alaigh' ~ Subject: FW: Statement on Manchester ThirdParty Rev iew Sent wit h Good (www ,good .com ) -----Origi nal Message----From: Wri ght , Vivieca (Si mpson) Sent: Wednesday , July 19, 20 17 04:48 PM Eastern Standard Time To: Ull yot, John ; Blackbum, Scott R.; Leinenkugel , Jake ; Ala igh, Poonam , M.D. Subject: RE : Statement on Ma nchester Third-Part y Review John adding Poonarn because she was not aware of this Statement. -----Original Message----From: Ul Iyot, John Sent: Wedne sday, Jul y 19, 20 17 03 :46 PM Eastern Standard Ti me To: Bla ckbum , Scott R.; Leinenkugel, Jake ; Wright, Vivieca (Simpson) Subject: Stateme nt on Manche ster Third-Part y Review FYI - good news - as discussed a number of outlets informed us they are wr it ing pieces today w it h Manchester VAMC whistleblowers very skeptica l about the origina l OMI report and OM l' s ability to conduct a credible re-invest igation of th e same facts at Manchester VAMC. AMERICAr-... pVERSIGHT VA-19-0799-G-000281 D8_00020997 We responded with the following after discussing with SecVA (this had been my recommendation at Tuesday's staff meeting): Secretary Shulkin has been clear that the top-tobottom review he ordered following the Boston Globe article will be comprehensive, transparent, and brand new. The Undersecretary of Health will personally supervise the review, and we're also identifying a third-party panel of medical experts to be named shortly who will review the final report and provide input to the VA. Manchester Veterans deserve no less. -- Curt Cashour, Press Secretary, U.S. Department of Veterans Affairs Thanks, John U. AMERICAN PVERSIGHT VA-19-0799-G-000282 OS 00020998 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent : 7/19/201711 :58:14 PM To : David shulkin [Drshulkin@aol.comJ Subject: Re: Statement on Manchester Third-Party Review lt was not worded right by any means- it is a setup- I am very concerned and not happy at all- how is there a commitment declared on my behalf without my approval or consent - and I was with you~ you could've just walked over to me and had a quick discussion Sent from my iPhone On Jul 19, 2017, at 10:29 PM , David shulkin wrote : We had talked about it and agreed not to get cornered into a third party review Miguel is the one is interv iewed with the globe and suggested the third pa1iy to them I dent know who suggested doing that he do the interview- this is too volatile to have him as a spokesperson The Department now is responding to the story and once again playing defense to a bad story. I cannot figure out how it puts you as a target- this was as is the role of the USh - youve delegated it for now - which is your perogative but the USH holds the responsibility Im not sure what you would have suggested we could have done differen t Sent from my iPhone On Jul 19, 2017, at 10:00 PM , Poonam Alaigh ~(b) (6) > wrote : David you have to talk to me about this before you work out an action plan with John for VHA -Miguel or I were not involved and n get agreed to thisA this puts me in a vulnerable position and boxes me terribly - I now become the direct target Sent from my iPhone Begin forwarded message : From: 11Alaigh, Poonam , M .D . 11 Date: July 19, 2017 at 9:56 :58 PM GMT+ I To: 'Poonam Alaigh 1 - (b) (6) > Subject: FW: Statement on Manchester Third-Party Review Sent with Good (www.good.com ) AMERICAN PVERSIGHT VA-19-0799-G-000283 DS_ 00020999 -----Original Message----From: Wright, Vivieca (Simpson) Sent: Wednesday, July 19, 2017 04:48 PM Eastern Standard Time To: Ullyot, John; Blackbum, Scott R.; Leinenkugel, Jake; Alaigh, Poon am, M.D. Subject: RE: Statement on Manchester Third-Party Review John adding Poonam because she was not aware of this Statement. -----Original Message----From: Ullyot, John Sent: Wednesday, July 19, 2017 03 :46 PM Eastern Standard Time To: Blackbum, Scott R.; Leinenkugel, Jake; Wright, Vivieca (Simpson) Subject: Statement on Manchester Third-Party Review FYI - good news - as discussed a number of outlets informed us they are writing pieces today with Manchester VAMC whistleblowers very skeptical about the original OMI report and OM l's ability to conduct a credible reinvestigation of the same facts at Manchester VAMC. We responded with the following after discussing with SecVA (this had been my recommendation at Tuesday's staff meeting): Secretary Shulkin has been clear that the top-to-bottom review he ordered following the Boston Globe article will be comprehensive, transparent, and brand new. The Undersecretary of Health will personally supervise the review, and we're also identifying a thirdparty panel of medical experts to be named shortly who will review the final report and provide input to the VA. Manchester Veterans deserve no less. -- Curt Cashour, Press Secretary, U.S. Department of Veterans Affairs Thanks, John U. AMERICAN PVERSIGHT VA-19-0799-G-000284 OS 00021000 Message David shulkin lDrshulkin@aol.com] 7/19/2017 9:29 :14 PM Poonam Alaigh I(b) (6) @hotmail.com] Re: Statement on Manchester Third-Party Review From: Sent : To : Subject: We had talked about it and agreed not to get cornered into a third party review Miguel is the one is interviewed with the globe and suggested the third party to them 1 dont know who suggested doing that he do the interview- this is too volatile to have him as a spokesperson The Depastment now is responding to the story and once again playing defense to a bad story. 1 cannot figure out how it puts you as a target- this was as is the role of the USh - youve delegated it for now which is your perogative but the USH holds tbe responsibility Im not sure what you would have suggested we could have done different . Sent from my iPhone - On Jul 19, 2017, at 10:00 PM, Poonam Alaigh (b) (6) > wrote : David you have to talk to me about this before you work out an action plan with John for VHA Miguel or I were not involved and n get agreed to thisA this puts me in a vulnerable position and boxes me terribly - I now become the direct target Sent from my iPhone Begin forwarded message : From: 11Alaigh, Poonam, M.D~11 Date: July 19 2017 at 9:56:58 PM GMT+ l To: 'Poonam Alaigh' - (b) (6) Subject: FW: Statement on Manchester Third-Party Review Sent with Good (www.good .com ) -----Ori ginal Message----From: Wright , Vivieca (Simpson) Sent: Wednesday, July 19, 2017 04 :48 PM Eastern Standard Time To: Ullyot, John- Blackburn , Scott R.; Leinenkugel, Jake ; Alaigh, Poonam , M.D. Subject: RE: Statement on Manchester Third-Party Review John adding Poon am because sl1ewas not aware of this Statement. AMERICAN PVERSIGHT VA-19-0799-G-000285 DS 00021001 -----Original Message----From: Ullyot, John Sent: Wednesday, July 19, 2017 03 :46 PM Eastern Standard Time To: Blackbum, Scott R.; Leinenkugel, Jake; Wright, Vivieca (Simpson) Subject: Statement on Manchester Third-Party Review FYI - good news - as discussed a number of outlets informed us they are writing pieces today with Manchester VAMC whistleblowers very skeptical about the original OMI report and OM l's ability to conduct a credible re-investigation of the same facts at Manchester VAMC. We responded with the following after discussing with SecVA (this had been my recommendation at Tuesday's staff meeting): Secretary Shulkin has been clear that the top-to-bottom review he ordered following the Boston Globe article will be comprehensive, transparent, and brand new. The Undersecretary of Health will personally supervise the review, and we're also identifying a third-party panel of medical experts to be named shortly who will review the final report and provide input to the VA. Manchester Veterans deserve no less. -- Curt Cashour, Press Secretary, U.S. Department of Veterans Affairs Thanks, John U. AMERICAN PVERSIGHT VA-19-0799-G-000286 OS 00021002 Message Poonarn Alaigh I(b) (6) @hotmail.com] 7/19/2017 9:00:08 PM David ShuIkin [drshulkin@aol.com] Fwd: Statement on Manchester Third-Party Review From: Sent : To : Subject: David you have to talk to me about this before you work out an action plan with John for VHA - Miguel or I were not involved and n get agreed to thisA this puts me in a vuJnerable position and boxes me terribly - I now become the direct target Sent from m.y iPhone Begin forwarded message : - > From: 11Alaigh , Poonarn, M.D . 11 Date: July 19, 2017 at 9:56:58 PM GMT+ 1 To: 'Poonam Alaigh' (b) (6) Subject: FW: Statement on Manchester Third-Party Review Sent with Good (www .good .com ) -----Original Message--From: Wright, Vivieca (Simpson) Sent: Wednesday July 19, 2017 04 :48 PNIEastem Standard Time To: Ullyot , John ; Blackbum , Scott R. ; Leinenk'Ugel, Jake; Alaigh, Poonam , J.D. Subject: RE : Statement on Manchester Third-Party Review John adding Poonam because she was not aware of this Statement. -----Original Message----From: Ullyot., John Sent: Wednesday , July 19, 2017 03 :46 PM Eastern Standard Time To: Blackburn, Scott R. ; Leinenkugel, Jake; Wright , Vivieca (Simpson) Subject: Statement on Manchester Third-Party Review FYI - good news - as discussed a number of outlets informed us they are writing pieces today with Manchester VAMC whistleblowers very skepHcal about the original OMI report and OMl's ability to conduct a credible re-investigation of the same facts at Manchester VAMC. We responded with the following after discussing with SecVA (this had been my recommendation at Tuesday's staff meeting): AMERICAN PVERSIGHT VA-19-0799-G-000287 DS 00021003 Secretary Shulkin has been clear that the top-to-bottom review he ordered following the Boston Globe article will be comprehensive, transparent, and brand new. The Undersecretary of Health will personally supervise the review, and we're also identifying a third-party panel of medical experts to be named shortly who will review the final report and provide input to the VA. Manchester Veterans deserve no less. -- Curt Cashour, Press Secretary, U.S. Department of Veterans Affairs Thanks, John U. AMERICAN PVERSIGHT VA-19-0799-G-000288 OS 00021004 Message Davidshulkin [Drshulkin@aol.com] From: Sent: 7/20/2017 6:5 1:33 AM To: Thomas Bowman [(b) (6) Tom- @yahoo.co m] l ets try to connect about the choice funding situation today . Im in London today but cou l d connect today if you have some time Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000289 OS 00021005 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 7/25/2017 2:44:45 PM To: DavidShulkin [drshulkin@aol.com] South Korea Subject: I am going - I was thinking otherwise because of all the stuff we have to do here. But you have a great need for me- so am going- don't know what the future will handle and can lead VHAwithout the slightest be so might as well use the time I have today Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000290 OS 00021006 Message From: David Shulkin [drshulkin@aol.com] Sent : To ; 7/22/2017 4:51 :08 PM (b) (6) Darin Selnick ■■■■@gmail.com] Subject: Re: Paralyzed Veterans of America Urges Open-Minded Debate on Future Funding For Veterans Healthcare Interesting I had not seen Sent from my iPad On Jul 22, 2017, at] 2:30 PM, Darin Selnick (b) (6) mail.com> wrote: I thought you would like to see this from PVA http://www.proewswire.com/news-releases/para!yzed-veterans-of-america-urges-open-mindeddebate-on-future-funding-for-veterans-healthcare-300492566.htm1 Darin AMERICAN PVERSIGHT VA-19-0799-G-000291 DS_00021007 Message From: Sent: To ; Subject: Darin Selnick (b) (6) @gmail.com] 7/22/2017 4:30:08 PM David shulkin [Drshulkin@aol.com] Paralyzed Veterans of America Urges Open-Minded Debate on Future Funding For Veterans Healthcare I thought you would like to see this from PVA http://www .prnewswire .com/news-releases/paralyzed-veterans-of-america-urges-open-minded-debate-onfuture-funding-for-veterans-healthcare-300492566 .htrnl Darin AMERICAN PVERSIGHT VA-19-0799-G-000292 DS_00021008 Message David shulkin LDrshulkin@aol.com] 8/21/2017 10:01:33 PM Poonam Alaigh I(b) (6) @hotmail.com] Re: We. have the Grace of God From: Sent: To ; Subject: Yup lucky Sent from my iPhone On Aug 21, 2017 ~at 10:47 AJvf, Poonam Alaigh - (b) (6) wrote: http ://www .cnn .com/201 7/08/21 /poli ti cs/kfi Ie-sam-cl ovi s-lgbt-comments/i ndex. html Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000293 DS_00021009 Message From: Sent : To ; Subject: Poonam Alaigh I(b) (6) @hotmail.com] 8/21/2017 4:47:39 PM David shulkin [Drshulkin@aol.comJ We have the Grace of God http://www.cnn.com/2017/08/21/politics/kfile-sam-clovis-lgbt-comments/index .html Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000294 DS_00021010 Message From: Mail Delivery Subsystem [mailer -daemon@googlemail.com] Sent : 7/28/20 17 1:54:02 AM secshulki n@gmail .com Subject: Delivery Statu s Notification (Failure) Attachments : icon.png ; warning_triangle .png; details .bet; new ema il address To : Address not found Your me age wasn't del vered to -(b) (6) (a)hoi 111 il.c n because the addres couldn't be found heck for typos or unnecessary spaces and tr again LEARNMORE A 7hi.1lmk will take mu Ir, a J/un -pm·/1 .,it c '111~1responsefrom the remote server was: 550 5.1. 1 <(b) (6) AMERICAN PVERSIGHT @hoit mail . com> Recipient not found . VA-19-0799-G-000295 DS_00021011 Reporting-MTA: dns; Arrival-Date: Thu, googlemail.com 27 Jul X-Original-Message-ID: vV2pob 18:54:01 -0700 (PDT) Final-Recipient: rfc822; Action: failed Status: 5 . 1.1 Remote-MTA: domain 2017 dns; -@hoitmail.com (b) (6) smtp.secureserver.net. (68.178.213.37, the server for the hoitmail.com.) Diagnostic-Code: smtp; 550 5.1.1 <-@hoitmail.com> (b) (6) Recipient not found. Last-Attempt-Date: AM~RICAN pVERSIGHT Thu, 27 Jul 2017 18:54:02 -0700 (PDT) VA-19-0799-G-000296 DS_00021012 Message From: Sent: To: Subject: David Shulkin [secshulk in@gma il.com] 7/28/2017 1:54:0 1 AM l@frenchangel59 .com; bruce (b) (6) (b) @mac.com; mb (b) (6) @gmail.com; lper-@gma ( (b) b (6) (:'hoitma il.com (6) (6) (b) )new email address il.com; ( 6 Dear Friends-) I have set up a new email address just for our secure communication on issues in the future. I will use this account for future secured communications, although I will still respond to my aol account if you send me a message there as well. Thanks David Shulkin AMERICAN PVERSIGHT VA-19-0799-G-000297 OS 00021013 Message From: Sent: To: Subject: David Shulkin [secshulk in@gma il.com] 7/28/2017 1:54:0 1 AM l@frenchangel59 .com; bruce (b) (6) (b) @mac.com; mb (b) (6) @gmail.com; lper-@gma ( (b) b (6) (:'hoitma il.com (6) (6) (b) )new email address il.com; ( 6 Dear Friends-) I have set up a new email address just for our secure communication on issues in the future. I will use this account for future secured communications, although I will still respond to my aol account if you send me a message there as well. Thanks David Shulkin AMERICAN PVERSIGHT VA-19-0799-G-000298 OS 00021014 Message Poonam Alaigh I(b) (6) @hotmail.com] 7/26/2017 5:42:30 PM David shulkin [Drshulkin@aol.comJ Re: John U From: Sent : To : Subject: Of course not- but why is he inserting himself- I would never take him up on this Sent from my iPhone On Jul 26, 2017, at] :35 PM , David shulkin wrote : Im not sure - id take scott up on this Sent from my iPhone - On Jul 26, 2017 , at 1:30 PM, Poonam Alaigh (b) (6) > wrote : FYI-?? Sent from my iPhone Begin forwarded message : From: 11Alaigh, Poonam, M .D. 11 Date: July 26, 2017 at 1:30:12 PM EDT To: 'Poonam Alaigh' - (b) (6) > Subject: FW: John U Sent with Good (www .good .com) -----Original Message----From: Blackbum , Scott R. Sent: Wednesday , July 26, 2017 12: 16 PM Eastern Standard Time To: Alaigh , Poonarn, M .D. Subject: John U Hi, I know there is some friction between VHA/OPIA. Let me know if I can help . I am happy to sit down with you/John to help you guys work things out. The Depa1tment needs you both to be successfuJ . So if there is anything I can do to help that, I want to help . Just let me know . AMERICAN PVERSIGHT VA-19-0799-G-000299 DS_00021015 Scott Scott Blackburn Interim Deputy Secretary Department of Veterans Affairs AMERICAN PVERSIGHT VA-19-0799-G-000300 DS_00021016 Message David shulkin lDrshulkin@aol.com] 7/26/2017 5:35:53 PM Poonam Alaigh I(b) (6) @hotmail.com] Re: John LI From: Sent : To : Subject: Im not sure - id take scott up on this - Sent from my iPhone 011 > Jul 26, 2017, at] ;30 PM, Poonatn Alaigh (b) (6) wrote : FYI-?? Sent from my iPhone Begin forwarded message : - > From: '1Alaigh, Poonam, M .D .11 Date: July 26, 2017 at 1:30: 12 PM EDT To: 'Poonam Alaigh' (b) (6) Subject: FW: John U Sent with Good (www .good .com) -----Original Message----From: Blackbum, Scott R. Sent: Wednesday , July 26, 2017 12: 16 PM Eastern Standard Time To: Alaigh, Poonam , M .D. Subject: John U Hi, r know there is some friction between VHA/OPIA . Let me know ifl can help . I am happy to sit down with you/John to help you guys work things out. The Department needs you both to be successful. So if there is anything I can do to help that, I want to help. Just let me know . Scott Scott Blackburn AMERICAN PVERSIGHT VA-19-0799-G-000301 DS_00021017 Interim Deputy Secretaty Department of Veterans Affairs AMERICAN PVERSIGHT VA-19-0799-G-000302 DS_00021018 Message Poonarn Alaigh I(b) (6) @hotmail.com] From: Sent : 7/26/2017 5:30 :44 PM To : David Shu Ikin (drshulkin@aol.com] Fwd: John U Subject: FYI- ?? Sent from my iPhone Begin forwarded message : From: "Alaigb Poonam , M.D ." Date: July 26, 2017 at 1:30: 12 PM EDT To: 'Poonam A1aigh1 ~(b) (6) > Subject: FW: John U Sent with Good (www .good .com) -----Original Message----From: Blackbum , Scott R. Sent: Wednesday, July 26, 2017 12: ·16 PM Eastern Standard Time To: Alaigh, Poonam, M .D . Subject: John U Hi , I know there is some friction between VHNOPIA. Let me know if I can help. I am happy to sit down with you/John to help you guys work things out. The Department needs you both to be successful , So if there is anything I can do to help that, I want to help . Just Jet me know . Scott Scott Blackbum Interim Deputy Secretary Deparunell1ofVelerru.1SAffairs AMERICAN PVERSIGHT VA-19-0799-G-000303 DS 00021019 Message From: Sent: To: CC: Subject: Bruce Moskowitz [bruce (b) (6) (b) @mac.com] 8/25/2017 6:23:05 PM (6) apple.com] (b) (6) (b) (b)(6) (6) (b) (6) (b) (6) @apple.com]; Poonam Alaigh (b) (6) [secshulkin@gmail.com] VAMeeting @gmail.com];DavidShulkin Thank you for your very valuable discussion today. Your group has the talent to develop a portable medical record that brings important innovation to both patients and health care workers. what we learn from doing this for the VA will give Apple the opportunity if they decide to move forward, to bring this innovation to the general public. The history of the VA has been cooperative R&Dthat has translated to improved health care for not only Americans but the population worldwide. I mentioned just a few, the CT scan, the cardiac Stent, the Pacemaker, the nicotine patch and the hepatitis vaccine . I look forward to providing any assistance necessary for a successful outcome. sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000305 OS 00021021 Message From: Sent: To: Subject: Poonam Alaigh I(b) (6) @hotmail.com] 7/23/2017 12:43:01 AM David Shulkin [drshulkin@aol.com] Hoping You are having a great birthday one in de when I am there celebration- Happy Birthday again birthday boy- wil l have to do another sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000306 OS 00021022 Message David shulkin lDrshulkin@aol.com] 7/22/2017 5:45:39 PM Poonam Alaigh I(b) (6) @hotma ii .com I Re: Quick advice From: Sent: To : Subject: Thanks but this is not a (b) (6) But i will deal with itSent from my iPhone On Jul 22, 2017, at 1:35 PM, Poonam Alaigh- (b) (6) > wrote: Have you seen anybody- what about some PT· I know its tough with all the travel that is coming up but • • (b) (6) • • • From: David ShtJlkin Sent: Saturday , July 22, 2017 12:52 PM To: Poonarn Alaigh Subject: Re: Happy birthday Thanks Poonam I wish my (b) (6) Sent from my iPad > On Jul 221 2017 1 at 8:05 AM , Poonam Ala lgh < wrote : > > Getting started with a whole bunch of stuff and just realiied the day- happy birthday to a friend who is most dearest and precious . Wish you the worlds happiness and success on this blessed day l! A friend always and unconditionally- Poonam > > Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000307 DS 00021023 Message Poonam Alaigh I(b) (6) @hotmail.com] 7/22/2017 5:35: 19 PM David Shulkin [drshulkin@aol.com] Quick advice From: Sent: To: Subject: Have you seen anybody- what about some PT- I know its tough with all the travel that is coming up but • • • • • (b) (6) From: David Shulkin Sent: Saturday, July 22, 2017 12:52 PM To : Poonam Alaigh Subject : Re: Happy birthday Thanks Poonam I wish my (b) (6) Sent from my iPad > On Jul 22, 2017, at 8:05 AM , Poonam Alaigh < (b) (6) @hotma il.com> wrote : > > Getting started with a who le bunch of stuff and just realized the day- happy birthday to a friend who is most dearest and precious . Wish you the worlds happ iness and success on this blessed day!! A friend always and unconditional ly- Poonam > > Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000308 OS 00021024 Message From: David shulkin [Drshulkin@aol.com] Sent: 7/20/2017 4:08:08 PM To: (b) (6) Thomas Bowman ■■■■■■l@vahoo.com] Heard it went well todayAny sense that Did you feel we can get a vote before good about it? recess? Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000309 OS 00021025 Message From: Poonam Alaigh (b) (6) Sent: 7/28/2017 11:0 1:07 PM .com; mb (b) (6) @gmai l.com (b) (6) @gmail.com]; bruce (b) (6) (b) @mac.com; l@frenchangel59 ( L Perl ■■■ To: @gmail .com] b ) ( 6 ) Human Services that they won't be able to We just got notified from Medicare in the Department of Health and CC: Subject: David Shulkin [Secshulkin@gma il.com] Hospita l Star Ratings (6) do star ratings for our hospitals until December 2018. As a solution to this and knowing how critical it is for us, David and I have our quality teams working on using the same methodology to develop star ratings for our hospitals that compare to the private hospitals . We hope to have something that we can share with you in the next 3-4 weeks . We will need to involve "the Five" as part of this discussion. More when we speak on Sunday AMERICAN PVERSIGHT VA-19-0799-G-000310 OS 00021026 Message From: Sent: To : David Shulkin (drshulkin@aol.com] 8/2/2017 11:17 :49 PM Poonam Alaigh I(b) (6) @hotmail.com) http://amp.tmz.com/2017 /08/02/v-a-secretary-david-shul kin-transgenders-donal d-trump-mi Iitary-ban Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000311 DS_00021027 Message From: David shulkin [Drshulkin@aol.com] Sent: 7/19/2017 9:56:06 PM To: (b) (6) Thomas Bowman ■■■■■■l@vahoo.com] Heard it went well todayAny sense that Did you feel we can get a vote before good about it? recess? Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000312 OS 00021028 Message IP !1@frenchangel59.com] ( 7/14/2017 10:04:34 PM b David ) shulkin [drshulkin@aol.com] FW:( Article - Darin Selnick From: Sent : To : Subject: 6 ) FYI ( @frenchange1S9.com] From: IP [mailto ■ Sent: Friday, Julyb 14, 2017 4:51 PM ) C. EOP/WHO' To: 'Kushner,Jared ( - Darin Selnick Subject: RE: Article 6 ) David is very upset. Right now David is overseas - on his return we'll talk . Have a nice Shabbas and give our love to lvanka. (b From: Kushner,Jared C. EOP/WHO[ mailto ■@who.eop.gov] ) Sent: Friday, July 141 2017 4:27 PM (6) To: IP Subject: Re: Article - Darin Selnick This is (b) (5) Sent from my iPad On Jul 13, 2017, at 4:33 PM, IP wrote: b ) I don't have to say anything; just look at the highlighted. ( 6 ) >http:// da ilycal ler. com /2016/ 10/20/va -slowed -privat e-care-option-by-hi ri ng-fi rm-pentagon -fired/< VA Slowed Private Care Option By Hiring Firm Pentagon Fired Luke Rosiak, Investigative Reporter 10:45 PM 10/20/2016 Officials with the Department of Veterans Affairs {VA) chose a contractor to run its Choice Card program who was previously fired for allegedly defrauding the government after working on a similar contract with the Department of Defense (DOD.) The contractor , TriWest, now takes so long to schedule appointments with private healthcare providers that many veterans could shorten wait times by opting for traditional VA care, whose delays Choice was intended to allow veterans to escape. Choice Card links vets with private doctors, but VA seemingly tried to sabotage the program, fearing it jeopard izes its budget. AMERICAN PVERSIGHT VA-19-0799-G-000313 DS_00021029 TriWest contracts to administer parts of Tricare , the active military's healthcare system, since 1996, TriWest paid $10 million in September, 2011, to settle charges that it defrauded the government by negotiating low prices with doctors but not passing the resulting savings .on to taxpayers . "Those who overbill Tricare threaten to undermine the health care provided to our men and women in uniform,'' Tony West , assistant attorney general for the Civil Division of the Department of Justice, said of the legal settlement at the time. But the standards seem to be lower for care owed to those who former ly wore the unifo rm of the U.S. military, because VA gave TriWest a contract in September, 2013, to run its Community Care program, a precursor to Choice Card that allowed veterans to use private doctors in some circumstances. Inspector genera l reports said that prog ram was run poorly, pointing the blame both at TriWest and the way VA set up their work. Meanwhile, Congress created the Choice Card program to enable any veteran delayed more than 30 days for VA care, or who didn't live close to a VA facility, t o seek private health care services. VA managers and leaders of the American Federation of Government Employees (AFGE)union , which represents most of the department's employees opposed it, fearing that fewer veterans in the government system would mean smaller budgets and fewer civil service jobs. When VA leaders claimed budget shortfalls threatened closure of hospitals, they asked Congress to Jet them re-purpose $3.3 billion originally authorized for the Choice Card prog ram . When the bill became law anyway, VA gave the Choice Card contract to TriWest and HealthNet , another company that worked on Community Care. A VA spokesperson said that "i n order to enact [Choice] within 90 days, VA held an industry day to try to partner with ind ustry to operate the program. Unfortunately, given the timeline set to roll out the program , VA's only option was to modify a previously existing natio nal community care contract, which was never intended to handle the scope" of the Choice Card model. Official data obtained by The Daily Caller News Foundat io n shows that more vets are now waiting months for pri vate care because contractors take so long to schedule appointments. Consequently, VA bureaucrat s and their union will likely get the result they sought: veterans going back into the government healthcare system despite its delays. Private care doctors aren't happy with the Choice Card initiative either, because the companies, which also manage payments , have been so slow to pay, causing many private care physicians to refuse veterans, leading to the same result . A knowledgeable VA source told TheDCNF that after a patient does finally see a private doctor, TriWest takes up to 75 days to get the medical results of that appointment back into the VA system. That makes followup care impossible. Darin Selnick, an Air Force veteran and fo r mer VA official under George W. Bush who now runs Concerned Veterans For America's Fixing Veterans Health Care Taskforce, said that "TriWest and Health Net may not have been the best choices," but much of th e failure is because VA " didn't want it to work ." AMERICAr-... pVERSIGHT VA-19-0799-G-000314 D8_00021030 Officials at VA "didn't like the idea of patients going outside ," because "what does any organization want to do? It wants to get more money, more people, more power, it wants to grow," Selnick added . Scheduling delays happen because the system has a middleman, Selnick said. What other health care plan has "a system where you have to call a 1-800 number and they set up an appointment for you" with a provider that they select?," he asked. Half of all veterans are on Medicare anyway, so the VA should simply pay a small supplement to Medicare providers , instead of creating multiple administrative layers of VA bureaucrats and contractors in between veterans and healthcare workers, Selnick noted, wh ich would purportedly save billions of tax dollars annually. Those close to the issue bel ieve "the chief problem with Choice is that we've had to rely on VA to implement it , and the department is just not very good at implementing things ," a spokesman for the House Committee on Veterans Affairs , which designed the Choice Card program, told TheDCNF The committee never requested a th ird-party administrator to schedule appointments , the spokesman noted. Companies involved in the Choice program defend their record. "Overall , TriWest is processing 90% of clean claims from prov iders within 30 days," the company explained , adding that it got "except ional" and "very good" performance ratings for its Tricare work, and saved the mil itary money , but voluntarily entered a settlement on the assumption that more savings were possible. Hiring people with pr ior records of failure is a pattern at VA. When hospital directors come under criticism for poor management, VA executives routinely remove them , then reinstate them at another hospita l where the poor performance cont inues. Only weeks after the Chicago VA fired Deloris Judd from the federal workforce for patient abuse and dishonesty, the Phoenix VA hired her to wor k on the Choice Card program . AMERICAr-... pVERSIGHT VA-19-0799-G-000315 D8_00021031 Message L Perl (b) (6) @gmail.com] 7/13/2017 12:38:02 AM Poonam Alaigh I(b) (6) @hotmail.com] Bruce Moskowitz [bruce (b) (6) (b) @mac.comJ;l@frenchangel59.com; ( Marc Sherman (mb (b) (6) @gmail.com] (6) b Re: See DUNKIRKEarly in IMAX and Support Veterans ) . From: Sent : To ; CC: Subject: David shulkin [drshulkin@aol.com]; ( 6 The head of IMAX is a very close friend of ours and very) much wants to help our vets .. Best ....L On Wed, Jul 12, 2017 at 6 : 15 PM , Poonam AJaigh ~(b) (6) > wrote: Yes this is awesome-we have to see if we can get the others to do the same thing in honor of our Veterans for the relevant movies Sent from my iPhone On Jul 12, 2017, at 6:43 PM, Bruce Moskowitz Exclusive PrewRelease IMAX Screening of Dunkirk to Support Veterans For a donation of $50 to MPTF's Veterans Benefits Assistance Program , you can attend an exclusive pre-release screening of DUNKIRK in IMAX. The Veterans Benefits AMERICAN PVERSIGHT VA-19-0799-G-000316 DS_00021032 Assistance Program helps entertainment industry military veterans , their surviving spouses , and their families obtain VA pension benefits that they are entitled to but may need help navigating the maze of VA paperwork to access. MPTF's social workers walk veterans and their families through the VA claims process every step of the way until benefit awards are received. In the past year , MPTF has screened nearly 700 entertainment industry military veterans and their surviving spouses , helping them to collectively obtain over $200 ,000 in retroactive benefits plus additional ongoing monthly support. Please help us he!p a veteran by making a gift today. For each donation of $50 you will receive a special invitation to attend an exclusive advance screening of Dunkirk on July 19th at 7PM at AMC Century City 15 in I MAX with popcorn and a soft drink included . Your contribution will help MPTF to serve those in our industry who have served our country. Home I Privacy Policy I Email Preferences MPTF The Wasserman Campus I 23388 Mulholland Drive I Woodland Hills CA 91364 Toll-free 855-760-MPTF I Donor Relations 818-876-1977 1MPTF Foundation 818-876-1900 info@mptf .com AMERICAN PVERSIGHT VA-19-0799-G-000317 OS 00021033 MAKE A GIFT VOLUNTEER It's easy to llpdate yollr Email Preferences . Be sure to add info@mptf .com to your address book or safe senders list so our emails get to your inbox You may also review our Privacy Policy AMERICAN PVERSIGHT VA-19-0799-G-000318 DS_00021034 Message From: David shulkin [Drshulkin@aol.com] Sent: 7/12/2017 6:11:42 PM l@frenchangel59.com ( Subject: bRe: See DUNKIRK Early in IMAX and Support Veterans. ) ( 6 I did- seems good ) To: Sent from my iPhone (b @frenchangel59 (b On Jul 12, 2017, at 6 :35 PM, <1 .com> wrote : ) (6 I don't know if you saw this. ) ) (6 ) See an Advance Screening of DUNKIRK ill IMAX When You Support Industry MiNtary Veterans Exclusive Pre-Release IMAX Screening of Dunkirk to Support Veterans For a donation of $50 to MPTF's Veterans Benefits Assistance Program , you can attend an exclusive pre-release screening of DUNKIRK in IMAX. The Veterans Benefits Assistance Program helps entertainment industry military veterans , their surviving spouses , and thei r families obtain VA pension benefits that they are entitled to but may need help navigating the maze of VA paperwork to access , MPTF 's social workers walk veterans and their families through the VA claims process every step of the way until benefit awards are received . In the past year , MPTF has screened near ly 700 entertainment industry military veterans and their surv iving spouses , helping them to collective ly obta in over $200 ,000 in retroactive benefits plus additional ongoing monthly support . Please help us help a veteran by making a gift today. For each donation of $50 you will receive a spec ial invitatio n to attend an exclusive advance screening of Dunkirk on July 19th at 7PM at AMC Century City 15 in IMAX with popcorn and a soft drink included . Your contribution will help MPTF to serve those in our industry who have served our country. AMERICAN PVERSIGHT VA-19-0799-G-000319 OS 00021035 Home I Privacy Polley I Email Preferences MPTF The Wasserman Campus I 23388 Mulholland Drive I Woodland Hills, CA 91364 Toll-Free: 855-760-MPTF I Donor Relations : 818-876-1977 1MPTF Foundation : 818-876-1900 info@mptf .com MAKE A GIFT VOLUNTEER It's easy to update your Emall Preferences . Be sure to add info@mptf .com to your address book or safe senders 11st so our emails get to your inbox. You may also review our Privacy Policy . AMERICAN PVERSIGHT VA-19-0799-G-000320 OS 00021036 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com] 7/12/2017 4:43:31 PM (6) From: Sent : l@frenchangel59.com ( bDavid shulkin [drshulkin@aol.com]; Poonam Alaigh I(b) (6) @hotmail.com]; Marc Sherman )[m b-■l@gmail.com] ; Curtis .Coy@va.gov; lper-@gmail.com (b) (6) (b) (Re: See DUNKIRK Early in IMAX and Support Veterans (6). 6 ) To : CC: Subject: This is very magnanimous Sent from my iPad Bruce Moskowitz M .D . On Jul 12, 2017, at 12:35 PM 1( @frenchangel59.com wrote : b ) I don't know if you saw this. ( 6) See an Adva nce Screening of DUNKIRK ill IMAX When You Support /ndm;l!y MiNtary Veterans - ~ ~~ ~ - ~- - - - ~ -------=----=-=---------=----- §iir,e""1 ~......--...t .. -~ Exclusive Pre-Release IMAX Screening of Dunkirk to Support Veterans For a donation of $50 to MPTF's Veterans Benefits Assistance Program , you can attend an exclusive pre~release screening of DUNKIRK in IMAX. The Veterans Benefits Assistance Program helps enterta inment industry military veterans their surviving spouses , and their families obtain VA pension benefits that they are entitled to but may need help navigating the maze of VA paperwork to access . MPTF's social workers walk veterans and their families through the VA claims process every step of the way until benefit awards are received . In the past year , MPTF has screened nearly 700 entertainment industry military veterans and their surv iving spouses , helping them to collectively obtain over $200 ,000 in retroactive benefits plus additional ongoing monthly support. Please help us help a veteran by making a gift today. For each donation of $50 you will receive a special invitation to attend an exclusive advance screening of Dunkirk on July 19th at 7PM at AMC Century City 15 in IMAX with popcorn and a soft drink included . AMERICAN PVERSIGHT VA-19-0799-G-000321 DS_00021037 Your contribution will help MPTF to serve those in our industry who have served our country. Horne I Privacy Policy I Email Preferences MPTF The Wasserman Campus I 23388 Mulholland Drive I Woodland Hills, CA 91364 Tall-free 855-760-MPTF I Donor Relations . 818-876-1977 1MPTF Foundation · 818-876-1900 info@mptf .com MAKE A GIFT VOLUNTEER It's easy to update your Email Preferences. Be sure to add info@mptf.com to your address book or safe senders list so our emails get to your inboX. You may also review our Privacy Policy. AMERICAN PVERSIGHT VA-19-0799-G-000322 DS_00021038 Message From: Sent : To : CC: Subject: l@frenchangel59.com i1@frenchangel59 .com] ( ( b7/12/2017 4:35 :19 PM b 'Poonam Alaigh' I(b) (6) [?hotmail.com]; 'Marc Sherman' )'David shulkin' [drshulkin@aol.com]; ) ([mbt!!!!lll@gmail.com]; ( 'Bruce Moskowitz' [bruce (b) (6) (b) @mac.com]; Curtis.Coy@va.gov (b) (6) 6lper-@gmail.com 6 (6) (b) )FW: (6) ) IMAX and Support Veterans. See DUNKIRK Early in I don't know if you saw this. See an Advance Screening of DUNKIRK in IMAX When You Support lndust,y Milita,y Veterans ~ULY- 11, 2017 VISlrT OUR ·WEB SITE . I Exclusive Pre-Release IMAX Screening of Dunkirk to Support Veterans For a donation of $50 to MPTF's Veterans Benefits Assistance Program , you can attend an exclusive pre-release screening of DUNKIRK in IMAX. The Veterans Benefits Assistance Program helps entertainment industry military veterans , their surviving spouses, and their families obtain VA pension benefits that they are entitled to but may need help navigating the maze of VA paperwork to access . MPTF's social workers wa lk veterans and their fami lies through the VA claims process every step of the way until benefit awards are received. In the past year , MPTF has screened nearly 700 entertainment industry military veterans and their surviving spouses, helping them to collective ly obtain over $200 ,000 in retroactive benefits plus additional ongoing monthly support . Please help us help a veteran by making a gift today. For each donation of $50 you wil l receive a special invitation to attend an exclusive advance screening of Dunkirk on July 19th at 7PM at AMC Century City 15 in IMAX with popcorn and a soft drink included. AMERICAN PVERSIGHT VA-19-0799-G-000323 OS 00021039 Your contribution will help MPTF to serve those in our industry who have served our country. fy'!PTF Suppo,ters just like you hetp ·to make a difference every day, MAKE A GIFT Home I Privacy Policy I Email Preferences MPTF The Wasserman Campus I 23388 Mulholland Drive IWoodland Hills, CA 91364 Tol l-free 855-760-MPTF I Donor Relations : 818-876-1977 I MPTF Foundation 818-876-1900 info@mptf .com MAKE A GIFT VOLUNTEER It's easy to update your Email Preferences . Be sure to add info@mptf .com to your address book or safe senders list so our emails get to your inbox. You may also review our Privacy Policy . AMERICAN PVERSIGHT VA-19-0799-G-000324 OS 00021040 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 7/19/2017 4:09:53 PM Bruce Moskowitz [brucem~@mac .com] (b) (6) (b) ( (b) (6) L Perl (6) [-@gmail.com]; IP [~frenchangel59.com]; (b)b(6) [~hotmail.com] Re:)Kaiser Permanente and managed care Subject: ( 6 ) This is really good guidance To: (b) (6) mb-@gma CC: il.com; Poonam Alaigh Thanks Bruce sent from my iPhone (b) (6) (b) > on Jul 19, 2017, at 2:44 PM, Bruce Moskowitz wrote: (6) > I spoke with the senior administrators to get their thoughts on managed care contracting and the VA. The takeaway points: > The VA should first look to contract with large not for profit health systems, Geisinger, intermountain, Partners etc. > > > If the VA contracts with Humana etc there will be more risk for cost containment, controls and most important serious ability to access care in a timely fashion. quality of care > > claims have to be processed > > The not for profits in 30 days to have credibility. use Peer to Peer review to maintain quality of care and prevent over utilization > > Kaiser has "secret shoppe rs" to check on a 77 aspects > > claims over 5,000 dollars are meticulously of care. reviewed by administrators and physicians > > The VA has no system in place to direct Veterans to the correct hospital and emergency center geographic region. Kaiser is also struggling with this. MGHhas a system. > > Discharge planning is a significant system in place. in a problem for the choice program and needs to have an automated > > Access to appointments with electronic advanced in the non profit system . monitoring of followup and ancillary testing access is more > > > > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000325 OS 00021041 Message Bruce Moskowit z [bruce~@mac .com] (b) (6) (b) (6) Sent: 7/19/2017 1:44:31 PM To: IP [ll@frenchangel59 .com]; L Perl [(b) (6) @gmail.com];mb-@gmail.com; Davidshulkin ( (b) (6) b [drshulkin@aol.com]; Poonam Alaigh [(b) (6) @hotmail.com] ) Permanente and managed care Kaiser Subject: ( 6 ) I spoke with the senior administrators to get their thoughts on managed care contracting and the VA. The takeaway points: The VA should first look to contract with large not for profit health systems, Geisinger, intermountain, Partners etc. From: If the VA contracts with Humana etc there will be more ris k for cost containment, controls and most important serious ability to access care in a timely fashion . claims have to be processed The not for profits Kaiser has "secret in 30 days to have credibility use Peer to Peer review to maintain shoppers" claims over 5,000 dollars to chec k on all are meticulously aspects quality of care . quality of care and prevent over utilization of care. reviewed by administrators and physicians The VA has no system in place to direct Veterans to the correct hospital and emergency center geographic region . Kaiser is also struggling with this. MGHhas a system. Discharge planning in place. is a significant Access to appointments with electronic advanced in the non profit system. in a problem for the choice program and needs to have an automated system monitoring of followup and ancillary testing access is more sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000326 OS 00021042 Message (b) (6) From: (b) (b)(6) (6) Sent : 7/11/2017 6:08:12 PM To : (b) (6) p.org] (b) (6) (b) .edu] M .D. ■■■■■■lmayo David shulkin [Drshulkin@aol.com]; Ike Perlmutter [1@frenchangel59 .com); Laurie Perlmutte r (6) ( (b) (6) @gmail.com]; Bruce Moskowitz [brucem b(b) (6) (b) @mac.com]; M;:irc Sherman CC: ) (6)(b) (6) (b) (6) @ccf.org]; [mb (b) (6) @gmail.com) ; (b) (6) ■-■ ( vl.D. (b) (6) @PARTNERS.ORG) 6 Re: VA update Subject: (b) (6) (b) (6) ■••@jhmi.edu); ) Totally agree. Progress in deed!! Sent from my iPhoae On Jul 9, 2017 at 7:59 PM, (b) (6) M.D . (b) (6) (b) (6) Caution:This email came from outside Kaiser Permanente. Do not open attachmenlsor click on links if _ou do not recognizeLbesender. David - trus is an impressive set of changes in a vety short peiiod of time! You are making bold moves and we are supportive and proud of your example . Well done David . We remain here to help you if you see something we can do to be supportive . My best. (b) Ill (6) (b) (6) M.D. President and CEO Mayo Clinic Administration (b) (6) (b) (6) (b) (6) Mayo Clinic (b) (6) www.mavoclinic.org On Jul 9, 20 17, at 8:52 AM, David shulkin wrote: Dear Colleagues- I know we have not had a call recently and therefore I wanted to provide you with just a brief update on recent activities . Thanks to your guidance we have been making a lot of progress recently . For purpose of brevity , I will just mention a few. 1) Accountability- we had the new law passed two weeks ago and since then have been making big changes to the culture. We are communicating AMERICAN PVERSIGHT VA-19-0799-G-000327 DS_00021043 internally that people will be held accountable and have removed, suspended or demoted close to 800 people, As important I have taken two additional steps. First, we are the first agency ever to commit to publishing our accountability actions- part of my goal to be the most transparent organization in government. Second, we are now requiring a signoff on all settlements with employees- as we had a system that was out of control giving millions to employees to make them go away rather than to take appropriate actions . 2) Technology- we are making good progress on the EMR - and are engaging EPIC as well as Gerner in the discussions . We still do not have a CIO- which makes it challenging - but I have now identified a truly remarkable candidate that I am beginning the vetting process on. In addition we will be announcing new programs in national access to telehealth at the end of the month that will be a game-changer for veterans . 3) Choice- we are seeking an immediate re-authorization of the Choice program and are working with Congress to get that done before the summer recess. We are making good progress for a bill in the Fall that would eliminate the 40/30 rules and give much broader access to Choice and add quality parameters to the ensure that veterans get the best quality care . 4) Facilities- I have recently published our list of 1100 vacant or underutilized facilities and plans to immediately move on 142 of these with a commitment to address all within 2 years . We do need some legislative help with this and we are working with leadership to get this done. We are also working much closer with DOD to integrate facility planning and with the private sector about public private partnerships. 5) Strategic Shifting of Priorities- All facilities are now presenting plans to me to shift resources towards "foundational services" for veterans that include programs like PTSD treatment, traumatic brain injury, prosthetics, behavioral health, spinal cord injury, war related injuries, blind rehabilitation, and away from general services that can be dealt with better in the private sector. This is having a big impact on the way that people are thinking about how we invest in the future . 6) Disability redesign- This turns out to be a fundamental issue for us. This system is so broken that it is actually driving inappropriate demand on the healthcare side . The Commission on Care identified this as a big issue and this is something I am now beginning to address . We are making progress on get our time to deal with claims much lower. We have a new process that will take claims from 125 days down to under a week and we are rolling this out in September. 7) Suicide prevention- our biggest push here will be to work towards autoenrollment for service members that are leaving to enter the VA. Last week I learned that when we went back to look at a large number of young veterans that had committed suicide that the average gap in time for treatment from leaving service to getting VA care was 1.5 years. That is just way too long. AMERICAN PVERSIGHT VA-19-0799-G-000328 OS 00021044 Lots more is going on but this gives a flavor. I will be leaving mid week for an international confe rence on veterans affairs in London with our allies, but should be in touch on email or phone if you need me (international numbe (b) (6) Th anks again for your continued support. David Shulkin NOTICETO RECIPIENT: If you are not the intended recipient of this e-mail , you are prohibited from sharing, copying , or otherwise using or disclosing its contents. If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them . Thank you. AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000329 DS 00021045 Message David shulkin LDrshulkin@aol.com] 7/9/2017 7 :58:39 PM L Perl (b) (6) @gmail.com) Re: VA update From: Sent : To : Subject: Thank you Laurie- its been you and Ike that has given us all the needed support to do what needs to be done- we are all etemally grateful David Sent from my iPhone OuJuJ 9, 2017, at 3:46 PM, L Perl- (b) (6) > wrote: David ---such tremendous achievements in a re]atively short period of time Congratulations! Best ..Laurie On Sun, Jul 9, 2017 at 9:52 AM, David shulkin wrote: Dear Colleagues- I know we have not had a call recently and therefore I wanted to provide you wtt:hjust a brief update on recent activities . Thanks to your guidance we have been making a lot of progress recently. For purpose of brevity , I will just mention a few. 1) Accountability- we had the new law passed two weeks ago and since then have been making big changes to the culture. We are communicating interna lly that people will be held accountable and have removed, suspended or demoted close to 800 people, As important I have taken two additional steps . First, we are the first agency ever to commit to publishing our accountability actions• part of my goal to be the most transparent organization in government. Second , we are now requiring a sign off on all settlements with employees- as we had a system that was out of control giving millions to employees to make them go away rather than to take appropriate actions. 2) Technology- we are making good progress on the EMR - and are engaging EPIC as well as Cerner in the discussions. We still do not have a CIO- which makes it challenging - but I have now identified a truly remarkable candidate that I am beginning the vetting process on. In addition we will be announcing new programs in national access to telehealth at the end of the month that will be a gamechanger for veterans . 3) Choice- we are seeking an immediate re-authorization of the Choice program and are working with Congress to get that done before the summer recess . We are making good progress for a bill in the Fall that would eliminate the 40/30 rules and give much broader access to Choice and add quality parameters to the ensure that veterans get the best quality care. 4) Facilities- I have recently published our list of 1100 vacant or underutilized facilities and plans to immediately move on 142 of these with a commitment to address all within 2 years . We do need some legislative help with this and we are working with leadership to get this done . We are also working much closer with DOD to integrate facility planning and with the private sector about public private partnerships . AMERICAN PVERSIGHT VA-19-0799-G-000330 DS 00021046 5) Strategic Shifting of Priorities- All facilities are n0w presenting plans to me to shift resources towards ''foundationa l services" for veterans that include programs like PTSD treatment , traumatic brain injury, prosthetics , behaviora l health , spinal cord injury, war related injuries, blind rehabilitation , and away from general services that can be dealt with better in the private sector. This is having a big impact on the way that people are thinking about how we invest in the future . 6) Disability redesign- This turns out to be a fundamental issue for us. This system is so broken th-at it is actually driving inappropriate demand on the healthcare s ide. The Commission on Care identified this as a big issue and this is something I am now beginning to address . We are mal wrote : Dear Colleagues- I know we have not had a call recently and therefore I wanted to provide you with just a brief update on recent activities . Thanks to your guidance we have been making a lot of progress recently . For purpose of brevity, I will just mention a few . 1) Accountability- we had the new law passed two weeks ago and since then have been making big changes.to the culture . We are communicating internally that people will be held accountable and have removed, suspended or demoted close to 800 people, As important I have taken two additional steps . First, we are the first agency ever to commit to publishing our accountability actions- part of my goal to be the most transparent organization in government, Second , we are now requiring a signoff on all settlements witll employees- as we had a system tllat was out of control giving millions to employees to make them go away rather than to take appropriate actions , 2) Technology- we are making good progress 011the EMR - and are engaging EPIC as well as C.erner in tne discussions. We still do not have a CIO- which makes it challenging - but I have now identified a truly remarkable candidate that I am beginning the vetting process on. In addition we will be announcing new programs in national access to te lehealth at the end of the month that will be a game-changer for veterans . 3) Choice- we are seeking an immed iate re-authorization of the Choice pr0gram and are working with Congress to get that done before the summer recess. We are rnaking good progress for a bill in the Fall that would eliminate the 40/30 rules and give much broader access to Choice and add quality parameters to the ensure that veterans get the best quality care. 4) Facilities- I have recently published our list of 1100 vacant or underutilized facilities and plans to immediate ly move on 142 of these with a commitment to address all within 2 years. We do need some legislative help with this and we are working with leadership to get this done. We are alsoworking much closerwtth DOD to integrate facility planning and with the private sector about public private partnerships . 5) Strategic Shifting of Priorities- All facilities are now presenting plans to me to shift resources towards "foundational services" for veterans that include programs like PTSD treatment, traumatic brain injury , prosthetics, behavioral health, spinal cord injury, war related injuries, blind rehabilitation, and away from general services that can be dealt with better in the private sector. This is having a big impact on the way that people are thinking about how we invest in the future . AMERICAN PVERSIGHT VA-19-0799-G-000332 DS 00021048 6) Disability redesign- This turns out to be a fundamental issue for us. This system is so broken that it is actually driving inappropriate demand on the healthcare side. The Commission on Care identified this as a big issue and this is something I am now beginning to address . We are making progress on get our time to deal with claims much lower . We have a new process that will take claims from 125 days down to under a week and we are rolling this out in September. 7) Suicide prevention- our biggest push here will be to work towards autoenrollment for service members that are leaving to enter the VA. Last week I learned that when we went back to look at a large number of young veterans that had committed suicide that the average gap in time for treatment from leaving service to getting VA care was 1.5 years. That is just way too long. Lots more is going on but this gives a flavor. I will be leaving mid week for an international conference on veterans affairs in London wtth our allies , but should be in touch on email or phone if you need me (international number (b) (6) Thanks again for your continued support. David Shulkin AMERICAN PVERSIGHT VA-19-0799-G-000333 D8_00021049 Message From: David shulkin [Drshulkin@aol.com] Sent: 7/9/2017 1:52:36 PM To: Ike Perlmutter [ll@frenchangel59.com]; Laurie Perlmutter (b) (6) @gmail.com]; Bruce Moskowitz ( [bruce (b) (6) b(b) @mac.com]; Marc Sherman [mb (b) (6) @gmail.com]; (b) (6) (b) (6) @ccf.org]; .D. kp.org]; (b) (6) ) (6) (b) (6) (b) (b) (6) (6) (b) (6) @jhmi.edu]; (b) (6) (@PARTNERS.ORG];(b) (6) (b) (6) (b) (6) (b) 6 VA update (6) Subject: ) Dear Colleagues- I know we have not had a call recently and therefore I wanted to provide you with just a brief update on recent activities. Thanks to your guidance we have been making a lot of progress recently . For purpose of brevity, I will just mention a few. 1) Accountability- we had the new law passed two weeks ago and since then have been making big changes to the culture . We are communicating internally that people will be held accountable and have removed, suspended or demoted close to 800 people, As important I have taken two additional steps . First, we are the first agency ever to commit to publishing our accountability actions- part of my goal to be the most transparent organization in government. Second, we are now requiring a signoff on all settlements with employees- as we had a system that was out of control giving millions to employees to make them go away rather than to take appropriate actions . 2) Technology- we are making good progress on the EMR - and are engaging EPIC as well as Gerner in the discussions . We still do not have a CIO- which makes it challenging - but I have now identified a truly remarkable candidate that I am beginning the vetting process on. In addition we will be announcing new programs in national access to telehealth at the end of the month that will be a game-changer for veterans . 3) Choice- we are seeking an immediate re-authorization of the Choice program and are working with Congress to get that done before the summer recess . We are making good progress for a bill in the Fall that would eliminate the 40/30 rules and give much broader access to Choice and add quality parameters to the ensure that veterans get the best quality care . 4) Facilities- I have recently published our list of 1100 vacant or underutilized facilities and plans to immediately move on 142 of these with a commitment to address all within 2 years . We do need some legislative help with this and we are working with leadership to get this done . We are also working much closer with DOD to integrate facility planning and with the private sector about public private partnerships . 5) Strategic Shifting of Priorities- All facilities are now presenting plans to me to shift resources towards "foundational services" for veterans that include programs like PTSD treatment, traumatic brain injury, prosthetics , behavioral health, spinal cord injury, war related injuries, blind rehabilitation, and away from general services that can be dealt with better in the private sector . This is having a big impact on the way that people are thinking about how we invest in the future. 6) Disability redesign- This turns out to be a fundamental issue for us. This system is so broken that it is actually driving inappropriate demand on the healthcare side. The Commission on Care identified this as a big issue and this is something I am now beginning to address. We are making progress on get our time to deal with claims much lower. We have a new process that will take claims from 125 days down to under a week and we are rolling this out in September. AMERICAN PVERSIGHT VA-19-0799-G-000334 OS 00021050 7) Suicide prevention- our biggest push here will be to work towards autoenrollment for service members that are leaving to enter the VA. Last week I learned that when we went back to look at a large number of young veterans that had committed suicide that the average gap in time for treatment from leaving service to getting VA care was 1.5 years. That is just way too long. Lots more is going on but this gives a flavor. I will be leaving mid week for an international conference on veterans affairs in London with our allies, but should be in touch on email or phone if you need me (international number (b) (6) Thanks again for your continued support. David Shulkin AMERICAN PVERSIGHT VA-19-0799-G-000335 OS 00021051 Message David shulkin [Drshulkin@aol.com] 7/17/2017 7:02:22 AM Poonam Alaigh [-@hotmail.com] (b) (6) Re: Did you let Ike know From: Sent: To: Subject: Interesting that Access is pretty our access to care site has no quality mediocre to poor and satisfaction ratings for new hampshire is high Sent from my iPhone (b) (6) > on Jul 17, 2017, at 6:18 AM, Poonam Alaigh <-@hotmail . com> wrote: > > > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000336 OS 00021052 Message David shulkin [Drshulkin@aol.com] 7/17/2017 5:41:18 AM Poonam Alaigh I(b) (6) @hotmail.com] Re: Did you let Ike know From: Sent: To: Subject: Yes Sent from my iPhone > on Jul 17, 2017, at 6:18 AM, Poonam Alaigh <-@hotmail.com> (b) (6) wrote: > > > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000337 OS 00021053 Message From: Sent: To: Subject: Poonam Alaigh I(b) (6) @hotmail.com] 7/17/2017 5:18:42 AM Drshul kin@aol .com Did you let Ike know sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000338 DS_ 00021054 Message Davidshulkin [Drshulkin@aol.com] 7/11/2017 3:30:14 PM Sent: To: Marc Sherman [ mbtl■■ (b) (6) @gmail.com]; Bruce Moskowit z [bruce (b) (6) (b @mac.com]; Ike Perlmutter [llt@frenchangel59.com] ) ( Subject: Fwd: (6) b ) ( 6 Peter's bac kground ) Sent from my iPhone From: Begin forwarded message: > > > > > > > https: // www.lin kedin . com/ in / petershelby sent with Good (www.good.com) AMERICAN PVERSIGHT VA-19-0799-G-000339 OS 00021055 Message Bruce Moskow itz [bruce (b) (6) (b) @mac.com) 7/11/2017 3:31 :57 PM (6) David shulkin [Drshulkin@aol.comJ Ike Perlmutter ■ ( @frenchangel59.com]; Marc Sherman [mb (b) (6) @gmail.com] Re:CIO b From: Sent : To : CC: Subject: ) ( 6 If you can get Radu he is superb a forward thinker. He has led many conferences and is highly regarded. As for ) your Annals article it is well done . Sent from my iPad Bruce Moskowitz M .D . On Jul 11, 2017 , at 11: 10 AM, David sbulkin wrote : Were meeting some good cio candidates- and my thinking is to take your advice (always a good idea) and take several people to help get a real talent pool on board . One guy i really like because of military, government, health and emr, and private sector experience is-(b) (6) good references too-his CV is attached . Another guy that interviewed very well with my team (but i did not meet yet) is Radu Shrestha- he is the CTO at the university of pittsburg medical center . He nay be perfect as CIO of the health administration- a position we never had but really need. Bruce have you heard of him? We need to keep it confidential at this point as they dont know he is looking until we indicate we are ready to move forward- 1 will meet him as soon as 1 return . David Sent from my iPhone Begin forwarded message : F.-om: DJS Date: July 1 1, 2017 at 10:57 :55 AM EDT To: 'Shulkin 1 Subject: FW: (No Subject) Sent with Good (www.good .com) -----Original Message----- F.-om:(b) (6) (b) (6) Sent: Tuesday , July 11, 201 7 10:48 AM Eastern Standard Time To: DJS Subject: RE : (No Subject) Yes, attached. AMERICAN PVERSIGHT VA-19-0799-G-000340 DS 00021056 - (b) (6) White House Liaison Department of Veterans AffairS- (b) (6) ~ ffice (b) (6) From: DJS Sent: Tuesday,July 11, 2017 10:48 AM To: (b) (6) (b) (6) Subject: RE: (No Subject) Can you send me an electronic copy? Sent with Good (www.good.com ) -----Original Message----From : (b) (6) (b) (6) Sent: Tuesday, July 11, 2017 10:43 AM Eastern Standard Time To: DJS Cc: Wright , Vivie ca (Simpson); (b) (6) Subject: RE: Yes , I do . I submitted his info to PPO for vetting yesterda y after I recei ved bis biographlcru for m retamed . - (b) (6) Wbit e House Liaison Deparunent or Veterans Affairs (b) (6) ffice (b) (6) cell -----Origi11alMessage----From: DJS Sent : Tue sday. July 11. 2017 10:43 AM AMERICAN PVERSIGHT VA-19-0799-G-000341 DS_00021057 To; (b) (6) (b) (6) Cc: Wri t. 1v1eca anpso u): (b) (6) Subject: -do (b) (6) you bave (b) (6) cv- the candidate for cio Sent wjth Good (www.good.com ) ~(b) (6) AMERICAr-... pVERSIGHT 17.docx> VA-19-0799-G-000342 D8_00021058 Message David shulkin lDrshulkin@aol.com] 7/11/2017 3:10:59 PM Ike Perlmutter ■ ( @frenchangel59.com] Marc Sherman [mbs~@gmail.com]; b (b) CI.O ) (6) From: Sent : To : CC: Bruce Moskowitz [bruce (b) (6) (b) @mac.com] Subject: (6) (b) (6), (b) (2) ( . docx; Untitled attachment 93491.htm Attachments : ■---■17 6 ) Were meeting some good cjo candidates- and my thinking is to take your advice (always a good idea) and take several people to help get a real tal.ent pool on board . One guy i really like because of military , government, health and emr, and private sector experience is.(b) (6) good references too- his CV is attached . Another guy that interviewed very well with my team (but i did not meet yet) is Radu Shrestha- he is the CTO at the university of pittsburg medical center. He nay be perfect as CIO of the health administration- a position we never had but really need. Bruce have you heard of him? We need to keep it confidential at this point as they dont know he is looking until we indicate we are ready to move forward- I will meet him as soon as I return . David Sent from my iPhone Begin forwarded message ~ From: DJS Date: July 11, 2017 at l 0:57:55 AM EDT To: 'Shulkin 1 Subject: FW: (No Subject) Sent with Good (www .good.com ) -----Original Message---From: (b) (6) (b) (6) Sent: Tuesday , July 11, 2017 10:48 AM Eastern Standard Time To: DJS Subject: RE : (No Subject) Yes, attached. - (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000343 DS 00021059 White House Liaison Departm ent of Vete rans Affairs -(b) (6) office -(b) (6) cell From: DJS Sent: Tuesday, July 11, 2017 10:48 AM To: (b) (6) (b) (6) Subject: RE: (No Subject) Can you send me an electroni c copy? Sent w ith Good (www.good.com ) -----Original Me ssage---From: (b) (6) (b) (6) Sent: Tu esday, July 11, 20 17 10:43 AM Ea stern Standard Tim e To: DJS Cc: Wright, Vivieca (Simp son); (b) (6) Sub.iect: RE : Yes , I do. I submill ed his info to PPO for vetti ng yes terday afler T received his biog raphka l fon n retLmlCd. - (b) (6) Wllit e House Liaison D epartm ent of Veterans Affair s ffice (b) (6) ell (b) (6) ----Ori ginal Message- -- From : DJ S Sent Tuesday, July 11. 20 17 10:43 AM To : (b) (6) (b) (6) Cc: Wri ght, Vivieca (Si.mpson);IIIIIIIIIIIII (b) (6) Subjec t -(b) (6), (b) (2) do yoll have-(b) (6) cv- the candidate for cio Sent w iU1Good (www.good.com) AMERICAr-... pVERSIGHT VA-19-0799-G-000344 D8_00021060 (b) (6), (b) (2) (b) (6) @thee .ws (b) (6) Career Objective/Mission (b) (6), (b) (2) Key Career Achievements (b) (6), (b) (2) • • (b) (6), (b) (2) • • • • Career History Summary Company Role (b) (6), (b) (2) Oates 2015 - Present 2013 - 20152012 - 2013 2010 - 2012 2009 -2010 2008 -2009 2000 - 2008 1996 - 2000 AMERICAN PVERSIGHT Persona l and Confident ial Please do not distr ibute VA-19-0799-G-000345 DS_00021061 (b) (6), (b) (2) (b) (6) page 2 PROFESSIONAL EXPERIENCE (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) Health Information Exchange Experience: • (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) 2010 - 2012 Consulting Experience: • (b) (6), (b) (2) AMERICAN PVERSIGHT Personal and Confiden tial' Please do not distr ibute VA-19-0799-G-000346 D8_00021062 (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) page 3 (b) (6), (b) (2) (b) (6), (b) (2) Management Experience : • (b) (6), (b) (2) • • • • (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) AMERICAN PVERSIGHT Personal and Confidentia l Please do not distribute VA-19-0799-G-000347 D8_00021063 Phillip LaJoie page 4 (b) (6) @thee .ws IT Management Experience: (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) AMERICAN PVERSIGHT Personal and Confidentia l Please do not distribute VA-19-0799-G-000348 D8_00021064 (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) page 5 (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) AMERICAN PVERSIGHT Persona l and Confidential Please do not distribute VA-19-0799-G-000349 D8_00021065 Message From: Sent : To : CC: Subject: IP !1@frenchangel59.com] ( 7/11/2017 2:02:45 PM b 'David ) shulkin' [drshulkin@aol.com] ( 'L Perl' (b) (6) @gmail.com]; 'Bruce Moskowitz' [bruce (b) (6) (b) @mac.com];'Marc Sherman' [mb6 (b) (6) @gmail.com] (6) RE:)Fwd: I agree with Marc 100%. (b) (6) From: Marc Sherman [mailto:mb~@gmail.com] Sent: Monday, July 10, 2017 10:30 PM To: David shulkin (b) (6) ( (b) (6) (b) Cc:L Perl ~@gmail.com>; IP <1@frenchangel59.com>; Bruce Moskowitz b (6) Subject: Re: Fwd: ) ( Great article. Let's hope it stays that way . There are some good political lessons and adv ice buried within the 6 article Cl ) Marc Sherman (b) (6) On Jul 10, 2017 10 :18 PM , 11David Shulkin" wrote : Interesting > > https://www .googJe .com/ am p/s/mobi Ie.nytimes .com/2017 /07 / I 0/us/pol itics/house-senate-veteran-affairscommi ttees. amp .html > > > > Sent with Good (www .good .com ) AMERICAN PVERSIGHT VA-19-0799-G-000351 DS_00021067 Message From: Marc Sherman [mb (b) (6) @gmail.com) Sent : 7/11/2017 2:29:41 AM To ; David shulkin [drshulkin@aol.com] L Perl ■■■ ; Bruce Moskowitz. [bruce (b) (6) (b) @mac.com) (b) (6) @gmail.com); IP [1@frenchangel59.com) ( Re: Fwd: b (6) CC: Subject: ) ( 6 Great article. Let's hope it stays that way . There are some good political lessons and advice buried within the ) article l1 Marc Sherman (b) (6) On Jul 10, 2017 10:18 PM, "David Shulkin" wrote : Interesting > > https ://www.googl e.com/ amp/ s/m obi Ie.nytim es .com/201 7/0 7/ I 0/us/pol itics/house-senate-veteran-affairscommittees .amp .html > > > > Sent with Good (www .good.com ) AMERICAN PVERSIGHT VA-19-0799-G-000352 DS_00021068 Message From: David Shulkin [drshulkin@aol.com] Sent: 7/11/2017 2:18:31 AM To: Bruce Moskowitz [bruce (b) (6) (b) @mac .com];Marc Sherman [mb (b) (6) @gmail.com]; Ike Perlmutter [1IJ@frenchangel59.com]; Laurie Perlmutter [(b) (6) @gmai l.com ] (6) ( Subject: Fwd: b ) ( 6 Interesting ) > > https://www.google.com/amp/s/mobile.nytimes.com/2017/07/10/us/politics/house-senate-veteran-affairscommittees.amp.html > > > > sent with Good (www.good.com ) AMERICAN PVERSIGHT VA-19-0799-G-000353 OS 00021069 Message To: Davidshulkin [Drshulkin@aol.com] 7/12/2017 6:13:33 PM DarinSelnick(b) (6) @gmail.com] Subject: Re: From: Sent: I wi 17 Sent from my iPhone > on Jul 12, 2017, at 12:33 PM, Darin selnick <(b) (6) mail .com> wrote: > > You might want to let Bruce know I am off the project. > > Thanks > > Darin > > sent from my iPhone > gmail .com> wrote : >> on Jul 12, 2017 , at 6 :13 AM, Darin selnick (b) (6) >> >> I have not communicated with apple since we talked last , I only yesterd~d -(b) (6) to let her know I would not be involved . I will have them talk to -(b) >> (6) >> Darin a social lunch with moving forward . >> >> sent from my iPhone >> >>> on Jul 12 , 2017, at 3: 19 AM, David shulkin wrote: >>> >>> Darin-please dont communicate further with Apple- im really trying to protect >>> >>> Glad to discuss more when i return >>> >>> sent from my iPhone AMERICAN PVERSIGHT you VA-19-0799-G-000354 OS 00021070 Message From: (b) (6) DarinSelnick-@g Sent: 7/12/2017 10:33:27 AM To: Davidshulkin [Drshulkin@aol.com] Subject: Re: mail.com] You might want to let Bruce know I am off the project. Thanks Darin sent from my iPhone > on Jul 12, 2017, at 6 : 13 AM, Darin selnick (b) (6) gmail . com> wrote : > ~e -(b) (6) > > Darin not communicated with apple since we talked last , I only yesterda~ to let her know I would not be involved. I will have them talk to -(b) (6) a social lunch with moving forward. > > sent from my iPhone > >> on Jul 12, 2017 , at 3:19 AM, David shulkin wrote: >> >> Darin - please dont communicate further with Apple - im really trying to protect you >> >> Glad to discuss more when i return >> >> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000355 OS 00021071 Message To: (b) (6) DarinSelnick-@gmail .com] 7/12/2017 10:13:46 AM Davidshulkin [Drshulkin@aol.com] Subject: Re: From: Sent: I have not communicated with apple since we talked last, I only yesterday had a social lunch with -(b) (6) (b) to let her know I would not be involved. I will have them talk to 11111111 moving forward. (6) Darin sent from my iPhone > on Jul 12, 2017, at 3:19 AM, David shulkin > >Darin-please dont communicate further wrote: with Apple- im really trying to protect you > > Glad to discuss more when i return > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000356 OS 00021072 Message From: Sent: To: David shu lkin [Drshulkin@ao l.com] 7/12/2017 7:19:25 AM @gmail .com] Darin Selnick (b) (6) Darin - please Glad to discuss dont communicate further with Apple - im really trying to protect you more when i return Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000357 OS 00021073 Message Poonam Alaigh I(b) (6) @hotmail.com] 7/10/2017 7:23 :32 AM David Shu Ikin [drshulkin@aol.com] Fwd: [EXTERNAL]thank you From: Sent : To : Subject: Sent from my iPhone Begin forwarded message : From: "Alaigb Poonam, M.D ." Date: July 10, 2017 at 8:22:27 AM GMT+ l To: 'Poonam Alaigh 1 ~(b) (6) > Subject: FW: [EXTERNAL] thank you Sent with Good (www .good.com) -----Original Message----From: (b) (6) Sent: Sunday, July 09, 2017 06:51 PM Eastern Standard Time To: Alaigh, Poonam, M.D. Subject: FW: [EXTERNAL] thank you FYI. Sent with Good (www .good .com) -----Original Message----(b) (6) From: (b) (6) om ail.com Sent: Saturday July 08, 2017 03: 12 PNIEastern Standard Time To: (b) (6) Subject: [EXTERNAL] thank you DearDr .-(b) (6) 1 want to thank you for your call yesterday . It was a pleasure speaking with you! I wanted to let (b) you know that I heard from Dr.11111 Iast night via e-mail and have connected with him. (6) I will channel your story about Duke as I continue through the process . I hope our professional paths cross again in the future. Thank you, AMER, .,, I PVERSIGHT VA-19-0799-G-000358 DS_00021074 - (b) (6) , ■ PsyOMBA Pre-Doctoranntern I Organizational Consultant Organizational Development Services, Widener University (b) (6) (b) (6) mail.com " Between stimulus and response there Is a space . lh that space is our power to choose our response. In our response lies QUrgrowth and our freedom ~-Vlktor E. Frankl AMERICAr-... pVERSIGHT VA-19-0799-G-000359 D8_00021075 Message David shulkin lDrshulkin@aol.com] 7/17/2017 9:41:44 PM IP !1@frenchangel59. com] ( Re:bStory in Boston Globe today From: Sent : To ; Subject: ) ( 6 Im doing a thorough review- agree its not good ) But the re are more like this out there We need a whole different group of managers . to get this straightened out and as you know we have ve ry little bench David Sent from my iPhone ( @frenchangel59.com On Jul 17, 2017, at 7:01 PM , IP <1 > wrote : b ) David, ( 6) https://www .bostonglobe .com/metro/2017 /07 /16/top-two-officials-removed-manchesterhospital/rn HF7NS39X7v3Ge1Sm MTLN/story. htm I The attached article is very, very scary. What's happening at the Manchester New Hampshire VA is outrageous and unacceptable. Please let me know when we're going to get the ranking report ( 1 to 5 Stars) on the VA locations . I believe we were supposed to get this report on June 30 th • It's very important that we get this information as soon as possible. Thank you, Ike From: DJS[mailto:vacodjsl@va.gov ] Sent: Sunday,July 16, 2017 3:47 PM To: 'ip' Subject: FW: Story in BostonGlobetoday FYI Sent with Good (www .good.com ) -----Original Message----From: DJS Sent: Sunday , July 16, 2017 03 :45 PM Eastern Standard Time To: 'ip' AMERICAN PVERSIGHT VA-19-0799-G-000360 DS_00021076 Subject: FW : Story in Bost on Globe today Sent with Good (www .good .com ) -----Original Message ---From: DJS Sent: Sunda y, Jul y 16, 2017 03 :31 PM Eas tern Standard Time To: 'ip' Subject: FW : Story in Bost on Glob e today FYI- I wanted to keep you in the loop David Sent with Good (www .good.com ) -----Ori ginal Message----From: DJS Sent: Sunda y, July 16, 20 17 0 l: 58 PM Ea st ern Standard Tim e To: 'Miller, Stephen EOP/WH0 1 Cc: 'Andrew Brember g'; 'Reed Cord ish' Subject: Story in Bo ston Glob e toda y Tl1e rc is a story today in the Bos ton Globe loday tha l has a numb er of serious alle gations regardin g manage ment al the Man ches ter New Hamp shire VA. Whil e these issues a re new to me, I am truly disappoiut ed that local mana gement kept these issues fro m us and that mun erous whistleblowe rs had iudicated mana geme nt was not listening. I made the decision, effec tive immedi ately to remo ve the medical center director and chief of staff and put in place tbe deputy netw ork dire ctor. I will be sending a team imm edia tely from D .C .to inves tigate the issues and repo rt back. T he te am will includ e a member of the new Wbi stleblower Prot ection Office. Furtb ennor e I have bee n in touch with Gove rnor Sinuuu will be speakin g direc tly ·with press tomo rrow in New Ha mps hire to deal with these issues head 011. I c-.inassure you many o f U1c issues reported on are very o ld and 0U1ers i11 acc urate and much goo d is occurrin g io Manc heste r. B11tover al l I consider this a failure of man age ment and I w ill hold people acco w1table . We will co ntinue lo have issues in VA but my commi tment will re main to act quick ly , lrn nsparcotl y. and wo rk fo fix systems and restore trust. Let me know if you have questions David Shulki n Sent with Good (www .good .com) AMERICAr-... pVERSIGHT VA-19-0799-G-000361 DS 00021077 Message From: Sent : To : CC: Subject: IP !1@frenchangel59.com] ( 7/17/2017 6:01:50 PM b David ) shulkin [drshulkin@aol.com] ( (b) lper-@gmail.com; brurn (b) (6) (b) @mac.com; mb (b) (6) @gmail.com FW:6(6) Story in Boston Globe today (6) ) David, https :ljwww .bostongl obe .com/metro/201 7/07 /16/top-two-offici.a Is-removed-ma nchesterhospital/rn HF7NS39X7v3Ge1Sm MTLN/story .htm I The attached article is very, very scary. What's happening at the Manchester New Hampshire VA is outrageous and unacceptable. Please let me know when we're going to get the ranking report ( 1 to 5 Stars) on the VA locations. I believe we were supposed to get this report on June 30 th . It's very important that we get this information as soon as possible . Thank you, Ike From: DJS [ mailto:vacodjsl@va.gov ] Sent: Sunday_,July 16_,2017 3:47 PM To: 'ip' Subject: FW: Story in BostonGlobetoday FYI Sent with Good (www .good .com ) -----Origi na.l Message----From: DJS Sent: Sunday, July 16, 2017 03 :45 PM Eastern Standard Time To: 'ip' Subject: FW: Story in Boston Globe today Sent with Good (www .good .com) -----Original Message----From: DJS Sent: Sunday , July 16, 2017 03:31 PM Eastern Standard Time To: 'ip' Subject: FW : Story in Boston Globe today AMt-Hll.,AN PVERSIGHT VA-19-0799-G-000362 DS 00021078 FYI- I wanted to keep you in the loop David Sent with Good (www .good.com ) -----Original Message----From: DJS Sent: Sunday, July 16, 20 17 01:58 PM Eastern Standard Time To: 'Miller, Stephen EOP/WHO' Cc: 'Andre w Bremberg'; 'Reed Cardish' Subject: Story in Boston Globe toda y There is a story today in the Boston Globe today that has a number of serious allegations regarding managemenl at the Manchester New Hampshire VA Wlule these issues are new lo me, I am truly disappointed that local management kept these issues from us and llrat munerous whistleblowers had indicated management was not listening. I made the decision, effective immediately to remove tbe medical center direotor and chief of staff and put in place the deputy network director. I will be seudiug a team immediately frotn D.C.to investigate tl1e issues and report back. The team will include a member of the new Wlustleblower Protection Office. Furtbennore f have been in touch with Governor Sinunuwill be speaking directly wiU1press tomorrow in New Hampslrite to deal with these issues head on. J can assarc you many of the issues reported on are ve1y old and others inaccurate and much good is occuning in Manchester. But overall I con.siderthis a frtilureor management and I wiJI hold people accountable. We wilJ continue to have issues in VA but my comrnil:luenlwill remain to actqn.ickly, transparently, and work to !ix systems and restore tmst. Let me know if you have questions David Shnlk:in Sent with Good (www.good.com) AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000363 DS 00021079 Message From: (b) (6) Sent : 7/8/2017 3:24:13 PM To : David shulkin [Drshulkin@aol.comJ Re: Look Subject: (b) (6) @gmall.com] It 1s a GHA TP from Texas I remember now taking the picture when we were in Chicago for ACHE. On Sat, Jul 8, 2017 at 7:40 AM David shulkin wrote: Who is that ? Sent from my iPhone > On Jul 8, 2017 , at 12: 15 AM , (b) (6) (b) (6) ail.com > wrote: > > I randomly saw this today on linkedin. > < Screenshot _ 2017-07-08-00-20-19 .png> Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000364 DS 00021080 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 7/8/2017 11:40:50 AM To: (b) (6) Re:Look Subject: (b) (6) @gmail.com] Who is that? Sent from my iPhone > On Jul 8, 2017, at 12:15 AM, (b) (6) (b) (6) <-r@gmail.com> wrote: > > I randomly saw this today on linkedin. > AMERICAN PVERSIGHT VA-19-0799-G-000365 OS 00021081 Message From: (b) (6) Sent: 7/8/2017 4:15:46 AM David Shulkin [drshulkin@aol.com] Look Screenshot_2017-07-08-00-20 -19. png To: Subject: Attachments: (b) (6) @gmail.com] I randomly saw this today on linkedin. AMERICAN PVERSIGHT VA-19-0799-G-000366 OS 00021082 Message Poonam Alaigh I(b) (6) @hotmail.com] 7/7/2017 11:37:14 AM David shulkin [Drshulkin@aol.comJ Re: Fwd: Re: From: Sent : To : Subject: Just spoke to him and he will take care of it this morning Sent from my iPad On Jul 7, 2017, at 7: 16 AM, David shulkin wrote : (b) (6) Can you send a reminder to-just to confirm with phillythat they might meet her Sent from my iPhone Begin forwarded message : From: (b) (6) < (b) (6) Date: July 6, 2017 at 10:52:40 PM EDT To: David Shulkin Subject: Re: mail.com > Hi David, Thanks for checking in, I have not heard anything yet. ■ (6) (b) On Jul 6, 2017 , at 8:55 PM, David shulkin wrote : -(b) did you hear anything yet from the pruladel phia VA? (6) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000368 DS_00021084 Message From: David shulkin lDrshulkin@aol.com] 7/7/2017 11:16 :50 AM Poonam Alaigh I(b) (6) @hotmail.com] Fwd: Re: Sent : To : Subject: (b) (6) Can you send a reminder to-just to confirm with philly that they might meet her Sent from my iPhone Begin fo.-warded message : From: (b) (6) < (b) (6) Date: July 6, 2017 at 10:52:40 PM EDT To: Davjd Shulkin Subject: Re: Hi David , Thanks for checking in, I have not heard anything yet. ■ (6) (b) On Jul 6, 2017 at 8:55 PM, David shu]kjn wrote: -(b) did you hear anything yet from the philadelphia VA? (6) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000369 DS 00021085 Message From: David shulkin [Drshulkin@aol.com] Sent : 7/6/2017 4 :44:46 PM To ; IP il@frencha ngel59. com] ( Re:bRE: Subject: ) ( Ike- he has been6 sent home for the time being (i knew i hadnt seen him in a while) until they sort out his final ) disposition Thanks for following up David Seot from my iPhone (b @french.ange159 On Jul 6, 20 17, at 9:56 A.NI,IP <11 .com> wrote : It's very nice. ) (6 ) From: David shulkin [mailto:Drshulkin@aol.com ] Sent: Thursday, July 06, 2017 7:16 AM ( @frenchangel59.com >; Laurie Perlmutter~>;(b) (6) To: Ike Perlmutter <1 b <.QJ.~ -~(b) (6) .@fil!@!l~Q!! P ; Bruce Moskowitz ) (6) Subject: Fwd: ( 6 In case you wanted) to see yesterday's Marc Sherman fox interview https:/ /m .youtube .com/watch?v=ob0mO5 V4VXO Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000370 DS_00021086 Message IP !1@frenchangel59.com] ( 7/6/20171 :56:21PM b 'David ) shulkin ' [Drshulkin@aol .com]; 'Laurie Perlmutter' (b) (6) @gmail.com]; 'Marc Sherman' [mb( ••(b) (6)l@gmai l.com); 'Bruce Moskowitz' [bruce (b) (6) (b) @mac.com] RE:6 (6) From: Sent : To : Subject: ) It's very nice. From: David shulkin [mailto:Drshulkin@aol.comJ Sent: Thursday, July 06, 2017 7:16 AM ( (b) (6) To: Ike Perlmutter <1@frenchangel59.com>; Laurie Perlmutter ~@gmail.com>; b (b) (6) (b) (6) (b) ; Bruce Moskowitz ) (6) Subject: Fwd: Marc Sherman ( 6 In case you wanted) to see yesterday's fox interview https://m .youtube.com/watch?v=obOmD5V4 VXO Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000371 DS_00021087 Message David shulkin [Drshulkin@aol.com] 7/6/2017 11:16:15 AM Ike Perlmutter.@frenchangel59.com]; Laurie Perlmutter (b) (6) @gmail.comJ; Marc Sherman ( b l .com); Bruce Moskowitz [bruce (b) (6) (b) @mac.com) [mb••■ (b) (6) @gmai ) Fwd: (6) From: Sent : To : Subject: ( 6 ) In case you wanted to see yesterday's fox interview https://m .youtube.com/watch?v=ob0mO5V4VX0 Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000372 DS_ 00021088 Message David Shulkin (drshulkin@aol.com) 7/8/2017 5 :11:15 PM Poonam Alaigh I(b) (6) @hotmail .com] Re: The Smart-Medicine Solution to the Health-Care Crisis - The Wall Street JoumaL From: Sent : To; Subject: And less on our shoulders ! Sent from my iPad On Jul 8, 2017, at8 :1SAM, Poonam Alaigh ~(b) (6) >w rote: Charlie?? Putting a lot on his shoulders Sent from my iPhone On Jul 8, 2017 , at 7:49 AM, David shulkin wrote: Bruce- this is absolutely the way to go- we are trying to move this way- i just brought in a new head of technology innovation- a true entrepreneur millenialWhere should we start? One particular technology or approach this broadly? David Sent from my iPhone On Jul 8, 2017 , at 7 :25 AM, Bruce Moskowitz This is the only possible alternative to improving health care especially the telemedicine part and patient records. We have access to everything in this article for free via the 5 academic centers and the other entities mentioned in the article. The cost of doing business unde r the same model that the VA has been using is prohibitively expensive and Jacks the ability to provide timely care. I thought you would be interested in the following story from The Wall Street Journal. The Smart-Medicine Solution to the Health-Care Crisis https ://www .wsj .com/article email/the-smart-medicine-solutionto-the-health-care-crisis-149944 3449IMyQjAxMTE3MzAzODkw Nj g l Wj/ AMERICAN PVERSIGHT VA-19-0799-G-000373 DS_00021089 Download the WaJI Street Joumal app here : WSJ, Sent from my i Pad Brnce Moskowitz M .D_ AMERICAr-... pVERSIGHT VA-19-0799-G-000374 DS 00021090 Message Poonam Alaigh I(b) (6) @hotmail.com] 7/8/201712:15 :16 PM David shulkin [Drshulkin@aol.comJ Re: The Smart-Medicine Solution to the Health-Care Crisis - The Wall Street JoumaL From: Sent : To : Subject: Charlie ?? Putting a lot on his shoulders Sent from my iPhone On Jul 8, 2017 , at 7:49 AM, David shulkin wrote : Bruce- this is absolutely the way to go- we are trying to move this way- i just brought in a new head of technology innovation- a true entrepreneur millenialWhere should we start? One partic ular technology or approach this broadly? David Sent from my iPhone On Jul 8, 2017, at 7:25 AM, Bruce Moskowitz wrote : This is the only possible aJtemative to improving heaJth care especially the telemedicine part and patient records . We have access to everything in this article for free via the 5 academic centers and the other entities mentioned in the article. The cost of doing business under the same model that the VA has been using is prohibitively expensive and lacks the ability to provide timely care . I thought you would be interested in the following story from The Wall Street Journal . The Smart-Medicine Solution to the Health-Care Crisis https ://www .wsj .com/articl e emai 1/the-smart-m edi cine-solution-to-the-heal thcare-cri si s-1499443449-lMyQj AxMTE3MzAzODk-wNj g I Wj/ Download the Wall Street Journal app here: WSJ. Sent from my iPad Bruce Moskowitz M .D. AMERICAN PVERSIGHT VA-19-0799-G-000375 DS 00021091 Message From: David shulkin [Drshulkin@aol.com] Sent : 7/8/201711:49:24 To ; Charlie Wiggins I(b) (6) (})remedyventures .com) Fwd: The Smart-Medicine Solution to the Health-Care Crisis - The Wall Street Journal. Subject: AM Fyi Sent from my iPhone Begin forwarded message ~ From: Bmce Moskowitz (6) Date: July 8, 2017 at 7:25:06 AM EDT To: David shulkin , Poonam Alaigh (b) (6) - (b) (6) LPerl- (b) (6) >, IP (b frenchan el59.com> ) Subject: The Smart-Medicine Solution to the Health-Care Crisis - The Wall Street Journal. (6 ) This is the only possible alternative to improving health care especially the telemedicine part and patient records. We have access to everything in this article for free via the 5 academic centers and the other entities mentioned in the article . The cost of doing business under the same model that the VA bas been using is prohibitively expensive and lacks the ability to provide timely care. I thought you would be interested in the following story from The Wall Street Journal. The Smart-Medicine Solution to the Health-Care Crisis https ://www .wsj .com/article email/the-smart-medicine-solution-to-the-heal th-care-crisisl499443449-lM yQj AxMTE3 MzAzOD kwNj g l Wj / Download the Wall Street Journal app here: WSJ . Sent from my iPad Bruce Moskowitz M.D . AMERICAN PVERSIGHT VA-19-0799-G-000376 DS_00021092 Message CC: David shulkin [Drshulkin@aol.com] 7/8/2017 11:49:11 AM (b) (6) (b) @mac.com] Bruce Moskowitz [brucentl■■■ (6) mbsllll■l@gmail.com; (b) (6) (b) (6) @gmail.com] ; IP Poonam Alaigh I(b) (6) @hotmail.com]; L Perl ■■■ Subject: Re: b The Smart-Medicine Solution to the Health-Care Crisis - The Wall Street Journal. From: Sent : To : ll@french;,mgel59 .com l ( ) ( 6 Bruce- this is absolutely the way to go- we are trying to move this way) i just brought in a new head of technology innovation- a true entrepreneur millenial- Where should we start? One particular technology or approach this broadly? David Sent from my iPhone On Ju] 8_, 2017 , at 7:25 AM, Bruce Moskowitz Date : Thu, Aug 3, 2017 at 10:37 AM Subject: FW : Please ST AND DOWN > To: palaigh89- (b) (6) Sent with Good (www .good .com) -----Original Message----From: (b) (6) Sent: Thursday , August 03, 2017 10:36 AM Eastern Standard Time To: Mulligan, Ricci;~(b) (6) Cc: Alaigh, Poonam, M.D. Subject: Please STAND DOWN (b) 111 and Ricci, (6) Effective immediately , please stand down ALL activities related to the VA project between the VA, 5 Centers and Apple on the digital EHR until we receive clearance from Dr. Alaigh to resume activities . Please confirm receipt of this email and confirm that you have communicated with a1l members of your workgroups and respective teams . Thank you, (b) (6) Senior Ad\'isor, Acting Under Secretary for Health Dc1rnrtmcnt of Vctcra11s Affairs Veterans Health Admi nistration 810 Vermo11t A, ·enuc, NW Rm. 815c Washington, DC 20420 AMERICAN PVERSIGHT VA-19-0799-G-000379 DS_00021095 mec? Message From: David Shulkin [drshulkin@aol.com) Sent : 7/11/2017 2:24:57 AM To : Darin Selnick (b) (6) @gmail.com] http://www .startribune. com/va-makes-publ ic-its-di sciplinary-action-against-em ployees/4 33 135853/ Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000381 DS_00021097 Message From: David Shulkin [drshulkin@aol.com] Sent : 7/11/2017 2:24:07 AM To : Thomas Bowman (b) (6) @yahoo.com] http://www .startribune. com/va-makes-publ ic-its-di sciplinary-action-against-em ployees/4 33 135853/ Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000382 DS_ 00021098 Message From: Sent: To: Subject: Jennifer Lee (b) (6) @gmail.com] 7/8/2017 11:51:27 AM David Shulkin [drshulkin@aol.com] quick updates Hi Dr. Shulkin, Here are a few quick updates to help for when we catch up by phone later: -Telehealth event - I've pinged several folks at the WH to try to nail down a date (most recently last night). -(b) (6) and Darin have also been pinging separately. It's apparently still with the WH scheduling team . We will keep pushing . -Google DeepMind- Ready to announce any time . Comms working on this. We will have a draft press release ready for your review by Monday . -Whole Health - Should be active in 18 sites by this fall - we could announce this first phase of rollout as part of comprehensive suicide prevention (or as a solution to the opioid problem) in September? That way it would be clearly connected to one of your priority areas. We have time on your schedule the week of 7/24 when Tracy is in town to provide a deeper dive -Sanford Health gift - We have a call next week with them . It seems most of the tests on their Sanford chip have already been run on our MVP samples, so we want to ask for something more with immediate clinical impact. As you suggested , I think prostate ca markers would make sense so we can build on the work we're already doing in oncology . I'll have an update for you by the time you get back. Maybe we can look to September (prostate ca awareness month) or if/when we do another Launchpad-like event? (b) -IBM Watson -111111 and the team do feel the collaboration is valuable and most of the kinks have already been (6), worked out. If we expand to prostate , the volume should increase. (An additional 100 samples were uploaded this week) . The (b) issue of staffing on our side is real but more for the POP/ precision oncology program in (2) general - not specific to Watson. For POP, they already have the funding and FTE, they just needed exemptions to actually hire. This is happening now . -Novartis- I'm talking with-(b) (6) today about this. I would envision a network of potentially "cobranded" sites to support rapid ramp-up of clinical trials. Novartis could help provide ongoing staffing support at sites. They are interested but we need to work out details . It would be good to have this fit in with the other investments in oncology that we are making . -Regeneron- We are working out how we can provide access to our data without transferring the data - and how much access we want to provide them with in exchange for# exome sequencing. Our folks went to Regeneron in NYC for a day-long face to face that went very well. In our next conference call we will negotiate the nuts and bolts of the deal. Should have a good sense of what we can get to with them in the next 2-3 weeks . -HBOT- CCI had a great meeting with FDA and got official approval for off-label use. This was the major concern of our SMEs and clinicians . CCI is working to launch a small HBOT pilot in San Antonio. CCI is also working on a new Light therapy protocol for chronic pain and PTSDin Boston (about 60 veterans) and also SGBfor PTSD.These could be announced soon . Thanks and talk to you soon! Jen AMERICAN PVERSIGHT VA-19-0799-G-000383 OS 00021099 100 Message IP !1@frenchangel59.com] ( 7/25/2017 6:31 :50 PM b 'Poonam Alaigh' I(b) (6) (E)hotmail.com) ) ( Drshulkin@aol.com; 'Lauri€ Perlmutter' ■■-@gmail.com) (b) (6) RE:6[EXTERNAL]Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosecl From: Sent : To : CC: Subject: I Fox News ) Poonam , Please let us know what exactly we need to do to get the twins their house back from the bank. Thank you, Ike (b) (6) From: PoonamAlaigh [mailto-@hotmail.com] Sent: Monday,July 24J2017 7:58 PM To: Ike Perlmutter; Laurie Perlmutter Cc: Drshulkin@aol.com Subject: Fwd: [EXTERNAL]Homeless,84-year-oldwar veteran twins say 'it's hell' after home foreclosedI Fox News Ike and Laurie- while we are trying to get more info, please see articles and hnks on the latest regarding the twins that you brought to our attention- a lot of donations and funds being raised . THANK YOU!! Sent from my iPad Begin forwarded message : - > From: "Alaigh, Poonam , M .D.'' Date: July 24, 2017 at 7:53:58 PM EDT To: 'Poonam Alaigh 1 (b) (6) Subject: FW: rEXTERNALI Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Sent with Good (www .good .com ) -----Original Message--From: Pape, Lisa M . Sent: Nfonday, July 24 2017 05: 19 PM Eastern Standard Time To: Alaigh, Poonam, M.D. Subject: FW: [EXTERNAL] Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed IFox News Read these articles Lisa Pape, LISW Acting VFIA COS AMERICA! PVERSIGHT VA-19-0799-G-000385 DS_00021101 -----Original Message----- From: (b) (6) Sent: Monda y, July 24, 2017 12 : 10 PM Eastern Standard Time (b) (6) To: Pape , Lisa M .; (b) (6) Cc: Lynch, Thomas (VHA); (b) (6) W (V ACO); Hyduke, Barbara ; VHA 10NC Action ; VHA l 0B; VISN Support Team 3; (b) (6) VHA 10NA3 Action;-(b) (6) - (b) (6) Subject: RE : [EXTERNAL] Homeless , 84-year-old war veteran twins say 'it's hell' after home forec losed I Fox News I couldn't find t he follow up on-air video online, but here are two online articles: http://fox40 .com/2017 /07 /21/vetera ns-affa irs-comm unity-ste p-u p-to-help-84-year-o Id-horn el esstwi ns/ http://www .foxnews.com/ us/2017 /07 /23/homel ess-84-year-old-wa r-veteran-twins-helped-byveterans-affairs-donations-from-community .pr int .htm 1# From: Pape, Usa M. Sent : Saturday, July 22, 2017 11:01 AM To:-~ >; (b) (6) va. ov> (b) (6) (b) (6) (b) (6) Cc: Lynch, Thomas (VHA) ; -(b) (6) W (VACO) ~>; (b) (6) Hyduke, Barbara ; VHA lONC Action ; VHA 10B ; VISN Support Team 3 ; (b) (6) ~>; VHA 10NA3 Action ; (b) (6) (b) (6) va. ov>; (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) ~> Subject: RE: [EXTERNAL] Homeless, 84-year-old war veteran t w ins say 'it' s hell' after home foreclosed Fox News I I Nope Lisa Pape, LISW Acting VHA COS -----Original Message--- -- From:-(b) (6) Sent: Saturday, July 22, 2017 0 1:54 PM Ea stern Standard Time To: (b) (6) Pape, Lisa M. Cc: Lynch, Thomas (VHA); (b) (6) W (V ACO) ; Hyduke , Barbara ; VHA 10NC Action ; AMER,\, , ,,. pVERSIGHT VA-19-0799-G-000386 D8_00021102 - VHA 1OB; VISN Support Team 3; (b) (6) (b) (6) VHA 10NA3 Act ion; -(b) (6) (b) (6) Subject: RE : [EXTERNAL] Homeless, 84-year-old war vete ran twins say 'it's hell ' after home foreclosed IFo x News Would defer to Ms. Pape. From: (b) (6) Sent: Saturday,July 22, 2017 10:35 AM To: -(b) (6) Pape, Lisa M. Cc: Lynch,Thomas (VHA); (b) (6) W (VACO);Hyduke, Barbara; VHA lONCAction; VHA 108; VISN SupportTeam 3; (b) (6) ■ (b) (6) VHA 10NA3Action; (b) (6) (b) (6) Subject: RE: [EXTERNAL]Homeless,84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Good morning, Please advise if a HOC is still needed . If not. we will close out the request. Thanks. (b) (6) From: (b) (6) Sent: Fridayr July 21, 2017 7:38 PM To: (b) (6) (b) (6) Cc: Lynch,Thomas (VHA); (b) (6) (b) (6) Pape, Lisa M.; VHA 108 W (VACO);Hyduke, Barbara; VHA l0NC Action; VISN Support Team 3; (b) (6) Subject: RE: [EXTERNAL]HomelessJ 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Good evening, The last update I just received from the VAMC is that the Veterans both arri ved at the Mathe r ED where they were seen by social work/homeless and the one brot her who had the accident earlie r this week was seen by medical. His injuries were minor and nothing new was needed medically. They were provided a meal while t here and offered a hotel room fo r th e weekend t o be paid by Voluntary Services, but they declined the latter because they planned to retu rn to their friends ' home. They also met with a benefits counselor from Volunteers of America to start the process for VBA benefits. They will meet again with someone from the VA Homeless Program and the Coe Housing Navigator early next week t o assesswh at permanent housing solution would be best fo r t hem. AMERICAN PVERSIGHT VA-19-0799-G-000387 DS 00021103 Please let me know if there are any additional questions at this time. Thank you, - (b) (6) (b) (6) From:- Sent: Friday, July 21, 2017 1:05 PM (b) (6) (b) (6) (b) (6) To: (b) (6) ~> ; -~> ; -(b) (6) (b) (6) (b) (6) ~>; Pape, Lisa M. ; VHA 108~> (b) (6) Cc: Lynch, Thomas (VHA) ; -(b) (6) W (VACO)~>; Hyduke, Barbara ; VHA lONC Action ; VISN Support (b) (6) ~> Team 3 ; (b) (6) Subject: RE:[ EXTERNAL} Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Hello, adding VST 3 for their awareness, t hanks. From: (b) (6) Sent: Friday~ July 21, 2017 4:02 PM (b) (6) (b) (6) Pape, Lisa M.; VHA 10B To: -Cc: Lynch, Thomas (VHA);-(b) (6) W (VACO); Hyduke, Barbara; VHA l0NC Action; VHA 10B; (b) (6) Subject: RE: [EXTERNAL]Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed Fox News I I just received notification that the Veterans are on their way to the VAMC in Mather , but perhaps they will stop at the SSVFoffice too. A Homeless Social Worker is wait ing for th em at th e ED to assesstheir needs - it seems they want to make sure the Veteran who was in an accident a few nights ago and presented at the ED has his medical needs assessed ASAPt oo . This was tru ly a collaborative effort and we appreciate your support. The Veterans were located at a park, Fox 40 was there and t he Veterans friends and a Coe navigator were there. There will be a followup story on Fox 40 tonight at 6pm Pacific. AMERICAN PVERSIGHT VA-19-0799-G-000388 DS_00021104 (b) (6) From:Sent: Friday, July 21, 2017 12:54 PM (b) (6) (b) (6) To:-~>; Pape, Lisa M . ; VHA 108 (b) (6) Cc: Lynch, Thomas (VHA) ; -(b) (6) W (VACO)~>; Hyduke, Barbara ; VHA lONC Action ; VHA 10B (b) (6) (b) (6) I ~>; ; (b) (6) (b) (6) ~> Subject: [EXTERNAL ] Homeless, 84-year-old war veteran twins say 'it's hell' afte r home fore closed I Fox News Please see this additional update: SSVFhas confirmed that one of the SSVFgrantees, Volunteers of America, has made contact with the Veterans and they will be arriving at the grantee location within the hour for an intak e screening . The SSVFgrantee is in close proximity to the local VAMC (walking distance) and t he SSVF Regional Coordinator has ensured that the grantee keep -(b) (6) VAMC staff updated on the progress so that the coordinated assessment goes smoothly and the Veterans are connected to the available resources. The VA staff , SSVFgrantees, and community partners are realty putting forth a coordinated joint effort . From:-(b) (6) Sent: Friday, July 21, 2017 2:36 PM To: Pape, Lisa M.; VHA 108 Cc: Lynch, Thomas (VHA); -(b) (6) -(b) (6) W (VACO); Hyduke, Barbara Subject: RE: [EXTERNAL] Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed Fox News I Lisa, This is t he response we have so far : • The Chief Public Affairs Officer at NCH CS, -(b) (6) added OPIA, VJSN 21 PAO & VHA (b) (6) (b) Commsto ani nternal email with VAMC leadership . I believe-ga ve-the (6)the group an (b) (6) will contact the Fox News reporter directly and give reporter ' s contact info.111111 update afterwards. This was the plan she sent to V AMC leadership : AMERICAN PVERSIGHT VA-19-0799-G-000389 OS 00021105 o When the reporter does a follow-up story he will be emailing me. This has not be scheduled as of yet. o I told the station we were having a hard time finding the Veterans and if the reporter could facilitate a connection that would be great. She was happy to do that when they do the follow-up. o I pitched an interview for our homeless team to talk about our program - the news director was excited about the idea and will share that with Joe . • • The GoFundMe site ( https://www.gofundme.com/help-gary-and-clifford-kukor at $92K and states the Veterans are staying with a friend. ) is currently The VISN Suspense Lead will submit a summary from the V AMC to 1ON on Monday and will include Dr. Alaigh, (b) (6) and Lisa Pape . I will report back when the VAMC provides another update . Thank you, -- MBA (b) (6) (b) (6) Health System Specialist Office of the VHA Chief of Staff (10B) VA Central Office, Washington, D.C. Office: (b) (6) Mobile: (b) (6) (b) (6) AMERICAr-... pVERSIGHT @va.gov VA-19-0799-G-000390 DS_00021106 Yourfeedback is important to our mission. Please take a brief customer survey to tell us how we are doing . From: Pape,Lisa M. Sent: Friday, July 21, 2017 12:21 PM To: VHA 10B Cc: Lynch,Thomas (VHA); -(b) (6) -(b) (6) W (VACO); Hyduke, Barbara Subject: FW: [EXTERNAL]Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News 108 , Please task out for follow by COB today with plan Thanks Lisa M . Pape, LISW Acting Chief of Staff {108) Department of Veteran Affairs Phone: 202-461-7016 Cell: 202-329-5841 From: Pape,Lisa M. Sent: Friday, July 21, 2017 12:20 PM To: -(b) (6) Lynch,Thomas (VHA) Cc: Alaigh, Poonam,M.D. Subject: RE: [EXTERNAL]Homeless,84-year-old war veteran tw ins say 'it's hell' after home foreclosed I Fox News On it. -(b) and Tom, (6) WE need to intervene . Hoping for resolution today. Lisa M. Pape, LISW Acting Chief of Staff {108) AMERICAN PVERSIGHT VA-19-0799-G-000391 OS 00021107 Department of Veteran Affairs Phone: 202-461-7016 Cell: 202-329-S841 From: Alaigh, Poonam,M.D. Sent: Friday, July 21, 2017 10:13 AM To: Pape,LisaM. Subject: FW: [EXTERNAL]Homeless, 84-year-old war veteran twins say 'it's. hell' after home foreclosed Fox News I Can someone look into this asap Sent with Good (www .good.com ) -----Original Message----(b From: 1P ■@frenchaoge1S9 . com] ) July 21, 2017 09 :33 AM Eastern Standard Time Sent: Friday, (6) To: DJS · Alaigh, Poonam, M .D. Subject: [EXTERNAL] Homeless , 84-year-o]d war veteran twins say 'it's hell' after home foreclosed IFox News Poonam and David, Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Is there something we can do to help these 2 vets? http:ljwww.foxnews.com/us/2017 hell-after-home-foreclosed. html /07 /20/homeless-war-vetera n-84-year-old-twins-say-its- Best, Ike AMERICAN PVERSIGHT VA-19-0799-G-000392 DS_00021108 Message Poonarn Alaigh I(b) (6) @hotmail.com] 7/24/201711:58:25 PM Laurie Perlmutter (b) (6) @gmail.com] Ike Perlmutter [l@frenchangel59.com]; ( Drshul ki n@aol .com b Fwd: [EXTERNAL] ) Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed From: Sent: To : CC: Subject: I Fox News ( 6 ) trying to get more info , please see articles and links on the latest regarding the Ike and Laurie- while we are twins that you brought to our attention- a lot of donations and funds being raised . THANK YOU!! Sent from my iPad Begin forwarded message : From: 11Alaigh , Poonam, M.D . 11 Date: July 24, 2017 at 7:53:58 PM EDT To: ·'Poonam Alaigh' - (b) (6) > Subject: FW: [EXTERNAL] Homeless. 84-year -old war veteran twins say 'it's hell' after home foreclosed I Fox News Sent with Good (www .good .com) -----Original Message--- -From: Pape , Lisa M. Sent: Nlonday , July 24, 2017 05: 19PMEastern Standard Time To: Alaigh, Poonam, M .D. Subject: FW: [EXTERNAL] Homeless 84-year-old war veteran twins say 'it's hell' after home foreclosed IFox News Read these articles Lisa Pape , LISW Acting VHA COS -----Original Message----From: (b) (6) Sent: Monday, July 24, 2017 12; 10 PM Eastern Standard Time (b) (6) To: Pape Lisa J\lf.; (b) (6) W (VACO); Hyduke , Barbara; VHA l0NC Action ; Cc: Lynch , Thomas (VHA) ; (b) (6) VHA 10B; VISN Support Team 3; (b) (6) VHA 10NA3 Action;-(b) (6) - (b) (6) Subject: RE : [EXTERNAL] Homeless, 84-year-old war veteran twins .say 'it's helJJ after home foreclosed IFox News I couldn't find the follow up on-air video online, but here are two on line articles: AMERICAN PVERSIGHT VA-19-0799-G-000393 DS 00021109 http://fox40.com/2017 twi ns/ /07 /21/vetera ns-aff airs-comm unity-step-u p-to-help-84-year-o Id-horn eless- http://www .foxnews.com/ us/ 2017/07 /23/homel ess-84-yea r-ol d-wa r-veteran-twi ns-helped -by,. veterans-affairs-donations-from-comm unity.print .htm I# From: Pape, Lisa M. Sent: Saturday, July 22, 2017 11:01 AM (b) (6) (b) (6) (b) (6) (b) (6) To:-~>; va. ov> (b) (6) Cc: Lynch, Thomas (VHA) ; -(b) (6) W (VACO) ~>; Hyduke, Barbara ; VHA l0NC Action ; VHA 10B ; VISN Support Team 3 ; (b) (6) (b) (6) (b) (6) ~> ; VHA 10NA3 Action (b) (6) (b) (6) (b) (6) (b) (6) va. ov>; (b) (6) (b) (6) ~> Subject: RE: [EXTERNAL]Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed Fox News I I Nope Lisa Pape_, LISW Acting VHA COS -----Original Message----From: -(b) (6) Sent: Saturday , July 22, 2017 01 :54 PM Eastern Standard Time To: (b) (6) Pape, Lisa M . Cc: Lynch, Thomas (VHA); (b) (6) W (VACO); Hyduke, Barbara; VHA lONC Action ; VHA 108; VISN Support Team 3; (b) (6) VHA 10NA3 Action ;-(b) (6) - (b) (6) (b) (6) Subject: RE : [EXTERNAL] Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed IFox News Would defer to Ms . Pape. From: (b) (6) Sent: Saturday,July 22, 2017 10:35 AM To: -(b) (6) Pape, Lisa M. Cc: Lynch,Thomas (VHA); -(b) (6) AMERl1...,A1 PVERSIGHT W (VACO);Hyduke, Barbara; VHA l0NC Action; VHA 108; VISN VA-19-0799-G-000394 DS_00021110 (b) (6) VHA 10NA3Action; (b) (6) (b) (6) ■ (b) (6) Subject: RE: [EXTERNAL]Homeless,84-year-oldwar veteran twins say 'it's hell' after home foreclosed I Fox News Good morning, Please advise if a ROCis sti ll needed. If not, we will close out the request. Thanks. (b) (6) From: (b) (6) Sent: Friday,July 21, 2017 7:38 PM (b) (6) (b) (6) Pape,Lisa M.; VHA 108 (b) (6) Cc: Lyne W (VACO);Hyduke, Barbara;VHA l0NC Action; VISN Support Team 3; (b) (6) Subject: RE: [EXTERNAL]Homeless , 84-year-oldwar veteran twins say 'it's hell' after home foreclosed I Fox News To: (b) (6) Good evening, The last update I just received from the VAMC is that the Veterans both arrived at the Mather ED where they were seen by social work/homeless and the one brother who had the accident earlier this week was seen by medical . His injuries were minor and nothing new was needed medically , They were provided a meal while there and offered a hotel room for the weekend to be paid by Voluntary Services, but they declined the latter because they planned to return to their friends' home. They also met with a benefits counselor from Volunteers of America to start the process for VBA benefits. They will meet again with someone from the VA Homeless Program and the Coe Housing Navigator early next week to assesswhat permanent housing solution would be best for them . Please let me know if there are any additional questions at this time. Thank you, - (b) (6) From: (b) (6) Sent: Friday, July 21, 2017 1:05 PM AMEFm...1/-\1 PVERSIGHT VA-19-0799-G-000395 DS 00021111 (b) (6) (b) (6) (b) (6) To: (b) (6) ~> ; -~> ; -(b) (6) (b) (6) ~>; Pape, Lisa M .< Lisa.Pape2@va.gov>; VHA 108 (b) (6) Cc: Lynch, Thomas (VHA) ;-(b) (6) W (VACO)~> ; Hyduke, Barbara ; VHA lONC Action ; VISN Support (b) (6) ~> Team 3 ; (b) (6) Subject: RE: [EXTERNAL]Homeless, 84-year-old war veteran twins say 'it's hell' after home foredosed I Fox News Hello, adding VST 3 for their aw areness, tha nks. From: (b) (6) Sent: Friday, July 21, 2017 4:02 PM (b) (6) (b) (6) To: -Pape,Lisa M.; VHA 108 Cc: Lynch,Thomas (VHA);-(b) (6) W (VACO);Hyduke, Barbara; VHA l0NC Action; VHA 108; (b) (6) Subject: RE: [EXTERNAL]Homeless, 84-year-oldwar veteran twins say 'it's hell' after home foreclosed I Fox News I jus t received notification that the Veterans are on their way to the VAMC in Mat her, but perhaps they will stop at the SSVFoffice too. A Home less Social Worker is wait ing fo r th em at the EDto assess their needs - it seems they want to make sure t he Veteran who was in an accident a f ew nights ago and presented at the ED has his medical needs assessed ASAP t oo. Thi s was tru ly a collaborative effort and we appreciate your support. The Veterans were located at a park, Fox 40 was there and t he Veterans friends and a Coe navigator we re there. There will be a followup story on Fox 40 tonight at 6pm Pacific. From:-(b) (6) Sent: Friday, July 21, 2017 12:54 PM (b) (6) To: -(b) (6) ~; Pape, Lisa M.< Lisa.Pape2@va.gov>; VHA 108 (b) (6) Cc: Lynch, Thomas (VHA) ; -(b) (6) W (VACO)~>; Hyduke, Barbara ; VHA lONC Action ; VHA 10B (b) (6) ; (b) (6) ~> ; (b) (6) I (b) (6) ~> Subject: [EXTERNAL] Homeless, 84-year -old war vetera n twins say 'it's hell' after home fore closed I Fox News AMERICAN PVERSIGHT VA-19-0799-G-000396 DS_00021112 Please see this additional update: SSVFhas confi rmed that one of the SSVF grantees, Volunteers of America, has made contact with the Veterans and they will be arriving at the grantee location within the hour for an intake screening. The SSVFgrantee is in close proxim ity to t he local VAMC (walking distance) and the SSVFRegional VAMC staff updated on the prog ress so Coordinator has ensured that the grantee keep -(b) (6) that the coordinated assessment goes smoothly and the Veterans are connected to the available resources. The VA staff , SSVFgrantees , and commun ity partners are really putting forth a coordina t ed joint effo rt. From: (b) (6) Sent: Friday, July 21, 2017 2:36 PM To: Pape,Lisa M.; VHA 10B Cc: Lynch,Thomas (VHA); -(b) (6) -(b) (6) W (VACO); Hyduke, Barbara Subject: RE: [EXTERNAL]Homeless,84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Lisa, This is the response w e have so far : • The Chief Public Affairs Officer at NCHCS , -(b) (6) added OPIA , VISN 21 PAO & VHA (b) (6) (b) Comms to an internal email with VAMC leadership . I believe-gave-the (6)the group an reporter's contact info. -(b) (6) will contact the Fox News reporte r directl y and give update afterwards. This was the plan she sent to VAMC leade rship: 1. < !--[if !supportLists ]-->< !--[endif]-- > When the reporter does a fol low-up story he will be emailing me . This has not be scheduled as of yet. 2. < !--[if !supportLists]-- >< !--[endif]--> l told the station we were having a hard time finding the Veterans and if the reporter could facilitate a connection that would be great. She was happy to do that when they do the follow -up. 3. < !--[if !supportLists]-- >< !--[endif]-- > I pitched an interview for our homeless team to talk about our program - the news director was excited about the idea and will share that with Joe . • The GoFund.Me site ( https:ljwww.gofundme.com/help -gary-and -clifford -kukor ) is currently at $92K and states the Veterans are staying with a friend. AMERICAN PVERSIGHT VA-19-0799-G-000397 OS 00021113 • The VISN Suspense Lead will submit a summary from the V AMC to ION on Monday and will include Dr. Alaigh, (b) (6) and Lisa Pape . I will report back when the VAMC provides another update. Thank you, -- MBA (b) (6) (b) (6) Health System Specialist Office of the VHA Chief of St aff (108) VA Central Off ice, Washington, D.C. Office: (b) (6) Mob ile: (b) (6) (b) (6) va.gov Your feedback is important to our mission . Please take a brief customer survey to tell us how we are doing. From: Pape,Lisa M. Sent: Friday,July 21, 2017 12:21 PM To: VHA 10B Cc: Lynch,Thomas (VHA); -(b) (6) -(b) (6) W (VACO);Hyduke, Barbara Subject: FW: [EXTERNAL]Homeless,84-year-oldwar veteran twins say 'it's hell' after home foreclosed I Fox News 108, AMERll.,AI PVERSIGHT VA-19-0799-G-000398 OS 00021114 Please task out for follow by COB today with plan Thanks Lisa M. Pape, LISW Acting Chief of Staff (108) Department of Veteran Affairs Phone: 202-461-7016 Cell: 202-329-5841 From: Pape,Lisa M. Sent: Friday,July 21, 2017 12:20 PM To: -(b) (6) Lynch,Thomas (VHA) Cc: Alaigh, Poonam,M.D. Subject: RE: [EXTERNAL]Homeless,84-year-oldwar veteran twins say 'it's hell' after home foreclosed I Fox News (b) On it.1111 and Tom , (6) WE need to intervene . Hoping for resolution today . Lisa M. Pape, LISW Acting Chief of Staff (108) Department of Veteran Affairs Phone: 202-461-7016 Cell: 202-329-5841 From: Alaigh, Poonam,M.D. Sent: Friday,July 21, 2017 10:13 AM To: Pape,Lisa M. Subject: FW: [EXTERNAL]Homeless,84-year-oldwar veteran twins say 'it's hell' after home foreclosed I Fox News AMERICAN PVERSIGHT VA-19-0799-G-000399 OS 00021115 Can someone look into this asap Sent with Good (www .good.com ) -----Original Message----(b From: IP ■@fret1changeJ59.com] ) July 2 1, 20 17 09:33 AM Eastern Standard Time Sent: Friday, (6) To: DJS ; Alaigh, Poonam , M .D. Subject: [EXTERNAL] Homeless , 84-year-old war veteran twins say 'it's hell ' after home foreclosed IFox News Poonam and David, Homeless, 84-year -old war veteran twins say 'it 's hell' after home foreclosed ] Fox News Is there something we can do to help these 2 vets? http:ijwww.foxnews.com/ us/2017 /07 /20/homeles s-war-vetera n-84-year-old -twins-say -itshell-after -home-foreclosed .html Best, Ike AMERICAr-... pVERSIGHT VA-19-0799-G-000400 DS 00021116 Message IP !1@frenchangel59.com ] ( 7/22/201710 :51:52 AM b 'Poonam Alaigh' I(b) (6) (E)hotmail.com) ) ( Shulkin' [dr shulkin@aol.com ] 'David RE:6[EXTERNAL)Homeless, 84-year-old war veteran twins say 'it 's hell' after home foreclosed From: Sent : To : CC: Subject: I Fox News ) Incredible News!!! Thank you so much for immediately reacting and finding a solution to this sad situation. We truly appreciate it. Thank you again. All my Best, Ike (b) (6) From: PoonamAlaigh [mailto-@hotmail.com] Sent: Friday,July 21, 201710:01 PM To: Ike Perlmutter Cc: DavidShulkin Subject: Fwd: [EXTERNAL]HomelessJ84-year-oldwar veteran twins say 'it's hell' after home foreclosedI Fox News Please see below resolution- thanks so much for btinging this to our urgent attention Ike !! Sent from my iPhone Begin foi:-wardedmessage : - > From: "Alaigb , Poonam, M .D." Date: July 21, 2017 at 9:59:59 PM EDT To: 'Poonam Alaigh 1 (b) (6) Subject: FW: [EXTERNAL] Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Sent wi th Good (www .good .com) -----O riginal Message----From: Pape , Lisa M . Sent: Friday, July 21, 2017 09:33 PM Eastern Standard Time To: Alaigh, Poonam , M .D . Cc: Hyduke , Barbara Subject: RE : [EXTERNAL] Home less, 84-year-old war vete ran twins say 'it's hell' after home foreclosed IFox News I just received notifica tion that the Veterans are on their way to the VAMC in Mather, but perhaps they will stop at the SSVF office too . A Home less Social Worker is wai ting for them at AMERICAN PVERSIGHT VA-19-0799-G-000401 DS_00021117 the ED to assess their needs - it seems they want to make sure the Veteran who was in an accident a few nights ago and presented at the ED has his medical needs assessed ASAP too . This was truly a coJlaborative effort and we appreciate your support . The Veterans were located at a park , Fox 40 was there and the Veterans friends and a CoC navigator were there. There will be a followup story on Fox 40 tonight at 6pm Pacific . Lisa Pape, LISW Acting VHA COS -----Original Mes sage----- · From: Alaigh, Poonarn, M.D . Se nt: Friday , July 21, 2017 08 :54 PM Eastern Standard Time To: Pape , Lisa M. Cc: Hyduke, Barbara Subject: RE : [EXTERNAL) Homeless, 84-year-old war veteran twins say 'it's hell' after borne foreclosed IFox News Let me know when resolved - thanks Sent with Good (www .good.com ) -----Original Message--From: Pape, Lisa M . Sent: Friday , July 21, 2017 04 :09 PM Eastern Standard Time To: Alaigb, Poonam, M .D. Cc: Hyduke, Barbara Subject: FW: [EXTERN AL] Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News This is getting addressed . Lisa M. Pape, LISW Acting Chief of Staff {108) Department of Veteran Affairs Phone: 202 -461-7016 Cell: 202-329-5841 AMERICAr-... pVERSIGHT VA-19-0799-G-000402 D8_00021118 From:-(b) (6) Sent: Friday,July 21, 2017 3:54 PM To: (b) (6) Pape, Lisa M.; VHA 108 Cc: Lynch,Thomas (VHA); (b) (6) W (VACO);Hyduke, Barbara;VHA 10NCAction; VHA 108; (b) (6) (b) (6) Subject: [EXTERNAL]Homeless,84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Please see this additional update : SSVFhas confirmed that one of the SSVFgrantees , Volunteers of America, has made contact with the Veterans and they will be arriving at the grantee location within the hour for an intake screening . The SSVFgrantee is in close proximity to the local VAMC (walking distance) and the SSVFRegional VAMC staff updated on the progress so Coordinator has ensured that the grantee keep -(b) (6) that the coordinated assessment goes smoothly and the Veterans are connected to the available resources. The VA staff, SSVFgrantees, and community partners are really putt ing forth a coordinated joint effort. From: (b) (6) Sent: Friday, July 21, 2017 2:36 PM To: Pape,Lisa M.; VHA 10B (b) (6) (b) (6) Cc: Lynch,Thomas (VHA); -W (VACO);Hyduke, Barbara Subject: RE: [EXTERNAL]Homeless,84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Lisa, This is the response we have so far: • The Chief Public Affairs Officer at NCHCS , -(b) (6) added OPIA, VISN 21 PAO & VHA (b) (6) (b) Comms to an internal email with VAMC leadership . I believe-gave-the (6)the group an (b) (6) will contact the Fox News reporter directly and give reporter ' s contact info.1111111 update afterwards. This was the plan she sent to V AMC leadership: 1. When the reporter does a follow-up story he will be emailing me . This has not be scheduled as of yet. AMERICAN PVERSIGHT VA-19-0799-G-000403 DS_00021119 2. I told the station we were having a hard time finding the Veterans and if the reporter could facilitate a connection that would be great. She was happy to do that when they do the follow-up. 3. I pitched an interview for our homeless team to talk about our program - the news director was excited about the idea and will share that with Joe . • • The GoFu ndMe site ( https://www.gofundme.com/help -gary-and-clifford -kukor ) is currently at $92K and states the Veterans are staying with a friend . The VISN Suspense Lead will submit a summary from the VAMC to ION on Monday and will include Dr. Alaigh, (b) (6) and Lisa Pape. I will report back when the VAMC provides another update. Thank you, -- MBA (b) (6) (b) (6) Health System Specialist Office of the VHA Chief of Staff (108) VA Central Office, Washington, D.C. Office: (b) (6) Mob ile: (b) (6) (b) (6) @va.gov Yourfeedback is important to our mission. Pleasetake a brief customer survey ta tell us how we are doing. AMERICAr-... pVERSIGHT VA-19-0799-G-000404 DS_00021120 From: Pape,Lisa M. Sent: Friday, July 21, 2017 12:21 PM To: VHA 10B Cc: Lynch,Thomas (VHA); -(b) (6) -(b) (6) W (VACO); Hyduke, Barbara Subject: FW: [EXTERNAL]Homeless,84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News 108, Please task out for follow by COB today with plan Thanks Lisa M. Pape, LISW Acting Chief of Staff (108) Department of Veteran Affairs Phone: 202-461-7016 Cell: 202-329-5841 From: Pape,Lisa M. Sent: Friday, July 21, 2017 12:20 PM To: -(b) (6) Lynch, Thomas (VHA) Cc: Alaigh, Poonam,M.D. Subject: RE: [EXTERNAL]Homeless,84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News (b) On it. Ill and Tom , (6) WE need to intervene . Hoping for resolution today. Lisa M. Pape, LISW Acting Chief of Staff (108) Department of Veteran Affairs Phone: 202-461-7016 AMERICAN PVERSIGHT VA-19-0799-G-000405 OS 00021121 Cell: 202-329-5841 From: Alaigh, Poonam,M.D. Sent: Friday,July 21, 2017 10: 13 AM To: Pape,Lisa M. Subject: FW: [EXTERNAL]Homeless,84-year-oldwar veteran twins say 'It's hell' after home foreclosed I Fox News Can someone 1ook into this asap Sent with Good (www .good .com) -----Original Message--(b) From: IP ■@frenchange159 . com ] (6), July 21, 2017 09 :33 AM Eastern Standard Time Sent: Friday To: DJS ; Alaigh , Poonam , M .D. Subject: [EXTERNAL] Homeless , 84-year-old war veteran twins say 'it's hell' after home foreclosed IFox News Poonam and David, Homeless, 84-year -old war veteran twins say 'it's heW after home foreclosed I Fox News Is there something we can do to help these 2 vets? http:ljwww.foxnews.com/us/2017 hell-after-home-foreclosed. html /07 /20/homeless-war-vetera n-84-year-old-twins -say-its- Best, Ike AMERICAN PVERSIGHT VA-19-0799-G-000406 DS 00021122 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent : 7/22/2017 2:01:25 AM To : Ike Perlmutter [l@frenchangel59.com] ( David Shulkin [drshulkin@aol.com] b Fwd: [EXTERNAL] ) Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed CC: Subject: I Fox News ( 6 ) thanks so much for bringing this to our urgent attention .Ilce!! Please see below reso lution- Sent from my iPhone Begin forwarded message : - > From: 11A1aigh, Poonam, M.D . 11 Date: July 21, 2017 at 9 :59 :59 PM EDT To: 'Poonam Alaigh' (b) (6) Subject: FW: [EXTERNAL] Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Sent with Good (www.good.com ) -----Original Message----From: Pape, Lisa M . Sent: Friday, July 21 2017 09 :33 PM Eastern Standard Time To: AJaigh, Poouam, M .D. Cc: Hyduke , Barbara Subject: RE : [EXTERNA L] Homeless , 84-year-old war veteran twin s say 'ies hell' after home foreclosed IFox News I just received notification that the Veterans are on their way to the V AMC in Mather, but perhaps they will stop at the SSVF office too . A HomeJess SociaJ Worker is. waiting for them at the ED to assess their needs- it seems they want to make sure the Veteran who was in an accident a few nights ago and presented at the ED has his medical needs assessed ASAP too . This was truly a collaborative effort and we appreciate your suppo11. The Veterans were located at a park , Fox 40 was there and the Veterans friends and a CoC navigator were there . There will be a followup story on Fox 40 tonight at 6pm Pacific. Lisa Pape , LISW Acting VHA COS -----O riginal Message----From: Alaigh , Poonam, M .D . Sent: Friday , July 21 , 2017 08 :54 PM Eastern Standard Time AMEFi1 .Jr I PVERSIGHT VA-19-0799-G-000407 DS 00021123 To: Pape, Lisa M. Cc: Hyduke , Barbara Subject: RE : [EXTERNAL] Homeless , 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox New s Let me know when resolved - thanks Sent with Good (www .good .com) -----Original Message----From: Pape, Lisa M . Sent: Friday, July 21, 2017 04 :09 PM Eastern Standard Time To: Alaigh , Poonam , M .D. Cc: Hyduke, Barbara Subject: FW : [EXTERNAL] Homeless , 84-year-old war veteran twins say 'it's hell' after home foreclosed IFox News This is getting addressed . Lisa M . Pape, LISW Acting Chief of Staff (108) Department of Veteran Affairs Phone: 202-461-7016 Cell: 202-329-5841 From:-(b) (6) Sent: Friday, July 21, 2017 3:54 PM To: (b) (6) Pape, Lisa M.; VHA 108 Cc: Lynch, Thomas (VHA); (b) (6) W (VACO); Hyduke, Barbara; VHA 10NC Action; VHA 108; (b) (6) (b) (6) Subject: [EXTERNAL] Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed News I Fox Please see this additional update : SSVFhas confi rmed that one of the SSVFgrantees , Volunteers of America , has made contact with the Veterans and they will be arriv ing at the grantee location within the hour for an intake screen ing. The SSVFgrantee is in close proximity to the local VAMC (walking distance) and the SSVFRegional AMEF , pVERSIGHT VA-19-0799-G-000408 D8_00021124 Coordinator has ensured that the grantee keep -(b) (6) VAMCstaff updated on the progress so that the coordinated assessment goes smoothly and the Veterans are connected to the available resources . The VA staff, SSVFgrantees, and community partners are really putting forth a coordinated joint effort. From: (b) (6) Sent: Friday, July 21, 2017 2:36 PM To: Pape,Lisa M.; VHA 10B Cc: Lynch,Thomas (VHA); -(b) (6) -(b) (6) W (VACO); Hyduke, Barbara Subject: RE: [EXTERNAL]Homeless,84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Lisa, This is the response we have so far: • The Chie f Pub lic Affairs Officer at NCHCS , -(b) (6) added OPIA , VISN 21 PAO & VHA (b) (6) (b) Comms to an internal email with V AMC leadership. I believe-gave-the (6)the group an (b) (6) will contact the Fox News reporter directly and give reporter ' s contact info . ~ update afterwards. This was the plan she sent to V AMC leadership : When the reporter does a follow-up story he will be emailing me. This has not be scheduled as of yet. 2. I told the station we were having a hard time fincting the Veterans and if the reporter could facilitate a connection that would be great. She was happy to do that when they do the follow-up. 3. I pitched an interview for our homeless team to talk about our program - the news ctirector was excited about the idea and will share that with Joe . l. • • The GoFundMe site ( https://www.gofundme.com/help-gary-and-clifford-kukor) is currently at $92Kand states the Veterans are staying with a friend. The VISN Suspense Lead wi ll submit a summa ry from the V AMC to l0N on Monday and will include Dr. Alaigh, (b) (6) and Lisa Pape . I will report back when the VAMCprovides another update. AMERICAN PVERSIGHT VA-19-0799-G-000409 DS_00021125 Thank you, -- MBA (b) (6) (b) (6) Health System Specialist Office of the VHA Chief of Staff (10B) VA Central Office, Washington, D.C. Office (b) (6) Mobile: (b) (6) (b) (6) @va .gov Yourfeedback is important to our mission. Please take a brief customer survey to tel/ us how we are doing . From: Pape,Lisa M. Sent: Friday, July 21, 2017 12:21 PM To: VHA 108 Cc: Lynch,Thomas (VHA); -(b) (6) -(b) (6) W (VACO);Hyduke, Barbara Subject: FW: [EXTERNAL]Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News 108 , Please task out for follow by COB today with plan Thanks Lisa M. Pape, LISW Acting Chief of Staff (108) AMERICAN PVERSIGHT VA-19-0799-G-000410 OS 00021126 Department of Veteran Affairs Phone: 202-461-7016 Cell: 202-329-5841 From: Pape,Lisa M. Sent: Friday, July 21, 2017 12:20 PM To: -(b) (6) Lynch,Thomas (VHA) Cc: Alaigh, Poonam,M.D. Subject: RE: [EXTERNAL]Homeless,84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News (b) On it. .. (6) and Tom , WE need to intervene . Hoping for resolution today. Lisa M. Pape, LISW Acting Chief of Staff (108) Department of Veteran Affairs Phone: 202-461-7016 Cell: 202-329-5841 From: Alaigh, Poonam,M.D. Sent: Friday,July 21, 2017 10:13 AM To: Pape,Lisa M. Subject: FW: [EXTERNAL]Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Can someone look into this asap Sent with Good (www .good .com ) -----O rigina l Message----(b) From: IP ■@frenchangel59 . com] (6) Sent: Fri day, July 21 , 2017 09:33 AM Eastern Standard Time AMEFm...,A1 PVERSIGHT VA-19-0799-G-000411 DS_00021127 To: DJS; Alaigh, Poonam, M.D. Subject: [EXTERNAL] Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Poonam and David, Homeless, 84-year-old war veteran twins say 'it's hell' after home foreclosed I Fox News Is there something we can do to help these 2 vets? http://www.foxnews.com/us/2017 hell -after-home -foreclosed .html /07 /20/homeless-war-veteran-84-year-old-twins-say-its- Best, Ike AMERICAN PVERSIGHT VA-19-0799-G-000412 OS 00021128 Message David shulkin LDrshulkin@aol.com] From: Sent : 7/26/201711 :09:31 AM To : (b) (6) Subject: Fwd: [EXTERNAL] Thank you! (b) (6) Phantl■■■■l@va.gov) Print Sent from my iPhone Begin forwarded message : From: SreyRam Kuy_ (b) (6) Date: July 26, 20 l 7 at 1: 11:03 AM EDT To: DJS , David shullcin Subject: Re: [EXTERNAL] Thank you! Secretary Shulkin, I just wanted to say how much I enjoyed reading your article in USA Today citing the many accomplishments of the VA - from training new doctors to leading the way in research and medical advancement. Thank you for making us so proudt As an RWJ CLinical Scholar alumna, I was a VA Scholar and did all my medical training at the VA. I am indebted to the VA I also wanted to say that if there is ever any way I could contribute - as a volunteer on a committee, as a volunteer advisor , drafting white papers or other opportw1ities , I would love to contribute any way I could . It's an honor and privilege to serve our nation's heroes. Please let me know anyway I can help using my experiences with managed care, leadin g opioid initiatives, quality metrics, etc. I really admire and look up to you as a role modeJ for RW J alumni wanting to make a rea l difference and truly change the world. Thanks for the inspiration! Respectful Iy, SreyRam ps. Here's a recent article about a talk I gave as the keynote speaker for President Bush's leader ship program . Hope yo u enjoy it. http ://www .bushcenter .org/publi cati ons/articles/2017 /07 /americas-two-economies. htm I SreyRam Kuy, MD, MHS, FACS ail .com (b) (6) (b) (6) On Tue, May 9, 20 17 at 9: 14 PM, DJS wrote: AMERICAN PVERSIGHT VA-19-0799-G-000413 DS_00021129 Thanks for updating me on your impressjve progress I continue to be hopefu l We will find the right role for you here Thanks for keeping in touch David Shulkin Sent with Good (www .good .com) -----Original Message----From : SreyRam Kuy~ (b) (6) Sent: Tuesday, May 09, 2017 05:04 PM Eastern Standard Time To: David shulkin; Shulkin, David J., MD Subje ct: [EXTERNAL] Thank you! Secretary Shulkin. Thanks so much for the wonderful opportun ity to meet with you back in March. I just wanted to say it was such an honor to get to meet and talk with you about serving our veterans. As an RWJ Clirucal Scholar, you are such an inspiration to me as a role model and a mentor. Again, thank you for the opportunity to get to meet you! I just wanted to share with you some updates in my work. This is an article that came out about my efforts to improve healthcare quality on the state level and the Early Career Achievement Award I'm receiving thjs month from Oregon Health Sciences University School of Medicine . https://www .ohsu.edu/xd/ education/school s/school-of-medi cine/news-andevents/2017 earlycareer.cfm I also was fortunate enough to receive a national community service AMERICAr-... pVERSIGHT VA-19-0799-G-000414 D8_00021130 award from RandomActs .org . witl1 a monetary prize , that I was able to donate to Dog Tag Bakery , a DC non-profit that helps wounded veterans develop business skills. http ://www .randomacts.org/news/cita- 2016-public- vote-winner / Again, thanks so much for taking the time to chat with me about veterans health , and for being such an inspiration . I'm often in DC for Medicaid and the National Quality Forum , and always appreciate an opportunity to say Hi, connect and express my interest in helping contribute to the VA and the efforts to serve our veterans . Thank you for being an inspiration and a role model for me. Respectfully, SreyRam SreyRam Kuy , NID, MHS , F ACS Chief Medical Officer , Medicaid Louisiana Department of Health Phone: (b) (6) Email:~ (b) (6) AMERICAr-... pVERSIGHT VA-19-0799-G-000415 D8_00021131 Message Davidshulkin [Drshulkin@aol.com] 7/26/2017 11:09:22 AM SreyRamKuy■■■ (b) (6) @g m ail . com] Re: [EXTERNAL] Thank you! From: Sent: To: Subject: Thanks again for staying in touch I love your persistence Im thinking of how best to work this out David shulkin sent from my iPhone > on Jul 26, 2017 , at 1 : 11 AM, SreyRam Kuy <-(b) (6) @gmail . com> wrote : > > secretary shulkin, > > > > > > > I just wanted to say how much I enjoyed reading your article in USA Today citing the many accomplishments of the VA - from training new doctors to leading the way in research and medical advancement. Thank you for making us so proud ! As an RWJclinical scholar alumna , I was a VA scholar and did all my medical training at the VA. I am indebted to the VA. > > > > > > > I also wanted to say that if there is ever any way I could contribute - as a volunteer on a committee , as a volunteer advisor, drafting white papers or other opportunities , I would love to contribute any way I could . It ' s an honor and privilege to serve our nation ' s heroes. Please let me know anyway I can help using my experiences with managed care , leading opioid initiatives, quality metrics , etc . > > I really admire and look up to you as a role model for RWJ alumni > wanting to make a real difference and trul y change the world . Thanks > for the inspiration! > > Respectfully > SreyRam , > > ps . Here ' s a recent article about a talk I gave as the keynote > speaker for President Bush' s leadership program . Hope you enjoy it . > http :// www.bushcenter . org / publications / articles / 2017/ 07/ americas-two-economies > > > (b) (6) >(b) (6) > >> >> >> >> >> . html FACS on Tue, May 9 , 2017 at 9:14 PM, DJS wrote: Thanks for updating me on your impressive progress I continue to be hopeful we will find the right role for you here >> >> Thanks for keeping in touch >> >> David shulkin >> >> >> >> sent with Good (www.good . com) >> >> >> >> >> >> >> » -----original Messa .. ---- From: SreyRam Kuy (b) (6) @gmail.com] sent : Tuesday , May , 7 05:04 PM Eastern To: David shulkin; shulkin , David J . , MD Subject: [EXTERNAL] Thank you! Standard Time >> >> secretary AVl[T'il .1f shulkin , I PVERSIGHT VA-19-0799-G-000416 OS 00021132 >> >> >> >> >> >> >> >> >> >> >> » >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> » » >> >> >> >> >> » Thanks so much for the wonderful opportunity to meet with you back in March. I just wanted to say it was such an honor to get to meet and talk with you about serving our veterans. As an RWJclinical scholar, you are such an inspiration to me as a role model and a mentor . Again, thank you for the opportunity to get to meet you! I just wanted to share with you some updates in my work . This is an article that came out about my efforts to improve healthcare quality on the state level and the Early career Achievement Award I'm receiving this month from Oregon Health Sciences University school of Medicine. https://www.ohsu.edu/xd/education/schools/school-of-medicine/news-and-events/20 l 7_earlycareer.cfm I also was fortunate enough to receive a national community service award from RandomActs.org, with a monetary pri ze, that I was able to donate to Dog Tag Bakery, a DC non-profit that helps wounded veterans develop business skills . http ://www.randomacts.org / news/ cita -2 016- public - vote -winner / Again , thanks so much for taking the time to chat with me about veterans health , and for being such an inspiration. I ' m often in DC for Medicaid and the National Quality Forum, and always appreciate an opportunity to say Hi , connect and express my interest in helping contribute to the VA and the efforts to serve our veterans . Thank you for being an inspiration and a role model for me. Respectfully SreyRam , SreyRam Kuy, MD, MHS, FACS chief Medical officer , Medicaid Louisi ana De artment of Health Phone : (b) (6) Email : (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000417 OS 00021133 Message (b) (6) SreyRamKuy [-@gmail .com] 7/26/2017 5:11:03 AM DJS[vacodjsl@va.gov]; Davidshulkin [DrShulkin@aol.com] Re: [EXTERNAL] Thank you! From: Sent: To: Subject: Secretary Shulkin, I just wanted to say how much I enjoyed reading your article in USA Today citing the many accomplishments of the VA - from training new doctors to leading the way in research and medical advancement. Thank you for making us so proud! As an RWJclinical scholar alumna, I was a VA scholar and did all my medical training at the VA. I am indebted to the VA. I also wanted to say that if there is ever any way I could contribute - as a volunteer on a committee, as a volunteer advisor , drafting white papers or other opportunities, I would love to contribute any way I could. It's an honor and privilege to serve our nation's heroes . Please let me know anyway I can help using my experiences with managed care, leading opioid initiatives , quality metrics, etc. I really admire and look up to you as a role model for RWJalumni wanting to make a real difference and truly change the world . Thanks for the inspiration ! Respectfully SreyRam , ps. Here's a recent article about a talk I gave as the keynote speaker for President Bush's leadership program . Hope you enjoy it . http :// www.bushcenter.org / publications / articles / 2017/ 07/ americas-two-economies.html (b) (6) (b) (6) Kuy, MD, MHS , FACS ·7 . com on Tue , May 9, 2017 at 9 :14 PM, DJS wrote : > Thanks for updating me on your impressive progress > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > I continue to be hopeful we will find the right role for you here Thanks for keeping in touch David shulkin sent with Good (www.good.com) -----original Messa .. ---From: SreyRam Kuy (b) (6) @gmail. com] sent : Tuesday , May , 17 05 :04 PM Eastern Standard Time To: David shulkin; shulkin , David J., MD Subject: [EXTERNAL] Thank you! secretary shulkin , Thanks so much for the wonderful opportunity to meet with you back in March. I just wanted to say it was such an honor to get to meet and talk with you about serving our veterans. As an RWJclinical scholar, you are such an inspiration to me as a role model and a mentor . Again , thank you for the opportunity to get to meet you! I just wanted to share with you some updates in my work . This is an article that came out about my efforts to improve healthcare quality on the state level and the Early career Achievement Award I'm receiving this month from Oregon Health Sciences University school of Medicine. AVl[T'il .1/-\I PVERSIGHT VA-19-0799-G-000418 OS 00021134 > > > > > > > > > > > > > > https://www.ohsu.edu/xd/education/schools/school-of-medicine/news-and-events/20l7_earlycareer.cfm I also was fortunate enough to receive a national community service award from RandomActs.org, with a monetary prize, that I was able to donate to Dog Tag Bakery, a DC non-profit that helps wounded veterans develop business skills. http://www.randomacts.org/news/cita-2016-public-vote-winner/ Again, thanks so much for taking the time to chat with me about veterans health, and for being such an inspiration. I'm often in DC for Medicaid and the National Quality Forum, and always appreciate an opportunity to say Hi, connect and express my interest in helping contribute to the VA and the efforts to serve our veterans. Thank you for being an inspiration and a role model for me. > > Respectfully, > > > > > > > SreyRam SreyRam Kuy, MD, MHS, FACS chief Medical officer, Medicaid Louisiana De artment of Health Phone : (b) (6) Email : (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000419 OS 00021135 Message From: David shu lkin [Drshulkin@ao l.com ] Sent: 7/6/20 17 7: 11 :26 PM To: Bruce Moskowi t z [brucemcll■■■ (b) (6) (b) @mac . com] IP ll@frenchangel59.com] (6) ( Re:bTerry Fadem CC: Subject: I tried tonight ) ( 6 calling ) him several times- he just sent me a note that it was the wrong number so he will call me Sent from my iPhone (b) (6) > on Jul 6, 2017, at 2 : 59 PM, Bruce Moskowitz > Any update (b) (6) . com> wrote: > > sent f rom my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000420 OS 00021136 Message From: Bruce Moskowitz [bruce (b) (6) (b) @mac .com] Sent: 7/6/2017 6:59:03 PM To: drshulkin@aol.com IP ll@frenchangel59.com] ( Terry b Fadem CC: Subject: Any update (6) ) ( 6 ) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000421 OS 00021137 Message David shulkin lDrshulkin@aol.com] 7/5/2017 3!16:03 PM Poonam Alaigh I(b) (6) @hotmail.com] Re: Touching base From: Sent : To : Subject: No - Sent from my iPhone > Otdul S, 2017, at 10:22 AM, Poona.tn AJaigh (b) (6) wrote : Do you want me to reach out to him Sent from my iPhone Begin forwarded message : (b) (6) From: ~ Date: July S, 2017 at 10: 11: 17 AM EDT To:-(b) (6) Subject: Touching base Hi Poonam , Hope you're doing terrific . We have missed you at our SAHLF meetings . Hopefully you can join us sometime! We are planning to do the next one in New York. Perhaps this might be easier for you . I'm reaching out because I'm a candidate for the VA Undersecretary role and would love your guidance given all of your experience and perspective acting in the role . -(b) (6) suggested you'd have some good thoughts and would love your candid view of the position. If you have a free moment or two I can give you a call--let me know . - ( Many thanks for your guidance in advance-I (b) (6) AMERICAN PVERSIGHT (b) (6) b ) ( 6 ) VA-19-0799-G-000422 DS 00021138 Message Poonarn Alaigh I(b) (6) @hotmail.com] 7/5/2017 2:22:07 PM David Shu Ikin (drshulkin@aol.com] Fwd: Touching base From: Sent: To : Subject: Do you want me to reach out to him Sent from my iPhone Begin fo.-warded message : From:~(b) (6) Date: July 5, 2017 at 10:11:17 AM EDT To:-(b) (6) Subject: Touching base Hi Poonam , Hope you 1re doing terrific . We have missed you at our SAHLF meetjngs. Hopefully you can join us sometime! We are planning to do the next one in New York _ Perhaps this might be easier for you. I'm reaching out because I'm a candidate for the VA Undersecretary role and would love your guidance given all of your experience and perspective acting in the role . -(b) (6) suggested you'd have some good thoughts and would love your candid view of the position . If you have a free moment or two I can give you a call~-Jet me know. - Many thanks for your guidance in advance- (b) (6) (b) (6) AMERICAN PVERSIGHT (b) (6) VA-19-0799-G-000423 DS 00021139 Message From: David shulkin LDrshulkin@aol.com] Sent : 7/2.2/2017 5:43 :51 PM To : (b) (6) Subject: Re: (b) (6) @gmail.com] Good thoughts Sent from my iPhone On Jul 22, 2017, at 1:21 PM, (b) (6) (b) (6) mail.com> wrote ; Probably could as a political , even at GS13 level to start. I'm sure PPO is still trying to place young communicators from the campaign . Best place to look for resumes I think. I asked Curt to take a look . He seems to be better writer and communjcator . I keep pushing for him to get more involved with your stuff in the front end vs behind the scenes. Seems solid in his capabilities . Could probably do even better things ifbe was closer. On Sat, Jul 22, 2017 at 1 :02 PM David Shulkin wrote : I wonder if we could do a scarmucci and find a really good and talented young writer ? Sent from my iPad (b) (6) > On Jul 22, 2017, at 11:13 AM, (b) (6) ail.com> wrote: > > I don't think-(b) (6) remarks for Youngstown are good . 1 think Brandon or Cttrt should help. Let me know if you agree before I ask them to chop. Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000424 DS 00021140 Message From: (b) (6) Sent : 7/22/2017 5:21:31 PM To: David Shu Ikin (drshulk in@aol.com] Re: Subject: (b) (6) @gmail.com] Probably could as a political, even at GS 13 level to start. Jim sure PPO is still trying to place young communicators from the campaign. Best place to look for resumes I think. 1 asked Curt to take a look. He seems to be better writer and communicator. I keep pushing for him to get more involved with your stuff in the fron t end vs behind the scenes . Seems solid in his capabilities . Could probably do even better things if he was closer. On Sat, Jul 22, 2017 at 1 :02 PM David Shulkin wrote : I wonder if we could do a scarmucci and find a really good and talented young writer? Sent from my iPad (b) (6) > On Jul 22, 2017 , at 1 1: 13 AM,, (b) (6) ail .com > wrote: > > I don't think-(b) (6) remarks for Youngstown are good . I think Brandon or Curt should help . Let me know if you agree before I ask them to chop . Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000425 DS 00021141 Message To: DavidShulkin [drshulkin@aol.com] 7/22/2017 5:02:12 PM (b) (6) (b) (6) Subject: Re: From: Sent: I wonder if we could do a scarmucci @gmail.com] and find a really good and talented young writer? Sent from my iPad > On Jul 22, 2017, at 11:13 AM, (b) (6) > > I don't think -(b) (6) if you agree be~sk AMERICAN PVERSIGHT (b) (6) <-r@gmail.com> wrote: remarks for Youngstown are good. I think Brandon or curt should help . Let me know them to chop. VA-19-0799-G-000426 OS 00021142 Message To: DavidShulkin [drshulkin@aol.com] 7/22/2017 4:48:53 PM (b) (6) (b) (6) Subject: Re: From: Sent: Let's ask them to try ThNks And thanks for the bday wishes sent from my iPad > > On Jul 22, 2017, at 11:13 AM, (b) (6) > I don't think -(b) (6) if you agree be~sk AMERICAN PVERSIGHT (b) (6) <-r@gmail.com> wrote: remarks for Youngstown are good. I think Brandon or curt should help . Let me know them to chop. VA-19-0799-G-000427 OS 00021143 Message From: (b) (6) (b) (6) Sent: 7/22/2017 3:13:56 PM To: David Shulkin [drshulkin@aol.com] @gmail.com] I don't think-(b) (6) remarks for Youngstown are good. I think Brandon or Curt should help. Let me know if you agree before I ask them to chop. AMERICAN PVERSIGHT VA-19-0799-G-000428 OS 00021144 Message David shulkin lDrshulkin@aol.com] From: Sent : 7/13/2017 4:00 :32 PM To : Marc Sherman [mb (b) (6) @gmail.com] Bruce Moskowitz [bruce (b) (6) (b) @mac.com] Re: Human Resources (6) BCC: Subject: 1 did not know about the development from the lunch - sorry Sent from my iPhone On Jul 13, 2017 , at 12:22 PM, Marc Sherman <- (b) (6) > wrote: Thanks for the quick reply . I am leaving for vacation until July 28 and then would love to get together with Peter and get to know him . I will tell AU to stand down on the search and we can then have them interface directly with Peter ifhe thinks they can help him with advisory. They have offered to develop on line HR training programs and other things. You are right that they offered advisory but after a two hour lunch meeting two weeks ago, they got the message that advisory is useless unless you have a director to advise , so they were cajoled into helping find the director first. Our fault that we crossed signals . On Thu, Jul 13, 2017 at 1:14 AM, David shulkin wrote : Marc- yes we do have a person now- which is why i wrote and suggested you may want to meet ( or speak) to Peter. My understanding from the emails we received is that we had sought this assistance from AU and that they were only able to offer advisory assistance but not anyone to come to VA to fill a role . We received no information that any candidates were identified or any on the horizon- sorry if there was a mis communication. We are very appreciative of these efforts of course and now that Peter is on board we are in a better position to take advantage of AU's advisory offer David Sent from my iPhone On Jul 13, 2017, at 4:47 AM, Marc Sherman <- (b) (6) wrote : David Can you confirm that the VA now has a full time HR Director? I am asking because in our call a few weeks ago you had identified the HR Director vacancy to be one of the biggest issues to solve . Following the call Bruce searched out American University as a player in the HR space and recruited them to help by lobbying the University President. They agreed to help after we had a meeting and several phone calls over the last two weeks . As a result of that effort, the AU General Counsel is currently spending significant time searching out HR Director candidates . If the slot has been filled I need to call her off ASAP for obvious reasons. Please let me know as soon as you can AMERICAN PVERSIGHT VA-19-0799-G-000429 DS 00021145 Thanks . Hope the trip is fruitful. Marc On Tue , Jul 11, 2017 at I I :04 AM David shulkin wrote : Two updates- one here and one on the next email Our new head of HR started last week- great background and ready to change the status quo- his name is Peter Shelby and Ike and I thought a call to get to know him and offer assistance might be valuable . His office number is - (b) (6) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000430 DS 00021146 Message From: Marc Sherman [mb (b) (6) @gmail.com] Sent : 7/13/2017 10:22:08 AM To : David shulkin [Drshulkin@aol.com] Bruce Moskowitz [bruce (b) (6) (b) @mac.com] Re: Human Resources (6) CC: Subject: Thanks for the quic k reply. lam leaving for vacation until July 28 and then would love to get together with Peter and get to know him. I will tell AU to stand down on the search and we can then have them interface directly with Peter if he thinks tliey can help him with advisory. They have offered to develop online HR training programs and other things. You are right that they offered advisory but after a two hour lunch meeting two weeks ago, they got the message tbat advisory is useless unless you have a director to advise, so they were cajoled into helping find the director first. Our fault that we crossed signals . On Thu, Jul 13, 2017 at 1:14 AM, Da vid shulkin wrote: Marc- yes we do have a person. now- which is why i wrote and suggested you may want to meet (or speak) to Peter. My understanding from the emajls we received is that we had sought this assistance from AU and that they were only able to offer advisory assistance but not anyone to come to VA to fill a role. We received no information that any cru1didateswere identified or any on the horizon- sorry if there was a mis communication . We are very appreciative of these efforts of course and now that Peter is on board we are in a better position to take advantage of AU's advisory offer David Sent from my iPbone On Jul 13, 2017 , at 4A7 AM, Marc Sherman <- (b) (6) > wrote : David Can you confirm that the VA now bas a full time HR Director? I am asking because in our call a few weeks ago you had identified the HR Director vacancy to be one of the biggest issues to solve . Following the call, Bruce searched out American University as a player in the HR space and recruited them to help by lobbying the University President. They agreed to help after we had a meeting and several phone calls over the last two weeks . As a result of that effort , the AU General Counsel is currently spending significant time searching out HR Director candidates . If the slot has been filled, I need to call her off ASAP for obvious reaso ns . Please let me know as soon as you can Thanks . Hope the trip js fruitful. Marc On Tue, Jul 11, 2017 at 11:04 AM, David shulkin wrote : Two updates- one here and one on the next email Our new head of HR started last week- great background and ready to change the staws quohis name is Peter Shelby and Ike and I thought a caU to get to know him and offer assistance AMERICAN PVERSIGHT VA-19-0799-G-000431 DS 00021147 might be valuable. His office number is-(b) (6) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000432 OS 00021148 Message David shulkin lDrshulkin@aol.com] 7/13/2017 5:14:56 AM Marc Sherman [mb (b) (6) @gmail.com] Bruce Moskowitz [bruce (b) (6) (b) @mac.com] Re: Human Resources (6) From: Sent : To : CC: Subject: Marc- yes we do have a person now- which is why i wrote and suggested you may want to meet (or speak) to Peter. My understanding from the emails we received is that we had sought this assistance from AU and that they were only able to offer advisory assistance but not anyone to come to VA to fiLIa role . We received no information that any candidates were identified or any on the horizon- sorry if there was a mis communication . We are very appreciative of these effo11s of course and now that Peter is on board we are in a better position to take advantage of AU's advisory offer David Sent from my iPhone On Jul 13, 2017, at 4 :47 AM, Marc Sherman <- (b) (6) > wrote : David Can you confirm that the VA now has a full time HR Director? I am asking because in our call a few weeks ago you had identified the HR Director vacancy to be one of the biggest issues to solve . Following the call, Bruce searched out American University as a player in the HR space and recruited them to help by lobbying the University President. They agreed to help after we had a meeting and several phone calls over the last two weeks . As a result of that effort , the AU General Counsel is currently spending significant time searching out HR Director candidates . If the slot has been filled, I need to call her off ASAP for obvious reasons . Please Jet me know as soon as you can Thanks . Hope the trip is fruitful. Marc On Tue , Jul I 1, 2017 at 11 :04 AM , David shulkin wrote : Two updates- one here and one on the next email Our new head of HR started last week- great background and ready to change the status quo- his name is Peter Shelby and Ike and I thought a call to get to know him and offer assistance might be valuable. His office number is-(b) (6) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000433 DS 00021149 Message From: Marc Sherman [mb (b) (6) @.gmall.com] Sent : 7/13/2017 2:47:23 AM To : David shulkin [Drshulkin@aol.com] Ike Perlmutter (l@frenchangel59.com]; ( Re: Human Resources b CC: Subject: David Bruce Moskowitz [brucer (b) (6) (b) @mac.com] (6) ) ( 6 ) Can you confirm that the VA now has a full time HR Direc tor? I am asking because in our call a few weeks ago you had identified the HR Director vacancy to be one of the biggest issues to solve. Following the call , Bruce searched out American University as a playe r in the HR space and recruited them to help by lobbying the University President. They agreed to help after we had a meeting and several phone calls over the last two weeks. As a result of that effort , the AU General Counsel is cutTently spending significant tjme searching out HR Director candidates . If the slot has been filled, I need to call her off ASAP for obvious reasons . Please let me know as soon as you can Thanks. Hope the trip is frnitful. Marc On Tue, Jul 11, 2017 at 11 :04 AM, David shulk:in wrote: Two updates- one here and one on the next email Our new bead of HR started last week- great background and ready to change the status quo- his name is Peter Shelby and Ike and I thought a call to get to know him and offer assistance might be valuable. His office number is-(b) (6) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000434 DS 00021150 Message (b) (6) (b) Bruce Moskowitz [bruce~@mac .com] (6) Sent: 7/11/2017 3:13:03 PM To: Davidshulkin [Drshulkin@aol.com] ( (b) (6) Ike Perlmutter [ll@frenchangel59.com]; CC: Marc Sherman [mb-@gmail.com] b Re: Human Resources Subject: ) ( 6 Good news ) Sent from my iPad Bruce Moskowitz M.D. From: > on Jul 11, 2017, at 11:04 AM, David shulkin wrote: > > Two updates- one here and one on the next email > > our new head of HR started last week- great background and ready to change the status quo- his name is Peter Shelby and Ike and I thought a call to get to know him and offer assistance might be valuable. His office number is -(b) (6) > > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000435 OS 00021151 Message Davidshulkin [Drshulkin@aol.com] Sent: 7/11/2017 3:04:36 PM To: Ike Perlmutter [ll@frenchangel59.com] ( CC: Bruce Moskowitz b [brucem (b) (6) (b) @mac.com]; Marc Sherman [mb (b) (6) @gmail.com] Subject: Human Resources ) (6) ( 6 ) Two updates- one here and one on the next email From: our new head of HR started last week- great background and ready to change the status quo- his name is Peter Shelby and Ike and I thought a call to get to know him and offer assistance might be valuable. His office number is -(b) (6) sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000436 OS 00021152 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 7/2/20 17 5:0 1:34 PM To: Bruce Moskowitz [bruce~@mac (b) (6) (b) (6) drshulkin@aol.com Re: Inventory Management CC: Subject: Thanks Bruce, definitely priority this week .com] a good back up plan after the Kurt situation- I will get working on this as a Sent from my iPhone (b) (6) > on Jul 2, 2017, at 8 : 34 AM, Bruce Moskowitz (b) (6) > ~who Hi~the general inventory (b) . com> wrote: (6) is at the Vanderbilt VA was part of the inventory management meeting in Baltimore. part of inventory , all medical devices . we can pair his group with a most critical manager which would solve the problem . > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000437 OS 00021153 Message From: IP ll@frenchangel59 .com] ( Sent: 7/11/2017 2:37:04 PM b To: 'David ) shulkin ' [drshulk in@aol .com] Donna ( Katen-Bahensky, MSPH - Medical Center Director Subject: 6 ) Office: (561) 422-8601 Cell:-(b) (6) Email: Donna.Katen-Bahensky@va.gov AMERICAN PVERSIGHT VA-19-0799-G-000438 OS 00021154 Message Bruce Moskow Ttz [bruce (b) (6) (b) @mac.com] 8/19/20171:45:03 PM (6) David Shulkin [secshulkin@gmail.com] Poonam Alaigh ••• .com); laurie perle (b) (6) @yahoo.com]; (b) (6) @gmail.com]; Ike Perlmutter !l@frenchangel59 ( From: Sent : To : CC: mbslll.l@gmail.com (b) (6) b ) Morass Re: NYTimes: A Start-Up Suggests a F'ixto the Health Care Subject : ( 6 ) The segment that pertains to Va is patient tracking and cost control in choice program is my focus I have a meeting with Apple this week. We have the software to do this and we have already identified how this gets integrated with Epic . Even though 1 can getthis done for free I can 1t without the authority to do so. Sent from my iPhone On Aug 19, 2017, at 9:30 AM, David Shulki11 wrote: Bruce- i agree this is the future- the GPS of healthcare I know the guys at AJedade- they are former Obama guys and here in DC- unbelievable that they raised 75m Sent from my iPhone On Aug 17, 2017, at 7:34 AM, Brnce Moskowitz wrote : There is an important section in this article that ve1ifies what 1 explained needs to be part of the Apple Effort and the Geotagging . Below I copied that section . We had various specialists from the academic centers on the first call with Apple since Apple can not do this alone . Without a similar initiative we can not meet quality care standards nor can we control costs . Aledade's software addresses that by collecting patient data from a variety of sources , creating a helicopter view. Doctors can see which specialists a patient has visited , which tests have been ordered , and, cruc ially, how much the overall care might be costing the health care system. More important, the software uses the data to assemble a battery of daily checklists for physicians ' practices . These are a set of easy steps for the practice to take - call this patient , order this vaccine - to keep on top of patients' care, and , in time, to reduce its cost. For example , say you're a doctor at a small practice in rural Kansas and one of your patients , a 67-year-old man with heart disease , has just gone to the emergency room . "In the past, we'd only find out our patients were at the hospital maybe weeks afterward ," said Dr. Bryan Dennett , who runs the Family Care Center in Winfield, Kan., with medical partner , Dr. Bryan Davis. With Aledade , Dr. Dennett is now alerted immediately , so ''we can call them when they're at the emergency room and say , 'Hey, what are you doing there? Come back here, we can take care of you !" It is not just emergency room visits . Aledade tells doctors which of their patients is eligible for preventive care like vaccines or an '1annual wellness AMERICAN PVERSIGHT VA-19-0799-G-000439 DS 00021155 visit." The doctors said that during such visits they have discovered several cond itions that would have ballooned into much bigger problems without treatment. The software lets doctors know when their patients have been discharged from the hosp ital , allowing them to schedule "transitional care management " visits. Such visits are a gimme for the hea lth care system - they have been proved to reduce hospital readmissions (which are extremely costly) , and patients say they find them valuab le in navigating the health care system . And because these visits are so effective at lowering overall health care costs , Medicare pays doctors a higher rate to provide such care meaning that primary care doctors can make money by following Aledade 's alerts . https://www .nytimes.com/2017/08/16/technology/a-start-up-suggests-a-fix-to-the health-care-morass .html?smprod=nytcore-ipad&smid=nytcore-ipad-share Aledade, a tech start-up , is working to reduce health care costs while improving care. The tesuJts are on view at two medical practices in southeast Kan sas. Sent from my iPad Bruce Mosk owitz M.D. AMERICAr-... pVERSIGHT VA-19-0799-G-000440 D8_00021156 Message From: Sent : To : CC: Subject: David Shulkin [secshulkin@gmail.com] 8/19/20171:30 :12 PM Bruce Moskowitz [bruce (b) (6) (b) @mac.com] Poonam Alaigh (b) (6) @gmail.com); (6) Ike Perlmutter lll@frenchangel59.com) ( Re: NYTimes: A Start-Up Suggests a Fix to the Health Care b Morass Bruce- i agree this is the future- the GPS of healthcare ) ( 6 ) 1 know the guys at A1edade~ they are former Obama guys and here in DC- unbelievable that they raised 75m Sent from my iPhone On Aug 17 2017 , at 7:34 AM , Bruce Moskowitz on Jul 6, 2017, at 6:13 AM, Poonam Alaigh <-@hotmail.com> > > Ona whole bunch of stuffthe accountability website. including Kurt / inventory wrote: management, Apple- and also gave him a heads up on > > Told him to let everyone know that we are going to be away for the next 2 weeks > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000444 OS 00021160 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 7/6/2017 10:13:36 AM To: DavidShulkin [drshulkin@aol.com] Spoke to Bruce this morning Subject: on a whole bunch of stuff- including the accountability website. Kurt/inventory management, Apple- and also gave him a heads up on Told him to let everyone know that we are going to be away for the next 2 weeks sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000445 OS 00021161 Message David shulkin [Drshulkin@aol .com] From: Sent : 6/29/2017 9:15 :16 PM To : (b) (6) Jennifer Lee ■■l@gmail.com] Fwd: Follow-up from NVS Oncology/VA Discussion Subject: Good job Sent from my iPhone Begin forwarded message: (b)(6) (6), (b) (2) From:-(b) (6), (b) (b) (2) Date: June 29, 2017 at 2:33:46 PM EDT artners.com > To: David shulkin Subject: Fwd: Follow-up from NVS Oncology/VA Discussion Jennifer was excellent. We had a very good call with Novartis and Jenn. All of us thought it was very productive. We wlll go through several rounds before it even gets near you to ensure that we only use your time when it's truly needed and makes sense. I will learn from this interaction so we can figure out what works and does not and apply that to others . Begin forwarded message: From: ' (b) (6) (b) (b)(6) (6) novarti s.com> To: "Jennife r.S.Lee@va.gov" , •-(b) (6), (b) (2) (b) (b)(6) (6), (b) (2) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) novartis.com >, ' (b) (6) (b) (6) novartis.com > Subject: Follow-up from NVS Oncology/VA Discussion 1111 Dear Jennifer and (b) (6) Thank you for the good conversation yesterday on opportunities for true partnerships with Novartis Oncology and the VA . A few summary points/follow-ups : • < !--[endif]--> There is mutual interest in the areas of Breast , Lung, and Heart Disease (with a focus on PTSD)--> just a reminder that Heart Disease sits out of our Oncology Business Unit , but we are absolutely happy to work with our colleagues in that disease area as relevant AMERICAN PVERSIGHT VA-19-0799-G-000446 DS_00021162 • • • ln terms of how a partnership could evolve, we envision a joint , potentially exclusive partnership between the VA and NVS Oncology on the areas below: 1. lntegrated Clinical Trials , with a focus on enhanced execution. A unique structure could be developed, and resources potentially would be needed to enable this (as well as the two other points below) 2. Care Beyond Trials- utilization of Big Data to help support learning of different patient dynami cs, treatment dynamics (rural/urban, for example), and care/treatment pathways • Based on the evolution of #2 , we can consider bringing in IBM Watson+/- COTA as a supporting capability • We also discussed having NVS own the partnership vs. IBM or COT A 3. Finally, we committed to being transparent around any areas that we may or may not have flexibility on given our organizational demand s-with the goal of speeding any collaborations along as effectively as possible. Next Steps : Both NVS and the VA to brainstorm more on what this relationship could look like. I'm happy to organize a draft of the NVS proposa l to share with you , and please let me know what thoughts you have as well Please let me know if I've missed anything , or if any clarifications are needed. - Best Regards, (b) (6) (b) (6) Head Strategy , Partnering & Operat ions Head Strategic Data (ad interim) US Oncology Novartis Pharmaceuticals Corporation (b) (6) AMERICAr-... pVERSIGHT VA-19-0799-G-000447 DS 00021163 Message From: DavidShulkin [drshulkin@aol.com] Sent: 7/22/2017 4:52:57 PM To: (b) (6) Poonam Alaigh[-@hotmail.com] Re: Happy birthday Subject: Thanks Poonam I wish my back was better- hard to enjoy in pain today Sent from my iPad > on Jul 22, 2017, at 8:05 AM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : > > Getting started with a whole bunch of stuff and j ust realized the day- happy birthday is most dearest and precious. Wish you the worlds happiness and success on this blessed always and unconditionallyPoonam to a friend who day ! ! A friend > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000448 OS 00021164 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 7/22/2017 12:05:01 PM To: DavidShulkin [drshulkin@aol.com] Happy birthday Subject: Getting started with a whole bunch of stuff and just realized the day- happy birthday to a friend who is most dearest and precious. Wish you the worlds happiness and success on this blessed day!! A friend always and unconditionallyPoonam Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000449 OS 00021165 Message To: Davidshulkin [Drshulkin@aol.com] 7/9/20 17 4:42:01 PM Poonam AlaighI(b) (6) @hotmail.com] Subject: Re: From: Sent: No hurry Sent from my iPhone (b) (6) > on Jul 9, 2017, at 11:50 AM, Poonam Alaigh <-@hotmail.com> wrote: > > should I work on it once I get back or now- would prefer once I am there > > sent from my iPhone > on Jul 9, 2017 , at 2 : 30 PM, David shulkin wrote: >> i think what happened was >> Poonam- I spoke with Terry Fedem this morning and had a good conversationsimply a lack of direct conversation since he was not aware of all of the work that had been done to get him a contract - and therefore he sent his own contract and proposal. » >> >> I think we need to simply have someone call copy to sign him and review the terms and if agreeable to him get him a >> >> we also need to be clear who will manage and supervise his involvement and hours so this out of control >> And will be defensible when reviewed by outside parties does not get >> >> >> >> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000450 OS 00021166 Message From: (b) (6) Poonam Alaigh[-@hotmail.com] Sent: 7/9/20 17 3:50:47 PM To: Davidshulkin [Drshulkin@aol.com] Subject: Re: Should I work on it once I get back or now- would prefer once I am there Sent from my iPhone > on Jul 9, 2017, at 2:30 PM, David shulkin wrote: > > Poonam- I spoke with Terry Fedem this morning and had a good conversationi think what happened was simply a lack of direct conversation since he was not aware of all of the work that had been done to get him a contract- and therefore he sent his own contract and proposal . > > I think we need to simpl y have someone call copy to sign > him and review the terms and if agreeable to him get him a > we also need to be clear who will manage and supervise his involvement and hours so this out of control > And will be defensible when reviewed by outside parties does not get > > > > s ent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000451 OS 00021167 Message From: Sent: To: Davidshulkin [Drshulkin@aol.com] 7/9/20 17 1:30:37 PM (b) (6) Poonam Alaigh [-@hotmail.com] (b) (6) (b) Bruce Moskowitz [bruce~@mac.com]; (6) ( l59 .com] Ike Perlmutter [ll@frenchange b ) ( Poonam- I spoke with Terry Fedem this morning and had a good conversationi think what happened was 6 simply a lack of direct conversation since he was not aware of all of the work that had been done to get him a contract- and therefore he sent his own contract and proposal.) CC: I think we need to simply have someone call copy to sign him and review the terms and if agreeable to him get him a we also need to be clear who will manage and supervise his involvement and hours so this of control And will be defensible when reviewed by outside parties does not get out sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000452 OS 00021168 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 7/17/2017 6:53:15 AM To: (b) (6) Poonam Alaigh [-@hot Subject: Re: In terms of the allegations mail.com] of thousands of patients waiting for specialist care - can we confirm that? Sent from my iPhone (b) (6) > on Jul 17, 2017, at 7:07 AM, Poonam Alaigh <-@hotmail.com> wrote: > > Let ' s talk this morning- I had a conversation with him last night > > sent from my iPhone > >> on Jul 17 , 2017, at 6 : 57 AM, David shulkin wrote : >> >> I f the cos can work clinically i would put him to work clinically pending the results of the review >> >> For the med i would keep her on virtual admin to the visn pending investigation >> >> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000453 OS 00021169 Message From: Sent: To: David shu lkin [Drshulkin@ao l.com] 7/17/2017 5:57:11 AM Poonam Alaigh I(b) (6) @hot mail.com] If the cos can work clinically i would put him to work clinically For the med i would keep her on virtual pending the results of the review admin to the visn pending investigation Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000454 OS 00021170 Message From: Sent: To: CC: Subject: David shu lkin [Drshulkin@ao l.com ] 6/ 30/2017 9:43: 17 PM (b) (6) (b) Bruce Moskowitz [brucerrl■■■l@mac . com] Ike Perlmutter ll@frenchangel59.com] (6) ( Fwd: Cleveland b Clinic CEO(b) (6) on what he's telling his senator, and news roundup by POLITICO's ) Pulse Check on SoundCloud - Hear the wor ld's sounds ( 6 ) > > Fyi- on why (b) (6) > > https: // m.soundcloud > > > > sent from my iPhone AMERICAN PVERSIGHT did not take VA secretary . com/ politico-pulsecheck job . / cleveland-clinic-c (b) (6) -and-news-roundup VA-19-0799-G-000455 OS 00021171 Message David shulkin LDrshulkin@aol.com] 6/30/2017 9:33 :33 PM From: Sent : - (b) (b) (6) ■--■hotmail.com] (6) Fwd: Cleveland Clinic CEO ■■■■I on what he's telling his senator , and news roundup by (b) (6) To : Subject: POLITICO's Pulse Check on SoundCloud - Hear the world's sounds Interesting to listen to-(b) (6) on VA Sent from my iPhone Begin forwarded message: From: (b) (6) Date: June 30, 2017 at 5:29:22 PM EDT To:-(b) (6) Cc: Dad Subject: Cleveland Clinic CEO (b) (6) on what he's telling his senator and news roundup by POLITlCO's Pulse Check on SoundCloud - Hear the world's sounds Fyi- on why (b) (6) did not take VA secretary job. (b) (6) https://m .soundcloud.com/politico-pul secheck/cleveland-cl inic-ceo=-.an roundup d-news- - (b) (6) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000456 DS_00021172 Message (b) (6) From: Sent: To: CC: Subject: Fyi- [dbshulkin@gmail.com] 6/30/2017 9:29:22 PM -@hotma il.com (b) (6) Dad [drshulkin@aol.com] on what he's telling his senator, and news roundup by POLITICO's Cleveland Clinic CEO(b) (6) Pulse Check on SoundCloud - Hear the world's sounds on why (b) (6) - did not take VA secretary https://m.soundcloud.com/politico-pulsecheck/cleveland-clinic-ce job. (b) (6) and-news-roundup (b) (6) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000457 OS 00021173 Message David shulkin lDrshulkin@aol.com] 7/1/2017 4 :47:13 PM Poonam Alaigh I(b) (6) @hotmail.com] Re: Whole health From: Sent: To : Subject: I know - Sent from my iPhone > On Jul 1, 2017 , at 12:04 PM, Poonatn Alaigh (b) (6) wrote : No more back and forth emails on this - you know exactly what I mean to say and feel - its not VAvsVHA Sent from my iPad On Jul 1, 2017 , at 11 :45 AM., David shulkin wrote : Lets think more about this vha vs VA thing Why cant we think of this as one department instead of separate entities? This silo stuff is part of the old culture . We have a chance to reset the culture . For the first time we have A VA secretary that understands healthcare and a va secretary and a ush that are on the same page and aligned Now is the time to break apart the silos- i know change is challenging Sent from my iPhone - On Jul 1, 2017 at 10 :05 AM, Poonam Alaigh (b) (6) > wrote : l was not aware that Jen was also working on Whole Health- just tell me all tha t she is working on in VHA - folks in VHA don't like her to be involved - but yo u are the boss and I am your girl Friday and will do whatever you want for as Jong as I can See below- moreover I brainstormed with Tracey and Steve Young to look for a practical Whole Health model that just does thisfocus on the sickest and make it cost effective - but I will completely back away because these guys can't get directions from both Jen and I - especially if she is not connecting and coordinating with me- I am simply tired of blocking and tackling Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000458 DS 00021174 Begin forwarded message : From: "Alaigh, Poonam, M .D ." Date : July 1, 20 17 at 10:00 :10 AM EDT To: 'Poonam Alaigh' ~(b) (6) Subject: FW: Whole health > Sent with Good (www .good .com) -----Original Message----From: Young, Steven W. Sent: Saturday, July 0 l , 2017 09:39 AM Eastern Standard Time To: Alaigh, Poonam , M .D. Subject: FW: Who le health FYl Sent with Good (www .good.com ) ----Original Message----From: Young, Steven W. Sent: Saturday , July 0 I, 2017 09:38 AM Eastern Standard Time To: DJS Cc: Lee, Jennifer S. (V ACO) Subject: RE : Whole health tollll I am fine with Jen reaching out directly (b) (6),that she Thanks for asking. I would also recommend (b) (2) touch base with Tracy Gaudet as well for context. Jen - I am in next week. Feel free to reach out to me too. Sent with Good (www .good.com ) -----Original Message----From: DJS AMERICAr-... pVERSIGHT VA-19-0799-G-000459 D8_00021175 Sent: Saturday, July 0 1, 2017 08:22 AM Eastern Standard Ti rne To: Young, Steven W . Cc: Lee , Jenn ifer S. (VAC O) Subject: Whole heal th Steve- J was thinking about the vjsn 1 budget presentationThere was a lot of money in U1e whole bealU1 pilot (Trecall 48 million) - l am a supporter of whole health but 1 am trying lo tU1d erstand why ii costs so inuch-J en Lee is working to help fmd ways lo make this model tnove faster Would you prefer sbe roach oul to (b) (6) lo understand the costs better or should (6),she work through yo ur office? (b) (2) Seut with Good (www.good.com ) AMERICAr-... pVERSIGHT VA-19-0799-G-000460 DS 00021176 Message Poonarn Alaigh I(b) (6) @hotmail.com] 7/1/2017 4 :04:23 PM David shulkin [Drshulkin@aol.com] Re: Whole health From: Sent: To : Subject: No more back and forth ema .ils on this-you know exactly what I mean to say and feel - its not VA vs VHA Sent from my iPad On Jul 1, 2017 , at 11 :45 AM, David shulkin wrote ; Lets think more about this vha vs VA thing Why cant we think of this as one department instead of separate entities? This silo stuff is part of the old culture. We have a chance to reset the culture . For the first time we have A VA secretary that understands heaJthcare and a va secretary and a ush that are on the same page and aligned Now is the time to break apart the silos- i know change is chaJlenging Sent from my iPhone On Jul 1, 2017 , at 10:05 AM, Poonam Alaigh - (b) (6) wrote ~ I was not aware that Jen was also working on Whole Health- just tell me all that she is worklng on in VHA - folks in VHA don't like her to be involved - but you are the boss and I am your girl Friday and will do whatever you want for as long as I can See below- moreover I brainstormed with Tracey and Steve Young to look for a practical Whole Health model that just does this- focus on the sickest and make it cost effective - but I will completely back away because these guys can't get directions from both Jen and I - especially if she is not connecting and coordinating with me- I am simply tired of blocking and tackling Sent from my iPad Begin forwarded message: - > From : 11Alaigh , Poonam , M.D . 11 Date: July 1, 2017 at 10:00:"JO AM EDT To: 'Poonam Alaigh' (b) (6) Subject: FW: Whole health AMERICAN PVERSIGHT VA-19-0799-G-000461 DS_00021177 Sent with Good (www .good.com ) -----Original Message----From: Youn g, Steve n W . Sent: Saturday , Jul y 01, 2017 09:39 AM Ea stern Standa rd Time To: Alaigh, Poonam, M .D . Subject: FW : Who.le health FYI. Sent with Good (www .good .com ) -----Original Message---From: Young , Steven W . Sent: Saturday, July 01, 2017 09:38 AM Eastern Sta ndard Time To: DJS Cc: Le e, Jennifer S. (VACO) Sub.iect: RE : Whole health (b) tollll Thanks for I am fine with Jen reaching out directl y asking. [ would also recommend that she Gaudet as well for context. (6), base with Tra cy touch (b) (2) Jen - I am in ne xt week. Feel free to reach out to me too . Sent with Good (www.good .com ) -----Orig inal Message----From : DJS Sent: Saturda y, Jul y 01, 2017 08:22 AM Eastern Standard Time To: Young , Steven W . Cc: Lee , Jennifer S. (V ACO) Subject: Whole health Steve- I was iliinking about the visn l budget presenta tion- AMERICAr-... pVERSIGHT There was a lol of money in lhe whole heallh pilot (1 recall 48 million) - I am a why it costs so muchsupporter of whole heallh bul I am Lrying lo 1mdersta11d Jen Lee is working to help find ways to make tJ1is model move faster Would you prefer she reach oul to (b) (6) to undcrsland the costs (6), (b) VA-19-0799-G-000462 (2) DS 00021178 better or should sbe work through your office? Sent with Good (www.good.c-0m) AMERICAr-... pVERSIGHT VA-19-0799-G-000463 D8_00021179 Message David shulkin lDrshulkin@aol.com] 7/1/2017 3:45:00 PM Poonam Alaigh I(b) (6) @hotmail.com] Re: Whole health From: Sent: To : Subject: Lets think more about this vha vs VA thing Why cant we think of this as one department instead of separate entities? This silo stuff is pa11of the old culture. We have a chance to reset the cuJture. For the first time we have A VA secretary that understands healthcare and a va secretary and a ush tbat are on the same page and aligned Now is the time to break apart the silos- i know change is challenging Sent from my iPhone On Jul 1, 2017 , at 10:05 AM, Poonam Alaigh ~(b) (6) @hotmail.com > wrote : I was not aware that Jen was also working on Whole Health- just tell me all that she is working on in VHA - folks in VHA don't like her to be involved - but you are the boss and I am your girl Friday and will do whatever you want for as long as I can See below- moreover I brainstormed with Tracey and Steve Young to look for a practical Whole Health model that just does this- focus on the sickest and make it cost effective - but 1 will completely back away because these guys can't get directions from both Jen and I- especially if sl1e is not tonnecting and coordinating with me- I am simply tired of blocking and tackling Sent from my iPad Begin forwarded message : - > From: "Alaigh , Poonam , M .D." < Poonam.Alaigh@va .gov> Date: July 1, 2017 at l 0:00 : l 0 AM EDT To: 'Poonam Alaigh' (b) (6) Subject: FW: Whole health Sent with Good (www .good.com ) -----Original Message----From: Young , Steven W. AMERICAN PVERSIGHT VA-19-0799-G-000464 DS 00021180 Sent: Saturday , July 01, 20 17 09:39 AM East ern Stan_dardTime To: Alaigh, Poonam , M .D. Subject : FW: Whole health FYl. Sent with Go od (www .good .com ) -----Oti gi nal Message----From: Young, Steven W . Sent: Saturda y, Jul y 01, 2017 09:38 AM Eastern Standard Time To: DJS Cc: Lee, Jennifer S. (V ACO) Subject : RE : Whole health tollll I am fine with Jen reac hing out directly (b) Thanks for asking. I wo uld also (6), recomm end that she to uch base with Tracy Gaude t as we ll for context. (b) (2) Jen - I am in next week . Feel free to reach out to me too . Sent with Good (www .good .com ) -----Original Message----Fr·om:DJS Sent: Saturday , Jul y 01, 20 17 08 :22 AM Eastern Standard Time To: Young , Steven W . Cc: Lee , Jennifer S. (VAC O) Subject: Whole health Steve- r was th.inking aboul the visn 1 budget presentationThere was a lot of money in lbe whole health pilot (l recall 48 million) - I a rna supporter of whole health but I a m trying to uuderst.and why it costs so much- Jen Lee is working to help find ways to make Lhismodel move faster Would you prefer _Shereach out to (b) (6) to m1derstand the costs better or should she ,vork thr0t1gh your office? (6), (b) (2) Sent with Good (www.good .com) AMERICAr-... pVERSIGHT VA-19-0799-G-000465 DS 00021181 Message Sent : Poonam Alaigh I(b) (6) @hotmail.com] 7/1/2017 2:05:59 PM To: Drshulkih@aol.com Subject: Fwd: Whole health From : I was not aware that Jen was also working on Whole Health-just tell me all that she is working on in VHA - folks in VHA don't like her to be involved - but you are the boss . and I am your girl Friday and will do whatever you want for as long as I can See below- moreover I brainsto1med with Tracey and Steve Young to look for a practical Whole Health model that just does this- focus on the sickest and make it cost effective - but I will completely back away because these guys can't get directions from both Jen and I - especially if she is not connecting and coordinating with me- I am simply tired of blocking and tackling Sent from my iPad Begin fmwarded message : From: 11Alaigh Poonam, M .D. 11 Date: July 1, 2017 at 10:00 :10 AM EDT To: 'Poonam Alaigh 1 - (b) (6) > Subject: F\V: Whole health Sent with Good (www .good.com ) -----Original Message----From: Young, Steven W . Sent: Saturday, July 01, 2017 09 :39 AM Eastern Standard Time To: Alaigh, Poonam, M.D. Subject: FW : Whole health FYI. Sent with Good (www .good .com) -----Original Message----From: Young Steven W . Sent: Saturday , July 01, 2017 09 :38 ANI Eastern Standard Time To: DJS AMERICA! PVERSIGHT VA-19-0799-G-000466 DS_00021182 Cc: Lee, Jennifer S. (V ACO) Subject: RE: Whole health I am fine with Je n reaching out directly to-(b) Thank s fo r asking, I wo uld also recomme nd (6), that she touch base wit h Tracy Gaudet as well for context. (b) (2) Jen -1 am in next week . Fee l free to reach out to me too , Sent with Good (www .good.com ) -----Ori ginal Message--From: DJS Sent: Saturday , Jul y 01, 2017 08:22 AM Eastern Standard Time To: Young , Steven W. Cc: Lee, Jennifer S. (V ACO) Subject: Whole health Steve- I was thinking about the visnl budget presenrationThere was a lot of money in lhewl10le health pilot ( I recall 48 million) - I am a supporter of whole health bul I am· trying lo understand w hy it costs so much- Jen Lee is working to help fmd ways to make this mode l move faster Would you ~refer she reach out to (b) (6) to understand the costs better or should she work through your office? (6), (b) (2) Sent w ith Good (www .good.com) AMERICAr-... pVERSIGHT VA-19-0799-G-000467 DS 00021183 Message David shulkin [Drshulkin@aol.com] Sent : 7/4/2017 6 :12:57 PM To : DjsShulkin (vacodjsl@va.gov) Subject: Fwd: Terry Fadem Attachments : Terry Fadem.vcf; Untitled atli;1chrnent 94121.htm From: Seot from my iPhone Begin forwarded message : From: Bruce Moskowitz Subject: Fwd: Terry Fadem mac .com> Sent from my iPhone Begin forwarded message : From: Bruce Moskowitz Subject: Ten·y Fadem The.(b) is cell (6) AMERICAN PVERSIGHT VA-19-0799-G-000468 DS_00021184 Contact Full Name: Last Name: First Name: Terry Fadem Fadem Terry Business Address: (b) (6) Home Address: (b) (6) Other Address: (b) (6) Home Phone : (b) (6) (6) Mobile Phone : (b) E-mail : (b) (6) AMERICAN PVERSIGHT @gmail.com VA-19-0799-G-000469 DS_00021185 Sent ?om my iPhone Message From: Davidshulkin [Drshulkin@aol.com] Sent: 8/26/2017 7:42:57 PM To: Poonam Alaigh I(b) (6) @hotmail.com] Subject: Re: Yes Sent from my iPhone > on Aug 26, 2017, at 2:51 PM, Poonam Alaigh <-@hotmail.com> (b) (6) wrote: > > Do you mean the Declaration > > sent from my iPhone > >> on Aug 26 , 2017, at 1 : 58 PM, David shulkin wrote : >> >> Dou know when we will see the revised Be There poster ? >> >> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000472 OS 00021188 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 8/26/2017 7:10:50 PM To: Davidshulkin [Drshulkin@aol.com] Subject: Re: Sent you something on the va email Sent from my iPhone > on Aug 26, 2017, at 1:58 PM, David shulkin > > Dou know when we will wrote: see the re vise d Be There poster ? > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000473 OS 00021189 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 8/26/2017 6:5 1:54 PM To: Davidshulkin [Drshulkin@aol.com] Subject: Re: Do you mean the Declaration Sent from my iPhone > on Aug 26, 2017, at 1:58 PM, David shulkin > > Dou know when we will wrote: see the re vise d Be There poster ? > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000474 OS 00021190 Message From: David shu lkin [Drshulkin@ao l.com] Sent: 8/26/2017 5:58:32 PM To: Poonam Alaigh I(b) (6) @hot mail.com] Dou know when we will see the r evised Be There poster? Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000475 OS 00021191 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 7/26/2017 7:37:10 PM To: (b) (6) (b) (6) CC: (b) (6) James- than ks so much for everything I told (b) (6) @gmail.com] yesterday- today im about 80 percent what a great better- team! but i have a ways to go d (b) (6) If so- please (b) (6) send an email to (b) (6) Thank you in advance for everything David shulkin sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000476 OS 00021192 Message From: Sent : To: David Shulkin [drshulkin@aol.com] 6/29/2017 2:36:32 AM Poonam Alaigh I(b) (6) @hotmail .com] http ://www .cnn .com/vi deos/world/201 7/06/29/ donald-trump-moon-j ae-i n-meeting-korea-hancockspkg. cnn/video/playl i sts/m obi le -digital -shorts/ Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000477 DS_00021193 Message From: Sent : David shulkin LDrshulkin@aol.com] 6/30/201710 :09:25 PM To : Poonam Alaigh I(b) (6) @hotmail.com] Subject: Fwd: Managed care expert Sent from my iPhone Begin fo.-warded message : From: Bmce Moskowitz Cc: Poonam Alaigh- (b) (6) Subject: Re: Managed care expert · mac .com> (b) (b) (6) When I spoke tollll last he was also adept at this-is quite capable in this roll also (6) although she did physician management at CC . The other choice is (b) (6) (b) (6) Florida or at cedars la (b) (6) or (b) (6) Sent from my iPhone On Jun 25 , 2017, at 1 :08 PM, David shulkin wrote : 11111 was my attending when Bruce- i know them both- high quality physicians- (b) (6) i trained at pittsburgH 11111 does mostly Both are more on the physician side than managed care- (b) (6) regional Ql and kenoykee physician management- Both would be strong contributors but i thin Poonam is looking for a true managed care operations exec who knows how the finance and budget aspects of managed care run Sent from my iPhone On Jun 25, 2017, at 10:56 AM, Brucel\.foskowitz (b) wrote : (6) (b) (6) (6) (b) (6) both have over 20 years (b) (b) (6) at Pitt andw_asat CC now in Aleghaney (6) (b) Health system. is MD, MBA-(b) (6) is MBA. I could (6) convince either one AMERICAN PVERSIGHT VA-19-0799-G-000478 DS 00021194 Sa??nnuny?hd Bruce Moskowitz MD. Message From: Sent : To : Subject : Davidshulkin [Drshulkin@aol.com] 6/ 25/20 17 6:2 1:24 PM (b) (6) (b) m ac . co m ] Bruce Moskowitz [bruce m ctl■■■l@ Re: Managed care expert (6) Ok terrific Sent from my iPhone > on Jun 25, 2017, at 2:02 PM, Bruce Moskowitz (b) (6) (b) > (6) > When I s poke to -(b) last he was also adept at this--~(b) (6) (b) (6) ~d~~ iliiiiiigement at cc. The other~----(6) (b) (6) (b) (6) wrote: (b) (6) in this Florida roll also or at cedars la > > sent from my iPhone > >> on Jun 25 , 2017, at 1 :08 PM, David shulkin wrote: >> (b) was my attending >> Bruce - i know them both - high quality physicians - 111111 pittsburgH (6) >> >> Both are more on the physician physician management>> side than managed care- (b) 111111 does when i trained mostly regional at QI and kenoykee (6) >> Both would be strong contributors but i thin Poonam is looking for a true managed care operations who knows how the finance and budget aspects of managed care run exec >> >> sent from my iPhone >> (b) (5) (b) >>> on Jun 25 , 2017, at 10:56 AM, Bruce Moskowitz wrote: >>> (6) (b) (6) (b) (6) >>> 1111111111111 or ~th have over ~s _experience -(b) at _Pitt ~nd -(b) (6) (b) . I couicl"con v,nce either one now ~ y He~ i s MD' MBA-(b) (6) 1s MBA (6) (6) >>> (6) >>> sent from my iPad >>> Bruce Moskowitz M. D. was at cc >> AMERICAN PVERSIGHT VA-19-0799-G-000480 OS 00021196 Message From: Sent: To: CC: Subject: Bruce Moskowitz [bruce~@mac (b) (6) (b) (6) 6/25/2017 6:02:48 PM Davidshulkin [Drshulkin@aol.com] (b) (6) Poonam Alaigh [-@hotmail.com] Re: Managed care expert 11111 last When I spoke to (b) she did phys~nt (6) (b) (6) -or ........ .com] he was also adept at this (b) (6) (b) (6) at cc. The other choice (b) (6) capable in this roll also...al,,;l;hough Florida or at cedars la -(b) (6) sent from my iPhone > on Jun 25, 2017 , at 1 :08 PM, David shulkin > > Bruce- i know them both> high quality > Both are more on the physician physician management- > wrote : (b) 11111 was my attending (6) (b) managed care- 11111 does mostly physicians- side than when i trained regional at pittsburgH QI and kenoykee (6) > Both would be strong contributors but i thin Poonam is looking for a true managed care operations who knows how the finance and budget aspects of managed care run exec > > sent from my iPhone > (b) (6) (b) >> on Jun 25, 2017, at 10:56 AM, Bruce Moskowitz wrote: >> (6) (b) (6) (b) (6) » 1111111111111 or ~h have over 2~ experience -(b) at Pitt (b) now~ey H~ is MD, MBA-(b) (6) is MBA. I c~convince (6) (6) >> (6) >> sent from my iPad >> Bruce Moskowitz M.D. and -(b) (6) either one was at cc > AMERICAN PVERSIGHT VA-19-0799-G-000481 OS 00021197 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 6/25/2017 5:08:23 PM To: Bruce Moskowitz [bruce~@mac (b) (6) (b) (6) (b) (6) Poonam Alaigh [-@hotmail.com] Re: Managed care expert CC: Subject: Bruce- i know them both- high quality Both are more on the physician physician management- .com] (b) 11111 was my attending (6) (b) managed care- 11111 does mostly physicians- side than when i trained regional at pittsburgH QI and -(b) (6) (6) but i thin Poonam is looking for a true managed care operations Both would be strong contributors who knows how the finance and budget aspects of managed care run exec sent from my iPhone (b) (5) > on Jun 25, 2017, at 10:56 AM, Bruce Moskowitz > (b) (6) > 1111111111111 or~~(b) (6) no~ney ~(6) > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT (b) (6) (b) (6) wrote: have over 20~experience -(b) at Pitt and -(b) (6) was at cc is MD, MBA-(b) (6) is MBA.I couT'ci convince eittie"r""'one (6) VA-19-0799-G-000482 OS 00021198 Message (b) (5) (b) (6) From: Bruce Moskowitz [bruce Sent: 6/25/2017 2:56:17 PM To: Poonam Alaigh I(b) (6) @hotmail.com]; Managed care expert Subject: (b) (6) ...... ~y (6) (b) (6) or ~th He~ Sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT (b) (6) is mac .com] David Shulkin [drshulkin@aol.com] have over ~s_experience -(b) at_Pitt MD, MBA -(b) (6) 1s MBA. I couicl"'conv1nce (6) ~nd -(b) (6) either one was at cc now VA-19-0799-G-000483 OS 00021199 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 6/28/2017 2:52:44 PM (b) (6) @gmail.co m ] Jennifer Lee ■■■ Re: DEA- tell health Excellent Sent from my iPhone > on Jun 28, 2017, at 10:51 AM, Jennifer > > I got a call from DEAthis > I ' ll keep you posted. > Thank you ! AMERICAN PVERSIGHT Lee -gmail (b) (6) .com> wrote: morning . We're moving along again. VA-19-0799-G-000484 OS 00021200 Message From: Jennifer Lee (b) (6) @gmail.com] Sent: 6/28/2017 2:51:43 PM To: Davidshulkin [drshulkin@aol.com] DEA- tell health Subject: I got a call from DEA this I'll keep you posted. Thank you! AMERICAN PVERSIGHT morning. We're moving along again. VA-19-0799-G-000485 OS 00021201 Message From: David shulkin lDfshulkin@aol.com] 6/26/2017 9:19:42 PM Poonam Alaigh I(b) (6) @hotmail.com] Fwd: Sent : To : Subject: Sent from my iPhone Begin fo.-warded message : From: (b) (6) ~(b) (6) Date: June 26, 2017 at 2:40 :18 PM EDT To: Dad > VA SHOULD IMPROVE COLLECTlON OF QUALITY MEASURES : A GAO reportreleased late Friday found that VA's clinical quality metrics and models provide incompleteinfonnation that "may not accurately reflect clinical productivity and efficiency ." The metrics don't include all providers and clinical services, nor do they accurately reflect the intensity of clinical workload, per the report . The GAO found that VA's Central Office had taken. steps to help medical centers improve their monitoring of provider productivity , however. Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000486 DS 00021202 Message From: David shulkin LDrshulkin@aol.com] 6/26/201710:57:31 AM Poonam Alaigh I(b) (6) @hotmail.com] Re: [EXTERNAL]Apple Sent : To : Subject: Maybe best to stay out of it- you dont need this now Sent from my iPhone On Jun 26,2017 , at 4 :00 AM, Poonam Alaigh - (b) (6) > wrote : Maybe I should say something to hm about not attending and I know he still will- that way we can let Bmce and Ike know that he simply doesn't listen - I know that this will further strain our relationship but that 1s fine- now it's a Darin, Jen, Baligh and probable Shereef- Anti Poonam movement Sent from my iPad On Jun 25, 2017, at 10:05 PM, David Shulkjn wrote: Im not sure- I guess we could ask her to leave-(b) as the VA rep and not Darin? Is that the best thing or just let Darin keep getting further into trouble (6) -----Original Message---(b) (6) From : Poonam Alaigh ~> To : David Shulkin Sent: Sun, Jun 25, 2017 7:22 pm Subject: Fwd: [EXTERNAL) Apple How do you want to address this Sent from my iPhone Begin fo,warded message : From: "Alaigh, Poonam , M.D."< Poonam .Alaigh@va .gov ;,Date : June 25 , 2017 at 7:21 :34 PM EDT (b) (6) To: 'Poonam Alaigh' ~> Subject: FW: [EXTERNAL] Apple Sent With Good (www.good .com) -----Origina I Message----From: Bruce Moskowitz bruce (b) (6) (b) mac .com Sent: Saturday , June 24, 2017 06 :18 PM (6) Eastern Standard Time To: (b) (6) Cc: Alaigh , Poonam, M.D. Subject: Re: [EXTERNAL] Apple I think that Poonam will tell you what to do with Darin then I will send it out AMERICAN PVERSIGHT VA-19-0799-G-000487 DS_00021203 Sent from my iPhone > On Jun 24, 2017, at 2:01 PM, (b) (6) (b) (6) > > Dr. Moskowitz, I have removed Responsive Health from the table and added Darin Selnick for the VA. I do not have contact information for the Apple COO but have provided the other two names and email addresses below: > > (b) (6) > (b) (6) >- (b) (6) (b) (6) le.com > (b) (6) > > > > -----Original Message----> From: Bruce Moskowitz mailto:bruce (b) (6) (b) mac.com > Sen~ 24, 2017 1 :37 PM (6) >To:--(b) (6) > Subject: Re: [EXTERNAL] Apple > > You still have listed responsive health as part of working group. Also will need email of Apple people if Mr. Perlmutter decides to send it himself > > Sent from my iPad > Bruce Moskowitz M.D. > » On Jun 24, 2017 , at 12:53 PM, (b) (6) (b) (6) >> » Dr. Moskowitz, Modifications made and attached . -(b) (6) >> » -----Original Message----» From: Bruce Moskowitz mailto :bruce (b) (6) »Sen~24 , 201712:19PM >>To:--(b) (6) » Subject: Re: [EXTERNAL] Apple (b) (6) mac.com >> » Executive committee put The 5 CEO's Dr-(b) (6) Dr. -(b) (6) (b) (6) Dr. -(b) (6) and Mr. ~d or their designated alternate . For the executive group take~ (b) (6) From mid level take out-(b) (6) Add Mayo Clinic to mid level and Working group. To the working group we will have available physicians who will be the end user to represent primary care and subspecialty . >> >> Sent from my iPad >> Bruce Moskowitz M.D. >> »> On Jun 24 , 2017 , at 11:22AM , (b) (6) va. ov> wrote : (b) (6) >>> »> Good Morning Dr. Moskowitz , I am attaching a copy of the responses we received from the five Centers and Apple . The responses are listed in the category that they provided to us. I am available to discuss the responses and other updates anytime today at-(b) (6) (b) (6) >>> >>> .. AMERICAr-... pVERSIGHT VA-19-0799-G-000488 DS 00021204 >>> >> > AMERICAN PVERSIGHT VA-19-0799-G-000489 DS_ 00021205 Message To : Poonam Alaigh I(b) (6) @hotmail.com] 6/26/2017 8:00:42 AM David Shu Ikin (drshulkin@aol.com] Subject: Re: [EXTERNAL] Apple From: Sent : Maybe I should say something to hm about not attending and I know he still will- that way we can let Bruce and Ike know that he sjmply doesn't listen - I know that this wiU further strain our relati.onsrup but that's fine- now it's a Darin, Jen, Baligh and probable Shereef - Anti Poonam movement Sent from my iPad On Jun 25, 2017, at 10:05 PM , David Shulkin wrote : Im not sure- I guess we could ask her to leave-(b) or just let Darin keep getting further into trouble (6) as the VA rep and not Darin? Is that the best thing -----Origina I Message----(b) (6) From: Poonam Alaigh ~> To : David Shulkin Sent: Sun, Jun 25, 2017 7:22 pm Subject: Fwd: [EXTERNAL] Apple How do you want to address this Sent from my iPhone Begin forwarded message : From: "Alaigh , Poonam, M.D."< Poonam.Alaigh@va .gov > Date: June 25, 2017 at 7:21 :34 PM EDT (b) (6) To: 'Poonam Alaigh' ~> Subject: FW: [EXTERNAL] Apple Sent with Good (www.good.com ) -----Original Message----From: Bruce Moskowitz bruce (b) (6) (b) mac.com Sent: Saturday, June 24, 2017 06:18 PM (6) Eastern Standard Time To: (b) (6) Cc: Alaigh, Poonam, M.D. Subject: Re: [EXTERNAL] Apple I think that Poonam will tell you what to do with Darin then I will send it out Sent from my iPhone > On Jun 24, 2017, at 2:01 PM, (b) (6) (b) (6) > > Dr. Moskowitz , I have removed Responsive Health from the table and added Darin Selnick for the VA. I do not have contact information for the Apple COO but have provided the other two names and email addresses below: > > (b) (6) AMERICAN PVERSIGHT (b) (6) VA-19-0799-G-000490 DS_00021206 > (b) (6) > (b) (6) ~ >-(b) (6) > > > > -----Original Message----> From: Bruce Moskowitz mailto:bruce (b) (6) > Sen~ 24, 2017 1:37 PM >To:~(b) (6) > Subject: Re: [EXTERNAL] Apple (b) (6) mac.com > > You still have listed responsive health as part of working group. Also will need email of Apple people if Mr. Perlmutter decides to send it himself > > Sent from my iPad > Bruce Moskowitz M.D. > » On Jun 24, 2017, at 12:53 PM, (b) (6) (b) (6) >> » Dr. Moskowitz, Modifications made and attached . -(b) (6) >> » -----Original Message---->> From: Bruce Moskowitz mailto:bruce (b) (6) » Sent: Saturday, June 24, 2017 12:19 PM >> To: (b) (6) » Subject: Re: [EXTERNAL] Apple (b) (6) mac.com >> » Executive committee put The 5 CEO's Dr-(b) (6) Pr.-(b) (6) Dr. (b) (6) and Mr. -(b) (6) and or their designated alternate. For the executive group take out (b) (6) From mid level take out-(b) (6) Add Mayo Clinic to mid level and Working g roup . To the working group we will have available physicians who will be the end user to represent primary care and subspecialty. >> » Sent from my iPad » Bruce Moskowitz M.D. >> »> On Jun 24, 2017 , at 11 :22 AM , (b) (6) (b) (6) >>> »> Good Morning Dr. Moskowitz, I am attaching a copy of the responses we received from the five Centers and Appl.e. The responses are listed in the category that they provided to us. I am available to discuss the responses and other updates anytime todayat (b) (6) -(b) (6) >>> >>> >>> >> > AMERICAr-... pVERSIGHT VA-19-0799-G-000491 DS 00021207 M essage David Shulkin [drshul krn@ao l.com ] From: Sent : 6/26/20 17 2:05 :23 AM To : (b) (6) [:':'hotmail.com Subject : Re: [EXTERNAL) Appl e Im not sure- I guess we could ask her to leave -(b) keep getting further into trouble (6) as the VA rep and not Dalin ? Is that the best thing or just let Darin ----- Orig ina I Message ----(b) (6) From: Poonam Alaigh ~@hotmail.com> To: David Shulkin Sent: Sun , Jun 25 , 2017 7:22 pm Subject: Fwd: [EXTERNAL] Apple How do you want to address this Sent from my iPhone Begin forwarded message : From: "Alaigh , Poonam , M.D." Date: June 25, 2017 at 7:21 :34 PM EDT (b) (6) To : 'PoonamAlaigh ' ~ Subject: FW: [EXTERNAL] Apple Sent with Good (www.good .com) -----Or iginal Message---- From: Bruce Moskowitz brllce (b) (6) (b) mac.com Sent: Saturday, June 24, 2017 06:18 PM (6) Eastern Standard Time To: (b) (6) Cc : Alaigh, Poonam , M.D. Subject : Re: [EXTERNA L] Apple I think that Poonam will tell you what to do with Darin then I wi.11send it out Sent from my iPhone (b) (6) > On Jun 24, 2017 , at 2 :01 PM, (b) (6) > > Dr. Moskowitz , I have removed Responsive Health from the table and added Darin Se lnick for the VA. I do not have contact information for the Apple COO but have provided the other two names and email addresses below: > > (b) (6) (b) (6) le.com > (b) (6) (b) (6) > (b) (6) >> > > > -----Orig inal Message----> From: Bruce Moskowitz mai lto:bruce (b) (6) > Sent: Saturday , June 24 , 2017 1:37 PM AMERIC,AI PVERSIGHT (b) (6) mac.com VA-19-0799-G-000492 DS 00021208 >To: (b) (6) > Subject: Re: [EXTERNAL] Apple > > You still have listed responsive health as part of working group . Also will need email of Apple people if Mr. Perlmutter decides to send it himself > > Sent from my iPad > Bruce Moskowitz M.D. > » On Jun 24, 2017 , at 12:53 PM, (b) (6) (b) (6) >> » Dr. Moskowitz, Modifications made and attached. -(b) (6) >> » -----Original Message---->> From: Bruce Moskowitz mailto;bruce (b) (6) » Sen~ 24, 2017 12:19 PM >>To:~(b) (6) » Subject: Re: [EXTERNAL] Apple (b) (6) mac.com >> Dr. (b) (6) Dr. -(b) (6) and Mr. TYson. and » Executive committee put The 5 CEO's Dr-(b) (6) or their designated alternate. For the executive group take out (b) (6) From mid level take out_(b) (6) Add Mayo Clinic to mid level and Working group. To the working group we will have available physicians who will be the end user to represent primary care and subspecialty. >> » Sent from my iPad >> Bruce Moskowitz M.D. >> »> On Jun 24 , 2017 , at 11:22 AM, (b) (6) (b) (6) >>> >» Good Morning Dr. Moskowitz, I am attaching a copy of the responses we received from the five Centers and Apple. The responses are listed in the category that they provided to us. I am available to discuss the responses and other updates anytime today at (b) (6) -(b) (6) >>> >>> >>> >> > AMERICAr-... pVERSIGHT VA-19-0799-G-000493 DS 00021209 Message From: Sent : To : Subject : Poonam Alaigh I(b) (6) @hotmail.com] 6/25/2017 11:22:21 PM David ShuIkin (drshulkin@aol.com] Fwd: [EXTERNAL] App le How do you want to address th is Sent from my iPhone Begin foi:-wardedmessage : - > Fr om: "Alaigh , Poonam , M.D ." Date: June 25 , 2017 at 7:21:34 PM EDT To: 'Poonam Alaigh 1 (b) (6) Subject: FW: [EXTERNAL] Apple Sent with Good (www .good.com ) -----O riginal Message-- --From: Bruce Moskowitz [brucem (b) (6) (b) e, mac .com (6)tern Standard Time Sent: Saturday , June 24, 2017 06:18 PM Eas To: (b) (6) Cc: Alaigh, Poonarn, M .D. Subject: Re: [EXTERNAL] Apple I lhink thal Poonarn will tell you whaLl.odo wilh Darin tJ1en I will send ii.out Sent from my iPhone > On Jun 24, 2017 at 2:0 l PM, (b) (6) (b) (6) > > Dr. Moskowitz , I have removed Responsive Health from the table and added Darin Selnick for the VA. I do not have contact information for U1eApple COO but have provided the other two names and email addresses below : > > (b) (6) (b) (6) a le .com > (b) (6) (b) (6) a le.com > (b) (6) > > > > ---Origioal Message---> From: BruceMoskowil.7.fmailto:brucen(b) (6) (b) > Scot: Saturday , June 24 2017 1:37 PM (6) > To: (b) (6) > Subjec t:Re : rEXTERNAL l App le > >- ac.coml > You still have listed responsive bea\thas part of workin g group . Also will need email of A pple people if Mr . Perlmutter decides to send it himself AMEr-.. PVERSIGHT VA-19-0799-G-000494 DS_00021210 > > Sen1fro Ill my iPad > Bruc-eMoskowitzM.D . > >> On JW124, 2017 , al 12:53 PM. -(b) (6) ~(b) (6) > wrote: >> >> Dr. Moskowitz, Modifications made and attached~ -(b) (6) >> >> -----Original Message--->> From: Bruce Moskowitz fmaillo:brucem .(b) (6) (b) mac.com >> Sent: Saturday, June 24. 2017 12: 19 PM (6) >> To:-(b) (6) >> Su~ject: Re: [EXTERNAL] Apple >> >> Executive commiuee put The 5 CEO's Dr (b) (6) Dr. (b) (6) Dr .-(b) (6) a~ (b) (6) and or their designated alternate. For the executive group take out (b) From mid level take out~(b) (6) Mayo Clinic to mid level and Working group. To the working group (6)we will have available physicians who will be the end user to represent primary care a11d subspecialty. >> >> Sent from my iPad >> Bruce Moskowitz M.D . >> >>> On Jtm24 . 20 17, at ll :22 AM, _(b) (6) ~(b) (6) > wrote: >>> >>> Good Morning Dr. Moskowitz, I am attaching a copy of the responses we received from lhe five Centers and Apple. The responses are listed in the category that they provided to us. I am available to discuss the responses -(b) (6) and otl1erupdates anytime today al-(b) (6) >>> >>> >>> >> > AMERICAr-... pVERSIGHT VA-19-0799-G-000495 D8_ 00021211 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com] Sent: 6/24/2017 4:09:23 PM (6) To: ers. (b) (6) (b) (6) (b) (6) @ccf.org;(b) (6) (b) (6) @jhmi.edu]; mayo.edu] .org; (b) (6) M.D(b) (6) (b) (6) (b) CC: . (6) (b) (6) @gmail.com]; (b) (6) (b) @mayo.edu]; IP ll@frencha ( (6)ail.com; DavidShulkinb [drshulkin@aol.com];Poonam Alaigh I(b) (6) @)hotmail.com] (b) (6) Subject: ) ( 6 ) The portable EMRinitiative with Apple and the VA is divided into three groups, the executive committee, mid level project management and a working group . I want to extend the opportunity to each CEOto be on the executive committee or have a representative of their choosing. Thank you for your commitment to the From: VA. sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000496 OS 00021212 Message From: David shulkin [drshulkin@aol.com] Sent : To : 6/28/2017 10:46:53 PM IP !1@frenchangel59.com] ( Subject: Re:bVA update ) ( Thanks Ike- sorry6i missed your call ) I read this- i think we will be ready to engage-(b) (6) in two weeks to work through this- im glad she has prepared this Im out tonight at an event but if you need me to call let me know and ill sneak out David Sent from my iPhone On Jun 28, 2017, at 6:01 PM, IP ~( @frenchangel59 .com> wrote : b ) David, ( Please read when you get6 a chance. ) Thank you, Ike ( ] From: IP [ mailto ■@frenchange1S9.com b June 28, 2017 5:43 PM Sent: Wednesday, To: (b) (6) i. )m' (6) (b) (6)( (b) mac.com· ■@frenchangel59 (b) (b) (6) Cc: bruce .com ; ~ (6) (6) (6) Subject: FW: VA6update ) (b) We wil l read and stay on top of this. Thank you so much .. (6) From: BruceMoskowitz[ mailto:brucen(b) (6) Sent: Wednesday,June 28, 2017 4:05 PM (b) (6) ' mac.com To: (b) (6) Cc: (6) MarisolGarcia;-(b) (6) Subject: Re: VA update Thank you very important will review Sent from my iPhone On Jun 28, 2017, at 3:07 PM, (b) (6) (6) Bruce and Ike, (b) (6) <~w (6) rote: On June 8th -(b) and I met with David Shulkin about the VA IT system. We discussed (6) the MASSscheduling project and recommended using the Epic ambu latory suite in the VA side by side w ith the Cerner Inpatient system. We gave him the attached document AMERICAN PVERSIGHT VA-19-0799-G-000497 DS_00021213 that recommends the Epic ambulatory suite for improved interoperability as veterans go to many Epic sites around the U.S. for their care. One of the questions that David asked us was how much it would cost to do the system alone, without a prime. We looked at what it would cost if the VA were a normal, samesized customer, without the use of a prime (systems integrator), using their own staff on the project, and without all of the additional requirements of a government procurement. It costs the VA about 55% more to do all of those things. It is our normal practice to train customer staff to participate in the implementation, eventually manage the rollout and manage the system on an ongoing basis. This is less expensive, retains the knowledge within the organization and reduces dependence on the vendor. This also assumes the normal time frame for a large customer implementation of the ambulatory suite wh ich is 12-15 months to initial go-live, and 3 months for each large rollout. We don't know if this is possible at the VA but it would be our suggestion to approach it as close to this way as possible. In addition to the savings mentioned above, we would also significantly reduce the price of the software and implementation. We would love to work with the VA to come up with a meaningful proposal incorporating our best practices. On another note, you asked about developing a summary document from the VA out of VISTAand how long that would take to provide information to the Choice program. We actually have a summary document from the VA currently that already comes to Epic and we are talking with them about including additional items. (See attached 3 screen document) . We are interested in your thoughts . (b) (6) (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000498 OS 00021214 Message David shulkin lDrshulkin@aol.com] 7/6/2017 11:47:32 AM Ike Perlmutter (~frenchangel59.com] ( Bruce Moskowitzb [bruce (b) (6) (b) @mac.com] ; Marc Sherman (mb (b) (6) @gmail.com]; Laurie Perlmutter From: Sent : To : CC: ) (b) (6) i••■@gm,;iil.com] (6) ( Subject: Fwd: (No Subject) Attachments : WH COSMeeting6 w-Sec Shulkin 7.5.17-1 (4).docx; Untitled attachment 94432.htm ) I wanted to share this attachment that 1 discussed with WH staff yesterday on our policy initiatives - this is not a complete list but some if the major milestones . They said that no other department has anywhere as robust an agenda Sent from my iPhone Begin forwarded message : From: DJS Date: July 6, 2017 at 7:44 :22 AM EDT To: 'Shulki n ' Subject: FW: (No Subject) Sent with Good (www .good .com ) -----Original Message----From: Wright , Vivieca (Simpson) Sent: Thursday , July 06, 2017 07 :38 AM Eastern Standard Time To: DJS Subject: RE : ----Original Message--- From: DJS Sent Thursday, July 06, 2017 7:0 I AM To: Wright, Vivieca (Simpson) Subject Can you emajJ me a cop or Lhepolicy sheet we reviewed with the WH yesterday? Sentwith Good (www.good.com) AMERICAN PVERSIGHT VA-19-0799-G-000499 DS 00021215 The Honorable David J. Shulkin Secretary, Department of Veterans Affairs Cabinet Affairs Meeting with White House Chief of Staff July 5, 2017 Greater Access Accountability & Transparency Fiscal Responsibility & Efficiency Fraud, Waste, Abuse Choice Choice Choice Access ChoiceAct Expansion Additional 1.8M authorized appointments VA and HHS Partnership- Increase Providers 0TH Servicesin MH EHRDecision LaunchedAccessand Quality Tool Accountability Legislation(passed) State of VA WH Hotline VBA Offices Going Paperless Omaha Public-PrivatePartnership Completed Establishedthe Office of Whistleblower Protection Establisheda Fraud, Waste and Abuse Task Force Completed Reauthorization of ChoiceFunding:Enhances the President's commitment for Veterans to have greater access to healthcare. VA has multiple accounts allotted for Community Care. Without congressional intervention to reauthorize funding, Veterans could experience significant delays in care. RevisedChoice Legislation:Fulfills the President's commitment to provide Greater Choice in healthcare for Veterans. Consolidation of the Community Care programs . Proposalto Pilot Medicare Subvention: Perform healthcare services that would typically be covered under Medicare/Medicaid and do so in a way that we would be reimbursed by HHS. Telehealth Expansion:Enhances the President's commitment to allow patients to receive care anywhere regardless of location. July Completed Completed September December July Self-Scheduling:Enhances the President's commitment to allow Veterans to request healthcare appointments at any time with the use mobile applications. Same Day Servicesin CBOCs:Expand same day services for Mental Health and Primary Care to all community outpatient clinics. July Access Minute Clinics:Expand partnerships with CVSand Walmart for minute clinics to allow Veterans greater access to care. December Appeals Appeals Modernization: Moves the VA from the antiquated appeals process into the modern era and provide Veterans with much quicker resolution of their appeals . July Access Access AMERICAN PVERSIGHT December VA-19-0799-G-000500 OS 00021216 Transparency Publish Accountability Actions: Enhances the President's August commitment to restoring trust and confidence in the agency. Coordination with Federal Agencies Coordination with Federal Agencies Benefits Benefits Benefits Benefits Health Benefits Health Benefits Smoking Facility Management AMERICAN PVERSIGHT Align Veterans Employment with Department of Labor: Allows VA to focus on benefits and reduces duplicative efforts for a common purpose. Consolidation of Federal Cemeteries: NCA seeks to sign MOU's with the Department of the Army and the National Park Service to operate and maintain some of their national cemeteries, in order to streamline operations and promote efficiency in the federal government. While we can affect functional oversight through MOUs and IAA's, formal transfer may require certain executive or legislative action. October Automatic enrollment for transition service members: Enhances the President's commitment to improve services and improves our suicide prevention efforts Decision Ready Claims: Currently at two sites but will be rollout to all sites in September. November Blue Water Navy: Exposure risk associated with sailors off the shore of Vietnam - data is limited due to the length of time that has passed. There is growing support in congress for a legislative fix- this issue has been passed down over multiple administrations. Gulf War Brain Cancer Presumptive: Data suggests some significant evidence of a correlation with brain tumors - was submitted as a presumptive under the Obama Adm in and was rejected by 0MB . Consideration of resubmission Proposal to Integrate with Tricare: We propose consolidating non-active duty TRICAREbenefits into VA because it is not only cost effective, but also eases the provision of health care to Veterans as services offerings are standardized, a greater community of providers is available, and Veterans are not required to navigate multiple insurance and provider systems. STAAB Rulemaking: Expands the eligibility criteria for Veterans to receive payment or reimbursement to include Veterans who receive partial payment from a health-plan contract for non-VA emergency treatment. Smoke Free Campuses at all VA Medical facilities: Pursue legislation action; all VA healthcare sites (except nursing homes) will be smoke free . Currently all other major medical campuses outside of VA are smoke free. National realignment and facility modernization: Enhances the President's commitment to reduce waste from underutilized or vacant buildings . December September December December December December December November VA-19-0799-G-000501 OS 00021217 Message From: David shulkin [Drshulkin@aol.com] Sent : 6/29/2017 1:14:05 AM To : (b) (6) (b) (6) @gmail.com]; Vivieca Simpson I(b) (6) @gmail.comJ http://www .politico.com/story/2017 /06/28/till erson-blows-up-at-whi te-house-aide-24007 5 Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000503 DS_00021219 Message From: David shulkin lDrshulkin@aol.com] Sent : 6/27/2017 11:21:28 AM To : Djs Shulkin [vacodjsl@va.gov] Ike Perlmutter (l@frenchangel59.com]; Laurie Perlmutter (b) (6) @gmail.com); Marc Sherman ( [mbs~@gmail.comJ; Br'U!=eMoskowitz [brucerrll-■ b (b) (b) (6) (b) @mac.co mJ; ■■■l@gri,ail.eom; (b) (6) -(b) (6) ) -@sunnyshulkin .com]; (b) (6) (b) (6)(6) @gmail.com);(b) (b) (6) (b) ■■■■hotmail.com) ; (b) (6) ( -@sunnyshulkin.com] yahoo.com]; (b) (6); Michae l Tepper (b) (6) (6) (6) (b) 6@me .com); (b) (6) (b) (6) @gmail.com);- (b) (b) (6) (b) (6) @gmail.com); Thomas (b) (6) (6) ) Bowman (b) (6) @yahoo.com]; (b) (6) @yahoo .com);Charlre Wiggins (b)(6) (6) (b) (6) @remedyventures.comJ Op-Ed by Sean Parnell on vA Leadership BCC: Subject : Fyi Washington Examiner: Finally, the VA has solid, reform-minded leadership (26 June Sean Parnell 4.8M onJine visitors/mo ; Washington DC) With toda y's political polarization , it's worthw hile to pause and focus on what's going right in Washington . Let's start by conunending the new secretary of the Department of Veterans Affa irs, David Shulkin for his steady an d decisive leadership in the last several months , Shulkinwas not my first choice to lead the VA . I had hoped to see a chief executive at the department with a military service background. Moreover I feared that by elevat ing someone from the last ad.ministration's leadership (he served previously as undersecreta1y for health) , , e would just end up\: ith "more of the same ." Base on Shulkin's initial performance in the job , that worry was ut1founded. He has dra.maticaH exceeded expectation.s. Shulkin 1s predecessors Eric Sbinseki and Robert McDonald were both m.ilitarv veterans and both were fimdamentally decent , well-meaning men. But they seemed too ready to defer to the VA status quo, which made it difficult for them to deliver the changes the department requires. Their successor appears more action-oriented and has made a number of positi ve moves to boost confidence and improve perfonnance . He's made it clear he wants to bring a different style ofleadershfp fo the historically troubled VA. "Slow, incremental, stead change isn't v,1hat tl,js organization needs," Shulk1n said in a June 20 press briefing. "What v e need is bolder , fundamental cbangc , dealing \-vith tbe issues that - frankly - are really hard to deal with. that go back decades . TI1at means by definition. we're going to have to take greater risks ." What docs "bolder fundamental change 11 look like? Consider some of Shulkiu's initial actions : Pledging to work within a budget. lt1a May 3 I White House briefing Shulkin supplied a detailed overvie of the challenges the VA faces, and the steps he-. ill take to address those challenges . He was forthright io sayit1gthe VA's problems don't stem from a lack of funding (though he has noted there are legacy issues with tech nology and healthcare costs that will need to be addressed) . "I have said that the problems in VA are not largely going to be solved through additional money." Shulkintold reporters . "TI1ese are going to be solved through management practices focus , and some AMERICAN PVERSIGHT VA-19-0799-G-000504 DS 00021220 legislation changes. But our issues are not because we're lacking the financial resources to be able to accomplish our mission." The V A's problems are cultural and managerial, and simply pouring more funding into a dysfunctional bureaucracy will only magnify that dysfunction. Kudos to Shulkin for recognizing that reality. Improving accountability for poor performers. Shulkin has been a vocal proponent of VA Accountability and Whistle blower Protection Act, which would enhance the department's ability to discipline or fire underperfonning employees. That bill passed Congress and was signed into law by President Trump on Friday. Now it's up to the VA to implement the law, which will be the hard part - but at least the department has a leader who's on record pledging support for greater accountability. He's made it clear he doesn't intend mass firings, but that removing those who deserved to be fired \vill improve morale and recruitment. Shulkin's efforts to expedite firing of VA employees involved in prescription drug thefts suggest he's serious about holding people accountable. Embracing choice for veterans' healthcare. Congress passed legislation in 2014 to expand healthcare choice for veterans, allowing them to seek compensated care from physicians outside the VA system. While President Barack Obama signed that measure into law, the program was limited, temporary and badly implemented. But Shulkin has signaled an opem1ess to integrating private care choice into the VA model more effectively. Ifhe holds to that commitment, it will go a long way toward fixing what's broken in VA healthcare. Cutting \vaste. Elected officials and bureaucrats like to talk about reducing "waste, fraud and abuse," yet somehow the needed cuts never arrive. This week, Shulkin took a concrete step in that direction by presenting a plan to dispose of at least 431 vacant VA facilities in the next two years and putting a freeze on new office space, for tens of millions of dollars in estimated savings. "We owe it to the American taxpayer to apply as much of our funding as possible to helping veterans," Shulkin said in a statement. "Maintaining vacant buildings, including close to 100 from the Revolutionary War and Civil War, makes no sense, and we're working as quickly as possible to get them out of our inventory." Sure, it's low-hanging fruit - but then why didn't previous administrations go after the low- hanging fruit? Again, it's a step in the right direction, and one hopes Shulkin and his team will keep pushing to cut unnecessary spending and put the VA's dollars back to work on behalf of veterans. To be sure, Shulkin has a steep hill to climb in fixing what's broken at the VA. He can expect opposition from a recalcitrant bureaucracy and stubborn government labor unions that can be expected to stymie any kind ofreform. If he wavers in the face of such opposition, he should be held accountable. He will no doubt make decisions that the veterans' community may disagree with, and in that case we should make our concerns known. But in the meantime, he's demonstrated a high degree of professionalism, integrity and respect for both veterans and taxpayers, and that deserves our support. Finally, let's celebrate Shulkin's example of mature, forward-looking leadership, which is lacking in Washington today. While Democrats and Republicans in Congress, egged on by an unhinged and unreliable media, continue their increasingly absurd investigation of alleged Russian hacking and "collusion"-a charge that looks more strained and bogus by the day-it's reassuring to know there are those within the Trump administration who are focusing on issues that matter to Americans. If others in Washington hope to rebuild trust with the public, they should take note of Shulkin's example. AMERICAN PVERSIGHT VA-19-0799-G-000505 OS 00021221 Message IP !1@ ( frenchangel59.com] 7/9/2017 3:27:02PM b 'David ) shulkin' [Drshulkin@aol.com]; 'Laurie Perlmutte r' (b) (6) @gmail.com]; 'Marc Sherman' [mb( ••(b) (6)l@gma il.com); 'Bruce Moskowitz' [bruce (b) (6) (b) @mac.com] RE:6Accountability news (6) From : Sent : To : Subject : ) David, This is an excellent and a very importa nt step to ensuring accountability at the VA. People will now th ink twic e before abusing t heir posit ion. You have delivered a very strong message and have begun to change the culture at the VA. Again, this is excellent. All my Best, Ike From: David shulkin [mailto :Orshulkin@aol.com ] Sent: Friday 1 July 07, 2017 4:13 PM ( (b) (6) To: Ike Perlm utt er <1@frenchange l59.com> ; Lauri e Perlmutter ~@gmail.com> ; Marc Sherman b ( (b) (6) (b) (6) (b) ; Bruce Moskow it z ; David Shulkin ) news b Accounta bility (6) Subject: ( ) 6 ( http://www .washingtonexarniner.com/trump-administration-has-fired-more-than-500-va-employees-since) 6 january/art icle/2627988 ) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000506 DS_00021222 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com] 7/7/2017 8:58:46 PM (6) L Perl (b) (6) @gmail.com) David shulkin [Drshulkin@ao l.com1; Ike Perlmutter [1@frenchangel59 .com); Marc Sherman ( b (b) (6) [mbtl■l@gmail.com] ) Re: Accountability news From: Sent : To ; CC: Subject: ( 6 ) Agree Sent from my iPad Bruce Moskowitz M .D . On Jul 7, 2017, at 4 :50 PJVI,L Perl~ (b) (6) wrote: Good a1ticle------- it has put eve1yone working at the VA on notice .....L On Fri, Jul 7, 2017 at 4:13 PM , David shulkin wrote : http ://www .washingtonexami ner .com/trum p-admi nistration-has-fued-more-than-5 00-vaem ployees-si nce-j anuary/ arti cl e/262 7988 Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000507 DS_00021223 Message From: Sent : To : Subject: David shulkin [Drshulkin@aol.com] 7/7/2017 8:13:14 PM Ike Perlmutte r a@frenchangel59 .com]; Laurie Perlmutter (b) (6) @gmail.comJ; Marc Sherman ( b [mb ••■ ; Bruce Moskowitz [brucem (b) (6) (b) @mac.com);David Shulkin [drshulkin@aol.com) (b) (6) @gmail.com) Accountability news ) (6) ( 6 ) http://www .washingtonexaminer.com/trump-administration-has-fired-more-than-500-va-employees-since - january/article/2627988 Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000508 DS_00021224 Message From: Poonarn Alaigh I(b) (6) @hotmail.com] Sent : 6/30/2017 1: 15 :05 PM To : David shulkin [Drshulkin@aol.com] Re: I.oaks grim for rnonday Subject: 1 spoke to windom in details yesterday- can fill you in when we meet- but agree with the appmach to keep the . pressure on scott on the other side Sent from my iPhone On Jun 30, 2017 at 6:37 A.Ni, David shulkin wrote: Scott- weeks have gone by and given the note below i want to make sure we are getting there . The goal is to have the contract specs prepared and ready to execute . We gave a timeline of three to four months from our announcement When will this be done? The two short term goals i had were to have technical consultants working full time on the contract specs (mitre) and a person or people here weeks ago from DoD to replace (b) (6) (b)((6) Are these two issues resolved? I am not sure-sup to date . Ill b ) We now have congressional inquiries asking when will the contract be done? How rnuoh is the ( cost ? Wl1at are the timelines ? And much more detail- i 6think we need serious help to get this done. ) I know you are driving this hard so im not getting in the weeds but just want sone reassurance I know its saying the very obvious but this is our most visible initiative in the Department Thanks Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) From:-~ Date: June 30, 2017 (6) at J: 03 :46 AM EDT To: David Shullcin Subject: looks grim for mouday Hi David , Windom asked- (b) (6) for ''every resume" of people working at VA (according to her last night) . Plus MITRE has not executed the agreement as of this morning. They went completely dark yesterday (the day before we were supposed to sign on) . AMERICAN PVERSIGHT VA-19-0799-G-000509 DS 00021225 I did see a draft agreement where they had changed the start date to next Monday (July 10). I would say that, too, is at risk given bureaucracy on both sides. Best regards (b) 1111 (6) AMERICAN PVERSIGHT VA-19-0799-G-000510 OS 00021226 Message From: David shulkin LDrshulkin@aol.com] Sent : 6/30/201710 :37:43 AM To : Vivieca Simpson I(b) (6) Elgmail.com) Fwd: looks grim for monday Subject: Vivieca- this cannot fail t Sent from my iPhone Begin forwarded message : From: David shuJkin Date: June 30 , 2017 at 6:36 :55 AM EDT To: "Scott R. Blackbum 11 Cc: Vivieca Simpson- (b) (6) > Subject: Fwd: looks grim for monday Scott- weeks have gone by and given the note below i want to make sure we are getting there . The goal is to have the contract specs prepared and ready to execute . We gave a timeline of three to four months from our announcement When will this be done? The two short term goals i had were to have technical consultants working fuJI time on the contract specs (mitre) and a person or people here weeks ago from DoD to replace (b) (6) Are these two issues resolved ? I am not sure (b) is up to date . Ill Ill (6) We now have congressional inquiries asking when will the contract be done? Howrnuoh is the cost? Wl1at are the timelines? And much more detail- i think we need serious help to get this done. I know you are driving this hard so irn not getting in the weeds but just want sone reassurance I know its saying the very obvious but this is our most visible initiative in the Department Thanks Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) From:-~ Date: June 30, 2017 (6) at 3: 03 :46 AM EDT To: David ShuJkin Subject: looks grim for mooday Hi David , AMERICAN PVERSIGHT VA-19-0799-G-000511 DS_ 00021227 Windom asked-(b) (6) for "every resume" of people working at VA (according to her last night). Plus MITRE has not executed the agreement as of this morning. They went completely dark yesterday (the day before we were supposed to sign on). I did see a draft agreement where they had changed the start date to next Monday (July 10). I would say that, too, is at risk given bureaucracy on both sides. Best regards (b) 1111 (6) AMERICAN PVERSIGHT VA-19-0799-G-000512 OS 00021228 Message David shulkin LDrshulkin@aol.com] 6/30/201710 :36:SS AM Scott R. Blackburn [Scott.Blackburn@va.gov] Vivieca Simpson I(b) (6) E!gmail.com) Poonarn Alaigh I(b) (6) @hotl'T)ail.com]; vacodJs@va.gov Fwd: looks grim for monday From: Sent : To : CC: BCC: Subject: Scott- weeks have gone by and given the note below i want to make sure we are getting there . The goal is to have the contract specs prepared and ready to execute . We gave a timeline of three to four months from our announcement When will this be done ? The two short tenn goals i had were to have technical consultants working full time on the contract specs (mitre) and a person or people here weeks ago from DoD to replace (b) (6) Are these two issues (b) is up to date . resolved? I am not sure 11111 (6) We now have congressional inquiries asking when will the contract be done? How much is the cost? What are the timelines? And much more detail- i think we need serious help to get this done . I know you are driving this hard so im not getting in the weeds but just want sone reassurance 1 know its saying the very obvious but this is our most visible injtiative in the Department Thanks Se11tfrom my iPhone Begin forwarded message : (b) (6) (b) (6) From:-~ > Date: June 30, 2017 (6) at 3:03 :46 AM EDT To: David Shulkin Subject: looks grim for monday Hi David, (b) (6) Windom asked-for every resume" of people working at VA (according to her Jast night) , 11 Plus MITREhas not executed the agreement as of this morning . They went completely dark yesterday (the day before we were supposed to sign on) . I did see a draft agreement where they had changed the start date to next Monday (July 10). I would say that , too, is at risk given bureaucracy on both side . Best regards (b) 11111 (6) AMERICAN PVERSIGHT VA-19-0799-G-000513 DS 00021229 Message David shulkin l Drshulk in@aol.com] 7/17/2017 4:08:37 PM Ike Perlmutter [l@fr encha ngel59.com]; Marc Sherman [mbsll.l@ ( (b) (6) gmail.com] Fwd: [EXTERNAL b] FW: Washington Examiner: 'Historic preservation ' blocks VA bid to save millions, help more vets From: Sent : To : Subject : ) ( 6 ) Fyi Washington Examiner: 'Histo.-ic preservation' blocks VA bid to save millions , help more vets Sent with Good (www .good.com ) -----O riginal Message--- -From: (b) (6) BOP/WHO_(b) (6) Sent: Monday, July 17, 2017 11:27 AM Eastern Standard Time To: DJS Subject: [EXTERNAL ] FW : Washington Examiner: 'Historic preservation' blocks VA bid to save millions, help more vets Thi s is great From: RNC War Room [mailto (b) (6) Sent: Monday, July 17, 20 17 10:05 AM Subject: Washington Exam iner: 'Historic preserva tion ' blocks VA bid to save millions help more vets 'Historic prese1Vation' blocksVAbidto savemillions,helpmorevets Washington Examiner PaulBedard July17, 2017- 9:13 AM >http://www. washingtonexami ner.com/historic-preservation-blocks-va-bid-to-save-millions-help-more< vets/article/2628821 Talkabout yourfixer-uppers. AMERICAN PVERSIGHT VA-19-0799-G-000515 DS_00021231 TheDepartment of VeteransAffairsis tryingto unloadhundreds of vacantanduselessbuildings,potentially savingtaxpayers$23millioneveryyear,buthistoricpreservation tagshavebeenslappedon manyof them,blockingaction. VA SecretaryDavidJ. Shulkinsaidthe agencyownsthousands of buildingsfromthe Revolutionary War, CivilWar,WorldWarI, andWorldWarII, manyvacantandunderhistoricalpreservation status. Citing100buildingsthatarefromthe CivilWarandRevolutionary War,Shulkinsaid"eventhoughtheyare buildingsthatwe aren'tusingor buildings thataretoooldto viablyuse,theystill havehistoricpreservation status." Overall,2,226VA buildings,hospitals,privategarages,andevena bowlingalleyin Iowa- 35 percentof its 6,297realestateholdings- havehistoricstatus,blockingdestruction or majorrenovations . Onedates to 1735. Butthatis no longergoingto holdupVA'sbidto do something aboutthem. "I needto workwithotherfederalagenciesandgovernment organizations to makesurethatwe canget thoseproperlyaddressed, eithergiftthem,or givethembackto organizations thatwantto maintainthemor readdress someof theirstatus,"Shulkinsaid. Shulkinis on a two-yearmissionto dumpor repurpose1,100buildings.Hesaidtheeffortwouldsave taxpayers$15.7 millionannuallybeginning in 2017anda totalof $23millionin combinedannualsavings. "Myplanis to dealwiththose1,100in the nexttwoyears.Whenyoulookat them,thereare142thatI've alreadymadedecisionson, andI'mproceeding eitherto disposeof them,destroythem,or essentially give thembackto the [GeneralServicesAdministration, thefederalrealestateagency],backto thefederal inventory," hesaid. VAofficialssaidhealsois workinghardwithnon-governmental groupsandlocalgovernments for partnerships thatwill helpveterans,eitherprovidingthemcheaphousingin the buildingsor otherservices - andshareupkeepcosts. AMERICAN PVERSIGHT VA-19-0799-G-000516 OS 00021232 "Wedon't wantto justdemolish them,'' saidspokesman TerrenceHayes . "That'sa lastresort." ForShulkin , thegoalis helpingvetsandcuttingcoststo taxpayers. Whenheannounced hisplan,Shulkin said, "Weoweit to theAmerican taxpayerto applyasmuchof ourfundingaspossibleto helpingveterans ," adding,"Weneedto moverapidlyto bringsavingsto taxpayers. Wewillworkthroughthe legal requirementsandregulationsfor disposalandreuse,andwewilldo it as swiftly aspossible ." Disclaime r: TheRepublican NationalCommittee providedtheabovearticleas a serviceto itsemployees andotherselectedindividuals.Anyopinionsexpressed thereinarethoseof thearticle's authoranddo not necessarily reflecttheviewsandopinionsof theRNC. AMERICAr-... pVERSIGHT VA-19-0799-G-000517 D8_00021233 Message From: Sent: To: Subject: David shu lkin [Drshulkin@ao l.com] 8/6/20 17 1:51:52 PM Poonam Alaigh I(b) (6) @hot mail.com] Re: Will we be able to chat today? What time is good for you Sent from my iPhone > on Aug 6, 2017, at 6:53 AM, Poonam Alaigh <-@hotmail.com> (b) (6) wrote: > > About > > Manchester so I can debrief my team on it > > I ke/ Bruce discussion I had > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000518 OS 00021234 Message Poonam Alaigh I(b) (6) @hotmail.com] 8/6/20 17 10:53:58 AM David shu lkin [Drshulkin@ao l.com ] Will we be able to chat today? From: Sent: To: Subject: About Manchester Ike/Bruce so I can debrief discussion my team on it I had Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000519 OS 00021235 Message Davidshulkin [Drshulkin@aol.com] From: Sent: 7/6/20 17 2:35:32 AM To: @aol.com (b) (6) Re: Update to discussion on the train Subject: Ok - thanks Sent from my iPhone > on Jul 5, 2017, at 9:47 PM, -@aol.com (b) (6) wrote: > > Hey David - hope all is well . Wanted-o ive ou a heads up from a VERY reliable info source . Former VA employee and senator Teste r s t affer (b) (6) ) is very vocal working against the prospect of Poonam as USH. Info to -(b) (6) is comi ng rom Jenn, e r Lee (majority source ) with some coming from implications for Darin as well . sorry to b'otTieruwith this but I am not sure of all the political you on some of these issues. would rather leave th~ The implications for to you to sort out . Poonam are more obvious. sorry for the bother --- -(b) > (6) > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000520 OS 00021236 Message From: Sent: To: Subject: (b) (6) @aol.com] @aol.com (b) (6) 7/6/20 17 1:47:06 AM DJS[d rshulk in@aol.com] Update to discussion on t he train Hey David - hope all is well. Wanted to from a VERY reliable info source. Former VA employee and senator Tester staffer is very vocal working against the prospect (b) (6) of Poonam as USH. Info to Michelle Lee (majority source) with some coming from Darin as well. Sorry to bother u with this but I am not sure of all the political implications for The implications for you on some of these issues. Would rather leave th~ to you to sort out. Poonam are more obvious . sorry for the bother --- -(b) (6) sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000521 OS 00021237 Message David shu lkin [Drshulkin@ao l.co m] 6/25/2017 8:57:24 PM @yahoo.co m] (b) (6), (b) (b) (6) From: Sent: To: (2) Dr Jen l ee (b) (6) -gmai sent l .com f rom my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000522 DS_ 00021238 Message From: David Shulkin [drshulkin@aol.com] Sent: 6/24/2017 2:36:55 PM To ; Poonam Alaigh Re: Subject: I(b) (6) @hotmail.com) Yup Sent from my iPad On Jun 24, 2017 , at 9:31 AM , Poonam Alaigh - (b) (6) > wrote : I didn't like it at all when he first said it, but after that it was so obvious that he was playful about it- it was all in great spirits - it's just him. Sent from my iPhone On Jun 24, 2017, at 7:49 AM, David ShuJkin wrote : This is what the Post covered https://www .washingtonpost.com/news/post-politics/wp/2017 /06/23/trump-actsout-firing-his-va-secretary-if-new-reform s-are-not-implementedsuccessfullynutm terrn=.b0324e6b 1 lb9 Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000523 DS_00021239 Message I(b) (6) From: Poonam Alaigh @hotmail.com] Sent: To ; 6/24/2017 1:31 :50 PM David Shu Ikin (drshulk in@aol.com] Subject: Re: l didn 1tlike it at all when he first said it but after that it was so obvious that he was playful about it- it was all in great spirits - it s just him. 1 Sent from my iPhone On Jun 24, 2017, at 7:49 AM, David Shulkin wrote : This is what the Post covered https://www .washingtonpostcom/news/post-politics/wp/2017/06/23/trump -acts-out-ftring -hisva-secretary-if-new-reforms-are-not-implemented-successfully/?utm term=.b03 24e6b 11b9 Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000524 DS_00021240 Message From: Sent : To : David Shulkin [drshulkin@aol.com] 6/24/2017 11:48:08 AM Poonam Alaigh I(b) (6) @hotmail .com] This is what the Post covered https://www .washingtonpost.com/news/post-politics/wp/2017/06/23/trump-acts-out-firing-his-va-secretary-ifnew-reform s-are-not-im plem ented-successful Iy/? utm term =. b03 24e6b 11b9 Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000525 DS_00021241 Message From: David Shulkin [drshulkin@aol.com] Sent : 6/29/2017 2:38 :34 AM To: (b) (6) (b) (b)(6) (6) va.gov]; Vivieca Simpson I(b) (6) @gmail.com] http ://www.cnn.com/videos/world/201 7/06/29/ donald-trump-moon-j ae-in-meeting-korea-hancockspkg.cnn/video/playl i sts/mobile-digitaJ-shorts/ Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000526 OS 00021242 Message From: DavidShulkin [drshulkin@aol.com] Sent: 6/24/2017 5:34:30 PM To: (b) (6) Poonam Alaigh [-@hotmail.com] Re: Ike Subject: Good idea Sent from my iPad (b) (6) > on Jun 24, 2017, at 1:24 PM, Poonam Alaigh <-@hotmail.com> > > You may want to let him know how Darin is trying wrote: to block me through Kussman on the commission > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000527 OS 00021243 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 6/24/2017 5:24:29 PM To: DavidShulkin [drshulkin@aol.com] Ike Subject: You may want to l et him know how Darin is trying to block me through Kussman on the commission Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000528 OS 00021244 Message From: Sent : To : Subject: Poonarn Alaigh I(b) (6) @hotmail.com] 7/28/2017 12 :34:23 PM David Shu Ikin [drshulkin@aol.com] Fwd: Atlantic Health System CEO Brian Gragnolati selected as the American Hospital Association's chair-elect designate Sent from my iPhone Begin forwarded message: (b) (6) From:•-(b) (6) atlant ichealth.or > Date: July 28, 2017 at 8:10:48 AM EDT To: Poonam Alaigh MD~ (b) (6) Subject: Fwd: Atlantic Health System CEO Brian Gragnolati selected as the American Hospital Association's chair-.elect designate Sent from my iPhone Begin forwarded message: From: Atlantic Health Communications Date: July 28, 2017 at 8:00:27 AM EDT To: AH GAL (b) (6) at lantichealth .or > Subject: Atlantic Health System CEO Brian Gragnolati selected as the American Hospital Association's chair-elect designate This message is from Valen"eSimon, Chief Marketing Officer, Atlantic Health System : I am pleased to share that the American Hospital Association has announced that our very own Brian has been selected as the chair-elect designate . He will serve as ChairElect in 2018 and assume the chairmanship in 2019, becoming the top-elected official of the national organization representing America 's hospitals and health systems. Please take a moment to join us on social media via Facebook , Twitte r and Linked In, to help share the news. Outing this critically important and exciting time for all of us in the health care field , Brian 1s leadership will help drive transformation within our system and across the nation . His new role will also shine a spotlight on our outstanding team at Atlantic Health System , helping to promote our trusted network of caring and advance our mission to build healthier communities . Please join us in congratulating Brian on this prestigious recognition. The information contained in this email is intended only for the use of the person(s) identified above. This communication may contain work product which is privileged and confidential, and may contain content which is regulated by Federal law . If you are not an intended recipient or the employee or agent responsible to deliver this to the intended recipient, you have received this AMEr- I PVERSIGHT VA-19-0799-G-000529 DS 00021245 message in error and any review, distribution or copying of it by you is prohibited. If you have received this message in error, please notify the sender immediately, and delete the message. Email and communication system messages generated by members of the Atlantic Health System workforce may not necessarily reflect the views of Atlantic Health System, its officers, directors or management. AMERICAN PVERSIGHT VA-19-0799-G-000530 OS 00021246 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 6/23/2017 2:50:15 AM Poonam Alaigh I(b) (6) @hotmail.com] Re: More folks? Give me a break please This has absolutely Ill explain nothing to do with me - in person but please am not involved other thsn totally having your back no more emails sent from my iPhone (b) (6) > on Jun 22, 2017 , at 10:10 PM, Poonam Alaigh <-@hotmail.com > wrote : > > But why would you not tell me- I j ust want honesty especially when i as ked you directly > > sent from my iPad > >> on Jun 22, 2017 , at 10 : 09 PM, David shul kin wrote: >> >> Nothing to worry about >> >> Ive got it under control >> >> sent from my iPhone >> >>> on Jun 22, 2017, at 9 : 55 PM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote : >>> >>> Just heard that more interviews for the USH- thought it was already submitted you since you have to pic k the ver y best - can I trust anyone ? >>> >>> sent from my iPhone >> AMERICAN PVERSIGHT - anyway, don ' t blame VA-19-0799-G-000531 OS 00021247 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 6/23/2017 2:10: 19 AM To: Davidshulkin [Drshulkin@aol.com] Re: More folks? Subject: But why would you not tell me- I just want honesty especially when asked you directly Sent from my iPad > on Jun 22, 2017, at 10:09 PM, David shulkin wrote: > > Nothing to worry about > > Ive got it under control> > sent from my iPhone > >> on Jun 22 , 2017, at 9: 55 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote: >> >> Just heard that more interviews for the USH- thought it was already submitted you since you have to pick the very best - can I trust anyone ? - anyway, don't blame >> >> sent from my iPhone > AMERICAN PVERSIGHT VA-19-0799-G-000532 OS 00021248 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 6/23/2017 2:09: 12 AM To: Poonam AlaighI(b) (6) @hotmail.com] Re: More folks? Subject: Nothing to worry about Ive got it under controlSent from my iPhone > on Jun 22 , 2017, at 9:55 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : > > Just heard that more inter views for the USH- thought it was already since you have to pic k the very best - can I trust anyone ? su bmitted - anyway, don't blame you > > s ent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000533 OS 00021249 Message From: Sent: To: Subject: Poonam Alaigh I(b) (6) @hotmail.com] 6/23/2017 1:55:34 AM DavidShulkin [drshulkin@aol.com] More folks? Just heard that more interviews for the USH- thought it was already since you have to pick the very best - can I trust anyone? submitted - anyway, don't blame you Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000534 OS 00021250 Message Davidshulkin [Drshulkin@aol.com] 6/22/2017 12:04:02 PM Poonam AlaighI(b) (6) @hotmail.com] Re:Just an Fyi From: Sent: To: Subject: It will be good Sent from my iPhone (b) (6) > on Jun 22, 2017, at 6:18 AM, Poonam Alaigh <-@hotmail.com> wrote: > > Right after you suggested , I tried to get Baligh to sit with me today but OCLAsaid it was too late since we submitted the names already. I as ked Baligh to sit behind me so that in case there was a question , I could h.. come up front but he told me he had a doctors appointment so could not be there. I will have (b) (6) from his team be there instead- I will be fine with the choice questions so don't worr y - thanks or all your support- as long as I have that I don't really need anything else . Enj oy your trip today and hopefully can catch up towards the end of the day > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000535 OS 00021251 Message David shulkin [Drshulkin@aol.com] 6/28/2017 2:19:50 AM Darin Selnick (b) (6) @gmail.com] Re: Article on You From: Sent : To ; Subject: Thanks Darin Sent from my iPhone On Jun 27, 2017, at 9:18 PM, Darin Selnick (b) (6) The other month I gave you the book from Sean Parnell. He just wrote an op-ed about you I think you will like. http://www.washingtonexaminer.com/finaJly-the-va-has-solid-reform-mindedleadership/article/2627091 Darin AMERICAN PVERSIGHT VA-19-0799-G-000536 DS_00021252 Message From: Sent : To ; Subject: Darin Selnick (b) (6) @gmail.com] 6/28/2017 1:18:17 AM David shulkin [Drshulkin@aol.comJ Article on You The other month I gave you the book from Sean Parnell. He just wrote an op-ed about you l think you will like. http://www .washingtonexaminer.com/flnally-the-va-has-solid-reform-minded-1eadership/ article/2627091 Darin AMERICAN PVERSIGHT VA-19-0799-G-000537 OS 00021253 Message From : Sent : To: Subject: Poonam Alaigh I(b) (6) @hotmail.com] 6/20/2017 11 :29:4 9 PM David Shulkin [drshulkin@aol.com] Fwd: Terry Fadem Let me handle this and we can regroup Sent from my iPhone Begin forwarded message : - > From: "Alaigh, Poonam , M .D . 11 Date: June 20, 2017 at 7:29 :02 PM EDT To: 'Poonam Alaigh 1 (b) (6) Subject: FW: Terry Fadem Let me handle this and we can regroup Sent with Good (www .good.com ) -----Original Message----From: Pape, Lisa M. Sent: Tuesday , June 20, 2017 07 :24 PM Eastern Standard Time To: Alaigh, Poonam , M.D. Cc: Beck , Lucille B. Subject: RE : Ten)' Fadem I spoken with Rachel -- they think the paperwork is with VWS- I sent an email to her asking-(b) It is a~ay-(4) Apparently this guy may have also sent a proposed contract to Dr Shulkin today -- and asks for a large retainer payment ~Will let you know as soon as VW S responds Lisa Pape, LISW -----Original Message----From: Alaigb, Poonam , M .D . Sent: Tuesday , June 20, 2017 06:48 PM Eastern Standard Time To: (b) (6) Ramoni , Rachel Cc: Pape , Lisa NI.; Beck, Lucille B. Subject: RE : Terry Fadem AMEHI Jf I PVERSIGHT VA-19-0799-G-000538 DS 00021254 (b) I though I signed off on a contrac t that was for around ~day or something- Rachel, didn't know that had to go through CSEMO- you told me that (4) it could be executed in 2 weeks when we spoke over a month ago on this since it was a small contract and didn't need to be competed for. Not sure who is handling this , but please let me know what is happening since we are talking to Apple about a project and we have to make sure we have all the W aspect clarified before we move forward Sent with Good (www.good.com ) -----Origina l Message----From: (b) (6) Sent: Tuesday , June 20, 2017 11 :46 AM Eastern Standa rd Time To: Alaigh, Poonam, M .D .; Ramoni , Rachel Cc: Pape , Lisa M. Subject: RE : Terry Fadem I was told by -(b) (6) yesterday that on Friday the folder was stil l in CSEMO for approval by the VACOS . I was not able to confirm if Executi ve Recruitment has spoken to him abou what we can offer in the way of funding for a consultant. We had asked them to do this several weeks ago . __ (b) (6) ,PFl.'D . Director of Operations Office of Research and Development (10P9) Department of Veterans Affairs 810 Vermont Ave NW Washington, DC 20420 (b) (6) - (b) (6) From: Alaigh, Poonam,M.D. Sent: Tuesday,June 20, 2017 11:33 AM To: Ramoni,Rachel;-(b) (6) AMERI\...Jr 1 PVERSIGHT VA-19-0799-G-000539 DS_00021255 Cc: Pape, Lisa M. Subject: RE: Terry Fadem Please send me an update on this- haven't heard from anyone about this - Lisa can you connect when rachel on this too please Sent with Good (www .good .com) -----Original Message---- · From: Ramoni , Rachel Sent: Friday , June 16, 2017 06:48 PM Eastern Standard Time To: Alaigh, Poonam, M .D.; (b) (6) Subject: RE : Terry Fadem I've added (b) (6) (ORD's director of operations) , who can give an update . Rachel Sent with Good (www.good.com ) -----Orig inal Message----Fro m: Alaigh, Poonam , M.D. Sent: Friday , June 16, 2017 06:40 PM Eastern Standard Time To: Ramoni , Rachel Subject: Terry Fadem Is he on board- can we start using him on projects - U1ereis an initiative we mighl need to pull him in on Sent with Good (www.good.com) AMERICAr-... pVERSIGHT VA-19-0799-G-000540 DS 00021256 Message Poonam Alaigh I(b) (6) @hotmail.com] 6/14/2017 4:17 :01 PM David shulkin [Drshulkin@aol.comJ Re: Terry Fadem From: Sent : To : Subject: (b) l signed off on his per diem contract ofl think it was i1111111our for 1 hour max a day that could be rolled up into (4) weekly or montWy invoices Sent from my iPhone On Jun 14, 2017 , at 12:06 PM , David shulkin wrote : Do you know where things stand with Terrys contract ? Sent from my jPhone Begin fo1warded message : F.-om: Bruce Moskowitz Date: June 14, 2017 at 6:41 :45 AM EDT (6) (b) (6) To: drshulkin@aol .com , IP ~(b @frenchangel59 .com>, ~ ) Subject: Terry Fadem (6 ) This document produced by the VA team working with Apple has our urgent concem that we need Terry Fadem now . He was agreeable to your idea to get him engaged quickly to work by the hour as a consuJtant for now . The group working with Apple even after I told Darren not to have follow up discussions without our teams input was about to turn over the lucrative data base for FREE that Apple and J&J , both know the huge value it holds. Than you for pursuing this . Sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000541 DS_00021257 Message David shulkin [Drshulkin@aol.com] Sent : 6/14/2017 4:01:23 PM To : Poonam Alaigh I(b) (6) @hotmail.com] Subject: Fwd: Terry Fadem Attachments : DVP HEALTH (2).docx; Untitled attachment 94710.htrn From: Do you know where things stand with Terrys contract? Sent from my iPhone Begin forwarded message : From: Bruce Moskowitz Date: June 14, 2017 at 6:41:45 A.Iv! EDT (6) ( @frenchangel59 To: drshulkin@aol.com , IP <1 .com>, - (b) (6) b Subject: Terry Fadem ) ( This document produced by the VA team working with Apple has our urgent concern that we 6) need Terry Fadem now . He was agreeable to your idea to get him engaged quickly to work by the hour as a consultant for now . The group working with Apple even after I told Darren not to have follow up discussions without our teams input was about to turn over the lucrative data base for FREE that Apple and J&J , both know the huge value it holds . Than you for pursuing this. AMERICAN PVERSIGHT VA-19-0799-G-000542 DS_00021258 Where is the VA in developing a Digital Platform that is dynamic and can transparently exchange real-time Electron Health Records and Health Data Analytics between the patient and the Care Provider? Last fall VA executed a proof-of-concept (POC) to test a FHIR API based, microservices architecture, to exchange real-time EHRand Health Data Analytics between VA, DoD, and Community Care providers. The POC leveraged 21 APls across four cloud environments to connect to Cerner, EPIC,VistA, and GOPHEREHRs and enable healthcare delivery for several clinical scenarios. These scenarios focused on seamless access to data from disparate systems, real-time health analytics to provide clinical decision support at the point of care, and Veteran engagement with coordinated care through automated workflows. The clinical care pathways in this POCfocused on three key areas of VA care: Traumatic Brain Injury (TBI), Women's Reproductive Health, and patients with multiple medical conditions including Obesity, Diabetes, and Congestive Heart Failure. VA has already started developing the production version of the platform, Digital Veteran Platform (DVP), with a planned integration with MyHealtheVet. Conversations between Apple and VA centered around how to develop a common roadmap where VA's emerging DVP will deliver Veteran data to Apple's Health Kit. VA is currently developing a set of FHIR-based API and Core Data Services in alignment with Argonaut Project standards and secured with OAuth 2.0. FHIR presents an unprecedented opportunity for Healthcare System to Healthcare System solutions implementing bidirectional health information exchange (HIE). VA and the 5 Centers' development of FHIR solutions enabling Apple to ingest Veteran data realize true exchange of health record data between VA, Choice Program care providers and DoD. VA and Apple also discussed the potential to collaborate on the use data analytics and artificial intelligence to unlock a number of silos of Veteran data including VA's Million Veteran Program (MVP). The goal is not only for enhanced Veteran care, but also for advanced knowledge sharing, clinical decision support, technical expertise, and process interoperability with organizations throughout the United States care delivery system. By simplifying access to the largest data set of clinical data anywhere, it will accelerate the discovery and development of new clinical pathways for the benefit of the Veterans and the community at large. AMERICAN PVERSIGHT VA-19-0799-G-000543 OS 00021259 Background...User Storiesfor POC Meet Byron, a teacher, father, and Iraq war Veteran. Byron's medical data is part of VA's DVP, automatically imported after he separated from the military. At his fi rst appo intment at VA, the clinician notices t he presence of a Traumatic Brain Injury (TBI) and flags that in DVP. DVP automatically notifies Byron's VA primary care provider and recommends a TBI care pat hway. Byron's Care Plan is updated accordingly. Two months later, Byron suffe rs a seizure at wo rk, loses consciousness, and is tr ansported to a local hospital. DVP automatically collects his Episodic Care Record from the local hospital and initiates a refe rral for a VA neurology appointment. Byron forge t s t o schedule his appointment, and after 72 hours, DVP automatically intervenes to put Byron in touch with his VA provider. At Byron's appointment, his doctor prescribes medication and a mob ile seizure tracking application for his smartphone. Through the application, DHP tracks multiple seizures over the next four weeks and notif ies the doctor, whose nurse increases Byron' s dosage. But Byron needs a solution-fast. He wants to cont inue teach ing, but he doesn't have time to t est, which medications w ill still allow him to drive to work and continue to care for his daughte r . At Byron's next visit, DHP prompts his doctor to run the Epilepsy Analytics Modu le to assesshis clinical history. The modu le returns 15 anti-epileptic drugs and further refines and recommends three drugs that have been successful w ith other patients like Byron, and will allow him to cont inue to drive. Byron and his docto r choose a new medication with the highest likelihood of success. The change in medication, enabled by DHP, has kept Byron seizure-free for six months. As a result, he is able to continue doing what he loves, live an active lifestyle, and take care of his daughter. AMERICAN PVERSIGHT VA-19-0799-G-000544 DS_00021260 POC Main Takeaways - Byron's Story When Byron first seeks care within VA, he is enrolled in a traumatic brain injury care pathway . His health information with the DoD Cerner system is automatically imported into VA through the MuleSoft API gateway, mapped to common standards so as to maintain its semantic relationships. This is critical because it allows VA to similarly apply internal real time analytics to both internal and external data sources. The Joint VA/DoD Traumatic Brain Injury Clinical Practice Guideline was used to develop a Traumatic Brain Injury Care Pathway within the Apervita real time analytics platform, which was responsible for curating and analyzing Byron's data to trigger the recommendation for care pathway enrollment. eluminate is an example of a readily adoptable marketplace solution, developed in partnership between Georgia Tech and the biopharmaceutical company UCB, that harnesses the power of predictive analytics to raise the standard of epilepsy care. eluminate put data from nearly 10 million patients through an advanced machine learning algorithm and generated personalized models for 15 commonly prescribed anti-epileptic drugs. The system leverages a common FHIR framework and was readily adopted leveraging the API gateway. Treatment recommendations for this narrowly focused clinical task were then provided via a SMART on FHIR application within the GOPHEREHRto highlight the ability to provide real-time insights for healthcare providers at the point-of -care to inform treatment decisions. Open source collaboratives are providing advances in precision medicine to population health. The POC leveraged the Observational Health Data Sciences and Informatics or Odyssey framework which utilizes the Observational Medical Outcomes Partnership (OMOP) Common Data Model to help standardize the format and content of observational data, so standardized applications, tools and methods can be applied to them. This enabled the use of advanced visualization techniques such as tree-mapping that allowed the exploration of relationships between unique observations. In this case, to explore cohorts and better understand characteristics of epilepsy patients like Byron as well as the effects of interventions at a population level. AMERICAN PVERSIGHT VA-19-0799-G-000545 OS 00021261 Meet Nora, a graphic designer, aspiring mother and Afghan war Veteran. Nora's medical data is part of VA's DVP, automatically imported after she t ransitioned from her Combat Systems Operator position in the Navy. She is general ly healthy aside from her struggles with mild depression, asthma, and genet ic predisposition to obesity. Nora receives her routine care through the VA Women's Health Primary Care Physician, or PCP, Her Care Plan includes nutritional counseling and exercise guidance in a supporting effort to reverse the obesity. Nora is seen by VA Mental Health for her ongoing batt le with depression . Because she cannot always spend time trave ling to clinics, she has a Mobile First Program that allows for telemedicine visits with her physician or psychologist without ever leaving the house. Nora is trying to start her family, and has been trying t o become pregnant for six months . She has been experiencing fertility difficulties that Nora's PCPsuspects may be due to her obesity. An initial round of lab testing and ultrasound workup is ordered, and no abnorma lities are shown in the results. Her PCPis able to put her on a diet and weight loss regimen, and two months later, she becomes pregnant. Throughout her pregnancy, Nora experiences diffe rent complications relat ing to gest ational diabetes, and even a reduced fetal movement scare. She is referred to VA endocr inology and Maternal Fetal Medicine (MFM). Even though MFM is an outside clinic, the structured dat a flows back-and-forth between the clinic and her VA PCP.Nora is able to reach out to her medical team through her mobile app instead of having to visit an emergency room. Nora gives birth to a healthy baby girl, and DHP continues to faci litate seamless care for Nora and her baby . This is our vision for the future of care for our Veterans. Main Takeaways - Nora's Story A strategic API Gateway, with Mobi le Backend as a Service (MBaaS), allowed the rapid development of innovative Veteran -facing solutions. A mobile application was developed by leveraging a library of functiona l APls that spanned different systems, to provide the frictionless AMERICAr-... pVERSIGHT VA-19-0799-G-000546 D8_00021262 transition of Nora's DoD medical records to a VA built app. To simplify life for Nora and help her health care team provide the best service, a significant set of components are operating in concert on the backend . Analytics triggering automated processes to involve and engage Nora in her healthcare establish that great first impression. Process automation and self-service can effectively reduce human workload and related delays. By creating automated processes tailored to clinical decisions and simplifying the appointment setup process, it is easy for Nora to follow through with her shared care plan with her provider. Sophisticated Veteran user expectations around virtual care were met by using a low cost, high qu ality video commu nicatio n solution integrated with a mobile application made possible by the sophistication of the DVP architecture. The mobile application also leveraged native platform capabilities to obtain Nora's patient generated data from internet connected health devices. The DVP approach also allowed for the conceptual onboarding of Care in the Community Partners rapidly while hiding the complexity for the Veteran within the mobile perspective. Meet Warren, a Vietnam War Veteran, is managing a number of complex medical conditions Warren is the next user story we are building. We have modeled the way he currently receives care, and the future state. Current state : Warren has congestive heart failure with periodic exacerbations. While experiencing increased shortness of breath and leg swelling, he visits an urgent -care physician who reviews notes from Warren's cardiologist and primary-care provider (PCP),gets blood studies, doubles a medication, and schedules a follow-up visit with the PCP. 3 weeks later , Warren's PCPruns a blood test and finds elevated potassium. The PCPadds another water pill to reduce the potassium and swelling, orders an ECG, and refers Warren to a cardiologist for further examinatiol'). 6 weeks later, Warren visits a cardiologist for new occasional fainting. His potassium is low, likely causing heart -rhyt hm problems and fainting. The cardiologist repeats the ECG,adds a potassium supplement and schedules a stress test, fo llow-up visit, and a 3-day heart--rhythm monitoring test. AMERICAr-... pVERSIGHT VA-19-0799-G-000547 D8_0 002 1263 1 week later, Warren completes the tests. He does not receive the results. 3 weeks later, Warren sees the cardiologist again. The stress test is unchanged and the rhythm test is normal. Warren is feeling better but dislikes the extra pills. The cardiologist requests that Warren see his PCPto manage his medications in another month. Future State Today: Warren has congestive heart failure with periodic exacerbations, so he is enrolled in a clinical pathway module for CHFthat includes home monitoring. His target weight is between 180 and 187 pounds. Warren has recently had increasing shortness of breath and leg swelling. The platform's connected home health monitor detects weight gain from retained water. Because Warren is above 190 pounds, the platform sends a task to the nurse to call him. The next day, the nurse calls Warren, updates his symptoms in the platform, and reviews the plan of care with him. He reminds Warren that when his weight is over 187 pounds, he should take an extra water pill for up to three extra pills a week until it returns to the goal range. In 3 days, Warren is feeling better. One Year Later: Warren weighs 195+ for over five days. The platform tasks the nurse to call Warren. The nurse notes that Warren is taking an extra water pill as prescribed but his weight will not go down. The nurse's data entry triggers a task to the pharmacist to review Warren's chart and evaluate whether medication titration is warranted. The clinical pharmacist accepts the platform's recommendation of doubling a medication and confirms recommended blood tests in a week. Warren receives a message on his app and confirms that he understands. But despite daily alerts from his smartphone app to come to the lab, Warren does not appear. 3 days after the labs are past due, the platform sends a task to the nurse to call Warren. Warren says he feels too sick to go to the lab. The nurse convinces Warren to go to the lab and schedules a visit with the PCP. 3 days later, blood tests are normal. The physician orders a platform-recommended ECG- transmitted wirelessly to the platform - which shows some subtle changes. The platform recommends a special heart stress test and Warren finds an appointment at a non-VA location for later that week. AMERICAN PVERSIGHT VA-19-0799-G-000548 OS 00021264 5 days later, Warren gets the stress test, which is unchanged. The results are sent electronically to the VA's platform, which detects that Warren's state now falls outside the standard clinical pathway. Based on data from other VA patients with a similar history, the PCPorders a second medication and follow-up labs, and 1 week later, the platform guides the clinical pharmacist as she titrates the medication to Warren's blood values and symptoms. Within 2 weeks, Warren is feeling better. AMERICAN PVERSIGHT VA-19-0799-G-000549 OS 00021265 Sent from my iPad Bmce Moskowitz MD. Message (b) (6) (b) Bruce Moskowitz [bruce~@mac .com] (6) Sent: 6/14/2017 10:41:45 AM ( (b) (6) To: .com]; mb-@gmail .com drshulkin@aol.com; IP [ll@frenchangel59 b Terry Fadem Subject: ) Attachments: DVP HEALTH (2).docx; Untitled attachment 94716.txt ( 6 ) This document produced by the VA team working with Apple has our urgent concern that we need Terry Fadem now. He was agreeable to your idea to get him engaged quickly to work by the hour as a consultant for now. The group working with Apple even after I told Darren not to have follow up discussions without our teams input was about to turn over the lucrative data base for FREE that Apple and J&J, both know the huge value it holds. Than you for pursuing this. From: AMERICAN PVERSIGHT VA-19-0799-G-000551 OS 00021267 Where is the VA in developing a Digital Platform that is dynamic and can transparently exchange real-time Electron Health Records and Health Data Analytics between the patient and the Care Provider? Last fall VA executed a proof-of-concept (POC) to test a FHIR API based, microservices architecture, to exchange real-time EHRand Health Data Analytics between VA, DoD, and Community Care providers. The POC leveraged 21 APls across four cloud environments to connect to Cerner, EPIC,VistA, and GOPHEREHRs and enable healthcare delivery for several clinical scenarios. These scenarios focused on seamless access to data from disparate systems, real-time health analytics to provide clinical decision support at the point of care, and Veteran engagement with coordinated care through automated workflows. The clinical care pathways in this POCfocused on three key areas of VA care: Traumatic Brain Injury (TBI), Women's Reproductive Health, and patients with multiple medical conditions including Obesity, Diabetes, and Congestive Heart Failure. VA has already started developing the production version of the platform, Digital Veteran Platform (DVP), with a planned integration with MyHealtheVet. Conversations between Apple and VA centered around how to develop a common roadmap where VA's emerging DVP will deliver Veteran data to Apple's Health Kit. VA is currently developing a set of FHIR-based API and Core Data Services in alignment with Argonaut Project standards and secured with OAuth 2.0. FHIR presents an unprecedented opportunity for Healthcare System to Healthcare System solutions implementing bidirectional health information exchange (HIE). VA and the 5 Centers' development of FHIR solutions enabling Apple to ingest Veteran data realize true exchange of health record data between VA, Choice Program care providers and DoD. VA and Apple also discussed the potential to collaborate on the use data analytics and artificial intelligence to unlock a number of silos of Veteran data including VA's Million Veteran Program (MVP). The goal is not only for enhanced Veteran care, but also for advanced knowledge sharing, clinical decision support, technical expertise, and process interoperability with organizations throughout the United States care delivery system. By simplifying access to the largest data set of clinical data anywhere, it will accelerate the discovery and development of new clinical pathways for the benefit of the Veterans and the community at large. AMERICAN PVERSIGHT VA-19-0799-G-000552 OS 00021268 Background...User Storiesfor POC Meet Byron, a teacher, father, and Iraq war Veteran. Byron's medical data is part of VA's DVP, automatically imported after he separated from the military. At his fi rst appo intment at VA, the clinician notices t he presence of a Traumatic Brain Injury (TBI) and flags that in DVP. DVP automatically notifies Byron's VA primary care provider and recommends a TBI care pat hway. Byron's Care Plan is updated accordingly. Two months later, Byron suffe rs a seizure at wo rk, loses consciousness, and is tr ansported to a local hospital. DVP automatically collects his Episodic Care Record from the local hospital and initiates a refe rral for a VA neurology appointment. Byron forge t s t o schedule his appointment, and after 72 hours, DVP automatically intervenes to put Byron in touch with his VA provider. At Byron's appointment, his doctor prescribes medication and a mob ile seizure tracking application for his smartphone. Through the application, DHP tracks multiple seizures over the next four weeks and notif ies the doctor, whose nurse increases Byron' s dosage. But Byron needs a solution-fast. He wants to cont inue teach ing, but he doesn't have time to t est, which medications w ill still allow him to drive to work and continue to care for his daughte r . At Byron's next visit, DHP prompts his doctor to run the Epilepsy Analytics Modu le to assesshis clinical history. The modu le returns 15 anti-epileptic drugs and further refines and recommends three drugs that have been successful w ith other patients like Byron, and will allow him to cont inue to drive. Byron and his docto r choose a new medication with the highest likelihood of success. The change in medication, enabled by DHP, has kept Byron seizure-free for six months. As a result, he is able to continue doing what he loves, live an active lifestyle, and take care of his daughter. AMERICAN PVERSIGHT VA-19-0799-G-000553 DS 00021269 POC Main Takeaways - Byron's Story When Byron first seeks care within VA, he is enrolled in a traumatic brain injury care pathway . His health information with the DoD Cerner system is automatically imported into VA through the MuleSoft API gateway, mapped to common standards so as to maintain its semantic relationships. This is critical because it allows VA to similarly apply internal real time analytics to both internal and external data sources. The Joint VA/DoD Traumatic Brain Injury Clinical Practice Guideline was used to develop a Traumatic Brain Injury Care Pathway within the Apervita real time analytics platform, which was responsible for curating and analyzing Byron's data to trigger the recommendation for care pathway enrollment. eluminate is an example of a readily adoptable marketplace solution, developed in partnership between Georgia Tech and the biopharmaceutical company UCB, that harnesses the power of predictive analytics to raise the standard of epilepsy care. eluminate put data from nearly 10 million patients through an advanced machine learning algorithm and generated personalized models for 15 commonly prescribed anti-epileptic drugs. The system leverages a common FHIR framework and was readily adopted leveraging the API gateway. Treatment recommendations for this narrowly focused clinical task were then provided via a SMART on FHIR application within the GOPHEREHRto highlight the ability to provide real-time insights for healthcare providers at the point-of -care to inform treatment decisions. Open source collaboratives are providing advances in precision medicine to population health. The POC leveraged the Observational Health Data Sciences and Informatics or Odyssey framework which utilizes the Observational Medical Outcomes Partnership (OMOP) Common Data Model to help standardize the format and content of observational data, so standardized applications, tools and methods can be applied to them. This enabled the use of advanced visualization techniques such as tree-mapping that allowed the exploration of relationships between unique observations. In this case, to explore cohorts and better understand characteristics of epilepsy patients like Byron as well as the effects of interventions at a population level. AMERICAN PVERSIGHT VA-19-0799-G-000554 OS 00021270 Meet Nora, a graphic designer, aspiring mother and Afghan war Veteran. Nora's medical data is part of VA's DVP, automatically imported after she t ransitioned from her Combat Systems Operator position in the Navy. She is general ly healthy aside from her struggles with mild depression, asthma, and genet ic predisposition to obesity. Nora receives her routine care through the VA Women's Health Primary Care Physician, or PCP, Her Care Plan includes nutritional counseling and exercise guidance in a supporting effort to reverse the obesity. Nora is seen by VA Mental Health for her ongoing batt le with depression . Because she cannot always spend time trave ling to clinics, she has a Mobile First Program that allows for telemedicine visits with her physician or psychologist without ever leaving the house. Nora is trying to start her family, and has been trying t o become pregnant for six months . She has been experiencing fertility difficulties that Nora's PCPsuspects may be due to her obesity. An initial round of lab testing and ultrasound workup is ordered, and no abnorma lities are shown in the results. Her PCPis able to put her on a diet and weight loss regimen, and two months later, she becomes pregnant. Throughout her pregnancy, Nora experiences diffe rent complications relat ing to gest ational diabetes, and even a reduced fetal movement scare. She is referred to VA endocr inology and Maternal Fetal Medicine (MFM). Even though MFM is an outside clinic, the structured dat a flows back-and-forth between the clinic and her VA PCP.Nora is able to reach out to her medical team through her mobile app instead of having to visit an emergency room. Nora gives birth to a healthy baby girl, and DHP continues to faci litate seamless care for Nora and her baby . This is our vision for the future of care for our Veterans. Main Takeaways - Nora's Story A strategic API Gateway, with Mobi le Backend as a Service (MBaaS), allowed the rapid development of innovative Veteran -facing solutions. A mobile application was developed by leveraging a library of functiona l APls that spanned different systems, to provide the frictionless AMERICAr-... pVERSIGHT VA-19-0799-G-000555 D8_00021271 transition of Nora's DoD medical records to a VA built app. To simplify life for Nora and help her health care team provide the best service, a significant set of components are operating in concert on the backend . Analytics triggering automated processes to involve and engage Nora in her healthcare establish that great first impression. Process automation and self-service can effectively reduce human workload and related delays. By creating automated processes tailored to clinical decisions and simplifying the appointment setup process, it is easy for Nora to follow through with her shared care plan with her provider. Sophisticated Veteran user expectations around virtual care were met by using a low cost, high qu ality video commu nicatio n solution integrated with a mobile application made possible by the sophistication of the DVP architecture. The mobile application also leveraged native platform capabilities to obtain Nora's patient generated data from internet connected health devices. The DVP approach also allowed for the conceptual onboarding of Care in the Community Partners rapidly while hiding the complexity for the Veteran within the mobile perspective. Meet Warren, a Vietnam War Veteran, is managing a number of complex medical conditions Warren is the next user story we are building. We have modeled the way he currently receives care, and the future state. Current state : Warren has congestive heart failure with periodic exacerbations. While experiencing increased shortness of breath and leg swelling, he visits an urgent -care physician who reviews notes from Warren's cardiologist and primary-care provider (PCP),gets blood studies, doubles a medication, and schedules a follow-up visit with the PCP. 3 weeks later , Warren's PCPruns a blood test and finds elevated potassium. The PCPadds another water pill to reduce the potassium and swelling, orders an ECG, and refers Warren to a cardiologist for further examinatiol'). 6 weeks later, Warren visits a cardiologist for new occasional fainting. His potassium is low, likely causing heart -rhyt hm problems and fainting. The cardiologist repeats the ECG,adds a potassium supplement and schedules a stress test, fo llow-up visit, and a 3-day heart--rhythm monitoring test. AMERICAr-... pVERSIGHT VA-19-0799-G-000556 D8_ 0002 1272 1 week later, Warren completes the tests. He does not receive the results. 3 weeks later, Warren sees the cardiologist again. The stress test is unchanged and the rhythm test is normal. Warren is feeling better but dislikes the extra pills. The cardiologist requests that Warren see his PCPto manage his medications in another month. Future State Today: Warren has congestive heart failure with periodic exacerbations, so he is enrolled in a clinical pathway module for CHFthat includes home monitoring. His target weight is between 180 and 187 pounds. Warren has recently had increasing shortness of breath and leg swelling. The platform's connected home health monitor detects weight gain from retained water. Because Warren is above 190 pounds, the platform sends a task to the nurse to call him. The next day, the nurse calls Warren, updates his symptoms in the platform, and reviews the plan of care with him. He reminds Warren that when his weight is over 187 pounds, he should take an extra water pill for up to three extra pills a week until it returns to the goal range. In 3 days, Warren is feeling better. One Year Later: Warren weighs 195+ for over five days. The platform tasks the nurse to call Warren. The nurse notes that Warren is taking an extra water pill as prescribed but his weight will not go down. The nurse's data entry triggers a task to the pharmacist to review Warren's chart and evaluate whether medication titration is warranted. The clinical pharmacist accepts the platform's recommendation of doubling a medication and confirms recommended blood tests in a week. Warren receives a message on his app and confirms that he understands. But despite daily alerts from his smartphone app to come to the lab, Warren does not appear. 3 days after the labs are past due, the platform sends a task to the nurse to call Warren. Warren says he feels too sick to go to the lab. The nurse convinces Warren to go to the lab and schedules a visit with the PCP. 3 days later, blood tests are normal. The physician orders a platform-recommended ECG- transmitted wirelessly to the platform - which shows some subtle changes. The platform recommends a special heart stress test and Warren finds an appointment at a non-VA location for later that week. AMERICAN PVERSIGHT VA-19-0799-G-000557 OS 00021273 5 days later, Warren gets the stress test, which is unchanged. The results are sent electronically to the VA's platform, which detects that Warren's state now falls outside the standard clinical pathway. Based on data from other VA patients with a similar history, the PCPorders a second medication and follow-up labs, and 1 week later, the platform guides the clinical pharmacist as she titrates the medication to Warren's blood values and symptoms. Within 2 weeks, Warren is feeling better. AMERICAN PVERSIGHT VA-19-0799-G-000558 OS 00021274 Sent Bruce from my iPad Moskowi tz AMl H CAt\ pVERSIGHT M.D. VA-19-0799-G-000559 DS_00021275 Message From: Sent: To: Subject: DavidShulkin [drshulkin@aol.com] 6/24/2017 2:24:27 AM (b) (6) Poonam Alaigh [-@hotmail.com] Re: For tomorrow - heads up sure Sent from my iPad (b) (6) > on Jun 23, 2017, at 10:19 PM, Poonam Alaigh <-@hotmail.com> wrote: > > Around 11- I have some errands to run- can I te xt when I am ready around that time ? > > sent from my iPhone > >> on Jun 23 , 2017, at 9 : 57 PM, David shulkin >> >> what time works ? wrote : >> >> sent from my iPad >> >>> on Jun 23, 2017, at 7:18 PM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote: >>> >>> I have 18 agenda items - we will have to go fast though - all his has been piling had much time together >>> >>> sent from my iPhone up since we haven't >> AMERICAN PVERSIGHT VA-19-0799-G-000560 OS 00021276 Message From: Sent: To: Subject: Poonam AlaighI(b) (6) @hotmail.com] 6/24/2017 2:19:45 AM DavidShulkin [drshulkin@aol.com] Re: For tomorrow - heads up Around 11- I have some errands to run- can I text when I am ready around that time? Sent from my iPhone > on Jun 23, 2017, at 9:57 PM, David shulkin wrote: > > what time works ? > > sent from my iPad > >> on Jun 23, 2017, at 7 : 18 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : >> >> I have 18 agenda items- we will have to go fast though- all his has been piling had much time together up since we haven ' t >> >> sent from my iPhone > AMERICAN PVERSIGHT VA-19-0799-G-000561 OS 00021277 Message From: DavidShulkin [drshulkin@aol.com] Sent: 6/24/2017 1:57:34 AM To: (b) (6) Poonam Alaigh [-@hotmail.com] Re: For tomorrow - heads up Subject: What time works? Sent from my iPad (b) (6) > on Jun 23, 2017, at 7:18 PM, Poonam Alaigh <-@hotmail.com> > > I have 18 agenda items- we will much time together have to go fast though- all wrote: his has been piling up since we haven't had > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000562 OS 00021278 Message From: Sent: To: Subject: DavidShulkin [drshulkin@aol.com] 6/24/2017 1:57:14 AM (b) (6) Poonam Alaigh [-@hotmail.com] Re: For tomorrow - heads up Sent from my iPad (b) (6) > on Jun 23, 2017, at 7:18 PM, Poonam Alaigh <-@hotmail.com> > > I have 18 agenda items- we will much time together have to go fast though- all wrote: his has been piling up since we haven't had > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000563 OS 00021279 Message From: Sent: To: Subject: (b) (6) Poonam Alaigh [-@hotmail.com] 6/23/2017 11:18:37 PM DavidShulkin [drshulkin@aol.com] For tomorrow - heads up I have 18 agenda items- we will much time together have to go fast though- all his has been piling up since we haven't had Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000564 OS 00021280 Message Bruce Moskow itz [bruce (b) (6) (b) @mac.com) 6/20/201711:10:36 PM (6) Poonam Alaigh I(b) (6) @hotmail.com) David shulkin [Drshulkin@aol.com1; mb (b) (6) @gmail.com; IP !l@frenchang ,el59.com] ( Re: VA DATA BASE b From: Sent : To : CC: Subject: ) ( 6 ) Thank you Sent from my iPad Bruce Moskowitz M .D. On Jun 20, 2017 , at 7:07 PM , Poonam Alaigh ~(b) (6) > wrote: I am working on trying to understand why and where is contract is stuck- give me a couple of days- I have a couple of folks working on this as we speak. I agree, having him on board as soon as possible will be critical. Sent from my iPad On Jun 20, 2017, at 12:50 PM, Bruce Moskowitz wrote : Terry has brilliant pathways .forward. We need to get him activated . The patient identity protection is available to us from the format that Mayo Clinic did with the Watson computer. We should borrow it. I agree the Veteran community will be willing partners when they are infonned how data improves health care and early disease detection. Sent from my iPad Bruce Moskowitz M.D. On Jun 20, 2017 , at 12:45 PM David shulkin wrote: I agree we should never do anexclusive I like terrys idea - most important is that VA need to protect patient identity and keep the veteran community informed. Congress too. Lets run the taps and work thls through Dr Alaigh and Rachel Ramoni Sent from my iPhone On Jun 20, 2017, at 11:07 AM, Bruce Moskowitz wrote : (6) We should discuss this . From my talks with J&J, CVS, and Apple all wanted the data base. I am also aware IBM Watson and others are very interested . Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000565 DS 00021281 Bruce Moskowitz M.D. Begin forwarded message : From: Terry Fadem (b) (6) ail.com > Date: June 20, 20 17 at 11 :02:52 AM EDT To: Bruce Moskowitz (6) BASE Subject: VA DA TA Bmce , Patient data is, in my opinion, the most valuable assets the VA has . It can be leve raged into hundr eds of millions in revenue as follows; J_ An exchange is established (outside of the VA) ...but owned and controlled by the VA, and a board as it should be a joint venture compa ny in my way of thinking at the moment 2. That sells seats on the 'data exchange' for a mi llion to two million a year (initially limit the number of seats available to create some urgency - like 50 seats ... 3. Then charge a use fee to the seat holders who want to make inquiries into the data base. There are a couple of other permutations of how this data base can work , but the basic exchange concept is what the VA can do that no other organization in the world posses in terms of capability, breadth and depth of data and so on ...only Kaiser has a similar data base but they do not have the same scale or scope .. Anyway ...I have been considering this for a while .,ever since we started discussing licensing at the V A. ..one thing that the VA SHOULD NOT EVER DO is to allow an exclusive license to be granted for use or access to their patient date base, nor should they aver sell the data or data AMERICAr-... pVERSIGHT VA-19-0799-G-000566 DS 00021282 base to any entity as they will then lose control and end up with only pennies on the dollar in return. I am happy to discuss this and any other potential business concepts with the VA as well as get them launched ...but a this point, I have already 'donated' enough time and energy to them and would want to move forward only under contract. best regards, Terry AMERICAN PVERSIGHT VA-19-0799-G-000567 OS 00021283 Message Poonam Alaigh I(b) (6) @hotmail.com] 6/20/201711:07:23 PM Bruce Moskowitz [brucentl••■ (b) (6) (b) @mac.com] David shulkin [Drshulkin@aol.com]; (6) mbsll-■ ,el59.com] (b) (6) @gmail.com; IP !l@frenchang ( Re: VA DATA BASE b From: Sent : To : CC: Subject: ) ( 6 lam working on trying to understand why and where is contract is stuckgive me a couple of days- [ have a ) couple of folks working on this as we speak. I agree, havjng him on board as soon as possible will be criticaJ . Sent from my iPad On Jun 20, 2017 , at 12:50 PM, Bruce Moskowitz wrote: Terry has brilliant pathways forward . We need to get rum activated . The patient identity protection is available to us from the format that Nfayo Clinic did with the Watson computer. We should borrow it. I agree the Veteran community will be willing partners when they are informed how data impro ves health care and early disease detection. Sent from my iPad Bruce Moskowitz M .D . On Jun 20, 2017, at 12:45 PM, David shulkin wrote : I agree we should never do anexclusive I like terrys idea - most irnpo11antis that VA need to protect patient identity and keep the veteran community informed . Congress too . Lets run the taps and work this through Dr Alaigh and Rachel Ramoni Sent from my iPhone On Jun 20, 2017, at 11 :07 AM, Bruce Moskowitz wrote : (6) We should discuss this . From my talks with J&J , CVS, and Apple all wanted the data base . I am also aware IBM Watson and others arevery interes ted . Sent from my iPad Bruce Moskowitz M .D. Begin forwarded message : From: Terry Fadem (b) (6) mail .com > Date: June 20, 2017 at 11:02:52 AM EDT To: Bruce Moskowitz Subject: VA DAT(6) A BASE AMERICAN PVERSIGHT VA-19-0799-G-000568 DS_00021284 Bruce, Patient data is, in my opinion, the most valuable assets the VA has. It can be leveraged into hundreds of millions in revenue as follows; 1. An exchange is established (outside of the VA) ...but owned and controlled by the VA, and a board as it should be a joint venture company in my way of thinking at the moment 2. That sells seats on the 'data exchange' for a million to two million a year (initially limit the number of seats available to create some urgency like 50 seats ... 3. Then charge a use fee to the seat holders who want to make inquiries into the data base. There are a couple of other permutations of how this data base can work, but the basic exchange concept is what the VA can do that no other organization in the world posses in terms of capability, breadth and depth of data and so on ...only Kaiser has a similar data base but they do not have the same scale or scope .. Anyway ...! have been considering this for a while ..ever since we started discussing licensing at the VA ..one thing that the VA SHOULD NOT EVER DO is to allow an exclusive license to be granted for use or access to their patient date base, nor should they aver sell the data or data base to any entity as they will then lose control and end up with only pennies on the dollar in return. I am happy to discuss this and any other potential business concepts with the VA as well as get them launched ...but a this point, I have already 'donated' enough time and energy to them and would want to move forward only under contract. best regards, Terry AMERICAN PVERSIGHT VA-19-0799-G-000569 OS 00021285 Message From: Sent : To : David shulkin LDrshulkin@aol.com] 6/20/2017 4:53 :46 PM Bruce Moskowitz [bruce (b) (6) (b) @mac.com] (6) mbsll■l@gmail.com; IP (l@frenchangel59 .com]; Poonam Alaigh I(b) (6) @hotmail.com) (b) (6) ( Re: VA DATA BASE b CC: Subject: ) ( 6 ) Thats petiect Sent from my iPhoae On Jun 20, 2017, at 12:50 PM , Bruce Moskowitz wrote : I agree we should never do anexclusive I like terrys idea - most important is that VA need to protect patient identity and keep the veteran community informed. Congress too . Lets run the taps and work this through Dr AJaigh and Rachel Ramoni Sent from my iPhone 2017 , at 1 L07 AIVJ , Bruce Moskowitz wrote : (6) We should discuss this . From tny taJks with J&J , CVS, and Apple aJl wanted the data base. I am aJso aware IBNIWatson and others are very interested. Sent from my iPad Bruce Moskowitz M .D. Begin fo1warded message : From: Terry Fadem (b) (6) nail.com > Date: June 20 , 2017 at 11:02 :52 AM EDT To: Bruce Moskowitz (6) BASE Subject: VA DATA Bruce , AMERICAN PVERSIGHT VA-19-0799-G-000570 DS 00021286 Patient data is, in my opinion, the most valuable assets the VA has. It can be leveraged into hundreds of millions in revenue as follows; 1. An exchange is established ( outside of the VA) ...but owned and controlled by the VA, and a board as it should be a joint venture company in my way of thinking at the moment 2. That sells seats on the 'data exchange' for a million to two million a year (initially limit the number of seats available to create some urgency like 50 seats ... 3. Then charge a use fee to the seat holders who want to make inquiries into the data base. There are a couple of other permutations of how this data base can work, but the basic exchange concept is what the VA can do that no other organization in the world posses in terms of capability, breadth and depth of data and so on ...only Kaiser has a similar data base but they do not have the same scale or scope .. Anyway .. .! have been considering this for a while ..ever since we started discussing licensing at the VA ..one thing that the VA SHOULD NOT EVER DO is to allow an exclusive license to be granted for use or access to their patient date base, nor should they aver sell the data or data base to any entity as they will then lose control and end up with only pennies on the dollar in return. I am happy to discuss this and any other potential business concepts with the VA as well as get them launched ...but a this point, I have already 'donated' enough time and energy to them and would want to move forward only under contract. best regards, Terry AMERICAN PVERSIGHT VA-19-0799-G-000571 OS 00021287 Message Bruce Moskowftz [bruce (b) (6) (b) @mac.com] 6/20/2017 4:50 :33 PM (6) David shulkin [Drshulkin@aol.comJ mbs~@gmail.com; IP ■ (b) ( @frenchangeJ59 .com]; Poonam Alaigh I(b) (6) @hotmail.com) Re: VA (6)DATA BASE b From: Sent : To : CC: Subject: ) ( Terry has brilliant pathways forward. 6We need to get him activated . The patient identity protection is available ) to us from the fonnat that Mayo Clinic did with the Watson computer . We should borrow it. I agree the Veteran community will be willing partners when they are infonned how data improves . health care and early disease detection . Sent from my iPad Bruce Moskowitz M .D. On Jun 20, 2017 , at 12:45 PM, David shulkin wrote · I agree we should never do anexclusive I like ten-ys idea - most important is that VA need to protect patient identity and keep the veteran community informed . Congress too . Lets run the taps and work th.is through Dr Alaigh and Rachel Ramoni Sent from my iPhone On Jun 20, 2017 , at 11:07 AM, Bruce Moskowitz wrote : We should discuss this . From my talks with J&J, CVS , and Apple all wanted the data base. I am also aware IBM Watson and others are very interested . Sent from my iPad Bruce Moskowitz M .D . Begin forwarded message : From: Terry Fadem (b) (6) t1 mail.com > Date: June 20, 2017 at 11:02 :52 AM EDT To: Bruce Moskowi tz (6) Subject: VA DA TA BASE Bruce , Patient data is , in my opinion, the mos t valuable assets the VA has . It can be leveraged into hundreds of millions in revenue as follows; 1. An exchange is established (outside of the VA) ...but owned and controlled by the VA , and a board as it should be a joint venture company in my way of thin king at the moment AMERICAN PVERSIGHT VA-19-0799-G-000572 DS 00021288 2. That sells seats on the 'data exchange' for a million to two million a year (initially limit the number of seats available to create some urgency - like 50 seats ... 3. Then charge a use fee to the seat holders who want to make inquiries into the data base. There are a couple of other permutations of how this data base can work, but the basic exchange concept is what the VA can do that no other organization in the world posses in terms of capability, breadth and depth of data and so on ...only Kaiser has a similar data base but they do not have the same scale or scope .. Anyway ...! have been considering this for a while ..ever since we started discussing licensing at the V A. ..one thing that the VA SHOULD NOT EVER DO is to allow an exclusive license to be granted for use or access to their patient date base, nor should they aver sell the data or data base to any entity as they will then lose control and end up with only pennies on the dollar in return. I am happy to discuss this and any other potential business concepts with the VA as well as get them launched ...but a this point, I have already 'donated' enough time and energy to them and would want to move forward only under contract. best regards, Terry AMERICAN PVERSIGHT VA-19-0799-G-000573 OS 00021289 Message From: Sent : To : David shulkin lDrshulkin@aol.com] 6/20/2017 4:45 :04 PM Bruce Moskowitz [bruce (b) (6) (b) @mac.com] (6) mbsll■l@gmail.com; IP (l@frenchangel59 .com]; Poonam Alaigh I(b) (6) @hotmail.com) (b) (6) ( Re: VA DATA BASE b CC: Subject: ) ( 6 J agree we should never do anexclusive ) l like terrys idea - most jmpottant is that VA need to pi:otect patient identity and keep the veteran community infonned . Congress too. Lets run the taps and work this through Dr Alaigh and Rachel Ramoni Sent from my iPhone On Jun 20, 2017 , at 11 :07 AM Bruce Moskowitz wrote : We should discuss this . From my talks with J&J, CVS, and Apple all wanted the data base . lam also aware IBM Watson and others are very interested . Sent from my iPad Bruce Nloskowitz M.D . Begin fo1warded message : From: Terry Fadem (b) (6) c. omail.com > Date: June 20, 20 17 at 11:02 :52 AM EDT To: Bruce Moskowitz Subject: VA DATABASE (6) Bruce, Patient data is, in my opinion, the most valuable assets the VA has. lt can be leveraged into hundreds of millions in revenue as follows ; 1. An exchange is established (outside of the VA). ..but owned and controlled by the VA, and a board as it should be a joint venture company in my way of thinking at the moment 2. That sells seats on the 'data exchange ' for a million to two million a year (initially limit the number of seats available to create some urgency - like 50 seats ... 3. Then charge a use fee to the seat holders who want to make inqui1ies into the data base. There are a couple of other permutations of how this data base can work , but the basic e change concept is what the VA can do that no other organization in the world posses in terms of capability, breadth and depth of data and so on ...only Kaiser has a similar data base but they do not have the same scale or scope . AMERICAN PVERSIGHT VA-19-0799-G-000574 DS 00021290 Anyway .. .! have been considering this for a while ..ever since we started discussing licensing at the VA ..one thing that the VA SHOULD NOT EVER DO is to allow an exclusive license to be granted for use or access to their patient date base, nor should they aver sell the data or data base to any entity as they will then lose control and end up with only pennies on the dollar in return. I am happy to discuss this and any other potential business concepts with the VA as well as get them launched ...but a this point, I have already 'donated' enough time and energy to them and would want to move forward only under contract. best regards, Terry AMERICAN PVERSIGHT VA-19-0799-G-000575 OS 00021291 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com] From: (6) Sent : 6/20/2017 3:07:07 PM To : mb (b) (6) @gmail.com; IP a@frenchangel59 .com]; David shulkin ldrshulkin@aol.com]; Poonam Alaigh ( I(b) (6) G>hotmail.com) b Fwd: VA DATA BASE ) Subject: ( 6 We should djgcuss this. From my talks) with J&J, CVS, and Apple all wanted the data base. 1 am also aware IBM Watson and others are very-interested. Sent from my iPad Bruce Moskowj tz M .D . Begin forwarded message : From: Terry Fadem (b) (6) ail.com > Date: June 20, 2017 at 11 :02:52 AM EDT To: Bruce Moskowitz < brucem (b) (6) (b) mac .com> Subject: VA DATA BAS"E (6) Bruce , Patient data is, in my opinion, the most valuable assets the VA has. It can be leveraged into hundreds of millions in revenue as follows ; L An exchange is established (outside of the VA)...but owned and controlled by the VA, and a board as it should be a joint venture company in my way of thinking at the moment 2. That sells seats on the 'data exchange' for a million to two million a year (irutiaJly limit the number of seats available to create some urgency - like 50 seats ... 3. Then charge a use fee to the seat holders who want to make inquiries into the data base. There are a couple of other permutations of how this data base can work , but the basic exchange concept is what the VA can do that no other organization in the world posses in tenns of capability , breadth and depth of data and so on ...only Kaiser has a similar data base but they do not have the same scaJe or scope .. Anyway ...I have been considering this for a while ..ever since we started discussing licensing at the V A. ..one thing that the VA SHOULD NOT EVER DO is to allow an exclus-ive license to be granted for use or access to the-irpatient date base, nor should they aver se11the data or data base to any entity as they will then lose control and end up with only pennies on the dollar in return. I am happy to discuss this and any other potential bus-iness concepts with the VA as well as get them launched ...but a this point, I have already 'donated' enough time and energy to them and would want to move forward only under contract best regards, Terry AMERICAN PVERSIGHT VA-19-0799-G-000576 DS 00021292 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 6/24/2017 8:12:46 PM Ike Perlmutter [ll@frenchangel59.com] ( 3 Names b ) ( 6 Darin selnick- senior advisor ) Kayla Williams- Center for WomenVeterans To: Subject: Jake Leinenkugel- senior advisor sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000577 OS 00021293 Message David shulkin [Drshulkin@aol.com] From: Sent : 7/13/2017 5:17:49 AM To ; Darin Selnic (b) (6) @gmail.com] Re: former-va-secreta ry-u rges-co ngress-to-close-outdated-bui Subject: Id ings- This is good Sent from my iPhone On Jul 13, 2017, at 2:42 AM, Darin Selnick (b) (6) mail.com> wrote: I thought you would like to see this article. https ://www .stripes.com/news/us/fonn er-va-secretary-urges-congress-to-close-outdatedbujidings-or-va-will-faiI-1.477714 Darin AMERICAN PVERSIGHT VA-19-0799-G-000578 DS_00021294 Message From: Darin Selnick (b) (6) Sent : 7/13/2017 12:42:35 AM To : David shulkin [Drshulkin@aol.comJ former-va-secretary-urges-congress-to-close-outdated-buildings- Subject: @gmail.com] I thought you would like to see this article . https://www .stripes.com/news/us/former-va-secretary-urges-congress-to-close-outdated-buildings-or-va-willfail-1 .477714 Darin AMERICAN PVERSIGHT VA-19-0799-G-000579 DS_00021295 Message From: DavidShulkin [drshulkin@aol.com] Sent: To: 6/22/2017 2:08:04 AM (b) (6) (b) @mac . com] Bruce Moskowitz [brucerrl■■■■ Subject: Re: Choice Program That's (6) very clever Sent from my iPad > on Jun 21, 2017, at 4:07 PM, Bruce Moskowitz wrote: (b) (6) (b) > (6) > one way that may get the VA on the route to improving the choice program is a realization that it needs to be structured differently . Essentially you have two companies the VA and community Medicine. The VA can control who has access to medicine outside of the VA system but the VA can not control private health care . outside the VA to > The solution is to have a not for profit that works with all health care entities maintain which hospitals , clinics and health care workers agree to the guidelines of the VA to establish timely visits that uphold quality care standards and are cost effective . The outside not for profit would meet regularly with the VA to monitor the community care to make sure all metrics are met . > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000580 OS 00021296 Message From: Bruce Mos kow it z [bruce (b) (6) (b) @mac .com] Sent : 6/ 21/2017 8:07:53 PM To : David shu lkin [drshul kin@aol .com]; Poonam Alaigh (b) (6) @hot mail.com]; IP [ll@frenchangel59.com]; ( b (b) (6) @gmail.com]; mb (b) (6) @gmai l.com Cho ice Program ) Subject: (6) L Perl ( 6 ) One way that may get the VA on the route to improving the choice program is a realization that it needs to be structured differently . Essentially you have two companies the VA and Community Medicine. The VA can control who has access to medicine outside of the VA system but the VA can not control private health care. The solution is to have a not for profit that works with all health care entities outside the VA to maintain which hospitals , clinics and health care workers agree to the guidelines of the VA to establish timely visits that uphold quality care standards and are cost effective . The outside not for profit would meet regularly with the VA to monitor the community care to make sure all metrics are met . sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000581 OS 00021297 Message From: Sent: To: CC: Subject: Marc Sherman [mb (b) (6) @gmail.com] 6/23/2017 4:06:19 PM David shulkin [drshulkin@aol.com]; Poonam Alaigh (b) (6) @hotmail.com] L Perl (b) (6) @gmail.com]; Bruce Moskowitz [bruce (b) (6) (b) @mac.com]; IP ll@frenchangel59.com]; ( Marisol Garcia .@frenchangel59 .com] b (6) (b) Tomorrow 's call(6) agenda ) ( 6 ) David and Poonam, I thought I would put down some thoughts to make tomorrow's call efficient. The purpose of tomorrow's call (at least for me) is to discuss Choice. If you would rather focus on a different topic , let us know . In addition to what we already know about the impediments to executing Choice effectively, there has been a lot of press and recent Hill talk about issues facing Choice. So, specifically, the purpose of tomorrow's call is so you can tell us how we can help you deal with and fix impediments. On another note, the budget discussions this week on the Hill raised some questions by Congress (legitimate and political), some of which are part of the Choice discussion and some not, but all significant -- especially since they are on the Congressional radar screen . For example , 1. The ability to manage care contracts (and related issues of quality and ability of care assessments) ; 2. HR leadership and the reverberating effects of that void ; 3. Dearth of medical personnel (highlighted by the exchange between Poonam and the Congressional committee ; 4. Mapping of community care capabilities for Choice delivery (also highlighted an the exchange between Poonam and the Florida congressman) ; 5. Hiring roadblocks in general 6. Roadblocks and hazards posed by staff cultural issues - e.g. , Apple leadership assignment delays and J&J Again , you should let us know which , if any of these you would like to discuss on tomorrow's call or another time ...the purpose of which is for you to tell us where you need help from us and how we can help you . Tomorrow's agenda should be your agenda . Marc AMERICAN PVERSIGHT VA-19-0799-G-000582 OS 00021298 Message From: Sent: To: CC: Subject: Attachments: David shu lkin [Drshulkin@ao l.com ] 6/21/2017 5:01:12 PM Marc Sherman [ mbsll■l@gmail.com] (b) (6) Ike Perlmutter ll@frenchangel59.com]; Bruce Moskow itz [bruce (b) (6) (b) @mac.com] ( Fyi facil ities b (6) IMG_ 4076.JPG;)Untitled attachment 94836 .txt ( 6 ) AMERICAN PVERSIGHT VA-19-0799-G-000583 OS 00021299 VA Announces Pl an to Dispose Move p Buildings in . 24 Months ro1ected to Save Taxpayers Millions Annually Folio WASHINGTON_ Of Or Reuse All Its Vacant . Ve_te~ans _ Affairs Secretawin6 throu~h on a key promise from less tllan a mon_th ago, Department o1 buildings in 24 months (efth r. David J . ~h~lkin today announced a plan to dispose of all vacant VA er by demohshmg or setting for reuse). Or.the Shulkin raised th . . issue . . at White had House Me vacant building as a priority in his "State of the VA" address delivered O n ay 31. Nationwide, VAcost current! Y has 4 30 vacant or mostly vacant buildings that are on average more than 60 years old, and t axpayers more than $7 million per year to maintain. Today Shulkin on 71 . Dr. Of the r an . ~ounced t~at: of those 430 buildings, VA has begun disposal or reuse processes processes on ae~~tntng ~59 building~, Dr. Shulkin announced VA will begin disposal_or reuse buildings within;~ ~~~t~~~ the next six months, and plans to initiate disposal of the final 288 vacant "We . as possible . . V t owe it,, to .the Ame( ican t axpayer to apply as much of our fundmg to helpmg Re eri8~-s, said Dr. Shulkin. ''Maintaining vacant buildings, including close to 100 from the evo u ionary War and Civil War, makes no sense and we're working as quickly as possible to get them out of our inventory." Th~ ~ecretary also announced that VA will review another 784 non-vacant, but underutilized, bu1fd1ngs to determine if additional efficiencies can be identified to be reinvested in Veterans' services . Finally , in addition to the building closure, Dr. Shulkin announced today that the Veterans Benefits Administration is freezing its footprint and will maximize space management by leasing or eliminating office space nationwide , thanks to a robust telework program and the digitization of claim files. VA estimates these actions will save taxpayers an additional $15.7 million annually beginning in 20i7, for a tota l of close to $23 mill ion in combined annual savings from the initiatives. "As I said in my State of the VA presentation, we need to move rapidly to bring savings to taxpayers," sa id Or . Sh ul k in . 'We will work through the legal requirements and regulations for disposal and reuse and we w ill do it as sw ift ly as possible ." ### ~ (b) (6) - · elations, U.S Department of Vet er ans Affa irs 810 Vermont Ave. NW Room 913 Washin ton. D.C. 20420 (b) (6) (b) (6) @va.gov work) ( 'cell) b ) ( 6 ) VA-19-0799-G-000584 Sent from my iPhone Message From: Alaigh, Poonam, M.D. [Poonam.Alaigh@va .gov] Sent: 6/24/2017 7:11:48 PM To: 'Poonam Alaigh' I(b) (6) @hotmail.com]; 'David Shulkin' [drshulkin@aol.com] RE: (No Subject) Subject: I think that's a good idea- will make that happen Sent with Good (www .good.com) -----Original Message----From: DJS Sent: Saturday, June 24, 2017 02:34 PM Eastern Standard Time To: Alaigh, Poonam, M.D. Subject: Can we make a determination on if Camille is doing anything at all? I think he is doing very little - just like at treasury. Should we have him report to-(b) so she keeps a closer eye? (6) Sent with Good (www.good.com) AMERICAN PVERSIGHT VA-19-0799-G-000586 OS 00021302 Message David shulkin [Drshulkin@aol.com] 6/16/2017 9:53 :49 PM Poonam Alaigh I(b) (6) @hotmail.com] Fwd: VA- AGENDA FOR TON IGHT - 6/16/17 AT 6:00 PM From: Sent : To; Subject: We should have one objective for this meet ing- I) the objective- keep it short- Nothing here is useful to us at tlus point its just informational Sent from my iPhone Begin forwarded message : - >._ , (b) @frenchangel59 .com> From: "Marisol Garcia" , , "Bruce Moskow itz" , (b frenchan el59.com > (6) ) FOR TONIGHT - 6/16/17 AT 6:00 PM Subject: VA - AGENDA Friday, June 16th (6 ) 6:00 PM -6:45 PM ESli Dial-in Information: US: 1-605-475--(b) (6) Passcode:(b) (6) AGENDA 1. CIO 2. Hiring of Kurt Heyssel from John Hopkins for $300K - What's happening? 3. Choice Funding/ Choice Act Provider Locator 4. Terry Fadem -When are we going to hire him? - Recommendation for him to work with Apple and add to the committee. 5. Secretary and Poonam - We should get the names of people that are not doing a good job and are not capable. We need to get those people a different job at another location. AMERICAN PVERSIGHT VA-19-0799-G-000587 DS_00021303 6. CFO Participants: Laurie, Dr. Poonam Alaigh Secretary David Shulkin, Marc Sherman, Dr. Bruce Moskowitz, Ike AMERICAr-... pVERSIGHT VA-19-0799-G-000588 DS 00021304 Message From: Sent : To : Subject: Man·sol Garcia.@frenchangel59 .com] (b) 6/16/2017 9:31:26 (6) PM L Perl (b) (6) @gmail.com); (b) (6) @hotmail.com; David shulkin [Drshulkin@aol.com]; mb (b) (6) @gmail.com~ Bruce Moskowitz [brucem (b) (6) (b) @mac.com]; l@frenchangel59.com ( VA - AGENDA FOR TONIGHT - 6/16/17 (6) AT 6:00 PM b Friday, June 16th ) ( 6 ) 6:00 PM - 6:45 PM EST Dial-in Information: US: 1-605-475--(b) (6) Passcode: (b) (6) AGENDA 1. CIO 2. Hiring of Kurt Heyssel from John Hopkins for $300K - What's happening? 3. Choice Funding/ Choice Act Provider Locator 4. Terry Fadem -When are we going to hire him? - Recommendation for him to work with Apple and add to the committee. 5. Secretary and Poonam - We should get the names of people that are not doing a good job and are not capable. We need to get those people a different job at another location. 6. CFO Participants: Laurie, Dr. Poonam Alaigh Secretary David Shulkin, Marc Sherman, Dr. Bruce Moskowitz, Ike AMERICAN PVERSIGHT VA-19-0799-G-000589 DS_00021305 Message (b) (6) @american.edu] From: (b) (6) Sent: 6/25/2017 8:43:49 PM (b) (6) (b) @mac . com] Bruce Moskowit z [brucerrl■■■■ To: CC: Subject: -@american.edu]; (b) (6) (b) (6) Re: VA-American University I can meet anytime after June 30. (6)DavidShulkin [drshulkin@aol.com];Poonam Alaigh [poonam.alaigh@va.gov] In Chicago until then. Sent from my iPhone (b) (6) > on Jun 19, 2017, at 5:54 PM, Bruce Moskowitz > secretary opportunity shul kin would like to set up a meeting after for the VA. Thank you (b) . com> wrote: (6) I had the opportunity to discuss this excellent > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000590 OS 00021306 Message From: Sent: To: CC: Subject: Bruce Moskowitz [bruce (b) (6) (b) @mac .com] 6/19/2017 10:53:58 PM (6) (b) (6) (b) (6) @american.edu]; (b) (6) (b) (6) David Shulkin [drshulkin@aol .com]; Poonam Alaigh (b) (6) VA-Amer ican University Secretary shulkin would like to set opportunity for the VA. Thank you up a meeting after I had the ican.edu]; (b) (6) @va.gov] opportunity to discuss -@american.edu] (b) (6) this excellent Sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000591 OS 00021307 Message To : David shulkin LDrshulkin@aol.com] 6/18/2017 6:01:25 PM Poonam Alaigh I(b) (6) @hotmail .com J Subject: Re: From: Sent : Thank you Poonam Please wish-(b) a very happy day as well (6) lm on my way to arkansas Sent from my iPhone On Jun 18, 2017 at 10:31 AM, Poonam Alaigh- (b) (6) > wrote : Happy Fathers Day to one of the best Dads I know- a Dad who always makes sure his children are taken care of, and does everything he can to bring happiness to them, no matter what the ci.rcumstance or situation . AMERICAN PVERSIGHT VA-19-0799-G-000592 DS 00021308 Message From: Sent: To: Poonam Alaigh I(b) (6) @hotmail.com] 6/18/2017 2:31:08 PM David Shulkin [drshulkin@aol.com] Happy Fathers Day to one of the best Dads I know - a Dad who always makes sure his children are taken care of, and does everything he can to bring happiness to them, no matter what the circumstance or situation . AMERICAN PVERSIGHT VA-19-0799-G-000593 OS 00021309 Message Poonam Alaigh I(b) (6) @hotmail.com] 6/21/2017 3:31:41 PM David shulkin [Drshulkin@aol.com] Marc Sherman [mbsll-■ (b) (6) @gmail.com] Re: Senator Isakson From: Sent : To : CC: Subject: Works for me too- thanks Sent from my iPhone On Jun 21, 2017, at 7:22 AM, David shulkin wrote : Saturday at 3 works for me Sent from my iPhone On Jun 21, 2017, at 6:43 A.NL Marc (b) (6) Sherman <-wrote: I will be available later in the day on Saturday (3 or 3 :30pm) or early on Sunday (before l lam). Marc Sherman (b) (202) 7581111 (6) On Jun 21 2017 4:09 AM, "Poonam Alaigh 11 ~(b) (6) > wrote: Marc- David and I are testifying in budget hea1ings today and lam testifying al another hearing tomorrow . You have a good finger on the pulse, so we are fine with your plan of action with Chairman Isakson- in fact in the round table last week be hinted at his desire to look at capital asset management- so I think you have struck the right cord with him already . Let's try to regroup over the weekend, even if its just the 3 of us to assess the developments thus far as would realJy like your input. Thanks a ton , Sent from my iPad > On Jun 20, 2017, at 11 :07 PM, Marc Sherman > > David and Poonam > > Ina follow-up to my meeting last week with Rep Roe (see my summa1y memo to you on June 12), I am meefrng with Sen. Isakson on Thursday . Rep . Roe had asked that I meet with Isakson to fill him in on my conversation with him last week, the planned steps forward and obtain his support based on my prior discussion with him about the topic . Are there other topics that you would like me to cover with Isakson that would be helpful to you or the cause? If so, Jet's do that by a short phone call among the three of us. > > On another note , there has been a lot of rumbling (as we discussed) about Choice funding and budgeting and related issues. Does it make sense for all of us AMERICAN PVERSIGHT VA-19-0799-G-000594 DS_00021310 to have a call dedicated to this topic soon so you can tell us how we can help you in addressing this topic? It has huge implications to so many things that impact the success of the VA transformation. My hope was for us to talk about it last Friday, but we ended up with limited time. > >Marc AMERICAN PVERSIGHT VA-19-0799-G-000595 OS 00021311 Message From: Sent : To : CC: Subject: Bruce Moskowitz [bruce~@mac (b) (6) (b) 6/ 21/2017 11:25 :19 AM (6) Davidshulkin [Drshulkin@aol.com] Poonam Alaigh [-@ho t mail.com] (b) (6) Re: Senator Isakson .com] Agree Sent from my iPad Bruce Moskowitz M.D. > on Jun 21 , 2017 , at 7:2 4 AM, David shulkin wrote : > > The only correction longer than va waits- to these points i would offer is that with some exceptions of course community care waits are typically much > > sent from my iPhone > >> on Jun 21, 2017 , at 6: 36 AM, Bruce Moskowitz wrote: (b) (6) (b) >> (6) >> The concern about the choice program is going to hit a critical phase for the following have an immediate solution: reasons that >> >> 1 . The wait time in the choice program is as problematic as the wait time at the VA. >> >> 2 . Lack of vetting who is delivering care both from a hospital standpoint therefore there is no cost control and more important quality control. and physician standpoint >> >> 3 . No system to control unnecessary laboratory testing , radiologic procedures and surgical >> >> 4. No control on treatment with controlled substances leading to further substance abuse . procedures. >> >> 5. The cost of the program will of care issues . spiral out of control but the more problematic issue will be quality >> >> All the systems already exist to solve all the issues , however until we sit down and decide how to integrate VA care with community care and make the total system seamless and cost effective we can not achieve any goal . >> >> >> >> sent from my iPad >> Bruce Moskowitz M.D. >> >>> on Jun 20, 2017 , at 11:07 PM, Marc Sherman wrote : >>> >>> David and Poonam >>> >>> Ina follow-up to my meeting last week with Rep Roe (see my summary memo to you on June 12), I am meeting with sen . Isakson on Thursday . Rep. Roe had asked that I meet with Isakson to fill him in on my conversation with him last week , the planned steps forward and obtain his support based on my prior discussion with him about the topic. Are there other topics that you would like me to cover with Isakson that would be helpful to you or the cause ? If so, let's do that by a short phone call among the three of us . >>> >>> on another note , there has been a lot of rumbling (as we discussed ) about choice funding and budgeting and related issues. Does it make sense for all of us to have a call dedicated to this topic soon so you can tell us how we can help you in addressing this topic ? It has huge implications to so many things that impact the success of the VA transformation . My hope was for us to talk about it last Friday , but we ended up with limited time. >>> >>> Marc > AMERICAN PVERSIGHT VA-19-0799-G-000596 OS 00021312 Message From: Davidshulkin [Drshulkin@aol.com] Sent : 6/ 21/2017 11:24:39 AM To : Bruce Moskowitz [brucem~@mac (b) (6) (b) (6) Poonam Alaigh [-@ho t mail.com] (b) (6) Re: Senator Isakson CC: Subject: The only correction to these points than va waits- with some exceptions .com] i would offer of course is that community care waits are typically much longer Sent from my iPhone > on Jun 21 , 2017, at 6 : 36 AM, Bruce Moskowitz wrote : (b) (6) > The concern about the choice program is going to hit a critical phase for the following have an immediate solution: > reasons that > > 1. The wait time in the choice program is as problematic as the wait time at the VA. > > 2 . Lack of vetting who is delivering care both from a hospital standpoint therefore there is no cost control and more important quality control. and physician standpoint > > 3. No system to control > > 4 . No control unnecessary on treatment > laboratory with controlled > 5 . The cost of the program will care issues . spiral testing substances out of control , radiologic leading procedures to further and surgical substance but the more problematic issue procedures. abuse. will be quality of > > All the systems already exist to solve all the issues , however until we sit down and decide how to integrate VA care with community care and make the total system seamless and cost effective we can not achieve any goal . > > > > sent from my iPad > Bruce Moskowitz M.D. > >> on Jun 20, 2017, at 11:0 7 PM, Marc Sherman wrote: >> >> David and Poonam >> >> Ina follow-up to my meeting last week with Rep Roe (see my summary memo to you on June 12 ), I am meeting with sen . Isakson on Thursday . Rep. Roe had asked that I meet with Isakson to fill him in on my conversation with him last week , the planned steps forward and obtain his support based on my prior discussion with him about the topic. Are there other topics that you would like me to cover with Isakson that would be helpful to you or the cause ? If so , let ' s do that by a short phone call among the three of us . >> >> on another note , there has been a lot of rumbling (as we discussed ) about choice funding and budgeting and related issues. Does it make sense for all of us to have a call dedicated to this topic soon so you can tell us how we can help you in addressing this topic ? It has huge implications to so many things that impact the success of the VA transformation. My hope was for us to talk about it last Friday, but we ended up with limited time . >> >> Marc AMERICAN PVERSIGHT VA-19-0799-G-000597 OS 00021313 Message David shulkin LDrshulkin@aol.com] 6/21/201711 :22:36 AM Marc Sherman [mb (b) (6) @gmail.com] Poonam Alaigh I(b) (6) @hotmail.com] Re: Senator Isakson From: Sent : To : CC: Subject: Saturday at 3 works for me Sent from my iPhone On Jun 21 , 2017, at 6:43 AM, Marc Sherman <- (b) (6) wrote : I will be available later in the day on Saturday (3 or 3:30pm) or early on Sunday (before 11am) . Marc Sherman (202) 758-8700 > wrote : On Jun 21, 2017 4 :09 AM , 11Poonam Alaigh 11 - (b) (6) Marc- David and I are testifying in budget hearings today and I am testifying at another hearing tomorrow . You have a good finger on the pulse , so we are fine with your plan of action with Chairman Isakson- in fact in the round table last week he hinted at his desire to look at capital asset management- so I think you have struck the right cord with him already . Let's try to regroup over the weekend , even if its just the 3 of us, to assess the developments thus far as would really like your input. Thanks a ton , Sent from my iPad > On Jun 20, 2017, at 11:07 PM, Marc Sherman <~ (b) (6) > wrote: > > David and Poonam > > Ina follow-up to my meeting last week with Rep Roe (see my summary memo to you on June 12), I am meeting witb Sen . Isakson on Thursday . Rep . Roe had asked that I meet with Isakson to fill him in on my conversation with him last week, the planned steps forward and obtain his support based on my prior discussion with him about the topic . Are there other topics that you would like me to cover with Isakson that would be helpful to you or the cause? If so, let's do that by a shott phone call among the three of us. > > On another note, there has been a lot of rumbling (as we discussed) about Choice funding and budget ing and related issues . Does it make sense for all of us to have a call dedicated tp this topic soon so you can tell us how we can help you in addressing this topic ? It has huge implications to so many things that impact the success of the VA transformation . My hope was for us to talk about it last Friday , but we ended up with limited time , > > Marc AMERICAN PVERSIGHT VA-19-0799-G-000598 DS 00021314 Message From: Marc Sherman [mb (b) (6) @.gmail.com] Sent : 6/21/201710:43:26 To : Poonam Alaigh I(b) (6) @hotmail.com) Drshulkin@aol .com Re: Senator Isakson CC: Subject: AM 1 will be available later in the day on Saturday (3 or 3:30pm) or early on Sunday (before I lam). Marc Sherman (b) (6) On Jun 21, 2017 4:09 AM, "Poonam Alaigh" ~(b) (6) > wrote: Marc- David and I are testifying in budget hearings today and I am testifying at another hearing tomorrow . You have a good finger on the pulse, so we are fine with your plan of action with Chairman ]sakson- in fact in the round table last week he hinted at his desire to look at capital asset management- so I think you have struck the right cord with him already. Let's try to regroup over the weekend , even if its just the 3 ofus, to assess the developments thus far as wouJd really like your input. Thanks a ton . Sent from my iPad > wrote: > On Jun 20 2017 , at 11 :07 PM, Marc Sherman <- (b) (6) > > David and Poonam > > Ina follow-up to my meeting last week with Rep Roe (see my swnmary memo to you on June 12), I am meeting with Sen. Isakson on Thursday. Rep . Roe had asked that I meet with Isakson to fill him in on my conversation with h.im last week, the planned steps forward and obtain his support based on my prior cliscussion with him about the topic. Are there other topics that you would like me to cover with Isakson that would be helpful to you or the cause? If so, let's do that by a short phone call among the three of us. > > On another note ,, there has been a lot of rumbling (as we discussed) about Choice funcling and budgeting and related issues . Does it make sense for all of us to have a ca11dedicated to this topic soon so you can tell us how we can help you in addressing tl1is topic? It has huge implications to so many things that impact the success of the VA transformation. My hope was for us to talk about it last Friday , but we ended up with limited time . > > Marc AMERICAN PVERSIGHT VA-19-0799-G-000599 DS 00021315 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com] Sent : 6/ 21/2017 10:36:16 AM (6) To : Marc Sherman [ mbtl■■ (b) (6) @gmail.com] CC: Davidshulkin [drshulkin@aol.com]; Poonam Alaigh (b) (6) @hot mail.com]; IP ll@frenchangel59.com]; L Perl ( b (b) (6) @gmail.com] Subject: Re: Senator Isakson ) ( 6 ) The concern about the choice program is going to hit a critical phase for the following reasons that have an immediate solution: From: 1. The wait time in the choice program is as problematic as the wait time at the VA. 2 . Lack of vetting who is delivering care both from a hospital standpoint therefore there is no cost control and more important quality control. 3 . No system to control 4. No control unnecessary on treatment laboratory with controlled 5. The cost of the program wi ll spiral care issues. testing substances out of control , radiologic leading and physician procedures to further and surgical substance but the more problematic standpoint issue procedures . abuse. will be quality of All the systems already exist to solve all the issues , however until we sit down and decide how to integrate VA care with community care and make the total system seamless and cost effective we can not achieve any goal . sent from my iPad Bruce Moskowitz M.D. > on Jun 20, 2017, at 11 :07 PM, Marc Sherman wrote : > > David and Poonam > > Ina follow-up to my meeting last week with Rep Roe ( see my summary memo to you on June 12) , I am meeting with sen. Isakson on Thursday . Rep. Roe had asked that I meet with Isakson to fill him in on my conversation with him last week , the planned steps forward and obtain his support based on my prior discussion with him about the topic . Are there other topics that you would like me to cover with Isakson that would be helpful to you or the cause ? If so , let ' s do that by a short phone call among the three of us. > > on another and related can tell us that impact we ended up note , there has been a lot of rumbling (as we discussed ) about choice funding and budgeting issues . Does it make sense for all of us to have a call dedicated to this topic soon so you how we can help you in addressing this topic ? It has huge implications to so many things the success of the VA transformation . My hope was for us to talk about it last Friday, but with limited time . > > Marc AMERICAN PVERSIGHT VA-19-0799-G-000600 OS 00021316 Message Poonam AlaighI(b) (6) @hotmail.com] 6/21/2017 8:09:29 AM Marc Sherman [mb (b) (6) @gmail.com] Drshulkin@aol.com Re: Senator Isakson From: Sent: To: CC: Subject: Marc- David and I are testifying in budget hearings today and I am testifying at another hearing tomorrow. You have a good finger on the pulse, so we are fine with your plan of action with chairman Isakson- in fact in the round table last week he hinted at his desire to look at capital asset management- so I think you have struck the right cord with him already. Let's try to regroup over the weekend, even if its just the 3 of us, to assess the developments thus far as would really like your input. Thanks a ton. sent from my iPad (b) (6) > on Jun 20, 2017 , at 11 :07 PM, Marc Sherman wrote: > > David and Poonam > >Ina follow-up to my meeting last week with Rep Roe ( see my summary memoto you on June 12), I am meeting with sen. Isakson on Thursday. Rep. Roe had asked that I meet with Isakson to fill him in on my conversation with him last week, the planned steps forward and obtain his support based on my prior discussion with him about the topic. Are there other topics that you would like me to cover with Isakson that would be helpful to you or the cause? If so, let ' s do that by a short phone call among the three of us. > > on another and related can tell us that impact we ended up note, there has been a lot of rumbling (as we discussed) about choice funding and budgeting issues. Does it make sense for all of us to have a call dedicated to this topic soon so you how we can help you in addressing this topic ? It has huge implications to so many things the success of the VA transformation. My hope was for us to talk about it last Friday, but with limited time. > > Marc AMERICAN PVERSIGHT VA-19-0799-G-000601 OS 00021317 Message Davidshulkin [Drshulkin@aol.com] 6/21/2017 3:28:12 AM (b) (6) Marc Sherman [mb-@gmail.com] (b) (6) Poonam Alaigh[-@hotmail.com] Re: Senator Isakson From: Sent: To: BCC: Subject: Marc- i dont think ill have any time to discuss have no ability to get on the phone before the weekend - there is so much happening simply sent from my iPhone (b) (6) > on Jun 20, 2017, at 11:07 PM, Marc Sherman wrote: > > David and Poonam > >Ina follow-up to my meeting last week with Rep Roe ( see my summary memoto you on June 12), I am meeting with sen . Isakson on Thursday. Rep. Roe had asked that I meet with Isakson to fill him in on my conversation with him last week, the planned steps forward and obtain his support based on my prior discussion with him about the topic. Are there other topics that you would like me to cover with Isakson that would be helpful to you or the cause? If so, let's do that by a short phone call among the three of us. > > on another and related can tell us that impact we ended up note, there has been a lot of rumbling (as we discussed ) about choice funding and budgeting issues. Does it make sense for all of us to have a call dedicated to this topic soon so you how we can help you in addressing this topic ? It has huge implications to so many things the success of the VA transformation. My hope was for us to talk about it last Friday, but with limited time. > > Marc AMERICAN PVERSIGHT VA-19-0799-G-000602 OS 00021318 Message From: Sent: To: CC: Subject: Marc Sherman [mb (b) (6) @gmail.com] 6/21/2017 3:07:49 AM David shulkin [drshulkin@aol.com]; Poonam Alaigh (b) (6) Bruce Moskowitz [bruce (b) (6) (b) @mac.com]; L Perl (b) (6) IP ll@frenchangel59.com]; ( Senator Isakson b (6) @gmail.com] ) ( 6 David and Poonam ) In a follow-up to my meeting last week with Rep Roe (see my summary memo to you on June 12), I am meeting with Sen. Isakson on Thursday . Rep . Roe had asked that I meet with Isakson to fill him in on my conversation with him last week , the planned steps forward and obtain his support based on my prior discussion with him about the topic. Are there other topics that you would like me to cover with Isakson that would be helpful to you or the cause? If so, let's do that by a short phone call among the three of us. On another note , there has been a lot of rumbling (as we discussed) about Choice funding and budgeting and related issues. Does it make sense for all of us to have a call dedicated to this topic soon so you can tell us how we can help you in addressing this topic? It has huge implications to so many things that impact the success of the VA transformation . My hope was for us to talk about it last Friday , but we ended up with limited time . Marc AMERICAN PVERSIGHT VA-19-0799-G-000603 OS 00021319 Message From: Sent : To : Subject : IP !1@ ( fre nchangel59.com] 6/16/2017 1:15:12 PM b David ) shulkin [drshulk in@aol. com] ; Poonam Alaigh I(b) (6) @hotmail.com) ( Act Provid er Locator Choice 6 ) htt:ps://www .va.gov/opa/apps/locator/ David and Poonam : This is how the VA wastes money and causes more problems. We to ld th em in January we would donate a program that gives the Veteran the closes doctor and hospital by specialty th at is approved for care and agreeab le t o see Vet erans immediately. Instead they spent money to set up th is dysfunctional site that now has a bannerthat the site has a problem. This is how the program runs. I Typed in primary care in my area and it lists everyone including ind ividuals long retired and 98% of th ose listed do not practice . primary care many radiologists, orthopedists and path ologists are list ed under primary care. What they did was too k a listin g of all physicians in a geographic area and put t hem as providers. No one on th e list would provide services to Veterans and I called 30 on the list personally and no one knew they were listed. Ike AMERICAN PVERSIGHT VA-19-0799-G-000604 DS 00021320 Message From: David shulkin LDrshulkin@aol.com] Sent : 6/28/2017 5:56 :51 PM To : Vivieca Simpson I(b) (6) Fwd: Re: Subject: Elgmail.com) Lets discuss Sent from my iPhone Begin forwarded message: (b) (6) From: -(b)(b) (6) =s~ea=k= ·e:.:...r== ·c=-=h= ·.:.:co=m= > (6) Date: June 28, 2017 at 11:48:23 AM EDT To: David shulkin Subject: Re: You are an inspiring leader and it is an honor to be able to work with you If you can find an advisory group or some role for ali meshkin to play i would be grateful For the last four years she has been my eyes and ears on veterans issues Newt Sent from my iPad On Jun 27, 2017 at 9:36 PM, David shulkin wrote: Newt- thanks so much for your comprehensive piece on veterans - it was well done and ill make sure the President sees it. Also I wanted to let you know we held our first robotics workshop today and generated some great ideas to jump start efforts in VA. Also today i heard from (b) (6) some of our efforts in genomics today that were moving forward on All of these were generated from you and are great steps fo1ward. I cant thank you enough David Shulkin Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000605 DS 00021321 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 8/7/20 17 4:59:54 PM Poonam AlaighI(b) (6) @hotmail.com] Re: Don't th ink it's public yet Good for -(b) (6) Sent from my iPhone > on Aug 7, 2017, at 12:43 PM, Poonam Alaigh <-@hotmail.com> (b) (6) wrote: > > North Carolina > > sent from my iPhone > >> on Aug 7, 2017 , at 12 : 38 PM, David shul kin wrote : >> » In chi cago ? >> >> sent from my iPhone >> >>> on Aug 7, 2017, at 12:2 9 PM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote: >>> is j oining as CEOof BCBS >>> But (b) (6) >>> >>> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000606 OS 00021322 Message From: Sent: To: Subject: (b) (6) Poonam Alaigh [-@hotmail.com] 8/7/20 17 4:43:49 PM Davidshulkin [Drshulkin@aol.com] Re: Don't th ink it's public yet North Carolina Sent from my iPhone > on Aug 7, 2017, at 12:38 PM, David shul kin wrote: > > In chicago ? > > sent from my iPhone > >> on Aug 7, 2017 , at 12 :29 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : >> is j oining as CEOof BCBS >> But (b) (6) >> >> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000607 OS 00021323 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 8/7/2017 4:38:13 PM To: Poonam AlaighI(b) (6) @hotmail.com] Re: Don't th ink it's public yet Subject: In chicago? Sent from my iPhone > on Aug 7, 2017, at 12:29 PM, Poonam Alaigh <-@hotmail.com> (b) (6) > > But (b) (6) is joining wrote: as CEOof BCBS > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000608 OS 00021324 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 8/7/2017 4:29:46 PM To: David Shulkin [drshulkin@aol.com] Don't think it's pub lic yet Subject: But (b) (6) is joining as CEO of BCBS Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000609 OS 00021325 Message Poonarn Alaigh [...il@hotmail.com] (b) (6) 6/18/201712 :09:01 PM David Shu Ikin [drshulkin@aol.com] Fwd: Travel itinerary for Newark/London/Copenhagen From: Sent : To : Subject: To keep you in the loop with our itinerary Sent from my iPhone Begin forwarded message : - > From: "Alaigh, Poonam, M.D ." Date: June 17, 2017 at 1:21:55 PM EDT To: 'Poonam Alaigh 1 (b) (6) Subject: FW: Travel itinerary for Newark/London/Copenhagen Sent with Good (www .good.com ) -----Original Message----From: Alaigh , Poonam, M.D . Sent: Saturday , June 17, 2017 01 :21 PM Eastern Standard Time To: (b) (6) Subject: Travel itinerary for Newark/London/Copenhagen United British British United night #110- Frida July 7UJto London - departs at 1800 airw ays # 820- Wednesda y - July 12 to Copenhagen - departs at 1605 airw ays # 819- Sunda y- JuJy 16 to Loodon - departs at I 15 night # 921- F1ida July 21 to Newark- departs al 1800 Can y ou book asap since there are limited seats , my husba11djust booked bis seats this morning - even if there was a way doing il today Thanks Sent with Good (www.good .com ) AMERICAN PVERSIGHT VA-19-0799-G-000610 DS 00021326 Message David shulkin [Drshulkin@aol.com] 6/16/2017 9:49:51 PM Poonam Alaigh I(b) (6) @hotmail.com] Fwd: Google Alert - shulkin From: Sent: To: Subject: See story 2 Sent from my iPhone Begin forwarded message : From: Google Alerts Date: June 16, 2017 at 4:04 :13 PM EDT To: drshulkin@aol.com Subject: Google Alert - shulkin Googe Alerts shulkin Daily u 1dtP.• Jun 16 2017 NEW~ VA Sec. Shulkin Says Veterans Cho ice Will Run Out of Money New Hampshire Public Radio VA Secretary David Shulkin made the disclosure about the Veterans ,.. to fix with Cho ice , and we've increased our use of Choice," says Shulkin . @ (l CJ Hag as IrrE?ltc>~an1 Democrats criticize Trump's budget plan as hurting VA care KSNT News David Shulkin Veterans Affai rs Secretary David Shulkin attends a Cabinet meeting with President Donald Trump , Monday , June 12 , 2017 , in the . Democrats criticize Trump's budget plan as hurting VA ca re - WRAL.com Full Coverage @ IJ CJ Flag as 1rrel~van1 VA chief withdraws Staab appeal , vows to replace 'IU' pay cut Fairfield Daily Republic Vete rans Affairs Secretary David Shulkin made two surpr ise announcements Wednesday before the Senate VA Committee that should relieve some ... IU Cut Reversa l Leaves VA Looking for Ways to FLmd Choice Expans ion - Military .com VA st ill planning to round down benefit payouts - Military Times Fllll Coverage AMERICAN PVERSIGHT VA-19-0799-G-000611 DS 00021327 Fla~ .,i,lrr(.'lev.irl Disabled veterans could face cuts under Trump budget Gainesville Daily Register Veterans Affairs Secretary Dr. David Shulk in acknowledged that about 7,000 veterans over age 80 currently receive IU out of a total of about 225,000 ... @ l1 CJ rtag "6 11relevant WFB VA Secretary Shulkin Joins Rep. Poliquin For Congressional Charity Baseball Game Congressman Bruce Pol iquin WASHINGTON - Last night, Congressman Bruce Poliquin (M E-02) was joined by Department of Veterans Affairs (VA ) Secretary David J . Shulkin for ... @ l1 CJ Flag as 1rrele~a'11 Tim Price, David Shulkin 5TA Health and Human Services Secretary Tom Price, left, shakes hands with Veterans Affairs Secretary David Shulkin before the start of a meeting of the , .. Flag as 1rrel1.va\I See more results I Edit this alert You have received this email because you have subscribed to Google A lerts. Unsubscribe I View al l your alerts Receive this alert as RSS feed Send Feedback AMERICAr-... pVERSIGHT VA-19-0799-G-000612 DS_00021328 Message From: Davidshulkin [Drshulkin@aol.com] Sent : 7/ 12/201 7 7:19:58 AM To : (b) (6) Poonam Alaigh [-@hotmail.com] Re: Appointment delays Subject : I told darinno more with apple Sent from my iPhone > on Jul 11, 2017, at 11:54 PM, Poonam Alaigh <-@hotmail.com> (b) (6) wrote: > > It's her -(b) (6) from Apple that Darin communicates with directly - I am about to respond to your email to > > sent from my iPhone > (b) (6) (b) >> on Jul 11, 2017 , at 10 : 39 PM, Bruce Moskowitz wrote: >> (6) >> Reminds me of the cartoon the patient is on his last breath From an acute allergic him with an epipen. The doctor responds I can't until begging the doctor to inject go through it to find out if you have any contraindications! reaction and I open your EMRand >> >> sent from my iPad >> Bruce Moskowitz M.D. >> >>> on Jul 11, 2017 , at 4 : 59 PM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote : >>> >>> Let me get to the bottom of it , but in the meantime Bruce can you find out for me who at the VA was involved - Darin ? >>> >>> sent from my iPhone >>> (b) (6) (b) >>>> on Jul 11, 2017 , at 9 :54 PM, Bruce Moskowitz wrote: >>>> (6) »» I got an email from Apple , I had this as an imperative but someone at the VA put it on the back burner. This can be done at the same time as the EMRsince it is critical to the success of clearing up the appointment issue both in choice Program and the VA. >>>> >>>> sent from my iPad >>>> Bruce Moskowitz M.D. >>>> >>>>> on Jul 11 , 2017, at 3:20 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : >>>>> >>>>> Bruce-you are completely on point with this - this is what we need Apple to work with us on as a priority >>>>> >>>>> sent from my iPhone >>>>> (b) (6) (b) >>>>>> on Jul 11 , 2017 , at 9:02 PM, Bruce Moskowitz wrote : >>>>>> (6) >>>>>> The only prevention is to harness existing technology. The VA needs a mobile app that provides a patient to request an appointment with demographic information and the patients reason for an appointment. The computerized program should be able to discern how urgent the appointment is Ci . e . New breast mass urgent, versus appointment for hip arthritis ) . Knowing the reason for the visit should allow for probable tests to be scheduled on the same day (a confirmed breast mass will have a slot for a mammogramand biopsy on the same day). Also it will allow all vital information on the patient to be available i . e . Previous mammogramsand risk factors so that the physician does not have to sift through the medical record to find it . >>>>>> >>>>>> sent from my iPad >>>>>> Bruce Moskowitz M. D. AMERICAN PVERSIGHT VA-19-0799-G-000613 OS 00021329 Message Davidshulkin [Drshulkin@aol.com] Sent : 7/ 12/2017 7:18:17 AM To : IP [19@frenchangel59 .com] ( Re:bAppointment delays Subject : ) ( 6 ok i 77 handle ) Sent from my iPhone From: > on Jul 12, 2017, at 12:12 AM, IP wrote: ( > b > My understanding is that Darin hasn ' t been with us for a week. ) > > someone should tell Apple , and the ( other places , that he ' s been talking to . > 6 > Thank you. ) > > -----original Message----> From: Poonam Alaigh [mailto-h(b) (6) @hotmail.com] > sent : Tuesday, July 11, 201~P M (b) mac.com > > To: Bruce Moskowitz Cc: David shulkin ; (6) IP <■@frenchangel (b) (6) > mbs~gmail . com; L Perl <-(b) (6) @gmaii.com > b > subJect: Re: Appointment delays ) > ( > It ' s -(b) (6) from Apple that Darin communicates with directly - I am about > to re"s'p"o"ncl"o your email to her 6 > ) > sent from my iPhone > (b) (6) (b) on Jul 11, 2017 , at 10 : 39 PM, Bruce Moskowitz > wrote: (6) >> >> Reminds me of the cartoon the patient is on his last breath From an acute > allergic reaction and begging the doctor to inject him with an epipen. The > doctor responds I can ' t until I open your EMRand go through it to find out > if you have any contraindications ! » >> >> sent from my iPad >> Bruce Moskowitz M.D. >> >>> on Jul 11 , 2017, at 4: 59 PM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote : >>> >>> Let me get to the bottom of it , but in the meantime Bruce can you find > out for me who at the VA was involved - Darin ? >>> >>> sent from my iPhone >>> (b) (6) (b) >>>> on Jul 11, 2017 , at 9:5 4 PM, Bruce Moskowitz > wrote : (6) >>>> >>>> I got an email from Apple, I had this as an imperative but someone at > the VA put it on the back burner . This can be done at the same time as the > EMRsince it is critical to the success of clearing up the appointment issue > both in choice Program and the VA. >>>> >>>> sent from my iPad >>>> Bruce Moskowitz M. D. >>>> >>>>> on Jul 11 , 2017, at 3:20 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote: >>>>> >>>>> Bruce-you are completely on point with this- this is what we need > Apple to work with us on as a priority >>>>> >>>>> sent from my iPhone >>>>> >>>>>> o-n Jul 11 2017, at 9:02 PM, Bruce Moskowitz (b) mac. com> wrote : > >>>>> (6) >>>>>> The only prevention is to harness existing technology. The VA needs a > mobile app that provides a patient to request an appointment with AVl[T'il .1/""\I PVERSIGHT VA-19-0799-G-000614 OS 00021330 > demographic information and the patients reason for an appoi ntment. The > computerized program should be able to discern how urgent the appointment is >(i.e. New breast mass urgent, versus appointment for hip arthritis). Knowing > the reason for the visit should allow for pr obable tests t o be scheduled on > the same day (a confirmed breast mass will have a sl ot for a mammogramand Also it will allow all vital information on the > biopsy on the same day). i.e. Previous mammogramsand risk factors so that > patient to be available > the physician does not have to sift through the medical record to find it. >>>>>> >>>>>> Sent from my iPad >>>>>> Bruce Moskowitz M.D. > AMERICAN PVERSIGHT VA-19-0799-G-000615 OS 00021331 Message From: IP [ll@frenchangel59 .com] ( Sent : b 7/ 11/201 7 10:12 :39 PM To : ) (b) (6) 'Poonam Alaigh' [-@hotmail.com] ( shulkin' [drshulkin@aol.com]; mb-@gmail.com; (b) (6) 'David 6 (b) (6) (b) [bruce~@mac.com ] RE:)Appointment (6) delays CC: Subject : My understanding is that Someone should tell Darin hasn't (b) (6) 'L Perl' [-@gmail.com]; 'Bruce Moskowitz' been with us for a week. Apple, and the other places, that he's been talking to. Thank you. ----- Original Message----From: Poonam Alaigh [mailto. (b) (6) @hotmail.com] sent: Tuesday , July 11 , 201 · To: Bruce Moskowitz cc:-shulkin ; IP <( @frenchangel59.com >; (6) mbs(b) (6) gmail. com; L Perl <(b) (6) @gmaib . com> subJect : Re: Appointment delays ) ( It ' s -(b) (6) from Apple that Darin communicates with directly - I am about to re~o your email to her 6 ) sent from my iPhone (b) (6) (b) > on Jul 11 , 2017 , at 10: 39 PM, Bruce Moskowitz > > Reminds me of the cartoon the patient is on his last breath From an acute allergic reaction and begging the doctor to inject him with an epipen . The doctor responds I can't until I open your EM R and go through it to find out if you have any contraindications! > > sent from my iPad > Bruce Moskowitz M.D. > >> on Jul 11, 2017 , at 4 :5 9 PM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote : >> >> Let me get to the bottom of it , but in the meantime Bruce can you find out for me who at the VA was involved - Darin ? >> >> sent from my iPhone >> (b) (6) (b) >>> on Jul 11, 2017 , at 9 :54 PM, Bruce Moskowitz wrote : (6) >>> >>> I got an email from Apple , I had this as an imperative but someone at the VA put it on the back burner . This can be done at the same time as the EM R since it is critical to the success of clearing up the appointment issue both in choice Program and the VA. >>> >>> sent from my iPad >>> Bruce Moskowitz M.D. >>> >>>> on Jul 11 , 2017, at 3: 20 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : >>>> >>>> Bruce-you are completely on point with this- this is what we need Apple to work with us on as a priorit y >>>> >>>> sent from my iPhone >>>> >>>>> 0~017, at 9 :02 PM, Bruce Moskowitz (b) (6) (b) wrote: >>>>> (6) >>>>> The only prevention is to harness existing technology . The VA needs a mobile app that provides a patient to request an appointment with demographic information and the patients reason for an appointment. The computerized program should be able to discern how urgent the appointment is (i . e . New breast mass urgent, versus appointment for hip arthritis ) . Knowing AIVlt-Hll.,AI\J PVERSIGHT VA-19-0799-G-000616 OS 00021332 the reason for the v1s1t s hould al low for probable tests to be schedu l ed on the same day (a confirmed breast mass will have a slot for a mammogramand biopsy on the same day). Also it will allow all vital information on the patient to be available i .e. Prev i ous mammograms and risk factors so that the physician does not have to sift through the medical record to find it. >>>>> >>>>> >>>>> Sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000617 OS 00021333 Message From: Poonam AlaighI(b) (6) @hotmail.com] Sent : CC: 7/ 11/201 7 9 :54:40 PM (b) (6) (b) @mac . com] Bruce Moskowitz [brucerrl■■■■ Davidshulkin [drshulkin@aol.com]; IP ll@frenchangel59 .com]; mb (b) (6) @gmail.com; LPerl (6) ( Subject: (b) (6) @gmail.com] Re: Appointment delays To : It's her -(b) (6) from Apple that b ) ( 6 ) Darin communicates with directly - I am about to respond to your email to sent from my iPhone (b) (6) > on Jul 11, 2017 , at 10 : 39 PM, Bruce Moskowitz wrote : (6) > Reminds me of the cartoon the patient is on his last breath From an acute allergic reaction and begging the doctor to inject him with an epipen . The doctor responds I can ' t until I open your EMRand go through it to find out if you have any contraindications! > > > sent from my iPad > Bruce Moskowitz M. D. > >> on Jul 11, 2017 , at 4 : 59 PM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote: >> >> Let me get to the bottom of it , but in the meantime Bruce can you find out for me who at the VA was involved - Darin ? >> >> sent from my iPhone >> (b) (6) (b) >>> on Jul 11 , 2017 , at 9: 54 PM, Bruce Moskowitz wrote: >>> (6) >>> I got an email from Apple , I had this as an imperative but someone at the VA put it on the back burner . This can be done at the same time as the EMRsince it is critical to the success of clearing up the appointment issue both in choice Program and the VA. >>> >>> sent from my iPad >>> Bruce Moskowitz M.D. >>> >>>> on Jul 11, 2017 , at 3:20 PM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote : >>>> >>>> Bruce-you are completely on point with this- this is what we need Apple to work with us on as a priority >>>> >>>> sent from my iPhone >>>> (b) (6) (b) > wrote : >>>>> on Jul 11 , 2017 , at 9:02 PM, Bruce Moskowitz >>>> (6) >>>>> The only prevention is to harness existing technology . The VA needs a mobile app that provides a patient to request an appointment with demographic information and the patients reason for an appointment. The computerized program should be able to discern how urgent the appointment is ( i.e. New breast mass urgent, versus appointment for hip arthritis ) . Knowing the reason for the visit should allow for probable tests to be scheduled on the same day (a confirmed breast mass will have a slot for a mammogramand biopsy on the same day) . Also it will allow all vital information on the patient to be available i.e. Previous mammogramsand risk factors so that the physician does not have to sift through the medical record to find it . >>>>> >>>>> sent from my iPad >>>>> Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000618 OS 00021334 Message Davidshulkin [Drshulkin@aol.com] 7/11/2017 7:08:55 PM Bruce Moskowit z [bruce~@mac (b) (6) (b) Re: Appointment delays (6) From: Sent: To: Subject: We will .com] show you our VARapp to see what you think- Poonam can we set this up? Sent from my iPhone > on Jul 11, 2017 , at 3:01 PM, Bruce Moskowitz wrote: (6) > The only prevention is to harness existing technology. The VA needs a mobile app that provides a patient to request an appointment with demographic information and the patients reason for an appointment. The computerized program should be able to discern how urgent the appointment is ( i . e . New breast mass urgent, versus appointment for hip arthritis ) . Knowing the reason for the visit should allow for probable tests to be scheduled on the same day (a confirmed breast mass will have a slot for a mammogramand biopsy on the same day) . Also it will allow all vital information on the patient to be available i.e. Previous mammogramsand risk factors so that the physician does not have to sift through the medical record to find it. > > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000619 OS 00021335 Message (b) (6) (b) Bruce Moskowitz [bruce~@mac .com] (6) Sent: 7/11/2017 7:01:24 PM (b) (6) To: Davidshulkin [drshulkin@aol.com];Poonam Alaigh [-@hotmail.com] ( (b) (6) (b) (6) CC: L Perl [-@gmail.com] IP [~frenchangel59.com]; mb-@gmail.com; b Appointment delays Subject: ) ( 6 The only prevention is to harness existing technology. The VA needs a mobile app that provides a patient ) to request an appointment with demographic information and the patients reason for an appointment. The computerized program should be able to discern how urgent the appointment is (i.e. New breast mass urgent, versus appointment for hip arthritis). Knowing the reason for the visit should allow for probable tests to be scheduled on the same day (a confirmed breast mass will have a slot for a mammogramand biopsy on the same day). Also it will allow all vital information on the patient to be available i.e . Previous mammogramsand risk factors so that the physician does not have to sift through the medical record to find it. From: sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000620 OS 00021336 Message From: Sent : To : Subject: Alaigh, Poonam, M.D. [Poonam.Alaigh@va.gov] 6/21/2017 8:54:57 PM 'Marisol Garcia'.@frenchangel59 .com]; 'David shulkin' [Drshulkin@aol.com) (b) RE: [EXTERNAL] FW: (6) FW: Senator Isakson Tomorrow is not good- I am testifying on our budget Sent with Good (www .good .com) -----Ori gj nal Message----From: Marisol Garcia. (b) @frenchange159.com ] Sent: Wednesday, June (6) 21, 2017 03 :21 PM Eastern Standard Time To: David shulkin ; Alaigh Poonam, NI.D. Subject: [EXTERNAL] FW: FW : Senator Isakson Do you have time tomorrow between 10 am and 12pm? -----Original Message----From : Bmce J\lfoskowitz [mailto :bruce (b) (6) (b) mac.com (6) Sent: Wednesday, June 21, 2017 12:56 PM To: IP (b) Cc: Nlarc Shenna~ David shulkin ; Poonam Alaigh.; L Perl ; ■@frenchangel59.com (6) Subject: Re : Senator Isakson Anytime except this afternoon Sent from my iPhone (b @frenchangel59.com> wrote : > On Jun 21, 2017, at 12:51 PM, IP (6 > We should be very concerned and may need to stop the program as soon ) > as possible to avoid being emba1nssed. > > I've asked Marisol to set-up a call so we can all discuss. Please > email her your availability today or tomorrow for a quick call . > > Thank you .. > > -----Original Message----> From : Bruce Moskowitz [mailto :brucetn (b) (6) (b) mac .com (6) > Sent: Wednesday, June 21, 2017 6 :36 AM > To : Marc Sherman > Cc: Dav id shulkin ; Poonam Alaigh ; IP; L Perl > Subject : Re : Senator Isakson AMERICAN PVERSIGHT VA-19-0799-G-000621 DS_00021337 > > The concern about the choice program is going to hit a criticaJ phase > for the following reasons that have an immediate solution: > > 1. The wait time in the choice program is as problematic as the wait > time at the VA. > > 2. Lack of vetting who is delivering care both from a hospital > standpoint and physician standpoint therefore there is no cost contro l > and more important quality control. > > 3. No system to control unnecessary laboratory testing , radiologic > procedures and surgical procedw·es. > > 4. No control on treatment with controlJed substances leadi ng to > further substance abuse. > > 5. The cost of the program will spiral out of contro l but the more > problematic issue will be quality of care issues. > > All the systems already exist to solve all the issues , however until > we sit down and decide how to integrate VA care with community care > and make the tota l system seamless and cost effective we can not acbjeve any goal. > > > > Sent from my iPad > Bruce Moskowitz M.D. > >> On Jun 20, 2017, at 1J:07 PM, Marc Sherman <- (b) (6) > wrote : >> >> David and PooL1am >> >> In a follow-up to my meeting last week with Rep Roe (see my summary >> memo > to you on June 12), I am meeting with Sen. Isakson on Thursday . Rep. > Roe had asked that I meet with Isakson to fill him in on my > conversation with him last week , the planned steps forwa rd and obtain > his support based on my prior discussion with him about the topic. Are > there other topics that you wou ld like me to cover with Isakson that > would be helpful to you or the cause? If so, let's do that by a short phone call among the three of us. >> >> On another note, there has been a lot of rumbling (as we discussed) >> about > Choice fund ing and budgeting and related issues. Does it make sense > for all of us to have a call dedicated to this topic soon so you can > teU us bow we can help you in addressing this topic? It has huge > implications to so many things that impact the success of the VA > transformation. My hope was for us to talk about it last F1iday, but we ended up w1tb limited time. IVIL-1 pVERSIGHT VA-19-0799-G-000622 DS 00021338 Marc Message (b) (6) Poondrn Alaigh ~hotmail.com] 6[16/2017 8:07:56 PM (b) Marisol Garcia.@frenchangel59 .com] (6) David shulkin [Drshulkin@aol.com]; Bruce Moskowitz [bruce (b) (6) (b) @mac.com];mb (b) (6) @gmail.com (6) Re: Corference Call TONIGHT From: Sent: To : CC: Subject: Yes thanks Sent from my iPhone (b) @frenchangel59.com> wrote : On Jun 16, 2017, at 2:55 PM, Marisol Garcia <111 (6) HiPlease let me know if you are available tonight at 6:00 PM for a conference call. The call should be around 30 to 45 minutes. I will email the agenda when I get your the confirmations . Thank you , Marisol AMERICAN PVERSIGHT VA-19-0799-G-000624 DS 00021340 Message From: Sent: To : Subject: David shulkin LDrshulkin@aol.com] 6/16/2017 7:10 :10 PM (b) renchangel59 ;com] Marisol Garcia .@f Re: Conference (6) Call TONIGHT Ok Sent from my iPhone (b) @frenchangel59 On Jun 16, 2017, at 2 :54 PM, Marisol Garcia <1111 . com> wrote : (6) HiPlease let me know if you are available tonight at 6:00 PM for a conference call. The call should be aroL1nd30 to 45 minutes. I will email the agenda when I get your the confirmations. Thank you, Marisol AMERICAN PVERSIGHT VA-19-0799-G-000625 OS 00021341 Message Poonarn Alaigh I(b) (6) @hotmail .com] 6/20/2017 8:47:27 AM W . ~mayo .edu] (b) (6) (b) From: Sent: To : (6) (b) (6) (b) (6) David Shulkin (drshulkin@aol.comJ; ■--■ @partners.org]; (b) (6) M.O (b) (6) m;;iyo.edu); (b) (6) [(b) (6) @jhmi.eduJ; ■■l@ccf.org; (b) (b) (6) kp.org . com]; L Perl (b) (6) @gmail.com); Bruce Moskowitz (6) ; IP ■@frer,changel59 (b) (6) ( b [bruce..,...-• mbsll■l@gmail.com; Stephanie . Reel -@jhu .edu) ~jhu.edu];(b) (6) (b) @mac.com]; (b) (6) (b) (b) CC: ) (6)·••■@mayo.edu); (b) (6) (b) (6) (6) ■■■■■■■■l@aol.com) Christopher J. (b)(6) Re: Update: Conference Call( I VA, Apple & Medical/Digital Experts Subject : (b) (6) (6) 6 ) Thanks-(b) captured really well. We will discuss next steps including the team structure next week after we hear from (6) all the participants this wee k. Sent from my iPad (b) (6) On Jun 19, 2017, at 7:58 AM, -W. (b) ~> wrote: (6) Hi - sharing the agenda and highlight of a call last week that included leadership of the VA;Apple; the "group of five" academic centers; Ike, Dr. Moskowitz, Marc Sherman and others. Strong, favorable progress was made during the course of Wednesday's call. (b) (6) Johns Hopkins CIO (included here) spoke behalf of the "group of five" CIOs who had met w/ the Apple team prior to the call. The output of those conversations are reflected in the document embedded w/in the agenda document. If you have questions or comments, feel free to reach owt to yol:lr CIO or Dr. Alaigh in follow -up. Best, - (b) (6) Chair IMayo Clinic De artment of Public Affairs (b) (6) e(b) (6) ( bf (b) (6) ).edu ( 6 ) AMERICAN PVERSIGHT VA-19-0799-G-000626 DS 00021342 Message (b) (6) W. ~mayo .edu] (b) 6/19/2017 11:57:50 (6) AM David ShuIkin (drshulkin@aol .com]; Poonam Alaigh I(b) (6) @hotmail.com]; (b) (6) M. D. To: (b) (6) (6) (b) @partners.org]; (b)■■M .D. (b) (6) mayo .edul ; (b) (6) !1@frenchangel59.com]; L Perl kp.org; IP (6) (b) (6) @jhrpi.eduJ; (b) (6) (b) (6) ( .com]; mb (b) (6) @gmail.com b (b) (6) @gmai l.com]; Bruce Moskowitz [bruce~iiiiill@mac (b) (6) (b) CC: ) (6) Stephanie Reel (-@jhu.edu) -@jhu.edu); Ross, Christopher J. (b) mayo.edu] (6) (b) (b) Subject: Upd;,ite: Conference ( (6) Call I VA, Apple (6) & Medical/Digital Experts 6 Attachments : confca Ilagenda.pdf ; confca Ilhighl ights. pdf From: Sent: ) Hi -- sharing the agenda .and highlight of a call last week that included leadership of the VA; Apple; the "group of five'' academic centers; Ike, Dr. Moskowitz, Marc Sherman and others . Strong, favorable progress was made during the course of Wednesday's call. Stephanie Reel, Johns Hopkins CIO (included here) spoke behalf of the ''group of five" CIOs who had met w/ the Apple team prior to the call. The output of those conversations are reflected in the document embedded w/in the agenda document. If you have questions or comments, feel free to reach out to your CIO or Dr. Alaigh in follow-up . Best, - (b) (6) Chair IMayo ClinicDriartment of PublicAffairs ( cell, (b) (6) (b) (6) b : (b) (6) Ioffice ) ( 6 ) AMERICAN PVERSIGHT VA-19-0799-G-000627 DS 00021343 Conference Call I VA, Apple & Medical/Digital Experts I June 14, 2017 Date: Wednesday Time: 11 a.m. - 12:30 p.m . ET/10-11:30 Dial-in Information: United States: 1.866 .244 .•(b) a.m . CT/8 - 9:30 a.m. PT (6) International: 719.457 .• (b) (6) Passcode:-(b) (6) Participants: Bruce Moskowitz , M .D. Marc Sherman Ike Perlmutter Apple: (b) (6) (b) (6) (b) (6) (b) (6) - Apple , Chief Executive Officer - App le, Chief Operating Officer -Apple , Di,·ector of C? :obal Government -Apple, Vice Pres:dent fo,· Pubk Polley and Governme nt Affairs Office of Veterans Affairs: David Shulkin , M .D. - Secretary of Veter,m s Affairs Poonam Alaigh , M .D. -Acting Under -Secretary for Health Darin Selnick- Senior Advisor to the Secretary Rob C. Thomas II -Acting Assistant Secretary & Chief Information Off icer Department of Veterans Affairs - Senior Advisor, Acting Under-Secretary for Health, Department of (b) (6) Veterans Affairs , Veterans Health Administrat ion Medical Institutions: Christopher Ross - Chief Information Officer, Mayo Clinic M .D. - Associate Dean/Center for Connected Care, Mayo Clinic - Interim Chief Information Officer , Cleveland Clinic M .D. -Associate Chief Information Officer , Cleveland Clinic Stephanie L. Reel - Senior Vice President and CIO, Johns Hopk ins Health System, Johns Hopkins Medicine , Vice Provost and CIO, Johns Hopk ins Univers ity - Senior Vice President , Care Delivery Technology Services, Kaiser Permanente (b) (6) (b) (6) - Cofounder , CEO - Responsive Health M .D. - Co-founder , Responsive Health/ Mount Sinai Health System (b) (6) - Payer Advisor , Responsive Health (b) (6) - Development Head, Responsive Health (6) (b) (6) - SME for Public Sector, Responsive Health (b) (6) Aaron Mosko wi tz - Biomedica l Research & Education Foundat ion, Executive Director M .D. - Vice President , Connected Health I Partners HealthCare (b) (6) M.D. - Chief Informat ion Officer and Vice President , Informat ion (b) (6) Systems, Brigham Health (b) (6) (b) (6) (b) (6) Moderator: -(b) (6) AMERICAN PVERSIGHT - Chair, Department of Public Affairs/Mayo Clinic VA-19-0799-G-000628 OS 00021344 Agenda : 1) Introdu ctions -- (b) (6) Moderator 2) Review/Discussion of Purpose of Call -All Drott Meeting Objectives: • Consensus/endorsement of goals • Define roadmap and next steps • Determine core working team moving forward/ARCIV 3) Project Objectives/Status I Veterafl's Administration Perspective - David Shulkin, M.D. 4) Perspective of the Medical Experts-- What Works/What Doesn't - Medical Experts • Status of portable medical record for the private sector • What will it tc1keto get to "state of the art?" o Preventive health/ear ly detection of disease o How does the medical record pick up that which may threaten health • What are medical centers work ing on that has been well received by pati ents? 5) Discussion of Digital/Veteran Platform Project Road Map- Stephanie Reel ~ DigitalVeteran PlatformExperience.< The attachment that reflects shared perspective of medical providers/Apple team . 6) Review/Discussion of Potent ial Project Requirements - All • Clinical needs re: obta ining information from the patient's EMR o Quick reference screen • Patient problem list • Medications • Allergies • Laboratory results • Diagnostic tests by specialty • Clinical notes by specialty • Dynamic vs. static EMR • Early disease detection • Chart medication adherence • Laboratory results depicted by l n graph form to permit lifestyle modification conversations • Alerts for follow-up appointments/tests • Integration of clinica l notes, lab and diagnostic text into integrated platform 7) Next steps Discussion: • Defining the core working team -ARCIV • Timeline. AMERICAr-... pVERSIGHT VA-19-0799-G-000629 DS 00021345 This content should not be distributed outside of the participants of this call nor should it be published publicly. Digital Veteran Platform : Veteran-Mediated Data Exchange Background (b) (4) AMERICAr-... pVERSIGHT VA-19-0799-G-000630 DS_ 00021346 Proposal 347 (b) (4) Guiding Principles (b) (4) Next Steps (b) (4) AMERICAr-... pVERSIGHT VA-19-0799-G-000632 DS_ 00021348 (b) (4) This content shouldnot be distributed outside of the participantsof this call nor shouldit be publishedpublicly. AMERICAr-... pVERSIGHT VA-19-0799-G-000633 DS_ 00021349 Highlights: Confer ence Call I VA, Apple & Med ical/D igita l Experts 1. -(b) (6) (Mayo Clinic) modera t ed the call, and summarized the goals of the call. a. Introductions of participants b. Commitment to build consensus around overarching goals in support of our VA c . Describe the proposed approach d. Identify accountable leaders, governance and working group strategy . 2 . Poonam Alaigh, MD (VA-Acting Under Secretary for Health) described the VA's vision for healthcare for the Veterans a. The implementation of a Data Exchange Platform , ensuring that the "Veteran owns her/his own record ". This will require a high-performing network across the VA and around the nation, wherever care is provided. b. A 'Care Finder" platform that will be interfaced to the exchange, ensuring that the ''Veteran can identify the best place to get care." c. Veterans and providers should have information at the "tips of their fingers. " d. Artificial intelligence should be considered, as weJI as the ability for veterans to be proactive around wellness. 3. Stephanie Reel (Johns Hopkins Medicine) reviewed the Digital Veteran Platform: The VeteranMediated Data Exchange a. A review of our commitment to support the VA through a collaboration betwe .en Apple and 5 leading health systems b. A review of our four initiatives i. Care Finder ii. Veteran Health Data Exchange 111. Medication Tracking and Compliance 1v. Transitions of Care c . A plan to achieve pat ient-focused care d. A focus on efficiency and effectiveness e. Clear guiding principles i. We will act in the best interests of the Veteran ii. We will support the ability of the Veteran's care team to provide the best care iii. We will identify and implement standards-based solutions where possible iv . We will deploy solutions that can be leveraged and adopted by the healthcare industry more broadly f. An agreement to create and support the most appropriate governance structure and work ing group structure to ensure success 4. Group Discussion a. Optimal governance structure i. CEOGroup ii. Project governing group iii. Workgroup/projecl: team b. Review/feedback on project guid ing prin ciples 1. Broad agreement AMERICAr-... pVERSIGHT VA-19-0799-G-000634 DS 00021350 ii. Suggestion to add "joy in medicine" for providers into the mix c . Known requ irements feedbac k i. Quick Reference Screen 1. Problem lfst 2. Medications 3. Allerg!es 4. Lab Results 5. Diagnostic tests by specialty 6. Clinical notes by specialty ii. Dynamic vs Static EMR iii , Early disease detection iv. Chart med ication adherence v. Graphical representation of results vi, Alerts for follow-up appointments and tests vii . Integration of notes, results and diagnostic test into an integ rated platform 5. Next steps/time line a. Poonam Alaigh, M.D. Agreed to serve as the Accountable leader and ident i fied Rob Thomas (VA- CIO) as her partner i. Will work wit h I. Perlmutter, M. Sherman and B. Moskowitz, M. D. to define the governance structu re and workfng group structure b. Dr. Alaigh has reached out to participants identifying those Willin g/inte rested in serving on a governance committee as well as those individuals who will be part of the wor k group for this initiative , asking for a comm it ment by Thursday, June 22. i. Strong expression of interest among participants on call to serve AMERICAr-... pVERSIGHT VA-19-0799-G-000635 DS 00021351 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 6/23/2017 11:39:21 AM To: Davidshulkin [Drshulkin@aol.com] Re: Egyptian embassy dinner next week? Subject: Just finished with Bruce for the last 30min and now in an EMRmeeting- call me if you want though Sent from my iPhone > on Jun 23, 2017, at 7:23 AM, David shulkin wrote: > > No - are u free for a call > > sent from my iPhone > (b) (6) >> on Jun 23 , 2017, at 5 :46 AM, Poonam Alaigh <-@hotmail >> >> Didn't get any confirmationdo i need to do anything else . com> wrote: >> >> sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000636 OS 00021352 Message Davidshulkin [Drshulkin@aol.com] 6/23/2017 11:22:14 AM Poonam AlaighI(b) (6) @hotmail.com] Re: Egyptian embassy dinner next week? From: Sent: To: Subject: No - are u free for a call Sent from my iPhone > on Jun 23, 2017, at 5:46 AM, Poonam Alaigh <-@hotmail.com> (b) (6) > > Didn't get any confirmation- do i need to do anything wrote: else > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000637 OS 00021353 Message Poonam Alaigh I(b) (6) @hotmail.com] 6/23/2017 9:46: 19 AM Drshul kin@aol .com Egyptian embassy d inner next week? From: Sent: To: Subject: Didn't Sent get any confirmation- do need to do anything else from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000638 OS 00021354 Message Sent: David shulkin [Drshulkin@aol.com] 6/20/2017 2:59:28 AM To: (b) (6) Subject: Re: From: (b) (6) - -(b) and -(b) (6) (6) tiffinany? Im pissed Is this had aisles Sent from my iPhone > On Jun 19, > 2017, at 10:53 PM, (b) (6) (b) (6) <-r@gmail.com> wrote: > Middle seat for 3 hrs is the worst :-( > > sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000639 OS 00021355 Message From: (b) (6) (b) (6) Sent: 6/20/2017 2:53:23 AM To: David Shulkin [drshulkin@aol.com] @gmail.com] Middle seat for 3 hrs is the worst:-( Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000640 DS_ 00021356 Message Davidshulkin [Drshulkin@aol.com] 6/17/2017 5:01:45 PM Poonam AlaighI(b) (6) @hotmail.com] Re: Quickquestion From: Sent: To: Subject: I submitted your name to the wh- should be ok- held all other names Sent from my iPhone (b) (6) > on Jun 17, 2017, at 12:56 PM, Poonam Alaigh <-@hotmail.com > wrote: > > Any update on the USHposition- I amok if you want to repost, but just wanted to know so I can mentally prepare either ways obviously being settled in a place ( either NJ or D.C. ) helps vs shlepping like this. > > You said something in Ike's ca 77 yesterday maybe I am being overly sensitive but didn't that I just remembered- " if we ever get the nomination .. . " know if there was something you were protecting me from > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000641 OS 00021357 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 6/17/2017 4:56:40 PM To: Drshulkin@aol.com Quick question Subject: Any update on the USH pos1t1on- I amok if you want to repost, but just wanted to know so I can mentally prepare either ways obviously being settled in a place ( either NJ or D.C.) helps vs shlepping like this. You said something in Ike's call maybe I am being overly sensitive yesterday that I just remembered-" if we ever get the nomination ... "but didn't know if there was something you were protecting me from sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000642 OS 00021358 Message To: Jared Kushner [(b) (b) (6) (6) 6/21/2017 11:33:05 PM David shu lkin [Drshulki n@ao l.co m] Subject: Re: From: Sent: (b) (5) on 6/20/17, Jared- 7:01 AM, "David congratulations shulkin" wrote: •• on a (b) (5) see you soon David sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000643 OS 00021359 Message Davidshulkin [Drshulkin@aol.com] From: Sent: 6/20/2017 11:01:54 AM To: Jared Kushner (b)(b) (6) (6) Jared- congratulations I also appreciated difference on a great day yesterday with the launch of tech week the shout out for VA- it means a lot to our staff who are working hard to make a See you soon David sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000644 OS 00021360 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 6/25/2017 4:54:25 PM (b) (6) Poonam Alaigh [-@hotmail.com] Re:Just realized I dont have it yet- these people cannot even get this right Sent from my iPhone (b) (6) > on Jun 25, 2017, at 12:19 PM, Poonam Alaigh <-@hotmail.com> > > That I still have to earn your secretary wrote: coin - haven ' t got it yet > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000645 OS 00021361 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 6/25/2017 4:19:10 PM To: Subject: David Shulkin [drshulkin@aol.com] Just realized That I still have to earn your Secretary coin - haven't got it yet Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000646 OS 00021362 Message Poonam AlaighI(b) (6) @hotmail.com] Sent: 6/15/2017 8:31:29 AM To: (b) (6) (b) @mac . com] Bruce Moskowitz [bruce~■■■■ CC: drshulkin@aol.com; IP ll@frenchange (6) l59.com ]; mb (b) (6) @gmail.com ( Re:Terry Fadem. And Apple Subject: b ) ( 6 Yes, good idea- will you give him ) a heads up Bruce, and then I can connect with him prior governance/oversight meeting From: to the first Sent from my iPhone (b) (6) > on Jun 14, 2017 , at 9:46 PM, Bruce Moskowitz wrote: (6) > I spo ke with Terry he immediately understands how to structure this to get the VA maximal benefit. we need to involve him as we put the committees in place and protect the intellectual capital of the VA prior to starting working on the project . we need to have a plan that is fair to all parties involved , the 5 academic partners, Apple and the VA. > > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000647 OS 00021363 Message From: (b) (6) Sent : 6/15/2017 8:23 :37 PM To : drshulkin@aol.com The Congressional Baseball Game for Charity Subject: (b) (6) @gmail.com) I MLB.com The CongressionaJ Baseball Game for Charity I MLB.com http://m.mlb .com/nationals/tickets/info/congressional AMERICAN PVERSIGHT VA-19-0799-G-000648 DS_00021364 Message Sent : David Shulkin [drshulkin@aol.com] 6/14/2017 1:19:21 AM To : (b) (6) From: va.gov]; Vivieca Simpson I(b) (6) @gmail.com) (b) (6) (b) (b)(6) (6) Re: [EXTERNAL)First Meeting of the President's Commission on Combating Drug Addiction and the Opioid Crisis Subject: http://www.cnn.com/videos/tv/2017/06/13/david-shulkin-secretaiy-veterans-affairs-cabinet-meeting-erinbumett-outfront-cnntv. cnn/vi deo/play Lists/eri n-bumett-outfront/ Sent from my iPad On Jun 13, 2017 , at 9:07 PM , (b) (6) (b) (6) (b) (b)(6) (6) K -----Ori gin al Message----From: David shulkin [Drshulkin@aol.com ] Sent: Tuesday, June 13, 2017 09:05 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: Re: [EXTERNAL] First Meeting of the President's Commission on Combating Drug Addiction and the Opioid Crisis I had not seen the email before - and it was not clear how o me before that i was invited Lets look at the schedule tommorow and see what we can do Sent from my iPhone On Jun 13, 2017, at 6:50 PM, (b) (6) wrote : (b) (6) (b) (b)(6) (6) May 1 send to valintino , Clancy etc? -----Original Message----From: (b) (6) EOP/ONDCP c.ONDCP.EOP.GOV Sent: Tuesday, June 13, 2017 05 :59 PM Eastern Standard Time (b) (6) To: (b) (6) Subject: RE : [EXTERNAL] First lvieeting of the President's Commission on Combating Drug Addiction and the Opioid Crisis (b) (6) Thanks for your response. yes we welcomeyou sending staff in LheSecretary's stead. The guidancethat we received was that Secretariesor Deputy Secretaiieswould have a speakingrole questioningthe non profit groups, and other staff would be able Loatlend and obse1ve. Thanks AMERICAN PVERSIGHT VA-19-0799-G-000649 DS_00021365 (b) (6) Executive Assistru1t National Drug Control Policy (b) (6) (b) (6) (b) (6) --- -Original Message----[maillo (b) (6) From: (b) (6) (b) (6) Sent Tuesday. June 13, 2017 5:53 PM To: (b) (6) EOP/ONDCP (b) ONDCP.EOP.GOV> (b)(6) (6) Subject: RE : [EXTERNAL] First Meeting of the President's Commission on Combating Drug Addict.ion and the Opioid Crisis Hi-(b) (6) sec shulkin will not be in attendance. but can we send someone else in his stead? -----Original Message----From: (b) (6) NDCP.EOP.GOV (b) (b)(6) (6) J (b) (6) (6) Sent: Tuesday. June 13, 2017 05 :25 PM Eastern Standard Time To: (b) (6) (b) (6) Subj ect: [EX TERNAL ] First Meeting of the President's Commission on Combating Drng Addiction and the Opioid Crisis Good afternoon-(b) (6) I'm fol.lowing up on an exchange l11atyou had with Abe Goldschmidt regarding Secretary Shulkin participating in the First Meeting of the President's Commission on Combating Drug Addiction and the Opioid Crisis to be beld this Friday, June 16, 2017 from 12:30 - 2:30pm at the EEOB Room 350. Please advise if be will be able to j oin us and if so, if any staff w j(J be accompanying him. Eacb guest will need to submit ilieir clearance infonnation l11rough the I ink below. hltps://events.whilehouse.gov/fonn?rid::7T6476FV2X Please let me know if you have any questions. Respectfully, (b) (6) Executive Assistru1t National Drug Control Policy (b) (6) (b) (6) (b) (6) AMERICAr-... pVERSIGHT VA-19-0799-G-000650 D8_00021366 Message From: David shu lkin [Drshulkin@ao l.com] Sent: 6/13/2017 5:50:58 PM To: Poonam Alaigh I(b) (6) @hot mail.com] can you find out if we are working on stellate street journal and being tested by DoD ganglion blocks for ptsd- this is front page on the wall Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000651 OS 00021367 Message From: Sent: To : David Shulkin [drshulkin@aol.com] 6/14/2017 1:17:58 AM Poonam Alaigh I(b) (6) @hotmail .com) http://www.cnn.com/videos/tv/201 7/06/ 13/david-shulkin-secretary-veterans-affairs-cabinet-meeting-erinbu mett-outfront-cnntv.cnn/video/playlists/erin-burnett-outfront/ Sent from my jPad AMERICAN PVERSIGHT VA-19-0799-G-000652 DS_ 00021368 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 7/1/2017 1:21:13 AM To: Bruce Moskowit z [bruce~@mac (b) (6) (b) (6) Re: Ike and Laurie Subject: Thanks so much Bruce please send terrys .com] number and ill call tommorow Enjoy the fourth sent from my iPhone (b) (6) > on Jun 30, 2017, at 8:49 PM, Bruce Moskowitz wrote: (6) > I had dinner with them tonight. If you can not engage Terry under the usual method they want to provide his services via BREFfoundation either free or under reimbursement model. They want you to choose the most expedited outcome . Laurie and I serve on the board so we can get it done immediately. They do want You to talk with Terry first . Enjoy the holiday we spoke your praises and believe you are the best the VA will ever have to get all that we envision done. > > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000653 OS 00021369 Message From: David shulkin l Drshulkin@aol.com] Sent : 7/6/2017 2:05:llPM To : Poonam Alaigh I(b) (6) @hotmail.com] Re: POUTICO's Morning eHealth : Telemedicine in the schools (for now) - ONC moves to speed interoperability Tales from VistA land Subject: On rt]s Sent from my iPhoae On Jul 6, 2017 , at7 :51 A.NI,Poonam Alaigb - (b) (6) > wrote : What report was positive on inventory management- not aware ofit? Sent from my iPhone On Jul 6, 2017 , at 7 :21 AM, David shulkin wrote: Im not worried about Bruce but we we should get a succinct statement on where we are on 1ils implementation I had asked forvan update two weeks ago a11dthe report was fairly positive- which had surprized me Sent from my iPhone On JuJ 6, 2017 , at 4 :38 A.NI,Poonam Alaigb - (b) (6) > wrote : Yes- this i s what Bruce has been speaking to us about- should we try to get a call with them today or tomorrow - I am leaving tomorrow evening so won't be available over the weekend unless you want to talk to them- we needed to get caught up but don't know that we will have time Seht from tn y i Phone On Jul 5, 2017, at 7:40 PM , David Shu1kin wrote : See the Iast story We should get ready for the rebuttal Sent from my iPad Begin forwarded message ; From: (b) (6) ~(b) (6) > Date: July 5, 2017 at 11:22 :27 AM AMERICAN PVERSIGHT VA-19-0799-G-000654 DS_00021370 EDT To: Dad Subject: Fwd: POLITICO's Morning eHealth: Telemedicine in the schools (for now)-ONC moves to speed juteroperability Tales from VistA land NEWS FROM THE VA IT WARS - Sen. Ted Cruz la st week jntroduced the VA Information Technology Restructuring Act, which would create a Chief Information Officer position within the Veterans Health Administration. The bill is backed by a Kochsponsored vets group, Concerned Veterans for America , which said it would he] p the VA make better tech decisions. But VA insiders say creating such a position is unnecessary and potentia11y counterproductive . For the past two years, the VA's Office of Information and Technology has had "IT account managers" at each VA division including the Vete rans Health Adm inistration. The point of thjs was to stream line IT functions and avoid duplication in spending and planning, one senior offic ial told us. - POLlTICO's Nancy Scola had this storyabout Jared Kushner's Office of American lnnovation, including an admi nistration official's claim that Kushner played a key role in VA Secretary David Shulkin 1s decision to skirt the bidding process and choose a Cemer system Iike the one the DoD is insta llin g. Interestingly, a month ago an aide to Kushner told us his office hadn't influenced Shulkin's choice. - Here's one consultant's take on Shulkin's decision to go with a solesource contract. - VISTA-GENERATED DATA whic h has brought us discoveries AMERICAr-... pVERSIGHT VA-19-0799-G-000655 D8_00021371 such as Vioxx's link to heart attacks continues to provide important evidence. A study in the British Medical Journal , based on an examination of 3.5 mi!Jion VA medical records , showed that prescription strength proto n-pum p inhibitors - heartburn d.rugs--are associated with a potentia l 25 percent increased risk of early death . The study did not exami ne over-thecounter proton-pump inhibitors. "The VA has the largest integrated electronic medical reco rd system in the wo tld ," lead author Ziyad Al-Aly of Washington Univer sity in St. Louis told CNN. "This enab led us to look at a large number of patients and fo llow them up for abo ut six years to exam ine our research questio ns." - AND A NEW VA SCANDAL : VA offic ials are warning that a fledgling effort to digi tally track medical equipment is in danger of "catastrophic failure ," according to a report in the Austin AmericanStatesman . It quote s VA offic ials worried last year that the departme nt's $543 million contract with Hewlett-Pack ard Enterprise Services to implement a real-tim e locating system was caree ning off the rails. The syste m, whi ch consists of tagging and wireless ly tracki ng everyt hing from cathet ers to hospi tal beds, has been hailed as a way to pote ntially save millions of dollars in lost or misplaced equipment. Read all about it here . Sent from my iPhone Begin forwarded message: From: "Mornin g eHea lth " Date: July 5, 20 17 at AMERICAr-... pVERSIGHT VA-19-0799-G-000656 D8_00021372 I0:07:03 AM EDT To: ~(b) (6) > Subject: POLITICO' s Morning eHealth: Telemedicine in the schools (for now) ONC moves to speed interoperability Tales from VistA land Reply-To: "POLIT ICO subscri ptions" <~ fe8312777d6106757d -630302 HTML778973872-13763190@pol iti coemai 1.com > By Arthur Allen I 07/05/20 l 7 10:0 I AM EDT With help fro m David Pittman and Darius Tahir GOP LIKES TELEMEDlCINE IN THE SCHOOLS; THE PRICETAGNOT SO MUCH : One of th e unintended effec ts of the Senate's Obama care repe al bill would be to slash money that pa ys for schoo l nurses to use telemedic ine that connect s sick kids to medical experts , our David Pj ttman reports. In poor and rural areas , man y of them in reddest Trump Coun try, the school nurse is not just handin g out bandaids anymore: she's become a de pVERSIGHT VA-19-0799-G-000657 DS_0002 1373 facto medical guide . marshalling health care for poor kids with obes ity, asthma and diabetes , while on the lookout for issues like child abuse and teen pregnan cy, David reports in thi s ~ "In many of our situ ations ... the school nurse is the only health care provider a child ever sees," said Kelli Marie Garber, who runs a grow1ng school -based t elemedicine progra m out of Charl eston , S.C . - Republi can politicians genera lly like telemedicine HHS Secretary Tom Price calls it an "exciting innovation ." But the 26 percent cut to Medicaid planned by the administration and Congr ess for the nex.t decade would deplete the funds that dozens of states are drawin g on to make public school s a place of healin g for kids. FIRST FROM MORN ING EBEALTH: ONC is taking a step toward fulfillin g the 21st Century Cures Act section that aims to expedite interoperability . The agency has announced a Jul y 24 meeting to pVERSIGHT VA-19-0799-G-000658 DS_0002 1374 start developing common rules for providers to electronic ally share informa tion with each other, ONC officials tell David . Cures gives ONC until the end of the year to publish the 11trusted exchange framework," a set of terms and conditi ons for health information exchange . The hope is that with these rules established , providers will experience less friction around sharing patient data . ONC has been working with groups like the Sequoia Proj ect, the CommonWe ll Health Alliance and Direct Trust, and hopes to help fill in the gaps that separate those and other networks . More for Pros here . Tweet oft .he Day: Andy Slavitt @ASlav irt The free press, hope for checks & balances, and your right to call people names. Donald Trump Jr. @Dona ldJTrumpJr Out of curiosity , what exactly are Big Govt, opprressive taxation, anti 2A left wing socialists celebratin g today? Welcome to Monday morning eHealth , where we can hear fireworks from the Mall and we're sure pVERSIGHT VA-19-0799-G-000659 DS_0002 1375 that at least one of them was set off in honor of press freedom . Send your stories to aal len@politico.com , or engage via Twitter @Dav id Pittman , @athurallen202 , @Darius Tahir , @POLIT ICOPro , @Morning eHeaJth. NO FLOOR SCHEDULE YET FOR USER FEE REAUTHORIZATI ON - House Energy and Comme rce Chairman Greg Walden told Pro's Prescription Pulse the House will cons ider the package "soon," despite missing the bipartisan , selfimposed deadline to pass it before Congress left for the July Fourth recess ... Aides for Senate Major ity Leader Mitch McConnell and House Majority Leader Kevin McCarthy also said there's no time scheduled for the bill to hit the floor in either chamber. ... If a deal is not reached shortly, the FDA will be forced to begin send ing out layoff notices on Aug. 1. SWEET RELIEF : A bipartisan group of lawmakers led by Texas Rep .-(b) (6) Burgess introduced a bill Friday aimed at pVERSIGHT VA-19-0799-G-000660 DS_0002 1376 easing meaningful use require ments for doctors and hospital s. The simple oneparagraph bill ~ 3120) elimin ates part of a senten ce in the 2009 HIT ECH Act that requires the HHS secretary to create "more stringent measures of meaningful use 11 over tim e. Sponsors, including Burgess , and Rep s. Debbie Dingell . Pat Tiberi and Mike Thompson called the change "common sense ." "Electronic health records place an enormous burden on physicians, and have failed to live up to their promise to improve health care delivery for patients ," Bur gess, chairman of the Energy and Co mmerce's health subco mm ittee , said in a release. "Unfort unately, curren t law places an arbitrary requirem ent on the secretary of He alth and Hum an Services to impo se an increasi ngl y stringent burden on physic ians' use of these records systems ." NEWS FROM THE VA IT WARS - Sen. Ted Cruz last week introduced the VA Informa tion Technology Re structuring Act, which would create a pVERSIGHT VA-19-0799-G-000661 DS_00021377 Chief Information Officer position within the Vete rans Health Adm inistr ation. The bill is backed by a Ko ch-spon sored vets group , Concerned Veterans for America, whic h said it would help the VA make better tech decision s. But VA insid ers say creating such a position is unnecessary and potentia lly counterp roducti ve . For the past two years , the VA's Offi ce oflnformation and Technology has had "IT account manager s" at each VA division includin g the Veterans Health Admini stration. The point of this was to stream line lT functions and avoid duplicati on in spending and plannin g, one senior offic ial told us. - POLITI CO's Nancy Scola had this story about Jared Ku shner's Office of American Innovation , including an administ ration offic ial' s claim that Kushner played a key role in VA Secretary David Shulkin's decision to skirt the bidding process and choose a Cemer syste m like the one the DoD is installi ng . interestin gly, a month ago an aide to pVERSIGHT VA-19-0799-G-000662 DS_0002 1378 Kushner told us his office hadn't influenced Shulkin's choice . - Here's one consultant's take on Shulkin's decision to go with a sole-source contract. - VlSTAGENERATED DATA - which has brought us discoveries such as Vioxx's link to heart attacks continues to provide important evidence . A study in the British Medical Journal , based on an examination of 3.5 million VA medical records, showed that prescription strength proton-pump inhibitors - heartburn drugs-are associated with a potential 25 percent increased risk of early death. The study did not examine over-the-coun ter proton-pump inhibit ors. "The VA has the largest integrated electronic medical record system in the world," lead author Ziyad Al-Aly of Washington University in St. Louis told CNN. "This enabled us to look at a large number of patients and follow them up for about six years to examine our research questions ." pVERSIGHT VA-19-0799-G-000663 DS_0002 1379 -A ND A NEW VA SCANDAL : VA officials are warning that a fledgling effort to digitally track medical equipm ent is in danger of "catastrophic failure," according to a report in the Austin Ame rican -Statesman . It quotes VA officials worr ied last yea r that the department's $543 million contract with Hew Iett-Packard Enterpri se Services to implement a real-time locati ng syste m was caree ning off the rai Is. The system, which consis ts of tagging and wireless ly track ing everything from catheters to hospital beds , has been haHed as a way to potentially save mil lions of dollars in lost or misplaced equ ipment. Read all about it here . NHS GETS WRIST S LA P OVER GOOGLE INTRUS ION: The EU Information Commi ssio ner's Office on Monda y ordered a National Health Service hospita l in the U.K . to change how it handles patient data after it failed to comply wit h data protection law in a trial of an app developed by Google . The Royal Free NHS Fou ndatio n Trust provided persona l pVERSIGHT VA-19-0799-G-000664 OS_ 0002 1380 data of around 1.6 million patients to Google's Al division DeepMind. The hospital shared the data to test a system for managing acute kidney injury. The investigation found that patients were not adequately informed that their data would be used as part of the test. Pros can read more here. STUDY PITS OTC, CONVENTIONAL HEARING AIDS: The report in JAMA by scientists at Johns Hopkins School of Medicine compared five of the cheaper devices, which cost from $30 to $350, to a conventional hea1ing aid costing $1,9 10 among 42 adults with mild to moderate hearing Joss. Three of the five cheaper devices provided improvements in speech understanding similar to that of the hearing aid; one demonstrated little improvement, and speech understanding was worse with the fift h. Sen. Elizabeth Warren has championed legislation to enable FDA regulation of the inexpensive hearing aids, but the bill 8Q! stuck 1n a controversy with gun lovers who say it could impinge AMERICAr-... pVERSIGHT VA-19-0799-G-000665 DS_00021381 on their right to use silencers. FREE THE DATA: The drug and medical devices industries paid $8.18 billion to doctors and hospitals in 20l6,just slightly above the previous year , according to new CMS data released late last week . earl y 1,500 companies made payments to more than 630 ,000 physicians and 1,146 teaching hospitals according to the Open Payments data . Nea rly half of the dollar amo unt - $4 .36 billion - was for research . Another $2 .8 billion went towa rds a variety of "genera l" uses , according to CMS , including consultin g, speaking fees, travel and lodging and royalty and licensing fees . The remaining $1 .02 billion went to physician s with an ownership or investment interest in a drug or device company . MATCH MIXUP: The American Health Information Managemen t Association and Integratin g the Healthcare Enterprise (IHE) are seeking public comment on a collaborative white ~ detailing pVERSIGHT VA-19-0799-G-000666 OS_ 0002 1382 requirements and constraint s for pati ent demographic data exchange and aggregation. The paper w as deve loped by the IHE Patient Care Coord ination Committee and the AH.IMAStandards Task For ce. Meanwhile ... Che ck out this Pew data visualization on the risk of patient matchin g errors . EP IC NO-SH OW lN WISCONS IN: Wi scons in's Department of Health Services has chosen Cemer for a major I 0year, $33 million co ntract to handle records for state-run mental hospital s and other facilities . Homet own hero Epic was not among the five bidd ers that bid for the project. Epic bad no comment on the news . WHAT WE'RE CL lCKJNG: NYTimes : When ransomware isn 't after a ransom ProPublica's take on CMS withholding of Medicare Advantage data Time profiles Epic's Jud y Faul kner pVERSIGHT VA-19-0799-G-000667 OS_ 0002 1383 KPMG on doctors' readiness for MACRA Health Data Management: digital disruption is already happening GE's Mark Segal : Don't call EHR typing "desk work" - it's part of the clinic JAMA : Genomic medicine still lacks a good evidence base , says CDC leader MedCityNews : How groups are helping patients get their records To view online: http://www .politico .c om/tipsheets/morning - ehealth/2017/07/05/tel emedicine-in-theschool s-for-now221161 To change your alert settings, please go to https://secure.politic o.com/settings/settin &! POLITICO This email was sent to (b) (6) ~ by : POLITICO , LLC 1000 Wilson Blvd . Arlington, VA , 22209 , USA AMERICAN PVERSIGHT VA-19-0799-G-000668 DS_00021384 Please click here and follow the steps to unsubscribe . AMERICAN PVERSIGHT VA-19-0799-G-000669 OS_00021385 Message Poonarn Alaigh I(b) (6) @hotmail.com] 7/6/2017 11:51:30 AM David shulkin [Drshulkin@aol.comJ Re: POUTICO'sMorning eHealth : Telemedicine in the schools (for now) - ONC moves to speed interoperability Tales from VistA land From: Sent : To : Subject: What report was positive on inventory management- not aware of it? Sent from my iPhone On Jul 6, 2017 , at 7 :21 A.NL David shulkin wrote : Im not worried about Bruce but we we should get a succinct statement on where we are on rtls implementation I had asked forvan update two weeks ago and the report was fairly positive- which had surp1ized me Sent from my iPhone On Jul 6, 2017 , at 4: 38 AM, Poonam Alaigh - (b) (6) wrote : Yes- this is what Bruce has been speaking to us about- should we try to get a call with them today or tomorrow - I am leaving tomorrow evening so won't be available over the weekend unless you want to talk to them- we needed to get caught up but don't know that we will have time Sent from my iPhone On Jul 5, 2017, at 7:40 PM, David Shulkin wrote : See the last story We should get ready for the rebuttaJ Sent from my iPad Begin forwarded message : (b) (6) From: (b) (6) ~ Date: July 5, 2017 at 11 :22 :27 AM EDT To: Dad Subject: Fwd: POLITICO's Morning eBealth: Telemedicine in the schools (for now)- ONC moves to speed interoperability - Tales from VistA land NEWS FROM THE VA IT WARS - Sen. Ted Cruz last week introduced the VA Information Technology Restructuring Act, which would create AMERICAN PVERSIGHT VA-19-0799-G-000670 DS 00021386 a Ch.ief Information Officer position within the Veterans Health Administration. The bill is backed by a Koch-sponsored vets group , Concerned Veterans for America , which said it would help the VA make better tech decisions. But VA insiders say creating such a position is unnecessary and potentia11ycounterproductive. For the past two years, the VA's Office of Information and Technology has had "IT account managers" at each VA division including the Veterans Health Administration. The point of this was to streamline IT functions and avoid duplication in spending and planning, one senior official told us. - POLITICO's Nancy Scola had this storyabout Jared Kushner's Office of American Innovation , including an administration official's claim that Kushner played a key role in VA Secretary David Shulkin's decision to skirt the bidding process and choose a Cemer system like the one the DoD is installing . lnterestjngly , a month ago an aide to Kushner told us his office hadn't influenced Shu_lkin'schoice. - Here's one consultant's take on Shulkin's decision to go with a sole-source contract. - VlST A-GENERA TED DATA - which has brought us discoveries such as Vioxx's link to heart attacks - continues to provide important evidence . A study in the British Medical Journal , based on an examination of3 .5 million VA medical records , showed that prescription strength proton-pump inhibitors - heartburn drugs--are associated with a potential 25 percent increased risk of early death. The study did not examine over-the-counter protonpump inh.ibitors. "The VA has the largest integrated electronic medical record system in the world," lead author Ziyad Al-Aly of Washington University in St. Louis told CNN. "This enabled us to look at a large number of patients and follow them up for about six years to examine our research questions ." - AND A NEW VA SCANDAL : VA officials are warn ing that a fledgling effort to digitalJy track medical equipment is in danger of "catastrophic failure ," according to a report in the Austin American-Statesman . It quotes VA officia ls worried last year that the department's $543 million contract with Hewlett-Packard Enterprise Services to implement a real-time locating system was careening off the rails . The system, which consists AMERICAr-... pVERSIGHT VA-19-0799-G-000671 D8_00021387 of tagging and wireless ly tracking everything from catheters to hospital beds, has been haifod as a way to potentially save millions of dollars in lost or misp laced equipment. Read all about it here . Sent from my iPhone Begin forwarded message : From: "Morning eHealtb" Date : July 5, 2017 at 10:07:03 AM EDT To: ~(b) (6) > Subject: POLITlCO's Morning eBealt h: Telemedicine in the schools (for now)- ONC moves to speed interoperability - Tales from VistA land Reply-To: "POLITICO subscriptions" <~ fe8312777d6106757d630302 HTML-7789738721376319-0@pol iticoemail .com> By Arthur Allen I 07/05/2017 10:01 AMEDT With help from David Pittman and Darius Tahir GOP LIKES TELEMEDICINE IN THE SCHOOLS; THE PRICETAG- NOT SO MUCH: One of the unintended effects of the Senate's Obamacare repeal bill would be to slash money that pays for school nurses to use telemedidne that connects sick kids to medical experts , our David Pittman reports . In poor and rural areas , many of them in reddest Trump Country , the school nurse is not just handing out bandaids anymore : she's become a de facto medical guide , marshalling health care for poor kids with obesity , asthma and diabetes , while on the lookout for issues like child abuse and teen pregnancy , David reports in this story . AMERICAr-... pVERSIGHT VA-19-0799-G-000672 DS_ 00021388 "In many of our situations ... the schoo l nu rse is the only health care prov ider a child ever sees," said Kelli Marie Garber , who runs a growing school-based telemedicine program out of Charleston, S.C. - Repub lican politicians generall y like te)emed icine - HHS Secretary Tom Price calls it an "exciting jnnovation ." But the 26 percent cut to Medicaid planned by the administration and Congress for the next decade would deplete the funds that dozens of states are drawing on to make public schools a place of healing for kids . F IRST FROM MORNING EHE ALTH : ONC is taki ng a step toward fulfi Iiing the 21st Centuty Cures Act section that aims to expedite interoperability . The agenc y has announced a Jul y 24 meeting to start developing commo n rules for pmv iders to electronica lly share j nformati on with each other , ONC officials tell Da vid . Cures gives ONC until the end of the year to publish the "trusted exchange framework ," a set of terms and cond itions for health infonnation exchange . The hope is that with these rules estab lished, providers wiU experience less friction aroun d sharin g patient data . ONC has been work ing with gro ups like the Sequoia Project, the Co mmonWell Health Alliance and Direct Trust . and hopes to help fiU in the gaps that separate those and other networks . More for Pros here . Tweet of the Day: Andy Slavitt @ASlavitt The free press , hope for checks & balances , and your right to call people names. Donald Trump Jr. @DonaldJTrumpJr Out of curiosity , what exac tly are Big Govt, opprressive taxation , anti 2A left wing sociali sts celebrating today ? AMERICAr-... pVERSIGHT VA-19-0799-G-000673 D8_00021389 Welcome to Monday morni ng eBea lth, where we can hear fireworks from the Mall and we're sure that at least one of them was set off in honor of press freedom . Send your stories to aallen@politico.com , or engage via Twitter @David Pittman , @athurallen202 , @DariusTahir , @POLITICOPro , @Morning eHealth . NO FLOOR SCHEDULE YET FOR USER FEE REAUTHORIZATION -House Energy and Commerce Chairman Greg Walden told Pro's Prescription Pulse the House will consider the package "soon," despite missing the bipartisan , self-imposed deadline to pass it before Congress left for the July Fourth recess ... Aides for Senate Majority Leader Mitch McConnell and House Majority Leader Kevin McCarthy a1so said there's no time scheduled for the bill to hit the floor in either chamber .... If a deal is not reached shortly, the FDA will be forced to begin sending out layoff notices on Aug . 1. SWEET RELIEF: A bipartisan group oflawmakers led by Texas Rep .~(b) (6) introduced a bill Friday aimed at easing meaningful use requirements for doctors and hospitals. The simple one-paragraph bi11(H.R . 3120) elimit1ates part of a sentence in the 2009 HITECH Act that requires the HHS secretary to create "more stringent measures of meaningful use" over time. Sponsors, including Burgess , and Reps. Debbie Dingell , Pat Tiberi and Mike Thompson called the change "common sense ." "Electronic health records place an enom10us burden on physicians , and have failed to live up to their promise to improve health care delivery for patients ," Burgess , chairman of the Energy and Commerce's health subcommittee , AMERICAr-... pVERSIGHT VA-19-0799-G-000674 D8_00021390 said in a release, "Unfortunately, current law places an arbitrary requirement on the secretary of Health and Human Services to impose an increasingly st1ingent burden on physicians' use of these records systems ." NEWS FROM THE VA IT WARS - Sen. Ted Cruz last week introduced the VA Information Technol ogy Restructurin g Act, which would create a Chief lnfonnation Officer position within the Veterans Health Administration. The bill is backed by a Ko ch-sponsored vets group, Concerned Veterans for America , which said it would help the VA make better tech decisions. But VA insiders say creating such a position is unnecessary and potentiall y counterproductive. For the past two years, the V A's Office of Information and Technolo gy has had 11 IT account managers" at each VA division including the Veterans Health Administration. The point of this was to streamline IT functions and avoid duplication in spending and planning, one senior official told US. - POLJTICO's Nancy Scola had this storv about Jared Kushner's Office of American Innovation , including an administration official's claim that Kushner played a key role in VA Secretary David Shulkin's decision to skirt the bidding process and choose a Cemer system like the one the DoD is installing. Interestingly, a month ago an aide to Kushner told us his office hadn't influenced Sbulk.in's choice . - Here's one consultant's take on Shulkin's decision to go with a solesource contract. -VISTA-GENERATEDDATAwhich has brought us discoveries such as Vioxx's link to heart attacks - AMERICAr-... pVERSIGHT VA-19-0799-G-000675 D8_00021391 continues to provide important evidence . A study in the British Medical Journal , based on an examination of3 .5 million VA meclical records, showed that prescription strength proton-pump inhibitors - heartburn drugs--are associated with a potential 25 percent increased risk of early death . The study did not examine over-thecounter proton-pump inhibi tors. "The VA has the largest integrated electronic medical record system in the world," lead author Ziyad Al-AJy of Washington University in St. Louis told CNN. "This enabled us to look at a large numb er of patients and follow them up for about six years to examine our research questions." - AND A NEW VA SCANDAL : VA officials are warning that a fledgling effort to digitally track medical equipment is in danger of "catastrophic failure," according to a report in the Austin AmericanStatesman . It quotes VA officials worried last year that the department's $543 million contract with Hewlett-Packa rd Enterprise Setvices to implement a real-time locating system was careen ing off the rails. The system, which consists of tagging and wirelessly tracking everything from catheters to hospital beds, has been hailed as a way to potentially save millions of dollars in lost or misplaced equipment. Read all about it here . NHS GETS WRIST SLAP OVER GOOGL E INTRUSION: The EU Infonnation Commissioner's Office on Monday ordered a Nationa l Health Service hospital in the U.K. to change how it handles patient data after it failed to comply with data protection law in a trial of an app developed by Google. The Royal Free NHS Foundation Trust provided personal data of around 1.6 million AMERICAr-... pVERSIGHT VA-19-0799-G-000676 D8_00021392 patients to Google's Al division DeepMind. The hospital shared the data to test a system for managing acute kidney inj ury. The investigation found that patients were not adequate ly informed that their data wou ld be used as part of the test Pros ean read more here . STUDY PITS OTC, CONVENTIONAL BEARING AIDS: The report in JAMA by scientists at Johns Hopkins School of Medicine compared five of the cheaper devices, which cost from $30 to $350, to a conventional hearing aid costing $1,9 10 among 42 adults with mild to moderate hearing Joss. Three of the five cheaper devices provided improvements in speech understanding similar to that of the hea1ing aid ; one demonstrated little improvement, and speech understanding was worse with the fifth . Sen. Elizabeth Warren has chan1pioned legislation to enable FDA regulation of the inexpensive hearing aids, but the bill got stuck in a controversy with gun lovers who say it could impinge on their right to use silencers . FREE TBE DAT A: The drug and medica l devices industries paid $8.18 biJlionto doctors and hospita ls in 2016, just slightly above the previous year, accordi ng to new CMS data released late last week. Nearly 1,500 companie s made payments to more than 630,000 physic ians and l, 146 teaching hospitals according to the Open Payments data . Nearly half of the dollar amount - $4.36 billion - was for research . Another $2.8 billion went towards a variety of "general" uses, according to CMS, including consulting, speaking fees , trave l and lodging and royalty and licensiT\g fees. The remaining $1.02 billion went to physicians with an AMERICAr-... pVERSIGHT VA-19-0799-G-000677 D8_0002139 3 ownership or investment interest in a drug or device company . MATCH JVIIXUP:The American Health Information Management Association and Integrating the Healthcare Enterprise (IHE) are seeking public comment on a collaborative white paper detailing requirements and constraints for patient demographic data exchange and aggregation. The paper was developed by the IHE Patient Care Coordination Committee and the AHIMA Standards Task Force. Meanwhile ... Check out this Pew data visualization on the risk of patient matching errors. EPIC NO-SHOW IN WISCONSIN: Wisconsin's Department of Health Services has chosen Cemer for a major 10-year , $33 million contract to handle records for state-run mental hospitals and other facilities. Hometown hero Epic was not among the five bidders that bid for the project. Epic had no comment on the news . WHAT WE'RE CLICKING: NYTimes: When ransomware isn't after a ransom ProPublica's take on CMS withholding of Medicare Advantage data Time profi les Epic's Judy Faulkner KPMGon doctors' readiness for MACRA Health Data Management : digital disruption is already happening GE's Mark Segal: Don't call EHR typ ing "desk work" - it's part of the clinjc AMERICAr-... pVERSIGHT VA-19-0799-G-000678 D8_00021394 JAMA : Genomic mecLicinestill lacks a good evidence base, says CDC leader MedCitvNews : How groups are helping patients get their records To view online : http://www.politico .com/tipsheets/m ommgehealth/2017/07/05/telemedicine-inthe-schools-for-now-221161 To change your alert settings, please go to https: //secure. politico.com/settings/ settings POLTICO This email was sent to (b) (6) ~ by : POLITICO, LLC 1000 Wilson Blvd . Arlington , VA, 22209, USA Please chck here and follow the steps to unsubscribe . AMERICAN PVERSIGHT VA-19-0799-G-000679 DS_ 00021395 Message David shulkin lDrshulkin@aol.com] 7/6/2017 11:21:27 AM Poonam Alaigh I(b) (6) @hotmail.com] Re: POUTICO's Morning eHealth : Telemedicine in the schools (for now) - ONC moves to speed interoperability Tales from VistA land From: Sent : To : Subject: Im not worried about Bruce but we we should get a succinct statement on where we are on rtls implementation l had asked forvan. update two weeks . ago and the report was fairly positive- which had surprized me Sent from my iPbone On Jul 6, 2017 , at 4:38 AM Poonam Alaigh - (b) (6) wrote: Yes- this is what Bruce has been speaking to us about- should we try to get a call with them today or tomorrow- I am leaving tomorrow evening so won't be available over the weekend unless you want to talk to them- we needed to get caught up but don't know that we will have time Sent from my iPhone On Jul 5, 2017 , at 7:40 PM , David Shulkin wrote : See the 1a.st story We should get ready for the rebuttal Sent from my iPad Begin forwarded message ; (b) (6) From: (b) (6) ~ > Date: July 5, 2017 at I 1:22:27 AMEDT To: Dad Subject: Fwd: POLITICO's Morning eHealth: Telemedicine in the schools (for now)- ONC mo"es to speed interoperability - Tales from VistA land NEWS FROM THE VA IT WARS - Sen . Ted Cru z last week introduced the VA Information Technology Restructuring Act, which would create a Chief Infonnation Officer position within the Veterans Health Administration. The bill is backed by a Kochsponsored vets group , Concerned Veterans for America, which said it would help the VA make better tech de cis ions . But VA inside rs say creating such a position is unnecessary and potentially counterproductive . Fo r the past two years , the V A's Office of Information and Technology has had "IT account managers" at each VA division including the Veterans Health Administration . The point of this was to streamline IT functions and avoid duplication in spending and planning , one senior official told us . AMERICAN PVERSIGHT VA-19-0799-G-000680 DS 00021396 - POLITICO's Nancy Scola had this storyabout Jared Kushner's Office of American lnnovation , including an administrat ion official's claim that Kushner played a key role in VA Secretary David Shulkin's decision to skirt the bidding process and choose a Cerner system like the one the DoD is installing. Interestingly , a month ago an aide to Kushner told us his office hadn't influenced Shulkin's choice. - Here's one consultant's take on Shulkin's decision to go with a sole-source contract. - VISTA-GENERATED DATA -which has brought us discoveries such as Vioxx's link to heart attacks - continues to provide important evidence . A study in the British Medical Journal , based on an examination of3.5 million VA medical records, showed that prescription strength proton-pump inhibitors heartburn drugs.--are associated with a potential 25 percent increased risk of early death . The study did not examine over-thecounter proton-pump inhibitors. "The VA bas the largest integrated electronic medical record system in the world," lead author Ziyad Al-Aly of Washi ngton University in St. Louis told CNN. "This enabled us to look at a large number of patients and follow them up for about six_years to exam ine our research questions.'' -AND A NEW VA SCANDAL : VA officials are warning that a fledgling effort to digitally track medical equipment is in danger of "catastrophic failure," according to a report in the Austin American-Sta tesman . It quotes VA officia ls wonied last year that the department's $543 million contract with Hewlett-Packard Enterprise Services to implement a real-time locating system was careening off the rails. The system, which consists of tagging and wirelessly tracking everyth ing from catheters to hospital beds, has been hailed as a way to potentially save millions of dollars in lost or misplaced equipment. Read all about it here . Sent from my iPhone Begin forwar ded message : From: "Morning eHealt h" Date: Ju ly 5, 2017 at 10:07 :03 AM EDT To: ~ (b) (6) > Subject: POLITICO's Morning eHealth: Telemedicine in the schools (for now) - ONC moves to speed interoperability - Tales from VistA land Reply-To: "POLITICO subscriptions" AMERICAr-... pVERSIGHT VA-19-0799-G-000681 D8_00021397 By Arthur Allen I 07/05/20 17 10:0 1 AM EDT With help;fi'om David Pi/Iman and Darius Tahir GOP LIKES TELEMEDICINE IN THE SCHOOLS~ THE PRICETAG - NOT SO MUCH : One of the unintended effects of the Senate's Obama care repeal bill would be to slash money that pays for school nurses to use telemedicine that connects sick kids to medical experts, our David Pittman reports . In poor and mral areas, many of them in reddest Tmmp Country, the school nurse is not ju st handing out bandaids anymore: she's become a de facto medical guide, mar shalling health care for poor kids with obesity, asthma and diabetes , while on the lookout for issues like child abuse and teen pregnancy , David reports in this story . 0 In many of our situations ... the school nurse is the only health care provider a child ever sees," said Kelli Marie Garber, who runs a growing schoolbased telemedicine program out of Charleston , S.C. - Republican politicians generally like telemedicine - HHS Secretary Tom Price calls it an "exciting innovation .'' But the 26 percent cut to Medicaid planned by the administration and Congress for the next decade would deplete the funds that dozens of states are drawing on to make public schools a place of healin g for kids . FIRST FROM MORNING EHEAL TH : ONC is taking a step toward fulfilling the 2 1st Century Cures Act section that aims to expedite interoperabi lity . The agency has announced a July 24 meeting to start developing common rules for providers to electronically share infonna tion with each other, ONC officials tell David. Cures gives ONC until the end of the yea r to publish the "trusted exchange framework ," a set ofterms and conditions for health information exchange. The hope is that with these rules establi shed, provjders will experience less friction around sharing patient data . ONC has been worki ng with groups like the Sequoia Project , the CommonWell Health Alliance and Direct Trust, and hopes to help fill jn the gaps that separate those and other networks. More for Pros here . Tweet of the Day: Andy Slavitt @ASlavitt The free press, hope for checks & balances , and your AMERICAr-... pVERSIGHT VA-19-0799-G-000682 D8_00021398 right to call people names. Donald Ttump Jr . @DonaldJTrumpJr Out of curios ity, w hat exactly are Bi g Govt, opp rre ssive taxation , anti 2A left wing socia lists celebrating today ? Welcome to Monday morning eHealth , wh ere we can hear fireworks from the Mall and we're sure that at least one of them was set off in honor of press fi-eedom. Send your stories to aallen@pol itico.co01 , or engage via Twitter @David Pittman , @athurallen202 , @DariusTahir , @POLITICOPro , @Morning eHealth . NO FLOOR SCHEDULE YET FOR USER FEE REAUTHORIZATION - House Energy and Commerce Chairman Greg Walden told Pro's Prescription Pulse the House will co nside r the package 11soo n, 11 desp ite missing the bipartisan , selfim posed deadline to pass it before Congress left for the Jul y Fourth recess ... Aides for Senate Majority Leader Mitch McConnell and House Majorit y Leader Kevin McCarthy also said there's no time schedu led for the bill to hit the floor in either chamber . ... If a deal is not reached short ly, the FDA w ill be forced to begin send in g out la yoff notices on Aug. 1. SWEET RELIEF:A bipartisan group of lawmakers led by Texas Rep .~(b) (6) introduced a bill Friday aimed at easing meaningful use require ments for doctors and hospitals. The simple one-paragraph bill (H.R . 3120) elimin ates part of a sentence in the 2009 HITECH Act that requires the HH S secretary to create "more stringent measures of meaningful use 11 over time . Sponsors, includi ng Burgess , and Re ps. Debbie Dingell , Pat Tiberi and Mike Thompson called the change 'lcornmon sense .'' "Electro nic health records place an enormous burden on phys icians, and have fa iled to live up to their prom ise to imp rove health care delivery for patients ," Burgess , chainnan of the Energy and Commerce's hea lth subcommittee , said in a release . "Unfortu nately, current law places an arbit rary req uir ement on the secreta ry of Hea lth and Human Services to impose an inc reasingly stringent burden on phys icians' use of these records systems ." N EWS FROM THE VA IT WARS- Sen. Ted Cruz last week introduced the VA Information Technology Restructuring Act , which would create a Chief Information Ofiicer po sition within the Veterans Health Administration. The bill is backed AMERICAr-... pVERSIGHT VA-19-0799-G-000683 D8_00021399 by a Koch-sponsored vets group, Concerned Veterans for America , which said it would help the VA make better tech decisions . But VA insiders say creating such a position is unnecessary and potentially counterproductive . Fo r the past two years, the VA's Offic e of Inform ation and Technology has had "IT accoun t man agers" at each VA division including the Veterans Health Administra tion. The point of this was to streamline lT functions and avoid duplication in spending and plannin g, one senior official told us. - POLITICO's Nancy Scola had this story about Jared Kushner's Office of American Im10vation, including an administration official's claim that Kushner played a key role in VA Secretary Da vid Shulkin's decision to skirt the bidding process and choose a Cemer system like the one the DoD is installing . Interestingly , a month ago an aide to Kushner told us his office hadn't influenced Shulkin's choice. - Here's one consultant's take on Shulki n's decision to go with a sole-source contrac t. - VISTA-GENERATED DATA- which bas brought us discove ries such as Vioxx's link to heart attacks - continues to provide important evidence . A study mtbe British Medical Journal , based on an examination of 3.5 million VA medical records, showed that prescription strength proton-pump inhib itors - heartburn drugs--are associated with a potential 25 percent increased risk of early death. The study did not examine over-the-co unter protonpump inhibitors . "The VA has the largest integrated electronic medical record system in the world," lead author Zlyad Al-Aly of Washington University in St. Louis told CNN . "This enabl ed us to look at a large number of patient s and follow them up for about six years to examine our research questions ." - AND A NEW VA SCANDAL: VA officials are warning that a fledgling effort to digitally track medical equipm ent is in danger of "catastrophic failure ," according to a report in the Austin American-Statesman. It quotes VA officia ls worried last year that tbe department's $543 mil.lion contract with Hewlett-Packard Enterpri se Services to implement a real-tim e locating system was careening off the rails. Tbe system, which consists of tagging and wire lessly tracking everythi ng from catheters to hospital beds, has been hailed as a way AMERICAr-... pVERSIGHT VA-19-0799-G-000684 D8_00021400 to potentially save millions of dollars in lost or misplaced equipment. Read all about it here . NBS GETS WRIST SLAP O VER GOOGLE LNTR USION: The EU Information Commissioner's Office on Monday ordered a National Health Service hospital in the UK. to change how it handJes patient data after it failed to comply with data protection law in a trial of an app developed by Google . The Royal Free NHS Foundation Trust provided personal data of around 1.6 million patients to Google's AI division DeepMind . The hospital shared the data to test a system for managing acute kidney injmy The investigation found that patients were not adequate ly informed that their data would be used as part of the test. Pros can read mote here. STU DY PITS OTC, CONVENT IONAL BEARING AIDS : The report in JAMA by scientists at Johns Hopkins School of Medicine compared five of the cheaper devices , which cost from $30 to $350, to a conventional hearing aid costing $1,910 among 42 adults with mild to moderate hearing loss. Three of the five cheaper devices provided improvements in speech understanding similar to that of the hearing aid; one demonstrated litt le improvement , and speech understanding was worse with the fifth. Sen. Elizabeth Warren has championed legislation to enable FDA regulation of the inexpensi ve hearing aids, but the biJl got stuck in a controversy with gun lovers who say it could impinge on their right to use silencers . FREE T HE, DAT A : The drug and medical device s industries paid $8. 18 billion to doctors and hospitals in 2016 , just slightly above the previous year, according to new CMS data released late last week. Nearly 1,500 companies made payments to more than 630,000 physicians and 1,146 teaching hospitals according to the Open Payments data . Nearly half of the dollar amount - $4.36 billion was for research. Another $2.8 billion went towards a variety of "general" uses, according to CMS, including consulting, speaking fees , travel and lodging and royalty and licensing fees . The remaining $1.02 billion went to physicians with an ownership or investment interest in a drug or device company. AMERICAr-... pVERSIGHT VA-19-0799-G-000685 D8_00021401 MATCH MIXUP: The American Health Information Management Association and Integrating the Healthcare Enterprise (Ilffi) are seeking public comment on a collaborative white paper detailing requirements and constraints for patient demographic data exchange and aggregation . The paper was developed by the IHE Patient Care Coordination Committee and the AHIMA Standards Task Force. Meanwhile ... Check out this Pew data visualization on the risk of patient matching errors. EPIC NO-SHOW IN WISCONSIN: Wisconsin's Department of Health Services has chosen Cemer for a major I O-year, $33 million contract to handle records for state-run mental hospitals and other facilities. Hometown hero Epic was not among the five bidders that bid for the project. Ep ic had no comment on the news . WHAT WE'RE CLICKING: NYTimes : When ransornware isn't after a ransom ProPublica's take on CMS withholding of Medicare Advantage data Time profiles Epic's Judy Faulkner KPMG on doctors' readiness for J\IIACRA Health Data Management : digital disruption is already happening GE's Mark Segal~Don't call EHR typing "desk work" - it's part of the clinic JAMA: Genomic medicine still lacks a good evidence base , says CDC leader MedCityNew s: How groups are helping patients get their records To 1 iew online : http:/ /www .politico .com/tipsheets/momingeheal th/201 7/07 /05/telemedi cine-in-the-schools-fornow-221161 To change your alert settings, please go to h ttps: //secure. politico.com/settings/settings AMERICAN PVERSIGHT VA-19-0799-G-000686 DS_00021402 PO ITICO This email was sent t~(b) (6) by: POLITICO, LLC 1000 Wilson Bl vd. Arlington , VA, 22209, USA Please click here and follow the steps to unsubscribe. AMERICAN PVERSIGHT VA-19-0799-G-000687 DS 00021403 Message Poonam Alaigh I(b) (6) @hotmail.com] 7/6/2017 8!38:00 AM David ShuIkin (drshulk in@aol.com] Re: POLITICO'sMorning eHealth : Telemedicine in the schools (for now) - ONC moves to speed interoperability Tales from VistA land From: Sent : To: Subject: Yes- this is what Bruce has been speaking to us about- should we try to get a call with them toda y or tomorrow - I am leaving tomorrow evening so won't be available over the weekend unless you want to talk to them- we needed to get caught up but don't know that we will have time Sent from my iPhone On Jul 5, 2017, at 7:40 PM David Shulkin wrote: See the Iast story We should get ready for the rebuttal Sent from my iPad Begin forwarded message: (b) (6) From: (b) (6) ~ Date: July 5, 2017 at 11:22:27 AM EDT To: Dad Subject: Fwd: POLITICO's Morning eHealth: Telemedicioe in the schools from VistA land (for now) - ONC moves to speed interoperability-Tales NEWS FROM THE VA IT WARS - Sen. Ted Cruz las t week introduced tbe VA Information Technology Restructuring Act, which would create a Chief Infonnation Officer position within the Veterans Health Administration. The bill is.backed by a Koch-sponsored vets group, Concerned Veterans for America, which said it would help the VA make better tech decisions. But VA insiders say creating such a position is unnecessary and potentially counterproductive . For the past two years, the VA's Office of Information and Technology has had "IT account managers" at each VA division including the Veterans Health Administration. The point of this was to streamJine IT functions and avoid duplication in spending and planning , one senior official told us . -PO LITIC O's Nancy Scola had this story about Jared Kushner's Office of American Innovation, including an administration official's claim that Kushner played a key role in VA Secretary David Shulkin's decision to skirt the bidding process and choose a Cemer system like the one the DoD is installing . Interestingly, a month ago an aide to Kushner told us his office hadn't infl uenced Shulkin's choice. - Here's one consultant's take on Shullcin's. decision to go with a sole-source contract. AMERICAN PVERSIGHT VA-19-0799-G-000688 DS_00021404 - VISTA-GENERATED DATA - which bas brought us discoveties such as Vioxx's link to heart attacks - continues to provide important evidence . A studv in the British Medical Journal , based on an examination of 3.5 million VA medical re cords, showed that prescription strengt h proton-pump inhibitors heartburn drug s--are associated with a potential 25 percent increase d risk of early death. The study did not exam ine over -the-counter proton-pump inhibitors. "The VA has the largest integrated electronic medi cal record system in the world, " lead author Ziyad Al-Aly of Washington University in St. Louis told CNN. "This enabled us to look at a large number of patients and follow them up for about six years to examine our research questions." - AND A NEW VA SCANDAL : VA officials are warnjng that a fledgling effort to digitally track medical equipment is in danger of "catastrophic failure, 11 according to a report in the Austin American-Sta tesman. It quotes VA officia ls worried last year that the department's $543 million contract with HewlettPacka rd Enterprise Services to implement a real-tim e lo cating system was careening off the rails . Tbe system, w hich consjsts of tagging and wirelessly tracking everything from catheters to hospital beds, has been hailed as a way to potentially save millions of dollars in lost or misplaced equipment. Read all about it here. Sent from my iPhone Begin forwarded message : From: "Mornjng eHealth " Date: July 5, 20 17 at 10:07:03 AME DT To:~(b) (6) Subject: POLITICO's Morning eHealth: Telemedicine in the schools (for now)- . ONC moves to speed interoperabi]ityTales from VistA land Reply-To: "POLITI CO subscriptions" <~ fe8312777d6106757d-630302 HTML-778973872-13763190@politicoemail.com > B y Arthur Allen I 07/05/20 1710 :01 AM EDT With help from David Piuman and Darius Tahir GOP LIKES TELE.MEDICINEIN THE SCROOLS; THE PRICETAG- NOT SO MUCH : One of the unjnt ended effects of the Senate's Obam acare repeal bill would be to slash money that pays for school nurses to use telemedicine that connects sick kids to medical experts, our David Pittman reports. In poor and rnral areas, many of them in reddest Trump Country , the school nurse js not just handin g out bandaids anymore: she's become a de facto medical guide, marshalling health care for poor kids with obesity, asthma and diabetes , while on the looko ut for issues like child abuse and teen pregnancy, David reports in this story . AMERICAr-... pVERSIGHT VA-19-0799-G-000689 D8_00021405 "In many of our situations ... the school nmse is the onJy health care provider a child ever sees," said Kelli Marie Garber, who runs a growing school-based telemedicine prog ram out of Charleston , S.C - Republican politicians generally like telemedicine - HHS Secretary Tom Price calls it an "exciting innovatio n." But the 26 percent cut to Medicaid planned by the administration and Congress for the next decade wou ld deplete the funds that dozens of states are drawing on to make public schoo ls a place of healing for kids . FIRST FROM MORNING EHEAL TH: ONC is taking a step toward fulfilling the 21st Century Cures Act section that aims to expedite interoperabi lity. The agency has announced a July 24 meeting to start developing common rules for providers to electronica lly share infomrntio n with each other, ONC officials teJl David. Cures gives ONC until the end of the year to publish the "trusted exchange framework," a set of terms and conditions for health information exchange. The hope is that with these rules established, providers will exper ience less friction around sharing patient data . ONC has been working with groups like the Sequo ia Project, the Common Well Health Alliance and Direct Trust, and hopes to help fill in the gaps that separate those and other networks . More for Pros here. Tweet of the Day : Andy Slavitt @ASla vitt The free press, hope for checks & balances, and your right to call people names . D onald Trump Jr. @DonaldJTrumpJr Out of curiosity, what exactly are Big Govt , oppITessive taxation , anti 2A left wing socialists celebrating today? Welcome to Monday morning eHealth, where we can hear fireworks from the Mall and we're sure that at least one of them was set off in honor of press freedom. Send your stories to aallen(a),politico.com, or engage via Twitter @David Pittman , @athurallen202 , @DariusTahir , @POLITICOPro , @Morning eHealth . NO FLOOR SCHEDULE YET FOR USER FEE REAUTHORIZATION -House Energy and Commerce Chairman Greg Walden told Pro's Prescription Pulse the House will consider the package "soon ," despite missing the bipartisan, self-imposed deadline to pass it before Congress left for the July Fourth recess ... Aides for Senate Majority Lea der Mitch McConnell and House Majority Leader Kevin McCarthy also said there's no time schedul ed for the bill to hit the floor in eithe r chan1ber. ... If a deal is not reached shortly, the FDA will be forced to begin sending out layoff notices on Aug. 1. SWEET RELIEF: A bipartisan group oflawmakers led by Texas Rep .~(b) (6) introduced a bill Friday aimed at easi ng AMERICAr-... pVERSIGHT VA-19-0799-G-000690 D8_00021406 meaningful use requirements for doctors and hospitals . The sim ple one-paragraph bill (HR. 3120) eliminates part of a sentence in the 2009 HlTECH Act that requires the HH S secretary to create "more stringent measures of meaningful use'' over time . Sponsors, including Burgess, and Reps . Debbie Dingell , Pat Tiberi and Mike Thompson called the change "common sense." "Electronic health records place an enormous burden on physicians , and have failed to live up to their promise to improve health care delivery for patients," Burgess, chairman of the Energy and Commerce's health subcommittee, said in a release. "Unfortunately , current law places an arbitrary requirement on the secretary of Health and Human Services to impose an increasing ly stringent burden on physicians' use of these records systems." NEWS FROM THE VA IT WARS - Sen. Ted Cruz last week introduced the VA Information Technology Restructuring Act, wh ich would create a Chief Information Officer position within the Veterans Health Administration. The bill is backed by a Kochsponsored vets grou p, Concerned Veterans for America, whic h said it would help the VA make better tech decisions. But VA insiders say creating such a po sition is unnecessary and potentially counterprod uctive . For the past two years, the VA's Office of Infomiati on and Techno logy has had "IT account managers" at each VA division including the Veterans Health Administration. The point of this was to streamline IT functions and avoid duplication in spending and planning, one senior official told us . - POLITICO's Nancy Scola had this story about Jared Kushner's Office of American Innovation , including an administration official' s claim that Kushner played a key role in VA Secretary David Shulkin's decision to skirt the bidding process and choose a Cerner system like the one tbe DoD is installing. Interestingly, a month ago an aide to Kushner told us his office hadn't influenced Shulkin's choice. - Here's one consultant's take on Shulkin's decision to go with a soJe-source contract. - VISTA-GENERATED DATA - which has brought us discoveries such as Vioxx's link to heart attacks - continues to provide important evidence . A study in the British Medical Journal , based on an examination of 3.5 million VA medical records, showed that prescription strength proton-pump inhibitors heartburn drugs-~are associated with a potential 25 percent increased risk of early death . The study did not examine over-thecounter proton-pump inhibitors. "The VA has the largest integrated electronic medical record system in the world," lead author Zjyad Al-AJy of Washington University in St. Louis told CNN . "This enabled us to look at a la rge number of patients and follow them up for about six yea rs to exam ine our research questions ." AMERICAr-... pVERSIGHT VA-19-0799-G-000691 D8_00021407 - AND A NEW VA SCANDAL : VA officials are warning that a fledgling effort to digitally track medical equipment is in danger of 11 catastrophic failure ," according to a report in the Austin American-Statesman. It quotes VA officia ls worried last year that the department's $543 million contrac t with Hewlett-Packard Enterprise Services to impl ement a real-tim e locatjng system was careenjng off the rails. The system , whic h consists of tagging and wirelessly tracking everyth ing from catheters to hospita l beds, has been hailed as a way to potentially save millions of dollars in lost or misplaced equipment. Read all about it here , NHS GETS WRJST SLAP OVER GOOGLE lNTRUSION: The EU Informatio n Commissione r's Office on Monday ordered a National Health Service hospital in the U.K . to change how it hand les patient data after it failed to comply with data protection law in a trial of an app developed by Google. The Royal Free NHS Foundat ion Trust prov ided personal data of around 1.6 million patients to Google's AI division DeepMind . The hospita l shared the data to test a system for managing acute kidney injury . The invest igation found that patients were not adequate ly informed that their data wou ld be used as part of the test. Pros can read more here . STUDY PITS OTC, CONVENTIONAL HEARING AIDS : The report in JAMA by scientists at Johns Hopkins School of Medicine compared five of the cheaper device s, which cost from $30 to $350, to a conventiona l hearing aid costing $1,910 among 42 adults with mild to moderate hearing loss. Three of the five cheaper devices prov ided improvements in speech understanding similar to that of the heari ng aid; one demonstrated little improvement , and speech under standing was worse with the fifth . Sen. Elizabeth Warren bas championed legislation to enable FDA regulation of the inexpensive hearing ruds, but the bi)I got stuck in a controversy with gun lovers who say it could impinge on their right to use silencers. FREE THE DATA: The drug and medical devices industii es paid $8. 18 billion to doctors and hospitals in 2016, just slightly above the previous year, according to new CMS data released late last week, Nearly 1,500 compan ies made payments to more than 630,000 physicians and 1,146 teaching hospitals according to the Open Payments data . Near ly half of the dollar amount - $4.36 billion - was for research . Another $2.8 billion went towards a varie ty of "general" uses, according to CMS, including consulting , speaking fees, travel and lodging and roya lty and licensing fees. The remruning $1.02 billion went to physicians with an ownersh ip or investment interest in a drug or device company. MATCH MJXUP: The American Health Infonnation Management Association and Integrating the Healthcare Enterprise (IlIE) are seeking pub lic comment on a collaborat ive white paper detai ling requ irements and constrai nts for patient demographic AMERICAr-... pVERSIGHT VA-19-0799-G-000692 D8_00021408 data exchange and aggregation . The paper was developed by the 1HE Patient Care Coorclination Committee and the AlilMA Standards Task Force. Meanwhile ... Check out this Pew data visualization on the risk of patient matcrung errors " EPIC NO-SHOW IN WISCONSIN: Wisconsin's Department of Health Services has chosen Cerner for a major 10-year, $33 million contract to handle records for state-run mental hospitals and other facilities . Hometown hero Epic was not among the five bidders that bid for the project. Epic had no comment on the news . WHAT WE'RE CLICKING: NYTimes: When ransomware isn't after a ransom ProPublica's take on CMS withholding of Medicare Advantage data Time profiles Epids Judy Faulkner KPMG on doctors' readiness for MACRA Health Data Management : digital disruption is already happening GE's Mark Segal: Don't caJI EHR typing "desk work" - it's part of the clinic JAMA : Genomic medicine still lacks a good evidence base, says CDC leader MedCityNews : How groups are helping patients get their records To view online : http :/ /www .politico .com/tipsheets/morni ngehealth/201 7/07 /0 5/telemedicine-in-the-school s-for-now-22116 1 To change your alert settings, please go to https: //secure.politico.com/settings/settings POLTICO This email was sent to~(b) (6) by : POLITICO, LLC 1000 Wilson Blvd. Arlington, VA, 22209 , USA Please click here and follow the steps to unsubscribe. AMERICAN PVERSIGHT VA-19-0799-G-000693 DS_00021409 Message From: David Shulkin (drshulk 1n@aol.com) Sent : 7/5/2017 11:40 :05 PM To : Poonam Alaigh I(b) (6) @hotmail.com] Fwd: POLITICO'sMorning eHealth : Telemedicine in the schools (for now) - ONC moves to speed interoperability Tales from VistA land Subject: - See the last story We should get ready for the rebuttal Sent from my iPad Begin forwarded message : (b) (6) From: (b) (6) ~ Date: July 5, 2017 at 11 :22:27 AM EDT To: Dad Subject: Fwd: POLJTICO's Morning eBealth: Telemedicine in the schools (for now) ONC moves to speed internperability - Tales from VistA land NEWS FROM THE VA IT WARS - Sen. Ted Cruz last week introduced the VA Information Technology Restructuring Act_, which would create a Chief Information Officer position wi thin the Veterans Health Administration. The bill is backed by a Koch-sponsored vets group , Concerned Veterans for America, which said it would help the VA make better tech decisions . But VA insiders say creating such a position is unnecessary and potentially counterproductive . For the past two years , the V A's Office of Info1mation and Technology has had 111T account managers" at each VA division including the Veterans Health Administration . The point of this was to streamline IT functions and avoid duplication in spending and planning , one senior official told us . -POLITICO's Nancy Scola had this storyabout Jared Kushner's Office of American Innovation , including an administration official's claim that Kushner played a key role in VA Secretary David Shulkin's decision to skirt the bidding process and choose a Cemer system like the one the DoD is instaUing . Interestingly , a month ago an aide to Kushner told us his office hadn't influenced Shulkin's choice . - Here's one consultant's take on Shulkin's decision to go with a sole-source contract. -VISTA-GENERATED DATA -which has brought us discoveries such as Vioxx's link to heart attacks - continues to provide important evidence . A study in the British Medical Journal , based on an examination of 3.5 million VA medical records , showed that prescription strength proton-pump inhibitors - heartburn drugs--are associated with a potential 25 percent increased risk of earJy death . The study did not examine over-the-counter proton-pump inhibitors . nThe VA has the largest integrated electronic medical record system in the world," lead author Ziyad Al-Aly of Washington University in St. Louis told CNN. "This enabled us to look at a large number of patients and follow them up for about six years to examine our research questions ." -AND A NEW VA SCANDAL: VA officials are warning that a fledgling effort to digitally track medical equipment is in danger of "catastrophic failure," accordjng to a report in the Austin AMERICAN PVERSIGHT VA-19-0799-G-000694 DS_00021410 American-Statesman . It quotes VA offic ials wo rried last year that the departm ent's $543 million contract w ith Hew lett- Packard Enterprise Services to impl ement a real-time locating system was careen ing off the rails. The system, which consists of tagging and wireless ly tracki ng every thin g from cath eters to ho spital beds , has been hailed as a way to potential ly save millions of dollars in lost or misplaced equipment. Read all about it here . Sent from my iPhone Begin forwarded message : From: "Morning eHea lth " Date: July 5, 2017 at 10:07:0 3 AM EDT To:~ (b) (6) > Subject : POLITICO's Morning eHealth : Telemedicine in the schools (for now) - ONC moves to speed interoperability-Tales from VistA land Reply-To: "POLITI CO subscriptions" By Arthur Allen I 07/05/2017 10:01 AM EDT With helpfrom David Pittman and Darius Tahir GOP LrKEs TELEMEDICINE lN THE SCHOOLS; THE PRICETAG NOT SO MUCH : One of the unint ended effects of the Senate's Obamacare repeal bill would be to slas h money that pays for sc hool nu rses to use telemedicine that connects sick kjds to medical experts, our David Pittm an reports. In poor and rural areas, man y of them in reddest Trump Country, the scho ol nurse is not just handin g out bandaids anymore: she's become a de facto medical guide, mar shallin g health care for poor kids with obesity, asthma and diabetes , while on the lookout for issues lik e chil d abuse and teen pregnancy , David reports in this story. "In many of our situations ... the school nu rse is the only health care provider a child ever sees, " said Kelli Marie Garber , who runs a grow ing school-ba sed telemedicine progra m out of Charle ston, S.C. - Republican politicians genera lly like telemedi cine - HH S Secretary Tom Prjce calls it an "exciting inn ovation ." But the 26 p ercent cut to Medicaid planned by the administration and Congress for the next decade wo uld deplet e the funds that dozens of states are drawing on to mak e public schools a place of healing for kids . FCRST FROM MORNING EB.EAL TH: ONC is takjng a step towa rd fulfiJling the 2 1st Cent ury Cures Act sect ion tha t aims to expedite interopera bili ty. The agency bas announc ed a Jul y 24 m eeting to sta11 developing common rules for providers to electronjcally share informa tion wit h each other, ONC officia ls tell David. Cures gives ONC until the end of the year to publish the "tms ted exchange framewo rk," a set of term s and conditions for health information exchange . The hope is that with these rules established, prov iders will experience less friction around sharing patient data . ONC has been working with groups like the Sequoia Project, the Corn.monWelJ HeaJth Alliance aod Di rect Trust , and hopes to help fill in the gaps that separat e those and other networks . More for Pros here . AMERICAf\ pVERSIGHT VA-19-0799-G-000695 D8_00021411 Tweet of the Day: Andy Slavitt @ASlavitt The free press , hope for checks & balances, and your right to call people names . Donald Trump Jr. @DonaldJTrumpJr Out of curiosity, what ex actly are Big Govt, opprressive taxation, anti 2A left wing socialists celebrating today? Welcome to Monday morning eHeaJth, where we can hear fireworks from the Mall and we're sure that at least one of them was set off in honor of press freedom . Send your stories to aa11en@politico.com , or engage via Twitter @David Pjttman . @atburallen202 , @DariusTahir , @POLITICOPro , @Morning eHealth . NO FLOOR SCHEDULE YET FOR USER FEE REAUTHORIZATION House Energy and Commerce Chainnan Greg Walden told Pro's Prescription Pulse the House will conside r the package "soon," despite missing the bipartisan , self-imposed deadline to pass it before Congress left for the July Fou11h recess ... Aides for Senate Majority Leader Mitch McConnell and House Majority Leader Kevin McCarthy also said there's no time scheduled for the bill to hit the floor in either chamber . ... If a deal is not reached shortly, tl1eFDA will be forced to begin sending out layoff notices on Aug. 1. SWEET RELIEF: A bipartisan group of lawmakers led by Texas Rep. -(b) (6) Burgess introduced a bill Frida y aimed at easing meaningful use requirements for doctor s and hospitals . The simple one-paragraph bill (HR. 3120) eliminates part of a sentence in the 2009 HITECH Act that requires the HHS secretary to create "more stringent measures of meaningful use" over time. Sponsors , including Burgess , and Reps. Debbie Dingell , Pat Tiberi and Mike Thompson called the change "common sense." "Electronic health records place an enormous burden on physicians , and have failed to live up to their promise to improve health care delivery for patients ," Burgess , chairman of the Energy and Commerce's health subcommittee , said in a release. "Unfortunately , current law places an arbitrary requirement on the secretary of Health and Human Services to impose an increasingl y stringent burden on physicians' use of these records systems." NEWS FROM THE VA IT WARS - Sen. Ted Cruz last week introduced the VA Information Technology Restructuring Act, which would create a Chief lnfonnati on Ofttcer posit-ion within the Veterans Health Administration. The bill is backed by a Koch-sponsored vets group, Concerned Veterans for America, which said it wou ld help the VA make better tech decisions . But VA insiders say creating such a position is unnecessary and potentially counterproductive . For the past two years, the VA's Office of Jnform.ation and Technology has had "IT account manager s" at each VA division including the Veteran s Health Administration . The point of this was to streamline IT functions and avoid duplication in spending and planning , one senior officia l told us. - POLITICO's Nancy Scola had this story about Jared Kushner 's Office of American Innovation , including an administration officia l's claim that Kushner played a key role in VA Secretary David Shulkin's decision to skirt the bidding process and choose a Cerner system like the one the DoD is installing. Interestingly , a month ago an aide to Kushner told us his office hadn't influenced Shulkin's choice. AMERICAr-... pVERSIGHT VA-19-0799-G-000696 D8_00021412 - Here's one consultant's take on Shulk.in's decision to go with a sole-sou rce contract. - VlSTA-GENERA TED DA TA - which has brought us discoveries such as Vioxx's link to heart attacks - continues to provide important evidence . A study in the British Medical Journal , based on an examination of 3.5 million VA medical records, showed that prescription strength proton-pump inhibitors -heartburn drugs--are associate d with a potential 25 percent increased risk of early death. The study did not examine over-the-counter proton-pump inhibitors. "The VA has the largest integrated electronic medical record system in the world," lead author Zjyad Al-Aly of Washington University ju SL Lows told CNN , "This enabled us to look at a large number of patients and follow them up for about six years to examine our research questions." -AND A NEW VA SCANDAL : VA officia ls are warning that a fledgling effort to digitally track medical eqwpment is in danger of "catastrophic failure," according to a report in the Austin American-Statesman . It quotes VA officials worried last year that the department's $543 million contract with HewlettPackard Enterprise Services to implement a rea l-time locating system was careening off the rails. The system, which consists of taggi ng and wirelessly tracking everyth ing from catheters to hospital beds , has been hailed as a way to potentially save millions of dollars in lost or misplaced equipment. Read all about it here . NHS GETS WRIST SLAP OV ER GOOGLE INTRUSIO N : The EU Information Commissioner's Office on Monday ordered a Nationa l Health Service hospital in the U.K. to change how it handles patient data after it failed to comply with data protection law in a trial of an app developed by Google. The Royal Free NHS Foundation Trust provided personal data of around 1.6 million patients to Google's Al division DeepMind. The hospital shared the data to test a system for managing acute kidney injury. The investigation found that patients were not adequately informed that their data would be used as part of the test. Pros can read more here. STUDY PITS OTC , CONVENTIONAL HEARING AIDS : The report in JAMA by scientists at Johns Hopkins School of Medicine compared five of the cheaper devices , which cost from $30 to $350, to a conventiona l bearing aid costing $ 1,910 among 42 adults with mild to moderate hearing loss. Three of the five cheaper devices provided improvements in speech understa nding similar to that of the hearing aid; one demonstrated little improveme nt, and speech understanding was worse with the fifth. Sen. Elizabeth Wan·en has championed legislation to enable FDA regulation of the inexpensive bearing aids, but the bill got stuck in a controversy with gun lovers who say it could impinge on their right to use silencers . FREE THE DATA : The drug and medical devices industries paid $8. 18 billion to doctors and hospitals in 20 16, just slightly above the prev ious year, according to new CMS data released late last week. Nearly 1,500 companies made payments to more than 630,000 physicians and 1, 146 teaching hospitals according to the Open Payments data . Near ly half of the dollar amount - $4.36 billion - was for research. Another $2.8 billion went towards a variety of "general" uses, according to CMS, including consulting , speaking fees, travel and lodging and royalty and AMERICAf\ pVERSIGHT VA-19-0799-G-000697 D8_00021413 Licensingfees. The remaining $1.02 billion went to physicians with an ownership or investment interest in a drug or device company . MA TCB MIXUP: The American Health Information Management Association and Integrating the Healthcare Enterprise (Ilffi) are seeking public comment on a collaborative white paper detailing requirements and constraints for patient demographic data exchange and aggregation. The paper was developed by the IHE Patient Care Coordination Committee and the AHIMA Standards Task Force . Meanwhile ... Check out thjs Pew data visualization on the risk of patient matching errors. EPIC NO-SHOW IN WISCONSIN: Wisconsin's Department of Health Services has chosen Cerner for a major 10-year, $33 million contract to handle records for state-run mental hospitals and other facilities. Hometown hero Epic was not among the five bidders that bid for the project. Epic had no comment on the news. WHAT WE'RE CLICKING: NYTimes : When ransomware isn't after a ransom ProPublica's take on CMS withholding of Medicare Advantage data Time profiles Epic's Judy Faulkner KPMGon doctors' readiness for MACRA Health Data Management: digital disruption is already happening GE's Mark Segal: Don't call EHR typing 11desk work 11 - it's part of the clinic JAMA : Genomic medjcine still lacks a good evidence base , says CDC leader MedCityNews : How groups are helping patients get their records To view online: http} /www .politico .com/tipsbeets/morning-ehealth/2017 /07 /05/telemedicine-inthe-schools-for-now-221161 To change your alert setti11gs,please go to https://secure.politico.com/settings/settings PO ITICO This email was sent t~(b) (6) Arlington, VA, 22209, USA by: POLITICO , LLC I 000 Wilson Blvd . Please click here and foUow the steps to unsubscribe. AMERICAN PVERSIGHT VA-19-0799-G-000698 DS_00021414 Message From: Darin Selnick (b) (6) Sent : 6/28/2017 12:30:48 AM To; David shulkin [Drshulkin@aol.comJ Fwd: Trump's breakthrough for veterans Subject: @gmail.com] I Fox News (VA op-ed by Newt) FYI - Good article from Newt on you. Darin http://www .foxnews .com/opi nion/2017 /06/27 /trumps-breakthrough-for veterans. html ?utm source=Gi n gri ch+Producti ons+ Li st& utm campaign= I 83dfb4ca8 trum pva 2017 06 27&utm medium =email&utm tenn =0 bd29bdc370-183dfb4ca8-51242337 One of President Trump's most important promises throughout the campaign was to ensure that American veterans receive tbe respect and care tbey deserve , Just months into his presidency, this is a promise on which he has delivered . First, the president's decision to nominate Dr. David Shulkin as secretary of Veterans Affairs was critical. During his earliest days in office, I observed President Trump meticulously vet and rule out dozens of people for the posL He knew the VA was gigantic and deeply flawed , and be needed someone extremely competent to tun the organization - someone who could wrangle the entrenched bu reaucracy without being swallowed by it. That is what led President Trump to choose ShuJkin. Let this sink in for a moment: Before President Trump took office, it was nearly impossible to fire a had VA employee. Unde,pe1:forming VA employees got bonuses. And el.ecutives who had been disciplined in the past 0 received.full pen ion benefits. Jl1e 1:4 had become a scandal -laden, bureaucratic void. In just five months, Shulkin has helped imp lement a VA Office of Accountability and Whistleblower Protection, created a website to track and publish wait times at every VA hospital, drastically increased mental health services across the system, and developed a way to electronically transfer veterans' medical records from the Department of Defense to the VA to simplify their transition from service to civilian life . Each one of these accomplishments is remarkable . But for President Trump and Secretary ShuJkin, these achievements were merely the starting point. AMERICAN PVERSIGHT VA-19-0799-G-000700 DS_00021416 On Friday , President Trump signed the Veterans Accountability and Wbistleblower Protection Act, which is the next great breakthrough for VA reform. This legislation gives Secretary Shulk:in the authority he needs to properly deal with or fire VA employees who fail to do their job s. The law shortens a years-long appeals process for disciplined employees and ensures that such employees will not be paid during disciplinary appeals . It also allows Shulkin to deny bonuses to underpetfonning employees and cut pensions for executives who misbehave . Under the law, VA employees who report misconduct within the organization will be protected from retaliation . Let this sink in for a moment: Before President Trump took office and worked with the House of Representatives and the Senate to pass this bipartisan law, it was neatl y impossible to fire a bad VA employee. Underperforming VA employees got bonuses. And executives who had been disciplined in the past received full pension benefits . The VA had become a scandal-laden, bureaucratic void, and only a few members of Congress were trying to do anything about it. But this is no longer the case. As President Trump said before signing the law, these refonns are only the beginning, and "we will not rest until the job is 100 percent complete for our great veterans .'' While President Trump has been the main driver of this push to refonn the VA, Speaker Paul Ryan and members of the House and Senate Veterans Affairs Committees deserve credit as well. Prior to Trump taking office, they had been working diligently to cure the ailments of the VA but did not have the support they needed from the previou s administration. As Speaker Ryan said on June 21 before Congress sent the bill to President Trump's desk, "We all saw the scandals at the VA. We need to make sure something like this never happens again, and that the veterans get the care and treatment that they deserve , that they have earned ." Now, with the support of President Tnimp and Secretary Shulkin, this is not only possible but as Shulkin said earlier this month at a Christian Science Monitor breakfast , such change at the VA would also come quickly. He said, "that slow and incremental steady change isn't what this organization needs . That what we need is bolder, fundamental change dealing with the issues that frankly are really hard to deal with and that go back decades . That means, by definition , we are going to have to take greater risk . That is part of what [President Tnimp] has asked us to do." AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000701 DS 00021417 This law is a pe1fect example of how President Trump can make the government work - something I discuss in my #1 New York Times bestselling new book , "Understanding Trump . 11 The VA might be the most visible example of federal incompetence , but the President has a great opportunity to work with Congress on reforms similar to the Veterans Accountability and Whistleblower Protection Act to cut waste at the Department of Defense , help eliminate fraud in Medicaid and Medicare, and begin reforming the entire federal civil service. Finally , in addition to the substance of the Veterans Accountability Law , I thought last Friday ' s signing ceremony clearly demonstrated how direly needed these reforms were. President Trump and Secretary Shulkin introduced U.S. Army Sergeant-(b) (6) Verardo, who lost a leg and an arm in Afghanistan after being deployed in 2010 with the 82nd Airborne Division . Verardo w1derwent 110 surgeries and years of therapy to overcome his wounds . And despite his injuries, he was fortunate . Secretary Shulkin said Friday that 37 other men with whom Verardo had been deployed did not return from their missions. Still, Verardo came home to what he called "a broken VA system." Upo n transitioning from the Department of Defense to the VA system, Verardo constantly battled bureaucracy . He once had to wait 57 days to get his prosthetic leg repaired . It took three-and-a-half years for the VA to properly outfit his home with accessibility equipment. During his brief speech at the signing ceremony, he described a situation where he bad to make a three-hour round trip to a VA facility, so doctors there could make sure he still had his " sedous combat injuries '' - remember he lost two limbs . As Secretary Shulk:in said, "the VA failed -(b) (6) After five months in office, President Trump has done exactly what he promised and is dismantling and refonning this abysmal VA system to ensure that no other veteran has an experience similar to Sergeant Verardo ' s. The years of corruption at the VA are over, and once again, protecting the lives of vetera ns, not the jobs of bureaucrats, is the priority . Sent from my iPhone AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000702 DS 00021418 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 8/12/2017 1:11:25 AM To: (b) (6) Poonam Alaigh [-@hot Re: Monday Subject: Oh it not necessary mail.com] for you to make a trip for that Sent from my iPhone (b) (6) > on Aug 11, 2017, at 9:09 PM, Poonam Alaigh <-@hotmail.com> wrote: > > The Baligh show and tell > > sent from my iPhone > >> On Aug 11 , 2017, at 9 :07 PM, David shulkin >> >> Im not sure what meeting you are referring wrote : to ? >> >> sent from my iPhone >> (b) (6) >>> on Aug 11 , 2017, at 8:16 PM, Poonam Alaigh <-@hotmail.com > wrote: >>> >>> You sure you don't need me in person ? Really won't be a big problem (only a hassle ) if you think it's going to be a value add >>> >>> sent from my iPhone >>> >>>> On Aug 11 , 2017, at 7:4 8 PM, David shulkin wrote: >>>> »>> Thats fine >>>> >>>> sent from my iPhone >>>> (b) (6) . com> wrote : >>>>> on Aug 11 , 2017 , at 7:42 PM, Poonam Alaigh <-@hotmail >>>>> >>>>> I am changing my plans so I attend the care Planning meeting by phone in nj- it's only an hour and it's going to be too much going back and forth to de in one day . Most importantl y , if you are good with it , I will be too . >>>>> >>>>> But if you want me to be there in person, I will >>>>> >>>>> sent from my iPhone >>>> >> AMERICAN PVERSIGHT VA-19-0799-G-000703 OS 00021419 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 8/12/2017 1:09:27 AM To: Davidshulkin [Drshulkin@aol.com] Re: Monday Subject: The Baligh show and tell Sent from my iPhone > on Aug 11, 2017, at 9:07 PM, David shulkin wrote: > > Im not sure what meeting you are referring to ? > > sent from my iPhone > >> on Aug 11 , 2017, at 8 :16 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : >> >> You sure you don ' t need me in person ? Really won't be a big problem (only a hassle ) if you thin k it ' s going to be a value add >> >> sent from my iPhone >> >>> on Aug 11 , 2017, at 7:48 PM, David shul kin wrote : >>> >>> Thats fine >>> >>> sent from my i Phone >>> >>>> on Aug 11 , 2017, at 7:42 PM, Poonam Alaigh <-(b) (6) @hotmail.com > wrote : >>>> >>>> I am changing my plans so I attend the care Planning meeting by phone in nj - it ' s onl y an hour and it's going to be too much going bac k and forth to de in one day. Most importantly, if you are good with it , I will be too. >>>> >>>> But if you want me to be there in person , I will >>>> >>>> sent from my iPhone >>> > AMERICAN PVERSIGHT VA-19-0799-G-000704 OS 00021420 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 8/12/2017 1:07:12 AM (b) (6) Poonam Alaigh [-@hot mail.com] Re: Monday Im not sure what meeting you are referring to? Sent from my iPhone (b) (6) > on Aug 11, 2017, at 8:16 PM, Poonam Alaigh <-@hotmail.com> wrote: > > You sure you don't need me in person? Really won' t be a big problem (only a hassle ) if you think it's going to be a value add > > sent from my iPhone > >> on Aug 11, 2017 , at 7 :4 8 PM, David shulkin >> » Thats fine wrote: >> >> sent from my iPhone >> >>> on Aug 11 , 2017, at 7:42 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : >>> >>> I am changing my plans so I attend the care Planning meeting by phone in nj - it's only an hour and it's going to be too much going back and forth to de in one day. Most importantly, if you are good with it, I will be too . >>> >>> But if you want me to be there in person , I will >>> >>> sent from my iPhone >> AMERICAN PVERSIGHT VA-19-0799-G-000705 OS 00021421 Message From: Sent: To: Subject: Poonam AlaighI(b) (6) @hotmail.com] 8/12/2017 12:16:44 AM Davidshulkin [Drshulkin@aol.com] Re: Monday You sure you don't need me in person? Really won't be a big problem (only a hassle) going to be a value add if you thin k it ' s Sent from my iPhone > on Aug 11, 2017 , at 7:48 PM, David shul kin wrote: > > Thats fine > > s ent from my iPhone > (b) (6) >> on Aug 11, 2017, at 7:4 2 PM, Poonam Alaigh <-@hotmail.com > wrote: >> >> I am changing my plans so I attend the care Planning meeting by phone in nj- it's only an hour and it ' s going to be too much going bac k and forth to de in one day. Most importantly, if you are good with it, I will be too . >> >> But if you want me to be there in person , I will >> >> sent from my iPhone > AMERICAN PVERSIGHT VA-19-0799-G-000706 OS 00021422 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 8/11/2017 11:48:51 PM Poonam AlaighI(b) (6) @hotmail.com] Re: Monday Thats fine Sent from my iPhone (b) (6) > on Aug 11, 2017, at 7:42 PM, Poonam Alaigh <-@hotmail.com> wrote: > > I am changing my plans so I attend the care Planning meeting by phone in nj- it's only an hour and it's going to be too much going bac k and forth to de in one day. Most importantly, if you are good with it, I will be too . > > But if you want me to be there in person , I will > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000707 OS 00021423 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 8/11/2017 11:42:06 PM To: DavidShulkin [drshulkin@aol.com] Monday Subject: I am changing my plans so I attend the care Planning meeting by phone in nj- it's only an hour and it's going to be too much going back and forth to de in one day. Most importantly, if you are good with it, I wi 77 be too. But if you want me to be there in person, I will sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000708 OS 00021424 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 6/24/2017 8:08:43 PM To: (b) (6) -@aol.com Re: Apple project status Subject: I got it -(b) (6) thanks- ill handle Sent from my iPhone > on Jun 24, 2017, at 2:43 PM, -@aol.com (b) (6) wrote: > wanted to provide status report on the joint project w Apple. Darin called me last week to tell that Apple does not like working w Bruce. He also reported that it was his responsibility to report Reed cat the WHon Bruce activity and that I was to stay in close contact with Darin. FYI. > me to > > A call was set up this week by Apple that included me (as rep for Poonam), rob Thomas, Ricci mulligan, and 3 people from Apple. Bruce was not invited to the call. The discussion was led by Apple with Darin the most active voice from our side . A set of milestones for the project had been developed by VA for distribution to the field. Apple asked to review before distribution which has apparently now been done. Darin and Ricci wanted the names submitted to them so they could distribute to the field. That did not happen yet. That Apple call also discussed the roles of each of the three levels of participants. The last item on the Apple VA call was them noting that other issues had been raised during an in-person work session (e.g. Analytics, artificial intelligence etc - raised by VA IT). VA was asked for a list of issues of importance or need by the VA and they (apple) would begin to review and prioritize next step projects. The genomic data was not specifically discussed but when I briefed Bruce he immediately interpreted this was implied in the analytics reference and shared with me an emphatic response that this was not to be discussed again . While I am clear on the importance and value of the genomics data I am not sure that others are e.g. IT folks or possibly Darin. FYI > > Bruce reached out yesterday for Update on the names submitted by Apple and the 5 centers and we agreed to touch bases this am. I provided him the names and a brief update on the Apple call this morning > > Bruce wanted some minor edits to the participant list which has now been provided and he wanted to discuss with Ike how the list should be distributed ( by Ike, Bruce or us). That decision is pending but it is clear he wants to make certain that everyone knows who is on point to oversee this project > > He also asked that the working level document of milestones etc developed by Ricci mulligan and edited / approved by Apple not be distributed before approved by executive group . He is concerned that Apple doesn't have a good handle on this project and he wants it directed top---down so the product meets our needs and not apples. > > I advised Bruce that I had been requested by Apple to speak with them on Monday. He did not specifically ask to be included but had previously said he did not want meetings without being included. > > Bottom line - The Darin-Apple approach to this project appears to be exclusive of Bruce and is likely to create quite a challenge. I am trying not to get in the middle but that is a challenge as well. Darin clearly communicated with Apple that we had a green light to proceed with Apple - VA projects that did not include the five centers or others. Apple raised that they were willing to complete additional documents e.g. MOUand Darin said that he was on point with those requests. > > Let me know if you have questions or advice. In the meantime - I am tip-toeing thru this - with extreme caution being exercised. Poonam had provided guidance on Thursday - just wanting to make certain you all had Update and we were on the same page. > > > > > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000709 OS 00021425 Message From: Darin Selnick (b) (6) Sent : 6/18/2017 12:15:27 PM To: David shulkin [Drshulkin@aol.com] Re: Update s Subject: @gmail.com] Great we need to keep the PY A initiative confidential and limited to key VA staff, if it gets out prematurely we probably lose them . Darin On Sun, Jun 18, 20 17 at 4:48 AM, David shulkin wrote : Ok thanks Darin- lets pursue this Sent from my iPhone On Jun 17, 201 7, at 10:47 PM , Darin Selnick (b) (6) , mail.com > wrote : Apple Partnership : I had a talk on Friday with (b) (6) - VP of Government Affairs from Apple . She is now my Apple counterpart . Apple was pleased overall with the conference call and the VA partnership, but was concerned about the Govetnat1ce getting in the way and believe that VA should be leading the effort Bruce leading the effort. Apple and-(b) (6) going forward. I agree, and now that we have one agreed upon path with the Centers on-board at.id working closel y with Apple and VA, I do not think that will be an issue . As we discussed , we just need to let the combined working group get there work done and I wtll work with -(b) (6) and Bruce to ensure that. What you need to know, is that -(b) (6) wi 11be in DC and ta\ king to Jared at the WH and will tell him that VA needs to be in the lead going forward . PVA suppo1·t of our CARE plao and P ilots: -(b) (6) asked to meet me and we met on Friday. Bottom line is that PV A, -(b) (6) and the National leadership above him, are ready to break ranks with the other Big 6 VSOs and publicaly support the VA CARE plan, including the pilots. They are tired with the status quo , frustrated, and do not see the VAMCs improving. They just want to ensure their members get good care, whether it is at a VA facility or in the Community I have been working on this with-(b) (6) since last November. Once I was able to explain the intent of the CARE plan and the pilots, it erased his concerns , His problem was that the way it had been explained to hjm from VA staff was confusing and they did not understand it. To get PV A public support , we need to do the following which I agree with and recommend we do. 1, Have a private meeting at VA with just you, me, VA staff and PVA staff, no other VSOs . Purpose is to fully e plain to them exactly how the CARE plan and pilots wouJd work. They need to fully understand so that they can explain it to their leadership and members. -(b) (6) says he respects and trusts you, so he wants to hear it from you. Other VA staff he thinks are spinning. 2. Besides understanding the CARE plan, PY A needs to support VA the ammunition and the marketing materials, at an 8th grade leve l, toe plain to thei r members and to defend themsel ves AMERICAN PVERSIGHT VA-19-0799-G-000710 DS 00021426 against attacks. Once they go public and break ranks, they expect to be attacked, but they are ready to do it if we support them and provide them the talking points and other information and resources they need to be successful in their support. 3. PV A would like to assist us and provide input into the CARE plan marketing materials, that way they know they will have the ammunition they need to be successful with their support. This really helps us as we need to test out and focus group our message. -(b) (6) believes there is a I year window on this and they are ready to support us if we follow up quietly and bring them into the fold quickly. This is a big break for us and I recommend we do it soon. I have talked to John, Brooks and Jake about it and we will make this happen quickly in coordination with the rest of the team , once you give us the ok. Let me know what you think and if you would like to discuss it with me and the team. Darin AMERICAN PVERSIGHT VA-19-0799-G-000711 OS 00021427 Message From: David shulkin LDrshulkin@aol.com] Sent : 6/18/201711:48:17 To : Darin Selnick (b) (6) Re: Updates Subject: AM @gmail.com] Ok thanks Darin- lets pursue this Sent from my iPhone Ot1 Jun 17, 2017, at 10:47 PM , Darin Selnick (b) (6) omail.com > wrote: Apple Partnership : I bad a talk on Friday with (b) (6) - VP of Government Affairs from Apple . She is now my Apple counterpart . Apple was pleased overall with the conference call and the VA partnership , but was concerned about the Governance getting in the way and (b) (6) that VA should be lead ing the effort Bruce leading the effort . Apple and-believe going forward. I agree, and now that we have one agreed upon path with the Centers on-board and working closely with Apple and VA, I do not think that will be an issue . As we discussed , we just need to let the combined working group get there work done and I will work with -(b) (6) and Bruce to ensure that. What you need to know, is that-(b) (6) will be in DC and talking to Jared at the WH and will tell him that VA needs to be in the lead going forward. PVA support of our CARE plan and Pilots: -(b) (6) asked to meet me and we met on (b) (6) and the NationaJ leadership above him, are ready to Friday. Bottom lit1e is that PV A, break ranks with the other Big 6 VSOs and publicaly support the VA CARE plan, including the pilots. They are tired with the status quo, frustrated, and do not see the VAM Cs improving . They just want to ensure their members get good care, whether it is at a VA facility or in the Community I have been working on this with -(b) (6) since last November. Once I was able to explain the intent of the CARE plan and the pilots, it erased his concerns . His problem was that the way it had been explained to him from VA staff was confusing and they did not understand it. To get PV A public support, we need to do the following which I agree with and recommend we do. 1. Have a private meeting at VA with just you, me VA staff and PV A staff, no other VSOs . Purpose is to fully explain to them exactly how the CARE pla11and pilots would work. They need to fully understand so that they can explain it to thei r leadership and says he respects and trusts you, so he wants to hear it from you . Other VA members . -(b) (6) staff he thinks are spinning . 2. Besides unders tanding the CARE plan , PVA needs . to support VA the ammunition and the marketing materials , at an 8th grade level, to explain to thei r members and to defend themselves against attacks. Once they go public and break ranks, they expect to be attacked, but they are ready to do it if we support them and provide them the taJking points and other information and resources they need to be successful in their support . AMERICAN PVERSIGHT VA-19-0799-G-000712 DS 00021428 3. PV A would like to assist us and provide input into the CARE plan marketing materials, that way they know they will have the ammunition they need to be successful with their support. This really helps us as we need to test out and focus group our message. -(b) (6) believes there is a l year window on this and they are ready to support us if we follow up quietly and bring them into the fold quickly. This is a big break for us and I recommend we do it soon. I have talked to John, Brooks and Jake about it and we will make this happen quickly in coordination with the rest of the team, once you give us the ok. Let me know what you think and if you would like to discuss it with me and the team. Darin AMERICAN PVERSIGHT VA-19-0799-G-000713 OS 00021429 Message From: Darin Selnicl (b) (6) Sent: 6/18/2017 2:47:46 AM To: David shulkin [Drshulkin@aol.com] Updates Subject: @gmail .com] Apple Partnership: I had a talk on Friday with (b) (6) - VP of Government Affairs from Apple. She is now my Apple counterpart. Apple was pleased overall with the conference call and the VA partnership, but was concerned about the Governance getting in the way and Bruce leading the effort. Apple and -(b) (6) believe that VA should be leading the effort going forward. I agree, and now that we have one agreed upon path with the Centers on-board and working closely with Apple and VA, I do not think that will be an issue. As we discussed , we just need to let the combined working group get there work done and I will work with -(b) (6) and Bruce to ensure that. What you need to know, is that-(b) (6) will be in DC and talking to Jared at the WH and will tell him that VA needs to be in the lead going forward . PVA support of our CARE plan and Pilots: -(b) (6) asked to meet me and we met on Friday . Bottom line is that PV A, -(b) (6) and the National leadership above him, are ready to break ranks with the other Big 6 VSOs and publicaly support the VA CARE plan, including the pilots. They are tired with the status quo, frustrated , and do not see the VAMCs improving. They just want to ensure their members get good care, whether it is at a VA facility or in the Community I have been working on this with-(b) (6) since last November . Once I was able to explain the intent of the CARE plan and the pilots, it erased his concerns. His problem was that the way it had been explained to him from VA staff was confusing and they did not understand it. To get PV A public support, we need to do the following which I agree with and recommend we do. 1. Have a private meeting at VA with just you, me, VA staff and PV A staff, no other VSOs . Purpose is to fully explain to them exactly how the CARE plan and pilots would work. They need to fully understand so that they can explain it to their leadership and members . -(b) (6) says he respects and trusts you, so he wants to hear it from you. Other VA staff he thinks are spinning. 2. Besides understanding the CARE plan, PV A needs to support VA the ammunition and the marketing materials , at an 8th grade level, to explain to their members and to defend themselves against attacks. Once they go public and break ranks, they expect to be attacked , but they are ready to do it if we support them and provide them the talking points and other information and resources they need to be successful in their support . 3. PVA would like to assist us and provide input into the CARE plan marketing materials , that way they know they will have the ammunition they need to be successful with their support. This really helps us as we need to test out and focus group our message . -(b) (6) believes there is a 1 year window on this and they are ready to support us if we follow up quietly and bring them into the fold quickly . This is a big break for us and I recommend we do it soon. I have talked to John, Brooks and Jake about it and we will make this happen quickly in coordination with the rest of the team, once you give us the ok. Let me know what you think and if you would like to discuss it with me and the team. Darin AMERICAN PVERSIGHT VA-19-0799-G-000714 OS 00021430 5 Message From: (b) (6) Jennifer Lee [-@gmail.com] Sent: 6/27/2017 5:53:52 PM To: Davidshulkin [Drshulkin@aol.com] Re: Call with -(b) (6), (b) and Sanford (2) Subject: Ok, will do. I ' ll track Charlie down. Btw, we scheduled your call with -(b) for tomorrow afternoon. I need more details but I think thiscould make a nice announcement. I'll (6) Thanks, Jen > on Jun 27, 2017 , at 12: 47 PM, David shulkin talk with -(b) (6) about it . wrote: > > Also please try to meet charlie wiggins- he is now at VA- should be around this aftetnoon > > sent from my iPhone > (b) (6) >> on Jun 27 , 2017, at 12 :09 PM, Jennifer Lee -gmail . com> wrote: >> >> Just wanted to you know I had a good call with Mark yesterday - brainstorming partnerships. >> Tomorrow, we'll be talking with Novartis - will keep you posted . on some pharma >> >> Also , I j ust~e background but -(b) >> Thanks, (6) >> Jen with the sanfordhealth folks again. sounds like a sizable gift! I ' m getting more wants to tell you himself . I ' m going to try to get a quick call on your schedule . >> > AMERICAN PVERSIGHT VA-19-0799-G-000716 OS 00021432 Message Davidshulkin [Drshulkin@aol.com] From: Sent: 6/27/2017 4:47:36 PM To: Jennifer Lee [(b) (6) Re: Call with (b) (6), (b) (2) Subject: Also please try to meet charlie wiggins- he is now at VA- should be around this aftetnoon Sent from my iPhone > on Jun 27, 2017, at 12:09 PM, Jennifer > (b) (6) Lee -gmail .com> wrote: > Just wanted to you know I had a good call with -(b) yesterday - brainstorming partnerships . (6) > Tomorrow, we' ll be talking with Novartis - will keep you posted . on some pharma > > Also , I j ust~ background but -(b) > Thanks , (6) > Jen with the sanfordhealth folks again . sounds like a sizable gift! wants to tell you himself. I' m going to try to get a quick call I'm getting more on your schedule. > AMERICAN PVERSIGHT VA-19-0799-G-000717 OS 00021433 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 6/27/2017 4:46:57 PM To: Jennifer Lee [(b) (6) Re: Call with (b) (6), (b) (2) Subject: Thats great Keep at it- full steam ahead! Sent from my iPhone > on Jun 27, 2017, at 12:09 PM, Jennifer (b) (6) Lee -gmail .com> wrote: > > Just wanted to you know I had a good call with -(b) yesterday - brainstorming partnerships. (6) > Tomorrow, we' ll be talking with Novartis - will keep you posted . > > Also , I j ust~ background but -(b) > Thanks, (6) (b) >> ■ (6) AMERICAN PVERSIGHT on some pharma with the sanfordhealth folks again. sounds like a sizable gift! wants to tell you himself. I ' m going to try to get a quick call I'm getting more on your schedule . VA-19-0799-G-000718 OS 00021434 Message From: Jennifer Lee (b) (6) @gmail.com] Sent: 6/27/2017 4:09:35 PM To: Davidshulkin [drshulkin@aol.com] (6), (b) and Sanford ■■■■ Callwith (b) (2) Subject: Just wanted to you know I had a good call with -(b) yesterday - brainstorming partnerships. (6) Tomorrow, we'll be talking with Novartis - will keep you posted. Also, I just sp~ith background but -(b) (6) iilnks, (b) (6) AMERICAN PVERSIGHT on some pharma the Sanfordhealth folks again. sounds like a sizable gift! I'm getting more wants to tell you himself. I'm going to try to get a quick call on your schedule. VA-19-0799-G-000719 OS 00021435 Appointment From: Sent: To: Marisol Garcia .@frenchangel59 (b) 6/16/2017 8:19:39 (6) PM Subject: Location: VA - Follow-up - WE WILL EMAIL AGENDA BY 6:00 PM ) ( Conference Call .com] (b) (6) @gmail.com];-@hotma (b) (6) L Perl --■ i l.com; David shulkin [Drshulkin@aol.com]; Bruce Moskowitz [bruce (b) (6) (b) @mac.com]; l@frenchangel59.com ( (6) 6/16/2017 10:00:00 PM 6/16/2017 10:45:00 PM End: Show Time As: Tentative Start: Recurrence : mb (b) (6) @gmail.com; b 6 ) (none) Friday, June 16th -(b) (6) -6:45 PM EST Dial-in Information: US: 1-605-475--(b) (6) Passcode: (b) (6) Participants: Laurie, Dr. Poonam Alaigh Secretary David Shulkin, Marc Sherman, Dr. Bruce Moskowitz, Ike All my Best, Marisol (b) (6) (Office) AMERICAN PVERSIGHT VA-19-0799-G-000720 OS 00021436 (b) (6) (Weekend) (b) (6) (Cell) (b) Email : ■@frenchangel59.com (6) AMf:::RICAr-... pVERSIGHT VA-19-0799-G-000721 DS_00021437 Message From: Sent: To: Subject: Bruce Moskowitz [bruce (b) (6) (b) @mac .com] 6/16/2017 11:16:40 PM (6) IP ll@frenchangel59 .com]; Poonam Alaigh I(b) (6) @hotmail.com]; David shulkin [drshulkin@aol.com] ( Terry b ) ( 6 Just checked with ) him tonight he has heard nothing Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000722 OS 00021438 -W. Message (b) (6) (b) ~mayo .edu] (6) PM 6[ 15/20171:31 :03 ( IP ll@frenchangel59.com] b (b) (6) (b) (6) (b) Poonam Alaigh ~hotmail.com]; Bruce Moskowitz [bruce~@ma cc om] ; L Perl (6) .q:ir,l (b)) (6) (b) (6) David shulkit'l [drshulkin@aol -@gm"'il .com]; mb~@.gmail.com; VA(Apple From: Sent : To : CC: Subject: 6 ) Thank you again for your kind words; an honor to support this important work in support of veterans. - (b) (6) Chair I Department of Public Affairs (cell)-(b) (6) - ( On Jun 1s·, 2017 , at 9:24 AM, IP wrote : b ) (b) ( (6) I was think ing a lot about 6yesterday 's meeting -- what you were able to accomplish was truly amazing. ) Your abil ity to partner with so many stakeholders and ·coordinate a complicated set of topics into organized and cohesive agenda with a clear and defined outcome/next steps was unbelievable. We would not made the progress nor achieved the results we did if not but for your focus, expertise, and commitment. I want to thank you and let you know how much we appreciate your help and you being on the team . All my Best, Ike -----Original Message----- (6) @hotmail.com ) From: Poonam Alaigh (mailto (b) Sent: Wednesday, June 14, 2017 8:43 PM (b) (6) To:-W . Cc: Bruce Moskowitz; IP; L Perl;~ (b) (6) Subject: Re: VA Apple David shulkin Thanks to-(b) most definitely for a successfully executed complex meeting today with so many (6) different stakeholders and participants. We are really excited about the possibilities that can now be generated as a result of the best of intellects, innovators and intentions working together. Most importantly, David and I cant thank you enough, (the Fab Four T~am- Laurie, Ike, Bruce, Marc), for your invaluable and tireless support to us and our Veterans! Sent from my iPad (b) (6) (b) (6) > On Jun 14, 2017, at 7 :46 PM, _ W.-@mayo .edu> wrote : > > Thank you for your kinds words and this group's amazing commitment and leadership to support our nation's veterans. > AMER11...,A1\J PVERSIGHT VA-19-0799-G-000723 DS 00021439 >-(b) (6) > Chair I Mayo Clinic Department of Public Affairs > (c) (b) (6) > > » On Jun 14, 2017, at 11:07 AM, Bruce Moskowitz wrote: (b) (6) (b) (6) >> » You made an astoundingly complicated agenda easy with a defined outcome. Thank you >> » Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000724 OS 00021440 Message _w_ (b) (6) Poonam Alaigh [-@hotmail.com] 6/15/2017 12:43:20 AM Sent: [~@mayo .edu] To: (b) (6) (b) (6)[bruce~@mac.com]; CC: Bruce Moskowitz IP [ll@frenchangel59.com]; L Perl [-@gmail.com]; (b) (6) (b) ( (b) (6) (6) [drshulkin@aol.com] b mb-@gmail.com; Davidshulkin (b) (6) ) Re: VAApple Subject: ( 6 ) Thanks to (b) most definitely for a successfully executed complex meeting today with so many different stakeholders(6) and participants. We are really excited about the possibilities that can now be generated as a result of the best of intellects, innovators and intentions working together. From: 11111 Most importantly, David and I cant thank you enough, (the Fab Four Team- Laurie, your invaluable and tireless support to us and our Veterans! Ike, Bruce, Marc), for sent from my iPad > on Jun 14, 2017, at 7:46 PM, -(b) (6) > > Thank you for your kinds words and this nation's veterans . > > (b) w. ~@mayo.edu> wrote : (6) group's amazing commitment and leadership to support our (b) (6) (b) (6) Department of Public Affairs > > (b) (6) (b) wrote: >> on Jun 14, 2017, at 11:07 AM, Bruce Moskowitz >> (6) >> You made an astoundingly complicated agenda easy with a defined outcome. Thank you >> >> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000725 OS 00021441 Message _w_ [lllllll@ma yo.edu] (b) (6) (b) (6) Sent: 6/14/2017 11:46:12 PM (b) (5) (b) ( (b) (6) To: Bruce Moskowitz [bruce~mac .com]; IP [~frenchangel59.com]; L Perl [-@gma il.com]; b (b) (6) (b) (6) mb-@gmail.com; Poonam (6) Alaigh [-@ho tmail.com]; David shulkin [drshulkin@aol.com] ) VAApple Subject: ( 6 ) Thank you for your kinds words and this group's amazing commitment and leadership to support our nation's veterans . From: (b) (6) (b) (6) Department of Public Affairs (b) . com> wrote: (6) agenda easy with a defined outcome. Thank you > on Jun 14, 2017 , at 11 :07 AM, Bruce Moskowitz > > You made an astoundin gly complicated (b) (6) > sent from my i Phone AMERICAN PVERSIGHT VA-19-0799-G-000726 OS 00021442 Message To : thomas bowman (b) (6) 6/18/2017 11:20:45 AM drshulkin@aol.com Subject: Re: Dinner june 27 - 7 pm From: Sent : @yahoo.com] Thank you ....1 am reall y looking forward to this exp erience ..... never had dinner at one of the embassies ....thank you for inviting me .... Sent from Yahoo Mail on Android On Sat, Jun 17, 2017 at 10:07 PM David Shulkin wrote : Tom- at this poin t - right now its single- but if there is another spot open l will give you first dibs . I will know by June 22nd . -----Orig ina I Message----(b) (6) From: thomas bowman._@yahoo .com> To : Drshulkin ; David Shulkin Sent: Sat , Jun 17, 2017 3:35 pm Subject: Re: D·inner june 27 - 7 pm Will do .....is this single to me or does it also include a guest with me ..... Sent from Yahoo Mail on Android On Sat, Jun 17, 2017 at 2:28 PM, David shulkin wrote: For the dinner on the 27 th for some reason the embassy has not heard from you - it ma.yjust be an error but just in case for security purposes would you be able to confirm your attendance- would you please confirm your rsvp at : events@egyptembassy .net Thanks David Sent from my iPhone A\llERICAN PVERSIGHT VA-19-0799-G-000727 DS_00021443 Message From: David Shulkin [drshulk i'n@aol.com] Sent : 6/18/2017 2:07 :32 AM To : (b) (6) Subject: @yahoo .com Re: Dinner june 27 - 7 pm Tom- at this point - light now its single- but if there is another spot open I will give you first dibs. I will know by June 22nd . -----Orig ina I Message----(b) (6) .com> From : thomas bowman ~@yahoo To : Drshulkin : David Shulkin Sent: Sat, Jun 17, 2017 3:35 pm Subject: Re: Dinner june 27 - 7 pm Will do .....is this single to me or does it also include a guest with me ..... Sent from Yahoo Mail on Android On Sat, Jun 17, 2017 at 2:28 PM, David shulkin wrote: For the dinner on the 27th for some reason the embassy has not heard from you - it may just be an error but just In case for security purposes would you be able to confirm your attendance- would you please confirm your rsvp at : events@egyptembassy.net Thanks David Sent from my iPhone A\llERICAN PVERSIGHT VA-19-0799-G-000728 DS 00021444 Message David shulkin [Drshulkin@aol.com] From: Sent : 7/12/2017 7:17:22 AM To : (b) (6) (b) @mac.com] Bruce Moskowitz [brucentl■■■ Re: [EXTERNAL]Re: VA email from (6) the Under Secretary . Subject: Ok great Sent from my iPhone On Jul 12, 2017, at 1 :45 AM, Bruce Moskowitz wrote · Fortunately most of tlus is on the shelf and plug and playt Sent from my iPhone On Jul 11, 2017 , at 7: 17 PM, (b) (6) (b) (b)(6) (6) Thanks , Dr. Alaigh . 1111 (b) I know the team s have a call tomorrow at 11 :00. Perhaps you and I could (6) chat briefly before that. Please let me know what might work . Sent from my iPhone On Jul 11, 2017, at 6 :11 PM, Alaigh , Poonam, M .D .< Poonam .Alaigh@va .gov> wrote : Thanks Bruce for ensuring that we are all aligned in our objectives around this collaboration, -(b) (6) I am copying-(b) who is on (6)Our priority is point for the Secretary and I regarding this project. to build this mobile techno logy that wjLJensure our Veterans can chose to get care anywhere based on gee-access/quality data both inside the VA and in Community Care . -(b) (6) can you connect with -(b) (6) on this please . Thanks Sent with Good (www.good.com ) -----Original Message----(b) mac .com Fro01: Bruce Moskowitz [brucem (b) (6) (6) Sent: Tuesday , July 11, 2017 05: 17 PM Eastern Standard Time To: (b) (6) Cc: (b) (6) Alaigh, Poonam , M .D .; David shuJkin Subject: [EXTERNAL] Re: VA email from the Under Secretary. AMERICAN PVERSIGHT VA-19-0799-G-000729 DS_00021445 I have copied the undersecretary and the Secretary who are in charge of this on the VA side. This is an important area that needs integration with the portable EMR and needs to develop at the same time , to save lives . All three of us understand the importance of getting the EMR done however this is an urgent issue especially for critical care and suicide prevention . We have the academic resources to plug this in and 1 can bring more resources in from the academic centers to work on this part. The bottom Jine is whether you have a potential breast cancer or need an acute psychiatric appointment to prevent suicide the po11able EMR is not going to save your life this attachment to the ENIR may. Sent from my i Pad Bruce Moskowitz M .D. On Jul 11, 2017, at 4 :55 PM, (b) (6) a le .com > wrote: (b) (b)(6) (6) Our understanding of the priority of the EMR is from the entire VA team not only from Darin . We are working well with the VA and the medical centers and have just completed a roadmap to guide the work . I don ' t think it would be helpful to add ru1 additional focus until the EMR work is furt11er along. I understand the urge to solve all problems at once, but we will share the roadmap and progress repo11 this week and I believe there will be agreement with how we are proceeding . On Jul 11, 2017, at 4:46 PM, Bruce Moskowitz wrote : What is in the email shou ld be a priority . 1 will need to walk your team throug h the specifi cs. This technol ogy also is jmport ant for the private sector . Sent AMERICAr-... pVERSIGHT VA-19-0799-G-000731 OS_0002144 7 from my iPad Bruce Mosko witz M.D . Begin forwar ded messag e: F r 0 m p 0 0 11 a m A I a 0 0 h < (b) (6) b Q ! m i I :.. C Q > AMERICAr-... pVERSIGHT VA-19-0799-G-000732 D8_00021448 D a t e J u ] y J , 2 0 1 7 a t 3 2 0 0 3 p M E D T T 0 B r u C e M 0 s k 0 w t z < b. r !! C AMERICAr-... pVERSIGHT VA-19-0799-G-000733 D8_00021449 e m ( b ) I(6 ) '• I I I I (b) (6) .:. Q m > C C D a V l d s h u t k n < Q s h !! I k !! @ Q ! .:. AMERICAr-... pVERSIGHT VA-19-0799-G-000734 DS_ 00021450 Q m > ' I p (b) (6) f I ~ !! f h ~ !! g ~ l 5 9 .:. f Q m > 'II m l?. ~ I ( b ) ( 6 ) I • I ' g ~ i l .:. Q m II < m AMERICAr-... pVERSIGHT VA-19-0799-G-000735 DS_00021451 l?. ~ I(b I) ~(6 I ) @ g Ill a ! I C Q m > , L p e r 1 < (b) (6) g m ~ i l .;. Q > s u b J e C AMERICAr-... pVERSIGHT VA-19-0799-G-000736 D8_00021452 t R e A p p 0 I n t m e n t d e I a y s B r u C e y 0 u a r e C 0 m p 1 e t e 1 y 0 n p 0 n t AMERICAN PVERSIGHT VA-19-0799-G-000737 DS_ 00021453 w t h t h s t h s s w h a t w e n e e d A p p 1 e t 0 w 0 r k w t h u s 0 n a s a p r 0 r AMERICAN PVERSIGHT VA-19-0799-G-000738 DS_ 00021454 t y s e n t f r 0 m m y 1 p h 0 n e 0 n J u 1 I I ' 2 0 I 7 a t 9 0 2 p M ' B r u C e M 0 AMERICAN PVERSIGHT VA-19-0799-G-000739 DS_ 00021455 s k 0 w t z < !?_ r m I ( b ) I(6 ) I I • I (b) (6) .:. f Q m > w r 0 t e T h e 0 n y p r e V AMERICAr-... pVERSIGHT VA-19-0799-G-000740 DS_ 00021456 e n t 0 n s t 0 h a r n e s s e X s t n g t e C h n 0 1 0 g y T h e V A n e e d s a m 0 b AMERICAN PVERSIGHT VA-19-0799-G-000741 DS_00021457 e a p p t h a t p r 0 V d e s a p a t e n t t 0 r e q u e s t a n a p p 0 n t m e n t w t h d e AMERICAN PVERSIGHT VA-19-0799-G-000742 DS_ 00021458 m 0 g r a p h C n f 0 r m a t 0 n a n d t h e p a t e n t s r e a s 0 n f 0 r a n a p p 0 n t AMERICAN PVERSIGHT VA-19-0799-G-000743 DS_ 00021459 m e n t T h e C 0 m p u t e r z e d p r 0 g r a m s h 0 u 1 d b e a b 1 e t 0 d s C e r n h 0 w u AMERICAN PVERSIGHT VA-19-0799-G-000744 DS_ 00021460 r g e n t t h e a p p 0 n t m e n t s ( e N e w b r e a s t m a s s u r g e n t V e r s u s AMERICAN PVERSIGHT VA-19-0799-G-000745 DS_00021461 a p p 0 n t m e n t f 0 r h p a r t h r t s ) K n 0 w n g t h e r e a s 0 n f 0 r t h e V AMERICAN PVERSIGHT VA-19-0799-G-000746 DS_ 00021462 s t s h 0 u 1 d a 1 1 0 w f 0 r p r 0 b a b 1 e t e s t s t 0 b e s C h e d u 1 e d 0 n t h e s a m e AMERICAN PVERSIGHT VA-19-0799-G-000747 DS_ 00021463 d a y ( a C 0 n f r m e d b r e a s t m a s s w 1 1 h a V e a s 1 0 t f 0 r a m a m m 0 g r a m a n AMERICAN PVERSIGHT VA-19-0799-G-000748 DS_ 00021464 d b 0 p s y 0 n t h e s a m e d a y ) A 1 s 0 t w a 1 1 0 w a 1 1 V t a 1 n f 0 r m a t AMERICAN PVERSIGHT VA-19-0799-G-000749 DS_ 00021465 0 n 0 n t h e p a t e n t t 0 b e a V a a b 1 e e p r e V 0 u s m a m m 0 g r a m s a n AMERICAN PVERSIGHT VA-19-0799-G-000750 DS_ 00021466 d r s k f a C t 0 r s s 0 t h a t t h e p h y s C a n d 0 e s n 0 t h a V e t 0 s 1 f t t h r 0 u AMERICAN PVERSIGHT VA-19-0799-G-000751 DS_ 00021467 g h t h e m e d C a 1 r e C 0 r d t 0 f n d t s e n t f r 0 m m y 1 p a d B r u C e M 0 s k AMERICAN PVERSIGHT VA-19-0799-G-000752 DS_ 00021468 Message From: (b) (6) Sent : 7(11/2017 11:53:42 PM To : apple.com]; Alaigh, Poonam, M.D . [Poonam .Alaigh@va.gov] (b) (6) (b) (b)(6) (6) (b) (6) (b) (6) 'Bruce Moskowitz' [bruce (b) (6) (b) @mac.com]; ··••■ l-·@apple .com]; 'David shulkin' [drshulkin@,;1ol.com] (6) RE: (EXTERNAL]Re: VA email from the Under Secretary. CC: Subject: - -(b) (6) (b) (b)(6) (6) va.gov] I can make myself available for a call anytime between 630-l0am. Let me know what works for you. (b) (6) Sent with Good (www .good .com) -----Original Message----(b) (b)(6) (6) From: (b) (6) a le.com Sent: Tuesday, July 1·1, 2017 07: 18 PM Eastern Standard Time To: Alaigh, Poonam, M.D. Cc: Bruce Moskowitz ; (b) (6) David shulkin; (b) (6) Subject: Re : [EXTERNAL] Re : VA email from the Under Secretary , Thanks, Dr. Alaigh . 1111 (b) r know the teams have a call tomorrow at 11:00. Perhaps you and I could chat briefly before that. Please (6) let me know what might work. Sent from my iPhone On Jul 11, 2017 , at 6:11 PM , Alaigh, Poonam M .D . wrote: Thanks Bruce for ensuring that we are all aligned in our objectives around this collaboration, ram copying-(b) who is on point for the Secretary and I regarding this project. Our priority is to build this (6) mobile techno logy that will ensure our Veterans can chose to get care anywhere based on gee-access/quality data both inside the VA and in Community Care -(b) (6) -(b) (6) can you connect with -(b) (6) on this please Thanks Sent with Good (www .good.com ) -----Original Message----From: Bruce Moskowitz [bruce (b) (6) (b) e, mac .com (6) Sent: Tuesday , July 11, 2017 05 : 17 PNI Eastern Standard Time (b) (6) To: Cc: (b) (6) Alaigh, Poonam, M.D.· David shulkin Subject: [EXTERNAL] Re : VA email from the Under Secretary . AMEFu Jt, PVERSIGHT VA-19-0799-G-000754 DS 00021470 I have copied the undersecretary and the Sec.retary who are in charge of this on the VA side. This is an important area that needs integration with the portable EMR and needs to develop at the same time , to save lives . All three of us understand the importance of getting the EMR done however this is an urgent issue especially for critica l care and suicide prevention. We have the academic resources to plug this in and I can bring more resources in from the academic centers to work on this part . The bottom tine is whether you have a potential breast can.cer or need an acute psychiat1ic appointment to prevent suicide the portable EMR is not going to save your life this attachment to the EMR may . Sent from my iPad Brnce ·Moskowitz M.D. On Jul 11, 2017, at 4 :55 PM, (b) (6) (b) (b)(6) (6) Our understanding of the priority of the EMR is from the entire VA team not only from Darin . We are working well with the VA and the medical centers and have just completed a roadmap to guide the work. I don ' t think it would be helpful to add an adilitional focus until the EMR work is further along . I understand the urge to solve all problems at once, but we will share the roadmap and progress report this week and I believe there will be agreement with how we are proceeditig. On Jul l l , 2017, at 4:46 PM, Bruce Moskowitz wrote : (6) Offline will exp lain that Daren apparent ly is no longer in charge and why this is a priority in conjunction with the EMR Setit from my iPad Bruce Moskowitz M.D. On Jul 11, 2017, at 4 :34 PM , (b) (6) (b) (b)(6) (6) a le .com > wrote: Hi Bruce, As you know , the VA told us that their first priority is the mobile EHR issue , and that is why we are working to get that project off the ground first. We are making progress .there which we will share later this week with the senior oversight team . - (b) (6) On Jul 11, 2017 , at 3:41 PM., Bruce Moskowitz Date: July 11, 2017 at 3 :20:03 PM EDT To: Bruce Moskowitz (b) (6) (b) <~ (6) @mac .com> Cc: David shulkin , IP (b) ~ (6) om>, ··~ (b) (6) om " <~ (b) (6) com>, L Perl (b) (6) ~ m> Subject: Re: Appointment delays Bruce- you are completely on point with this- this is what we need Apple to work with us on as a priority Sent from my iPhone On Jul 11, 2017 , at 9:02 PM, Bruce Mosko witz wrote : The only prevent ion is to harness existin g tecbnol ogy. The VA needs a mobile app that provid es a patie nt to request fill appoint ment with demog raphic inform ation and the patient s reason for an appoi nt ment . The comput erized progra m should be able to discern how urgent the AMERICAr-... pVERSIGHT VA-19-0799-G-000757 D8_00021473 appoint ment is (i.e. New breast mass urgent, versus appoint ment for hip arthriti s). Knowi ngthe reason for the visit should allow for probab le tests to be schedu led on the same day (a confir med breast mass will have a slot for a mamm ogram and biopsy on the same day). Also it will allow all vital inform ation on the AMERICAN PVERSIGHT VA-19-0799-G-000758 DS_00021474 patient to be availab le i.e. Previo us mamm ograms and risk factors so that the physici an does not have to sift throug h the medica 1 record to find it. Sent from my iPad Bruce Mosko witz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000759 DS_00021475 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com] 7/11/201711:45:13 PM (6) apple .com) (b) (6) (b) (b)(6) (6) Alaigh, Poonam, M .D.[Poonam.Alaigh@va.gov]; (b) (6) [drshulk in@<1ol.com}; (b) (6) (b) (b)(6) (6) Re: (EXTERNAL]Re: VA email from the Under Secretary. From: Sent: To : CC: Subject: (b) (6) @apple.com);David shulkin Fortunate ly most ofthis is on the shelf and plug and play! Sent from my iPhone On Jul 11, 2017 , at 7 :17 P~ (b) (6) (b) (b)(6) (6) Thanks, Dr. Alai gh. (b) 1111 I know the teams have a call tomorrow at 1·1 :00. Perhaps you and I could chat briefly (6) before that. Please let me know what might work Sent from my iPhone On Jul 11, 2017, at 6:11 PM, Alaigh, Poonarn , M.D . (b) (6) Thanks Bruce for ensuring that we are all aligned in our objectives around this coflaboration , -(b) (6) I am copying-(b) who is on point for the Secretary and I to build this mobile technology that will regarding this project Our priority is (6) ensure our Veterans can chose to get care anywhere based on geo-access/quality data both inside the VA and in Comm unity Care . -(b) (6) can you connect with-(b) (6) on this please . Thanks Sent with Good (www.good .com ) -----Ori ginal Message----From: Bruce Moskowitz bruce1 (b) (6) (b) c,.mac.com (6) Sent: Tuesday , July 11, 2017 05 :17PM Eastem Standard Time To: (b) (6) Cc: (b) (6) Alaigh, Poonarn M.D. · David shulkin Subject: [EXTERNAL] Re : VA email from the Under Secretary . I have copied the undersecretary and the Secretary who are in charge of this on the VA side. This is an important area that needs integration with the portable EMR and needs to develop at the same time, to save lives . AJl three of us understand the importance of getting the EMR done however this is an urgent issue especially for critical care and suicide prevention . We have the academic resources to plug this in and I can bri11gmore resources in from the academic AMERICAN PVERSIGHT VA-19-0799-G-000760 DS 00021476 centers to work on this part . The bottom 1ine is whether you have a potential breast cancer or need an acute psychiatric appointment to prevent suicjde the portable EMR is not going to save your life this attachment to the EMR may. Sent from my iPad Bruce Moskowitz M .D. On Jul 1 1, 20 17, at 4:55 PM, (b) (6) wrote: (b) (b)(6) (6) Our w1derstanding of the priority of the EMR is from the entire VA team not on ly from Darin. We are working well with the VA and the medical centers and have just comp leted a roadmap to guide the work . I don ' t think it would be helpful to add an additional focus until the EMR work is further along . I understand the urge to solve aJI prob lems at once , but we will share the roadmap and progress report this week and I believe there will be agreement with how we are proceeding. On Ju.I 11, 2017, at 4 :46 PM , Bruce Moskowitz (b) mac .com > wrote : wrote: Hi Bruce , As you know , the VA told us that their first p1iority is the mobile EHR issue , and that is why we are working to get that project off the grou nd fir st. We are making progress there which we will share later this week with the senior oversight team. - (b) (6) On Jul 11, 20 17, at 3:4 1 PM , Bruce Moskowitz (b) (6) (b) ~ (6) @mac .com > wrote: What is in the emai l shou ld be a priority . 1 wi ll need to wa lk yollf team through the AMERICAr-... pVERSIGHT VA-19-0799-G-000761 D8_00021477 specifics . This . technology also ts important for the private sector. Sent from my iPad Bruce Mo skow itz M .D. Begin forwarded message : From: Poona m Alaigh (b) (6) tmail.c om> Date: July 11, 2017 at 3:20 :0 3 PM EDT To: Bruce Mosko witz Cc: David shulkin , IP (b) ~ (6) enchan gel59 .c om> .Ii ( b ) @gmai ( I.com" 6 , L Perl (b) (6) l(b) l@g (6) mail.co m> Subjec t: Re: Appoi ntmen t delays Bruceyou are comple tely on point with this- thjs is what we need Apple to work with us on as a priority Sent from my iPhone 0 11 J u 1 1 2 0 1 7 AMERICAr-... pVERSIGHT VA-19-0799-G-000763 D8_00021479 a t 9 0 2 p M , B r u C e M 0 s k 0 w t z < !! r I( I I •I b ) ( 6 ) (b) (6) rn a f .:. Q m > w r AMERICAr-... pVERSIGHT VA-19-0799-G-000764 D8_00021480 0 t e T h e 0 n 1 y p r e V e n t 0 n s t 0 h a r n e s s e X s t n g t e C h n 0 1 0 g y AMERICAN PVERSIGHT VA-19-0799-G-000765 DS_00021481 T h e V A n e e d s a m 0 b e a p p t h a t p r 0 V d e s a p a t e n t t 0 r e q u e s t a n AMERICAN PVERSIGHT VA-19-0799-G-000766 DS_ 00021482 a p p 0 n t m e n t w t h d e m 0 g r a p h C n f 0 r m a t 0 n a n d t h e p a t e n t s r AMERICAN PVERSIGHT VA-19-0799-G-000767 DS_ 00021483 e a s 0 n f 0 r a n a p p 0 n t m e n t T h e C 0 m p u t e r z e d p r 0 g r a m s h 0 u 1 d b e AMERICAN PVERSIGHT VA-19-0799-G-000768 DS_ 00021484 a b 1 e t 0 d s C e r n h 0 w u r g e n t t h e a p p 0 n t m e n t s ( e N e w b r e a s t AMERICAN PVERSIGHT VA-19-0799-G-000769 DS_ 00021485 m a s s u r g e n t V e r s u s a p p 0 n t m e n t f 0 r h p a r t h r t s ) K n 0 w n g AMERICAN PVERSIGHT VA-19-0799-G-000770 DS_ 00021486 t h e r e a s 0 n f 0 r t h e V s t s h 0 u 1 d a 1 1 0 w f 0 r p r 0 b a b 1 e t e s t s t 0 b e s AMERICAN PVERSIGHT VA-19-0799-G-000771 DS_00021487 C h e d u 1 e d 0 n t h e s a m e d a y ( a C 0 n f r m e d b r e a s t m a s s w 1 1 1 h a V e a s 1 AMERICAN PVERSIGHT VA-19-0799-G-000772 DS_ 00021488 0 t f 0 r a m a m m 0 g r a m a n d b 0 p s y 0 n t h e s a m e d a y ) A 1 s 0 t w a 1 1 0 AMERICAN PVERSIGHT VA-19-0799-G-000773 DS_ 00021489 w a 1 1 V t a 1 n f 0 r m a t 0 n 0 n t h e p a t e n t t 0 b e a V a a b 1 e e p r e AMERICAN PVERSIGHT VA-19-0799-G-000774 DS_00021490 V 0 u s m a m m 0 g r a m s a n d r s k f a C t 0 r s s 0 t h a t t h e p h y s C a n d 0 e s n AMERICAN PVERSIGHT VA-19-0799-G-000775 DS_00021491 0 t h a V e t 0 s f t t h r 0 u g h t h e m e d C a 1 r e C 0 r d t 0 f n d t s e n t f r AMERICAN PVERSIGHT VA-19-0799-G-000776 DS_00021492 0 m m y 1 p a d B r u C e M 0 s k 0 w t z M D AMERICAN PVERSIGHT VA-19-0799-G-000777 DS_00021493 Message From: on behalf of Sent: To: CC: Subject : (b) (6) (b) (6) apple.com (b) apple.com] (b)(6) (6) apple .com] (b) (b)(6) (6) 7/11/2017 11:17:39 PM Alaigh, Poonam, M .D.[Poonam. Alaigh@va.gov] Bruce Moskowitz [bruce (b) (6) (b) @mac.com]; (b) (6) (b) (6) [drshulkin@aol.com); (b) (6) va.gov] (6) (b) (b)(6) (6) Re: [EXTERNAL]Re: VA email from the Under Secretary . @apple .com]; David shulkin Thanks Dr . Alaigh . (b) 1111 r know the teams have a call tomon-ow at 11:00. Pe1'haps you and r could chat briefly before that . Please (6) let me know what might work. Sent from my iPhone On Jul 11, 2017 , at 6: 11 PM, Alaigh, Poonam , M.D .< Poonam .Alaigh@va.gov > wrote : Thanks Bruce for ensuring that we are all aligned in our objectives around this collaboratio~ -(b) (6) lam copying-(b) who is on point for the Secretary and I regarding this project , Our p1iority is to build this (6) mobile technolog y that will ensure our Veterans can chose to get care anywhere based on gee-access/quality data both inside the VA and in Community Care. -(b) (6) can you connect with -(b) (6) on this please. Thanks Sent with Good (www .good.com ) -----Original Message----From: Bruce Moskowitz [brucem (b) (6) (b) c mac .com (6) Sent: Tuesday, July 11, 2017 0S:17P1vIEastem Standard Time (b) (6) To: Alaigh , Poonam , M .D.; David shulkin Cc: (b) (6) Subject: [EJ\.'TERNAL] Re : VA email from the Under Secretary. I have copied the undersecretary and the Secretary who are in charge of this on the VA side . This is an important area that needs integration with the portable EMR and needs to develop at the same time , to save lives . All three of us understand the importance of getting the E!vIRdone however this is an urgent issue especially for critical care and suicide prevention. We have the academic resources to plug this in and I can bring more resources in from the academic centers to work on this part .. The bottom Ii ne is whether you have a potential breast cancer or need an acute psychiatric appointment to prevent suicide the portab le filv1R is not going to save your life this attachment to the EMR may . Sent from my iPad Bruce Moskowitz M .D . On Jul 11, 2017, at 4:55 PM, (b) (6) AMER11...,A1 PVERSIGHT (b) (b)(6) (6) VA-19-0799-G-000778 DS 00021494 Our understanding of the priority of the E.MR is from the entire VA team not only from Darin. We are work ing we ll with the VA and the medical centers and have ju st completed a roadmap to guide the work. I don ' t think it wo uld be helpful to add an additional foc us until the EJvIRwork is further along . I understand the urge to solve all problems at once, but we will share the roadmap and progress report this week and I believe there will be agreement with how we are proceed ing. On Jul 11, 2017 , at 4:46 PM , Bruce Moskowitz < bruce (b) (6) (b) (6) Offiine will explain that Daren apparent ly is no longer in charge and why this is a pr iority in conju nction with the EMR Sent from my iPad Bruce Moskowitz MD. On Jul 11, 2017, at 4 :34 PM , (b) (6) (b) (b)(6) (6) a le .com > wrote: Hi Bruce , As you know , the VA told us that their first priority is the mobile EHR issue, and that is why we are worki ng to get that project off the ground first. We are making progress there which we will share later this week with the senior overs ight team . - (b) (6) On Jul 11, 20 17, at 3:4 1 PM, Bruce Moskowitz (6) wrote: What is in the email should be a priority . I wi ll need to walk your team through the specifics. This technology also is impmiant for the private sector. Sent from my iPad Bruce Moskowitz M. D. Begin forwarded message : Fr-om:Poonam Alaigh (b) (6) ~ m> Date: July 11, 2017 at 3 :20:03 PM EDT To: Bruce Moskowitz <~ AMERICAr-... pVERSIGHT (b) (6) (b) (6) VA-19-0799-G-000779 D8_00021495 @mac.com > . Cc: David shulkm , IP .(b) @frenchange l59 .c (6) om>, ··~ (b) (6) om " <~ (b) (6) com > L Perl (b) (6) ~ rn> Subject : Re: Appo intment delays Bruce - you are completely on point with this- this is what we need Apple to work with us on as a priority Sent from my iPhone On Jul 11, 2017, at 9:02 PM , Bruce Mosko witz wrote: The on ly prevent ion is to harness existin g technol ogy . The pVERSIGHT VA-19-0799-G-000780 DS_0002 1496 VA needs a mobile app that provid es a patient to request an appoint ment with demog raphic inform ation and the patient s reason for an appoint ment. The comput erized progra m should be able to discern how urgent the appoint ment is (i.e. New breast mass urgent, versus appoint ment for hip arthriti s). Knowi ngthe AMERICAN PVERSIGHT VA-19-0799-G-000781 DS_00021497 reason for the visit should allow for probab le tests to be schedu led on the same day (a confir med breast mass will have a slot for a mamm ogram and biopsy on the same day). Also it will allow all vital inform ation on the patient to be availab le i.e. Previo us mamm ograms and risk factors so that the physici an AMERICAN PVERSIGHT VA-19-0799-G-000782 DS_00021498 does not have to sift throug h the medica 1 record to find it. Sent from my iPad Bruce Mosko witz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000783 DS_00021499 Message From: (b) (6) Sent : 6/15/2017 2:15:48 AM To : David shulkin [Drshulkin@aol.comJ Re:Sunday Subject: (b) (6) @gmail.com] K will tell him On Wed , Jun 14, 2017 at 10:06 PM Da vid sbuJkin wrote: -(b) (6) took a picture if the ticket today Sent from my iPhone >. > On Jun 14, 2017 , at 9;57 PM , (b) (6) (b) (6) > (b) is the agent with you this weekend . He asked for your train time back on sunday, he needs · to book his (6) tmrw to be with you . We gave him Friday train Sent from Grnail Mobile AMERICAN PVERSIGHT VA-19-0799-G-000784 DS 00021500 Message Davidshulkin [Drshulkin@aol.com] From: Sent: 6/15/2017 2:06:54 AM To: Subject: (b) (6) Re: Sunday -(b) (6) took a picture @gmail.com] (b) (6) if the ticket today Sent from my iPhone > on Jun 14, 2017, at 9:57 PM, (b) (6) > (b) (6) <-r@gmail.com> > .(b) is the agent with you this weekend . He asked for your train his(6)train tmrw to be with you. we gave him Friday AMERICAN PVERSIGHT wrote: time back on sunday , he needs to book VA-19-0799-G-000785 OS 00021501 Message From: (b) (6) Sent: 6/15/2017 1:57:22 AM To: David Shulkin [drshulkin@aol.com] Sunday Subject: (b) (6) @gmail.com] -(b) is the agent with you this weekend. He asked for your train time back on sunday, he needs to book his train (6) tmrw to be with you. We gave him Friday AMERICAN PVERSIGHT VA-19-0799-G-000786 OS 00021502 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 6/14/2017 1:03:06 AM To: (b) (6) @hotmail.com] Re: Honoring(b) (6) Subject: Ive already done this For me to do this once- we had a full celebration again - when i have no relationship and recognition of him with him seems disingenous Sent from my iPhone > on Jun 13 , 2017, at 8:0 7 PM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote : > > we have decided to present the highest award from the secretary to him and wanted you to do it next week when you are at NLC. He is not doing well and I know it would mean a lot to him-the she refused employees since the y respect him so much. For some reason when this was messaged to (b) (6) on your behalf alleging that in the 30 min you wanted to deliver your tal k and you wou n t ave time for anything else . I thin k that there is nothing more important than recognizing and giving him that honor, but if you don't have time , I will do it . It was always on the agenda for me to do it , but I thought it would be more meaningful if you did it - I am fine either ways- you know I am adaptable > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000787 OS 00021503 Message From: Poonam AlaighI(b) (6) @hotmail.com] Sent: 6/14/2017 12:07:06 AM To: DavidShulkin [drshulkin@aol.com] Honoring(b) (6) Subject: We have decided to present the highest award from the secretary to him and wanted you to do it next week when you are at NLC. He is not doing well and I know it would mean a lot tall the employees since they respect him so much. For some reason when this was messaged to (b) (6) she refused on your behalf alleging that in the 30 min you wanted to deliver your talk and you wou n t have time for anything else. I think that there is nothing more important than recognizing and giving him that honor, but if you don't have time, I will do it. It was always on the agenda for me to do it, but I thought it would be more meaningful if you did it - I am fine either ways- you know I am adaptable sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000788 OS 00021504 Message From: Poonarn Alaigh I(b) (6) @hotmail.com] Sent : 6/16/2017 6:24:50 PM To : David Shu Ikin [drshulkin@aol.com] Fwd: Phone call Subject: Let's talk about this- but l spoke to him and have mitigated this and he under stands your perspective now Sent from my iPhone Begin forwarded message : From: "Alaigh, Poonam, M.D." Date: June 16, 2017 at2:22 :38 PM EDT To: 'Poonam Alaigh 1 - (b) (6) > Subject: FW: Phone call Sent with Good (www .good .com) -----Origin al Message----From: Windom , John H. Sent: Friday, June 16, 2017 12:20 PM Eastern Standard Time To: Alaigh, Poonam, .IvlD. Subject: Phone call Ma' am I would like to speak to you at your earliest convenience . I jus t spoke to Rob Thomas at length (he called me), and many of his comments attributed to the Secretary may undermine our overall success . I would like to send the Secretary a note updating him on the status of negotiations and offer some comments in how we are planning to move forward. Forc ing contract(s) and personnel on me at this stage just undermines efficiency and success . Standing by . V/r, John 202- 794-49 l 1 CAPT John H. Windom Special Advisor to the Unde r Secretary for Health 810 Vermont Avenue NW (Suite 375X) AMERICAN PVERSIGHT VA-19-0799-G-000789 DS 00021505 Washington, DC 20420 John .Wi ndom@va.gov Office: (202) 461-5820 Mobile: (202) 794-4911 AMERICAr-... pVERSIGHT VA-19-0799-G-000790 DS_00021506 Message From: Sent : To: David Shulkin (drshulkin@aol.com) 7/28/2017 6:55:36 PM Poonam Alaigh I(b) (6) @hotmail .com] https://www .statnews .com/2017/07/28/trump-va-reforms-fact-check/ Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000791 DS_00021507 Message Darin Selnick (b) (6) @gmc11l.com] 6/15/2017 4:05:00 AM David shulkin [Drshulkin@aol.com] Fwd: Image from https ://georgewbush-wh itehouse. archives.gov /news/ rel eases/2006/08/i mages/20060801-2 _ d0384-1-515h.jpg. From: Sent : To : Subject: l thought you would want to see this note from Secretary Prinicpi . You made a similar comment the other day . Darin ---------- Forwarded message---------c. ahoo .com> From : Anthony Principi (b) (6) Date ~Wed, Jun 14, 2017 at 1~47 PM Subject: Fwd: Image from https ://georgewbush whi tehouse .archi ves .gov/news/rel eases/2006/08/images/2006080 l -2 d-03 84-1-51 Sh.j pg . (b) (6) To : -(b) (6) ,lmco .com >, Darin Selnick (b) (6) ail.com > Hi. (b) (6) and Darin , I was sitting next to a foimer Hispanic Marine who lost both legs in lraq in 2006 . See below email and photo of him with President Bush. I mentioned to him I was Secretary and asked about his care at the VA. After he was discharged from Bethesda he went home to Richmond and received care at the V AJ\IIC. He said he would never go back as the care and rehab were terrible . He prefer s to drive to Walter Reed where he receives great care . I'm afraid something is terribly wrong when we can't provide world class treatment to a veteran who lost both legs and most of his thighs. I was heartbroken and embarrassed . Darin if you want to share with the Secretary that's fine with me . Tony Anthony J. Principi Begin forwarded message : From: Anthony Principi (b) (6) ahoo.com > Date: June 14, 2017 at 2:51:01 PM CDT To:~(b) (6) Subject: Fwd: Image from https://georgewbush whitehouse.archives.gov/news/releases/2006/08/images/20060801-2 d-0384-1-515h.ipg . Hi Logan , I met an incredible Marine , (b) (6) , who lost both legs in lraq. The President pinned hi·s Purple Heart on him at Bethesda. See below photo. I mentioned to him I served as the President's Secretary of the VA and he asked me to remind the President he owes him a run . If the President is still painting images of wounded service members I know he would love to be included . His email address is : (b) (6) ahho.com . AMERICAN PVERSIGHT VA-19-0799-G-000792 DS_00021508 I was pleased to learn the President is receiving the Leo Thorsness award . I know they would love an acceptance video , but understand if that is not possible. I look forward to seeing the President and First Lady next week. Best Tony Anthony J . Principi Begin forwarded message : From: Reaper (b) (6) ahoo.com > Date: June 14, 2017 at 2:42 :28 PM CDT To: (b) (6) ahoo.com Subject: Image from https://georgewbushwhitehouse.archives. gov /news/releases/2006/08/images/20060801-2 515h.i pg. d-0384-1- https://georgewbushwhi tehouse. archives. gov/news/releases/2006/08/i mages/20060801-2 d-03 84-151Sh.j pg (b) (6) (b) (6) (b) (6) Sent from my iPhone AMERICAr-... pVERSIGHT VA-19-0799-G-000793 DS 00021509 Message From: David Shulkin [drshulkin@aol.com] Sent : 6/14/2017 1:17:45 AM To : Ike Perlmutter.@frenchangel59.com); Laurie Perlmu tter (b) (6) @gmail.com]; Marc Sherman ( [mb••(b) (6)l@gmail.com) ; Bruce Moskowitz [bruce (b) (6) (b) @mac.com) b ) (6) ( 6 /20 I 7/06/ l 3/ david-shulkin-secreta1y-veterans-affairs-cabinet-meeting-erinhttp ://www.cnn.com/videos/tv ) bumett-outfront-cnntv.cnn/video/play1ists/erin-burnett-outfront/ Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000794 DS_00021510 Message Sent : David shulkin lDrshulkin@aol.com] 6/19/2017 3:55:45 PM To : (b) (6) From: @gmail.com] (b) (6) Fwd: POLITICO:Trump demands face time with favored Cabinet heads Subject: Sent from my iPhone Begin fo.-warded message : - > (b) (6) From: (b) (6) Date: June 19, 2017 at 7:33 :58 AM CDT To: Dad Subject: POLITICO: Trump demands face time with favored Cabinet heads Trump demands face time with favored Cabinet heads POLITICO CIA chief Mike Pompeo spends three hours almost every day driving downtown from Langley to brief the president , and he' s not aJone . Read the full story Shared from Apple News Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000795 DS_00021511 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 7/6/20 17 11 :17:33 AM To: (b) (6) Poonam Alaigh [-@hot Re: Accountabilitywebsite Subject: mail.com] Yes Sent from my iPhone (b) (6) > on Jul 6, 2017, at 5:37 AM, Poonam Alaigh <-@hotmail.com> wrote: > > can you as k for a quic k demo before it gets rolled out- none of us have seen it and although we have given input in VHA-don't know if all of that has been incorporated - just don't want any miss on this as it is li ke no other agency or private sector enterprise doing it. > > Also , we should try to get a call with I ke and all today if possible this so they feel part of the journey with us and give them a heads up about > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000796 OS 00021512 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 7/6/2017 9:37:50 AM To: DavidShulkin [drshulkin@aol.com] Accountabilitywebsite Subject: can you ask for a quick demo before it gets rolled out- none of us have seen it and although we have given input in VHA-don't know if all of that has been incorporatedjust don't want any miss on this it is like no other agency or private sector enterprise doing it. Also, we should try to get a call with Ike and all so they feel part of the journey with us today if possible as and give them a heads up about this sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000797 OS 00021513 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com) 6/20/2017 10:32:58 PM (6) va.gov) (b) (6) (b) (b)(6) (6) Poonam Alaigh I(b) (6) @hotmail.com); drshulkin@aol.com; IP !l@frenchangel59.com); ( Re: [EXTERNAL)Re: Veterans Affairs, Apple, Academic Health System Collaboration b From: Sent : To ; CC: Subject: mb (b) (6) @gmail.com ) ( 6 was personally chosen by me for their the academic centers on the call ) Yes I am available . Every attendee in skill set. Some were not able to make the call and we need their expertise . I also identified two parts of the agenda that would take considerable time to get done and we will benefit by including three individuals who already have a shelf ready solution . Sent from my iPad Bruce Moskowitz M .D. On Jun 20, 2017 , at 6:26 PM, (b) (6) (b) (b)(6) (6) Yes, I am still waiting for a few responses from our partners and they are due Thursday. Perhaps we can discuss then when we will have the best sense of everyone's responses. Does Thursday morning look possible on your schedule? -(b) (6) Sent with Good (www .good .com ) -----O riginal Message----From: Bruce Moskowitz [bruce (b) (6) (b) c.mac .com (6) Sent: Tuesday , June 20, 2017 05 :40 PM Eastern Standard Time To: (b) (6) Cc: Poonam Alaigh ; drsbulk:in@aol.com ; IP; - (b) (6) Subject: Re: [EXTERNAL ] Re : Veterans Affairs, Apple, Academic Health System Col Iaborati on We need to get back to the group on the governance I am available anytime to discusss Sent from my iPad Bmce Moskowitz M .D . On Jun 14, 2017, at 3:49 PM, (b) (6) (b) (6) Thank you very much Dr. Moskowitz. As always, your feedback is so helpful. On our call today we had mentioned a three tier system with Governan ce (CEO), Technical Expertise (CIO) and Working group . Apple requeste d a leane r process which would reduce the model to two levels and eliminate the Technica l Expertise level. Wo uld you suggest the addition of 2-3 CIO's at the Governance level in order to flatten the structure? Thank you for your consideration. -(b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000798 DS_00021514 Sent: Wednesday,June 14, 2017 3:36 PM From : BruceMoskowitz [mailto:bruce (b) (6) (b) (6) To: (b) (6) Cc: PoonamAlaigh; drshulkin@aol.com ; IP; ~ (b) (6) mac.com] Subject : [EXTERNAL]Re: VeteransAffairs, Apple, AcademicHealth System Collaboration For governing committee I and Mr . Perlmutter spoke it will be the 5 CEO's and -(b) (6) who will have the opportunity to be directly involved along with the choice from Apple we should leave that up to Mr . ~(b) (6) Also obviously Mr . Perlmutter (he will ask Mrs for her involvement) and Mr. Sherman are critical since this is definitely going to tum out to be the most transformative issue to improve medical care not just for the VA but for the nation . Sent from my iPad Bruce Moskowitz M.D . On Jun 14, 2017, at2:45 PM, (b) (6) (b) (b)(6) (6) wrote: Good Afternoon , Thank you for your participation on the mid-day call to discuss the collaboration between the Veterans Affairs, Apple and the five academic medical centers. As we discussed, we will begin by identifying those individuals from each of the aforementioned organizations to serve on a governance committee as well as those individuals who will be part of the work group for this initiative . Please forward your recommendations and their contact information to me by (b)(6) (6) a.oov ). Thursday June 22 (b) Thank you for your participation and enthus iasm! (b) (6) Senior Advisor, acting Unde r Se cretary for Healt h D epartmen t of Veterans Affairs Veterans Health Administration 810 Verm ont Avenu e, NW Rm. 8 15 c Wusbing ton, DC 20-U0 AMERICAr-... pVERSIGHT VA-19-0799-G-000799 D8_00021515 mum: "11. Message From: (b) (6) (b) Bruce Moskow it z [bruce~@mac Sent : 6/ 14/201 7 9:47 :54 PM (6) To ; (b) (b) (6) (6) -(b) (6) va.gov) (b) (6) ( (b) (6) Poonam Ala igh ~hot mail.c om); drshulkin@aol.com ; IP a@fren changel59.com); mb ~@gma b Re: [EXTERNAL) Re: Veterans Affa irs, Apple, Academic Healt h System Collaboration CC: Subject : .com] il.com ) ( 6 ir CIO on t he board but to be politically Yes t hat would be appropr iate and actually most of the CEO'swould put the correct we need t o give them the choice. When you get to t he next level) the work ing group I wi ll give you the ones who actually wi ll wo r k. Sent from my iPhone On Jun 14, 2017, at 3:49 PM, (b) (6) (b) (b)(6) (6) ~>wrote : Thank you very much Dr. Moskowitz . As always, your feedback is so helpful. On our call today we had mentioned a three tier system with Governance (CEO),Technical Expertise (CIO) and Working group . Apple requested a leaner process which would reduce the model to two levels and eliminate the Technical Expertise level. Would you suggest the addition of 2-3 CIO's at the Governance level in order to flatten the structure? Thank you for your consideration. -(b) (6) From: Bruce Moskowitz [ mailto:bruce (b) (6) (b) mac.com (6) Sent: Wednesday, June 14, 2017 3:36 PM To: (b) (6) (b) (6) Cc: Poonam Alaigh; drshulkin@aol.com; IP; ~ Subject: [EXTERNAL] Re: Veterans Affairs, Apple, Academic Health System Collaboration (b) (6) For governing committee I and Mr . Perlmutter spoke it w ill be th e 5 CEO's and-who w ill have the opportunity to be direct ly involved along w ith the choice from Apple we should leave that up to Mr. -(b) Also obv iously Mr. Perlmutter (he will ask Mrs for her involvement) and Mr . Sherman are critical (6) since this is definitely going to tu rn out to be th e most transformative issue to im prove medical care not ju st for the VA but for th e natio n. Sent from my iPad Bruce Moskow it z M.D. On Jun 14, 2017 , at 2:45 PM, (b) (6) (b) (b)(6) (6) ~>wrote: Good Afternoon , Thank you for your participation on the mid -day call to discuss the collaboration between the Veterans Affairs , Apple and the five academic medical centers. As we discussed, we wi ll begin by identifying those individ uals from each of the aforementioned organizations to serve on a governance committee as well as those individuals who w ill be part of the work group for t his initia t ive. Pleaseforward your recommendations and their contact information to me by Thursday June 22 (b) (b)(6) (6) ~)Thank you for your partici pation and enthusiasm! (b) (6) Senior Adrhor, acting Under Secretary for Health Department of Veterans Affairs Veterans Health Administration 810 Vermont Avenue, NW AMERICAN PVERSIGHT VA-19-0799-G-000801 DS_00021517 Rm. 815c Wa shington , DC 20-nO iPhooe: (b) (6) (b) (6) AMERICAr-... pVERSIGHT VA-19-0799-G-000802 DS_00021518 Message From: (b) (6) Sent : 6/14/2017 7:49 :29 PM (b) (6) (b) @mac.com] Bruce Moskowitz [brucerrl■■■ Poonam Ala igh I(b) (6) @hotmail.com); (6) drshulkin@aol.com ; IP ■ ( @frenchangel59.com]; mb (b) (6) @gmail.com RE: [EXTERNAL]Re: Veterans Affairs, App le, Academic Health System Collaboration b To ; CC: Subject: (b) (b)(6) (6) va.gov) ) ( 6 Thank you very much Dr. Moskowitz. As always, your feedback is so helpful. On our call today we had mentioned a ) three tier system with Governance (CEO),Technical Expertise (CIO) and Working group. Apple requested a leaner process which would reduce the model to two levels and eliminate the Technical Expertise level. Would you suggest the addition of 2-3 ClO's at the Governance level in order to flatten the structure? Thank you for your consideration. -(b) (6) (b) (6) (b) From: Bruce Moskowitz [mailto:brucem-@mac.com] (6) To: (b) (6) (b) (6) Cc: Poonam Alaigh; drshulkin@aol.com; IP; mb~n@gmail.com Subject: [EXTERNAL]Re: Veterans Affairs, Apple, Academic Health System Collaboration Sent: Wednesday, June 14, 2017 3:36 PM For governing committee I and Mr. Perlmutter spoke it wi ll be the 5 CEO's and-(b) (6) who will have the opportunity Also obviously Mr . to be directly involved along w ith the choice from Apple we should leave that up to Mr. -(b) (6)definitely going to turn out to Perlmutter (he will ask Mrs for her involvement) and Mr . Sherman are critica l since this is be t he most transformative issue to improve medical care not just for the VA but for the nat ion. Sent from my iPad Bruce Moskowitz M.D. On Jun 14, 2017 , at 2:45 PM, (b) (6) (b) (b)(6) (6) ~>wrote : Good Afternoon, Thank you for your participation on the mid-day call to discuss the collaboration between the Veterans Affairs, Apple and the five academic medical centers . As we discussed, we will begin by identifying those individuals from each of the aforementioned organizations to serve on a governance committee as well as those individuals who will be part of the work group for this init iative. Please forward your recommendations and thei r contact information to me by Thursday (b) (b)(6) (6) June22~) Thank you for your part icipation and enthus iasm! (b) (6) Senior Advisor, acting Under Secretary for Health Department of Veterans Affair s Veterans Health Administration 810 Vermont Avcnu{', NW Rm. SIScWllsbiugton, DC 20420 iPhonc: (b) (6) (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-000803 DS_00021519 Message Poonam Alaigh I(b) (6) @hotmail.com] Sent : 7/11/2017 8:38:26 PM To : David Shu Ikin (drshulkin@aol .com] Subject: Fwd: (EXTERNAL]11 July Veterans Affairs Media Summary and News Clips Attachments : 170711_Veterans Affairs Media Summary and News Clips.docx; ATT0000l.htm; 170711_Veterar,s Affairs Media Summary and News Clips.pdf; ATT00002.htm From: Showed story #3, 7 to Ray- he says it's like a Playboy in brail and without the centerfold Sent from my iPhone Begin forwarded message : From: 11Alaigh Poonam , M.D ." To: "'Poonam Alaigh' 11 - (b) (6) Subject: FW: [EXTERNAL] 11 July Veterans Affairs Media Summary and News Clips Sent with Good (www .good .com ) -----Original Message----From: VA Media Analysis [VAMediaAnalysis@barbaricum .com ] Sent: Tuesday , July 11, 2017 05:18 ANr Eastern Standard Time To: VA Media Analysis Subject: [EXTERNAL] 11 July Veterans Affairs Media Summary and News Clips Good morning, Please find the attached Veterans Affairs Media Summary and News Clips, BARBARICUM AMERICAN PVERSIGHT VA-19-0799-G-000804 DS_00021520 Veterans Affairs Media Summary and News Clips 11 July 2017 1. Top Stories 1.1 - The New York Times: A Bipartisan Congress That Works? Veterans Committees Show How It's Done (10 July , Nicholas Fandos , 30M online visitors/mo; New York, NY) This is Congress? Something strange is happening in the staid hearing rooms of the House and Senate Veteran Affairs Committees here this summer , though few have taken notice. As the rest of Congress fights over the health care overhaul and looming budget deadlines, the committees responsible for writing legislation affecting veterans are quietly moving forward with an ambitious, long-sought and largely bipartisan agenda that has the potential to significantly reshape the way the nation cares for its 21 million veterans . Hyperlink to Above 1.2 - U.S. News & World Report (AP): New Food Pantry at Salt Lake's VA Already Serving Dozens - A food pantry that recently opened to help veterans in Salt Lake City is already serving dozens of people. (10 July, 24M online visitors/mo ; Washington , DC) A food pantry that recently opened to help veterans in Salt Lake City is already serving dozens of people a month. The Salt Lake City Tribune reports the food pantry that opened in March at the George E. Wahlen Department of Veterans Affairs Medical Center serves close to 100 veterans and their families every month . Hyperlink to Above 1.3 - The Washington Times: VA denies claims for Gulf War illness more often, study finds (10 July , Dave Boyer , 10.8M online visitors/mo; Washington , DC) Veterans claiming "Gulf War illness" are about three times less likely than other veterans to have their disability claims approved by the Department of Veterans Affairs , according to a new watchdog report Monday that recommended the agency beef up its response to the illness. The Government Accountability Office said the VA handled about 11,400 claims for Gulf War illness (GWI) in fiscal 2015 , more than double the number of claims filed in 2010. Hyperlink to Above 1.4 - Military.com: Quick Action Needed From Congress on VA Choice Program (10 July , Richard Sisk, 9M online visitors/mo ; San Francisco , CA) Congress is returning this week from the July 4 recess under deadlines for action on an array of budget issues, including authorizing funding for the Veterans Affairs Department's Choice program . Funding for Choice , which allows veterans flexibility in seeking private health care, will likely run out by Aug. 7 unless lawmakers act to provide a fix, accord ing to VA Secretary Dr. David Shulkin. Hyperlink to Above 1.5 - The Salt Lake Tribune: 'A godsend': Salt Lake V.A.'s new food pantry is in high demand (10 July, Luke Ramseth, 3.2M online visitors/mo ; Salt Lake City, UT) That's why the couple makes weekly trips to a new food pantry at the George E. Wahlen Department of Veterans Affairs Medical Center. Opened in March , the pantry already serves close to 100 veterans and their families per month , said Natalie Green , a VA health care administration trainee who started the program . Late last year, Green said, she realized the 1 A\llERICAN PVERSIGHT Veterans Affairs Media Summary aod News Clips 11 July 2017 VA-19-0799-G-000805 DS 00021521 extent of the veteran hunger problem. Some 1.7 million veterans experience food insecurity annually. Hyperlink to Above 1.6 - Knoxville News Sentinel (USA Today Network - Tennessee): Veterans' health care data could lead to rapid medical breakthroughs (10 July, Brittany Crocker, 2.1M online visitors/mo; Knoxville, TN) Scientists at Oak Ridge National Laboratory are developing a secure platform for researchers to access the healthcare data of 22.5 million military veterans, accelerating the timeline for medical research breakthroughs. Scientists from ORNL's Computational Sciences and Engineering Division started building the platform as part of the laboratory's involvement in a national partnership between the Department of Veterans Affairs and the Energy Department. Hyperlink to Above 1.7 - The Tennessean (USA Today Network - Tennessee): Gulf War veterans face more, longer delays at VA, government report says (10 July, Jake Lowary, 2.1 M online visitors/mo; Nashville, TN) Gulf War veterans often wait four times longer for care and their claims at the VA are three times more likely to be denied, according to a report released Monday by the Government Accountability Office . The GAO report is the most recent indication that the VA itself acknowledges some of its own shortcomings in training, knowledge of medical conditions and the inner workings for which veterans across the country continually blast the VA. Hyperlink to Above 1.8 - Austin American-Statesman: VA releases list, but is mum on why employees were fired (10 July, Jeremy Schwartz, 2.1 M online visitors/mo; Austin, TX) The Department of Veterans Affairs last week released its first public list of fired and disciplined employees, an initiative of its newly created Office of Accountability and Whistleblower Protection. The list, which includes job descriptions, but not names of disciplined employees, is meant to increase transparency and accountability at the VA, which came under intense criticism for failing to adequately discipline employees responsible for secretly manipulating wait times ... Hyperlink to Above 1.9 - Stars and Stripes: Report: VA claims for Gulf War illness denied 80 percent of the time (10 July, Nikki Wentling, 1.4M online visitors/mo; Washington, DC) The Department of Veterans Affairs denies more than 80 percent of veterans' claims for benefits for Gulf War-associated illnesses -- an approval rating three times lower than all other types of claims , according to a Government Accountability Office report released Monday. From 2010 to 2015, the VA approved 17 percent of claims - or 18,000 of 102,000 -- for health care and disability compensation for veterans suffering from Gulf War Illness ... Hyperlink to Above 2. Veteran and Employee Experience 2 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000806 OS 00021522 2.1 - Breitbart: VA Under Trump Admin Fires More Than 500 Employees, Suspends 200 for Misconduct (10 July, Katherine Rodriguez , 19.1M online visitors/mo; Los Angeles, CA) The Department of Veterans Affairs fired more than 500 employees and suspended nearly 200 for misconduct since President Trump's inauguration in January, keeping true to campaign promises to clean up the agency . The VA's accountability report released Friday noted that the agency removed 526 employees, suspended 194 employees for more than two weeks, and demoted 27 employees . Hyperlink to Above 2.2 - The Hill: Week ahead: Defense spending, Trump nominees top agenda (10 July, Ellen Mitchell, 11.SM online visitors/mo; Washington, DC) Congress returns from its July 4th recess on Monday and must tackle several fiscal 2018 defense bills and Pentagon nominations before the month-long August recess in three weeks. The Senate Veterans Affairs Committee, the House Rules Committee and the Senate Appropriations Committee will all move forward legislation, starting with a markup of the Senate VA bill Tuesday. Hyperlink to Above 2.3 - The Salt Lake Tribune: Tribune Editorial: Someone finally steps up to help hungry veterans (10 July, Editorial Board, 3.2M online visitors/mo; Salt Lake City , UT) We have shamefully underfunded and understaffed our system of veterans' services. For example, in 2015 the wait times for Utah veterans seeking medical care were longer than the national average, and the national average was pretty poor. Granted, the Department of Veterans Affairs (VA) in Salt Lake City has made great improvements over the last year, detailed in a June op-ed by Shella Stovall, acting director of the VA Salt Lake City Health Care System. Hyperlink to Above 2.4 - Investor's Business Daily: Good News For Veterans: Trump Tells Hundreds Of VA Workers 'You're Fired!' (10 July, 3.2M online visitors/mo; Los Angeles , CA) Accountability: For decades, political leaders have lamented the scandal-plagued Veterans Health Administration, and did little more than throw more money at the problem. The Trump administration is firing workers who aren't doing their jobs. According the Department of Veterans Affairs, 526 have been fired for misconduct since President Trump took office. Another 200 have been suspended and 33 demoted. Hyperlink to Above 2.5 - WXIA (NBC-11, Video): Man shot by police during bank standoff had issue with VA benefits (10 July, Phillip Kish, 1.5M online visitors/mo; Atlanta, GA) The man shot dead by authorities after he claimed to have a bomb at a Marietta bank had visited the Atlanta Veteran Affairs office days before the incident. VA spokesperson James Hutton confirmed to NBC News that Brian Easley was at the Atlanta office on July 3 to discuss an issue with his BA benefits. After being informed of what he needed, Easley said that he'd return on Thursday with the paperwork to settle the matter. Hyperlink to Above 3 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000807 OS 00021523 2.6 - WFED (AM-1500, Audio): VA's first 'accountability' posting shows hundreds fired since Trump inauguration (10 July, Terry Wing, 831 k on line visitors/mo; Washington, DC) The Department of Veterans Affairs has posted its first list of employee removals, suspensions and demotions showing VA has fired 525 staffers since President Trump took office in January. The list, posted on Friday, includes doctors, nurses, housekeepers and even grave diggers. It does not include employee names, due to privacy reasons but does note the employee's position and VA region. Hyperlink to Above 2.7 - WFED (AM-1500): What VA's now public adverse action reports don't say about employee accountability (10 July Nicole Ogrysko, 831k online visitors/mo; Washington, DC) Some federal employee groups and experts are scratching heads over the Veterans Affairs Department's recent decision to publish a weekly list of all major disciplinary actions for its workers . VA is the first federal agency to publish such information, and it described the decision as a step toward improving accountability and transparency at a department which has long struggled to use governmentwide disciplinary procedures to tackle entrenched cultural challenges. Hyperlink to Above 2.8 - WSYX (ABC-6, Video): Veterans Administration mistakenly declares war veteran "dead" (11 July, Kurt Ludlow, 450k online visitors/mo; Columbus, OH) A military veteran turned to Six On Your Side for help after getting the surprise of his life. He was surprised to find out he was "dead." At least as far as the government was concerned. "We are so sorry to learn of the death of Manis McKenzie, and extend to you our deepest sympathy," said Manis as he read from a letter to his wife from the Veterans Administration. Hyperlink to Above 2.9 - KRGV (ABC-5, Video): Veterans Accountability Report Questioned (10 July, 277k online visitors/mo; Weslaco, TX) The U.S. Department of Veterans Affairs is providing the removal, suspensions and demotions of employees as of July 3, 2017 in an online accountability report. The report shows 23 veterans health administrations across the country. According to the Veterans Health Administration, the Rio Grande Valley is under the Veterans Integrated Service Network (VISN 17). It's made up of seven different VA medical health care clinics in Texas. The VA accountability report shows several removals and suspensions and demotions. Hyperlink to Above 2.10 - Cape May County Herald: Veterans Affairs Pitches Vision; Crest Dune Project on Hold (10 July, Rachel Rogish, 191k online visitors/mo; Rio Grande, NJ) Hinker concluded by requesting permission to set up a booth at upcoming concerts held in the borough. "I like to engage people," said Hinker, explaining the personal interaction she seeks to facilitate while presenting Veterans Affairs. "We want every vet to have a good experience." Hyperlink to Above 2.11 - WTOK (ABC-11, Video): Town hall addresses veterans' concerns (10 July, Jeffrey May, 66k online visitors/mo; Meridian, MS) 4 AMERICAN PVERSIGHT Veterans Affairs Media Summary and News Clips 11 July 2017 VA-19-0799-G-000808 OS 00021524 Local veterans had the chance to have their questions about their health benefits answered. The associate director of the Sonny Montgomery VA Medical Center in Jackson stopped in Meridian Monday for a town hall meeting. He participated in a Q & A session with veterans and their families. Hyperlink to Above 2.12 -WAGM (FOX-8): Poliquin Introduces Bipartisan Legislation to Streamline VA Workforce Acquisition (10 July, Taylor Lumpkin , 36k online visitors/mo; Presque Isle, ME) Subcommittee on Oversight and Investigations Chairman Jack Bergman (R-Mich.) and Ranking Member Annie Kuster (D-NH), along with Rep. Bruce Poliquin (R-Maine), introduced bipartisan legislation to streamline VA's processes for workforce acquisition. "I'm proud to join Rep . Poliquin and Ranking Member Kuster in supporting this legislation that takes critical steps to improve the methods by which the VA trains, recruits, and retains top professional talent in acquisition career fields ," said Bergman . Hyperlink to Above 2.13 - Dayton Business Journal: VA cuts 70 positions across Ohio, as part of new accountability effort (10 July, 20k online visitors/mo; Dayton, OH) The U.S. Department of Veterans Affairs has implemented a new accountability practice whereby poor-performing employees can be removed from their jobs. And since January, the VA has fired more than 500 people across its extensive footprint. That's the word from the VA's adverse actions report, which was released last week. Hyperlink to Above 2.14- Corridor News: VA Apprenticeship Program To Train, Employ Veterans To Assist Other Veterans In Properly Filing For VA benefits (10 July, 17k online visitors/mo; San Marcos, TX) Veterans service organizations (VSOs) play a major role as advocates for the Veteran community, and as partners with VA, to ensure this nation's Veterans receive the benefits they have earned. An important part of this partnership is to support VSOs as they train their advisors on the benefit process. Hyperlink to Above 3. Access to Healthcare 3.1 - The Huffington Post (Video): No Marine Left Behind ... Except This One (10 July, Jon Hotchkiss, 22 .9M online visitors/mo; New York, NY) In 2012, he went to the VA. .. where it was determined that he had only about 70% mobility in his right shoulder and his constant chronic pain was verified. It was determined that he needed surgery on his shoulder . James was forced to wait 5 years for his operation . He was told he needed the surgery in 2012. In 2017 the VA finally arranged for him to get it. Hyperlink to Above 3.2 - The Hill: Humane Society pushes bills to connect wounded vets, service dogs (10 July, Sumner Park, 11.SM online visitors/mo; Washington, DC) 5 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000809 OS 00021525 The Humane Society of the United States is urging lawmakers to pass a package of bills to make it easier for veterans and service members to get therapy dogs. The bills have bipartisan support, but animal rights advocates are making a new push to get the legislation through Congress, with lawmakers nearing their August recess with an already busy docket. Hyperlink to Above 3.3 - WRC (NBC-4, Video): Washington DC VA Medical Center Operating Room Temporarily Shut Down (10 July, Scott MacFarlane, 4.8M online visitors/mo; Washington, DC) Federal officials ordered an operating room at the Washington DC VA Medical Center shut down late last week after the latest in a series of maintenance issues that have plagued the facility in recent months. The temporary shutdown lasted approximately three hours, according to a U.S. Department of Veterans Affairs spokesman. Hyperlink to Above 3.4 - Hartford Courant (Video): Service Dogs Provide Lifeline For Disabled And Veterans (10 July, Matt Ormseth, 2.1 M online visitors/mo; Hartford, CT) Charles returned from a tour in Kuwait with PTSD and a brain injury suffered when he was thrown out of an armored truck - "invisible wounds," he called them . He had planned on getting a master's degree in social work at UConn and working at Veteran's Affairs, but he couldn't concentrate, couldn't rid himself of flashbacks from tours in the Middle East and Bosnia in the '90s. The nightmares were happening three to four times a week, he said. Hyperlink to Above 3.5 - KSAT (ABC-12): Rep. Beto O'Rouke lays out veteran, mental health plans at town hall, Congressman running for U.S. senate seat (10 July, Chris Shad rock, 1.1M online visitors/mo; San Antonio, TX) U.S. Rep. Beto O'Rourke (D-16) announced on Monday his plans at a town hall meeting in Somerset for a piece of legislation dedicated to veterans and mental health. O'Rourke said an estimated 20 veterans die from suicide every day. He acknowledged there aren't enough mental health care providers and that it's difficult to get veterans to receive the care they need from the VA. Hyperlink to Above 3.6 - Pantagraph: Veterans Corner 7/10/17 (10 July, 834k online visitors/mo; Bloomington, IL) I am a friend of a veteran who has serious mental health issues. His limited insurance coverage for such issues is inadequate and he periodically ends up in the emergency room for threatening suicide. He was discharged from military duty with a general discharge under other than honorable conditions. Hyperlink to Above 3.7 - WFED (AM-1500, Tom Temin Commentary): VA's new list: Playboy without the centerfold (10 July, Tom Temin, 831k online visitors/mo; Washington, DC) Secretary David Shulkin, a physician, has thrown himself into the management reform effort at VA. I think he relishes it. The latest gambit is posting to VA's website a list of adverse employee actions, to be updated weekly. The initial list has 26 pages each with 29 demotions, suspensions of more than 14 days, and removals. I guess "removal" means firing. 6 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000810 OS 00021526 Hyperlink to Above 3.8 - WKRG (CBS-5): New Mobile V.A. Clinic On Track (10 July, Bill Riales, 272k online visitors/mo; Mobile, AL) Veterans say after decades of talks, it's about time. Land and permits have been acquired and the new Mobile Veterans Outpatient Clinic is on target to be completed by November 2018 . That's the word from the company that is building the new facility, U.S. Federal Properties of Kansas City, Mo. Hyperlink to Above 3.9 - Johnson City Press: Congressman Roe's response to July 3 protest (10 July, Brandon Paykamian, 196k online visitors/mo; Johnson City, TN) During a July 3 ceremony honoring Mountain Home's historic buildings, Robert Rose turned his wheelchair to face away from the Republican 1st Congressional District representative to express his opposition to the "Opioid Safety Initiative," which Rose claims restricts access to pain medications for patients and veterans suffering from chronic pain. Hyperlink to Above 3.10 - Circa (Video): Veterans want pot and more accountability as the VA battles the opioid epidemic (10 July, Allison Maass, 22k online visitors/mo; Arlington, VA) In the U.S. millions of people are addicted to opioids, and the veterans' community is no stranger to the epidemic. A recent report found the guidelines the VA had recommended to manage addiction risks when prescribing opioids had not always been followed, and though progress has been made since, some veterans think there is still a long way to go. Hyperlink to Above 3.11 -WGCU (NPR-90.1, Audio): VA Expands Emergency Mental Health Care To Vets With 0TH Discharges (10 July, Stephanie Colombini, 1.4k online visitors/day; Fort Myers, FL) This week the Department of Veterans Affairs expanded emergency mental health care to vets with other-than-honorable discharges. It's part of an effort to curb the recent increase in veteran suicide. According to the VA, the rate of suicide among veterans who don't use VA care is increasing at a much higher rate than for those who do. Hyperlink to Above 4. Women Veterans - No Coverage 5. Appeals Modernization - No Coverage 6. Strategic Partnerships 6.1 - Managed Healthcare Executive: ICER, VA join to work on drug value, price negotiations (11 July, Tracey Walker, 348k online visitors/mo; North Olmstead, OH) 7 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000811 OS 00021527 The Institute for Clinical and Economic Review (ICER) will work with the Department of Veterans Affairs (VA) Pharmacy Benefits Management Services office (PBM) to facilitate their integration of ICER reports into VA's form ulary management process of evaluating the comparative clinical effectiveness and value of drugs . Hyperlink to Above 6.2 - mHealth Intelligence: VA, Air Force Expand Tele-ICU Program for Patient Care, A tele-lCU collaboration between the VA and the Air Force aims to extend patient care for service members in critical condition. (10 July , 53k online visitors/mo; Danvers , MA) A collaboration between the VA's Midwest Healthcare Netwo rk and the Air Force's Medical Operations Agency will open a tele-lCU program to Air Force servicemen at five military treatment centers across the country. Through this new agreement, the Air Force now can access the VA's centralized tele-lCU capabilit ies in Minneapo lis. Hyperlink to Above 7. Supply Chain Modernization - No Coverage 8. Other - No Coverage 8 AMERICAr-... pVERSIGHT Veterans Affairs Media Summary and News Clips 11 July 2017 VA-19-0799-G-000812 DS 00021528 1. Top Stories 1.1 - The New York Times: A Bipartisan Congress That Works? Veterans Committees Show How It's Done (10 July, Nicholas Fandos, 30M online visitors/mo; New York, NY) WASHINGTON to becoming law. Magnanimous hearings . Bipartisan votes. Substantial legislation on its way This is Congress? Something strange is happening in the staid hearing rooms of the House and Senate Veteran Affairs Committees here this summer, though few have taken notice. As the rest of Congress fights over the health care overhaul and looming budget deadlines, the committees responsible for writing legislation affecting veterans are quietly moving forward with an ambitious, long-sought and largely bipartisan agenda that has the potential to significantly reshape the way the nation cares for its 21 million veterans. It could also provide President Trump with a set of policy victories he badly wants. "It's a case study in Washington working as designed," said Phillip Carter, who studies veterans issues at the Center for a New American Security and advises Democrats . "And it's shocking because we so rarely see it these days." The tally thus far is impressive, if not exactly the stuff of headline news: The secretary of Veterans Affairs was confirmed unanimously, the only cabinet secretary with that level of congressional approval. Congress quickly passed a temporary funding extension for the Veterans Choice Program, which pays for private-sector health care for veterans facing long wait times at government facilities . Then it passed a new law that makes it easier for the department to hire and fire. The next bit of legislation on the brink of becoming law expedites disability benefits appeals. This is happening as Congress finds itself stalled by a growing list of priorities that lawmakers had hoped to send to Mr. Trump before the August recess. In the case of the health care overhaul, the Senate leadership has even decided to sidestep the committee process that typically sets the pace of legislation moving through the Capitol. Lawmakers with coveted spots on the veterans committees are quick to acknowledge that caring for those who served the country in uniform has long been largely a bipartisan pursuit. But ideological differences do exist between the parties on how to care for veterans' health needs, particularly when it comes to the Choice program, which was hastily written after a 2014 scandal over the manipulation of patient wait times and has proved to be a flawed, if popular, fix. Whether the latest bout of amity can persist will largely depend on whether lawmakers are able to agree on a way to permanently fix the program, and streamline a half dozen others that send veterans out for private care, before it loses its authorization in January. But as lawmakers talk about how they will do it, it almost sounds like an idealized version of how Washington works. "We don't want to have a fight for fights' sake . We want to find solutions," said Johnny Isakson, the courtly Republican chairman of the Senate Committee on Veterans' Affairs. "So when we 9 AMERICAN PVERSIGHT Veterans Affairs Media Summary and News Clips 11 July 2017 VA-19-0799-G-000813 OS 00021529 have opposition to an issue from a member, we try to bring them into the fold and sometimes maybe address the concern they have." Mr. Isakson, 72, a former real estate executive, is among an increasingly rare breed of deal makers in the upper chamber. Those watching the 15-person committee say he has gone a long way to set the tone for its work. He has found a willing partner in Jon Tester of Montana, the committee's top Democrat, who along with being a political moderate is up for re-election next year in a rural state that voted overwhelmingly for Mr. Trump . "With Johnny at the helm, we've been able to get a lot of stuff done," Mr. Tester said. "Do Johnny and I agree on everything? No, we don't, but we believe we can communicate and move forward." The 24-member House committee, which is more ideologically diverse, has its own incentives to compromise . Representative Phil Roe of Tennessee, its chairman, was by most accounts chastened by harsh blowback to a draft bill floated in April that would have made service members pay to be eligible for G.I. Bill benefits. The committee's top-ranking Democrat, Tim Walz of Minnesota, represents a right-leaning rural district and is in the early stages of running for governor. The two men have been working side by side on the committee for nearly a decade. That both sides remain cautiously confident in the Department of Veterans Affairs secretary, David Shulkin, who also served in the Obama administration, has helped as well. Mr. Tester and Mr. Walz have shown that they are willing to maneuver their caucuses toward compromise if the Republican position is within range. To pass the accountability legislation, a long-held priority for both parties that had the support of influential veterans' groups, the Democrats had to overcome initial opposition to weakening the protections afforded to department employees accused of wrongdoing. The changes were opposed by the largest federal workers' union. The final legislation, which Mr. Trump signed into law late last month, makes it easier for the department to fire problematic employees, incentivizes whistle-blowing and gives the secretary greater hiring authorities to fill vacant medical center director jobs. Legislation that overhauls the department's appeals procedure was an easier lift. About half a million veterans have pending claims contesting a Veterans Benefits Administration decision. The process, as currently configured, can take years to sort out. The legislation tries to significantly expedite that process by creating distinct queues for veterans based on the evidence they wish to submit with their claims. The department had championed a similar proposal during the Obama administration, and it won support from the veterans groups. But then lawmakers ran out of time to move it through Congress . The legislation won quick passage in the House this term and, with Congress returning from recess, is expected to win passage in the upper chamber as well. Lawmakers hope it will become law before the August recess. The good feeling may soon be put to the test, however. "What they are getting done now is lowhanging fruit," said Paul Rieckhoff, the chief executive of the Iraq and Afghanistan Veterans of America. "You could argue it is a great political strategy: Get points on the board, get wins. But I don't think that's going to last." 10 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000814 OS 00021530 Mr. Rieckhoff was referring to negotiations, which are expected to intensify this fall, over a reimagining of the multibillion-dollar Choice program and a half dozen other programs that allow veterans to seek health care in their communities at government expense. In the aftermath of the 2014 scandal, lawmakers created a program that gave veterans facing long wait times and travel distances the option of going to private doctors . But lawmakers from both parties agree that its unnecessarily cumbersome scheduling and payment process, among other problems, needs fixing. Exactly how to do so is where the fights might occur. Democrats support community care in theory, but they are fearful that Republicans in the majority and the White House could try to use a significant expansion of the program to force further privatization of the department's services. Republicans largely deny that that is their agenda. Mr. Shulkin plans to present lawmakers with the department's own plan, which could either heighten animosities or dampen them. "If they simply reauthorize Choice resources at the current level, that achieves bipartisan consensus easily," Mr. Carter said. "If they revamp Choice to make it more aggressive, the fiscal implications of that will make many Republicans balk and the privatization implications will make Democrats balk." The committees remain in the early stages of negotiations. For now, though, Democratic and Republican leaders alike are content to take stock of a rare moment of agreement. "I think it's been probably the most productive time of any committee I've ever been on," Mr. Walz said. "It's a unique time." Back to Top 1.2 - U.S. News & World Report (AP): New Food Pantry at Salt Lake's VA Already Serving Dozens - A food pantry that recently opened to help veterans in Salt Lake City is already serving dozens of people. (10 July , 24M online visitors/mo; Washington, DC) SALT LAKE CITY (AP) -A food pantry that recently opened to help veterans in Salt Lake City is already serving dozens of people a month. The Salt Lake City Tribune (http://bit.ly/2tA6Wdk ) reports the food pantry that opened in March at the George E. Wahlen Department of Veterans Affairs Medical Center serves close to 100 veterans and their families every month . Natalie Green is the Veterans Health Administration trainee who started the program. She says veterans return with an immense need for support. The newspaper reports some 1.7 million veterans experience food insecurity every year. Green says VA funds can only be used for medical services, not for a food pantry. So, she set up a separate account that accepts donations. Air Force veteran Rebecca Clark says the food pantry "was a godsend." 11 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000815 OS 00021531 Back to Top 1.3 - The Washington Times: VA denies claims for Gulf War illness more often, study finds (10 July, Dave Boyer, 10.SM online visitors/mo; Washington, DC) Veterans claiming "Gulf War illness" are about three times less likely than other veterans to have their disability claims approved by the Department of Veterans Affairs, according to a new watchdog report Monday that recommended the agency beef up its response to the illness . The Government Accountability Office said the VA handled about 11,400 claims for Gulf War illness (GWI) in fiscal 2015, more than double the number of claims filed in 2010. But approval rates for GWI were about three times lower than all other veterans' claimed disabilities, GAO said. Among the possible reasons for the lower approval rate are that GWI claims "are not always well understood by VA staff, and veterans sometimes file for benefits without medical records to adequately support their claim," the report said. The GAO said the department's ability to accurately process GWI claims "is hampered by inadequate training, and its decision letters for denied claims do not communicate key information to veterans" about why a claim was rejected. Veterans who served in the Gulf War, which often included exposure to a toxic environment from oil fires and chemical weapons, have been at increased risk for several illnesses including joint pain, gastrointestinal problems, fatigue and neurological disorders. Since 1994, the VA has automatically presumed a connection between those illnesses and Gulf War service, a move that should enable veterans to receive a disability rating and benefits more quickly . Late last year, the government extended the deadline for veterans to apply for GWI benefits through the end of 2021. GA said the VA's claims staffers often rely on the agency's medical examiners to assess a veteran's disability before a decision is made on a claim. But VA medical examiners told investigators that "conducting Gulf War general medical exams is challenging because of the range of symptoms that could qualify as GWI." VA has developed elective GWI training for its medical examiners, but only 10 percent of examiners had taken the training as of February, GAO said. The VA said all its pension and compensation examiners will complete a mandatory 90-minute course on GWI by November, and it will make necessary changes in the notification process by August. Back to Top 1.4 - Military.com: Quick Action Needed From Congress on VA Choice Program (10 July, Richard Sisk, 9M online visitors/mo; San Francisco, CA) 12 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000816 OS 00021532 Congress is returning this week from the July 4 recess under deadlines for action on an array of budget issues , including authorizing funding for the Veterans Affairs Department's Choice program. Funding for Choice, which allows veterans flexibility in seeking private health care, will likely run out by Aug. 7 unless lawmakers act to provide a fix, according to VA Secretary Dr. David Shulkin. The department initially proposed paying for Choice with cuts to the Individual Unemployability program, a lifeline to more than 225,000 elderly and disabled vets, but backed off the plan after an uproar from vets and veterans service organizations. Currently, the Choice program allows veterans to use private care if they can't get an appointment with the VA within 30 days or they live more than 40 miles from the nearest VA facility. Shulkin has pledged to expand the program and lift some of the restrictions under a revamped Choice program expected to be unveiled later this week . The new plan would be included in the VA's budget for fiscal 2018 , which begins Oct. 1. In his proposed budget, President Donald Trump called for $2.9 billion in new funding for Choice in fiscal 2018 and $3.5 billion in fiscal 2019. Meanwhile, the VA is faced with funding Choice past Aug. 7, which will leave Congress with only three weeks to act before the traditional August recess. Shulkin has urged Congress to pass emergency stopgap funding for the Choice program or give him the authority to transfer funds out of other VA accounts . Currently, he cannot transfer funds. At a Senate Veterans Affairs Committee hearing last month, Shulkin made clear that he will no longer be looking at cuts to the Individual Unemployability program to pay for Choice. Shulkin said that cuts to IU had been one of several options that the VA had considered to keep funds flowing to Choice and expand the program, but "as I began to listen to veterans and their concerns, it became clear that this would be hurting some veterans." He said the IU cuts would amount to "a take away from veterans who can't afford to have those benefits taken away. I'm really concerned about that," Shulkin said. "This is part of a process. We have to be looking at ways to do things better , but I am not going to support policies that hurt veterans." Veterans currently eligible for the IU benefit have a 60 to 100 percent disability rating through the VA and are unable to secure a job because of their disability. IU allows them to receive the highest compensation rate. The budget proposal would have removed veterans from the IU program when they reached the minimum age for Social Security. About 225,000 veterans aged 60 or older could have been affected by the cut -- about 7,000 of them over the age of 80. "It shouldn't have been proposed to begin with," Veterans of Foreign Wars National Commander Brian Duffy said of the initial plan to cut IU. "Balancing budgets on the backs of veterans is something the VFW will never tolerate." 13 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000817 OS 00021533 Back to Top 1.5 - The Salt Lake Tribune: 'A godsend': Salt Lake V.A.'s new food pantry is in high demand (10 July , Luke Ramseth, 3.2M online visitors/mo; Salt Lake City , UT) Navy veteran Carl Callahan and his wife, Shannon, receive about $1,600 in Social Security benefits each month . They use it to pay rent and utilities on their South Salt Lake apartment, which the Department of Veterans Affairs helped them find after a stint of homelessness two years ago. They use it to pay their cellphone bills and buy gas for the car . Sometimes they use it to pay medical bills for Shannon, who takes frequent trips to the hospital for her asthma. By the time the bills are paid, Callahan said, about $100 is leftover for groceries lucky." "if we're That's why the couple makes weekly trips to a new food pantry at the George E. Wahlen Department of Veterans Affairs Medical Center . Opened in March , the pantry already serves close to 100 veterans and their families per month, said Natalie Green, a VA health care administration trainee who started the program. Late last year, Green said, she realized the extent of the veteran hunger problem. Some 1.7 million veterans experience food insecurity annually . And for younger veterans who served in Afghanistan and Iraq, the food insecurity rate is about 27 percent - nearly double that of the general U.S. population, according to a University of Minnesota study . Green said she was surprised to find only four other VA hospitals nationwide with a food pantry, and those operated only a day or two each month. "We have veterans coming back with an immense need for support," she said . "We know food and nutrition directly affects health outcomes, yet [access to food] was something that was kind of missing from the whole health picture." Part of the problem, Green quickly learned, was that VA funds couldn't be allocated for a food pantry. They must be used for traditional medical services. So she had to get creative. So Green set up an external account that could accept donations for the pantry. She secured a vacant room, lined up a partnership with the Utah Food Bank, and procured canned food donations from the VA staff. She documented her policies and procedures so other VA hospitals could follow a similar path. "She cut through the bureaucratic red tape," VA Salt Lake City spokeswoman Jill Atwood said. On a recent Thursday, two veterans were sitting in the hallway outside the pantry at 2:30 p.m., waiting for Green to unlock the door. The pantry stocks the usual assortment of canned food. And depending on donations , Green also tries to stock nutritional items such as milk, eggs , meat, fruits and veggies - items Callahan and others say often are impossible to find at other food banks in the area. 14 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000818 OS 00021534 "This was a godsend, really," said Rebecca Clark, an Air Force veteran who served in the Gulf War. Her husband, Jesse, also served in the Air Force and had a $90,000 job in aircraft maintenance until he got hurt about five years ago, Clark said. "Everything started going downhill fast after that," she said. The couple recently came to the VA in search of housing assistance - and were told about the food pantry . they now live in a hotel "It helps a lot because with all the other food banks, with the amount of disability we're getting, they're like, 'Oh, you make more than $200 too much, so you can't come here.'" Clark said. "And the church is like 'Well, you're not a member, so you can't come here .' "We would stretch out one meal a day until we got here," she added. "Now, we can buy meats, and this gives you everything else." Callahan, 62, was an electronics technician aboard the USS Constellation in the late 1970s. He visits the VA often for help with his memory loss, depression and post-traumatic stress disorder, he said. Now he also comes for the food pantry. "It's just been tough financially, trying to keep up with everything," Callahan said. "Places like this really help out." Back to Top 1.6 - Knoxville News Sentinel (USA Today Network - Tennessee): Veterans' health care data could lead to rapid medical breakthroughs (10 July, Brittany Crocker, 2.1 M online visitors/mo; Knoxville, TN) Scientists at Oak Ridge National Laboratory are developing a secure platform for researchers to access the healthcare data of 22.5 million military veterans, accelerating the timeline for medical research breakthroughs. Scientists from ORNL's Computational Sciences and Engineering Division started building the platform as part of the laboratory's involvement in a national partnership between the Department of Veterans Affairs and the Energy Department. The partnership aims to address complex health issues that disproportionately affect veterans more than other communities, like prostate cancer, cardiovascular conditions and suicide prevention. "We are creating architecture to allow for rapid advancements in medical research," said Edmon Begoli, the principal investigator for the project and the division's chief architect. 15 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000819 OS 00021535 "Typically these can take five, 10 or even 15 years, but given the gold mine of data that we have, it will enable scientists to move much faster and to see the benefits much sooner than they currently can ." Largest in the world The VA's healthcare data set is the largest and most comprehensive in the world, and it's still expanding . In 2011, the VA launched the Million Veterans Program to consolidate service members' genetic information with their health records and information on their lifestyles and exposures during their military service. To participate, current and former service members donate blood for genome sequencing and fill out surveys on their lifestyles and military service history . Energy Secretary Rick Perry, an Air Force veteran , donated blood to have his own genome sequenced into the database when he announced the Energy Department's involvement in May. "We're bringing together the VA's unparalleled and vast database of healthcare and genomic data with DO E's world class super computing and data analysis," Perry said in a video announcing the project. Unlikely pair At first glance, the Energy Department and the VA might seem like unlikely partners. But, with records on more than 22 .5 million current and former service members, the VA literally has more data than they know what to do with. That's where DOE comes in. The Energy Department is the nation's steward for highperformance computing. Oak Ridge National Laboratory's Titan supercomputer is the fastest in the country. "Nowhere will you find this large of a population with this much comprehensive healthcare data," said Shaun Gleason, ORNL's Computational Sciences and Engineering Division director. "This is a tremendous gold mine for doing discovery on, but you need the high-performance compute power to mine the data and analyze it. We're trying to enable these medical discoveries by building this platform to start with and making it available to the researches the VA wants to have access to it." Begoli said teams of DOE and VA researchers are already active and ORNL expects to be able to start mining the data set in the fall. "Hundreds of papers are being planned," he said . "There will be major discoveries and I say this with confidence because some of these abstracts are already hinting at some correlations that have been discovered. We expect rapid breakthroughs in medical research." Back to Top 16 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000820 OS 00021536 1.7 - The Tennessean (USA Today Network - Tennessee): Gulf War veterans face more, longer delays at VA, government report says (10 July, Jake Lowary, 2.1 M online visitors/mo; Nashville, TN) Gulf War veterans often wait four times longer for care and their claims at the VA are three times more likely to be denied, according to a report released Monday by the Government Accountability Office. The GAO report is the most recent indication that the VA itself acknowledges some of its own shortcomings in training, knowledge of medical conditions and the inner workings for which veterans across the country continually blast the VA. The VA processed some 11,400 claims in 2015- more than double than 2010 -from Gulf War veterans reporting conditions from Gulf War Illness (GWI), a collection of symptoms and conditions that many veterans from the wars in the early 1990s are suffering . "VA's ability to accurately process GWI claims is hampered by inadequate training, and its decision letters for denied claims do not communicate key information to veterans," the report reads. "VA medical examiners told GAO that conducting Gulf War general medical exams is challenging because of the range of symptoms that could qualify as GWI." Symptoms that have been related to GWI include joint pain, gastrointestinal problems, fatigue, and neurological problems, according to GAO, which could include an array of actual diagnoses. Part of the problem, the GAO report says, is that the VA has training for its examiners, but that training is elective. Just 10 percent of those eligible for the training have taken part, according to the report . "Federal internal control standards call for adequate training for staff so they can correctly carry out an agency's procedures," the report said. Claims processors reported depending on examiners to approve or deny claims . The GAO also found that denial letters often lacked explanations of why the claims were denied. As a result of the findings in the report, the VA said it would make the 90-minute training for examiners mandatory and would work with a focus group to more clearly define GWI. In its response, the VA pointed to a $2-million 2014 study that tried to develop a single definition for GWI, but the committee appointed came up with two definitions. The claims filed by veterans for GWI conditions were approved just 17 percent of the time between 2010 and 2015, the same time period the number of claims spiked . "This approval rate was consistently lower than that of the non-Gulf War Illness medical issues in each year we reviewed, which officials attributed, in part, to the complexity of processing Gulf War Illness-related medical issues," the report reads . Many of those veterans had other claims that were approved and resulted in some disability compensation, the report found, but potentially not what they may have been entitled to . 17 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000821 OS 00021537 In some areas of the country, the approval rate was less than 9 percent. More than 2,000 undiagnosed illness claims in Muskogee, Okla., for example, were denied in 2015. In Nashville, the denial-to-approval ration was 1,095-194, or nearly 13 percent. Back to Top 1.8 - Austin American-Statesman: VA releases list, but is mum on why employees were fired (10 July, Jeremy Schwartz, 2 .1M online visitors/mo; Austin, TX) The Department of Veterans Affairs last week released its first public list of fired and disciplined employees, an initiative of its newly created Office of Accountability and Whistleblower Protection. The list, which includes job descriptions, but not names of disciplined employees, is meant to increase transparency and accountability at the VA, which came under intense criticism for failing to adequately discipline employees responsible for secretly manipulating wait times to make it appear that vets were getting into medical clinics faster than they actually were. But so far at least, the department isn't being very transparent about its latest transparency initiative. In response to questions from the Statesman, the VA is refusing to reveal the reasons behind any of the firings, suspensions and demotions it handed out in the first half of 2017. Nor will the VA reveal the location of fired employees, beyond the VISN, the VA's nomenclature for its 21 sprawling regional networks in the U.S. The region that includes Central Texas stretches from Amarillo to El Paso. For Texas readers, that means we don't know if any of the personnel actions are connected to a damning Inspector General report released last year that found systematic data manipulation by scheduling clerks to "zero out" wait times in Central Texas, in many cases on orders of higherups. And Austin veterans can't know if any of the firings occurred at the outpatient clinic here or any of the other medical facilities surrounding the Texas capital. We do know that the list includes 23 medical employees in the VA region that covers Central Texas, and that a "senior leader" was fired in June. When we asked the VA for the reason behind the senior leader's firing, or whether any of the discipline was related to the scheduling manipulation, we were pointed back to the VA's press release. The communique states only that the VA will not release the names of the fired individuals, an entirely defensible position, but says nothing about withholding the reason for the discipline. Without that information , the list does little to illuminate the specific problems at the VA that officials are aiming to clean up through these personnel actions. The public has been given little context to understand the significance of the firings except the sheer volume of disciplined employees. Back to Top 18 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000822 OS 00021538 1.9 - Stars and Stripes: Report: VA claims for Gulf War illness denied 80 percent of the time (10 July, Nikki Wentling, 1.4M online visitors/mo; Washington, DC) The Department of Veterans Affairs denies more than 80 percent of veterans' claims for benefits for Gulf War-associated illnesses -- an approval rating three times lower than all other types of claims, according to a Government Accountability Office report released Monday. From 2010 to 2015, the VA approved 17 percent of claims - or 18,000 of 102,000 -- for health care and disability compensation for veterans suffering from Gulf War Illness, which is an umbrella term for certain medical conditions common in some of the 1 million servicemembers who deployed to Southwest Asia in the past 27 years. Besides claims getting denied more often, veterans seeking benefits for Gulf War illness are having to wait four months longer on average to hear back from the VA, the GAO found. There's confusion among VA staff about how to handle the claims, the report states. The Government Accountability Office also found VA medical examiners, who are key in providing information for veterans' claims, lacked training on Gulf War illness. As of February, 90 percent of medical examiners had not been trained on how to conduct exams for Gulf War illness. The VA made the training optional. However, the VA attributes the low approval ratings to the complexity of Gulf War illness, thought to be caused by toxic exposure. There's not a single definition for Gulf War illness, which includes a cluster of different conditions, as well as nine infectious diseases. "There's a whole range of illnesses that are covered under this umbrella term of Gulf War Illness, and it's difficult to know the causes of those conditions," said the report's author, Melissa Emrey-Arras. "Part of that is because many of the people who served were exposed to things like pesticides, smoke from oil well fires and even depleted uranium. It's difficult to piece together." VA Deputy Chief of Staff Gina Farrisee responded to the report in a letter, promising medical examiners would be required to go through training on Gulf War illness by November. The training is a 90-minute online course . "We strongly believe people at VA need full training on this before doing medical exams," Emrey-Arras said. In 1994, Congress passed legislation allowing Gulf War veterans with undiagnosed illnesses a "presumption," meaning they don't have to prove to the VA their illnesses were caused by military service. An amalgam of medically unexplained chronic illnesses found among Gulf War veterans, including fibromyalgia, fatigue and gastrointestinal disorders, was added to that presumption in 2001. Nine infectious diseases were added in 2010. To secure benefits, veterans had to have served on active duty in Southwest Asia any time after Aug. 2, 1990, and have an illness that falls into one of those categories. Even with the law, approvals are low compared to other types of claims. While 17 percent of claims of Gulf War illness were approved from 2010 to 2015, VA staff approved 57 percent of veterans' claims for all other medical issues during the same time. 19 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000823 OS 00021539 Ron Brown, president of the National Gulf War Resource Center, has been helping Gulf War veterans with their denied claims for the past three years. He communicates between veterans and VA leadership, and is often successful at getting a veteran's denial reversed . Brown had a direct line of communication with former VA Secretary Bob McDonald and he has advocated for better training for VA staff. He has also criticized the VA for being too vague in denial letters to veterans, contending more specific information about why a claim was denied would help veterans know their next step. The Government Accountability Office discovered the same problem . Emrey-Arras described the denial letters as technical, legalistic and "difficult to understand." "I'm extremely disappointed," Brown said. "These are the same issues the National Gulf War Resource Center has been trying to bring to the VA's attention for three years now. I'm left scratching my head on what we've accomplished. We've had 26 years to get this right, and we're not even close. These vets are struggling." article continues below Brown served in Operation Desert Storm in 1990-91 and it took 13 years to gain approval for his own claim of Gulf War illness. He now lives in Roanoke, Va. According to a breakdown in the report of approvals and denials of Gulf War illness claims by city, Roanoke had one of the lower approval ratings in 2015. That year, the Roanoke office denied 544 claims and approved 47 from veterans who said they were suffering from medically unexplained chronic illnesses. The office also denied 1,482 claims from veterans who sought benefits for undiagnosed illnesses related to their Gulf War service and approved 51. Besides requiring more training for medical examiners, Farrisee wrote the VA would be more specific in its letters of denial to veterans and gather a group of experts to come up with a clear plan for researching Gulf War illnesses. The VA has spent more than $160 million from 1994 through 2015 on research related to Gulf War illnesses and was given another $12.3 million for the research in 2016. Yet, the VA has not added any conditions since 2010 to ones already associated with Gulf War service. It tried and failed last year to create a fast-track to compensation for Gulf War veterans with brain cancer. "There's not a clear, single definition of what Gulf War Illness is at this point," Emrey-Arras said. "The VA has had a goal of having a single definition, and yet they don't have it. They have no strategic plan of getting there, no steps laid out to make that so." VA officials will have more opportunity to respond Thursday, when the report will be the subject of a congressional hearing. Two subcommittees of the House Committee on Veterans' Affairs one that deals with VA oversight and the other focused on disability assistance - will hold the hearing at 10 a.m. Brown isn't confident the report and another hearing will produce change. He provided testimony last March about the VA's low approvals for Gulf War claims and will again submit written testimony with similar information. 20 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000824 OS 00021540 "This isn't the first time they've had reports from the GAO, and what's changed?" Brown said. "We keep regurgitating the same stuff over and over again. It's just like anything else, nothing ever gets resolved fast at the VA." Back to Top 2. Veteran and Employee Experience 2.1 - Breitbart: VA Under Trump Admin Fires More Than 500 Employees, Suspends 200 for Misconduct (10 July, Katherine Rodriguez, 19.1M online visitors/mo; Los Angeles, CA) The Department of Veterans Affairs fired more than 500 employees and suspended nearly 200 for misconduct since President Trump's inauguration in January, keeping true to campaign promises to clean up the agency. The VA's accountability report released Friday noted that the agency removed 526 employees, suspended 194 employees for more than two weeks, and demoted 27 employees. Among those disciplined by the agency include 70 nurses, 25 physicians, 14 police officers, a public affairs specialist, a program analyst with the Government Accountability Office, and 22 senior officials. The agency also fired convicted felons and sex offenders who worked as housekeeping aides and food service workers. "Veterans and taxpayers have a right to know what we're doing to hold our employees accountable and make our personnel actions transparent," VA Secretary David Shulkin said in a statement. "Posting this information online for all to see, and updating it weekly, will do just that." Many veterans have died waiting for care, and VA officials have allegedly reported false data on wait times to receive cash bonuses. However, changes to improve the agency have been slow-going because the union that represents VA employees, the American Federation of Government Employees, has convinced Democrats to provide greater job protections for government employees. Secretary Shulkin, who was appointed as undersecretary to the VA under the Obama administration, grew frustrated with efforts by the government employees' union and other groups defending sub-par employees' rights to stay on the government payroll when these same employees neglected to care for veterans . "Just last week we were forced to take back an employee after they were convicted no more than three times for DWI and had served a 60-day jail sentence ... Our accountability processes are clearly broken," Shulkin said at the White House. Back to Top 21 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000825 OS 00021541 2.2 - The Hill: Week ahead: Defense spending, Trump nominees top agenda (10 July, Ellen Mitchell, 11.8M online visitors/mo; Washington, DC) Congress returns from its July 4th recess on Monday and must tackle several fiscal 2018 defense bills and Pentagon nominations before the month-long August recess in three weeks. The Senate Veterans Affairs Committee, the House Rules Committee and the Senate Appropriations Committee will all move forward legislation, starting with a markup of the Senate VA bill Tuesday. The House Rules Committee the same day will consider the House Armed Services Committee's annual defense policy bill, the National Defense Authorization Act, then consider amendments for the legislation on Wednesday. Once the process is completed, the bill could move to the floor for a full House vote as early as this week. The Senate Appropriations Committee, meanwhile is hoping to make headway on its military construction and veterans affairs spending bill, set to be marked up on Thursday. Lawmakers are scrambling to complete and vote on the bills prior to the start of the new 2018 fiscal year, beginning Oct. 1. At issue is the final topline for the Pentagon in fiscal 2018. The House Armed Services Committee passed a $696.5 billion defense policy bill, divided into $621.5 billion in the base budget and $75 billion in war funding known as the Overseas Contingency Operations account. The Senate, however, passed a version which would authorize a total of $700 billion, split into $640 billion base defense funding and $60 billion for the war fund. Both are above the $603 billion base defense budget President Trump proposed . Lawmakers also must work to fill in gaps in the Pentagon's personnel ranks. The Senate Armed Services Committee on Tuesday will hold a hearing for Navy Secretary nominee Richard V. Spencer. The hearing - originally set for June 22 but postponed as Senate Republicans held talks on their ObamaCare repeal-and-replace bill -will now be held at 9:30 a.m., at the Dirksen Senate Office Building, room G-50. Spencer is Trump's second choice for Navy secretary. The president's first pick, investor Philip Bilden, pulled out from consideration in February after he was unable to untangle and divest his business holdings to meet ethics rules. Air Force Secretary Heather Wilson is so far the only service secretary to make it through the nomination process. The White House has yet to name someone for Army secretary after two previous picks withdrew from consideration. Tennessee state Sen. Mark Green (R) withdrew his name from consideration in May, and nominee Vincent Viola dropped out in February . 22 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000826 OS 00021542 On Wednesday, the Senate Armed Services Committee will also hold a nomination hearing for four Defense Department positions: Army undersecretary, principal deputy undersecretary for policy, general council for the Department of the Navy and assistant secretary for special operations and low-intensity conflict. The nominees, Ryan McCarthy, David Trachtenberg, Charles Stimson and Owen West, respectively, are all expected to easily make it through the hearing with little controversy over their nominations . House and Senate committees this week will also hold hearings on a wide range of other issues. The Senate Veterans Affairs Committee will mark up legislation at 2:30 p.m. Tuesday at the Russell Senate Office Building, room 418 . http://bit.ly/2tQC7S3 The House Rules Committee will consider the National Defense Authorization Act at 5 p.m. Tuesday at The Capitol, House room 313. http://bit.ly/2uOquZQ The Senate Armed Services Committee will hold a confirmation hearing for the nominees to be principal deputy under secretary of Defense for policy, assistant secretary of Defense for special operations and low-intensity conflict, under secretary of the Army and general counsel of the Department of the Navy at 9:30 a.m. Wednesday at Dirksen G-50 . http://bit.ly/2tQrHIU The Senate Foreign Relations Committee will hold a hearing on the Taylor Force Act, which would stop U.S. economic aid to the Palestinian Authority, at 10 a.m. Wednesday at Dirksen 419. http://bit.ly/2uyVVHq The House Foreign Affairs Committee will hold a hearing on empowering women in the developing world with testimony from outside experts at 10 a.m. Wednesday at the Rayburn House Office Building, room 2172. http://bit.ly/2uOenM5 The House Veterans Affairs Committee will hold a hearing on the VA's capital assets, including Secretary David Shulkin's plans to close excess facilities, at 10 a.m. Wednesday at the Cannon House Office Building, room 334. http://bit.ly/2tyFcnF A House Foreign Affairs subcommittee will hold a hearing on the administration's fiscal 2018 budget request for the Western Hemisphere at 2 p.m. Wednesday at Rayburn 2172 . http://bit.ly/2tUQ29Q Another House Foreign Affairs subcommittee will have a hearing on terrorism in Southeast Asia at 2:30 p.m. Wednesday at Rayburn 2200 . http://bit.ly/2uz32Qo The Senate Appropriations subcommittee on military construction and veterans affairs will mark up its fiscal 2018 appropriations bill at 2:30 p.m. Wednesday at Dirksen 124. http://bit.ly/2tp1SJV The House Rules Committee will consider amendments for the National Defense Authorization Act at 3 p.m. Wednesday at House 313. http://bit.ly/2sP66LO The Senate Armed Services Committee will hold a hearing on the coup attempt in Montenegro with testimony from the country's ambassador to the U.S. at 9:30 a.m. Thursday at Dirksen G50. http://bit.ly/2tUV721 23 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000827 OS 00021543 The full Senate Appropriations Committee will mark up the fiscal 2018 military construction and veterans affairs appropriations bill at 10:30 a.m. Thursday at Dirksen 106. http://bit.ly/2uziiga A House Foreign Affairs subpanel will hold a hearing on the administration's fiscal 2018 budget request for the Middle East and North Africa at 1 p.m. Thursday at Rayburn 2172. Back to Top 2.3 - The Salt Lake Tribune: Tribune Editorial: Someone finally steps up to help hungry veterans (10 July, Editorial Board, 3.2M online visitors/mo; Salt Lake City, UT) Few would argue against the following assertions: • Members of the armed forces are invaluable to our nation's safety and morale. • We should care for our veterans. • Our care, in many circumstances, has failed miserably. We have shamefully underfunded and understaffed our system of veterans' services . For example, in 2015 the wait times for Utah veterans seeking medical care were longer than the national average, and the national average was pretty poor. Granted, the Department of Veterans Affairs (VA) in Salt Lake City has made great improvements over the last year, detailed in a June op-ed by Shella Stovall, acting director of the VA Salt Lake City Health Care System . But our veterans are still suffering, some from the most basic needs. Like food. Luckily, there are people able to fix a problem once identified, and that is exactly what Natalie Green, a SLC VA health care administration trainee, has done . Green noticed that some of the veterans receiving medical services at the George E. Wahlen Department of Veterans Affairs Medical Center were desperately hungry. So she started a food pantry . Twenty-seven percent of younger veterans who served in Iraq and Afghanistan suffer food insecurity. Yet VA funds cannot be allocated for food assistance . Services offered by the Utah Department of Veterans and Military Affairs include education, employment, health care, burial assistance and loan programs, but not food assistance. Green set up a separate account for private donations, asked for donations of canned goods from employees and other veterans and partnered with the Utah Food Bank to help fill the shelves. The pantry has been open since March and is already serving almost 100 veterans and their families a month. Not only has Green gone above and beyond to organize the food pantry, she has also documented her efforts to help other VA hospitals across the country do the same thing. Green essentially "cut through the bureaucratic red tape" and hopefully started a national movement. The United States Department of Veterans Affairs has taken note. The pantry is open every Thursday from 2:30 to 4:00 p.m. Donations can be made online by donating to the General Purpose fund and including in the comments section that donations 24 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000828 OS 00021544 should be directed to the Food Pantry GPF # 1063. Or donors can deliver in-kind donations to the SLC VA, Building 4, Room 1C25. No, it's not Thanksgiving or Christmas, but people still need to eat. At the very least, we can all help ensure that our veterans don't go hungry . Back to Top 2.4 - Investor's Business Daily: Good News For Veterans: Trump Tells Hundreds Of VA Workers 'You're Fired!' (10 July, 3.2M online visitors/mo; Los Angeles, CA) Accountability: For decades, political leaders have lamented the scandal-plagued Veterans Health Administration, and did little more than throw more money at the problem. The Trump administration is firing workers who aren't doing their jobs. According the Department of Veterans Affairs, 526 have been fired for misconduct since President Trump took office. Another 200 have been suspended and 33 demoted . Most of them worked at the VHA and included physicians, nurses, pharmacy technicians, food service workers, medical technicians, office workers, even some police officers. VA Secretary David Shulkin said this was part of a broader effort to reform the culture at the VA. "Veterans and taxpayers have a right to know what we're doing to hold our employees accountable and make our personnel actions transparent," he continued. "Posting this information online for all to see, and updating it weekly, will do just that." Expect more terminations now that Trump has signed the VA Accountability and Whistleblower Protection Act, which strengthens Shulkin's ability to get rid of bad employees, including senior executives. Contrast this with the Obama administration, which ceaselessly talked about accountability while providing little of it. In the wake of the 2014 widespread scandal at the VHA, where veterans died during endless waits for treatment and officials tried to cover it up, only nine employees (out of 57 targeted for disciplinary actions) were let go, three of whom were senior officials. And then, in June 2016, the Obama administration announced that it was abandoning the 2014 law's streamlined firing process altogether after deciding it was unconstitutional. Shulkin is also imposing a requirement that any monetary settlement with an employee over $5,000 has to be approved by a senior official. As the Daily Caller reports, in the past the VA "repeatedly made five- and six-figure payments to bad employees to get them to quit" rather than deal with a lengthy appeals process. 25 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000829 OS 00021545 In the two and half years that Bob McDonald was running the VA under Obama, the agency paid out more than $5 million in such payments. The message to VA employees was clear: If you're threatened with being fired, hold out for a settlement. Every government agency has the same problem as the VA - it's difficult to impossible to fire workers for misconduct, thanks to the heavy union presence and the Merit Systems Protection Board. The result is that managers not only avoid firing workers, they won't even give employees bad reviews out of fear of triggering lengthy and costly appeals. As a result, 99.5% of federal workers get a "fully successful" rating or above, according to an audit by the Government Accountability Office . More than a third got an "outstanding" rating. Government workers already make more money and get far more generous benefits than those in the private sector who pay their salaries. The fact that so many federal workers get what amounts to a guaranteed job for life is adding insult to injury. What's needed is a wholesale revamp of the rules and regulations covering government employees so that agency heads can actually create cultures of accountability, instead of just talking about it. But the need is more urgent at the VHA, where the failure of government employees can cost lives. Shulkin, to his credit, has taken the first step to remedying that. Back to Top 2.5 - WXIA (NBC-11, Video): Man shot by police during bank standoff had issue with VA benefits (10 July, Phillip Kish, 1.5M online visitors/mo; Atlanta, GA) The man shot dead by authorities after he claimed to have a bomb at a Marietta bank had visited the Atlanta Veteran Affairs office days before the incident. VA spokesperson James Hutton confirmed to NBC News that Brian Easley was at the Atlanta office on July 3 to discuss an issue with his BA benefits . After being informed of what he needed, Easley said that he'd return on Thursday with the paperwork to settle the matter. Easley didn't return as planned, Hutton said. On Friday, police said Easley walked into a Wells Fargo bank and said he had a bomb in his backpack. He made several demands that referenced the miltary and his status as a veteran, authorities said. Early in the standoff, he released some customers and employees. Police said he held two women hostage until after noon. After several hours of negotiations, authorities entered the bank and said that Easley was dead. They've declined to release details into how he died, but have classified the incident as an "officer-involved shooting." 26 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000830 OS 00021546 "I don't think that suspect had an idea what was going on or about to occur," Cobb County Police Sgt. Dana Pierce said on Friday. Authorities later confirmed that the backpack did not contain a bomb. The Georgia Bureau of Investigation has taken over the investigation, as they do most officerinvolved shootings. "VA is deeply saddened by the news in Cobb County," Hutton said. "VA worked closely with law enforcement to try to resolve the situation peacefully, but unfortunately it ended in tragedy . Our sincere condolences go out to everyone affected." The VA reminds veterans that the Veterans Crisis Line is available 24 hours a day at 1-800-2738255. Back to Top 2.6 - WFED (AM-1500, Audio): VA's first 'accountability' posting shows hundreds fired since Trump inauguration (10 July, Terry Wing, 831 k on line visitors/mo; Washington, DC) The Department of Veterans Affairs has posted its first list of employee removals, suspensions and demotions showing VA has fired 525 staffers since President Trump took office in January. The list, posted on Friday, includes doctors, nurses, housekeepers and even grave diggers. It does not include employee names, due to privacy reasons but does note the employee's position and VA region. In announcing the new effort at transparency last week, VA Secretary David Shulkin said veterans and taxpayers have a right to know what VA is doing to hold its 345,000 employees accountable. The so-called "accountability actions" will be posted on a weekly basis. (Veterans Affairs) [... ] Back to Top 2.7 - WFED (AM-1500): What VA's now public adverse action reports don't say about employee accountability (10 July Nicole Ogrysko, 831k online visitors/mo; Washington, DC) Some federal employee groups and experts are scratching heads over the Veterans Affairs Department's recent decision to publish a weekly list of all major disciplinary actions for its workers . VA is the first federal agency to publish such information, and it described the decision as a step toward improving accountability and transparency at a department which has long struggled to use governmentwide disciplinary procedures to tackle entrenched cultural challenges. "Together with the accountability bill the president signed into law recently, this additional step will continue to shine a light on the actions we're taking to reform the culture at VA," Secretary David Shulkin said in a July 7 statement. "Veterans and taxpayers have a right to know what 27 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000831 OS 00021547 we're doing to hold our employees accountable and make our personnel actions transparent. Posting this information online for all to see, and updating it weekly, will do just that." But federal employee groups and employment attorneys say the department's new adverse action reports don't tell the full story about VA's efforts - or struggles - to improve accountability. Sponsored Content: Questions about moving to the cloud? Chat with FDA Chief Information Officer Todd Simpson on July 25, at 1:30 p.m. They don't, for example, explain why VA appears to be on track to fire fewer employees during the first year of the Trump administration than the previous fiscal year. VA's July 3 report lists 525 removals during roughly the first six months of 2017. If the department removes employees at the same pace for the remaining six months, about 1,050 employees from VA will be fired by the end of 2017. Yet according to Office of Personnel Management information on the agency's data archive FedScope, 2,575 employees at VA were removed for discipline or performance in fiscal 2016. VA Removals for Discipline or Performance Year # of Removals FY2011 2,094 FY2012 2,036 FY2013 2,264 FY2014 2,590 FY2015 2,363 FY2016 2,575 Though the recent VA data shows disciplinary actions for the six months of the calendar year and OPM's information tracks removals for the given fiscal year, the department appears on track to fire fewer employees in fiscal 2017 than it has in each of the past six years. "They're firing at about half the rate they did last year," Richard Loeb, senior policy counsel for the American Federation of Government Employees, said. "I'm not really quite sure what all the claims of accountability are about. Obviously with the new law, they feel they'll be able to fire more easily and more quickly. This seems to be a notion of firing your way to excellence." The most recent data from VA won't likely include many removals that the department performed under the new VA Accountability and Whistleblower Protection Act, which President Trump signed into law June 23. Worried about the Trump administration's proposed cuts to federal retirement? Find out what these 100 members of Congress have to say about it. Shulkin has said the new law will allow him to move disciplinary actions through the decision and appeals process more quickly than previous methods . It shortens the time employees have to respond to a disciplinary action, shortens the grievance process, expedites the appeals process at the Merit Systems Protection Board for rank-and-file employees and eliminates the MSPB as avenue for senior executives to appeal disciplinary actions. 28 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000832 OS 00021548 In addition, the majority of the adverse actions described in the first report are among lowerlevel employees at VA, including 94 housekeepers, 55 food service workers and 21 clerks. Practically all of the 94 housekeepers that were removed or suspended during the first six months of the administration are likely veterans, because a provision in the U.S. Code requires VA hire only candidates with veterans preference to fill certain positions like custodians, guards, elevator operators or messengers . One person on the July 3 report was listed as a "senior leader" within the Veterans Health Administration's Central Office, and 17 others are listed as senior leaders within VA medical facilities. Few other VA employees on the most recent report carry higher-level ranks or senior titles. One general attorney at VA's Office of General Counsel was fired in March, for example. A supervisory biomedical engineer and several physicians were also removed. "The so-called VA scandals allegedly started when senior-level VA officials at the medical centers allegedly created secret waiting lists and the like," Loeb said. "I doubt that was done too often by housekeepers or laundry workers, but yet that's where the firing seems to be focused ." Debra D'Agostino, a federal employment attorney with the Federal Practice Group, said the majority of the employees in these lower-level positions don't have control over major decisions or policies that dictate how well VA is caring for and treating its veterans . "This data doesn't show that there's any real change happening in VA," she said. The adverse action reports don't list employee names due to privacy reasons, VA said . But the reports also lack details about the specific charges related to each disciplinary action. D'Agostino called VA's decision to exclude this information "odd," but said she and other lawyers within her practice have often argued with federal agencies over these details when seeking information on other employees who have faced similar charges. Federal circuit case law requires that agencies provide these lists so that employees and their attorneys can compare the charges and decisions with previous disciplinary actions from the department during the appeals process. "I'm not aware of any private sector employer that routinely fires people, as some do, that publishes a public list," Loeb said . "[You] might say they're not public employers either, but there's no requirement to publish these lists. These are facts, whether people are employed by agencies and how they left the agency, and as necessary, that type of information can be released for some background investigations or employment inquires or the like. But this doesn't seem to have any utility other than to tell people, 'Be afraid. Be very afraid."' VA's new public reports list the organization or Veterans Integrated Service Network (VISN) where the disciplinary action occurred, the position that the employee held, the action the department took and the date it was effective. But they don't indicate when VA made an initial proposal to remove, demote or suspend an employee for more than 14 days. 29 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000833 OS 00021549 "It's not clear [these] proposals [were] issued before Trump was inaugurated and then the decision was promptly made," D'Agostino said . The department can often take six months to a year to decide what kind of disciplinary action to make, D'Agostino added. Though the report only lists actions taken after Inauguration Day, she suspects VA made proposals for some of those actions before the new administration began. In addition to the new lists, Shulkin will also now require senior officials to approve any monetary settlements with an employee above $5,000. The undersecretary, assistant secretary of an "equivalent senior-level official within the organization" where the dispute occurred will need to sign off on the settlement. D'Agostino said employee settlements often widely vary. "$5,000 is a very low bar to require that level of review," she said. "That's going to have a tremendous impact on negotiations. Just the fact that it's been put out there is going to have a chilling effect on settlements." Reaching a settlement is the goal, she said , because it acknowledges that the agency and the employee "agree to disagree" and move forward. "There's going to be a lot more litigation that gets dragged on and on because of this," D'Agostino said. "This sends a chilling effect about bringing something like an [equal employment opportunity] EEO claim forward." Many federal employee groups said this decision sends the wrong message to the department's workforce and federal workers in general. "While there is value in posting these kinds of lists in terms of accountability, the larger and more positive effect, we believe, is to restore public confidence in the federal government's ability to effectively manage its workforce," Bill Valdez, president of the Senior Executives Association, said. "There has been a myth floating around that civil servants, because they cannot be fired easily, are unaccountable. This myth, which lists like this prove to be dead wrong, needs to be stamped out because the overwhelming number of federal employees are focused on delivering superior products and services to the American taxpayer . Moreover, the vast majority of civil servants would agree that poor performers should be disciplined or removed from the civil service ." AFGE, which represents roughly 230,000 VA employees, said it wants to hear more about the department's plans to fill 49,000 vacancies and improve the quantity and quality of health care to veterans, Loeb said. "This is not about accountability and it's not about transparency," he said. "It's about sending a message." Back to Top 30 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000834 OS 00021550 2.8 - WSYX (ABC-6, Video): Veterans Administration mistakenly declares war veteran "dead" (11 July, Kurt Ludlow, 450k online visitors/mo; Columbus, OH) A military veteran turned to Six On Your Side for help after getting the surprise of his life. He was surprised to find out he was "dead ." At least as far as the government was concerned. "We are so sorry to learn of the death of Manis McKenzie, and extend to you our deepest sympathy," said Manis as he read from a letter to his wife from the Veterans Administration. "And they said I had died March 30th and if I'd known that, I wouldn't have scheduled the knee surgery," he said as he laughed. McKenzie had just returned home from knee surgery. He's got a great sense of humor, which he promptly used on his wife. "I called my wife and I said, 'I thought you told me that the surgery went well.' She goes, 'well it did.' And I said, 'well I don't think it went so well. I got a letter stating that I died,"' he said. Manis joined the Marines when he was 17, and at 18 was in Vietnam. Later he joined the Navy Reserves where he served for 20 more years . He was eventually sent to Operation Desert Storm. "And then in 2004, my son was in my unit and we both got called up together to go to Kuwait for several months for Iraqi Freedom," he said. He survived all of it, only to be killed off by the V.A. in 2017. "Got to talkin' to 'em and they started the process of bringin' me back to life," he joked . The V.A. told him by phone that the only way to clear it up would be to go to Cleveland in person immediately. So, he got his son to drive him, swollen leg and all. "And I walk in and they said, 'can we help you?' I said 'yes, I'm dead and I'd like to be brought back to life.' And the guy sort of looked at me strange and everybody else in the waiting area laughed," he said. They'd made the three-hour drive only to be ushered out the door just minutes later. "All they did was copy my I-D's, fill out a small form and I was on my way back home to Columbus and that's, something like that, why they couldn't do that locally, I don't have a clue," he said. The whole thing was funny for awhile he said. Then the checks stopped. "And now my V.A. check's gonna be stopping and then yesterday in the mail I got a letter stating that since I'm retired from the Navy Reserves that they're stopping that check now too since I died . And so it's just a big mess." The V.A. told ABC 6/Fox 28 it was notified by a third party that Manis had died. Its statement said it "regrets the inconvenience." and has strengthened its verification process to reduce the likelihood of mistakes like this, which the agency says, don't happen very often . 31 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000835 OS 00021551 VA has found that these types of cases represent a very small number of beneficiaries in comparison to the millions of transactions completed each year. Additionally, VA has several matching programs that are designed to prevent overpayment and debts incurred by beneficiaries. One of these programs matches death record data from the Social Security Administration (SSA) with our database . When a match is made between SSA death records and VA records, the beneficiary is identified as possibly deceased, and a letter is sent to the beneficiary in order to confirm the match. During calendar year 2016, VA confirmed the accuracy of the automated SSA death match process, finding a 99. 67 percent accuracy rate. During that period, the process automatically suspended VA benefit payments for 103,243 beneficiaries. Of those, 345 beneficiaries had their benefit awards reactivated due to erroneous suspensions, representing less than 0.4 percent of the year's SSA match caseload. - Terrence Hayes, V.A. Spokesman "Why in the world they aren't required to have a death certificate before they start killing somebody off? I don't have a clue," said McKenzie. For now, Manis tries to laugh it all off. He's obviously thankful to be alive. But worried the mailman might bring some more bad news . "So I'm just curious today when I get the mail, anybody else killed me off," he joked. The V.A. said it restarted McKenzie's benefits within a few days of being notified he was alive. Back to Top 2.9 - KRGV (ABC-5, Video): Veterans Accountability Report Questioned (10 July, 277k online visitors/mo; Weslaco, TX) The U.S. Department of Veterans Affairs is providing the removal, suspensions and demotions of employees as of July 3, 2017 in an online accountability report . The report shows 23 veterans health administrations across the country. According to the Veterans Health Administration, the Rio Grande Valley is under the Veterans Integrated Service Network (VISN 17). It's made up of seven different VA medical health care clinics in Texas. The VA accountability report shows several removals and suspensions and demotions. "They're seeing now that they are terminating all these people. They're saying you know what they got terminated, what makes us think that we're not going to get terminated. The need to open their eyes and we're probably start getting better service . But right now it's not good service," said Veteran Richard Pena. Army Veteran and Americas Last Patrol Commander, Richard Pena is frustrated. He said an appointment letter he got from the VA came too late. "Then I get the letter the same day my appointment is. I saw the date on there. The same date of my appointment how can they know I didn't show up for my appointment the same day," said Pena. 32 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000836 OS 00021552 Pena hopes Veterans Affairs new accountability tactic works soon before his next medical appointment comes too late. Pena also questioned why specific facilities are not on the list. We reached out to the VA Texas Coastal Bend in Harlingen . They sent us this statement: "The Department of Veterans Affairs (VA) is making public a list of adverse employee actions taken since Jan. 20 in order to continue to shine a light on the actions we're taking to reform the culture at VA." "The news release further states that for privacy reasons, the adverse action list does not include employee names, but gives information on the position, VA region or administration and type of adverse or disciplinary action taken," said VA Texas Valley Coastal Bend Public Affairs Officer Reynaldo Leal. Back to Top 2.10 - Cape May County Herald: Veterans Affairs Pitches Vision; Crest Dune Project on Hold (10 July, Rachel Rogish, 191k online visitors/mo; Rio Grande, NJ) WILDWOOD CREST - "Wildwood Crest is my home," said Jacqueline Hinker, outreach specialist for the U.S. Department of Veterans Affairs. She spoke during the Borough Commission meeting July 5. Raised on Lavender Road and a graduate of Wildwood High School, Class of '84, Hinker has returned to the county in her present capacity . "I answer to the director," said Hinker, explaining her unique position as beneficial to veterans obtaining services. With less "red tape," Hinker finds "kinks" in the process chain and resolves issues if a veteran is unable to receive services. Doris Barnes, 96, of Cape May County recently received her hearing aids due to Hinker's investigation into her case. A veteran of World War II, Barnes can now hear. Hinker presented a vision of increasing enrollment in veterans' healthcare countywide; she desires county veterans to have access to optimum care and services. However, without "numbers," (translated enrollment) Hinker said services would not be as available. A 10,000-square-foot complex, newly built in Vineland, stands testament to growing veterans' enrollment in Cumberland County . Hinker wishes the same for Cape May County. Hinker also attended the June 28 Wildwood City Commission meeting and presented her vision. Though a long-term goal, finding a new facility for veteran care is on Hinker's agenda, eventually replacing present community-based outpatient clinic facility at the Coast Guard Training Center in Cape May. "We need to care for each other," said Hinker, referring not only to veterans but also to their families, friends, and care providers. Hinker said many veterans are not enrolled because they 33 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000837 OS 00021553 "want to leave it (healthcare) for those who really need it." Hinker said although this spirit is admirable, not enrolling decreases the services made available in the county. Hinker concluded by requesting permission to set up a booth at upcoming concerts held in the borough. "I like to engage people," said Hinker, explaining the personal interaction she seeks to facilitate while presenting Veterans Affairs. "We want every vet to have a good experience." Commissioner Joyce Gould offered assistance to Hinker's cause as did Mayor Carl Groen. "I will coordinate with you," Borough Administrator Constance Mahon said. A Veterans Affairs meeting is planned July 15 from 2 to 4 p.m. at the Cape May County Police Academy, 171 Crest Haven Road, Court House. Hinker said her position is personal: her father served during the Korean War and her husband in Operation Iraqi Freedom . Dune Project Update During Mahon's report, commissioners learned that the islandwide dune project remains in the design phase, according to the state Department of Environmental Protection, as cooperation continues with the Army Corps of Engineers. Kayak Launch Site A pre-application will be presented in Trenton by Mahon for the kayak launch at Sunset Lake . Mahon said the purpose is to "smooth out" any potential problems before the application process begins. No New Beach Signs New beach signs will not be installed on Crest beaches until upcoming winter months and spring of 2018. According to Mahon, the JIF (Atlantic County Joint Insurance Fund) has not yet written "uniform language" for the signs. However, Mahon assured commissioners that the signs would include the borough's designation as a TripAdvisor Hot Spot and as one of the top 10 beaches in New Jersey . Back to Top 2.11 - WTOK (ABC-11, Video): Town hall addresses veterans' concerns (10 July, Jeffrey May, 66k online visitors/mo; Meridian, MS) Local veterans had the chance to have their questions about their health benefits answered. The associate director of the Sonny Montgomery VA Medical Center in Jackson stopped in Meridian Monday for a town hall meeting. He participated in a Q & A session with veterans and their families . 34 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000838 OS 00021554 The VA wanted to inform the vets about the changes to medical and claims benefits and discuss the Veterans Affairs Choice Program that congress is examining. Local community vendors showcased the services they provide. "I hope that they see we are here to do the veterans in our community, to actually know that they can come to us and get them answers," said Jeff Sibley, veterans service officer. "And that they learn the new stuff coming out with the hospital." Veterans may stop by the Lauderdale County Veterans Office at 1827 23rd Avenue. Back to Top 2.12 -WAGM (FOX-8): Poliquin Introduces Bipartisan Legislation to Streamline VA Workforce Acquisition (10 July, Taylor Lumpkin, 36k online visitors/mo; Presque Isle, ME) Subcommittee on Oversight and Investigations Chairman Jack Bergman (R-Mich.) and Ranking Member Annie Kuster (D-NH), along with Rep. Bruce Poliquin (R-Maine), introduced bipartisan legislation to streamline VA's processes for workforce acquisition. "I'm proud to join Rep. Poliquin and Ranking Member Kuster in supporting this legislation that takes critical steps to improve the methods by which the VA trains, recruits, and retains top professional talent in acquisition career fields," said Bergman. "Our men and women in the military have provided an invaluable service. More often than not, their commitment comes with great physical sacrifice and lasting effects requiring a lifetime of care. Our Veterans deserve a reliable and effective support structure from well trained and dedicated professionals ." "I'm pleased to introduce this important legislation with my Republican colleagues," said Kuster. "VA has serious purchasing problems that delays healthcare services to our veterans and wastes billions of dollars of taxpayer funds. This bill would ensure that the Department of Veterans Affairs is able to hire and effectively train the employees it holds responsible for purchasing medical supplies and contracting construction projects. This bill would also enable the VA to reform its acquisitions bureaucracy and improve its overall government purchasing operation. I urge my colleagues in the House of Representatives to immediately pass this legislation so we can help improve the overall accountability, efficiency, and functioning of the VA." "Unfortunately, far too often we have seen excessive waste and inefficiencies at the VA that have in some cases severely hurt services to our Veterans," said Poliquin . "It is critical that the resources we put into the VA are used in the most efficient ways and to their maximum potential for our Veterans. To achieve this goal, we must ensure the workforce at the VA receives the training needed to cut down waste and improve efficiency, while also eliminating bureaucracy that harms the department's ability to ultimately carry out this mission. I'm enormously proud to push this legislation forward to increase efficiency, better our Veterans' services and make sure they receive the care and support they deserve." Background: 35 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000839 OS 00021555 The VA Acquisition Workforce Improvement and Streamlining Act would require VA to create career certification programs for construction and logistics employees, which would be in line with similar programs at the Department of Defense. It would also extend VA's career certification for contracting officers to VA's logistics workers and construction managers as well. Furthermore, the bill would direct VA to expand its acquisition intern programs to bring new college graduates and recent veterans into VA to replace retiring employees. The bill pays for these workforce improvements by consolidating redundant acquisition bureaucracy. The Subcommittee on Oversight and Investigations is expected to mark up this legislation on Wednesday. Back to Top 2.13 - Dayton Business Journal: VA cuts 70 positions across Ohio, as part of new accountability effort (10 July, 20k online visitors/mo; Dayton, OH) The U.S. Department of Veterans Affairs has implemented a new accountability practice whereby poor-performing employees can be removed from their jobs. And since January, the VA has fired more than 500 people across its extensive footprint. That's the word from the VA's adverse actions report, which was released last week . The U.S. Department of Veterans Affairs has implemented a new accountability practice whereby poor-performing employees can be removed from their jobs. The U.S. Department of Veterans Affairs has implemented a new accountability practice ... more It shows 71 people have either been fired or supended in the VA's Ohio district, which includes facilities in Dayton and Springfield. "Veterans and taxpayers have a right to know what we're doing to hold our employees accountable and make our personnel actions transparent," said U.S. Secretary of Veterans Affairs David Shulkin in a release. Secretary Shulkin pointed to the move as another step in long-sought transparency and accountability actions at VA, and noted that VA is the first federal agency to make such data public. The report follows the VA Accountability and Whistleblower Protection Act signed by President Donald Trump less than two weeks ago . For privacy reasons, the list does not include employee names, but gives information on the position, VA region or administration and type of adverse or disciplinary action taken. Back to Top 36 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000840 OS 00021556 2.14- Corridor News: VA Apprenticeship Program To Train, Employ Veterans To Assist Other Veterans In Properly Filing For VA benefits (10 July, 17k online visitors/mo; San Marcos, TX) Veterans service organizations (VSOs) play a major role as advocates for the Veteran community, and as partners with VA, to ensure this nation's Veterans receive the benefits they have earned. An important part of this partnership is to support VSOs as they train their advisors on the benefit process. VA's Vocational Rehabilitation and Employment (VR&E) program recently entered in to an agreement with Paralyzed Veterans of America to participate in an apprenticeship program to train Paralyzed Veterans' employees on how to assist Veterans to file for and obtain their benefits. A similar program is currently in effect with the Disabled American Veterans organization. Paralyzed Veterans is an advocate for quality health care, spinal cord injury and disease research, VA benefits, and civil rights for Veterans and all people with disabilities. As a service oriented non-profit organization, Paralyzed Veterans employs national service officers to serve Veterans. "The apprenticeship program with Paralyzed Veterans will put much needed resources into communities nationwide to work with our Veterans and assist them in applying for benefits," stated Tim Johnston, supervisor for rehabilitation services at VR&E. "This not only gives those accepted into the program a skill, but ensures that Veterans in communities, large and small, have access to trained professionals who can help them understand the process and apply for those benefits they have earned and deserve." In a memorandum of understanding between the two organizations, Paralyzed Veterans will provide a 36-month on-the-job training program to qualified Veterans who are selected for the apprenticeship program. Most of the apprenticeship is supervised work with some classroom and on-line learning. These are full-time national service officer positions. Pay during the apprenticeship is supplemented by the VR&E program . For the first 12 months, those selected for the program are paid $2,890 per month by Paralyzed Veterans, and an additional $651 from VA as a training allowance. In the remainder of the apprenticeship, Paralyzed Veterans pays $3,166.66, and VR&E pays $375 per month for training. The VR&E training allowance to the Veteran is tax-free . VA also pays for the training and necessary supplies. Selection for the program generally comes from two sources . Paralyzed Veterans may notify VR&E that they have a candidate in mind, or a VA vocational rehabilitation counselor can recommend someone for the program . The current memorandum of understanding will be in effect until May 2021. Back to Top 37 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000841 OS 00021557 3. Access to Healthcare 3.1 - The Huffington Post (Video): No Marine Left Behind ... Except This One (10 July, Jon Hotchkiss, 22 .9M online visitors/mo; New York, NY) On Friday, July 7th, 2017 Staff Sgt. James Hollon (USMC, Delta Company), his wife Angela and their 3-year old baby got in James' Red Ford truck and drove a few hours south from Portland to a friend's. For the next few nights, they'll sleep on their friend's couch. Yes. It's summer. But no. They're not on vacation. They're homeless . Let me tell you a little about James. He's from a small Texas town . As a teenager, he had a motorcycle that he rode too fast. He realized his life was going nowhere and that he need structure and discipline. He joined the marines at age 20 - the day was january 18th, 2000 . Just a handful of months before terrrorists with box cutters flew planes into the twin towers . He was trained. And deployed overseas. On his first mission, he assisted with the evacuation of the US embassy in Yemen after the USS Cole was attacked. Then, he served 5 combat tours in Iraq and Afghanistan as an infantryman. He was a soldier higher ups relied on. There came a point where he was in charge of a squad and multiple millions in warfare weaponry . While serving in combat, he got 14 concussions from being too close when IEDs exploded. They knocked him out. In some cases he was inside a vehicle. Other times, on foot. First, the blast wave in and of itself, is devastating . And that can give you a concussion. PTSD / TBI: Then, the blast can throw you and you hit your head inside the vehicle, or just as likely, your head hits the ground if you were on foot. His official medical records say he got at least 14 concussions. But James thinks the# is actually closer to 20. Today: we know that even just a few repeated concussions or traumatic brain injures - like those suffered by James Hollon - will result in diminished thinking capacity, diminished sensation like sight or balance, diminished language capacity, including communication, expression and understanding and diminished emotional capacity, including depression, anxiety, personality changes, aggression, inappropriate social behavior and suicide. 20 veterans a day kill themselves in the US. Repeated concussions will also likely cause early onset epilepsy, parkinsons, and alzheimers. After his combat duty, James was a drill instructor for the marines, training new recruits who would head to iraq and afghanistan . 3 year later, James became an ied specialist - teaching marines right before they shipped out to war the devestating effects these improvised bombs had, how these improvised explosive devices are made, how they are deployed, how to spot them, and how to dismantle them. 38 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000842 OS 00021558 James gave the marines 12 ½years.While on duty as a drill instructor, he injured his shoulder. Now, as a marine, he was taught to suck it up. To not complain. To deal with the pain. Because that's what a marine does. And that's what James did. And after giving the marine's 12 ½ years of service, James decided to move on ... VA BOTCHES SURGERY: In 2012, he went to the VA. .. where it was determined that he had only about 70% mobility in his right shoulder and his constant chronic pain was verified. It was determined that he needed surgery on his shoulder. James was forced to wait 5 years for his operation. He was told he needed the surgery in 2012. In 2017 the VA finally arranged for him to get it. Back to Top 3.2 - The Hill: Humane Society pushes bills to connect wounded vets, service dogs (10 July, Sumner Park, 11.SM online visitors/mo; Washington, DC) The Humane Society of the United States is urging lawmakers to pass a package of bills to make it easier for veterans and service members to get therapy dogs. The bills have bipartisan support, but animal rights advocates are making a new push to get the legislation through Congress, with lawmakers nearing their August recess with an already busy docket. "At a time in a country when we are so polarized, this is a set of issues that we can unite around," Wayne Pacelle, president and CEO of the Humane Society of the United States, told The Hill. "The American public will be pleased that the Congress is getting something done and is doing something done that is aligned with their values ." One of the bills, the Paws Act, would provide more service dogs to veterans with post-traumatic stress disorder (PTSD). Though veterans with physical disabilities already have access to service dogs, the bill would authorize the Veterans Administration to fund a five-year program to support organizations that provide companion animals to wounded veterans. Re-introduced by Reps. Ron Desantis (R-Fla.) and Earl Blumenauer (D-Ore.), the bill has 147 cosponsors. The bill has been referred to the House Veterans Affairs Subcommittee on Health . There is a companion bill in the upper chamber from Sens. Deb Fischer (R-Neb.) and Cory Booker (DN.J.) that has been referred to the Veterans Affairs Committee. Another bill in the current Congress, the Veterans Dog Training Therapy Act, would establish a pilot program allowing veterans with post-traumatic stress disorder (PTSD) to take part in therapeutic dog training. 39 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000843 OS 00021559 The bill passed the House in the last Congress, and was reintroducted this year by Reps. Steve Stivers (R-Ohio) and Tim Walz (D-Minn.). "Helping our veterans cope with Post Traumatic Stress Disorder is one of the most solemn responsibilities of our time," Walz told The Hill. The bill calls for Veterans Administration facilities to connect veterans with local dog training organizations and to study the therapeutic value of those programs. Walz said the program would help veterans rehabilitate by training therapy dogs, which would then go on to assist other disabled veterans. "As more research continues to be conducted, I believe this 'veterans helping veterans' pilot program carries great promise of improving the quality of life for all veterans involved," Walz said. Another bill, the Wounded Warrior Service Dog Act, from Reps. Jim McGovern (D-Mass.) and Walter Jones (R-N.C.), would allocate grants to nonprofits that train and provide service dogs to veterans with disabilities or PTSD . The bill is before a House Armed Services subcommittee. Jones told The Hill he's seen a change in attitudes over the issue. "Thanks to a lot of interests nationally was well within military, the whole attitude has changed that service men be given the opportunity to have a service dog after serving," he said. Lawmakers, though, face a tough schedule ahead, leaving many to question when the bills will finally move . Congress must pass a spending bill, raise the debt ceiling, and tackle GOP priorities, including ObamaCare repeal and potentially tax reform. Pacelle said the Humane Society is reaching out to lawmakers to push the legislation on veterans and animals along . "We inform our constituents, lobby offices, write position papers, take advertising, rally millions of Americans, and do much more to advance our goals on Capitol Hill," he told The Hill. "HSUS is all about getting the Congress to act on legislation to advance animal welfare." Back to Top 3.3 - WRC (NBC-4, Video): Washington DC VA Medical Center Operating Room Temporarily Shut Down (10 July, Scott MacFarlane, 4.8M online visitors/mo; Washington, DC) Federal officials ordered an operating room at the Washington DC VA Medical Center shut down late last week after the latest in a series of maintenance issues that have plagued the facility in recent months. The temporary shutdown lasted approximately three hours, according to a U.S. Department of Veterans Affairs spokesman. 40 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000844 OS 00021560 An air valve failed, the agency said, triggering a spike in temperature and humidity in the operating room, which is one of six inside the giant VA Medical Center on Irving Street in Washington, D.C. The emergency shutdown required the postponement of surgeries and raised new questions about the operations of the major medical facility, which treats about 98,000 local military veterans a year. An agency spokesman said two eye surgeries were postponed because of the malfunction. Repairs have since been completed, the spokesman said. The shutdown occurred weeks after a series of other maintenance and safety problems and a management shakeup at the medical center were revealed by a News4 I-Team investigation. Records obtained by the I-Team showed the agency hired a contractor to fix potentially unsafe floor cracks in the facility's surgery department in March. VA officials also ordered repairs of holes in the walls of the facility's "center core areas," completing the project in mid-February. The facility suffered a cockroach infestation and a lack of sanitary conditions in its food service areas in 2015, according to federal records reviewed by the I-Team. An agency spokeswoman told the I-Team the problems have since been remedied. In May, an I-Team investigation revealed the body of a patient went undiscovered for nearly two days in the parking lot outside the medical center. The cause of death has not been determined, according to federal officials who spoke with the I-Team. The agency acknowledged it will investigate the time lag between the death and discovery of the man. The string of recent problems closely preceded a major management shakeup at the medical center . The agency's longtime DC VA Medical Center director Brian Hawkins was reassigned to a position at VA headquarters in April. Days after questions were raised by the I-Team in June about the reassignment, the agency announced it had ordered a disciplinary action against Hawkins but would not specify the type of disciplinary action. The I-Team's reporting and a separate review by the U.S. Department of Veterans Affairs Office of Inspector General triggered a congressional investigation into the DC VA Medical Center . The inspector general review, released in April, revealed broader safety and management problems at the DC VA Medical Center, including dirty sanitary storage areas, supply shortages and more than $150 million in unaccounted for equipment and supplies. Eighteen of the medical center's 25 sterile storage areas were found to be dirty, according to the report by the VA Office of the Inspector General. In five storage areas, the clean equipment and supplies were mixed with the dirty. Seventeen areas lacked ways to monitor pressure, temperature and humidity. The medical center lacked an effective inventory system, and $150 million in equipment and supplies were not inventoried in the past year . Meanwhile, the lease on a large warehouse of non-inventoried items expires at the end of the month with no plan to relocate the contents and staffing constraints could make it difficult to address the situation . Also, no effective system was in place to ensure recalled supplies and equipment were not used on patients, according to the report. 41 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000845 OS 00021561 The unsanitary conditions and lack of attention to safety recalls placed patients at risk, as did a failure to ensure availability of supplies and equipment when needed, the report said. For example, a nurse reported a floor was out of tubes used to provide oxygen when a patient was in need. On a couple of occasions in March, the medical center ran out of bloodlines for treating dialysis patients . Follow us: @nbcwashington on Twitter I NBCWashington on Facebook Back to Top 3.4 - Hartford Courant (Video): Service Dogs Provide Lifeline For Disabled And Veterans (10 July, Matt Ormseth, 2.1 M on line visitors/mo; Hartford, CT) Twenty-five years as an Army chaplain tested Tony Charles' faith . But today, he has an angel that never leaves his side. Dozer, a 4-year-old golden retriever, is Charles' service dog. The two met in 2014, when Charles went to Educated Canines Assisting with Disabilities in Torrington to be paired with one of their dogs, which are trained to help people with physical and emotional disabilities. On his fifth night at the center, Charles suffered one of the nightmares that had plagued him since he retired from the military in 2012 . "He woke me up out of the nightmare and chest-thumped me with his head," Charles recalled . "I was disoriented as to where I was, and I said, 'I got to find the lights.' And when I said the word 'lights,' he went over and turned them on. "I really believe he is an angel in disguise." Dozer is one of more than 350 dogs ECAD has placed with veterans, children with autism and people with physical disabilities. ECAD's founders, Lu and Dale Picard, are now expanding their training center in Torrington, marking a new chapter in the center's 22-year history. "He's helped me regain my sense of pride," Charles said about Dozer. "I'm a different person. I'm much easier to live with ." Match Made In Heaven Charles returned from a tour in Kuwait with PTSD and a brain injury suffered when he was thrown out of an armored truck - "invisible wounds," he called them. He had planned on getting a master's degree in social work at UConn and working at Veteran's Affairs, but he couldn't concentrate, couldn't rid himself of flashbacks from tours in the Middle East and Bosnia in the '90s . The nightmares were happening three to four times a week, he said. "I was lost as to what to do with my life," he said. "I had thought I was going to be a social worker ... thought I could spend the rest of my life helping families through the VA. But my doctor said I couldn't do it." A psychologist suggested he apply for a service dog . Charles filed an application with ECAD, only to be told there was a two-year waiting list. He spent those two years raising money from 42 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000846 OS 00021562 the VA, the VFW and the American Legion to pull together the $25,000 needed to cover the cost of raising a service dog. A family whose veteran son had taken his own life gave him $10,000. "They felt that if their son had gotten a service dog, that maybe he wouldn't have committed suicide," said Charles. Finally, Charles met Dozer in 2014 . "Without any coaxing he came and put his head between my knees," he recalled. "It was a match made in heaven." The Picards have been raising service dogs since 1994, when Lu Picard's father suffered a stroke and she trained the family dog, Juliette, to tug him off the couch and pick up the things he dropped. At the time, the Picards were managing convenience stores. "I said, 'Dale, this what I should do,"' Lu Picard recalled . "Running convenience stores is a job, but I needed something more. I needed something I could be passionate about." The two started ECAD in 1995 out of a two-car garage in West Granby. They've since moved to a larger facility in Torrington, and last week the Picards broke ground on the new center. They've raised $700,000 for the project, about half its estimated cost. The 9,000-square-foot building will include housing for clients like Charles, who go through a two-week training session with their dogs before taking them home . "There's nothing worse than teaching 89 commands to a dog and giving him to someone who has no experience," said Dale Picard. "The dog will just drive you nuts." Dogs That Open The Fridge The Picards breed the dogs - all golden retrievers - on-site, and train them for a year before pairing them with clients. The dogs can open doors, fridges and washing machines for the physically disabled; they can press 911 panic buttons when their owners are hurt, and wake veterans like Charles from nightmares. The dogs are remarkably attuned to their owners' body language. "I didn't go to a mall for, like, seven years," Charles said . "But now, if I get panicked because too many people are coming towards me, [Dozer] will sense that and pull me away from the crowd or the noise." The dogs are as indispensable to some clients "as much as their wheelchair is to them, or their cane," said Lu. Charles credits Dozer with pulling him out of the aimlessness that followed his retirement. The dog has given him a routine - three walks a day, grooming once a day, a toothbrushing every night. Service dogs can help counter the guilt that often accompanies a disability, Lu said. After the stroke, her father felt he was a burden on his family; there was no convincing him otherwise, not until they trained the dog and he felt he was responsible, again, for something's well-being . 43 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000847 OS 00021563 "Nobody wants to be a burden on anybody," she said, "and the dog needs you as much as you need them." Dozer has helped Charles stave off the loneliness he sees engulf many veterans, loneliness that has driven some to suicide. "They lose their social context and become more and more isolated," he said . "But it's very difficult to do that when you've got a service dog that needs to be walked three times a day, and when you need to be groomed and look at least as good as your dog does." Charles still gets nightmares from time to time. But he has Dozer now; he can feel Dozer's warm mass at his hip, his angel watching over him as he drifts off to sleep. "I don't know when, but sometime after I fall asleep he gets off the bed and goes to his bed in the corner," he said. "And if I have a nightmare or a night terror, he'll come right over to me and do his job." Back to Top 3.5 - KSAT (ABC-12): Rep. Beto O'Rouke lays out veteran, mental health plans at town hall, Congressman running for U.S. senate seat (10 July, Chris Shad rock, 1.1M online visitors/mo; San Antonio, TX) U.S. Rep. Beto O'Rourke (D-16) announced on Monday his plans at a town hall meeting in Somerset for a piece of legislation dedicated to veterans and mental health . O'Rourke said an estimated 20 veterans die from suicide every day . He acknowledged there aren't enough mental health care providers and that it's difficult to get veterans to receive the care they need from the VA. The El Paso congressman said he hopes to change that with a proposal introduced as the Honor Out Commitment Act of 2017 . "These are ideas that don't have any partisan aspect to them," O'Rourke said. "We just want to serve Americans, veterans, heroes who need our help. We want to make sure we fulfill our commitment obligation to them." O'Rourke also said he will be running for a spot on the U.S. Senate against Ted Cruz in 2018. Back to Top 3.6 - Pantagraph: Veterans Corner 7/10/17 (10 July, 834k online visitors/mo; Bloomington, IL) Q: I am a friend of a veteran who has serious mental health issues . His limited insurance coverage for such issues is inadequate and he periodically ends up in the emergency room for threatening suicide. He was discharged from military duty with a general discharge under other 44 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000848 OS 00021564 than honorable conditions. I have known him since before he entered military service and I believe that a lot of his mental health issues are related to what he experienced in the service of his country. Does the VA offer any mental health assistance for this type of veteran? A: Discharges that are other than honorable, including a "general" discharge, are known as "bad paper'' and can prevent veterans from receiving federal benefits, such as health care, disability payments, education and housing assistance. In some cases, these veterans were unjustly discharged from the military because of mental health issues. An estimated 22,000 veterans with mental illnesses have received other-than-honorable discharges since 2009. VA Secretary Dr. David Shulkin recently announced that the VA would begin offering VA mental health care services to veterans with less-than-honorable discharges who urgently need it. Such veterans should contact their closest VA clinic or medical center for more information on how to access the mental health emergency services. This change in mental health care is just one of the ways that the VA is responding to the suicide crisis in the military and among veterans . Q: I am enrolled in VA Health Care and periodically see my VA doctor for a few health issues. I have a 40 percent service-connected disability rating. I currently have applied for a VA guaranteed loan. A part of the application process requires a copy of my most recent disability award letter . I receive an award letter each December from the VA with a statement as to what my monthly compensation will be for the next 12 months. The guarantee loan program is run by the VA; why do I have to get the darn award letter? If I have to get the letter, how do I get a copy? A: The VA is broken down into many sub-agencies that administer the individual VA programs . For security purposes and to guarantee that the VA loan guarantee administrator is actually dealing with the veteran who is applying for the program, most VA agencies do not share information between agencies . You can call the VA at 800-827-1000 to request a copy of your most recent award letter . Alternatively, if you are enrolled in Myhealthevet, you can go to the myhealthevet.gov website and print a copy. Did you know? The state of Illinois provides benefits to veterans that are separate from federal VA benefits. They include tax exemption/reduction for disabled veterans, veterans' preference in hiring for state jobs reporting to the governor, the Illinois Veterans Grant for college tuition and fees waiver and admission to the Illinois VA veterans' homes in Manteno, Quincy, LaSalle and Anna. Illinois also provides for the exemption of camping and admission fees for certain disabled persons and former prisoners of war who are Illinois residents and who wish to camp in parks under the control of the Illinois Department of Natural Resources. Documentation of disability status is required. Illinois does not require fishing and/or hunting licenses for disabled veterans with disability ratings from the VA of 10 percent or greater. Contact your local Illinois Department of Veterans Affairs (IDVA) at the Armory on South Main Street in Bloomington to apply for the disabled veteran fishing and hunting licenses. The Illinois State Fair offers free admission on "Veterans' Sunday" at the state fair to all honorably discharged veterans and their family . 45 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000849 OS 00021565 Cartage fees: When the federal government has furnished a headstone or marker, the Illinois Department of Veterans' Affairs shall pay up to the allowable reimbursement amount for the setting of such marker within Illinois. Currently, the maximum amount is $100 payable upon approval of the application. Indigent veterans: Each county with a Veterans Assistance Commission (53 of Illinois' 102 counties have VAC offices) shall provide burial for any honorably discharged indigent veteran, or their mothers, fathers, spouse or surviving spouse, or minor children, without sufficient means to defray the funeral expenses. The expense of such burial shall not exceed the sum of $900. Emergency food and transportation may also be provided in certain cases at the VAC offices. Contact your local commission for more information. Back to Top 3.7 - WFED (AM-1500, Tom Temin Commentary): VA's new list: Playboy without the centerfold (10 July, Tom Temin, 831k online visitors/mo; Washington, DC) The first time my mother felt I was old enough to drop off at the barbershop while she went to the grocery store, I naturally picked up one of the Playboy magazines off the table. Alas - this was a small town and a dry one - I was disappointed to discover the good stuff in the middle had been removed. Rats. That's a little how I felt looking at the Veterans Affairs Department's compilation of adverse employee actions since Jan. 20. Secretary David Shulkin, a physician, has thrown himself into the management reform effort at VA. I think he relishes it. The latest gambit is posting to VA's website a list of adverse employee actions, to be updated weekly. The initial list has 26 pages each with 29 demotions, suspensions of more than 14 days, and removals . I guess "removal" means firing. That's 749 the last page is a little short. VA wants to show it's tough on accountability and soft on transparency. Like the redacted Playboy, the list tantalizes, but doesn't reveal much. Sponsored content: Download our Executive Briefing to learn how agency and industry experts are using cloud for data and application strategy. But some. It lists neither names nor, disappointingly, descriptions of what the people did. The list does give the person's title, VA agency and region, but not specific locations. And it lists the action taken against them. We learn that violators of some work conditions run the ranks from housekeeping aids (suspension greater than 14 days), to physicians (removed), to police officer, to police chief (both removed). We see disciplinary action against people in all functions of the agency nurses and nursing assistants, purchasing agents and logistics technicians, program support specialists and secretaries, and senior leaders. At least one chief of surgery was excised from Region 15. 46 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000850 OS 00021566 I didn't make a scatter diagram, but the list seemed weighted towards the lower-level employees - lots of clerks, health aides, laundry workers, laborers, motor vehicle operators and food service workers. I found a mason, a plumber and a carpenter. Plenty of mid-level people also got kicked. Many nurses and specialists in medical administration, human resources, inventory management and pharmacy. A general attorney. You'll find a few in the higher ranks: supervisory biomedical engineer, several physicians, several listed as "senior leader." Know what to do with your Thrift Savings Plan the next time the stock market crashes? Senior Correspondent Mike Causey tells you how to avoid buying high and selling low. Looking at the list another way, VA separated or otherwise punished people who interact with or touch patients, money, materials and facilities. VA employees, knowing the agency and region in which they work, can check the date of the action and probably figure out who it was and what they did. But perhaps VA leadership felt listing the specific indiscretions would come too close to privacy violation . In not quite seven months, 749 people, or about 107 people per month, have been disciplined in one of the three ways mentioned. Out of an employee population of, let's say 325,000, that comes to 0.23 percent. Back to Top 3.8 - WKRG (CBS-5): New Mobile V.A. Clinic On Track (10 July, Bill Riales, 272k online visitors/mo; Mobile, AL) Veterans say after decades of talks, it's about time. Land and permits have been acquired and the new Mobile Veterans Outpatient Clinic is on target to be completed by November 2018. That's the word from the company that is building the new facility, U.S. Federal Properties of Kansas City, Mo. Rick Baier who is with the company, says there have been no changes with the project. The new clinic will be about 65 thousand square feet, or about twice as big as the current outpatient location, at the University of South Alabama Hospital building on Springhill Avenue. Baier says the location is on a tract of land at Rangeline and Halls Mill Roads. Right now there is just trees and scrub brush on the land. He hopes the land can start to be cleared for the project by the end of July. Back to Top 3.9 - Johnson City Press: Congressman Roe's response to July 3 protest (10 July, Brandon Paykamian, 196k online visitors/mo; Johnson City, TN) 47 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000851 OS 00021567 U.S. Rep. Phil Roe issued a response Monday to last week's protest at the Veterans Affairs Medical Center, Mountain Home, when a disabled veteran complained about the congressman's support for changes in VA drug administration policy. During a July 3 ceremony honoring Mountain Home's historic buildings, Robert Rose turned his wheelchair to face away from the Republican 1st Congressional District representative to express his opposition to the "Opioid Safety Initiative," which Rose claims restricts access to pain medications for patients and veterans suffering from chronic pain. On Monday, Roe, R sent an email to the Johnson City Press saying Rose's criticisms and protests were unwarranted, though he acknowledged the concerns of veterans like Rose in regard to their medications being taken away and tapered. "While I support the goals of this initiative and applaud the VA for taking steps to curb dependence on opioids, I also have been made aware of many concerns from veterans like Mr. Rose that necessary pain management may have been reduced or eliminated too quickly and will conduct oversight through my position as chairman of the House Committee on Veterans' Affairs as to whether the policy needs to be modified," Roe wrote . Roe believes the issue is more complicated than what Rose claimed. Roe said the new guidelines for restricting the opioid overuse is a measure that has been implemented to combat the national opioid epidemic. "The Veterans Health Administration has a long history with opioids that began in the 1990s when, along with the American Pain Society and other pain advocates, they declared pain as the '5th vital sign,' which resulted in widespread opioid use - and ultimately a high rate of addiction - to include among the veterans population," Roe said in his email to the Press. The congressman complained in his email that he was not afforded the opportunity to respond to Rose's criticisms . Roe was not available immediately following Rose's comments to the Press, and the Press' efforts to reach Roe and his staff on July 3 were unsuccessful. The Press again contacted Roe's office on Monday to request an interview. Lani Short, his press secretary, said the congressman would be unavailable because Roe's schedule was "especially full." Short said "everything he would say is found in the letter below," referring to Roe's email. Rose said he has suffered because of the guidelines, which were first officially implemented in 2012 after multiple Senate hearings in which experts in pain treatments, such as practitioner Dr. Alex Deluca, compared measures similar to the initiative to a "death sentence." Roe said he was disheartened to see veterans like Rose suffer but maintained the guidelines that restrict patients' access to opioids are positive measures, despite the opposition of many veterans like Rose and other doctors who have warned of the dangers of forced tapering of pain medications for people suffering from chronic pain and the disabilities that come with it. "Our country is in the midst of an opioid epidemic, and East Tennessee is among one of the regions hardest hit by opioid misuse and addiction . There's no question some of VHA's own practices - such as an initial refusal to work with state prescribing databases - have exacerbated this serious problem," Roe said in the email. "No one wants to see a veteran suffer, 48 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000852 OS 00021568 especially not when their pain could be connected to their service to their country, but veterans with chronic pain deserve the opportunity to live normal lives and to have their pain managed in a responsible way. "That's why VHA and the Department of Defense partnered to issue new guidelines, known as the 'Opioid Safety Initiative,' for the prescribing of opioids as a tool to help providers ensure they are providing veterans and service members with the best care possible." Roe said he was open to dialogue about the initiative that veterans like Rose have been campaigning against, although Rose said he was not allowed to speak to the congressman last week. Roe said he is doing everything he can to help the region's veterans. "Congress is working with the medical community, including providers at VHA, to curb the longterm prescribing of opioids to manage pain within the veteran and general population. In fact, the Comprehensive Addiction and Recovery Act, which I voted for and was signed into law by former President Obama, included a number of provisions to ensure veterans have access to quality care, including pain management programs," Roe said. "CARA also included grant funding to allow the VA Secretary and the Department of Justice to expand veterans treatment courts and provide additional resources for veterans' rehabilitation and substance use treatment programs . "My priority is - and will always be - ensuring veterans have access to the care and services they have earned. I believe we can work together to combat the opioid epidemic, and that we can do so in a way that minimizes disruptions in patient care, but it's going to require a careful and honest look at where we are and the challenges that lie ahead. I encourage any veteran in the First District to contact any of my offices if they believe I can be of assistance to them or their family . My door is always open," Roe said in his email to the Press. Back to Top 3.10 - Circa (Video): Veterans want pot and more accountability as the VA battles the opioid epidemic (10 July, Allison Maass, 22k online visitors/mo; Arlington, VA) Veteran and Missouri man Joshua Lee has learned the hard way how dangerous opioids can be. Lee was deployed to Afghanistan in 2009, and today suffers from PTSD, fibromyalgia and arthritis. For the pain, he was prescribed opioids by his physicians through the Department of Veterans Affairs (VA) . But things quickly spun out of control. By August of last year, Lee said he was taking 27 pills a day. "I didn't think the stuff I was on was going to screw me up that badly until I made a mistake of rescheduling when they were supposed to be mailed to me, and I wound up experiencing withdrawals for the first time in my life. And I realized I'm an addict. I would have done anything to get those pills," Lee said . 49 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000853 OS 00021569 In the U.S. millions of people are addicted to opioids, and the veterans' community is no stranger to the epidemic. A recent report found the guidelines the VA had recommended to manage addiction risks when prescribing opioids had not always been followed, and though progress has been made since, some veterans think there is still a long way to go. The Office of Special Counsel released a report earlier this month that found in 2014, less than 55 percent of VA patients prescribed long-term opioids were receiving regular urine drug tests (UDT), despite VA guidelines. UDTs are an essential tool in managing addiction risks, according to Dr. William Becker, assistant professor at General Internal Medicine at Yale School of Medicine. "I wouldn't want to be prescribing opioids without use of that tool," Becker said. But the lack of testing came at a time when more veterans were becoming addicted to the pain killer. The number of veterans with opioid-use disorders rose by 55 percent between 2010 and 2015, totaling 68,000 veterans, or 13 percent of the total number of veterans prescribed opioids, according to PBS Frontline . OSC ordered an investigation into the drug tests after a whistleblower reported patients were improperly prescribed narcotics at the community-based outpatient clinic in Dover, Delaware, part of the Wilmington VA Medical Center. As part of the claims, the whistleblower alleged that a veteran who was a patient at the clinic was prescribed opioids, but was not receiving the regular UDTs recommended by the VA guidelines, and had even gone years without a UDT. The opioid crisis goes beyond just the veteran community . According to the Center for Disease Control , one in four people prescribed opioids long term will struggle with addiction. And when it comes to to the number deaths due to drug overdoses related to opioids in the U.S., that number also quadrupled from 1999 to 2015, with 91 Americans dying every day due to opioid overdoses, the CDC said. But veterans are twice as likely to die from an accidental overdose, according to the National lnsitute of Health . "To the fact that opioids are prescribed more frequently in veteran populations and so because of increased rates of exposure , there's a higher risk for developing opioid use disorder," Becker said. But the VA has been trying to fight the epidemic for years. In 2010, the VA and the Department of Defense (DOD) had created a set of guidelines to help with the management of opioid therapy, then recommending long-term , opioid-treated patients receive UDTs before being prescribed, and have routine testing after that. An updated set of guidelines was also released in February, still including the recommendation of regular UDTs as part of addiction risk management. The VA has shown improvement since then. The agency reduced the number of veterans on long-term opioid treatment by over 187,000 from 2012 to 2016 , according to the VA , and has even improved on giving UDTs . In 2017, the number of long-term, opioid treated patients receiving a drug test within one year has jumped to 87 percent. 50 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000854 OS 00021570 Veterans prescribed opioids receiving UDTs U.S. Department of Veterans Affairs Chart from Veterans Affairs displaying the percentage of veterans on long-term opiod therapy who had received urine drug tests in the last year. In a statement a VA spokesperson told Circa, "Through education and outreach efforts, VA clinicians have a better understanding of the value UDT can have in certain patients for whom they provide care and they have begun to rely on these tests to a greater degree than they have in the past." But despite the improvements, some veterans think there is still a long way to go. In fiscal year 2016, there were 66,000 veterans still being treated for addiction to opioids. Dan Caldwell is the policy director for Concerned Veterans for America and is a veteran himself, serving in the Marine Corps for four years, and in 2009 was deployed to Iraq. He acknowledged that the VA has made some progress, but said they have a long way to go. "I think the biggest is accountability. When you don't follow the guidelines, you're terminated or your disciplined. They have guidelines in place they put in really starting a couple years ago, but if there's no teeth behind them, then nobody is going to follow them. And that's with everything within the VA," Caldwell said. And a major step towards improving accountability in the VA, according to Caldwell, was taken on June 23 when President Donald Trump signed a bill making it easier to fire VA employees. Caldwell also said turning toward privatization of veterans healthcare would also be a big improvement for the VA. And Lee is also working towards change in the VA system, and in April, he started to take action. He posted a photo on his Facebook page of him holding a clear,plastic bag, filled with over 9,800 smarties, one piece of candy for every pill he has to take in one year, to raise awareness of just how many pills veterans can be prescribed. Veteran Joshua Lee holding a bag of smarties to represent the number of pills he is prescribed by the VA every year. Joshua Lee Veteran Joshua Lee holding a bag of smarties to represent the number of pills he is prescribed by the VA every year. And after a trip to Colorado for his 15th anniversary with his wife, he said he tried recreational cannabis and it changed his life forever. "It works so much better than any medication, and it's the only reason I'm not a zombie today. You wouldn't recognize me on my pills, believe me," Lee said . Lee is now advocating for medical cannabis to be an option for veterans, and is doing so through helping to start the organization Veterans Alliance for Compassionate Access, working with experts and politicians and organizing events. 51 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000855 OS 00021571 "I'm not advocating medical cannabis as a cure all that's going to magically fix someone of their opioid addiction. It takes a combination of actual work on the person's behalf . There is no magic cure. But by combining medical cannabis with actual therapy, it is incredibly more efficient to get people off these addictive drugs and get there lives back in order, and get control of their own lives again," Lee said. Back to Top 3.11 -WGCU (NPR-90.1, Audio): VA Expands Emergency Mental Health Care To Vets With 0TH Discharges (10 July, Stephanie Colombini, 1.4k online visitors/day; Fort Myers, FL) This week the Department of Veterans Affairs expanded emergency mental health care to vets with other-than-honorable discharges. It's part of an effort to curb the recent increase in veteran suicide. According to the VA, the rate of suicide among veterans who don't use VA care is increasing at a much higher rate than for those who do. Dr. Glenn Catalano with the James A. Haley Veterans Hospital in Tampa says that's why it's critical the agency is now offering emergency mental health care to the over 500,000 vets with 0TH discharges -- a group that's not normally eligible for VA benefits. "Veteran safety is Job One ... by expanding the umbrella of care that we can to our veterans, we want to make sure that they're safe and that we can help them get through their transition to the point where they are back to being self-sufficient and taking care of themselves," Catalano said . Vets with 0TH discharges who have a mental health emergency can visit their local VA or call the Veterans Crisis Line to get help. Under the initiative, they may receive care for up to 90 days, which can include inpatient, residential or outpatient care. During that time, the VA medical center treating the service member and the Veterans Benefits Administration will work to determine if the mental health condition is related to military service, in which case the veteran would be eligible for ongoing coverage. Vets may be treated using the VA's tentative eligibility authority, but they may receive a bill for the services if it's determined down the line that they are ineligible. But the VA says its providers are able to use a broad interpretation of "related to military service." Veterans in distress can call the Veterans Crisis Line at 800-273-8255 or text 838255. Back to Top 4. Women Veterans 52 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000856 OS 00021572 5. Appeals Modernization 6. Strategic Partnerships 6.1 - Managed Healthcare Executive: ICER, VA join to work on drug value, price negotiations (11 July, Tracey Walker, 348k online visitors/mo; North Olmstead, OH) The Institute for Clinical and Economic Review (ICER) will work with the Department of Veterans Affairs (VA) Pharmacy Benefits Management Services office (PBM) to facilitate their integration of ICER reports into VA's formulary management process of evaluating the comparative clinical effectiveness and value of drugs . "This process evaluates the comparative clinical effectiveness and value of drugs . ICER will also work with VA staff to develop options for using 'value-based price benchmarks' suggested in ICER reports to support negotiations with pharmaceutical companies-with the goal of maintaining excellent access to important treatments while ensuring prudent use of VA resources," Ndidi Mojay, VA spokesperson, tells Managed Healthcare Executive. "As it has in the past, VA will continue to use ICER reports as part of its drug formulary management processes. VA's overarching goal is to incorporate as much high-quality information as possible, such as that found in ICER reports, into VA's drug review and decision-making processes." ICER's drug assessment reports include a full analysis of each therapy's comparative clinical effectiveness, cost-effectiveness, and potential budget impact. Patient input is used to inform these analyses and to identify other potential benefits and broader contextual considerations that should be considered in judgments of overall value. ICER uses transparent methods to calculate for each new drug a value-based price benchmark anchored to the benefit the drug brings to patients. For its drug assessment reports, ICER works with the patient community and clinical experts, and invites a broader public engagement by convening public meetings at which independent committees debate the report findings with the input of all stakeholders. VA uses drug reviews from a variety of sources, therefore using ICER reports in and of itself is not necessarily unique, according to Mojay. However, "from VA's perspective, what is unique about the collaboration arrangement is that VA and ICER staff can engage each other on issues of mutual interest," she says . ICER itself will determine the products it will consider for review . VA reviews all new molecular entities and prioritizes those reviews based on the needs of the Veteran population. Focus on value The goal of the ICER-VA collaboration isn't focused on savings, according to Mojay . "Rather, it focused on assessing value of treatment options and ensuring drugs are used appropriately for patients," she says. A unique element of this particular evaluation process is utilizing the effectiveness of drugs with a cross analysis of the long-term economics and costs, according to lnteliSys Health CEO Tom Borzilleri. 53 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000857 OS 00021573 "In the past, effectiveness was typically assumed based on clinical studies but no comprehensive data has ever been gathered across a defined group of patients using actual treatment effectiveness results and the costs associated with the ingredients prescribed," Borzilleri says. Managed care executives don't have either the funding or large populations of patients that can be enrolled in studies that are big enough to determine the comparative "value" of new drugs, according to Tom Sullivan, MD, chief strategic officer and chief privacy officer for DrFirst, a software solutions and services provider. "Adding cost to the equation of outcomes-also known as value-can provide pharmacoeconomic answers that have been difficult to obtain in the past," Sullivan says. "Kaiser and a very few others have some studies that have been previously helpful but the VA has a longer history of attempts to get these answers through large trials. Within the VA, its single vendor, uniform EHR and its successor should also make this easier and less costly to collect and mine the relevant data." If the studies are well designed and correctly implemented, the findings should lead both taxsupported plans and the private sector to better promote more cost-effective decisions regarding preferred treatments, according to Sullivan. "Further, those finding would lead to formulary policies with appropriate guidance and exceptions . Better adherence will follow if the proper education--and in some case incentives-takes the findings into consideration," he says. Borzilleri believes that although savings would be difficult to predict, "one would expect that the proposed methodology should provide new insights that may produce actionable data, which will produce improved cost abatement," he says . "When addressing the drug costs across the general population, it's a known fact that affordability has a direct influence and impact on drug compliance, adherence and patient outcomes. Identifying more effective or the most effective treatments will always have a positive impression on patient outcomes. But when addressing a population of patients that receive a fully-paid benefit, where affordability is not part of the equation as is with patients within the VA system, adherence most likely will not be able to be quantified as accurately." Back to Top 6.2 - mHealth Intelligence: VA, Air Force Expand Tele-ICU Program for Patient Care, A tele-lCU collaboration between the VA and the Air Force aims to extend patient care for service members in critical condition. (10 July, 53k online visitors/mo; Danvers, MA) A collaboration between the VA's Midwest Healthcare Network and the Air Force's Medical Operations Agency will open a tele-lCU program to Air Force servicemen at five military treatment centers across the country. Through this new agreement, the Air Force now can access the VA's centralized tele-lCU capabilities in Minneapolis. 54 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000858 OS 00021574 "For VA, telehealth is revolutionizing the way we practice medicine," said VA Secretary Dr. David J. Shulkin, who also sees patients by telehealth. "Tele-ICU is more than just a way of providing remote care." "We know it improves the quality of care, decreases costs by supporting evidence-based practices and it improves patient outcomes through decreased ventilator days, ventilatorassociated pneumonias and reduced lengths of stay . We are pleased to partner with the Air Force in this effort." The centralized tele-lCU center will provide specialty care to vulnerable patients at treatment centers in Las Vegas, NV, Hampton, VA, Biloxi, MS, Dayton, OH, and Anchorage, AK. Through live audio and video feeds, patients can consult with tele-lCU specialists and critical care nurses, as well get updates on their condition status through telecommunication. Specialists can use tele-lCU technology as a way to consult with family members, prescribe medications, order tests, and make diagnoses. Leaders at both the VA and the Department of Defense (DoD) believe the partnership is a significant step forward in healthcare delivery to veterans and servicemen. "Collaborative partnerships , such as this agreement with VA, help us provide the best possible care to our service members, military family members and retirees who receive health care through the Department of Defense," said Dr. David Smith, Acting Assistant Secretary of Defense for Health Affairs. Recently, the VA announced another investment in tele-lCU technology . A new program will connect Eastern Oklahoma VA Health Care System (EOVAHCS) and the Cincinnati VA TeleICU Monitoring Center to deliver quality intensive care for veterans who can't immediately reach an ICU specialist. "We are very excited to partner with the Tele-ICU Monitoring Center at the Cincinnati VA Medical," said Mark Morgan, EOVAHCS Director. "Tele-ICU exemplifies how the VA is leveraging advanced technologies to provide the highest quality services to Veterans." Back to Top 7. Supply Chain Modernization 8. Other 55 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000859 OS 00021575 Veterans Affairs Media Summary and News Clips 11 July 2017 1. Top Stories 1.1 - The New York Times: A Bipartisan Congress That Works? Veterans Committees Show How It's Done (10 July , Nicholas Fandos, 30M online visitors/mo; New York, NY) This is Congress? Something strange is happening in the staid hearing rooms of the House and Senate Veteran Affairs Committees here this summer , though few have taken notice. As the rest of Congress fights over the health care overhaul and looming budget deadlines, the committees responsible for writing legislation affecting veterans are quietly moving forward with an ambitious , long-sought and largely bipartisan agenda that has the potential to significantly reshape the way the nation cares for its 21 million veterans . Hyperlink to Above 1.2 - U.S. News & World Report (AP): New Food Pantry at Salt Lake's VA Already Serving Dozens - A food pantry that recently opened to help veterans in Salt Lake City is already serving dozens of people. (10 July, 24M online visitors/mo ; Washington , DC) A food pantry that recently opened to help veterans in Salt Lake City is already serving dozens of people a month. The Salt Lake City Tribune reports the food pantry that opened in March at the George E. Wahlen Department of Veterans Affairs Medical Center serves close to 100 veterans and their families every month . Hyperlink to Above 1.3 - The Washington Times: VA denies claims for Gulf War illness more often, study finds (10 July , Dave Boyer , 10.8M online visitors/mo; Washington , DC) Veterans claiming "Gulf War illness" are about three times less likely than other veterans to have their disability claims approved by the Department of Veterans Affairs , according to a new watchdog report Monday that recommended the agency beef up its response to the illness . The Government Accountability Office said the VA handled about 11,400 claims for Gulf War illness (GWI) in fiscal 2015, more than double the number of claims filed in 2010. Hyperlink to Above 1.4 - Military.com: Quick Action Needed From Congress on VA Choice Program (10 July , Richard Sisk , 9M online visitors/mo ; San Francisco , CA) Congress is returning this week from the July 4 recess under deadlines for action on an array of budget issues, including authorizing fund ing for the Veterans Affairs Department's Choice program. Funding for Choice , which allows veterans flexibility in seeking private health care , will likely run out by Aug. 7 unless lawmakers act to provide a fix, accord ing to VA Secretary Dr. David Shulkin. Hyperlink to Above 1.5 - The Salt Lake Tribune: 'A godsend': Salt Lake V.A.'s new food pantry is in high demand (10 July, Luke Ramseth, 3.2M online visitors/mo ; Salt Lake City, UT) That's why the couple makes weekly trips to a new food pantry at the George E. Wahlen Department of Veterans Affairs Medical Center. Opened in March, the pantry already serves close to 100 veterans and their families per month , said Natalie Green , a VA health care administration trainee who started the program . Late last year, Green said, she realized the 1 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000861 DS_00021577 extent of the veteran hunger problem . Some 1.7 million vete rans experience food insecurity annually. Hyperlink to Above 1.6 - Knoxville News Sentinel (USA Today Network-Tennessee): Veterans' health care data could lead to rapid medical breakthroughs (10 July , Brittany Crocker , 2.1M online visitors/mo; Knoxville , TN) Scientists at Oak Ridge National Laboratory are developing a secure platform for researchers to access the healthcare data of 22.5 million military veterans , accelerating the time line for medical research breakthroughs. Scientists from ORNL 's Computational Sciences and Engineering Division started building the platform as part of the laboratory's involvement in a national partnersh ip between the Department of Veterans Affairs and the Energy Department. Hyperlink to Above 1.7 - The Tennessean (USA Today Network-Tennessee): Gulf War veterans face more, longer delays at VA, government report says (10 July , Jake Lawary, 2.1M online visitors/mo ; Nashville , TN) Gulf War veterans often wait fou r times longer for care and their claims at the VA are three times more likely to be denied , according to a report released Monday by the Governme nt Accountability Office . The GAO report is the most recent indication that the VA itself acknowledges some of its own shortcomings in training , knowledge of medical conditions and the inner workings for which v eterans across the country continually blast the VA . Hyperlink to Above 1.8 - Austin American-Statesman: VA releases list, but is mum on why employees were fired (1 0 July , Jeremy Schwartz , 2.1M online visitors /mo; Austin , TX) The Department of Veterans Affairs last week released its first public list of fired and disciplined employees , an initiat ive of its newly created Office of Accountability and Whistleblower Protection , The list, which includes job descr iptions , but not names of disciplined employees , is meant to increase transparency and accountability at the VA, which came under intense criticism for failing to adequately discipline employees responsible for secretly manipulat ing wait times ... Hyperlink to Above 1.9 - Stars and Stripes: Report: VA claims for Gulf War illness denied 80 percent of the time (10 July, Nikki Wentling , 1 .4M online visitors/mo ; Wash ington, DC) The Department of Veterans Affairs denies more than 80 percent of v eterans ' claims for benefits for Gulf War-assoc iated illnesses -- an approval rating three times lower than all other types of claims , according to a Government Accountability Off ice report released Monday . From 201 Oto 2015 , the VA approved 17 percent of claims -or 18,000 of 102,000- - for health care and disability compensat ion for veterans suffering from Gulf War Illness ... Hyperlink to Above 2. Veteran and Employee Experience 2 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000862 D8_00021578 2.1 - Breitbart: VA Under Trump Admin Fires More Than 500 Employees, Suspends 200 for Misconduct (10 July, Kather ine Rodriguez , 19.1M online visitors/mo ; Los Angeles , CA) The Department of Veterans Affairs fired more than 500 employees and suspended nearly 200 for misconduct since President Trump 's inauguration in January , keeping true to campaign promises to clean up the agency . The VA 's accountability report released Friday noted that the agency removed 526 employees , suspended 194 employees for more than two weeks , and demoted 27 employees. Hyperlink to Above 2.2 - The Hill : Week ahead: Defense spending, Trump nominees top agenda (10 July, Ellen Mitchell , 11.BM online visitors/mo; Washington, DC) Congress returns from its July 4th recess on Monday and must tack le several fiscal 2018 defense bills and Pentagon nominations before the month-long August recess in three weeks. The Senate Veterans Affairs Committee, the House Rules Committee and the Senate Appropriations Committee will all move forwa rd legislation , starting with a markup of the Senate VA bill Tuesday. Hyperlink to Above 2.3 - The Salt Lake Tribune: Tribune Editorial: Someone finally steps up to help hungry veterans (10 July, Editorial Board , 3.2M online visitors/mo ; Salt Lake City , UT) We have shamefully underfunded and understaffed our system of veterans' services. For example , in 2015 the wait times for Utah veterans seeking medical care were longer than the national ave rage , and the national average was pretty poor . Granted, the Department of Veterans Affairs (VA) in Salt Lake City has made great improvements over the last year , detailed in a June op-ed by Shella Stovall, acting director of the VA Salt Lake City Health Care System. Hyperlink to Above 2.4 - Investor 's Business Daily: Good News For Veterans: Trump Tells Hundreds Of VA Workers 'You're Fired!' (10 July , 3.2M online visito rs/mo; Los Ange les, CA) Accountability: For decades , political leaders have lamented the scandal-plagued Veterans Health Administration, and did little more than throw more money at the problem. The Trump administration is firing workers who aren't doing their jobs. According the Department of Veterans Affairs , 526 have been fired for misconduct since President Trump took office . Another 200 have been suspended and 33 demoted . Hyperlink to Above 2.5 - WXIA (NBC-11, Video): Man shot by police during bank standoff had issue with VA benefits (10 July, Phillip Kish, 1.5M online visitors/mo; Atlanta , GA) The man shot dead by authorities after he claimed to have a bomb at a Marietta bank had visited the Atlanta Veteran Affairs office days before the incident. VA spokesperson James Hutton confirmed to NBC News that Brian Easley was at the Atlanta office on July 3 to discuss an issue with his BA benefits . After being informed of what he needed , Easley said that he'd return on Thursday with the paperwor k to settle the matter. Hyperlink to Above 3 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000863 D8_00021579 2.6 - WFED (AM-1500, Audio): VA's first 'accountability ' posting shows hundreds fired since Trump inauguration (10 July, Terry Wing , 831k online visitors/mo; Washington , DC) The Department of Veterans Affairs has posted its first list of employee remova ls, suspensions and demotions showing VA has fired 525 staffers since President Trump took office in January. The list, posted on Friday, includes doctors , nurses, housekeepers and even grave diggers . It does not include employee names , due to privacy reasons but does note the employee 's position and VA region . Hvperlink to Above 2.7 - WFED (AM-1500): What VA's now public adverse action reports don't say about employee accountability (10 July Nicole Ogrysko, 831k online visitors/mo; Washington, DC) Some federal employee groups and experts are scratching heads over the Veterans Affairs Department 's recent decision to publish a weekly list of all major discipl inary actions for its workers. VA is the first federal agency to publish such information , and it described the decision as a step toward improving accountab ility and transparency at a department which has long struggled to use governmentwide discipl inary procedures to tackle entrenched cultural challenges . Hvperlink to Above 2.8 - WSYX (ABC-6 , Video): Veterans Administration mistakenly declares war veteran "dead" (11 July, Kurt Ludlow, 450k online visitors/mo ; Columbus , OH) A military veteran turned to Six On Your Side for help after getting the surprise of his life. He was surprised to find out he was "dead ." At least as far as the government was concerned . "We are so sorry to learn of the death of Manis McKenzie , and extend to you our deepest sympathy," said Manis as he read from a letter to his wife from the Veterans Administrat ion. Hvperlink to Above 2.9 - KRGV (ABC-5 , Video) : Veterans Accountability Report Questioned (10 July, 277k online visitors /mo ; Weslaco , TX) The U.S. Department of Vete rans Affairs is providing the removal , suspensions and demot ions of employees as of July 3, 2017 in an online accountability report . The report shows 23 veterans health administrations across the country. According to the Veterans Health Administration , the Rio Grande Valley is under the Veterans Integrated Service Netwo rk (VISN 17). It's made up of seven different VA medical health care clinics in Texas . The VA accountability report shows several removals and suspensions and demotions. Hyperlink to Above 2.10 - Cape May County Herald: Veterans Affairs Pitches Vision: Crest Dune Project on Hold (10 July , Rachel Rogish , 191k online visito rs/mo; Rio Grande , NJ) Hinker concluded by requesting permission to set up a booth at upcoming concerts held in the borough . "I like to engage people ," said Hinker, explaining the personal interact ion she seeks to facilitate while presenting Veterans Affai rs. "We want every vet to have a good experience. " Hvperlink to Above 2.11 - WTOK (ABC-11, Video): Town hall addresses veterans' concerns (10 July , Jeffrey May, 66k online visitors/mo ; Meridian , MS) 4 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000864 D8_00021580 Local veterans had the chance to have their ques tions about their health benefits answered . The associate director of the Sonny Montgomery VA Medical Center in Jackson stopped in Merid ian Monday for a town hall meeting . He parti cipated in a Q & A session with veterans and thei r fam ilies. Hyperlink to Above 2.12 - WAGM (FOX-8) : Poliquin Introduces Bipartisan Legislation to Streamline VA Workforce Acquisition (10 July , Taylor Lumpkin , 36k online visitors/mo ; Presque Isle , ME) Subcommittee on Oversight and Investigations Cha irman Jack Bergman (R-Mich .) and Ranking Member Annie Kuster (D-NH) , along with Rep. Bruce Poliquin (R-Ma ine), introduced bipartisan legis latio n to streamline VA 's processes for wo rkforce acquis ition . "I'm proud to join Rep. Poliquin and Ranking Member Kuster in supporting this legislation that takes critical steps to improve the methods by wh ich the VA trains , recruits , and retains top professional talent in acquisition career fields ," sa id Bergman. Hyperlink to Above 2.13 - Dayton Business Journal : VA cuts 70 positions across Ohio, as part of new accountability effort (10 July , 20k online visitors /mo ; Dayton, OH) The U.S. Department of Veterans Affa irs has implemented a new accountability practice whereby poor-performing emp loyees can be removed from their jobs. And since January , the VA has fired more than 500 peop le across its extens ive footpr int. That 's the word from the VA 's adverse actions report , which was released last week. Hyperlink to Above 2.14 - Corridor News: VA Apprenticeship Program To Train, Employ Veterans To Assist Other Veterans In Properly Filing For VA benefits (10 July, 17k online visitors /mo ; San Marcos , TX) Veterans service organizations (VSOs) play a major role as advocates for the Veteran community , and as partners with VA , to ensure this nation 's Veterans receive the benefits they have earned . An important part of this partnership is to support VSOs as they tra in their adviso rs on the benefit process. Hyperlink to Above 3. Access to Healthcare 3.1 - The Huffington Post (Video) : No Marine Left Behind ... Except This One (10 July, Jon Hotchkiss , 22 .9M online visitors /mo ; New York , NY) In 2012 , he went to the VA ... where it was determi ned that he had only about 70% mobility in his right shoulder and his constant chronic pain was verified . It was determ ined that he needed surgery on his shoulder . James was forced to wait 5 years for his operation . He was told he needed the surgery in 2012 . In 2017 the VA finally arranged for him to get it. Hyperlink to Above 3.2 - The Hill : Humane Society pushes bills to connect wounded vets, service dogs (10 July , Sumner Park , 11.8M online visitors/mo ; Wash ington , DC) 5 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000865 D8_00021581 The Humane Society of the United States is urging lawmakers to pass a package of bills to make it easier for veterans and service members to get therapy dogs . The bills have bipartisan support, but animal rights advocates are making a new push to get the legislation through Cong ress , with lawmakers nearing their August recess with an already busy docket. Hyperlink to Above 3.3 - WRC (NBC-4 , Video): Washington DC VA Medical Center Operating Room Temporarily Shut Down (10 July , Scott MacFarlane, 4.8M online visitors/mo ; Wash ington , DC) Federal officials ordered an operating room at the Washington DC VA Medical Center shut down late last week after the latest in a series of maintenance issues that have plagued the facility in recent months. The temporary shutdown lasted approx imately three hours , accord ing to a U.S. Department of Veterans Affairs spokesman . Hyperlink to Above 3.4 - Hartford Courant (Video): Service Dogs Provide Lifeline For Disabled And Veterans (10 July, Matt Ormseth , 2.1M online visitors/mo ; Hartford , CT) Charles returned from a tour in Kuwait with PTSD and a brain injury suffered when he was thrown out of an armored truck- "invisible wounds ," he called them . He had planned on getting a master's degree in social work at UConn and working at Veteran 's Affairs , but he couldn't concentrate, couldn't rid himself of flashbacks from tours in the Middle East and Bosnia in the '90s . The nightmares were happen ing three to four times a week, he said . Hyperlink to Above 3.5 - KSAT (ABC-12): Rep. Beto O'Rouke lays out veteran, mental health plans at town hall, Congressman running for U.S. senate seat (10 July , Chris Shadrock , 1.1 M online visitors/mo ; San Antonio , TX) U.S. Rep. Beto O'Rourke (D-16) announced on Monday his plans at a town hall meeting in Somerset for a piece of legislation dedicated to veterans and mental health. O'Rourke said an estimated 20 veterans die from suicide every day. He acknowledged there aren 't enough mental health care providers and that it's diff icult to get veterans to rece ive the care they need from the VA. Hyperlink to Above 3.6 - Pantagraph: Veterans Corner 7/10/17 (10 July , 834k online visitors/mo ; Bloomington , IL) I am a friend of a veteran who has serious mental health issues. His limited insurance coverage for such issues is inadequate and he periodically ends up in the emergency room for threaten ing suicide . He was discharged from military duty with a general discha rge under other than honorab le cond itions . Hyperlink to Above 3.7 - WFED (AM-1500, Tom Temin Commentary) : VA's new list: Playboy without the centerfold (10 Ju ly, Tom Temin, 831k online visitors/mo; Washington , DC) Secretary David Shulkin, a physic ian, has thrown himself into the management reform effort at VA . I think he relishes it. The latest gambit is posting to VA's website a list of adverse employee actions , to be updated weekly . The initial list has 26 pages each with 29 demot ions, suspensions of more than 14 days, and removals. I guess "removal " means firing. 6 AMERICAr-... pVERSIGHT Veterans Affairs Media Summary and News Clips 11 July 2017 VA-19-0799-G-000866 D8_00021582 Hyperlink to Above 3.8 - WKRG (CBS-5): New Mobile V.A. Clinic On Track (10 July , Bill Riales , 272k online visitors/mo ; Mobile, AL) Veterans say after decades of talks, it's about time. Land and permits have been acquired and the new Mobile Veterans Outpatient Clinic is on target to be completed by November 2018 . That 's the word from the company that is building the new fac ility, U.S . Federal Properties of Kansas City , Mo. Hyperlink to Above 3.9 - Johnson City Press : Congressman Roe's response to July 3 protest (10 July , Brandon Paykamian, 196k online visitors/mo; Johnson City, TN) During a July 3 ceremony honoring Mountain Home's historic buildings , Robert Rose turned his wheelchair to face away from the Republican 1st Congressional District representative to express his opposition to the "Opioid Safety Initiative," which Rose claims restricts access to pain medications for patients and veterans suffering from chronic pain. Hyperlink to Above 3.10 - Circa (Video): Veterans want pot and more accountability as the VA battles the opioid epidemic (10 July, Allison Maass , 22k online visitors/mo; Arlington , VA) In the U.S. millions of people are addicted to opioids , and the veterans' community is no strange r to the epidemic . A recent report found the guidelines the VA had recommended to manage addict ion risks when prescribing opioids had not always been followed , and though progress has been made since, some veterans think there is still a long way to go. Hyperlink to Above 3.11 -WGCU (NPR-90 .1, Audio): VA Expands Emergency Mental Health Care To Vets With 0TH Discharges (10 July, Stephanie Colombini , 1.4k online visitors/day ; Fort Myers, FL) This week the Department of Veterans Affairs expanded emergency mental health care to vets with other-than-honorable discharges . It's part of an effort to curb the recent increase in veteran suicide. According to the VA , the rate of suicide among veterans who don't use VA care is increasing at a much higher rate than for those who do . Hyperlink to Above 4. Women Veterans - No Coverage 5. Appeals Modernization - No Coverage 6. Strategic Partnerships 6.1 - Managed Healthcare Executive : ICER, VA join to work on drug value, price negotiations (11 July, Tracey Walker , 348k online visitors/mo ; North Olmstead , OH) 7 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000867 D8_00021583 The Institute for Clinical and Economic Review (ICER) will work with the Department of Veterans Affairs (VA) Pharmacy Benefits Management Services office (PBM) to facilitate their integration of ICER reports into VA's formu lary management process of eva luating the comparative clinical effectiveness and value of drugs . Hyperlink to Above 6.2 - mHealth Intelligence: VA, Air Force Expand Tele-ICU Program for Patient Care, A tele-lCU collaboration between the VA and the Air Force aims to extend patient care for service members in critical condition. (10 July , 53k online visitors/mo; Danvers, MA) A collaboration between the VA 's Midwest Healthcare Network and the Air Force's Medical Operations Agency will open a tele-lCU program to Air Force servicemen at five military treatment centers across the country. Through this new agreement, the Air Force now can access the VA's centralized tele-lCU capabilities in Minneapolis . Hyperlink to Above 7. Supply Chain Modernization - No Coverage 8. Other - No Coverage 8 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000868 D8_00021584 1. Top Stories 1.1 - The New York Times : A Bipartisan Congress That Works? Veterans Committees Show How It's Done (10 July, Nicholas Fandos , 30M online visitors/mo ; New York , NY) WASHINGTON to becoming law. Magnanimous hearings . Bipartisan votes. Substantial legislation on its way This is Congress? Something strange is happening in the staid hearing rooms of the House and Senate Veteran Affairs Committees here th is summer , though few have taken notice . As the rest of Congress fights over the health care overhaul and looming budget deadlines , the committees responsible for writing legislation affecting veterans are quietly moving forward with an ambitious, long-sought and largely bipartisan agenda that has the potential to significantly reshape the way the nation cares for its 21 million veterans . It could also provide President Trump with a set of policy victor ies he badly wants . "It's a case study in Washington working as designed ,'' said Phillip Carter , who studies vete rans issues at the Center for a New Amer ican Security and advises Democrats . "And it's shocking because we so rarely see it these days." The tally thus far is impressive , if not exactly the stuff of headline news: The secretary of Veterans Affairs was confirmed unanimously, the only cabinet secretary with that level of congressional approval. Congress quickly passed a temporary funding extension for the Veterans Choice Program , which pays for private-sector health care for veterans facing long wait times at government facilities . Then it passed a new law that makes it easier for the department to hire and fire. The next bit of legislation on the brink of becoming law expedites disability benefits appeals . This is happening as Congress finds itself stalled by a grow ing list of prioritie s that lawmake rs had hoped to send to Mr. Trump before the August recess. In the case of the health care overhaul , the Se nate leadership has even dec ided to sidestep the committee process that typically sets the pace of legislation moving through the Capitol. Lawmakers with coveted spots on the veterans comm ittees are qulck to acknowledge that caring for those who served the country in uniform has long been largely a bipartisan pursuit. But ideological differences do exist between the parties on how to care for veterans' health needs , particularly when it comes to the Choice program , which was hastily written after a 2014 scanda l over the manipulation of patient wait times and has proved to be a flawed , if popular , fix. Whether the latest bout of amity can persist will largely depend on whether lawmakers are able to agree on a way to perma nently fix the program , and streamline a half dozen others that send veterans out for private care , before it loses its authorizat ion in January . But as lawmakers talk about how they wlll do it, it almost sounds like an idealized version of how Washington works. "We don't want to have a fight for fights' sake. We want to find solutions ," said Johnny Isakson , the court ly Republican chairman of the Senate Committee on Veterans ' Affairs . "So when we 9 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000869 DS 00021585 have opposition to an issue from a member, we try to bring them into the fold and sometimes maybe address the concern they have." Mr. Isakson, 72, a former real estate executive, is among an increasingly rare breed of deal makers in the upper chamber. Those watching the 15-person committee say he has gone a long way to set the tone for its work. He has found a willing partner in Jon Tester of Montana, the committee's top Democrat, who along with being a political moderate is up for re-election next year in a rural state that voted overwhelmingly for Mr. Trump . "With Johnny at the helm, we've been able to get a lot of stuff done," Mr. Tester said . "Do Johnny and I agree on everything? No, we don't, but we believe we can communicate and move forward." The 24-member House committee, which is more ideologically diverse, has its own incentives to compromise . Representative Phil Roe of Tennessee, its chairman, was by most accounts chastened by harsh blowback to a draft bill floated in April that would have made service members pay to be eligible for G.I. Bill benefits. The committee's top-ranking Democrat, Tim Walz of Minnesota, represents a right-leaning rural district and is in the early stages of running for governor. The two men have been working side by side on the committee for nearly a decade. That both sides remain cautiously confident in the Department of Veterans Affairs secretary, David Shulkin, who also served in the Obama administration, has helped as well. Mr. Tester and Mr. Walz have shown that they are willing to maneuver their caucuses toward compromise if the Republican position is within range. To pass the accountability legislation, a long-held priority for both parties that had the support of influential veterans' groups, the Democrats had to overcome initial opposition to weakening the protections afforded to department employees accused of wrongdoing. The changes were opposed by the largest federal workers' union. The final legislation, which Mr. Trump signed into law late last month, makes it easier for the department to fire problematic employees, incentivizes whistle-blowing and gives the secretary greater hiring authorities to fill vacant medical center director jobs. Legislation that overhauls the department's appeals procedure was an easier lift. About half a million veterans have pending claims contesting a Veterans Benefits Administration decision. The process, as currently configured, can take years to sort out. The legislation tries to significantly expedite that process by creating distinct queues for veterans based on the evidence they wish to submit with their claims. The department had championed a similar proposal during the Obama administration, and it won support from the veterans groups. But then lawmakers ran out of time to move it through Congress . The legislation won quick passage in the House this term and, with Congress returning from recess, is expected to win passage in the upper chamber as well. Lawmakers hope it will become law before the August recess. The good feeling may soon be put to the test, however. "What they are getting done now is lowhanging fruit," said Paul Rieckhoff, the chief executive of the Iraq and Afghanistan Veterans of America. "You could argue it is a great political strategy: Get points on the board, get wins. But I don't think that's going to last." 10 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000870 OS 00021586 Mr. Rieckhoff was referr ing to negotiat ions, which are expected to intensify this fall , over a reimagin ing of the multibillion-dollar Choice program and a half dozen other programs that allow veterans to seek health care in their communities at government expense . In the aftermat h of the 2014 scandal , lawmakers created a program that gave veterans facing long wait times and travel distances the option of going to private doctors. But lawmake rs from both parties agree that its unnecessarily cumbersome scheduling and payment process, among other problems , needs fixing . Exactly how to do so is where the fights might occur. Democrats support community care in theory , but they are fearful that Republicans in the majority and the White House could try to use a significant expansion of the program to force further privatization of the department's services. Republicans largely deny that that is thefr agenda . Mr. Shulkin plans to present lawmakers with the department's own plan , which could either heighten animosities or dampen them. "If they simply reauthor ize Choice resources at the current level, that achieves bipartisan consensus easily ,'' Mr. Carter said . "If they revamp Choice to make it more aggressive , the fiscal implications of that will make many Republicans balk and the privatization implications will make Democrats balk." The committees remain in the early stages of negotiat ions . For now, though , Democratic and Republican leaders alike are content to take stock of a rare moment of agreement. ''I think it's been probably the most productive time of any committee I've ever been on ," Mr. Walz said. "It's a unique time." Back to Top 1.2 - U.S. News & World Report (AP): New Food Pantry at Salt Lake's VA Already Serving Dozens - A food pantry that recently opened to help veterans in Salt Lake City is already serving dozens of people. (10 July , 24M online visitors/mo ; Washington , DC) SALT LAKE CITY (AP) - A food pantry that recently opened to help veterans in Salt Lake City is already serving dozens of people a month . The Salt Lake City Tribune (http://billy/2tA6Wdk) reports the food pantry that opened in March at the George E. Wahlen Department of Veterans Affairs Medical Center serves close to 100 veterans and their fami lies every month . Natalie Green is the Veterans Health Administration trainee who started the program. She says veterans return with an immense need for support . The newspaper reports some 1.7 million veterans experience food insecurity every year. Green says VA funds can only be used for medical services , not for a food pantry. So, she set up a separate account that accepts donations. Air Force veteran Rebecca Clark says the food pantry "was a godsend ." 11 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000871 D8_00021587 Back to Top 1.3 - The Washington Times: VA denies claims for Gulf War illness more often, study finds (10 July , Dave Boyer , 10.8M online visitors/mo; Washington , DC) Veterans claiming "Gulf War illness" are about three times less likely than other veterans to have their disab ility claims approved by the Department of Veterans Affairs , according to a new watchdog report Monday that recommended the agency beef up its response to the illness . The Government Accountability Office said the VA handled about 11,400 claims for Gulf War illness (GWI) in fiscal 2015 , more than double the number of claims filed in 2010. But approval rates for GWI were about three times lower than all other veterans ' claimed disabilities , GAO said. Among the possible reasons for the lower approval rate are that GWI claims "are not always well understood by VA staff, and veterans sometimes file for benefits without medical records to adequately support their claim, " the report said . The GAO said the department's ability to accurately process GWI claims "is hampered by inadequate training , and its decis ion letters for denied claims do not communicate key information to veterans '' about why a claim was rejected. Veterans who served in the Gulf War , which often included exposure to a toxic environment from oil fires and chemical weapons , have been at increased risk for several illnesses including joint pain , gastrointestinal problems , fatigue and neurological disorders . Since 1994, the VA has automatically presumed a connection between those illnesses and Gulf War service , a move that should enable veterans to receive a disability rating and benefits more quickly . Late last year, the government extended the deadline for vete rans to apply for GWI benefits through the end of 2021. GA said the VA's claims staffers often rely on the agency 's medical examiners to assess a veteran 's disability before a decision is made on a claim . But VA medical examiners told investigators that "conducting Gulf War general medical exams is challenging because of the range of symptoms that cou ld qualify as GWI." VA has developed elective GWI training for its medical examiners , but only 10 percent of examiners had taken the training as of February, GAO said . The VA said all its pension and compensation examiners will complete a mandatory 90-minute course on GWI by November . and it will make necess ary changes in the notification process by August. Back to Top 1.4- Military.com: Quick Action Needed From Congress on VA Choice Program (10 July , Richard Sisk , 9M online visitors/mo ; San Francisco , CA) 12 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000872 DS 00021588 Congress is returning this week from the July 4 recess under deadlines for action on an array of budget issues , including authorizing funding for the Veterans Affairs Department's Choice program. Funding for Choice, which allows veterans flexibility in seeking private health care, will likely run out by Aug. 7 unless lawmakers act to provide a fix, according to VA Secretary Dr. David Shulkin. The department initially proposed paying for Choice with cuts to the Individual Unemployability program, a lifeline to more than 225,000 elderly and disabled vets, but backed off the plan after an uproar from vets and veterans service organizations. Currently, the Choice program allows veterans to use private care if they can't get an appointment with the VA within 30 days or they live more than 40 miles from the nearest VA facility. Shulkin has pledged to expand the program and lift some of the restrictions under a revamped Choice program expected to be unveiled later this week . The new plan would be included in the VA's budget for fiscal 2018 , which begins Oct. 1. In his proposed budget, President Donald Trump called for $2.9 billion in new funding for Choice in fiscal 2018 and $3.5 billion in fiscal 2019. Meanwhile, the VA is faced with funding Choice past Aug. 7, which will leave Congress with only three weeks to act before the traditional August recess. Shulkin has urged Congress to pass emergency stopgap funding for the Choice program or give him the authority to transfer funds out of other VA accounts. Currently, he cannot transfer funds . At a Senate Veterans Affairs Committee hearing last month, Shulkin made clear that he will no longer be looking at cuts to the Individual Unemployability program to pay for Choice. Shulkin said that cuts to IU had been one of several options that the VA had considered to keep funds flowing to Choice and expand the program, but "as I began to listen to veterans and their concerns, it became clear that this would be hurting some veterans." He said the IU cuts would amount to "a take away from veterans who can't afford to have those benefits taken away. I'm really concerned about that," Shulkin said. "This is part of a process. We have to be looking at ways to do things better , but I am not going to support policies that hurt veterans." Veterans currently eligible for the IU benefit have a 60 to 100 percent disability rating through the VA and are unable to secure a job because of their disability. IU allows them to receive the highest compensation rate. The budget proposal would have removed veterans from the IU program when they reached the minimum age for Social Security. About 225,000 veterans aged 60 or older could have been affected by the cut -- about 7,000 of them over the age of 80. "It shouldn't have been proposed to begin with," Veterans of Foreign Wars National Commander Brian Duffy said of the initial plan to cut IU. "Balancing budgets on the backs of veterans is something the VFW will never tolerate." 13 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000873 OS 00021589 Back to Top 1.5 - The Salt Lake Tribune: 'A godsend' : Salt Lake V .A.'s new food pantry is in high demand (10 July , Luke Ramseth , 3.2M online visitors /mo; Salt Lake City , UT) Navy veteran Carl Callahan and his wife , Shannon , receive about $1,600 in Social Security benefits each month . They use it to pay rent and utilities on their South Salt Lake apartment , which the Department of Veterans Affairs helped them find after a stint of homelessness two years ago. They use it to pay their cellphone bills and buy gas for the car. Sometimes they use it to pay medical bills for Shannon, who takes frequent trips to the hospital for her asthma . By the time the bills are paid , Callahan said , about $100 is leftover for groceries lucky." "if we're That's why the couple makes weekly trips to a new food pantry at the George E. Wahlen Department of Veterans Affairs Medical Center. Opened in March , the pantry already serves close to 100 veterans and their families per month, said Natalie Green , a VA health care administration tra inee who started the program . Late last year, Green said , she realized the extent of the veteran hunger problem. Some 1.7 million veterans experience food insecurity annually. And for younger veterans who served in Afghan istan and Iraq, the food insecurity rate is about 27 percent - nearly double that of the general U.S. populatron , accord ing to a University of Minnesota study. Green said she was surpr ised to find only four other VA hospitals nationwide with a food pantry , and those operated only a day or two each month. "We have veterans coming back with an immense need for support," she said . "We know food and nutrition directly affects health outcomes , yet [access to food] was something that was kind of missing from the whole health picture ." Part of the problem , Green quickly learned , was that VA funds couldn't be allocated for a food pantry . They must be used for traditional medical serv'ices. So she had to get creative . So Green set up an external account that could accept donations for the pantry . She secured a vacant room, lined up a partnersh ip with the Utah Food Bank, and procured canned food donations from the VA staff. She documented her policies and procedures so other VA hospitals could follow a similar path. "She cut through the bureaucratic red tape ," VA Salt Lake City spokeswoman Jill Atwood said. On a recent Thursday , two veterans were sitting in the hallway outs ide the pantry at 2:30 p.m., waiting for Green to unlock the door. The pantry stocks the usual assortment of canned food . And depending on donations , Green also tries to stock nutritional items such as milk, eggs , meat , fruits and veggies - items Callahan and others say often are impossible to find at other food banks in the area . 14 AMERICAr-... pVERSIGHT Veterans Affairs Media Summary and News Clips 11 July 2017 VA-19-0799-G-000874 DS 00021590 "This was a godsend , really ," said Rebecca Clark, an Air Force veteran who served in the Gulf War . Her husband , Jesse, also served in the Air Force and had a $90,000 job in aircraft maintenance until he got hurt about five years ago, Clark said. "Everything started going downhill fast after that," she said . The couple recently came to the VA in search of housing assistance - and were told about the food pantry , they now live in a hotel "It helps a lot because with all the other food banks , with the amount of disability we're getting , they're like, 'Oh, you make more than $200 too much, so you can 't come here.' " Clark said. "And the church is like 'Well , you're not a member, so you can't come here.' "We would stretch out one meal a day until we got here," she added . "Now, we can buy meats , and this gives you everyth ing else ." Callahan , 62 , was an electronics technician aboard the USS Constellation in the late 1970s. He visits the VA often for help with his memory loss, depress ion and post-traumatic stress disorder , he said. Now he also comes for the food pantry. 'lt's just been tough financially, trying to keep up with everything ,1' Callahan said. 1 "Places like this really help out." Back to Top 1.6 - Knoxville News Sentinel (USA Today Network- Tennessee): Veterans' health care data could lead to rapid medical breakthroughs (10 July, Brittany Crocker , 2.1 M online visitors/mo ; Knoxville , TN) Scientists at Oak Ridge National Laboratory are developing a secure platform for researchers to access the healthcare data of 22 .5 million military veterans , accelerating the timeline for medical research breakthroughs . Scientists from ORNL's Computational Sciences and Engineering Division started building the platform as part of the laboratory 's involvement in a national partnersh ip between the Department of Veterans Affairs and the Energy Department. The partnership aims to address complex health issues that disproportionately affect veterans more than other communit ies, like prostate cancer , cardiovascular conditions and suicide prevention . "We are creating architecture to allow for rapid advancements in medical research ," said Edmon Begoli , the principal investigator for the project and the division's chief architect. 15 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000875 DS 00021591 ('Typically these can take five , 10 or even 15 years, but given the gold mine of data that we have, it will enable scient ists to move much faster and to see the benefits much sooner than they currently can ." Largest in the world The VA's healthcare data set is the largest and most comprehensive in the world , and it's stilf expanding . In 2011 , the VA launched the Million Veterans Program to consolidate service members' genetic information with their health records and information on their lifestyles and exposures during their military service . To participate, current and former service members donate blood for genome sequencing and fill out surveys on their lifestyles and military service history . Energy Secretary Rick Perry , an Air Force veteran, donated blood to have his own genome sequenced into the database when he announced the Energy Department's involvement in May. "We're bringing together the VA's unparalleled and vast database of healthcare and genom ic data with DOE's world class super computing and data analysis," Perry said in a video announcing the project. Unlikely pair At first glance , the Energy Department and the VA might seem like unlikely partners . But, with records on more than 22 .5 million current and former service members , the VA literally has more data than they know what to do with . That's where DOE comes in. The Energy Department is the nation's steward for highperformance computing . Oak Ridge National Laboratory's Titan supercomputer is the fastest in the country . "Nowhere will you find this large of a population with this much comprehensive healthcare data ," said Shaun Gleason , ORNL's Computational Sciences and Engineer ing Division director . "This is a tremendous gold mine for doing discovery on , but you need the high-performance compute power to mine the data and analyze it. We're trying to enable these medical discover ies by building this platform to start with and making it avai lable to the researches the VA wants to have access to il" Begoli said teams of DOE and VA researchers are already act ive and ORNL expects to be able to start mining the data set in the fall. "Hund reds of papers are being planned ,11he said . "There will be major discoveries and I say this with confidence because some of these abstracts are already hinting at some correlat ions that have been discovered. We expect rapid breakthroughs in medical research." Back to Top 16 Veterans Affairs Media Summary aod News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000876 DS 00021592 1.7 - The Tennessean {USA Today Network - Tennessee): Gulf War veterans face more, longer delays at VA, government report says (10 July , Jake Lowary , 2.1M online visitors/mo ; Nashville , TN) Gulf War veterans often wait four times longer for care and their claims at the VA are three times more likely to be denied , according to a report released Monday by the Government Accountability Office . The GAO report is the most recent indication that the VA itself acknowledges some of its own shortcomings in training , knowledge of medica l conditions and the inner workings for which veterans across the country cont inually blast the VA. The VA processed some 11,400 claims in 2015 - more than double than 2010 - from Gulf Wa r veterans reporting conditions from Gulf War Illness (GW I), a collection of symptoms and conditions that many veterans from the wars in the early 1990s are suffer ing. "VA's ability to accurately process GWI claims is hampered by inadequate train ing, and its decision letters for denied claims do not commun icate key information to veterans ," the report reads . "VA medica l examiners told GAO that conducting Gulf War general medical exams is challenging because of the range of symptoms that could qualify as GWI." Symptoms that have been related to GWI include joint pain, gastrointestinal problems , fat igue , and neurolog ical problems , accord ing to GAO , which could include an array of actual diagnoses . Part of the problem , the GAO report says , is that the VA has training for its examiners , but that training is elective. Just 10 percent of those eligible for the train ing have taken part, according to the report. "Federal internal cont rol standards call for adequate train ing for staff so they can correctly carry out an agency 's procedures ," the report said. Claims processors reported depending on examiners to approve. or deny claims . The GAO also found that denial letters often lacked explanations of why the claims were denied. As a resu lt of the findings in the report, the VA said it wo uld make the 90-min ute train ing for examiners mandatory and would work with a focus group to more clearly define GWI. In its response, the VA pointed to a $2-million 2014 study that tried to develop a single definition for GWI , but the committee appo inted came up with two defin itions . The claims filed by veterans for GW I conditions were appro ved just 17 percent of the time between 201 O and 2015 , the same time period the number of claims spiked. "This approval rate was cons istently lower than that of the non-Gulf War Illness medical issues in each year we reviewed , which officials attributed , in part , to the complexity of processing Gulf War Illness-related medical issues ," the report reads. Many of those veterans had other claims that were approved and resulted in some disability compensation , the report found , but potentially not what they may have been entitled to_ 17 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000877 DS 00021593 In some areas of the country, the approval rate was less than 9 percent. More than 2,000 undiagnosed illness claims in Muskogee , Okla ., for example , were denied in 2015. In Nashville , the denial-to-approval ration was 1,095-194, or nearly 13 percent. Back to Top 1.8 - Austin American-Statesman : VA releases list, but is mum on why employees were fired (10 July , Jeremy Schwartz , 2.1M online visitors /mo; Austin , TX) The Department of Veterans Affairs last week released its first public list of fired and discipli ned employees , an initiative of its newly created Off ice of Accountability and Whistleblower Protection . The list, which i ncludes job descriptions , but not names of disciplined employees , is meant to increase transparency and accountability at the VA, wh ich came under intense criticism for failing to adequately discipline employees respo nsi ble for secretly manipulating wait times to make it appear that vets were getting into medical clinics faster than they actually were . But so far at least, the department isn't being very transparent about its latest transparency initiative . In response to questions from the Statesman , the VA is refusing to reveal the reaso ns behind any of the firings, suspensions and demotions it handed out in the first half of 2017. Nor will the VA reveal the location of fire d employees, beyond the VISN , the VA's nomenclatu re for its 21 sprawl ing regional networks in the U.S . The region that includes Central Texas stretches from Amarillo to El Paso . For Texas readers , that means we don 't know if any of the personnel actions are connected to a damning Inspector General report released last year that found systematic data manipu lation by scheduling clerks to "zero out'' wait times in Central Texas , in many cases on orders of higherups . And Austin veterans can't know if any of the firings occurred at the outpatient clinic here or any of the other med ical facilities surround ing the Texas capital. We do know that the list includes 23 medical employees in the VA reg ion that covers Central Texas , and that a "se nior leader " was fired in June. When we asked the VA for the reason behind the senior leader 's firing , or whether any of the discipline was related to the scheduling manipulation, we were pointed back to the VA's press release . The communique states only that the VA will not release the names of the fired individua ls, an entirely defens ible pos ition , but says nothing about withholding the reason for the discipline . Without that information , the list does little to illuminate the specific problems at the VA that officials are aiming to clean up through these personnel actions . The public has been given little context to understand the signi,ficance of the firings except the sheer volume of disciplined employees . Back to Top 18 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000878 DS 00021594 1.9 - Stars and Stripes: Report: VA claims for Gulf War illness denied 80 percent of the time (10 July, Nikki Wentling , 1.4M online visitors/mo ; Washington , DC) The Department of Veterans Affairs denies more than 80 percent of veterans' claims for benefits for Gulf War-associated illnesses -- an approval rating three times lower than all other types of claims , according to a Government Accountability Office report re leased Monday . From 2010 to 2015 , the VA approved 17 percent of claims - or 18,000 of 102,000 -- for health care and disability compensation for veterans suffering from Gulf War Illness , which is an umbrella term for certain medical conditions common in some of the 1 million servicemembers who deployed to Southwest Asia in the past 27 years. Besides claims getting denied more often, veterans seeking benefits for Gulf War illness are having to wait four months longer on average to hear back from the VA, the GAO found. There 's confusion among VA staff about how to handle the claims, the report states. The Government Accountability Office also fou nd VA medical examiners, who are key in providing information for veterans ' claims , lacked training on Gulf War illness . As of February , 90 percent of medical examiners had not been trained on how to conduct exams for Gulf War illness. The VA made the training optional. However , the VA attributes the low approval rat ings to the complexity of Gulf War illness , thought to be caused by toxic exposure . There 's not a single definition for Gulf War illness , which includes a cluster of different conditions, as well as nine infectious diseases. "There 's a wh ole range of illnesses that are covered under this umbrella term of Gulf War Illness , and it's difficult to know the causes of those conditions.'' said the report 's author , Melissa Emrey-A rras. "Part of that is because many of the people who served were exposed to thing s like pesticides , smoke from oil well fires and even dep.leted uranium. It's difficult to piece together." VA Deputy Chief of Staff Gina Farrisee responded to the report in a letter, promi sing medical examiners wou ld be required to go through training on Gulf War illness by November . The training is a 90-minute online course. "We strongly believe people at VA need full training on this before doing medical exams ,'' Emrey-Arras said. In 1994, Congress passed legislation allowing Gulf War veterans with undiagnosed illnesses a ''presumpt ion," meaning they don't have to prove to the VA their illnesses were caused by military service. An amalgam of medically unexplained chronic illnesses found among Gulf War veterans, including fibromyalgia, fatigue and gastrointestina l diso rders , was added to that presumption in 2001 . Nine infectious diseases were added in 2010. To secure benefits , veterans had to have served on active duty in Southwest Asia any time after Aug. 2, 1990, and have an illness that falls into one of those categories . Even with the law, approvals are low compared to other typ es of claims. While 17 percent of claims of Gulf War illness were approved from 2010 to 2015 , VA staff approved 57 percent of veterans ' claims for all other medical issues during the same time. 19 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000879 DS 00021595 Ron Brown, president of the National Gulf War Resource Center, has been helping Gulf War veterans with their denied claims for the past three years. He communicates between veterans and VA leadership, and is often successful at getting a veteran's denial reversed . Brown had a direct line of communication with former VA Secretary Bob McDonald and he has advocated for better training for VA staff. He has also criticized the VA for being too vague in denial letters to veterans, contending more specific information about why a claim was denied would help veterans know their next step. The Government Accountability Office discovered the same problem . Emrey-Arras described the denial letters as technical, legalistic and "difficult to understand." "I'm extremely disappointed," Brown said. "These are the same issues the National Gulf War Resource Center has been trying to bring to the VA's attention for three years now. I'm left scratching my head on what we've accomplished. We've had 26 years to get this right, and we're not even close. These vets are struggling." article continues below Brown served in Operation Desert Storm in 1990-91 and it took 13 years to gain approval for his own claim of Gulf War illness. He now lives in Roanoke, Va. According to a breakdown in the report of approvals and denials of Gulf War illness claims by city, Roanoke had one of the lower approval ratings in 2015. That year, the Roanoke office denied 544 claims and approved 47 from veterans who said they were suffering from medically unexplained chronic illnesses. The office also denied 1,482 claims from veterans who sought benefits for undiagnosed illnesses related to their Gulf War service and approved 51. Besides requiring more training for medical examiners, Farrisee wrote the VA would be more specific in its letters of denial to veterans and gather a group of experts to come up with a clear plan for researching Gulf War illnesses. The VA has spent more than $160 million from 1994 through 2015 on research related to Gulf War illnesses and was given another $12 .3 million for the research in 2016 . Yet, the VA has not added any conditions since 2010 to ones already associated with Gulf War service. It tried and failed last year to create a fast-track to compensation for Gulf War veterans with brain cancer. "There's not a clear, single definition of what Gulf War Illness is at this point," Emrey-Arras said. "The VA has had a goal of having a single definition, and yet they don't have it. They have no strategic plan of getting there, no steps laid out to make that so." VA officials will have more opportunity to respond Thursday, when the report will be the subject of a congressional hearing. Two subcommittees of the House Committee on Veterans' Affairs one that deals with VA oversight and the other focused on disability assistance - will hold the hearing at 10 a.m. Brown isn't confident the report and another hearing will produce change. He provided testimony last March about the VA's low approvals for Gulf War claims and will again submit written testimony with similar information. 20 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000880 OS 00021596 "This isn't the first time they've had reports from the GAO, and what 's changed?" Brown said. "We keep regurgitat ing the same stuff over and over again . It's just like anything else , nothing ever gets resolved fast at the VA." Back to Top 2. Veteran and Employee Experience 2.1 - Breitbart: VA Under Trump Admin Fires More Than 500 Employees, Suspends 200 for Misconduct (10 July, Katherine Rodriguez , 19.1M online visitors/mo ; Los Angeles , CA) The Department of Veterans Affairs fired more than 500 employees and suspended nearly 200 for misconduct since President Trump 's inaugurat ion in January , keeping true to campaign promises to clean up the agency . The VA's accountability report released Friday noted that the agency removed 526 employees , suspended 194 employees for more than two weeks, and demoted 27 employees. Among those disciplined by the agency include 70 nurses , 25 physicians , 14 police officers, a public affairs specialist , a program analyst with the Government Accountability Office , and 22 senior officials. The agency also fired convicted felons and sex offenders who worked as housekee ping aides and food service workers . "Vetera ns and taxpayers have a right to know what we 're doing to hold our employees accountable and make our personnel actions transparent ,'' VA Secretary David Shulkin said in a statement. "Posting this information online for all to see, and updating it weekly, will do just that." Many veterans have died waiting for care , and VA officials have allegedly reported false data on wait times to receive cash bonuses . However , changes to improve the agency have been slow-going because the union that represents VA employees, the American Federation of Government Employees , has conv inced Democrats to provide greater job protections for government employees . Secretary Shulkin , who was appointed as undersecretary to the VA under the Obama administration , grew frustrated with efforts by the government employees ' union and other groups defending sub-par employees ' rights to stay on the government payro ll when these same employees neglected to care for veterans . "Just last week we were forced to take back an employee after they were convicted no more than three times for DWI and had served a 60-day jail sentence ... Our accountability processes are clearly broken ,µ Shulkin said at the White House. Back to Top 21 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000881 DS 00021597 2.2 - The Hill: Week ahead: Defense spending, Trump nominees top agenda (10 July , Ellen Mitchell , 11.8M online visitors/mo; Washington, DC) Congress returns from its July 4th recess on Monday and must tackle several fiscal 2018 defense bills and Pentagon nominations before the month-long August recess in three weeks . The Senate Veterans Affairs Committee , the House Rules Committee and the Senate Appropriations Committee will all move forward legislation , starting with a markup of the Senate VA bill Tuesday. The House Rules Comm ittee the same day will cons ider the House Armed Services Committee's annua l defense policy bill, the National Defense Authorizat ion Act , then consider amendments for the legislation on Wednesday. Once the process is completed , the bill could move to the floor for a full House vote as early as this week . The Senate Appropriations Committee , meanwhile is hoping to make headway on its military construction and veterans affairs spending bill, set to be marked up on Thursday . Lawmakers are scrambl ing to complete and vote on the bills prior to the start of the new 2018 fisca l year , beginning Oct. 1. At issue is the final topline for the Pentagon in fiscal 2018 . The House Armed Services Committee passed a $696.5 billion defense policy bill, divided into $62 1.5 billion in the base budget and $75 billion in war funding known as the Overseas Contingency Operat ions accou nt. The Senate , howeve r, passed a version which would authorize a total of $700 billion, split into $640 billion base defense fundfng and $60 billion for the war fund. Both are above the $603 billion base defense budget President Trump proposed . Lawmakers also must wo rk to fill in gaps in the Pentagon's personnel ranks. The Senate Armed Services Committee on Tuesday will hold a hearing for Navy Secretary nominee Richard V . Spencer . The hearing - originally set for June 22 but postponed as Senate Republicans held talks on the ir ObamaCare repeal-and-repla ce bill -wi ll now be held at 9:30 a.m., at the Dirksen Senate Office Building , room G-50 . Spencer is Trump's second choice for Navy secretary . The president's first pick, investor Philip Bilden , pulled out from consideration in February after he was unable to untangle and divest his business holdings to meet ethics rules. Air Force Secretary Heather W ilson fs so far the only service secretary to make it through the nomination process . The White House has yet to name someone for Army secretary after two previous picks withdrew from consideration . Tennessee state Sen . Mark Green (R) withdrew his name from consideration in May , and nominee Vincent Viola dropped out in February . 22 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000882 DS 00021598 On Wednesday, the Senate Armed Services Committee will also hold a nomination hearing for four Defense Department positions: Army undersecretary, principal deputy undersecretary for policy, general council for the Department of the Navy and assistant secretary for special operations and low-intensity conflict. The nominees, Ryan McCarthy, David Trachtenberg, Charles Stimson and Owen West, respectively, are all expected to easily make it through the hearing with little controversy over their nominations . House and Senate committees this week will also hold hearings on a wide range of other issues. The Senate Veterans Affairs Committee will mark up legislation at 2:30 p.m. Tuesday at the Russell Senate Office Building, room 418 . http://bit.ly/2tQC7S3 The House Rules Committee will consider the National Defense Authorization Act at 5 p.m. Tuesday at The Capitol, House room 313. http://bit.ly/2uOquZQ The Senate Armed Services Committee will hold a confirmation hearing for the nominees to be principal deputy under secretary of Defense for policy, assistant secretary of Defense for special operations and low-intensity conflict, under secretary of the Army and general counsel of the Department of the Navy at 9:30 a.m. Wednesday at Dirksen G-50 . http://bit.ly/2tQrHIU The Senate Foreign Relations Committee will hold a hearing on the Taylor Force Act, which would stop U.S. economic aid to the Palestinian Authority, at 10 a.m. Wednesday at Dirksen 419. http://bit.ly/2uyVVHq The House Foreign Affairs Committee will hold a hearing on empowering women in the developing world with testimony from outside experts at 10 a.m. Wednesday at the Rayburn House Office Building, room 2172. http://bit.ly/2uOenM5 The House Veterans Affairs Committee will hold a hearing on the VA's capital assets, including Secretary David Shulkin's plans to close excess facilities, at 10 a.m. Wednesday at the Cannon House Office Building, room 334 . http://bit.ly/2tyFcnF A House Foreign Affairs subcommittee will hold a hearing on the administration's fiscal 2018 budget request for the Western Hemisphere at 2 p.m. Wednesday at Rayburn 2172 . http://bit.ly/2tUQ29Q Another House Foreign Affairs subcommittee will have a hearing on terrorism in Southeast Asia at 2:30 p.m. Wednesday at Rayburn 2200 . http://bit.ly/2uz32Qo The Senate Appropriations subcommittee on military construction and veterans affairs will mark up its fiscal 2018 appropriations bill at 2:30 p.m. Wednesday at Dirksen 124. http://bit.ly/2tp1SJV The House Rules Committee will consider amendments for the National Defense Authorization Act at 3 p.m. Wednesday at House 313. http://bit.ly/2sP66LO The Senate Armed Services Committee will hold a hearing on the coup attempt in Montenegro with testimony from the country's ambassador to the U.S. at 9:30 a.m. Thursday at Dirksen G50. http://bit.ly/2tUV721 23 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000883 OS 00021599 The full Senate Appropriations Committee will mark up the fiscal 2018 military const ruetion and veterans affairs appropriations bill at 10:30 a.m. Thursday at Dirksen 106. http://bit.ly/2uz iiga A House Foreign Affa irs subpanel will hold a hearing on the administration's fiscal 2018 budget request for the Middle East and North Africa at 1 p.rn. Thursday at Rayburn 2172 . Back to Top 2.3 - The Salt Lake Tribune : Tribune Editorial : Someone finally steps up to help hungry veterans (10 July, Editorial Board , 3.2M online visitors/ mo; Salt Lake City, UT) Few would argue against the following assert ions: • Members of the armed forces are Invaluable to our nation's safety and morale . • We should care for our veterans. • Our care , in many circumstances , has failed miserably . We have shamefully underfunded and understaffed our system of veterans ' services . For example , in 2015 the wait times for Utah veterans seeking medical care were longer than the nationa l average , and the national average was pretty poor. Granted , the Department of Veterans Affairs (VA) in Salt Lake City has made great improvements over the last year , detailed in a June op-ed by Shella Stova ll, acting director of the VA Salt Lake City Health Care System . But our veterans are still suffering , some from the most basic needs. Like food . Luckily, there are people able to fix a problem once identified , and that is exactly what Natalie Green , a SLC VA health care administrat ion trainee , has done . Green noticed that some of the veterans receiving medical services at the George E. Wahlen Department of Veterans Affairs Medical Center were desperately hungry. So she started a food pantry. Twenty-seven percent of younger veterans who served in Iraq and Afghanistan suffer food insecurity . Yet VA funds cannot be allocated for food assistance. Services offered by the Utah Department of Veterans and Military Affairs include education , employment , health care, burial assistance and loan programs , but not food assistance . Green set up a separate account for private donations , asked for donat ions of canned goods from employees and other veterans and partnered w ith the Utah Food Bank to help fill the shelves . The pantry has been open since March and is already serving almos t 100 veterans and their families a month . Not only has Green gone above and beyond to organize the food pantry, she has also documented her efforts to help other VA hospitals across the country do the same thing. Green essentially "cut through the bureaucratic red tape" and hopefully started a national movement. The United States Department of Veterans Affairs has taken note. The pantry is open every Thursday from 2:30 to 4:00 p.m. Donations can be made online by donating to the General Purpose fund and including in the comments section that donations 24 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000884 DS 00021600 should be directed to the Food Pantry GPF # 1063. Or donors can deliver in-kind donat ions to the SLC VA , Building 4, Room 1C25. No, it's not Thanksgivi ng or Christmas , but people still need to eat. At the very least, we can all help ensure that our veterans don't go hungry . Back to Top 2.4 - Investor's Business Daily: Good News For Veterans : Trump Tells Hundreds Of VA Workers 'You're Fired!' (10 July, 3.2M online visitors/mo ; Los Angeles , CA) Accountability: For decades, political leaders have lamented the scandal-plagued Veterans Health Administrat ion , and did little more than throw more money at the problem . The Trump administration is firi ng workers who aren't doing their jobs . Acco rding the Department of Veterans Affairs , 526 have been fired for misconduct since President Trump took office. Another 200 have been suspended and 33 demoted . Most of them worked at the VHA and included physicians , nurses , pharmacy technicians, food service workers , medical technicians, office workers , even some police officers . VA Secretary David Shulkin said this was part of a broader effort to reform the culture at the VA. "Veterans and taxpayers have a right to know what we're doing to hold our employees accountable and make our personnel actions transparent, " he continued . " Posting this informat ion online for all to see, and updat ing it weekly , will do just that. " Expect more terminations now that Tr ump has signed the VA Accountability and Whistleblowe r Protection Act , which strengthens Shulkin 's ability to get rid of bad employees , including senio r executives . Contrast this with the Obama administration , wh ich ceaselessly talked about accountability while providing little of it. In the wake of the 2014 widespread scandal at the VHA , where veterans died during endless waits for treatment and officials tried to cover it up, only nine employees (out of 57 targeted for disciplinary actions) were let go, three of whom were senior officia ls. And then , in June 2016 , the Obama administration announced that it was abandoning the 2014 law's streamlined firing process altogether after deciding it was unconstitutional. Shulkin is also imposing a requirement that any monetary settlement with an employee over $5,000 has to be approved by a senior official. As the Daily Caller reports, in the past the VA "repeatedly made five- and six-figure payments to bad employees to get them to quit" rathe r than deal with a lengthy appeals process . 25 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000885 DS 00021601 In the two and half years that Bob McDonald was running the VA under Obama , the agency paid out more than $5 million in such payments . The message to VA employees was clear: If you're threate ned with being fired, hold out for a settlement. Every government agency has the same problem as the VA - it's difficult to impossible to fire workers for misconduct , thanks to the heavy union presence and the Merit Systems Protection Board. The result is that managers not only avoid firing workers, they won't even give employees bad reviews out of fear of triggering lengthy and costly appeals . As a result, 99 .5% of federal workers get a ''fully successful" rating or above, according to an audit by the Government Accountability Office. More tha n a third got an "outstanding" rating. Government workers already make more money and get far more generous benefits than tho se in the private sector who pay their salaries . The fact that so many federal workers get what amounts to a guaranteed job for life is adding insult to injury . What's needed is a wholesale revamp of the rules and regulations covering government employees so that agency heads can actually create cultures of accountability , instead of just talking about it. But the need is more urgent at the VHA, where the failure of government employees can cost lives. Shulkin , to his credit , has taken the first step to remedying that. Back to Top 2.5-WXIA (NBC-11, Video): Man shot by police during bank standoff had issue with VA benefits (10 July , Phillip Kish, 1.5M online visitors/mo; Atlanta , GA) The man shot dead by authorities after he claimed to have a bomb at a Marietta bank had visited the Atlanta Veteran Affairs office days before the incident. VA spokesperson James Hutton confirmed to NBC News that Brian Easley was at the Atlanta office on July 3 to discuss an issue with his BA benefits. After being informed of what he needed , Easley said that he'd return on Thursday with the paperwork to settle the matter . Easley didn't return as planned, Hutton said, On Friday , police said Easley walked into a Wells Fargo bank and said he had a bomb in his backpack. He made several demands that referenced the miltary and his status as a veteran, authorities said . Early in the standoff , he released some customers and employees. Police said he held two women hostage until after noon. After several hours of negotiations , authorit ies entered the bank and said that Easley was dead . They've dec lined to release details into how he died , but have classified the incident as an "officer-involved shooting." 26 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000886 DS 00021602 "I don't think that suspect had an idea what was going on or about to occur, " Cobb County Police Sgt. Dana Pierce said on Friday. Authorities later confirmed that the backpack did not contain a bomb . The Georgia Bureau of Investigation has taken over the investigation , as they do most officerinvolved shootings . "VA is deeply saddened by the news in Cobb County ," Hutton said." VA worked closely with law enforcement to try to resolve the situation peacefully , but unfortunately it ended in tragedy . Our sincere condolences go out to everyone affected." The VA reminds veterans that the Veterans Crisis Line is available 24 hours a day at 1-800-273 8255. Back to Top 2.6 -WFED (AM-1500 , Audio) : VA's first 'accountability ' posting shows hundreds fired since Trump inauguration (10 July , Terry Wing, 831k online visitors/mo ; Washington , DC) The Department of Veterans Affairs has posted its first list of employee remova ls, suspensions and demotions showing VA has fired 525 staffers since President Trump took office in January . The list, posted on Friday, includes doctors , nurses , housekeepers and even grave diggers. It does not include employee names, due to privacy reasons but does note the employee 's position and VA region. In announcing the new effort at transparency last week, VA Secretary David Shulkin said veterans and taxpayers have a right to know what VA is doing to hold its 345,000 employees accountable. The so-called "accountability actions" will be posted on a weekly basis . (Veterans Affairs) [.. . ] Back to Top 2.7 - WFED (AM-1500): What VA 's now public adverse action reports don't say about employee accountability (10 July Nicole Ogrysko, 831k online visitors/mo; Washington, DC) Some federal employee groups and experts are scratching heads over the Veterans Affairs Department's recent decision to publish a weekly list of all major disciplinary actions for its workers. VA is the first federal agency to publish such information , and it described the decision as a step toward improving accountability and transparency at a departme nt which has long struggled to use governmentwide disciplinary procedures to tackle entrenched cultural challenges. ''Together with the accountability bill the president signed into law recent ly, this add itional step will continue to shine a light on the actions we 're tak ing to reform the culture at VA," Secretary David Shulkin said in a July 7 statement. "Veterans and taxpayers have a right to know what 27 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000887 D8_00021603 we're doing to hold our employees accountable and make our personnel actions transparent. Posting this information online for all to see, and updating it weekly, will do just that." But federal employee groups and employment attorneys say the department's new adverse action reports don't tell the full story about VA's efforts - or struggles - to improve accountability. Sponsored Content: Questions about moving to the cloud? Chat with FDA Chief Information Officer Todd Simpson on July 25, at 1:30 p.m. They don't, for example, explain why VA appears to be on track to fire fewer employees during the first year of the Trump administration than the previous fiscal year. VA's July 3 report lists 525 removals during roughly the first six months of 2017. If the department removes employees at the same pace for the remaining six months, about 1,050 employees from VA will be fired by the end of 2017. Yet according to Office of Personnel Management information on the agency's data archive FedScope, 2,575 employees at VA were removed for discipline or performance in fiscal 2016 . VA Removals for Discipline or Performance Year # of Removals FY2011 2,094 FY2012 2,036 FY2013 2,264 FY2014 2,590 FY2015 2,363 FY2016 2,575 Though the recent VA data shows disciplinary actions for the six months of the calendar year and OPM's information tracks removals for the given fiscal year, the department appears on track to fire fewer employees in fiscal 2017 than it has in each of the past six years. "They're firing at about half the rate they did last year," Richard Loeb, senior policy counsel for the American Federation of Government Employees, said. "I'm not really quite sure what all the claims of accountability are about. Obviously with the new law, they feel they'll be able to fire more easily and more quickly. This seems to be a notion of firing your way to excellence." The most recent data from VA won't likely include many removals that the department performed under the new VA Accountability and Whistleblower Protection Act, which President Trump signed into law June 23. Worried about the Trump administration's proposed cuts to federal retirement? Find out what these 100 members of Congress have to say about it. Shulkin has said the new law will allow him to move disciplinary actions through the decision and appeals process more quickly than previous methods . It shortens the time employees have to respond to a disciplinary action, shortens the grievance process, expedites the appeals process at the Merit Systems Protection Board for rank-and-file employees and eliminates the MSPB as avenue for senior executives to appeal disciplinary actions. 28 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000888 OS 00021604 In addition, the majority of the adverse actions described in the first report are among lowerlevel employees at VA, including 94 housekeepers, 55 food service workers and 21 clerks. Practically all of the 94 housekeepers that were removed or suspended during the first six months of the administration are likely veterans, because a provision in the U.S. Code requires VA hire only candidates with veterans preference to fill certain positions like custodians, guards, elevator operators or messengers . One person on the July 3 report was listed as a "senior leader" within the Veterans Health Administration's Central Office, and 17 others are listed as senior leaders within VA medical facilities. Few other VA employees on the most recent report carry higher-level ranks or senior titles. One general attorney at VA's Office of General Counsel was fired in March, for example. A supervisory biomedical engineer and several physicians were also removed. "The so-called VA scandals allegedly started when senior-level VA officials at the medical centers allegedly created secret waiting lists and the like," Loeb said. "I doubt that was done too often by housekeepers or laundry workers, but yet that's where the firing seems to be focused ." Debra D'Agostino, a federal employment attorney with the Federal Practice Group, said the majority of the employees in these lower-level positions don't have control over major decisions or policies that dictate how well VA is caring for and treating its veterans . "This data doesn't show that there's any real change happening in VA," she said. The adverse action reports don't list employee names due to privacy reasons, VA said . But the reports also lack details about the specific charges related to each disciplinary action. D'Agostino called VA's decision to exclude this information "odd," but said she and other lawyers within her practice have often argued with federal agencies over these details when seeking information on other employees who have faced similar charges. Federal circuit case law requires that agencies provide these lists so that employees and their attorneys can compare the charges and decisions with previous disciplinary actions from the department during the appeals process. "I'm not aware of any private sector employer that routinely fires people, as some do, that publishes a public list," Loeb said. "[You] might say they're not public employers either, but there's no requirement to publish these lists. These are facts, whether people are employed by agencies and how they left the agency, and as necessary, that type of information can be released for some background investigations or employment inquires or the like. But this doesn't seem to have any utility other than to tell people, 'Be afraid. Be very afraid."' VA's new public reports list the organization or Veterans Integrated Service Network (VISN) where the disciplinary action occurred, the position that the employee held, the action the department took and the date it was effective. But they don't indicate when VA made an initial proposal to remove, demote or suspend an employee for more than 14 days. 29 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000889 OS 00021605 "It's not clear [these] proposals [were] issued before Trump was inaugurated and then the decision was promptly made ," D'Agostino said. The department can often take six months to a year to decide what kind of disciplinary action to make , D'Agostino added . Though the report only lists actions taken after Inauguration Day, she suspects VA made proposals for some of those actions before the new administration began . In addition to the new lists , Shulkin will also now require senior officials to approve any monetary settlements with an employee above $5,000. The undersecretary, assistant secretary of an "equivalent senio r-level official within the organization " where the dispute occurred will need to sign off on the settlement. D'Agostino said employee settlement s often wide ly vary. "$5,000 is a very low bar to require that level of review," she said. "That's going to have a tremendous impact on negotiations . Just the fact that it's been put out there is going to have a chilling effect on settlements ." Reaching a settlement is the goal, she said, because it acknowledges that the agency and the employee "agree to disagree " and move forward , "There 's going to be a lot more litigation that gets dragged on and on because of this / D'Agostino said. "This sends a chilling effect about bringing something like an [equal employment opportunity] EEO claim forward .'' Many federal employee groups said this decision sends the wrong message to the departmen t' s workforce and federal workers in general. "While there is value in posting these kinds of lists in terms of accountability , the larger and more posit ive effect , we believe , is to restore public confidence in the federal government 's ability to effectively manage its workforce ," Bill Valdez , president of the Senior Executives Association, said. "There has been a myth floating around that civil servants, because they cannot be fired easily, are unaccountable . This myth, which lists like this prove to be dead wrong , needs to be stamped out because the overwhelming number of federal employees are focused on delivering superior products and services to the American taxpayer. Moreover , the vast majority of civil servants would agree that poor performers should be disciplined or removed from the civil service ." AFGE , which represents roughly 230 ,000 VA employees , said it wants to hear more about the department 's plans to fill 49 ,000 vacancies and improve the quantity and quality of health care to veterans , Loeb said . "This is not about accountability and it's not about transparency ," he said. "It's about sending a message ." Back to Top 30 Veterans Affairs Media Summary aod News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000890 DS 00021606 2.8 - WSYX (ABC-6, Video): Veterans Administration mistakenly declares war veteran "dead" (11 July, Kurt Ludlow, 450k online visitors/mo; Columbus , OH) A military veteran turned to Six On Your Side for help after getting the surprise of his life. He was surprised to find out he was "dead ." At least as far as the government was concerned . 11 We are so sorry to learn of the deat h of Manis McKenzie , and extend to you our deepest sympathy ," said Manis as he read from a lette r to his wife from the Veterans Administrat ion. "And they said I had died March 30th and if I'd known that , I wouldn't have schedu led the knee surgery," he said as he laughed . McKenzie had just returne d home from knee surgery . He's got a great sense of humor , whic h he prompt ly used on his wife . "I called my wife and I said, 'I thought you told me that the surgery went well.' She goes, 'well it did .' And I said , 'well I don't think it went so well. I got a letter stating that I died,"' he said. Manis joined the Marines when he was 17, and at 18 was in Vietnam . Later he joined the Navy Reserves where he served for 20 more years . He was eventually sent to Operation Desert Storm. ''And then in 2004 , my son was in my unit and we both got called up together to go to Kuwait for severa l months for Iraqi Freedom ,'r he said. He survived all of it, only to be killed off by the V.A . in 2017 . "Got to talk in' to 'em and they started the process of bring ln' me back to life," he joked . The V.A. told' him by phone that the on ly way to clear it up would be to go to Cleveland 1n person immediately . So, he got his son to drive him, swollen leg and all. "And I walk in and they said, 'can we help you?' I said 'yes , I'm dead and I'd like to be brought back to life.' And the guy sort of looked at me strange and everybody else in the waiting area laughed ," he said. They'd made the three-hour drive only to be ushered out the door j ust minute s later . "All they did was copy my I-D's, fill out a small form and I was on my way back home to Columbus and that's , something like that, why they couldn't do that locally , I don 't have a clue ,'i he said. The whole thing was fun ny for awhile he said . Then the checks stopped. "And now my V.A. check's gonna be stopping and then yesterday in the mail I got a letter stating that since I'm retired from the Navy Reserves that they're stopping that check now too since I died . And so it's j ust a big mess ." The V.A. told ABC 6/Fox 28 it was notified by a third party that Manis had died. Its stateme nt said it "regrets the inconvenie nce." and has strengthened its verification process to reduc e the likelihood of mistakes like this , which the agency says , don't happen very often. 31 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000891 DS 00021607 VA has found that these types of cases represent a very small number of beneficiaries in comparison to the millions of transactions completed each year . Addmonally , VA has several matching programs that are designed to prevent overpayment and debts incurred by beneficiaries . One of these programs matches death record data from the Social Security Administration (SSA) with our database . When a match is made between SSA death records and VA records, the beneficiary is identified as possibly deceased , and a letter is sent to the beneficiary in order to confirm the match. During calendar year 2016 , VA confirmed the accuracy of the automated SSA death match process , finding a 99. 67 percent accuracy rate . During that period , the process automatically suspended VA benefit payments for 103,243 beneficiaries. Of those, 345 beneficiaries had their benefit awards reactivated due to erroneous suspensions , representing less than 0.4 percent of the year's SSA match caseload. - Terrence Hayes , V.A. Spokesman "Why in the world they aren't required to have a death certificate before they start killing somebody off? I don 't have a clue," said McKenzie. For now , Manis tries to laugh it all off. He's obviously thankful to be alive . But worried the mailman might bring some more bad news . "So I'm just curious today when I get the mail , anybody else killed me off," he joked. The V.A. said it restarted McKenzie 's benefits within a few days of being notified he was alive . Back to Top 2.9 - KRGV (ABC-5, Video) : Veterans Accountability Report Quest ioned (10 July , 277k online visitors/mo; Weslaco , TX) The U.S. Department of Veterans Affairs is prov iding the removal , suspensions and demotions of employees as of July 3, 2017 in an online accountability report . The report shows 23 veterans health administrations across the country . According to the Veterans Health Administration , the Rio Grande Valley is under the Veterans Integrated Service Network (VISN 17). It's made up of seven different VA medical healt h care clinics in Texas. The VA accountability report shows several removals and suspensions and demotions . "They' re seeing now that they are term inating all these people. They're saying you know what they got terminated , what makes us think tha t we're not going to get terminated. The need to open their eyes and we 're probably start getting better service . But right now it's not good service ," ,said Veteran Richard Pena. Army Veteran and Americas Last Patrol Commander , Richard Pena is frustrated . He said an appointment letter he got from the VA came too late . "Then I get the letter the same day my appointment is. I saw the date on there . The same date of my appointment how can they know I didn't show up for my appointment the same day ," said Pena . 32 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000892 DS 00021608 Pena hopes Veterans Affairs new accountability tactic works soon before his next medica l appointment comes too late. Pena also questioned why specific facil ities are not on the list We reached out to the VA Texas Coastal Bend in Harlingen . They sent us this statement: 'The Department of Veterans Affa irs 0/A) is making public a list of adverse employee actions taken since Jan. 20 in order to continue to shine a light on the actions we're taking to reform the culture at VA. " "The news release further states that for privacy reasons , the adverse action list does not include employee names , but gives informat ion on the position , VA region or administration and type of adverse or disciplinary action taken," said VA Texas Valley Coastal Bend Public Affairs Officer Reynaldo Leal. Back to Top 2.10- Cape May County Herald: Veterans Affairs Pitches Vision; Crest Dune Project on Hold (10 July, Rachel Rogish , 191k online visitors/mo ; Rio Grande , NJ) WILDWOOD CREST- ''Wildwood Crest is my home ," said Jacqueline Hinker , outreach specialist for the U.S. Department of Veterans Affairs. She spoke during the Borough Commission meeting July 5. Raised on Lavender Road and a graduate of Wildwood High School , Class of '84 , Hinker has returned to the county in her present capacity. "I answer to the director ," said Hinker, explaining her unique position as beneficial to veterans obtaining services . With less "red tape ," Hinker finds "kinks" in the process chain and resolves issues if a veteran is unable to receive services . Doris Barnes, 96, of Cape May County recently received her hearing aids due to Hinker's investigation into her case. A veteran of World War II, Barnes can now hear. Hinker presented a vision of increasing enrollment in veterans ' healthcare countywide ; she desires county veterans to have access to opt imum care and services . However , without "numbers ," (translated enrollment ) Hinker said services would not be as available . A 10,000-square-foot complex , newly built in Vineland, stands testament to growing veterans' enrollment in Cumberland County. Hinker wishes the same for Cape May County . Hinker also attended the June 28 Wildwood City Commission meeting and presented her vision . Though a long-term goal , finding a new facility for veteran care is on Hinker's agenda, eventually replacing present community-based outpatient clinic facility at the Coast Guard Training Center in Cape May. "We need to care for each other," said Hinker, referring not only to veterans but also to their families, friends , and care providers . Hinker said many veterans are not enrolled because they 33 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000893 DS 00021609 "want to leave it (hea lthcare ) for those who really need it.'' Hinker said although this spirit is admirable , not enrolling decreases the services made available in the county. Hinker concluded by request ing permission to set up a booth at upcoming concerts held in the borough. ''I like to engage people ," said Hinker, explain ing the personal interaction she seeks to facilitate while presenting Veterans Affairs. "We want every vet to have a good experience ." Commissioner Joyce Gou ld offered assistance to Hinker's cause as did Mayor Carl Groon . "I will coordinate wit h you ," Borough Administrator Constance Mahon said. A Veterans Affairs meeting is planned July 15 from 2 to 4 p .m. at the Cape May County Police Academy, 171 Crest Haven Road, Court House. Hinker said her positton is personal : her father served during the Korean War and her husband in Operation Iraqi Freedom . Dune Project Update During Mahon's report , commissioners learned that the isla ndwide dune project remains in the design phase , according to the state Department of Environmental Protection , as cooperation continues with the Army Corps of Engineers. Kayak Launch Site A pre-application will be presented rn Trenton by Mahon for the kayak launch at Sunset Lake . Mahon said the purpose is to "smooth out" any potential problems before the application process begins. No New Beach Signs New beach signs wHI not be installed on Crest beaches until upcom ing winter months and spring of 2018. According to Mahon , the JIF (Atlantic County Joint Insu rance Fund) has not yet written "uniform language " for the signs. However, Mahon assured commissioners that the signs would include the boro ugh's des ignat ion as a Tr ipAdvisor Hot Spot and as one of the top 10 beaches in New Jersey , Back to T op 2.11 - WTOK (ABC-11 , Video): Town hall addresses veterans' concerns (10 July , Jeffrey May , 66k on line visitors/mo ; Meridian , MS) Local veterans had the chance to have their questions about the ir health benefits answered . The associate director of the Sonny Montgomery VA Medical Center in Jackson stopped in Meridian Monday for a town hall meeting . He part icipated in a Q & A session with veterans and their families . 34 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000894 DS 00021610 The VA wanted to inform the vets about the changes to medical and claims benefits and discuss the Veterans Affairs Choice Program that congress is examining . Local community vendors showcased the services they provide . "I hope that they see we are here to do the veterans in our community , to actually know that they can come to us and get them answers ," said Jeff Slbley, veterans service officer. "And that they learn the new stuff coming out with the hosp ital." Veterans may stop by the Lauderdale County Veterans Office at 1827 23rd Avenue. Back to Top 2.12 - WAGM (FOX-8) : Poliquin Introduces Bipartisan Legislation to Streamline VA Workforce Acquisition (10 July , Taylor Lumpkin, 36k online visitors/mo ; Presque Isle, ME) Subcommittee on Oversight and Invest igations Chairman Jack Bergman (R-Mich.) and Ranking Member Annie Kuster (0-NH) , along with Rep . Bruce Poliquin (R-Ma ine) , introduced bipartisan legislat ion to streamline VA's processes for workforce acquisition . 'Tm proud to join Rep. Poliqu in and Ranking Member Kuster in supporting this legislation that takes critical steps to improve the methods by which the VA trains, recruits , and retains top professional talent in acquisition career fields, " said Bergman . "Our men and women in the military have provided an invaluable service . More often than not, their commitment comes with great physical sacrifice and lasting effects requiring a lifetime of care. Our Veterans deserve a reliable and effective support structure from well trained and dedicated professionals ." "I'm pleased to introduce this important legislation with my Republ ican colleagues, " said Kuster . "VA has serious purchasing problems that delays healthcare services to our veterans and wastes billions of dollars of taxpayer funds . This bill would ensure that the Department of Veterans Affairs is able to hire and effectively train the employees it holds responsible for purchasing medical supplies and contracting construction projects . This bill would also enable the VA to reform its acquisitions bureaucracy and improve its overall government purchasing operation . I urge my colleagues in the House of Representatives to immediate ly pass this legislation so we can help improve the overall accountability , efficiency , and functioning of the VA ." "Unfortunately , far too often we have seen excessive waste and ineffic iencies at the VA that have in some cases severely hurt services to our Veterans ," said Poliqu in. "It is critical that the resources we put into the VA are used in the most efficient ways and to the ir maximum potential for our Veterans. To achieve this goal , we must ensure the workforce at the VA receives the training needed to cut down waste and improve efficiency , while also eliminating bureaucracy that harms the department's ability to ultimately carry out this mission . I'm enormously proud to push this legislation forward to increase efficiency , better our Veterans ' services and make sure they receive the care and support they deserve .'' Background : 35 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000895 DS 00021611 The VA Acquisition Workforce Improve ment and Streamlining Act would require VA to create career certification programs for construction and logistics employees , which would be in line with similar programs at the Department of Defense. It would also extend VA's career certification for contracting officers to VA's logistics workers and construction managers as well. Furthermore, the bill would direct VA to expand its acquisition intern programs to bring new college graduates and recent veterans into VA to replace retiring employees. The bill pays for these workforce improvements by consolidating redundant acquisition bureaucracy . The Subcommittee on Oversight and Investigations is expected to mark up this legislation on Wednesday . Back to Top 2.13 - Dayton Business Journal: VA cuts 70 positions across Ohio, as part of new accountability effort (10 July, 20k online visitors/mo ; Dayton, OH) The U.S. Department of Veterans Affairs has implemented a new accountability practice whereby poor-performing employees can be removed from their jobs. And since January , the VA has fired more than 500 people across its extensive footprint. That's the word from the VA's adverse actions report, which was released last week. The U.S. Department of Veterans Affairs has implemented a new accountability practice whereby poor-performing employees can be removed from their jobs. The U.S. Department of Veterans Affairs has imp lemented a new accountability practice ... more It shows 71 people have either been fired or supended in the VA's Ohio district, which includes facilities in Dayton and Springfield. "Veterans and taxpayers have a right to know what we're doing to hold our employees accountable and make our personnel actions transparent ,~ said U.S. Secretary of Veterans Affairs David Shulkin in a release. Secretary Shulkin pointed to the move as another step in long-so ught transparency and accountability actions at VA, and noted that VA is the first federal agency to make such data public. The report follows the VA Accountability and Whistleblower Protection Act signed by President Donald Trump less than two weeks ago, For privacy reasons, the list does not include employee names , but gives information on the position, VA region or administration and type of adverse or disciplinary action taken . Back to Top 36 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000896 DS 00021612 2.14 - Corridor News: VA Apprenticeship Program To Train, Employ Veterans To Assist Other Veterans In Properly Filing For VA benefits (10 July , 17k online visitors/mo ; San Marcos , TX) Veterans service organizations (VSOs) play a major role as advocates for the Veteran community , and as partners with VA , to ensure this nation's Veterans receive the benefits they have earned . An important part of this partnership is to support VSOs as they train the ir advisors on the benefit process. VA's Vocational Rehabilitation and Employment (VR&E) program recently entered in to an agreement with Paralyzed Veterans of Ame rica to participate in an apprenticeship program to train Paralyzed Veterans ' employees on how to assist Veterans to file for and obtain their benefits . A similar program is currently in effect with the Disabled American Veterans organization . Paralyzed Veterans is an advocate for quality health care, spinal cord injury and disease research , VA benefits , and civil rights for Veterans and all people with disabilities . As a service oriented non-profit organ ization , Paralyzed Veterans employs nat ional service officers to serve Veterans. "The apprentices hip program with Paralyzed Veterans will put much needed resources into communities nationwide to work with our Veterans and assist them in applying for benefits, " stated Tim Johnston , supervisor for rehabilitation services at VR&E. "This not only gives those accepted into the program a skill , but ensures that Veterans in communities , large and small , have access to trained profess ionals who can help them understand the process and apply for those benefits they have earned and deserve ." In a memorandum of understanding between the two organlzations , Paralyzed Veterans will provide a 36-month on-the-job training program to qualified Veterans who are selected for the apprenticeship program . Most of the apprenticeship is supervised work with some classroom and on-line learning. These are full-t ime national service officer positions . Pay during the apprent icesh ip is supplemented by the VR&E program . For the first 12 months, those selected for the program are paid $2,890 per month by Paralyzed Veterans , and an additiona l $651 from VA as a training allowance . In the remainder of the apprenticeship , Paralyzed Veterans pays $3,166.66, and VR&E pays $375 per month for training. The VR&E training allowance to the Veteran is tax-free . VA also pays for the training and necessary supplies. Selection for the program generally comes from two sources. Paralyzed Veterans may notify VR&E that they have a candidate in mind, or a VA vocational rehabilitation counselor can recommend someone for the program . The current memorandum of understand ing will be in effect until May 2021 . Back to Top 37 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000897 DS 00021613 3. Access to Healthcare 3.1 - The Huffington Post (Video): No Marine Left Behind ... Except This One (10 July, Jon Hotchkiss , 22 .9M online visitors/mo ; New Y ork, NY) On Friday , July 7th , 2017 Staff Sgt. James Hollon (USMC , Delta Company ), his wife Angela and their 3-year old baby got in James ' Red Ford truck and drove a few hours south from Portland to a friend's. For the next few nights , they'll sleep on the ir friend's couch . Yes . It's summer _ But no. They 're not on vacation . They're homeless . Let me tell you a little about James . He's from a small Texas town . As a teenager , he had a motorcycle that he rode too fast. He realized his life was going nowhere and that he need structure and discipline . He joined the marines at age 20 - the day was january 18th, 2000 . Just a handful of months before terrrorists with box cutters flew planes into the twin towers . He was trained. And deployed overseas . On his first mission , he assisted with the evacuation of the US embassy in Yemen after the USS Cole was attacked . Then, he served 5 combat tours in Iraq and Afghan istan as an infantryman . He was a soldier higher ups relied on. There came a point where he was in charge of a squad and multiple millions in warfare weaponry . While serving in combat , he got 14 concussions from being too close when lEDs exploded. They knocked him out. In some cases he was inside a vehicle . Other times , on foot. First, the blast wave in and of itself, is devastating . And that can give you a concussion. PTSD / TBI: Then , the blast can throw you and you hit your head inside the vehicle , or just as likely, your head hits the ground if you were on foot. His official medical records say he got at least 14 concussions . But James thinks the# is actually closer to 20 . Today : we know that even just a few repeated concussions or traumat ic brain injures - like those suffered by James Hollon - will result in diminished thinking capacity , diminished sensation like sight or balance , diminished language capacity, including communication , expression and understanding and diminished emotional capacity , including depression , anxiety , personality changes , aggression , inappropriate social behavior and suicide. 20 veterans a day kill themselves in the US. Repeated concussions will also likely cause early onset epilepsy , parkinsons , and alzheimers. After his combat duty, James was a drill instructor for the marines, training new recruits who would head to iraq and afghan istan . 3 year later, James became an ied specialist - teaching marines right before they shipped out to wa r the devestating effects these improvised bombs had, how these improvised explosive devices are made, how they are deployed, how to spot them, and how to dismantle them. 38 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000898 DS 00021614 James gave the marines 12 ½years.While on duty as a drill instructor , he injured his shoulder. Now, as a marine , he was taught to suck it up. To not complain. To deal with the pain . Because that's what a marine does. And that's what James did. And after giving the marine 's 12 ½ years of service , James decided to move on ... VA BOTCHES SURGERY: In 2012 , he went to the VA ... where it was determined that he had only about 70% mobility in his right shoulder and his constant chronic pain was venned . It was determined that he needed surgery on his shoulder . James was forced to wait 5 years for his operat ion . He was told he needed the surgery in 2012. In 2017 the VA finally arranged for him to get it. Back to Top 3.2 - The Hill: Humane Society pushes bills to connect wounded vets, service dogs (10 July, Sumner Park, 11.8M online visitors/mo ; Wash ington , DC) The Humane Society of the United States is urging lawmakers to pass a package of bills to make it easier for veterans and service members to get therapy dogs. The bills have bipartisan support, but animal rights advocates are making a new push to get the legislation through Congress , with lawmakers nearing their August recess with an already busy docket. "At a time in a country when we are so polarized, this is a set of issues that we can unite around ,~ Wayne Pacelle , president and CEO of the Humane Society of the United States , told The Hill. "The American public will be pleased that the Congress is getting someth ing done and is doing something done that is aligned with their values ." One of the bills, the Paws Act , would provide more service dogs to veterans with post-traumat ic stress disorder (PTSD) . Though veterans with physical disabilities already have access to service dogs , the bill would author ize the Veterans Admi nistration to fund a five-year program to support organizat ions that provide compan ion animals to wounded veterans . Re-introduced by Reps. Ron Desantis (R-Fla .) and Earl Blumenauer (D-Ore .), the bill has 147 cosponsors . The bill has been referred to the House Veterans Affairs Subcommittee on Health. There is a companion bill in the upper chamber from Sens. Deb Fischer (R-Neb .) and Cory Booker (DN.J.) that has been referred to the Veterans Affairs Committee . Another bill in the current Congress , the Veterans Dog Training Therapy Act , wo uld establ ish a pilot program allowing veterans with post-traumatic stress disorder (PTSD) to take part in therapeut ic dog train ing . 39 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000899 DS 00021615 The bill passed the House ln the last Congress, and was re introducted this year by Reps . Steve Stivers (R-Ohio) and Tim Walz (D-Minn.) . "Helping our veterans cope with Post Traumatic Stress Disorder is one of the most solemn responsibilities of our time ," Walz told The Hill. The bill calls for Veterans Administration facilities to connect veterans with local dog training organizations and to study the therapeutic value of those programs. Walz said the program would help veterans rehabilitate by training therapy dogs , which would then go on to assist other disabled veterans. "As more research continues to be conducted, I believe this 'veterans he lping veterans' pilot program carries great prom ise of improv ing the quality of life for all veterans invo lved," Walz said . Another bill , the Wounded Warrior Service Dog Act , from Reps. Jim McGovern (D-Mass.) and Walter Jones (R-N .C.), would allocate grants to nonprofits that train and provide service dogs to veterans with disabilities or PTSD. The bill is before a House Armed Services subcommittee . Jones told The Hill he's seen a change in attitudes over the issue . "Thanks to a lot of interests nationally was well within military, the whole attitude has changed that service men be gfven the opportunity to have a service dog after serving ," he said . Lawmakers , though , face a tough schedule ahead , leaving many to question when the bills will finally move . Congress must pass a spending bill, raise the debt ceiling, and tackle GOP priorities , i nclud ing ObamaCare repeal and potentially ta x reform . Pacelle said the Humane Society is reaching out to lawmakers to push the legislation on veterans and animals along. "We inform our const ituents , lobby offices , write pos ition papers , take advertising , rally millions of Americans , and do much more to advance our goals on Capitol Hill," he told The Hill. "HSUS is all about getting the Congress to act on legislation to advance animal welfare ." Back to T op 3.3 - WRC (NBC-4, Video): Washington DC VA Medical Center Operating Room Temporarily Shut Down (10 July , Scott MacFarlane , 4 .BM online visitors/mo; Washington , DC) Federal officials ordered an operating room at the Washington DC VA Medical Center shut down late last week after the latest in a series of maintenance issues that have plagued the facility in recent months. The temporary shutdown lasted approximately three hours, according to a U.S . Department of Veterans Affairs spokesman . 40 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000900 DS 00021616 An air valve failed, the agency said, triggering a spike in temperature and humidity in the operating room, which is one of six inside the giant VA Medical Center on Irving Street in Washington, D.C. The emergency shutdown required the postponement of surgeries and raised new questions about the operations of the major medical facility, which treats about 98,000 local military veterans a year. An agency spokesman said two eye surgeries were postponed because of the malfunction. Repairs have since been completed, the spokesman said. The shutdown occurred weeks after a series of other maintenance and safety problems and a management shakeup at the medical center were revealed by a News4 I-Team investigation. Records obtained by the I-Team showed the agency hired a contractor to fix potentially unsafe floor cracks in the facility's surgery department in March. VA officials also ordered repairs of holes in the walls of the facility's "center core areas," completing the project in mid-February. The facility suffered a cockroach infestation and a lack of sanitary conditions in its food service areas in 2015, according to federal records reviewed by the I-Team. An agency spokeswoman told the I-Team the problems have since been remedied. In May, an I-Team investigation revealed the body of a patient went undiscovered for nearly two days in the parking lot outside the medical center. The cause of death has not been determined, according to federal officials who spoke with the I-Team. The agency acknowledged it will investigate the time lag between the death and discovery of the man. The string of recent problems closely preceded a major management shakeup at the medical center . The agency's longtime DC VA Medical Center director Brian Hawkins was reassigned to a position at VA headquarters in April. Days after questions were raised by the I-Team in June about the reassignment, the agency announced it had ordered a disciplinary action against Hawkins but would not specify the type of disciplinary action. The I-Team's reporting and a separate review by the U.S. Department of Veterans Affairs Office of Inspector General triggered a congressional investigation into the DC VA Medical Center . The inspector general review, released in April, revealed broader safety and management problems at the DC VA Medical Center, including dirty sanitary storage areas, supply shortages and more than $150 million in unaccounted for equipment and supplies. Eighteen of the medical center's 25 sterile storage areas were found to be dirty, according to the report by the VA Office of the Inspector General. In five storage areas, the clean equipment and supplies were mixed with the dirty. Seventeen areas lacked ways to monitor pressure, temperature and humidity. The medical center lacked an effective inventory system, and $150 million in equipment and supplies were not inventoried in the past year . Meanwhile, the lease on a large warehouse of non-inventoried items expires at the end of the month with no plan to relocate the contents and staffing constraints could make it difficult to address the situation . Also, no effective system was in place to ensure recalled supplies and equipment were not used on patients, according to the report. 41 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000901 OS 00021617 The unsanitary conditions and lack of attention to safety recalls placed patients at risk, as did a failure to ensure availability of supplies and equipment when needed, the report said . For example , a nurse reported a floor was out of tubes used to provide oxygen when a patient was in need. On a couple of occasions in March, the medical center ran out of bloodlines for treating dialysis patients . Follow us: @nbcwashington on Twitter f NBCWashington on Facebook Back to Top 3.4 - Hartford Courant (Video): Service Dogs Provide Lifeline For Disabled And Veterans (10 July , Matt Ormseth, 2.1M online visitors/mo; Hartford , CT) Twenty-fi ve years as an Army chaplain tested Tony Charles' faith. But today., he has an angel that never leaves his side. Dozer, a 4-year-o ld golden retriever , is Charles' service dog. The two met in 2014, when Charles went to Educated Canines Assisting with Disabilit ies in Torrington to be paired with one of thei r dogs, which are trained to help people with physical and emotional disabil ities . On his fifth night at the center , Charles suffered one of the nightmares that had plagued him since he retired from the military in 2012 . "He woke me up out of the nightmare and chest-thumped me with his head ," Charles recalled . "I was disoriented as to whe re I was, and I said, 'I got to find the lights.' And when I said the word 'lights,' he went over and turned them on. "I really believe he is an angel in disguise ." Dozer is one of more than 350 dogs ECAD has placed with veterans, children with autism and people with physical disabilities . ECAD's founders , Lu and Dale Picard , are now expanding their tra ining center in Torrington , marking a new chapter in the center's 22-year history . "He's helped me regain my sense of pride," Charles said about Dozer. I'm much easier to live with." ''I'ma different person. Match Made In Heaven Charles returned from a tour in Kuwait with PTSD and a brain injury suffered when he was thrown out of an armored truck - "invisible wounds ," he called them . He had planned on getting a master's degree in social work at UConn and working at Veteran's Affairs , but he couldn't concentrate, couldn't rid himself of flashbacks from to urs in the Middle East and Bosnia in the '90s. The nightmares were happening three to four times a week , he said. "I was lost as to what to do with my life," he said. ''I had tho ught I was going to be a social worker ... thought I could spend the rest of my life help ing families through the VA. But my doctor said I couldn't do it." A psychologist suggested he apply for a service dog. Charles filed an application with ECAD, only to be told there was a two-year waiting list. He spent those two years raising money from 42 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000902 DS 00021618 the VA, the VFW and the American Legion to pull together the $25,000 needed to cover the cost of raising a service dog. A family whose veteran son had taken his own life gave him $10,000. "They felt that if their son had gotten a service dog, that maybe he wouldn't have committed suicide," said Charles. Finally, Charles met Dozer in 2014 . "Without any coaxing he came and put his head between my knees," he recalled. "It was a match made in heaven." The Picards have been raising service dogs since 1994, when Lu Picard's father suffered a stroke and she trained the family dog, Juliette, to tug him off the couch and pick up the things he dropped. At the time, the Picards were managing convenience stores. "I said, 'Dale, this what I should do,"' Lu Picard recalled . "Running convenience stores is a job, but I needed something more. I needed something I could be passionate about." The two started ECAD in 1995 out of a two-car garage in West Granby. They've since moved to a larger facility in Torrington, and last week the Picards broke ground on the new center. They've raised $700,000 for the project, about half its estimated cost. The 9,000-square-foot building will include housing for clients like Charles, who go through a two-week training session with their dogs before taking them home. "There's nothing worse than teaching 89 commands to a dog and giving him to someone who has no experience," said Dale Picard. "The dog will just drive you nuts." Dogs That Open The Fridge The Picards breed the dogs - all golden retrievers - on-site, and train them for a year before pairing them with clients. The dogs can open doors, fridges and washing machines for the physically disabled; they can press 911 panic buttons when their owners are hurt, and wake veterans like Charles from nightmares. The dogs are remarkably attuned to their owners' body language. "I didn't go to a mall for, like, seven years," Charles said . "But now, if I get panicked because too many people are coming towards me, [Dozer] will sense that and pull me away from the crowd or the noise." The dogs are as indispensable to some clients "as much as their wheelchair is to them, or their cane," said Lu. Charles credits Dozer with pulling him out of the aimlessness that followed his retirement. The dog has given him a routine - three walks a day, grooming once a day, a toothbrushing every night. Service dogs can help counter the guilt that often accompanies a disability, Lu said. After the stroke, her father felt he was a burden on his family; there was no convincing him otherwise, not until they trained the dog and he felt he was responsible, again, for something's well-being . 43 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000903 OS 00021619 ''Nobody wants to be a burden on anybody," she said , "and the dog needs you as much as you need them ." Dozer has helped Charles stave off the loneliness he sees engulf many veterans , loneliness that has driven some to suicide . "They lose their social context and become more and more isolated ," he said. " But it's very difficult to do that when you've got a service dog that needs to be walked three times a day, and when you need to be groomed and look at least as good as your dog does ." Charles still gets nightmares from time to time . But he has Dozer now; he can feel Dozer's warm mass at his hrp, his angel watching over him as he drifts off to sleep . "I don't know when , but sometime after I fall asleep he gets off the bed and goes to his bed in the corner ," he said. "And if I have a nightmare or a night terror , he'll come right over to me and do his job." Back to Top 3.5 - KSAT (ABC-12): Rep. Beto O'Rouke lays out veteran, mental health plans at town hall, Congressman running for U.S. senate seat (1O July , Chris Shad rock , 1.1M online visitors/mo ; San Antonio , TX) U.S. Rep. Beto O'Rourke (D-16) announced on Monday his plans at a town hall meeting in Somerset for a piece of legislation dedicated to veterans and mental health . O'Rourke said an estimated 20 veterans die from suicide every day. He acknowledged there aren't enough mental health care providers and that it's difficult to get veterans to receive the care they need from the VA. The El Paso congressman said he hopes to change that with a proposal introduced as the Honor Out Commitment Act of 2017. "These are ideas that don't have any partisan aspect to them, " O'Rour ke said . "We just want to serve Americans , veterans , heroes who need our help. We want to make sure we fulfill our commitment obligation to them." O'Rourke also said he will be running for a spot on the U.S. Senate against Ted Cruz in 2018 . Back to Top 3.6 - Pantagraph: Veterans Corner 7/10/17 (10 July , 834k online visitors/mo; Bloomington , IL) Q: I am a friend of a veteran who has serious mental health issues . His limited insurance coverage for such issues is inadequate and he periodically ends up in the emergency room for threaten ing suicide . He was discharged from military duty with a general discharge under other 44 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000904 DS 00021620 than honorable conditions. I have known him since before he entered military service and I believe that a lot of his mental health issues are related to what he experienced in the service of his country. Does the VA offer any mental health assistance for this type of veteran? A: Discharges that are other than honorable, including a "general" discharge, are known as "bad paper'' and can prevent veterans from receiving federal benefits, such as health care, disability payments, education and housing assistance. In some cases, these veterans were unjustly discharged from the military because of mental health issues. An estimated 22,000 veterans with mental illnesses have received other-than-honorable discharges since 2009. VA Secretary Dr. David Shulkin recently announced that the VA would begin offering VA mental health care services to veterans with less-than-honorable discharges who urgently need it. Such veterans should contact their closest VA clinic or medical center for more information on how to access the mental health emergency services. This change in mental health care is just one of the ways that the VA is responding to the suicide crisis in the military and among veterans . Q: I am enrolled in VA Health Care and periodically see my VA doctor for a few health issues. I have a 40 percent service-connected disability rating. I currently have applied for a VA guaranteed loan. A part of the application process requires a copy of my most recent disability award letter . I receive an award letter each December from the VA with a statement as to what my monthly compensation will be for the next 12 months. The guarantee loan program is run by the VA; why do I have to get the darn award letter? If I have to get the letter, how do I get a copy? A: The VA is broken down into many sub-agencies that administer the individual VA programs . For security purposes and to guarantee that the VA loan guarantee administrator is actually dealing with the veteran who is applying for the program, most VA agencies do not share information between agencies . You can call the VA at 800-827-1000 to request a copy of your most recent award letter . Alternatively, if you are enrolled in Myhealthevet, you can go to the myhealthevet.gov website and print a copy. Did you know? The state of Illinois provides benefits to veterans that are separate from federal VA benefits. They include tax exemption/reduction for disabled veterans, veterans' preference in hiring for state jobs reporting to the governor, the Illinois Veterans Grant for college tuition and fees waiver and admission to the Illinois VA veterans' homes in Manteno, Quincy, LaSalle and Anna. Illinois also provides for the exemption of camping and admission fees for certain disabled persons and former prisoners of war who are Illinois residents and who wish to camp in parks under the control of the Illinois Department of Natural Resources. Documentation of disability status is required. Illinois does not require fishing and/or hunting licenses for disabled veterans with disability ratings from the VA of 10 percent or greater. Contact your local Illinois Department of Veterans Affairs (IDVA) at the Armory on South Main Street in Bloomington to apply for the disabled veteran fishing and hunting licenses. The Illinois State Fair offers free admission on "Veterans' Sunday" at the state fair to all honorably discharged veterans and their family . 45 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000905 OS 00021621 Cartage fees: When the federal government has furnished a headstone or marker , the Illinois Department of Veterans ' Affairs shall pay up to the allowable reimbursement amount for the setting of such marker within Illinois. Currently , the maximum amount is $100 payable upon approval of the application . Indigent veterans : Each county with a Veterans Assistance Commission (53 of Illinois' 102 counties have VAC offices) shall provide buria l for any honorably discharged indigent veteran , or their mothers, fathers , spouse or surviving spouse , or minor children, without sufficient means to defray the funera l expenses. The expense of such burial shall not exceed the sum of $900. Emergency food and transportation may also be provided in certain cases at the VAC offices. Contact you r local commiss ion for more information . Back to Top 3.7 -WFED (AM-1500, Tom Temin Commentary): VA's new list : Playboy without the centerfold (10 July , Tom Temin, 831k online visitors/mo; Washington, DC) The first time my mother felt I was old enough to drop off at the barbershop while she went to the grocery store, I naturally picked up one of the Playboy magazines off the table . Alas - this was a small town and a dry one - I was disappointed to discove r the good stuff in the middle had been removed. Rats. That 's a little how I felt looking at the Veterans Affairs Department's compilat ion of adverse employee actions since Jan . 20. Secretary David Shulkin, a physician , has thrown himself into the management reform effort at VA . I think he relishes it. The latest gambit is posting to VA's website a list of adverse employee actions , to be updated weekly . The initial list has 26 pages each with 29 demotions, suspensions of more than 14 days , and removals. I guess "removal" means firing. That's 749the last page is a little short. VA wants to show it's tough on accountability and soft on transparency . Like the redacted Playboy , the list tantalizes , but doesn't reveal much. Sponsored content Download our Executive Briefing to learn how agency and industry experts are using cloud for data and application strategy . But some. It lists neither names nor, disappointingly , descriptions of what the people did. The list does give the person 's title, VA agency and region, but not specific locat ions . And it lists the action taken against them. We learn that violators of some work conditions run the ranks from housekeeping aids (suspension greate r than 14 days) , to physicians (removed) , to police officer , to police chief (both removed). We see disciplinary action against people in all functions of the agencynurses and nursing assistants , purchasing agents and logistics technicians, program support specialists and secretaries , and senior leaders . At least one chief of surgery was excised from Region 15. 46 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000906 DS 00021622 I didn't make a scatter diagram , but the list seemed weighted towards the lower-level employees - lots of clerks , health aides , laundry workers , laborers , motor vehicle operators and food service workers. I found a mason, a plumber and a carpenter. Plenty of mid-level people also got kicked . Many nurses and specialists in medical administration , human resources, inventory management and pharmacy . A general attorney . You'll find a few in the higher ranks: supervisory biomedical engineer , several physicians, several listed as "senior leader. " Know what to do with your Thrift Savings Plan the next time the stock market crashes? Senior Correspondent Mike Causey tells you how to avoid buying high and selling low. Looking at the list another way , VA separated or otherwise punished people who interact with or touch patients , money , materials and facilities . VA employees , knowing the agency and region in which they work , can check the date of the action and probably figure out who it was and what they did. But perhaps VA leadership felt listing the specific indiscretions would come too close to privacy violation . In not quite seven months , 749 people , or about 107 people per month , have been disciplined in one of the three ways mentioned. Out of an employee population of, let's say 325 ,000, that comes to 0.23 percent. Back to Top 3.8 - WKRG (CBS-5): New Mobile V.A. Clinic On Track (10 July , Bill Riales, 272k online visitors/mo ; Mobile, AL) Veterans say after decades of talks , it's about time. Land and permits have been acquired and the new Mobile Veterans Outpatient Clinic ls on target to be completed by November 2018 . That's the word from the company that is building the new facility, U.S . Federal Properties of Kansas City, Mo. Rick Baier who is with the company , says there have been no changes with the project. The new clinic will be about 65 thousand square feet , or about twice as big as the current outpatient location , at the University of South Alabama Hospital building on Springhill Avenue . Baier says the location is on a tract of land at Rangeline and Halls Mill Roads . Right now there is just trees and scrub brush on the land. He hopes the land can start to be cleared for the project by the end of July . Back to Top 3.9 - Johnson City Press: Congressman Roe's response to July 3 protest (10 July , Brandon Paykamian, 196k online visitors /mo; Johnson City, TN) 47 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000907 DS 00021623 U.S. Rep. Phil Roe issued a response Monday to last week's protest at the Veterans Affairs Medical Center, Mountain Home, when a disabled veteran complained about the congressman's support for changes in VA drug administration policy. During a July 3 ceremony honoring Mountain Home's historic buildings, Robert Rose turned his wheelchair to face away from the Republican 1st Congressional District representative to express his opposition to the "Opioid Safety Initiative," which Rose claims restricts access to pain medications for patients and veterans suffering from chronic pain. On Monday, Roe, R sent an email to the Johnson City Press saying Rose's criticisms and protests were unwarranted, though he acknowledged the concerns of veterans like Rose in regard to their medications being taken away and tapered. "While I support the goals of this initiative and applaud the VA for taking steps to curb dependence on opioids, I also have been made aware of many concerns from veterans like Mr. Rose that necessary pain management may have been reduced or eliminated too quickly and will conduct oversight through my position as chairman of the House Committee on Veterans' Affairs as to whether the policy needs to be modified," Roe wrote . Roe believes the issue is more complicated than what Rose claimed. Roe said the new guidelines for restricting the opioid overuse is a measure that has been implemented to combat the national opioid epidemic. "The Veterans Health Administration has a long history with opioids that began in the 1990s when, along with the American Pain Society and other pain advocates, they declared pain as the '5th vital sign,' which resulted in widespread opioid use - and ultimately a high rate of addiction - to include among the veterans population," Roe said in his email to the Press. The congressman complained in his email that he was not afforded the opportunity to respond to Rose's criticisms . Roe was not available immediately following Rose's comments to the Press, and the Press' efforts to reach Roe and his staff on July 3 were unsuccessful. The Press again contacted Roe's office on Monday to request an interview. Lani Short, his press secretary, said the congressman would be unavailable because Roe's schedule was "especially full." Short said "everything he would say is found in the letter below," referring to Roe's email. Rose said he has suffered because of the guidelines, which were first officially implemented in 2012 after multiple Senate hearings in which experts in pain treatments, such as practitioner Dr. Alex Deluca, compared measures similar to the initiative to a "death sentence." Roe said he was disheartened to see veterans like Rose suffer but maintained the guidelines that restrict patients' access to opioids are positive measures, despite the opposition of many veterans like Rose and other doctors who have warned of the dangers of forced tapering of pain medications for people suffering from chronic pain and the disabilities that come with it. "Our country is in the midst of an opioid epidemic, and East Tennessee is among one of the regions hardest hit by opioid misuse and addiction . There's no question some of VHA's own practices - such as an initial refusal to work with state prescribing databases - have exacerbated this serious problem," Roe said in the email. "No one wants to see a veteran suffer, 48 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000908 OS 00021624 espec ially not when their pain could be connected to their service to their country , but veterans with chronic pain deserve the opportunity to live normal lives and to have their pain managed in a respons ible way . 'That's why VHA and the Department of Defense partnered to issue new guidelines , known as the 'Opioid Safety Initiative ,' for the prescribing of opioids as a tool to help providers ensure they are providing veterans and service members w ith the best care possible . 0 Roe said he was open to dialogue about the initiative that vetera ns like Rose have been campa igning against , although Rose said he was not allowed to speak to the congressman last week . Roe said he is doing everythi ng he can to help the region 's veterans . "Congress is working with the medical community , including providers at VHA , to curb the longterm prescribing of opioids to manage pain within the veteran and genera l population . In fact , the Comprehensive Addiction and Recovery Act , which I voted for and was signed into law by former President Obama , included a number of provisions to ensure veterans have access to quality care, including pain management programs ," Roe said. "CARA also included grant funding to allow the VA Secretary and the Department of Justice to expand veterans treatment courts and provide additional resources for veterans ' rehabilitation and substance use treatment programs . ''My priority is - and wilt always be - ensu ring vete rans have access to the care and services they have earned. I believe we can work together to combat the opioid epidemic, and that we can do so in a way that minimizes disruptions in patient care , but it's going to requ ire a careful and honest look at where we are and the challenges that lie ahead . I encourage any veteran in the First District to contact any of my offices if they believe I can be of assistance to them or their family . My door is always open ," Roe said in his email to the Press. Back to Top 3.1 O - Circa {Video): Veterans want pot and more accountability as the VA battles the opioid epidemic (10 July, Allison Maass , 22k online visitors/mo ; Arlington , VA) Veteran and Missouri man Joshua Lee has learned the hard way how dangerous opioids can be. Lee was deployed to Afghanlstan in 2009, and today suffers from PTSD , fibromyalgia and arthritis. For the pain, he was prescribed opioids by his physic ians through the Department of Veterans Affairs (VA). But things quickly spun out of control. By August of last year, Lee said he was taking 27 pills a day. "I didn 't think the stuff I was on was going to screw me up that badly until I made a mistake of rescheduling when they were supposed to be mailed to me , and I wound up experiencing withdrawals for the first time in my life. And I realized I'm an addict. I would have done anything to get those pills ," Lee said. 49 AMERICAr-... pVERSIGHT Veterans Affairs Media Summary and News Clips 11 July 2017 VA-19-0799-G-000909 DS 00021625 In the U.S. millions of people are addicted to opioids, and the veterans' community is no stranger to the epidemic. A recent report found the guidelines the VA had recommended to manage addiction risks when prescribing opioids had not always been followed, and though progress has been made since, some veterans think there is still a long way to go. The Office of Special Counsel released a report earlier this month that found in 2014, less than 55 percent of VA patients prescribed long-term opioids were receiving regular urine drug tests (UDT), despite VA guidelines. UDTs are an essential tool in managing addiction risks, according to Dr. William Becker, assistant professor at General Internal Medicine at Yale School of Medicine. "I wouldn't want to be prescribing opioids without use of that tool," Becker said. But the lack of testing came at a time when more veterans were becoming addicted to the pain killer. The number of veterans with opioid-use disorders rose by 55 percent between 2010 and 2015, totaling 68,000 veterans, or 13 percent of the total number of veterans prescribed opioids, according to PBS Frontline . OSC ordered an investigation into the drug tests after a whistleblower reported patients were improperly prescribed narcotics at the community-based outpatient clinic in Dover, Delaware, part of the Wilmington VA Medical Center. As part of the claims, the whistleblower alleged that a veteran who was a patient at the clinic was prescribed opioids, but was not receiving the regular UDTs recommended by the VA guidelines, and had even gone years without a UDT. The opioid crisis goes beyond just the veteran community . According to the Center for Disease Control , one in four people prescribed opioids long term will struggle with addiction. And when it comes to to the number deaths due to drug overdoses related to opioids in the U.S., that number also quadrupled from 1999 to 2015 , with 91 Americans dying every day due to opioid overdoses, the CDC said. But veterans are twice as likely to die from an accidental overdose, according to the National lnsitute of Health . "To the fact that opioids are prescribed more frequently in veteran populations and so because of increased rates of exposure , there's a higher risk for developing opioid use disorder," Becker said. But the VA has been trying to fight the epidemic for years. In 2010, the VA and the Department of Defense (DOD) had created a set of guidelines to help with the management of opioid therapy, then recommending long-term , opioid-treated patients receive UDTs before being prescribed, and have routine testing after that. An updated set of guidelines was also released in February, still including the recommendation of regular UDTs as part of addiction risk management. The VA has shown improvement since then. The agency reduced the number of veterans on long-term opioid treatment by over 187,000 from 2012 to 2016 , according to the VA, and has even improved on giving UDTs . In 2017, the number of long-term, opioid treated patients receiving a drug test within one year has jumped to 87 percent. 50 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000910 OS 00021626 Veterans prescribed opioids receiving UDTs U.S. Department of Veterans Affairs Chart from Veterans Affairs displaying the percentage of veterans on long-term opiod therapy who had received urine drug tests in the last year. In a statement a VA spokesperson told Circa, "Through education and outreach efforts, VA clinicians have a better understanding of the value UDT can have in certain patients for whom they provide care and they have begun to rely on these tests to a greater degree than they have in the past." But despite the improvements, some veterans think there is still a long way to go. In fiscal year 2016, there were 66,000 veterans still being treated for addiction to opioids. Dan Caldwell is the policy director for Concerned Veterans for America and is a veteran himself, serving in the Marine Corps for four years, and in 2009 was deployed to Iraq. He acknowledged that the VA has made some progress, but said they have a long way to go. "I think the biggest is accountability. When you don't follow the guidelines, you're terminated or your disciplined. They have guidelines in place they put in really starting a couple years ago, but if there's no teeth behind them, then nobody is going to follow them. And that's with everything within the VA," Caldwell said. And a major step towards improving accountability in the VA, according to Caldwell, was taken on June 23 when President Donald Trump signed a bill making it easier to fire VA employees. Caldwell also said turning toward privatization of veterans healthcare would also be a big improvement for the VA. And Lee is also working towards change in the VA system, and in April, he started to take action. He posted a photo on his Facebook page of him holding a clear,plastic bag, filled with over 9,800 smarties, one piece of candy for every pill he has to take in one year, to raise awareness of just how many pills veterans can be prescribed. Veteran Joshua Lee holding a bag of smarties to represent the number of pills he is prescribed by the VA every year. Joshua Lee Veteran Joshua Lee holding a bag of smarties to represent the number of pills he is prescribed by the VA every year. And after a trip to Colorado for his 15th anniversary with his wife, he said he tried recreational cannabis and it changed his life forever. "It works so much better than any medication, and it's the only reason I'm not a zombie today. You wouldn't recognize me on my pills, believe me," Lee said . Lee is now advocating for medical cannabis to be an option for veterans, and is doing so through helping to start the organization Veterans Alliance for Compassionate Access, working with experts and politicians and organizing events. 51 Veterans Affairs Media Summary and News Clips AMERICAN PVERSIGHT 11 July 2017 VA-19-0799-G-000911 OS 00021627 "I'm not advocating medical cannabis as a cure all that's going to magically fix someone of their opioid addiction. It takes a combination of actual work on the person 's behalf . There is no magic cure. But by combining medical cannabis with actual therapy , it is incredibly more efficient to get people off these addictive drugs and get there lives back in order, and get control of their own lives again ,uLee said. Back to Top 3.11 - WGCU (NPR-90.1, Audio) : VA Expands Emergency Mental Health Care To Vets With 0TH Discharges (10 July, Stephanie Colombini, 1.4k online visitors/day ; Fort Myers, FL) This week the Department of Veterans Affairs expanded emergency mental health care to vets with other-than-honorable discharges . It's part of an effort to curb the recent increase in veteran suicide. According to the VA, the rate of suicide among veterans who don't use VA care is increasing at a much higher rate than for those who do. Dr. Glenn Catalano w ith the James A . Haley Veterans Hospital in Tampa says that's why it's critic-al the agency is now offering emergency mental health care to the over 500 ,000 vets with 0TH discharges -- a group that's not normally eliglble for VA benefits. "Veteran safety is Job One ... by expanding the umbrella of care that we can to our veterans , we want to make sure that they're safe and that we can help them get through the ir trans ition to the point where they are back to being self-sufficient and taking care of themselves ," Catalano said . Vets with 0TH discharges who have a mental health emergency can visit their local VA or call the Veterans Crisis Line to get help. Under the initiative , they may receive care for up to 90 days, which can include inpatient , resident ial or outpatient care . During that time , the VA medical center treating the service member and the Veterans Benefits Administration will work to determine if the mental health condition is related to military service, in which case the veteran would be eligible for ongoing coverage . Vets may be treated using the VA's tentative eligibility authority, but they may receive a bill for the services if it's determined down the line that they are ineligible . But the VA says its providers are able to use a broad interpretation of ~related to military service .'' Veterans in distress can call the Veterans Crisis Line at 800-273-8255 or text 838255 . Back to Top 4. Women Veterans 52 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000912 DS 00021628 5. Appeals Modernization 6. Strategic Partnerships 6.1 - Managed Healthcare Executive : ICER, VA ioin to work on drug value. price negotiations (11 July, Tracey Walker , 348k online visitors/mo; North Olmstead , OH) The Institute for Clinical and Economic Review (ICER) will work with the Department of Veterans Affairs (VA) Pharmacy Benefits Management Services office (PBM) to facilitate their integration of ICER reports into VA's formulary management process of evaluating the comparative clinical effectiveness and value of drugs . ''This process evaluates the comparative clinical effectiveness and value of drugs . ICER will also work with VA staff to develop options for using 'value-based price benchmarks ' suggested in ICER reports to support negotiations with pharmaceutical companies-with the goal of maintafning excellent access to important treatments while ensuring prudent use of VA resources ," Ndidi Mojay, VA spokesperson , tells Managed Healthcare Executive. "As it has in the past, VA will continue to use ICER reports as part of its drug formulary management processes . VA's overa rching goal is to incorporate as much high-qual ity informat ion as possible , such as that found in ICER reports, into VA's drug review and decision-making processes ." ICER's drug assessment reports include a full analysis of each therapy 's comparatrve clinical effectiveness , cost-effectiveness , and potent ial budget impact. Patient input is used to inform these analyses and to identify other potential benefits and broader contextual considerations that should be considered in jud gments of overall value . ICER uses transparent methods to calculate for each new drug a value-based price benchmark anchored to the benefit the drug brings to patients . For its drug assessment reports , ICER works with the patient community and clinical experts, and invites a broader public engagement by convening public meetings at which independent committees debate the report findings with the input of all stakeholders . VA uses drug reviews from a variety of sources , therefore using ICER reports rn and of itself is not necessarily unique, according to Mojay . However, "from VA's perspective, what is unique about the collaboration arrangement is that VA and ICER staff can engage each other on issues of mutual interest ," she says. ICER itself will determine the products it will conside r for review. VA reviews all new molecular entities and prioritizes those reviews based on the needs of the Veteran population . Focus on value The goal of the ICER-VA collaborati.on isn't focused on savings , according to Mojay. "Rather, it focused on assessing value of treatment options and ensuring drugs are used appropriate ly for patients ," she says . A unique element of this particula r evaluation process is utilizing the effectiveness of drugs with a cross analysis of the long-term economics and costs, according to lnteliSys Health CEO Tom Borzilleri. 53 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000913 DS 00021629 "In the past , effectiveness was typically assumed based on clinical studies but no comprehensive data has ever been gathered across a defined group of patients using actual treatment effectiveness results and the costs associated with the ingredients prescribed ," Borzilleri says. Managed care executives don't have either the funding or large populations of patients that can be enrolled in studies that are big enough to determine the comparative "value" of new drugs , according to Tom Sullivan , MD, chief strategic officer and chief privacy office r for DrFirst , a software solutions and services provider. "Adding cost to the equation of outcomes-also known as value-can provide pharmaco economic answers that have been difficult to obtain in the past ," Sullivan says. "Kaiser and a very few others have some studies that have been previously helpful but the VA has a longer history of attempts to get these answers through large trials. Within the VA, its single vendor , uniform EHR and its successor should also make this easier and less costly to collect and mine the relevant data ." If the studies are well designed and correctly implemented , the findings should lead both taxsupported plans and the private sector to better promote more cost-effective decisions regarding preferred treatments , according to Sullivan. "Further , those finding would lead to formulary policies with appropriate guidance and exceptions. Better adherence will follow if the proper education--and in some case incentives-takes the findings into consideration ," he says . Borzilleri believes that although savings would be difficult to predict , ''one would expect that the proposed methodology should provide new insights that may produce actionable data, which will produce improved cost abatement ," he says. "W hen addressing the drug costs across the general population , it's a known fact that affordability has a direct influence and impact on drug compliance, adherence and patient outcomes . Identifying more effective or the most effective treatments will always have a positive impression on patient outcomes. But when addressing a populat ion of patients that receive a fully-paid benefit, where affordability is not part of the equation as is w ith patients with in the VA system , adherence most likely will not be able to be quantified as accurately ." Back to Top 6.2 - mHealth Intelligence : VA, Air Force Expand Tele-ICU Program for Patient Care, A tele-lCU collaboration between the VA and the Air Force aims to extend patient care for service members in critical condition. (10 July , 53k online visitors/mo ; Danvers , MA) A collaboration between the VA's Midwest Healthcare Network and the Air Force's Medical Operations Agency will open a tele-lCU program to Air Force servicemen at five military treatment centers across the country . Thro ugh this new agreement , the Air Force now can access the VA's centralized tele-lCU capabilities in Minneapolis. 54 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000914 DS 00021630 "For VA , telehealth is revolutionizing the way we practice medicine ,u said VA Secretary Dr. David J . Shulkin , who also sees patients by telehealth . ''Tele- ICU is more than just a way of provid ing remote care." "We know it improves the quality of care, decreases costs by supporting evidence-based practices and it improves patient outcomes through decreased ventilator days , ventilatorassoc iated pneumonias and reduced lengths of stay . We are pleased to partner with the Air Force in this effort ." The centralized tele -lCU center will provide specialty care to vulnerable patients at treatment centers in Las Vegas , NV, Hampton , VA, Biloxi , MS, Dayton , OH , and Anchorage , AK. Thro ugh live audio and video feeds , patie nts can consult with tele-lCU specialist s and critical care nurses , as we ll get updates on their condi tion status through telecommun ication. Special ists can use tele-lCU technology as a way to consult with fam ily members , prescribe medications , order tests , and make diagnoses . Leaders at both the VA and the Department of Defense (DoD) believe the part nership is a sign ifica nt step forward in healthcare delivery to veterans and servicemen. "Co llaborative partnerships , such as this agreement with VA, help us provide the best poss ible care to our service members , military fami ly members and retirees who receive health care through the Department of Defense ," said Dr. David Smith , Acting Assistant Secretary of Defense for Health Affairs . Recently , the VA announced another investment in tele-lCU technology . A new program will connect Eastern Ok lahoma VA Health Care System (EOVAHCS ) and the Cinc innati VA TeleICU Monitoring Cente r to deliver quality intensive care for veterans who can't immediately reach an ICU specialist. "We are very excited to partner with the Tele-ICU Monitoring Center at the Cincinnati VA Medical ," said Mark Morgan , EOVAHCS Director . "Tele-ICU exemplifies how the VA is leverag ing advanced technologies to provide the highest quality services to Vete rans." Back to Top 7. Supply Chain Modernization 8. Other 55 Veterans Affairs Media Summary and News Clips AMERICAr-... pVERSIGHT 11 July 2017 VA-19-0799-G-000915 DS 00021631 Message From: (b) (6) Sent: 6/15/2017 9:50:26 PM To: David Shulkin [drshulkin@aol.com] Making sure you had call in number for isaakson Subject: Attachments: AMERICAN (b) (6) @gmail.com] 20170615_175353.jpg PVERSIGHT VA-19-0799-G-000917 OS 00021633 (b) (6) From: (b) (6) Sent: To: Cc: Subject: (b) (6) (b) (6) I : EXTERNAL] Phone call w/ S Jackie, The call with Chairman Isakson · The Secretary is to ca/I (b) (6) The conference code is r 5:30PM. (b) (6) -----Original Mes From: (b) (6) Sent To: (b) (6) Sub e 15, 2017 12:01 PM (CLS-House) EXTERNAL] Phone ca// WI Senator Isakson OK. 8 ,t he does have an interview at ?pm_ 1 (b) (6) (b) (6) (CLS-House) 15, 2017 12:00 PM AL] Phone Ca//WI SenatoVA-19-0799-G-000918 r. la - Message Bruce Moskow Ttz [bruce (b) (6) (b) @mac.com] Sent : 6/19/201710:50:35 AM (6) To : drshulkin@aol.com; Poonam Alaigh I(b) (6) l]lhotmail.com] Subject: Fwd: VA Private Sector Employees Memo Attachments : VA Private Sector Employees .docx; Untitled attachment 95663.htrn From: This is from the general counsel that Marc knows at American University. We have a call at noon with their team who are willing to donate their time to assist HR. Perhaps your new hire would like to be on the call. I assume Poonam is on the call Sent from my iPad Bruce Moskowitz M.D. Begin forwarded message: From:~(b) (6) Date: June 18 1 2017 at 4:02:01 PM EDT To: " bruce (b) (6) (b) mac.com " (6)(6) (b) (b) (6) mac.corn> Subject: VA Private Sector Employees Memo Dr. Moskowitz: Attached is a brief memo related to private sector employees working to assist the VA. I will send you an additional memo later this evening. I look forward to our conference call on Monday. Thank you, (b) (6) 1111 Sent from Mail for Windows 10 AMERICAN PVERSIGHT VA-19-0799-G-000919 DS 00021635 Privileged and Confidential Attorney Client Work Product TO: Dr. Bruce Moskowitz From: (b) (6) Vice President and General Counsel American University Date: June 18, 2017 Potential Approaches for Involv ing the Private Sector in Management of, and Actions Relating to, Personnel at the Department of Veterans Affa irs (VA) A. New Author ity Under S. 1094 -The VA Accountabil ity and Whistleblower Protection Act of 2017 (b) (5) B. The VA has several opt ions for staffing the new Office : (b) (5) (b) (5) AMERICAN PVERSIGHT VA-19-0799-G-000920 OS 00021636 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 6/14/2017 1:01:01 AM @aol.com (b) (6) Re: Call with Apple No- as PoonAmsays- ill be multitas king Sent from my iPhone (b) (6) > on Jun 13, 2017, at 8:30 PM, -@aol . com wrote: > I was originall y told that you > David-tomorrow is the call with CEOand is a 90 minute discussion . Do you need would not be on the call but you are now on the 7i st of peop 7e on the ca 17 (as is Poonam) . Let me know if I can help . Thanks . in advance of the call to bring you up to speed ? (b) > (6) > sent from my iPhone lllllllllnfo AMERICAN PVERSIGHT VA-19-0799-G-000924 OS 00021640 Message From: Sent: To: CC: Subject: (b) (6) (b) (6) -@aol .co~@aol.corn] 6/14/2017 12:30:22 AM DJS[drshulkin@aol.com] (b) (6) Poonam Alaigh MD,MSHCPM,FACP [-@hotmail.com] Call with Apple I was originally told that you David- tomorrow is the call with CEO and is a 90 minute discussion. would not be on the call but you are now on the list of people on the call (as is Poonam). Do you need liililnfo in advance of the call to bring you up to speed? Let me know if I can help. Thanks. (b) (6) sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000925 OS 00021641 Message From: To : David shulkin LDrshulkin@aol.com] 6/17/201712:47:43 AM Poonam Alaigh I(b) (6) @hotmail .com J Subject: Fwd: RE: Sent : May be good Sent from my iPhone Begin forwarded message: From: (b) (6) mail.com > Date: June 16, 2017 at 6:55:18 PM EDT To: David shulkin Subject: RE: Secretary Shulkin ....lt's very nice to hear from you. I had lunch with David today and told him I would be happy to assist you in anyway I can. I had no specific area or location in mind when we talked, but I would be willing to help out in any number of ways....from providing Interim leadership assignments at hospitals to helping develop strategies and programs for the VA nationally. I served at 8 VA Medical Centers, beginning as a GS-9 trainee and ending in an SESposition in Ann Arbor(including Acting Director there for almost a year) before I jumped to the University of Michigan in 1991. By the way, I'm a Disabled Vietnam vet so I have a soft spot in my heart for our veterans. I'll be in the DC area at the end of the month as my son-in-law is getting promoted to full colonel and is being transferred to Arlington, VA. One last thing, I'm glad the VA and the military are finally getting together on an EM.R....it will be a significant step forward. Please let me know how I can help. I wish you the very best, -(b) (6) Sent from Mail for Windows 10 From: David shulkin Sent: Friday, June 16, 2017 5:40 PM To: (b) (6) mail.com Subject: (b) (6) sent me your cv- What are you looking to do? Are-you [coking for specific locations-? Thanjs David Shulkin Sent from my /Phone AMERICAN PVERSIGHT VA-19-0799-G-000926 DS 00021642 Message Davidshulkin [Drshulkin@aol.com] 6/27/2017 4:46:19 PM (b) (6) (b) @mac . co m ] Bruce Moskowit z [brucerrl■■■■ Re: CFO For VA (6) From: Sent: To: Subject: Id rather go with yours Sent from my iPhone > on Jun 27, 2017, at 12:39 PM, Bruce Moskowitz wrote: (b) (6) (b) > (6) > I Have 3 that that years of experience at major medical centers , however if the Whitehouse has a list of approved CFO's then the only question is , if it is better to have someone who is already part of a major hospital system. Let me know. > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000927 OS 00021643 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com] 6/27/2017 4:39:48 PM Sent: (6) mb~n@gmail.com; IP ll@frenchange To: l59.com]; drshulkin@aol.com (b) ( Subject: CFO(6) For VA b ) ( 6 I Have 3 that that years of experience at major medical centers, however if the Whitehouse has a list of approved CFO's then the only question) is, if it is better to have someone who is already part of a major hospital system. Let me know. From: Sent from my iPad Bruce Moskowitz M. D. AMERICAN PVERSIGHT VA-19-0799-G-000928 OS 00021644 Message From: Sent: To: Subject: cant wait till David shu lkin [Drshulkin@ao l.com] 8/30/2017 2:55: 11 AM Poonam Alaigh I(b) (6) @hot mail.com] Re: Town Hall he goes Sent from my iPhone > on Aug 29, 2017, at 10:24 PM, Poonam Alaigh <-@hotmail.com> (b) (6) wrote: > > we had one here and omg- Scott can really really tal k- the Vets would as k one question and he always had to have a final word that lasted for 10- lSmin ea ch time at a minimum. The guy simply loves to hear himself!! > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000929 OS 00021645 Message From: Sent: To: Subject: Poonam Alaigh I(b) (6) @hotmail.com] 8/30/2017 2:24:29 AM David Shulkin [drshulkin@aol.com] Town Hall We had one here and omg- Scott can really really talk- the Vets would ask one question and he always had to have a final word that lasted for 10-lSmin each time at a minimum. The guy simply loves to hear himself!! Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000930 OS 00021646 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 6/13/2017 4:03:54 PM To: (b) (6) Poonam Alaigh [-@hotmail.com] (b) (6) (b) Bruce Moskowitz [bruce~@mac.com] (6) Re: Draft agenda for tomorrow CC: Subject: Ok Sent from my iPhone (b) (6) > on Jun 13, 2017, at 12:01 PM, Poonam Alaigh <-@hotmail.com> wrote: > > we will together? call you this afternoon- David , maybe after the vso call if we finish early since we will be > > sent from my iPhone > >> on Jun >> >> I need talk first review the (b) (6) (b) 13, 2017, at 8:47 AM, Bruce Moskowitz wrote: (6) to talk with you for 5 minutes about the Daren problem and call tomorrow. David you need to not Daren he needs to be silent you need to give the path forward for portable EMR. Please agenda. >> >> >> >> >> sent from my iPad >> Bruce Moskowitz M.D. >> AMERICAN PVERSIGHT VA-19-0799-G-000931 OS 00021647 Message From: Poonam AlaighI(b) (6) @hotmail.com] Sent : 6/ 13/2017 4:01:44 PM (b) (6) (b) @mac . com] Bruce Moskowitz [brucerrl■■■■ To : CC: Subject: We will call together? Davidshulkin [drshulkin@aol.com](6) Re: Draft agenda for tomorrow you this afternoon- David, maybe after the vs o call if we finish early since we will be Sent from my iPhone (b) (6) > on Jun 13 , 2017, at 8: 47 AM, Bruce Moskowitz wrote : (6) > I need to talk with you for 5 minutes about the Daren problem and call tomorrow. David you need to talk first not Daren he needs to be silent you need to gi ve the path forward for portable EMR. Please re view the agenda . > > > > > > sent from my iPad > Bruce Moskowitz M.D. > AMERICAN PVERSIGHT VA-19-0799-G-000932 OS 00021648 Message From: David shulkin lDfshulkin@aol.com] Sent : 6/13/2017 2:16 :48 PM To : Darin Selnick (b) (6) @gmail.com] Subject: Fwd: Draft agenda for tomorrow Attachments : confcallagenda .docx; Untitled attachment 95780.htm Seot from my iPhone Begin forwarded message : From: Bruce Moskowitz Date: June 13, 2017 at 8:43 :43 A.Iv!EDT (6) To: David shuHcin Poonarn AJaigh - (b) (6) Subject: Draft agenda for tomorrow AMERICAN PVERSIGHT VA-19-0799-G-000933 DS_00021649 I VA, Apple & Medical/Digital Conference Call Experts I June 14, 2017 Date : Wedne sday Time : 11 Dial-in Information: ! United State _s:_1_._86_ 6_ ._2_4_ 4 _(b)_ __________________ a.m.-12:30 p.m. ET/10- ll:30 a.m. CT/8- 9:30 a.m. PT _ _ (6) International : 719.45 ~(b) (6) Posscode:(b) (6) Participant s : ·Conwnented [CWG1.1:Eic plorinBoptions for a more "tnod.11rar~d" type conforenc• cafl capa ~jlit,/. Bruce Moskow itz, M .D. Marc Sherman Ike Perlmutter Apple : -(b) (6) (b) (6) (b) (6) (b) (6) -Apple, Chief Executive Officer - Apple, Chief Operating Officer -Apple , Director · o1 Global Gavemment -Apple, Vice Prestc1ent for l'ub licP oll cy and Gover nment Affarr s Officeof VeteransAffairs: David Shulk1n, M. D. -Secretary ofVete.ra,1s Affair s Poonam Alaigh , M .D. - Acting Under-Secretary for Health Darin Selnick - Senior Advisor to the Secretary Rob C. Thoma s II -Acting Assistant Secretary & Chief Information Officer Department of Veterans Affairs Senfor Advisor, Actfng Under -Secretary for Health, Department of (b) (6) Veterans A f fairs , Veterans Health Administration Medical lnstltlltions : Christopher Ross - Chief Information Officer , Mayo Clinic M. D. - Associate Dean/Center for Connected Care, Mayo Clinic - Interim Chief Information Officer, Cleveland Clfnfc M .D. -Associate Chief lnformatlon Officer, Cleveland Clinic Stephanie L Reel - Senior Vice President and Cl0, Johns Hopkins Health System , Johns Hopklns Med icine , Vice Provost and CIO, Johns Hopk i ns Univers ity (b) (6) -Senior Vice President , Care Delivery Technology Services, Kaiser Permanente -(b) (6) - Cofounder , CEO- Responsive Health M.D . - co , founder, Responsive Health/ Mount Sinai Health System (b) (6) - Payer Advisor, Responsive Health (b) (6) - Development Head, Responsive Health (b) (6) - SME for Public Sector , Responsive Health (b) (6) Aaron Moskowitz - Biome dfcal Research & Education Foundation, Executive Director M.D. -Vice President , Connected Health I Partners HealthCar e (b) (6) M .D. - Chfef lnformatfon Officer and Vice President, Information (b) (6) Systems, Brigham Health (b) (6) (b) (6) (b) (6) Moderator: (b) (6) AMERICAN PVERSIGHT Chair, Department of Public Affairs/Mayo Clihic VA-19-0799-G-000934 DS 0002 1650 Agenda: 1) I ntrod LJctions (b) (6) , Moderator 2) Review/Discussion of Purpose of Cail -All Draft Meeting Objectives ~ • Consensus/endorsement of goals • Define roadmap and next steps • Determine core working team moviog forward/ARCIV 3) Project Objectives/Status I Veteran's Administration Perspective - David Shulkin, M.D . 4) Perspective of the Medical Experts-What Works/What Doesn't- Medicaj Experts • Status of portable medical record for the private sector • Wt,at will it take to get to "state of the art?" -;; Preventive health/early detection of disease 0 How does the med1cal record pick up t hat which may threaten health • What are medical centers working on that has been well received by patients? 5) Discuss-ionof Digital/Veteran Platform Project Road Map - Stephani e Reel ~ OlgitalVeteran PlatformExperfence., Theatlachment !hat reflectsshoredperspectiveof medical providers/Appleteam. 5) ReView/Discuss.ionof Potential Project Requrrements - All • • • • • • • Clinical needs re: obtaining inform ation from the patient's EMR Quick reference screen • Patient problem list • Medications • Allergies • laboratory results • Diagnostic tests by specialty • Clinfcal notes by specialty Dynamic vs. static EMR Early dlsease detection Chart medic;;1tionadherence Laboratory result s depicted by in graph form to permit lifestyle modification conversations Alerts for follow-up appointments/tests Integration of clinical notes, lab and diagnostic text into integrated platform 7) Next steps Discussion: • Defining the core working team -ARC IV • TTmeline AMERICAr-... pVERSIGHT VA-19-0799-G-000935 DS 0002 165 1 Digital Veteran Platform: Veteran-Mediated Data Exchange Background (b) (4) Confidential - Internal Only AMER11...,AI\J PVERSIGHT VA-19-0799-G-000936 OS 00021652 (b) (4) Proposal (b) (4) confidential - Internal Only AMER11...,AI\J T PVERSIGH VA-19-0799-G-000937 DS_ 00021653 (b) (4) Guiding Principles (b) (4) Next Steps (b) (4) Confidential - Internal Only AMER!<.. Al'-.. pVERSIGHT VA-19-0799-G-000938 DS_ 00021654 (b) (4) confidential - Internal Only AMER11...,AI\J PVERSIGH T VA-19-0799-G-000939 DS_ 00021655 Sent from my iPad Bmce Moskowitz MD. Message From: Bruce Moskowitz [brucem (b) (6) (b) @mac .com] Sent: 6/13/2017 12:43:43 PM To: David shu lkin [drshul kin@aol .com]; Poonam Alaigh [-@hotmail.com] (b) (6) Draft agenda for tomorrow confcallagenda.docx; Untitled attachment 95786.txt Subject: Attachments: I need to talk with you for 5 minutes first not Daren he needs to be silent the agenda. AMERICAN PVERSIGHT (6) about the Daren problem and call tomorrow. David you need to talk you need to give the path forward for portable EMR. Please review VA-19-0799-G-000941 OS 00021657 I VA, Apple & Medical/Digital Conference Call Experts I June 14, 2017 Date : Wedne sday Time : 11 Dial-in Information: ! United State _s:_1_._86 _ 6_ ._2_4-'4(b) _ _ __________________ a.m.-12:30 p.m. ET/10- ll:30 a.m. CT/8- 9:30 a.m. PT _ _ (6) Internat ional: 719.457 -(b) (6) Posscode:(b) (6) Participant s : ·Conwnented [CWG1.1:Eic plorinBoptions for a more "tnod.11rar~d" type conforenc• cafl capa ~jlit,/. Bruce Moskow itz1 M .D. Marc Sherman Ike Perlmutter Apple : -(b) (6) (b) (6) (b) (6) (b) (6) -Apple, Chief Executive Officer - Apple, Chief Operating Officer -Apple, Director o1 Global Govemment -Apple, Vice Presfdent for l'Ub lic.Polley and Government Affairs Office of Veterans Affairs : David Shulkln, M. D. - Sec,etary of Vetera,, s Affairs Poonam Alaigh , M.D. - Acting Under-Secretary for Health Darin Selnick - Senior Advisor to the Secretary Rob C. Thoma s 11-Actlng Assistant Secretary & Chief Information Officer Department of Vetera ns Affair s Senfor Advisor, Actrng Under-Secretary for Health, Department of (b) (6) Veterans Affairs , Veterans Health Administration Medical lnsUtlltions : Christopher Ross- Chief Information Offi cer, Mayo Clinic M.D. -Associate Dean/Center for Connected Care, Mayo Clinlc - Interim Chief Information Offfcer , Cleveland Clfnfc M .D. -As sociate Chief lnformatlon Officer, Cleveland Clinic Stephan1e L Reel - Senior Vlce President and CIO,Johns Hopkins Health System, Johns Hopkins Med icine , Vice Provost and CIO, Johns Hopkins Univers ity (b) (6) - Senior Vice President, Care Delivery Technology Services, Kaiser Permanente (b) (6) (b) (6) (b) (6) -(b) (6) (b) (6) (b) (6) (b) (6) (b) (6) Cofounder, CEO- Responsive Health M.D. - Co, founder , Responslve Health/ Mount Sinai Health System II - Payer Advisor, Responsive Health - Development Head, Responsive Health - SME for Public Sector, Responsive Health Aaron Moskowitz - Biomedfcal Research & Education Foundation, Executive Director M.D. -Vice President, Connected Health I Partners HealthCare (b) (6) M.D. - Chfef lnformatfon Officer and Vice President, Information (b) (6) Systems, Brigham Health Moderator: (b) (6) AMERICAN PVERSIGHT Chair, Department of Public Affairs/Mayo Clihic VA-19-0799-G-000942 DS 0002 1658 Agenda: 1) I ntrod LJctions (b) (6) , Moderator 2) Review/Discussion of Purpose of Cail -All Draft Meeting Objectives ~ • Consensus/endorsement of goals • Define roadmap and next steps • Determine core working team moviog forward/ARCIV 3) Project Objectives/Status I Veteran's Administration Perspective - David Shulkin, M.D . 4) Perspective of the Medical Experts-What Works/What Doesn't- Medicaj Experts • Status of portable medical record for the private sector • Wt,at will it take to get to "state of the art?" -;; Preventive health/early detection of disease 0 How does the med1cal record pick up t hat which may threaten health • What are medical centers working on that has been well received by patients? 5) Discuss-ionof Digital/Veteran Platform Project Road Map - Stephani e Reel ~ OlgitalVeteran PlatformExperfence., Theatlachment !hat reflectsshoredperspectiveof medical providers/Appleteam. 5) ReView/Discuss.ionof Potential Project Requrrements - All • • • • • • • Clinical needs re: obtaining inform ation from the patient's EMR Quick reference screen • Patient problem list • Medications • Allergies • laboratory results • Diagnostic tests by specialty • Clinfcal notes by specialty Dynamic vs. static EMR Early dlsease detection Chart medic;;1tionadherence Laboratory result s depicted by in graph form to permit lifestyle modification conversations Alerts for follow-up appointments/tests Integration of clinical notes, lab and diagnostic text into integrated platform 7) Next steps Discussion: • Defining the core working team -ARC IV • TTmeline AMERICAr-... pVERSIGHT VA-19-0799-G-000943 DS 00021659 Digital Veteran Platform: Veteran-Mediated Data Exchange Background (b) (4) Confidential - Internal Only AMER11...,AI\J PVERSIGHT VA-19-0799-G-000944 OS 00021660 (b) (4) Proposal (b) (4) confidential - Internal Only AMER11...,AI\J T PVERSIGH VA-19-0799-G-000945 DS_00021661 (b) (4) Guiding Principles (b) (4) Next Steps (b) (4) Confidential - Internal Only AMER!<.. Al'-.. pVERSIGHT VA-19-0799-G-000946 DS_ 00021662 (b) (4) confidential - Internal Only AMER11...,AI\J PVERSIGH T VA-19-0799-G-000947 DS_ 00021663 Sent Bruce from my iPad Moskowi tz AMl H CAt\ pVERSIGHT M.D. VA-19-0799-G-000948 DS_ 00021664 Message From: Sent: To: Subject: Attachments: Poonam Alaigh I(b) (6) @hotmail.com] 8/5/2017 6:22:44 PM David Shulkin [drshulkin@aol.com] Pie IMG_2475.JPG.jpeg; A TT0000l.txt You look so chummywith Jen- lol AMERICAN PVERSIGHT VA-19-0799-G-000949 OS 00021665 Sent from my iPhone Message Bruce Moskowitz [bruce~@gmail.com] (b) (6) (b) (6) Sent : 6/ 19/2017 11:52 :03 AM To : Davidshulkin [Drshulkin@aol.com] CC: Ike Perlmutt er [ll@frenchangel59.com]; Marc Sherman [mb-@gma il.com]; Poonam Alaigh ( (b) (6) b (b) (6) [~ho tmail.com] Subject : Re: Phil Roe ) ( 6 ) Let me know and I will get a committee together . They will do it for free however if there was the ability to receive a percentage of actual savings as a consulting group that would be best to get a commitment of time and longevity to the process. Let me know and I will proceed. From: sent from my iPad Bruce Moskowitz M. D. > on Jun 19 , 2017 , at 7: 43 AM, David shulkin wrote: > > This is clearly a priority for us > > I prefer not to go through congress for this - as it gets politicized should do this directly with the amcs and is always twisted - thibk we > > s ent from my iPhone > >> on Jun 19 , 2017 , at 5 : 57 AM, Bruce Moskowitz wrote : >> (6) >> In view of his remarks on the budget , it seems beneficial to tap the 5 academic centers to put together a group that studies how to reduce costs . I am aware that each of our partners has an active group that continually monitors cost savings in health care delivery . >> >> Rep. Phil Roe, R-Tenn. , chairman of the House committee on Veterans ' Affairs , warned against wasteful spending and said the VA budget needs a "hard look . " Throwing money at a problem rarely makes it go away and , when it does , the solution is often temporary ," Roe said . "It is time for the VA to take a hard look at how resources are allocated and make some tough calls about how to best serve our veterans and their families in a budget environment that is not infinite ." >> >> sent from my iPad >> Bruce Moskowitz M.D. > AMERICAN PVERSIGHT VA-19-0799-G-000952 OS 00021668 Message Davidshulkin [Drshulkin@aol.com] Sent: 6/19/2017 11:43:51 AM To: Bruce Moskowitz [brucem-@gmail.com] (b) (6) (b) (6) Marc Sherman [m~@gmail.com]; CC: Ike Perlmutter [ll@frenchangel59.com]; ( (b) (6) b (b) (6) [~hotmail.com] Subject: Re: Phil Roe ) ( 6 ) This is clearly a priority for us From: I prefer not to go through congress for thisshould do this directly with the amcs as it gets politicized Poonam Alaigh and is always twisted- thibk we sent from my iPhone (b) (6) (b) > on Jun 19, 2017, at 5:57 AM, Bruce Moskowitz wrote: > (6) > In view of his remarks on the budget, it seems beneficial to tap the 5 academic centers to put together a group that studies how to reduce costs. I am aware that each of our partners has an active group that continually monitors cost savings in health care delivery. > > Rep. Phil Roe, R-Tenn., chairman of the House committee on Veterans' Affairs, warned against spending and said the VA budget needs a "hard look." Throwing money at a problem rarely makes and, when it does, the solution is often temporary," Roe said. "It is time for the VA to take at how resources are allocated and make some tough calls about how to best serve our veterans families in a budget environment that is not infinite." wasteful it go away a hard look and their > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000953 OS 00021669 Message Bruce Moskowitz [bruce~@gmail.com] (b) (6) (b) (6) Sent: 6/19/2017 10:57:41 AM To: Davidshulkin [drshulkin@aol.com]; Poonam Alaigh [-@hotmail.com] (b) (6) CC: mb-@gmail.com; IP [l@frenchangel59.com] (b) (6) ( b Subject: Phil Roe ) ( 6 In view of his remarks on the budget,) it seems beneficial to tap the 5 academic centers to put together group that studies how to reduce costs. I am aware that each of our partners has an active group that continually monitors cost savings in health care delivery. From: Rep. Phil Roe, R-Tenn., chairman of the spending and said the VA budget needs a and, when it does , the solution is often at how resources are allocated and make families in a budget environment that is a House committee on Veterans' Affairs, warned against wasteful "hard look." Throwing money at a problem rarely makes it go away temporary," Roe said. "I t is time for the VA to take a hard look some tough calls about how to best serve our veterans and their not infinite ." sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000954 OS 00021670 Message From: Sent: To: Subject: Poonam Alaigh I(b) (6) @hotmail.com] 7/23/2017 12:21:20 AM Drshulkin@aol.com Don't understand gig and everything The 1111111111111 (b) (6) my w~ for me he and his team is getting involved with- but you deal with it, I have Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000955 OS 00021671 Message From: (b) (6) Poonam Alaigh[-@hotmail.com] Sent: 6/15/2017 12:44:37 AM To: (b) (6) (b) Bruce Moskowitz [bruce~@mac (6) drshulkin@aol.com Re: Ike CC: Subject: .com] Yes, agree- thanks Sent from my iPad (b) (6) (b) > on Jun 14, 2017 , at 12 :14 PM, Bruce Moskowitz wrote: (6) > I ke and I agree on the governing body we need Apple and the 5 CEO's . I know from who has been active from the academic centers who will put their heart and soul into the actual work product > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000956 OS 00021672 Message From: (b) (6) Sent: 6/30/2017 10:12:48 AM To : (b) (6) Subject: (b) (6) @me.corn] @yahoo.com; Byrne Family (b) (6) Virtual Introduction @verizon.net] Tom meet Jim meet Tom .. Tom Bowman is nominee to be Dr. Shulkin's Deputy at the VA Jim is nom inee to be the General Counsel for the VA Hi's session with the subcommittee is apparently scheduled for July 19. I thought it might be good for you two terrific. individuals to be introduced to each other at this stage . (b) (6) (b) (6) ( b ) ( I look forward to time 6 with each of you in the future . ) Thank you. - (b) (6) (b) (6) (b) (6) IF, (b) (6) (b) (6) Chair, Vistage CEO Board NYC Metro (CEO peer advisory board) President: The Point Group Network (private CEO coach network) Member: Business E ecutives for National Security Former Host: Master Class (CEO ihterview with student Q&A series at Pace University) Forme1· Board Member: Harvard Community Partners (pro bono alumni service for not for profit leaders in CT) Random Rouse Author: what made jack welch JACK WELCH, How Ordinary People Become Extraordinary Leader (Random House 2007) AMERICAN PVERSIGHT VA-19-0799-G-000957 DS 00021673 Message From: David shulkin [Drshulkin@aol.com] Sent : 6/29/2017 1:13 :48 AM To : Ike Perlmutter.@frenchangel59.com] ( b ) ( This is interesting to read about the guy in the white house personnel office 6 ) http://www .politico.com/story/2017/06/28/tillerson-blows-up-at-white-house-aide-240075 Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000958 DS_00021674 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 6/26/2017 10:54: 11 AM Poonam Alaigh I(b) (6) @hotmail.com] Re:Today Ok Sent from my iPhone > on Jun 26, 2017, at 5:39 AM, Poonam Alaigh <-@hotmail.com> (b) (6) > wrote: > Are we still on for dinner today- is so , can we meet st Rasoi Indian restaurant meet as early as 6pm if it works for you - 1810 K- I can also > > > Monday's are long days starting at 3am for me and want to see if we can just meet right after work so that I can call it a night soon - let ' s also have our folks drive us - we have business to conduct so should be fine > > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000959 OS 00021675 Message From: Sent: To: Subject: Poonam Alaigh I(b) (6) @hotmail.com] 6/26/2017 9:39:50 AM David Shulkin [drshulkin@aol.com] Today Are we still on for dinner today- is so, can we meet st Rasoi Indian as early as 6pm if it works for you restaurant -1810 K- I can also meet Monday's are long days starting at 3am for me and want to see if we can just meet right after work so that I can call it a night soon- let's also have our folks drive us - we have business to conduct so should be fine sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000960 OS 00021676 Message David Shulkin [secshulkin@gmail.com] 8/26/2017 2:53:32 AM Bruce Moskowitz [brucem (b) (6) (b) @mac.com] Ike Perlmutter ■ (6) Marc Sherman [mb (b) (6) @gmail.com]; Poonam Alaigh ( @frenchangel59.com]; b (b) (6) @gmail.com] ) med centers Re: Areas for five From: Sent : To : CC: Subject: ( 6 ) Ok will do Sent from my iPhone On Aug 23, 2017 at 11:46 AM Bruce Moskowitz wrote: Quite appropriate . I think it would be best if you directly asked the CEO's to be involved and get their direct input on the specifics. Sent from my iPad Bruce Nloskowitz M .D . On Aug 23, 2017, at 10:42 AM, David Shulkin wrote : Ike- here are the proposed areas for the five centers Subject: Areas for five med centers 1. Procurement/logistics 2. Human Resources 3. Finance 4. 1T 5. Public Relations 6. Cost Utilization choice 7. Construction/Facility management 8. Academic Relationships and GME 9. Research Portfolio 10. Quality in Choice Network I 1. Cost Savings AMERICAN PVERSIGHT VA-19-0799-G-000961 DS 00021677 Sent frem my iPhone Message Frotn: Bruce MoskowTtz [bruce .(b) (6) (b) @mac .com] Sent: To : 8/23/2017 3:46:53 PM (6) David Shu Ikin [secshulkin@gmail.com] Ike Perlmutter (l@frenchangel59.com]; Marc Sherman [mb (b) (6) @gmail.com]; Poonam Alaigh ( I b (b) (6) @gry,ail.com CC: ) med centers Re: Areas for five ( 6 Quite appropriate . I think it) wouJd be best if you directly asked the CEO 1s to be involved and get their direc t Subject'. input on the specifics . Sent from my iPad Bruce Moskowitz M .D. Ot1 Aug 23, 2017, at 10:42 AM , David Shulkin wrote : Ike- here are the proposed areas for the five centers Subject: Areas for five med centers 1. Procurement/logistics 2. Human Resources 3 . Finance 4. IT 5. Public Relations 6. Cost Utilization choice 7. Construction/Facility management 8. Academic Relationships and GME 9. Research Portfolio 10. Quality in Choice Network 1 l . Cost Savings Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000963 DS 00021679 Message From: Sent: To: CC: Subject: David Shulkin [secshulkin@gmail.com] 8/23/2017 2:42:57 PM Ike Perlmutter [ll@frenchangel59.com] ( Marc Sherman [mb b (b) (6) @gmail.com]; Bruce Moskowitz [brucem (b) (6) (b) @mac.com]; Poonam Alaigh ) .com] (6) (b) (6) @gmail ( med centers Fwd: Areas for five 6 ) Ike- here are the proposed areas for the five centers Subject: Areas for five med centers 1. Procurement/logistics 2. Human Resources 3. Finance 4. IT 5. Public Relations 6. Cost Utilization choice 7. Construction/Facility management 8. Academic Relationships and GME 9. Research Portfolio 10. Quality in Choice Network 11. Cost Savings Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000964 OS 00021680 Message Bruce Moskow itz [bruce (b) (6) (b) @mac .com] 8/21/2017 11 :58 :36 PM (6) David Shu Ikin [secshulkin@gmail.com] Marc Sherman [mb (b) (6) @gmail.com] Ike Perlmutter (l@frenchangel59.com]; ( Re: Areas for five b med centers From: Sent : To : CC: Subject: ) ( 6 Well done I would add quality of care review for both VA and Choice. ) Second I would use the academic centers to determine cost savings and income strategies Third I would recommend the VA work with the 5 cellters to det ennine which research projects merit funding . Sent from my iPhone On Aug 21 2017 , at 7:32 PM , David Shulkin wrote .: Bruce- this is what my initial list looks like. but you may have other ideas or suggestions David Subject: Areas for five med centers 1. Procurement/logistics 2. Human Resources 3. Finance 4. IT 5. Public Relations 6. Cost Utilization choice 7. Construction/Facility management 8. Academic Relationships and GTvIE 9. Research - Genomics Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000965 DS 00021681 Message From: David Shulkin [secshulkin@gmail.com] Sent: 8/21/2017 11:32:11 PM To: Bruce Moskowitz [brucerrl■■■ (b) (6) (b) @mac . com] Ike Perlmutter ll@frenchangel59.com]; (6) Marc Sherman [mb (b) (6) @gmail.com] ( Fwd: Areas for five b med centers CC: Subject: ) ( 6 list looks like but you may have other ideas or suggestions Bruce- this is what my initial ) David Subject: Areas for five med centers 1. Procurement/logistics 2. Human Resources 3. Finance 4. IT 5. Public Relations 6. Cost Utilization choice 7. Construction/Facility management 8. Academic Relationships and GME 9. Research - Genomics Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000966 OS 00021682 Message From: (b) (6) Sent: 8/14/2017 9:31:51 PM To: David Shulkin [drshulkin@aol.com] MT, Reno, NY Subject: (b) (6) @gmail.com] Sunday, Dinner with Tester and staff Will invite medical center and visn director Monday, Two events with Senator in addition to medical center tour etc. Tuesday, Reno VAMC Wed, American Legion Thursday, in DC Friday, leave DC around l to get to reception and dinner in Hamptons at 630 AMERICAN PVERSIGHT VA-19-0799-G-000967 OS 00021683 Message Marc Sherman [mb (b) (6) @.gmail.com] 6/17/2017 8:43 :53 PM David shulkin [Drshulkin@aol.comJ Re: Dinner june 27 - 7 pm From: Sent : To : Subject: As long as helping #2 is chocolate . Marc Shennan (b) (6) On Jun 17, 2017 2:44 PM , "David shulkin" wrote : If they get two responses youJl need to eat twice as much Sent from my iPhone On Jun 17, 2017 ) at 2:43 P1-f, Marc Sherman <- (b) (6) wrote: I will do it when i get home. It sounds like there Is a problem with their system if they didn't get multiple responses as that is the address i sent my original RSVP to. Marc Sherman (b) (6) On Jun 17, 2017 2 :28 PM, "David shulkin" wrote : For the dinner on the 27 th for some reason the embassy has not heard from you - it may just be an error but just in case for security purposes would you be able to confirm your attendance- would you please confirm your rsvp at : events@egyptembassy.net Thanks David Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000968 DS_00021684 Message From: thomas bowman (b) (6) @yahoo.com] Sent : 6/17/2017 7:35 :31 PM To : Drshulkin@aol.com; David Shulkin ldrshulkin@aol.comJ Subject: Re: Dinner june 27 - 7 pm Will do .....is this single to me or does it also include a guest with me ..... Sent from Yahoo Maj! on Android On Sat, Jun 17, 2017 at 2:28 PM, David shulkin wrote : For the dinner on the 27th for some reason the embassy has not heard from you - it may just be an error but just in case for security purposes would you be able to confirm your attendance- would you please confim, your rsvp at : events@egyptem bassy .net Thanks David Sent from my iPhone A\llERICAN PVERSIGHT VA-19-0799-G-000969 DS_00021685 Message From: David shulkin [Drshulkin@aol.com] Sent : 6/17/2017 6:44:27 PM To : Marc Sherman [mbtl■l@gmail.com] (b) (6) Re: Dinner june 27 - 7 pm Subject: If they get two responses yo ull need to eat twice as much Sent from my iPhone On Jun l 7, 2017, at 2:43 PM, Marc Shennan <- (b) (6) wrote: I wiU do it when i get home. It sounds like there Is a problem with their system if they didn't get multiple responses as that is the address i sent my original RSVP to . Marc Sherman (b) (6) On Jun 17, 2017 2:28 PM , 11David shulkin" wrote : For the dinner on the 27th for some reaso n the embassy has not heard from you - it may just be an error but just in case for security purposes would you be able to confinn your attendance- would you please confirm your rsvp at : events@egyptembassy .net Thanks Dav id Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000970 DS_00021686 Message From: Marc Sherman [mb (b) (6) @.gmail.com) Sent : 6/17/2017 6 :43 :04 PM To : David shulkin [Drshulkin@aol.com] Re: Dinner june 27 - 7 pm Subject: l will do it when i get home . lt sounds like there Is a problem with their system if they didn't get multiple responses as that is the address i sent my original RSVP to. Marc Sherman (b) (6) On Jun 17 2017 2:28 PM, "David shulkin" wrote: For the dinner on the 27th for some reason the embassy has not heard from you - it may just be an error but just in case for security purposes would you be able to confirm your attendance- would you please confirm your rsvp at : events@egyptem bassy .n et Thanks David Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000971 DS 00021687 Message Poonam Alaigh I(b) (6) @hotmail.com] 7/29/2017 10:10:51 PM David shulkin [Drshulkin@aol.comJ Re: My back pain is now news From: Sent : To ; Subject: I can deal with the feisty , fiery David that more than occasionally irritates , annoys and frustrates me but not this David in so much pain Sent from my iPad On Jul 29 2017 , at 5 :0.>PM , David shulkin wrote: Ok thanks Sent from my iPhone On Jul 29, 2017, at 5:35 PM, Poonam Alaigh - (b) (6) wrote : Everything you do makes news- forgot to tell you but when we were in the flight yesterday to NO, you must of stood up in the isle and there were a number of whispers behind where I was sitting where folks were saying" that is David Shulkin etc etc" . We need you to be better asap- hard to see you in so much pain keep me posted with daily updates Sent from my iPhone On Jul 29 2017 , at 3:53 PM, David Shulkin wrote : http://www.nola.com/national ssures trans .html politics/2017/07/veterans shulkin a Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000972 DS_00021688 Message From: Sent : To ; Subject: David Shulkin [drshulkin@aol.com] 7/29/2017 8:53 :19 PM Poonam Alaigh I(b) (6) @hotmail .com] My back pain is now news http://www.no1a.com/nationa1 politics/2017/07/veterans shulkin assures trans.html Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000973 DS_00021689 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 8/6/2017 11:04:45 PM To: (b) (6) Poonam Alaigh [-@hotmail.com] Re: Es Nash Subject: Always has By the way Lonnie wants to meet with me alone for the first in for the rest if you want to meet him I think he is here on a sales I suspect he wants to tell than substsnce job for his new company so its me privately that part of the meeting but then just a courtesy he wants to cone to va to help- can bring in visit but he is really more fluff sent from my iPhone (b) (6) > on Aug 6, 2017, at 2:08 PM, Poonam Alaigh <-@hotmail > > she really . com> wrote: looks anorexic > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000974 OS 00021690 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 8/6/2017 6:08:37 PM To: David Shulkin [drshulkin@aol.com] Es Nash Subject: She really looks anorexic sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-000975 DS_00021691 Message From: (b) (6) Poonam Alaigh[-@hotmail.com] Sent: 6/13/2017 11:54:36 PM To: Bruce Moskowitz [bruce~@mac (b) (6) (b) DavidShulkin [drshulkin@aol.com](6) Re: APple CC: Subject: Thanks Bruce- really .com] helpful Sent from my iPad (b) (6) > on Jun 13, 2017 , at 5:54 PM, Bruce Moskowitz (b) (6) . com> wrote: > Will leave you to devise welcome. > we need to acknowledge the great progress the VA team and Apple have made in working on geotagging to the Veterans location where they may access care in the private sector in a timely basis. second great progress has been made to develop a platform , so records from the Va are available to any health care worker in the private sector. > Nowwe have to take it to the next level what Apple and our 5 academic partners excel in, a portable medical record that provides the community health care team information from the health care record that is pertinent to the care of the patient without the need to sift through multiple levels of information. we also need to be sure that health care in the private sector gets entered into a well integrated patient platform that can be accessed by the VA health care team. > Finally we can not stop there , we have to go for a revolutionary health care record that promotes wellness and earl y detection of disease . > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-000976 OS 00021692 Message Davidshulkin [Drshulkin@aol.com] 6/23/2017 11:22:28 AM Poonam AlaighI(b) (6) @hotmail.com] Re: Philly today? From: Sent: To: Subject: No staying in de Sent from my iPhone > on Jun 23, 2017, at 5:42 AM, Poonam Alaigh wrote: > > Are you heading home today? I am in the 5pm train in case you are > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000977 OS 00021693 Message From: Sent: To: Subject: Poonam Alaigh I(b) (6) @hotmail.com] 6/23/2017 9:42:25 AM Drshul kin@aol .com Philly today? Are you heading home today? I am in the 5pm train in case you are Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000978 OS 00021694 Message David shulkin [Drshulkin@aol.com] From: Sent: 6/13/2017 2:01:10 PM To ; (b) (6) Subject: Fwd: Analysis of comments (b) (6) @gmail.com] Sent from my iPhone Begin forwarded message: From: David shuJkin Date: June 13, 2017 at 6:55:47 AM EDT (b) (6) To:-(b) (6) (b) (6) hotmail.com>, -Subject: Analysis of comments (b) (6) >,_(b) (6) https ://www.google.com/amp/s/amp.con.com/cnn/2017/06/12/politi cs/trump-cabinetranked/index .html Sent from my 1Phone AMERICAN PVERSIGHT VA-19-0799-G-000979 DS_00021695 Message Davidshulkin [Drshulkin@aol.com] 2/2/20 18 3:38:08 PM @nglbrg.com] (b) (6) (b) (6) Re: Pricing From: Sent: To: Subject: Got it- sorry Sent from my iPhone > on Feb 2, 2018, at 10:03 AM, David shulkin wrote: > > can you send us your number and we will call you at 1230 pm et ? > > sent from my iPhone > >> On Feb 2, 2018, at 9 : 22 AM, (b) (6) >> >> Dear Dr. shulkin: <-(b) (6) @nglbrg . com> wrote : >> >> Thank you for reaching out to me. I can be available at 1230pm today. >> >> To facilitate the discussion , I am attaching a copy of my CV. Also a copy of the last piece I published on drug prices . For a variety of reasons , the Veterans Administration is well-positioned to play an important role in bringing down drug prices and reducing the shortages that exist for some older drugs. Your leadership on these issues can make an important difference and I am happy to be of assistance in any way that might be useful to you . >> >> You can reach me a (b) (6) >> >> (b) (6) ng rg.com >> (b) (6) >> >> >> >> >> >> » -----original Message----From: David shulkin [mailto :Drshulkin @aol . com] Sent ... Fri da Febru a r y 2 2018 7: 42 AM To: (b) (6) <(b) (6) @n lb rg.com> (b) mac . com> cc : Bruce Mos ow,tz > I was given your name by Dr Bruce Moskowitz. >> Dr 1111111111111 (b) (6) wonderecl""i"t""ight have the opportunity to speak . we are working on drug pricing and I >> >> I have time toda y at 1230 pm or at 2 pm or monday at 11 am. if better sunday. have time either saturda y or >> >> Please let me know. >> » Thank you >> >> David shulkin MD >> secretary , us Department of Veteran Affairs >> >> sent from my iPhone >> <3WaysTrumpcan Lower Drug Prices.pdf > » AMERICAN PVERSIGHT VA-19-0799-G-000980 OS 00021696 Message From: Sent: To: CC: Subject: (b) (6) (b) (6) [-@nglbrg.com] 2/2/20 18 3:22:10 PM Davidshulkin [Drshulkin@aol.com] (b) (6) (b) (b)(6) (6) RE: Pricing (b) (6) (b) (6) this one (b) (6) (b) (6) -----original Message----From: David shulkin [mailto:Drshulkin@aol .com] sent ry 0 :03 AM (b) (6) (b) (6) To: ■■■ va. com > (b) (6) gov > cc: (b) (6) subject : Re: Pr1c1ng . can you send us your number and we will call you at 1230 pm et ? sent from my iPhone > On Feb 2, 2018, at 9 :22 AM, (b) (6) (b) (6) <-@nglbrg . com> wrote : > > Dear Dr. shulkin: > > Thank you for reaching out to me. I can be available at 1230pm today . > > To facilitate the discussion, I am attaching a copy of my OI. Also a copy of the last piece I published on drug prices . For a variety of reasons, the Veterans Administration is well-positioned to play an important role in bringing down drug prices and reducing the shortages that exist for some older drugs . Your leadership on these issues can make an important difference and I am happy to be of assistance in any way that might be useful to you > > You can reach me at (b) (6) > > > > (b) (6) (b) (6) ng rg.com > > > > > > -- - - -Original Message----From: David shulkin [mailto :Drshulkin@aol . com] sent~ · ry :42 AM To: (b) (6) <(b) (6) @n lb rg . com> (b) (5) cc : Bruce Mos ow,tz subject: Pricing (6) > (b) (6) > Dr 1111111111111 I was given your name by Dr Bruce Moskowitz. wonde~might have the opportunity to speak. > we are working on drug pricing > I have time today at 1230 pm or at 2 pm or monday at 11 am. if better sunday. have time either and I saturday or > > Please let me know. > > Thank you > > David shulkin MD > secretar y , us Department of Veteran Affairs > > sent from my iPhone > <3WaysTrumpcan Lower Drug Prices . pdf > AMERICAN PVERSIGHT VA-19-0799-G-000981 OS 00021697 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 2/2/20 18 3:03:13 PM To: (b) (6) (b) (6) Re: Pricing CC: Subject: (b) (6) [-@nglbrg.com] va.gov] (b) (b)(6) (6) can you send us your number and we will call you at 1230 pm et? Sent from my iPhone > On Feb 2, 2018 , at 9:22 AM, (b) (6) (b) (6) <-@nglbrg . com> wrote: > > Dear Dr. shulkin: > > Thank you for reaching out to me. I can be available at 1230pm today. > > To facilitate the discussion, I am attaching a copy of my 0/. Also a copy of the last piece I published on drug prices . For a variety of reasons, the Veterans Administration is well-positioned to play an important role in bringing down drug prices and reducing the shortages that exist for some older drugs . Your leadership on these issues can make an important difference and I am happy to be of assistance in any way that might be useful to you > > You can reach me at (b) (6) > > > > (b) (6) (b) (6) > > > > > > -----original Message----From: David shulkin [mailto :Drshulkin @aol .com] sent~ · ry :42 AM To: (b) (6) <(b) (6) g . com> (b) (5) (b) mac . com> ■■l Cc: Bruce Mos ow1tz ng rg . com (b) (6) > Dr 1111111111111 I was given your name by Dr Bruce Moskowitz. wonde~might have the opportunity to speak. > we are working on drug pricing > I have time today at 1230 pm or at 2 pm or monday at 11 am. if better sunday . have time either and I saturday or > > Please let me know. > > Thank you > > David shulkin MD > secretary, us Department of Veteran Affairs > > sent from my iPhone > <3WaysTrumpcan Lower Drug Prices.pdf > > AMERICAN PVERSIGHT VA-19-0799-G-000982 OS 00021698 Message @nglbrg.com] (b) (6) (b) (6) 2/2/2018 2:22:25 PM Davidshulkin [Drshulkin@aol.com] Bruce Moskowitz [bruce (b) (6) (b) @mac.com] RE:Pricing (6) 3WaysTrumpcan Lower Drug Prices.pdf; ABEBIO.DOC From: Sent: To: CC: Subject: Attachments: Dear Dr. Shulkin: Thank you for reaching out to me. I can be available at 1230pm today. I am attaching a copy of my CV. Also a copy of the last piece I published To facilitate the discussion, on drug prices . For a variety of reasons, the Veterans Administration is well-positioned to play an important role in bringing down drug prices and reducing the shortages that exist for some older drugs. in Your leadership on these issues can make an important difference and I am happy to be of assistance any way that might be useful to you You can reach me at (b) (6) (b) (6) (b) (6) ng rg . com -----original Message----From: David shulkin [mailto:Drshulkin@aol .com] Sent ... Frida February 2 2018 7:42 AM <(b) (6) @nlbrg.com> To: (b) (6) (b) mac.com> cc: Bruce Mos ow,tz Date: Thursday, June 15, 2017 at 7:31 AM To: Jared Kushner <(b) (b) (6) (6) Cc: •-(b) (6) EOP/WHO (b) (6) (b) (6) Subject: Fwd : (No Subject) Dont know if you saw (b) (5) Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000993 DS 00021709 Message From: Jared Kushner (b)(b) (6) Sent: 6/16/2017 10:33:40 (6) AM To : David shulkin [Drshulkin@aol.com] CC: who .eop .gov]; (b) (6) (b) (6) (b) (6) (b) (6) -EOP/WHO@who.eop .gov] EOP/WHO (b) (6) Subject : Re: (No Subject) @who .eop .gov; (b) (6) I spoke with him yesterday - we should have a (b) (5) From: David shulkin Date: Thursday, June 15, 2017 at 7:31 AM To: Jared Kushner (b) (6) (b) (6) Cc:•-(b) (6) EOP/WHO-(b) (6) (b) (6) who.eop.gov> Subject: Fwd: (No Subject} - Dont know if you saw (b) (5) Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000994 DS_00021710 Messa geFrotn ; David shulkin [Drshu1kin@ao1.com] Sent: 6/15/2017 11:31 :44 AM Jared Kushner (b) (b) (6) To: CC: S1,1bject : (6)□(b) (6) (b) (6) (b) (6) -EOP/WH who .eop .govJ Fwd : (No Subject) - Dont lrnow if you aw (b) (5) Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-000995 OS 00021711 Message David shulkin [Drshulkin@aol.com] 7/31/2017 11:06:17 AM Darin Selnick (b) (6) @gmail.com] Re: New PVAArticle From: Sent : To : Subject: Good idea Sent from my iPhone On Jul 30, 2017 , at 9 :46 PM, Darin Selnick (b) (6) I just sent it to John, Jake and Brooks . We can also bring it up at Morning Repo1t . Darin On Sun , Jul 30, 20 17 at 6:39 PM, David Shulkin wrote : Darin- I agree pretty amazing that he has come so far- much credit to you Lets make sure our team sees this -----Original Message----(b) (6) From : Darin Selnick~> To : David shulkin Sent: Sun , Jul 30, 2017 9:31 pm Subject: New PVA Article I just received this from Sherman , it is very good and supportive . You may want to borrow his term customization. http://www .pva blog .com/fou ndatio na 1-investment-in-va-choice-care-challenges-claims-of-imminentprivatization/ Darin AMERICAN PVERSIGHT VA-19-0799-G-000996 DS_00021712 Message From: Darin Selnick (b) (6) Sent : 7/31/20171:46 :38 AM To : David ShuIkin (drshulk in@aol.com] Re: New PVAArticle Subject: @gmail.com] l just sent it to John , Jake and Brooks . We can also bring it up at Morning Report . Darin On Sun, Jul 30, 2017 at 6 :39 PM , David Shulkin wrote : Darin- I agree pretty amazing that he has come so far- much credit to you Lets make sure our team sees this -----Original Message----(b) (6) From: Darin Selniok~> To : David shulkin Sent: Sun, Jul 30, 2017 9:31 pm Subject: New PVA Article I just received this from Sherman , it is very good and supportive . You may want to borrow his term customization . http://www. pvablog .com/fou ndatio naI-investment-in-va -choice-care-challe nges-cla ims-of-imminent-privatization/ Darin AMERICAN PVERSIGHT VA-19-0799-G-000997 DS_00021713 Message From: David Shulkin (drshulk 1n@aol.com] Sent : 7/31/2017 1:40 :22 AM To : (b) (6) Subject: @va.gov Fwd: New PVA Article please print this link -----Orig in a I Message----From : Darin Selnick (b) (6) gmail.com> To : David shulkin Sent: Sun, Jul 30 , 2017 9:31 pm Subject: New PVA Article I just received this from Sherman , it is very good and supportive. You may want to borrow his term customization . http://www .pvablog .com/f ou ndationa 1-investment-in-va-choice-care-challe nges-cla ims-of-imminent-privatization/ Darin AMERICAN PVERSIGHT VA-19-0799-G-000998 DS 00021714 Message From: David Shulkin [drshulk 1n@aol.com] Sent : 7/31/20171:39 :48 AM To : (b) (6) Subject: @gmail.com Re: New PVAArticle Darin- I agree pretty amazing that he has come so far- much credit to you Lets make sure our team sees this -----Orig ina I Message----From : Darin Selnick (b) (6) gmail.com> To : David shulkin Sent: Sun, Jul 30 , 2017 9:-31 pm Subject: New PVA Article I just received this from Sherman , it is very good and supportive . You may want to borrow his term customization . http://www .pvablog .com/fou ndationa 1-investment-in-va-choice-care-challenges-cla ims-of-imminent-privatization/ Darin AMERICAN PVERSIGHT VA-19-0799-G-000999 DS_00021715 Message From: Darin Selnic (b) (6) Sent : 7/31/20171:31 :33 AM To; David shulkin [Drshulkin@aol.comJ New PVA Article Subject: I just rece ived this from -(b) (6) customization. @gmail.com] it is very good and supportive . You may want to borrow his term http ://www. pvabl og .com/foundational-i nvestm ent-i n-va-choi ce-care-cha1 Ienges-clai ms-of-imminentprivatization/ Darin AMERICAN PVERSIGHT VA-19-0799-G-001000 DS_00021716 Message From: (b) (6) Sent : 8/18/2017 6:01 :52 PM To ; David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) @gmail.com) Ahhhh. :-/ :-/ :-/ On Aug 18, 2017 2:01 PM, "David shulkin 11 wrote: Well now that youve given me these ideas ....... . Sent from my iPhone On Aug 18, 2017, at 1:41 PM , (b) (6) (b) (6) I'm glad you're not like this http ://www .politico .com/ story/20 I 7/08/ 18/todd-rokita-boss-aides-staff -instructi ons-241 709 AMERICAN PVERSIGHT VA-19-0799-G-001001 DS_00021717 Message David shulkin [Drshulkin@aol.com] From: Sent: 8/18/2017 6:00:47 PM To ; (b) (6) Subject: Re: (b) (6) @gmail.com] Well now that youve given me these ideas ....... . Sent from my iPhone On Aug 18, 2017 , at 1 :41 PM , (b) (6) (b) (6) mail.com > wrote: I'm glad you're not like this http://www.politico.com/story/2017/08/1 8/todd-rokita-boss-aides-staff-instructions-241709 AMERICAN PVERSIGHT VA-19-0799-G-001002 DS_00021718 Message From: (b) (6) (b) (6) Sent : 8/18/2017 5:41 :56 PM To : David Shu Ikin (drshulkin@aol.com] @gmail.com) I'm glad you're not like this http:l/www ,politico.com/story/2017 /08/ 18/todd-rok:ita-boss-aides-staff-instructions-241709 AMERICAN PVERSIGHT VA-19-0799-G-001003 DS_00021719 Message Davidshulkin [Drshulkin@aol.com] Sent: 6/22/2017 12:33:14 PM To: Ike Perlmutter [~frenchangel59.com] ( Subject: June 30 b ) ( 6 Ike- just learned last night that unfortunately ) to a conflict From: Ivanka can no longer make the trip to NY on june 30th due Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001004 OS 00021720 Message From: David shulkin [Drshulkin@aol.com] Sent: 6/30/2017 9:30:08 PM To: (b) (6) -[-@ccf.org] Subject: VA (b) (6) -(b) just listened to the politico podcast of you- very well done and I appreciate the supportive words (6) I do think were making progressbut its tough work with so many middle managers committed to the status quo Happy July 4th David sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001005 OS 00021721 Message David Shulkin [secshulkin@gmail.com] 8/11/2017 12:22:02 AM L Perl (b) (6) @gmail.com) Marc Sherman Bruce Moskowitz [bruce (b) (6) (b) @mac.com];IP [1@frenchangel59.com); ( (6) b (b) (6) [mb -?l@gmail.com] Re: V.A. Plans to Fire Its D.C. Medical Director - Again )- The New York Times From: Sent : To ; CC: Subject: Th.is is the guy we almost had as deputy at VA if it wasnt for Ike! ( 6 ) http://www .cnn .com/201 7/08/1 0/pol itj cs/kfi Ie-sam-cl ovi s-on-the-raili o/i ndex .htm I This was a top story on cnn today- we Didnt need this Sent from my iPhone On Aug 9, 2017, at 9:47 PM, L Perl- (b) (6) > wrote: Wow! Excellent---- just simply terrific ....Bes t.. ..L On Wed , Aug 9, 2017 at 3: 13 PM , Bruce Moskowitz wrote : (6) Excellent quote, David you said it so anyone can understand the importance of the new law. https ://www .nytimes .com/201 7/08/09/us/pol itics/veterans-aff airs-bri anhawkins. html ?hp&action =click& pgtype= Homepage&cli ckSource=storyheading&module =second-column-region (R)ion=top-news&WT .nav=top-news Sent from my iPad Bruce Moskowitz M .D . AMERICAN PVERSIGHT VA-19-0799-G-001006 DS_00021722 Message From: Sent: To; CC: Subject: L Perl (b) (6) @gmail.com] 8/10/2017 1:47:20 AM Bruce Moskowitz [bruce (b) (6) (b) @mac.com] Marc Sherman [mb (b) (6) @gmail.com] David Shulkin [secshulkin@gmail.com]; (6) IP lll@frenchangel59.com]; ( Re: V.A. Plans to Fire Its D.C. Medical Director b - Again - The New York Times ) ( Wow! Excellent---- just simply terrific ....Best.. ..L6 ) On Wed, Aug 9, 2017 at 3:13 PM, Bruce Moskowitz wrote: (6) Excellent quote , David you said it so anyone can understand the importance of the new law. https://www .nytimes.com/20 l 7/08/09/us/politics/veterans-affairs-brianhawkj n s.htm 1?hp&acti on=cl ick&p gtype= Hom epage&cl ickSource=story-h eading& m odul e=second-col umnregi on(R)i on=top-news& WT .nav=top-news Sent from my iPad Bruce Moskowitz M .D . AMERICAN PVERSIGHT VA-19-0799-G-001007 OS 00021723 Message From: Sent: To: Subject: DavidShulkin [secshulkin@gmail.com] 8/9/20 17 10:21:42 PM (b) (6) (b) Bruce Moskowit z [bruce~@mac .com] (6)Director - Again- The New YorkTimes Re: V.A.Plans to Fire Its D.C. Medical Thanks Bruce Its never easy in DC Sent from my iPhone (b) (6) > on Aug 9, 2017, at 3:13 PM, Bruce Moskowitz wrote: (6) > Excellent quote , David you said it so anyone can understand the importance of the new law. > https :// www.nytimes.com / 2017/ 08/ 09/ us/ politics / veterans-affairs-brianhawkins . html ?hp&action=click&pgtype=Homepage&clicksource=story-heading&module=second-columnregion (R)ion=top - news&W"T.nav=top-news > > > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-001008 OS 00021724 Message (b) (6) (b) Bruce Moskowitz [bruce~@mac .com] (6) Sent: 8/9/2017 7:13:59 PM To: DavidShulkin [secshulkin@gmail.com] ( (b) (6) (b) (6) CC: L Perl [-@gmail.com] IP [~frenchangel59.com]; mb-@gmail.com; b Plans to Fire Its D.C.Medical Director - Again- The New YorkTimes V.A. Subject: ) ( 6 Excellent quote, ) David you said it so anyone can understand the importance of the new law. https://www.nytimes.com/2017/08/09/us/politics/veterans-affairs-brianhawkins.html?hp&action=click&pgtype=Homepage&clicksource=story-heading&module=second-columnregion(R)ion=top - news&wT.nav=top-news From: sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-001009 OS 00021725 Message David shulkin [Drshulkin@aol.com] 8/22/2017 6:23:24 PM Poonam Alaigh I(b) (6) @hotmail.com] Re: Intellectual Property From: Sent: To: Subject: You should Sent from my iPhone On Aug 22, 2017, at 10:27 A.NI, Poonam Alaigh - (b) (6) wrote : Ten-y Fadem is on board - do you want you let Ike et al know on our gmail group Sent from my iPhone Begin forwarded message : From: 11Alaigh , Poonam , M .D .11 Date: August 22, 2017 at 10:14:12 AM PDT To: 'Poonam Alaigh' - (b) (6) > Subject: FW: Intellectual Property Sent with Good (www .good.com ) -----Original Message----From: (b) (6) Sent: Tuesday , August 22, 2017 10:42 AM Eastern Standard Time To: Alaigh, Poonam, M .D. Cc: Lynch, Thomas (VHA) Subject: Intellectual Property Dear Dr . Alaigh, Given our past conversations about the handling of Intellectual Property , I wanted to share with you that I learned from Dr. Ramoni late Friday afternoon that the Office of Research and Development has achieved a contract with Terry Fadem to work with VA on these issues . Rachel had onJy heard about this a few minutes before she told me. I've shared this with (b) (6) who, up until now, (b) (6) was our top expert on I.P . and she was already aware. will be briefing VA' s new General Counsel on this later this afternoon . She also sent along the following link describing Mr. Fadem: https ://macki nstitute. wharton .u penn.edu/wp-content/upl oads/2015/06/F ademTerry Biol.pdf AMERICAN PVERSIGHT VA-19-0799-G-001010 DS_00021726 While I've gone back and forth about this issue, I've come to the conclusion that this is exactly what we need to do- and I'm glad to report it's being done . But I wanted to be sure you knew too! - (b) (6) AMERICAr-... pVERSIGHT VA-19-0799-G-001011 DS 00021727 Message Poonam Alaigh I(b) (6) @hotmail.com] 8/22/2017 5:27 :07 PM David Shulkin [drshulk in@ao l.com ] Fwd: Intellectual Property From: Sent : To : Subject: Terry Fadem is on board - do you want you let Ike et al know on our gmail group Sent from my iPhone Begin forwarded message : - > From: "Alaigh , Poonam , M.D." Date: August 22, 2017 at 10:14:12 AM PDT To: 'Poonam Alaigh ' (b) (6) Subject: FW: Intellectual Property Sent with Good (www .good.com ) -----Ori gin al Message----From: (b) (6) Sent: Tuesday , August 22, 2017 10:42 AM Eastern Standard Time To: Alaigh, Poonam , M .D. Cc: Lynch , Thomas (VHA) Subject: Intellectual Property Dear Dr. AJaigh, Given our past conversations about the handling of Intellectual Property , I wante d to share with you that I learned from Dr . Ramoni late Friday afternoon that the Office of Research and Development has achieved a contract with Terry Fadem to work with VA on these 1ssues. Rachel had only heard about this a few minutes before she told me. I've shared this with (b) (6) who , up until now, was our top expert on I.P . and she was already aware. (b) (6) will be briefing VA' s new General Counsel on this later this afternoon . She also sent along the following link describing Mr . Fadem : https ://m acki nsti tute. wharton .upenn .edu/ wp-content/u ploads/2015/06/F adem-Terry Bio 1.pdf While I've gone back and forth about this issue, I'v e come to the conclusion that this is exactly what we need to do- and I'm glad to report it's being done. But I wanted to be sure you knew too! AMERICAN PVERSIGHT VA-19-0799-G-001012 OS 00021728 01 3 7'29 Message From: David shulkin LDrshulkin@aol.com] Sent : 9/10/2017 7:59 :52 PM To : Jennifer Lee (b) (6) @gmail.com] Re: Draft article Subject: For a peer review journal- other than federal practitioner we will need data and a focus on policy- the policy being practicing across state lines to meet bealth shortage needs- We will need data on health sbortage areas and wait times. Sent from m.y iPhone On Sep 10, 2017 . at 2 :00 PM , Jennifer Lee~ (b) (6) > wrote: Hi Dr. Shulkin , How is Camp David? :) Thanks for your feedback on this. I was hoping we could target a peer-reviewed journal and would be glad to work on the next draft to get it up to par . What do you think it needs? on the telehealth side, should we look at reimbursement and licensing trends? ... on the genomic side , we could talk about genetic cohorts (like NIH PJvll-which is moving slowly) and then compare/contrast? looking fwd to your thoughts. Thanks, Jennifer On Thu . Sep 7, 2017 at l0 :20 PM, David Shulkin < drshulkin@aol.com > wrote: I always start with the audience or the target publication . This one is a challenge. Its not a peer review piece. Its not a good candidate for a Sounding Board or a Commentary in a scientific journa l as we would need to make it less about VA and more generic in the trends in healthcare citing VA as just an examp le. Its not a lay press editorial. That leaves a journal that has an audience interested in VA issues- like Federal Practitioner. If you are okay in this publication , and it is peer reviewed, I think this is a good piece . If you were hoping for something more , then we have some work to do on it. I do like the broad nature of the digital transformation of VA. Let me know your preferred path and then I can dig in more -----Original Message--~-From: .Jennifer Lee~>(b) (6) To : David shulkin Sent: Thu, Sep 7, 2017 5:48 pm Subject: Draft article Hi Dr. Shulkin , As promised, I've been working on a journal article/commentary for us on telehealth ...but as I was writing it I thought it might be more interesting to make it a little broader and include some other areas of innovation we aim to lead in, like genomics and precision medicine? Attached is a very rough draft. Thought I would share it with you early to get your feedback on the overall theme and direction . I'd be happy to narrow it back down to telehea lth if you like. We have plenty of material to work with either way. Thanks for your feedback! Jen AMERICAN PVERSIGHT VA-19-0799-G-001014 DS 00021730 01 5 Message From: Jennifer Lee (b) (6) @gmail.com] Sent : 9/10/2017 6:00:20 PM To : David ShuIkin (drshulkin@aol.com] Subject: Re: Draft article Hi Dr . Shulkin How is Camp David? ;) Thanks for your feedback on this. 1 was hoping we could target a peer-reviewed journal and would be glad to work on the next draft to get it up to par . What do you think it needs? on the telehealth side, should we look at reimbursement and licensing trends? ... on the genomic side, we could talk about generic cohorts (like NIH PMI-which is moving slowly) and then compare/contrast ? looking fwd to your thoughts . Thanks , Jennifer On Thu , Sep 7, 2017 at I 0:20 Pl\lf, David Shullcin wrote : I always start WTththe audience or the target publication. This one is a challenge. Its not a peer review piece . Its not a good candidate for a Sounding Board or a Commentary in a scientific journal as we would need to make it less about VA and more generic in the trends in healthcare citing VA as just an example. Its not a lay press editorial. That leaves a journal that has an audience interested in VA issues- like Federa l Practitioner. If you are okay in this publication, and it is peer reviewed, I think this is a good piece . If you were hoping for something more, then we have some work to do on it. I do like the broad nature of the digital transfonnation of VA. Let me know your preferred path and then I can dig in more ----Original Message--- .(b) (6) From : Jennifer Lee<~> To : David shulkin Sent: Thu , Sep 7 , 2017 5:48 pm Subjec t: Draft article Hi Dr. Shulkin, As promised , I've been working on a journal article/commentary for us on telehealth ...but as I was writing it I thought it might be more interesting to make it a little broader and include some other areas of innovation we aim to lead in , like genomics and precision medicine? Attached is a very rough draft. Thought I would share it with you early to get your feedback on the overall theme and direction. I'd be happy to narrow it back down to telehealth if you like . We have plenty of material to work with either way . Thanks for your feedback! Jen AMERICAN PVERSIGHT VA-19-0799-G-001016 DS 00021732 Message From: Sent: To: Subject: David Shulkin [drshulkin@aol.com] 9/8/2017 2:20:05 AM (b) (6) @gmail.com Re: Draft article I always start with the audience or the target publication. This one is a challenge. Its not a peer review piece. Its not a good candidate for a Sounding Board or a Commentary in a scientific journal as we would need to make it less about VA and more generic in the trends in healthcare citing VA as just an example. Its not a lay press editorial. That leaves a journal that has an audience interested in VA issues- like Federal Practitioner. If you are okay in this publication, and it is peer reviewed, I think this is a good piece. If you were hoping for something more, then we have some work to do on it. I do like the broad nature of the digital transformation of VA. Let me know your preferred path and then I can dig in more -----Original Message----(b) (6) From: Jennifer Lee ~@gmail.com> To : David shulkin Sent: Thu, Sep 7, 2017 5:48 pm Subject: Draft article Hi Dr. Shulkin, As promised, I've been working on a journal article/commentary for us on telehealth ...but as I was writing it I thought it might be more interesting to make it a little broader and include some other areas of innovation we aim to lead in, like genomics and precision medicine? Attached is a very rough draft. Thought I would share it with you early to get your feedback on the overall theme and direction. I'd be happy to narrow it back down to telehealth if you like. We have plenty of material to work with either way. Thanks for your feedback! Jen AMERICAN PVERSIGHT VA-19-0799-G-001017 OS 00021733 Message From: Sent: To : David shulkin lDrshulkin@aol.com] 9/7/2017 9 :59:20 PM (b) (6) Jennifer Lee ??l@gmail.com] David Shulkin [drshulkin@aol.com] Re: Draft arti~le BCC: Subject: Ok ill look at [t Sent from my iPhone (b) (6) On Sep 7, 2017, at 5:48 PM, Jennifer Lee~> wrote: Hi Dr. Shulkin, As promised, I've been working on a journal article/ commentary for us on te lehealth ...but as I was writing it I thought it might be more interesting to make it a little broader and include some other areas of innovation we aim to lead in, like genomics and precision medicine? Attached is a very rough draft. Thought I would share it with you early to get your feedback on the overall theme and dfrection. I'd be happy to narrow t back down to telehealth if you like. We have plenty of material to work with either way. Thanks for your feedback! Jen AMERICAN PVERSIGHT VA-19-0799-G-001018 DS 00021734 Message From: Sent: To: Subject: Attachments: Jennifer Lee (b) (6) @gmail.com] 9/7/20 17 9:48:28 PM David shu lkin [drshul kin@aol .com] Draft artic le Digital health draft artic le.docx; Untitled attachment 96299 .htm Hi Dr. Shulkin, As promised, I've been working on a journal article/commentary for us on telehealth ...but as I was writing it I thought it might be more interesting to make it a little broader and include some other areas of innovation we aim to lead in, like genom ics and precision medicine? Attached is a very rough draft. Thought I wou ld share it with you early to get your feedback on the overall theme and direct ion. I'd be happy to narrow it back down to te lehealth if you like. We have plenty of material to work with either way. Thanks for your feedback ! Jen AMERICAN PVERSIGHT VA-19-0799-G-001019 OS 00021735 DRAFT Why VA is Poised to Lead the Digital Health Revolution The Department of Veterans Affairs is in the throes of a monumental transformation-one that puts at its forefront the modernization of the Veterans Health Administration, the largest integrated health system in the country tasked with one of its most vital missions, to care for those who have served and sacrificed for this Nation. Core to this transformation will be a new paradigm for how VA delivers care that not only meets the access needs of Veterans, but sets a new standard for service and convenience that puts the VetercJ.tjijquarely at the center of everything we do. As we undergo this transformation, we aim to build th~{qiihdaijq:qfor the health care system of the future. Health care stands on the precipice of ii f~plution-the ig~of digital health and democratized health information, the dawn ofbls gafa, machine learrlilg1.and the promise of precision medicine. As Eric Topol wrote, "wh~r~pnce patients could ndt~JPY!1n access their data, today they can actually generate and own it ... tod~y Piltient? c~prapidly diaBp?e their skin lesion or child's ear infection .. in shg~, li)re seeing an unpr~q~dented shakeseri du~IYchallenged ... " Topol' s reflections for bfqlc1cbased change in the health care the abillt'.Yofpublic policy, financing, is Uitquely poised to lead the that perhaps no other ,nu~+wi ... system in the Nation, and in an incredibly vast majority of this telehealth is delivered, however, u~p;,nc

quality care. Offering flexible work schedules that allow young physicians to also work out of their homes by fully leveraging technology will no doubt give VA competitive advantages in hiring. Our focus has been on using technology to empower Veterans and give them more choice in how they want their health care delivered. We have been clear to stress that the virtual visit is entirely optional. For those Veterans who have the technology and are comfortable with it, VA Video Connect offers innumerable benefits in convenience, cost savings, and avoidable in-person visits. AMERICAN PVERSIGHT VA-19-0799-G-001021 OS 00021737 Veterans who prefer to go to their clinic can keep seeing their VA or community doctor in the same way they always have. Veterans can also choose to involve their family members or loved ones in their virtual care encounters. Using 3-way videoconferencing, VA Video Connect will enable a VA provider to easily conference in a family member or a consultant for more complicated cases. For our aging Veteran population, telehealth into the home is an essential tool in keeping Veterans independent and in the community for as long as possible. VA is already using telehealth for home monitoring post-discharge for CHF exacerl?etions, but VA's new program will support much more proactive gathering of patient-generiftic!:data for conditions such as dementia, diabetes and chronic kidney disease, so the caq;;t~~tp can monitor a patient's condition and intervene early to prevent deterioration or hospitaU~~jorl?j Telehealth expansion will also help VA addressjJ~ IBst urgent clirllq~Lproblem-veteran suicide. With 20 Veterans taking their lives by ?u~cideevery day, suiciqffl{ymains VA' s most pressing health care need. Telemental health lci'<<\'~r?.barrierstq accessing iq~pJal health for Veterans who live in areas with shortages of provid~r?;SUCfl~?lhrural areas; lbcyre studies show Veterans have an even higher risk ot)?ubst.~e(ref). Tel~l~ntalhealth has been shown to be patient satisfaction is particularly effective at preventing acute psychiatqq fiQ?Pit1tlizations,~pg high for telemental health, in some caseijjyvefibisb&r than irl4p?f?Onvisits. VA will integrate teleh.%~ltbllt!?t.he robustijpfrastrugtur~ }JPYflhave qyilt in the Veterans Crisis Line-which is singuljfirl its re~gbvmd exte"&t!lc?(iij'ascrisisJjp~s go. Staffed 24 hours a day with over 800 staff arid iith a mis~i@Pto guaraijfij~24 hour follow up, the VCL has averted disaster and saved countleijij Uves pftygby texfi~?saging chats. Telehealth will complement these inten~2tiiiirJinkJng patt~ijjij/Jifebtlyjggientalbyalth providers, as well as peer support staff, ePIproviding Unpijci;;ederlt~tb~c.:cess tomi'&t!!l.health care and support. Big Data ijij~ Precision ~felisine VA is leveragifig ~pother of its itrfngths to tackle veteran suicide and other challenging health issues-big data. 1\ti+bas arguaply the richest health data of any system in the nation. The EHR data available in the vl"I}~corppijife data warehouse represents over 22 million patients and their accompanying 200 millioij i:iipfogy procedures, 315 million consults, 2.2 billion pharmacy fills, 7.7 billion lab results and 4.5billion clinical orders - a startling [XX] petabytes of data. We are already using big data to better predict those which of our veteran patients are at higher risk of suicide so we can intervene early. VA has partnered with entities like Google DeepMind to help prevent kidney disease before it develops, and IBM Watson to help identify the best possible therapeutic targets for veterans with cancer. Combining VA' s rich phenotypic data in the electronic health record with the genomic data for nearly 600,000 patients in the VA's Million Veteran Program and its easy to see why VA is positioned to lead in precision medicine. (In less than 3 years, the MVP will meet its goal of I AMERICAN PVERSIGHT VA-19-0799-G-001022 OS 00021738 million participants making it the largest biobank in the world). Already, in just one year, VA has doubled the number of gene variant associations found through the MVP and is submitting over 42 abstracts to the Society of Genetic Medicine conference this fall. VA has established interagency partnerships with the Department of Energy to make available its analytic and computing power to realize even more discoveries. We predict that the number of gene associations will grow exponentially in the coming years. Because VA's research arm is integrated into the delivery system, VA will be able to function as a true learning health system, applying genetic discoveries to clinical practice at the point of care, using tools built into VA' s future electronic health record, which will now be integrated "Yitbthe DoD. VA' s big data applications extend well beyond health car~ ~?f'A encompasses far more than just a health care system-we also operate one of the larg~st!pm@Jg~p., tuition support, housing, disability claims, and vocational rehab programs cbuntry. ~p)pther health care system is ...,"'"'9 ~i,ov directly connected to such robust social and eduq~t(onal programs. Fully integrating this benefits-related data and data analytics wbuJq ynable VA to tailor its services to each individual Veteran's needs, delivery and maximizing the VA's ability to support the Veteran civilian life. It would also shed light on the impact of our outcomes that matter to Veterans. Innovation and patients interact with each for traditional health rapidly changing pace of technology and require rapid cycles of study, active practice settings that nurture is just such a testbed for innovation. VA has the largest footprint of any health health care workforce. VA also houses a $1.8 billion care system in """'1.ooooo"'1~iuu nt.,,or~,tPrl with its health system. Couple the diverse needs of our intramural patients with our for their mission and it is not hard to see why VA is fertile ground for innovative, solutions. Whether mobile apps, prosthetic limbs, or new models of caregiving, VA no shortage of new approaches to improving care and the care experience for Veterans and their families. Through our Diffusion of Excellence program and Innovators Network, we have sought to nurture and identify innovative solutions and disseminate them throughout our system. In addition, VA has a unique platform to influence the practice of the Nation's entire health care workforce. With over 1,800 academic affiliations, VA conducts the largest education and training effort for health professionals in the US. In 2016, over 127,000 trainees across more AMERICAN PVERSIGHT VA-19-0799-G-001023 OS 00021739 than 40 health professions received some or all of their clinical training in the VA. Over 65% of all US-trained physicians and 50% of psychologists have had VA training at some point in their career. VA is the Nation's largest employer of nurses (with more than 90,000 RNs, LPN/L VNs, and nursing assistants) as well as the largest employer of psychologists and social workers. As VA identifies best practices in digital health, we can help train large numbers of health care professionals on how to operate effectively under new paradigms of digital health care. The Right Incentives In general, adoption of technology-enabled care delivery moq1d?b,as been hindered by reimbursement policy and a lack of incentives for providers !P promote virtual care over inperson care. VA does not experience these barriers. VtJPYricelJPY~?a global budget, a 2-year advance appropriation through Congress that is infgmiedby histqmsal modeling of utilization and service delivery. VHA then uses a capi tati OQdP~?edresource allqe~tion system, the Veterans Equitable Resource Allocation (VERA), to dytffltlihe each regional netlprk' s budget. Each VA hospital facility receives its allocation based ori ~ ?ipiilar formula. We earl i'\"qghaveadjusted this allocation formula to ensure that the right incentiveij ~tYin Plii;~to support adpp;(on of telehealth and other virtual care mog~l?Itbroughout the Iii (i)urpayment structure differentiates us from Medicare and Medicaid, and ~ijijbl@@more innovatii?n in how we deliver care. What really separates VA from other sys\~ms thOUgpt~pd from 9!b.yragencies in the federal have ..o J?gtu~ tPcYbaitl~{)It' s the reason we have government, is our mis~iPP !P?!t[Yethose 'JPYD"9 over 380,000 employijjijfinany o~tpem veterijp?tffiifselvesI ih9 call VA their home and are excited to come to wOrij~yery day ijqd positivelyjmpact veterans and their families. Our mission is one that brings peopletqg~ther 1 ijycinin times ofjpyper-partisanship, as demonstrated by our many sigpiffii?iJt iiP~cti san legiij[ijjiVeaciji@M~pientij qyer the past few months. These legislative todlij ijpd authOriti@iit9.reform and modernize the system for the advarn:;c$pave giveriuij Q!i:!}V future if(tfiy areas ofHR;ijppyals clijim~ processing, and GI bill administration. We fully expect even more ijj~grms and innov#i:ttxe,vete:r@J'kCentered programs from our partners in Congress. Our mission also itipgs a wide ijijj@.y of potential partners to our table-countless corporations, universities, foundatiqp~, and ngpprofits have approached us with an interest in collaborating to benefit veterans. It is rijfj~Jh't$i\qiiys to find so many stakeholders united behind one common goal and we do not undere$tiifiite the inherent power and potential of a diverse and broad coalition joining forces with us. The access crisis has given VA extraordinary opportunity to reexamine the way it delivers care and to reinvent the system of the future. We look to train all of our resources toward building the VA of the future with the veteran at the center of everything we do. Ifwe fully leverage our scale, technology, federal policy and political strengths, innovation, and training, there is every reason for VA to emerge as the leader in the digital health revolution. AMERICAN PVERSIGHT VA-19-0799-G-001024 OS 00021740 025 Message From: Sent: To: CC: Subject: Poonam Alaigh (b) (6) @gmail .com] 8/18/2017 10:58 :20 PM IP ll@frenchangel59 .com]; L Perl (b) (6) ( David b Shulkin [Secshulkin@gma il.com] This ) weekend @gmail.com]; Mar isol Garcia .@frenchangel59.com] (b) (6) ( 6 ) you have time this weekend in NJ, call me and I would really love for both of you to come Ike and Laurie- if over to our place where you can also meet-(b) my better half Thanks and great speaking to you earlier. (6) AMERICAN PVERSIGHT VA-19-0799-G-001026 OS 00021742 Message From: Sent: To: Subject: Mariso l Garcia .@frenchangel59 .com] (b) 7/25/2017 2:33:44 (6) PM David shu lkin [Drshulkin@ao l.com ];-@hotma (b) (6) Call for Sunday, July 30th at 5:30 PM il.com Poonam and David, Ike would like to have a call with Laurie, Bruce, Marc and both of you. Please let me know if 5:30 PM works for you. Thank you, Marisol AMERICAN PVERSIGHT VA-19-0799-G-001027 OS 00021743 Message From: David shulkin [Drshulkin@aol.com] Sent : 7/3/2017 2 :42:24 PM L Perl (b) (6) @gmail.com) Re: To ; Subject: Laurie- By law when we get rid of a property we cannot sell it but we need to give it back to GSA (government services agency) that then disposes of it or gives it to another government agency. One of the law changes we need is to reinvest the proceeds back to VA- we are worlcing on this Sent from my iPhone - On Jul 3, 2017 , at 9:59 AM, L Perl (b) (6) > wrote: It is best to sell these properties asap----- we don't have the people or the talent to handle the homeless situation-- it will cost huge sums of money to fix these places up. On Sun, Jul 2, 2017 at 5 :00 PM , David shulkin wrote: See below http ://www. tennessean. com/ story/n ews/2017 /07 /02/why-v a~owns-gol f-clubhouses-barn s-andsmoking-shelter-and-how-its-trying-uni oad-them/408343001 / Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001028 DS_00021744 Message From: Sent : To; L Perl (b) (6) @gmail.com] 7/3/2017 1:59:11 PM David shulkin [Drshulkin@aol.com] Ike Perlmutter a@frenchangel59.com]; ( Marc Sherman [mb (b) (6) @gmail.com]; Bruce Moskowitz (b) (6)b(b) [brucemcll?lill@mac.com] Subject : Re: ) (6) ( 6 ) It is best to sell these properties asap----- we don't have the people CC: or the talent to handle the homeless situation-- it will cost huge sums of money to fix these places up. On Sun, Jul 2, 2017 at 5:00 PM, David shulkin wrote : See below http ://www.tennessean.com/ story/news/201 7/07 /02/why-v a-owns-go If-club houses-bams-and-sm oki ng-shel terand-how-i ts-trying-unload-them/ 40834 3 00 I/ Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001029 DS_00021745 Message From: David shulkin [Drshulkin@aol.com] Sent : 7/2/2017 10:00:58 PM To ; Bruce Moskowitz [bruce (b) (6) (b) @mac.com] Re: (6) Subject: We will save you a spot Sent from my iPhone On Jul 2, 2017 , at 5:20 PM , Bruce Moskowitz wrote : My wife said if she puts me in the old soldiers home at least you can increase occupancy to 4! Sent from my iPhone On Jul 2, 2017 , at 5:00 PM, David shulkin wrote: See below http ://www .tennessean .com/ story/news/201 7/0 7/02/why-va-own s-go] fclubhouses-barns-and-sm oking-shelter-and-how-i ts-tryi ng-unJ oadthem/408343001/ Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001030 DS_00021746 Message David shulkin [Drshulkin@aol.com] 7/2/2017 9 :58:30 PM Marc Sherman [mb (b) (6) @gmail.com] Bruce Moskowitz [bruce (b) (6) (b) @mac.com]; L Perl (b) (6) ill@frenchangel59 .com l (6) ( From: Sent: To ; CC: @gmail.com]; Ike Perlmutter Re: b Subject: ) ( 6 ) Sent from my iPhone On Jul 2, 2017, at 5:30 PM, Marc Sherman <- (b) (6) wrote : Can you get us a 10 a.m . tee time next Saturday before it's disposed of? Marc Sherman (b) (6) On Jul 2, 2017 5:20 PM, "Bruce Moskowiti' wrote : (6)can increase occupancy to 4! My wife.said if she puts me in the old soldiers home at least you Sent from my iPhone On Jul 2, 2017, at 5:00 PM, David shulkin wrote: See below http://www .tennessean.com/story/news/2017/07/02/why-va-owns -golfclubhouses-barns-and-sm oking-shel ter-and-how-i ts-trying-unloadthem/408343001/ Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001031 DS_00021747 Message Marc Sherman [mb (b) (6) @gmail.com] 7/2/2017 9 :30:53 PM Bruce Moskowitz [bruce (b) (6) (b) @mac.com) L Perl ??? enchangel59 .com] (6)shulkin [drshulkin@aol.com] ; Ike Perlmutter !l@fr (b) (6) @gmail.com); David ( From: Sent : To ; CC: Subject: Re: Can you get us a 10 a.m. tee time next Saturday before it's disposed of? b ) ( 6 ) Marc Sherman (b) (6) On Jul 2, 2017 5:20 PM, "Bruce Moskowitz 11 wrote : (6)can increase occupancy to 4! My wife said if she puts me in the old soldiers home at least you Sent from my iPhone On Jul 2, 2017 , at 5:00 PM , David shulkin wrote: See below http ://www. tennessean. com/ story/n ews/2017 /07 /02/why-va-own s-gol f-clubhouses-barn s-andsm oki ng-shelter-and-how-i ts-trying-unload-them/408343001 / Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001032 DS_00021748 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com] 7/2/2017 9 :20:36 PM (6) David shulkin [Drshulkin@aol.comJ Ike Perlmutter ? ( @frenchangel59.com]; Marc Sherman [mb (b) (6) @gmail.com]; Laurie Perlmutter b (b) (6) @gmail.com] Re: ) From: Sent : To ; CC: Subject: ( 6 My wife said if she puts me) in the old soldiers home at least you can increase occupancy to 4! Sent from my iPhone On Jul 2, 2017 , at5:00 PM, David shulkin wrote: See below http ://www .tennessean .com/story/news/201 7/07 /02/why-v a-owns-golf-club houses-barns-andsm oking-shelter-and-how-i ts-trying-uni cad-them/ 408343001 / Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001033 DS_00021749 Message From: Sent : To ; CC: David shulkin [Drshulkin@aol.com] 7/2/2017 9 :00:06 PM Ike Perlmutter a@frenchangel59.com] ( b (b) (6) @gma il.com]; Bruce Moskowitz [bruce (b) (6) (b) @mac.com]; Laurie Perlmutter Marc Sherman [mboo? ) (6) (b) (6) @gmail.com] See below ( 6 ) http:/ /www .tennessean .com/story/news/2017/07/02/why-va-owns-golf-clubhouses-barns-and-smoking-shelter- and-how-its-trying-unload-them/408343001/ Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001034 DS_00021750 Message Sent: David Shulkin [drshulkin@aol.com] 6/20/2017 10:39:07 AM To: (b) (6) From: -(b) (6) veterans (b) (6) @gmail.com] the talk on Friday to the bush people need to includ and the bush institute contributions The mayors talk should in clued rdcognition ecognition of bushs efforts of some of the mayors who really stepped to help up veteran efforts Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-001035 OS 00021751 Message From: Sent: To : CC: Subject: #J- below Poonarn Alaigh (b) (6) @gmail.com] 8/30/2017 3:25:36 PM IP !1@frenchangel59.com] ( David b Shulkin [Secshulkin@gmail.com] Fwd: ) Peter Shelby - HR ( 6 ) ---------- Forwarded message--------From : Poonam Alaigh ~(b) (6) Date : Wed , Aug 30, 2017 at 11:15 AM Subject: Peter Shelby - HR (b) (6) To:--(b) (6) > > Peter She1by- HR Assistant Secretary for Office of Human Resources & Administration As Assistant Secretary ofVA ' s Office of Human Resources & Administration (HR&A) , Peter Shelby oversees a team that supports over 325,000 VA employees and 6,000 human resources professionals across the country . To meet the needs of the VA workforce , Mr . Shelby leads an HR&A team who provides professional assistance in the areas of Administration, Human Resources Management, Diversity and Inclusion, Resolution Management, Labor-Management Relations, Veterans Employment, Employee ._______ _, Development and Senior Executive Management. Prior to assuming his current position , Mr . Shelby is Principal and Founder of Transcendent Performance, an HR and talent development consuJting practice . Previously, Peter was a Senior Vice President with Related Companies in New York City . Prior to his work in the private sector, Mr . Shelby served in several human capital leadership roles in the lntelhgence Community, including Associate Dean at Na6onal Intelligence University , Chief Lea.rning Officer for National Reconnaissance Office (NRO) , and Deputy for Learning and Development for the Defense Intelligence Agency . Mr . Shelby retired from the Marine Corps as a Major after 24 years of non-commissioned and commissioned officer service. Peter holds an MBA in Human Resources Management from Northcentral University, and a faster of Arts in Adult Education from George Mason University . He received his Bachelor of Arts in English Literature (summa cum laude) from The Citadel. He is a certified Senior Professional in Human Resources , a:nd SHRNI Senior Certified Professional . Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-G-001036 DS 00021752 Message From: David Shulkin (secshulkin@gmail.com] Sent : To : 8/18/2017 9:03:14 PM Ike Perlmutter [l@frenchangel59.com] ( Subject: Re: Accomplishents b ) ( 6 It looks like the slide is cuttoff so ill reaend tonight ) Sorry Sent from my iPhone On Aug 18, 2017 , at 4 :52 PM , David Sbulkin wrote : Just in case you had not received earlier David Sent from my iPhone Begin forwarded message : From: David Shulkin Date: August 17, 2017 at 9:05:51 PM EDT To: secshulkin@gmail.com Subject: Accomplishents AMERICAN PVERSIGHT VA-19-0799-G-001037 DS_00021753 Message David Shulkin (secshulkin@gmail.com] Sent : 8/18/2017 8:52:16 PM To : Ike Perlmutter.@frenchangel59.com] ( Subject: Fwd: Accomplishents b Attachments : Veterans Affairs) Progress Since 1.pptx; Untitled attachment 96434 .htm From: ( 6 ) Just in case you had not received earlier David Sent from my iPhone Begin forwarded message : From: David Shulkin Date: August 17, 2017 at 9:05:51 p_NfEDT To: secshulkin@gmaiLcom Subject: Accomplishents AMERICAN PVERSIGHT VA-19-0799-G-001038 DS_00021754 Veterans Affairs ProgressSince 1/20/2017 o Executive Order- Established Accountability and Whistleblower Office Reporting to Secretary o Passed Accountability Law- Published over 750 Firings/Suspensions o Announced a New Electronic Record for the Department of Defense and VA o Published Wait Times for Appointments o Released Plans to Eliminate 1100 Vacant/Underutilized Buildings o Passed Choice and Quality Employment Legislation o Launched the White House Hotline - Addressed Thousands of Veteran Complaints o Introduced New Commercial Advanced Prosthetic for Veterans o Passed Forever GI Education Bill o Launched Private/Public Construction Model {First one in Omaha) o Redesigned Caregivers Program to expand services o Passed Appeals Modernization Legislation o Eliminated Federal Regulations Governing State Nursing Home Construction o Created Fraud, Waste and Abuse Advisory Group o Introduced New Process for Disability Claims for 30 days Resolution {Decisio n Ready Claims) o New Tele-Health Regulation to Disseminate Adv anced Technology to Rural Veterans o Announced Mental Health Care for Other than Honorable Discharges to Address Suicides o Passed the Mark of 600,000 Veterans Employed through Employment Initiative s AMERICAN PVERSIGHT VA-19-0799-G-001039 OS 00021755 040 Message From: Sent: To: Subject: Attachments: David Shulkin [secshulk in@gma il.com] 8/18/2017 1:07:24 AM Ike Perlmutter [ll@frenchangel59.com] ( Fwd: Accompl ishents b Veterans Affairs) Progress Since 1.pptx; Untitled attachment 96439.htm ( 6 ) Ike- i hope this one pager is helpful AMERICAN PVERSIGHT VA-19-0799-G-001041 OS 00021757 Veterans Affairs ProgressSince 1/20/2017 o Executive Order- Established Accountability and Whistleblower Office Reporting to Secretary o Passed Accountability Law- Published over 750 Firings/Suspensions o Announced a New Electronic Record for the Department of Defense and VA o Published Wait Times for Appointments o Released Plans to Eliminate 1100 Vacant/Underutilized Buildings o Passed Choice and Quality Employment Legislation o Launched the White House Hotline - Addressed Thousands of Veteran Complaints o Introduced New Commercial Advanced Prosthetic for Veterans o Passed Forever GI Education Bill o Launched Private/Public Construction Model {First one in Omaha) o Redesigned Caregivers Program to expand services o Passed Appeals Modernization Legislation o Eliminated Federal Regulations Governing State Nursing Home Construction o Created Fraud, Waste and Abuse Advisory Group o Introduced New Process for Disability Claims for 30 days Resolution {Decisio n Ready Claims) o New Tele-Health Regulation to Disseminate Adv anced Technology to Rural Veterans o Announced Mental Health Care for Other than Honorable Discharges to Address Suicides o Passed the Mark of 600,000 Veterans Employed through Employment Initiative s AMERICAN PVERSIGHT VA-19-0799-G-001042 OS 00021758 043 Message David Shulkin [secshulkin@gmail.com] Sent : 8/18/2017 1:26:49 AM To ; IP !1@frenchangel59.com] ( Subject: Re:bThe VAand Cancer Patients ) ( 6 followup Of course- we will ) From: Sent from my iPhone On Aug 17, 2017, at 3:43 PM , IP ~( @frenchangel59 .com> wrote : When you get a b chance )( plea se 6) read. Our veter ans shou ldn't have to fight for basic ca re and treatment. We need to fix thi s. (b) (6) (b) (6) From:-[~ Sent: Thursday, August 17, 2017 6:53 AM To: IP Subject: The VA and CancerPatients One of my patients has stage 4 lung cancer too and I had to pull him away from the VA to get treated He lost so much weight that I knew something was wrong The whole culture there is wrong - many think that their jobs are entitlements and the patients are an annoyance Many have Medicare so I can remove them from the YA and get them into regular care A few would speak but not put stuff in writing because of retaliation Thanks (b) (6) (b) (6) MDFAAD Professor , University of Miami . Consulting Associate , Duke University . Clinical Associate in Dermatology , University of Pennsylvania School of Medicine www .palmbeachcosmetic .com (b) ~ (6) 1500 North Dixie Highwav, Suite 303 West Palm Beach, FL 33401 AMERICAN PVERSIGHT VA-19-0799-G-001044 DS_00021760 Message From: Sent : To ; Subject: Poonam Alaigh (b) (6) @gmail.com ] 8/ 17/20 17 7:58:40 PM IP !1@frenchangel59. com]; Secshulkin@gmail .com ( Re:bFW: The VA and Cancer Patien ts ) ( lam having my 6deputy contact Dr ..(b) ) (6) today , and will give you an update thanks ( @frenchangel5 9 .com> wrote : On Thu , Aug 17, 20 17 at 3 :43 PM IP <11 When you get a chance b ) please read. ( 6) Our veterans should n't have to fig ht for basic care and trea t ment. We need to fix t his. (b) (6) (b) (6) From:-[~ Sent: Thursday, August 17, 2017 6:53 AM To: IP Subject: The VA and CancerPatients One of my patients has stage 4 lung cancer too and I had to pull him away from the VA to get treated He lost so much weight that I knew something was wrong The whole culture there is wrong - many thin k that thei r jobs are entitlements and the patients are an annoyance Many have Medicare so I can remove them from the VA and get them into regul ar care A few would speak but not put stuff in writing because of retaliation Thanks (b) (6) (b) (6) MDFAAD Professor , Unive rsity of Miami . Consulting Associate , Duke University. Clinical Assoc iate in Dermatology , Uni versity of Pennsylvan ia School of Medicine www .pa1mbeachcosmetic .com AIVlt-Hll.,AI PVERSIGHT VA-19-0799-G-001045 DS_00021761 (b) ~ . (6) Dixie Highwa y, Swte 1500 North " 30., West Palm Beach , FL 33401 AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001046 DS_()0021762 Message From: Sent: To : Subject: IP !1@frenchangel59.com] ( 8/17/2017 7:43:24 PM b (b) )(6) @gmail.com ; Secshulkin@gmail.com ( The VA and Cancer Patients FW: 6 ) When you get a chance please read . Our veterans shouldn't have to fight for basic care and treatment . We need to fix this. (b) (6) (b) (6) From:-[~ Sent: Thursday, August 17, 2017 6:53 AM To: IP Subject: The VA and CancerPatients One of my patients has stage 4 lung cancer too and I had to pull him away from the VA to get treated He lost so much weight that I hew something was wrong The whole culture there is wrong - many think that their jobs are entitlements and the patients are an annoyance Many have Medica re so I can remove them from the VA and get them into regular care A few would speak but not put stuff in writing because of retaliation Thanks (b) (6) (b) (6) MDFAAD Professor, University of Miami . Consulting Associate , Duke University. Clinical Assoc iate in Dennatology , Universi ty of Pennsylvania School of Medicine www.palmbeachcosmetic.com (b) IDill.11111 (6) 1500 North Dixie Highway, Suite 303 West Palm Beach, FL 33401 AMERICAN PVERSIGHT VA-19-0799-G-001047 DS_00021763 Message From: Marc Sherman [mb (b) (6) @gmail.com] Sent : 7/13/2017 4:06 :02 PM To : David shulkin [Drshulkin@aol.comJ Re: VA HR Director Search Subject: No problem . Many moving parts and a successful conclusion. Marc Shennan (b) (6) On Jul 13 201 7 11 :55 AM "David shul kin" wrote: Thanks Marc- so1Tyfor the miscommunication Sent from my iPhone On Jul 13 2017, at 12:36 PM, Marc Sherman <- (b) (6) > wrote: FYI ---------- Forwarded message---------From : Marc Sherman <- (b) (6) > Date : Thu, Jul 13, 2017 at 6:35 AM Subject: VA HR Director Search To : IP (b frenchan el59 .corn>, L Perl - (b) (6) > ) (b) (6) (b) (6) Cc: omail.com >, Bruce Moskowitz (6(b) (6) ) (b) (6) (b) 11111 (6) Great news!!!! By a stroke ofluck and coincidence, the VA has just identified an HR Director candidate . The process with him has gone lightening fast and be wiJl move fo1ward to bead HR . I wanted to let you know immediately so you (and others) don't spend any more of your valuable time in 11search mode ." We again express our great appreciation for your stepping in to help solve that first critical need. We did speak to the Secretary about how wonderful AU and you have been and the great things that you offered about post-hiring advisory and online training and he would love the new HR Director to directly explore that further with you once he gets settled in his new role . Once I have a chance to meet with the new Director (after my vacation :-) ) I will be back in touch with you to set up a get together . Thanks again for everything. Best 1 Jarc AMERICAN PVERSIGHT VA-19-0799-G-001048 DS_00021764 Message David shulkin [Drshulkin@aol.com] From: Sent : 7/13/2017 3:55:27 PM To : Marc Sherman [mb (b) (6) @gmail.com] Re: VA HR Director Search Subject: Thanks Marc- sorry for the miscommunication Sent from my iPhone On Jul 13, 2017, at 12:36 PM, Marc Shem1an <- (b) (6) > wrote : FYI ---------- Forwarded message---------From : Marc Sherman <- (b) (6) > Date : Thu, Jul 13, 2017 at 6:35 AM Subject: VA HR Director Search To: IP ( c frenchanoeJ59 .com>, L Perl ~(b) (6) > b (b) (6) (b) (6) Cc: nail.com >, Bruce Moskowitz )(b) (6) ( 6) (b) (6) (b) 1111 (6) Great news!!!! By a stroke of luck and coincidence, the VA has jus t identified an HR Director candidate . The process with him has gone lightening fast and he will move fo1ward to head HR_ I wanted to let you know immedjately so you (and others) don't spend any more of your vaJuable time in "search mode." We agrun express our great appreciation for your stepping in to help solve that first critical need . We did speak to the Secretary about how wonderful AU and you have been and the great things that you offered about post-hiring advisory and online training and he would love the new HR Director to directly explore that further with you once he gets settled in his new role . Once I have a chance to meet with the new Director (after my vacation :-) ) [ will be back in touch witl1 you to set up a get together. Thanks again for everything . Best AMERICAN PVERSIGHT VA-19-0799-G-001049 DS 00021765 Message From: Marc Sherman [mb (b) (6) @gmail.com] Sent : 7/13/201710 :36:53 AM To : David shulkin [drshulkin@aol.com] Fwd: VA HR Director Search Subject: FYI ---------- Forwarded message-------~-From : Marc Sherman <~ (b) (6) > Date : Thu, Jul 13, 2017 at 6:35 AM Subject: VA HR Director Search (b To : ..liiiii' ange159.com>, LPerl - (b) (6) ) (b) (6) Cc: (b) (6) G mail.com >, Bruce Moskowitz Date: August 29, 2017 at 1:32 :29 PM EDT (b) (6) ' o o 1 hulkin@aol.com (b) (6) (b) (6) (b) (b)(6) (6) , Bruce Moskowitz (b) ) . arc Shennan <- (b) (6) (6 hotmail(6) .com> ) (b) (6) (b) (6) > Poonam Alaigh Subject: RE: Update on VA activities David We are already working with you on procurement and IT. We would be happy to also help with Graduate Medical Education and Research overview . Please let us know how (b) (6) (b) (6) M.D . Dean of the Medical FacuJty CEO , Johns Hopkins Medicine 733 N Broadway/ Suite 100 Baltimore , MD 21205 (b) (6) (b) (6) -----Original Message---F rom : David shulkin [mailto :Drshulkin@aol.com ] Se11 t Tuesday , Augus129 , 201712:21 PM To: (b) (6) M.D. (b) (6) PARTNERS.ORG>; (b) (6) AMER1 HI PVERSIGHT VA-19-0799-G-001051 DS 00021767 - (b) (6) ~ (b) (6) (b) (6) (b) (6) (b) (6) (b Cc: Ik ) Subject: Update on VA activities (b) (6) . , arc Sherman <~ (b) (6) 11111 (b) (6) ma o.edu>; (b) (6) .oro> >; Poonam Alaigh Dear Colleagues- much has happened in this first seven months to set VA on an improved path - including a record 5 pieces oflegislation that were passed with full bipartisan support . There is still a lot to do . There are 11 areas that we could use your jnstitutions assistance with- ill list them here hoping that some areas might be a good fit for your organ ization to take a lead on assisting with- and certainly if you are interested in specific ones we could discuss in more detail I. Procurement and Log istics 2. Human Resource Reorg 3. Finance and Budgeting 4. fT 5. Pub]jc Relations 6. Cost and Util ization of the Choice Network 7. Construction and Facility Management 8. Graduate Medical Education 9. Research overview IO. Quality measurement of the Choice network 11. Cost saving opportun ities Thanks for your thoughts if any of these 11 might be something your organization wou ld lead on and thank you for your continued support AMEf -..,, pVERSIGHT VA-19-0799-G-001052 D8_00021768 David Shulkin Sent from my iPhone 053 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 6/19/2017 10:11:59 PM (b) (6) (b) @mac . com] Bruce Moskowitz [brucerrl???? To: Poonam AlaighI(b) (6) @hotmail.com]; .com]; L Perl (6) mbs(b) (6) @gmail.com; IP ll@frenchangel59 ( @gmail.com] b (b) (6) Subject: Re: HR ) ( 6 ) Bruce- is there a contact at AU that we can connect with? CC: Sent from my iPhone (b) (6) (b) > on Jun 19, 2017, at 2:53 PM, Bruce Moskowitz wrote: > (6) > The American University is willing to donate the time to do the following: > >Setup an online > > Have their > > Invite employees whole Department come in and assist leadership > course for training > They actively to their twice yearly in any way that would be beneficial leadership work with the Cleveland clinic conference. so they are well versed on HR for medical institutions. > > > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-001054 OS 00021770 Message From: Sent : To : CC: l Perl (b) (6) @gmaif.com] 6/19/2017 9:29:00 PM Bruce Moskowitz [bruce (b) (6) (b) @mac.com] David shulkin [drshulkin@aol.com]; (6) Poonam Alaigh I(b) (6) @hotmail.com]; Marc Sherman [mb-?l@gmail.comJ ; IP ll@frerichangel59 .coJ11l (b) (6) ( Re: HR b ) ( 6 Absolutely terrific news--- you are amazing! L ) Subject ; On 1vfon,Jun 19, 2017 at 3 :53 PM, Bruce Moskowitz wrote: Set up an online course for training employees Have their whole Department come in and assist in anyway that would be beneficial Invite leadership to their twice yearly leadership conference . They actively work with the Clevela.t1dClinic so they are well versed on HR for medical institutions . Sent from my iPad Brnce Nloskowitz M .D . AMERICAN PVERSIGHT VA-19-0799-G-001055 DS 00021771 Message Bruce Moskowi t z [bruce (b) (6) (b) @mac .com] 6/19/2017 7:53:41 PM (6) David shu lkin [drshul kin@aol .com]; Poonam Alaigh ??l@hot mail.com] (b) (6) mb (b) (6) @gmail.com; IP ll@frenchange l59.com]; L Perl (b) (6) @gmail.com] ( From: Sent: To: CC: b ) ( 6 The American University is willing to ) donate the time to do the following: Set up an online course for training employees HR Subject: Have their Invite whole Department come in and assist leadership They actively to their twice yearly in any way that would be beneficial leadership work with the Cleveland clinic conference. so they are well versed on HR for medical institutions. sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-001056 OS 00021772 Message IP !1@frenchangel59.com] ( 8/18/2017 9:02 :28 PM b 'David ) Shulkin' [secshulkin@gmail.com] RE:(Accomplishments From: Sent : To : Subject: 6 ) Thank you David. I received and its perfect. I am taking this tomorrow with me. Also working on a second list which I am curren t ly making some changes on - I will email you soon so you can give me your input . Thank you, Ike From: David Shulkin[mailto:secshulkin@gmail.com] Sent: Friday,August 18, 2017 4:52 PM To: Ike Perlmutter Subject: Fwd: Accomplishents Just in case you had not recei ved earlier David Sent from my iPhone Begin forwarded message : From: Dav id Shulkin Date: August 17, 2017 at 9:05:51 PM EDT To: secshulkin@gmaiLcom Subject: Accomplishents AMERICAN PVERSIGHT VA-19-0799-G-001057 OS 00021773 Message Poonarn Alaigh I(b) (6) @hotmail.com] 7/15/2017 2:22 :00 PM David Shu Ikin (drshulk in@aol .com] Re: for decision - GPO Changes Rel12ase-- do not issue From: Sent : To : Subject: Agree David- my team was ready to send something out on Wednesday but the 10th floor with John who brings the pinheads into every discussion blocked it and thought it was not good to do. This is like the Care Giver issue- has been simmering and will explode if not preemptively addressed in a larger, positive and veteran centric context We will have to clean up after the story vs creating the story. I am very concerned about John and OPIA being able to deliver what we need at VHA. Let's talk more about this. l have an entire list of things to discuss with you- let's try later today or tomorrow Sent from my iPhone On Jul 15, 2017, at 3:12 PM, Alaigh , Poonarn , M.D. wrote: Sent with Good (www .good.com ) -----Original Message----From: DJS Sent: Saturday July 15, 2017 09:5'1 ANr Eastern Standard Time To: AJaigh.,Poonam, M .D. Subject: FW: for decision - GPO Changes Release -- do not issue Th.is is getting too tnany cooks for now- let's stay off of further emails till we decide how best to address Sent with Good (www .good.com ) -----Original Message----From: Tucker, Brooks Sent: Saturday, July 15, 2017 08 :57 AM Eastern Standard Time To: Leinenkugel , Jake ; DJS~Blackburn, Scott R .; Ullyot, John ; Alaigh, Poonarn , M .D. Cc: Wright Vivieca (Simpson) ; O'Connor , Christopher Selnick, Darin Subject: RE : for decision - GPO Changes Release -- do not issue I had too many to recall frustrating engagements with VACO and VlSN 6 in NC from 2010-2015 on behalf of SEN Burr around this shift to limiting or re scoping GPD and a new NOFA process to apply. The VA resistance to a State funded transitional housing facility with wraparound services seeking formal partnership with VA was most perplexing and highly bureaucratic . Only AMERICAN PVERSIGHT VA-19-0799-G-001058 DS 00021774 after engaging VE through Lynda Davis and Scott did it finaUy get attention and some traction , but it took many intervening years. There has to be a better way to do this , possibly by leveraging IGA and the CYEBs. PIT counts are superficial and do not capture the fu ller and insicLiousnature of a problem where many who would need services are living out of cars and on peop le's couches or on the cusp of those outcomes and are out of public sight. When Burr looked at NC "unique'' v isitors to VA who identified as homeless that number was much larger than the P[T I think VA should expect and inspect not dictate , Sent with Good (wvvw.good.com ) -----Original Message----From: Leinenkugel , Jake Sent: Saturday , July 15, 2017 08 : 19 AM Eastern Standard Time To: DJS ; Blackbum , Scott R.; Ullyot , John ; Alaigh, Poonam , M.D . Cc: Wright , Vivieca (Simpson); O'Connor , Christopher ; Tucker , Brooks ; Selnick, Darin Subject: RE: for decision - GPD Changes Release -- do not issue I think we shou ld begin discussion of considering a hand off to States with largest homeless populations . Ramp up State & County VA resources , align with governors and mayors . VAMC's cou ld be centers for rneetin,gs and coord inated efforts (rele vance for engagi.ng youn,ger Vets) . My point is giving up our VACO contro l, administratio n, scorecard of GPS & PIT's , ongoing congressional pressures and time/resource laden queries and responses . Tum over agreed upon budget to States and let them pinpoint stressed population centers, establish their most effective local programs , bring in pri v ate donors and activate VSO's and establish their stand downs , scorecards and success measurements. Governors and Ma yors cou ld discuss status and needs at their annua l Governor & Mayor Conferences. V ACO cou ld announce annua l awards programs for top States/Cities . Another initiative that should come under modernization . Maybe include same approach for Suicides? Believe this cou ld become big idea for future major SECY AIWH announcement, surrounded by key governors and mayor s. Apologize for weekend ramble. Sent w ith Good (www .good.com ) -----Origina l Message--- - From: DJS Sent: Saturday , July 15, 2017 12:46 AM Eastern Stan dard Time To: Blackbum, Scott R.~U llyot, John ; AJaigh, Poonam , M.D. Cc: Wright, Vivieca (Simpson); Leinenkugel , Jake; O'Connor , Christopher Subject: RE : for decision - GPD Changes Release -- do not issue Should we consider the "transparency" strategy and pub lic ally list the pit counts- where we are making progress and where we are not ? AMERICAr-... pVERSIGHT VA-19-0799-G-001059 DS 00021775 Sent with Good (www.good.com ) -----Ori gin al Message----From: Blackbum , Scott R. Sent: Friday , July 14, 2017 06:42 PM Eastern Standard Time To: Ullyot , John ; Alaigh, Poonam , M.D. Cc: Wright, Vivieca (Simpson); DJS ; Leinenkuge l, Jake; O'Connor, Christopher Subject: RE : for decision - GPD Changes Release -- do not issue Regarding homelessness communications, we need to align on a few things to make sure we have a good strategy to manage the messaging from now (starting with the GPD announcement) through the end of the year (when PIT count is released). 1. < !--[endif]--> Grant Per Diems (GPS) . There will be winners and losers. I know the Secretary is working with the team on a decis ion on how to deal with the losers. This is out of the Vermont (Sanders) discussions . eed to settle that before announcing this on GPD . 2. < !--[if !supportLists]-- >< !--[endif]--> The Point in Time (PIT) count numbers for 2017 (which was done in ~January 2017) will be released in early Fall and they aren 't going to be good . LA is the biggest problem . We are actively working to mitigate this (which is why've I've been out there twice and have working closely with the LA team and the Homelessness team) . We need to be careful in our communications. The truth is that we are doing great stuff and this is still a priority, but this is also a complex problem . 3. < !--[if tsupportLists]-- >< !--[endif]--> Our homelessness goal. Seems we are pivoting off the "zero" goal, which is ok. But people in this community are nervous fueled by some of the interagency work being defunded in the overall President ' s budget. The question we are getting is "is this still a priority for you and are you really committed? " . The answer is "yes" that we are still committed , we just need to make sure we nail the communications . We also did a national posting for our Homelessness leader which closed last week. I'm hoping some top notch external candidates get through our certs (I know of at least one outside star that applied). We should see what the timeline is for that. From: Ullyot, John Sent: Friday, July 14, 2017 2:58 PM To: Alaigh, Poonam,M.D. Cc: Wright, Vivieca(Simpson); DJS;Blackburn,Scott R.; Leinenkugel, Jake; O'Connor, Christopher Subject: Re: for decision - GPDChangesRelease-- do not issue AMERICAN PVERSIGHT VA-19-0799-G-001060 OS 00021776 + Scott/Jake/Chris O'Connor Thanks Poonam - we heard from Scott and Chris and lhmk we should all have a discussion 011 this as there are real risks for doing a release, particularly after SecVA 's conversation with Senator Sanders. Lets us know when we can set up a call. Thanks everyone, John U. From: "Alaigh, Poonam , M .D." Date: Friday , July 14, 2017 at 2:01 PM To: Department of Veterans Affairs Department of Veterans Affairs Cc: "Wright Vivieca (Simpson)" , DJS Subject: RE : for decision - GPD Changes Re1ease -- do not issue John - is yonr team working on this now? Sent with Good (www.good .com) -----Original Message----- From: Alaigh, Poonam, M.D. Sent: Friday. July 14, 201712:58 AM Eastern Standard Time To: Ull ot, John Cc: Wright, Vivieca (Simpson); DJS Subject: FW: for decision - GPO Changes Release -- do not iSSL1e Thanks for your gtudance John, but we in VHA, the business unit, would like to proceed with the press release. Tlis importru\l for the community to know the positive changes we are making in our Homeless progrrun and our commitment lo our communil)' parl11ersas v e make posi6ve changes to IJ1eprogram. I am fine with broadeni1,g lhe message based on your teams inp\ll but somethjng needs lo go oul Sent with Good (www .good.com) -----OriginaJ Message----From: Screen, Gina Seot: Thursday, July 13 2017 02:5 1 PM Eastern Standard Time AMERICAN PVERSIGHT VA-19-0799-G-001061 DS 00021777 To: Alaigh , Poonam M .D. . Jensen, Jon M .; Lynch, Thomas (VHA). Pape Lisa M . Cc:-(b) (6) Subject: FW : for decision - GPD Changes Release -- do not issue All - Ijust wanted to provide an update to Dr. Alaigh' s request for a news release on GPD. Gina From: (b) (6) (CLS-House) Sent: Thursday, July 13, 2017 2:49 PM To: Tallman, Gary; Screen,Gina Cc: (b) (6) (b) (6) (VACO);Cashour,Curtis; (b) (6) (VACO) Subject: RE: for decision - GPDChangesRelease-- do not issue Agree that we should hold on releasing at this point. The only significant push back has been from Sanders . (b) (6) From: Tallman, Gary Sent: Thursday, July 13, 2017 2:42 PM To: (b) (6) Cc: (b) (6) (b) (6) (CLS-House);Screen,Gina (VACO);Cashour,Curtis; (b) (6) Subject: FW: for decision - GPDChangesRelease -- do not issue (VACO) (b) Ginallllll (6) h1 terms of an active press release, the answer on that tactical approach was 'no ' (see below) ; however, the messaging from the draft release and the planning products are fine from a press standpoint as an "RTQ " ifwe get media requests . Q/A gets into good specifics. Assessment is that this is not a ' burning platfon n ', and we don 't need to light it. So far, we 're aware of one media query . If we get enough media requests we can look to line the SMEs up perhaps for a AMERICAN PVERSIGHT VA-19-0799-G-001062 OS 00021778 quick roundtable engagement (subject to further coordination) . from members . More interest is anticipated Ron : view from OPIA is that the more active approach on this is more appropriate via member/committee engagement. If OCLA thinks the messaging is good , recommendation is member briefing/call route on this one . Thanks Gary Gary C Tallman Executive Direclnr Office of Public and Jntergove rn111 entaf Aff airs Office : 202-4 6 1-7 ./30 Ce!/: 202- 603-././08 garv. talfman(a),va .gov From: Ullyot, John Sent: Thursday, July 13, 2017 2:17 PM To: Cashour,Curtis Cc:Tallman, Gary; Hutton, James;Wagner,John (Wolf) Subject: Re: for decision- GPDChangesRelease-- do not issue Thanks Curt - agree no release should be sent out on this, and we should just use the release inform ation to respond to individual requests that come in. Also, we shou ldn' t attribute the quo te to the Secretary , but rather to (b) (6) release , this is moot , and the responses can just be from you or James via emai l. Since we 're not issuing a Thanks , John U. AMERICAr-... pVERSIGHT VA-19-0799-G-001063 DS_00021779 From: Curt Cas hour Date: Thursday , July 13, 2017 at 12:34 PM To: Department of Veterans Affairs Department of Veterans Affa irs Cc: "Tallman , Gary" , "Hutton, James" , Wolf Wagner Subject: for decision - GPD Changes Relea se John, The USH wants to blast out the attached press release (GPO OFA Draft NRL gt edits) . The bottom line is that VA has made adjustments to a home less veteran grant program called Grant Per Diem that is resulting in some grantees - some of whom have relied on VA funding for many years - to lose their funding . We have had one media inquiry on this issue so far, but I'm sure we will get others . I think the info in the release will be great to share when we get questions from the press , but I don 't think it makes sense to do a release at this time, as it will likely result in a lot of negative attention . Let me know what you think . Thanks , Curt Cashour Press Secretary Department of Veterans Affairs 202-461- 73 88 Curt. Cashour@va.gov @curtcashour From: Tallman, Gary Sent: Thursday, July 13, 2017 10:57 AM To: (b) (6) (b) (6) Cc: (b) (6) (VACO) (VACO);Screen,Gina; (b) (6) Subject: RE: GPDPressRelease AMEF\I\_.Jr I PVERSIGHT (CLS-House);Cashour,Curtis VA-19-0799-G-001064 OS 00021780 Thanks (b) (6) (b) (6) good package of info here . Gina : the initial draft release on this needed a lot of re-work ; it ' buried the lead ' and didn' t get to the clear ' why ' this is being done . I have reworked the draft. Please use my version going forward for draft coordination . Curt: Per the 8:30 meeting , I think we need to raise this up in terms of 1) do we need an active release and 2) when. Given the significant changes to this program , and that letters are alread y starting to come in from members on behalf of applicants that have in the past been , but are not now, gettin g selected , that it is in our interest to get something out on this. Gary C Tallman Ex.ecutive Director Office of Pub lic and Intergovern mental Affairs Office: 202-461-7430 Cell: 202-603-4408 gary.tallman@va.gov From: (b) (6) (b) (6) (VACO) Sent: Thursday, July 13, 2017 9:59 AM To: Tallman, Gary Cc: (b) (6) (VACO) Subject: FW: GPDPress Release +Gary Tallman for awareness AMERICAN PVERSIGHT VA-19-0799-G-001065 OS 00021781 From: (b) (6) Sent: To: (b) (6) (b) (6) Cc: (b) (6) (b) (6) (VACO) Subject: FW: GPOPress Release Including you two for awareness . (b) (6) Fellow PRSA Senior Comm unications Specialist , VHA Office of Communications Media Relations Team Email : VHAC010B2BMedia@VA.GOV Mobile (b) (6) Work : (b) (6) Virtual Emp loyee Phoenix, AZ (NIST) From: (b) (6) Sent: Wednesday,July 12, 2017 2:03 PM To: (b) (6) Subject: RE: GPOPressRelease For your conside ration . From: (b) (6) Sent: Wednesday,July 12, 2017 4:51 PM To: (b) (6) (b) (6) (VACO);(b) (6) Subject: RE: GPOPress Release (VACO);(b) (6) They were great and we have a draft being edited as we speak . Shall we include you on the final version for awareness or??? Also is there an org chart for the national Homeless . Veterans Office with peop le listed? (b) (6) AMERICAN PVERSIGHT APR, Fe llowPRSA VA-19-0799-G-001066 DS 0002178 2 Senior Commwiications Specialist, VHA Office of Commwiications Media Relations Team Email: VHACO10B2BMed1a@V A.GOV Mo bile : (b) (6) Work: (b) (6) Virtual Emp loyee Ph oenix, AZ (MSn From: (b) (6) (b) (6) (VACO) Sent: Wednesday,July 12, 2017 11:06 AM To: (b) (6) (b) (6) (VACO);(b) (6) Subject: RE: GPDPressRelease I recommend speaking with (b) (6) ru1d(b) (6) about it. They're the SM Es and wil.lgive you all the guidance you need to prepare the release. They're also very easy to work with . - (b) (6) From: (b) (6) Sent: Wednesday,July 12, 2017 2:01 PM To: (b) (6) (VACO);(b) (6) (b) (6) (VACO);(b) (6) Subject: FW: GPOPress Release Looping you guys in do you have awareness or visibility on this program? Jon Jensen has sent a draft p]an wh ich I can try to pull together a news release from, bu t wanted to check with you all first. (b) (6) APR Fe llow PRSA Senior Communications Specialist , VHA Office of Communications Media Relations Team Email: VHACO10B2BMedia@VA .GOV AMEH1 Jf I PVERSIGHT VA-19-0799-G-001067 DS_00021783 Mobile : (b) (6) Work : (b) (6) Virtual Employee Phoenix, AZ (MST) Fmm: Screen,Gina Sent: Wednesday, July 12, 2017 10:15 AM To: (b) (6) Subj ect : FW: GPDPressRelease Please see below. There is a comms plan drafted-(b) (6) below. is the contact. Please see deadline Sent wit11Good (www .good .com) -----Original Message--Fro m : Lynch, Thomas (VHA) Se nt: Wednesday , July 12, 2017 01:09 PMEastern Standard Time To: Jensen , Jon M.; Screen , Gina ; -(b) (6) Cc : Pape , Lisa M. S ubjec t : GPD Press Release (b) (6) Lisa has gotten a message from Dr. A1aigh asking that we have a press re lease Jon, Gina , ~ ready by tl1e end oftbe day (her reqt1est) to address the GPO changes. Specially , she would like us to get ahead of this story before it tnetastasizes beyond Vermont and Phoeni x. 1 realize that this w ill probably be coordinated with the 10 111floor , can we have something up to them this afternoon? TGL Thomas G . Lynch, MD Assistant Deputy Under Secretary for Health for Clinical Operation s Veterans Health Admin istration 81OVermont Ave, NW AMEh 'V I'll pVERSIGHT VA-19-0799-G-001068 DS 00021784 Washington, D C 20420 Office: 202 461 7046 Thomas .lynch2@va .gov AMERICAr-... pVERSIGHT VA-19-0799-G-001069 DS_00021785 Message From: David Shulkin [secshulkin@gmail.com] Sent : 2/8/2018 2:32:11 AM To : (b) (6) (b) Bruce Moskowitz [bruce~@mac.com] (6) Re:WH Subject: Got it Sent from my iPhone On Feb 7, 2018, at 6:13 PM, Bruce Moskowitz wrote: (6) I think that if some of this is politically correct then you can promote it. Al prefers not to take credit. Sent from my iPhone Begin forwarded message: (b) (6) From: (b) (6) ~> Date: February 7, 2018 at 4:54:08 PM EST To: David shulkin < . om>, Bruce Moskowitz (6)Costs Subject: FW: Prescription Drug I forgot to mention the most important point. CMS publishes a Medicare Part D Dashboard with very granular information about what drugs were dispensed and the cost. The data for 2015 is available on their website. It should be a relatively simple matter for Mr. Valentino and his colleagues at the VA PBM to "score" the savings that would have resulted if the VA had been administering Part D in 2015. If, as I suspect, the number is many billions of dollars, it would put tremendous pressure on Congress to capture those savings and use them for Obamacare or VA reform and put the Pharma lobby on the defensive. If the savings are small, (which I doubt) you can move on to other ideas and not waste time or credibility on this one. (b) (6) (b) (6) From: (b) (6) Sent: Wednesday, February 7, 2018 3:45 PM To: David shulkin Cc: Bruce Moskowitz (6) Subject: Prescription Drug Costs Dear Secretary Shulkin: Bruce Moskowitz suggested it would be a good idea for me to reduce my thoughts about how and why to use the VA PBM to reduce prescription drug costs in all government sponsored prescription drug programs. The 2 page document I prepared is attached. AMERICAN PVERSIGHT VA-19-0799-G-001070 DS_00021786 I believe that Michael Valentino, Chief Consultant to the VA PBM can verify many of the facts about the VA operation that are discussed in my paper. I have riot spoken to him about this paper and have no reason to believe th at he is aware that I am in communication with you . Mike is a co-author of the publication cited in my paper th at describes the VA PBM as a Nati onal model for prov iding a high quality prescription drug benefit at the lowest cost. The government can not have its cake and eat it too. Unless it is willing to stand up to the Pharma lobby and make fundamental changes in the way drugs are prescribed and paid for, it can not reduce costs. Cutting entitlement spending across the board while simultaneous ly protecting Pharma's profits is simply unfair to the millions of senior citizens and poor people who need help in paying for essential medicines. I am available at anytime to provide whatever assistance.would be of value to you on these issues. In the near future, I hope to also put my ideas fo r dealing with drug shortages and price spikes on elder generic drugs on paper . This is yet another way th e government can lower the cost of providing a robust. Prescription drug benefit. Best regard s, I( b ) (6) (b) ((b) (6) 6 ) AMERICAr-... pVERSIGHT VA-19-0799-G-001071 DS 00021787 Message Bruce Moskowitz [bruce (b) (6) (b @mac.com) Sent : 2/7/2018 11:13 :29 PM ) To : David Shulkin [secshulkin@gmail.com] (6) Subject: WH Attachments : Proposal to Reduce Gov Drug Costs.pdf; Untitled attachment 96586.htm From: I think that if some of this is politically correct then you can promote it. Al prefers not to take credit. Sent from my iPhone Begin forwarded message: (b) (6) From: (b) (6) ~> Date: February 7, 2018 at 4:54:08 PM EST To: David shulkin , Bruce Moskowitz I forgot to mention the most important point. CMS publishes a Medicare Part D Dashboard with very granular information about what drugs were dispensed and the cost. The data for 2015 is available on their website. It should be a relatively simple matter for Mr. Valentino and his colleagues at the VA PBM to "score" the savings that would have resulted if the VA had been administering Part Din 2015 . If, as I suspect, the number is many billions of dollars, it would put tremendous pressure on Congress to capture those savings and use them for Obamacare or VA reform and put the Pharma lobby on the defensive. If the savings are small, (which I doubt) you can move on to other ideas and not waste time or credibility on this one. (b) (6) (b) (6) From: (b) (6) Sent: Wednesday, February 7, 2018 3:45 PM To: David shulkin Cc: Bruce Moskowitz (6) Subject: Prescription Drug Costs Dear Secretary Shulkin: Bruce Moskowitz suggested it would be a good idea for me to reduce my thoughts about how and why to use the VA PBM to reduce prescription drug costs in all government sponsored prescription drug programs . The 2 page document I prepared is attached. I believe that Michae l Valentino, Chief Consultant to the VA PBM can verify many of the facts about the VA operation that are discussed in my paper. I have not spoken to him about this paper and have no reason to believe that he is aware that I am in communication with you. Mike is a co-author of the publication cited in my paper that describes the VA PBM as a National model for providing a high quality prescription drug benefit at the lowest cost. The government can not have its cake and eat it too. Unless it is willing to stand up to the Pharma lobby and make fundamental changes in the way drugs are prescribed and paid for, it can not reduce costs. AMEF.. .,, I PVERSIGHT VA-19-0799-G-001072 DS 00021788 Cutting entitlement spending across the board while simultaneously protecting Pharma's profits is simply unfair to the millions of senior citizens and poor people who need help in paying for essential medicines , I am available at anyt ime to provide whatever assistance would be of value to you on these issues. Jn the near future, I hope to also put my ideas for dealing with drug shortages and price spikes on older generic drugs on paper. This is yet another way the government can lower the cost of provid ing a robust. Preiicription drug benefit . Best regards, I(b ) (6) (b) ((b) (6) 6 ) AMERICAr-... pVERSIGHT VA-19-0799-G-001073 DS 00021789 NOT FOR PUBLICATION-CONFIDENTIAL A Proposal to Reduce the Government's Prescription Drug Costs (b) (4) AMERICAN PVERSIGHT VA-19-0799-G-001074 OS 00021790 O75 O76 077 Message From: Poonam AlaighI(b) (6) @hotmail.com] Sent: 8/8/20 17 10:36: 14 AM p.org] (b) (6) (b) (b)(6) (6) CC: bruce (b) (6) (b) @mac.com; Marc Sherman [mb (b) (6) @gmail.com]; Ike Perlmutter ll@frenchangel59.com]; ( DavidShulkin [drshulkin@aol.com]; Laurie Perlmutter (b)(6) b (6) @gmail.com] Thanks and really Subject: ) appreciate your team ( 6 ) -(b) (6) yesterday our team had an extremely productive session led by Dr~(b) (6) from your ~ip as we learnt about your transformational journey . It was extreme~e and my design team as we are building the foundation of what is needed for us to be an agile, high performing organization. Thanks and really appreciate your support to us and our nations Veterans . Looking forward to catching up soon- Poonam To: sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001078 OS 00021794 Message DavidShulkin [secshulkin@gmail.com] Sent: 8/28/2017 3:16:15 PM To: l@frenchangel59 .com ( bRe: Poonam Subject: ) ( 6 think we have a plan moving ahead I ke- i had a )goid call with-(b) (6) David From: Sent from my iPhone > > > > > > > > > > > > > > > > > > on Aug 23 , 2017, at 9: 49 PM, b I agree with you 100%. ) ( -----original Message----From: David shulkin [mailto :secshulkin @gmail .com] 6 sent : Wednesday, August 23 , 2017 6:26 PM ) To : Ike Perlmutter subject: Poonam wrote: b ) ( 6 ) I spoke to presidential personnel and told them i needed her but that we wanted a deep dive on any issues in her background before the president signs off sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001079 OS 00021795 Message From: Sent: To: Subject: ( ( l@frenchangel59 .com [l@frenchangel59.com] b8/24/2017 1:49:44 AM b )'DavidShulkin' [secshulkin@gmail.com] ) (RE:Poonam ( 6 6 ) ) I agree with you 100%. -----original Message----From: David shulkin [mailto:secshulkin@gmail Sent: Wednesday, August 23, 2017 6:26 PM To: Ike Perlmutter subject : Poonam .com] I spoke to presidential personnel and told them i needed her but that we wanted a deep dive on any issues in her background before the president signs off sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001080 OS 00021796 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 8/23/2017 10:25 :57 PM ( Ike Perlmutter [~frenchangel59.com] b Poonam ) ( 6 I spoke to presidential personnel and told them i needed her but that we wanted a deep dive on any iss ues ) in her backgro und before the president signs off To: Subject: sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001081 OS 00021797 Message From: Sent: To: Subject: Attachments: David shu lkin [Drshulkin@ao l.com ] 8/15/2017 5:12:32 PM Ike Perlmutter [ll@frenchangel59.com] ( Fwd: Wish list b Wish list.docx; Untitled attachment 96623 .htm ) ( 6 ) of the wish list Ike- attached is my first draft Subject: Wish list AMERICAN PVERSIGHT VA-19-0799-G-001082 OS 00021798 VA Wish List Moving applications to the Cloud - Cloud.gov Consolidating Call/Contact Centers Rapid Dissemination of our mobile Veteran appointment app Rapid Dissemination of the new veteran appointment scheduling system Working with CMS and 0MB on Medicare Subvention Helping dispose of vacant and underutilized buildings Moving all clinical hires to Title 38 Facilitating Outsourcing of services Eliminating the Neimer ruling on Benefits Payouts Integrating TRICAREand VA Autoenrollment of departing service members into VA healthcare Getting Medicare to incorporate VA into their Star Rating System Assisting with delaying the VA Corporate Organizational structure Developing managed care cost controls for care in the community Sole Sourcing to Academic Medical Centers Developing a system for Instant Benefits Adjudication Expanding Caregiver programs to decrease unnecessary long term care in institutions Expanding GME to rural areas Developing new public/private construction partnerships DOD/VA facility integration Leadership Training and Succession Planning One Veteran- Assisting in bring together DOD and VA in purchasing, logistics, IT, Suicide Prevention, etc Expanding Clinical Genomics Value Based Purchasing Models Hiring CFO/CIO/OGC Faster AMERICAN PVERSIGHT VA-19-0799-G-001083 OS 00021799 084 085 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com) 8/8/2017 8:54:49 PM (6) @gmail.com] Poonam Alaigh (b) (6) Secshulkin@gmail.com Re: The Washington Post: Veterans' health-care g,3p creates 'greater risk' for opioid abuse From: Sent : To : CC: Subject: One of the group has a simple plug in to stop this from occurring Sent from my iPad Brnce Moskowitz NI.D. On Aug 8, 2017, at 4:50PM , Poonam Alaigh- (b) (6) > wrote: Yes- you are correct. On Tue, Aug 8, 2017 at 7:14 AM Bruce Moskowitz wrote : (6) Th1swas.my prime initiative with Apple to solve this . The academic centers discussed this on the first call with Apple. I thought you might like this story from The Washington Post. Veterans ' health-care gap creates ' greater risk for opioid abuse The lack of coordination and differing clinical standards among VA and non-VA community providers can be deadly . https ://www.washi ngton post com/news/powerpost/wp/20 I 7/08/0 7/veterans-heal th-care-gapcreates-greater-ri sk-for-opi oid-abuse / Sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-001086 DS_00021802 Message From: Sent : To : Subject: Poonam Alaigh (b) (6) @gmail.com] 8/8/2017 8:50:57 PM Bruce Moskowitz [bruce (b) (6) (b) @mac.com]; Secshulkin@gmail.com Re: The Washington Post: Veterans'(6) health-care gap creates 'greater risk' for opioid abuse Yes- you are correct. On Tue, Aug 8, 2017 at 7:14 AM Bruce Moskowitz wrote : (6) This was my prime initiative with Apple to solve this . TI1e academic centers discussed this on the first call with Apple . I thought you might like this story from The Washington Post. Veterans' health-ca re gap creates .greater risk ' for opioid abuse The lack of coordination and differing clinical standards among VA and non-VA community providers can be deadly. https ://www .washi ngtonpost.com/news/powerpost/wp/201 risk-for-opi oid-abuse/ 7/08/07 /veteran s-beal th-care-gap-creates-greater- Sent from my iPad Bruce Moskowitz M .D . AMERICAN PVERSIGHT VA-19-0799-G-001087 DS_00021803 Message (b) (6) (b) Bruce Moskowitz [bruce~@mac .com] (6) 8/8/2017 11:14:14 AM (b) (6) Secshulkin@gmail.com; Poonam Alaigh [-@gmail.com] The Washington Post: Veterans' health-care gap creates 'greater risk' for opioid abuse From: Sent: To: Subject: This was my prime initiative call with Apple. I thought you might like this with Apple to solve this. story The academic centers discussed this on the first from The Washington Post. Veterans' health-care gap creates 'greater risk' for opioid abuse The lack of coordination and differing clinical standards among VA and non-VA community providers deadly. can be https: // www.washingtonpost.com / news/ powerpost / wp/ 2017/ 08/ 07/ veterans-health-care-gap-creates-greaterrisk-for-opioid-abuse / sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-001088 OS 00021804 Message To: Davidshulkin [Drshulkin@aol.com] 9/13/2017 7:24:45 PM (b) (6) (b) (6) Subject: Re: From: Sent: @gmail.com] Thanks Sent from my iPhone > On Sep 13, 2017, at 12:13 PM, (b) (6) (b) (6) <-r@gmail.com> wrote: > > I reached out to -(b) (6) from senator lees office as a start. I hope it works out > > sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-001089 OS 00021805 Message From: (b) (6) Sent: 9/13/2017 4:13:32 PM To: David Shulkin [drshulkin@aol.com] I reached out to -(b) (6) (b) (6) @gmail.com] from Senator lees office as a start. I hope it works out Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-001090 OS 00021806 Message From: (b) (6) Poonam Alaigh [-@hotmail.com] Sent: 8/19/2017 5:51:13 PM To: Davidshulkin [Drshulkin@aol.com] Subject: Re: Will call you in 15-20min Sent from my iPhone > on Aug 19, 2017, at 1:38 PM, David shulkin > > If you get any downtime call wrote: me about donovan storyb > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001091 OS 00021807 Message From: David shu lkin [Drshulkin@ao l.com] Sent: 8/19/2017 5:38:32 PM To: (b) (6) (:'hot mail.com If you get any downtime call me about donovan sto ryb Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001092 OS 00021808 Message David shulkin LDrshulkin@aol.com] From: Sent : 8/16/2017 1 :17 :22 AM - (b) (b) (6) ?--?hotmail.com] Re: Room (6) To : Subject: 0 Sent from my iPhone On Aug 15, 2017, at 9:05 PM,_(b) (6) (b) (6) hotmail .corn> wrote : Wait we are paying (b) (6) -Bari ,M.D . On Aug 15, 2017, at 9:03 PM, David shuJkin wrote: Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6) Date: August 15, 2017 at 8:30:22 PM EDT To: David Shulkin Subject: Room ail.com > Rates in south Hampton, the 2 bedroom cottage . Ts $695 a night. You probably could rent a house cheaper than that. I don't know if the y allow House renting. Let me know if you want to pursue Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-001093 DS_00021809 Message -(b) (b) (6) hotmail.com) 8/16/2017 1:05:22 AM (6) From: Sent : David [drshulkin@aol.com] Re: Room To : Subject: Wait we are paying (b) (6) -Bari,M.D . On Aug 15, 2017, at 9:03 PM, David shulkin wrote: Sent from my iPhone Begin forwarded message : From: (b) (6) (b) (6) ail.com> Date: August 15, 2017 at 8:30 :22 PM EDT To: David Shulkin Subject: Room Rates in south Hampton, the 2 bedroom cottage. Is $695 a night. You probably could rent a house cheaper tl1anthat. I don 1t know if they allow House renting . Let tne know if you want to pursue Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-001094 DS 00021810 Message David shulkin lDrshulkin@aol.com] From: Sent : 8/16/20171:03 :23 AM - (b) (b) (6) ?--?hotmail.com] Fwd: Room (6) To : Subject: Se11tfrom my iPhone Begin forwarded message : (b) (6) From: (b) (6) Date: August 15 2017 at 8:30:22PMEDT To: David Shulkin Subject: Room Rates in south Hampton, the 2 bedroom cottage . Is $695 a night . You probably could rent a house cheaper than that. [ don't know if they allow House renting . Let me know if you want to pursue Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-001095 DS 00021811 Message From: (b) (6) Sent: 8/16/2017 12:30:22 AM To: David Shulkin [drshulkin@aol.com] Room Subject: (b) (6) @gmail.com] Rates in south Hampton, the 2 bedroom cottage. Is $695 a night. You probably could rent a house cheaper than that. I don't know if they allow House renting. Let me know if you want to pursue this cottage. It's probably within the 300%percent per diem rate. Will confirm Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-G-001096 OS 00021812 Message From: Sent: To: Attachments: Poonam Alaigh I(b) (6) @hotmail.com] 11/21/2017 12:06:31 PM David Shulkin [drshulkin@aol.com] imagel.JPG; ATT0000l.txt Like every year, you missed my birthday excited to see you AMERICAN PVERSIGHT on Sunday. No worries- just wish me in person later today- so VA-19-0799-G-001097 OS 00021813 Sent from my iPhone Message David shulkin lDrshulkin@aol.com] 7/6/2017 7 :11:53 PM Bruce Moskowitz [bruce (b) (5) (b) Fwd: Re: (6) From: Sent: To : Subject: mac.com] Sent from my iPhone Begin fo.-warded message : From: Terry Fadem (b) (6) ail.com> Date: July 6, 2017 at 3 :02:06 PM EDT To: David shulkin Subject: Re: (b) (6) by the way ...the nwnber you referenced-was cell phone . recently changed to direct calls to my terry On Jul 6, 2017 1:14 PM, "Terry Fadem" (b) (6) l mail.com> wrote: It all depends on the time ....i will be at a dinner this evening from 6EST until about l 0EST..1f you want to try to reach me at 5EST. ..the best number is my cell phone (b) (6) i expect Not sure about privacy to speak to get home around llEST ...my home phone is (b) (6) during the middle of the evening ...but you can try my cell if that is the only option you have. Best regards , Terry On Jul 6, 2017 12:55 PM, 11David shulkin 11 wrote : Terry- i wanted to talk to you about the VA contract Will you be available this evening? If so what number can i reach you on - (b) (6) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001100 DS_00021816 Message From: David shulkin LDrshulkin@aol.com] Sent : 2/16/2018 9:14:04 PM To : Thomas Bowman (b) (6) Fwd: the latest Subject: @yahoo.com] Sent from my iPhone Begin forwarded message : From: Donovan Slack (b) (6) c O mil.com > Date: February 16, 2018 at 3:53:37 PM EST To: David Shulkin Subject: the latest Statement by VA Press Secretary Curt Cashour Departure of VA Chief of Staff Feb . 16, 2018 Today VA announced that the department ' s Chief of Staff Vivieca Wright Simpson has elected to retire following the release of a VA Inspector General investigation on Wednesday . VA also announced that it has opened a fonnal investigation into her actions identified in the IG report . President Trump has made clear that he expects VA leaders to hold themselves and other employees accountable when they fail to live up to the high standards taxpayers and Veterans deserve . VA will continue to review the IG report and its recommendations in more detail before determining possible additional personnel accountability actions . Separately, VA announced that it has opened an investigation into allegations of email hacking . To be clear , while VA is still currently investigating these hacking allegations , we have thus far found no credible or conclusive evidence of a compromise to our email system or a user 's account VA will announce a new chief of staff sho11ly. ### Donovan Slack AMEFi1 Jf I PVERSIGHT VA-19-0799-G-001101 DS 00021817 Rspo?er (202)415-9493 102 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 8/30/2017 2:55:30 PM To: (b) (6) Poonam Alaigh [-@hot Re: A heads up Subject: mail.com] I reached out to four highmar k people yrsterday and ask fir candid and confidential opinions- waiting for responses Also reached out to a castlight senior Good news is that weve received heavily no political Btw - ive totally stopped listening exec where she worked as well calls on her behalf- unlike many others that lobbied me to scott sent from my iPhone > on Aug 30 , 2017, at 10:2 7 AM, Poonam Alaigh <-(b) (6) @hotmail . com> wrote: > > Just found out from Scott that Amy is extremely politically connected- her father runs all the ial debates and is a Godfather of the Republican party. Also , she is extremely close to -(b) he is her mentor and is in constant contact with him. Also , Toby ' s wife worked for her. (6) He also she is extremely strong headed and opinionatedit will be extremely tough to let her go - y politically if she doesn't work out. Did you do a reference check on her - I am still for some reason hesitant on her, can ' t really pinpoint anything in particular though - but will go with your guidance > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001103 OS 00021819 Message From: Poonam Alaigh I(b) (6) @hotmail.com] Sent: 8/ 30/2017 2:27:3 1 PM To: DavidShulkin [drshulkin@aol.com] A heads up Subject: Just found out from Scott that Amy is extremely politically connected- her father runs all the ial debates and is a Godfather of the Republican party. Also, she is extremely close to -(b) he is her mentor and is in constant contact with him. Also, Toby's wife worked for her. (6)He also she is extremely strong headed and opinionated - it will be extremely tough to let her go - y politically if she doesn't work out. Did you do a reference check on her- I am still for some reason hesitant on her , can't really pinpoint anything in particular though- but will go with your guidance sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-G-001104 OS 00021820 Message David shulkin LDrshulkin@aol.com] From: Sent : 3/15/2018 1:23 :10 PM To : @yahoo.com] Thomas Bowman (b) (6) Fwd: Chris meeting with Darin and Camilo Subject: Sent from my iPhone Begin forwarded message : From: Carolyn M Clancy (b) (6) , mail.corn> Date: March 15, 2018 at 9 :.05:27 AM EDT To: David shulkin Subject: Chris meeting with Darin and Camilo Barb joined -- im understanding Darin told him aJl Modernization plaus need to go thru DPC? AMERICAN PVERSIGHT VA-19-0799-G-001105 DS 00021821 Message From: Sent: To: Subject: Barb joined AMERICAN Carolyn M Clancy (b) (6) @gmail.com] 3/15/2018 1:05:27 PM David shulkin [drshulkin@aol.com] Chris meeting with Darin and Camilo -- im understanding PVERSIGHT Darin told him all Modernization plans need to go thru DPC? VA-19-0799-G-001106 OS 00021822 11111 To: Monday, December 04, 2017 8:20 AM Leinenk.ugel, Jake Cc: Subject: (b) (6) -@.gmait.com FW: Jake's Overview and Recommendations (Final Ora:ft.) Thank you! Will S\\>ing by after meeting with Chris LaddelL From: Leinenkugel, Jake Sent: Monday, December 04, 2017 4:38:24 .AM To: 5andoval, camilo J. Cc: Leinenkugel, Jake Subject: Jake's Overview and Recommendations (Final Draft) Cam: My intent is to provide my overall political perspective of key items that nee VA Leadership structure. My retnarks ,vill be very brief and l will intentionally \e: or documents. 1. My initial impression of Dr. David Shulkin was that he would be a game chan; approach to POTUS Veteran agenda. 2. I-le accepted my role as a former CEO and business leader with a strong tearr acumen around sales, marketing, finance and risk taking. He properly utilized 1 Comish and his team around ne\v ideation for innovation, a.~signment of po\iti< and connecting with Cabinet Affairs. He also asked n1eto create, develop and Branding/Marketing platform ''Choose VA" to replace old "My VA''~ Projec'1 3. Trust ended \Vhenhe accused me on May 6th with a phonecall violently ::urrentActing USH Poonamby havingher Actingrole rescindedby callin~ old him I teUthe truth,did not makea call or speakto that affect. l sugges iarification.He foundout laterin the dayit wasdueto sometax & legal JH Advisor.He neverapologized.I havenotsincefelt a senseof trust o :scusskeytopicsandactionitems. Hethenwantedmeto "beginrunnir-Lin.gactions.MyreplieshavealsobeenthatI dothingsin the bestinto 1ureouractionswillnevercauseembarrassment askedtobrin. Camilo Sandoval intotheVAasrequested b~WH, 1VERSIGH 11 11n 'f #iifl'U ' ' AK rl n ,nt VA-19-0799-G-001107 nrnn,. .,rlv inef'!l rt ~.n intn \pf:l npfqnin DS_ 00021823 Leinenkugel,Jake Subject: FW: Jake's Overview and Recommendations (final Draft) From: Leinenkugel,Jake Sent: Monday, December04, 2017 4:38:24 AM To: Sandoval,CamiloJ. Cc: Leinenkugel,Jake Subject: Jake's Overview and Recommendations(Final Draft} Cam: rvty intent is to provide my overall political perspective of key items that need to be addressed within the VA Leadership structure. :t-. -1y remarks will be very brief and l will intentionally leave out supporting testimony or documents, 1. t-.1yinitial impression of Dr. David Shulkin was that he would be a game changer that provided an aligned approach to POTUS Veteran agenda, 2, He accepted my role as a former CEO and business leader with a strong team building sense, business acumen around sales, marketing, finance and risk taking. He properly utilized me to initially meet with Reed Cornish and his team around new ideation for innovation,assignment of political for Assistant Secretary roles and connecting \Vith Cabinet Affairs. He also asked me to create. develop and implement new VA Brnnding/~farkcting platform "Choo<.;e V AP to replace (11:1"My VA". Project completed August,. 2017. 3. Trust ended when he accused me on !\fay 6th with a phone call violently accusing me of undermining current Acting USH Poonam by having her Acting role rescinded by calling \VH directly. I finnly denied and told him I tell the truth, did not make a call or speak to that affect. l suggested he call the \:VHCounsel for clarification. He found out later in the day it ,vas due to some tax & legal issues and not a call from a Senior \VH Advisor. He never apologized. I have not since felt a sense of trust even though I \vould meet weekly to discuss key topics and action items. He then \vanted me to "begin nmning everything by the COS*'prior to taking actions. My replies have also been that I do things in the best interest of POTUS, his Veteran agenda an ensure our actions will never cause embarrassment. 1 4. I asked to bring Camilo Sandovalinto the VA as reque::;tedby \VlL Placed in VHAand was immediately looked upon as a "\VHspy" and not properlyinsertedinto leadershiprole after severalrequests to SECVA, COS, Interim Deputy Secretaryand ActingUSH. He was and continuesto be shunnedand underutilized.Th. is truly sad after he gave great overviewsin regardsto Telehealthand the requiredchangesneededto the Hea: EnrollmentCenter. Again, he was neversupportedby SECVA or anyof his leadershipstaff. 5. I continued to build alignmentwith as manydepartmentheadswithinVA as possibleat the same time as :,lacingthe right politicalinto key roles. The COSthen startedher actionsof makingas manyof those issignmentsgettingproperlyandtimely administereda very slow andcomplicatedprocess. ,. The currentCOS - Vivieca\VrightSimpsonwasproudto tell meshe is a Democrat\vhocompletelytrust: he Secretaryand it's herjob to protecthimand his agenda.She alsohad allegedobstructionistchargesbac ~014(PittsburgVAi\1C). i~I ..Tbe COS helpedarrangethe Denmark& GreatBritaintripthathadher,the ActingUSH,SECVAand6 l ___ iflllilillllfll _______________ VA-19-0799-G-001108 t r o..:..o.o.....A@tillffiL - OS 00021824 security members out of country during a critical time for legislation, placing political appointees and also a HH\jor V .A\1C issue that needed immediate attention (Boston Globe investigation into bad practices in NH), No firm succession nor schedule of travel \Vas provided to any political staff members of VA. 8. COS has on numerous occasions slowed the hiring practices for political position requests to build their organizations (OCLA, HRA, VEO and declined a replacement of our former \Vhite House Liaison, 9. COS signed off on at least 4 fraudulently altered political appointee packages in regards to salaries and grade levels, AH have been discussed for action \Vith current OGC and OA WP. 10. COS believed to be under extensive investigation by IO in regards to Trip (Denmark & Great Britain). 11, Current Deputy Secretary Torn Bowman came on board and immediately wanted to know why I went to WH, how often, who did I meet with and what issues were covered. l had no problem with those questions until I discovered he thought my role was not required. I emphasized to him my mission and role is to ensure completion and execution of the President's Veterans agenda and I am well qualified to ensure proper alignment of our missions. 12. Deputy Secretary doesn't trust current slate of political staff, in particular our Assistant Secretary of OPIA He called him out several times as not providing correct legislative information for new Veteran Care Act. Not true. DEPSEC has his own agenda to assist former boss Senator Isakson and his agenda (not dynamic new Choice options requested by POTUS agenda. 13. Deputy Secretary adamant about sending out thank-you press release to SECVA Chairman and comrnittee for getting hill forwarded even though \VH wanted nothing released due to current Tax Reform legislation. (Email and personal accounts of 3 political; overhearing conversation directed to A/S OPIA on o rneetmg.) . .. I) ec, 1SI a fter mornmg 14. Deputy Secretary continually meeting in COS office and not bringing key staff into discussions and solutions. Solutions: 1. Do nothing. 2, Immediately remove COS with a Political due to being under investigation with IG. Replace with Don Loren (Retired Navy Admiral and current Assistant Secretary). This action is critical and \Vill immediately change dynamics \Vithin VACO operations. 3. Remove/Retire D.EPSEC after legislation passes (Jan. 20 l 8 ). Replace with Jake Leinenkugel as Acting Deputy Secretary \vhile bringing new. candidate up for nomination. 4. Return Acting USH to former position. Replace with former USH Usman (BG Ret) 5. APDUSH - Miquel Lapuz return to former position and replacewith former PDUSH Dr. Stone (!v1G Ret) 6. USH - New Commission and replacewith Dr Stone plus other key candidates. 0 7. Senior \Vhite House Advisor to Office of Innovation- Formal announcementof Cam Sandoval to oversee, 0fflanageand direct EHRand HEC Projects. ':d\!v /WERSIGHT .. VA-19-0799-G-001109 OS 00021825 8. SECVA- Put on notice to exit after major legislation and key POTUS VA initiatives in place. Utilize outside team (Ike) and strong political candidates such as Kussman. Sent with Good (www.good.com) AMf-f~ICAN PVERSIGHT VA-19-0799-G-001110 OS 00021826 Message David Shulkin (drshulk in@aol.com] 6/14/2019 5:52 :35 PM From: Sent : (b) (6) ou=Exchange Administrative Group (FYDIBOHF23SPDL T)/cn=Recipients/cn=fc32c39aa lcd4c09ac57b5245 15e5388-La France, Ma] Fwd: Memorandum for Record - final complete package - Attorney client priviledge Subject: Attachments : RE: VA CID advisory support for Cerner contract; RE: VA MEETING; RE: [EXTERNAL]VA-CID CALL; RE: [EXTERNAL) Follow up meet ing; Follow up; Re: [EXTERNAL)Re: Open API - it is CLOUD+ languge + Rasu; RE: SecVA; (EXTERNAL] Fwd: Contact review ; RFP review matr ix draft _v8.xlsx;. RE: (EXTERNAL)Re: VA EHR; RE: Update ; RE: contractual language - PWS - EHR; FW: Gett ing it right ; RE: lnteroperabilty listening sessions; [EXTERNAL]RE: VA EHR; OIT - how to keep the trains running and positive momentum goi ng; [EXTERNAL)Just FYI; connect or meet ; RE: Contract Language; Re: API Pledge; Special Government Employee - would Marc Sherman consider this?; Camilo; RE: Follow up; 180416 MEMORANDUM OF RECORDWPB Blackburn vS.pdf; 180401 OIT cont inu ity document vl.docx ; 180401 OIT recommended personnel action vl .docx; 180401 OIT cont inu ity document vl.docx ; 180401 OIT recommended personnel action vl.docx To : [External Email] -----Orig ina I Message----(b) (6) From: thomas bowman ~@yahoo .com> To: David Shulkin Sent: Sun, Apr 22, 2018 6:48 am Subject: Fw: Fwd: Memorandum for Record - final complete package Sent from Yahoo Mail on Android ---- Forwarded Message ---(b) (6) @gmail.com> From: "Scott Blackburn" -=allll To:' (b) (6) @yahoo .com" ~(b) (6) @yahoo.com> Cc: Sent: Mon, Apr 16, 2018 at 11:23 PM Subject: Fwd: Memorandum for Record - final complete package Begin forwarded message : From: "Blackburn , Scott R." Date: April 16, 2018 at 11:22:50 PM EDT To: "Blackburn, Scott R." , "Scott Blackbum~"(b) (6) (b) (6) ~> Subject: Memorandum for Record - final complete package Scott Blackbum Executive in Charge , Office of Information & Technology US Department of Veterans Affairs Thanks.(b) I managed to find the other 4. I will shoot them all an email over the weekend , I'll cc you guys too in case (6)to be included. Thanks for all the support. you want A\llERICAN PVERSIGHT VA-19-0799-G-001111 DS_ 00021827 Have a great weekend, Scott From: (b) (6) EDP/WHO [mailto-who (b (b) .eop.gov) Sent: Wednesday , November 01, 2017 9:33 AM(6) ) (6 To: Blackburn, Scott R. Subject: [EXTERNAL)RE: VACIO advisory support ) for Cerner contract (b) (6) (b) (6) Here is the first he can help likely with the others - let me know if you need help tracking them down - I don't have them at the moment From: Blackburn, Scott R.[ mailto :Scott.Blackburn@va.gov] Sent: Tuesday, October 31, 2017 4:31 PM (b) EOP/WHO ~ To: (b) (6) Subject: FW: VACIO advisory support (6) for Cerner contract I (b) (6) Happy Halloween! I just want to follow up on this exchange with Jared. Can you help connect us with the 5 CIOs so we can bounce our EHRplan off of them before we go final? Thanks again for all the support! Scott From: Kushner, Jared C. EOP/WHO [mailto -(b who .eop.gov l ) To: Blackburn, Scot t R. (6 Cc: Liddell , Christopher P. EOP/WHO; Windom ) , John H.; DJS;(b) (6) Sent: Friday, October 27, 2017 5:36 AM EOP/WHO; (b) (6) EDP/WHO Subject: [EXTERNAL)Re: VACIO advisory support for Cerner contract We would love that. We also think you should build in some flexibi lity and requ irements around where we think the EMR market might go so that you aren't locked into a program 10 years from now that is obsolete . (b) will connect you and schedule next meeting ? (6) Sent from my iPhone On Oct 27, 2017, at 1:56 AM, Blackburn, Scott R. wrote: Jared / Chris Thank you for taking time Tuesday evening to discuss t he (b) (5) (b) (6) (b) (b) (6) (6), (b) (2) A\llERICAN PVERSIGHT VA-19-0799-G-001112 DS_00021828 (b) (5) Scott This is Scott Blackburn, the Acting CIO for the Department of Veterans Affairs (VA). On behalf of the Secretary David Shulkin, I would like to invite you to participate in a critical review of our Electronic Health Record (EHR)modernization strategy and corresponding Request for Proposal (RFP)to Cerner. Your organizations have been at the forefront of the evolution high quality IT-based health care services and delivery for decades, and thus we would be remiss if we did not seek to gain your insight prior to our final contracting decision. I anticipate a round table style engagement/discussion in the Washington, D.C. area that will last approximately two hours . I will be accompanied by the Program Executive Officer for VA Electronic Health Record Modernization (PEO EHRM), John Windom, and his key staff members including his Chief Medical Officer (CMO), Chief Technology Officer (CTO)and Director of Contracts. We have spoken to many commercial health care industry leaders regarding EHRimplementation and deployment , and continue to maintain a strong relationship with our Department of Defense (DoD) counterparts, with regards to their EHRdeployment activities and related challenges. We believe that we have developed a comprehensive RFPwith particular emphasis on notable "fail points" EHR-deployment arena such as Governance, Training, Change Management, Data Migration , Funding, et c. to name only a few , but look forward to your thoughts on these and others . I ask that you please provide me your primary schedule manager or point of contact to coordinate a date and time that maximizes our overall participation at this all-important review forum. Thank you in advance for your attention to this note, participation and willingness to help our Veterans continue to receive the very best healthcare . Scott Blackburn Scott Blackburn Acting CIO & Executive in Charge, Office of Information & Technology US Department of Veterans Affairs thanks ;- Vl[T'il .1AN PVERSIGHT VA-19-0799-G-001113 OS 00021829 From: DJS Sent: Tuesday, November 14, 2017 2:15 PM To: Blackburn, Scott R. Subject: RE: VA MEETING Yes and yes Sent with Good (www.good .com) From: Blackbum, Scott R. Sent: Tuesday November 14, 2017 10:46:39 AM To: DJS Subject: RE: VA MEETING Got it. Are you ok with Bmce joining and inviting a few others (it looks like 1-2 clinicians from MGH)? For the 5 CIOs who ask, I will tell them that Bruce is an advisor and ex.1:ensionof the WHN A team. Is that ok to say? From: DJS Sent: Tuesday November 14, 20 17 l:4 3 PM To: Blackburn, Scott R. Subject: RE: VA MEETING I don't have any real advice but to keep the conversation focused on the topics you need advice and value on Sent with Good (www .good .com) From: Blackbum, Scott R. Sent: Tuesday, November 14, 2017 10:38:25 AM To: DJS Subject: FW: VA MEETING The call with the 5 CI Os is Wednesday 3-5pm. On our pre-calls , 2 of the CIOs have asked about Bmce and what his involvement is. I have never had any contact ,vith Bruce , but it seems like a sensitive relationship . Any advice on how to handle? We invite d Jared/Chris from WH as a courtes y. I don 't think either plan to jo in , but they must have invited Bmce ,vho is now asking a fe,. others to Join (see be!O\ ). Can discuss live later before or after heating prep . Scott Jr~ (b) (6) From: Schnitzer, Jay Sent: Tuesday November 14, 20 l 7 12:47 PM To: Blackburn, Scott R. A\llERICAN PVERSIGHT VA-19-0799-G-001114 OS 00021830 (b) Cc:-11111 (6) BRNALJFW: VA :MEETING Subject: LEXT Hi Scott, Please see the email trail below. Just want you aware in case we have people joining the call withou t your knowledge or approval. Thanks Be st, Jay Jay J. Schnitzer. M .D., Ph .D. MITRE From:-(b) (6) (b) (6) r@PARTNERS.ORG> Date: Tuesda Nov 14 2017 , 11:43 AM To: Karson , Andrew Scolt,M .D. (b) (6) Cc: Schnitzer, Jay J ~(b) (6) > Subject: RE: VA MEETING But do the people hosting the call kno, you are going to be on the call? I am copying Jay as he is helping coordina te t he call.. (b) (6), (b) (2) From: Karson. Andrew Scott M.D. Sent: Tt1esday, No ember 14 201 7 11:3 1 AM (b) (6) @.PARTNERS.ORO> To:-(b) (6) Subject: RE: VA MEETING Dear .(b) (6), (b) (2) for the n ote. I th.ink that you and I ma" have a little mis- understan ding . l agree that y ou can of collfse handl e the Thanks call , but Gregg and Bruc e Mosko vitz invite d me to the calJ tomorrow so tha t they can have a hands-on clinicians perspective. Brnc e and I spoke very briefly (between his patients) a little while ago and Brn ce sent me the below inf01111ation. I am hoping to touch base with yo u befo re t he call if t hat is po ssible for yo u. I am tied up in presentations/meetings the rest of the day. but could speak th is evenin g (6pm?) or tomono w if that is okay with you . (And if needed I ~ ill break out of other meetings today) Many thanks , Andy From:-(b) (6) Sent: Tuesday,November 14, 2017 [ 1: 16A M To: Karson , Andrew Scott ,M .D . (b) (6) Sub ,ject: RE: VA MEETING I bad a call with them today in prep for tomo rrow ' s call . I ap preci ate the offer but I don .t think it is my plac e to invite you . It oeeds to come from the VA. From: Karson , Andrew Scott ,IVLD. Sent: Tuesday No ember 14 2017 11: 11 AM (b) (6) @PARTNERS.ORO> To:-(b) (6) Subject: FW : VA MEETlNG Dear -(b) (6), (b) (2) A\llERICAN PVERSIGHT VA-19-0799-G-001115 DS_00021831 Given some conflicts that Gregg has being a senior advisor for the VA, Gregg has asked me to join the 3pm VA call tomorrO\ to be available for the clinician perspective . Would you be up for a 15 minute check-in call with me at some point tomorrow before the VA call? If so, then I'll roach out to Susan Briggs to g t us a tim e. Many thanks , Andy From: Karso11, Andrew Scott ,M.D . Sent: 1\1esda , November 14, 2017 11:06 AM To: 'Bruce Mosko witz' (6) Subjed: RE: VA MEETING Dear Bruce Many thanks for the note . I'll review the below a little later today a11dI'll be back in touch. Many thanks and best Andy From: Bruc e Mosko, itz mailto :bruce1 (b) (6) (b) @mac .com (6) Sent: Tuesday , November 14, 2017 10:45 AM (mm h.harvard.edu > To: Karson. Andrew Scott ,M.D . (b) (6) Subject: VA MEETING The call will take place this Wednesday . November 15th between 3:00 PM and 5:00 PM (b) Dial In Number : 800-767-III (6) Passcode : -(b) (6) Thank you for your time and involvement. Some background information. These are my concerns as a clinician . Cemer does not have the ability to provide the following in the Choice Program: Tracking duphcate testing Tracking over utilization by providers Tracking duplicate prescriptions and medication errors. Tracking tests that were ordered, completed and results go to all physicians involved in the Veterans care Patient notification of critically abnormal results with followup resolution Arranging appointment followup between the VA and Private . sector Emergency room visits in the private sector ability to access records immediately and VA physicians notified of emergency care and followup Cerner has no registry to tract what Cardiac and osthopedic devices are implanted in case there is a recaII of the device Automatic record transfer from the Choice Provider to the VA patient record with flagging new information to Av1r-r-,1 .1/-\1 PVERSIGHT VA-19-0799-G-001116 DS_00021832 every VA health care worker A radiology platform to see films in high definition to compare X-rays and ability for radiologists to efficiently find previous films. For instance a radiologist needs to know if a lung nodule is new or was there previousl y and the same size . Cardiologists need to access catheterization films in high definition Cerner has no system to alert VA health care worke rs when a patient is at a particu lar office or hosp ital to participate in care management in real time . Sent from my iPad Bruce Moskowitz M .D. The information in this e-mail is intended only for the person to whom it is addressed . If you believe this e-ma il was sent to you in error and the e-mail contains patient information , please contact the Partners Compliance Helpline at http://www.partners.org/complianceline . If the e-mail was sent to you in error but does not conta in patient informat ion , please contact the sende r and properly dispose of the e-mail. Dr . Mosk?'vitz. Thank you so much for the note and for all the help/support . I would love to meet you in person . Do you have any plans to be in Washington anytime soon ? [ thought the cal l last week ,;\,1as e:dremely valuable . The experience and wisdom of the participants is such a great asset , e wou ld be fools to not take full ad antage of it. I do agree full y that there was a lot to cover in on ly tv o hours. I think the moderator, , as doing the best he could to get as much out of it as possible , while trying to be respectful of the time that so man y important people were volunteering. lf the 5 CIOs were willing to follow up , perhaps we schedule another session(s) on various deep dive topics ? We would absolutely love that. Just by way of introduction - I jumped into the CIO role less than 2 months ago when our previous ClO (Rob Thomas) abmptl retired to deal with some personal issues . I am a disabled Anny Veteran (MlT ROTC) . After getting out of service I went to business school and then to McKinsey where I made partner and spent 9+ years there leading large business transformations in industrial clients . Bob McDonald (the fonner P&G CEO and fom1er Secretary) convinced me to join VA to lead the tumarow1d after the 2014 Phoenix scandal . From Feb -Sept , I served as Secretary Shulkin ' s Deputy until a political appointee was put in place. Then jumped into the CIO role to work with the team and make sure this gets done . We are still awaitin g a permanent CfO. I would be happy to jump on the phone this\ eek to if you would like. Thanks again for your suppoli! Scott Scott Blackbum Acting CIO and Executive in Charge , Office of Information & Technology US Dcpaliment of Veterans Affairs From: Bruce Mosko witz [mailto :bmcet~(b) (6) Sent: Monday November 20. 2017 6:02 AM To: Blackbum, Scott R. Subject: [EXTERNAL ] V A-CIO CALL A\llERICAN PVERSIGHT mac .com] VA-19-0799-G-001117 OS 00021833 Dear Scott : l thought the VA-CIO call November 15 to help you with pract ical industry expertise relating to your proposed Cemer implementation generated some valuable conversation . The particjpants were some of the most highly experienced CIOs with deep EMR backgrounds , together with physicians who focus on medical error prevention and improving the EMR experience. I hope and expect that you found it of great value . Since we have not spoken before , you may not be aware that I am the person who persona lly recruited the Academic Medical Centers to prov ide the VA with advice , intended to help the VA create and implement a path to fix its care delivery issues , as well as advise on other areas where they can be of value to better veterans' care. I have been a central point for the group and was the collection point for the partic ipants' post-call debrief Also, for reference purposes , each of the people on yesterday's call has perfo1med flawless implementatjons of state of the art El\lJR systems on behalf of their respective healthcare deli very systems , some more than once . Since the call was structured to focus the discuss1on on the few direct questions set forth in your agenda, ru1dthe moderator controlled the timing of each question ve1y tightly, ihe breadth of the discussion was somewhat limited . As a res ult, you only bad the benefit of the experts' advice in the areas that the moderator put on the table ... and the participant's want to make sure you have the benefit of their complete thoughts and feedback Everyone felt good about the discussion on the agenda questions and felt that the scope and implementation issues relating to DOD/ VA interoperability were well in hand. However , some of the participants' questions raised about other areas left them uneasy about the readiness of the system for implementation or the readiness of the Cerner RFP contract for execution . Based on some of the offshoot discussions, the partic ipants felt tliat many non-DO D interoperabi lity solutions have not yet been fully addressed or solved, leading to incomplete system planning and contracting protections , greatly risking an unsuccessful implementation and large additional cost and time overruns . The interoperability with community provider partners did not seem to be defined completely. Some additional areas that were ident ified by the VA and its contractor 1s participants and moderator as incomp lete in the call are: seamless sharing of Choice partner records , dup licate procedure and medical error prevention, flagging mechanisms and implantable device identification, among others. Unti l the design of the system and all functiona l requirements are ident ified and completed , the participants fear that these as yet undeveloped processes and solutions will result in a significant increase in the cost of the implementation and operation of the Choice program and impact quality care delivery to our veterans who choose to take advantage of the Choice program . Lastly , at the beginning of yesterday's call your moderator identified the comfort that Congress expressed at recent hearings from the participation of the CIOs in the process . However, yesterday's relatively short discussion on a massive topic was limited and not set up to have a platform for full discuss1on in a two hour phone call with a few questions . Also, as mentioned in the call at various times , the participants' did not have access to the RFP contract document, its scope and the contractual provisions and protections, a critical part they feel of evaluating the completeness of a successful des1gn and imp lementation. As such , the participants want to make sure that yesterday's discussion i.s understood by everyone - the VA and Congress alike - to be a limited dialogue to provide their valuable experiences on the topics put on the table by the moderator, but not as a confirmation of the project's completeness or readiness for contract execution or implementat ion which they believe likely has shortfalls . In general , we liked what we heard , we are honored tliat you felt our advice wou ld be of value, but have had discussion about a very limited part of the project and have questions about the system design, whether it is ready for implementation and whether the contract (from the limited discussion) has adequate safeguards to proceed without risk to the cost and success of the effort. Whi le this was the first time you have spoken to any of these participants on the top ic of EMR, and maybe on any topic, the participants would be pleased to provide further feedback and advice should you desire on the A\llERICAN PVERSIGHT VA-19-0799-G-001118 DS 00021834 remaining issues that are still incomplete and to help you work toward a successful RFP contract, design and implementation . Sent from my iPad Bruce Moskowitz 1vLD. ll1ank you B1uce . Ve ry helpful. From: Bruce Moskowitz Lmailto:bmcem~(b) (6) Sent: Monday November 27, 2017 10: 18 AM To: Blackbum. Scott R . (b) Cc: mbsl~gma.il.com Subject: Fwd: (6) fEXTERNALl Follow up meeting c ac.comj I should point out this would be ideal functionality requirements of any EMR contract if not part of what has been reviewed by the VA we need to discuss these points further since they are derived from the previous meeting points made by the CIO ' s and we can again cover them in the agenda Sent from my iPad Bruce Moskowitz NI.D. Begin forwarded message : From: Bmce Moskowitz (6) Date: November 27, 2017 at 8:41 : 19 AM EST To: "Blackbum, Scott R.11 Cc:" - (b) (6) " <- (b) (6) Subject: Re: [EXTERNAL] Follow up meeting Prior to any meeting we need to know what is not in the contract so we can make progress: Cemer Contract has to have the responsibility of 100% connectivity to all EMR platforms for Choice to work Cemer has to have telemedic-ine built into the system Cerner needs to tract duplicate diagnostic testing Cerner needs to have medication error , tracking of controlled substances and duplicate presc1iption monitoring Cerner needs to tract appointment times between the VA and the Choice Program . Cernerneeds to have voice recognition built in These are the basics we need to know prior to writing an agenda and meeting . Thank you Sent from my iPad Smee Moskowitz M .D . A\llERICAN PVERSIGHT VA-19-0799-G-001119 DS_00021835 On Nov 26, 2017 , at 9:23 AM, Blackbum, Scott R. < Scott .Blackburn@va.gov > wrote: Bruce - thanks for the note . I hope you and Marc both had a great Thanksgiving . .Sounds good on all below . Let's shoot for the week of December 11th or December 18th in Washington . If the CI Os can get us the list of issues by December 5th, we will tum around the gap analysis quickly . Happy to work with Stephanie , Andrew and Marc on the agenda development - that would be very helpful. Scott -----Otiginal Message----From : Bruce Moskowitz mailto :bruce (b) (6) Sent: Friday , November 24, 2017 7:08 PM (b) (6) mac.com To : Blackbum, Scott R. (b) (6) Cc : ~ Subject: [E)(TERNAL] Follow up meeting I am speakjng for myself and it would seem to me that holding it at Cerner would restrain an open honest discussion of what is needed to insure that we have all the key pieces to have the the EMR that we all see as a necessity to provide the end users with all tools necessary to provide quality care . The five CIO ' s are very knowledgeable regarding all capabilities of Cemer . I have been an end user of Cerner and know as do the CEO ' s the process to quickly move the agenda forward. We are committed to your adoption of Cemer as the EMR however being rnshed into a contract without due diligence on our part would be problematic . We can be avrulable for a meeting in Washington ASAP fully realizing some will need to be on a conference call. I would recommend an agenda that reflects the way forward by both groups and would recommend you allow Stephanje Reel .Andrew Karson and Marc Shennan to assist in the agenda development. Sent from my iPad Bruce Moskowitz M .D. Bruce/ Marc - thanks again for all your support. We really appreciate what you are doing to bring the best of the healthcare industry to help Veterans/VA. I spoke with David and he gave the green light to move forward. We absolutely want to get this feedback and greatly appreciate the help. The only caveat is that we move as aggressively/quickly as possible. There are still a few things we need to figure out with respect to timing on signing the contract w ith Congress/budget/funding/etc (e.g., one of the reasons for starting soon is to get in sync with DoD's roll out to leverage synergies; another variable is the Continuing Resolution and timing of when the government budget is fina lized which could possibly push out to Jan/Feb rather than December as current ly projected). But we will figure that out . The point being is that we love the idea, do want the A\llERICAN PVERSIGHT VA-19-0799-G-001120 DS 00021836 feedback, and agree with the logic we discussed on the phone. We will delay the signing as long as we can to make sure we get this right (the concern is making sure we don't miss the window). If you could reach out to the 5 CEOs/CIOs,it would be greatly appreciated. I will commit to making sure the VA turns around the gap analysis as fast as possible. Do you think it could then be possible to shoot for a full day session in midDecember (week of 11th or 18 t h )? David had the idea of possibly doing it at the Cerner Innovation Laboratory in Kansas City so we can test/challenge somethings on the spot. Thanks again for all your support! I hope you and your famil ies have a great Thanksgiving. Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs Thank you progress is being made but as my group keeps saying devil is in the details Sent from my iPhone On Feb 28, 2018, at 4:36 PM, Blackburn , Scott R. wrote : Bruce - as promised here is more information on what, e will have to address the other 4 issues you mentioned. Lstill owe you device registry. Let me know if this makes sense or not. Also happy to get you on the phone rnrectly with my experts. - Scott Voice Recognition. Our new Cerner EHR platform includes Enterprise Dragon Nuance . VHA currently deploys the enterprise version, . hich maintains people voice print and the Clinical Staff say it works very well (my primary care provider at the Washington VA Medical Center uses it) . Ce mer will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Cemer without any rework. The Clinician can use the dictation and other features with voice recognition . How will all entered lab data, from any source, be available on a graph Graphs will be available in 2 spots. 1. Workflow MPage lab Component and 2. Results review flowsheet. When outside labs are mapped we would use the same names as internal and then they would appear on the same line . Even if they are not exactly named the same the results review flowsheet allows for 2 different lab values to be graphed together. Catching test duplication, over utilization and medication duplication/errors at time of ordering instead of after the fact All tests are configured to have a time where an alert is issued based on parameters we configure and can flex by venue. Over utilization will be avoided with real time alerting but VA would have to use a mechanism to monitor , via report. l11e med duplication is configured similarly to test and parameters will detennine how the system acts . Tall man lettering reduces errors in look alike , sound alike meds , and finally in instances we identify errors we can configure rules to catch those . For meds all allergy checking, dupes , dose range checks , and interactions are checked at time of ordering . As an aside, while the DoD Cemer implementation bas been far from perfect this is one area where it has been very successful ; the new DoD /Cerner system has already prevented over 15,000 duplicate tests at their initial three sites that have been implemented. Streamlined SOAP notes. Yes, the VA/Cemer system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs. A\llERICh1 PVERSIGHT VA-19-0799-G-001121 OS 00021837 From: Blackburn, Scott R. Sent: Wednesday, February 28, 20 18 2:30 PM To: 'Bruce Moskowitz' Cc: DJS; Marc Sherman~O'Rourk e, Peter M.; IP;~ (b) (6) + languge + Rasu Subject: RE : [EXTERNAL] Re : Open APT - it is CLOUD Brue - w certainly aren .t going to l t you get tar and feathered! Again, we reall appreciate all the suppmt you 've given us . On these other 4, l"JI get you answers on these ASAP . I know these are topics you' e brought up in past and we were definite1y listening. J' ve been hammering the team to make sure we incorporate all this feedback into the negotiation . Let me send you the specifics where we have landed to make sure that we got them right. Stand by .. . Scott From : Bruce Moskowitz [mailto:bruce (b) (6) (b) mac.com Sent : Wednesda y, Febma ry 28, 2018 1:13 PM (6) To: Blackburn, Scott R. Cc: DJS . Marc Shenrum O'Rourke, Peter M .; JP. lper-(b) @gniail.com Subject: Re: [EXTERNAL] Re : Open API - it is CLOUD (6) + languge + Rasu Thank you my five CIO' s had looked foIWard to tar and feathering me if the cloud is not done correctly! The other issues are : Voice Recognit ion All entering lab data on a graph from any source Catching test duplication, over uti)jzation and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018, at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incredibly helpful. Thank you very much. f had my team dig into this this more this morning. What you have stated belo, is clearly the intent (we need everything to be OPEN and absolutely do not want to inadvertent]_ create vendor lock); we.ve also gone back this momign to confinn with Cemer that this is their intent . We are going to alter the language to make this more c1ear. We don .1 anticipate an pushback. A fe, things I learned this morning ... o The contract does NOT lock us in to Amazon Web Services (AWS). Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. A\llERICAN PVERSIGHT VA-19-0799-G-001122 OS 00021838 o Currently 3 cloud providers meet the Government security requirements AWS, Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuStream/Dell. At VA, we use both AWS and Azure right now. Again, the goal here is to create open env ironment as long as the provider meets certa in standards (these standards are dictated by GSA, not VA). o Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it wil l be OPEN and not proprietary to their specific AWS cloud. o DoD is excited to follow our lead on all of this. I spent the morning at the Pentagon with the DoD C!O/team. This wi ll help not just Veterans, but servicemembers still in uniform. Thanks again for the feedback and support . We are going to make sure this is crystal clear. Scott (b) (6) (b) , mac.com (6) Sent: Tuesday , Febmary 27, 2018 9:29 PM To: Blackbum , Scott R. Cc: DJS; Marc Shennan; O'Rourke, Peter M.; IP; ~ (b) Subject: rEXTERNAL] Re: Open APT- it is CWUD (6) + languge+ Rasu From: Bruce Moskowitz [mailto:bruce Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 9 :20 PM , Bruce Moskowitz wrote : (6) To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz wrote : (6) This is a problem it should say open cloud to all entities not commercial cloud A\llERICAN PVERSIGHT VA-19-0799-G-001123 OS 00021839 Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R wrote : David/Bruce/Marc - here are a few updates : #I) Rasu is all io as far as starting to help right away. just got off the phone with him. He has UPMC conunitments rest oftl:us week and is Cbaim1an of HiMSSTnnovation committee (so we will all be at HiMSStogether .ne~i week) . H?' ever ifhe needs to come to Washington this week for something , he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us . He said he doesn . t have to wait for the IPA paperwork to come through for him to help . l'-ve attached Rasu ' s CV in case you need it. #2) The AP ls are cloud based. Here is the response from ous Technical lead ... o The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner's entire remote hosted customer base. o In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. #3) Below is the lP language that we negotiated. This is what caused Aneesh Chopra (one of the experts oo our MITRE panel) to jwnp out of his chair last week. He claims this is the holy grail that no other healthcare syst m has been able to get from either Ceroer or Epic. Anccsh claims that as a result of what, , e ' vc negotiated below that other healthcare systems will be willing to join us in the attached pledge (shall we decide to go fonvard with it) aod we couJd do this next week at HiMSS . When I spoke to Rasu, he told me Aneesb bad already -called him about this and that UPMC would be willing to sign this pledge. Of importanc e; Third 1Mrr 1I party AP! developers shall retain their IP rights when their A Pl is used to connect to the Ccmcr interface. and there ,,\ill be no derivative Contractor IP ownership when third parties consume Cemer terminology through OQenAPls . A\llERICAN PVERSIGHT VA-19-0799-G-001124 DS_00021840 Regarding the question on sharing development with othe rs, see PWS Section 5.5.4 opening paragraph : To accelerate better and more responsive service to the Veteran , VA is making a deliberate shift towards becoming a standards u\l.lT2] -based API driv en digital enterprise . A cornerstone of this effort is the setup of a strategic Open APl Program , The Digital Veteran P latform API Gatewa y; that is adopting an outside-in , va lue-to-business driven approach to create A Prs that are managed as products to be consumed by develope rs within and outside of VA. Finally. Ccmcr's response and the final negotiation language on sharing their data model as a result of the lnteroperability Panel findings is as follm s. Cemcr agreed to suggested addition of PWS paragraph 5.8(h) as highlighted at no additional cost: 49 Understand how Ceroer will provide tbe VA wilh access to the data model. share data for analytics freely to 3 rd parties , increase the amount of computable data exchanged wiLJ13' d parties . RFP Section 5.8 address tl1e support to business intelligence and data analy tics. Section 5.10.4.1 supports lhe sharing of Contractor proprietary infom,ation/dala model extension points (e.g .. ingestion and record APTs) witb bol11international and national slandards designating organizations . Panelists However , current language acknowledged IJris does not require access to the recommendation is EHRM data model , a stretch goal . supporting understanding of and therefore increase the exchange of computable data witb communit y care providers. Suggest adding to RFP Section 5.8 : " h) Provide the VA EHRM data, model. underpimung terminology model , tables. definitions. and examples of fully o ulatcd Veteran data files. Provide documentation or software tJiat is used for ualit_y checks and tJiat illustrate what data .. clements arc computable . Ccrne r Conci requested ch: Suggest addin Section 5.10.4 The Contractc support Know Interoperabilit supporting lhe e11.1eusio11 of c Suggest adding to Section 5.10 .4. l: content assets '.11) The Contractor shall support. terminologies , Knowledge Interoperabilit y by decision suppo supporting lhe extension of clinical rules , order se content assets such as terminologies to the extent clinical decision support rules, order extensions ar sets. etc . This includes the ability to consiste nt wi1 curate. extend. and share that modcJ ,md be knowledge witb clinical practices off partners . This fosters rapid adoption controHingn: from industry best practice s, e.g ., standard. Tlu clinical professional societies :. includes the al curate , extend Suggest VA obtain a price from the share thal kno with clinical Contractor lo provide a report partners . Thi~ explain IJ1esteps involved iu accessiJ.1gthe data mode l, including rapid adoptior producing an examp le data file, and indusuy best demonstrating how much of the data practices , e .g., professional is computable ; provide cost societies ." estimates for outside parties to access the data via this mechanism. A\llERICAN PVERSIGHT VA-19-0799-G-001125 DS_00021841 -Scott Scott, this breakfast is off. Mr. Perlmutter can no longer do. No need to travel, Scott. Sorry about that. Thank you. From: Blackburn, Scott R. Sent: Friday, March 09, 2018 4:09 PM To: (b) (6) Cc:(b) (6) Subject: RE: SecVA (b) (6) Awesome! Thanks so much. From: (b) (6) Sent: Friday, March 09, 2018 2:50 PM To: Blackburn , Scott R. Cc:(b) (6) (b) Subject: RE: SecVA (6) Scott- meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM . He has a speech and dinner that evening. He said you can leave after the 11am meet ing. I've added our travel t eam to provid e you details offl ights. Thank you! From: Blackburn, Scott R. Sent: Friday, March 09, 2018 2:19 PM To: (b) (6) Cc:(b) (6) Subject: RE: SecVA (b) (6) I'll be there. I'll plan to mimic his schedule . Sent with Good (www .good.com ) From: (b) (6) Sent: Friday, March 09, 2018 2:18:28 PM To: Blackburn, Scott R. Cc:(b) (6) (b) Subject: SecVA (6) Scott - just a heads up that boss wants you to travel with him to Mar-A -Largo on Tuesday. He will be meeting w/Mr . Perlmutter , Dr. Moskow itz, and Marc Sherman. We are trying to firm up the time. He may be departing early afternoon on Monday or early on Tuesday. Please confirm if you are available to travel with him. Thanks. Scott lets discuss tommorow Sent from my iPhone A\llERICAN PVERSIGHT VA-19-0799-G-001126 DS_00021842 Begin forwarded message : From: David Shulkin Date: March 11, 2018 at 12:31 :22 PM EDT To: Bruce Moskowitz < bruce (b) (6) (b) mac .com > ( frenchangel59 .com>, I (b) Cc: IP <8@ (6) mail .com ,~ Subject:b Re: Contact review (6) (b) (6) ) Great list( 6 Is leslie cooper from mayo- i could not find him or her ) Sent from my iPhone On Mar 11 , 2018, at 11 :02 AM , Bruce Moskowitz These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain Jonathan ManisCIO- suttrr Andrew Karson MD.- partners Leslie Cooper M.D. Clifford Ko M.D.- american college surgeons Sent from my iPad Bruce Moskowitz M.D . Mr. Blackburn , 1ent back and read Mr. Sherman . s email and reviewed my notes . I ,;i. I see no recommended language for insertion in the contract to address his concerns. What it appears to be is a push to perfonn an interoperability sandbox/test platfonn in advance of contract m- ard . Vr John John H. Windom Senior Exec utive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vennont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John .Windom @va .gov Office : (202) 461-5820 Mobil : (202) 794-491 J Executive Assistant: Ms. -(b) (6) Appointments and Scheduling (b) (6) ~ Office : -(b) (6) From: Windom, JohnH. Sent: Friday, March 23, 2018 1:47 PM To: Blackburn,Scott R.~Bowman,Thomas I VIL r 1 .1n1 PVERSIGHT VA-19-0799-G-001127 DS_00021843 Cc: Zenooz. Ashwini. Short, John (V ACO) Subject: RE : lEXTERNALJ Re : VA EHR Mr. Blackburn, Not sure where Mr. She1.man is going with his comments but our language in the contract is consistent with the requirements or our Clinicians, various external reviews and the Mitre repoti. Mr. Sherman is seeking specificity in the interoperability realm that simply does not exist today and is evolving even as J type. We have provisions in the EHR contract to insert technology as we, the VA, as well as to incorporate evolving technology and standards. The DVP acquisition is our bridge to the use of APis (gateways), FHJR, etc. We have modified our interoperability language (below) based on the Mitre and the many external reviews to give us the utmost flexibility over the 10-year life of this contract. The Secretary personally halted the recent phone call to stop Marc Sherman, et. Al's parade of national interoperability objectives as not feasible at this juncture "anywhere," but included as part of our overall interoperability strategy that includes the DVP acquisition/strntegy. We are committed to establishing the interoperability test bed/sandbox at IOC to solidify our interoperability objectives prior to fuU deployment to the enterprise. Jo addition, I believe Mr. Sherman meant to highlight section 5.5.1 which speaks to the data domains that were called into question and their inclusion in the contract. They are clearly in the contract as captured below. Mr. Sherman does not understand the cultun of VA or the federal government. We bave an incremental/iterntive change management strategy that will culminate in a successful EHR Modernization effort. He appears to be more of a ''big bang" theo1.y guy. The problem is, we must continue to deliver uninterrupted and quality care to our Veterans during the transformation within the parameters of the law and other regulations/polides (e.g. cybei-security, cloud, etc.) bounding our integration/implementation strategies. Our existing language is sound and appropriately balances change management risks, future insertion of technology, innovation opp01iunities, standards development, etc. without artificially inflating the cost of the contract through the incorporation of excess specificity that never materializes in practice. Through the Initial Operating Capabilities OOC) process and the judicious issuance of task orders ~ we will have the ability to change course direction as appropriate without excess risk to the tax:payers or our overall success. Mr. Sherman continues to fail to recognize that it is Program Management Oversight (PMO) and VA commitment to change management that will drive our success in these areas, not more words in the contract. Via-, John JDIQ PWS 5.5.1: Workflow Development and Normalization: j) TI1e Contractor shall enable configuration of the application that supports external community data without requiring the clinician to go to special screens to see and use reconciled external data . By IOC entry. the Contractor shall support incorporation of the following external conunun.ity data domains including but not limited to these domains and subdomains : o Problems o Allergies o Home Medications o Proc edures - inclllding associated reports and with appropriatel .filtered CPT codes o lm1mmizatjo ns o Discharge Swnmaries o Progress Notes o Consult Notes o History & Phys icals o Operative Notes o Rad iolog and Diagnostic Rep orts (Jnto ' "Documentation " component) By IOC ex it, the Contractor shall support incorporation of the following external community data domains. including but not limited to t hese domains and sub-domains : o Results oLabs - General - Patl10logy and Microbiology oVitals o Radiology and Diagnostic Reports (Into 'Diagnostic Report " component) A PVERSIGHT VA-19-0799-G-001128 DS 00021844 o Images IDIQ PWS Section 5.10.4: Seaml ss Interoperability/ Joint Industry Outreach includes significant d tail on the topic. The interoperability section is copied belov this table for reference. IDIQ PWS section 5.5.4 Data Exchange - Application Pi-ogram Inte,face (API) Gateway also includes detail on the creatjon of strategic open APls VA NF- 177: Interoperability - Data Standards : The system shall support the use of the health data standards identified in the VA DoD Health lnfonnation Technical Standards Profile and by the VA DoD Interagency Clinical lnfonnatics board, including following common data standards: National lofonnation Exchange Model NIEM ; Health Level 7 HL7: Logical Observation Identifiers Names and Codes LOINC. Systematized Nomenclature of Medicine SNOMED; Rx.Noon, MedRT , )CD, CPT, HCPCS, Veteran fofonnation Model VlM; and Healthcare Information Technolog y Standards Panel HITSP as well as VA/DOD/lPO extensions to these standards. VA-NF-T23: Info rmatic s - Care Integration : VA must be able to seamlessly integrate with HIE and external-to-EHR shared services to provide for a seamless e .perience-and to more effective ly integrate in community care efforts, as well as with other parts of VA (e.g. identity management) . This includes but is not limited to the EHR produc t ability to suppo1t extemal shared services (SOA services, such as identity management , care plan service , scheduling , etc.) accessed via standards-based APis. (Process Continuity , Evolution fa.1ension) KSR5 !NOW +l VA NF-Zl t: Health Informa tion Exc hange : 1l1e system shall support VA electronic exchange of health records via other interoperable net\. orks (e.g . CareQuahty Conrn10nWell Hea lth Alliance, DirectTrust National Associat ion for Trusted Exchange) by supporting their specifications , security and content specifications 5.10.4 Seamless Interoperability/ Joint Ind ustry Outr each The Contractor is required to coUaborate with VA affiliates. comnmnity partners , EHR providers , healthcare pro iders and vendors to advance seamless care throughout the health care provider market. Seamless care will require the creation of an integrated inpatient and outpatient solution with software components that have been designed , integrated, mainta ined. and deployed with a design architecture that allows for access to and sha1ing of common data and an enabli ng security-framework that supports end-to-end healtl1care related clinical and business operations . Seamless care is the experience patients and providers have moving from task to task and encounter to encounter within or between organizations such that high-quality decisions form casil_ and complete care plans execute smoothly. lnfonnation systems support the seamless-care experience by gathering data , interpreting data , presenting infonnation. and managing tasks. Current ly, industry lacks specific and unifonn interoperabi lity standards to support seamless care between organizations that employ different EHR systems. The Requirements Traceability Matrix Section D, Attachment 003, sets forth specific lnfo1matics and Interoperability cootract requirements . To accomplish this , the Contractor shall provide softv are and services to enable seamless care between VA encounters , encounte rs with other Government healthcare institutions , and outside entities through advancements in all areas of the EHR that occur. Jn addition, the software and services shall support the VA designated standards , such as SMART on FH[Rand SMART-enab led applications or other published standards . The objecti c of these interoperability solutions is to advance the state of the art supporting seamless care for Veterans. Existing organizations promoting interoperability among EHR vendors , such as The Argonaut Project, have developed or are planning to develop technology standards or technical approaches that may support tl1e EHRM sean1less care strategy. To the extent that underlying third party technology is available or made available to meet the following timelines the following interoperabiljty software solutions and services shall be del ivered wider this section : a) B_ Initial Operating Capability (rOC) the Contractor shall provide a sofu,vare solution nabling VA, DoD and community providers-. ho have connected to the EHRM to share interactive care plans (fCPs) for Veterans . ICPs will enable collaborative communication betveen providers and be~ een providers and Veterans. in managing Veteran care . b) Within 24 months of applica ble task order award, the Contractor shall provide a sofh are solution enabling VA, DoD and connected commut1ity providers to complete referraJ management activities for Veterans . A\llERICAN PVERSIGHT VA-19-0799-G-001129 DS 00021845 c) B I IOC the Contractor shall provide a softv are solution enabling VA to release and consume via on-demand access , a Veteran ' s complete longitudinal health record to and from DoD and connected commw1ity partners , irrespective of which EHR they use, provided such EHR technology is certified by the Health and Human Services Office of the NationaJ Coordinator (ONC) or its successor. Tue longitudinal record solution shall support Provider-toProvider record sharing , as well as Provider-Veteran-Provider sharing (Veteran mediated record shariug) . including appropriate consent management. The bi-directional health infonnation exchange shall maximize use of discrete data that supports context-driven clinical decisions and infonnatics . d) Within 24 mo)1thsof applicable task order a, ard, the Contractor shall provide a soft\ are solution enabling connected VA, DoD and community providers connected to the EHRM to send and receive Admission/Discharge/Transfer notifications 'pushed '' from the provider initiating a Veteran care event to enable proactive engagement by VA care coordinators when notified of a Veteran care event. e) Within 24 months of applicable task order award, the Contractor will demonstrate a solution for identification and management of Veterans at high risk of suicide, in collaboration ,,vith commw1ity partners . t) By (OC, the contractor shall provide URL based image access to the VA, commw1ity and academic partner systems who can support the URL and a viewer to the provid rs via th health information exchange netv orks. Within 36 months of applicable task order award the Contractor shall provide a sofuvare solution enabling-VA. DoD and community providers connected to the EHRM to have nationwide access to Veterans. imaging associated with diagnostic tests . g) By lOC, the Contractor sha.11provide a software solution for multilateral standards-based ing~stiot1, no1malization, storage , and exporting of Health Infomiation Exchang acqHired Veteran health iufonnation . The Contractor shaJl ensure that the solution provides a computable dataset for pu1poses of population health and research analytics , clinical decision support. and workflow integration . h) By IOC the Contractor shall provide the capability to connect and exchange VA electronic health records via other interoperable nch orks such as. eHeaJth Ex.change. CareQuality. CommouWeU Health Alliance. DirectTrust , National Association for Trusted Exchange by supporting tl1eir specifications , security and content specifications . Contractor shall support network record locator services and patient provider associations as applicable in accordance with applicable technical standards and the Trusted Exchange Framework and Common Agreement (TEFCA) . i) By COC, the Contractor shall provide a capability for provider collaboration via secure e-mail using the ONC Direct protocol or future VA-designated standard~ ithin a Cemer Millennitun EHR workflm, context. j) Within 36 months of applicable task order award, the Contractor shall provide a solution for a Sofu are Development Kit (SOK) enabling standards-based applications (e.g., SMART , FHI R, etc .) integrated with EHRM solutions and platfonns. k) Ce mer shall deli er annuaJly an Interoperability Plan to the VA on bow it intends to meet the objecti es established in PWS section -.10.4. The initial plan will be due within 3 months of applicable TO award. l) The Contractor shall conduct an annual Interoperability Self-Assessment against standards that shaU be specified by VA, such as those promulgated by HIMSS or future standards to be identified by VA. TI1eannual self assessment shall report on the state of each data clement (e.g., ~ hich are supported in what capacities and in which fonnats) . This will help assure standards implementatio11consistency and assure standards compliance with c ol ing nationaJ standards. m) Tue Contractor shall support Knm ledge Interoperabilit y by supporting the extension of clinical content assets such as terminologies , clinical decision support rnles. and order sets etc . to the extent such extensions arc consistent with the model and best practices of the controlling national standard . TI1is incl.udes the abilit to curate, e:-,,.-tend , and share that knm ledge with clinical partners. This fosters rapid adoption from industry best practices. e.g., clinical professional societies. 5.10.4.1 Data Design and Info1.mationSharing In support of the interoperability objectives under thjs Section, agreed upon Contractor proprietary infonnation/data model extension points (e.g. ingestion and record APis) may be provided to both intcmationaJ and national standards designating organizations as described and set forth in an applicable Task Order . The Contractor shaJI provide VA access and usage rights into any underlying proprietary tenninolog y/code systems for the purpose of enhancing national standards to address any gaps identified in the EHRM solution . The Contractor shall also make the interoperability capabilities and product enhancements developed wider this contract available to non-VA Cemer clients . 5.10.4.2 VA Digital Health Platform/Digital Veterans Platform Integration A\llERICAN PVERSIGHT VA-19-0799-G-001130 DS 00021846 VA anticipa tes deve lopin g a Digital Health Platfonn/ Dig ital Veterans Platform (DVP ) to consolidate critical VA EHR and non-EHR operatio nal systems. l11e Cont ractor shal l integra te the EHRM to inte roperate with DVP , or fu ture state VA platfolUl , including the DVP APT gatewa_ or any other method desig nated b VA. John H . Windom. Senior Executive Serv ice (SES ) Program Executive for Electronjc Healt h Record Modernizatio n (PEO EH RM) Special Advi sor to tbc Under Secretary for H alth 8 1l Vennont Avenue W (5 th Floor Suite -080) Washington DC 20420 John.Windom (@va .gov Office: (202) 461-5820 Mobil : (202) 794--4911 Ex cutive Assistant: Ms. -(b) (6) -Appointments and Scheduling (b) (6) ~ Office : (b) (6) Fl'om:Blackburn , Scott R. Sent: Frida y, March 23 20 18 12:15 PM To: Wll.ldom, JohnH : Bowman, Thomas Subject: FW: [EXTERNALlRe: VA EHR John - you might want to swing the by Secretary/Deputy ' s office before end of day to get a sense of where he is with respect to this. Sent with Good (www .good .com ) From: Marc Sherman Sent: Friday. March 23. 20 18 9 :47:3 9 AM To: Blackbum, Scott R. Cc: Bruce Moskowit z; DJS Subject: [EXTERNALlRe: VA EHR Scott Thanks for inviting m to listen in on your calls th.is " eek with the subj ect matter expe rts. I" as happy to make ti me to paiticipate as requested and ah ays ha ppy to prov1de my thoughts for your co nsid eratio n when requested. Tread carefull y your email abou t th e efforts to wo rk out t he hol es raised by the experts . You are on th e wa y to kicking off an exciting project wit h a high ly respected Contractor/ end or an d a VA team that has "vorked very hard ; and I know e e1yone has the goal to buil d the best t1e:\.'tgeneration system for the vetera ns" healthcare . Ho, ever , there were several major issues raised in the calls thjs week , ith the technical and clinical expe1ts th at you try to ell..'u la in awa y in your email as solved but indeed are not according to the expe1ts. These issues , they believe , , ill prevent a successful implementation an d I fea r come back to ha unt thjs proj ect and its overseers. I hate to be a naysayer , but I respectfu lly don't agree with some of your conclusions exp resse d in your emai l whe n I listen to the experts with whom you consulted ; and the experts are in fact not swaye d by the follo"v-up conversations wit h them. The e>..']Je rts are recommending a system for the VA that has various enhancemen ts to tod ay ' s standard system functionality . At a minimum , I hea rd those expe rt s Cll..']Jress their opinions that the contract dangerously lacks definitions, standards and a clear ex pression of this requir ed, defin ed enhanced (non-standard) functionality (they articulate it much better than I). Failing to exp ress this type of definitional t VIL r I .Jr I PVERSIGHT VA-19-0799-G-001131 DS_00021847 clarity in the contract is an invitation to ambiguity , disputes and ultimate fai lure of purpose . The best "oversight and management of the contract" will not tum a contract lacking specificity into a vision of clarity . Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confinn its agreement to provide the full functionalit y desired and have a bett r understanding of what is e""'Pcted of them. Clarity in the contract is a healthy ingredient for the VA and the Contractor. I ,;i.,ould be del ighted to be ,>vrongand welcome a demonstration of where Section 5. I of the contract provides this sp cificity that Drs. Cooper and Huff , for exampl , urged. In light of the system requirements that these experts say must be included , which are enhancements of toda y' s standard deliverables , the contract lang uage is ambiguous. You say that "risk cannot be I 00% driven out of any transformation of this magnitude ," a concept to which [ subscribe. However , when yo u substitute this concept for clear , written and defined functionality , especially for a design that is expected to be uniq ue in many respects , you are doomed to disappointment and conflict. [ am sorry to be so harsh in my opinions , but the experts are so united on this point ; and together w ith my historica l observations offailures in nearly identical situations I jus t see warning flares going off. Scott , I want to see this project get started , and quickly , as much as anyone , but with the clarity that equall y serves the VA and the Contractor , and prevents evident problems down the road . I also believe these things are easy to resolve in the contract language in relatively minimal time . Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10: 19 PM, Blackburn, Scott R. wrote: Marc/ Bruce , Thank you once again for all your support and especially for linking us up with these CIOs/experts . This was incredibly valuable. Secretary Shulkin. John Windom and I got together earlier today as well to talk about the path ahead. A few notes : o In ord r to make sure we w1derstand some of the more specific detailed points , members of our team reached out today for individual follow ups with Dr. Cooper Dr. Karson , Dr. Shrestha., Jon Manis and Stephanie , Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did com1ect with Dr. Cooper today on the point Marc highlights below. to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in - .1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed tw.o weeks ago include Cris Ross at Mayo as well Stan Huff at Intem1ountain and Dr. Karson at Partners) . o We will also follo"v up v ith Stan on some of the issues he raised as well . For example : Stan will be excited to learn that Cerner has priorit ized an additional 40 engineers to accelerate FHIR A Pis for VA in support of this contract. This will also be11efitIntermountain as Stan was telling us they've only had l 015 for their ent ire company to date . If V A/ DoD/lntennountain work together we will quickly get to the 200 number Stan mentioned . o Per Stephanie ' s suggestion , we are going to start moving forward A SAP on fom1alizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of expc1iise throughout our journey . Obvious! we will want Stephanie , John , Andy Rasu , etc. Cris Ross (Mayo) , Will Morris o r Ed Marx (Cleveland Clinic) , Frank Opclka (American College of Surgeons) are others you ' ve introduced us to along the ,vay that we would love to include . We would like to" ork wi th you to make sure we get this right . o As recommended last night , an interoperability sandbox/te st bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify th requisite interoperability A\llER PVERSIGHT VA-19-0799-G-001132 OS 00021848 requirements prior to full enterprise deployment. This is a great suggestion and very consistent have been hearing from many experts . ith what we o Our team is reviewing all the feedback (both oral from the calls and the written not s that some provided) and cross -walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any shovvstoppers. Upon receiving the feedback , we feel very good that we have a solid contract from which we will just need to make minor revisions. o After discussing this with Secretary Shulkin today , we feel strongly about moving forward quickly . We" ill make any necessary tv,,eaks with Cemer ASAP (we absolutely do not anticipate any push back ; and Cemer bas promised to tum things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretarv Shulkin could sign as earlv as next week If the Omnibus falls through (which let's hope not) , then we would have to request a transfer from the Congressional approp1iation committees which will then take ~2 weeks. Signing the initial task orders will allow us to start moving forward with Cemer on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting , change management (with will include wide involvement from clinicians inside and outside VA ... something ,ve heard loud and clear from Bmcet ), help desk establishment , and project oversight (which we ' ve heard loud and clear from Stephanie/Jon). As a reminder, given the IDIQ structure of the contract we would not be signing the fufl contract (rather just Year J - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand ". o Marc makes a great point below on turning DoD's struggles into a positive. We have been working very closely ,vith the DoD tean1 over the past 9 months (T now have my own Pentagon 1D pass I am there so much ; John and Twork very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g ., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments oo trouble ticket management based on what you ' ve read in the papers). We are paying very close attention to their implementation issues (workflow, change management, governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce 's point of making sure we have clinician buy-in and involvement from the get-go (I couldn 't agree more) . This will make getting move on change management in Task Order # 1 so important. o As you both kno, , risk cannot be J00% driven out of any transformation of this magnitude. Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance , as well as the VA 'S access to senior industry advisors ." l think we have a great plan . The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again, we believe the construct of the contract , and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns , as well as suppo1t the time ly injection of technological advancements (e.g. cloud, APfs, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperability remains at the forefront or our concerns , and your comments the MJTRE study and va,ious other eA1emal inputs contributing significantl y to our RFP language and corresponding requirements. Interoperability will be a moving target for years to come, but our contract allows us to leverage tl1c best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc , thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners " on this journey and we arc incredibly appreciate. We look forward to continuing this relationship as we take the ne\.1 steps. Scott From: Marc Sherman [mailto :~ (b) (6) Sent: Wednesda y, March 21, 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff A\11ERICAN PVERSIGHT VA-19-0799-G-001133 OS 00021849 I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought r would offer some reaction/feedback that still seems unsettled . 1 will outline my nighttime thoughts below in case you find them usefuJ . 1. I thought that Dr . Cooper made a good case for inseti ing specific definitions and standards on the meaning and use of "interoperability ," especially sjnce that term bas as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally clifferent standard . That runs the risk of not being disco vered until Jater, perhaps even up to implementation, a very costly result , Perhaps a similar problem (a seemingly big prob lem) that the DOD implementation faces now where the users are rebelling. Unfortunately, if this "gap 11 in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr . Cooper , why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity . It will pay dividends later in terms ofless arguments , better initial design , happier user community, less overall cost , better healthcare deJivery, etc . Then , with the standard fully defined and set in the 01iginal PWS, the mock-up test will be much sooner in time and much more complete the first time, allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms . Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them the VA, the patients and healthcare , so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5. 1. 1) of the PWS. DL Cooper , as a physician user and not a technician, deferred on the effectiveness of the existing contract lang uage to others but commented that the CIO of NIA YO read the contract and also did not think it adequately contained the 1ight defining language to set out unambiguous definitions and standard . 1 have read the contract again last night and happen to agree , or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2. I was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effoti . Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractuaJly prevent similar mistakes. 3. I have other thoughts as well that we should discuss , but these are the ones that I felt more pressing to highLight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8 :24 AM, Blackbum , Scott R. wrote : o problem Marc. Thanks for all your help . Very helpful call last night. From: Marc Sherman [mailto:~ (b) (6) Sent: Wednesday. larch 2 1. 2018 12:12 AM To: Blackbum . Scott R . Subject: !EXTERNALlRe: St.anHuff Scott A\llERICAN PVERSIGHT VA-19-0799-G-001134 DS_ 00021850 I won't be able to join the caJl tomorrow as .I have a previo1.,1scommi1ment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (b) (6) On Tue, Mar 20, 2018, 10:30 PM Blackburn, ScottR. wrote '. Bruce/Marc- thanks for introducing us to all the experts we talked to tonight. It was extremely valuab1e. We have Stan Huff from lntennountain tomorrow at 10am . I assume you have the calendarinvite case it is 1-800-767--(b) (6) (b) (6) but just in We have been unable to schedule anything with Dr . Ko (very busy calendar). We will trying. Scott Scott Blackbum Executive in Charge, Office of Information & Technology US Department of Veterans Affairs Hmm . Have you spoken to the Secretary directly yet? I wrote him about Marc Sherman's email but he didn't respond . Not sure where his head is at. I don't understand why ogc would meet him without you . It kills me how we don't trust each other and try to work point to point through the Secretary . Sent.with Good (www.good .com) From:Windom, John H. Sent: Tuesday, March 27, 2018 6:34:17 AM To: Blackburn,Scott R. Subject: Update Sir There was a meeting between Shulkin and the attorneys (Byrne and Fleck) last week that I was not invited to. This is the language proposed for inclusion in the contract following that meeting . Does the inclusion of this language close the deal? Before negotiating with Cemer, I need to understand weather it closes the deal. I discuss with the TAC this morning. Just received yesterday eve . Thank you. John John, Reference is made to the note I sent you last Wednesday whereby I mentioned that OGC (Mr. Byrne) wanted to review our RFP. (b) (6) recently shared the following OGC requested PWS change (italicized) presumably as a result of that review : Av1r-r-,1 .1/-\1 PVERSIGHT VA-19-0799-G-001135 DS 00021851 Please consider this recommended change to PWS Section (b) (5) Sent with Good (www.good.com) (b) - TAC has advised the EHRM PEOof the requested (b) (5) (6) - Thanks, (b) (6) (b) (6) Contracting Officer Department of Veterans Affairs Office of Procurement, Acquisition and Logistics Technology Acquisition Center (b) (6) (b) (6) ( (b) (6) e-mail: b ~ ) ( 6 ) "For Internal VA Use Only - Working Draft, Pre-Decisional, Deliberat ive Document : This e-mail and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information . If you are not the intended recipient of this e-mail, you are hereby notified that any dissemination, distribution or copying of this e-mail, and any attachments thereto , is strictly prohibited. If you have received this e-mail in error, please notify me via return e-mail or telephone {732) 440 -(b) and permanently delete the original and any copy of any e-mail and any printout thereof " (6) From: (b) (6) (b) (6) (OGC) Sent: Friday, March 23, 2018 12:27 PM To: (b) (6) Cc:(b) (6) .. Subject: contractual (OGC);(b) (6) language - PWS - EHR (OGC); Fleck, Robert R. (OGC);(b) (6) (OGC) (b) (6) A\llERICAN PVERSIGHT VA-19-0799-G-001136 OS 00021852 o(b) is out today, and so I am sending thjs directly to you : (6) (b) (5) Please consider this recommended change to PWS Section (b) (5) (b) (5) --- -------- --------- Thanks , (b) 1111 (6) (b) (6) Associate Chief Counsel Procurement Law Group Office of the General Counsel U.S. Department of Veterans Affairs 810 Vermont Avenue , N.W. Room 1056/Mail Code 025 Wasrungton, DC 20420 Phone : (b) (6) (b) (6) (b) (6) Sir. Lthink this recent language request (see belm ) for (b) (5) 11111 That meant a lot to me . Please get back to vacationing and thanks for your concern for my (b) Vr John (6) John H. Windom , Senior Executive Service (SES) Program Executi ve for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health A v1r-till.1AI PVERSIGHT VA-19-0799-G-001137 DS_00021853 811 Vennont Avenue NW (Yh Floor Suite 5080) Washington., DC 20420 John .Windom @vagov Office : (202) 461-5820 Mobile: (202) 794-491 J Execut ive Ass istant: Ms. Kelli (b) Appointments and Scheduling (b) (6) ~ Office ( (6) b ) ( 6 ) 1111 - From: Windom, John H. Sent: Tuesday, March 27, 2018 9:29 AM To: DJS Cc: Byrne, Jim (OGC); Blackbum, ScottR. Subject: RE: Getting it right Mr. Secretary '. I am seeking a 30 minute audience ovvitbMr. Byrne to disc uss the recently proposed language for (b) (5) V/r, John Proposed Language : Please consider th;s recommended change to PWS Sect ion (b) (5) John H. Windom , Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 81 l Vem1ont Avenue NW ( - th Floor Suite 5080) Washington , DC 20420 John .Windom @va .gov Office : (202) 461-5820 A Vlt-til .1AI PVERSIGHT VA-19-0799-G-001138 OS 00021854 1obile: (202) 794-4911 E 'ecutive Assistant Ms. -(b) (6) (b) (6) ~ - Appointments and Scheduling Office: -(b) (6) From: DJS Sent: Tuesday March 27. 2018 7 :50 AM To: Windom . John H. Cc: Byme , Jim (OGC) Subject: FW : Getting it right John- can you help craft a response to this Sent with Good (www .good .com) From: Blackbum. Scott R. Scnl: Sunday, March 25 . 2018 9:3 7:38 AM To: DJS Subject: RE: Gett..i.ug it right I'm not sure if you read Marc ' s response to mine yet. Or if so, what your thoughts are on it. I fear we are still talking past each other. If he/others were to come back with specific counter language to the language in the contract then we would certrunly consider that (that is the level we are working at right now). But we aren ' t getting that nor do I see us getting that without Marc or anything else really digging into the details of our contract. We are way beyond the high level philosophy . Let me know and I'll direct the team . In Bahamas now and only have connectivity sporadically, but back in US (Florida/Disney) tomorrow morning . Back in the office on Thursday . Sent with Good (www .good.com ) From: DJS Sent: Sunday, March 25. 20l8 12:08:17 PM To: Byrne, Jim (OGC) Cc: Blackbum, Scott R . Subject: Geltiog it right Jim- did you get any further clarity on (b) (5) Scott I assume your best to orchestrate all of this is moving in the right direction A\llERICAN PVERSIGHT VA-19-0799-G-001139 DS_00021855 Thanks Sent with Good (www .good.com ) Thanks Bob. I did attend today 's listening session, 10am -11:3Dam. I did not attend the session at 1pm. For the sake of documenting. Here are a few notes. (b) (5) (b) (6) From: Fleck, Robert R. (OGC) Sent: Wednesday, January 31, 2018 8:28 AM To: Blackburn, Scott R. Subject: RE:lnteroperabilty listening sessions Scott, As we discussed, although it would be (b) (5) I I I Bob Robert R. Fleck Chief Counsel, Procurement Law Group Office of the General Counsel Room 1050 810 Vermont Avenue, NW Washington, DC, 20420 Office 202-461-4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC?552. Do not release this information without prior authorization from the sender. If this has inadvertently reached the wrong party, please delete this information immediately and notify the sender. Any security screening of this email by information / VI PVERSIGHT VA-19-0799-G-001140 OS 00021856 officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney -client privilege and/or work product privilege. From: Blackburn , Scott R. Sent: Tuesday, January 30, 2018 2:53 PM To: Fleck, Robert R. (OGC) Cc:(b) (6) Subject: RE:lnteroperabilty listening sessions Can we talk at 3:30pm? From: Fleck, Robert R. (OGC) Sent: Tuesday, January 30, 2018 2:33 PM To: Blackburn, Scott R. Cc: Byrne, Jim (OGC) Subject: RE:lnteroperabilty listening sessions I can see you now. Bob Robert R. Fleck Chief Counsel, Procurement law Group Office of the General Counsel Room 1050 810 Vermont Avenue, NW Washington, DC, 20420 Office 202-461 -4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney -client privilege . Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC?552. Do not release this information without prior authorization from the sender . If this has inadvertently reached the wrong party, please delete this information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney -client privilege and/or work product privilege. From: Blackburn, Scott R. Sent: Tuesday, January 30, 2018 2:32 PM To: Fleck, Robert R. (OGC) Cc: Byrne, Jim (OGC) Subject: RE:lnteroperabilty listening sessions (b) (5) From: Fleck, Robert R. (OGC) Sent: Tuesday, January 30, 2018 10:27 AM To: Blackburn, Scott R. A\/lERICAN PVERSIGHT VA-19-0799-G-001141 OS 00021857 Cc: Byrne, Jim (OGC) Subject: RE:lnteroperabilty listening sessions Scott, (b) (5) (b) (6) (b) (6) If you have any questions, please let me know. Bob Robert R. Fleck Chief Counsel, Procurement law Group Office of the General Counsel Room 1050 810 Vermont Avenue, NW Washington, DC, 20420 Office 202-461-4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney -client privilege . Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC?552. Do not release this information without prior authorization from the sender. If this has inadvertently reached the wrong party, please delete this information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney-client privilege and/or work product privilege. From: Blackburn, Scott R. Sent: Monday, January 29, 2018 11:04 AM To: (b) (6) GBPwho.eop.gov Cc: Fleck, Robert R. (OGC); Byrne, Jim (OGC);(b) (6) Subject: lnteroperabilty listen ing sessions (b) 1111 (6) It was a pleasure meeting you today. I am cc'ing Jim Byrne and Bob Fleck. Jim/Bob- Chris Liddell asked me (or someone from VA- perhaps Windom or Ash) (b) (5) (b) (6) Scott Scott Blackburn Acting CID & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs A\/lERICAN PVERSIGHT VA-19-0799-G-001142 OS 00021858 Scott, (b) (5) Please let me know if you have additional questions. -- Thanks! (b) (6) (b) (6) Off ice of the White House Counsel (b) (6) (b) (6) ~ who.eop.gov From: Liddell, Christopher P. EOP/WHO Sent: Monday, February 12, 2018 2:37 PM To: Blackburn, Scott R. (b) (6) . EOP/WHO (b) (6) (b) (6) who.eop.gov> Subject: RE:VA EHR @who.eop.gov>;- (b) (6) EOP/WHO Scott I discussed this with -(b) (6) ( copied here) She is going to advise on the best approach to ensure we do everything correctly She will let us know of appropriate next steps Thanks Chris From: Liddell, Christopher P. EOP/WHO Sent: Monday, February 12, 2018 9:31 AM To: ' Blackburn, Scott R.' <5cott.Blackburn@va.gov> Cc:(b) (6) OP/WHO (b) (6) Subject: RE:VA EHR @who.eop.gov> Scott Sorry for slow reply - happy to catch up at some stage this week A\llERICAN PVERSIGHT VA-19-0799-G-001143 OS 00021859 Chris From: Blackburn, Scott R.[mai lto:Scott.Blackburn@va.gov] Sent: Thursday, February 8, 2018 9:41 PM To: Liddell, Christopher P. EOP/WHO(b) (6) Subject: VA EHR who.eop.gov;::,- ChrisIf you have time possibly early next week, I would love to get your advice related to our EHR. The next few weeks will be critical (with budget hearings, discussions with appropriators, Veteran Service Organizations, etc) and we want to make sure we handle everything appropriately. If you are open to it, I can work with Quellie to find time. Also, I have attached the Executive Summary of MITRE's VA interoperabi lit y report . Overall very consistent w ith everything else we seem to be hearing. Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs Camilo - I hope you had a good weekend. I appreciate the conversation on Friday and thought I would put my thoughts down on paper (as prom ised). I am including Peter on this as he/I have begun having some of these conversat ions over the past few weeks (although Pete in fairness has had a lot on his mind with his new role) and also cc'ing Jake. Attached are two documents: o The 8 things that I believe need to happen to not just keep the lights on, but also to keep our positive momentum going. I believe we should aspire for much more than just keepi ng the lights on duri ng this upcoming transition (at least in Off) as we have a huge organl zation making some huge changes and if we don't keep the momentum, it w ill make th e next guy's job impossible. I am a big believer that the sign of an effective leader is how the organizat ion performs when that leader leaves. So thls will be important to me to know (which is why I'm wr iti ng this out). o #1 out of 8 is stabilizing the leadership of OIT to get us through the next 6 months and set the new CIO up for success (I firmly believe it will 6 months before we have a permanent CIO). So I have 5 specific recommendations under that I've gone into greater detai l. I am worried about t his not ju st because of folks leaving (I was always planning to leave this Spring...actually I was supposed to leave a few months ago; Ricci's retirement date is 4/15) , but also because of possible morator iums on SESmoves (e.g., possible OPM moratorium on hiring because no permanent Secretary in place, 120 moratorium on moving SESsonce new Secretary put in place, etc) . So any waivers to these or anything we can do to push stuff through, I would love to work together to make happen. I would strongly advise you guys to .get to know Bill James better . I am convinced he is the right guy to step up and lead OIT through transition until the permanent CIO comes on board . If you can get comfortable with him, I would suggest that we th en transition sooner rather than later given I th ink it will be better for that person to start fresh with the new leadership team on t he 10th floor (rather than me hanging around as a lame duck for a month). We can talk about what that means as far as timing, transition, handover. I am more th an willing to fade to the back for a little bit to .a support role (to help boost up Bill and make him successful) or fade away completely (if that is better for the organization} . I thin k you guys know we well enough to know that I'll do whateve r is best for Veterans and the organizat ion; and will always do so in the most professional manner. I' ve now given 3.5 years (way longer than I had ever planned to) and I want to see the positive momentum continue well after I'm gone. Talk to you tomorrow, A v1 L r " .,, , PVERSIGHT VA-19-0799-G-001144 DS 00021860 Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs Hi Scott, Just FYI: Deborah Scher had me fired today . She knew I was working on detailing out; we had discussed it. You were incredibly nice and I was looking forward to working with you and your team . Best Regards , Mike Hi Scott, Greetings. You and I met in a few SecVA meetings. Would you have a few minutes to connect or meet? My exec coach (-(b) (6) says she worked with- (b) and her team and you might know her. (6) I'm here at VACO. Thanks. Best Regards, Mike Michael Tepper Sen ior Advisor to the Secretary Center for Strategic Partnership s .Department of Veteran Affairs (o) 202 -461-500 5 (c) 202.-658-89 82 MorTis, Genevieve (OS/O cno)Genevieve.Morris(@,hbs.gov I don .1think I have a phone number for her. bu! will let you kno\Vifl can find it. From:Sandoval, Camilo l Sent: Monday , April 02 , 2018 9:03 AM To: Blackbum., Scott R . Cc: Windom., JohnH. Subject: RE : Contract Language Scott,Do you have Genevieve ' s work email address and phone number? I need to contact her today and not sure where I can find her or if she at the VA yet. Thank you, Camilo A\llERICAN PVERSIGHT VA-19-0799-G-001145 DS_00021861 From: Blackbun \ Scott R. Sent: Sunday. April 01, 2018 6 :28 :05 PM To: Saudov al, Cami lo J. Cc: Windom ,. John H. Subject: RE: Contract l.anguage Yep I knov Genevieve. She is good. Will give it some thought. ls she detailed in to VHA I assume? From: Sandoval, Camilo J. Sent: Sunday, April 01, 2018 8:39 PM To: Blackburn, Scott R . Cc: Windom, John H. Subject: RE; Contract l.anguage Excellent , I'll touch base with Windom tomorrow morning . Also, there' s someone by the name of Genevieve Morris from the Office of National Coordinator (ONC) joining the VA tomorrow on a 120 day detail. I believe she will be helping us review the contract as well, at least with regards to interoperabi lity, and already working with the EHR team. Do you know (of) her? Any thoughts on how we might utilize her expertise in combination with Rasu , beyond just reviewing the Cerner contract? She seems to have a solid policy background in her respective space . Do you see Genevieve and Rasu working together to cover the policy and functional aspects of Interoperability? Camilo From: Blackbum, Scott R. Sent: Sunday. April 01 2018 4 :38:47 PM To: Sandoval Camilo J. Cc: Windom. John H . Subject: RE: Contract Language Not sure we did. John? What he might be talking about is the feedback from the calls we had 2 weeks ago . I believe John and team have created a thorough matrix to reconcile that feedback (and Ash did follow ups with each to make sure \ e understood their feedback and then lmderstood how we were reconciling that feedback). There was also the language that we received via OGC. rn lea e it to John to, , eigh in. Fro m: Sa11doval. Cami lo J. Sent: Sunda , Ap1il0 1, 2018 7:3 5 PM To: Blackbum, Scott R. Cc: Windom. Jolm H. Subject: Re: Contract Language Scott, I just spoke wjth Bruce Moskowitz regarding where things are with EHR and he mentioned you recently AVlcHICAN PVERSIGHT VA-19-0799-G-001146 DS_00021862 received language provided by severa l CIOs (Leslie Cooper, Stan Huff, Stephanie Reel, Jonathan Manis) . Could you kindly forward me those emails and documents? I believe it was in regards to interoperability . Hope you had a great Easter Sunday. Thank you. Camilo Scott, Did Rasu ever complete the required IPA paperwork? I am ready to move here. I'm confused why he was announced before being officially on-boarded (looks nefarious) . Let's discuss in the mo rning . Thank you. Camilo Sandoval M: 917-680 -2011 During the 2014 scandal (after Secretary Shinseki was fired and before McDonald came in), Dr. Jonathan Perlin did this for 60 days. Would Marc be willing to do something similar? http:ljwww .modernhealthcare .com/article/20140626/NEWS/306269942 http:ljwww .modernhealthcare .com/article/20140628/MAGAZINE/306289971 https:ljwww .tennessean .com/story/news/health/2014/0G/26/veterans-affairs-turns-hca-exec-help/11399441/ Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs Team - I want to introduce each of you to Camilo Sandoval and ask that each of you on to "to " line schedule an hour to meet with him next week. Will ask Eric to coordinate . Camilo is a member of the V.A. political team . Given we are going through some transition at the top of the organization right now , it is important that he understands our key issues. As you can imagine , the political team is very busy right now bring Acting Secretary Wilkie up to speed, prepping Admiral Jackson for a late April confirmation hearing , and figuring out how to reset the Department 's agenda at the Secretary/Department level. This is a similar process that we went through during the Presidential transition period Oust a lighter version) . Please get these set up for next week. Thanks , Scott Sent with Good (www .good.com) Ccing Eric here. Eric - can you help coordinate these for next week? To include formal/templates if necessary (see Camilo's note below). I would have each give the same briefings they gave me when I came on board a few months ago Oust dust them off and update them accordingly). Rick and Dom are highest priority . A VIL I I .Jr I PVERSIGHT VA-19-0799-G-001147 DS_00021863 I would then say Martha, Lloyd ,.(b) I also added Helga and Marcy . (6) and Jackie and Luwanda . I'd have them block an hour for each . Sent with Good (www .good .com) From: Sandoval,CamiloJ. Sent: Saturday,April 07, 2018 11:33:24 AM To: Blackburn,Scott R. Subject: RE: Follow-up Scott, ! need you to help push harder. For example , I have not heard back from My calendar for next week is still empty . Please__. Dom or Rich . You have the list of people I requested to meet below and I'm not going to chase anyone down . Please have someone coordinat~ this as Bill suggested and let's get this done ASAP. Also, please remind everyone this is a briefing request so i can better understand their area of responsibility and portfolio . Ttiank you Camilo 917-680-2011 From: Sandoval,CamiloJ. Sent: Thursday, April 05, 2018 9:23:26 PM To: Blackburn,Scott R. Subject: RE: Re: Follow-up Would be super helpfu l to connect with you r Cos and CFO next. I'm not feeling the love, but I might be misreading the vibes . Bill suggested (per my email last night) that the Cos should take the lead in requesting 1:1 briefings. The format is simple, they can brief me using their preferred method/format . The main goal for me is to listen and learn .and build relat ionships. If Eric could help me coord inate with everyone's calendar, that would be greatly appreciated (including Dom). My preference is to have these briefings completed by end of next week if possible. Briefing Request Eric Huweart Rick Chandler Dominic Cussatt Martha Orr Luwanda Jones Lloyd Thrower (b) (6) Jackie Patillo Thank you. Camilo From: Blackburn , Scott R. Sent: Thursday , April 05, 2018 9:25 PM A\llERICAN PVERSIGHT VA-19-0799-G-001148 DS 00021864 To: Sandoval, Camilo J . Subject: RE: Re: Foll ow -up Happy to help on the 1 on ls . Is there any specific you need me to push? From: Sandoval, Camilo J. Sent: Thursday, Ap ril 05, 2018 5:37 PM To: Blackburn , Scott R. Subject: Re: Follow -up Scott, Here are the 3 takeaways and follow up items I' ll work to get more clarity on. 1). CIO interview process/pipe line/time line 2). Timel ine for a decision point on Acting/C ID 3). VBA/Benefi t s I need your help pushing for my 1:1 meetings w ith team directly below CIO & PDAS.My calenda r is complete ly empty for all of next week ! !! Thank you sir. Camilo Camilo Sandoval M : 917-680-2011 Thanks .(b) I managed to find the other 4. I will shoot them all an emai l over the weekend . I' ll cc you guys too in case (6)to be included. Thanks for all the support. you want Have a great weekend , Scott From: (b) (b (b) I EOP/WHO [ma ilto-who (6) .eop .gov] ) Sent: Wednesday , November 01, 2017 9:33 AM(6) To: Blackburn, Scott R. (6) Subject: [EXTERNAL)RE: VACIO advisory support for Cerner cont ract (b) (6) (b) (6) Here is the first he can help like ly with the others - let me know if you need help tracking them down - I don't have them at the moment From: Blackburn, Scott R.[ mailto:Scott .Blackburn@va.gov ] Sent: Tuesday, October 31 , 2017 4:31 PM To: (b) (6) EOP/WHO ~(b) > for Cerner contract Subject: FW: VACIO advisory support (6) (b) (6) A\/lERICAN PVERSIGHT VA-19-0799-G-001149 DS_00021865 Happy Halloween! I just want to fo llow up on this exchange with Jared. Can you help connect us with the 5 CIOsso we can bounce our EHR plan off of them before we go final? Thanks again for all the support! Scott From: Kushner, Jared C.EOP/WHO (mailtoa@ (b who.eop.gov] Sent: Friday, October 27, 2017 5:36 AM ) To: Blackburn , Scott R. (6 Cc: Liddell, Christopher P. EOP/WHO; Windom, ) John H.; DJS;(b) (6) Subject: (EXTERNAL)Re: VACIO advisory support for Cerner contract EOP/WHO; (b) (6) EOP/WHO We wou ld love that . We also thin k you should build in some flexibi lity and requirements around where we think the EMR market might go so that you aren't locked into a program 10 years fro m now that is obsolete. ? (b) will connect you and schedule next meeting (6) Sent from my iPhone On Oct 27, 2017, at 1:56 AM, Blackburn, Scott R.< Scott.Blackburn@va.gov > wrote : Jared/ Chris Thank you for taking time Tuesday evening to discuss the (b) (5) (b) (5) (b) (6) (b) (6), (b) (2) (b) (6) Scott This is Scott Blackburn, the Act ing CIO for the Departmen t of Vet erans Affairs (VA). On behalf of t he Secretary David Shu Ikin, I wo uld like to invite yo u t o partic ipate in a cri tical review of our Electronic Health Record (EHR)modernization strat egy and correspondi ng Request for Proposal (RFP)to Cerner. Your organizat ions have been at the forefront of AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001150 DS_00021866 the evolution high quality IT-based health care services and delivery for decades, and thus we would be remiss if we did not seek to gain your insight prior to our final contracting decision. I anticipate a round table style engagement/discussion in the Washington, D.C. area that will last approximately two hours . I will be accompanied by the Program Executive Officer for VA Electronic Healt h Record Modernization (PEO EHRM), John Windom, and his key staff members including his Chief Medi cat Officer (CMO), Chief Technology Officer (CTO) and Director of Contracts. We have spoken to many commercial health care industry leaders regarding EHR implementation and deployment, and continue to maintain a strong relationship with our Department of Defense (DoD) counterparts, with regards to their EHR deployment activities and related challenges. We believe that we have developed a comprehensive RFPwith particular emphasis on notable "fail points" EHR-deployment arena such as Governance, Training, Change Management, Data Migration, Funding, etc . to name only a few, but look forward t o your thoughts on thes e and others. I ask that you please provide me your primary schedule manager or point of contact to coordinate a date and time that maximizes our overall participation at this all-important review forum . Thank you in advance for your attention to this note, participation and willingness to help our Veterans continue to receive the very best healthcare. Scott Blackburn Scott Blackburn Acting CIO & Executive in Charge, Office of Information & Technology US Department of Veterans Affairs thanks From: DJS Sent: Tuesday, November 14, 2017 2 : 15 PM To: Blackburn , Scott R. Subject: RE: VA MEETING Yes and yes Sent with Good (www .good.com ) From: Blackbum , Scott R. Sent: Tuesday, November 14. 2017 10:46:39 AM To: DJS Subject: RE: VA MEETING Got it. Are you ok with Bruce joining and inviting a few others (it looks like 1-2 clinicians from MOH) ? AVlt"'til .1AI PVERSIGHT VA-19-0799-G-001151 OS 00021867 For the 5 CIOs, ho ask . I will tell them that Bruce is an adviso r and e,-1ensio n of the \1/HN A team . Is that ok to say? From: DJS Sent: Tuesday, November 14, 2017 I :43 PM To: Blackbum, Scotl R. Subject: RE: VA MEETING I don't have any real advice but to keep the conversation focused on the topics you need advice and value on Sent with Good (www .good .com) From: Blackbum, Scott R. Sent: Tuesday, November 14. 2017 10:38:25 AM To: DJS Subject: FW: VA MEETING The call 'vviththe 5 IOs is We dn esda y 3-5pm. On our pre-calls. 2 of th e CIOs have asked about Bm ce and what his in volvement is . I have never had any conta ct with Bruce , but it seems like a sensitiv e relationship . Any adv ice on how to handl e? We invited Jar ed/Chris from WH as a co u1tesy . I don ' t think either plan to join , but they m ust ha ve invite d Bmce who is now ask ing a few others to jo in (sec belo v ). Can discuss live late r befo re or after hearing prep . Scott (b) (6) From: Schnitzer. Jay Jr~ Sent: Tuesday, November 14, 2017 12:47 PM To: Blackbum, Scott R. Cc:-(b) (6) Subject: rEXTERNAL] FW: VA .MEETING Hi Scott, Please see the ema il trail below. Just want you aware in case we have people joining the call withou t your knowledge or approval . Thanks , Best , Jay Jay J. Schnitzer , M .D ., Ph.D . MITRE From:-(b) (6) (b) (6) (a). PARlNE RS.ORG> Date: Tuesday, Nov 14, 2017 11:43 AM To: Karson , Andrew Scott,M .D. (b) (6) h.harvard .edu> Cc: Schnitzer Jay J ~(b) (6) > Subject: RE: VA MEETlNG AMERICAN PVERSIGHT VA-19-0799-G-001152 OS 00021868 But do the p eople hostin g th e call know yo u are goi ng to be on t he ca ll? I am cop ying Ja y as be i s helping coor dinate the cal l.. (b) (6), (b) (2) From : Karso n, An drew Scott ,M. D . Sent : Tuesday, Nove mber 14, 20 17 11:3 1 AM (b) (6) alP.ARTNERS.ORG > To:-(b) (6) Subject: RE: VA MEETING Dea r.(b) (6), (b) (2) Thanks for t he note. I thin k that you and I may have a Little mis- und erstanding . I agree t hat yo u can of course h and le t he call , but Gregg and Bm ce Mos kov itz inv ited me to the ca ll tomo rrow so that they can have a hands-on clini cians perspec tive. Bm ce and I spoke very briefly (between his patients) a littl e while ago and Brn ce sent me the below info m1atio n . I am hop ing to touch base w ith yo u befo re the cal l if that is possibl e fo r yo u. I am tied up in prese ntat ions/meeti ngs the rest of th e day. but could speak thi s evenin g (6 pm ?) or tomorrow if that is okay with you. (An d if neede d I will break o ut of oth er mee tings today) , Man y t hanks , Andy Frnm : -(b) (6) Sent : Tuesday. Nove mber 14 , 20 17 11: 16 AM To : Karson, Andr ew Scott ,M.D . (b) (6) Subject: RE: VA MEETING m h.barvard .edu > I b ad a ca ll with them today in prep for tomorrow ' s call. l ap precia te the offe r but I don.t think it is my place to invite you . It needs to co me from the VA. From : Ka rson, Andrew Scott ,M.D. Sent : Tuesday.Novem be r 14, 20 17 11:11 AM (b) (6) @PARTNERS .ORG > To:-(b) (6) Subject: FW: VA MEETING Dear. (b) (6), (2)me con fl icts th at Gregg bas being a senio r adv isor fo r the VA, Gregg has aske d me to j oin the 3pm VA call Given(b)so tom o rrow to be availabJc fo r the cl inic ian perspective. Wo uld yo u be up for a 15 minut e check -in ca ll with me at some point tomorr ow befo re the VA ca ll? If so, the n l ' ll reach out to Susan Briggs t o ge t us a time. Ma ny th anks, Andy F rom: Ka rson, A ndrew Scott ,M .D . Sent : Tuesday, Nove mber J4, 20 17 11:06 A M To: 'Bm ce Moskow itz' (6) Subject: RE: VA MEETING Dear Bru ce , Many th anks for th e note. I'll review th e below a littl e late r toda y and I'll be back in touch, Many thank s and best , Andy From : Bru ce Moskowi tz mailto :brucerr (b) (6) (b) (al nae .com (6) Sent: Tuesda y, Nove mbe r 14, 2017 10:45 AM To: Kar son, An drew Scott ,M .D. (b) (6) rm h.harvard .edu > Subject: VA MEETI NG The call will take place this Wednesday, November 15th between 3 :00 PM and 5:00 PM AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001153 D8_00021869 Dial In Number : 800-76 7...(b) (6) Passcode:-(b) (6) Thank you for your time and involvement. Some background information. These are my concerns as a cJinician. Cerner does not have the ability to provide the following in the Choice Program: Tracking duplicate testing Tracking over utilization by providers Tracking duplicate prescriptions and medication errors . Tracking tests that were ordered, completed and results go to all physicia ns involved in the Veterans care Patient notification of critically abnonnal results with followup resolution Arranging appointment followup between the VA and Private sector Emergency room visits in the private sector ability to access records immediately and VA physicians notified of emergency care and followup Ceme r has no registry to tract what Cardiac and orthopedic devices are implanted in case there is a recall of the device Automatic record transfer from the Choice Pro vider to the VA patient record with flagging hew information to every VA health care worker A radiology platform to see films in high definition to compare X-rays and ability for radiologists to efficiently find previous films. For instance a radiologist needs to know if a lung nodule is new or was there previously and the same size. Cardiologists need to access catheterization films in high def mition Cemer has no system to alert VA health care workers when a patient is at a particular office or hospital to participate in care mana gement in real time. Sent from my iPad Bruce Moskowitz M.D. The information in this e-mail is intended only for the person to whom it is addressed . If you believe th is e-mail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance Helpline at http://www .partners.orglcomp lianceline . If the e-mail was sent to you in error but does not contain patient information , please contact the sender and properly dispose of the e-mail. Dr. M oskowitz . AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001154 D8_00021870 Thank ou so much for the note and for all the help/support. I would love to meet you in person. Do you have any plans to be in Washington anytime soon? I thought the call last week was e;\.iremely aluabl . ll1e experience and wisdom of the participants is such a great asset we would be fools to not take full advantage of it. I do agree fully that there was a lot to cover in only two hours. I th ink the moderator was dojng the best he could to get as much out of it as possibl , while tJying to be r spectful of the time that so many important peopl wer volunteering . If the 5 CIOs were willing to follow up, perhaps we sch dul another session(s) on various deep ilive topics? We would absolutely lo e that. Just by way of introduction - Jjtunped into the CIO role less than 2 months ago when our previous CIO (Rob TI10mas) abmptly retired to deal . ith some personal issues. I am a disabled Army Veteran (MIT ROTC). After getting out of service I went to bus iness school and then to McKinsey where I made partner and spent 9+ years there leading large bus iness transfom1ations in industrial clients. Bob McDo nald (the fonner P&G CEO and fom1er Secretary) convinced me to join VA to lead the tumarottnd after the 2014 Phoenix scandal. From Feb -Sept, I served as Secretary Shulkin .s Deputy until a political appointee was put in place. Then jumped into the CIO role to work with the team and make sure this gets done . We are still awaiting a pe,manent CIO . I would be happ to jwnp on the phone this, . eek to if ou ,vou ld like . Thanks again for your support! Scott Scott Blackbum Acting CCOand Executive in Charge , Office of lnfon n at ion & Technology US Depa1tment of Veterans Affrurs From: Bruce Moskowitz [mailto:bruce1~(b) (6) (b) (6) Sent: Monday, November 20, 2017 6:02 AM To: Blackbum, Scott R. Subject: rEXTERNAL)VA-CTOCALL mac.com] Dear Scott: I thought the VA-CIO call November 15 to help you with practical industry expertise relating to your proposed Cerner implementation generated some valuable conversation . The participants were some of the most highly experienced CI Os with deep EMR backgrounds , together with physicians who focus on medical error prevention and improving the EMR experience. I hope and expect that you found it of great value . Since we have not spoken before, you may not be aware that I am the person who personally recruited the Academic Medical Centers to provide the VA with advice , intended to help the VA create and implement a path to fix its care delivery issues , as well as advise on other areas where they can be of value to better veterans 1 care. I have been a central point for the group and was the co1lection point for the participants 1 post-call debrief Also, for reference purposes , each of the people on yesterday's call has performed flawless implementations of state of the art EMR systems on behalf of their respective healthcare delivery systems , some more than once . Since the call was structured to focus the discussion on the few direct questions set forth in your agenda, and the moderator controlled the timing of each question very tightly , the breadth of the discussion was somewhat limited. As a result, you only had the benefit of the experts' advice in the areas that the moderator put on the table ... and the participant's want to make sure you have the benefit of their complete thoughts and feedback. Everyone felt good about the discussion on the agenda questions and felt that the scope and implementation issues relating to DOD/ VA interoperability were well in hand . However , some of the participants' questions raised about other areas left them uneasy about the readiness of the system for ) I I I I I PVERSIGHT VA-19-0799-G-001155 DS_00021871 implementation or the readiness of the Cerner RFP contract for execution . Based on some of the offshoot discussions , the participants felt that many non-DOD interoperability solutions have not yet been fully addressed or solved, leading to incomplete system planning and contracting protections, greatly risking an unsuccessful implementation and Jarge additional cost and time ovenuns . The interoperability with community provider partners clid not seem to be defined completely. Some additionaJ areas that were identified by the VA and its contractor's participants and moderator as incomplete in the call are: seamless sharing of Choice partner records, duplicate procedure and mecticaJerror prevention , flagging mechanisms and implantable device identification , among others . Until the design of the system and aJl functional requirements are identified and completed , the participants fear that these as yet undeveloped processes and solutions will result in a significant increase in the cost of the implementation and operation of the Choice program and impact quality care delivery to our veterans who choose to take advantage of the Choice program . Lastly, at the beginning of yesterday's call your moderator identified the comfort that Congress expressed at recent hearings from the participation of the CIOs in the process . However, yesterday's relatively short discussion on a massive topic was limited and not set up to have a platform for full discuss-ion in a two hour phone call with a few questions . Also, as mentioned in the call at various times, the participants' did not have access to the RFP contract document , its scope and the contractual provisions and protections , a criticaJ part they feel of evaluating the completeness of a successful design and implementation. As such, the participants want to make sure that yesterday's discussion is understood by everyone - the VA and Congress alike - to be a limited dialogue to provide their valuable experiences on the topics put on the table by the moderator , but not as a confinnation of the project's completeness or readiness for contract execution or implementation , which they believe Jjkely has shortfalls . In generaJ, we liked what we heard, we are honored that you felt our advice would be of value, but have had discussion about a very limited part of the project and have questions about the system design, whether it is ready for implementation and whether the contract (from the limited discussion) has adequate safeguards to proceed without risk to the cost and success of the effort . Wnile this was the first time you have spoken to any of these participants on the topic of EMR, and maybe on any topic , the participants would be pleased to provide further feedback and advice should you desire on the remaining issues that are still incomplete and to help you work toward a successful RFP contract, design and implementation. Sent from my iPad Bruce Moskowitz M.D. Thank you Bruce. Very helpful. From: Bruce Mo skowitz [mailto :brucc1~111ac (b) (6) (b) Sent: Monday, No vember 27, 201 7 10:18 AM (6) .com] To: Blackbum.,Scott R. Cc: mb~(b) (6) gmaiJ.cotn Subject: Fwd : [EXTERNAL] FoUow up meeting 1 should point out this would be ideal functionality requirements of any EMR contract if not part of what has been reviewed by the VA we need to discuss these points further since they are derived from the previous meeting points made by the CIO' s and we can again cover them in the agenda Sent from my iPad Bruce Moskowitz M .D. Begin forwarded message: AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001156 DS 00021872 From: Bruce Moskowitz (6) Date: Novembe r 27, 20 17 at 8:41: 19 AM EST To: "Blackbum, Scott R. " Cc: o.~oo (b) (6) Subject: Re: [EXTERNAL] Follow up meeting Pri or to any meetin g we need to know wha t is not in the contract so we can make progress : Cerner Contract has to have the responsibility of 100% connectivity to all EN.IRplatfom1s for Choice to work Cerner ha s to have tele meclicine bwlt into the system Cerne r needs to tract dup ljcate diagnost ic testi ng Cerner needs to have medication error , tracki ng of controlled substances and duplicate prescription monitoring Cemer needs to tract appo intm ent times between the VA and the Choice Program . Cerner needs to have voice recognition built in These are the b asics we need to la10w prior to writing an agenda and meeting. Thank you Sent from my iP ad Bruce Moskow itz M .D. @va.gov> wrote: On Nov 26, 20 17, at 9:23 AM, Blackbum, Scott R. wrote : AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001158 D8_00021874 Bruce - as promised here is more information on what, e will have to address the other 4 issues you mentioned. l still owe you device registry . Let me know if this makes sense or not. Also happ y to get you on th phone directly with my experts . - Scott Voice Recognition. Our new Cemer EHR platform includ s Enterprise Dragon Nuance . VHA currently deploys the enterprise version ,vhich maintains people voice print and th Clinical Staff say it works very well (my primary care provider at the Washington VA Medical Center uses it). Cemer will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Cemer without any rework. Th Clinician can use the dictation and other features with voice recognition. How will all entered lab data, from any source, be available on a graph Graphs will be available in 2 spots. l. Workflow MPage lab Component and 2 . Results review flowsbeet. When outside labs are mapped , e would use the same names as internal and then they would appear on the same line. Even if they are not exactly named the same the results review flo.wsheet allows for 2 different lab values to be graphed together. Catching test duplication, over utilization and medication duplication/errors at time of ordering instead of after the fact All tests are configured to have a time where an alert is issued based on parameters we configure and can flex by venue. Over utilization will be avoided with real time alerting but VA would hav e to use a mechanism to monitor , via report. The med duplication is configured similarly to test and parameters will detennine how the system acts. Tall man lettering reduces errors in look alike , sound alike meds , and finally in instances we identif) errors we can configure mies to catch those . For meds all allerg y checking , dupes , dose range checks , and interactions are checked at time of ordering. As an aside , while the DoD Cemer implementation has been far from perfect this is one area where it has been very successful; the new DoD/Cemer system has alread y prevented over J5,000 duplicate tests at their initial three sites that have been implemented . Streamlined SOAP notes. Yes , the VA/Cemer system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs. From: Blackburn , Scott R. Sent: Wednesday , Februal)' 28, 2018 2 :30 PM To: 'Bmce Moskowitz' Cc: DJS ; Marc Shem1an; O'Rourke , Peter M.; IP; lperl .(b) j2 gmailcom (6) + languge + Rasu Subject: RE: [EXTERNAL] Re : Open API - il is CLOUD Bruce - ,;,,1e ce1tainly aren ' t going to let you get tar and feathered support you ' ve given us. I Again , we really appreciate all the On these other 4, C'll get you answers on these ASAP . I know these are topics you ' ve brought up in past and we were definitely listening . r've been hammering the team to make sure we incorporate all this feedback into the negotiation . Let me send you the specifics where we have landed to make sure that we got them right. Stand by ... Scott From: Bruce Moskowitz mailto :bruce (b) (6) (b) Sent: Wednesday , Febmal) ' 28 , 2018 1:13 PM (6) To: Blackburn, Scott R. mac.com Cc: DJS. Marc Shern1an; O'Rourke , Peter M. ; IP ;~ (b) (6) + languge + Rasu Subject: Re : [EXTERNAL] Re: Open API - it is CLOUD AMERICAN PVERSIGHT VA-19-0799-G-001159 OS 00021875 Thank you my five CIO ' s had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are : Voice Recognit ion AJI entering lab data on a graph from any source Catching test duplication, over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R. wrote: Brnc e - thi s is incredibly helpfu l. Thank you very much . I had my team dig into this this mor e thi s morning. Wh at you have stated below is clearly the intent (we need everything to be OPEN and absolutely do not , ant to inadverte ntly create vendor lock) ; we've also gone back th is mom ign to confi nn with Cemer th at thi s is their intent. We are going to alter the language to make th is more clear . We don 't anticipa te any pu shba ck. A few things I learned this morning ... o The contract does NOT lock us in to Amazon Web Services (AWS}. Rather any cloud provide r or applicat ions t hat meet security and pr ivacy requ irement s to protec t Veteran data can inter face with Open APls or push dat a t o the VA/Cerner system . o Currently 3 cloud providers meet the Government security requirements AWS, Azure/Microsoft and CSRA. There are several others that we expect to come on board soon including Google and VirtuSt ream/Del l. At VA, we use both AWS and Azure right now. Again, the goal here is to create open environment as long as the prov ider meets certain standards (these standards are dictated by GSA, not VA). o Cerner does have a partnership w ith AWS (which is why we highl ighted that) but it is just one example of the open could environ ments they are planning to work with . We have confirmed that it will be OPEN and not propr ietary to their specific AWS cloud . o DoD is excited to follow our lead on all of this . I spent the morning at the Pentagon with the DoD CIO/team . This will help not just Veterans , but servicemembers sti ll in uniform . Tha nks again for the feedback and support. We are going to make sure thi s is crystal clea r. Scott From: Bruce Moskowitz [mailto:bruce1 (b) (6) (b) Sent: Tuesday February 27, 2018 9:29 PM (6) To: Blackburn, Scott R . AMERICAN PVERSIGHT VA-19-0799-G-001160 OS 00021876 Cc: DJS; Marc Sherman; O'Rourke, Peter NL IP~ lper-(b) @.gmaiJ.com Subject: LEXTERNALJ Re: Open API - it is CLOUD+ (6)languge + Rasu Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platfmms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 20 18, at 9:20 PM, Bruce Moskowitz wrote: (6) To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to aJI Working on Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz wrote : (6) This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackbu rn, Scott R. wrote : D avid/B mce/Marc - here arc a few updates : # l) Rasu is all in as fat as startin g to help right away . I just got off the phone with him. He has UPMC commitments rest of this week and is Chairman of HiMSSInnovation committee (so we wil l all be at HiMSS together next week) . However ifhe needs to co me to Washington this wee k for so meth ing, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IP A paperwork to com e through for him to help . I' ve attached Rasu ' s CV in case you need it. #2) The APIs are cloud based. Here is the response from out Technical lead ... AMERICAr-... pVERSIGHT VA-19-0799-G-001161 D8_00021877 o The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner's entire remote hosted customer base. o In a recent press release Cerner and Amazon announced that they would be working toge ther in cooperation to accelerate HealthCare Innova tions. #3) Below is the IP language that we negotiated. This what caused Aneesh Chopra (one of the experts oo our MITRE panel) to jwnp out of bis chair last v,1eek. He claims tms is the holy grail that no other healthcare system has been able to get from either Cerner or Epic. Aneesh claims that as a result of what we ' ve negotiated below . that other healthcare systems will be willing to join us in the attached pledge (shall we decide to go forward with it) and we could do this next week at HiMSS . When 1 spoke to Rasu , he told me Aneesh had already called him about this and that UPMC would be willing to sign this pledge . js Of importanc e: Third (MJTlI party A Pl developers shall retain their IP rights when their API is used to connect to the Cemer interface. and there "' ill be no derivative Contractor [P o\\lnership when third parties consume Cemer terminology through o en APls . Regarding the questio n on sharing de elopment with others . sec PWS Section 5 .5 .4 opening paragraph : To accelerat e better and more responsive service to the Veteran , VA is making a deUberate shift towards becoming a sta.ndards!MJT2 1-based APl driven digital enterprise. A cornerstone of this effort is the setup of a strategic Open API Program , The Digital Veteran Platfonn AP1 Gatewa y, that is adopting an outside-in , value-to-business driven approach to create API's that are managed as products to be conswned by developers within and outside of VA. Finally. Cemer's response and the final negotiation language on sharing their data mode] as a result of the Interoperability Panel findings is as follows, Cemer agreed to sugge ted addition of PWS paragraph 5.8(h) as highlighted at no additiona l cost : 49 Understand how RFP Section 5.8 address lbe Cemer will provide support to business AMERICAN PVERSIGHT Suggest adding lo RFP Section 5.8: Cemer Cone, "h) Pro, .idc the VA EHRM data requested eh, VA-19-0799-G-001162 DS_00021878 the VA wilh access lo the data model, share data for analytics freely lo 3ropart.ies, increase the amount of computable data exchanged with 3rd parties , inlelligence and data analytics. Section5 .I0.4.l supportslhe sharing of Contractor proprietary infom1ation/dala model extension points (e.g.. ingestion and record APis) with both international and national standards designating organizations. However, current language Panelists acknowledged this does not.require access to the recouunendation is EHRM data model, a stretch goal. supporting understanding of and lherefore increase the exchange of computable data with commuuit)' care providers. model. w1dc inning tcnninology modeL tables, definilions. and examples of fully populated Veteran data files. Pro\'ide documentation or software Uiat is used for uaJity checks and IJ1atillustrnte what data elements are computable... Suggest adding to Section 5.10.4.1: " o) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support niJes, order sets, etc. Tbis includes the ability to curate. extend, and share that knowledge with clinical partners. This fosters rapid adoption from iodusl.ly best practices, e.g ., clinical professional societies." Suggest VA obtaiu a price from tbe Contractor to provide a report e>..l)lainlhe steps involved io accessing U1edala modcL iocludiog producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Suggest add.in Seclion 5.10.4 The Contractc support Know Interoperabilit supporting lhf extension of c content assets terminologies, decision suppo rules, order se to the extent extensions ar consistent wi1 model and be ))racticcs of t: controlling n; standard. T hi includes lhe al curate. extend share tlml kno with clinical partners. Thl~ rapid adoptior industry best practices e.g .. professionaJ societies." -Scott Scott, this breakfast is off. Mr. Perlmutter can no longer do . No need to travel, Scott . Sorry about that. Thank you. From : Blackburn, Scott R. Sent: Friday, March 09, 2018 4 :09 PM To: (b) (6) Cc: (b) (6) (b) (6) Subject: RE:SecVA Awes ome! Than ks so much . From: (b) (6) Sent : Friday, March 09, 2018 2:50 PM Blackburn, Scott R. Cc: (b) (6) (b) (6) Subject: RE:SecVA To: AMERICAN PVERSIGHT T. VA-19-0799-G-001163 DS_00021879 Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner t hat evening. He said you can leave afte r the 11am meeting . I've added our tra vel team to provide you details of flig hts. Thank you! From: Blackburn, Scott R. Sent: Friday, March 09, 2018 2:19 PM To: (b) (6) Cc:(b) (6) (b) (6) Subject: RE: SecVA I' ll be there . I' ll plan to mimic his schedule. Sent with Good (www .good .com ) From: (b) (6) Sent: Friday, March 09, 20 18 2:18:28 PM To: Blackburn , Scott R. - (b) (6) (b) (6) Scott - j ust a heads up t hat boss wants you t o t ravel with him to Mar -A-Largo on Tuesday. He w ill be meeting w/Mr . Perlmutter , Dr. Moskow itz, and Marc Sherman. We are t rying t o firm up t he time . He may be depa rt ing early afternoo n on Monday or early on Tuesday. Please confirm if you are available to travel wit h him . Thanks. Scott lets discuss tommorow Sent from my iPhone Begin fo.rwarded message : From: David Shulkin Date: March 11, 2018 at 12:31 :22 PM EDT To: Bruce Moskowitz ( frenchangel59.com>, I (b) Cc: IP <9@ (6) mail.com . ~ Subject:b Re: Contact review (6) ) Great list( 6 Is leslie cooper from mayo- i could not find him or her ) (b) (6) Sent from my iPhone On Mar 11 , 20 18, at 11:02 AM , Bruce Moskowitz These are the individuals to review the contract; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain Jonathan ManisCIO- suttrr Andrew Karson MD.- partners AMERICAN PVERSIGHT VA-19-0799-G-001164 DS_ 00021880 Leslie Cooper M.D. Clifford Ko M.D.- american college surgeons Sent from my iPad Bruce Moskowitz M.D. Mr. Blackbum. Iv cnt back and read Mr. Shennan .s email and re .ewed m notes . I see no recommended language for insertion in the contract to address his concerns. What it appears to be is a push to perfonn an interoperabi lity sandbox/test platfo rm in advance of contract award. Vr John John H. Windom. Senior Executive Scnrice (SES) Program Executive for Electronjc Health Record Modernization (PEO EHRM) Special Ad isor to the Under Secretary for HealtJ1 81 l Vennont Avenue NW (5 th Floor Suite 5080) Washington. DC 20420 John .Windom (a),va .gov Office: (202) 461-5820 Mobil : (202) 794-491 I Exec utive Assistant: Ms. -(b) (6) (b) (6) ~ Office: -(b) (6) -Appointments and Scheduling From: Windom , JohnH. Sent: Frida y. March 23, 2018 1:47 PM To: Blackbum , Sco11R.; Bowman , Thomas Cc: Zenoo z, Ashwini: Short, John (V ACO) Subject: RE : (EXTERNALl Re : VA EHR Mr. Blackbu rn, Not sure where Mr. Sherman is going with his comments but our language in the contract is consistent with the requirements or our Clinicians, various external reviews and the Mitre report. Mr. Sherman is seeking specificity in the interoperability realm that simply does not exist today and is evolving even as I type. We have provisions in the EHR contract to inseti technology as we, the VA, as well as to incorponte evolving technology and standards. TheDVP acquisition is our bridge to the use of APls (gateways), FHIR, etc. We have modified our interoperability language (below) based on the Mitre and the many external reviews to give us the utmost flexibility over the 10-year life of this contract. The Secretary personally halted the recent phone call to stop Marc Sherman, et. Al's parade of national interoperab ility objectives as not feasible at this juncture "a nywhere," but included as pa1i of our overall interoperability strntegy that includes the DVP acquisition/strategy. We are committed to establishing the interoperability test bed/sandbo x at IOC to solidify our interoperability objectives prior to full deployment to the enterprise. In addition, I believe Mr. Sherman meant to higbli.ght section 5.5.1 which speaks to the data domains that were called into question and their inclusion in the contract. They are clearly in the contract as captured below. Mr. Sherman does not understand the culture of VA or the federal government. We have an incremental/iterative change management strategy that will culminate in a successful EHR Modernization effort. He appears to be more of a "big bang " theory guy. The problem is, we must continue to deliver uninterrupted and quality care to our Veterans during the transformation within the parameters of the law and other regulations/policies (e.g. cybersecurity, cloud, etc.) bounding our integrat ion/implementation strategies. Our existing language is sound and appropriately balances change management risks, future insertion of technology, innovation opportunities, standards development, etc. without artificially inflating the cost of the contract th.rough the incorporation of excess specificity that never materializes in practice. Through the Initial Operating Capabilities (IOC) process and the judicious issuance of task orders, we will have the ability to change course direction as appropriate without excess risk to the taxpayers or our AMERICAN PVERSIGHT VA-19-0799-G-001165 DS_00021881 overall success. Mr. Sherman continues to fail to recognize that it is Program Management Oversight (PMO) and VA commitment to change management that will drive our success in these areas, not more words in the contract. V/r, John IDIQ PWS 5.5.1: Workflow Development and Normalization: j) The Contractor shall enable configuration of the application that supports external community data without requiring the clinician to go to special screens to see and use reconciled external data. By IOC entry, the Contractor shall support incorporation of the following external community data domains, including but not limited to these domains and subdomains: o Problems o Allergies o Home Medications o Procedures - including associated reports and with appropriately filtered CPT codes o Immunizations o Discharge Summaries o Progress Notes o Consult Notes o History & Physicals o Operative Notes o Radiology and Diagnostic Reports (Into "Documentation" component) By IOC exit, the Contractor shall support incorporation of the following external community data domains, including but not limited to these domains and sub-domains: o Results o Labs - General - Pathology and Microbiology o Vitals o Radiology and Diagnostic Reports (Into "Diagnostic Report" component) o Images IDIQ PWS Section 5.10.4: Seamless Interoperability/ Joint Industry Outreach includes significant detail on the topic. The interoperability section is copied below this table for reference. IDIQ PWS section 5.5.4 Data Exchange - Application Program Interface (API) Gateway also includes detail on the creation of strategic open APis. VA NF -1 77: Interoperability - Data Standards: The system shall support the use of the health data standards identified in the VA DoD Health Information Technical Standards Profile and by the VA DoD Interagency Clinical Infonnatics board, including following common data standards: National Information Exchange Model NIEM; Health Level 7 HL7; Logical Observation Identifiers, Names and Codes LOJNC; Systematized Nomenclature of Medicine SNOMED; RxNorm, MedRT, ICD, CPT, HCPCS, Veteran Infonnation Model VIM; and Healthcare Infonnation Technology Standards Panel HITSP as well as V A/DOD/IPO extensions to these standards. VA-NF-T23: Informatics - Care Integration: VA must be able to seamlessly integrate with HIE and external-to-EHR shared services to provide for a seamless experience and to more effectively integrate in community care efforts, as well as with other parts of VA (e.g., identity management). This includes but is not limited to the EHR product ability to support external shared services (SOA services, such as identity management, care plan service, scheduling, etc.) accessed via standards-based APis. (Process Continuity, Evolution, Extension) KSR5 [NOW+] VA NF-Zll: Health Information Exchange: The system shall support VA electronic exchange of health records via other interoperable networks (e.g. CareQuality, Common Well Health Alliance, DirectTrust, National Association for Trusted Exchange) by supporting their specifications, security and content specifications AMERICAN PVERSIGHT VA-19-0799-G-001166 OS 00021882 5.10.4 Seamless Interoperability/ Joint Industry Outreach The Contractor is required to collaborate with VA affiliates, community partners, EHR providers, healthcare providers, and vendors to advance seamless care throughout the health care provider market. Seamless care will require the creation of an integrated inpatient and outpatient solution with software components that have been designed, integrated, maintained, and deployed with a design architecture that allows for access to and sharing of common data and an enabling security framework that supports end-to-end healthcare related clinical and business operations. Seamless care is the experience patients and providers have moving from task to task and encounter to encounter within or between organizations such that high-quality decisions form easily and complete care plans execute smoothly. Information systems support the seamless-care experience by gathering data, interpreting data, presenting information, and managing tasks. Currently, industry lacks specific and uniform interoperability standards to support seamless care between organizations that employ different EHR systems. The Requirements Traceability Matrix Section D, Attachment 003, sets forth specific Informatics and Interoperability contract requirements. To accomplish this, the Contractor shall provide software and services to enable seamless care between VA encounters, encounters with other Government healthcare institutions, and outside entities through advancements in all areas of the EHR that occur. In addition, the software and services shall support the VA designated standards, such as SMART on FHIR and SlvIART-enabled applications, or other published standards. The objective of these interoperability solutions is to advance the state of the art supporting seamless care for Veterans. Existing organizations promoting interoperability among EHR vendors, such as The Argonaut Project, have developed or are planning to develop technology standards or technical approaches that may support the EHRM seamless care strategy. To the extent that underlying third party technology is available or made available to meet the following time lines, the following interoperability software solutions and services shall be delivered under this section: a) By Initial Operating Capability (IOC), the Contractor shall provide a software solution enabling VA, DoD and community providers who have connected to the EHRM to share interactive care plans (ICPs) for Veterans. ICPs will enable collaborative communication between providers, and between providers and Veterans, in managing Veteran care. b) Within 24 months of applicable task order award, the Contractor shall provide a software solution enabling VA, DoD and connected community providers to complete referral management activities for Veterans. c) By IOC, the Contractor shall provide a software solution enabling VA to release and consume, via on-demand access, a Veteran's complete longitudinal health record to and from DoD and connected community partners, irrespective of which EHR they use, provided such EHR technology is certified by the Health and Human Services Office of the National Coordinator (ONC) or its successor. The longitudinal record solution shall support Provider-toProvider record sharing, as well as Provider-Veteran-Provider sharing (Veteran mediated record sharing), including appropriate consent management. The bi-directional health information exchange shall maximize use of discrete data that supports context-driven clinical decisions and infonnatics. d) Within 24 months of applicable task order award, the Contractor shall provide a software solution enabling connected VA, DoD and community providers connected to the EHRMto send and receive Admission/Discharge/Transfer notifications "pushed" from the provider initiating a Veteran care event to enable proactive engagement by VA care coordinators when notified of a Veteran care event. e) Within 24 months of applicable task order award, the Contractor will demonstrate a solution for identification and management of Veterans at high risk of suicide, in collaboration with community partners. f) By IOC, the contractor shall provide URL based image access to the VA, community and academic partner systems who can support the URL and a viewer to the providers via the health information exchange networks. Within 36 months of applicable task order award, the Contractor shall provide a software solution enabling VA, DoD and community providers connected to the EHRM to have nationwide access to Veterans' imaging associated with diagnostic tests. g) By IOC,the Contractor shall provide a software solution for multilateral standards-based ingestion, normalization, storage, and exporting of Health lnfonnation Exchange acquired Veteran health information. The Contractor shall ensure that the solution provides a computable dataset for purposes of population health and research analytics, clinical decision support, and workflow integration. h) By IOC, the Contractor shall provide the capability to connect and exchange VA electronic health records via other interoperable networks, such as. eHealth Exchange, CareQuality, Common Well Health Alliance, DirectTrust, National Association for Trusted Exchange by supporting their specifications, security and content specifications. Contractor shall support network record locator services and patient provider associations as applicable in accordance with applicable technical standards and the Trusted Exchange Framework and Common Agreement (TEFCA). AMl=HICAN PVERSIGHT VA-19-0799-G-001167 OS 00021883 i) By IOC , the Contractor sha ll provide a capability for pro vider collaboratio n via sec w-e e-mail using the ONC Direct protocol or foture VA-designated standard within a Cemer Mill ennium EHR wo rkflow conte>-.'t. j) Within 36 mon ths of app licab le task ord er award , the Contractor shall provide a solution for a Software Deve lopme nt K it (S DK) enabling standards-base d app lications (e .g., SMART , FHIR , etc.) integrated w ith EHRM solutio ns and platfonn s. k) Ceruer shall delive r annually an Interoperab ility Plan to the VA on ho w it inten ds to meet the objectives estab lished in PWS sectio n 5.10.4. The in itiaJ plan wil l be due within 3 months of app licable TO award. 1) l11e Contractor shall conduct an annual lnt erop erabi tity Self-Assessment against stan dards that sha ll be specified by VA , suc h as th ose prom ulgated by HJMSS or future standa rd s to be identifi ed by VA. Th e annuaJ sel f assessment shall repo rt on th e state of each dat a eleme nt (e.g. , which are supported in what capac ities and in which fonnats) . Th is will h elp assure stan dard s impl ementat ion consistency and ass ure standards compl ian ce with evo lving nationaJ standards . m) Th e Contractor shal l support Know ledge Int ero pera bility by support ing the e:\.'tension of clinical conte nt assets such as te rmino logies , clini cal dec ision suppo1t rules , and o rder sets, etc., to t he extent such e;,...'te nsious are co nsistent with the mode l and best prac tices of th e controlling national standard . This includes the abi lity to curate , exten d, and share that know ledge with clinical part ners. Thi s fosters rap id adoption fro m indu stry best pr actices , e.g ., clinical professional soc ieties. 5.10.4.1 Data Design and Information Shari ng In support of the interoperability objectives under tltis Section , ag reed upon Contrac tor proprietary informatioll/data nsion po ints (e.g .. inge stion and record APls) may be provided to both inte rnat ional and nation al stan dards mode l e:>..1.e designating organizations as desc ribed and set fo1th in an applicable Ta sk Ord er . Th e Co ntract or shalJ pro vide VA access and usage rights into any und erl y ing propri etary te nnin ology/code systems for the purpo se of enhancin g nat iona l standard s to address any ga ps identifi ed in the EHRM solut ion . Th e Co ntractor shall aJso make the intero perability capabiliti es and prodt1ct en hancemen ts deve loped lmd cr thi s cot1tract available to non-VA Cemer client s. 5.10.4.2 VA Digital Health Platform / Digital Veterans Platform Integration VA antici pates deve loping a DigitaJ Health 1?latfom1/Digital Veterans Pl atfom , (DVP) to consolidate criti.cal VA EHR and non-EHR operational systems. Th e Contr ac tor shaJ I integrate the EHRM to interopera te w ith DVP , or future state VA pla tform , including the DVP API gateway or any other method designat ed by VA. John H. Wind o m, Senior Exec utive Serv ice (SE S) Program E xecu ti ve for Elect ronic Hea lth Record Mod ern ization (PEO EHRM) Spec ia l Advi sor to the Und er Secretary for Hea lth 8 1l Vennont Ave nue NW (5th Floo r Suite 5080) Washin gto n., DC 20420 John .Windom @va .gov Offi ce: (202) 46 1-5820 Mobile : (202 ) 794-49 11 Exec utive Assistan t: Ms. -(b) (6) Appointme nts and Schedulin g ~(b) (6) Office: ~(b) (6) From: Blackbum, Scott R. Sent: Friday , March 23 , 20 18 12: 15 PM To: Windom , John H .; Bowman, Thom as Subject: PW: LEXTERNALJ Re: VA EHR John - you might want to swing the by Secretary/Deputy ' s office before end of day to get a sense of w here he is with respect to this . AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001168 D8_00021884 Sent with Good (www .good .com) From: Marc Sherman Sent: Friday , March 23, 2018 9:47 :39 AM To: Bbickburn. Scott R. Cc: Brnce Moskowitz ; DJS. Subject: [E.,'(TERNALJ Re: VA EHR Scott , Thanks for inviting me to listen in on your calls this week" ith the sub_jectmatter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested . I read carefuUy your email about the efforts to work out the holes raised b_ the experts . Yon arc on the , ay to kick ing off an exciting project with a high! respected Contractor/vendor and a VA team that has worked very hard ~ and ( know everyone has the goal to build the best ne~t generation system for the veterans ' healthcare . Hm ever there were several major issues raised in the calls this ,. eek ,vith the technical and clinical experts that you try to explain away iu your email as solv ed , but indeed are not according to the experts. 1l1ese issues , they belie ve \. ill pre ent a successful implementation and I fear come back to haunt this project and its overs crs. I hate to be a naysayer. but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with " hom ou consulted: and the experts are in fact not swayed by the follow-up conversations with them . 1l1e experts are recommending a system for the VA that has. various enhancements to today ' s standard system functionality . At a minimum. I heard those experts express their opinions that the contract dangerously lacks definitions , standards and a clear expression of this required , defined enhanced (non-standard) fw1ctionality {they articu1ate it much better than I). Failing to express this type of definitional clarity in the contract is an in itation to ambiguit). disputes and ultimate failLtre of purpos . The best "oversight and management of the contract" ,,;ill not tum a contract lacking specificity into a vision of clarity . Including contractual c1arity allows tl1e Contractor to w1derstand TODAY what is expected so that toda y it can confirm its agreement to pro vide the fiill functionalit y desired and hav e a better understanding of what is expected of them . Clarity in the contract is a healthy ingredient for the VA and the Contractor. I would be delighted to be\. rong and welcome a demonstration of where Section 5. 1 of the contract provides this specificity that Drs . Cooper and Huff , for example urged . Iu light of the system requirements that these experts say must be included which are enhancements oftoda y ' s standard deliverables the contract language is ambiguous . You say that "risk cannot be I 00% driven out of any transformation of this magnitude ," a concept to which I subscribe. However when you substitute this concept for clear , v,rritten and defined functionality especiall y for a design that is expected to be unique in many respects , you arc doomed to disappointment and conflict. [ am sorry to be so harsl1 in m opinions , but the experts are so united on this point: and together with my historical observations of failures in nearl y identical situations I just see warning flares going off. Scott I want to see this project get started , and quickl y, as much as anyone , but, iththe clarity that equally serves the VA and the Contractor , and prevents evident problems down tl1e road . I also believe tl1ese things are eas y to resolve in the contract language in rclati ely minimal time . Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10~19 PM, Blackburn, ScottR . wrote : Marc I Bruce. AMERICAN PVERSIGHT VA-19-0799-G-001169 DS 00021885 Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlie r today as well to talk about the path ahead. A few notes: o In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha, Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr . Zenooz did connect w ith Dr. Cooper today on the point Marc highlight s below to make sure we are on the same page and have the language right (part was us better understandin g his point; part was pointing him to the specific language in 5. l. l and giving him the broader context with what we a.re doing with Lighthouse as our API gateway and the VA Open AP[ Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Ma.yo as well Stan Huff at Intermow1tain and Dr. Ka.rson at Pa1tners). o We will also follow up with Stan on some of the issues be raised as well. For example: Stan will be excited to learn that Cemcr has prioritized an additional 40 engineers to accelerate FHIR APis for VA in support of this contract. This will also benefit Intermounta.in as Stan was telling us they 've only had I015 for their entire company to date. If V A/DoD/Intermountain work together we will qu ickly get to the 200 number Stan mentioned. o Per Stephanie's suggestion , we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of expertise throughout our journey Obviously we will want Stephanie, John , Andy, Rasu, etc. Cris Ross (Mayo), Will Morris or Ed Marx (Cleveland Clinic) , Frank Opelka (American College of Surgeons) are others you 've introduced us to along the way that we wo uld love to include. We would like to work with you to make sure we get this right. o As recommended last night, an interoperability sandbox/test bed will be estab lished during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperabil ity requirements prior to full enterprise deployment. This is a great suggestion and very consistent .with what we have been hearing from many experts. o Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-wa lking this against the languag e in the RFP/cont ract documents (both EHR and also .Lighthouse). We are not seeing any major changes to the contra.ct nor do we see any showstoppers. Upon receiving the feedback , we feel very good that we have a solid contract from which we will just need to make minor revisions. o After discussing this with Secretary Shulkin today, we feel stronglv a.bout moving forward quickly. We will make any necessary tweaks with Cemer ASAP (we abso lutely do not anticipate any push back and Cemer has promised to tum things a.round immediately) and wi ll move forward to sign the overarching IDIO contract. Asswning Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week. If the Omnibu s falls through (which let's hope not), then we wou ld have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks. Signing the initial task orders will allow us to start moving forward with Cemer on the initia.13 hospitals (which will be in Washington state) on things like site surveys, infra.structure readiness, data hosting , change management (with will include wide involvement from clinicians inside and outside VA ... something we heard loud and clear from Bruce!) , help desk establishment , and project overs ight (which we 've heard loud and clear from Stephanie/Jon). As a reminder, given the JDJQ structure of the contract we wo uld not be signing the full contract (rather just Year 1 -which is ~5% of the value of the contract). But this will allow us to get moving and out of the "qu icksand ". o Ma.re makes a great point below on turning DoD 's struggles into a positive. We have been working ve ,y close ly with the DoD tea.n1over the past 9 month s (I now have my own Pentagon ID pass I am there so much ; John and I work very closely with their EHR lead Stacy Cummings; John Windom talks to her several ti.mes a week). We have incorpora ted a lot of their stumbles into our cont ra.ct (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that ; and most recently we have made some adjustments on trouble AMf::Ri<.. I l'-1 pVERSIGHT VA-19-0799-G-001170 DS 00021886 ticket management based on what you've read i1Jthe papers). We are paying veiy close atte ntion to their implementation issues (workflow. change management, gove rn ance) to make sure we don .t make the same mistake t'l-vicc. DoD ' s biggest problems are around implementation and change management. This underscores Brnce 's point of making sure we have clin ician buy-in and invol vement from the get-go (I cou ldn.t agree more) . This will make getting move on change management in Task Order # I so important. o As you both know. risk cannot be 100% driven out of any transfonnation of this magnitude. Stephanie Reel so succ inctly captured , ooit is the oversight and manage ment of the cont ract that wi ll be of the utmost importance , as well as the VA access to senior industry adv iso rs." I th ink we have a great plan . The biggest thing J wo rry about will be executing and we are definitel y going to need all the help we can get. Again. we believe the construct of the contract. and mo re importantly the proper oversight and management of the contract will great ly mit igate cost, schedule and perfom1ance concerns. as we ll as support the time ly injection of teclmological advanc ements (e.g. cloud , APis , etc.) at the approp riate pac e and balance necessary to support our Veterans withoutjeopardjzing our overa ll care. foteroperabi lity remains at the forefront or our concerns , and your comm ents, the MITRE study and various other externa l inputs contributing significantly to our RFP lang uage and corresponiling requirements. Interoperabi lity will be a moving ta rget for years to come. but ou r contract allows us to leverage the best of ideas ofindushy throughout the contract ' s life without incurring the exorbitant costs yo u have alluded to , as well as not be bound by potentiall y antiquated definitions . Brnce/Marc , thank you for everything. As I mentioned to Bruce recently. you have been tremendous ''de maniling partners " on this jour ney and we are incredibly apprec iate . We look forward to continujng tl1is relationship as we take the next steps. Scott .s From:Marc Sherman [majlto:~ (b) (6) Sent: Wednesda y, March 21, 2018 9:31 AM To: Blackbum . Scott R. Cc: DJS Subject: Re: !EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful . 1. I thought that Dr . Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability," especial ly since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later , perhap s even up to imp lementation , a very costly result. Perhaps a similar problem (a seeming ly big problem) that the DOD implementation faces now where the users are rebellin g. Unfortunatel y, if this "gap" in definition is not discovered until IOC, it will be very difficul t and very expensi ve to fix (ala the DOD problem) . I agree with Dr. Cooper , why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments , better initial design , happier user community , less overall cost, better healthca re delivery, etc. Then , with the standard fuJly defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a mode l for the country and the future of healthcare (as Ms . Reel envis ioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA, the patients and healthcare , so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred ? Why would you not want to be specific in the contract to prevent ambiguity ? Dr . Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS . Dr. Cooper , as a physician user and not a technician , deferred on the effectiveness of the AMf=f pVERSIGHT VA-19-0799-G-001171 DS_00021887 existing contract language to others, but commented that the CIO of MA YO read the contract and also did not think it adequately contained the right definjng language to set out unambiguous definitions and standard. 1 have read the contract again last night and happen to agree, or am missing it. Ifl am wrong, it would be useful for someone to point me in the right direction. 2. I was also trunking about the current reported problems of the DOD implementation seeming ly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs . The VA runs that same risk. Perhaps that problem could be a benefit to your effort . Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportun ity to contractually prevent similar mistakes . 3. I have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote: No prob lem Marc . TI1anks for all your h elp. Very helpfu l call last nig ht. (b) (6) Sent: Wednesday, March 21, 2018 12:12 AM To: Blackbum, Scott R. Subject: ['EXTERNALlRe: Stan Huff From: Marc Shennan [mamo:~ Scott I won't be able to join the call tomorrow as [ have a previous commi,tment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (b) (6) On Tue, Mar 20, 2018, 10:30 PM Blackburn , Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable. We have Stan Huff .from Intermountain tomorrow at 10am. I assume you have the calendar invite, but just in case it is 1-800-767--(b) (6) (b) (6) We have been unable to schedule anything with Dr. Ko (very busy calendar). We will trying. Scott Scott Blackburn Executive in Charge , Office of Information & Technology US Department of Veterans Affairs AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001172 D8_00021888 Hmm ..Have you spoken to the Secretary directly yet? I wrote him about Marc Sherman's email but he didn 't respond . Not sure whe re his head is at. I don 't understand why ogc would meet him without you . It kills me how we don't trust each other and try to work point to point through the Secretary . Sent. with Good (WWW .good .com) From: Windom, John H. Sent: Tuesday, March 27, 2018 6:34:17 AM To: Blackburn, Scott R. Subject: Update Sir There was a meeting between Shulkin and the attorneys (Byrne and Fleck) last week that I was not invited to. This is the language proposed fo r inclus ion in the contract following that meeting . Does the inclusion of this language close the deal? Before negotiating with Cemer , I need to understand weather it closes the deal. I discuss with the TAC this morning . Just received yesterday eve . Thank you . John John , Reference is made to the note I sent you last Wednesday whereby I mentioned that OGC (Mr. Byrne) wanted to review our RFP. (b) (6) recently shared the following OGC requested PWS change (italicized) presumably as a result of that review: Please consider th is recommended change to PWS Sect ion (b) (5) Sent with Good (www .good.com) -(b) - TAC has advised the EHRM PEO of the requested (b) (5) (6) - Tha nks, (b) (6) Cont ract ing Officer AIVlt-Hll.,Al PVERSIGHT VA-19-0799-G-001173 DS 00021889 Department of Veterans Affairs Office of Procurement, Acquisit ion and Logistics Technology Acquisition Center (b) (6) Office :-(b) (6) Mobile -(b) (6) (b) (6) e-mail: ~ "Far Internal VA Use Only - Working Draft, Pre-Decisianal, Deliberative Document : This e-mail and any attachments are intended anly far the use afthe addressee(s) named herein and may contain privileged and/ar confidential information . If you are nat the intended recipient af this e-mail , yau are hereby notified that any dissemination, distribution ar copying of this e-mail, and any attachments thereto , is strictly prohibited . If yau have received this e-mail in error, please notify me via return e-mail ar telephone and permanently delete the original and any capy of any e -mail and any printout thereof " {732) 440-(b) (6) From: (b) (6) (b) (6) (OGC) Sent: Friday, March 23, 2018 12:27 PM To: (b) (6) Cc:(b) (6) (OGC);(b) (6) Subject: contractual language - PWS - EHR . (OGC);Fleck, Robert R. (OGC);(b) (6) . (OGC) (b) 1111 (6) o(b) is out today, and so I am sending this directly to you: (6) Please consider this recommended change to PWS (b) (5) Thanks, (b) 1111 (6) (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-001174 OS 00021890 Associate Chief Counsel Procuremen t Law Group Office of the General Counsel U. S. Department of Veterans Affairs 810 Vermont Avenue , N .W . Room 1056/M ail Code 025 Washing ton, DC 20420 Phone : (b) (6) Fax : (b) (6) (b) (6) Sir, [ think this recent lang uage request (see below) for (b) (5) Please get back to vacationi ng and thanks for your concern for my -(b) (6) Yr Jolm That meant a lot to me . John H . Windom , Senior Exec utive Service (SES) Program Exec utive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW ( - th Floor Suite 5080) Washington , DC 20420 John.Windom @va .gov Office: (202) 461-5820 Mobile : (202) 794-4911 Execut ive Ass istant Ms .-(b) (6) - Appointments and Scheduling (b) (6) ~ Office : -(b) (6) From: Windom , John H. Sent: Tuesday, March 27, 2018 9:29 AM To: DJS Cc: Byrne, Jim (OGC) ; Blackbum , Scott R. Subject: RE : Getting it right Mr . Secretary : I am seeking a 30 minute aud ience with Mr. Byrne to discuss the recently proposed language for (b) (5) V/r , John Proposed Language : AMERICAN PVERSIGHT VA-19-0799-G-001175 OS 00021891 Please consider this recommended change to PWS Sec/ion (b) (5) John H. Windom. Sen ior Executiv e Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Unde r Secretar for Health 81 1 Vennont A venue NW (5 th Floor Suite 5080) Washington, DC 20420 John.Windom @va .gov Office : (202) 46 I -5820 Mobi le: (202) 794-4911 Executive Assistant: Ms . -(b) (6) Appointmen ts and ScbeduJing (b) (6) (b) (6) ~ Office : - From: DJS Sent: Tuesday, March 27. 2018 7:50 AM To: Windom John H . Cc: Byrne. Jim(OGC) Subject: FW: Getting it right John- can you help craft a response to this Sent with Good (www .good .com) From: Blackburn, Scott R. Senl: Sunday, March 25, 2018 9:37:38 AM To:DJS Subject: RE : Getti ng il right I'm not sure if you read Marc's response to mine yet. Or if so, what your thoughts are on it. I fear we are still talking past each other . If he/others were to come back with specific counter language to the language in the A VIL I II .,, I PVERSIGHT VA-19-0799-G-001176 OS 00021892 contract then we would certainly consider that (that is the level we are working at right now). But we aren ' t getting that nor do I see us getting that without Mate or anything else really digging into the details of our contract. We are way beyond the high level philosophy . Let me know and I'll direct the team. In Bahamas now and only have connectivity sporadically, but back in US (Florida/Disney) tomorrow morning . Back in the office on Thursday. Sent with Good (www.good .com ) From: DJS Sent: Slmday, March25 . 201812 :08 :17PM To: Byrne, Jim (OGC) Cc: Blackbum. Scott R . Subject: Getting it right Jim- did you get any further clarity on (b) (5) Scott I assume your best to orchestrate all of th.is i s moving in the right direction Thanks Sent with Good (www .good .com ) Thanks Bob. I did att end to day' s listen ing session, 10am-11:30am . I did not attend the session at 1pm . For t he sake of doc ument ing, Here are a few notes . (b) (5) (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-001177 DS_00021893 From: Fleck, Robert R. (OGC) Sent: Wednesday , January 31, 2018 8:28 AM To: Blackburn, Scott R. Subject: RE:lnteroperabi lt y listening sessions Scott, As we discussed, although it would be (b) (5) Bob Robert R. Fleck Chief Counsel, Procurement l aw Group Office of the Genera! Counsel Room 1050 810 Vermont Avenue , NW Washington, DC, 20420 Office 202-461-49 54 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC?552. Do not release this information without prior authori zation from the sender. If this has inadvertently reached the wrong party, please delete this information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney -client privilege and/or work product privilege. From: Blackburn, Scott R. Sent: Tuesday, January 30, 2018 2:53 PM To: Fleck, Robert R. (OGC) Cc:(b) (6) Subject: RE:lnteroperabilty listening sessions Can we talk at 3:30pm? From: Fleck, Robert R. (OGC) Sent: Tuesday, January 30, 2018 2:33 PM To: Blackburn, Scott R. Cc: Byrne, Jim (OGC) Subject: RE:lnteroperabilty listening sessions I can see you now. Bob Robert R. Fleck Chief Counsel, Procurement law Group Office of the General Counsel Room 1050 810 Vermont Avenue, NW ) VI I II .I/ I PVERSIGHT VA-19-0799-G-001178 OS 00021894 Washington, DC, 20420 Office 202-461-4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC?552. Do not release this information without prior authorization from the sender . If this has inadvertently reached the wrong party, please delete this info rmation immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney -client privilege and/or work product privilege. From: Blackburn, Scott R. Sent: Tuesday, January 30, 2018 2:32 PM To: Fleck, Robert R. (OGC) Cc: Byrne, Jim (OGC) Subject: RE:lnteroperabilty listening sessions (b) (5) (b) (5) From: Fleck, Robert R. (OGC) Sent: Tuesday, January 30, 2018 10:27 AM To: Blackburn, Scott R. Cc: Byrne, Jim (OGC) Subject: RE:lnteroperab ilty listening sessions Scott, (b) (5) (b) (6) (b) (6) If you have any questions, please let me know. Bob Robert R. Fleck Chief Counsel, Procurement Law Group Office of the General Counsel Room 1050 810 Vermont Avenue, NW Washington, DC, 20420 Office 202-461 -4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Informa tion Act, 5 USC?552. Do not release this information without prior authorization from the sender. If this has inadvertently reached the AMcHICAN PVERSIGHT VA-19-0799-G-001179 OS 00021895 wrong party, please delete this information immediate ly and notify the sender. Any security screening of this email by informat ion officers or server administrators is not intended to be consent to any party to review the content of the email or a w aiver of the attorney -client privilege and/or work product privilege. From: Blackburn, Scott R. Sent: Monday, January 29, 2018 11:04 AM To: (b) (6) @who .eop .gov Cc: Fleck, Robert R. (OGC); Byrne, Jim (OGC);(b) (6) Subject: lnteroperabilty listen ing sessions (b) 1111 (6) It was a pleasure meeting you today. I am cc'ing Jim Byrne and Bob Fleck. Jim/Bob - Chris Liddell asked me (or someone from VA- perhaps Windom or Ash) (b) (5) (b) (6) Scott Scott Blackburn Acting CIO & Executive -i n-Charge, Office of Information & Technology Department of Veterans Affairs Scott, (b) (5) Please let me know if you have additional questions . - Thanks! (b) (6) (b) (6) Office of the White House Counsel (b) (6) (b) (6) ~who.eop.gov AMERICAN PVERSIGHT VA-19-0799-G-001180 DS 00021896 From : Liddell, Christopher P. EOP/WHO Sent: Monday, February 12, 2018 2:37 PM To: Blackburn, Scott R. (b) (6) EOP/WHO (b) (6) who .eop.gov> (b) (6) Subject : RE:VA EHR @who.eop .gov>;-(b) (6) EOP/WHO Scott I discussed this with -(b) ( copied here) (6) She is goi ng t o advise on the best approach t o ensure we do everyt hing correctl y She w ill let us know of appropriate next steps Thanks Chris From : Liddell, Christopher P. EOP/WHO Sent: Monday, February 12, 2018 9:31 AM To: 'Blackbum, Scott R.' I ( EOP/WHO (b) (6) Cc: (b) (6) Subject: RE:VA EHR b ) ( Scott 6 ) @who .eop.gov> Sorry for slow reply - happy to catch up at some stage t his week Chris From : Blackburn, Scott R.[mailto:Scott.B lackburn@va.gov] Sent: Thursday, February 8, 2018 9:41 PM To: Liddell, Christopher P. EOP/WHO (b) (6) Subject: VA EHR w ho.eop.gov> Chris If you have time possibly early next week, I wou ld love to get your advice related to our EHR. The next few weeks will be critical (with budget hearings, discussions with appropri ator s, Veteran Service Organizations, etc) and we want to make sure we handle everything appropriately. If you are open to it, I can work with Quelli e to fi nd time. Also, I have attached the Executive Summary of M ITRE'sVA interop erabil ity repo rt. Overall very consistent with everyt hing else we seem to be hearing. Scott Scott Blackburn Executive in Charge, Office of Information & Techno logy US Department of Veterans Affai rs AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001181 D8_00021897 Camilo - I hope you had a good weekend. I appreciate the conversation on Friday and thought I would put my thoughts down on paper (as promised). I am including Peter on this as he/I have begun having some of these conversations over the past few weeks (although Pete in fairness has had a lot on his mind with his new role) and also cc'ing Jake. Attached are two documents: o The 8 things that I believe need to happen to not just keep the lights on, but also to keep our positive momentum going. I believe we should aspire for much more than just keeping the lights on during this upcoming transition (at least in OIT) as we have a huge organization making some huge changes and if we don't keep the momentum, it will make the next guy's job impossible. I am a big believer that the sign of an effective leader is how the organization performs when that leader leaves. So this will be important to me to know (which is why I'm writing this out). o #1 out of 8 is stabilizing the leadership of OIT to get us through the next 6 months and set the new CIO up for success (I firmly believe it will 6 months before we have a permanent CIO). So I have 5 specific recommendations under that I've gone into greater detail. I am worried about this not just because of folks leaving (I was always planning to leave this Spring...actually I was supposed to leave a few months ago; Ricci's retirement date is 4/15), but also because of possible moratoriums on SESmoves (e.g., possible OPM moratorium on hiring because no permanent Secretary in place, 120 moratorium on moving SESsonce new Secretary put in place, etc). So any waivers to these or anything we can do to push stuff through, I would love to work together to make happen. I would strongly advise you guys to get to know Bill James better. I am convinced he is the right guy to step up and lead OIT through transition until the permanent CIO comes on board. If you can get comfortable with him, I would suggest that we then transition sooner rather than later given I think it will be better for that person to start fresh with the new leadership team on the 10th floor (rather than me hanging around as a lame duck for a month). We can talk about what that means as far as timing, transition, handover. I am more than willing to fade to the back for a little bit to a support role (to help boost up Bill and make him successful) or fade away completely (if that is better for the organization). I think you guys know we well enough to know that I'll do whatever is best for Veterans and the organization; and will always do so in the most professional manner. I've now given 3.5 years (way longer than I had ever planned to) and I want to see the positive momentum continue well after I'm gone. Talk to you tomorrow, Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs Hi Scott, Just FYI: Deborah Scher had me fired today . She knew I was working on detailing out; we had discussed it. You were incredibly nice and I was looking forward to working with you and your team . Best Regards, Mike Hi Scott, A Greetings. You and I met in a few SecVA meetings. Would you have a few minutes to connect or meet? My exec coach (-(b) (6) says she worked with -(b) and her team and you might know her. (6) Vl[T'ill.1AI VA-19-0799-G-001182 PVERSIGHT OS 00021898 I'm here at VACO. Thanks . Best Regards, Mike Michael Tepper Senior Advisor to the Secretary Center for Strategic Partnerships Department of Veteran Affair s (o) 202-461-5005 (c) 202-658-8982 Morris; Genevieve (OS/ONC/IO)Genevieve.Morris@hhs.gov Ldon.t think I have a phone number for her. bur. "viii let you know if I can find it. From: Sandoval.Camilo J. Sent: Monday, April 02 , 2018 9:03 AM To: Blackburn, Scott R. Cc: WindoULJohnH . Subject: RE : Conlract Language Scott,Do you have Genevieve ' s work email address and phone number ? I need to contact her today and not sure where I can find her or if she at the VA yet. Thank you, Camilo From: Blackbum, Scott R. Sent: Sunday, April 01, 2018 6 :28:05 PM To: SandovaJ Camilo J. Cc: Windom. John H . Subject: RE : Conlract Language Yep , I know Genevieve . She is good . Will give it some thought. ls shed tailed in to VHA I asstune? From: Sandoval, Camilo J. Sent: Sunday, April 01, 2018 8:39 PM To: Blackburn.Scott R. Cc: Windom Jolm H. Subject: RE: ConlractLanguage Excellent, I'll touch base with Windom tomo rrow morning . Also, there ' s someone by the name of Genevieve Morris from the Office of National Coordinator (ONC) joining the VA tomorrow on a 120 day detail. I belie ve she will be helping us review the contract as well, at least with regards to interoperability, and already working with the EHR team . Do you know (of) her? Any thoughts on how we might utilize her expertise 1n combination with Rasu, beyond AMERICAN PVERSIGHT VA-19-0799-G-001183 DS_ 00021899 just reviewing the Cerner contract ? She seems to have a solid policy background in her respective . space . Do you see Genevieve and Rasu working together to cover the policy and functional aspects of Interoperab ility? Camilo From: Blackburn , Scott R. Sent: Sunday, April 01, 2018 4:38:47 PM To: Sandoval, Camilo J. Cc: Windotn. John H. Subject: RE: Contract Language ot sure we di.d. John? What he might be talking about is the feedback from the calls we had 2 weeks ago . [ believe John and team have created a thorough matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback and then 1tndcrstood how we , ere rcconci ling that feedback). There ,. as also the language that we rccci cd via OGC. I'll lea e it to John to weigh in . From: SMdovaL Camilo J. Senl: Sunday, April 0 1, 2018 7:35 PM To: Blackburn, Scott R. Cc: Windom. John H. Subject: Re: Contract Language Scott, I just spoke with Bruce Moskowitz regarding where things are with EHR and he mentioned you recently received language provided by several CIOs (Leslie Cooper , Stan Huff , Stephanie Reel , Jonathan Manis) . Could you kindly forward me those emails and documents? I believe it was in regards to interoperability . Hope you had a great Easter Sunday. Thank you . Camilo Scott, Did Rasu ever complete the requ ired IPA paperwork? I am ready to move here. I'm confused why he was announced before being officially on-boarded (looks nefarious). Let's discuss in the morning. Thank you. Camilo Sandoval M: 917-680-2011 During the 2014 scandal (after Secretary Shinseki was fired and before McDonald came in), Dr. Jonathan Perlin did this for 60 days. Would Marc be willing to do something similar? http:ljwww.modernhealthcare.com/article/20140626/NEWS/306269942 ) , PVERSIGHT VA-19-0799-G-001184 DS_00021900 http://www.modernhealthcare .com/article/20140628/MAGAZINE/306289971 https://www .tennessean.com/story/news/health/2014/06/26/veterans-affairs-turns-hca-exec-help/11399441/ Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs Team - I want to introduce each of you to Camilo Sandoval and ask that each of you on to "to" line schedule an hour to meet with him next week. Will ask Eric to coordinate . Camilo is a member of the V.A. political team . Given we are going through some transition at the top of the organization right now, it is important that he understands our key issues. As you can imagine , the political team is very busy right now bring Acting Secretary Wilkie up to speed, prepping Admiral Jackson for a late April confirmation hearing, and figuring out how to reset the Department's agenda at the Secretary/Department level. This is a similar process that we went through during the Presidential transition period Uust a lighter version) . Please get these set up for next week. Thanks , Scott Sent with Good (www.good.com) Ccing Eric here. Eric - can you help coordinate these for next week? To include format/templates if necessary (see Camila 's note below). I would have each give the same briefings they gave me when I came on board a few months ago (just dust them off and update them accordingly). Rick and Dom are highest priority . I would then say Martha , Lloyd ,.(b) I also added Helga and Marcy. (6) and Jackie and Luwanda. I'd have them block an hour for each . Sent with Good (www.good.com) From: Sandoval, Camilo J. Sent: Saturday,April 07, 2018 11:33:24 AM To: Blackburn,Scott R. Subject: RE: Follow-up Scott, My calendar for next week is still empty. Please , I need you to help push harder. For example, I have not heard back from Dom or Rich . You have the list of people I requested to meet below and I'm not going to chase anyone down . Please have someone coordinate this as Bill suggested and let's get this done ASAP. Also, please remind everyone this is a briefing request so i can better understand their area of responsibility and portfolio. Thank you Camilo 917-680-2011 AMERICAN PVERSIGHT VA-19-0799-G-001185 DS 00021901 From: Sandoval,CamiloJ. Sent: Thursday, April 05, 2018 9:23:26 PM To: Blackburn,Scott R. Subject: RE: Re: Follow-up Would be super helpful to connect with your cos and CFO next. I'm not feeling the love, but I might be misreading the vibes. Bill suggested (per my email last night} that the cos should take the lead in requesting 1:1 briefings. The format is simple, they can brief me using their preferred method/format. The main goal for me is to listen and learn and build relationships. If Eric could help me coord inate with everyone's calendar, that would be greatly appreciated (including Dom). My preference is to have these briefings completed by end of next week if possible. Briefing Request Eric Huweart Rick Chandler Dominic Cussatt Martha Orr Luwanda Jones Lloyd Thrower (b) (6) Jackie Pati Ilo Thank you . Camilo From: Blackburn, Scott R. Sent: Thursday , April 05, 2018 9:25 PM To: Sandoval, Camilo J . Subject: RE: Re: Follow-up Happy to help on the 1 on ls . Is there any specific you need me to push? From: Sandoval, Camilo J. Sent: Thursday, Apri l OS,2018 5;37 PM To: Blackburn, Scott R. Subject: Re: Follow-up Scott , Here are the 3 takeaways and follow up items I'l l work to get more clarity 0n . l}. CIO interview process/pipeline/timeline 2}. Timeline for a decision point on Acting/CIO 3}. VBA/Benefits I need your help pushing for my 1:1 meetings with team directly below CIO & PDAS. My calendar is completely empty for all of next week!!! Thank you sir . Camilo AIVlt-Hll.,AN PVERSIGHT VA-19-0799-G-001186 DS 00021902 Camilo Sandoval M: 917-680-2011 187 Message From: Sent: To ; Subject: Blackburn, Scott R. [Scott .Blackburn@va.gov ] 11/3/2017 10:23:29 PM EOP/WHO illllltvho.eop.gov) (b (b) (b) (6) RE: VACIO adv isory support for Cerner contract ) (6) (6 ) Thanks .(b) I managed to find the other 4. I w ill shoot them all an email over the weekend. I' ll cc you guys too in case (6)to be included . Thanks for all the support . you want Have a great weekend, Scott From: (b) (6) (b) EOP/WHO[mailto.. who.eop.gov] (6) Sent: Wednesday,November01, 2017 9:33 AM To: Blackburn,Scott R. Subject: [EXTERNAL]RE: VACIO advisory support for Cerner contract (b) (6) (b) (6) Here is the first he can help likely with the others - let me know if you need help tracking them down - I don't have them at the moment From: Blackburn, Scott R.[ mailto :Scott.Blackburn@va.gov ] Sent: Tuesday, October 31, 2017 4:31 PM To: (b) (6) EOP/WHO ~(b) > Subject: FW: VACIO advisory support (6) for Cerner contract I (b) (6) Happy Halloween! I just want to follow up on this exchange with Jared. Can you help connect us with the 5 CIOs so we can bounce our EHRplan off of them before we go final? Thanks again for all the support! Scott From: Kushner,Jared C.EOP/WHO[ mailtoa(b @who.eop.gov] Sent: Friday,October 27, 2017 5:36 AM ) (6) To: Blackburn,Scott R. Cc: Liddell, ChristopherP. EOP/WHO;Windom, John H.; DJS;(b) (6) EOP/WHO;(b) (6) EOP/WHO Subject: [EXTERNAL]Re: VACIO advisorysupport for Cerner contract We would love that. We also think you should build in some flexibi lity and requirements around where we think the EMR market might go so that you aren't locked into a program 10 years from now that is obsolete. (b) will connect you and schedule next meeting ? (6) Sent from my iPhone On Oct 27, 2017, at 1:56 AM, Blackburn, Scott R.< Scott.Blackburn@va.gov > wrote: Jared/ Chris - AMERICAN PVERSIGHT VA-19-0799-G-001188 DS_00021904 Thank you for taking time Tuesday evening to discuss the EHR/Cerner contract. We too want to make sure we get thi s right and are looking back 5 years from now knowing we made the right decision. We would love to ask your help in connecting us with the CIOs of Kaiser Permanente -(b) (6) who was on the phone Tuesday night), Cleveland Clinic (which looks to now be Edward Marx), Mayo Clinic (Cris Ross), Johns Hopkins (Stephanie Reel), and We want to have them review what we are about to Partne rs Healthcare -(b) (b) (6) (6), (b) do, provide feedback/advice, and especially call out anything major that we might not (2) be st ructuring correctly. Our thought is to host a two-hou r " red team" session sometime in the next week or two (the sooner the better) before we sign the final deal. Of course we wou ld love for the two of you to join as well if you are available. If you wou ld be willing to introduce us, or provide their contact information, it would be greatly appreciated. Below is a draft of the email that I would plan to send the m. Also as discussed, my team wou ld love to get together with you to discuss "Phase 2" (the Digital Veteran Plat for m) that would create an API gateway and enable health information exchange . As mentioned, we have issued a broad RFIto the private sector and would li ke to do an Industry Day. We would love to partner with you on thi s. Scott This is Scott Blackburn, the Acting CIO for the Department of Veterans Affairs (VA). On behalf of the Secretary David Shulkin, I would like to invite you to participate in a critical review of our Electronic Health Record (EHR) modernization strategy and corresponding Request for Proposal (RFP)to Cerner. Your organizations have been at the forefront of the evolution high quality IT-based health care services and delivery for decades, and thus we would be remiss if we did not seek to gain your insight prior to our final contracting decision . I anticipate a round table style engagement/discussion in the Washington , D.C. area that will last approximately two hours. I will be accompanie d by the Program Executive Officer for VA Electronic Health Record Modernization (PEOEHRM), John Windom , and his key staff members including his Chief Medical Officer (CMO), Chief Technology Officer (CTO) and Director of Contracts. We have spoken to many commercial health care industry leaders regarding EHRimplementation and deployment , and continue to mainta in a strong relationship with our Department of Defense (DoD) counterparts, with regards to their EHRdeployment activities and related challenges. We bel ieve that we have developed a comprehens ive RFPwith particular emphasis on notable "fail points" EHR-deployment arena such as Governance, Traini ng, Change Management , Data Migration, Funding, etc . to name only a few, but look forward to your thoughts on these and others . I ask that you please provide me your primary schedu le manager or point of cont act to coordinate a date and time t hat maximizes our overall participation at this all-important review forum . Thank you in advance for your at tention to this note, participation and wil lingness to help our Veterans continue to receive the very best healthcare. AMERICAr-... pVERSIGHT VA-19-0799-G-001189 DS_ 00021905 Scott Blackburn Scott Blackburn Acting CIO & Executive in Charge, Office of Information & Technology US Department of Veterans Affairs AMERICAr-... pVERSIGHT VA-19-0799-G-001190 DS 00021906 Message From: Sent : To : Subject: Blackburn, Scott R. [Scott .Blackburn@va.gov] 11/14/2017 7:15 :28 PM DJS [vacodjsl@va.gov] RE: VA MEETING thanks From: DJS Sent: Tuesday, November 14, 2017 2:15 PM To: Blackburn, Scott R. Subject: RE: VA MEETING Yes and yes Sent with Good (www .good .com ) From: Blackburn, Scott R. Sent: Tuesday, November 14, 2017 10:46:39 AM To: DJS Subject: RE: VA MEETING Got it. Are you ok with Bruce joining and inviting a few others (it looks like 1-2 clinicians fr om MGH)? For the 5 CIOs who ask, I will tell them that Bruce is an advisor and extension of the WH/VA team. Is that ok to say? From: DJS Sent: Tuesday, November 14, 2017 1:43 PM To: Blackburn, Scott R. Subject: RE: VA MEETING I don't have any real advice but to keep the conversation focused on the topics you need advice and value on Sent with Good (www .good .com ) From: Blackburn, Scott R. Sent: Tuesday, November 14, 2017 10:38:25 AM To: DJS Subject: FW: VA MEETING The call with the 5 CIOs is Wednesday 3-Spm. On our pre-calls, 2 of the CIOs have asked about Bruce and what his involvement is. I have never had any contact w ith Bruce, but it seems like a sensitive relationship . Any advice on how to handle? AMERICAN PVERSIGHT VA-19-0799-G-001191 OS 00021907 We invited Jared/Chris from WH as a courtesy . I don' t think either plan to join, but they must have invite d Br1..1ce who is now asking a few othe rs to join (see below). Can discuss live later before or after hearing prep . Scott From: Schnitzer, Jay J [mailto:(b) (6) mitre.or Sent: Tuesday, November 14, 2017 12:47 PM To: Blackburn,Scott R. Cc:-(b) (6) Subject: [EXTERNAL] FW: VA MEETING Hi Scott, Please see the email trail below. Just want you aware in case we have people joining the call without your knowledge or approval. Thanks , Best , Jay Jay J. Schnitzer , M .D ., Ph.D . MITRE From:-(b) (6) (b) (6) @.PARTNERS.ORG> Date: Tuesday Nov 14 2017 11:43 AM To: Karson, Andrew Scott,M.D. (b) (6) Cc: Schnitzer Jay J (b) (6) 1aJmitre .or > Subject: RE: VA MEETING But do th e people hosting the call know you are going to be on the call? I am copying Jay as he is helping coordinate t he call.. (b) (6), (b) (2) From:Karson, Andrew Scott,M.D. Sent: Tuesday, November 14, 2017 11:31 AM To:-(b) (6) ~(b) (6) Subject: RE: VA MEETING > Dear.(b) (6), (b) (2) Thanks for the note. I think that you and I may have a little mis-understanding. I agree that you can of course handle the call, but Gregg and Bruce Moskovitz invite d me to the call tomorrow so that the y can have a hands-on clinicians perspect ive. Bruce and I spoke very briefly (between his patients) a little while ago and Bruce sent me the below information. I am hoping t o t ouch base wit h you before th e call if that is possible for you. I am tied up in presentations/meetings the rest of the day, but could speak th is evening (6pm?) or tomorrow if that is okay with you. (And if needed I will break out of ot her meetings today). Many thanks, Andy (b) (6) From:Sent: Tuesday, November 14, 2017 11:16 AM To: Karson, Andrew Scott,M.D. (b) (6) Subject: RE: VA MEETING r , PVERSIGHT h.harvard.edu > VA-19-0799-G-001192 DS_00021908 I had a call with them today in prep for tomorrow's call. I appreciate the offer but I don't think it is my place to invite you. It needs to come from the VA. From: Karson, Andrew Scott,M.D. Sent: Tuesday, November 14, 2017 11:11 AM (b) (6) To:-(b) (6) ~> Subject: FW: VA MEETING Dear.(b) (6), (2) Given(b)some conflicts that Gregg has being a senior advisor for the VA, Gregg has asked me to join the 3pm VA call tomorrow to be available for the clini cian perspective. Would you be up for a 15 minute check-in call with me at some point tomorrow before the VA call? If so, then I'll reach out to Susan Briggs to get us a time. Many thanks, Andy From : Karson, Andrew Scott,M .D. Sent: Tuesday, November 14, 2017 11:06 AM To: 'Bruce Moskowitz' (6) Subject: RE:VA MEETING Dear Bruce, Many thanks for the note. I'll review the below a little later today and I'll be back in tou ch. Many thanks and best, Andy From: Bruce Moskowitz (mailto:bruce (b) (6) (b) mac.com Sent: Tuesday, Novem ber 14, 2017 10:45 AM (6) To: Karson, Andrew Scott,M.D. (b) (6) h.harvard.edu > Subject: VA MEETING The call will take place this Wednesday, November 15th between 3 :00 PM and 5:00 PM (b) Dial In Number: ~ (6) Passcode :-(b) (6) Thank you for your time and involvement. Some background informati on. These are my concerns as a cJinician. Cerner does not have the ability to provide the following in the Choice Program: Tracking duplicate testing Tracking over utilization by providers Tracking duplicate prescriptions and medjcation errors . Tracking tests that were ordered, completed and results go to all physicians involved in the Veterans care Patient notification of critically abnormal results with followup resolution IL-I I pVERSIGHT VA-19-0799-G-001193 D8_00021909 Arranging appointment followup between the VA and Private sector Emergency room visits in the private sector ability to access records immediately and VA physicians notified of emergency care and followup Cerner has no registry to tract what Cardiac and ort hopedic devices are implanted in case there is a recall of the device Automatic record transfer from the Choice Provider to the VA patient record with flagging new information to every VA health care worker A radiology platfonn to see films in high defin ition to compare X-rays and ability for radiologists to efficiently find previous films. For instance a radiologist needs to know if a lung noduJe is new or was there previously and the same size. Cardiologists need to access catheterization films in high definition Cemer has no system to alert VA health care workers when a patient is at a particular office or hospital to participate in care management in rea l time. Sent from my iPad Bruce Moskowitz M .D. The information in this e-mail is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information , please contact the Partners Compliance HelpLine at http://www .partners .org/comptianceline . [f the e-mail was sent to you in error but does not contain patient information , please cohtact the sender and properly dispose of the e-mail . AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001194 DS 00021910 Message From: Blackburn, Scott R. [Scott .Blackburn@va.gov] Sent : 11/20/20 17 10:33 :00 PM To : (b) (6) (b) Bruce Moskow itz [br ucem~@mac (6) RE: [EXTERNAL] VA-CIO CALL Subject: .com ] Dr. Moskowi t z, Thank you so much fo r the not e and for all th e help/support. to be in Washington anytime soon? I would love to meet you in person. Do you have any plans I thought the call last week was extremely valuab le. The experience and wisdom of the participants is such a great asset - we wou ld be fools to not take full advantage of it. I do agree fully that there was a lot to cover in only two hours . I think the moderator was doing the best he could to get as much out of it as possible, while trying to be respectful of the time that so many important people were volunteering. If the 5 CIOs we re willing to follow up, perhaps we schedule another session(s) on various deep dive topics? We would absolutely love that. Just by way of introduction - I jumped into the CIO ro le less than 2 months ago when our previous CIO (Rob Thomas) abruptly retired to deal with some personal issues. I am a disabled Army Veteran (MIT ROTC). After getting out of service I went to business school and then to McKinsey where I made part ner and spent 9+ years there leading large business transformations in industrial clients. Bob McDona ld (the former P&G CEO and former Secretary) convinced me to join VA to lead the turnaround after the 2014 Phoenix scandal. From Feb-Sept, I served as Secretary Shulkin's Deputy until a political appointee was put in place. Then jumped into the CIO role to work with the team and make sure this gets done . We are sti ll awaiting a permanent CIO. I would be happy to jump on the phone this week t o if you wou ld like. Thanks again for your support! Scott Scott Blackburn Acting CIO and Executiv e in Charge, Offic e of Information & Techno logy US Department of Vet erans Affa irs (b) (6) (b) From: Bruce Moskowitz [ mailto:bruce~@mac.com] Sent: Monday, November 20, 2017 6:02 AM (6) To: Blackburn, Scott R. Subject: [ EXTERNAL ] VA-CIO CALL Dear Scott: I thought the VA-CIO call N ovember 15 to help you with practical industry expertise relating to your proposed Cerner implementation generated some valuable conversation. The participan ts were some of the most highly experienced CIOs with deep EMR backgrounds , together with physicians who focus on medical error prevention and improving the EMR experience. I hope and expect that you found it of great value . Since we have not spoken before , you may not be aware that I am the person who personally recruited the Academic Medical Centers to provide the VA with advice, intended to help the VA create and implement a path to fix its care delive ry issues, as well as advise on other areas where they can be of value to bette r veterans' care. I have AMERICAN PVERSIGHT VA-19-0799-G-001195 OS 00021911 been a central point for the group and was the collection point for the participants' post-call debrief. Also, for reference purposes, each of the people on yesterday's call has performed flawless implementations of state of the art EMR systems on behalf of their respective healthcare delivery systems, some more than once. Since the call was structured to focus the discussion on the few direct questions set forth in your agenda, and the moderator controlled the timing of each question very tightly, the breadth of the discussion was somewhat limited. As a result, you only had the benefit of the experts' advice in the areas that the moderator put on the table ... and the participant's want to make sure you have the benefit of their complete thoughts and feedback. Everyone felt good about the discussion on the agenda questions and felt that the scope and implementation issues relating to DOD /VA interoperability were well in hand. However, some of the participants' questions raised about other areas left them uneasy about the readiness of the system for implementation or the readiness of the Cerner RFP contract for execution. Based on some of the offshoot discussions, the participants felt that many non-DOD interoperability solutions have not yet been fully addressed or solved, leading to incomplete system planning and contracting protections, greatly risking an unsuccessful implementation and large additional cost and time overruns. The interoperability with community provider partners did not seem to be defined completely. Some additional areas that were identified by the VA and its contractor's participants and moderator as incomplete in the call are: seamless sharing of Choice partner records, duplicate procedure and medical error prevention, flagging mechanisms and implantable device identification, among others. Until the design of the system and all functional requirements are identified and completed, the participants fear that these as yet undeveloped processes and solutions will result in a significant increase in the cost of the implementation and operation of the Choice program and impact quality care delivery to our veterans who choose to take advantage of the Choice program. Lastly, at the beginning of yesterday's call your moderator identified the comfort that Congress expressed at recent hearings from the participation of the CIOs in the process. However, yesterday's relatively short discussion on a massive topic was limited and not set up to have a platform for full discussion in a two hour phone call with a few questions. Also, as mentioned in the call at various times, the participants' did not have access to the RFP contract document, its scope and the contractual provisions and protections, a critical part they feel of evaluating the completeness of a successful design and implementation. As such, the participants want to make sure that yesterday's discussion is understood by everyone - the VA and Congress alike - to be a limited dialogue to provide their valuable experiences on the topics put on the table by the moderator, but not as a confirmation of the project's completeness or readiness for contract execution or implementation, which they believe likely has shortfalls. In general, we liked what we heard, we are honored that you felt our advice would be of value, but have had discussion about a very limited part of the project and have questions about the system design, whether it is ready for implementation and whether the contract (from the limited discussion) has adequate safeguards to proceed without risk to the cost and success of the effort. While this was the first time you have spoken to any of these participants on the topic of EMR, and maybe on any topic, the participants would be pleased to provide further feedback and advice should you desire on the remaining issues that are still incomplete and to help you work toward a successful RFP contract, design and implementation. Sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-G-001196 OS 00021912 Message Blackburn, Scott R. [Scott.Blackburn@va.gov] From: Sent : 11/27/2017 3:42:51 PM To : Bruce Moskowitz [bruce (b) (6) (b) @mac.com] (6) (b) (6) @gmail . com mbtl-? RE: [EXTERNAL)Follow up meeting CC: Subject: Thank you Bruce. Very helpful. (b) (6) (b) From: Bruce Moskowitz [mailto:bruce~@mac.com] Sent: Monday,November 27, 201710:lSAM (6) To: Blackburn, Scott R. (b) (6) Cc: mbs~@gmail.com Subject: Fwd: [EXTERNAL] Follow up meeting l should point out this would be ideal functionality requirements of any EMR contract if not pai1 of what has been reviewed by the VA we need to discuss these poin ts further since they are derived from the previous meeting points made by the CIO ' s and we can again cover them in the agenda Sent from my iPad Bruce Moskowitz M .D. Begin forwarded message : From: Bruce Moskowitz (6) Date: November 27, 2017 at 8:41: 19 AM EST To: "Blackbum , Scott R. " < Scott .Blackbum@va .gov> (b) (6) (b) (6) Cc:''-'' wrote: Bmce - thanks for the note . I hope you and Marc both had a great Thanksgi ving. Sounds good on all below. Let's shoot for the week of December 11th or December 18th in Washington . If the CI Os can get us the list of issues by December 5th, we will turn around the gap analysjs quickl y. Happ y to work with Stephanie, Andrew and Marc on the agenda development - that would be very helpful. Scott -----Origin al Message----From: Bmce Moskowitz [rnailto :bruce (b) (6) Sent: Friday , November 24, 2017 7:08 PM (b) (6) To : Blackbum, Scott R . Cc : - (b) (6) Subject: [EXTERNAL] Follow up meeting [ am speaking for myself and it would seem to me that holding it at Cerner would restrain an open honest discussion of what is needed to insure that we have all the key pieces to have the the EMR that we all see as a necessit y to provide the end users with all tools necessary to provide quality care. The five CIO ' s are very knowledgeable regarding all capabilities of Cemer. I have been an end user of Cerner and know as do the CEO ' s the process to quickly move the agenda forward. We are committed to your adoption of Cemer as the EMR howe ver being rushed into a contract without due diligence on our part would be prob lematic. We can be available for a meeting in Washington ASAP fully realizing some will need to be on a conference call. I would recommend an agenda that reflects the way forward by both groups and would recommend you allow Stephanie Reel .Andrew Karson and Marc Shennan to assist in the agenda development. Sent from my iPad Bruce Moskowitz M.D . AMERICAr-... pVERSIGHT VA-19-0799-G-001198 D8_00021914 Message From: Sent: To: Subject: Blackburn, Scott R. [Scott .Blackburn@va.gov] 11/22/2017 11:49:19 PM 'Bruce Moskowitz' [bruce (b) (6) (b) @mac.com];'mb Follow up (6) (b) (6) @gmail.com' [mb (b) (6) @gmail.com] Bruce/ Marc - thanks again for all your support. We really appreciate what you are doing to bring the best of the healthcare industry to help Veterans/VA. I spoke with David and he gave the green light to move forward. We absolutely want to get this feedback and greatly appreciate the help. The only caveat is that we move as aggressively/quickly as possible. There are still a few things we need to figure out with respect to timing on signing the contract with Congress/budget/funding/etc (e.g., one of the reasons for starting soon is to get in sync with DoD's rollout to leverage synergies; another variable is the Continuing Resolution and timing of when the government budget is finalized which could possibly push out to Jan/Feb rather than December as currently projected). But we will figure that out . The point being is that we love the idea, do want the feedback, and agree with the logic we discussed on the phone. We will delay the signing as long as we can to make sure we get this right (the concern is making sure we don't miss the window) . If you could reach out to the 5 CEOs/CIOs,it would be greatly appreciated . I will commit to making sure the VA turns around the gap analysis as fast as possible. Do you think it could then be possible to shoot for a full day session in midDecember (week of 11th or 18th )? David had the idea of possibly doing it at the Cerner Innovation Laboratory in Kansas City so we can test/challenge somethings on the spot. Thanks again for all your support! I hope you and your families have a great Thanksgiving. Scott Scott Blackburn Acting CIO & Executive-in-Charge, Off ice of Information & Technology Department of Veterans Affa irs AMERICAN PVERSIGHT VA-19-0799-G-001199 OS 00021915 Message Bruce Moskowitz [bruce (b) (6) (b) @mac.com] 2/28/2018 9:53 :27 PM (6) Blackburn, Scott R. [Scott.Blackburn@va.gov) DJS[vacodjsl@va.gov) ; Marc Sherman [mboo? (b) (6) @gmail.com); O'Rourke, Peter M.[Peter .0Rourke@va.gov); IP ll@frenchangel59 .com]; Iper-@gma i I.com ( (b) Re: it is CLOUD+ languge + Rasu b [EXTERNAL)Re: Open API -(6) From: Sent : To : CC: Subject: ) ( 6 Thank you progress is being made but as my group keeps saying devil is in the details ) Sent from my iPhone On Feb 28, 2018, at 4:36 PM, Blackburn, Scott R wrote: Bruce - as promised here is more information on what we will have to address the other 4 issues you mentioned. I still owe you device registry . Let me know if this makes sense or not . Also happy to get you on the phone directly with my experts. - Scott Voice Recognition. Our new Cerner EHRplatform includes Enterprise Dragon Nuance. VHA currently deploys the enterprise version which maintains people voice print and the Clinical Staff say it works very well (my primary care provider at the Washington VA Medical Center uses it) . Cerner will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Cerner without any rework. The Clinician can use the dictation and other features with voice recognition. How will all entered lab data, from any source, be available on a graph Graphs will be available in 2 spots. 1. Workflow MPage lab Component and 2. Results review flowsheet. When outside labs are mapped we would use the same names as internal and then they would appear on the same line . Even if they are not exactly named the same the results review flowsheet allows for 2 different lab values to be graphed together . Catching test duplication, over utilization and medication duplication/errors at time of ordering instead of after the fact All tests are configured to have a time where an alert is issued based on paramete rs we configure and can flex by venue. Over utilization will be avoided with real time alerting but VA would have to use a mechanism to monitor, via report . The med duplication is configured similarly to test and parameters will determine how the system acts. Tall man lettering reduces errors in look alike, sound alike meds, and finally in instances we identify errors we can configure rules to catch thos e. For meds all allergy checking, dupes, dose range checks, and interactions are checked at time of ordering . As an aside, white the DoD Cerner implementation has been far from perfect this is one area where it has been very successful; the new DoD/Cerner system has already prevented over 15,000 duplicate tests at their initial three sites that have been implemented. Streamlined SOAP notes. Yes, the VA/Cerner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs. From: Blackburn,Scott R. Sent: Wednesday,February28, 2018 2:30 PM To: 'Bruce Moskowitz' AMERI ,1/--\I PVERSIGHT VA-19-0799-G-001200 OS 00021916 (b) Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP; ~ (6) languge + Rasu Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD+ Bruce - we certainly aren't going to let you get tar and feathered! Again, we really appreciate all the support you've given us. On these other 4, I'll get you answers on these ASAP. I know these are topics you've brought up in past and we were definitely listening. I've been hammering the team to make sure we incorporate all this feedback into the negotiation. Let me send you the specifics where we have landed to make sure that we got them right. Stand by ... Scot t From: Bruce Moskowitz mailto:bruce (b) (6) (b) mac.com Sent: Wednesday, February 28, 2018 1:13 PM (6) To: Blackburn, Scott R. (b) Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP; ~ (6) languge + Rasu Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD+ Thank you my five CIO ' s had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are : Voice Recognition All entering lab data on a graph from any source Catching test duplication, over utilization and medication duplication/errors at time of ordering not after the fact Streamlined SOAP notes Sent from my iPad Bruce Moskowitz M.D. On Feb 28, 2018 , at 12:52 PM, Blackburn , Scott R.< Scott.Blackbum@va .gov> wrote : Bruce - this is incredibly helpful. Thank you very much. I had my team dig into this this more this morning. What you have stated below is clearly the intent (we need everything to be OPENand absolutely do not want to inadvertent ly create vendor lock); we've also gone back this mornign to confirm with Cerner that this is their intent. We are going to alter the language to make this more clear. We don't anticipate any push back. A few things I learned this morning ... o o AMERICAN PVERSIGHT The cont ract does NOT lock us in to Amazon Web Services (AWS). Rather any cloud provider or applications that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Cerner system. Currently 3 cloud providers meet the Government security requirements - AWS, Azure/Microsoft and CSRA. There are several others t hat we expect to come on board soon including Google and VirtuStream/De ll. At VA, we use both AWS and Azure right now. Again, the goal VA-19-0799-G-001201 OS 00021917 o o here is to create open environment as long as t he provide r meets certain standards (these standards are dictated by GSA, not VA). Cerner does have a partnership with AWS (which is why we highlighted that) but it is just one example of the open could environments they are planning to work with. We have confirmed that it will be OPENand not proprietary to their specific AWS cloud. DoD is excited to fo llow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team . This will help not just Vetera ns, but servicemembers still in uniform. Thanks again for the feedback and support. We are going t o make sure this is crystal clear. Scott From: Bruce Moskowitz [ mailto:bruce (b) (6) Sent: Tuesday, February 27, 2018 9:29 PM (b) (6) mac.com To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP; ~ (b) Subject: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu (6) Apologize for the wording instead of their commercial cloud a cloud based system open To all entities and instead of Amazon it should be all platforms working to accelerate health care iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018 , at 9 :20 PM, Bruce Moskowitz wrote: (6) To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importance an open platform to all not just amazon but to all Working on Sent from my iPad Bruce Moskowitz M.D . On Feb 27, 2018 , at 8:20 PM, Bruce Moskowitz wrote : (6) This is a problem it should say open cloud to all entities not commercial cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. AMERICAr-... pVERSIGHT VA-19-0799-G-001202 DS_00021918 Sent from my iPhone On Feb 27, 2018, at 6:09 PM, Blackbum, Scott R. wrote : David/Bruce/Marc- here are a few updates: #1) Rasu is all in as far as starting to help right away. just got off the phone with him , He has UPMC commitments rest of this week and is Chairman of HiMSS Innovation committee (so we will all be at HiMSS together next week). However if he needs to come to Washington this week for something, he will find a way to do it (and we will use invitation travel to pay for it). He is willing to start engaging right away to help us. He said he doesn't have to wait for the IPA paperwork to come through for him to help. I've attached Rasu's CV in case you need it. #2) The APls are cloud based. Here is the response from our Technical lead ... o The Open APls that VA has access to from Cerner reside in their Commercial Cloud environment. This environment is designed to scale to accommodate Cerner's entire o remote hosted customer base. ln a recent press release Cerner and Amazon announced that they would be work i ng together in cooperation to accelerate HealthCare Innovations . #3} Below is the IP language that we negotiated. This is what caused Aneesh Chopra (one of the experts on our MITRE panel) to jump out of his chair last week. He claims this is the holy grail that no other healthcare system has been able to get from either Cerner or Epic. Aneesh claims that as a result of what we've negotiated below , that other healthcare systems will be willing to join us in the attached pledge (shall we decide to go forward with it) and we could do this next week at HiMSS. When I spoke to Rasu, he told me Aneesh had already called him about this and that UPMC would be willing to sign this pledge. Of importance : Third rMmJ party API developers shall retain their IP rights when thei r API is used to connect to the Cerner interfa ce, and there will be no der ivative Contractor IP AMERICAr-... pVERSIGHT VA-19-0799-G-001203 D8_00021919 ownership whe n third part ies consume Cerner t ermi nology through open A Pis. Rega rding the quest ion on sha ring develop ment w ith oth ers , see PW S Sect ion 5.5.4 opening paragra ph: To accelerate better and more responsive service to t he Veteran, VA is making a deliberat e shift toward s becoming a standards[Mm] -based API driven digita l enterpr ise. A cornerstone of t his effort is the set up of a strat egic Open API Program, The Digital Veteran Platfo rm API Gat eway, t hat is adopt ing an outsid e-in, value-to- business driven approach to create APl's th at are managed as produc ts to be consumed by developers with in and outside of VA. Finally , Ce rner's response and the fin al negot iat ion lang uage on sha ring th eir data mode l as a result of t he Interoperabil ity Panel find ings is as follows, Gerner ag reed to sugges ted add ition of PWS paragrap h 5.8(h) as highl ighted at no addi tiona l cos t: 49 Understand bow RFP Sectiou 5.8 address tbe Suggest adding to RFP Section 5$ : '.h) Pro, .ide the VA EHRM data Cemer will provide support to business tbe VA wilh access intelligence and data model. underpim1ing terminology model, tables, definitions, and Lothe data model analytics. Section 5.10.4.l supports the examples of full) populated Veteran share data for uing of Contractor analytics freely lo s]_ll data files. ProYide docwnenuition or 3rd parties, increase proprietary infonnation/cfala software IJiatis used for quaJity model el\t eusion points (e.g., checks and IJ1at iJlustralc what dat11 Lbeamouol of computable data ingestion and recordAP ls) elements are computable. exchanged witb 31'11 with both international and parties. national standards designating Suggest adding to Section 5. 10.4.1: organizations. "11)The Contractor shall support However, cun ent language Knowledge Interoperability by Panelists acknowledged I.his does not. require access to the supporting the extension or clinical content assets such as terminologies, Tccommendation is EHRM data model, a stretch goal. supporting understanding of clinicaJ decision support mJes, order and therefore increase the sets. etc. This includes the ability to exchange of computable data curale. e:\. 1.end. and share that. wi1J1communit)' care knowledge with clinicaJ providers. partners. This fosters rapid adoption from industry best practices, e.g., clinicaJ professional societies.., Suggesl VA obtain a price from the Contractor Lo provide a report explain the steps involved in accessing the data model, including producing au example data file, and demonstrating how much of lhe data is computable; provide cost estimates for outside parties to access the data via this mechanism. AMERICAN PVERSIGHT Ceroer Cone, requested ch, Suggest addin Seclion5 .10A The Contractc support Know lnteroperabilit supporting I.b e:\.tension of c content assets terminologies, decision suppo rules order se to the extent extensions ar consistent wi1 model and be J> ractices oft contl'Olling n. standard. T hi includes the al curate, extend slwe lhat kno with clinical partners. Thi~ rapid adoptior industry best practices. e.g., professionaJ societies..o VA-19-0799-G-001204 DS_00021920 -Scott AMERICAN PVERSIGHT VA-19-0799-G-001205 OS 00021921 Message From: Sent : To; (b) (6) (b) (6) @va.gov] Subject: 3/9/2018 9 :10:18 PM Blackburn, Scott R. [Scott .Blackburn@va.gov] ; (b) (6) (b) (6) va.gov]; (b) (6) (b) (6) (b) (b)(6) (6) (b) (6) @va.gov] (b) (6) @va .gov) (b) (6) (b) (6) (b) (6) RE: SecVA Importance : High CC: @va.gov) @va.gov) ; (b) (6) @va.gov] (b) (6) Scott, this breakfast is off. Mr. Perlmutter can no longer do . No need to travel , Scott. Sorry about that. Thank you. From: Blackburn,Scott R. Sent: Friday, March 09, 2018 4:09 PM To: (b) (6) Cc: (b) (6) (b) (6) Subject: RE: SecVA Awesome! Thanks so much. From: (b) (6) Sent: Friday, March 09, 2018 2:50 PM To: Blackburn,Scott R. (b) (6) Cc: (b) (6) Subject: RE: SecVA Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM . He has a speech and dinner that evening. He said you can leave after the 11am meeting . I've added our travel team to provide you details of flights . Thank you! From: Blackburn,Scott R. Sent: Friday, March 09, 2018 2:19 PM To: (b) (6) Cc: (b) (6) (b) (6) Subject: RE: SecVA I'll be there . I II plan to mim ic his schedule . Sent with Good (www .good .com ) From: (b) (6) Sent: Friday, March 09, 2018 2:18:28 PM To: (b) (6) Cc: (b) (6) (b) (6) Subject: SecVA Scott - just a heads up that boss wants you to travel with him to Mar-A-Largo on Tuesday. He w ill be meeting w/Mr. Perlmutter , Dr. Moskow itz, and Marc Sherman. We are trying to firm up the time. He may be departing early afternoon on Monday or early on Tuesday. Please confirm if you are available to travel with him . Thanks. AMERICAN PVERSIGHT VA-19-0799-G-001206 DS_ 00021922 Message David Shulkin [secshulkin@gmail.com] 3/11/2018 4:31 :54 PM Blackburn, Scott R. [Scott .Blackburn@va.gov) [EXTERNAL]Fwd: Contact review From: Sent : To : Subject: Scott lets discuss tommorow Sent from my iPhone Begin forwarded message : From: David Shulkin Date: March 11, 2018 at 12:31:22 PM EDT To: Bruce Nloskowitz , 1 (b)(6) (6) Subject:) Re: Contact review (b) (6) (6 ) Great list Is leslie cooper from mayo- i could not find him or her Sent from my iPhone On Mar 11, 2018 , at 11:02 AM, Bruce Moskowitz wrote : (6) These are the individuals to review the contract; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain Jonathan ManisCIO- suttrr Andrew Karson MD. - prutners Leslie Cooper M.D. CliffordKoM .D .- american college surgeons Sent from my iPad Bruce Moskowitz M .D. AMERICAN PVERSIGHT VA-19-0799-G-001207 DS_00021923 Message Windom, John H.( John.W ind om@va .gov] 3/23/2018 5:54:36 PM Blackburn, Scott R. [Scott .Blackburn@va.gov]; Bowman, Thomas (Thomas.Bowm an@va.gov] Zenooz, Ashwini [Ashwini .Zenooz@va.gov]; Short , John (VACO) [John.Short@va .gov) RE: (EXTERNAL] Re: VA EHR From: Sent : To ; CC: Subject: Mr. Blackburn, I went back and read Mr . Sherman's email and reviewed my notes. I see no recommended language for insertion in the contract to address his concerns. What it appears to be is a push to perform an interoperability sandbox/test platform in advance of contract award. Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5 th Floor Suite 5080) Washington, DC 20420 John.Windom@va.gov Office: (202) 461 -5820 Mobile: (202) 794-4911 Executive Assistant: Ms. -(b) (6) - Appointments and Scheduling (b) (6) ~ Office (b) (6) From: Windom, John H. Sent: Friday, March 23, 2018 1:47 PM To: Blackburn,Scott R.; Bowman,Thomas Cc: Zenooz,Ashwini; Short, John (VACO) Subject: RE: [EXTERNAL]Re: VA EHR Mr. Blackburn, Not sure where Mr. Sherman is going with his comments but our language in the contract is consistent with the requirements or our Clinicians, various external reviews and the Mitre report. Mr. Sherman is seeking specificity in the interoperability realm that simply does not exist today and is evolving even as I type. We have provisions in the EHR contract to insert technology as we, the VA, as well as to incorporate evolving technology and standards. The DVP acquisition is our bridge to the use of APls (gateways), FHIR, etc. We have modified our interoperability language (below) based on the Mitre and the many external reviews to give us the utmost flexibility over the 10-year life of this contract. The Secretary personally halted the recent phone call to stop Marc Sherman, et. Al's parade of national interoperability objectives as not feasible at this j uncture "anywhere," but included as part of our overall interoperability strategy that includes the DVP acquisition/strategy. We are committed to establishing the interoperability test bed/sandbox at IOC to solidify our interoperability objectives prior to full deployment to the enterprise. In addition , I believe Mr. Sherman meant to highlight section 5.5.1 which speaks to the data domains that were called into question and their inclusion in the contract. They are clearly in the contract as captured below. Mr. Sherman does not understand the culture of VA or the federal government. We have an incremental/iterative change management strategy that will culminate in a successful EHRModernization effort. He appears to be more of a "big bang" theory guy. The problem is, we must continue to deliver uninterrupted and quality care to our Veterans during the transformation within the parameters of the law and other regulations/policies (e.g. cybersecurity, cloud, A Vlt r 1 .1r\l PVERSIGHT VA-19-0799-G-001208 DS_00021925 etc.) bounding our integration/implementation strategies. Our existing language is sound and appropriately balances change management risks, future insertion of technology, innovation opportunities, standards development, etc. without artificially inflating the cost of the contract through the incorporation of excess specificity that never materializes in practice. Through the Initial Operating Capabilities {IOC) process and the judicious issuance of task orders, we will have the ability to change course direction as appropriate without excess risk to the taxpayers or our overall success. Mr. Sherman continues to fail to recognize that it is Program Management Oversight {PMO) and VA commitment to change management that will drive our successin these areas, not more words in the contract. V/r, John IDIQ PWS 5.5.1: Workflow Development and Normalization: j) The Contractor shall enable configuration of the application that supports external community data without requiring the clinician to go to special screens to see and use reconciled external data. By IOC entry, the Contractor shall support incorporation of the following external community data domains, including but not limited to these domains and subdomains: o Problems o Allergies o Home Medications o Procedures - including associated reports and with appropriately filtered CPT codes o Immunizations o Discharge Summaries o Progress Notes o Consult Notes o History & Physicals o Operative Notes o Radiology and Diagnostic Reports (Into "Documentation" component) By IOC exit, the Contractor shall support incorporation of the following external community data domains, including but not limited to these domains and sub-domains: o Results o Labs - General - Pathology and Microbiology o Vitals o Radiology and Diagnostic Reports (Into "Diagnostic Report" component) o Images IDIQ PWS Section 5.10.4: Seamless Interoperability/ Joint Industry Outreach includes significant detail on the topic. The interoperability section is copied below this table for reference. IDIQ PWS section 5.5.4 Data Exchange - Application Program Interface {API) Gateway also includes detail on the creation of strategic open AP ls. VA NF-177: Interoperability - Data Standards: The system shall support the use of the health data standards identified in the VA DoD Health Information Technical Standards Profile and by the VA DoD lnteragency Clinical Informatics board, including following common data standards: National Information Exchange Model NIEM; Health Level 7 HL7; Logical Observation Identifiers, Names and Codes LOINC; Systematized Nomenclature of Medicine SNOMED; RxNorm, MedRT, ICD, CPT, HCPCS,Veteran Information Model VIM; and Healthcare Information Technology Standards Panel HITSPas well as VA/DOD/IPO extensions to these standards. VA-NF-T23: Informatics - Care Integration: VA must be able to seamlessly integrate with HIE and external -to -EHR shared services to provide for a seamless experience and to more effectively integrate in community care efforts, as well AME=RICAN PVERSIGHT VA-19-0799-G-001209 OS 00021926 as with other parts of VA (e.g., identity management). This includes but is not limited to the EHR product ability to support external shared services (SOA services, such as identity management, care plan service, scheduling, etc.) accessed via standards-based APls. (Process Continuity, Evolution, Extension) KSRS [NOW+] VA NF-211: Health Information Exchange: The system shall support VA electronic exchange of health records via other interoperable networks (e.g. CareQuality, CommonWell Health Alliance, DirectTrust, National Association for Trusted Exchange) by supporting their specifications, security and content specifications 5.10.4 Seamless Interoperability/ Joint Industry Outreach The Contractor is required to collaborate with VA affiliates, community partners, EHR providers, healthcare providers, and vendors to advance seamless care throughout the health care provider market. Seamless care will require the creation of an integrated inpatient and outpatient solution with software components that have been designed, integrated, maintained, and deployed with a design architecture that allows for access to and sharing of common data and an enabling security framework that supports end-to-end healthcare related clinical and business operations. Seamless care is the experience patients and providers have moving from task to task and encounter to encounter within or between organizations such that high-quality decisions form easily and complete care plans execute smoothly. Information systems support the seamless-care experience by gathering data, interpreting data, presenting information, and managing tasks. Currently, industry lacks specific and uniform interoperability standards to support seamless care between organizations that employ different EHRsystems. The Requirements Traceability Matrix Section D, Attachment 003, sets forth specific Informatics and Interoperability contract requirements. To accomplish this, the Contractor shall provide software and services to enable seamless care between VA encounters, encounters with other Government healthcare institutions, and outside entities through advancements in all areas of the EHRthat occur. In addition, the software and services shall support the VA designated standards, such as SMART on FHIR and SMART-enabled applications, or other published standards. The objective of these interoperability solutions is to advance the state of the art supporting seamless care for Veterans. Existing organizations promoting interoperability among EHRvendors, such as The Argonaut Project, have developed or are planning to develop technology standards or technical approaches that may support the EHRM seamless care strategy. To the extent that underlying third party technology is available or made available to meet the following timelines, the following interoperability software solutions and services shall be delivered under this section: a) By Initial Operating Capability (IOC), the Contractor shall provide a software solution enabling VA, DoD and community providers who have connected to the EHRM to share interactive care plans (ICPs) for Veterans. ICPswill enable collaborative communication between providers, and between providers and Veterans, in managing Veteran care. b) Within 24 months of applicable task order award, the Contractor shall provide a software solution enabling VA, DoD and connected community providers to complete referral management activities for Veterans. c) By IOC, the Contractor shall provide a software solution enabling VA to release and consume, via on-demand access, a Veteran's complete longitudinal health record to and from DoD and connected community partners, irrespective of which EHRthey use, provided such EHRtechnology is certified by the Health and Human Services Office of the National Coordinator (ONC) or its successor. The longitudinal record solution shall support Provider-toProvider record sharing, as well as Provider-Veteran-Provider sharing (Veteran mediated record sharing), including appropriate consent management. The bi-directional health information exchange shall maximize use of discrete data that supports context-driven clinical decisions and informatics. d) Within 24 months of applicable task order award, the Contractor shall provide a software solution enabling connected VA, DoD and community providers connected to the EHRM to send and receive Admission/Discharge/Transfer notifications "pushed" from the provider initiating a Veteran care event to enable proactive engagement by VA care coordinators when notified of a Veteran care event. e) Within 24 months of applicable task order award, the Contractor will demonstrate a solution for identification and management of Veterans at high risk of suicide, in collaboration with community partners. AMERICAN PVERSIGHT VA-19-0799-G-001210 OS 00021927 f) By IOC, the contractor shall provide URL based image access to the VA, community and academic partner systems who can support the URLand a viewer to the providers via the health information exchange networks. Within 36 months of applicable task order award, the Contractor shall provide a software solution enabling VA, DoD and community providers connected to the EHRM to have nationwide access to Veterans' imaging associated w ith diagnostic tests. g) By IOC, the Contractor shall provide a software solution for multilateral standards-based ingestion , normalization , storage, and exporting of Health Information Exchange acquired Veteran health information. The Contractor shall ensure that the solution provides a computable dataset for purposes of population health and research analytic s, clinical decision support , and workflow integrat ion. h} By IOC, the Contractor shall provide the capability to connect and exchange VA electronic health records via other interoperable networks, such as. eHealth Exchange, CareQuality , CommonWell Health Alliance , DirectTrust, National Association for Trusted Exchange by supporting their specificat ions, security and content specifications. Contractor shall support network record locator services and patient provider associations as applicable in accordance with applicable technical standards and the Trusted Exchange Framework and Common Agreement (TEFCA}. i) By IOC, the Contractor shall provide a capability for provider collaboration via secure e-mail using the ONC Direct protocol or future VA-designated standard within a Cerner Millenn ium EHRworkflow context. j) Within 36 months of applicable task order award, the Contractor shall provide a solution for a Software Development Kit (SOK}enabling standards-based applications (e.g., SMART, FHIR,etc.) integrated with EHRM solut ions and platforms. k) Cerner shall deliver annually an Interoperability Plan to the VA on how it intends to meet the objectives established in PWS section 5.10.4. The initial plan will be due within 3 months of applicable TO award . I) The Contractor shall conduct an annual Interoperability Self-Assessment agal nst standards that shall be specified by VA, such as those promulgated by HIMSSor future standards to be identified by VA. The annual self assessment shall report on the state of each data element (e.g., which are supported in what capacities and in wh lch formats). This w ill help assure standards implementation consistency and assure standards compl iance with evolving national standards. m) The Contractor shall support Knowledge Interoperability by supporting the extension of clfnical content assets such as terminologies, clinlcal decision support rules, and order sets, etc., to the extent such extensions are consistent with the model and best pract lces of the controlling national standard . This includes the ability to curate, extend, and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies. 5.10.4.1 Data Design and Information Sharing In support of the interoperabil ity objectives under this Section, agreed upon Contractor proprietary information/data model extension points (e.g., ingest ion and record APls) may be provided to both international and national standards designating organizations as described and set forth in an applicable Task Order. The Contractor shall provide VA access and usage rights into any underlying proprietary termino logy/code systems for the purpose of enhancing national standards to address any gaps identified in the EHRM solut ion. The Contractor shall also make the interoperability capabilit ies and product enhancements developed under this contract available to non-VA Cerner clients. 5.10.4.2 VA Digital Health Platform/Digital Veterans Platform Integration VA anticipates developing a Digital Health Platform/Digital Veterans Platform (DVP) to consolidate critical VA EHRand non-EHR operational systems. The Contractor shall integrate the EHRM to interoperate with DVP, or future state VA platform , including the DVP API gateway or any other method designated by VA. John H. Wind om, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (st11Floor Sulte 5080) AMf=HI('Af\ pVERSIGHT VA-19-0799-G-001211 D8_00021928 Washingt on, DC 20420 John.Windom@va.gov Office : (202) 461-5820 Mo bile: (202) 794-4911 Executive Assistant: Ms. -(b) (6) (b) (6) ~ Office: (b) (6) - Appoi ntments and Scheduling From: Blackburn,Scott R. Sent: Friday, March 23, 2018 12:15 PM To: Windom, John H.; Bowman,Thomas Subject: FW: [EXTERNAL]Re: VA EHR John - you might want to swing the by Secretary/Deputy ' s office before end of day to get a sense of where he is with respec t to this . Sent with Good (www .good .com ) From: Marc Sherman Sent: Friday, March 23, 2018 9:47:39 AM To: Blackburn,Scott R. Cc: Bruce Moskowitz; DJS Subject: [EXTERNAL]Re: VA EHR Scott , Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your considerati ,on when requested . I read carefully your emai l about the efforts to work out the holes raised by the experts. You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard; and I know everyone has the goal to build the best next generat ion system for the veterans ' healthcare . However, there were several major issues raised in the calls this week with the technica l and clinical experts that you try to explain away in your email as solved , but indeed are not according to the experts . These issues , they believe, w ill prevent a successful implementat ion and I fear come back to haunt this project and its overseers . I hate to be a naysayer, but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted ; and the experts are in fact not swayed by the follow-up conve rsations with them . The experts are recommend ing a system for the VA that has various enhancements to today 's standard system functionality . At a minimum , I heard those experts express their opinions that the contract dangerously lacks definitions, standards and a clear express ion of this required, defined enhanced (non-standard) funct ionality (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to amb iguity , disputes and ultimate failure of purpose. The best "oversight and management of the contract " will not turn a contract lacking specificity into a vision of clarity. Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functionality desired and have a better understand ing of what is expected of them . Clarity in the contract is a healthy ingredient for the VA and the Contractor . AMERICAN PVERSIGHT VA-19-0799-G-001212 DS 00021929 I would be de lighted to be wrong and welcome a demo nstration of where Section 5.1 of the contract provides this specificity that Drs. Cooper and Huff, for example, urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables, the contract language is ambiguous . You say that "risk cannot be 100% driven out of any transformatio n of this magnitude ," a concept to which I subscribe. However , when you substitute this concept for clear , written and defined functionality , especially for a design that is expected to be unique in many respects , you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions , but the experts are so united on this point; and together with my historical observations of failures in nearly identical situations I just see warning flares going off. Scott, I want to see this project get started, and quickly, as much as anyone, but with the clarity that equally serves the VA and the Contractor , and prevents evident problems down the road . I also believe these things are easy to resolve in the contract language in re latively minimal time . Just my opinion and food for thought as you make your decisions . Marc On Wed, Mar 2 1, 2018 at 10:19 PM, Blackburn, Scott R.< Scott.Blackburn@va.gov > wrote : Marc/ Bruce, Thank you once again for all your support and especially for linking us up with these ClOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead. A few notes: o In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha, Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did conne ct with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right {part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 health care institutions signed two weeks ago include Cris Rossat Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIRAPls for VA in support of this contract . This will also benefit lntermountain as Stan was telling us they've only had 1015 for their entire company to date . If VA/DoD/lntermountain work together we will quickly get to the 200 number Stan mentioned . o Per Stephanie's suggestion, we are going to start moving forward ASAPon formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of AM f:::RIC'Af\. pVERSIGHT VA-19-0799-G-001213 DS_ 00021930 expertise throughout our journey. Obviously we will want Stephanie, John, Andy, Rasu, etc. Cris Ross(Mayo) , Will Morr is or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are ot hers you've introduced us to along the way that we would love t o include . We would like to work with you to make sure we get this right. o As recommen ded last night , an interoperabil ity sandbox/test bed will be established during our Initial Operating Capabiliti es (IOC) imp lementation/deployment process to solidify the requisite interoperabil ity requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts. o Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walki ng this against the language in the RFP/contract documents (both EHRand also Lighthouse) . We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make mino r revisions. o After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks wit h Cerner ASAP(we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and wi ll move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week. If the Omnibus falls through (which let's hope not) , then we would have to request a transfer from the Congressional appropr iation committees which will then take ~2 weeks. Signing the initial task orders will allow us to start moving forward with Cerner on t he initial 3 hospitals (which will be in Washington state) on things like site surveys, infrast ructure readiness, data hosting, change management (with will include wide involvement from clinicians inside and outside VA...something we heard loud and clear from Bruce!), help desk establishment, and project ove rsight (which we've heard loud and clear from Stephanie/Jon). As a rem inder, given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~s%of the value of the contract). But this w ill allow us to get moving and out of the "quicksand". o Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with t he DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with the ir EHRlead Stacy Cummings; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you've read in the papers). We are paying very close attention to their implementat ion issues (workflow, change management, governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more). This will make getting move on change management in Task Order #1 so important. AMERICAr-... pVERSIGHT VA-19-0799-G-001214 DS_00021931 o As you both know, risk cannot be 100% driven out of any transformation of this magnitude. Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance , as well as the VA'S access to senior industry advisors." I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again, we believe the construct of the contract, and more importantly the proper overs ight and management of the contract wi ll great ly mitigate cost, schedule and performance concerns, as well as support the timely injection of techno logical advancements (e.g. cloud, APls, etc.) at the approp riate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interope rability rema ins at the forefront or our concerns, and your comments , t he MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements. Interoperability wi ll be a moving target for years to come, but our contract allows us to leverage the best of ideas of ind ustry throughout the contract's life without incurring the exorbitant costs you have alluded to, as we ll as not be bound by potentially antiquated definitions. Bruce/Marc , thank you for everything. As I mentioned to Bruce recent ly, you have been tremendous "demanding partners" on this journey and we are incredib ly appreciate. We look forward to continu ing t his relationship as we take the next steps. Scott From: Marc Sherman [mailto: ~ (b) (6) Sent: Wednesday, March 21, 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL]Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1. I thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard. That runs the risk of not being discovered until later , perhaps even up to implementation , a very costly result. Perhaps a similar problem (a seemingly big problem) that the DODimplementation faces now where the users are rebelling. Unfortunately, if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DODproblem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS)now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design, happier user community, less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first tim e , allowing the users to provide input sooner and better , eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001215 D8_00021932 system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fairness to them , the VA, the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWSand cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician , deferred on the effectiveness of the existing contract language to others , but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree , or am missing it. If I am wrong , it would be useful for someone to point me in the right direction. 2 . I was also thinking about the current reported problems of the DODimplementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VAruns that same risk. Perhaps that problem could be a benefit to your effort . Why not accumulate all of the user complaints / issues in the DODimplementation identified by the users and chart them out . Then identify which of those issues would be issues if they existed in the VAimplementation and include them in the contract as definitional requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ... and you have an added advantage and opportunity to contractually prevent similar mistakes . 3. I have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today . Best Marc On W ed, Mar 21, 2018 at 8:24 AM , BJackbum , Scott R. wrote: No pro blem Marc. Thanks for all you r help. Very helpfu l call last night. From: Marc Sherman [mailto: ~ (b) (6) Sent: Wednesday, March 21, 201812:12 AM To: Blackburn, Scott R. Subject: (EXTERNAL]Re: Stan Huff Scott l won't be abl e to j oin the call tomotTow as [ have a previous commi tme nt that I cannot move. I will catch up with you or Bru ce aft.e r. AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001216 D8_0002193 3 Marc Marc Sherman (b) (6) 011 Tue, Mar 20, 2018 , 10:30 PM Blackbum , Scott R . < Scott .Blackbum@ya ,gov> wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable . We have Stan Huff from Intermountain tomorrow at 10am. I assume you have the calendar invite, but just in (b) (6) (b) (6) case it is 1-800-767-- We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying . Scott Scott Blackbum Executive in Charge , Office of Information & Technology US Department of Veterans Affairs AMERICAN PVERSIGHT VA-19-0799-G-001217 DS 00021934 Message From: Blackburn, Scott R. [Scott .Blackburn@va.gov] Sent: 3/27/2018 12:19:26 PM To: Windom, John H. [John.W indom@va.gov] RE: Update Subject: Hmm. Have you spoken to the Secretary directly yet? I wrote him about Marc Sherman's email but he didn't respond. Not sure where his head is at. I don't understand why ogc would meet him without you. It kills me how we don't trust each other and try to work point to point through the Secretary. Sent with Good (www.good.com) From: Windom, John H. Sent: Tuesday, March27, 2018 6:34:17 AM To: Blackburn,Scott R. Subject: Update Sir There was a meeting between Shulkin and the attorneys (Byrne and Fleck) last week that I was not invited to . This is the language proposed for (b) (5) Thank you . John John , Reference is made to the note I sent you last Wednesday whereby I mentioned that OGC (Mr . Byrne) wanted to review our RFP . (b) (6) recently shared the following OGC requested PWS change (italicized) presumably as a result of that review: Please consider this recommended change to PWS Section (b) (5) AMERICAN PVERSIGHT VA-19-0799-G-001218 OS 00021935 Sent with Good 9-0799-G-001 21 9 Message (b) (6) From: Sent : To: (b) (6) @va.gov ] Subject: 3/27/20 18 1:45:14 PM (b) (6) (OGC)(b) (6) (OGC)(b) (6) (b) (6) Robert R. (OGC) [Robert .Fleck@va.gov]; (b) (6) [M ichele. FosterSES@va.gov]; (b) (6) (b) (6) RE: contractual language - PWS - EHR Importance : High (b) (6) (b) (6) CC: (b) (6) (b) (6) @va.gov) ; Fleck, (b) (6) @va.gov]; Foster, Michele (SES) - TAC has advised the EHRM PEO of the requested (b) (5) - Thanks , (b) (6) (b) (6) Contracting Officer Department of Veterans Affairs Office of Procurement , Acquisition and Logistics Technology Acquisit ion Center (b) (6) (b) (6) (b) (6) (b) (6) "For Internal VA Use Only- Working Draft, Pre-Decisional , Deliberative Document : This e-mail and any attachments are intended only for the use of the addressee(s) named herein and may contain privileged and/or confidential information . If you are not the intended recipient of this e-mail , you are hereby notified that any dissemination , distribution or copying of this e-mail , and any attachments thereto, is strictly prohibited. If you have received this e-mail in error, please notify me via return e-mail or telephone (732) 440-(b) and permanently delete the original and any copy of any e-mail and any printout thereof. " (6) (b) (6) (OGC) From: (b) (6) Sent: Friday, March 23, 2018 12:27 PM To: (b) (6) (b) (6) Cc: (b) (6) . (OGC);(b) (6) Subject: contractual language - PWS- EHR (OGC); Fleck, Robert R. (OGC);(b) (6) (OGC) (b) Ill (6) o(b) is out today, and so I am sending this directly to you: (6) Please consider this recommended change to PWS Section (b) (5) AMERICAN PVERSIGHT VA-19-0799-G-001220 OS 00021937 (b) (5) Thanks , (b) 11111 (6) (b) (6) Associate Chief Counsel Procurement Law Group Office of the General Counsel U.S . Department of Veterans Affairs 810 Vermont Avenue , N.W. Room 1056/Mail Code 025 Washington , DC 20420 Phone : (b) (6) (b) (6) (b) (6) AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001221 DS 00021938 Message From: Windom, John H. [John.Windom@va .gov] Sent : 3/27/2018 1:42 :46 PM Blackburn, Scott R. [Scott .Blackburn@va.gov) FW : Gett ing it right To : Subject: Sir, I thin k t his recent language request (see below) for (b) (5) Please get back to vacationing and thanks for you r concern for my -(b) (6) Vr John That meant a lot to me. - John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John.Windom@va .gov Office: (202) 461-5820 Mobile: (202) 794 -4911 (b) Executive Assistant: Ms . -(b) (6) - Appo intments and Scheduling (6) (b) (6) ~ Office (b) (6) From: Windom, John H. Sent: Tuesday, March 27, 2018 9:29 AM To: DJS Cc: Byrne, Jim (OGC); Blackburn,Scott R. Subject: RE: Getting it right Mr. Secret ary : I am seeking a 30 minut e audience with Mr. Byrne t o discuss the recent ly proposed language for (b) (5) V/r, John Proposed language: Please consider this recomm ended chang e to P WS Section (b) (5) AMERICAN PVERSIGHT VA-19-0799-G-001222 00021939 (b) (5) John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5 th Floor Suite 5080) Washington, DC 20420 John. Wi ndom@va.gov Office: (202) 461-5820 Mobile: (202) 794 -4911 Executive Assistant : Ms. -(b) (6) - Appointments and Scheduling (b) (6) ~ Office : (b) (6) From: DJS Sent: Tuesday, March 27, 2018 7:50 AM To: Windom, John H. Cc: Byrne, Jim (OGC) Subject: FW: Getting it right John- can you help craft a response to this Sent with Good (www .good .com) From: Blackburn,Scott R. Sent: Sunday, March 25, 2018 9:37:38 AM To: DJS Subject: RE: Getting it right I'm not sure if you read Marc ' s response to mine yet. Or if so, what your thoughts are on it I fear we are still talking past each other. If be/others were to come back with specific counter language to the language in the contract then we would certainl y consider that (that is the level we are working at right now). But we aren 't AMERICAN PVERSIGHT VA-19-0799-G-001223 DS_00021940 getting that nor do I see us getting that without Marc or anything else rea1ly digging into the details of our contract. We are way beyond the high level philosophy , Let me know and I'll direct the team . In Bahamas now and only have connectivity sporadically , but back in US (Florida/Disney) tomorrow morning. Back in the office on Thursday . Sent with Good (www .good .com) From: DJS Sent: Sunday, March 25, 201812:08:17 PM To: Byrne,Jim (OGC) Cc: Blackburn,Scott R. Subject: Getting it right Jim- did you get any further clarity on (b) (5) Scott I assume your best to orchestrate all of this is moving in the right direction Thanks SeJlt with Good (www .good .com ) AMERICAN PVERSIGHT VA-19-0799-G-001224 DS 00021941 Message From: Blackburn, Scott R. [Scott .Blackburn@va.gov ] Sent : 2/1/2018 11:23 :21 PM To : Fleck, Robert R. (OGC) [Robert .Fleck@va .gov] Byrne, Jim (OGC) [Jim.Byrne@va.gov ] RE: lnteroperabilty listening sessions CC: Subject: Thanks Bob. I did attend today's list ening session, 10am-11:30am. I did not att end t he session at 1pm . For the sake of documen t ing. Here are a few notes . o (b) (5) o o (b) (6) o From: Fleck, Robert R. (OGC) Sent: Wednesday,January 31, 2018 8:28 AM To: Blackburn,Scott R. Subject: RE: Interoperabilty listening sessions Scott , As we discussed , although it would be (b) (5) Bob Robert R. Fleck Chief Counsel , Procurement Law Group Office of the General Counsel Room 1050 810 Vermont Avenue , NW Washington , DC, 20420 Office 202-461-4954 AMERICAN PVERSIGHT VA-19-0799-G-001225 DS_00021942 ATTENTION : This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege . Portions of this transmiss ion may contain information also protected from disclosure under the Freedom of Information Act , 5 USC ?552 . Do not release this information without prior author ization from the sender. If this has inadvertently reached the wrong party , please delete th is information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney-clien t privilege and/or work product privilege . From: Blackburn, Scott R. Sent: Tuesday, January 30, 2018 2:53 PM To: Fleck, Robert R. (OGC) Cc: (b) (6) Subject: RE: Interoperabilty listening sessions Can we ta lk at 3:30pm? From: Fleck, Robert R. (OGC) Sent: Tuesday, January 30, 2018 2:33 PM To: Blackburn, Scott R. Cc: Byrne, Jim (OGC) Subject: RE: Interoperabilty listening sessions I can see you now. Bob Robert R. Fleck Chief Counsel , Procureme nt Law Group Office of the General Counsel Room 1050 810 Vermont Avenue , NW Washington , DC, 20420 Office 202-461-4954 ATTENTION : This electronic transmission may contain attorney work-produc t or information protected under the attorney-client privilege . Portions of this transmiss ion may contain information also protected from disclosure under the Freedom of Information Act , 5 USC ?552 . Do not release this information without prior authorization from the sender . If this has inadvertently reached the wrong party , please delete this information immediately and notify the sender . Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney-client privilege and/or work product privilege . From: Blackburn, Scott R. Sent: Tuesday, January 30, 2018 2:32 PM To: Fleck, Robert R. (OGC) Cc: Byrne, Jim (OGC) Subject: RE: Interoperabilty listening sessions (b) (5) From: Fleck, Robert R. (OGC) Sent: Tuesday, January 30, 2018 10:27 AM A Vlt-t~ll.1AI PVERSIGHT VA-19-0799-G-001226 OS 00021943 To: Blackburn, Scott R. Cc: Byrne, Jim (OGC) Subject: RE: Interoperabilty listening sessions Scott, (b) (5) (b) (6) (b) (6) If you have any questions , please let me know . Bob Robert R. Fleck Chief Counsel, Procurement Law Group Office of the General Counsel Room 1050 81O Vermont Avenue , NW Washington , DC, 20420 Office 202-461-4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act , 5 USC ?552 . Do not release this information without prior authorization from the sender. If this has inadvertently reached the wrong party , please delete this information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney-client privilege and/or work product privilege . From: Blackburn, Scott R. Sent : Monday, January 29, 2018 11:04 AM To:~(b) (6) Cc: Fleck, Robert R. (OGC); Byrne, Jim (OGC);(b) (6) Subject: Interoperabilty listening sessions - (b) (6) It was a pleasure meet ing you today. I am cc'ing Jim Byrne and Bob Fleck. Jim/Bob- Chris Liddell asked me (or someone from VA- perhaps Windom or Ash) to (b) (5) (b) (6) Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Departm ent of Vet eran s Affairs AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001227 D8_00021944 Message From: (b) (6) Sent: 2/12/2018 7:54 :08 PM To : Liddell, Christopher P. EOP/WH (b) (6) [Scott.Blackburn@va.gov] EOP/WH (b) (6) (b) (6) [EXTERNAL] RE: VA EHR CC: Subject: EOP/WH (b) (6) who.eop.gov] who .eop.gov]; Blackburn , Scott R. @who.eop.gov] Scott, (b) (5) Please let me know if you have additional questions. -- Thanks! (b) (6) (b) (6) Office of the White House Counsel (b) (6) (b) (6) ~ who.eop.gov From: Liddell, Christopher P. EOP/WHO Sent: Monday, February 12, 2018 2:37 PM To: Blackburn, Scott R. Cc:(b) (6) . EOP/WHO(b) (6) (b) (6) who.eop.gov> Subject: RE:VA EHR @who.eop.gov>;- (b) (6) EOP/WHO Scott I discussed this with -(b) (6) ( copied here) She is going to advise on the best approach to ensure we do everything correctly She will let us know of appropriate next steps Thanks Chris AMERICAN PVERSIGHT VA-19-0799-G-001228 OS 00021945 From: Liddell, Christopher P. EOP/WHO Sent: Monday, February 12, 2018 9:31 AM To: 'Blackbum, Scott R.' Cc: (b) (6) . EOP/WHO (b) (6) Subject: RE:VA EHR @who.eop .gov> Scott Sorry for slow rep ly - happy to catch up at some stage th is week Chris From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Thursday, February 8, 2018 9:41 PM To: Liddell, Christopher P. EOP/WHO (b) (6) Subject: VA EHR who.eop.gov> Chris If you have time possibly early next week, I would love to get your advice related to our EHR. The next few weeks will be critical (w ith budget hearings, discussions with appropriators, Veteran Service Organizations , etc) and we want to make sure we handle everything appropriately. If you are open to it, I can work with Quellie to fi nd time . Also, I have attached the Executive Summary of MITRE's VA interoperabil ity report . Overall very consistent with everything else we seem to be hearing. Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs AMf:::RICAr-... pVERSIGHT VA-19-0799-G-001229 DS_ 00021946 Message From: Sent: To: CC: Subject: Attachments: Blackburn, Scott R. [Scott .Blackburn@va.gov] 4/2/2018 2:23:16 AM Sandoval, Camilo J. [Camilo.Sandoval@va.gov]; O'Rourke, Peter M. [Peter .ORourke@va.gov] Leinenkugel, Jake [Thomas.Leinenkugel@va .gov] OIT - how to keep the trains running and positive momentum going 180401 OIT continuity document vl.docx; 180401 OIT recommended personnel action vl.docx Camilo - I hope you had a good weekend. I appreciate the conversation on Friday and thought I would put my thoughts down on paper (as promised). I am including Peter on this as he/I have begun having some of these conversations over the past few weeks (although Pete in fairness has had a lot on his mind with his new role) and also cc'ing Jake. Attached are two documents: o The 8 things that I believe need to happen to not just keep the lights on, but also to keep our positive momentum going . I believe we should aspire for much more than just keeping the lights on during this upcoming transition (at least in OIT) as we have a huge organization making some huge changes and if we don't keep the momentum, it will make the next guy's job impossible. I am a big believer that the sign of an effective leader is how the organization performs when that leader leaves. So this will be important to me to know (which is why I'm writing this out) . o #1 out of 8 is stabilizing the leadership of OIT to get us through the next 6 months and set the new CIO up for success (I firmly believe it will 6 months before we have a permanent CIO). So I have 5 specific recommendations under that I've gone into greater detail. I am worried about this not just because of folks leaving (I was always planning to leave this Spring...actually I was supposed to leave a few months ago; Ricci's retirement date is 4/15), but also because of possible moratoriums on SESmoves (e.g., possible OPM moratorium on hiring because no permanent Secretary in place, 120 moratorium on moving SESsonce new Secretary put in place, etc). So any waivers to these or anything we can do to push stuff through, I would love to work together to make happen. I would strongly advise you guys to get to know Bill James better. I am convinced he is the right guy to step up and lead OIT through transition until the permanent CIO comes on board. If you can get comfortable with him, I would suggest that we then transition sooner rather than later given I think it will be better for that person to start fresh with the new leadership team on the 10th floor (rather than me hanging around as a lame duck for a month). We can talk about what that means as far as timing, transition, handover. I am more than willing to fade to the back for a little bit to a support role (to help boost up Bill and make him successful) or fade away completely (if that is better for the organization) . I think you guys know we well enough to know that I'll do whatever is best for Veterans and the organization; and will always do so in the most professional manner . I've now given 3.5 years (way longer than I had ever planned to) and I want to see the positive momentum continue well after I'm gone. Talk to you tomorrow, Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs AMERICAN PVERSIGHT VA-19-0799-G-001230 OS 00021947 Keeping the "lights on" in OIT and maintaining momentum during upcoming transition. 8 major things that need to happen to successfully bridge to the next CIO. (1) Follow through on the appropriate personnel actions so that the new CIO has a good team to work with on Day 1 when he/she arrives (estimate ~6 months given time to find/vet/confirm nominee). Given how slow HR processes are and how difficult it is to retain/attract a top IT talent in government, we need the new CIO to hit the ground running and not spend the first 6-12 months rebuilding (which is what Laverne Council had to do and what limited her success). I will send a separate note on what I think we should do now to ensure things remain stable until that person is able to come on board. But it will include: a. Have a good Acting CIO who understands VA, understands our current plan/trajectory, and has a deep understanding of government IT. I believe we have the right guy for this in Bill James. b. Follow through on SES/SLactions in the pipeline - even if this requires a waiver against any hiring moratorium we might have due to not having a Secretary in place (right now we are vulnerable because we have a very thin bench and personnel actions have taken so long. Vivieca made a huge mistake by taking so long to approve these. This, and knowing Shulkin wasn't considering him for the permanent CIO role, were actually the primary reasons why Rob Thomas left. Let's not make same mistake Vivieca made). c. Position ourselves to backfill vacancies as people depart. Right now we have way too many people in Acting roles which creates all kinds of management issues and distractions (e.g., EEOcomplaints because people are confused who their supervisor is). Let's not accidentally compound this problem. d. Retain high performers - Dominic Cussatt (CISO), Rich Chandler (OIT CFO), Charles Worthington (CTO), Drew Myklegard (Lighthouse), Bill James, Susan McHugh-Polley. (2) Figure out what specifically we need to do to close the Cerner EHRM deal, and close it. a. Get clear on what specific language in the contract needs to change. The problem we have been having between WPB/SMEs and the actual negotiating team is that we are talking past each other. Philosophically, I believe we are all on the same page (which is what has been frustrating). At this point, we need to be talking about specific language changes required to close the deal. If we get alignment, Windom will close. b. Figure out who can sign it and when. Given the high profile nature and protest risk, this is going to be more challenging than we think. ClinicComp (the ones who have already protested) CEO has already issued a public statement saying we need to wait until a permanent Secretary and then give that person 90 days to review. c. As an aside, we will probably have to pay for a premium for the delay. We've gotten Cerner to hold the price now for 6 months because they've believed we were about to sign. I wouldn't be surprised if they now raise the price. We just need to be ready for that. AMERICAN PVERSIGHT VA-19-0799-G-001231 OS 00021948 (3) Continue momentum on Open API (Lighthouse) related initiatives. This will be the Trump administrations legacy in the health IT space. VA is the one making it real and we need to keep it up. a. Lock Drew Myklegard down with a Term SESposition. b. Complete IPA for Dr. Rasu Shretha, Chief Innovations Officer, UPMC c. Continue signing up healthcare systems for the VA Open API Pledge d. Appropriately loop in WH Office of American Innovation (and Aneesh Chopra) e. Launch Open API working group ("coalition of the willing" which Rasu will lead and Drew will support) f. g. Proceed with Lighthouse RFPand Lighthouse Labs work Finalize MOU with Apple and continue "Project Pluto" (publically announcement should be ready in next 30-60 days) h. Post Cerner signing, plan for White House event with the Open API Pledge signees, Cerner/Epic/ All script CEOs,Apple CEO, and other in this industry. Not to celebrate Cerner deal, but rather celebrate a new age of healthcare IT cooperation driven by White House Office of American Innovation, CMS, ONC, and VA. Work with Chris Liddell and Jared Kushner on this. (4) Follow through on major projects (other than EHRM and Lighthouse). This is what Bill James does now. Business owners are in parenthesis. a. FMBT (OM) b. Telehealth (VHA) c. DMLSS (VHA, OEI, OALC) d. BIP/BDM, Appeals and GI Bill implementation e. Scheduling (VHA) - MASS, Faster Care for Veterans Act, VSE, Online Scheduling. We (VBA) have a strategy and need to make a few big decisions by ~september 2018 f. Service Now (see email I sent out earlier today) g. PIV (OSP)August 8, 2018 is a huge risk for the Department. h. HR Smart (HRA) i. BOSS(NCA) j. Care in the Community, Suicide Prevention, Homelessness, Caregivers, RTLS(VHA) - we have a full "18 for 18" Business Plan we are executing with VHA. k. Cloud Migration I. Innovation to the Rescue projects (5) Get alignment on the on-line Veteran facing digital strategy. Charles Worthington and Marcy Jacobs have a great plan. VBA has been a pain in the neck on this. Charles can lay it out for you. (6) Make sure we are progressing on closing data centers as promised. I have promised HOGR that VA will close 68 data centers in FY18 and we are on track to (Representatives Hurd and Connelly will hold us to this - and blame failure on instability). We need to deliver. Eddie Pool is all over this. We have a plan to go from 395 data centers (which is nuts) to 14 core, 42 speciality AMERICAN PVERSIGHT VA-19-0799-G-001232 OS 00021949 and a computer room for patient safety/quality at each VAMC). So it will be from 395 to 54 + 168 (reclassified) by end of FY2020. (7) Allow our operational folks {under Susan McHugh-Polley and Dale Ferraro) and Security/Cyber folks {under Dominic Cussatt) to do their jobs. These guys are good ("fire and forget" as we used to say in the Army). Make sure they are happy, give them whatever the need, and stay out of their way. If Susan and/or Dominic leave - then we need to worry. (8) Make sure we are on top of OIG/GAO/FISMA and FITARA requirements. This is Martha Orr's full-time job and she does a good job staying on this. Bill James understands this well as does Dominic Cussatt (as many of these are Cyber related). a. We have been on the OIG/GAO "material weakness" list for 17 straight years. We have made tremendous progress on this to the point in which many believe we will be taken off this fall (which would be HUGE!). If we don't, it will be because they want to see sustained progress over a multi-year period and we will get off at the end of FY19 (at current pace). This will be a big win that the next Secretary/Clo can celebrate. b. Note: OIT is under continual yearly audit by OIG. We work very well with them. They spend 9 months each year auditing us and 3 months writing their report. Then they start all over again each year. What you will find is that OIT has a good modernization plan, the organizational structure is fine, and the priorities are right. The issue is focus/delivery/execution. What is above will lay out a good framework for exactly that. Then once the new CIO comes on board, he/she will have a few more strategic priorities to add to this (that we cannot tackle until then). These include: o EHRM execution. Right now, we don't know what we don't know. The new CIO will have to be heavily involved in overseeing this. o Technical debt/ infrastructure. The majority of our current operational problems are due to underfunding and dumb investments made over the past few decades. As a result we have a fragile infrastructure (e.g., I just made a special exception to replace our CMOP servers that run all our pharmacies. I found out these servers were years past their life expectancy and about to crash any day which would have been our next USA Today cover story). Unfortunately this is a systematic issue. Susan McHugh-Polley is the most knowledgeable on this as she runs the infrastructure. However this is a funding/budgeting issue. o Accelerating cloud migration. o Telehealth technology strategy longer term. o Question of whether or not VHA should have its own CIO (Commission on Care recommendation) and what would this mean given our appropriation laws and FITARA requirements that are in direct conflict with this. AMERICAN PVERSIGHT VA-19-0799-G-001233 OS 00021950 OIT recommended personnel actions to stabilize the organization through transition: 1. Place Bill James in permanent PDAS position (position unfilled for past 14 months, Ricci Mulligan has been acting). I would do this for a few reasons: a. This will allow VA to hire an A player from the outside into his current EPMO role (which will be highly sought after in the federal IT community). Our bench is too thin right now and this is too important of a role to have vacant. If Bill is Acting, then we have to find another Acting for his old role (which creates a negative ripple effect and has terrible unintended managerial consequences that create distractions, such as EEO complaints when there is confusion on who someone's supervisor is). b. This will NOT bind the new CIO to keeping Bill in this role. As SES,a new CIO can move Bill into any other SESposition to create room for whoever he/she wants in this role (if that person does not want to keep Bill). There is recent precedence for this in OIT. Laverne Council did this to Ron Thompson when she decided she didn't want him in the PDAS role; she replaced him with Rob Thomas (who ultimately became Acting CIO when Laverne left). c. However it will provide the new CIO will positive continuity as he/she gets ramped up (similar to Jon Rychalski and Ed Murray or Don Loren and Kevin Hanretta) d. Bill can then naturally slide into the Acting CIO role when I leave (soon) without any creative HR/legal paperwork. 2. Move Bill James into Acting CIO role when Scott Blackburn leaves (which I plan to do soon). As I've thought of it more, I do believe Bill is the right person. You should both "interview" for some reason you are uncomfortable Charles Worthington take some creativity). 3. with Bill, my out of the box recommendation Bill. If would be (reminder: Charles is actually on a detail to us from 0MB so this would Even if I did this, I would still have Bill be the permanent PDAS. Bed down current top-talent that is key to our modernization momentum. a. Hire Drew Myklegard into Term SESrole over Lighthouse and Open API initiatives (projects such as Lighthouse is exactly why we have Term SESauthorities, this is a natural fit) b. Hire Charles Worthington as a SL into CTO role reporting to the CIO. Charles has been on detail to us from 0MB (US Digital Services) for 14 months. I brought him on to backfill for Marina Martin who was a political in the previous administration. This would be bringing Charles in as a career employee (not a political slot) so we don't lose him. If we lose Charles, we will eventually lose all our USDSteam (currently 25-30 people under Marcy Jacobs - Marcy and the VA USDSteam are VA employees administratively reporting to OIT/EPMO/Bill James). If the next CIO/Secretary/DepSec wants to bring in a political eventually (like Marina Martin), then this would not prohibit them from doing so. Marina used to report to the DepSec. Charles reported to me as iDepSec and I pulled him into OIT when I became CIO. AMERICAN PVERSIGHT VA-19-0799-G-001234 OS 00021951 4. Complete existing SEShiring actions that are currently underway a. Executive Director, Application Management (CMO) - Daniel McCune EOD 4/16 b. Executive Director, Security Operations (OIS) - selection made (Mr. Horton) however going through ECQ process right now. 1 of 2 SESunder Dominic Cussatt. c. DCIO, Strategic Sourcing - selection made. Nomination package sent to COSVAon 3/15. d. Executive Director, Information Security and Policy. Posting closed on 3/27. This is the other SESunder Dominic Cussatt. e. Executive Director, IT Budget and Finance. Selection made. Nomination sent to CSEMO on 3/26. This is actually Ricci Mulligan's former role (previous to be detailed to PDAS) and will be the budget person under Rick Chandler. f. 5. Executive Director, Enterprise Command Operations. Package sent to COSVA3/14. Post EPMO-DAS position {currently filled by Bill James) as soon as Bill moves over to permanent PDAS position. Because this is a high profile and highly sought-after role, this will attract a top-tier SESeither from another government agency or commercial sector. This heavy hitter will be needed badly. AMERICAN PVERSIGHT VA-19-0799-G-001235 OS 00021952 Message From: Michael Teppe (b) (6) Sent: 4/13/2018 5:51:31 PM To: Blackburn, Scott R. [Scott .Blackburn@va.gov] [EXTERNAL] Just FYI Subject: gmail .com] Hi Scott, Just FYI: Deborah Scher had me fired today. She knew I was working on detailing out; we had discussed it. You were incredibly nice and I was looking forward to working with you and your team . Best Regards , Mike AMERICAN PVERSIGHT VA-19-0799-G-001236 OS 00021953 Message From: Tepper , Michael [M ichael.Tepper@va.gov] Sent : 4/2/2018 7 :22:07 PM To ; Blackburn, Scott R. [Scott .Blackburn@va.gov] Tepper , M ichael [M ichael.Tepper@va.gov] connect or meet CC: Subject: Hi Scott, Greet ings. You and I met in a few SecVA meet ings. Wou ld you have a few minutes to connect or meet? My exec coach (-(b) (6) says she worked with -(b) and her team and you might know her. (6) I' m here at VACO. Thanks. Best Regards, Mike MichaelTepper SeniorAdvisorto the Secretary Centerfor Strategic Partnerships Departmentof Veteran Affairs (o) 202-461-5005 (c) 202 -658 -8982 AMERICAN PVERSIGHT VA-19-0799-G-001237 DS_ 00021954 Message From: Blackburn , Scott R. [Scott.Blackburn@va.gov] Sent : 4/2/2018 1:40:53 PM To : Sandoval, Camilo J. [Camilo.Sandoval@va.govJ Windom , John H.[John.W indom@va .gov) RE: Contract Language CC: Subject: Morris, Genevieve (OS/ONC/10) Genevieve.Morris@hhs.gov I don't think I have a phone number for her, but will let you know if I can find it, From: Sandoval,Camilo J. Sent: Monday,April 02, 2018 9:03 AM To: Blackburn,Scott R. Cc: Windom, John H. Subject: RE:Contract Language Scott ,Do you hav e Gene vieve' s work email address and phone number ? I need to contact her toda y and not sure where I can find her or if she at the VA yet. Thank you , Camilo From: Blackburn,Scott R. Sent: Sunday, April 01, 2018 6:28:05 PM To: Sandoval,CamiloJ. Cc: Windom, John H. Subject: RE:Contract Language Yep, I know Genevieve. She is good . Will give it some thought. Is she detailed in to VHA I assume? From: Sandoval,Camilo J. Sent: Sunday,April 01, 2018 8:39 PM To: Blackburn,Scott R. Cc: Windom, John H. Subject: RE:Contract Language Excellent , I'll touch base with Windom tomorrow mornin g. Also there ' s, someone by the name of Genevieve MoJTis from the Office of Nat ional Coordina tor (ONC) joi ning the VA tomonow on a 120 day detail. I believe she will be helping us review the contr act as well , at least wi th regards to interoperabi lity, and already working with the EHR team. Do you know (of) her ? Any thoughts on how we might utilize her expertise in combination with Rasu , beyond just reviewing the Cerne r contrac t? She seems to have a solid policy background in her respecti ve space . Do you see Genev ieve and Rasu working together to cover the policy and functionaJ aspects of Interoperability ? Camilo AMERICAN PVERSIGHT VA-19-0799-G-001238 DS_00021955 From: Blackburn,Scott R. Sent: Sunday,April 01, 2018 4:38:47 PM To: Sandoval,CamiloJ. Cc: Windom, John H. Subject: RE:Contract Language Not sure we did . John? What he might be talking about is t he feedback from the calls we had 2 weeks ago. I believe John and team have created a thorough matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their f eedback and then understood how we were reconciling that feedback). There was also the language that we received via OGC. I'll leave it to John to weigh in. From: Sandoval,CamiloJ. Sent: Sunday,April 01, 2018 7:35 PM To: Blackburn,Scott R. Cc: Windom, John H. Subject: Re: Contract Language Scott, I just spoke with Bmce Moskowitz regarding where things are with EHR and he mentioned you recently received language provided by several CIOs (Leslie Cooper, Stan Huff , Stephanie Reel, Jonathan Manis) . Could you kindly forward me those emails and documents? I believe it was in regards to interoperability . Hope you had a great Easter Sunday. Thank you . Camilo AMERICAN PVERSIGHT VA-19-0799-G-001239 DS_00021956 Message From: Sent: To: Subject: Sandoval, Camilo J. [Camilo.Sandoval@va.gov] 4/15/2018 4:00:05 PM Blackburn, Scott R. [Scott.Blackburn@va.gov] Re: API Pledge Scott, Did Rasu ever complete the required IPA paperwork? I am ready to move here. I'm confused why he was announced before being officially on-boarded (looks nefarious). Let's discuss in the morning. Thank you . Camilo Sandoval M: 917-680-2011 AMERICAN PVERSIGHT VA-19-0799-G-001240 OS 00021957 Message From: Sent : To ; Subject: Blackburn, Scott R. [Scott .Blackburn@va.gov] 4/5/2018 7 :01:16 PM Sandoval, Camilo J. [Camilo .Sandoval@va.govJ Special Government Employee - would Marc Sherman consider this? During the 2014 scandal (after Secretary Shinseki was fired and before McDonald came in), Dr. Jonathan Perlin did this for 60 days. Would Marc be willing to do something similar? http :ljwww .modernhea lthcare .com/ article/20140626/N EWS/306269942 http :ljwww .modernhea lthcare .com/ a rticle/20140628/MAGAZI NE/306289971 https :ljwww.tennessean.com/sto ry/news/hea lth/2014/06/26/vetera ns-affairs-tu rns-hca-exec-hel p/113 99441/ Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs AMERICAN PVERSIGHT VA-19-0799-G-001241 DS_ 00021958 Message From: Blackburn, Scott R. [Scott .Blackburn@va.gov] Sent: 4/7/2018 3 :52:48 PM To: Chandler, Richard C. [Richard.Chandler2@va.gov]; Cussatt, Dominic (SES)[Dominic.Cussatt@va.gov]; Thrower, Lloyd [Lloyd.Thrower@va .gov]; Patillo, Jackie [Jackie.Patillo@va.gov]; (b) (6) (b) (6) Luwanda F. (01&T) [Luwanda.Jones@va.gov]; Orr, Martha [Martha.Orr@va .gov]; (b) (6) (b) (6) CC: Subject: (b) (6) (b) (6) @va .gov]; ????? ????l@va.gov] Huweart, Eric D. [Eric.Huweart@va.gov]; James, Bill [Bill.James@va .gov]; Sandoval, Camilo J. [Camilo.Sandoval@va.gov] Camilo Team - I want to introduce each of you to Camilo Sandoval and ask that each of you on to "to" line schedule an hour to meet with him next week. Will ask Eric to coordinate . Camilo is a member of the V.A. political team . Given we are going through some transition at the top of the organization right now, it is important that he understands our key issues. As you can imagine, the political team is very busy right now bring Acting Secretary Wilkie up to speed , prepping Admiral Jackson for a late April confirmation hearing , and figuring out how to reset the Department's agenda at the Secretary/Department level. This is a similar process that we went through during the Presidential transition period Gust a lighter version). Please get these set up for next week. Thanks , Scott Sent with Good (www.good.com) AMERICAN PVERSIGHT VA-19-0799-G-001242 OS 00021959 Message From: Blackburn, Scott R. [Scott .Blackburn@va.gov] Sent: 4/7/2018 3 :55:43 PM Sandoval, Camilo J. [Camilo.Sandoval@va.gov] To: CC: Subject: Huweart, Eric D. [Eric.Huweart@va .gov] RE: Follow-up Ccing Eric here. Eric - can you help coordinate these for next week? To include format/templates if necessary (see Camila's note below). I would have each give the same briefings they gave me when I came on board a few months ago Gust dust them off and update them accordingly). Rick and Dom are highest priority. (b) I would then say Martha , Lloyd , ~ I also added Helga and Marcy. (6) and Jackie and Luwanda . I'd have them block an hour for each . Sent with Good (www.good.com) From: Sandoval, Camilo J. Sent: Saturday, April 07, 2018 11:33:24 AM To: Blackburn, Scott R. Subject: RE:Follow-up Scott, My calendar for next week is still empty. Please , I need you to help push harder . For example , I have not heard back from Dom or Rich. You have the list of people I requested to meet below and I'm not going to chase anyone down. Please have someone coordinate this as Bill suggested and let's get this done ASAP . Also , please remind everyone this is a briefing request soi can better understand their area of responsibility and portfolio. Thank you Camilo 917-680-2011 From: Sandoval, Camilo J. Sent: Thursday, April 05, 2018 9 :23:26 PM To: Blackburn, Scott R. Subject: RE:Re: Follow-up Would be super helpful to connect with your Cos and CFO next . I'm not feeling the love, but I might be misreading the vibes. Bill suggested (per my email last night) that the Cos should take the lead in requesting 1:1 briefings . The format is simple , they can brief me using their preferred method/format. The main goal for me is to listen and learn and build relat ionsh ips. If Eric could help me coord inate w ith everyone ' s calendar, that would be greatly appreciated (including Dom). My preference is to have these briefings completed by end of next week if possible . AMERICAN PVERSIGHT VA-19-0799-G-001243 OS 00021960 Briefing Request Eric Huweart Rick Chandler Dominic Cussatt Martha Orr Luwanda Jones Lloyd Thrower (b) (6) Jackie Patillo Thank you. Camilo From: Blackburn,Scott R. Sent: Thursday, April 05, 2018 9:25 PM To: Sandoval,CamiloJ. Subject: RE: Re: Follow-up Happy to help on the 1 on ls. Is ther e any specific you need me to push? From: Sandoval,CamiloJ. Sent: Thursday,April 05, 2018 5:37 PM To: Blackburn,Scott R. Subject: Re: Follow-up Scott, Here are the 3 takeaways and follow up items I'l l work to get more clarity on. 1). CIO interview process/pipe line/time line 2). Timel ine for a decision poin t on Acting/CID 3). VBA/Benefits I need your help pushing fo r my 1:1 meetings w it h team directly below CI0 & PDAS.My calendar is complete ly empty for all of next week! ! ! Thank you sir. Camilo Camilo Sandoval M: 917-680-2011 AMERICAN PVERSIGHT VA-19-0799-G-001244 DS_00021961 MEMORANDUM OF RECORD Updated: April 16, 2018 Involvement of Mr. Ike Perlmutter, Dr. Bruce Moskowitz and Attorney Marc Sherman in EHRM Update to include interactions with Mr. Camilo Sandoval post Secretary Shulkin firing and ultimately my decision to resign from the Department November 15 CIO call : (b) (6), (b) (2) (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-001245 OS 00021962 (b) (6), (b) (2) (b) (6) (b) (6) (b) (6) (b) (6), (b) (2) (b) (6) (b) (6) (b) (6) (b) (6), (b) (2) AMERICAN PVERSIGHT VA-19-0799-G-001246 DS_00021963 (b) (6), (b) (2) Post-Thanksgivingdevelopments: (b) (6), (b) (2) AMERICAN PVERSIGHT VA-19-0799-G-001247 DS_ 00021964 (b) (6), (b) (2) January MITRE interoperability study: (b) (6), (b) (2) (b) (6) (b) (6) AMERICAN PVERSIGHT (b) (6) VA-19-0799-G-001248 DS_ 00021965 Post February concerns: (b) (6), (b) (2) (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-001249 DS_ 00021966 (b) (6), (b) (2) (b) (6) (b) (6) (b) (6) (b) (6) AMERICAN PVERSIGHT (b) (6) VA-19-0799-G-001250 DS_ 00021967 (b) (6), (b) (2) (b) (6) (b) (6) (b) (6) Any knowledge of motivations or conflict of interest: (b) (6), (b) (2) (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-001251 OS 00021968 (b) (6), (b) (2) Other White House involvement: (b) (6), (b) (2) (b) (6) (b) (6) Update : Mr. Camilo Sandoval oversight of OIT, post Shulkin firing: (b) (6), (b) (2) AMERICAN PVERSIGHT VA-19-0799-G-001252 OS 00021969 (b) (6), (b) (2) (b) (6) (b) (6) (b) (6) (b) (6) AMERICAN PVERSIGHT VA-19-0799-G-001256 DS_ 00021973 (b) (6), (b) (2) Update: decision to resign: (b) (6), (b) (2) AMERICAN PVERSIGHT VA-19-0799-G-001257 DS_00021974 Keeping the "lights on" in OIT and maintaining momentum during upcoming transition. 8 major things that need to happen to successfully bridge to the next CIO. (1) Follow through on the appropriate personnel actions so that the new CIO has a good team to work with on Day 1 when he/she arrives (estimate ~6 months given time to find/vet/confirm nominee). Given how slow HR processes are and how difficult it is to retain/attract a top IT talent in government, we need the new CIO to hit the ground running and not spend the first 6-12 months rebuilding (which is what Laverne Council had to do and what limited her success). I will send a separate note on what I think we should do now to ensure things remain stable until that person is able to come on board. But it will include: a. Have a good Acting CIO who understands VA, understands our current plan/trajectory, and has a deep understanding of government IT. I believe we have the right guy for this in Bill James. b. Follow through on SES/SLactions in the pipeline - even if this requires a waiver against any hiring moratorium we might have due to not having a Secretary in place (right now we are vulnerable because we have a very thin bench and personnel actions have taken so long. Vivieca made a huge mistake by taking so long to approve these. This, and knowing Shulkin wasn't considering him for the permanent CIO role, were actually the primary reasons why Rob Thomas left. Let's not make same mistake Vivieca made). c. Position ourselves to backfill vacancies as people depart. Right now we have way too many people in Acting roles which creates all kinds of management issues and distractions (e.g., EEOcomplaints because people are confused who their supervisor is). Let's not accidentally compound this problem. d. Retain high performers - Dominic Cussatt (CISO), Rich Chandler (OIT CFO), Charles Worthington (CTO), Drew Myklegard (Lighthouse), Bill James, Susan McHugh-Polley. (2) Figure out what specifically we need to do to close the Cerner EHRM deal, and close it. a. Get clear on what specific language in the contract needs to change. The problem we have been having between WPB/SMEs and the actual negotiating team is that we are talking past each other. Philosophically, I believe we are all on the same page (which is what has been frustrating). At this point, we need to be talking about specific language changes required to close the deal. If we get alignment, Windom will close. b. Figure out who can sign it and when. Given the high profile nature and protest risk, this is going to be more challenging than we think. ClinicComp (the ones who have already protested) CEO has already issued a public statement saying we need to wait until a permanent Secretary and then give that person 90 days to review. c. As an aside, we will probably have to pay for a premium for the delay. We've gotten Cerner to hold the price now for 6 months because they've believed we were about to sign. I wouldn't be surprised if they now raise the price. We just need to be ready for that. AMERICAN PVERSIGHT VA-19-0799-G-001259 OS 00021976 (3) Continue momentum on Open API (Lighthouse) related initiatives. This will be the Trump administrations legacy in the health IT space. VA is the one making it real and we need to keep it up. a. Lock Drew Myklegard down with a Term SESposition. b. Complete IPA for Dr. Rasu Shretha, Chief Innovations Officer, UPMC c. Continue signing up healthcare systems for the VA Open API Pledge d. Appropriately loop in WH Office of American Innovation (and Aneesh Chopra) e. Launch Open API working group ("coalition of the willing" which Rasu will lead and Drew will support) f. g. Proceed with Lighthouse RFPand Lighthouse Labs work Finalize MOU with Apple and continue "Project Pluto" (publically announcement should be ready in next 30-60 days) h. Post Cerner signing, plan for White House event with the Open API Pledge signees, Cerner/Epic/ All script CEOs,Apple CEO, and other in this industry. Not to celebrate Cerner deal, but rather celebrate a new age of healthcare IT cooperation driven by White House Office of American Innovation, CMS, ONC, and VA. Work with Chris Liddell and Jared Kushner on this. (4) Follow through on major projects (other than EHRM and Lighthouse). This is what Bill James does now. Business owners are in parenthesis. a. FMBT (OM) b. Telehealth (VHA) c. DMLSS (VHA, OEI, OALC) d. BIP/BDM, Appeals and GI Bill implementation e. Scheduling (VHA) - MASS, Faster Care for Veterans Act, VSE, Online Scheduling. We (VBA) have a strategy and need to make a few big decisions by ~september 2018 f. Service Now (see email I sent out earlier today) g. PIV (OSP)August 8, 2018 is a huge risk for the Department. h. HR Smart (HRA) i. BOSS(NCA) j. Care in the Community, Suicide Prevention, Homelessness, Caregivers, RTLS(VHA) - we have a full "18 for 18" Business Plan we are executing with VHA. k. Cloud Migration I. Innovation to the Rescue projects (5) Get alignment on the on-line Veteran facing digital strategy. Charles Worthington and Marcy Jacobs have a great plan. VBA has been a pain in the neck on this. Charles can lay it out for you. (6) Make sure we are progressing on closing data centers as promised. I have promised HOGR that VA will close 68 data centers in FY18 and we are on track to (Representatives Hurd and Connelly will hold us to this - and blame failure on instability). We need to deliver. Eddie Pool is all over this. We have a plan to go from 395 data centers (which is nuts) to 14 core, 42 speciality AMERICAN PVERSIGHT VA-19-0799-G-001260 OS 00021977 and a computer room for patient safety/quality at each VAMC). So it will be from 395 to 54 + 168 (reclassified) by end of FY2020. (7) Allow our operational folks {under Susan McHugh-Polley and Dale Ferraro) and Security/Cyber folks {under Dominic Cussatt) to do their jobs. These guys are good ("fire and forget" as we used to say in the Army). Make sure they are happy, give them whatever the need, and stay out of their way. If Susan and/or Dominic leave - then we need to worry. (8) Make sure we are on top of OIG/GAO/FISMA and FITARA requirements. This is Martha Orr's full-time job and she does a good job staying on this. Bill James understands this well as does Dominic Cussatt (as many of these are Cyber related). a. We have been on the OIG/GAO "material weakness" list for 17 straight years. We have made tremendous progress on this to the point in which many believe we will be taken off this fall (which would be HUGE!). If we don't, it will be because they want to see sustained progress over a multi-year period and we will get off at the end of FY19 (at current pace). This will be a big win that the next Secretary/Clo can celebrate. b. Note: OIT is under continual yearly audit by OIG. We work very well with them. They spend 9 months each year auditing us and 3 months writing their report. Then they start all over again each year. What you will find is that OIT has a good modernization plan, the organizational structure is fine, and the priorities are right. The issue is focus/delivery/execution. What is above will lay out a good framework for exactly that. Then once the new CIO comes on board, he/she will have a few more strategic priorities to add to this (that we cannot tackle until then). These include: o EHRM execution. Right now, we don't know what we don't know. The new CIO will have to be heavily involved in overseeing this. o Technical debt/ infrastructure. The majority of our current operational problems are due to underfunding and dumb investments made over the past few decades. As a result we have a fragile infrastructure (e.g., I just made a special exception to replace our CMOP servers that run all our pharmacies. I found out these servers were years past their life expectancy and about to crash any day which would have been our next USA Today cover story). Unfortunately this is a systematic issue. Susan McHugh-Polley is the most knowledgeable on this as she runs the infrastructure. However this is a funding/budgeting issue. o Accelerating cloud migration. o Telehealth technology strategy longer term. o Question of whether or not VHA should have its own CIO (Commission on Care recommendation) and what would this mean given our appropriation laws and FITARA requirements that are in direct conflict with this. AMERICAN PVERSIGHT VA-19-0799-G-001261 OS 00021978 OIT recommended personnel actions to stabilize the organization through transition: 1. Place Bill James in permanent PDAS position (position unfilled for past 14 months, Ricci Mulligan has been acting). I would do this for a few reasons: a. This will allow VA to hire an A player from the outside into his current EPMO role (which will be highly sought after in the federal IT community). Our bench is too thin right now and this is too important of a role to have vacant. If Bill is Acting, then we have to find another Acting for his old role (which creates a negative ripple effect and has terrible unintended managerial consequences that create distractions, such as EEO complaints when there is confusion on who someone's supervisor is). b. This will NOT bind the new CIO to keeping Bill in this role. As SES,a new CIO can move Bill into any other SESposition to create room for whoever he/she wants in this role (if that person does not want to keep Bill). There is recent precedence for this in OIT. Laverne Council did this to Ron Thompson when she decided she didn't want him in the PDAS role; she replaced him with Rob Thomas (who ultimately became Acting CIO when Laverne left). c. However it will provide the new CIO will positive continuity as he/she gets ramped up (similar to Jon Rychalski and Ed Murray or Don Loren and Kevin Hanretta) d. Bill can then naturally slide into the Acting CIO role when I leave (soon) without any creative HR/legal paperwork. 2. Move Bill James into Acting CIO role when Scott Blackburn leaves (which I plan to do soon). As I've thought of it more, I do believe Bill is the right person. You should both "interview" for some reason you are uncomfortable Charles Worthington take some creativity). 3. with Bill, my out of the box recommendation Bill. If would be (reminder: Charles is actually on a detail to us from 0MB so this would Even if I did this, I would still have Bill be the permanent PDAS. Bed down current top-talent that is key to our modernization momentum. a. Hire Drew Myklegard into Term SESrole over Lighthouse and Open API initiatives (projects such as Lighthouse is exactly why we have Term SESauthorities, this is a natural fit) b. Hire Charles Worthington as a SL into CTO role reporting to the CIO. Charles has been on detail to us from 0MB (US Digital Services) for 14 months. I brought him on to backfill for Marina Martin who was a political in the previous administration. This would be bringing Charles in as a career employee (not a political slot) so we don't lose him. If we lose Charles, we will eventually lose all our USDSteam (currently 25-30 people under Marcy Jacobs - Marcy and the VA USDSteam are VA employees administratively reporting to OIT/EPMO/Bill James). If the next CIO/Secretary/DepSec wants to bring in a political eventually (like Marina Martin), then this would not prohibit them from doing so. Marina used to report to the DepSec. Charles reported to me as iDepSec and I pulled him into OIT when I became CIO. AMERICAN PVERSIGHT VA-19-0799-G-001262 OS 00021979 4. Complete existing SEShiring actions that are currently underway a. Executive Director, Application Management (CMO) - Daniel McCune EOD 4/16 b. Executive Director, Security Operations (OIS) - selection made (Mr. Horton) however going through ECQ process right now. 1 of 2 SESunder Dominic Cussatt. c. DCIO, Strategic Sourcing - selection made. Nomination package sent to COSVAon 3/15. d. Executive Director, Information Security and Policy. Posting closed on 3/27. This is the other SESunder Dominic Cussatt. e. Executive Director, IT Budget and Finance. Selection made. Nomination sent to CSEMO on 3/26. This is actually Ricci Mulligan's former role (previous to be detailed to PDAS) and will be the budget person under Rick Chandler. f. 5. Executive Director, Enterprise Command Operations. Package sent to COSVA3/14. Post EPMO-DAS position {currently filled by Bill James) as soon as Bill moves over to permanent PDAS position. Because this is a high profile and highly sought-after role, this will attract a top-tier SESeither from another government agency or commercial sector. This heavy hitter will be needed badly. AMERICAN PVERSIGHT VA-19-0799-G-001263 OS 00021980 Keeping the "lights on" in OIT and maintaining momentum during upcoming transition. 8 major things that need to happen to successfully bridge to the next CIO. (1) Follow through on the appropriate personnel actions so that the new CIO has a good team to work with on Day 1 when he/she arrives (estimate ~6 months given time to find/vet/confirm nominee). Given how slow HR processes are and how difficult it is to retain/attract a top IT talent in government, we need the new CIO to hit the ground running and not spend the first 6-12 months rebuilding (which is what Laverne Council had to do and what limited her success). I will send a separate note on what I think we should do now to ensure things remain stable until that person is able to come on board. But it will include: a. Have a good Acting CIO who understands VA, understands our current plan/trajectory, and has a deep understanding of government IT. I believe we have the right guy for this in Bill James. b. Follow through on SES/SLactions in the pipeline - even if this requires a waiver against any hiring moratorium we might have due to not having a Secretary in place (right now we are vulnerable because we have a very thin bench and personnel actions have taken so long. Vivieca made a huge mistake by taking so long to approve these. This, and knowing Shulkin wasn't considering him for the permanent CIO role, were actually the primary reasons why Rob Thomas left. Let's not make same mistake Vivieca made). c. Position ourselves to backfill vacancies as people depart. Right now we have way too many people in Acting roles which creates all kinds of management issues and distractions (e.g., EEOcomplaints because people are confused who their supervisor is). Let's not accidentally compound this problem. d. Retain high performers - Dominic Cussatt (CISO), Rich Chandler (OIT CFO), Charles Worthington (CTO), Drew Myklegard (Lighthouse), Bill James, Susan McHugh-Polley. (2) Figure out what specifically we need to do to close the Cerner EHRM deal, and close it. a. Get clear on what specific language in the contract needs to change. The problem we have been having between WPB/SMEs and the actual negotiating team is that we are talking past each other. Philosophically, I believe we are all on the same page (which is what has been frustrating). At this point, we need to be talking about specific language changes required to close the deal. If we get alignment, Windom will close. b. Figure out who can sign it and when. Given the high profile nature and protest risk, this is going to be more challenging than we think. ClinicComp (the ones who have already protested) CEO has already issued a public statement saying we need to wait until a permanent Secretary and then give that person 90 days to review. c. As an aside, we will probably have to pay for a premium for the delay. We've gotten Cerner to hold the price now for 6 months because they've believed we were about to sign. I wouldn't be surprised if they now raise the price. We just need to be ready for that. AMERICAN PVERSIGHT VA-19-0799-G-001264 OS 00021981 (3) Continue momentum on Open API (Lighthouse) related initiatives. This will be the Trump administrations legacy in the health IT space. VA is the one making it real and we need to keep it up. a. Lock Drew Myklegard down with a Term SESposition. b. Complete IPA for Dr. Rasu Shretha, Chief Innovations Officer, UPMC c. Continue signing up healthcare systems for the VA Open API Pledge d. Appropriately loop in WH Office of American Innovation (and Aneesh Chopra) e. Launch Open API working group ("coalition of the willing" which Rasu will lead and Drew will support) f. g. Proceed with Lighthouse RFPand Lighthouse Labs work Finalize MOU with Apple and continue "Project Pluto" (publically announcement should be ready in next 30-60 days) h. Post Cerner signing, plan for White House event with the Open API Pledge signees, Cerner/Epic/ All script CEOs,Apple CEO, and other in this industry. Not to celebrate Cerner deal, but rather celebrate a new age of healthcare IT cooperation driven by White House Office of American Innovation, CMS, ONC, and VA. Work with Chris Liddell and Jared Kushner on this. (4) Follow through on major projects (other than EHRM and Lighthouse). This is what Bill James does now. Business owners are in parenthesis. a. FMBT (OM) b. Telehealth (VHA) c. DMLSS (VHA, OEI, OALC) d. BIP/BDM, Appeals and GI Bill implementation e. Scheduling (VHA) - MASS, Faster Care for Veterans Act, VSE, Online Scheduling. We (VBA) have a strategy and need to make a few big decisions by ~september 2018 f. Service Now (see email I sent out earlier today) g. PIV (OSP)August 8, 2018 is a huge risk for the Department. h. HR Smart (HRA) i. BOSS(NCA) j. Care in the Community, Suicide Prevention, Homelessness, Caregivers, RTLS(VHA) - we have a full "18 for 18" Business Plan we are executing with VHA. k. Cloud Migration I. Innovation to the Rescue projects (5) Get alignment on the on-line Veteran facing digital strategy. Charles Worthington and Marcy Jacobs have a great plan. VBA has been a pain in the neck on this. Charles can lay it out for you. (6) Make sure we are progressing on closing data centers as promised. I have promised HOGR that VA will close 68 data centers in FY18 and we are on track to (Representatives Hurd and Connelly will hold us to this - and blame failure on instability). We need to deliver. Eddie Pool is all over this. We have a plan to go from 395 data centers (which is nuts) to 14 core, 42 speciality AMERICAN PVERSIGHT VA-19-0799-G-001265 OS 00021982 and a computer room for patient safety/quality at each VAMC). So it will be from 395 to 54 + 168 (reclassified) by end of FY2020. (7) Allow our operational folks {under Susan McHugh-Polley and Dale Ferraro) and Security/Cyber folks {under Dominic Cussatt) to do their jobs. These guys are good ("fire and forget" as we used to say in the Army). Make sure they are happy, give them whatever the need, and stay out of their way. If Susan and/or Dominic leave - then we need to worry. (8) Make sure we are on top of OIG/GAO/FISMA and FITARA requirements. This is Martha Orr's full-time job and she does a good job staying on this. Bill James understands this well as does Dominic Cussatt (as many of these are Cyber related). a. We have been on the OIG/GAO "material weakness" list for 17 straight years. We have made tremendous progress on this to the point in which many believe we will be taken off this fall (which would be HUGE!). If we don't, it will be because they want to see sustained progress over a multi-year period and we will get off at the end of FY19 (at current pace). This will be a big win that the next Secretary/Clo can celebrate. b. Note: OIT is under continual yearly audit by OIG. We work very well with them. They spend 9 months each year auditing us and 3 months writing their report. Then they start all over again each year. What you will find is that OIT has a good modernization plan, the organizational structure is fine, and the priorities are right. The issue is focus/delivery/execution. What is above will lay out a good framework for exactly that. Then once the new CIO comes on board, he/she will have a few more strategic priorities to add to this (that we cannot tackle until then). These include: o EHRM execution. Right now, we don't know what we don't know. The new CIO will have to be heavily involved in overseeing this. o Technical debt/ infrastructure. The majority of our current operational problems are due to underfunding and dumb investments made over the past few decades. As a result we have a fragile infrastructure (e.g., I just made a special exception to replace our CMOP servers that run all our pharmacies. I found out these servers were years past their life expectancy and about to crash any day which would have been our next USA Today cover story). Unfortunately this is a systematic issue. Susan McHugh-Polley is the most knowledgeable on this as she runs the infrastructure. However this is a funding/budgeting issue. o Accelerating cloud migration. o Telehealth technology strategy longer term. o Question of whether or not VHA should have its own CIO (Commission on Care recommendation) and what would this mean given our appropriation laws and FITARA requirements that are in direct conflict with this. AMERICAN PVERSIGHT VA-19-0799-G-001266 OS 00021983 OIT recommended personnel actions to stabilize the organization through transition: 1. Place Bill James in permanent PDAS position (position unfilled for past 14 months, Ricci Mulligan has been acting). I would do this for a few reasons: a. This will allow VA to hire an A player from the outside into his current EPMO role (which will be highly sought after in the federal IT community). Our bench is too thin right now and this is too important of a role to have vacant. If Bill is Acting, then we have to find another Acting for his old role (which creates a negative ripple effect and has terrible unintended managerial consequences that create distractions, such as EEO complaints when there is confusion on who someone's supervisor is). b. This will NOT bind the new CIO to keeping Bill in this role. As SES,a new CIO can move Bill into any other SESposition to create room for whoever he/she wants in this role (if that person does not want to keep Bill). There is recent precedence for this in OIT. Laverne Council did this to Ron Thompson when she decided she didn't want him in the PDAS role; she replaced him with Rob Thomas (who ultimately became Acting CIO when Laverne left). c. However it will provide the new CIO will positive continuity as he/she gets ramped up (similar to Jon Rychalski and Ed Murray or Don Loren and Kevin Hanretta) d. Bill can then naturally slide into the Acting CIO role when I leave (soon) without any creative HR/legal paperwork. 2. Move Bill James into Acting CIO role when Scott Blackburn leaves (which I plan to do soon). As I've thought of it more, I do believe Bill is the right person. You should both "interview" for some reason you are uncomfortable Charles Worthington take some creativity). 3. with Bill, my out of the box recommendation Bill. If would be (reminder: Charles is actually on a detail to us from 0MB so this would Even if I did this, I would still have Bill be the permanent PDAS. Bed down current top-talent that is key to our modernization momentum. a. Hire Drew Myklegard into Term SESrole over Lighthouse and Open API initiatives (projects such as Lighthouse is exactly why we have Term SESauthorities, this is a natural fit) b. Hire Charles Worthington as a SL into CTO role reporting to the CIO. Charles has been on detail to us from 0MB (US Digital Services) for 14 months. I brought him on to backfill for Marina Martin who was a political in the previous administration. This would be bringing Charles in as a career employee (not a political slot) so we don't lose him. If we lose Charles, we will eventually lose all our USDSteam (currently 25-30 people under Marcy Jacobs - Marcy and the VA USDSteam are VA employees administratively reporting to OIT/EPMO/Bill James). If the next CIO/Secretary/DepSec wants to bring in a political eventually (like Marina Martin), then this would not prohibit them from doing so. Marina used to report to the DepSec. Charles reported to me as iDepSec and I pulled him into OIT when I became CIO. AMERICAN PVERSIGHT VA-19-0799-G-001267 OS 00021984 4. Complete existing SEShiring actions that are currently underway a. Executive Director, Application Management (CMO) - Daniel McCune EOD 4/16 b. Executive Director, Security Operations (OIS) - selection made (Mr. Horton) however going through ECQ process right now. 1 of 2 SESunder Dominic Cussatt. c. DCIO, Strategic Sourcing - selection made. Nomination package sent to COSVAon 3/15. d. Executive Director, Information Security and Policy. Posting closed on 3/27. This is the other SESunder Dominic Cussatt. e. Executive Director, IT Budget and Finance. Selection made. Nomination sent to CSEMO on 3/26. This is actually Ricci Mulligan's former role (previous to be detailed to PDAS) and will be the budget person under Rick Chandler. f. 5. Executive Director, Enterprise Command Operations. Package sent to COSVA3/14. Post EPMO-DAS position {currently filled by Bill James) as soon as Bill moves over to permanent PDAS position. Because this is a high profile and highly sought-after role, this will attract a top-tier SESeither from another government agency or commercial sector. This heavy hitter will be needed badly. AMERICAN PVERSIGHT VA-19-0799-G-001268 OS 00021985 DEPARTMENT OF VETERANS AFFAIRS Washington DC 20420 May 5, 2020 In Reply Refer To: 001B FOIA Request: 19-09094-F Austin R. Evers & Mehreen Rasheed Executive Director American Oversight foia@americanoversight.org Dear Austin Evers & Mehreen Rasheed: This is the Eighth Partial Initial Agency Decision (IAD) to your Freedom of Information Act (FOIA) request to the Office of the Secretary, U.S. Dept. of Veterans Affairs (OSVA) dated July 11, 2019, referred to this FOIA office on July 2, 2019, and assigned FOIA tracking number 1909094-F. You requested, as you phrase it: "All emails sent or received by former Secretary David Shulkin or former Chief of Staff and Acting Secretary Peter O'Rourke on any personal, non-governmental, or nonofficial email account regarding official agency business. [...] Please provide all responsive records from November 9, 2016, through March 28, 2018." Eighth Partial IAD & Reasonable Searches Dated 8/2/19 On August 2, 2019, OSVA received approximately twenty-two thousand (22,000) pages of emails from David Shulkin working on VA business on his aol.com and gmail.com email accounts, in which Mr. Shulkin did not copy a VA employee. OSVA now releases to you six hundred eighty-nine (689) pages, Bates-numbered 19304-20000. OSVA releases partial email addresses of Laurie Perlmutter (lperl), Marc Sherman (mbs), Bruce Moskowitz (brucem), whereas redacting their email addresses would not identify them as the recipients or senders. OSVA releases the names of Marc Sherman's associates Michael Zinner, Terry Fadem, Clifford Ko, and Kurt Heyssel, as well as Perlmutter associate Marisol Garcia. OSVA releases names of RFP panelists Amy Cooper, Stan Huff, Stephanie Reel, Jon Manis, Karson, Ed Marx, Frank Opelka, Aneesh Chopra, Cris Ross, Carla Smith, Ryan Howells, Paul Sutton, and Kenneth Mandi. VA elects to release the names and VA contact information of VA Senior Executives. VA also releases photographs of the VA Secretary, as well as public photographs. After reviewing the six hundred eighty-nine (689) pages, OSVA redacts some information with FOIA Exemptions 5 and 6. Exemption 5 protects interagency or intra-agency memorandums or letters that would not be available by law to a party other than an agency in litigation with the agency. The presidential communications privilege protects agency communications to or from the President or his advisers. On two (2) pages, OSVA redacts communications between VA officials and the President or his advisers. Loving v. DOD, 550 F.3d 32, 37-38 (D.C. Cir. 2008) (Exemption 5 "incorporates" Presidential Communications Privilege, which protects "'communications directly involving and documents actually viewed by the President,' as well as documents 'solicited and received' by the President or his 'immediate White House advisers'" (internal citations omitted)); Berman v. CIA, 378 F. Supp. 2d 1209, 1219-20 (E.D. Cal. 2005) (same), aff'd on other grounds, 501 F.3d 1136 (9th Cir. 2007); Judicial Watch, Inc. v. DOJ, 365 A I A PVERSIGHT Austin Evers & Mehreen Rasheed Page 2 May 5, 2020 F.3d 1108, 1110 n.1 (D.C. Cir. 2004) ("embrac[ing] the definitional analysis set forth" in In re Sealed Case, 121 F.3d 729, 749-50, 752 (D.C. Cir. 1997), protecting documents covered by Presidential Communications Privilege); Amnesty Int'l USA v. CIA, 728 F. Supp. 2d 479, 522 (S.D.N.Y. 2010) ("all twenty documents reflect or memorialize communications between senior presidential advisers and other United States government officials and are therefore properly withheld"). Out of ten thousand six hundred thirty-six (10,636) pages released to you thus far, OSVA redacted information per the presidential communications privilege on only forty-five (45) pages. 5 U.S.C. ? 552(b)(5) exempts from required disclosure "inter-agency or intra-agency memorandums or letters which would not be available by law to a party other than an agency in litigation with the agency." Under the attorney-client and work product privileges, the VA redacts portions of records, emails, and communications between VA employees and attorneys relating to potential federal lawsuits or administrative proceedings against the VA. The release of this information would impede the ability of VA employees and attorneys to speak openly and frankly about legal issues concerning lawsuits or administrative proceedings against the VA. The release of this information would also compromise the VA's legal positions for its lawsuits and administrative proceedings. 5 U.S.C. ? 552(b)(6) exempts from required disclosure "personnel and medical files and similar files the disclosure of which would constitute a clearly unwarranted invasion of personal privacy." FOIA Exemption 6 permits VA to withhold a document or information within a document if disclosure of the information, either by itself or in conjunction with other information available to either the public or the FOIA requester, would result in an unwarranted invasion of an individual's personal privacy without contributing significantly to the public's understanding of the activities of the federal government. Specifically, the information being withheld, as indicated on the enclosed documents, under FOIA Exemption 6, consists of names, identities, photographs, email addresses, phone numbers, cellular numbers, facsimile numbers, unsuccessful resume application details, medical details, photographs, and personal details unrelated to the VA of: federal employees, federal contractors, veterans, private citizens, and their family members. Federal employees, federal contractors, veterans, private citizens, and their family members retain a significant privacy interest under certain circumstances, such as in instances where the release of their information could represent a threat to their well-being, harassment, or their ability to function within their sphere of employment. The federal employees, federal contractors, veterans, private citizens, and their family members whose information is at issue have a substantial privacy interest in their personal information. In weighing the private versus the public interest, we find that there is no public interest in knowing the names, identities, email addresses, phone numbers, cellular numbers, facsimile numbers, unsuccessful resume application details, medical details, photographs, and personal details unrelated to the VA of: federal employees, federal contractors, veterans, private citizens, and their family members. The coverage of FOIA Exemption 6 is absolute unless the FOIA requester can demonstrate a countervailing public interest in the requested information by demonstrating that the FOIA requester is in a position to provide the requested information to members of the general public and that the information requested contributes significantly to the public's understanding of the activities of the Federal government. Additionally, the requester must demonstrate how the public's need to understand the information significantly outweighs the privacy interest of the person to whom the information pertains. Upon consideration of the records, I have not been able to identify a countervailing public interest of sufficient magnitude to outweigh the privacy interest of the individuals whose names are redacted. The protected information has been redacted and (b)(6) inserted. "Withholding a telephone number or e-mail A\11 IC/\ PVERSIGHT Austin Evers & Mehreen Rasheed Page 3 May 5, 2020 address, alone, is not sufficient to protect that [privacy] interest; alternate means of contacting and harassing these employees would be readily discoverable on the Internet if this court ordered their names disclosed." Long v. Immigration & Customs Enf't, 2017 U.S. Dist. LEXIS 160719 (D.C. Cir. 2017). Out of the twenty-two thousand (22,000) pages, OSVA has reviewed about seventeen thousand (17,000) pages and released ten thousand six hundred thirty-six (10,636) pages, some redacted, to you. About six thousand four hundred (6,400) pages predate November 9, 2016 and, thus, are non-responsive to your FOIA request. Of ten thousand six hundred thirty-six (10,636) pages released to you, four thousand eight hundred twenty-eight (4,828) pages relate to three (3) informal advisors. Previous Partial Initial Agency Decisions On April 7, 2020, OSVA released one thousand nine hundred seventy-nine (1,979) pages, Bates-numbered 20001-21985 redacted with FOIA Exemptions 4, 5, and 6. 5 U.S.C. ? 552(b)(4) exempts from disclosure "trade secrets and commercial or financial information obtained from a person and privileged or confidential." "Where commercial or financial information is both customarily and actually treated as private by its owner and provided to the government under an assurance of privacy, the information is "confidential" within Exemption 4's meaning." Food Marketing Inst. v. Argus Media, No. 18-481, at *2 (U.S. June 24, 2019). Redacted information includes details of multiple proposals (including from Apple), with proposed technical approaches, teaming or partnership agreements, assessment methodology, and labor rates, all of which the VA never accepted. Such information is marked confidential, and offerors (such as Apple) typically treat such as commercially private information or having received an assurance of privacy from the VA. FOIA Exemption 5 also permits an agency to withhold material reflecting the thoughts, opinions, and recommendations of federal officials reviewing an issue. Under the deliberative process privilege and FOIA Exemption 5, OSVA redacts internal government deliberations, thoughts, opinions, recommendations, and solutions from federal employees reviewing in their professional capacities: VA programs, potential responses to news or Congressional inquiries, talking points, a proposed Executive Order, and unsubstantiated allegations. The information contained in the responsive records is both predecisional and deliberative because it reflects preliminary opinions, proposed solutions, recommendations, potential responses to news or Congressional inquiries, talking points, a proposed Executive Order, unsubstantiated allegations, and a VA OIG complaint details, which do not reflect VA's final decision. Exposure of premature discussions before a final decision is made could create undue public confusion. The release of the redacted information would negatively impact the ability of federal employees to openly and frankly consider issues amongst themselves when deliberating, discussing, reviewing, proposing changes to, and making recommendations on: VA programs, potential responses to news inquiries, talking points, a proposed Executive Order, unsubstantiated allegations, and a VA OIG complaint details. The information reveals the thoughts, deliberations, and opinions that, if released, would have a chilling effect on the ability of federal officials to discuss, opine, recommend or be forthcoming about the agency's issues which require full and frank assessment. Here, the disclosure of the withheld information is likely to compromise the integrity of this deliberative, decision-making, or investigation process. Moreover, the predecisional character of a document is not altered by the passage of time. Bruscino v. BOP, No. 94-1955, 1995 WL 444406 at *5 (D.D. C. May 15, 1995), aff'd in part, No. 95-5212, 1996 WL 393101 (D.C. Cir. June 24, 1996); Bruscino v. BOP, No. 94-1955, 1995 WL 444406 at *5 (D.D. C. May 15, 1995), aff'd in part, No. 95-5212, 1996 WL 393101 (D.C. Cir. A\11 ICA PVERSIGHT Austin Evers & Mehreen Rasheed Page 4 May 5, 2020 June 24, 1996); Access Reports v. DOJ, 926 F.2d 1192, 1196-97 (D.C. Cir. 1991) ("talking points" memoranda are predecisional); ACLU v. DHS, 738 F. Supp. 2d 93, 112 (D.D.C. 2010) ("'talking points' are predecisional . . . the document itself suggests that a public statement was anticipated at the time of its creation, and given that no official statement has yet been made, the talking points remain ripe recommendations that are ready for adoption or rejection by the Department"); Sec. Fin. Life Ins. Co., No. 03-102-SBC, 2005 WL 839543, at *11 (D.D.C. Apr. 12, 2005) ("The undisputed evidence establishes that these [talking points] are deliberative."); Judicial Watch, Inc. v. U.S. Dep't of Commerce, 337 F. Supp. 2d 146, 174 (D.D.C. 2004) (protecting "talking points" and recommendations on how to answer questions); St. Louis Sewer Dist., No. 10-2103, at *18 (E.D. Mo. Mar. 2, 2012) (protecting email communications, "press releases, talking points and 'Q & A,'" drafts, and briefing materials); Citizens for Responsibility & Ethics in Wash. v. DHS, 514 F. Supp. 2d 36, 44 (D.D.C. 2007) (protecting briefing materials concerning Hurricane Katrina response including proposed "solutions and approaches"); Judicial Watch, Inc. v. DOE, 310 F. Supp. 2d 271, 317 (D.D.C. 2004) (protecting briefing materials for Secretary of the Interior), aff'd in part, rev'd in part on other grounds & remanded, 412 F.3d 125, 133 (D.C. Cir. 2005); Klunzinger v. IRS, 27 F. Supp. 2d 1015, 1026 (W.D. 1998) (protecting paper to brief commissioner for meeting); Thompson v. Dep't of the Navy, No. 95-347, 1997 WL 527344, at *4 (D.D.C. Aug. 18, 1997) (protecting materials to brief senior officials responding to media inquiries, as "disclosure of materials reflecting the process by which the Navy formulates its policy concerning statements to and interactions with the press" could stifle frank communication within the agency), aff'd, No. 975292, 1998 WL 202253, at *1 (D.C. Cir. Mar. 11, 1998) (per curiam); Williams v. DOJ, 556 F. Supp. 63, 65 (D.D.C. 1982) (protecting "briefing papers prepared for the Attorney General prior to an appearance before a congressional committee"). On March 10, 2020, OSVA released you two thousand three hundred four (2,304) pages, nonconsecutively Bates-numbered 15140-19303, redacted with FOIA Exemptions 4, 5, and 6. One thousand eight hundred fifty-nine (1,859) pages between those Bates-numbers predated November 9, 2016 and were, thus, non-responsive to your FOIA request. On February 3, 2020, OSVA released one thousand nine hundred fifty-four (1,954) pages, Bates-numbered 1659-3638, redacted with FOIA Exemptions 4, 5, and 6. On January 14, 2020, OSVA released seven hundred six (706) pages, Bates-numbered 950-1658, redacted with FOIA Exemptions 5 and 6. On January 6, 2020, OSVA released to you five hundred forty-three (543) pages, nonconsecutively Bates-numbered 10033-11500, redacted with FOIA Exemptions 5 and 6. The other four thousand two hundred seventy-nine (4,279) pages, within pages Bates-numbered 10033-14999, predated November 9, 2016 and, thus, are non-responsive to your FOIA request. On January 6, 2020, OSVA also re-released to you nine hundred forty-nine (949) pages, Batesnumbered 1-949, previously released to you on November 21, 2019, but with fewer redactions. Approximate 30,800 Pages of Emails Received on or About 1/15/2020 On or about December 23, 2020, Mr. Shulkin submitted approximately thirty thousand eight hundred (30,800) pages of emails in which he copied a VA email address. From OSVA's preliminary review, about sixteen thousand four hundred (16,400) pages predate November 9, 2016, and thus, are non-responsive to your FOIA request. From a sample size of four hundred thirty-five (435) emails totaling two thousand one hundred thirty-four (2,134) pages, Shulkin did not copy, forward, or send to his VA email address, two A\11 IC A PVERSIGHT Austin Evers & Mehreen Rasheed Page 5 May 5, 2020 hundred two (202) emails totaling nine hundred seven (907) pages. We estimate eight thousand three hundred (8,300) pages in which Shulkin copied, forwarded, or sent to his VA email address, and six thousand one hundred (6,100) pages in which Shulkin did not copy, forward, or send to his VA email address. For your past FOIA request 18-07426-F, OSVA has released to you all of Shulkin's aol and gmail emails, possibly redacted, in which Shulkin directly communicated with the three (3) informal advisors and copied, forwarded, or sent to his VA email address. For your FOIA request 18-11960-F, OSVA has produced and will continue to produce all of Shulkin's aol and gmail emails referencing the three (3) informal advisors and copying or sending emails to VA email address. OSVA will process the six thousand one hundred (6,100) pages in which Shulkin did not copy, forward, or send to his VA email address as responsive to this FOIA request. FOIA Mediation As part of the 2007 FOIA amendments, the Office of Government Information Services (OGIS) was created to offer mediation services to resolve disputes between FOIA requesters and Federal agencies as a non-exclusive alternative to litigation. Using OGIS services does not affect your right to pursue litigation. Under the provisions of the FOIA Improvement Act of 2016, the following contact information is provided to assist FOIA requesters in resolving disputes: VA Central Office FOIA Public Liaison: Name: Doloras Johnson Email Address: vacofoiaservice@va.gov Office of Government Information Services (OGIS) Email Address: ogis@nara.gov Fax: 202-741-5769 Mailing address: National Archives and Records Administration 8601 Adelphi Road College Park, MD 20740-6001 FOIA Appeal This concludes OSVA's Eighth Partial IAD to request 19-09094-F. Please be advised that should you desire to do so, you may appeal the determination made in this response to: Office of General Counsel (024) Department of Veterans Affairs 810 Vermont Avenue, NW Washington, DC 20420 If you should choose to file an appeal, please include a copy of this letter with your written appeal and clearly indicate the basis for your disagreement with the determination set forth in this response. Please be advised that in accordance with VA's implementing FOIA regulations at 38 C.F.R. ? 1.559, your appeal must be postmarked no later than ninety (90) days of the date A\11 ICA PVERSIGHT Austin Evers & Mehreen Rasheed Page 6 May 5, 2020 of this letter. Sincerely, Richard Ha, JD, CIPP/G OSVA FOIA Officer Attachments - Redacted six hundred eighty-nine (689) pages A E: ., J)VERSIGHT Message From: Sent: To: Subject: David Shulkin [secshulk in@gma il.com] 11/24/2017 9:33 :17 PM (b) (6) (b) mac . com] Bruce Moskowi t z [brucemcll???? Re: Man O War Project .pdf (6) Got it BruceI never learned we are following with interest about equine therapy in medical school sent from my iPhone (b) (6) > On Nov 24, 201 7 , at 11:4 1 AM, Bruce Moskowitz > From Mack > >< Mano war Project.pdf (b) (6) . com> wrote: > > > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000001 OS 00019304 Message From: Sent: To: Subject: Attachments: Bruce Moskowitz [brucem (b) (6) (b) mac.com] 11/24/2017 4:41:08 PM (6) Secshulkin@gmail .com Man O War Project.pdf Man O War Project .pdf; Unt it led attachment 76277.txt From Mack AMERICAN PVERSIGHT VA-19-0799-H-000002 OS 00019305 .--L P.O.BOX2340 I SCOTIA, NY12302 I\MANO'WAR PROJECT The Honorable David J. Shulkin, IYID Secretary, US Department of Veterans Affairs 810 Vermont Avenue, NW Washington, DC 20420 November 16, 2017 Re: Columbia University Study/ Man O' War Project .h4vL Jj,t(./i.,,r,/~ -~ ~,Ji It was a pleasure to meet you and speak for a few moments at the Prostate Cancer Foundation dinner in New York recently. As a patriot and a former 2nd Lieutenant in the U.S. Army, I admire and applaud your service to our country as our Secretary of Veterans Affairs. Sharing a mutual concern for the health and welfare of our veterans) I wanted to take a moment to bring your attention to the Man O' War Project for veterans, which I founded with Columbia University in early 2016. This ground-breaking study is being conducted by a distinguished group of researchers at Columbia, headed by Dr. Yuval Neria, Professor of Medical Psychology, Columbia U and Director of the Trauma and PTSD Program, NYS Psychiatric Institute andDr. Prudence Fisher, Associate Professor of Clinical Psychiatric Social Work, Columbia U and Research Scientist, NYS Psychiatric Institute. It is the first and only university-led clinical research trial to determine the effectiveness of equine-assisted therapy for veterans with PTSD and to establish unifom1guidelines for its application. In your efforts to address the veteran crisis in our country, you understand the need for effective a1temativesto traditional group and one-on-one therapies for those afflicted with PTSD, \Ve believe that research-based tmderstanding of the positive effects of equine-assisted therapy for veterans suffering from PTSD is critical in order to achieve the break-out status this important alternative tTeatmentdeserves. After a successful pilot study in 2016, we are now completing our 8th group of veterans in the official clinical trial \Vi.theven more compelling results. In addition, we have recently decided to inc1udeMRls as part of the study, making Man O' Vlar the only equine therapy program in the nation to utilize neuroimaging. This state-of-the-art technology provides an objective measure which further validates and strengthens the clinical data of the research. We anticipate the study to be complete in the spring of 2018, with the results being published in a top-tier medical joumal. After that, it is our hope to take the program nationwide through the publicatfon of the treatment manual and training videos, so that veterans everywhere may access this vital alternative therapy with a well-designed, researched-proven protocol. I have included for your review a White Paper on the Project, together with some information on the Iv1Rl component. Once you have had a chance to review the materials, I would very much like to meet with you, together with Dr. Neria a11d Dr. Fisher, to discuss the promise and future of this important program. While there are many equine therapy "wellness" programs out there, Man O' Vlar is the only university-led program creating a credible treatment alternative based on proven scientific research by some of the best researchers in the PTSD field. As such, we believe that we are uniquely qualified to deliver equine therapy as a successful, life-saving, mainstream treatment for our brave veterans suffering with PTSD. JU.~ . -f / ht... J wrote : December 5 lunch is perfect. We can pick a place as we get closer. Happy Thanksgiving to you atid-(b) (6) Hope you get a chance to chill out. On Wed , Nov 22, 2017 at 4:30 PM, David Shulkin wrote : Thats the presidents holiday party for congress- infact every single night in december im now booked Could we try for a lunch? Dec 4 or 5 would work Sent from my iPhone On Nov 22, 2017, at 1:58 PM, Marc Sherman <~ (b) (6) > wrote: Unfortunately I am in Dallas next week and don't return to DC until Tuesday Dec S. I could get together that day if it works for you . How was the concert? On Tue, Nov 21, 2017 at 9 :16 PM, David Shulkin wrote: Marc- any chance you are free for dinner this coning monday or tuesday night? David Sent from my iPhone On Nov 17, 2017, at 11 :35 PM, Marc Sherman Let's reschedule for after Thanksgiving . Let me know what options work for you. On Fri, Nov 17, 2017 at I 1:33 PM, Marc Sherman <- (b) (6) > wrote : Thank you for the invitation . 1 really appreciate it, but atn not a huge Dead fan ...but you should not give up the opportunity. It sounds like a blast. I was invited to a critical meeting in NY which I had originally declined because of our dinner. The concert will give me the opportunity to now attend (the AMERICAN PVERSIGHT VA-19-0799-H-000005 DS_00019308 organizer was not happy that I was ditcrung the meeting) . I can now make amends . On Fri, Nov 17, 20 17 at 7:04 AM , David Shullcin wrote : Marc- ne xt tuesday i have tickets to the grateful dead at the verizon ceoter with back stage passes- i thought it would be fun to go if you are up for it Sent from my iPhone On Nov 9, 20 17, at 9 :40 AM , Marc Sherman (b) (6) <> wrote : Yes 1 that works. On Wed ~ Nov 8, 2017 at 10:48 PM, David Shulkin wrote : Would the 21st work? Sent from my iPhone On Nov 8,2017 , at 10:07 PM , Marc Sherman (b) (6) <> wrote : Assuming you mean next week (the week before Thanksgiving) . How about Tuesday Nov 14? On Wed , Nov 8, 2017 at 9:49 PM , David Shullcin wrote : Marc- the week before veterans day is like christmas week for macys Maybe the week before thanksgiving ? Sent from my iPhone < - On Nov 5, 2017, at 10:44 PM, Marc Shennan (b) (6) wrote: Sorry for the delayed response .. .I was out of the AMERICAN PVERSIGHT VA-19-0799-H-000006 DS 00019309 country and just returned. Than ks for the heads up about (b) (6) Idon't speak to him much about his work there, but he has mentioned to me about career employees who do not want to see the Center succeed and their deliberate efforts to undermine the effort and sabotage him and the results . Michae 1 worked for me for a long time and the reaction to interpersonal skills does not conform to my extensive experience with him . Perhaps the problem is not really with (b) (6) -but with those trying to eliminate the person trying to change things and make something happen. Just a thought. Also, we had talked a few weeks back about trying to have dinner this week. Are you available? It would be good AMERICAN PVERSIGHT VA-19-0799-H-000007 OS 00019310 to catch up . I could probab Iy have dinner on Tuesday, Wednesday or Thursday. On Sun , Oct 29, 2017 at 1:37 PM, David Shulkin wrote: Marc- just to give you a beads up - i ve heard there are big issues with (b) (6) performance] have no contact with him but ive heard that he is very bright and motivated but his i bterpersonal skills are lacking and nobody will work with him and the operations center has broken down- Im not planning on getting involved and dont know the outcome but i suspect there will be some management intervention in the upcoming future Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000008 D8_00019311 > On Oct 14, 2017, at 2:29 PM, 1,farc Sherman ~ (b) (6) gmail.com > wrote : > > Also , consistent with our Apple discussion , Bruce is going ..l!d (b) (b) (6) (6) get back involved in the Apple effort andteU- (b) that you(6) gave your blessing . Pleas e let me know if I misunderstood . > > AMERICAN PVERSIGHT VA-19-0799-H-000009 D8_00019312 Message Marc Sherman [mb From: (b) (6) gmail.com] Sent : 11/22/2017 9 :54:24 PM To : David Shulkin [secshulkin@gmail.com] Re: Apple Subject: December 5 lunch is perfect. We can pick a place as we get closer . Happy Thanksgiving to you and -(b) (6) Hope you get a chance to chill out . On Wed , Nov 22, 2017 at 4:30 PM, David Shulk.in wrote: Thats the presidents holiday party for congress- infact every single night in december im now booked Could we try for a lunch? Dec 4 or 5 would work Sent from my iPhone On Nov 22 2017 at 1:58 P:NI Marc Sherman <- (b) (6) wrote: Unfo1tunately I am in Dallas next week and don't return to DC until Tuesday Dec 5. I could get together that day if it works for you . How was the concert? On Tue , Nov 21, 20 I 7 at 9 :I 6 PM, David ShuJ kin wrote : Marc- any chance you are free for dinner this coning monday or tuesday night ? David Sent from my iPhone On Nov 17, 2017 , at 11:35 PM, Marc Sherman <- (b) (6) > wrote : Let's reschedule for after Thanksgiving . Let me know what options work for you. On Fri, Nov 17, 2017 at 11:33 PM , Marc Sherman <- (b) (6) wrote : Thank you for the invitation . I really appreciate it , but am not a huge Dead fan ...but you should not give up the opportunity. ft sounds like a blast I was invited to a critical meeting in NY which I had 01igina1ly declined because of our dinner . The concert will give me the opportunity to now attend (the organizer was ' not happy that I was wrote : Marc- next tuesday i have tickets to the grateful dead at the verizon center with back stage passes- i thought it would be fun to go if you are up for it Sent from my iPhone On Nov 9, 2017 , at 9:40 AM, Marc Sherman wrote ; Would the 21st work? Sent from my iPhone On Nov 8, 20 17, at 10:07 PM, Marc Sherman <~ (b) (6) > wrote : Assuming you mean next week (the week before Thanksgiving) . How about Tuesday Nov 14? On Wed, Nov 8, 2017 at 9:49 PM , David Shulk:in wrote : Marc- the week before veterans day is like chtistmas week for ruacys Maybe the week before thanksgiving? Sent from my iPhone On Nov 5, 2017 , at 10:44 PM, Marc Sherman (b) (6) -wrote : Sorry for the delayed response ...I was out of the country and just returned. Thanks for the heads up about-(b) (6) I don't speak to him much about his work there, but he has mentioned to me about career employees who do not want to see the Center succeed and their deliberate efforts to undermine the effort and sabotage him and the (b) (6) results. worked for me for a long time and the reaction to interpersonal skills does not conform to my extensive experience with him. Perhaps the problem is (b) (6) not really with but with those trying to eliminate the person trying to change things and make something happen . Just a thought . AMERICAN PVERSIGHT VA-19-0799-H-000011 DS_00019314 Also, we had talked a few weeks back about trying to have dinner this week Are you avai table? It would be good to catch up . I could probably have dinner on Tuesday , Wednesday or Thursday. On Sun, Oct 29 , 2017 at l ;37 PM David ShuJkin wrote: Marc- just to give you a heads up - ive heard there are big issues with-(b) (6) performance- I have no contact with him but ive heard that he is very bright and motivated but his ibterpersonaJ skills are lacking and nobody will work with him a11dthe operations center has broken down- Im not planning on getting involved and dont know tl,e outcome but i suspect there wrn be some management intervention in the upcoming future Sent from my iPhone < - > > On Oct 14, 2017, at 2 :29 PM, Marc Sherman (b) (6) wrote : > > Also, consistent with our Apple discussion ~ Bruce is going to call-(b) Wallace and get back (6) involved in the Apple effort and tell -(b) that (6) you gave your blessing . Please let me know if I misunderstood . > AMERICAN PVERSIGHT VA-19-0799-H-000012 DS 00019315 3 Message David Shulkin (secshulkin@gmail.com] From: Sent : 11/22/2017 9 :30:33 PM To: Marc Sherman [mb Re: Apple Subject: (b) (6) gmail.com] Thats the presidents holiday party for congress- infact every single night in december im now booked Could we try for a lunch? Dec 4 or 5 would work Sent from my iPhone On Nov 22, 2017 , at 1:58 PNI, Marc Sherman <~ (b) (6) > wrote : Unfortuna tely I am in Dallas next week and don't return to DC until Tuesday Dec 5. I could get together that day if it works for you . How was the concert ? On Tue , Nov 21, 2017 at 9~16 PM , David Shulkin wrote : Marc- any chance you are free for dinner this coning monday or tuesday night? David Sent from my iPhone On Nov 17, 2017, at 1 I :35 PM, Marc. Sherman <- (b) (6) > wrote : <- Lees reschedule for after Thanksgiving . Let me know what options work for you. (b) (6) On Fri , Nov 17, 2017 at 11 :33 PM , Marc Sherman wrote : Thank you for the invitation . I really appreciate it, but am not a huge Dead fan ...but you should not give up the opportunity . It sounds like a blast I was invited to a critical meeting in NY which I had originally declined because of our dinner . The concert will give me the opportunity to now attend (the organizer was not happy that I was ditching the meeting) . I can now make amends. On Fri., Nov 17, 2017 at 7:04 AM, David Shulkin < secshulkin@gmail. com > wrote: Marc- next tuesday i have tickets to the grateful dead at the verizon center with back stage passes- i thought it would be fun to go if you are up for it Sent from my iPhone On Nov 9, 2017, at 9:40 AM, Marc Sherman wrote : Would the 21st work? Sent from my iPhone On Nov 8, 2017, at 10:07 PM, Marc Sherman (b) (6) <-wrote : Assuming you mean next week (the week before Thanksgiving) . How about Tuesday Nov 14? On Wed , Nov 8, 20 l 7 at 9:49 PM, David Shulkin wrote : Marc- the week before veterans day is llke christmas week for macys . Maybe tbe week before thanksgiving ? Sent from my iPhone On Nov 5, 2017 , at 10:44 PM , Marc Sherman <- (b) (6) > wrote : Sony for the delayed response ...! was out of the country and just returned . Thanks for the heads up about-(b) (6) I don't speak to him much about his work there , but he has mentioned to me about career employees who do not want to see the Center succeed and their deliberate efforts to undermine the effort and sabotage him and the (b) (6) resuJts. worked for me for a long time and the reaction to interpersonal skills does not conform to my extensive experience with him . Perhaps the problem is not really with (b) (6) but with those trying to eliminate the person trying to change things and make something happen. Just a thought. Also, we had talked a few weeks back about tryi ng to have dinner this week. Are yo u AMERICAN PVERSIGHT VA-19-0799-H-000015 DS 00019318 available? It would be good to catch up . I could probably have dinner on Tuesday, Wednesday or Thursday. On Sun, Oct 29 2017 at 1 :37 PM , David Shulkin wrote: Marc- just to give you a heads up - ive heard there are big issues with-(b) (6) performance- 1 have no contact with him but ive heard that he is very bright and motivated but his ibterpersonal skills are lacking and nobody will work with him and the operations center has broken down- Im not planning on getting involved and dont know the outcome but i suspect there will be some management intervention in the upcoming future 0 Sent from my iPhone < - > > On Oct 14 2017, at 2:29 PM, Marc Sherman (b) (6) wrote: > > Also, consistent with our Apple discussion, Bruce is going to call-(b) Wallace and (6) in the Apple get back involved effort and tell -(b) that you (6) gave your blessing. Please let me know if I misunderstood. > > AMERICAN PVERSIGHT VA-19-0799-H-000016 DS 0001931'9 Message Marc Sherman (mb From: (b) (6) gmail.com] Sent : 11/22/2017 6:58:46 PM To : David Shulkin (secshulkin@gmail.com] Re: Apple Subject: Unfortunately I am in Dallas next week and don't return to DC until Tuesday Dec 5. I could get together that day if it works for you . How was the concert? On Tue, Nov 21, 2017 at 9: 16 PM, David Shulkin wrote : Marc- any chru1ce you are free for dinner this coning monday or tuesday night? David Sent from my iPhone On Nov 17 2017 at 11 :35 PM Marc Sherman <~ (b) (6) > wrote : Let's reschedule for after Thanksgiving . Let me know what options work for you . (b) (6) On Fri, Nov 17, 2017 at 11:33 PM, Marc Sherman <-wrote: Thank you for the invitation . I really appreciate it, but am not a huge Dead fan ...but you should not give up the opportunity . It sounds like a blast. I was invited to a critical meeting in NY which 1 had originally declined because of our dinner. The concert will give me the opportunity to now attend (the organizer was not happy that I was ditching the meeting). I can now make amends . On Fri, Nov 17, 2017 at 7:04 AM , David Shu1kin wrote: Marc- next tuesday i have tickets to the grateful dead at the verizon center with back stage passes- i thought it would be fun to go if you are up for it Sent from my iPhone On Nov 9, 2017 , at 9:40 AM, Nlarc Sherman <- (b) (6) > wrote: Yes, that works . On Wed, Nov 8, 2017 at 10:48 PM, David Shulkin wrote: Would the 21st work? Sent from my iPhone On Nov 8, 2017, at 10:07 PM , Marc Sherman Assuming you mean next week (the week before Thanksgiving). How about Tuesday Nov 14? On Wed, Nov 8, 2017 at 9:49 PM, David Shulkin wrote : AMERICAN PVERSIGHT VA-19-0799-H-000017 DS 00019320 Marc- the week before veterans day is like christmas week for macys, Maybe the week before thanksgiving ? Sent from my iPhone On Nov 5, 2017, at 10:44 PM, Marc Sherman <~ (b) (6) > wrote: Sorry for the delayed response ..J was out of the country and just returned . Thanks for the heads up about-(b) (6) I don't speak to him much about his work there, but he has mentioned to me about career employees who do not want to see the Center succeed and their deliberate efforts to undermine the effort and sabotage him and the results. -(b) (6) worked for me for a long time and the reaction to interpersonal skills does not conform to my extensive experience with him. Perhaps the problem is not really with-(b) (6) but with those trying to eliminate the person trying to change things and make something happen, Just a thought. Also, we had talked a few weeks back about trying to have dinner this week. Are you available? lt would be good to catch up , I could probably have dinner on Tuesday , Wednesday or Thursday. On Sun, Oct 29, 2017 at 1:37 PM , David Shulkin wrote : Marc- jus t to give you a heads up - ive heard there are big issues with_(b) (6) performance- I have no contact with him but ive heard that he is very bright and motivated but his ibterpersonal skills are lacking and nobody will work with him and the operations center has broken down- Im not planning on getting involved and dont know the outcome but i suspect there will be some management intervention in the upcoming future Sent from my iPhone > On Oct 14, 2017, at 2:29 PM 1 Marc Sherman <- (b) (6) > wrote : > > Also, consistent with our Apple discussion , (b) (b) (6) Bruce is going to call -and get (6) AMERICAN PVERSIGHT VA-19-0799-H-000018 DS 00019321 back involved in the Apple effort and tell -(b) that you gave your blessing. Please let (6) me know if I misunderstood. > > AMERICAN PVERSIGHT VA-19-0799-H-000019 OS 00019322 Message David Shulkin (secshulkin@gmail.com] 11/11/2017 1:28:37 AM Marc Sherman [mb (b) (6) gmail.com] Re: Apple Frotn: Sent : To : Subject: Great Sent from my iPhone On Nov 9, 2017, at 9:40 AM, Marc Sherman- (b) (6) > wrote : Yes, that works. On Wed , Nov 8, 2017 at 10~48 PM, David Shulk.in wrote : Would the 21st work? Sent from my iPhone On Nov 8, 20 17, at 10:07 PM, Marc Sherman <~ (b) (6) > wrote : Assuming you mean next week (the week before Thanksgiving) . How about Tuesday Nov 14? On Wed , Nov 8, 201 7 at 9:49 PM , David Shulkin wrote : Marc- the week before veterans day is like christmas week for macys Maybe the week before thanksgiving? Sent from my iPhone On Nov 5, 2017 at 10:44 PM Marc Sherman <~ wrote: (b) (6) > Sorry for the delayed response .. .I was out of the country and just l don't speak returned. Thanks for the heads up about-(b) (6) to him much about his work there , but he has mentioned to me about career employees who do not want to see the Center succeed and their deliberate effm1s to undermine the effort and sabotage him and the results. -(b) (6) worked for me for a long time and the reac tion to interpersonal skills does not conform to my extensive experience with him. Perhaps the problem is not really with-(b) (6) but with those trying to eliminate the person trying to change things and make something happen . Just a thought. Also, we had talked a few weeks back about trying to have dinne r this week. Are you available? It would be good to catch up. I could probably have dinner on Tuesday , Wednesday or Thursday. AMERICAN PVERSIGHT VA-19-0799-H-000020 DS 00019323 On Sun, Oct 29, 2017 at 13 7 PM , David Shu Ikin wrote : Marc- just to give you a heads up - ive heard there are big issues with-(b) (6) perfonnance- I have no contact with him but ive heard that he is very bright and motivated but his ibterpersonal skills are iacking and nobody will work with him and the operations center has broken down- Im not planning on getting involved and dont know the outcome but i suspect there will be some management intervention in the upcoming future Sent from my iPhone <- > > On Oct 14, 2017 , at 2;29 PM, Marc Sherman (b) (6) wrote : > > Also, consistent with our Apple discussion , Bruce is going to (b) (b) (6) can?and get back involved in the Apple effo11and (b) tell (6) that you gave your blessing. Please Jet me know ifl (6) misunderstood . > > AMERICAN PVERSIGHT VA-19-0799-H-000021 DS 00019324 Message Marc Sherman [mb From: (b) (6) gmail.com) Sent : 11/9/2017 2:40:49 PM To: David Shu Ikin (secshulkin@gmail.com] Re: Apple Subject: Yes, that works. On Wed , Nov 8, 2017 at 10:48 PM, David Shulk:in < secshulkin@gmail.com > wrote : Would the 21st work? Sent from my iPhone On Nov 8, 2017 , at 10:07 PM , Marc Sherman <- (b) (6) wrote: Assuming you mean next week (the week before Thanksgiving) . How about Tuesday Nov 14? On Wed, Nov 8, 2017 at 9:49 PM David Shulkin wrote : Marc- tl1e week before veterans day is like christmas week for macys Maybe the week before thanksgiving? Sent from my iPhone On Nov 5, 2017 , at 10:44 PM, Marc Sherman <- (b) (6) > wrote : Sony for the delayed response ...! was out of the country and just retw.ned. Thanks for the heads up about-(b) (6) I don't speak to him much about his work there , but he has mentioned to me about career employees who do not want to see the Center succeed and their deliberate efforts to undermine the effort and sabotage him and the results . -(b) (6) worked for me for a long time and the reaction to interpersonal skills does not conform to my extensive but with experience with him . Perhaps the problem is not really with-(b) (6) those trying to eliminate the person trying to change things and make something happen . Just a thought. Also we had talked a few weeks back about trying to have dinner this week . Are you available? It would be good to catch up. I could probably have dinner on Tuesday, Wednesday or Thursday . On Sun, Oct 29, 2017 at 1:37 PM, David Shulkin wrote : Marc- just to give you a heads up - ive heard there are big issues with (b) (6) performance- I have no contact with him but ive heard that he is very bright and motivated but his ibterpersonal skills are lacking and nobody will work with him and the operations center has broken down- Im not planning on getting involved and dont know the outcome but i suspect there will be some management intervention in the upcoming future Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000022 DS 00019325 > On Oct 14, 2017 , at 2:29 PM, Marc Shennan <~ (b) (6) > wrote : > > Also , consistent with our Apple discussion , Bruce is going to call -(b) -(b) (6) and get back involved in the Apple effort and tell-(b) that (6) you gave (6) your blessing . Please let me know if I misunderstood . > > AMERICAN PVERSIGHT VA-19-0799-H-000023 DS 00019326 Message David Shulkin (secshulkin@gmail.com] Frotn: Sent : 11/9/2017 3:48:05 AM To: Marc Sherman [mb Re: Apple Subject: (b) (6) gmail.com] Would the 21st work? Sent from my iPhone On Nov 8, 2017, at 10:07PM, Marc Sherman - (b) (6) > wrote : Assuming you mean next week (the week before Thanksgiving) . How about Tuesday Nov 14? On Wed, Nov 8, 2017 at 9:49 PM, David Shulkin wrote : Marc- the week before veterans day is like christmas week for macys . Maybe the week before thanksgiving? Sent from my iPhone On Nov 5, 2017, at l 0:44 PM, Marc Sherman <- > (b) (6) wrote: Sorry for the delayed response ..J was out of the country and just returned. Thanks for the heads up about-(b) (6) I don't speak to him much about hi.s work there, but he has mentioned to tne about career emj)loyees who do not want to see the Center succeed and their deliberate efforts to undermine the effort and sabotage h.im and the results . -(b) (6) worked for me for a Jong time and the reaction to interpersonal skills does not conform to my extensive experience with him. Perhaps the problem is not rea11ywith-(b) (6) but with those trying to eliminate the person trying to change things and make something happen. Just a thought. Also, we had talked a few weeks back about trying to have dinner this week. Are you available? It would be good to catch up. I could probably have dinner on Tuesday, Wednesday or Thursday . On Sun, Oct 29 2017 at 1:37 PM David Shulkin wrote: Marc- just to give you a heads up - ive heard there are big issues with -(b) (6) perfonnance- I have no contact with him but ive heard that be is very bright and tnotivated but his ibterpersonal skills are lacking and nobody will work with him and the operations center has broken down- Im not planning on getting involved and dont know the outcome but i suspect there will be some managemen t intervention in the upcoming future Sent from my iPhone > On Oct 14, 2017, at 2:29 PM, Marc Sherman AMERICAN PVERSIGHT (b) (6) > VA-19-0799-H-000024 DS 00019327 > Also, consistent with our Apple discussion, Bruce is going to call-(b) and get back involved in the Apple effort and tell-(b) that (6) you gave (6) your blessing. Please let me know if I misunderstood. > > -(b) (6) AMERICAN PVERSIGHT VA-19-0799-H-000025 OS 00019328 Message From: Marc Sherm,in [mb (b) (6) gmail.com) Sent : 11/9/2017 3:07:20 AM To: David Shu Ikin (secshulkin@gmail.com) Re: Apple Subject: Assuming you mean next week (the week before Thanksgiving) . How about Tuesday Nov 14? On Wed, Nov 8, 2017 at 9:49 PM, David Shulkin wrote : Marc- the week before veterans day is. like christmas week for macys Maybe the week before thanksgiving? Sent from my iPhone On Nov 5, 2017, at 10:44 PM , Marc Sherman <- (b) (6) > wrote : Sorry for the delayed response ...I was out of the country and just returned . Thanks for the heads up about-(b) (6) I don't speak to him much about his work there, but he has mentioned to me about career employees who do not want to see the Center succeed and their deliberate efforts to undermine the effort and sabotage him and the results . -(b) (6) worked for tne for a long time and the reaction to interpersonal skills does not confo1m to my extensive experience with him. Perhaps the problem is not really with-(b) (6) but with those trying to eliminate the person trying to change things and make something happen . Just a thought Also, we had talked a few weeks back about trying to have dinner this week . Are you available ? It would be good to catch up. I could probably have dinner on Tuesday, Wednesday or Thursday. On Sun, Oct 29, 2017 at l :37 PM, David Shulkin wrote : Marc- just to give you a beads up - ive beard there are big issues with-(b) (6) perfonnance- I have no contact with him but ive heard that he i~ very bright and mot~vated but his ibterpersonaJ skills are lacking and nobody will work with him and the operations center has broken down- Im not planning on getting involved and dont know the outcome but i suspect there will be some management intervention in the upcoming future Sent from my iPhone > On Oct 14, 2017, at2 :29PNL Marc Sherman <~ (b) (6) > wrote: > > Also, consistent with our Apple discussion, Bruce is going to call -(b) -(b) (6) and get back (6). Please Jet me know ifI involved in the Apple effort and tell -(b) that you gave your blessing (6) m i.sunderstood. > > AMERICAN PVERSIGHT VA-19-0799-H-000026 DS 00019329 Message From: David Shulkin [secshulkin@gmail.com] 11/9/2017 2:49:09 AM Marc Sherman [mb (b) (6) gmail.com] Re: Apple Sent : To : Subject: Marc- the week before veterans day is like christmas week for macys Maybe the week before thanksgiving ? Sent from my iPhone On Nov 5, 2017 , at 10:44 PNI, Nfarc Sherman <~ (b) (6) > wrote : Sorry for the delayed response ...I was out of the country and just returned . Thanks for the heads up about-(b) (6) I don't speak to him much about hjs work there , but he has mentioned to me about career employees who do not want to see the Center succeed and their deliberate efforts to undermine the effort and sabotage him and the results. -(b) (6) worked for me for a long time and the reaction to interpersonal skills does not conform to my extensive experience with him . Perhaps the problem is not really with -(b) (6) but with those trying to eliminate the person trying to change things and make so)llethh1ghappen. Just a thought Also, we had talked a few weeks back about trying to have dinner this week. Are you available ? It would be good to catch up . I could probably have dinner on Tuesday , Wednesday or Thursday . On Sun, Oct 29, 2017 at 1:37 PM, David Shulkin wrote : Marc- just to give you a heads up - ive heard there are big issues with-(b) (6) perfonnance- r have no contact with him but ive heard that he is very bright and motivated but his ibterpersonal skills are lacking and nobody will work with him and the operations center has broken down- Im not planning on getting involved and doht know the outcome but i suspect there will be some management intervention in the upcoming future Sent from my iPhone > On Oct 14, 2017, at2 :29 PM, Marc Sherman <- (b) (6) > wrote: > > Also, consistent with our Apple discussion , Bruce is going to call -(b) -(b) (6) and get back (6)_ Please let me know ifl involved in the Apple effort and tell -(b) that you gave your blessing (6) misunderstood . > > AMERICAN PVERSIGHT VA-19-0799-H-000027 DS 00019330 Message Frotn: Sent: To: Subject: Marc Sherm,in [mb (b) (6) gmail.com) 11/6/2017 3:44:53 AM David Shulkin (secshulkin@gmail.com l Re: Apple Sony for the delayed response .. .l was out of the country and j ust returned. Thanks for the heads up about -(b) (6) I don\ speak to him much about his work there, but he has mentioned to me about career employees who do not want to see the Center succeed and the ir deliberate efforts to undermine the effort and sabotage him and the results . -(b) (6) worked for me for a long time and the reaction to interpersonal ski11sdoes not conform to my extensive experience with him . Perhaps the problem is not really with-(b) (6) but with those trying to eliminate the person trying to change things and make something happen. Just a thought. Also, we had talked a few week"Sback about trying to have dio.ner this week . Are you available? It would be good to catch up . l cou]d probably have dinner on Tuesday, Wednesday or Thursday . On Sun, Oct 29, 20 17 at l :37 PM, David ShuJkin wrote: Marc- just to give you a heads up - ive heard there are big issues with-(b) (6) perfo1mance- I have no contact with him but ive heard that he is very bright and motivated but his.ibterpersonal skills are lacking and nobody will work with him and the operations center has broken down- Im not planning on getting involved and dont know the outcome but i suspect there will be some management intervention in the upcoming future Sent from my iPhone (b) (6) > On Oct 14, 2017, at 2:29 PM, lvlarc Sherman > AJso, consistent with our Apple discussion, Bruce is going to call--(b) (b) (6) and get back involved in the Apple effort and tell -(b) that you gave your blessing. Please let me(6)know if I misunderstood , (6) > > AMERICAN PVERSIGHT VA-19-0799-H-000028 DS 00019331 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 10/29/2017 5:37 :10 PM To: (b) (6) Marc Sherman [mb-gmail.com] Re: Apple Subject: Marc- just to give you a heads up - ive heard there are big issues with -(b) (6) performanceI have no contact with him but ive heard that he is very bright and motivated buthisibterpersonal skills are lacking and nobody will work with him and the operations center has broken down- Im not planning on getting involved and dont know the outcome but i suspect there will be some management intervention in the upcoming future sent from my iPhone (b) (6) > on Oct 14 , 2017 , at 2:2 9 PM, Marc Sherman wrote : > > Also , consistent with our A~discussion , Bruce is going to call -(b) -(b) (6) and get back involved Please"'ietmeknow if I misunderstood. in the Apple effort and tell -(b) that you gave your blessing. (6) > (6) > AMERICAN PVERSIGHT VA-19-0799-H-000029 OS 00019332 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 10/29/2017 12:55:13 PM To: (b) (6) Marc Sherman [mb-gmail.com] Re: Apple Subject: Thats right Thanks Marc Sent from my iPhone (b) (6) > on Oct 14 , 2017, at 2: 29 PM, Marc Sherman wrote: > > Also , consistent with our A~discussion , Bruce is going to call -(b) -(b) (6) and get back involved in the Apple effort and tell -(b) that you gave your blessing. Please"'ietmeknow if I misunderstood . (6) > (6) > AMERICAN PVERSIGHT VA-19-0799-H-000030 OS 00019333 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 10/15/2017 5:21 :07 PM To: (b) (6) Marc Sherman [mb-gmail.com] Re: Apple Subject: This is correct Thanks again Sent from my iPhone (b) (6) > on Oct 14 , 2017, at 2 : 29 PM, Marc Sherman wrote: > > Also , consistent with our A~discussion , Bruce is going to call -(b) -(b) (6) and get back involved in the Apple effort and tell -(b) that you gave your blessing. Please"'ietmeknow if I misunderstood . (6) > (6) > AMERICAN PVERSIGHT VA-19-0799-H-000031 OS 00019334 Message From: Marc Sherman [mb (b) (6) gmail.com] Sent: 10/14/2017 6:29:55 PM To: David Shulkin [Secshulkin@gmail.com] Apple Subject: (b) (b) (6) Also, consistent with our Apple discussion, Bruce is going to call -and get back involved in the (6) know if I misunderstood. Apple effort and tell-(b) that you gave your blessing. Please let me (6) AMERICAN PVERSIGHT VA-19-0799-H-000032 OS 00019335 Message (b) (6) (b) (6) -@aol.com-@aol.com] From: Sent: 11/22/2017 1:17 :49 AM To: Davidshulkin [Drshulkin@aol.com] Re: Interview today Subject: -(b) (6) doesn't listen and plans for his vision not our needs . Problem. We would make more progress If he could take feedback it would be a game changer but there have been many missed ~ him. opportunities Enjoy a few days back home. Take care, (b) 1111111 (6) sent from my iPhone > on Nov 21 , 2017 , at 8:08 PM, David shulkin wrote : > > I think it turned out fine> > Is there (b) (6) any hope for - thanks for your help or are we just wasting time ? > > > Have a great thanksgiving as well - im looking forward to a few days off > > David > > sent from my iPhone > >> on Nov 21 , 2017, at 8 :05 PM, -(b) (6) @aol.com wrote : >> >> David - so sorry that I didn ' t keep u in the loop on the status of the screens in the HIC. Hope the interview went well and that you were ok with the HIC part of the session - was much longer than expected >> >> Am headed home tonight but wanted to wish you a Happy Thanksgiving !!!! >> >> ~he >> -(b) >> (6) best , >> sent from my iPhone > AMERICAN PVERSIGHT VA-19-0799-H-000033 OS 00019336 Message Davidshulkin [Drshulkin@aol.com] From: Sent: 11/22/2017 1:08:19 AM To: (b) (b) --@aol.com Re: Interview today (6) (6) Subject: I think it turned out fineIs there any hope for -(b) (6) Have a great thanksgiving thanks for your help or are we just as well- wasting time? im looking forward to a few days off David sent from my iPhone > > > (b) (6) on Nov 21, 2017, at 8:05 PM, -@aol.com wrote: David - so sorry that I didn't keep u in the loop on the status of the screens in the HIC. Hope the interview went well and that you were ok with the HIC part of the session - was much longer than expected > > Am headed home tonight > > All the best, (b) > .. > (6) > sent from my iPhone AMERICAN PVERSIGHT but wanted to wish you a Happy Thanksgiving !!!! VA-19-0799-H-000034 OS 00019337 Message From: (b) (6) @aol.com (b) (6) @aol.com] Sent: 11/22/2017 1:05:56 AM To: Davidshulkin [drshulkin@aol.com] Interview toda y Subject: David - so sorry that I didn't keep u in the loop on the status of the screens in the HIC. Hope the interview went well and that you were ok with the HIC part of the session - was much longer than expected Am headed home tonight but wanted to wish you a Happy Thanksgiving !!!! A77 the best , (b) 1111 (6) sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000035 OS 00019338 Message To : David shulkin LDrshulkin@aol.com] 11/22/2017 12:02 :55 PM Poonam Alaigh (b) otmail .com/ (b)(6)(6) Subject: Re: Yesterday From: Sent : I will take care of the situation with Jen You invited Donovan not me- 1 will work on the other stuff Happy thanksgiving Sent from my iPhone On Nov 22, 2017, at 6:49 AM , Poonam Alaigh (b) (6) (b) (6) > wrote : David, as long as the person is in the VA, she is relevant, she will have a voice and she will continue to flame the stories, cause this salacious stuff gets the attention and thats what she wants- I am convinced that she is the one who is spreading the fabricated rumors. I heard that she continues to talk to the Hill and others at the VA and probably feeding it to the press through many different channels and thats why the story has life and doesnt die down- she is fanning these rutnors relent lessly. I comp letely disagree with you that having her in another role with calm her down. I can tell you first hand that when you are no longer at the VA, you are no longer relevant. Nobody wants to give you the time of the day. Rick gave me 20 min out of the 1 hour allocated to us yesterday. Even you had more important discussions with someone else, and would have been completely fine if I werent there- out of the 1.5 hours, I bare ly got 30 min knowing that there was so much I needed to say in order to (b)(6); non-responsive (b)(6); non-responsive (b)(6); non-responsive (b)(6); non-responsive Thats why I need an anchor in DC-whether its with (b)(6); non-responsive (b)(6); non-responsive AMERICAN PVERSIGHT VA-19-0799-H-000036 DS 00019339 (b)(6); non-responsive (b)(6); non-responsive Take care, know that I will always be your friend, unconditionally AMERICAN PVERSIGHT VA-19-0799-H-000037 OS 00019340 Message From : David shulkin LDrshulk in@aol.com ] Sent : 11/22/20 17 5:04:01 PM To : Poonam Alaigh (b) otmail.comI (b)(6)(6) Re: Best compliment ever to date since I left Subject : Yes nice compliment for sure Sent from my iPhone (b)(6)(6) On Nov 22, 20 17 at 11~30 AM, Poonam Alaigh - (b) wrote : (b) (6) Just got off the phone with-from IBM who says that he wants me to work with him, so at some point he wiUeithe r buy rne out of Remedy or buy Remedy- I know he was joking but still nice to hear. Jokes aside, I th ink there ls potential here- lets discuss at the right time AMERICAN PVERSIGHT VA-19-0799-H-000038 DS 00019341 Message David shulkin [Drshulkin@aol.com] 11/26/2017 9:38:56 PM (b) (6) Marc Sherman [mb...gmail.com] Ike Perlmutter -renchangel59.com] ( (b) Fwd: Google Alert b - shulkin (6) From: Sent: To ; CC: Subject: ) ( 6 ) Marc- this is a thoughtful analysis of the politics in DC David Sent from my iPhone Begin forwarded message : From: Google Alerts Date: November 26, 2017 at 3 :00:48 PM EST To: drshulkin@aol.com Subject: Google Alert - sbulk.in Google AJerts shulkin NJW';,. Shulkin is the right man to navigate changing role of private providers with VA The Hill Many were surprised when President Trump nominated Shulkin for VASecretary, given his previous appointment as VA Under Secretary for Health during the Obama admin istration. Not only did Trump campaign heavily on th e promise to allow veterans to see the doctor of the choice, but appointing a ... 9 I) CJ -,. --u-l~v-,1 See more results I Edit this alert You have received this email because you have subscribed to Google Alerts . Unsubscnbe I View all you r alerts Receive this alert as RSS feed Send Feedbac AMERICAN PVERSIGHT VA-19-0799-H-000039 OS 00019342 Message From: David Shulkin [drshulkin@aol.com] Sent: 11/24/2017 8:02:29 PM To: (b) (6) Subject: (b) (6) otma il.com Re: Opening my VA stuff Great picture- happy thanksgiving -----Original Message----(b) (6) (b) (6) From: Poonam Alaigh ~hotmail.com> To : David Shulkin Sent: Fri, Nov 24, 2017 11:16 am Subject: Opening my VA stuff And this is one of my fav pies that-(b) took- you were still ush- didn't know what the future was going to be and you convinced me to come to West Point (6) to get a sense of our Veterans in the face of disability and adversity : this is the only event I went to and am so glad I did. I have this pie framed AMERICAN PVERSIGHT VA-19-0799-H-000040 OS 00019343 Message From: Sent: To: Subject: Attachments: Poonam Alaigh (b) otmail.com] (b)(6)(6) 11/24/2017 4:16:03 PM David Shulkin [drshulkin@aol.com] Opening my VA stuff IMG_1629.JPG; ATT0000l.txt (b) took- you were still And this is one of my fav pies that ? ush- didn't know what the future was going to be and you convinced me to come to(6)West Point to get a sense of our Veterans in the face of disability and adversity: this is the only event I went to and am so glad I did. I have this pie framed AMERICAN PVERSIGHT VA-19-0799-H-000041 OS 00019344 Sent from my iPhone Message From: Sent: To: Subject: Attachments: Poonam Alaigh (b) otmail.com] (b)(6)(6) 11/20/2017 6:53:17 PM David Shulkin [drshulkin@aol.com] remin iscing some great moments IMG_9579.jpg; IMG_9580 .jpg; IMG_9575.jpg everyone is laughing so hard- was such a great farewell!! They just sent me the pictures - and you are looking happy in a few of them AMERICAN PVERSIGHT VA-19-0799-H-000044 OS 00019347 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 11/25/2017 12:47:06 AM To: (b) (6) Poonam Alaigh [_,ot mail.com] (b) (6) Re: Spoke to Beto O'Rourke today Subject: Ok thanks Sent from my iPhone (b) (6) (b) (6) > on Nov 24, 2017, at 7:26 PM, Poonam Alaigh <-otmail .com> wrote: > > He was concerned about El Paso and the fact that the Sail re port showed a significant decline in the mental health continuity scores and the ability to retain mental health providers. You might want to speak to the El Paso MCD to understand the issues and then have Carolyn, Steve Young or better if you circle back with him - I told him I was going to let you know if his concerns > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000048 OS 00019351 Message From: Sent: To: Subject: Poonam Alaigh (b) otmail.com] (b)(6)(6) 11/25/2017 12:26:12 AM David Shulkin [drshulkin@aol.com] Spoke to Beto O'Rourke today He was concerned about El Paso and the fact that the Sail report showed a significant decline in the mental health continuity scores and the ability to retain mental health providers. You might want to speak to the El Paso MCD to understand the issues and then have Carolyn, Steve Young or better if you circle back with him - I told him I was going to let you know if his concerns Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000049 OS 00019352 Message From: (b) (6) (b) (6) Jennifer Lee [-gmail.com] Sent: 12/19/2017 8:20:03 PM To: drshulkin@aol.com Thank you and update Subject: Dr. shulkin, Thank you for meeting with me yesterday and for your advice. I told them "yes." I just heard back this afternoon that they would like to make a public announcement tomorrow(!) They want me me to join the governor-elect and new health secretary in Richmond tomorrow morning for a press conference. I can't believe how fast this is moving! I am going to let Carolyn and Lisa know now too. Thank you for everything , Jennifer AMERICAN PVERSIGHT VA-19-0799-H-000050 OS 00019353 Message DavidShulkin [secshulkin@gmail.com] From: Sent: 11/26/2017 9:37 :54 PM To: (b) (6) Bruce Moskowit z [brucem~mac (b) (6) Marc Sherman [mb-gmail CC: Subject: Bruce- Re: agree with your sentiments .com] (b) (6) .com]; Ike Perlmutt er [-renchange ( (b) b (6) ) ( 6 ) l59.com] David sent from my iPhone (b) (6) > on Nov 24, 2017, at 5:42 PM, Bruce Moskowitz wrote: (6) > Thank you I read it and also the discussion. I think this a complicated comparison since it is so dependent on data collection and how metrics can be chan ged by inclusion and exclusion of data . At the end of the day patient satisfaction is of upmost importance since it encompasses total care outcomes. But I believe if we work hard the patient satisfaction data will be positive. > > > sent from my iPhone > >> on Nov 24, 2017, at 5 :18 PM, David s hulkin wrote : >> >> Bruce- this weeks JAMAhas an article showing that VA had better performance on many clinical measures than non VA hospitals but VA had worse performance on patient satisfaction measures >> >> >> >> >> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000051 OS 00019354 Message (b) (6) Bruce Moskowit z [brucem~mac .com] (b) (6) Sent: 11/24/2017 10:42:58 PM To: DavidShulkin [secshulkin@gmail.com] (b) (6) CC: Marc Sherman [mb-gmail .com]; Ike Perlmutt er [-renchange l59.com] ( (b) b (6) Subject: Re: ) ( 6 Thank you I read it and also the discussion. I think this )a complicated comparison since it is so dependent on data collection and how metrics can be changed by inclusion and exclusion of data. At the end of the day patient satisfaction is of upmost importance since it encompasses total care outcomes. But I believe if we work hard the patient satisfaction data will be positive. From: sent from my iPhone > on Nov 24, 2017, at 5: 18 PM, David shulkin > wrote: > Bruce- this weeks JAMAhas an article showing that VA had better performance on many clinical than non VA hospitals but VA had worse performance on patient satisfaction measures measures > > > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000052 OS 00019355 Message From: Sent: To: CC: Attachments: David Shulkin [secshulk in@gma il.com] 11/24/2017 10:18:30 PM (b) ???lmac . com] (b) (6) (b) (6) Marc Sherman [mb gmail(6) .com]; Ike Perlmutter -frenchange ( (b) IMG_ 4332.JPG; Untitled attachment 78011.txt b (6) l59.com] ) ( 6 Bruce- this weeks JAMA has an article showin g that VA had )better performance on many clinical but VA had worse performance on patient satisfaction measures than non VA hospitals AMERICAN PVERSIGHT measures VA-19-0799-H-000053 OS 00019356 NiGBPRNAL MEDIONE "'"' 1 ..... publicRepOrtingof Quality at Veterans Affairs ww:o<<1-v eterans AffairsHospitals ~eBlaYJr.MD;JohnOliverDelancey,MD, MPH: o. Brock Hewitt E ,.oLJ , Jeanette W. Chung,PhD;KarlY.Bilimoria MD MS ' 10,.,rooo ' ' fhiS analysis usedCentersfor Medicare ~ Medicaid Hospital com pare datato compareoutcome. pat ient experience.and ttJiavioral healthmeasuresbetween Veterans Affairs (VA) ,idnon-VA hospitalsfor July 2012-March 2015. VA hospitals ti,Jd betteroutcomesthan non-VA hospitals for 6 of 9 patient safetyindicators."Therew . .. other 3 indicator .~renos1gmf1cant differencesfor the outcomesfor II s. ln ad_d1t1on , VAhospitalshadbetter a mortalityandreadmissions metrics Howev f er orth r . hos . . e pa ient experiencemeasuresnon-VA phi:~~!~ s:red be_ tter_than VAhospitalsfor n~rsingand man mmumcatIon.responsiveness. quietness,pain age~ent, andon whetherthe patient wouldrecommend ~::~~:~: -ldt~others. Forbehavioralhealthmeasures, non-VA I etter on 4 of 9 measures, whileVAhospitalsdid b etter on l measure. JAMAIntern Med.20 17;1n(6),882-88S . doi,10.\001fjamaintemmed2017 .0605 formancemeasuresanddriveimprovement.ln fact, whatbeganin the 1990sasa smallsetof measures to encourage improvement efforts by networkleaders,todayisasophisticatedmatrixof25measuresand measuresets usedto assess eachVAfacility. mance of US Department of Thismatrix- knownasStrategicAnalytics for Improvement and Veterans Affairs (VA) hospitals Learning(SAIL)- includesa comprehensive set of clinicalperforwith non-VA hospitals using edartideat mancemetrics.includingallveteran-relevant metricsreported to CMS ~1emalmedicine.co n Centersfor Medicare& Medicaid aswellasassessandthe NationalCommitteefor QualityAssurance. js'lic es(CMS) Hosp1t z mpare data. VA hospitals (n = 129)were mentsof factorsthoughtto enablequalityandsafetyimprovement :m,pared withboth ac., _mic and community hospitals(n = 4010) (eg,employeemorale,nursingturnover . leadership vacancies, iW1d se. ,rang eofdinic.alouh:omes and patient experiencemeasures.VA lectedutilizationmetrics). AAoverallimprovement indexisderived hasim. 'IJSl)llals performedbetter than non-VA hospitalsfor most outcome from SAiL to determinewhethereachfacility'sperformance proved in the prior year. In 2016. 82% of 146 VA facilities demon. -m.res-including lower ratesof inpatient safetyeventssuchaspresTheSAILimprovement indeX isrow mocer, iatrogenic pneumothorax.and centralline-associatedblood- stratedtangibleimprovements. incorporatedinto performance plansof facilityandnetwOfi< leadefS. t1.J11infection-and lower 30-day mortality and readmissionrates A secondfactorexplaining the VP:.s better~ono. n:utemyocardialinfarction (Ml). pneumonia, heart failure. and ..,ihtyare 2 recurringcomponentsof ef_ ~renC)' andaccc ~ nd value of US health care. In the June 'o'6toimprove the qua;, idne, Blayet al1 comparedthe perfor:om ssue ofJAMAlnterr O"TtOC obstructive pulmonary disease. At the sametime. VA hospi. scored lowerfor patient experience and behavioralhealth.Given tain measuresthan the pc"iVate sectorrelat':5t~!,: gramsanddearorganizational goalsem~ng oonectbltllf tlWI locallevel.Blayet al1foundtha t VAhOSPI~ TtitVAniple:non-VAfacilitiesonsurgicalpatientsafety=-_, mentedthe NatiOnal surgicalQuahty irnprotiona~~ in the 19SOSNSQlPcollects dinieal 1n _in formathe VAs.-m., .calautcomes i~.-. ftdlill'-? ~ lff'IQue missionand heightened visibility of VA as a public-sector .thesefindings raise 2 questions: how does VA ensurethe he.a carepossiblefor veterans in all aspectsof care.and what ! .e Adoing toaddressareas that may need further improvement? postoperative su~ oustedoutcomes t,er,veefl JdP The.iodingthat VA hospitals perform better on qualitywhen and I cterscancomparensk-adJ. nteffortsonce IIMIY 2017 ea nch quality ,rnproveme edwith hosprt:alsin the private sector is not novel. A ablingthernto lau . retati','e to theirpeers - IS~ o of 69 published studi es reported that the VA perform~ as :~ .ty -~theYcan1rnpravt! . h-....,qualitYauta,rnes16" ti vvo=-unl::unil18VAS ,_.nli,OttieeVIIJl'I'!-:_ as.Ofbe er than o priv ate health care systems on most. chnical A thirdtactore,.r-. researctijie,pedaev-~~ rates res.2Addition ally. the VA has higher screening ) J cted research prograrn-:,,aspnrnarY~ ~ -= 6 ()% ranse. . natiaf1a1~ rJ10(ielStoC3fl!tor . ~~~' c.cbi r2neer (82% vs a nationalaverage oo . within thehyl()COCCUS I11 :':menta1~1th,andfll!W t,acpracttcein~ ~ stap edur:.~ r.no "'"'mber of methic illin-resiStant o ..1... ,-r r,ed 72%,frorll l .64 . ..-1Pr.1te~.co1"" Entia~and ~ itSUU"'".1 rf!!P'-.- , "c,;d ecoons in the nt ensive care unit ucvo ieve5iower30- etforttD~-.ur,ctied l'1ev:...':ramtt,af~ ~~itl~~f/ll ..-.~ /1000p lent oda)'S, 2007-2012).Aand ~tt,an 65years 1998 _,.__....nre-o-.-,A~ (QUERl),aP'.....,.2 1 _.....iiorateevlCl"'.--~r-. ei,eY .--_ , . .., n pcrva e i,ospl tals fo . Since the rOfltC. t,ealth frOfTIEl-IRS .,... ~"""9l~Dlaf!!nLuo t,ette' .--1111M~ tD- _...uae;c1ct,ett',... 1\/Aa,..,..... ~ ZI, iJl7 - VA-19-0799-H-000054 Sent from my iPhone Message From: (b) (6) (b) (6) (b) (6) Sent: 11/11/2017 4:58:50 PM To: David Shulkin [drshulkin@aol.com] Speech: excellent Subject: gmail.com] Best Speech! Such a nice addition with the recognition. Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000056 OS 00019359 Message David shulkin lDrshulkin@aol.com] 11/11/2017 11:49 :33 AM Vivieca Simpson I(b) (6) (Elgmail.com) Fwd: Re: Frotn: Sent : To : Subject: Not sure what that means Sent from my iPhone Begin forwarded message : From: (b) (6)(b) (6) c. 0 ail.com > Date: November 10, 2017 at 9: 16:40 PM EST To: David shulkin Subject: Re: Sorry for the delay . I will be in touch soon Wishing you and everyone the best on Veterans Dayl ? (b) (6) On Nov 10, 2017 , at 7 :23 PM , David shulkin wrote : -(b) any progress on your paperwork from the WhiteHouse ? (6) David Shulkin Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000057 DS_00019360 Message From: (b) (6) (b) (6) Sent: To : 12/13/2017 10:52 :13 PM David shulkin [Drshulkin@aol.comJ Subject: Re: Director Succession Concept for Sec (b) (6) gmall.com] Ok On Wed , Dec 13, 2017 at 5:47 PM David shulkin wrote: I cannot open for some reason Please send to djs email Sent from my iPhone (b) (6) (b) (6) > On Dec 13, 2017, at 3 :35 PM, (b) (6) mail .com> wrote : > > Hi Dr Shulkin , Bob mentioned you asked about this idea for succession for MCD roles . Sharing if there is an appetite . > (b) (6) ~ > > > > -------------> From : Callahan, Robert W . JR . VHALEB > Sent: Tuesday, December 12, 2017 1:53 :24 PM (b) (6) > To : (b) (6) > SubjecL Director Succession Concept for Sec > > -(b) (6) here ' s the proposal we discussed about how to solve Director succession to a large degree. > > I was working with folks in HLTI to develop and 1 hear the proposal got held up and side tracked in WFM , hasn ' t gone anywhere . > > faybe you can help facilitate if there is still interest and higher level. > > Bob >> Sent from Gmail Nlobile > Sent from Gmai l Mobile AMERICAN PVERSIGHT VA-19-0799-H-000058 DS 00019361 Message From: Sent: Davidshulkin [Drshulkin@aol.com] 12/13/2017 10:11:08 PM [(b) (b)(6)(6) To: (b) (6) Subject: Re: Director Succession Concept for Sec gmail.com] I cannot open for some reason Please send to djs email Sent from my iPhone > on Dec 13, 2017 , at 3:35 PM, (b) (6) (b) (6) (b) (6) > > Hi Dr Shulkin , Bob mentioned you asked about this is an appetite. >. > > > > > gmail . com> wrote : idea for succession for MCDroles. sharing if there (b) (6) > From: Callahan , Robert W. JR. VHALEB > Sent. 7 1:53:24 PM (b) (6) > To: (b) (6) > subject: Director succession concept for sec > > -(b) (6) here ' s the proposal we discussed about how to solve Director > > I was working with folks in HLTI to develop and I hear the proposal WFM,hasn ' t gone anywhere . > > Maybe you can help facilitate if there is still interest succession to a large degree . got held up and side tracked in and higher level . > > Bob > > sent from Gmail Mobile > AMERICAN PVERSIGHT VA-19-0799-H-000059 OS 00019362 Message From: (b) (6) Sent: 12/13/2017 8:35:17 PM David Shulkin [drshulkin@aol.com] Director Succession Concept for Sec DoD Fast-Track to MCD Concept Paper V3.docx To: Subject: Attachments: (b) (6) (b) (6) gmail.com] Hi Dr Shulkin, Bob mentioned you asked about this idea for succession for MCD roles. Sharing if there is an appetite. (b) 1111 (6) From: Callahan , Robert W . JR . VHALEB Sent: Tuesday, December 12, 2017 1:53:24 PM (b) (6) To: (b) (6) Subject: Director Succession Concept for Sec -(b) (6) here ' s the proposal we discussed about how to solve Director succession to a large degree . I was working with folks in HLTI to develop and I hear the proposal got held up and side tracked in WFM, hasn 't gone anywhere . Maybe you can help facilitate if there is still interest and higher level. Bob Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000060 OS 00019363 CONCEPT PAPER FAST-TRACKING DOD HEALTHCARE EXECUTIVES FOR MEDICAL CENTER DIRECTOR POSITIONS Background One of the prime sources for VHA to find healthcare leadership talent is the Department of Defense (DoD). There are just under 60 military medical centers/hospitals and over 370 medical clinics worldwide . Each is led by a team of healthcare professionals in a similar pattern to VHA's medical center executive leadership teams. Upon separation or retirement, many of these seasoned leaders apply for VHA facility quad or director positions. Unfortunately, they do not always compete well against internal VHA candidates who are familiar with the OPM executive core qualifications and are able to convey their experiences in the context of the VHA healthcare system structure, processes and issues . In 2016, VHA began advertising Medical Center Director (MCD) positions in groups rather than one vacancy at a time. This enabled hiring managers to better align the candidates with the available positions and gave candidates flexibility to roll their applications from one vacancy announcement to another . However, as a general rule, the "silver medalists" - those who made the Best Qualified (BQ) list but were not selected - were dropped from further consideration. The internal candidates in this group continue to serve VHA whether or not they apply for a directorship again . The prior military officers generally walk away, resulting in a loss of potential leadership talent for VHA. Mr. Bob Callahan, Lebanon VAMC MCD, raised this idea while in conversation with the Secretary during a site visit and at the Annual VA Senior Leaders Meeting in Leesburg. Mr. Callahan proposed that VHA craft a way to tap and further develop the DoD leadership resource as one strategy to build a stronger and more viable pipeline to meet MCD shortages in VHA. This proposed initiative builds on Mr. Callahan's proposal. It seeks to prevent the loss of high potential prior military healthcare leaders who have not had a chance to become acclimated to the VHA system and contribute to its mission . It proposes using the current MCD hiring process to identify high-potential leaders from the DoD sector and place them in an orientation/training internship with the expressed intent of having them move into an MCD position upon successful completion of the program. Initiative Concept Description Purpose: To provide a structured learning pathway for prior military executive-level healthcare leaders to transition into VHA, gain needed VHA-specific knowledge and experience, and be placed in or compete favorably for VHA MCD positions . AMERICAN PVERSIGHT VA-19-0799-H-000061 DS 00019364 FAST-TRACKING FROM DOD TO MCD 2 Goals: o Decrease the "opportunity loss" to meet VHA executive staffing needs with top tier healthcare leadership talent coming out of DoD. o Facilitate the transition of prior military officers into the VHA system and increase the likelihood of their long-term success. o Strengthen the leadership and technical competencies of newly hired VHA executives from DoD sources to match the VHA environment. o Build more connections between VHA and DoD to support VHA future staffing needs . Scope: A total of five to ten prior military health care leaders would participate per year, depending on the number of BQ candidates identified through the MCD hiring process. This would be an individualized program-participants would not form a class or cohort. Each participant would be on their own learning timeline based on a thorough assessment of their developmental needs. Costs: Salary and travel necessary to support the acquisition of the knowledge, skills and experiences outlined in the training portfolio. Estimated costs per person are: o Salary - $120-185K /participant for 6-18 months in program (GS-15/1 + "all US" locality pay). o Training - $9-1 BK for 30-60 total days TOY outside assigned training facility. o Total Cost - $129K-$203K per participant Program costs will be borne or shared directly or indirectly (reimbursement) by the following offices: o The facility or VISN where the trainee is assigned o Corporately through 1ON o Corporately through the Center for Leadership Development (formerly HLTl) Participant Selection: Individual participants will be selected from prior military applicants for VHA MCD positions who met the announcement's requirements and made it to the first round of interviews or beyond (to the BQ level). The MCD panels and/or Executive Review Board (ERB) will nominate potential participants through the DUSHOM for USH approval. Nomination criteria include a strong, proven track record of progressive healthcare leadership positions and a drive to continue service to the Veteran population . The Workforce Management and Consulting (WMC) office Executive Recruitment team will extend offers to potential candidates that explain the program, participation expectations, appointment status, VAMC location where they will be assigned for the duration of the program, and potential steps upon completion of the training portfolio. AMERICAN PVERSIGHT VA-19-0799-H-000062 DS 00019365 3 FAST-TRACKING FROM DOD TO MCD Participant Status: Program participants will be placed on temporary appointments NTE 18 months in positions at the GS15 level, during which the incumbent is expected to advance to an SES position either competitively or through a direct placement. BQ candidates for MCD positions have met the eligibility requirements for an SES position. However, OPM policies limit VHA's ability to place individuals in an SES position who are not performing the duties of an SES. GS-15 positions have fewer limitations, but are in limited supply. Position of Assignment: There are several options for assigning the participants to a position. o Create a pool of temporary NTE positions, hold at WMC, and tap when needed for program use only. (preferred) o Double-encumber the Director (SES) position at the VAMC selected as the participant's training site. o Double-encumber the Associate Director positions at the VAMC selected as the participant's training site. o Create an Associate Director position at selected training sites specifically for use with the program. o Assign the participant against any vacant Associate Director position in VHA, although this may impact the permanent hiring process for the vacancy. Program Oversight: Policy and direction for the program will come from the USH jointly through the DUSHOM and ADUSH for Workforce Services . The program will be included in the leadership development initiatives monitored by the NLC Workforce Committee. An ad hoc Executive Steering Committee will assist in outlining the knowledge, skill and ability expectations to guide creation of MCD fast-track training plan; identify the designated training sites; and define the periodic and end-of-program participant evaluation process. HLTl will provide program management support and work in conjunction with WMC to successfully implement the program. WMC will be the primary interface between VHA and the program candidate until they are hired and brought on board. Location Selection: Five to 10 host location options will be identified by the Executive Steering Committee in consultation with the respective MCDs and NDs, and approved by the DUSHOM. Consideration will be given to location, complexity level, executive staffing situation distinction of the assigned leadership, and challenges currently confronting the VAMCs. AMERICAN PVERSIGHT VA-19-0799-H-000063 DS 00019366 FAST-TRACKING FROM DOD TO MCD 4 Participant Learning: The local MCD will serve as the participant's supervisor and Preceptor . Within the first week on the job, participants will complete a detailed skills inventory based on the MCD competency model covering the leadership and technical standards for MCD positions. In addition, they will complete one or more leadership assessments, as selected by NCOD or HLTl. Within two weeks, a three-member panel consisting of two MCDs (Preceptor +1) and an ND will conduct an in-depth interview with the participant to determine their specific skill development needs and discuss developmental options. The Preceptor will use the results of the skills inventory, leadership assessments, the interview, and the core training guide prepared by the Executive Steering Committee to develop an individual learning plan for the participant. The plan will be created within the participant's first month on the job. It will cover a broad array of experiential learning events to expose the participant to all facets of MCD leadership. It will include rotational assignments within the medical center, specific learning projects or activities, and anticipated TDYs to other designated medical centers for expressed learning purposes. Also included in the training plan will be ECO preparation, interviewing techniques, and appropriate VHA-oriented leadership coursework, such as ones in Servant Leadership or the ILEAD model. Program participants will complete the DOD Indoctrination Training session hosted by Lovell VAMC. They will meet at least weekly with their Preceptors to review progress, discuss issues and reflect on the MCD's decision-making process . Quarterly review sessions will be held with the participant and the three-person panel referenced above. Program Completion: The Preceptor will call for a competency review when he/she deems the participant has successfully completed the training plan and demonstrated a readiness for an MCD position. The review will be conducted by the same or similar 3person panel that did the initial skills assessment interview. The panel will make one of three recommendations: o Ready to advance - WMC will work to inject the participant into the competitive MCD hiring process or place the individual using direct hire authorities. o Continue development - the Preceptor will create an amended training plan to focus on those areas the panel found lacking in the participant's readiness . o Withdraw from training - this will occur if the participant hits the end of their NTE appointment without meeting the expected MCD readiness standards, or when it becomes apparent they do not have the enabling skills for an MCD position within the near future . WMC may attempt to find a suitable position for the participant at the GS-14/15 level before initiating their release from VHA. Conclusions AMERICAN PVERSIGHT VA-19-0799-H-000064 DS 00019367 5 FAST-TRACKING FROM DOD TO MCD VHA has lost numerous high-quality candidates for its senior VAMC executive positions by failing to leverage the available pool of leaders coming from DoD who apply to become an MCD, but are not selected. The idea of placing "silver medalist" candidates into a temporary position for 6-18 months to learn "the VHA way" has great potential to tap this resource, strengthen the leadership pipeline, and help VHA fill its MCD positions with capable leaders. The proposed program focuses on growing through exposure and experiences the leadership and technical competencies needed to be a successful MCD. It is individualized to the specific needs of the participant. It can be scoped based on the pool of candidates who apply for MCD positions-offers would go to only those BQ candidates the selection panels and/or ERB deem to have the potential to succeed with the training and experiences provided by the program. The standards, training activities, and readiness assessments are driven by current MCD and ND leaders. Even if a participant does not progress to the level needed for an MCD appointment, VHA still can benefit by keeping the person on board in a different leadership position or can release the individual from continued employment. Funding will be needed to cover participant salaries and TOY costs (i.e., $129K-$203K per participant). WMC will need to outline the HR-related components of the program, to include appropriate selection and appointment processes. Despite these few challenges, this initiative warrants VHA senior leadership support. Recommendations and Next Steps o WMC determine the viability of the program from an HR perspective, outline HR options and recommendations to meet initiative goals, define the grades, and secure the positions for the trainees. (October 2017) o The NLC Workforce Committee review, approve and incorporate the initiative into its oversight portfolio. (October 2017) o The DUSHOM, USH and NLC discuss and lend their individual and group support to the initiative. (November 2017) o Establish the funding source(s) for the program. (October 2017) o The Executive Steering Committee is organized and meets to begin outlining program specifics, to include identifying potential VAMC training sites, creation of the training template and standards, and specifying the review and evaluation process. (September 2017) o First participant is assigned and begins training. (January, 2018) AMERICAN PVERSIGHT VA-19-0799-H-000065 DS 00019368 6 FAST-TRACKING FROM DOD TO MCD POC: Denise Deitzen, Executive Director, VHA Center for Leadership Development, vhah lticore@va.gov AMERICAN PVERSIGHT VA-19-0799-H-000066 DS 00019369 Message From: Sent: To: Subject: David shulkin [Drshulkin@aol.com] 11/26/2017 11:08:24 PM otmail.com] Poonam Alaigh (b) (b)(6)(6) Re: This weekend Nice note from Dennis - one of the few class acts at VA Sent from my iPhone (b) (6) (b) (6) > on Nov 26, 2017, at 6:05 PM, Poonam Alaigh <-otmail .com> wrote: > > Has been so painful and emotional as I have been going thru the VA stuff and forever storing it away this is a card I opened today from Dennis- brought tears . David I am hoping that I heal soon for everyone's sake- still so raw > > > > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000067 OS 00019370 Message (b) (6) From: (b) (6) (b) (6) Sent : 11/10/2017 7:03:17 PM To : David Shu Ikin (drshulkin@aol.com] Fwd: Secretary Shulkin Subject: gmail.com) FYA , I sent. ---------- Forwarded message--------(b) (6) From : -@Bruce Moskowitz,MD (b) (6) Date: Fri, Nov 10, 2017 at 1:50 PM Subject: Secretary Shulkin (b) (6) (b) (6) (b) (6) To : (b) (6) ail.com> (b) (6) (b) (6) ail.com> (b) (6) Is it possible for you to send me the official contact information for Secretary ShuJkin? All I have is an email ., a friend of Dr. Moskowitz's , would like to contact him. address and-(b) (6) As always, thanks for your help! - (b) (6) (b) (6) ,MPA Patient Care Coordinator Dr. Bruce Moskowitz , MD Victor Ferris Medical Building (b) (6) (b) (6) (b) (6) Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000068 DS 00019371 Message From: Sent : David shulkin [Drshulkin@aol.com] 11/9/2017 2:45 :57 AM Poonam Alaigh (b) otmail .com! (b)(6)(6) Re: New normal To : Subject: Hang in there Sent from my iPhone - (b)(6)(6) Oo No v 8, 2017 , at 6:50 PM, Poonam Alaigh (b) > wrote ; There are simply no two people with the same intellectual capacity, energy and creativity like us to make great things happen. I have had to adlust so tremendously to a new normal David- lt is tough right now,. hoping we will be able to work together again at some point. Not really enjoying this but have no choice right now. AMERICAN PVERSIGHT VA-19-0799-H-000069 DS 00019372 Message From: Sent: To: Subject: Poonam Alaigh (b) otmail.com] (b)(6)(6) 11/8/2017 11:50:21 PM David Shulkin [drshulkin@aol.com] New normal There are simply no two people with the same intellectual capacity, energy and creativity like us to make great things happen. I have had to adjust so tremendously to a new normal David- it is tough right now, hoping we will be able to work together again at some point. Not really enjoying this but have no choice right now. AMERICAN PVERSIGHT VA-19-0799-H-000070 OS 00019373 Message To : Poonam Alaigh (b) otma il.com] (b)(6)(6) 11/8/2017 9:34:43 PM David shulkin [Drshulkin@aol.com] Subject: Re: Fw: From: Sent : I think she could be really valuable in our HIC or as a back up, the SICprogram- she would do surveys in all our facilities and so knows how to mitigate risk and identify the low performing facilities with recommendations . and track ing followups From: David shulkin Sent: Wednesday7 November 8, 2017 4:17 PM To: Poonam Alaigh Subject: Re: Fw: I will followup Sent from my iPhone (b) (6) (b) (6) wrote : On Nov 8, 2017, at 2;26 PM, Poonam Alaigh ~ What do you think (b) (6) From: -(b) (6) mail.com > Sent: Wednesday, November 8, 2017 11:13 AM (b)(6)(6) To:~(b) Subject: Hi Dr. Alaigh, I hope you are doing well with your new exciting role, per our previous text , I want to let you know I have given PVA my resignation notice. My last day will be November 30, 2017 . I am searchi ng for new opporl:t.Jnity hoping to stay in Veterans healthcare space which I have enjoyed for over 25 years. I am attaching me resume for your reference, should you have any connection or recommendation . I would love to come and work for Dr. Shulkin or Dr. Clancy if possible? I understand VAMC system so well I would be a .great additlon to VA. At the end of the day I feel good about my decision, I stand for something important through tough time like this. Thank you so much for your help, if nothing else I appreciate knowing you in short amount of time. You empower women like me. Respectfully, (b) (6)(b) (6) (b) (6)(b) (6) ~2017 AMERICAN PVERSIGHT (b) (6) resume-2.pdf> VA-19-0799-H-000071 DS 00019374 Message David shulkin [Drshulkin@aol.com] From: Sent : 11/8/2017 9:18:02 PM To: (b) (6) @va.gov Subject: Fwd: Fw: Attachments : (b) (6) (b) (6) 2017 resume-2.pdf; Untitled attachment 79061.htrn Print Sent from my iPhone Begin forwarded message : (b) (6) From: Poonam AJaigb (b) (6) Date: November 8, 2017 at 2 :26 :25 PM EST To: David Shulkin Subject: Fw: > What do you think From:-(b) (6) (b) (6) mail.com > Sent: Wednesday, November 8, 2017 11:13 AM (b)(6)(6) To:~(b) Subject: Hi Dr. Alaigh, I hope you are doing well with your new e,cciting role , per our previous text, I want to let you know I have .given PVA my res1gnat1onnotke . My last day will be November 30, 2017 . I am searching for new opportunity hoping to stay in Veterans healthcare space which I have enjoyed for over 25 years. I am attaching me resume for your reference, should you have any connection or recommendati on . I would love to come and work for Dr. Shulkin or Dr. Clancy if possible? I understand VAMC system so well I would be a great addition to VA. At the end of the day I feel good about my decision, I stand for something important through tough time like this . Thank you so much for your help, if nothing else I appreciate knowing you in short amount of time. You empower women like me. Respectfully, (b) (6)(b) (6) AMERICAN PVERSIGHT (b) (6) VA-19-0799-H-000072 DS 00019375 (b) (6), (b) (2) (b) (6) (b) (6) RN, BSN, MHA, CCM (b) (6) Objective (b) (6), (b) (2) Education (b) (6), (b) (2) Licenses & Certifications o (b) (6), (b) (2) o o o (b) (6) (b) (6) (b) (b) (6) (6) Professional Experience (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) A\llE:HICAN PVERSIGHT VA-19-0799-H-000073 OS 00019376 (b) (6), (b) (2) Professional Ex1>erience (continued) (b) (6), (b) (2) November 201.0-l;> resen t (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) Octobe.r 2008 - November 2010 (b) (6), (b) (2) (b) (6), (b) (2) Mar ch 2002 - Se]Jtember 2008 (b) (6), (b) (2) o o o (b) (6), (b) (2) (b) (6), (b) (2) o o o o A\11~HICAN PVERSIGHT VA-19-0799-H-000074 DS 00019377 (b) (6), (b) (2) Professional Experience (continuedl) _______ (b) (6), (b) (2) o --------;Nu:o=v=em:ib;::e:::--r li19w9"ii7 =-J:Ja~n~. 224JOio:022 ___ _ (b) (6), (b) (2) o o o (b) (6), (b) (2) February 1991- October 1997 (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) January 1988 _ December 1990 (b) (6), (b) (2) o Accomplishments Awards & Hono rs o (b) (6), (b) (2) o o o o o AMr:HICAN PVERSIGHT VA-19-0799-H-000075 D8_ 00019378 (b) (6), (b) (2) Accomplishments (continued) Developer o (b) (6), (b) (2) o o Reviewer o (b) (6), (b) (2) o o Presenter o (b) (6), (b) (2) o Published Written Worl Sent from my iPhone (b)(6)(6) On Nov 8, 2017, at 2 :26 PM, Poonam Alaigh (b) wrote ; What do you think (b) (6) From: -(b) (6) mail.com > Sent: Wednesday , November 8, 2017 11:13 AM (b)(6)(6) To:~(b) Subject: Hi Dr. Alaigh, I hope you are doing well with your new exciting ro le, per our previous text, I want to let you know I have given PVA my resignation notice. My last day will be November 30, 2017 . I am searching for new opporh.Jnity hoping to stay in Veterans healthcare space which I have enjoyed for over 25 years . I am attaching me resume for your reference, should you have any connection or recommendation. I would love to come and work for Dr. Shulkin or Dr. Clancy if possible? I understand VAMC system so well I would be a great addit ion to VA. At the end of the day I feel good about my decision , I stand for something important through tough time like this. Thank you so much for your help, if nothing else I appreciate knowing you in short amount of time . You empower women like me. Respectfully, (b) (6)(b) (6) (b) (6)(b) (6) ~2017 AMERICAN PVERSIGHT (b) (6) resume-2 .pdt> VA-19-0799-H-000078 DS 00019381 Message From: Sent: To: Subject: Attachments: otmail.com] Poonam Alaigh (b) (b)(6)(6) 11/8/2017 7:26:25 PM David Shulkin [drshulkin@aol.com] Fw: 2017 resume-2 .pdf (b) (6) (b) (6) What do you think (b) (6) From:-~@gma (b) (6) il.com> Sent: Wednesday, November 8, 2017 11:13 AM (b) (6) (b) (6) To: _,otma il.com Subject : Hi Dr. Alaigh, I hope you are doing well with your new exciting role, per our previous text , I want to let you know I have given PVA my resignation not ice. My last day will be November 30, 2017. I am searching for new opportunity hoping to stay in Veterans healthcare space wh ich I have enjoyed for over 25 years. I am attach ing me resume for your reference , should you have any connect ion or recommendation . I would love to come and work for Dr. Shulkin or Dr. Clancy if possible? I understand VAMC system so well I wou ld be a great addition to VA. At the end of the day I fee l good about my decision, I stand for someth ing important through tough time like this . Thank you so much for your help, if nothing else I appreciate know ing you in short amount of time . You empower women like me. Respectfully, (b) (6)(b) (6) (b) (6) AMERICAN PVERSIGHT VA-19-0799-H-000079 OS 00019382 (b) (6), (b) (2) (b) (6), (b) (2) (b) (6) RN, BSN, MHA, CCM (b) (6) Objective (b) (6), (b) (2) Education (b) (6), (b) (2) Licenses & Certifications o (b) (6), (b) (2) o o o (b) (6) (b) (6) (b) (b) (6) (6) Professional Experience (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) A\llE:HICAN PVERSIGHT VA-19-0799-H-000080 OS 00019383 (b) (6), (b) (2) Professional Experience {continued) (b) (6), (b) (2) (b) (6), (b) (2) o ovember 2010-Presenf (b) (6), (b) (2) o (b) (6), (b) (2) (b) (6), (b) (2) October 2008 - November 2010 o (b) (6), (b) (2) o o o (b) (6), (b) (2) March 2002 - Se-J)tember 2008 (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) A \llr:HICAN PVERSIGHT VA-19-0799-H-000081 D8_00019384 (b) (6), (b) (2) Professional Experience (continued) (b) (6), (b) (2) o November 1997 -Jan. 200l (b) (6), (b) (2) o o o (b) (6), (b) (2) February 1991- October 1997 (b) (6), (b) (2) (b) (6), (b) (2) o o o (b) (6), (b) (2) (b) (6), (b) (2) o January 1988- December 1990 (b) (6), (b) (2) o Accomplishments (b) (6), (b) (2) A \llr:HICAN PVERSIGHT VA-19-0799-H-000082 DS_00019385 (b) (6), (b) (2) Accomplishments (continued) Developer o o (b) (6), (b) (2) o Reviewer o o (b) (6), (b) (2) o Presenter o (b) (6), (b) (2) o Published Writfon Works o o o o o o o (b) (6), (b) (2) o Volunteer Ex erieoce o (b) (6), (b) (2) o o AM~HICAN PVERSIGHT VA-19-0799-H-000083 D8_00019386 Message Poonam Alaigh (b) otma il.com ] (b)(6)(6) 11/7/2017 7:59:04 PM David ShuIkin (drshulkin@aol.com] Fwd: The VA From: Sent : To : Subject: Sent from my iPhone Begin forwarded message : From: Donovan Slack (b) (6) c ail .com > Date: November 7, 2017 at 12:00:47 PM EST (b) (6) To: Poonam Alaigh - (b) (6) Subject: Re: Fw: The VA yep, shes fishing for confirmation of a rumor. Donovan Slack Reporter USA TODAY (202) 4 15-9493 On Tue , Nov 7, 2017 at 11 :58 AM, Poonam Alaigh (b) (6) (b) (6) > wrote : See below as per our conversation- tha nks (b)(6)(6) From: Poonam Alaigh (b) emed artners.com > Sent: Tuesday, November 7, 2017 11:57 AM (b)(6)(6) To:~(b) Subject: Fwd: The VA ---------- Forwarded message ---------From: Shannon Vavra~>(b) (6) Date: Tue, Nov 7, 2017 at 10 :23 AM Subject : The VA (b)(6)(6) To: (b) artners .com Hi th re, f, mune is ' h :umon Vavn1 and I'm a repot 1er al . xios. I am reachin g 0 111:11>0111:1 tip Ir ccived nl>0111(b) (6) volving \' J\ leadership . I'd like to figure ou 1 i ( thete',; anything to 1his, wo\ild you be comfo1:13b)e1allcing10 rne ~bo111 1his? We can fig111 :e 0111 AMERICAN PVERSIGHT VA-19-0799-H-000084 DS_00019387 con fiden ti~liLytha 1 would . make you feel co mfor l:1ble iCyou like. f7e I free wh ich ha., end , L<;>-end encryp1jon , 1.0 t-encb ou l to me O il my cell (b) (6) ox O il ignnl, Shannon Shannon Vavra News Desk Reporter, A~ios 773(b) (6) (b) (6) ra)axios.com 11-:!1,1111 ,;1o The info rmation contained in this transm ission and any attachments may be cotifidential, proprietary or privi leged, and may be subject to protection under appl icable law . Th is transmission is intended for the sole use of t he individua l or entity to whom it is addressed . If you think you have received this transmission in error , please alert compliance@remedypartners.com and then delete this e-mail immediate ly . Thank you. AMERICAN PVERSIGHT VA-19-0799-H-000085 DS_00019388 Message David shulkin lDrshulkin@aol.com] 11/7/2017 3:13:22 AM (b) (6) (b) (6) Poonam Alaigh ???J1otmail.com] Re: PleasEUR be Our Guest : 11th Annual IAVAHeroes Gala Nov. 9th From: Sent: To : Subject: lts a nice event Sent from my iPhoae (b) (6) (6) On Nov 6, 2017 , at 9:57 PM, Poonam Alaigh - (b) wrote : Yaay- invited to a Veterans Celebration- was feeling so down that I was going to miss out on it- there most definitely exists is a supernatural power- Boomerang! (b) (6), (b) (2) (b) (6) From:-~> Sent: Monday, November 6, 2017 5:41 PM (b) (6) (b) (6) To~~ Cc:-(b) (6) Subject: Please be OurGuest: 11th Annual IAVA Heroes Gala Nov. 9th Hello Dr. Al.aigh, I certainly miss seeing you at VACO! I would like to invite you, as our guest, to the 11th Annual IAVA Heroes Gala at Cipriani 42nd St this Thursday, November 9th. I am excited to share that we will be honoring Medal of Honor recipient and Retired Army Captain Florent Groberg, Former VA Secretary Robert McDonald, .and Community Solutions President Rosanne Haggerty. We will also be joined by special guests Stephen Colbert, Meghan McCain and Willie Geist. It is going to be a great evening! (b) To confirm your one complimentary ticket please RSVPto ~ (6) Tuesday, November 7. no later than Event details are in the attached, and availab le on line here . Please let me know if you have any questions. Thanks so much . We hope you can join us! - (b) (6) (b) (6), (b) Director, Political and Intergovernmental Affairs (2) Iraq and Afghan1stan Veterans of Amerlca (IAVA) 777 North Capitol Street , NE, Suite 403 Wash 1ngton , DC 20002 AMERICA PVERSIGHT VA-19-0799-H-000086 DS 00019389 (b) (6) !AVAI Twitter I Facebook I lnstagram IA VA has been making historic impacts on behalf of the veteran community for over a decade . Help support our fight! <2017 IA VA Veterans Heroes Gala Invitation.pdf.> AMERICAr-... pVERSIGHT VA-19-0799-H-000087 D8_00019390 M essage David shulkin LDrshu ikin@aol.com ] From : Sent : 11/7/20 17 2:50 :04 PM To : Poon am Alaigh (b) (b)(6)(6) Re: W eb Subject : ot mail.comJ Yes Sent from my iPhone (b)(6)(6) On N ov 7. 20 17, at 7:42 AM, Poonam Alaigh ~(b) > wrote : Its inte resting how even the web knows that we are no longer a team - fo r the firs t ti me in th e last 6 years, you r name does not appear in the "People Also Viewed" category on my linkedin profile AMERICAN PVERSIGHT VA-19-0799-H-000088 DS 00019391 Message From: Poonam Alaigh (b) (b)(6)(6) otmail.com] Sent: 11/7/2017 12:42:58 PM To: David Shulkin [drshulkin@aol.com] Web Subject: Its interesting how even the web knows that we are no longer a team- for the first time in the last 6 years, your name does not appear in the "People Also Viewed" category on my linkedin profile AMERICAN PVERSIGHT VA-19-0799-H-000089 OS 00019392 Message Poonam Alaigh (b) (b)(6)(6) From: otmail.com] Sent: 11/8/2017 2:35:21 PM To: DavidShulkin [drshulkin@aol.com] Re: Significant Subject: But I do need to talk to you soon when both you and I are not pressed for time- give me a few options Sent from my iPhone (b) (6) (b) (6) > on Nov 8, 2017, at 7:12 AM, Poonam Alaigh <-otmail .com> wrote: > > David if there is anything ever significant related to the va you think I should know of- just let me know. I need to be moving on and detaching myself from it so won' t be in the loo p with anything anymore > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000090 OS 00019393 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 11/8/2017 2:12:40 PM Poonam Alaigh (b) ot mail.com] (b)(6)(6) Re: Significant Ok Sent from my iPhone (b) (6) (b) (6) > on Nov 8, 2017, at 7:12 AM, Poonam Alaigh <-otmail .com> wrote: > > David if there is anything ever significant related to the va you think I should know of- just let me know. I need to be moving on and detaching myself from it so won' t be in the loop with anything anymore > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000091 OS 00019394 Message (b) (6) (b) (6) Poonam Alaigh [-hotmail.com] 11/2/2017 1:31:44 PM From: Sent : David ShuIkin (drshulkin@aol.com] Fwd: Hope sent you a new message To : Subject: lfyou get a chance to call me after 6 :30pm- call, Hope from the AP wants to do some good news stories and I can give her some stuff but wanted to brainstorm with you if possible-if not, will still do it. See below Sent from my iPhone Begin forwarded message : From: Linkedln Messaging Date: November 2, 2017 at 9 :18:18 AM EDT (b) (6) (b) (6) To: Poonam Alaigb ~ Subject: Hope sent you a new message Reply-To: Linkedln Messaging Im Poonam Alaigh ? ~ You have unread messages from Hope 1=-1 HopeYen Sure no problem Talk to you tomorro w and regards Opportuni ty is always within reach. Get the Linkedln app. o AMERICAN PVERSIGHT iOS . Android VA-19-0799-H-000092 OS 00019395 Etna are Isis/:3? A: Agassi 231113;} This ?211,351}, Wz-??ii ii?ai??d?c?i ikya?f?i?rx?araain {Am -r -, 03133351? at)? a: 131 13.3? zaei'mrmraij?k??a i3 ?Ufai?if?iL 'EifoM} 1? a lags: am: ifegistm'a? ira?a?mm: Eimix: :ivazi?aua; Eur-1?s 3:131:35 {3:52 Lii'aigcim and 3? Message From: David shulkin [Drshulkin@aol.com] Sent: 11/2/2017 1:23:55 PM To: (b) (6) Poonam Alaigh [_,otmail.com] (b) (6) Subject: Re: Hope you saw me in boston- im with Jennie and speaking today at harvard law Glad to be out of DC- the IG is toturing me Sent from my iPhone (b) (6) (b) (6) > on Nov 2, 2017, at 9 :10 AM, Poonam Alaigh <-otmail > > saw you in my dream last night- .com> wrote: hope you are well > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000094 OS 00019397 Message From: Sent : To : David shulkin LDrshulkin@aol.com] 11/ 19/20 17 8 :07 :10 PM Poonam Alaigh (b) otma il.com! (b)(6)(6) Subject: Re: Ive been telling you Sent from my iPh one - (b)(6)(6) On N ov 19, 2 017, at 2:37 PM , Poonam Alaigh (b) > wr ote : o(b) just returned fr om India last night and he to ld me that he got a phone call from Buzzfeed (6) last week on his cell phone whi le he was t here with some questions regardi.ng the VA. He told them he couldnt ta lk since he was overseas- but th is fab rication st uff doesnf seem to be dying down , Also, his number is unlisted , so dont know how t hey got his cell# AMERICAN PVERSIGHT VA-19-0799-H-000095 DS 00019398 Message From: Sent: To: Poonam Alaigh (b) otmail.com] (b)(6)(6) 11/19/2017 7:37:54 PM David Shulkin [drshulkin@aol.com] (b) .just returned from India last night and he told me that he got a phone call from Buzzfeed last week on his (6) cell phone while he was there with some questions regarding the VA. He told them he couldnt talk since he was overseas- but this fabrication stuff doesnt seem to be dying down. Also, his number is unlisted, so dont know how they got his cell# AMERICAN PVERSIGHT VA-19-0799-H-000096 OS 00019399 Message Davidshulkin [Drshulkin@aol.com] From: Sent : 11/25/2017 1:50 :05 PM To : Darin Selnick(b) (6) @gmail.com] Re: Rep Lamborn Veterans Empowerment Act Subject : Ok lets touch base Sent from my iPhone > on Nov 25, 2017, at 12:43 AM, Darin selnick (b) (6) gmail . com> wrote: > > Hope you are having a great Thanksgiving . > > Attached is the Rep Lamborn, Veterans Empowerment Act introduced this week. > > Here is the part you will > > > > > > > > > > > > > > > like the most , VA as secondary payer to Medicare and TRICARE. ' '( c) SECONDAR Y PAYER.12 ' ' (1) IN GENERAL . -Notwithstanding any other 13 provision of law, any health plan (including the 14 Medicare program under title XVIII of the social 15 security Act (42 u.s . c. 1395 et se q.) or a State 16 plan under title XI X of such Act (42 u . s . c . 1396 17 et se q . ) and the TRICAREprogram under chapter 18 55 of title 10) under which an eligible individual is 19 covered shall be responsible for the payment of costs 20 for any health care received by an eligible individual 21 for a non- service connected disability up to the max22 imum amount allowable under such plan before the 23 Vetscare Federal program is responsible for any 24 such costs , if applicable. > > With this bill out there, all of the VA CAREAct becomes the moderate compromise. HVACand SVAChave left a lot out of their bills that VA and the Administration wants . Monday meeting with the staff directors is a good time to remind them they need to put it in if the y want our support for their bills . You can always be the good cop to the WHbad cop. > > Happy to discuss OLAand comm. strateg y with you next week if you want as I have been working closely with 0MB, WH > > Best > > Darin > VA-19-0799-H-000097 OS 00019400 Message From: Davidshulkin [Drshulkin@aol.com] 1:49 :15 PM Sent : 11/25/2017 To : Darin Selnick(b) (6) @gmail.com] Re: Rep Lamborn Veterans Empowerment Act Subject : Plus the aco is in there Sent from my iPhone > on Nov 25, 2017, at 12:43 AM, Darin selnic k (b) (6) gmail . com> wrote: > > Hope you are having a great Thanksgiving . > > Attached is the Rep Lamborn, Veterans Empowerment Act introduced this week. > > Here is the part you will > > > > > > > > > > > > > > > li ke the most , VA as secondary payer to Medicare and TRICARE. ' '( c) SECONDAR Y PAYER.12 ' ' (1) IN GENERAL . -Notwithstanding any other 13 provision of law, any health plan (including the 14 Medicare program under title XVIII of the social 15 security Act (42 u.s . c. 1395 et se q.) or a State 16 plan under title XI X of such Act (42 u . s . c . 1396 17 et se q . ) and the TRICAREprogram under chapter 18 55 of title 10) under which an eligible individual is 19 covered shall be responsible for the payment of costs 20 for any health care received by an eligible individual 21 for a non- service connected disability up to the max22 imum amount allowable under such plan before the 23 Vetscare Federal program is responsible for any 24 such costs , if applicable. > > With this bill out there, all of the VA CAREAct becomes the moderate compromise. HVACand SVAChave left a lot out of their bills that VA and the Administration wants . Monday meeting with the staff directors is a good time to remind them they need to put it in if the y want our support for their bills . You can always be the good cop to the WHbad cop. > > Happy to discuss OLAand comm. strateg y with you next week if you want as I have been working closely with 0MB, WH > > Best > > Darin > VA-19-0799-H-000098 OS 00019401 Message From: Darin Selnicl (b) (6) Sent: 11/25/2017 5:43:28 AM David shulkin [Drshulkin@aol.com] Rep Lamborn Veterans Empowerment Act lamborn_veterans_empowerment_act.pdf To: Subject: Attachments: @gmail.com] Hope you are having a great Thanksgiving. Attached is the Rep Lamborn, Veterans Empowerment Act introduced this week. Here is the part you will like the most , VA as secondary payer to Medicare and TRICARE . " (c) SECONDARYPAYER .12 " (l) IN GENERAL-Notwithstanding any other 13 provision oflaw , any health plan (including the 14 Medicare program under title XVIII of the Social 15 Security Act (42 U.S.C. 1395 et seq.) or a State 16 plan under title XIX of such Act (42 U.S.C. 1396 17 et seq.) and the TRICARE program under chapter 18 55 of title 10) under which an eligible individual is 19 covered shall be responsible for the payment of costs 20 for any health care received by an eligible individual 21 for a non-service connected disability up to the max22 imum amount allowable under such plan before the 23 VetsCare Federal program is responsible for any 24 such costs, if applicable . With this bill out there, all of the VA CARE Act becomes the moderate compromise. HVAC and SYAC have left a lot out of their bills that VA and the Administration wants. Monday meeting with the staff directors is a good time to remind them they need to put it in if they want our support for their bills . You can always be the good cop to the WH bad cop. Happy to discuss strategy with you next week if you want as I have been working closely with 0MB , WH OLA and Comm. Best Darin AMERICAN PVERSIGHT VA-19-0799-H-000099 OS 00019402 G:\M\15\LAMBOR\LAMBOR_039 .XML (Orig inal Signature of Membe r ) 115TH CONGRESS 1ST SBJSSION H.R. To amend tit le 38, United States Code, to establish the Veterans Accountable Care Organization and to provide veterans access to private health insur ance plans, and for other purposes . IN rrHE HOUSE OF1 REPRESEN rrA TIVES Mr. introduced the following bill; which was referred to the Committee on ------------ LAMBORN A BILL rro amend title 88, United States Code, to estab lish the Veterans Accountable Care Organization and to provide veterans access to private health insurance plans, and for other purposes. Be 1:tenacted by the Senate and House of Representa- 1 2 t ives of the United States of Anier ica in Congress assernbled) 1 3 4 1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS . This Act may be cited as the "Veterans Ernpower- 5 ment Act ''. AMf= g:\VHLC \1 1161 7\ 1116 17.095 .xml November 16, 20 17 (11 :53 a. m.) PVERSIGHT (68034713) VA-19-0799-H-000100 OS 00019403 G:\M\15\LAMBOR\LAMBOR_039 .XML 2 1 SEC . 2. ESTABLISHMENT 2 3 OF VETERANS ACCOUNTABLE CARE ORGANIZATION. (a) ESTABLISHMENT.- 4 (l) IN GENERAL.-Chapter 3 of title 38, United 5 States Code, is amended by adding at the end the 6 following new section: 7 "? 323. Veterans Accountable 8 "(a) Care Organization There is established the ESTABLISHMENT.-(1) 9 Veterans Accountable Care Organization (in this section 10 referred to as the 'Corporation'). 11 "(2) The Corporation is a federally chartered cor- 12 poration. 13 "(3) The Corporation shall be incorporated and domi- 14 ciled in the District of Columbia, or another nearby State, 15 as determined by the board of directors of the Corpora16 tion. 17 "( 4) The Corporation shall be a charitable and non- 18 profit corporation. 19 " ( 5) Except as otherwise provided, the Corporation 20 shall have perpetual existence. 21 "(b) PURP0SE.-The purpose of the Corporation is 22 to furnish high quality hospital care, medical services, and 23 other health care (excluding nursing home care and dorni24 ciliary care) to individuals eligible for such care and serv25 ices under laws administered by the Secretary. AMf g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000101 OS 00019404 G:\M\15\LAMBOR\LAMBOR_039 .XML 1 "(c) BOARD o:F'DIBECTORS.-(1) The powers of the 2 Corporation shall be vested in a Board of Directors that 3 governs the Corporation. 4 "(2) rrhe Board of Directors shall be composed of the 5 following members: 6 "(A) rrhe Secretary of Veterans Affairs. 7 "(B) Two members appointed by the Speaker of 8 the House of Representatives, 9 shall be a veteran. 10 at least one of whom "(C) Two members appointed by the Minority 11 Leader of the House of Representatives, 12 of whom shall be a veteran. at least one 13 "(D) rrwo members appointed by the -Majority 14 Leader of the Senate, at least one of whom shall be 15 a veteran. 16 "(E) Two members appointed by the 1\/finority 17 Leader of the Senate, at least one of whom shall be 18 a veteran. 19 "(F) Two members appointed by the President, 20 at least one of whom shall be veterans. 21 "(3) The President shall designate a member of the 22 Board of Directors to serve as Chairperson of the Board. 23 The Board shall select a Vice Chairperson from among 24 its members. AM f g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000102 OS 00019405 G:\M\15\LAMBOR\LAMBOR_039 .XML 4 1 "(4)(A) A member of the Board of Directors shall 2 serve for a term of five years, except that the members 3 first appointed shall be appointed for staggered terms as 4 the President considers appropriate to ensure that the 5 terms of no more than three members expire in the same 6 year. 7 "(B) Any member appointed to fill a vacancy occur- 8 ring before the expiration of the term for which the mem- 9 ber' s predecessor was appointed shall be appointed only 10 for the remainder of that term. A member may serve after 11 the expiration of that member's term until a successor has 12 taken office. A vacancy on the Board shall not affect its 13 powers, but shall be filled in the same manner in which 14 the original appointment was made. 15 '' (C) The term of each member may be renewed for 16 an additional term, except that in no case shall any mem17 her serve more than two consecutive terms exceeding ten 18 years. 19 "(D) During the absence or disability of the Sec- 20 retary of Veterans Affairs or in the event of a vacancy 21 in the office of Secretary, the Acting Secretary of Veterans 22 Affairs shall serve as the member of the Board of Direc23 tors specified in paragraph 24 "(d) DUTIES.-In (2)(A). carrying out subsection (b), the 25 Corporation shall- AM f g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000103 OS 00019406 G:\M\15\LAMBOR\LAMBOR_039 .XML 5 "(1) transfer 1 2 partment 3 pursuant 4 erans Empowerment Act; 5 of Veterans Affairs to the Corporation to subsection (b) of section 2 of the Vet- "(2) establish priorities, milestones, and 6 timelines, in consultation with the Secretary of Vet- 7 erans Affairs, for the termination of functions of the 8 Veterans directly related to 9 the furnishing of hospital care, medical services, and 10 other health care (excluding nursing home care and 11 domiciliary care) pursuant 12 section 2; 13 Health Administration 14 mg to service-connected 15 issues- 17 to subsection (c) of such "Un with respect to centers of excellence relat- 16 rnJunes and other medical "(A) continue to administer such centers previously established by the Secretary; and 18 AMf personnel and assets of the De- '' (B) establish and administer additional 19 such centers as the Board of Directors 20 mines appropriate. 21 "( 4) in consultation with the Secretary, deter- carry 22 out such other actions necessary to carry out this 23 section. 24 "(e) PCHVERS.-rrhe Corporation shall- 25 " ( 1) appoint employees; and g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000104 OS 00019407 G:\M\15\LAMBOR\LAMBOR_039 .XML 6 "(2) adopt a Constitution and bylaws consistent 1 2 with the purpose set forth under subsection (b). 3 "(f) DUTY TO JV[AINTAINCORPORATEAND T1LX-EX- 4 EMPT STATUS.-(1) rrhe Corporation shall maintain its 5 status as a corporation incorporated under the laws of the 6 District of Columbia or another nearby State, as deter7 mined by the Board of Directors. 8 "(2) The Corporation shall maintain its status as an 9 organization exempt from the Internal Revenue Code of 10 1986. 11 "(g) VETERANS ACCOUNTABLE CARE ORGANIZATION 12 FUND.-(1) There is in the Treasury a fund to be known 13 as the Veterans Accountable Care Organization F1 und (in 14 this subsection referred to as the 'F1 und'). 15 "(2) Amounts recovered or collected under chapter 26 16 of this title shall be deposited in the Fund. 17 "(3) Amounts in the Fund shall be available, without 18 further appropriation and without fiscal year limitation, 19 to establish and administer centers of excellence described 20 in subsection (d)(3) and for health care or medical services 21 furnished to a veteran at a facility operated by the Cor- 22 poration.". AMf 23 (2) CLERICAL AMENDMENT.-rrhe table of sec- 24 tions at the beginning of chapter 3 of such title is g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000105 OS 00019408 G:\M\15\LAMBOR\LAMBOR_039 .XML 7 1 amended by inserting after the item relating to sec- 2 tion 322 the following new item: "323. Veterans Accountable Care Organization.". 3 4 (l) TRANSFER-All of the personnel, property, 5 records, and unexpended balances of appropriations, 6 allocations, 7 available, or to be made available in connection with 8 the direct furnishing of hospital care, medical serv- 9 ices, and other health care (excluding nursing home 10 care and domiciliary care) to individuals eligible for 11 such care and services under laws administered by 12 the Secretary of Veterans Affairs are transferred to 13 the Veterans Accountable Care Organization 14 lished under section 323 of title 38, United States 15 Code, as added by subsection (a). 16 AM f (b) TRANSFER OF PERSONNEL AND ASSETS.- and other funds employed, used, held, (2) REDUCTIONIN FORCE.-The estab- Secretary may 17 implement a reduction in force in carrying out para- 18 graph (1). 19 (c) TERMINATIONOF ]?uNCTIONS.- 20 (l) IN GENERAL.-Except as provided by para- 21 graph 22 Health Administration 23 nishing of hospital care, medical services, and other 24 health care (excluding nursing home care and domi- 25 ciliary care) to individuals eligible for such care and g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (2), all of the functions of the Veterans directly relating to the fur - (68034713) VA-19-0799-H-000106 OS 00019409 G:\M\15\LAMBOR\LAMBOR_039 .XML 8 1 services under laws administered 2 shall terminate 3 ment of this Act. one year after the date of the enact- (2) EXTENSIONS.-The 4 by the Secretary Secretary of Veterans 5 Affairs may make not more than two 90-day exten- 6 sions to the termination 7 (1) if the Secretary notifies CongTess of such exten- 8 SlOnS. 9 (3) CERTIFICATION date specified in paragraph OF TERMINATION DATE.- 10 The Secretary shall certify to Congress the date on 11 which paragraph 12 (d) RECOlVIl\IENDATIONS ]'OR STATUTORY (1) is carried out. llMEND- 13 lVIENTS.-Not later than 180 days after the date of the 14 enactment of this Act, the Secretary shall submit to Con- 15 gress a report that contains recommendations for tech- 16 nical and conforming amendments to Federal statutes to 17 carry out this Act. 18 SEC. 3. ESTABLISHMENT 19 20 OF VETERANS HEALTH INSUR- ANCE PROGRAM. (a) ESTABLISHlVIENT.-Chapter 73 of title 38 ' 21 United States Code, is amended by adding at the end the 22 following new section: 23 "? 7309A. Veterans Health Insurance 24 "(a) ESTABLISHlVIENT.-There is established m the 25 Veterans Health Administration AMf g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT Program the Veterans Health In- (68034713) VA-19-0799-H-000107 OS 00019410 G:\M\15\LAMBOR\LAMBOR_039 .XML 9 1 surance Program (in this section referred to as the 'Pro2 gram'). 3 ''(b) DU'l'IES.-Under the Program, the Secretary 4 shall administer the provision of health insurance support 5 to veterans under chapter 26 of this title.". 6 (b) CLERICAL fuvIENDMEN'l' __ rrhe table of sections 7 at the beginning of chapter 73 of such title is amended 8 by inserting after the item relating to section 7309 the 9 following new item: "7309A. Veterans Health Insurance Program. " . 10 SEC. 4. DESIGNATION OF EXISTING AUTHORITIES FOR HOS11 PITAL 12 OTHER HEAL TH CARE. 13 (a) DESIGNA'l'ION.-Subchapter CARE, MEDICAL SERVICES, AND I of chapter 17 of 14 title 38, United States Code, is amended by inserting after 15 section 1701 the following new section: 16 "? 1701A. VetsCare Federal 17 authorities 18 services, 19 gram 20 for program: designation hospital care, and other "(a) IN GENERAL.-Effective health of medical care as pro- as of the date de- 21 scribed in section 2(c)(3) of the Veterans Empowerment 22 Act, the authorities for the provision of hospital care, med23 ical services, and other health care (other than nursing 24 home care and domiciliary care) in subchapter II of this 25 chapter and under any other law administered by the Sec- AM f g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000108 OS 00019411 G:\M\15\LAMBOR\LAMBOR_039 .XML 10 1 retary may be referred to as the 'VetsCare Federal pro2 gram'. 3 "(b) DESIGNATIONOF' RECIPIEN'l'S.-Effective as of 4 the date described in section 2(c)(3) of the Veterans Em5 powerment Act, any eligible individual who receives hos6 pital care, medical services, and other health care (exclud7 ing nursing home care and domiciliary care) in accordance 8 with the authorities referred to in subsection (a) after such 9 date may be referred to in the receipt of such care or serv 10 ices as participating 11 12 AM f in the 'Vets Care Federal program'. "(c) SECONDARYPAYER."(1) IN GENERAL.-Notwithstanding 13 prov1s10n of law, any health 14 lVIedicare program 15 Security Act (42 U.S.C. 1395 et seq.) or a State 16 plan under title XIX of such Act (42 U.S.C. 1:396 17 et seq.) and the TRI CARE program under chapter 18 5 5 of title 10) under which an eligible individual is 19 covered shall be responsible for the pa_yment of costs 20 for any health care received by an eligible individual 21 for a non-service connected disability up to the max- 22 imum amount allowable under such plan before the 23 V etsCare 24 such costs, if applicable. g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT plan any other (including the under title XVIII of the Social J?ederal program is responsible for any (68034713) VA-19-0799-H-000109 OS 00019412 G:\M\15\LAMBOR\LAMBOR_039 .XML 11 "(2) N0TIFICA'l'I0N.-The 1 2 and Human 3 any other head of a relevant department 4 of the J?ederal Government shall notify the Secretary 5 of Veterans Affairs of an eligible individual being 6 covered under a health plan described in paragraph 7 (1). 8 "(d) 9 Services, the Secretary of Defense, or TREATMENT OF EMPLOYER or agency SPONSORED HEALTH PLANS.- 10 AMf Secretary of Health "(1) IN GENERAL.-The pro-v1s10ns of section 11 1862(b)(3)(C) 12 1395y(b)(3)(C)) 13 or other incentives for an employee who is an eligible 14 individual not to enroll (or to terminate 15 under a health plan that would (in the case of such 16 enrollment) be responsible under subsection (c) for 17 the pay:ment of costs for hospital care, medical serv- 18 ices, or other health care received by the eligible in- 19 dividual for a non-service connected disability in the 20 same manner as such section 1862(b)(3)(C) 21 to financial or other incentives for an individual enti- 22 tled to benefits under title XVIII of the Social Secu- 23 rity Act (42 U.S.C. 1395 et seq.) not to enroll (or 24 to terminate 25 or a large group health plan which would (in the g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT of the Social Security Act (42 U.S.C. shall apply with respect to financial enrollment) applies enrollment) under a group health plan (68034713) VA-19-0799-H-000110 OS 00019413 G:\M\15\LAMBOR\LAMBOR_039 .XML 12 1 case of enrollment) be a primary plan (as defined in 2 section 1862(b)(2)(A) of such Act). 3 "(2) 4 regulation adopt such additional 5 prohibition described in paragraph 6 retary 7 shall be implemented taking into account the adop- 8 tion of such exceptions. 9 REGULA_TIONS.-The Secretary considers appropriate may by exceptions to the (1) as the Sec- and such paragraph "(3) AGREEMENTS.-The Veterans Accountable 10 Care Organization 11 Human Services may enter into agreements to carry 12 out this subsection. Any such agreement 13 vide that any expenses incurred by the Secretary of 14 Health and Human 15 out this subsection shall be reimbursed by the Vet- 16 erans Accountable Care Organization. 17 and the Secretary of Health and Services pertaining shall pro- to carrying "( 4) GROUP HEALTH PLAN DEFINED.-In this 18 subsection, the term 'gToup health plan' means a 19 group health plan (as that term is defined in section 20 5000(b)(l) 21 without regard to section 5000 (d) of the Internal 22 Revenue Code of 1986). 23 "(e) ELIGIBLE INDIVIDUALS.-An individual is eligi- of the Internal Revenue Code of 1986 24 ble to participate in the VetsCare ] 7 ederal program if such 25 individual was enrolled in the system of annual patient AM f g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000111 OS 00019414 G:\M\15\LAMBOR\LAMBOR_039 .XML 13 1 enrollment established and operated by the Secretary 2 under section 1705(a) of this title as of the date described 3 rn section 2 (c) (3) of the Veterans 4 Empowerment Act.". (b) CLERICAL fuvIENDMENT__ rrhe table of sections 5 at the beginning of such chapter is amended by inserting 6 after the item relating to section 1701 the following new 7 item: "l 701A. VetsCare Federal program: designation of authorities for hospital care, medical services, and other health care as program.". 8 SEC. 5. HEALTH INSURANCE SUPPORT FOR NEW VETERANS 9 AND VETERANS ELECTING HEAL TH INSUR- 10 ANCE SUPPORT IN LIEU OF ELIGIBILITY FOR 11 HOSPITAL 12 OTHER HEALTH CARE UNDER EXISTING AU- 13 THORITIES. 14 CARE, MEDICAL SERVICES, (a) IN GENERAL.-Part AND II of title 38, United States 15 Code, is amended by inserting after chapter 24 the fol16 lowing new chapter: "CHAPTER 26-VETERANS 17 INDEPENDENCE 18 "SUBCHAPTER "2601. "2602. "26m~. "2604. "2605. "2606. "2607. IN HEALTH CARE I-VETERANS GENERALLY VetsCare Choice program: designation of recipients. Eligibility. Qualifying health insurance. Health insurance support. 'l'reatment of other health plans. Receipt of health care through the Department. Pharmacy benefits. "SUBCHAP'l'ER II-MEDICARE-ELIGIBLE VE'l'ERANS "2611. VetsCare Senior program: designation of recipients. "2612. Medicare support. AM f g:\VHLC\111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000112 OS 00019415 G:\M\15\LAMBOR\LAMBOR_039 .XML 14 "Subchapter 1 2 "? 2601. VetsCare 3 I-Veterans Generally Choice program: designation of re- cipients . . f'or t h e prov1s10n . . " (a ) I N c~ :rENERAL.-. ~r~h . e aut 11onties 4 5 of health insurance support under this subchapter may be 6 referred to as the 'Vets Care Choice program'. 7 "(b) DESIGNATION OF RECIPIENTS.-Any 8 who receives health insurance veteran support under this sub- 9 chapter may be referred to in the receipt of support as 10 participating in the 'Vets Care Choice program'. 11 "(c) RELATIONSHIP TO CARE BY VETERANS Ac- 12 COUNTABLE CARE 0RGANIZATION.-Health insurance 13 support under this subchapter is in addition to any health 14 care or medical services furnished to a veteran at a facility 15 operated by the Veterans Accountable Care Organization. 16 "? 2602. Eligibility 17 "(a) IN GENERAL.-Except as provided in sub- 18 sections (c) and (cl), the following veterans shall be pro19 vided health insurance support under this subchapter: 20 AM f "(1) Veterans who first enroll in the system of 21 annual patient 22 by the Secretary under section 1705(a) of this title 23 on or after the date described in section 2(c)03) of 24 the Veterans Empowerment Act. g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT enrollment established and operated (68034713) VA-19-0799-H-000113 OS 00019416 G:\M\15\LAMBOR\LAMBOR_039 .XML 15 "(2) Veterans enrolled in such system as of the 1 2 date described in section 2(c)(3) 3 Empowerment 4 port under this subchapter 5 hospital care, medical services, and other health care 6 (excluding nursing home care and domiciliary care) 7 under the VetsCare Federal program under chapter 8 17 of this title or any other law administered by the 9 Secretary. 10 "(b) of the Veterans Act who elect health insurance ENROLLMENT.-The sup- in lieu of eligibility for Secretary shall admin- 11 ister- 12 "(1) 13 VetsCare 14 open enrollment period for the ] 1 ederal Employees 15 Health 16 8905(g); and 17 an open enrollment Choice program Benefits program period for that corresponds described rn the to the section "(2) special enrollment periods based on quali- 18 fying life events of veterans 19 under the Federal Employees Health Benefits Pro- 20 gram, except that the change of priority group shall 21 also be treated as a qualifying life event. 22 "(c) similar to such events EFFECT OF ELECTION.-vvnile an election 23 under subsection (a)(2) of a veteran described in that sub24 section is in effect, the veteran is not eligible for hospital 25 care, medical services, and other health care (excluding AMf g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000114 OS 00019417 G:\M\15\LAMBOR\LAMBOR_039 .XML 16 1 nursing home care and domiciliary care) under chapter 1 7 2 of this title or any other law administered by the Sec- 3 retary. 4 "(d) EXCEPTIONS.-r:rhe following veterans are not 5 eligible for health insurance support under this sub- 6 chapter: 7 " ( 1) Any veteran eligible for care under the 8 lVIedicare progTarn under title A~tII 9 Security Act (42 U.S.C. 1395 et seq.). 10 of the Social "(2) Any veteran who- 11 '' (A) first enrolls in the system of annual 12 patient enrollment established and operated by 13 the Secretary under section 1705(a) of this title 14 on or after the date described in section 2(c)(3) 15 of the Veterans Act; and 16 "(B) is in priority 17 group 7 or priority group 8. 18 "(e) COlVIlVIENCElVIENT OF AVAILABILITY OF Sur- 19 PORT.-Health insurance support under this subchapter 20 shall commence being available as follows: AM f 21 "(1) vVith respect to veterans in priority group 22 1, 2, or 3, on the first day of the first month that 23 begins on or after the date described 24 2(c)03) of the Veterans Empowerment Act. g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT in section (68034713) VA-19-0799-H-000115 OS 00019418 G:\M\15\LAMBOR\LAMBOR_039 .XML 17 "(2) vVith respect 1 to veterans in a priority 2 group other than 1, 2, or 3, on the first day of the 3 first month that begins on or after the date that is 4 180 days after the commencement date under para- 5 graph (1). 6 "(f) PRIORITY GROUP DEFINED.-ln this section, 7 the term 'priority group' means the priority groups estab8 lished by the Secretary for purposes of the enrollment of 9 veterans in the patient enrollment system under section 10 1705(a) of this title. 11 "? 2603. Qualifying health insurance 12 "Health insurance support may be provided under 13 this subchapter only for health plans that14 "(1) include the types of health care authorized 15 under section 1079 of title 10, United States Code; 16 and 17 "(2) provide such additional 18 erage as the Secretary 19 of this subchapter. 20 "? 2604. Health insurance 21 "(a) elements of cov- shall prescribe for purposes support IN GENERAL.-The Secretary shall provide 22 health insurance support to veterans eligible for such sup23 port under this subchapter through premium support 24 under subsections (b) and (c), cost-sharing support under 25 subsection (d), and alternative AM f g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT support under subsection (68034713) VA-19-0799-H-000116 OS 00019419 G:\M\15\LAMBOR\LAMBOR_039 .XML 18 1 (e) by paying or reimbursing such veterans for the costs 2 associated with such health insurance support. The Sec- 3 retary shall make such pa,y1nents or reimbursements in a 4 manner similar to the manner in which the Centers for 5 lVIedicare & _Medicaid Services make similar pa,yments and 6 reimbursements. 7 "(b) PREMIUM SUPPORT GENERALLY.-The pre - 8 mium support provided by the Secretary under this sub9 section is as follows: 10 any veteran with a service- 11 connected disability rated as 100 percent disabling, 12 health insurance support sufficient to provide bene- 13 fits to the veteran under a health plan that are actu- 14 arially equivalent to 100 percent of the full actuarial 15 value of the benefits provided under the health plan. 16 A health plan under this paragraph 17 to as a 'Tier 1 Plan'. 18 AM f "(1) TIER 1.-To "(2) TIER 2.-To may be referred any veteran in priority gToup 19 1 not covered by paragraph 20 priority group 2, health insurance support sufficient 21 to provide benefits to the veteran under 22 plan that are actuarially equivalent to 90 percent of 23 the full actuarial 24 under 25 paragraph g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (1) and any veteran in value of the benefits the health plan. A health a health provided plan under this may be referred to as a 'Tier 2 Plan'. (68034713) VA-19-0799-H-000117 OS 00019420 G:\M\15\LAMBOR\LAMBOR_039 .XML 19 1 "(3) TIER 3.-To 2 3 or priority group 4, health insurance support suffi- 3 cient to provide benefits 4 health plan that are actuarially equivalent to 80 per- 5 cent of the full actuarial value of the benefits pro- 6 vided under the health plan. A health plan under 7 this paragraph 8 Plan'. to the veteran may be referred "( 4) TIER 4.-To 9 under to as a 'Tier a 3 any veteran in priority group 10 5 or priority group 6, health insurance support suffi- 11 cient to provide benefits 12 health plan that are actuarially equivalent to 70 per- 13 cent of the full actuarial value of the benefits pro- 14 vided under the health plan. A health plan under 15 this paragraph 16 Plan'. to the veteran may be referred "(5) TIER 5.-To 17 AM f any veteran in priority group under a to as a a:rier 4 any veteran not in a priority 18 group covered by paragraphs 19 not 20 2602(d)(2) 21 sufficient to provide benefits to the veteran under a 22 health plan that are actuarially equivalent to 60 per- 23 cent of the full actuarial value of the benefits pro- 24 vided under the health plan. A health plan under g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT ineligible for such (l) through support of this title, health (4) and under section insurance support (68034713) VA-19-0799-H-000118 OS 00019421 G:\M\15\LAMBOR\LAMBOR_039 .XML 20 1 this paragraph 2 Plan'. 3 " (c) may be referred llDDI'l'IONAL 4 NEED.-rrhe PREMIUM to as a 'Tier SUPPORT BASED 5 ON premium support provided by the Secretary 5 under this subsection is as follows: 6 r:ro any veteran with an annual gross 7 household income that is less than 133 percent of 8 the poverty line, health insurance support sufficient 9 to cover any costs of such monthly premium that are 10 more than 2 percent of the monthly gross household 11 income of the veteran. 12 "(2) To any veteran with an annual gross 13 household income that is between 133 percent and 14 150 percent 15 support sufficient to cover any costs of such monthly 16 premium 17 monthly gross household income of the veteran. 18 "(3) that of the poverty line, health insurance are more than To any veteran with 3 percent of the an annual gross 19 household income that is between 150 percent and 20 200 percent 21 support sufficient to cover any costs of such monthly 22 premium 23 monthly gross household income of the veteran. 24 25 AMf "(1) g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT that of the poverty line, health insurance are more than "( 4) r:ro any veteran 4 percent of the with an annual gross household income that is between 200 percent and (68034713) VA-19-0799-H-000119 OS 00019422 G:\M\15\LAMBOR\LAMBOR_039 .XML 21 1 250 percent 2 support sufficient to cover any costs of such monthly 3 premium 4 monthly gross household income of the veteran. 5 "(5) that of the poverty line, health insurance are more than r:ro any veteran 6.3 percent of the with an annual gross 6 household income that is between 250 percent and 7 300 percent 8 support sufficient to cover any costs of such monthly 9 premium 10 that of the poverty line, health insurance are more than 8.05 percent of the monthly gross household income of the veteran . "(6) 11 To any veteran with an annual gross 12 household income that is between 300 percent and 13 400 percent 14 support sufficient to cover any costs of such monthly 15 premium 16 monthly gross household income of the veteran. 17 "(d) that of the poverty line, health insurance are more than 9.5 percent COST-SHARING SUPPORT.-The of the cost -sharing 18 support provided by the Secretary under this subsection 19 is as follows: 20 AMf "(1) To any veteran with an annual gross 21 household income that is less than 150 percent of 22 the poverty line, health insurance support sufficient 23 to cover cost-sharing in order to ensure that the ef- 24 fective minimum actuarial value of the benefits pro- g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000120 OS 00019423 G:\M\15\LAMBOR\LAMBOR_039 .XML 22 1 vided under the health plan of the veteran is not less 2 than 94 percent. 3 "(2) with an annual gross 4 household income that is between 150 percent and 5 200 percent 6 support sufficient to cover cost-sharing 7 ensure that the effective minimum actuarial value of 8 the benefits provided under the health plan of the 9 veteran is not less than 87 percent. 10 "(3) of the poverty line, health insurance To any veteran with in order to an annual gross 11 household income that is between 200 percent and 12 250 percent 13 support sufficient to cover cost-sharing 14 ensure that the effective minimum actuarial value of 15 the benefits provided under the health plan of the 16 veteran is not less than 73 percent. 17 "(e) ALTERNATIVE 18 of the poverty line, health insurance SUPPORT in order to FOR VETERANS WITH CERTAIN HEALTH INSURANCE.- 19 AM f To any veteran "(l) IN GENERAL.-Notwithstanding any other 20 provision of this section, upon the election of a vet- 21 eran eligible for health insurance support under this 22 subchapter 23 plan that includes a health savings account under 24 section 223 of the Internal 25 the Secretary shall contribute an amount calculated g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT who obtains a high deductible health Revenue Code of 1986, (68034713) VA-19-0799-H-000121 OS 00019424 G:\M\15\LAMBOR\LAMBOR_039 .XML 23 1 under paragraph 2 count on behalf of the veteran. 3 (2) into such health savrngs ac- "(2) AlvIOUNTCALCULATED.-The amount cal- 4 culated under this paragraph 5 the difference between- is an amount equal to 6 "(A) the amount of health insurance 7 port the veteran would otherwise have received 8 under the subsection of this section applicable 9 to the veteran; and sup- 10 "(B) the amount payable by the veteran in 11 connection with the high deductible health plan 12 described in paragraph 13 "(f) DETERMINATIONS 14 PLANS.-ln making (1). BASED determinations ON under COST OF this section 15 with respect to the amount of health insurance support 16 to provide to a veteran, the Secretary shall make such de17 terminations based on the costs associated with the sec- 18 ond-least -costly health plan available to the veteran in the 19 area in which the veteran resides. 20 21 AM f "(g) DEI<-,INITIONS.-ln this section: "(1) The term 'cost-sharing', in connection with 22 the receipt of health care and treatment 23 health plan, means any copayments, deductibles, or 24 other charges imposed, collected, or otherwise re- 25 quired by a health insurance provider or health care g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT under a (68034713) VA-19-0799-H-000122 OS 00019425 G:\M\15\LAMBOR\LAMBOR_039 .XML 24 1 provider in connection with the receipt of health care 2 and treatment under such health plan. 3 "(2) The term 'poverty line' means the poverty 4 line (as defined in section 673(2) of the Community 5 Services Block Grant Act (42 U .S.C. 9902 (2)) appli- 6 cable to a family of the size involved. 7 "(3) The term 'high deductible health plan' has 8 the meaning given that term in section 223(c)(2) of 9 the Internal Revenue Code of 1986. 10 "(4) The term 'priority group' means the pn- 11 ority groups established by the Secretary for pur- 12 poses of the enrollment of veterans in the patient en- 13 rollment system under section 1705(a) of this title. 14 "? 2605. Treatment of other health plans 15 16 AM f "(a) SECONDARYPAYER."(1) IN GENERAL.-Notwithstanding any other 17 provision of law, any health plan (including a State 18 plan under title XIX of the Social Security Act (42 19 U.S.C. 1396 et seq.) and the TRICARE 20 under chapter 55 of title 10) under which a veteran 21 is covered that is not a health plan for which health 22 insurance support is provided under this subchapter 23 shall be responsible for the payment of costs for any 24 health care received by an eligible individual for a 25 non -service connected disability up to the maximum g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT program (68034713) VA-19-0799-H-000123 OS 00019426 G:\M\15\LAMBOR\LAMBOR_039 .XML 25 1 amount allowable under such plan before any health 2 plan for which health insurance support is provided 3 under this subchapter 4 costs, if applicable. 5 "(2) NOTIFICATION.-rrhe for any such Secretary of Health 6 and Human 7 any other head of a relevant department 8 of the Federal Government shall notify the Secretary 9 of Veterans Services, the Secretary of Defense, or or agency Affairs of an eligible individual being 10 covered under a health plan described in paragraph 11 (1). 12 "(b) 13 HEALTH 14 AM f is responsible TREATMENT OF1 EMPLOYER SPONSORED PLANS.- "(1) IN GENERAL.-r:rhe prov1s10ns of section 15 1862(b)(3)(C) 16 1395y(b)(:3)(C)) shall apply with respect to financial 17 or other incentives for an employee who is a veteran 18 not to enroll (or to terminate 19 health 20 health insurance support is provided under this sub- 21 chapter and that would (in the case of such enroll- 22 ment) be responsible under subsection 23 pa,yment of costs for health care received by the vet- 24 eran 25 1862(b)(3)(C) g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT of the Social Security Act (42 U.S.C. plan that rn the enrollment) is not a health same manner as under a plan for which (a) for the such section applies to financial or other incentives (68034713) VA-19-0799-H-000124 OS 00019427 G:\M\15\LAMBOR\LAMBOR_039 .XML 26 1 for an individual 2 XV1II of the Social Security Act (42 U .S.C. 1395 et 3 seq.) not to enroll 4 under a group health plan or a large group health 5 plan which would (in the case of enrollment) be a 6 primary plan (as defined in section 1862(b)(2)(A) 7 such Act). to benefits under (or to terminate title enrollment) of 8 "(2) 9 regulation adopt such additional 10 prohibition described in paragraph 11 retary 12 shall be implemented taking into account the adop- 13 tion of such exceptions. 14 REGULATIONS.-The considers appropriate Secretary may by exceptions to the (1) as the Sec- and such paragraph "03) AGREEMENTS.-rrhe Secretary of Veterans 15 Affairs 16 Services may enter into agTeements to carry out this 17 subsection. Any such agTeement shall provide that 18 any expenses incurred by the Secretary 19 and Human Services pertaining to carrying out this 20 subsection shall be reimbursed by the Secretary of 21 Veterans Affairs. 22 AM f entitled and the Secretary of Health and Human of Health "(4) GROUP HEALTH PLAN DEFINED.-In this 23 subsection, 24 group health plan (as that term is defined in section 25 5000(b)(l) g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT the term 'group health plan' means a of the Internal Revenue Code of 1986 (68034713) VA-19-0799-H-000125 OS 00019428 G:\M\15\LAMBOR\LAMBOR_039 .XML 27 1 without regard to section 5000(d) 2 Revenue Code of 1986). 3 "? 2606. Receipt 4 5 of health of the Internal care through the Depart- ment "(a) (iA)NTRACTS.-_.__'iny A l1ea11.h . : msurance prov1"d~ er 6 that provides a health plan for which health insurance 7 support may be provided under this subchapter or sub- 8 chapter II may enter into a contract with the Veterans 9 Accountable Care Organization under which the medical 10 personnel and facilities of the Veterans Accountable Care 11 Organization may be treated as a designated provider for 12 purposes of such health plan. 13 "(b) COST OF CARE.-r:rhe cost, including any copay- 14 ments, of any health care or treatment provided to a vet- 15 eran by the Veterans Accountable Care Organization 16 under a contact under subsection (a) shall be determined 17 by the Veterans Accountable Care Organization. 18 " (c) lvIECHANISlVI.-The Board of Directors of the 19 Veterans Accountable Care Organization shall establish a 20 mechanism through which the Veterans Accountable Care 21 Organization enters into contracts with health insurance 22 providers under subsection (a). AM f g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000126 OS 00019429 G:\M\15\LAMBOR\LAMBOR_039 .XML 28 1 "? 2607. Pharmacy 2 benefits "A veteran who is enrolled m the VetsCare Choice 3 program or the VetsCare Senior program may fill pre- 4 scriptions at pharmacies of the Department. 5 "SUBCHAPTER 6 II-lVIEDIGARE-ELIGIBLE VETERANS 7 "? 2611. VetsCare Senior program: designation 8 cipients 9 "(a) IN GENERAL.-The of re- authorities for the provision 10 of health insurance support under this subchapter may be 11 referred to as the 'Vets Care Senior program'. 12 "(b) DESIGNATION OF RECIPIENTS.-Any 13 who receives health insurance veteran support under this sub- 14 chapter may be referred to in the receipt of support as 15 participating 16 in the 'VetsCare Senior program'. "(c) RELATIONSHIP TO CARE BY VETERANS Ac - 17 COUNTABLE CARE ORGANIZATION.-Health insurance 18 support under this subchapter is in addition to any health 19 care or medical services furnished to a veteran at a facility 20 operated by the Veterans Accountable Care Organization. 21 "? 2612. Medicare support 22 "(a) IN GENERAL.-rrhe Secretary shall provide 23 health insurance support to each covered veteran equal to 24 the costs incurred by such veteran for lVIedicare premiums 25 and cost-sharing under parts A, B, C, and D of title XVIII 26 of the Social Security Act (42 U.S.C. 1395 et seq.) and AM f g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000127 OS 00019430 G:\M\15\LAMBOR\LAMBOR_039 .XML 29 1 for premiums and cost-sharing for medicare supplemental 2 policies under section 1882 of such Act (42 U.S.C. 3 1395ss). 4 "(b) RELATIONSHIP vVITH VETSCARE _F1EDERAL.- 5 Notwithstanding any other provision of law, if a covered 6 veteran is enrolled in the VetsCare F1 ederal program under 7 section 1701A of this title, the 1\!Iedicare program under 8 title A~II of the Social Security Act (42 U.S.C. 1395 9 et seq.) (or a rnedicare supplemental policy under section 10 1882 of such Act (42 U.S.C. 1395ss)) shall be responsible 11 for the pa,y1nent of costs for any health care received by 12 an eligible individual for a non-service connected disability 13 up to the maximum amount allowable under such program 14 (or supplemental policy) for such health care before the 15 VetsCare F1 ederal program is responsible for any such 16 costs, if applicable. 17 "(c) AVAILABILITYOF PAYMENT OR REilVIBURSE- 18 lVIENT.19 AM f "(1) COlVIlVIENCElVIENT.-Healthinsurance 20 port under this subchapter 21 available as follows: sup- shall commence being 22 "(A) With respect to covered veterans 23 priority group 1, 2, or 3, on the first day of the 24 first month that begins on or after the date de- g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT in (68034713) VA-19-0799-H-000128 OS 00019431 G:\M\15\LAMBOR\LAMBOR_039 .XML 30 1 scribed in section 2(c)(3) of the Veterans Em- 2 powerment Act. 3 "(B) vVith respect to covered veterans in a 4 priority group other than 1, 2, or 3, on the first 5 day of the first month that begins on or after 6 the date that is 180 days after the commence- 7 ment date under paragraph 8 "(2) EXCLUSION 9 10 OF CERTAIN VETERANS.-A covered veteran is not eligible for health insurance support under this section if such veteran"(A) first enrolls in the system of annual 11 12 patient enrollment established and operated by 13 the Secretary under section 1705(a) of this title 14 on or after the date of the enactment 15 Act; and 17 of this "(B) is in priority group 7 or 8. 16 "(cl) DEFINITIONS.-In this section: "(1) The term 'cost -sharing', in connection with 18 AMf (l). 19 the receipt of health care and treatment 20 :Medicare program 21 Security Act (42 U.S.C. 1395 et seq.) or medicare 22 supplemental policies under section 1882 of such Act 23 (42 24 deductibles, or other charges imposed, collected, or 25 otherwise required by a health insurance provider or g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT U.S.C. under the under title XV1II of the Social 1395ss), means any copayments, (68034713) VA-19-0799-H-000129 OS 00019432 G:\M\15\LAMBOR\LAMBOR_039 .XML 31 1 health care provider in connection with receipt of 2 health care and treatment 3 supplemental policies. 4 under such program "(2) r:rhe term 'covered veteran' or means a vet- 5 eran receiving benefits under the Medicare program 6 under title XVIII of the Social Security Act. "(3) The term 'priority group' means the pn- 7 8 ority groups established 9 poses of the enrollment of veterans in the patient en- 10 rollment system under section 1705(a) of this title.". 11 (b) CLERICAL_IUVIENDlVIEN'l' .-The by the Secretary for pur- table of chapters 12 at the beginning title 38, United States Code, is amended 13 by inserting after the item relating to chapter 24 the fol14 lowing new item: "Chapter 26 .Veterans Independence in Health Care ............................. 15 16 (c) CONI<-,ORlVITNG llMENDl\IEN'l'S.(1) l\fINilVIUlVI ESSENTIAL COVERAGE.-Section 17 5000A(f)(l)(A)(v) 18 1986 is amended by striking "or 18" and inserting 19 ", 18, or 2 6". 20 21 AM f 2601". of the Internal Revenue Code of (2) :MEDICAREPAR'l' B.(A) NON-APPLICATIONOF LA'l'E ENROLL- 22 lVIEN'l'PENAL'l'Y.-Section 23 Security Act (42 U.S.C. 1395r(b)) is amended, 24 in the second sentence, by inserting "or months 25 for which the individual can demonstrate g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT 1839(b) of the Social that (68034713) VA-19-0799-H-000130 OS 00019433 G:\M\15\LAMBOR\LAMBOR_039 .XML 32 1 the individual was enrolled in the VetsCare Sen- 2 ior program under subchapter II of chapter 2 6 3 of title 38, United States Code" after "an indi- 4 vidual described in section 1837(k)(3)". (B) SPECBL ENROLLMENTPERIOD.-Sec- 5 6 tion 18~37 of the Social Security Act (42 U.S.C. 7 1395p) is amended by adding at the end the 8 following new subsection: 9 "(m)(l) In the case of any individual who is enrolled 10 in the Vets Care Senior program under subchapter II of 11 chapter 26 of title 38, United States Code at the time 12 the individual is entitled to part A under section 226 or 13 section 2 2 6A and who is eligible to enroll but who has 14 elected not to enroll (or to be deemed enrolled) during the 15 individual 's initial enrollment period, there shall be a spe16 cial enrollment period as specified by the Secretary. 17 "(2) In the case of an individual who enrolls during 18 the special enrollment period provided under paragraph 19 (1), the coverage period under this part shall begin on 20 such date specified by the Secretary. 21 " (3) An individual may only enroll during the special 22 enrollment period provided under paragraph (1) one time 23 during the individual's lifetime. 24 " (4) r:rhe Secretary of Veterans Affairs shall collabo- 25 rate with the Secretary of Health and Human AM f g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT Services (68034713) VA-19-0799-H-000131 OS 00019434 G:\M\15\LAMBOR\LAMBOR_039 .XML 33 1 and the Commissioner of Social Security to provide for 2 the accurate identification of individuals described in para3 graph (1). The Secretary of Veterans Affairs shall provide 4 such individuals with notification with respect to this sub- 5 section. rrhe Secretary of Veterans Affairs shall collabo6 rate with the Secretary of Health and Human Services 7 and the Commissioner of Social Security to ensure appro - 8 priate follow up pursuant to any notification provided 9 under the preceding sentence.''. 10 SEC. 6. COORDINATION BETWEEN VETSCARE CHOICE PRO11 GRAM AND ELIGIBILITY TO MAKE CONTRIBU- 12 TIONS TO HEALTH SAVINGS ACCOUNTS. 13 (a) IN GENERAL.-Section 223(c)(l)(B) of the Inter- 14 nal Revenue Code of 1986 is amended by striking "and" 15 at the end of clause (ii), by striking the period at the end 16 of clause (iii) and inserting ", and", and by adding at the 17 end the following new clause: 18 "(iv) coverage for health 19 support 2O gram under subchapter 21 title 38, United States Code." . 22 under the VetsCare insurance Choice pro- I of chapter 2 6 of (b) DENIAL OF DEDUCTIONFOR AMOUNTSNOT IN- 23 CLUDIBLEIN GROSS INCOME.-Subsection (b) of section 24 223 of the Internal Revenue Code of 1986 is amended by 25 adding at the end the following new paragraph: AM f g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (68034713) VA-19-0799-H-000132 OS 00019435 G:\M\15\LAMBOR\LAMBOR_039 .XML 34 1 " ( 9) AlvIOUNTSNOT INCLUDIBLE IN GROSS IN- 2 COME.-No 3 of an individual shall be taken into account under 4 subsection 5 such amount, when paid to or on behalf of such indi- 6 vidual, is excluded from gross income of the indi- 7 vidual or exempt from taxation under any provision 8 of Federal law.". 9 (c) EFFECTIVE DATE.-The amount paid to a health savings account (a) if (without regard to this section) amendments made by 10 this section shall apply to amounts paid to a health sav11 ings account (as defined in section 223 (d) of the Internal 12 Revenue Code of 1986) after the date of the enactment 13 of this Act. 14 SEC. 7. PUBLICATION OF HEALTH CARE INFORMATION. 15 (a) IN GENERAL.-rrhe Secretary of Veterans Affairs 16 shall make available to the public on an ongoing basis in17 formation about the operations of the Veterans Health Ad18 ministration in a manner similar to publication of infor- 19 mation under the l\!Iedicare Accountable Care Organiza20 tion program to better monitor and support continuous 21 improvement in the Veterans Health Administration. 22 (b) ELEMENTS.-rrhe information 23 subsection (a) shall include information published under about the oper- 24 ations of the Veterans Health Administration, AM f g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT including (68034713) VA-19-0799-H-000133 OS 00019436 G:\M\15\LAMBOR\LAMBOR_039 .XML 35 1 metrics regarding quality, safety, patient experience, time2 liness, and cost-effectiveness. 3 SEC. 8. VETERANS' ELIGIBILITY FOR LONG-TERM CARE IN- 4 SURANCE. 5 (a) IN GENERAL.-Section 9001 of title 5, United 6 States Code, is amended7 8 9 10 11 paragraphs (5) through ( 10) as ( 6) through ( 11), respectively; (2) by inserting after paragraph (4) the fol- lowing: "(5) VETERAN.-The term 'veteran' has the 12 same meaning given the term in section 101 (2) of 13 title ~38,United States Code."; 14 15 16 17 18 19 20 21 (~3)in paragraph (6), as so redesignated- (A) in subparagraph (A), by striking (B) in subparagraph (B), by striking "(1) or (3)." and inserting "(1), (3), or (5)."; (C) in subparagraph (C), by striking "or (4)" and inserting "( 4), or (5) "; and (D) in subparagraph (D), by striking "or (4)" and inserting "(4), or (5)"; 23 (4) in paragraph 25 g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT "or . d. rnser . , t.mg "(4). . , or (r:.) (4) . .. ." an .J . " ; 22 24 AM f (1) by redesignating (7), as so redesignated, by . . "(-):). , or (6) d J ..'' ; an~ stn .k.mg .,,or (-) :) .''. an d msertrng (5) in paragTaph (11), as so redesignated- (68034713) VA-19-0799-H-000134 OS 00019437 G:\M\15\LAMBOR\LAMBOR_039 .XML 36 1 2 3 4 (A) rn subparagraph (C), "Commerce; and" and inserting (B) in "Services." by (C) by inserting after subparagraph 6 '' (E) with respect to a veteran, 8 striking "Services; and"; and 5 7 striking "Commerce;"; (D), subparagraph and inserting by (D): the Sec- retary of Veterans Affairs.". (b) TECHNICAL AND CONFORMING A:MENDMENTS.- 9 Title 5, United States Code, is amended as follows: 10 11 (1) Section 9002 is amended- (A) in subsection (a), by striking "or (5)" 12 and inserting ''(5), or (6)''; and 13 (B) in subsection (e)- 14 15 (i) in paragraph (4)" and inserting "( 4), or ( 5)"; and 16 (ii) in paragTaph (4), by striking "sec- 17 tion 18 9001 (10)". 19 (2) Section 9004(d) 9001(9)" and is inserting "section amended by inserting 20 after "withheld under subsection (b)" the following: 21 ", who is an enrollee by virtue of being a veteran de- 22 scribed in section 9001(5) of this title,". 23 24 AM f (2), by striking "or g:\VHLC\ 111617\111617.095.xml November 16, 2017 (11 :53 a.m.) PVERSIGHT (3) Section 9008(c) is amended by striking "(3) or (4)" and inserting "0-3), (4), or (5)". (68034713) VA-19-0799-H-000135 OS 00019438 Congress//DTDs/bill v2.8 20020720//EN" "http://xml.house.gov/bill.dtd"> key="H" dms-id="H63209FC4C83F4704BCC73D2342E676A5" public- bill-type="olc"> G:\M\15\LAMBOR\LAMBOR_039.XMLXXXXXXXXXXXXXXXXXXXXll/16/2017 11:53XXXXXXXXXXll/09/2017 16:58XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX number>68034713 display="no">[Discussion {author-note}?> Draft] (Original [DISCUSSION of Member) DRAFT]

I 115th CONGRESS H. R. lst Session IN THE HOUSE OF REPRESENTATIVES name-id="L000564">Mr. referred to the Lamborn Committee on introduced the following -------- A BILL To Accountable amend Care insurance plans, title Organization and for 38, and other United to States provide Code, veterans to establish access to the private Veterans health purposes. l.
Short title; inline="no-display-inline">This Empowerment Act Act section-type="section- table may be style="OLC"> cited of contents
as the Veterans .
2.
Establishment Veterans Accountable Care display- of Organization
(a)
Establishment
(l)
In PVERSIGHT VA-19-0799-H-000136 OS 00019439 general
Chapter at the end the display-inline="no-display-inline" id="HDA9DEF6E802D436EB6499FE1728EF9BA" style="USC">
323.
Veterans Accountable Care Organization
(a)
Establishment
(l)There Veterans Accountable Care Organization Corporation) id="H39B9E6CF497D4E80AA508AAEA601C9D9" indent="upl">(2)The Corporation is a federally chartered corporation. (3)The in the District directors of of id="H539AF356A71E4BD8BDACF28CB95C08A6" indent="upl">(4)The Corporation shall be a charitable and nonprofit corporation. (5)Except have perpetual as otherwise provided, the Corporation shall existence. (b)
Purpose
Th e purpose of services, and individuals the Corporation other is health eligible for care such to furnish high (excluding care and quality nursing services hospital home care under laws care, and medical domiciliary administered care) to by the Secretary. (c)
Board of Directors
(l)The of Directors id="HEA095869B8El4A27AlE754A34B6B4448" indent="upl">(2)The following of display-inline="yes-display- Board of Directors shall be members: id="H912E2E595D6647138ED38DAABA7A7ADA">(A)The of Veterans Affairs. id="H81061DC6196A40Fl8B056988293B7607">(B)Two by the Speaker of the House of Representatives, at least members one of whom shall be a veteran. (C)Two . id="H5AFD0ED1949649C68AD54532F7578BF5">(D)Two PVERSIGHT members VA-19-0799-H-000137 OS 00019440 appointed by the Majority Leader of the Senate, at least one of whom shall be a veteran. (E)Two by the Minority Leader of the Senate, at least one members of whom shall be a veteran. (F)Two by the President, at least one of whom shall members be veterans. The of Directors to Chairperson serve from (A)(4) display-inline="yes-display- display-inline="yes-display-inline">A serve the a member members. id="H2528848B5AlC429094C74DlB07FC2FE6" Directors designate The Board id="H97FBBFDFE04A45338C99320323FDE9A8" (3) Any before the shall expiration be appointed expiration Board of shall original only that not of for term the memberaEUR(TM)s affect its appointment (C) commented="no">(D) terms The absence appointed the of indent="upl">(B)During Secretary the of Veterans Acting Directors Secretary specified in subparagraph> (d)
Duties
In carrying out (l)transfer Affairs to the title>Veterans ; ) , , ~o medical " with Veterans care, n subsection assets (b) of of displaythe Department section 2 of id="HDD0AlFEE94C3485292AODDODDA18FlB6">(2)establish of shalla.EUR" the Health services, , PVERSIGHT priorities, Secretary of Veterans Administration and other Affairs, directly health milestones, care for related (excluding to to centers of display- excellence relating to id="H3BDD2533B6AF4BA78B6B418BF68A994B">(A) inline="yes-display-inline">continue and of id="HB87806CFDB5244D79BD61ClB0AlFF8A3">(3)with by the (c) to administer such centers display- previously established and id="HB58725681Dl44F0B860D9E36AFE0A95D">(B)establish administer additional such centers as the Board of Directors determines appropriate. (4)in the Secretary, carry out such other actions necessary to consultation carry out this section. (e)
Powers
The Corporation shalla.EUR" (l)appoint employees; and (2)adopt set forth under id="HE64039756C274BEF86C6353E636D0A00">(f)
Duty maintain corporate display-inline="yes-display-inline" id="HB618188DC2D04F2ABF5E3391A318DDE6">(l)The maintain its status Columbia or another as to a corporation nearby incorporated State, as Corporation under determined by the the laws Board of of the shall District of Directors. (2)The organization exempt from the Corporation Internal Revenue shall Code maintain its status as an of 1986. (g)
Veterans Accountable Care id="H4879F368379F41FFA51B8543F4C712E6" inline">(l)There known as as the the Veterans Accountable subsection referred Fund) (2)Amounts this title shall Amounts or in centers of described in subsection (d) (3) a veteran at a facility operated to collected year Fund and furnished fiscal the appropriation services Fund (in this under chapter 26 of indent="upl">(3) id="H2331ABA3807F457AA19C962CCD534FB8" without Care in . recovered the is shall limitation, to and for be available, establish health without and care administer or medical by the Corporation.
. f . .-. " n , PVERSIGHT VA-19-0799-H-000139 OS 00019442 (2)
Clerical amendment
The title is amended table by inserting of after sections the at item the beginning relating to of section chapter 3 of 322 the such following new item: 323. Veterans Accountable Care Organization.. (b)
Transfer personnel and of assets
(l)
Transfer
A 11 of the personnel, allocations, in and connection health and funds employed, used, the direct (excluding for such are transferred 323 of records, other with care property, care and title 38, id="H153E2E0BB6624F238CA996B8CF1139E3" commented="no">(2)
Reduction may implement a reduction in force in in carrying out force
The Secretary paragraph (1) . (c)
Termination id="HAA32BDF544534E0399C3EE823BFC9A44">(l)
In general
Except Veterans Health medical services, care) display-inline="yes- to as provided Administration and individuals Secretary shall directly other health eligible terminate for one year by paragraph relating care such to (excluding care after and the (2), the all functions of home care services of the furnishing nursing date of under the enactment hospital and laws of care, domiciliary administered of the by the this Act. (2)
Extensions
The Secretary termination of Veterans date specified Affairs in may make paragraph (1) not if more the than two Secretary 90-day extensions notifies to Congress the of such date on extensions. (3)
Certification termination which date
The paragraph (1) is carried Secretary shall certify to Congress the out. (d)
Recommendations statutory amendments
Not enactment of this recommendations ) , , ~o " n , PVERSIGHT Act, for the technical Secretary and later shall conforming than submit 180 days to Congress amendments to after for the date a report Federal that statutes of the contains to carry VA-19-0799-H-000140 OS 00019443 out this Act.
3.
Establishment Veterans Health Insurance of Program
(a)
Establishment
Chapter 73 of following title 38, United States Code, is amended by adding at the end the new section:
7309A.
Veterans Health Insurance Program
(a)
Establishment
There is established Insurance Program in (in this Program) the Veterans section Health referred Administration to as the Veterans Health the . (b)
Duties
Und er the Program, support to the Secretary veterans under shall chapter administer 26 of the provision of health insurance this title.
. (b)
Clerical amendment
The title is amended table by inserting of after sections the at item the beginning relating to of section chapter 7309 73 of the such following new item: 7309A. Veterans Program..
4.
Designation existing authorities for hospital care, medical services, and other of health care
(a)
Designation
Subchapter after I of section chapter 1701 display-inline="no-display-inline" id="H27544F60324F4E5A93C3EAEA87DEA086" style="USC">
1701A.
VetsCare Federal program: other health (a)
In general
Effective and for as program
Veterans of authorities , PVERSIGHT as Empowerment medical care) in services, subchapter of the date described Act, and II other of this health chapter in section 2(c) the authorities care (other than under any and for (3) the of nursing other the provision home care law VA-19-0799-H-000141 OS 00019444 administered by the Secretary may be referred to as the VetsCare Federal program. (b)
Designation recipients
, any health in display-inline="yes-display-inline">Effective section eligible care such care of the Veterans who receives nursing referred of (3) individual (excluding authorities receipt 2(c) home care to in subsection or services as hospital and (a) Empowerment care, domiciliary after such as participating date in medical care) the ActVetsCare other with in the the Federal program. (c)
Secondary payer
(l)
In general
Notwithstanding law, any Social Security Act (42 U.S.C. such under which costs for connected et an eligible any (including seq.) 1395 and individual health Federal plan (42 U.S.C. 1396 care disability VetsCare health Act up to program the is the is received the et Medicare seq.) or covered shall amount responsible program a State TRICARE program by an eligible maximum any for be under allowable such under XVIII title chapter of XIX of 55 of for for the title 10) payment of a non-service such costs, title under responsible individual any under plan other plan before the if applicable. (2)
Notification
The head Secretary of a relevant Secretary plan of Health under a health under subsection or connected disability financial or other other Social enrollment) (c) the a group enrollment) apply for the received for 1862 (b) (3) (C) of with respect (in the payment by the as such 1395 health plan or be a primary plan (as case of of costs section seq.) a large defined group Social such for or Security other enroll (or to enrollment) hospital be care, for terminate medical a non-service 1862 (b) (3) (C) applies to not in to individual entitled et the financial not eligible an individual (42 U.S.C. to individual would same manner incentives Act section an eligible that care in of shall who is plan health Security under of (3) (C)) an employee services, case of of (1) . provisions 1395y(b) for enrollment) the agency Secretary id="HEF6A4D1838C44E48BCFF2F80B1FE7832">(l)
In general
The of or the id="H6EC041Cl7E894BOC83C3D68993C4866D">(d)
Treatment (2)
Regulations
The Secretary described shall ) , , ~o in may by regulation paragraph be implemented " n , PVERSIGHT (1) taking as adopt the into such Secretary account additional considers the adoption exceptions appropriate of to and the such prohibition paragraph such VA-19-0799-H-000142 OS 00019445 exceptions. (3)
Agreements
The Secretary of subsection. of the is defined regard to term in group section section health health 5000(b) 5000(d) of plan (1) the of the Internal Revenue 1986) . (e)
Eligible individuals
(4)
Group Internal Code Accountable may enter Human Services defined
In means to Veterans of section display-inline="yes-display-inline">An in annual 1705(a) the VetsCare patient of enrollment this Veterans Federal title as Empowerment program if established of the such and date individual individual operated described in is eligible was enrolled by the section in Secretary 2(c) (3) the under of the Act.
. (b)
Clerical amendment
The amended by inserting table after the of item sections at relating to the beginning section of 1701 the such chapter following is new item: 1701A. for hospital care, medical VetsCare services, and as program..
5.
Health support for eligibility new veterans and for care, hospital veterans medical electing health services, and insurance other insurance support health care in lieu under of existing authorities
(a)
In general
Part after chapter display-inline="no-display-inline" id="H3A60C8183E8947999EA2A4F7E20E31CD" style="USC"> 26
Veterans quoted-block="no-quoted-block" idref="H7DE83536AD5548E4B8E7905346B330A9" lowest- regeneration="yes- lowest-bolded-level="division-lowest-bolded"> idref="HD08B526C366E44229AE05D1BA4F3880D" level="subchapter">Subchapter Generally idref="H51E9B424512341D7B6El1E829FD84D6C" n PVERSIGHT level="section">2601.aEUR,VetsCare VA-19-0799-H-000143 OS 00019446 Choice program: idref="HlC8CACA98029457B89E22D68E33EBFFE" level="section">2602.aEUR,Eligibility. 2604.aEUR,Health support. 2603.aEUR,Qualifying idref="HB6184C6F4D324CB9AD4D7E6F88768192" other health 2605.aEUR,Treatment plans. idref="H8B83F64A53Dl46BC9C331D36502B7226" health care through 2606.aEUR,Receipt of Department. idref="H0037DAA47E6C482096DFEC23B73DlF65" level="section">2607.aEUR,Pharmacy benefits. Subchapter Veterans idref="H6469BA6906684E49B51ClC9D26244Dl3" program: 2611.aEUR,VetsCare recipients. idref="HC24027056C064426AF281BFCCCEAEE3A" level="section">2612.aEUR,Medicare support. I
Veterans
2601.
VetsCare Choice program: id="H969D722CED764471Al561F5F4B411FC0">(a)
In general
The under Generally
this authorities subchapter may be for referred the to as provision the of health insurance VetsCare support Choice program. (b)
Designation recipients
Any this subchapter VetsCare . the receipt health of support support under as participating in the id="H5657DE1893CA41E2938DDF8BD0F45A59" commented="no">(c)
Relationship Care insurance Organization
Health subchapter a veteran to at is in addition a facility to operated any by the health insurance care Veterans or medical services Accountable Care Organization.
2602.
Eligibility
(a)
In general
Except and this (d), the following veterans established on or Empowerment , .-. . n health id="HEC292E7A65834Bl486C2E46A05Bl0F69">(l) inline="yes-display-inline">Veterans title shall as provided the and date who first operated by the described in enroll Secretary section 2(c) in the under (3) of displaysystem section the of annual 1705(a) of patient this Veterans Act. , PVERSIGHT VA-19-0799-H-000144 OS 00019447 (2)Veterans in section health 2(c) insurance care, medical the under law under in Veterans support care) other of services, domiciliary any (3) enrolled this and other the VetsCare administered system as Empowerment subchapter health by the such in care lieu of (excluding Federal program displayof the date described Act eligibility for nursing under who elect hospital home care chapter and 17 of this title or Secretary. (b)
Enrollment
The Secretary id="HB23E196928F249468EEFDOEFBD6CEC5E">(l)an that corresponds Benefits to program open the open described enrollment enrollment in period period section for 8905(g); for the the displayVetsCare Federal Employees id="HA83792216DF447EA96AA533885E442A4">(2)special enrollment periods under the Federal group shall on qualifying Employees also Health be treated as life events Benefits of Program, a qualifying program Health and (c)
Effect election
While in that subsection services, under and chapter an election is in other health 17 of this effect, the care under veteran is (excluding title or any subsection not nursing other law (a) (2) of of a veteran eligible for hospital home care and domiciliary administered described care, medical care) by the Secretary. (d)
Exceptions
The following veterans are not eligible for health insurance support under this subchapter: (l)Any eligible Act for care (42 U.S.C. id="HECD4DDDOOF5F41619A65BFF8EDF9AA8A">(2)Any veteran whoaEUR" (A)first established after and the date enrolls operated described by the in in Secretary section the under 2(c) (3) system section of the of annual 1705(a) Veterans displaypatient of this enrollment title on or Act; and (B)is group display-inline="no-display-inline" id="H7890AFDE1AB945BB959B4949452E1644">(e)
Commencement of availability inline="yes-display-inline">Health commence being (l)With veterans ) available in 1, 2, or 3, on the first day of the first respect month that to begins VA-19-0799-H-000145 OS 00019448 on or after the Empowerment date described in (3) of the Veterans id="H00400D566Dl9442A8725E9892D34Fl3F">(2)With or 2(c) Act. (f)
Priority defined
In priority veterans groups in the this established patient section, by the enrollment the term Secretary system priority for under purposes section group of 1705(a) the of means enrollment of this title.
2603.
Qualifying health insurance
Health under this subchapter of for health plans thataEUR" id="H9C020F956CD942D8B3667C4CB80EEE37">(l)include 1079 only insurance title 10, the United States Code; types of health care display- authorized id="H43B9D0D83CE649C4BFA1C746945F5D8A">(2)provide additional elements coverage as section and
2604.
Health insurance support
(a)
In general
The veterans under subsections alternative the make Centers costs such for eligible (b) support under associated payments with or Medicare Secretary for such support and (c), cost-sharing subsection such (e) health reimbursements & Medicaid under Services subchapter support under or reimbursing support. a manner The similar make provide this by paying insurance in shall to similar the manner payments and reimbursements. (b)
Premium generally
The subsection Tier disability provide plan. rated benefits 100 percent to of A health under the as the full plan 100 percent veteran under actuarial under this 1 Plan. display-inline="yes-display-inline">To by paragraph sufficient to (1) under a Tier the and provide equivalent -~.' .. PVERSIGHT ) by the id="HD9B6D24C832948288D114307678E5E12">(2)
Tier 2
any health paragraph not support id="HCE67D7D220A54388A5678C037668CDD9">(l)
Tier 1
To a health premium to health any plan. veteran benefits 90 percent any to of A health in the the plan priority veteran full group under actuarial under veteran this in 2, health a health value paragraph priority of 1 insurance plan the group that are benefits may be referred to 2 Plan. VA-19-0799-H-000146 OS 00019449 (3)
Tier 3
To or priority veteran group under actuarial this of paragraph group actuarial benefits actuarially provided referred of paragraph Tier insurance plan the that priority group benefits to 80 percent of A health plan plan. 3 the the full under 3 Plan. to sufficient actuarially provided referred any support are benefits may be as veteran to provide equivalent under the to health a Tier in priority group benefits to 70 percent of A health plan plan. 5 the the full under 4 Plan. id="HB71C40A66E2F4549BABB2ECCE7653A5F">(5)
Tier 5
To covered section are sufficient display-inline="yes-display-inline">To under group the that support veteran id="HBBE5F68F03AD46D5B09BC4737DB1C853">(4)
Tier or priority this insurance plan may be 4
Tier under provide equivalent provided referred not to health 60 plan. A 5 Plan. (c)
Additional premium support based premium support provided The Secretary under this subsection is as follows: id="H1916F778125347F2A087F25BE7B40608">(l)To an annual line, on need
(2)To premium with poverty poverty line, premium support more 3 percent than between 133 percent sufficient to of monthly the cover and any gross 150 percent costs of of such household income of gross household health that are income that insurance support more 4 percent than is between 150 percent sufficient to of monthly the any cover and any gross veteran 200 percent costs of of such household income of gross household health that are income that insurance support more 6.3 than is between sufficient percent of 200 percent to the cover monthly any and any 250 percent costs gross veteran of of such household income of veteran. (5)To an annual poverty monthly of are insurance is id="HFAB291D189EE455BAC2498ECF6ABE03A">(4)To an annual monthly the that that veteran. with the line, premium (3)To an annual monthly the household veteran veteran. A. -~. .. ,, . PVERSIGHT VA-19-0799-H-000147 OS 00019450 (6)To an annual the poverty monthly the gross line, household health premium that are income that insurance support more 9.5 than is between 300 percent sufficient percent of any to the cover and any monthly 400 percent costs gross veteran of of such household income of veteran. (d)
Cost-sharing support
The support provided by the Secretary subsection is (l)To with as cost-sharing an annual line, health the effective the veteran with not gross line, ensure that the health plan of is that is not between in provided to under the cost-sharing benefits veteran in value provided less 73 percent. to the 250 percent actuarial than of cover and of order any 200 percent sufficient veteran 200 percent cost-sharing less than of cover and value support minimum veteran that plan any actuarial income insurance effective ensure health id="H0BC37FA7042A4547A6E49E15FFCA500A">(3)To poverty of order under to the id="H81406DB24A2E41589781C7269690564D">(e)
Alternative support for veterans id="H65BFE3F93AFE4BADB33384BBCDC14CFF">(l)
In general
Notwithstanding election of a veteran a high deductible section 223 the of calculated any eligible obtains amount to less veteran 94 percent. household effective an annual the is sufficient actuarial less that any id="H5342B180ED584884B5C9D8D7A2934A13">(2)To poverty with income support minimum an annual the household insurance gross is under for health Internal under health plan Revenue paragraph other insurance that Code (2) provision support includes of into 1986, such of this section, under a health this savings the Secretary shall health savings account upon the subchapter account who under contribute an on behalf of the an amount equal veteran. (2)
Amount calculated
The to the difference id="HFA9CF7792A5C4C13AA183A9FB77D1DC0">(B)the by the paragraph under id="H5F8B5ED561264E1EB3323637125CCE0E">(A)the of payable calculated betweenaEUR" insurance subsection amount veteran in connection with the high deductible health amount plan described in (1) . (f)
Determinations cost the make health h, .~." of plans
In amount such plan of health insurance determinations available PVERSIGHT making based to the determinations support to on the costs veteran in provide the under to associated area in this a veteran, with which the the based section the with Secretary respect on to shall second-least-costly veteran VA-19-0799-H-000148 OS 00019451 resides. (g)
Definitions
In this section: (l)The cost-sharing, under a health collected, in in plan, or means otherwise connection with connection any required the with copayments, the by a health receipt of receipt of deductibles, health or insurance care and health other care and charges provider treatment term or under treatment imposed, health such care provider health plan. (2)The poverty line Community size Services means Block Grant the poverty Act line (42 U.S.C. (as defined 9902(2)) in term section applicable to 673(2) of a family of the the involved. (3)The that term in Revenue Code has of the meaning priority group of 1705(a) of
id="HF40B238455AC4361BF1AACB3AA7B5D79">(4)The purposes other high display-inline="yes- term by the enrollment system Secretary under for section title.
id="HB6184C6F4D324CB9AD4D7E6F88768192">2605.
Treatment health of plans
(a)
Secondary payer
(l)
In general
Notwithstanding is not a health subchapter shall amount support is title be XIX of under plan by an eligible maximum insurance if under TRICARE program received the plan any chapter for which allowable provided Social title for for under under the 55 of health responsible individual other such this the a non- plan before subchapter is applicable. (2)
Notification
The Secretary of Federal Defense, Government individual being or any shall notify covered under Secretary other head the of a relevant Secretary a health plan of Health department of Veterans described and or Affairs in Human Services, of agency of the the an eligible paragraph (1) . (b)
Treatment employer sponsored id="HD987396E161E40BC8B6E6D68974ED575">(l)
In general
The ) health of , PVERSIGHT provisions of section 1862 (b) (3) (C) of the Social Security VA-19-0799-H-000149 OS 00019452 Act (42 U.S.C. incentives under 1395y(b) for an employee a health provided under that this subchapter under the in veteran Act a group health enrollment) is not the with a veteran not a health (a) same manner for apply and subsection incentives Security shall who is plan responsible other (3) (C)) that for as (42 U.S.C. plan 1395 or seq.) a large be a primary for which (in the payment (as of section to health (or for under enroll in (or which section other terminate enrollment) insurance of costs or to health case benefits plan defined financial support such enrollment) health care 1862 (b) (3) (C) applies to not group plan enroll plan entitled et to to would the such an individual respect title to terminate would (in is be received by to financial or XVIII of Social the enrollment) the case 1862 (b) (2) (A) of under of such Act) . (2)
Regulations
The Secretary described shall in may by regulation paragraph (1) be implemented as taking adopt the into such additional Secretary account exceptions considers the to appropriate adoption of the and prohibition such paragraph such exceptions. (3)
Agreements
The Secretary enter into that any carrying of Veterans agreements Affairs to carry expenses incurred out subsection this and out by the the this Secretary subsection. Secretary shall be of of Any such Health reimbursed Health and by the and Human Services agreement shall Human Services Secretary may provide pertaining to of Veterans Affairs. (4)
Group defined
In means a group Internal Code health Revenue of plan (as of 1986 Code this subsection, that term without the is defined regard to term in health group section section health 5000(b) 5000(d) of plan (1) the of the Internal Revenue 1986) .
2606.
Receipt health care through the of Department
(a)
Contracts
Any health plan subchapter under which for II which Organization health may enter the health medical insurance into may be treated support a contract personnel as insurance and may be provided with the facilities a designated provider Veterans of provider the for that under provides this Accountable Veterans subchapter Care Accountable purposes of such a or Organization Care health plan. (b)
Cost care
The copayments, of Accountable Care by the Veterans any health care Organization Accountable or treatment under Care a contact cost, provided under to including any by the Veterans a veteran subsection of (a) shall be determined Organization. (c)
Mechanism
The Care Organization -~. PVERSIGHT ) ' " shall establish Board a mechanism of Directors through which of the the Veterans Veterans Accountable Accountable VA-19-0799-H-000150 OS 00019453 Care Organization subsection enters into contracts with health insurance under (a) .
2607.
Pharmacy inline="no-display-inline">A the providers VetsCare veteran Senior program benefits
II
Medicare-Eligible
id="H6469BA6906684E49B51ClC9D26244D13">2611.
VetsCare Senior program: (a)
In general
The under recipients
this authorities subchapter may be for referred to the as provision the of health VetsCare insurance support Senior program. (b)
Designation recipients
Any this subchapter to who receives may be referred Senior program. VetsCare (c)
Relationship Care insurance Organization
Health subchapter a veteran to at is in addition a facility to operated any health by the insurance care Veterans or medical services Accountable Care Organization.
2612.
Medicare support
(a)
In display-inline="yes-display-inline">The support to Medicare each covered premiums Social Security medicare and Act veteran equal cost-sharing to under (42 U.S.C. 1395 policies under supplemental 1395ss) Secretary et the shall costs parts seq.) A, and section provide incurred health by such B, C, and for 1882 general
Notwithstanding if Act disability supplemental law, section section costs f , o~o " for cornmented="no" id="H62047913D31049ECAF8F7B995EF06C58">(b)
Relationship of the . display-inline="no-display-inline" VA-19-0799-H-000151 OS 00019454 id="H54E51E82F49446578A7A535FBD86841B">(c)
Availability (l)
Commencement
Health shall commence being . day of the inline">(A)With or support display-inline="no-display- respect to covered veterans month that begins on or first tle>Veterans Empowerment in priority group the described after date 1, 2, in Act (B)With than 1, 2, or 3, that is 180 days respect on the first after the day of to the commencement covered first veterans month date under that in display- a priority begins on or group after other the date paragraph (1) . (2)
Exclusion veterans
A health Act; section 1705(a) patient not veteranaEUR" of this enrollment title established on or after the date display-inline="no-display-inline" id="H273800BE39CB4BB4A7478AA9A90151FF">(B)is veteran display-inline="no-display-inline" id="H290E9669D329418BB6AF8AF7AB575299">(A)first certain priority group display-inline="yes- 7 or 8. (d)
Definitions
In this section: (l)The health care Security 1882 term and Act of such charges Act imposed, health care program or cost-sharing, treatment (42 U.S.C. under 1395 the et 1395ss), collected, or in supplemental Medicare seq.) (42 U.S.C. provider display-inline="yes- program or medicare means otherwise connection in with any connection under title supplemental copayments, required receipt XVIII the a veteran Social receiving Security benefits under term the Medicare covered program group the ' PVERSIGHT enrollment means of under Act. id="H593A68B5B38044AD9C1E3COFF10D2412">(3)The priority . . of receipt commented="no" veteran ) XVIII deductibles, id="H67EFF638574B433FB04311E4C4E30CEB">(2)The title the policies by a health of with the veterans priority in the groups patient established enrollment term by the system Secretary under for section VA-19-0799-H-000152 OS 00019455 1705(a) of this title.
. (b)
Clerical amendment
The Code, is amended table by inserting of after chapters the at item the beginning relating to title chapter 38, 24 the United States following new item: Chapter level="section">.Veterans Independence 262601. (c)
Conforming amendments
(l)
Minimum essential 5000A(f) coverage
Section Internal Revenue , 18, Code or of 1986 is amended by striking 18 and (2)
Medicare or 26. part B
(A)
Non- application of late inline">Section the enrollment 1839(b) second sentence, demonstrate that subchapter II individual described or individual chapter in Act title section 38, 1837(k) in of which the VetsCare States 1395r(b)) is amended, individual Senior can program Code in after under an (3). id="HECB0CAFDB9A84DE991BE600BBFD7C5F9" the following for the United commented="no">(B)
Special 1837 (42 U . S.C. months was enrolled 26 of display-inline="yes-display- Security Social Security Act enrollment (42 U.S.C. 1395p) is period
Section amended by adding at the end the new subsection: (l)In enrolled 38, commented="no">(m) at 226A and be deemed shall Senior the be a special time who is enrolled) program under the to is enroll as II entitled but indi vidualaEUR period case subchapter individual eligible during enrollment the the of of to who has T11s initial specified by the Secretary. (2)In the special this part enrollment shall Ml-~. PVERSIGHT begin period on such the provided date under specified indent="subsection" case of paragraph by the an individual (1), the who enrolls coverage period during under Secretary. VA-19-0799-H-000153 OS 00019456 (3)An enrollment period provided indent="subsection" individual under paragraph may only ( 1) one time enroll during during the the special indi vidualaEUR 1 Ms lifetime. (4)The collaborate of described individuals the shall of collaborate Social provided the the to Secretary provide of for (1). The Secretary with respect with the to ensure Security under indent="subsection" to the Secretary Health and accurate identification of Veterans this Secretary Affairs subsection. of Health appropriate Human Services of shall provide The Secretary and follow of Human Services up pursuant to and any preceding sentence..
6.
Coordination VetsCare Choice program and eligibility to make between contributions to health savings accounts
(a)
In display-inline="yes-display-inline">Section of 1986 is striking amended the by adding at the and end of clause following (iii) at and the the end inserting Internal of Revenue clause (ii), , Code by and, and new clause: display-inline="no-display-inline" id="H112A5E05EB504883AED561FAF4EDE9ED" style="OLC"> (iv)coverage insurance support title United 38, under the States VetsCare Choice program under for subchapter I of health chapter 26 of Code.. (b)
Denial deduction for section 223 following amounts of the not includible Internal Revenue in gross Code of of income
Subsection 1986 is amended by adding (b) at the end of the new paragraph: (9)
Amounts includible in gross income
No an individual shall be taken this section) such from gross Federal income amount, of the into amount account when paid individual under to or or paid subsection on behalf exempt to from of a health (a) such taxation if not savings account (without individual, under any regard is provision of to excluded of law.. The amendments health (as savings 1986) ) , id="H3F416672010449D0B3D6C522EBA11FD8">(c)
Effective o~o " after n account the , PVERSIGHT date of the made by this defined enactment in section apply the Internal to section 223(d) of Act.
this of shall amounts Revenue paid Code to a of VA-19-0799-H-000154 OS 00019457
7.
Publication health care of information
(a)
In general
The make of the available Veterans information under and continuous support to the the Health Medicare public Secretary on an ongoing Administration Accountable improvement in in Care the basis a manner Organization Veterans of Veterans information about the similar to publication program to better of monitor Health Administration. (b)
Elements
T he information operations published of safety, the patient under Veterans subsection Health experience, (a) shall Administration, timeliness, and include information including metrics about regarding the quality, cost- effectiveness.
8.
Veterans' long-term care id="H290CC8533F6645268439C0667810121B">(a)
In general
Section id="HD40EDC3021024E92AF2D9A5F59BCCA98">(l)by redesignating paragraphs (5) through (10) as (6) through (11), respectively; (2)by paragraph act-name="" id="HAB514925580D4D588861685568D71A36" style="OLC"> (5)
Veteran
Th e term title veteran 38, United States has the same meaning given the term in section Code.; 101(2) of (3)in paragraph so redesignatedaEUR" (A)in (A), by striking or (4) . and inserting (4), or (5) .; (B)in (B), by striking (l) or (3) . and inserting (l), (3), (5) .; (C)in subparagraph (C), (5); and or (4) and inserting (4), or id="HCBA8192928C84B8DB43FF44525E1E92A">(D)in (D), by striking or (4) and inserting (4), or (5); (4)in so redesignated, A1v1u .. ,, . PVERSIGHT by striking or (5) . and paragraph inserting (5), VA-19-0799-H-000155 OS 00019458 or (6) .; id="H40FCB15C6B1941D39E57FD3B781AAEA6">(5)in as paragraph so redesignateda.EUR" (A)in subparagraph (C), by striking Commerce; and and inserting Commerce;; (B)in subparagraph (D), and; and Services. and inserting Services; id="HD2C4F6323BB0487D89F8CAC2DEE0857A">(C)by subparagraph (D) : (E)with to the a veteran, inserting id="HAE8B3FB03B13460DA45049393397C9B6" Secretary of Veterans style="OLC"> respect Affairs.. (b)
Technical conforming United amendments
Title as 5, follows: id="HD25A79675B3C49E78B2C6A97FB268DFF">(l)Section 9002 is amendeda.EUR" (A)in (a), (6); or (5) and inserting (5), or and (B)in (e)a.EUR" id="HD588FC8AC25844B291323F26EAB8F082">(i)in by striking or (4) and inserting (4), paragraph or (2), (5); and (ii)in by striking section 9001(9) and inserting paragraph (4), section 9001(10). (2)Section is by inserting amended following: section , 9001(5) withheld an enrollee title,. commented="no" under by virtue subsection of being (b) a veteran (3) described the in display-inline="no-display-inline" id="H9F9BB09F304B470E8F48CCD7D5759A84">(3)Section by striking 9004(d) or (4) and inserting (3), 9008(c) (4), is amended or (5).
 AMLRICAN PVERSIGHT VA-19-0799-H-000156 OS 00019459 Message Davidshulkin [Drshulkin@aol.com] From: Sent: 11/3/2017 9:21:04 PM To: (b) (6) (b) (6) Poonam Alaigh [_,otmail.com] Re: Remember .. Subject: I know - unbelievable Sent from my iPhone (b) (6) (b) (6) > on Nov 2, 2017, at 10:03 PM, Poonam Alaigh <-otmail .com> wrote: > (b) (6) > -. . . he just withdrew his nomination > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000157 OS 00019460 Message otmail.com] Poonam Alaigh (b) (b)(6)(6) 11/3/2017 2:03:37 AM David Shulkin [drshulkin@aol.com] Remember .. From: Sent: To: Subject: (b) (6) -. .. he just withdrew his nomination Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000158 OS 00019461 Message From: (b) (6) Sent : 10/31/2017 5:38:28 PM To : David shulkin [Drshulkin@aol.comJ Re: Prints Subject: (b) (6) (b) (6) gmail.com] Ok. I hope they find it helpful. On Tue, Oct 31, 2017 at 12:45 PM David shulkin wrote: Nope Sent from my iPhone > On Oct 31 2017, at 1237 PM , (b) (6) (b) (6) (b) (6) > > Do you need me to print anything else for-(b) (6) and send over tomorrow? If you think of something Jet me know and I can package up by midday . A representative from the firm came last Thursday for the last file . >> Sent from Gma.il Mobile Sent from Gma.il Mobile AMERICAN PVERSIGHT VA-19-0799-H-000159 DS 00019462 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 10/31/2017 4:44:57 PM (b) (6) (b) (6) (b) (6) Re: Prints gmail.com] Nope Sent from my iPhone > On Oct 31, 2017, at 12:37 PM, (b) (6) (b) (6) (b) (6) gmail . com> wrote: > > Do you need me to print anythin g else for -(b) (6) and send over tomorrow? If you think of somethin g let me know and I can package up by midday. A representative from the firm came last Thursday for the last file . > > sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000160 OS 00019463 Message From: (b) (6) Sent: 10/31/2017 4:37:36 PM David Shulkin [drshulkin@aol.com] Prints To: Subject: (b) (6) (b) (6) gmail.com] 111111 Do you need me to print anything else for (b) (6) and send over tomorrow? If you think of something let me know and I can package up by midday. A representative from the firm came last Thursday for the last file. Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000161 OS 00019464 Message From : (b) (6) Sent : 10/28/2017 4:54:08 PM David ShuIkin (drshulkin@aol.com] Re: slides to discuss for AAMC To : Subject: (b) (6) (b) (6) gmall.com] Ok . -(b) (6) asked for similar slides from OAA and was waiting for them on Friday . Ill send a note to OAA to make sure this info is include to. On Sat, Oct 28, 2017 at 12 :25 PM David Shulkin wrote: Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000162 DS 00019465 Message From: David Shulkin [drshulkin@aol.com] Sent: 10/28/2017 4:25:11 PM To: (b) (6) Subject: Attachments: AMERICAN (b) (6) gmail.com slides to discuss for AAMC aamcslides.pptx PVERSIGHT VA-19-0799-H-000163 DS_ 00019466 -~J .~,F-~"~2 .Y,~ ~!.' .:~,:~~~?J .~;i~.~~~~a;~~~!;!~~~~aJ VA ~ ' ;.~!~~ ,C-Co:'OOP't'.oD,ilJII" ~ l'ltf:i.....,1,111"'111)~(JC'l)-~li~t~ '0!JPYi'Ot'll""1t'ti'#'11~o,i l~ p1Wolf,J;'-t'!"""1;hro~)r,~'-;1Hha11 ld;,o,:->>:?110 C~ 11,_... fill ........ ---o...-io ~ o-~II , liio!lillol~ai ........ , ,,n-. onooo W.W,l'li'l ~ ..,-..In'!..,... , ..... ...,_. W.1~,-.,lillri "Toeducate forVAandfortheNatton ' AMERICAN PVERSIGHT ;zc11~ .. _..,.. .... -..imt-,.......,lift IMl"-1.._ .. ....... Gl- ...... } o ....., ""..., ,._.......i...-i ' :J '2~11 lll-"IJ' l'CIILl!t"'IIS-.il!oil a,..a11.ii---- toi11i-1n-~ ~l~tllol" -o . 1,w,1. .......... M_ 'lllllilalilP--.~ ~ljiio;t.t..,._ ._...,...,....._ t.,_c.,n~- ..... .........,.,,, .,, 111,1,._.__,,..... ..oo1.Jllll.......,_ ,.__s,,__ ~ ,. VA-19-0799-H-000164 DS 00019467 January30, 1946 POLJCY MEMORANDUMNO.2 SUBJECT : PolleyIn Association of Veterans'HospitalsWith MedicalSchools. 1. GEJ\JERAL CONSIDERATIONS VA AMERICAN PVERSIGHT it wouid. therefore, be most unusual problems frequent!y can be sol.,,.edonly bytria! and exercise tolerance if the program is not to fail. There can be no faith of both parties VA-19-0799-H-000165 OS 00019468 VA Education Center of Excellence Number of Trainees and Faculty UPDATE on VACAA Residency Positions Message David Shulkin [drshulkin@aol.com] From: Sent: 10/28/2017 5:55:36 PM To: Poonam Alaigh (b) (b)(6)(6) Re: Remembering Subject: otmail.com] Great pict ure Sent from my iPad (b) (6) > on Oct 28, 2017, at 1:0 1 PM, Poonam Alaigh <-otmail (b) (6) > > -(b) (6) ex~what .com> wrote: sent this pie yesterday which I didn ' t have- this was the day you too k your oathwas to happen when we took this pie together . Brought bac k memories never > > > > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000169 OS 00019472 Message (b) (6) From: (b) (6) (b) (6) Sent : 10/30/2017 9 :40:02 PM To : David shulkin [Drshulkin@aol.comJ Re: pharma Subject: gmail.com) Ok On Mon , Oct 30, 20 17 at 5 :26 PM David shuJkin wrote: Can you make the edits here - ignore the part about expanding membership for now Sent from my iPhone Begin fmwarded message : From: David Shulkin Date: October 30, 2017 at l 1:41 :29 AM EDT To: david.shuJkin@va .gov Subject: Fwd: pharma Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000170 DS_00019473 Message From: Sent: David shulkin LDrshulkin@aol.com] 10/30/2017 9 :26:03 PM To : (b) (6) ???????I l????lgmai l.com] (b) (6) (b) (6) Subject: pharma Attachments : VA - PharmaAdvTsory_ V2.doc; Untitled attachment 80805.htm Can you make the edits here - ignore the paii about expanding membership for now Sent from my iPhone Begin forwarded message: From: David Shulkin Date: October 30, 20 17 at 11:4 1:29 AM EDT To: david.shulkin@va .gov Subject: Fwd: pharma AMERICAN PVERSIGHT VA-19-0799-H-000171 DS 00019474 Improving Access to Pharmaceuticals . - --iFormatted: Centered (b) (5) (b) (5) OBJECTIVES: Specific Objectives of t he Advisory Committee : (b) (5) ---{ Formatted: Font color: Red Formatted: Font color: Red Formatted: Font color Red Formatted: Font color: Red Formatted: Font color: Red PROPOSEDMEMBERSHIP : (b) (5) (b) (5) Formatted: Font: Bold, Font color; Red Formatted: Font: Bold, Font color: Red Formatted: Font: Bold, Font color: Red A\llERICAN PVERSIGHT VA-19-0799-H-000172 DS_00019475 (b) (5) (b) (5) (b) (5) _ A\llERICAN PVERSIGHT _.--{ Formatted: Font colo r: Red VA-19-0799-H-000173 D8_00019476 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 1/5/2018 3:05:26 AM To: IP -frenchangel59 ( (b) Re:(6) bRE: Subject: .com] ) ( 6 Ricky Mulligan )from VA Sent from my iPhone > on Jan 2, 2018, at 12:07 PM, IP <-renchangel59.com> ( (b) > b (6) > David , ) > ( > These are the people at Apple . > 6 > I need to know the names of the people in the VA that ) > Please email me the VA names. wrote: know about it . > > Thanks , > Ike > > -----original Message----> From: David shul kin [mail to : secshul ki n@gmai l . com] > sent: Monday, January 01 , 2018 8: 02 PM > To: IP > subject: > > > I inquired > > I hope that and heard that the two Apple people involved with VA are (b) (6) and- (b) (6) is helpful > > David > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000175 OS 00019478 Message (b) (6) From: @aol.com (b) (6) @aol .com) Sent : 1/4/2018 1:42:37 AM To : David Shu Ikin [secshulkin@gmail.com] Subject: Re: Fwd: RE: David, the only person to suggest is Ricci 1\lfulligan . She was taking her cues from the Apple folks and made hard for me to get the feedback I needed . it Sent from my iPhone On Jan 3, 2018 ~at 4: 15 PJ\II,David Shulkin wrote : (b) 1111 who VA might be good to identi fy? (6) Sent from my iPhone Begin forwarded message : ( From: IP ~(b) frenchangel59 .com > b (6) Date: January 2, 2018 at 12:07 :58 PM EST ) To: David Shulkin ( Subject: RE: 6) David, These are the people at Apple . I need to know the names of the people in the VA that know about it. Please email me the VA names . Thanks , Ike -----Original Message----From : David Shulkin fmailto :secshulkin@gmail.com ] Sent: Monday , January 01, 2018 8:02 PM To : IP Subject: I inquired and heard that the two Apple people involved with VA are-(b) (6) _ and (b) (6) I hope that is helpful David Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000176 DS 00019479 Message David Shulkin [secshulkin@gmail.com] 1/3/2018 9 :15:14 PM (b) (b) --@ao l.com Fwd:(6) RE: (6) From: Sent: To : Subject: (b) 1111 who VA might be good to identify? (6) Sent from my iPhone Begin forwarded message : ( (b) From: IP b (6) Date: January 2, 2018 at 12:07:58 PM EST ) To: David Shulkin ( Subject: RE: 6) David. These are the people at Apple . I need to know the names of the people in the VA that know about it. Please email me the VA names . Thanks , Ike -----Original Message----From : David Shulkin [mailto:secshulkin@gmaji.com Sent Monday, January 01 2018 8:02 PM To : IP Subject: - ] I inquired and heard that the two Apple people involved with VA are (b) (6) (b) (6) andlllll I hope that is helpful David Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000177 DS 00019480 Message DavidShulkin [secshulkin@gmail.com] From: Sent: 1/2/2018 6:02:26 PM To: IP -frenchangel59 ( (b) Re:(6) bRE: Subject: .com] ) ( 6 ) ~ __... (b) (6) sorrysent Poonam had been doing thisand besides Woukd it be helpful to speak to her? Darin the only person am aware of at VA is from my iPhone ( (b) > on Jan 2, 2018 , at 12 :07 PM, IP <-renchangel 59 . com> wrote: b (6) > David , ) > ( > These are the people at Apple . > 6 > I need to know the names of the people in the VA that know about it. ) > Please email me the VA names. > > > Thanks , > Ike > > -----original Message----> From: David shulkin [mailto :secshulkin @gmail . com] > sent : Monday, January 01, 2018 8 :02 PM > To: IP > subject: > > > I inquired > > I hope that and heard that the two Apple people involved with VA are (b) (6) and- (b) (6) is helpful > > David > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000178 OS 00019481 Message From: ( (b) IP [-renchangel59 Sent: b (6) 1/2/2018 5:07:58 PM To: ) Shulkin [secshulkin@gmail.com] David RE:( 6 ) Subject: .com] David, These are the people at Apple. I need to know the names of the people in the VA that know about it. Please email me the VA names. Thanks , Ike - - ---original Message----From: David shulkin [mailto:secshulkin@gmail sent : Monday, January 01 , 2018 8 :02 PM To: IP subject : I inquired and heard that I hope that .com] the two Apple people involved with VA are (b) (6) and- (b) (6) is helpful David sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000179 OS 00019482 Message From: David Shulkin [secshulkin@gma il.com] Sent: 1/2/2018 1:02:21 AM To: Ike Perlmutter -frenchangel59.com] ( (b) ~d (b) (6) ........ I hope that (6) b ) ( 6 hea~two (b) (6) ) and ....... Apple people involved with VA are is helpful David sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000180 OS 00019483 M essage David shulkin LDrshulk in@aol.com] 10/25/20 17 11: 22:00 PM otma il .com] Poona m Alaigh (b) (b)(6)(6) Re: W ow- never saw thi s comin g, From : Sent : To : Subject : Ok will do Thanks fir the words of w isdom Sent fro m my iPhone (b)(6)(6) On Oct 25, 2017, at 10:17 ANl Poonam Alaigb - (b) > wrote: Let me know t he next time you are in NYC-the Remedy offices are at 5 Penn Plaza and we cou ld meet right at Penn station or near it if I can arrange t o work t here vs Darien that day - but w ill need to know in advance. Hang in there- the best is yet t o come . From: David shulkin Sent: Wednesday, October 25 , 2017 10:13 AM To: Poonam Alafgh Subject: Re: Wow- never saw th is comi ng Thanks for the note I feel the same The environment here now is the wors t ive seem- its pure toxic - not enjoying it at all Sent fr om my iPhone (b) (6) (b) (6) On Oct 25, 2017, at 7:14 AM, Poonam Alaigh <~> wrote: David no matter what happens, our relationshi p is uncond iti onal and remember what you said-" what doesn 't kill us only makes us stronger" - our relationship will get stronger through all of th is. I will never doubt you r intentions fo r the decisions you make- may not like them but have and will always believe in you!! Let me know how t hings go this week- mi ss you and hopefully can at least speak on t he phone once in a whi le. Take care- whethe r you like it or not, you have a fr iend in me foreve r Sent fro m my iPhone (b) (6) (b) (6) On Oct 25, 2017, at 7 :00 AM, Poonam Alaigh <~> AMERICAN PVERSIGHT wro t e: VA-19-0799-H-000181 DS 00019484 Anyway- I am sure you have a good reason for it- good luck my friend for this week http://www.unionleader.com/health/VA-Secretary-Shulkin changes-Manchester-task-force-leadersh ip-10252017 - Sent from my iPhone AMERICAr-... pVERSIGHT VA-19-0799-H-000182 DS_ 00019485 M essage Poonam Alaigh (b) otma il.com ] (b)(6)(6) 10/25/20 17 2:17:17 PM David shulkin [Drshu lkin@aol.comJ Re: Wow- never saw th is com ing Frotn: Sent : To : Subject : Let me know t he next ti me you are in NYC-th e Remedy off ices are at 5 Penn Plaza and we could meet right at Penn station or near it if I can arrange to work the re vs Darien that day- but will need t o know in advance. Hang in the re- the best is yet to come. From: David shulkin Sent: Wednesday , October 25, 2017 10:13 AM To: Poonam Alaigh Subject: Re: Wow - never saw th is coming Thanks forthe note I fee l the same The environment here now is t he wo rst ive seem- its pure toxic - not enjoying it at all Sent fro m my iPhone (b) (6) (b) (6) On Oct 25, 2017, at 7:14 AM, Poonam Alaigh <~ .Q!.!!@lLf.Q!! P wro t e: David no matt er wh at happens, our relationship is uncondit ional and remember what you said" what doesn't kill us only makes us stronger" - our relat ionship will get stronger through all of t his. I will never doubt you r intentions for the decisions you make- may not like t hem but have and will always believe in you l ! Let me know how things go th is week- miss you and hopefully can at least speak on the phone once in a wh ile. Take care- whether you like it or not, you have a friend in me fo rever Sent fr om my iPhone (b) (6) (b) (6) On Oct 25, 2017, at 7:00 AM , Poonam Alaigh <~> wro t e: Anyway- I am sure you have a good reason fo r it- good luck my friend for t his week http:ljwww.unionleader.com/health/V A-Secretary-Shu Ikin-changesManchester-task-force-leadership-10252017 Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000183 DS 00019486 Message David shulkin [Drshulkin@aol.com] 10/25/2017 2:13:20 PM otmail.com] Poonam Alaigh (b) (b)(6)(6) Re: Wow- never saw this coming From: Sent : To : Subject: Thanks for the note l feel the same The environment here now is the wotst ive seem- its pure toxic- not enjoying it at all Sent from my iPhone (b)(6)(6) On Oct 25, 2017, at 7: 14 AM, Poonam Alaigh - (b) wrote : David no matter what happens, our relationship is unconditional and remembe r what you said- 11 wha t doesn't kill us only makes us stronger " - our relationship will get str onger through all of th.i s. 1 will never doubt your intentions for the decisjons. you make- ornay not like them but have and will always believe in you!! Let me know how things go this week- miss you and hopefully can at least speak on the phone once in a while. Take care- whether you like it or not , you have a friend in me forever Sent from my iPhone - (b) (6) (6) On Oct 25, 2017 , at 7 :00 AM , Poon am Alaigh (b) > wrote : Anyway- I am sure you have a good reason for it- good luck my friend for this week http :/ /www ,union Ieader .com/heal th/V A-Secretary-S hulkin-changes-Manchestertask-force-leadership-10252017 Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000184 DS_00019487 Message Poonam Alaigh (b) otmail.com] (b)(6)(6) 10/25/2017 11:14 :59 AM David Shu Ikin [drshulkin@aol.com] Re: Wow- never saw this coming From: Sent : To : Subject: David no matter what happens our relationship is unconditional and remember what you said-" what doesn't kill us only makes us stronger" - our relationship will get stronger through all of this . I will never doubt your intentions for the decisions you make- may not like them but have and will always believe in you t t Let me know how things go this week- miss you and hopefully can at least speak on the phone once in a while. Take care- whether you like it or not , you have a friend in me forever Sent from my iPbone (b)(6)(6) On Oct 25, 2017, at 7:00 AM, Poonam Alaigh - (b) wrote : Anyway- I am sure you have a good reason for it- good luck my friend for this week http ://www .uni onl eader. com/heal th/V A-Secretary-S hul ki o-changes-M anchester-task -force1eadershi p-1025201 7 Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000185 DS 00019488 Message From: Poonam Alaigh (b) (b)(6)(6) otma il.com] Sent : 10/25/201711:00 :04 AM To : David ShuIkin (drshulkin@aol.com] Wow- never saw this coming Subject: Anyway- I am sure you have a good reason for it- good luck my friend for this week http://www.unionleader .com/health/V A-Secretary-Shulkin-changes -Manchester-task-force -leadership 10252017 Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000186 DS_00019489 Message (b) (6) From: (b) (6) (b) (6) Sent : 10/24/2017 1:59:12 AM To : David Shu Ikin (drshulk in@ao l.com] Fwd: VA meet ing with David S. Subject: gmail.com) Sorry if I shared this already, could not remember. Wi ll taJk to him after you and have document s ready. I ll do my best to get aU of the documen ts I don t have withou t asking too many questions . --------- Forwarded message ----- --(b) (6) (b) (6) From: (b) (6) Date ~Mon, Oct 23, 2017 at 4;22 PM Subject: Re: VA meeting with David S. (b) (5) (b) (6) @mololamken .com> To : -- mail .com> Yes that works for me. You will see my office before you get to his and I'll make sure to introduce myself before you meet with him . On Mon , Oct 23, 20 17 at2 :SJ PM--(b) (5) (b) (6) @mololamken .com > wrote : Hi -(b) (6) - Thank you for reaching out. We're scheduled to meet with Dr. Shulkin at his office tomorrow from 1 to (b) (5) 2:30. Would you be able to meet afterwards? Best regards, _ (b) (6) (b) (6) (b) (6) (b) (5) (b) (5) Good Afternoon - Dr Sbulkin asked me to reach out to you to help prepare an investigation file. Would you like to meet tomorrow? I have a few documents that may be helpful to start. Or if you prefer by phone let me know . Understand you are on the schedule for Tuesday 1pm. (b) (6) Sent from Gmai l Mobile AMERICAN PVERSIGHT VA-19-0799-H-000187 DS_00019490 Sent from Gmail Mobile Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000188 DS_00019491 Message From: (b) (6) Sent : 10/24/2017 3:15:22 AM To : drshulkin@aol.com Did you see this? Subject: (b) (6) (b) (6) gmail.com) In your public box? D--Lighthouse API Management Platform - 36C I OBl 8Q2600 - Federal Business Opportunjties : Opportunities https://www .fbo .gov/index?s =opportunity&mode =form&id =b5a3e0c29fa78545f'D556dac972bac69&tab =core& cview=O AMERICAN PVERSIGHT VA-19-0799-H-000189 DS_00019492 Message David shulkin [Drshulkin@aol.com] From: Sent : 10/22/2017 2:34:52 PM To : (b) (6) Subject: Re: (b) (6) (b) (6) gmail.com] Thanks and maybe what group they have me speaking to- is it just the Deans or is it yhe main session? Sent from my iPhone On Oct 22, 2017, at 9:40 AM~(b) (6) (b) (6) (b) (6) omail,com > wrote : For brochure promotion, your bio, picture and intro was sent to the aamc on 10/10. I'll follow up to get clarity with organizers 011 where they are 011 promoting you and if it can be updated by tomorrow . On Sun, Oct 22, 2017 at 9:30 AM David ShuJkin wrote : (b) (6) take a look below http://www .cvent.com/events/leam-serve-lead-2017 -the-aamc-annuaf-meeting/event-summary123be9b8e9a64 l 83bftJde06dd65 7f5 6c.aspx ?ReflD=Meeti 11gs.org%20Page Why am I not featured as a speaker? Did I get booked in some small subgroup rather than the main speaking track? What do we know about how they are promoting this? 4300 attendees Sent from my iPad Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000190 DS 00019493 Message From: (b) (6) (b) (6) (b) (6) Sent: 10/22/2017 1:40:39 PM To : David Shu Ikin (drshulkin@aol.com) Re: Subject: gmail.com) For brochure promotion, your bio, picture and intro was sent to the aamc on 10/10. I'll follow up to get clarity with organizers on where they are on promoting you and if it can be updated by tom on-ow. On Sun, Oct 22, 2017 at 9;30 AM David Shulkin wrote: (b) (6) takea lookbelow http://www .cvent.com/events/learn-serve-lead-2017-the-aamc-annual-meeting/event-summarvl 23be9b8e9a64183bf0de06dd6S 7f56c.aspx?ReflD =Meetings.org%20Page Why am I not featured as a speaker? Did I get booked in some small subgroup rather than the main speaking track? What do we know about how they are promoting this? 4300 attendees Sent from my iPad Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000191 DS 00019494 Message David Shulkin (drshulkin@aol.com) From: Sent : 10/22/20171:30:24 To : (b) (6) (b) (6) - PM (b) (6) (b) (6) gmail.com] take a Jook below http://www.cveot.com/events/learo-serve-lead-2017-the-aamc-annual-meeti ng/event-summary 123be9b8e9a64 l 83bf0de06dd65 7f56c .aspx?RefID =Meeti ngs .org%20Page Why am I not featured as a speaker? Did I get booked in some small subgroup rather than the main speaking track? What do we know about how they are promoting this? 4300 attendees Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000192 DS_00019495 Message From: (b) (6) Sent: 10/22/2017 1:10:28 PM David Shu Ikin (drshulkin@aol.com] Re: Attorney Client Privileged To : Subject: (b) (6) (b) (6) gmail.com) Ok On Sat, Oct 21, 2017 at 6:08 PM David Shulkin wrote: Can we discuss on monday Sent from my iPad Begin forwarded message : (b) (5) From: 11~(b) @mololamken.com > Date: October 21, 2017(6) at 2:51 :13 PM EDT To: "drshulkin@aol.com " Subject : Attorney Client Pi-ivileged Dr . Shulkin , It was a pleasure meeting you and your wife yesterday . Following up on our discussion, it would be helpful to schedule a time to discuss in more detail the specifics of the-(b) (5) As I mentioned , we 're happy to meet whenever and wherever it's most convenient for you . If there is a 2-hour block this week that might work, please let me know . I look forward to talking further, and reaching a favorable resolution to this matter as quickly as possible . Best regards , 1111 (b) (5) (b) (6) Molo Lam.ken LLP (b) (6) T : (b) (6) M : (b) (6) (b) (6) ~ www.mololamken.com AMERICAN PVERSIGHT VA-19-0799-H-000193 DS 00019496 DS 00019497 Sent from Gmail Mobile Message David shulkin lDrshulkin@aol.com] 10/27/2017 7:02:29 PM Poonam Alaigh (b) otmail.comJ (b)(6)(6) Re: USA today intervi~w From : Sent : To : Subject: Ok havnt seen yet Im with new pa health conm issione r Karen murphy left Sent from my iPhone (b) (6) On Oct 27, 2017 , at 2:35 PM, Poonam Alaigh - (b) (6) wrote : I think it came out really great allaying rumors- most im portantly, showed your unwavering loyalty to the President- which right now is critical. AMERICAN PVERSIGHT VA-19-0799-H-000195 DS 00019498 Message From: (b) (6) Sent: 10/22/2017 (6) 11:56:14 AM To: David Shulkin [drshulkin@aol.com]; Jennifer Lee (b) (b)(6)(6) physician candidate in nyc Monica Nogue ira resume.pdf Subject: Attachments: -@amida (b) .com] gmail.com] Hi David, hi Jen, I met this young woman in New York City on Friday; I have a collaboration with NYU and she came to dinner that night. As I understand it she's a foreign-trained doctor with all the US certifications and boards, and is now looking for a residency in New York. She would love to do that at a VA facility. I cannot give her a qualified professional endorsement , but she made a great impression on me as someone I would enjoy working with. I'd be grateful if you could forward this to the right person at VA (or tell me who that is?) Thanks and best, (b) 1111 (6) AMERICAN PVERSIGHT VA-19-0799-H-000196 OS 00019499 (b) (6), (b) (2) (b) (6) Education (b) (6), (b) (2) Professional Experience (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) AMERICAN PVERSIGHT Page l VA-19-0799-H-000197 DS_00019500 (b) (6), (b) (2) (b) (6) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) , Brazil (January 2013 - March 2015) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) , Brazil (March 201 1 - December 20 11) (b) (6), (b) (2) o o o o AMf:::RICAr-... pVERSIGHT Page2 VA-19-0799-H-000198 DS 00019501 (b) (6), (b) (2) ,M. D. (b) (6) Research (b) (6), (b) (2) (b) (6), (b) (2) February 2008 - December 2012 Jinical Research o o o o o o (b) (6), (b) (2) (b) (6), (b) (2) July 2007 - December 2007 Laboratory Re earch o o (b) (6), (b) (2) (b) (6), (b) (2) (b) (6), (b) (2) A\llERICAN PVERSIGHT Page3 VA-19-0799-H-000199 DS_00019502 (b) (6), (b) (2) , M .D. (b) (6) (b) (6), (b) (2) Others (b) (6), (b) (2) (b) (6), (b) (2) Volunteer Work (b) (6), (b) (2) Languages (b) (6), (b) (2) A\llERICAN PVERSIGHT Page4 VA-19-0799-H-000200 D8_00019503 Message David shulkin [Drshulkin@aol.com] 10/18/2017 2:55:53 AM otmail.com] Poonam Alaigh (b) (b)(6)(6) Re: HAPPYDIWALI From: Sent : To: Subject: What an amazing experience to have hadSent from my iPhone (b)(6)(6) On Oct 17, 20 17, at 10:23 PM, Poonam Alaigh ~(b) > wrote : Sent from my iPhone Begin forwarded message : (b) (b)(6) (6) From: "(b) (6) ail.com > (b) (6) To: "Poonam Alaigh 11 (b) (6) hotmaiLcom > Subject: HAPPY DIW ALI (b) (6) <2017- 10-l 7-VIDEO-0000 12 16.mp4> AMERICAN PVERSIGHT VA-19-0799-H-000201 DS 00019504 en g ,-+ ~ z ~ (1) (b) (6) .,, ::l 0.. ::l ..., 0.. (1) (1) V, V, (1) .,, 0V, V, , Juno 011 MSU/4/4/2/9/sh 0 -0 0 C C er .... Ill "Tl ....a3 ID ::::J < .... 0 -. 0 -, - . 0 C s. ::> ., ~- .... a: "' < c.. ro ....... n 00 V, "' ....... "' ~ v, N :::r ro31-',.:= " .....i -. 3 "' V, ::> -< 0 :i;.c5 ~ V, "' w :::r C "lJ s V, ~ ::> (? llJ (1) Q_ ;-, -= 0 3 Q. 0 It II myprtv11909 to be hostingthis year's MInI11enal Summllon Veterans.Affairs 10 be heldIn Londonfrom Tuesday1810Thursday20 July2017. The overall theme lor this years engagement will be .Future Suppon to Vetaransand MentalHealth' and I verymuch hope you canattend (b) (6) lllllllllllllli11 be my primarypolnl of contactwithinlhe Mintstiyof Defenoe for ~\llilemall ~ (b) communication of the Summllprogramme. He can be contacted andbyph0neon02072180529 . (6) II Yo\ohaveany problemsgettingIn tolJChvia a-mall,Pleasecontactmy pl1vateoffice on +(44) 020 7218 -(b) = ro n ro "lJ ~::, n (1) ~ :::r ro ~ .., (1) (b) (6) I dOtiope you will be(6) able lo foln us and I look lo,ward to wefeomlngyou InJuly, C!Q 3 "' n IIARKLANCASTER TDVR 0 (b) (6) Dal/idShulkln (6) Honourable Secrelary of VeteransAffairs 0 0 ~ 0 E.. ~oThe {/) MERI ~DVE "' "' llJ ro 0 DeerDr Bari, sro C!Q :E "Tl (b) (6) Ministry of Defen (1) V, ::r(b) (6) / MINl8TAV O DEFENCE A.001'. 5 ZONE B MAIN BUI OINtl WMIT8'111l LONDON W Ill ~ 'io" n 9 '"d 0 0 0 '<: -t Ill C ..., ..., ::n s 0 ,-+ '"r1 0 810 VennontAlie, N.W. Washington,D.C. 20420 VA-19-0799-H-000202 Message From: David shulkin LDrshulkin@aol.com] Sent : 10/17/2017 1:39:53 AM To: (b) (6) Subject: Re: Veteran's Day Event (b) (6) (b) (6) gmail.com] Ok Sent from my iPhone On Oct 16, 2017, at 7:17 PM, (b) (6) (b) (6) (b) (6) mail.com> wrote: 1think you should do thjs. On Thu, Oct 12, 2017 at 11:30 AM Davjd shlllkin wrote: Sent from my iPhone Begin forwarded message: (b) (6) From: 11(b) (6) Date: October 12, 2017 at 8:30:30 AM EDT To: David shulkin (b) (6) Cc:" (b) (6) e, u hs.u enn.edu> Subject: Veteran's Day Event Dear Secretary Shulkin: I would like to formally invite you to a Veteran's Day event we are planning for Penn Medicine on November 20th at 5 PM . We were hoping that given all the events you attend around Veteran's Day, this might be easier and closer to when you might return home for the Thanksgiving holiday. If you would be able to attend, we usually have a formal program and would ask that along with the Dean Larry Jameson and Ralph Muller our CEO that you might make some remarks. Thank you for your kind consideration, I am, Sincerely, (b) (6) ,PhD Rear Admiral, USN (ret) Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000204 DS_00019507 Message From: (b) (6) Sent : 10/16/2017 11:17 :57 PM David shulkin [Drshulkin@aol.comJ Re: Veteran's Day Event To: Subject: (b) (6) (b) (6) gmail.com) l think you should do this. On Thu , Oct 12, 2017 at 11 :30 AM David shulkin wrote : Sent from my iPhone Begin forwarded message : (b) (6) From: 11(b) (6) Date: October 12 2017 at 8:30:30 AM EDT To: David shulkin (b) (6) Cc: "(b) (6) u hs.u enn .edu> Subject: Veteran's Day Event Dear Secretary Shulkin : I would like to formally invite you to a Veteran's Day event we are planning for Penn Medicine on November 20th at 5 PM. We were hoping that given all the events you attend around Veteran's Day , this might be easier and closer to when you might return home for the Thanksgiving holiday. If you would be able to attend, we usually have a formal program and would ask that along with the Dean Larry Jameson and Ralph lvluller our CEO that you might make some remarks . Thank you for your kind consideration, I am, Sincerely , (b) (6) , PhD Rear Admiral , USN (ret) Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000205 DS_00019508 Message David shulkin lDrshulkin@aol.com] Frotn: Sent : 10/12/2017 3:30:42 PM To : (b) (6) Subject: Fwd: Veteran's Day Event (b) (6) (b) (6) gmail.com] Sent from my iPhone Begin forwarded message : (b) (6) From:" (b) (6) Date: October 12, 2017 at 8:30:30 AM EDT To: David shulkin (b) (6) Cc: "(b) (6) u hs .u enn .edu > Subject: Veteran's Day Event Dear Secretary Shulkin : 1 would like to formally invite you to a Veteran's Day event we are planning for Penn Medicine on November 20th at 5 PM . We were hoping that given all the events you attend around Veteran 's Day , this might be easier and closer to when you might return home for the Thanksgiving holiday. If you would be able to attend, we usually have a formal program and would ask that along with the Dean Larry Jameson and Ralph Muller our CEO that you might make some remarks . Thank you for your kind consideration , I am, Sincerely , (b) (6) , PhD Rear Admiral , USN (ret) AMERICAN PVERSIGHT VA-19-0799-H-000206 DS 00019509 Message From: (b) (6) (b) (6) (b) (6) Sent : 10/21/2017 11:26 :09 AM To : David shulkin [Drshulkin@aol.comJ Re: Subject: gmail.com] That ' s a huge deal. Very nice On Fri , Oct 20, 2017 at I 1:48 PM David shulkin wrote : Potus called me after seeing it Sent from my iPhone > On Oct 20, 2017, at 8:28 PM, (b) (6) (b) (6) (b) (6) gmaiLcom > wrote : > > Just watched : Nice job on the interview today >> Sent from Gmail Mobile Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000207 DS 00019510 Message From: David shulkin [Drshulkin@aol.com] Sent: 10/21/2017 3:48:20 AM To: (b) (6) Subject: Re: Potus called me after (b) (6) (b) (6) seeing gmail.com] it Sent from my iPhone > On Oct 20, 2017, at 8:28 PM, (b) (6) > > Just watched: Nice job on the interview (b) (6) (b) (6) gmail .com> wrote: today > > sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000208 OS 00019511 Message From: (b) (6) Sent: 10/21/2017 12:28:31 AM David Shulkin [drshulkin@aol.com] To: (b) (6) (b) (6) gmail.com] Just watched: Nice job on the interview today Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000209 OS 00019512 Message From: (b) (6) (b) (6) (b) (6) gmail.com) Sent : 10/14/2017 12:05 :38 AM To : David Shu Ikin (drshulkin@aol.com] Shulkin Vows in Writing Not to Cut Program for Disabled Vets Subject: I Military .com http://www .military.com/daily-news/2017 /10/ 13/shulki n-vows-writing-not-cut-benefi t-program-disabledvets .html AMERICAN PVERSIGHT VA-19-0799-H-000210 OS 00019513 Message Marc Sherman (mb From: (b) (6) gmail.com) Sent : 10/14/2017 2 :36:23 PM To : David Shu Ikin (Secshulkin@gmail.com) Re: Subject: Are we talking at 11 am? I never heard back from my previous email so I am not sure. Marc Shennan (b) (6) wrote: On Oct 13, 2017 2:01 PM, 1'Marc Shennan' 1 <- (b) (6) My schedule has now changed and I can talk at 11am tomorrow if that still works for you. (b) (6) On Oct 12, 2017 10:37 PM, "David ShuJkin" wrote : I lam ? Sent from my iPhone On Oct 12, 2017, at 10:23 PNI, David Sbulk:in wrote : Time on saturday? Sent from my iPhone On Oct 12,20 17, at 5:58 PM, Marc Sherman <~ (b) (6) > wrote: It sounds like it will be a while before our schedules will allow us to have breakfast , lunch or dinner. I think it would be useful for us to talk. Should we pick a time to just talk by phone? Marc Sherman (b) (6) On Oct 12, 2017 12:27 PM, "David Shulkin" wrote : Im in nyc Sent from my iPhone On Oct 10, 2017 , at 9: 13 PM, Marc Sherman How about lunch tomorrow. I just had a cancellation. Could we make that work? On Tue, Oct 10, 2017 at 6:22 PM, David Shulk.in wrote : AMERICAN PVERSIGHT VA-19-0799-H-000211 DS 00019514 Marc- when i looked at november 7th it was wide open- now im tokd the reason why is because tbey have me out if town for a few days- sorry Any days that a lunch might work? Sent from rny iPhone On Oct 9, 2017, at 6:24 PM, Marc Sherma n <~ (b) (6) > wrote : How do you look for November 7 or 8? Marc Sherman (b) (6) On Oct 9, 2017 6:13 PM, "David Shulkin" wrote : Looks like ill need to be in ny that evening Sent from my iPhone On Oct 8, 2017, at 11:11 PM, Marc Sherman <- (b) (6) > wrote : Ok, I will hold off rearranging things until I hear a go from you. Let me know as soon as you know about your availability. On Sun, Oct 8, 2017 at 5 :28 PM , David Shulkin wrote : Its also uncertain 50/50 i need to be in ny on the 17 th - we can check in closer to then Sent from my iPhone On Oct 8, 2017, at 12:47 PM, Marc Sherman (b) (6) <> wrote : Thank you . I would love to do that. Unfortuna tely, the only AMERICAN PVERSIGHT VA-19-0799-H-000212 DS 00019515 day I could mavbe have dinner is th e l 7th ... and I would have to check if that is a poss ibility. I leave on the morning of the 18th for Canada and after that many other cities and won't be back in DC again until November 7. Before I stast checking to move things around , does October 17 dinner work for you? (b) (6) On Oct 8, 2017 12:37 PM, 11David Shulkin 11 wrote : larc- good caJI and great fac ilitation Maybe it would be good to think more about communicatio n strategies (your point) and we could get dinner the week of the 16 th if you are around AMERICAN PVERSIGHT VA-19-0799-H-000213 D8_00019516 Sent from my iPhone Message Marc Sherman (mb From: (b) (6) gmail.com) Sent : 10/13/2017 6:01:10 PM To : David Shu Ikin (Secshulkin@gmail.com) Re: Subject: My schedule has now changed and I can talk at 11am tomorrow if that still works for you. Marc Shennan (b) (6) On Oct 12, 2017 10:37 PM, "David Shulkin" wrote : llam? Sent from my iPhone On Oct 12, 2017 1 at 10:23 PM, David Shul kin wrote: Time on saturday? Sent from my iPhone On Oct 12, 2017, at 5:58 PM , Marc Sherman- (b) (6) > wrote : It sounds like it will be a while before our schedules will allow us to have breakfast ~lunch or dinner. I think it would be useful for us to talk . Should we pick a time to just talk by phone? Marc Sherman (b) (6) On Oct 12, 2017 12:27 PM, "David Shulkin" wrote: Im in nyc Sent from my iPhone On Oct 10, 2017, at 9:13 PM,Marc Sherman<- (b) (6) > wrote : How about lunch tomorrow . I just had a cancellation . Could we make that work? On Tue, Oct 10, 2017 at 6:22 PM, David Shulkin wrote : Marc- when i looked at november 7 th it was wide open- now im tokd the reason why is because they have me out if town for a few days- sorry Any days that a lunch might work? Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000215 DS 00019518 On Oct 9, 2017 , at 6 :24 PM, Marc Sherman <- (b) (6) > wrote : How do you look for November 7 or 8? Marc Sherman (b) (6) On Oct 9, 2017 6:13 PM , "David ShuJkin" wrote : Looks. like ill need to be in ny that evening Sent from my iPhone On Oct 8, 2017 , at 11: 11 PM., Marc Sherman <- (b) (6) > wrote : Ok, I will hold off rearranging things until I hear a go from you. Let me know as soon as you know about your availability. On Sun, Oct 8, 2017 at 5:28 PM, David Shulkin wrote : Its also uncertain 50/50 i need to be in ny on the 17th - we can check in closer to then Sent from my iPhone On Oct .8, 2017 at 12:47 PM , Marc Sherman (b) (6) <> wrote: Thank you. I would love to do that Unfortunat ely, the on]y day 1 could maybe have dinner is the 17tb ...and I would have to check if that is a possibility. I leave on the morning of the AMERICAN PVERSIGHT VA-19-0799-H-000216 DS_00019519 18th for Canada and after that many other cities and won't be back in DC again until November 7. Before I start checking to move things around, does October 17 ctinner work for you? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PM, 11David Shulkin 11 wrote : Marc- good call and great facilita ti.on Maybe it would be good to think more about communication strategies (your point) and we could get ctinner the week of the 16th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000217 D8_00019520 Message Marc Sherman (mb From: (b) (6) gmail.com) Sent : 10/13/2017 3:16:44 AM To : David Shu Ikin (Secshulkin@gmail.ca m) Re: Subject: lam in meetings until 1pm. Anytime after 1pm is good . Does a later time work for you? Marc Shennan (b) (6) On Oct 12, 2017 10:37 PM, "David Shulkin" wrote : llam ? Sent from my iPhone On Oct 12, 2017 1 at 10:23 PM, David Shul kin wrote : Time on saturday? Sent from my iPhone On Oct 12, 2017 , at 5:58 PM , Marc Sherman- (b) (6) > wrote : It sounds like it will be a while before our schedules will allow us to have breakfast~lunch or dinner. I think it would be useful for us to talk . Should we pick a time to just talk by phone? Marc Sherman (b) (6) On Oct 12, 2017 12:27 PM , "David Shulkin" wrote : Im in nyc Sent from my iPhone On Oct 10, 20 17, at 9:13 PM , Marc Sherman <- (b) (6) > wrote : How about lunch tomorrow . I just had a cancellation . Could we make that work ? On Tue, Oct 10, 2017 at 6:22 PM, David Shulkin wrote : Marc- when i looked at november 7 th it was wide open- now im tokd the reason why is because they have me out if town for a few days- sorry Any days that a lunch might work? Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000218 DS 00019521 On Oct 9, 2017 , at 6 :24 PM, Marc Sherman <- (b) (6) > wrote : How do you look for November 7 or 8? Marc Sherman (b) (6) On Oct 9, 2017 6:13 PM , "David ShuJkin" wrote : Looks. like ill need to be in ny that evening Sent from my iPhone On Oct 8, 2017 , at 11: 11 PM., Marc Sherman <- (b) (6) > wrote : Ok, I will hold off rearranging things until I hear a go from you. Let me know as soon as you know about your availability. On Sun, Oct 8, 2017 at 5:28 PM, David Shulkin wrote : Its also uncertain 50/50 i need to be in ny on the 17th - we can check in closer to then Sent from my iPhone On Oct .8, 2017 at 12:47 PM , Marc Sherman (b) (6) <> wrote: Thank you. I would love to do that Unfortunat ely, the on]y day 1 could maybe have dinner is the 17tb ...and I would have to check if that is a possibility. I leave on the morning of the AMERICAN PVERSIGHT VA-19-0799-H-000219 DS 00019522 18th for Canada and after that many other cities and won't be back in DC again until November 7. Before I start checking to move things around, does October 17 ctinner work for you? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PM, 11David Shulkin 11 wrote : Marc- good call and great facilita ti.on Maybe it would be good to think more about communication strategies (your point) and we could get ctinner the week of the 16th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000220 D8_00019523 Message David Shulkin [secshulkin@gmc1il.com] From: Sent : 10/13/2017 2 :37:29 AM To : (b) (6) Marc Sherman [mb...gmail.com] Subject: Re: l 1am? Sent from my iPhone On Oct 12, 2017, at 10:23 PM, David Shulkin wrote : Time on saturday? Sent from my iPhone On Oct 12, 2017, at 5:58 PM, Marc Sherman <- (b) (6) wrote: It sounds like it wlll be a while before our schedules will allow us to have breakfast , lunch or dinner . I think it would be useful for us to talk . Should we pick a time to just talk by phone? Marc Sherman (b) (6) On Oct 12, 2017 12:27 PM, "David Shulkin 11 < secshulkin@gmail.com > wrote: Im in nyc Sent from my iPhone On Oct 10, 2017 at 9: 13 PM, Marc Shennan <~ (b) (6) > wrote : How about lunch tomorrow. I just had a cancellation . Could we make that work? On Tue, Oct 10, 2017 at 6:22 PM, David Shulkin wrote : Marc- when i looked at november 7th it was wide open- now im tokd the reason why is because they have me out if town for a few days- sorry Any days that a lunch might work? Sent from my iPhone On Oct 9, 2017, at 6:24 PM, Marc Sherman <- (b) (6) > wrote : How do you look for November 7 or 8? Marc Shennan (b) (6) AMERICAN PVERSIGHT VA-19-0799-H-000221 OS 00019524 On Oct 9, 2017 6: 13 PM , "David Shulkin" wrote : Looks like ill need to be in ny that evening Sent from my iPhone On Oct 8, 2017, at 11: 11 PM, Marc Sherman <~ (b) (6) > wrote : Ok, I will hold off rearranging things until I hear a go from you. Let me know as soon as you know about your availability . On Sun, Oct 8, 2017 at 5:28 PM, David Shulkin wrote: Its also uncertain 50/50 i need to be in ny on the 17 th - we can check in closer to then Sent from my iPhone <- On Oct 8, 2017, at 12:47 PM, Marc Sherman (b) (6) wrote : Thank.you . I would love to do that Unfo11unatel y, the only day I could maybe have dinner is the 17th ...a11dI would have to check if that is a possibility. I leave on the morning of the 18th for Canada and after that many other cities and won't be back in DC again until November 7. Before I sta11 checking to move things around, AMERICAN PVERSIGHT VA-19-0799-H-000222 DS_00019525 does October 17 dinner work for you? Marc Shennan (b) (6) On Oct 8, 2017 12:37 PM, 11David Shulkin" <;sec shutJ...-i n@gm ail.com> wrote: Marc- good call and great facilitation Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000223 D8_00019526 Message David Shulkin (secshulkin@gmc1il.com] From: Sent : 10/13/2017 2:23:39 AM To : Marc Sherman [mb Re: Subject: (b) (6) gmail.com] Time on saturday? Sent from my iPhone On Oct 12, 2017 , at5:58 PM, Marc Sherman <- (b) (6) > wrote : It sounds like it will be a while before our schedules will allow us to have breakfast , lunch or djnner . I think it would be useful for us to talk. Should we pick a time to just talk by phone? Marc Sherman (b) (6) On Oct 12, 2017 12:27 PM, 11David ShuJkin 11 wrote: Im.in nyc Sent from my iPhone On Oct 10, 20 I 7 at 9: 13 PM, Marc Sherman <~ (b) (6) > wrote : How about lunch tomorrow. I just had a cancellation. Could we make that work? On Tue-, Oct IO, 2017 at 6:22 PM, David ShuJkin wrote : Marc- when i Jocked at november 7th it was wide open- now im tokd the reason why is because they have me out if town for a few days- sorry Any days that a lunch might work? Sent from my iPhone On Oct 9, 2017, at 6 :24 PM, Marc Sherman <~ (b) (6) > wrote : How do you look for November 7 or 8? Marc Sherman (b) (6) On Oct 9, 2017 6: 13 PM , "David ShuJkin" wrote : Looks like ill need to be in ny that evening Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000224 OS 00019527 On Oct 8, 20 17, at 11 :11 PM , Marc Shem1an <- (b) (6) > wrote : Ok , I will hold off rearranging things until I hear a go from you . Let me know as soon as you know abou t your avai lability . On Stm, Oct 8, 2017 at 5 :28 PM, David Shu Ikin wrote : lts also uncertain 50/50 i need to be in ny on the 17 th - we can check in closer to then Sent from my iPhone On Oct 8, 2017, at 12:47 PM, Marc Sherman (b) (6) > wrote : Thank you . I would love to do that. Unfortunately, the only day I coul d maybe have dinner is the l 7th ,..and I would have to check if that is a possibility . l leave on the morning of the 18th for Canada and after that many other citie s and won't be back in DC again un til November 7. Before I start checking to move things around, does October 17 dinner work for yo u? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PNI, "David Shulkin" wrote: Marc- good call and great facilitation Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000225 DS 00019528 Message Marc Sherman (mb From: (b) (6) grnail.com) Sent: 10/12/2017 9 :58:30 PM To : David Shu Ikin (Secshulkin@gmail.com) Re: Subject: lt sounds like it will be a while before our schedules will allow us to have breakfast , lunch or dinner. l think it would be useful for us to talk. ShouJd we pick a time to just talk by phone? Marc Sherman (b) (6) On Oct 12, 2017 12:27 PM , "David ShuJkin" < secshu1kin@gmail.com > wrote : Im in nyc Sent from my iPhone On Oct 10, 2017 , at 9: 13 PM, Marc Sherman <- (b) (6) wrote : How about lunch tomorrow . I just had a cancellation . Could we make that work? On Tue, Oct 10, 2017 at 6:22 PM, David Shulkin wrote : Marc- when i looked at november 7th it was wide open- now im tokd the reason why is because they have me out iftown for a few days- sorry Any days that a IUJ1chmight work? Sent from my iPhone On Oct 9, 2017, at 6:24 PM, Marc Sherman <- (b) (6) wrote : How do you look for November 7 or 8? Marc Sherman (b) (6) On Oct 9, 2017 6:13 PM , "David Shulkin" wrote: Looks like ill need to be in ny that evening Sent from my iPhone On Oct 8 2017, at 11: 11 PM, Marc Shennan Ok, I will hold off rearranging things until I hear a go from you . Let me know as soon as you know about your availability . On Sun, Oct 8, 2017 at 5:28 PM, David Shulkin wrote : Its also unce1tain AMERICAN PVERSIGHT VA-19-0799-H-000227 DS 00019530 50/50 i need to be in ny on the 17 th - we can check in closer to then Sent from my iPhone On Oct 8, 2017, at 12:47 PM , Nlarc Sherman <- (b) (6) > wrote : Thank you . r would love to do that. Unfort unately, the only day I could maybe have dinne r is the 17th ...and I would have to check if that is. a possibility . I leave on the morning of the 18th for Canada and after that many other cities and won't be back in DC again until November 7. Before I start checking to move tl1ings around , does October .17 dinner work for you? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PM, "David Shulkin" wrote : Marc- good call and great facilitation Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16 th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000228 DS_00019531 Message David Shulkin [secshulkin@gmail.com] From: Sent : 10/12/2017 4:27:52 PM To : Marc Sherman [mb Re: Subject: (b) (6) gmail.com] Im in nyc Sent from my iPhone On Oct 10, 2017, at9:13 PM, Marc Sherman <- (b) (6) > wrote : How about lunch tomorrow . I jus t had a cancellation . Could we make that work ? On Tue, Oct 10, 2017 at 6:22 PM, David Shulkin wrote: Marc- when i looked at novernber 7th it was wide open- now im tokd the reason why is because they have me out if town for a few days- sorry Any days that a lunch might work? Sent from my iPhone On Oct 9, 2017, at 6:24 PrvI,Marc Sherman <- (b) (6) wrote: How do you look for November 7 or 8? Marc Sherman (b) (6) On Oct 9, 2017 6: 13 PM, "David Shulkin" wrote : Looks like ill need to be in ny that evening Sent from my iPhone On Oct 8, 2017, at 11: 11 PM, Marc Sherman <- (b) (6) wrote : Ok, l will hold off rearranging things until I hear a go from you. Let me know as soon as you know about your availability. On Sun, Oct 8, 2017 at 5:28 PM, David Shulkin wrote: Its also uncertain 50/50 i need to be in ny on the 17th - we can check in closer to then Sent from my iPhone On Oct 8, 2017, at 12:47 PM, Marc Sherman <- (b) (6) > wrote : AMERICAN PVERSIGHT VA-19-0799-H-000229 DS 00019532 Thank you . I would love to do that. Unfortunately, the only day I could maybe have dinner is the 17th ...and I would have to check if that is a possibility . I leave on the morning of the 18th for Canada and after that many other cities and won' t be back in DC again until November 7. Before T start checking to move things around , does October 17 dinner work for you? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PM, 11David Shulkin" wrote : Marc- good call and great fac1litation Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16th if you are around Sent from my iPl1one AMERICAN PVERSIGHT VA-19-0799-H-000230 DS 00019533 Message From: Marc Sherman (mb (b) (6) gmail.com] Sent: 10/11/20171:13:03 To : David Shulkin (secshulkin@gmail.com] AM Subject: Re: How about lunch tomorrow . l just had a cancellation. Could we make that work? On Tue, Oct 10, 2017 at 6:22 PM , David Shulkin wrote : Marc- when i looked at november 7th it was wide open- now im tokd the reason why is because they have me out if town for a few days- sorry Any days that a lunch mi gbt work ? Sent from my iPhone On Oct 9, 2017 , at 6 :24 PM, Marc Sherman <- (b) (6) > wrote: How do you look for November 7 or 8? Marc Shennan (b) (6) On Oct 9, 2017 6: 13 PM "David Shulk.in" < secshulkin@gmail.com > wrote: Looks like ill need to be in ny that evening Sent from my iPhone On Oct 8, 2017 , at 11: 11 PM , Marc Shennan <- (b) (6) > wrote : Ok, I will hold off rearranging things unti I I hear a go from you . Let me know as soon as you know about your availability . On Sun , Oct 8, 2017 at 5:28 PM , David Shulk:in < secshulkin@gmail.com > wrote: Its also uncertain 50/50 i need to be in ny on the 17th - we can check in closer to then Sent from my iPhone <- On Oct 8, 2017, at 12:47 PM, Marc She1111an wrote: > (b) (6) Thank you . I would love to do that. Unfortunately , the only day I could maybe have dinner is the 17th ...and I would have to check if that is a possibility . I leave on the morning of the 18th for Canada and after that many other cities and won 1t be back in DC again until November 7. Before 1 start checking to move things around, does October 17 dinner work for you? AMERICAN PVERSIGHT VA-19-0799-H-000231 DS 00019534 Marc Sherman (b) (6) On Oct 8, 2017 12:37 PM, 11David Shulk:in11 wrote: Marc- good call and great facilitation Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000232 DS_00019535 Message From: David Shulkin [secshulkin@gmail.com] Sent : 10/10/201710:22 :0l PM To: Marc Sherman [mb Re: Subject: (b) (6) gmail.com] Marc- when i looked at november 7th it was wide open- now im tokd the reason why is because they have me out if town for a few days- sorry Any days that a lunch might work? Sent from my iPhone On Oct 9, 2017 , at 6 :24 PM , Marc Sherman <- (b) (6) > wrote: How do you look for November 7 or 8? Marc Sherman (b) (6) On Oct 9, 2017 6:13 PM, "David ShuJkjn' 1 < secshulkin@gmrul.com > wrote : Looks like ill need to be in ny that evening Sent from my iPhone On Oct 8, 2017 , at 11: 11 PM , Marc Sherman <- (b) (6) > wrote : Ok, I will hold off rearranging things until I bear a go from you . Let me know as soon as you know about your availability . On Sun, Oct 8, 2017 at 5:28 PM, David Shulkin wrote: Its also uncertain 50/50 i need to be in ny on the 17 th - we can check in closer to then Sent from my iPhone (b) (6) On Oct 8, 2017, at 12:47 PM Marc Sherman <-wrote : Thank you. I would love to do that. Unfortunately, the only day I could maybe have dinner is the 17th ...and I would have to check if that is a possibility . I leave on the morning of the 18th for Canada and after that many other cities and won't be back in DC again until November 7. Before I start checking to move things aroUJ1d,does October 17 dinner work for you? Marc Sherman (b) (6) AMERICAN PVERSIGHT VA-19-0799-H-000233 DS 00019536 On Oct 8, 2017 12:37 PM, "David Shulkin" wrote : Marc- good call and great facilitation Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16 th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000234 DS 00019537 Message David Shulkin [secshulkin@gmail.com] From: Sent : 10/10/2017 7:10:52 PM To : Marc Sherman [mb Re: Subject: (b) (6) gmail.com] 7th works Sent from my iPhone On Oct 9, 2017, at 6:24 PM, Marc Sherman <- (b) (6) > wrote: How do you look for November 7 or 8? Marc Sherman (b) (6) On Oct 9, 2017 6:13 PM, "David Shulk:in" wrote : Looks like ill need to be in ny that evening Sent from my iPhone On Oct 8, 2017, at 11: 11 PM, Marc Sherman <- (b) (6) > wrote: Ok, I will hold off rearranging things until I hear a go from you . Let me know as soon as you know about your availability. On Sun, Oct 8, 2017 at 5:28 PM, David Shulkin wrote: Its also uncertain 50/50 i need to be in ny on the 17th - we can check in closer to then Sent from my iPhone On Oct 8, 2017, at 12:47 PM, Marc Sherman <- (b) (6) wrote : Thank you. I would love to do that . Unfortunately , the only day I could maybe have dinner is the 17th...and I would have to check if that is a possibility . I leave on the morning of the 18th for Canada and after that ma11yother cities and won't be back in DC again until November 7. Before I start checking to move things around, does October 17 dinner work for you? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PM, "David Shulkin" wrote : Marc- good caJl and great facilitation AMERICAN PVERSIGHT VA-19-0799-H-000235 DS 00019538 Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16 th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000236 OS 00019539 Message From: Marc Sherman (mb (b) (6) .gmail.com) Sent : 10/9/2017 10:24:56 PM To: David Shu Ikin (Secshulkin@gmail.com) Subject: Re: How do you look for November 7 or 8? Marc Shennan (b) (6) On Oct 9 2017 6: 13 PM "David Shulkin" wrote : Looks like ill need to be in ny that evening Sent from my iPhone On Oct 8 2017, at 11:11 PM, Marc Sherman <- (b) (6) wrote : Ok, 1 will hold off rearranging things until I hear a go from you. Let me know as soon as you know about your availability . On Sun, Oct 8, 2017 at 5:28 PM, David Shulkin wrote: Its also unce11ain 50/50 i need to be in ny on the 17th - we can check in closer to then Sent from my iPhone On Oct 8, 2017, at 12:47 PM, Marc Shennan <- (b) (6) > wrote: Thank you. I would love to do that. Unfortunately, the only day I could maybe have dinner is the 17th ...and I would have to check if that is a possibility. I leave on the morning of the 18th for Canada and after that many other cities and won't be back in DC again until November 7. Before I start checking to move things around, does October 17 dinner work for you? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PM, 11David Shulkin 11 ,,vTote: Marc- good call and great facilitation Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16 th if you are around Sent from my iPhohe AMERICAN PVERSIGHT VA-19-0799-H-000237 DS 00019540 Message David Shulkin (secshulkin@gmail.com] Frotn: Sent : 10/9/201710 :13:54 PM To : Marc Sherman [mb Re: Subject: (b) (6) gmail.com] Looks like ill need to be in ny that evening Sent from my iPhone On Oct 8, 2017 , at 11 :11 PM , Marc Sherman <- (b) (6) > wrote : Ok, I will hold off rearranging things until I hear a go from you . Let me know as soon as you know about your availability . On Sun, Oct 8, 20) 7 at 5 :28 PM , David Shulkin wrote : Its also uncertain 50/50 i need to be in ny on the 17th - we can check in closer to then Sent from my iPhone On Oct 8, 2017 , at 12:47 PM , Nlarc Sherman <- (b) (6) wrote : Thank you. I would love to do that. Unfortunately , the only day I could maybe hav e dinner is the 17th...and I would have to check if that is a possibility. I leave on the morning of the 18th for Canada and after that many other cities and won't be back in DC again until November 7. Before I start checking to move things around, does October 17 dinner work for you? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PM, "David Shulkin'' wrote : Marc- good call and great facilitation Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000238 OS 00019541 Message From: Marc Sherm,in [mb (b) (6) gmail.com] Sent : 10/9/2017 3:11 :55 AM To: David Shu Ikin (secshulkin@gmail.com] Subject: Re: Ok, I will hold off rean-anging things until I hear a go from you. Let me kno:w as soon as you know about your availability. On Sun, Oct 8, 2017 at 5 :28 PM, David Shulkin wrote: Its also uncertain 50/50 i need to be in ny on the 17th - we can check in closer to then Sent from my iPhone On Oct 8, 2017, at 12:47 PM,1-farc Sherman <- (b) (6) > wrote : Thank you. I would love to do that. Unfortunately , the only day I could maybe have dinner is the 17th ...and I wouJd have to check if that is a possibility . I leave on the morning of the 18th for Canada and after that many other cities and won't be back in DC again until November 7. Before I start checking to move things around, does October 17 dinner work for you? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PM , "David Shulkin" wrote : Marc- good call and great facilitation Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16 th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000239 DS 00019542 Message From: David Shulkin (secshulkin@gmail.com] Sent : 10/8/2017 9:28 :08 PM To : Marc Sherman [mb Re: Subject: (b) (6) gmail.com] lts also uncertain 50/50 i need to be in ny on the 17th - we can check in closer to then Sent from my iPhone On Oct 8 2017, at 12:47 PM, Marc Sherman <- (b) (6) > wrote : Thank you . I would love to do that. Unfortunately , the only day I could maybe have dinner is the J 7th ...and I would have to check if that is a possibility . I leave on tl1e morning of the 18th for Canada and after that many other cities and won 1t be back in DC again until November 7. Before I start checking to move things around , does October 17 dinner work for you? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PrvJ.,"David ShuJkin" wrote : Marc- good caJl and great facilitation Maybe it would be good to think more about communication strategies (your point) and we could get djnner the week of the 16th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000240 DS 00019543 Message (b) (6) From: Marc Sherman [mb Sent : 10/8/2017 4:47:23 PM To: David Shu Ikin (Secshulkin@gmail.com) Re: Subject: gmail.com) Thank you. [ would love to do that. Unfortunately, the only day I could mavbe have dinner is the 17th ...and I would have to check if that is a possibility . Ileave on the momjng of the 18th for Canada and after that many other cities and won't be back in DC again until November 7. Before I start checking to move things around, does October 17 dinner work for you? Marc Sherman (b) (6) On Oct 8, 2017 12:37 PM, 11David Shulkin 11 wrote : Marc- good call and great facilitation Maybe it would be good to think more about communication strategies (your point) and we could get dinner the week of the 16 th if you are around Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000241 DS 00019544 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 10/8/2017 4:37:51 PM To: (b) (6) Marc Sherman [mb-gmail.com] Marc- good call and great facilitation Maybe it would be good to think more about communication strategies the week of the 16th if you are around (your point) and we could get dinner Sent from my iP hone AMERICAN PVERSIGHT VA-19-0799-H-000242 OS 00019545 Message To: DavidShulkin [secshulkin@gmail.com] 10/15/2017 5:22:00 PM Marc Sherman [mb (b) (6) gmail.com] Subject: Re: CIO From: Sent: Yes that would be great His name is Phil Lajoe Sent from my iPhone (b) (6) > on Oct 14 , 2017, at 2: 27 PM, Marc Sherman wrote: > > David > > I enjoyed our conversation earlier. Thanks for taking the time . > > I just talked to Ike and he did talk to the WHabout the CFO (at the same time as he talked about the CIO) , so he was indeed the force that got the CFO appro ved for you . He was not aware of the CIO status in the process and thought (as did I ) that it was being held up at the WH. Ike also thinks he can be of some help in moving the CIO through the FBI clearance process faster to get you quicker relief. Is it ok with you if he proceeds on that effort ? He would like to do that tomorrow so let me know today if possible . > > > Marc AMERICAN PVERSIGHT VA-19-0799-H-000243 OS 00019546 Message From: Sent: To: Subject: Marc Sherman [mb (b) (6) gmail.com] 10/14/2017 6:27:38 PM David Shulkin [Secshulkin@gmail.com] CIO David I enjoyed our conversation earlier. Thanks for taking the time. I just talked to Ike and he did talk to the WH about the CFO (at the same time as he talked about the CIO), so he was indeed the force that got the CFO approved for you. He was not aware of the CIO status in the process and thought (as did I) that it was being held up at the WH . Ike also thinks he can be of some help in moving the CIO through the FBI clearance process faster to get you quicker relief. Is it ok with you if he proceeds on that effort? He would like to do that tomorrow so let me know today if possible . Marc AMERICAN PVERSIGHT VA-19-0799-H-000244 OS 00019547 Message From: thomas bowman (b) (6) Sent: 2/28/2018 9:51 :22 PM To ; David Shu Ikin [drshulk in @aol.com] Fw: VA Secretary David Shulkin's top PR aide lobbied Congress to get him fired, sources say Subject: @yahoo.com] Sent from Yahoo Mail on Android ---- Forwarded Message --From: 1 (b) (6) comcast.net" (b) (6) (b) (6) (b) (6) (b) (6) @vva.org" (b) (6) (b) (6) @vva.org> , ' (b) (6) 11Offs&BOD" (b) @vva.org> ,' (b) (6) (6) (b) (6) (b) (6) , ' (b) (6) Cc: 'Thomas Bowman" <(b) (6) @com cast. net> (b) (6) @gmail.com>, (b) (6) @vva.org> , (b) (6) (b) @vva.org>, ' (b) (6) @vva.org>, o? (b) (6) @vva.org>, ' (b) (6) (b) (6) @vva.org>(6) , (b) (6) @vva.org> , 1(b) (6) @wa.org 11 @vva .org> @yahoo .com> , "Dr. David Shulkin" 1 Sent: Wed, Feb 28, 2018 at 4:26 PM Subject: Re: VA Secretary David Shulkin's top PR aide lobbied Congress to get him fired, sources say I agree with you 100% -(b) (6) ----- Original message----From: -(b) (6) Date: Wed, Feb 28, 2018 3:51 PM (b) (6) (b) (6) (b) (6) To: OBSCP@.vva.org:STCPresidents@.vva.org.(b) (6) (b) (b) (6) Cc; Thomas (6) Bowman;Dr. David Shulkin; Subject: VA SecreLaryDavid Shulkin's top PR aide lobbied Congress to get him fired. sources say ~- This is disgraceful! particular. As a leader Check in out this VA Secretary h tt ps ://u Dr . Shulkin WA Dr Shulkin article David sa t.ly from Shulkin's has has done my full much for Veterans Offs&BOD-(b) (6) and for Vletnam get him fired, Veterans in support! USA TODAY: top PR aide lobbied Congress to sources say /2oG92Vd Dr . (b) (6) National Treasurer Vietnam Veterans of America Sent from my iPhone A\llERICAN PVERSIGHT VA-19-0799-H-000245 OS 00019548 Message David shulkin [Drshulkin@aol.com] 10/15/201710:52 :51 PM (b) (6) (b) (6) Poonam Alaigh -otmail.com] Re: Wh ite House Diwali Celebration - Tuesday, Oct. 17 From: Sent : To : Subject: Dant know Sent from my iPhone (b) (6) (b) (6) On Oct 15, 2017, at 4:58 PM, Poonam Alaigh ~> wrote : Rsvped and will attend this- but how did I get the invite Sent from my iPhone Begin forwarded message: From:' (b) (6) (b)(6) (6) EOP/WHO" (b) Date: October 15, 2017 at 4:46 :04 PM EDT EOP/WHO" (b) ho.eo . ov> To: I (b) (6) (b)(6) (6) Subject: White House Diwali Celebration - Tuesday, Oct. 17 Good even ing, You are cordially invited to join us for a Wh it e House celebration of Diwali with President Donald J. Trump on Tuesday, October 17th at 3:00 p.m. in the Oval Office. If you are able to join us, please RSVPby Monday afternoon at 2:00 p.m . You will receive further instruct ion for your arr ival after you have RSVPed. We look forward to seeing.you on Tuesday! Sincerely, -- (b) (6) The White House, Office of Public liaison (b) (6) *Please note this invitation is intended solely for the recipient and is non-transferable. You will need to RSVP with using the email address at which you received this message.* AMERICAN PVERSIGHT VA-19-0799-H-000246 DS 00019549 Message From: Jennifer Lee (b) (b)(6)(6) gmail.com] Sent: 10/13/2017 5:45:51 PM To: Davidshulkin [Drshulkin@aol.com] Re: Follow up Subject: okay, will do . That is actually what I am discovering as well . She is the only person I can think of who is in communication with him and is also frequently on the Hi 17 . I will circle Thank you, Jen back with Vivieca. > on Oct 13, 2017 , at 12: 01 PM, David shulkin wrote: > > Thanks for askingi strongly prefer you dint spea k to himwhatever you say and spin itso please dont > > I think we found the source is Ash and i asked vivieca an upsetting call > Vivieca is going to talk with ash when she returns he is a rumor guy himself and will to reach put to you to tell take you as i know it was > > > sent from my iPhone > (b) (6) >> on Oct 13, 2017 , at 10 : 50 AM, Jennifer Lee -gmail .com> wrote: >> >> Dr. shulkin , >> I have been thinking a lot about your call on Wednesday- it was quite disturbing to me. I would like to get to the bottom of this- for both our sakes .~ay with you if I reach out to meet 1 : 1 with (b) (6) Steve B? If so, I will get his contact info from ..... >> Thank you, >> Jennifer > AMERICAN PVERSIGHT VA-19-0799-H-000247 OS 00019550 Message From: Sent: To: BCC: Subject: Davidshulkin [Drshulkin@aol.com] 10/13/2017 4:01:15 PM Jennifer Lee [(b) (b)(6)(6) (b) (6) (b) (6) (b) (6) Re: Follow up Thanks for askingi strongly whatever you say and spin it- gmail.com] prefer you dint speak to himso please dont I think we found the source is Ash and i asked vivieca an upsetting call Vivieca is going to talk with ash when she returns he is a rumor guy himself to reach put to you to tell and will take you as i know it was sent from my iPhone > on Oct 13 , 2017 , at 10 : 50 AM, Jennifer (b) (6) Lee -gmail .com> wrote: > > Dr. shulkin , > I have been thin king a lot about your call on Wednesday- it was quite disturbing to me. I would like to get to the bottom of this- for both our sakes .~ay with you if I reach out to meet 1:1 with (b) (6) Steve B? If so, I will get his contact info from ..... > Thank you, > Jennifer AMERICAN PVERSIGHT VA-19-0799-H-000248 OS 00019551 Message From: Sent: To: Subject: (b) (6) (b) (6) Jennifer Lee [-gmail.com] 10/13/2017 2:50:18 PM drshulkin@aol.com Follow up Dr. shulkin, I have been thinking a lot about your call on Wednesday- it was quite disturbing to me. I would like to get to the bottom of this- for both our sak~ okay with you if I reach out to meet 1:1 with Steve B? If so, I will get his contact info from -(b) (6) Thank you, Jennifer AMERICAN PVERSIGHT VA-19-0799-H-000249 OS 00019552 Message To : Poonam Alaigh (b) otmail.com] (b)(6)(6) 10/24/201710:37 !16 PM David shulkin [Drshulkin@aol.com] Subject: Re: Frotn: Sent : Its been fine, a lot of driving to Connecticut every day. I am staying here today and headin,g out to dinner with the CEO--(b) (6) shortly. Hope you are preparing well for the CAREhearing and Donovan. See article today https ://catalyst. nej m. o rg/the-va-g ua lity-1eade r-contra rv-assum pt ions/ From: David shulkin Sent: Tuesday, October 24, 2017 6:50 AM To: Poonam Alaigh Subject: How was day 1 at remedy? Sent from AMERICAN PVERSIGHT VA-19-0799-H-000250 OS 00019553 Message Sent: David shu lkin [Drshulkin@ao l.com] 10/24/2017 10:50:58 AM To: (b) (6) (b) (6) Poonam Alaigh ???J1ot m ail.co m ] From: How was day 1 at remedy? sent from AMERICAN PVERSIGHT VA-19-0799-H-000251 DS_00019554 Message David shulkin [Drshulkin@aol.com] 9/5/2017 3:15:47 PM David Shu Ikin [secshulkin@gmail.com] Fwd: Update on VA.activities From: Sent : To: Subject: Sent from my iPhone Begin foi:-wardedmessage : (b) (6) (b) (6) (b) (6) From: Date: September 5, 2017 at 7:03:23 AM EDT To: 'David shulkin' Subject: RE: Update on VA activities David Happy to help when I can . I am not an expe1t in procurement but could speak to it from the CEO position . I hope you are well (b) (6) (b) (6) M .D . Dean of the Medical Faculty CEO Johns Hopkins Medicine (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) -----Original Message----From : David shulkin [mailto :Drshulkin@aol.com ] Sent: Saturday, September 2, 2017 7:20 AM (b)(6)(6) To: (b) (6) ~(b) > Subject: Re : Update on VA activities (b) ... thanks so much-Jam truly appreciative of your help in these areas. (6) The other thing that may be coming up is a congressional hearing where it would be helpful to hear from you about areas that VA may need leg islative fixes to address systemic issues such as procurement. As we 1earn more details I hope we can include you . Is that something you would be open to? Thanks again , David AMERICAN PVERSIGHT VA-19-0799-H-000252 DS_00019555 Sent from my iPhone On Aug 29, 2017, at 1:32 PM, (b) (6) (b) (6) (b) (6) ~wrote : David We are aJready worlcing with you on procurement and IT. We would be happy to also help with Graduate Medical Education and Research overview . Please Jet us knowhow (b) (6) (b) (6) M.D. Dean of the Medical Faculty CEO, Johns Hopkins Medicine (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) ----OriginaJ Message----From: David shuJkin [mailto :Drshulkin@aol.com ] Sent: Tuesday, August 29, 2017 12:21 PM To: Torchiana, David E,M .D (b) (6) (b) (6) 'hmi.e (b) (6) (b) (b) (6)(6) (b) (6) (b) (6) (b) (6) TNERS.ORG>;-(b) (6) M.D . (b) (6) c. ccf.or >;-(b) (6) ( (b) frenchan el59 .com>; Bruce Moskowitz (b) (6) b mac.com>; Marc Sherman <(b)(6) (b) (6)) (6) Poonam Alaigh (b) (6) hotmail.com > ( Subject: Update on VA 6) activities (b) (6) >; Dear Colleagues- much has happened in this first seven months to set VA on an improved path - inclucling a record 5 pieces of legislation that were passed with full bipartisan support. AMERICAr-... pVERSIGHT VA-19-0799-H-000253 DS_ 00019556 There is still a lot to do. There are 11 areas that we could use your institutions assistance with- ill list them here hoping that some areas might be a good fit for your organization to take a lead on assisting with- and certainly if you are interested in specific ones we could discuss in more detail l. Procurement and Logistics 2. Human Resource Reorg 3. Finance and Budgeting 4. IT 5. Public Relations 6. Cost and Utilization of the Choice Network 7. Construction and Facility Management 8. Graduate Medical Education 9. Research overview 10. Quality measurement of the Choice network 11. Cost saving opportunities Thanks for your thoughts if any of these 11 might be something your organization would lead on and thank you for your continued support David Shulkin Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000254 OS 00019557 Message From: Torchiana, David F.,M.D. ~PARTNERS (b) (6) Sent: 9/5/20 17 12:5 1:43 PM To: David shulkin [Drshulkin@aol.com] RE:Update on VAactivities Subject: I will work on our delegation specific areas obviously very .ORG] these issues with our fol ks and also with Seth Moulton's office as he is a key member of and very versed on veteran's affairs as you know. Please let me know if there are of interest/focus that you would like me to focus on, I saw the original list & it is comprehensive. Regards, -(b) (6) - -- --original Message---- From: David shulkin [mailto:Drshulkin@aol . com] Sent~. Sat urd a Se tember 02, 2017 7:24 AM (b) (6) To: (b) (6) , M. D. ~PARTNERS subject: Up ate on VA activities David- I hope things . ORG > are well. In the next few months there may be planning for a congressional hearing hear from you about areas that VA may need legislative fi xes to address procurement . we would be specific with defining areas where you have fle does not . As we learn more details I hope we can include you. Is that where it would be helpful to systemic issues such as xibilities to manage where the VA something you would be open to ? > > Thanks so much for your continued support , > > David shulkin > > sent from my iPhone > >> on Aug 29, 2017 , at 1:32 PM, -(b) (6) >> >> David (b) (6) (b) (6) <-hmi .edu > wrote: >> >>- >> we are already working with you on procurement and IT. we would be happy to also help with Medical Education and Research overview . Please let us know how Graduate >> (b) >> (6) (b) (6) >> ........ M. D. >> ~edical Faculty CEO J ohns Ho ki ns Medi cine (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) >> >> >> - - - - -original Message- - -->> From: David shulkin [mailto :Drshulkin @aol .com] >> sen t: Tuesda Au ust 29, 2017 12 :21 PM (b)(6)(6) To: (b) (6) M.D. ~(b) (6) RG~ (b) (6) <(b) hmi. edu>; -(b) (6) (b) (6) (b) (6) (b) (6) ma~ <~ >; (b) (6) p.org > (b) (6) (b) (6) ( (b) (b) >> cc : I e Per mutter <-renchangelS9. com>. Bruce Moskowitz ; Marc Sherman (b) (6) (b) (6) (b) (6) ; (6) Poonam Alaigh < otmail .com> b (6) >> su'b'j"e"c't"updateon VA activities ) >> ( >> >>> 6 >>> Dear colleagues - much has happened in this first seven months to set VA on an improved path ) including a record 5 pieces of legislation that were passed with full bipartisan support . >>> >>> There is still a lot to do . There are 11 areas that we could use your institutions assistance withill list them here hoping that some areas might be a good fit for your organization to take a lead on assisting with- and certainly if you are interested in specific ones we could discuss in more detail >>> >>> 1 . Procurement and Logistics >>> AVl[T'ilCAN PVERSIGHT VA-19-0799-H-000255 OS 00019558 >>> 2. Human Resource Reorg >>> >>> 3. Finance and Budgeting >>> >>> 4. IT >>> >>> 5. Public Relations >>> >>> 6. Cost and Utilization of the choice Network >>> >>> 7. Construction and Facility Management >>> >>> 8. Graduate Medical Education >>> Research overview >>> 9. >>> >>> 10. Quality measurement of the choice network >> >> 11. Cost saving opportunities >> >> Thanks for your thoughts if any of these 11 might thank you for your continued >> >> David >>> >>> >>> Sent >> >> be something your organization would lead on and support shulkin from my iPhone The information in this e-mail is intended only for the person to whom it is addressed. If you believe this e-mail was sent to you in error and the e-mail contains patient information, please contact the Partners Compliance Helpline at http://www.partners.org/complianceline . If the e-mail was sent to you in error but does not contain patient information, please contact the sender and properly dispose of the e-mail. AMERICAN PVERSIGHT VA-19-0799-H-000256 OS 00019559 Message From: (b) (6) Sent: 9/5/20 17 11 :52:56 AM To: Davidshulkin [Drshulkin@aol.com] RE: Update on VA activities Subject: (b) (6) [-@ccf.org] - I would be happy to help in any way that you would think appropriate. (b) (6) (b) (6) ~ MD ~ (b) (6) (b) (6) (b) (6) (b) (6) - -- --original Message-- --From: David shulkin [mailto:Drshulkin@aol . com] Sent~. Frid a Se tem-ber 01 2017 7:41 PM To: (b) (6) <(b) (6) @ccf.org > subject : Re: Up ate on VA activities -(b) that makes a great deal of sense and ill do that. (6) I also know there is interest in congress from hearing from you on the commission on care recommendations and legislative changes re quired . would you be open to further discussion on this ? David sent from my iPhone > On Sep 1, 2017, at 3: 56 PM, (b) (6) (b) (6) > > David : > congratulations on all that you have done at the VA. we worked extremely well at the VA in the past and would be delighted to help in the future . The most productive way to do this would be to assign individuals with whomwe can engage with in discussions . >> (b) (6) (b) (6) ; ~ > > > > MD (b) (6) (b) (6) (b) (6) (b) (6) > -- --- Original Message----> From: David shulkin [mailto:Drshulkin@aol .com] sent : Tues da Au ust 29, 2017 12 :21 PM (b) (6) (b) (6) To : (b) (6) M.D. (b) (6) (b) (6) "hmi . edu>; -(b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) ( (b) (b) ; Marc Sherman (b) (6) (b) (6) (b) (6) b (6) (6) ) ( >> 6 >> Dear colleagues - much has happened in this first seven months to set VA on an improved path ) including a record 5 pieces of legislation that were passed with full bipartisan support . >> AMERICAN PVERSIGHT VA-19-0799-H-000257 OS 00019560 There is still a lot to do. There are 11 areas that we could use your institutions assistance withill list them here hoping that some areas might be a good fit for your organization to take a lead on assisting with- and certainly if you are interested in specific ones we could discuss in more detail >> >> >> 1. Procurement and Logistics >> >> 2. Human Resource Reorg >> >> 3. Finance and Budgeting >> >> 4. IT >> >> 5. Public Relations >> Cost and Utilization of the choice Network >> 6. >> Management and Facility >> 7. Construction >> >> 8. Graduate Medical Education >> Research overview >> 9. >> >> 10. Quality measurement of the choice network > > 11. Cost saving opportunities > > Thanks for your thoughts if any of these 11 might thank you for your continued be something your organization would lead on and support > > David shulkin >> >> >> Sent from my iPhone > > > ----------------------------------> > > Please consider the environment before printing this e - mail > > Cleveland clinic is currently ranked as the No. 2 hospital in the country by U.S. News & World Report (2017-2018). Visit us online at http://www.clevelandclinic.org for a complete li sting of our services, staff and locations. Confidentiality Note: This message is intended for use only by the individual or entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please contact the sender immediately and destroy the material in its entirety, whether electronic or hard copy. Thank you. Please consider the environment before printing this e-mail Cleveland clinic is currently ranked as the No. 2 hospital in the country by U.S. News & World Report (2017-2018). Visit us online at http://www.clevelandclinic.org for a complete li sting of our services, staff and locations. Confidentiality Note: This message is intended for use only by the individual or entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure under applicable l aw. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distributio n or copying of this communication is strictly prohibited. If you have received this communication in error, please contact the sender immediately and destroy the materia l in its entirety, whether electronic or hard copy. Thank you. AMERICAN PVERSIGHT VA-19-0799-H-000258 OS 00019561 Message jhmi.edu] (b) (6) 9/ 5/20 17 11 :03:23 AM 'David shulkin' [Drshulkin@aol.com] RE: Update on VAactivities (b) (6) From: Sent : To : Subject : (b) (6) David Happy to help when I can. I hope you are well - I am not an expert in procurement but could speak to it from the CEOposition. (b) (6) (6) .(b)....... ~edical M.D. . Faculty . . ne (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) -----original Message----From: David shulkin [mailto:Drshulkin @aol . com] Sent~Se~ . 2017 7 : 20 AM (b) (6) (b) (6) (b) (6) To: ......... subject : Re: upaate on VA activities (b) ~ thanks so much- I am truly appreciative of your help in these areas . (6) The other thing that may be coming up is a congressional hearing where it would be helpful to hear from you about areas that VA may need legislative fi xes to address systemic issues such as procurement. As we learn more details I hope we can include you. Is that something you would be open to ? Thanks again , David sent from my iPhone > on Aug 29, 2017 , at 1 : 32 PM, -(b) (6) (b) (6) (b) (6) <-hmi . edu> wrote: > > David > > we are already working with you on procurement and IT . we would be happy to also help with Medical Education and Research overview . Please let us know how >- Graduate > (b) > (6) (b) (6) > ........ M. D. > ~edical Faculty > CEO Johns Ho kin s Medic ine (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) > > > -----original Message----> From: David shulkin [mailto :Drshulkin @aol . com] (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) . e LI>; (b) (6) <(b) (6) (b) (6) p . or~ (b) (6) ( (b) (b) > cc : I e Per mutter <--renchangel5 9-com>. Bruce Moskowitz ; (6) otmail . com> bPoonam Alaigh <(b) (6) (6) > su~pdate on VA activities ) > ( > >> 6 ) (b) (6) AVl[T'ilCAN PVERSIGHT "hmi. edu>; -(b) (6) . com>; Marc Sherman VA-19-0799-H-000259 OS 00019562 >> Dear colleagues- including >> >> There ill list assisting a record much has happened in this first seven months to set VA on an improved path 5 pieces of legislation that were passed with full bipartisan support. is sti l l a lot to do. There are 11 areas that we could use your institutions assistance withthem here hoping that some areas might be a good fit for your organization to take a lead on with- and certainly if you are interested in specific ones we could discuss in more detail >> >> 1. Procurement and Logistics >> >> 2. Human Resource Reorg >> >> 3. Finance and Budgeting >> >> 4. IT >> >> 5. Public Relations >> Cost and Utilization of the choice Network >> 6. >> Management and Facility >> 7. Construction >> >> 8. Graduate Medical Education >> Research overview >> 9. >> >> 10. Quality measurement of the choice network > > 11. Cost saving opportunities > > Thanks for your thoughts if any of these 11 might thank you for your continued be something your organization would lead on and support > > David shulkin >> >> >> Sent from my iPhone > > AMERICAN PVERSIGHT VA-19-0799-H-000260 OS 00019563 Message Davidshulkin [Drshulkin@aol.com] 9/2/20 17 11:24:10 AM Torchiana, DavidF.,M.D. (b) (6) Update on VAactivities From: Sent: To: Subject: David- I hope things @PARTNERS .ORG] are well. In the next few months there may be planning for a congressional hearing where it would be helpful to hear from you about areas that VA may need legislative fixes to address systemic issues such as procurement. We would be specific with defining areas where you have flexibilities to manage where the VA does not . As we learn more details I hope we can include you. Is that something you would be open to? > > Thanks so much for your continued support , > > David shulkin > > sent from my iPhone > >> on Aug 29 , 2017 , at 1 : 32 PM, -(b) (6) >> >> David (b) (6) (b) (6) <-hmi . edu> wrote : >> >>- >> we are already working with you on procurement and IT . we would be happy to also help with Medical Education and Research overview . Please let us know how Graduate >> (b) >> (6) (b) (6) >> ........ M.D. >> ~edical Faculty CEO J ohns Ho ki ns Medic ine (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) >> >> >> -----original Message---- >> From: David shul kin [mailto:Drshul kin @aol . com] >> S 2017 12: 21 PM (b) (6) (b) (6) (b)(6)(6) PARTNER S. ORG~ (b) (6) <(b) "hmi . edu>; -(b) (6) (b) (6) (b) (6) yo.e u>; (b) (6) <~ >; (b) (6) (b) (6) ( (b) (6) (b renchangel59 . com>. Bruce Moskowitz ; Marc Sherman (b) (6) (b) (6) (b) (6) ; (6) Poonam Alaigh <-otmail . com > b) (6) >> Su Ject : Update on VA activities )( >> (6 >> >>> 6) >>> Dear colleaguesmuch has happened in this first seven months to set VA on an improved path ) including a record 5 pieces of legislation that were passed with full bipartisan support. >>> >>> There is still a lot to do . There are 11 areas that we could use your institutions assistance withill list them here hoping that some areas might be a good fit for your organization to ta ke a lead on assisting with - and certainly if you are interested in specific ones we could discuss in more detail >>> >>> 1. Procurement and Logistics >>> >>> 2 . Human Resource Reorg >>> >>> 3. Finance and Budgeting >>> >>> 4 . IT >>> >>> 5. Public Relations >>> of the choice Network >>> 6 . cost and Utilization >>> >>> 7. construction and Facility Management >>> >>> 8 . Graduate Medical Education AVl[T'il .1/-\I PVERSIGHT VA-19-0799-H-000261 OS 00019564 >>> >>> 9. Research overview >>> >>> 10. Quality measurement of >> >> 11. Cost saving opportunities >> >> Thanks for your thoughts if thank you for your continued >> >> David >>> >>> >>> Sent >> >> the choice any of these support network 11 might be something your organization would lead on and shulkin from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000262 OS 00019565 Message Davidshulkin [Drshulkin@aol.com] 9/ 2/20 17 11:20:06 AM (b) (6) (b) (6) jhmi.edu] (b) (6) Re: Update on VAactivities From: Sent : To : Subject : 111111 than ks (b) so much- I am truly appreciative of your help in these areas. (6) The other thing that may be coming up is a congressional hearing where it would be helpful to hear from you about areas that VA may need legislative fixes to address systemic issues such as procurement. As we learn more details I hope we can include you . Is that something you would be open to? Thanks again, David sent from my iPhone > on Aug 29 , 2017 , at 1 :3 2 PM, -(b) (6) (b) (6) (b) (6) <-hmi . edu> wrote : > > David > > we are already working with you on procurement and IT. we would be happy to also help with Medical Education and Research overview . Please let us know how >> Graduate (b) > (6) (b) (6) > ........ M. D. > ~edical Faculty > CEO Johns Ho kins Medicine (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) > > > -----original Message----> From: David shulkin [mailto :Drshulkin @aol . com] > Sent: Tuesda Au ust 29 , 2017 12 :21 PM (b) (6) (b) (6) (b) (6) > To : (b) (6) M.D. (b) (6) "hmi .edu >; -(b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) ( (b) (b) ; Marc Sherman (b) (6) (b) (6) (b) (6) b (6) (6) ) ( >> 6 >> Dear colleaguesmuch has happened in this first seven months to set VA on an improved path ) including a record 5 pieces of legislation that were passed with full bipartisan support . >> >> There is still a lot to do. There are 11 areas that we could use your institutions assistance with ill list them here hoping that some areas might be a good fit for your organization to ta ke a lead on assisting with- and certainl y if you are interested in specific ones we could discuss in more detail >> >> 1. Procurement and Logistics >> >> 2 . Human Resource Reorg >> >> 3 . Finance and Budgeting >> >> 4 . IT >> >> 5 . Public Relations >> of the choice Network >> 6 . cost and Utilization >> >> 7. construction and Facility Management >> >> 8 . Graduate Medical Education >> AVl[T'ilCAN PVERSIGHT VA-19-0799-H-000263 OS 00019566 >> 9. Research overview >> >> 10. Quality measurement of > > 11. Cost saving opportunities > > Thanks for your thoughts if thank you for your continued > > David >> >> >> Sent > > the choice any of these support network 11 might be something your organization would lead on and shulkin from my iP hone AMERICAN PVERSIGHT VA-19-0799-H-000264 OS 00019567 Message From: (b) (6) Sent : 9/ 1/2017 11:50:17 PM To : Davidshulkin [Drshulkin@aol.com] Re: Update on VAactivities Subject : (b) (6) [-@ccf.org] Yes Sent from my iPhone > on Sep 1, 2017, at 7:41 PM, David shulkin wrote: > (b) (6) >-that makes a great deal of sense and ill do that . > > I also know there is interest recommendations and legislative in congress from hearing from you on the commission on care changes required. would you be open to further discussion on this ? > > David > > sent from my iPhone > >> on Sep 1, 20 17 , at 3:56 PM, (b) (6) (b) (6) >> >> David: >> congratulations on all that you have done at the VA. we worked extremely well at the VA in the past and would be delighted to help in the future. The most productive way to do this would be to assign individuals with whomwe can engage with in discussions . >> (b) >> -(6) ~ ;; (b) (6) MD >> (b) (6) >> >> (b) (6) >> -- - -- original Message---->> From: David shulkin [mailto :Drshulkin @aol . com] >> S 20 17 12 : 21 PM (b) (6) (b) (6) (b)(6)(6) "hmi. edu>; -(b) (6) ~G > (b) (6) ??? (b) (b) (6) (b) (6) (b) (6) ma~ <(b) (6) (b) (6) (b) (6) ( (b) r <(b) renchangel59 . com>. Bruce Moskowitz ; Marc Sherman (b) (6) (b) (6) ; (6) .com> bPoonam Alaigh <-otmail (6) >> Su Ject: Update on VA activities ) >> ( >> >>> 6 >>> Dear colleagues - much has happened in this first seven months to set VA on an improved path ) including a record 5 pieces of legislation that were passed with full bipartisan support. >>> >>> There is still a lot to do. There are 11 areas that we could use your institutions assistance with ill list them here hoping that some areas might be a good fit for your organization to take a lead on assisting with- and certainly if you are interested in specific ones we could discuss in more detail >>> >>> 1. Procurement and Logistics >>> >>> 2. Human Resource Reorg >>> >>> 3. Finance and Budgeting >>> >>> 4 . IT >>> >>> 5. Public Relations >>> >>> 6 . cost and Utilization of the choice Network >>> >>> 7. construction and Facility Management AVl[T'il .1/-\I PVERSIGHT VA-19-0799-H-000265 OS 00019568 >>> >>> 8. Graduate Medical Education >>> Research overview >>> 9. >>> >>> 10. Quality measurement of the >> >> 11. Cost saving opportunities >> >> Thanks for your thoughts if any thank you for your continued >> >> David shulkin >>> >>> >>> Sent from my iPhone >> >> >> ---------------------------------->> >> the >> Please consider >> is >> Cleveland clinic choice of these network 11 might be something your organization would lead on and support environment before printing this e-mail currently ranked as the No. 2 hospital in the country by U.S. News & World Report (2017-2018). Visit us online at http://www.clevelandclinic.org for a complete listing of our services, staff and locations. Confidentiality Note: This message is intended for use only by the individual or entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please contact the sender immediately and destroy the material in its entirety, whether electronic or hard copy. Thank you. > Please consider the environment before printing this e-mail Cleveland clinic is currently ranked as the No. 2 hospital in the country by U.S. News & World Report (2017-2018). Visit us online at http://www.clevelandclinic.org for a complete listing of our services, staff and locations. Confidentiality Note: This message is intended for use only by the individual or entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please contact the sender immediately and destroy the material in its entirety, whether electronic or hard copy. Thank you. AMERICAN PVERSIGHT VA-19-0799-H-000266 OS 00019569 Message Davidshulkin [Drshulkin@aol.com] 9/1/2017 11:41:15 PM (b) (6) (b) (6) @ccf.org] Re: Update on VAactivities From: Sent: To: Subject: -(b) that makes a great deal of sense and ill do that. (6) I also know there is interest in Congress from hearing from you on the Commission on care recommendations and legislative changes required. Would you be open to further discussion on this? David sent from my iPhone > On Sep 1, 2017, at 3:56 PM, (b) (6) (b) (6) > > David: > congratulations on all that you have done at the VA. we worked extremely well at the VA in the past and would be delighted to help in the future . The most productive way to do this would be to assign individuals with whomwe can engage with in discussions. >> > ~ (b) (6) (b) (6) ~ MD (b) (6) > (b) (6) (b) (6) > -----original Message----> From: David shulkin [mailto:Drshulkin@aol.com] > sent: Tuesda Au ust 29, 2017 12:21 PM (b) (6) (b) (6) (b) (6) > To: (b) (6) M.D. (b) (6) "hmi . edu>; -(b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) ( (b) (b) ; Marc Sherman (b) (6) (b) (6) (b) (6) b (6) (6) ) ( >> 6 >> Dear colleaguesmuch has happened in this first seven months to set VA on an improved path ) including a record 5 pieces of legislation that were passed with full bipartisan support. >> >> There is still a lot to do. There are 11 areas that we could use your institutions assistance with; 77 list them here hoping that some areas might be a good fit for your organization to take a lead on assisting with- and certainly if you are interested in specific ones we could discuss in more detail >> >> 1. Procurement and Logistics >> >> 2. Human Resource Reorg >> >> 3 . Finance and Budgeting >> >> 4. IT >> >> 5 . Public Relations >> of the choice Network >> 6. cost and Utilization >> >> 7. construction and Facility Management >> >> 8. Graduate Medical Education >> >> 9. Research overview >> >> 10. Quality measurement of the choice network A Vl[T'il .1/'""\I PVERSIGHT VA-19-0799-H-000267 OS 00019570 > > > > 11. Cost saving opportunities Thanks for your thoughts if any of these thank you for your continued support > > David shulkin >> >> >> Sent from my iPhone > > > ----------------------------------> > the > Please consider > is > Cleveland clinic environment before 11 might be something your organization printing this would lead on and e-mail currently ranked as the No. 2 hospital in the country by U.S. News & World Report (2017-2018). Visit us online at http://www.clevelandclinic.org for a complete listing of our services, staff and locations. Confidentiality Note: This message is intended for use only by the individual or entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please contact the sender immediately and destroy the material in its entirety, whether electronic or hard copy. Thank you. AMERICAN PVERSIGHT VA-19-0799-H-000268 OS 00019571 Message From: Sent: To: Subject: (b) (6) (b) (6) @ccf.org] 9/1/2017 7:56:37 PM Davidshulkin [Drshulkin@aol.com] RE:Update on VAactivities David: Congratulations on all that you have done at the VA. We worked extremely well at the VA in the past and would be delighted to help in the future. The most productive way to do this would be to assign individuals with whomwe can engage with in discussions. - (b) (6) (b) (6) ~ MD ~ (b) (6) (b) (6) -----original Message----From: David shulkin [mailto:Drshulkin @aol . com] sent : Tuesda Au ust 29, 2017 12:2 1 PM (b) (6) (b) (6) To : (b) (6) M. D. (b) (6) (b) (6) "hmi . edu>; -(b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) ( (b) (b) ; Marc Sherman (b) (6) (b) (6) (b) (6) b (6) (6) ) ( > 6 > Dear colleaguesmuch has happened in this first seven months to set VA on an improved path including a record 5) pieces of legislation that were passed with full bipartisan support. > > There is still a lot to do . There are 11 areas that we could use your institutions assistance with; 77 list them he re hoping that some areas might be a good fit for your o rgani zati on to ta ke a lead on assisting with - and certainly if you are interested in specific ones we could discuss in more detail > > 1. Procurement and Logistics > > 2. Human Resource Reorg > > 3 . Finance and Budgeting > > > 4 . IT > 5 . Public Relations > > 6. cost and Utilization > > 7 . construction of the choice Network and Facility Management > > 8 . Graduate Medical Education > > 9. Research > > 10 . Quality overview measurement of the choice network 11. cost saving opportunities Thanks for your thoughts if any of these 11 might be something your organization you for your continued support would lead on and thank David shulkin > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000269 OS 00019572 Please consider the environment before printing this e-mail Cleveland clinic is currently ranked as the No. 2 hospital in the country by U.S. News & World Report (2017-2018). Visit us online at http://www.clevelandclinic.org for a complete listing of our services, staff and locations. Confidentiality Note: This message is intended for use only by the individual or entity to which it is addressed and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please contact the sender immediately and destroy the material in its entirety, whether electronic or hard copy. Thank you. AMERICAN PVERSIGHT VA-19-0799-H-000270 OS 00019573 Message jhmi.edu] (b) (6) 8/29/2017 5:32:29 PM 'David shulkin' [Drshulkin@aol.com];Torchiana, David F.,M.D. (b) (6) ? M.D.(b) (6) @mayo.edu]; (b) (6) (b) (6) @ccf.org];(b) (6) Ike Perlmutter -frenchangel59.com]; Bruce Moskowitz [brucem (b) (6) (b) ( (b) (b) (6) (b) (6) b . com]; Poonam Alaigh ???'1otmail.com] (6) (6) (b) (6) [mbtl???gmail RE:Update on VA ) activities ( 6 ) (b) (6) From: Sent: To: CC: Subject: David (b) (6) (b) (6) (b) (6) we are already working with you on procurement and IT. we would be happy to also help with Medical Education and Research overview. Please let us know how - @kp.org] Graduate (b) (6) (6) .(b)....... ~edical M.D. Faculty . . ne . (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) -----original Message----From: David shulkin [mailto:Drshulkin@aol .com] Sent: Tuesda Au ust 29, 2017 12:21 PM (b) (6) (b) (6) (b) (6) To: (b) (6) M.D. (b) (6) (b) (6) hmi .edu>; (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) ( (b) (b) ; Marc Sherman (b) (6) (b) (6) (b) (6) b (6) (6) ) ( > 6 > Dear colleaguesmuch has happened in this first seven months to set VA on an improved path including a record 5) pieces of legislation that were passed with full bipartisan support. > > There is still a lot to do. There are 11 areas that we could use your institutions assistance withill list them here hoping that some areas might be a good fit for your organization to take a lead on assisting with- and certainly if you are interested in specific ones we could discuss in more detail > > 1 . Procurement and Logistics > > 2 . Human Resource Reorg > > 3. Finance and Budgeting > > > 4. IT > 5 . Public Relations > > 6. cost and Utilization of the choice Network > > 7. construction and Facility Management > > 8. Graduate Medical Education > > 9. Research overview > > 10. Quality measurement of the choice network 11. cost saving opportunities Thanks for your thoughts if any of these you for your continued support 11 might be something your organization would lead on and thank David shulkin /-\Vl[T'il .1/-\I PVERSIGHT VA-19-0799-H-000271 OS 00019574 Sent from my iPhene Message From: Sent: To: CC: Subject: Davidshulkin [Drshulkin@aol.com] 8/29/2017 4:20:45 PM Torchiana, DavidF.,M.D. (b) (6) RG];(b) (6) (b) (6) ? M.D (b) (6) [(b) (6) @ ( (b) Ike Perl . itz [brucem (b) (6) (b) (6) (b) (6) b (6) (b) (6) [mb gmail.com]; Poonam Alaigh[_,otmail.com] ) Update on VAactivities ( 6 ) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) @kp.org] > Dear colleaguesmuch has happened in this first seven months to set VA on an improved path including a record 5 pieces of legislation that were passed with full bipartisan support. > > > There is still a lot to do. There are 11 areas that we could use your institutions assistance withill list them here hoping that some areas might be a good fit for your organization to take a lead on assisting with- and certainly if you are interested in specific ones we could discuss in more detail > > 1. > > 2. > > 3. > > 4. > > 5. > > 6. > > 7. > > 8. > > 9. > > 10. Procurement and Logistics Human Resource Reorg Finance and Budgeting IT Public Relations cost and Utilization construction of the choice Network and Facility Management Graduate Medical Education Research overview Quality measurement of the choice network 11. cost saving opportunities Thanks for your thoughts if any of these 11 might be something your organization you for your continued support would lead on and thank David shulkin > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000273 OS 00019576 Message From: (b) (6) (b) (6) (b) (6) Sent : 10/12/2017 8:04:04 PM To : David Shu Ikin (drshulk in @aol.com] Read this kinda funny Subject: gmail.com) http://www.cnn.com/2017 /10/12/poli ti cs/john-kelly-not-guitting-not -getting-fired/index. html AMERICAN PVERSIGHT VA-19-0799-H-000274 OS 00019577 Message David Shulkin (secshulkin@gmail.com] 10/9/201710:13:07 PM (b) (6) gmail.com] Marc Sherman [mbsl??? IP -renchangel59.com]; Bruce Moskowitz [brucem ( (b) Re:(6) bMedical Center Survey progress From: Sent : To : CC: Subject: Sounds good (b) (6) (b) (6) mac.com]; L Perl (b) (6) .gmail.com] ) ( 6 ) Sent from my iPhone On Oct 9, 2017, at 5:11 PM, Marc Sherman <- (b) (6) > wrote: D1:1v1d Our conversationyesterda about c-0ordinationwas well timed. To recap part of our conversationycsl.erday. wb.i.Ieyou are gathering your Medical Advisory Group for thoughtson ~'UfVeying V/\ Medical Centers, Bmce had reached out to a leading phy:,;icianexpert wiU1stro1~ survey experience lo pull together the national "pccialists and their program design, similar to wh.aL he had shared with you a few week:!ago and Ike had "hared wiU1Jared. We were pleased to learn today that U1eoutreach for those speciali sts and their program input is well under way, caJling for neur-tenn coordination. Marc AMERICAN PVERSIGHT VA-19-0799-H-000275 DS 00019578 Message From: Marc Sherman [mb (b) (6) gmail.com] Sent: 10/9/2017 9:11:45 PM To: David Shulkin [Secshulkin@gmail.com] IP -frenchangel59.com]; Bruce Moskowitz [brucem ( (b) Med b ical Center Survey progress (6) CC: Subject: David (b) (6) (b) (6) mac.com]; L Perl (b) (6) gmai l.com ] ) ( 6 ) Our conversation yesterday about coordination was well timed . To recap part of our conversation yesterday, while you are gathering your Medical Advisory Group for thoughts on surveying VA Medical Centers , Bmce had reached out to a leading physician expert with strong sun 1ey experience to pull together the national specialists and their program design , similar to what he had shared with you a few weeks ago and Ike had shared with Jared. We were pleased to learn today that the outreach for those specialists and their program input is well under way , calling for near-term coordination. Marc AMERICAN PVERSIGHT VA-19-0799-H-000276 OS 00019579 Message From: (b) (6) Sent : 10/10/2017 2:34:36 PM David Shu Ikin [drshulkin@aol.com) Re: CNN: Obama interior secretaries spent over $971,000 on non-commercial air travel To : Subject: (b) (6) (b) (6) gmail.com] Ok . Let me ask a person who can be discreet On Mon, Oct 9, 2017 at 10;04 PM David Shulkin wrote : Do you think it's possible to ee how much mcdonald and shinsecki traveled compared to me? Obama interior secretaries spent over $971,000 on non-commercial air travel CNN Just over $971 ,000 was spent on non-commercial travel for interior secretaries in the Obama administration during a seven-year period, according to records obtained by CNN . Read the full story Shared from Apple News Seht from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000277 DS 00019580 Message David Shulkin [drshulk rn@aol.com] From: Sent : 10/10/2017 2:04:22 AM To : (b) (6) (b) (6) gmail.c.omJ (b) (6) Fwd: CNN: Obama interior secretaries spent over $971,000 on non -commercial air travel Subject: Do you think it's possible to see how much mcdonald and shinsecki traveled compared to me? Obama interior secretaries spent ~)Ver$971,000 on non-commercial air travel CNN Just over $971 ,000 was spent on non-commercial travel for interior secretaries in the Obama administration during a seven-year period, according to records obtained by CNN . Read the full story Shared from Apple News Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000278 DS 00019581 Appointment FroiTI: Sent : To: Marisol Garcia.@frenchangel59.com] (b) 10/6/2017 9:50:01 (6) PM (b) (6) lper-@gmail.com; @yahoo .com;David Shulkin [secshulkin@gmail.com]; (b) (6) (b) (6) brucerrllll--@mac.com ; mb (b) (6) gmaiLcom; IP -frenchangel59 .com) (b) ( (b) Subject: Location: VA UPDATE- Conference Call for Sunday, October 8th at 11:00) AM ( Conference Call (6) b (6) 6 ) Start: 10/8/2017 3:00 :00 PM End: 10/8/2017 3:45:00 PM Show Time As: Tentative Recurrence: (none) Sunday, October 8 th 11:00 AM - 11:45 AM EST Dia1-in Information: US: 1-866-244- (b) (6) lnternational: 719-457 (b) (6) Passcode:(b) (6) Participants: Laurie Perlmutter, Secretary David Shulkin, Tom Bowman, Dr. Bruce Moskowitz, Marc Sherman and Ike Thank you, Marisol Garcia (b) (6) (Office) (b) (6) (Cell) (b) ?@frenchangel59.com (6) AMERICAN PVERSIGHT VA-19-0799-H-000279 DS_00019582 Message From: David shulkin LDrshulkin@aol.com] Sent: To : 10/15/2017 2 :34:41 PM Poonam Alaigh (b) (b)(6)(6) Subject: Re: memories otmail.comJ They are great pictures for sure Sent from my iPhone (b)(6)(6) On Oct 15, 2017, at 10:16 AM, Poonam Alaigh- (b) > wrote: As I am going through my VA stuff- these are the 2 best pies ever- one where lam truly myself with people who care and the other, bidding farewell to what will always live in my heart! AMERICAN PVERSIGHT VA-19-0799-H-000280 DS 00019583 Message From: (b) (6) (b) (6) (b) (6) Sent: 10/7/2017 8:01:00 AM To : David Shu Ikin [drshulkin@aol.com] gmail.com) http://blog .norml .org/2017/10/06/va-secretary-shulkin-still-hasnt-responded-to-the-american-legions-call-formari j uana-research / AMERICAN PVERSIGHT VA-19-0799-H-000281 OS 00019584 Message From: (b) (6) Sent : 10/7 /201712 :27:59 PM To : David Shu Ikin (drshulk in@ aol.com] Re: Found report Subject: (b) (6) (b) (6) gmail.com] Yea, I'11own that from when you were onboarded. I guess I thought everyone saw it because it was so publicized. On Sat, Oct 7, 20l 7 at 8:26 AM David Shulkin wrote : Very strange I never saw this before Sent from my iPad (b) (6) (b) (6) > On Oct 7, 2017, at 7:53 AM, (b) (6) > > Here is the corrosive report from 2014 that was Ieaked to the press . > ail .com > wrote : Sent from Gm ail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000282 DS 00019585 Message From: David Shulkin [drshulkin@aol.com] Sent: 10/7/2017 12:26:05 PM To: (b) (6) Subject: Re: Found report Very strange I never saw this (b) (6) (b) (6) gmail.com] before Sent from my iPad > On Oct 7, 2017, at 7: 53 AM, (b) (6) (b)(6)(6) <(b) gmail . com> wrote: > > Here is the corrosive > AMERICAN PVERSIGHT report from 2014 that was leaked to the press. VA-19-0799-H-000283 OS 00019586 Message From: (b) (6) Sent: 10/7/2017 11:53:18 AM David Shulkin [drshulkin@aol.com] Found repor t VA_Review.pdf To: Subject: Attachments: (b) (6) (b) (6) gmail.com] Here is the corrosive report from 2014 that was leaked to the press. AMERICAN PVERSIGHT VA-19-0799-H-000284 OS 00019587 June 27, 2014 ISSUES IMPACTING ACCESS TO TIMELY CARE AT VA MEDICAL FACILITIES There is a strong sentiment among many Veterans and stakeholders that in general VA provides high quality health care "once you get in the door" and that the current system needs to be fixed, not abandoned or weakened. The vast majority of VA employees are dedicated, hardworking, and committed to the Veterans they serve. VA doctors, nurses, and staff could choose to work at other facilities, often for greater compensation. They choose to work at the VA because they believe in this Nation's promise to its Veterans, and they work each day to realize that promise and deliver the quality care Veterans have earned and deserve. However, I also believe that it is clear that there are significant and chronic systemic failures that must be addressed by the leadership at VA. o The 14-day scheduling standard is arbitrary, ill-defined, and misunderstood. The manner in which this unrealistic goal was developed and deployed has caused confusion in rep orting and, in some cases, may have incentivized inappropriate actions. It is a poor indicator of either patient satisfaction or quality of care and should be replaced with a more insightful measure. o The Veterans Health Administration (VI-IA) needs to be restructured and reformed. It currently acts with little transparency or accountability with regard to its management of the VA medical structure. The VHA Leadership structure is marked by a lack of responsiveness and an inability to effectively manage or communicate to employees or Veterans. o A corrosive culture has led to personnel problems across the Department that are seriously impact ing morale and, by extension, the timeliness of health care. The problems inherent within an agency with an extensive field structure are exacerbated by poor management and communication structures, distrust between some VA employees and management , a history of retaliation toward employees raising issues, and a lack of accountability across all grade levels. o The Department's failures have generated a high level of oversight. The Department must be more agile and responsive in addressing legitimate oversight inquiries. o The technology underlying the basic scheduling system used by VA medical facilities is cumbersome and outdated. However, with regard to increasing access to care, the software underlying the scheduling system is secondary to the need for additional resources to actually schedule - doctors, nurses, and other health professionals; physical space; and appropriately trained administrative support personnel. o Many of the resource issues VA faces are endemic to the health care field (for example, shortages of certain types of specialists, an aging patient base, or geographical shortages around the country) or to the Federal government (for example, slowness in the hiring process or an inability to compete with private sector wages). However, VA has also demonstrated an inability to clearly articulate budgetary needs and to tie budgetary needs to specific outcomes. o VA needs to better plan and invest now for anticipated changes in the demographics of the veterans. This includes geographical changes, an increased number of female veterans, a surge in mental health needs, an increase in the special needs of younger veterans returning from Iraq and Afghanistan, and specific needs associated with a growing number of older veterans. pVERSIGHT VA-19-0799-H-000285 OS 00019588 ASSESSMENT: Issm~s IMP ACTING ACCESS TO TIMELY CARE AT VA MEDICAL FACILITIES The 14-day scheduling standard is arbitrary, m-de:fined, and misunderstooct The manner in which this unrealistic goal was developed and deployed has caused confusion in reporting and, in some cases, may have im::entivized inappropriate actions. It is a poor indicator of either patient satisfaction or quality of care and should be replaced with a more insightful measure. Background: In 1995, the Veterans Health Administration (VHA) set a 30-day goal for scheduling primary and specialty care medical appointments. In 2011, VHA shortened that goal to 14 days. VHA includes these performance measures in the performance contracts for Veterans Integrated Service Network (VISN) and VA Medical Center (VAMC) directors. VA also includes these measures in its budget submissions and performance reports to Congress. Also from FY2005 to FY2012, the number of appointments scheduled through VHA has increased approximately 19 percent from 5 .3 million to 6.3 million. Recognizing the inherent issues associated with the 14-day scheduling goal, VA has removed it from employee performance contracts. Observations: o The 14-day standard creates an unrealistic comparison between VHA and the private sector. Directly comparable data is not available for the private sector, primarily because experts seem to believe that time-to-appointment is only one component of overall patient satisfaction. Further, anecdotal evidence suggests that wait times for appointments are often times equal to, if not longer, in private facilities. o The perfonnance goal is complicated to compute and to understand because of vagaries around which "date" is being entered. For new patients, wait times are measured from the "create date" or the date on which an appointment is made. For existing patients, the wait times are measured from the "desired date" or the date on which the patient or health care provider wants the patient to be seen. Because the "desired date" is manually entered by a scheduler, it is more susceptible to manipulation. The "create date" is computer-generated date. o The 14-day standard was included as a measure in employee performance contracts. This may have created an incentive for employees to try to reduce a number over which they personally had very little direct control. In 2010, William Schoenhard, Deputy Under Secretary for Health for Operations and Management, authored a memo detailing a number of "gaming strategies" used to artificially make wait times look lower. Schoenhard noted, "[ w ]orkarounds may mask the symptoms of poor access and, although they may aid in meeting performance measures, they do not serve our Veterans. They may prevent the real work of improving our processes and design of systems." AMERICAN PVERSIGHT VA-19-0799-H-000286 OS 00019589 Solutions: o The Department plans to establish a panel of health care experts and industry leaders to catalogue best practices for measuring timely delivery of health care to Veterans and make recommendations to the new Under Secretary for Health. o Certain performance measures, like wait time data, should be used as management tools to help identify proper deployment of resources but not as a measure of whether highquality health care has been delivered in an appropriate fashion. VHA needs to be :restructured and reformed. It currently acts with little transparency or accountability with regard to its management of the VA medical structure. In its most modest form, this insularity bas impeded innovation and change. In its more extreme manifestations, it has impeded appropriate management, supervision, and oversight The VHA leadership structure often is unresponsiveness and unable to effectively manage or communicate to employees or Veterans. Background: VHA is America's largest integrated health care system with over 1,700 sites of care, serving 8.76 million Veterans each year. In addition, VHA is the Nation's largest provider of graduate medical education and a major contributor to medical research. In 2013, VA obligated approximately $150 billion. Approximately 98 percent of total funding went directly to Veterans in the form of monthly payments of benefits or for direct services, such as medical care. The existence of such a vast and geographically widespread field structure makes communication to and from the VA Central Office all the more critical. Observations: o VHA delivers quality care, but is resistant to reforms and change. Many recommendations or directives from VA Central Office or from oversight entities are minimized, slowly implemented, or ignored. o The VHA field structure is not accountable or transparent to Veterans, the Secretary, or the Department as a whole. For example, performance data from the field is often slow to be reported and sometimes openly contested by V AMCs through the press in direct contravention of facts and established procedures. o The VHA leadership team is not prepared to deliver effective day-to-day management or crisis management. Instead, VHA is marked by an inherent lack of responsiveness and a belief many issues raised by the public, the VA Leadership, or oversight entities are exaggerated, unimportant, or "will pass." 2 AMERICAN PVERSIGHT VA-19-0799-H-000287 OS 00019590 Solutions: o VA needs increased transparency into the way VHA operates. VHA needs a better structure and more accountability in how to manage the field structure. o VA Central Office needs to be much more hands on with the VHA field structure. o The reforms needed at VHA are not political - they are structural and operational. VHA requires significant leadership and management restructuring that: One, allows for increased, consistent flow of information from the VA Central Office to the regional and local field structure; and Two, allows for unobstructed flow of information from the field structure to regional and National management and leadership. A corrosive culture has led to personnel problems across the Department that are seriously impacting morale and, by extension, the timeliness of health care. The problems inherent within an agency with an extensive field structure are exacerbated by poor management and communication structures, a corrosive culture of distrust between some VA employees and management, a history of retaliation toward employees raising issues, and a lack of accountability. Observations: o The vast majority of VA employees are dedicated, hardworking, and committed to the Veterans they serve. VA doctors, nurses, and staff could choose to work at other facilities, often for greater compensation. They choose to work at the VA because they believe in this Nation's promise to its Veterans, and they work each day to realize that promise and deliver the quality care Veterans have earned and deserve. o There is a culture across much of the Department that encourages discontent and backlash against employees. Whistleblower complaints suggest poor management and reflect a palpable level of frustration at the local, regional, and National levels. As an example, approximately one-fourth of all whistleblower cases OSC is currently reviewing across the Federal government come from the Depaitment of Veterans Affairs. o There is a tendency to transfer problems rather than solve problems. This is in part due to the difficulty of hiring and firing in the Federal government. o There is culture that tends to minimize problems or refuse to acknowledge problems aH together. 3 AMERICAN PVERSIGHT VA-19-0799-H-000288 OS 00019591 Solutions: o The Department should strengthen management and reporting structures at the VA Central Office and throughout the VHA field structure as referenced above. o The Department must take swift and appropriate accountability actions. There must be recognition of how true accountability works. o The tone at the top should encourage employees to speak up about problems, but also to think of and be a part of solutions. The Department's failures have generated a high level of oversight. The Department must be more agile and responsive in transparently addressing all legitimate oversight requirements. Background: There is an incredible amount of oversight on the Department's activities. The IG, OSC, GAO, and several Congressional committees have conducted investigations and reviews into the Department's provision of timely care to Veterans. Over the last 4 1/2 years, VA has provided responses to over 104,000 Congressional inquiries. Over the last 2 1/2 years, VA has responded to over 7,500 requests for policy-related information. And, in the first 6 months of this fiscal year alone, the Department has participated in 33 hearings and 213 briefings for Congress. In the last five weeks, VA has sent over l 00 letters to Members of Congress and delivered over l 0,000 pages of documents. Twenty-one VA witnesses have provided hours of testimony at 11 hearings. In addition, VA has conducted daily outreach and information exchange between local VA facilities and local Congressional offices. VA has endeavored to be receptive to recommendations and responsive to requests fix infom1ation - but could still do more. Observations: o There have been a number of problems identified and recommendations made by the IG, GAO, OSC, Congress, and others. VA has not followed through on sufficiently addressing those problems or implementing those recommendations. o The IG is currently conducting investigations at 77 VA facilities. Since at least 2005, GAO and the IG have been identifying concerns regarding scheduling practices and data reliability. o As of June 23, the OSC had over 50 pending cases, all of which allege threats to patient health or safety. Of those, OSC has referred 29 cases to the VA for investigation. This represents over a quarter of all cases referred by OSC for investigation government-wide. Additionally, 5 U.S.C. ? 2302(c) requires agencies to ensure that employees are infom1ed of the rights and remedies available to them under the Whistleblower Protection Act and related laws. OSC has a whistleblower certification program to provide agencies with a process for meeting this requirement. VA is not certified. 4 AMERICAN PVERSIGHT VA-19-0799-H-000289 OS 00019592 Solutions: o VA should more proactively engage with its various oversight bodies. o VA should track oversight reports and recommendations. The Department should release quarterly metrics on recommendations made by oversight bodies and VA's response. o The Secretary should separately meet with the IG, OSC, and the Comptroller General on a quarterly basis. The General Counsel should separately meet with representatives of the IG, OSC, and GAO on a monthly basis. o The Department should review its process for responding to OSC whistleblower cases (underway), and should designate an official to assess the conclusions and the proposed c01Tectiveactions in OSC reports. o VA should also complete OSC's whistleblower certification program. The technology underlying the basic scheduling system used by VA medical facilities is cumbersome and outdated. Lack of certain functionalities cause scheduling delays and, in some cases, :reporting inaccuracies. However, with regard to increasing access to care, the software underlying the scheduling system is secondary to the need fo:r additional resource to actually schedule - doctors, nurses, and other health professionals; pb.ysical space; and appropriately trained administrative support personnel. Background: VA began using the VistA electronic health records system in 1985. VistA is the single integrated health information system used throughout VHA in all of its health care settings. VistA is open source and has been used in a number of civilian hospitals. The VA's VistA system has not changed in any appreciable way since 1985. This system predates the widespread use of the internet. From an engineering or work order management perspective, VistA has many flaws. But, it is state of the art in terms of providing an integrated health record that captures all documentation associated with a patient and it enables the collaboration of the delivery of that care. A 2011 survey by the American Academy of Family Physicians and a similar 2012 Medscape poll found that VistA was better than a large m3:jority of health IT solutions, including those offered by market leaders McKesson and Epic. VA plans to overhaul the outdated scheduling system and bring an innovative scheduling product into the electronic health record system. VA hopes to award a contract for the new patientscheduling system by the end of this fiscal year and have the system in place in fiscal 2015. 5 AMERICAN PVERSIGHT VA-19-0799-H-000290 OS 00019593 Observations: o Dated scheduling systems and practices are causing significant problems for the Department of Veterans Affairs' ability to deliver timely access to quality health care. But neither the systems ---nor the schedulers - are the source of extended wait times for Veterans seeking care. o Many of the resource issues VA face are endemic to the health care field (for example, shortages of certain types of specialists or geographical shortages around the country) or to the Federal government (for example, slowness in the hiring process or an inability to compete with private sector wages). However, VA has also demonstrated an inability to clearly articulate budgetary needs and to tie budgetary needs to specific outcomes. Solutions: o Immediate problems with scheduling systems and practices can and are being addressed. The Department will procure new technology and wiU train frontline personnel on a stronger, modern system. o VA needs additional resources to ensure adequate and appropriate health care for our Nation's Veterans. Those resources include: o Primary Care Physicians o Specialty Care Physicians o Administrators and Support Staff o Space (parking, examination, and surge space) o VA needs to start planning and investing now for anticipated changes in the demographics of the Veterans. This includes geographical changes, an increased number of female Veterans, a surge in mental health needs, an increase in the special needs of younger Veterans returning from Iraq and Afghanistan, and specific needs associated with older Veterans. o In the short term, VHA is working to increase the use of contract care. However, VHA must proceed with this carefully as proper oversight of the quality and timeliness of contract care is essential. 6 AMERICAN PVERSIGHT VA-19-0799-H-000291 OS 00019594 Message From: (b) (6) (b) (6) (b) (6) Sent: 10/7/2017 11:47:37 AM To : David Shu Ikin (drshulk in@aol.com] Culture Subject: gmail.com) Here's how corrosive was described in 2014. There's like 30 articles on the same topic . I'll try to find the report itself . http://www.usatoday .com/story/news/nation/2014/06/27/obama-va-health.care-delay-scandal-naborsgibson/11529807 / AMERICAN PVERSIGHT VA-19-0799-H-000292 OS 00019595 Message From: (b) (6) (b) (6) (b) (6) Sent : 10/5/2017 2:56 :47 PM To : David Shu Ikin (drshulkin@aol.com) Re: Tmrw Subject: gmail.com] He's not tiding tmrw. However they said they would let us know the ne xt time he is riding . On Thu , Oct 5, 2017 at 6:38 AM David Shulkin wrote: Yes Sent from my iPad > On Oct 5, 2017 , at 6 :20 AM, (b) (6) (b) (6) (b) (6) ail .com> wrote : > > Do you want me to try for a bike ride tmrw morning > -> Sent from Gmail Mobile Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000293 OS 00019596 Message From: David Shulkin [drshulkin@aol.com] Sent: 10/5/2017 10:37:15 AM To: (b) (6) Subject: Re: Tmrw (b) (6) (b) (6) gmail.com] Yes Sent from my iPad > On Oct 5, 2017, at 6:20 AM, (b) (6) (b)(6)(6) <(b) gmail .com> wrote: > > Do you want me to try for a bike ride tmrw morning > > sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000294 OS 00019597 Message From: (b) (6) Sent: 10/5/2017 10:20:16 AM David Shulkin [drshulkin@aol.com] Tmrw To: Subject: (b) (6) (b) (6) gmail.com] Do you want me to try for a bike ride tmrw morning Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000295 OS 00019598 Message From: (b) (6) Sent : 10/6/2017 4:42:49 PM To : drshulkin@aol.com Newsmakers 1 Subject: (b) (6) (b) (6) gmail.com) Here is your predecessors newsmakers. Will send a few more . http://comcastnewsmakers .com/2016/11 /09/sec-,robert-mcdonald-part-1 / AMERICAN PVERSIGHT VA-19-0799-H-000296 DS_00019599 Message -(b) (b) (6) 10/5/20171:57:17 (6) From: Sent : To: hotmail.com) AM David [drshulkin@aol .com) Fwd: Your picture is up Subject: Tool her over 24 hours to respond. Not too prompt (b) (6) -M.D . Begin forwarded message : From: Vivieca Simpson- (b) (6) Date: October 4, 2017 at 9 :25 : l 0 PM EDT hotmail.com > To: -(b) (6) (b) (6) Subject: Re: Your picture is up > Thanks On Oct 2, 2017 16:18, "-(b) (6) AMERICAN PVERSIGHT (b) (6) hotmail.com > wrote: VA-19-0799-H-000297 DS 00019600 Message (b) (6) From: (b) (6) (b) (6) gmail.com) Sent : 10/3/2017 7:38:20 PM To : David shulkin [Drshulkin@aol.comJ (b) (6) Re: Message from Unknown sender (36067111!111 Subject: Called and no answer, left my number On Tue, Oct 3, 2017 at 12:52 PM David shulkin wrote : Sent from my iPhone Begin forwarded message : (b) (6) From: 11(b) (6) atlantichealth .or > Date: October 3, 2017 at 12:50:40 PM EDT To: "Drshulkin (drshulkin@aol.com ) 11 Subject: FW: Message from Unknown sender (36067- (b) (6) Hi David , Please listen to message from a Dr . (b) (6) spelling) He is a retired surgeon asking for your contact info . Sa.id he needs to speak with you. (b) (6) (b) (6) (ce11) From: Cisco Unity Connection Messaging System [mail to: uni tyconnecti on@pdc0cuc0 1.ahs ys .org] Sent: Tuesday , October 03, 2017 12:45 PM To: dbrock0 l@pdc0cuc01 .ahsys .org Subject: Message from Unknown sender (36067- (b) (6) The information contained in this email is intended only for the use of the person(s) identified above . This communication may contain work product which is ptivileged and confidential, and AMERICAN PVERSIGHT VA-19-0799-H-000298 DS_00019601 may contain content which is regulated by Federal law. If you are not an intended recipient or the employee or agent responsible to deliver this to the intended recipient, you have received this message in error and any review, distribution or copying of it by you is prohibited. If you have received this message in error, please notify the sender immediately, and delete the message. E-mail and communication system messages generated by members of the Atlantic Health System workforce may not necessarily reflect the views of Atlantic Health System, its officers, directors or management. Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000299 OS 00019602 Message From: David shulkin [Drshulkin@aol.com] Sent : 10/3/2017 4:51 :54 PM To : (b) (6) ???????I l????lgmail.com] (b) (6) (b) (6) Subject: Fwd: Message from Unknown sender (36067~(b) (6) Attachments : VoiceMessage .wav; Untitled attachment 84224.htm Sent from my iPhone Begin forwarded message: (b) (6) From:' (b) (6) atlantichealth.or > Date: October 3, 2017 at 12:50:40 PM EDT To: "Drshulkin (drshulk1n@aol.com )" (b) (6) Subject: FW: Message from Unknown sender (3606711111 Hi David , Please listen to message from a Dr. (b) (6) spelling) He is a retired surgeon asklng for your contact info . Said he needs to speak with you. (b) (6) (b) (6) (cell) From: Cisco Unity Connection Messaging System [mailto :unityconnection@pdcOcucOl .ahsys.org] Sent: Tuesday, October 03, 2017 12:45 PM To: dbrock01@pdcOcucOl .ahsys.org (b) (6) Subject: Message from Unknown sender (36067EIIIIIIII The information contained in this email is intended only for the use of the person(s) identified above. This communication may contain work product which is p1ivileged and confidential, and may contain content which is regulated by Federal law. If you are not an intended recipient or the employee or agent responsible to deliver this to the intended recipient , you have received this message in error and any review, dist1ibution or copying ofit by you is prohibited. If you have received this message in error, please notify the sender immediately, and delete the message . Email and communication system messages generated by members of the Atlantic Health System workforce may not necessarily reflect the views of Atlantic Health System, its officers, directors or management AMERICAN PVERSIGHT VA-19-0799-H-000300 DS 00019603 Appointment Frotn: Sent : To: Man.sol Garcia .@ (b) frenchangel59 .com] 10/5/2017 11 :25:24 (6) PM (b) (6) lper -@ gmail..com; (b) (6) @yahoo .com;David Shulkin [secshulkin@gmail.com]; (b) (6) brucem ___ gmaiLcom; IP -fr enchangel59 .com] (b) mac.corn; mb (b) (6) ( (b) (6) Subject : Location : b (6) VA UPDATE - Conference Call for Sunday, October 8th at 9:00)AM ( Conference Call 6 ) 10/8/2017 1:00 :00 PM End: 10/8/2017 1:45:00 PM Show Time As: Tentative Start: Recurrence : (none) Sunday, October 8 th 9:00 AM - 9:45 AM EST Dia1-in Information: US: 1-866-244lnternational: 719-457(b) (6) (b) (6) (b) (6) Passcode: Participants: Laurie Perlmutter, Secretary David Shulkin, Tom Bowman, Dr. Bruce Moskowitz, Marc Sherman and Ike Thank you, Mariso l Garcia (b) (6) (Office) (b) (6) (Cell) (b) ?@frenchangel59.com (6) AMERICAN PVERSIGHT VA-19-0799-H-000302 DS_ 00019606 Message (b) (6) MD, DrPH (b) (6) @med.unc.edu] 10/2/2017 9:19:08 PM drshulkin@aol.com [rwjcsp _scholars] Welcome to the Clinical Scholars Program Alumni Association! From: Sent : To : Subject: The Clinical Scholars program is filled with people ''who want to chmige the worltl, and they won't be Slltisfied with anything less. ' ' - Clinical Scho lar alum and UCLA CSP associate director, Paul Chung. Welcome to the Clinical Scholars Program Alumni Association! The CSPAA was formed to create and sustain relationships between Clinical Scholars, National linician Scholars, National Advisory Committee members, program faculty and community partners that over the years have provided some of the best crossdisciplinary collaboration to improve healtl1 and healthcare that this country has ever witnessed . As a member of the CSP AA, you will be able to~ Community o o o Gain more efficient access to our vibrant community of alumni working as change agents througho ut the country Invest in the training and career development of emerging leaders in healthcare policy and research through the National Clinician Scholars Program Serve as a subject matter expert in the fields of health care delivery , health systems, and health policy for medical associations , local and federaJ governmental agencies, and foundations that approach the CSP Alumnj Association for expertise Career A\llERICAN PVERSIGHT VA-19-0799-H-000303 DS 00019607 o o Connect whb alumni for mentorship , collaboration, career transitions , and identifying promising canilidates to hire Network with alumni in-person at national conferences Communication o o Receive regular communication from the CSP AA, including learning about the achievements of other members Share your own experiences with our alumni group Though the RWJF Clinical Scholars program has ended, we want to ensure that alumni and future NCSP scholars continue to have the best opportunities to improve health and healthcare. We are writing to you today to ask for your help in building a strong and sustainable alumni association. We are reliant on volunteer donations to support staff and software to ensure that we can serve all alums and continue to grow. Please consider making a tax-deductible donation to the CSPAA today! For questions or to volunteer , please contact any of our board members: CSPAA Board Members : SreyRam Kuy, President (Yale CSP 07-09 VA) emaiJ: SreyRam@gmail.com Joshua Chodosh , Vice President (UCLA CSP 98-00 VA) email : Joshua .Chodosh @NYUMC .org Michael Knight , Treasurer (Penn CSP VA 15-17) email : knightmg @gmail.com Kym Gonzalez , Secretary (Penn CSP 15-17) email : kg.matarnoros@gmaH.com Dowin Boatright , Communications Chair (Yale CSP 15-17 VA) email: dowjn .boatright @yale .edu Kristin Jensen , Membershlp Co-Chair (Michlgan CSP 09-11) email: kristin.jensen @ucdenver.edu Anna Morgan , Membership Co-Chair (Penn CSP 15-17) email : aumorgan @gmail.com Alon Peltz , Program Activities Chair (Yale CSP 15-17) email: alonpeltz @gmail.com Gene Corbett, At Large (JI-IU CSP 73-75) email: ecc9h@viginia .edu Arden Morris , At Large (Washington CSP 00-02) email: ammsurg @stanford .edu Ben Springgate, At Large (UCLA CSP 05-08) email : benspringgate @gmail.com Des Ru11yan,Ex Officio (UNC 79-8)) email : desmond.runyan@childrensco1orado.org Mission statement: This Alumni As sociation , composed of alumni and facul ty of the Robert Wood John son Foundation Clinical Scholars program (1968-201 7) , Natfonal Clinician Scholar s Program and thei1. community partn ers pa st and pre sent fo sters an expanding network of Sch olars committed to improving the heallh and wellbeing of all peopl e; to ll elong connections to each other and to curr ent train ees; and to creating a culture ~fhealth, leadership , mentor sh-ip and scholar ship. AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000304 D8_00019608 Message DavidShulkin [secshulkin@gmail.com] Sent: 10/3/2017 1:59:03 AM (b) (6) (b) To: Bruce Moskowit z [brucem~mac .com] (b) (6) (6) (b) (6) ( (b) CC: IP [-renchangel59.com]; lper-@gmai l.com; mb-gmail .com bNYTimes:ReplacingFaulty Heart DevicesCosts Medicare $1.5 Billion in 10 Years Re:(6) Subject: ) ( 6 Thanks ) I talk with Kurt this week From: sent from my iPhone (b) (6) > on Oct 2, 2017, at 5: 57 PM, Bruce Moskowitz wrote : (6) > Kurt Heyssel and I have agreed that a device registry that we have proposed for the VA would be adapted in the private sector and provide a a significant benefit and a revenue source . we have all the infrastructure developed to implement this. > > > https :// www.nytimes.com / 2017/ 10/ 02/ health / heart-devices-medicare ipad-share . html ?smprod=nytcore-ipad&smid=nytcore- > > Anew report through 2014 . says seven types of defective pacemakers or defibrillators had to be replaced from 2005 > > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000306 OS 00019610 Message (b) (6) (b) Bruce Moskowitz [brucem~mac .com] (6) Sent: 10/2/2017 9:57:31 PM To: DavidShulkin [secshulkin@gmail.com] (b) (6) (b) (6) ( (b) CC: IP [-renchangel59.com]; lper-@gmai l.com; mb-gmail .com b (6) NYTimes: ReplacingFaulty Heart DevicesCosts Medicare $1.5 Billionin 10 Years Subject: ) ( 6 Kurt Heyssel and) I have agreed that a device registry that we have proposed for the VA would be adapted in the private sector and provide a a significant benefit and a revenue source. We have all the infrastructure developed to implement this. From: https: // www.nytimes.com /2 017/ 10/ 02/ health / heart-devices-medicare.html ipad-share A new report says seven types of defective through 2014 . pacemakers or defibrillators ?smprod=nytcore-ipad&smid=nytcorehad to be replaced from 2005 sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000307 OS 00019611 Message Davidshulkin [Drshulkin@aol.com] From: Sent : 10/11/2017 1:05 :36 AM To : (b) (6) (b) (6) Poonam Alaigh???l,otmail.com] Re: Going back to the simplicityof life Subject : Wow-looks fun Pretty miserable here- blowing bubbles sounds much better than swimming with these sharks Sent from my iPhone (b) (6) (b) (6) > on Oct 10, 2017, at 9 :02 PM, Poonam Alaigh <-otmail . com> wrote : > > While in Krakow this weekend . .. . . > > > > > > > > > > Making bubbles on the streets > > s ent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000308 OS 00019612 Message From: Sent: To: Subject: Attachments: While in Poonam Alaigh (b) otmail.com] (b)(6)(6) 10/11/2017 1:02:33 AM David Shulkin [drshulkin@aol.com] Going back to the simplicity of life imagel.JPG; ATT0000l.txt; image2.JPG; ATT00002.txt Krakow this AMERICAN PVERSIGHT weekend ..... VA-19-0799-H-000309 OS 00019613 Umloog mm; Making Sent bubbles from AMl H CAt\ on the streets my iPhon e pVERSIGHT VA-19-0799-H-000312 DS_00019616 Message Frotn: Sent: David shulkin LDrshulkin@aol.com] 10/6/2017 11:01:35 AM @yahoo.com] Thomas Bowman I(b) (6) Fwd: Brandon 's personal email To: Subject : Tom- just sharing-(b) (6) observations tlrnt he shared as he is leaving VA Sent from my iPhone Begin forwarded message : (b) (6) From: (b) (6) mail.com > Date: October 5, 2017 at 10:55:25 PM EDT To: Drshulkin@aol.com Subject: Brandon's personal email Sir, I wanted to write you from my personal account for two reasons . First I just wanted you to have my personal email. I will always have your back and I hope you won't hesitate to contact me if there is anything you need . Second , after speaking to you today I received a call from Rosemary about Lisa Reins from the WaPo. I'm pretty sure the Chief updated you on this . After thinking about it I realized that when you asked me about the political guys today, what you were really asking is can you trust any of them . I don't think my answer wm surprise you . No, with exception to S. Ithink Tom is going to be a great Deputy and is here for all the right reasons. He has your back, and has the Chiefs back- (b) (6) from OPIA is also a keeper. Shes a true belie ver, but completely has your back and has been cast out of the main group of politicals . Clearly you know Suraf. I like him and I see him fighting on your behalf everyday in Modernization. Lynda Davis I do111t even consider a political. She ia really on the outside .from what I can see and has been a joy to work with . Finally , Melissa. What little I have worked with her, I have found her to be sharp, committed, and loyal . I think she and Suraf will make a great team . As for the rest - setting aside the fact they tried to get me fired - I wouldn't tmst them further than I could throwtbem . The biggest issue you have is that they don 1t think t hey work for you or Tom, they think they work for POTUS and report to Jake . They see themselves as an extension of the WH. To a degree that is understand~b le at the Asst. Secretary level. But not to this extent. They are focused more on turf wars, personal vendettas, and political posturing the n they are about serving Veterans. That is how they came across at SLBM as well . You missed the first part of the accountability panel. It was a clown show at best. Thank God you got up there at the end or leaders would have been even more confused . Until Jake's position is eliminated, you and Tom will always have this problem . Other agencies have been successful at getting the WH to get rid of this rol:e, which according to the WH was simply meant to make sure the Presidents interests and agenda was secured during transition . Well now that WaPo has confirmed .that political appointees in both the WR and at VA are fanning the flames on the travel story , 1 think you and Tom have a solid case to make to get rid AMEFi1Jt I PVERSIGHT VA-19-0799-H-000313 DS 00019617 of the Senior Advisor to the WH role as a way to refocus these people on executing Presidents and your agenda. I think it carries more weight from Tom at this point, but then again, I wouldn't be surprised if they are already trying to throw him under the bus as well. Getting rid of Jake's role will help, but I honestly believe Peter Shelby and O'Rourke, and John U. Are the most toxic. I think Brooks might be tamed without the others firing each other up, but I don't know Brooks too well. I have no doubt they are working together to leak stories and are trying to get reporters to tear you and Vivieca down. Clearly someone in the WH is working with them. Getting rid of Jake's position would be a body blow to their whole perception of the power structure and will give you a chance to give some of them enough rope to hang themselves , or the chance to turn the tide and show you the y have your back. I hope this helpful. I hesitated before because I didn't want to appear to be whiney or unproductive . You have more than enough on your plate . But I also think its a matter of time before they tee up something that would drive a wedge between you and POTUS . Perhaps even deliberately screw with something in the CARE act. I really hope I'm wrong about that , but I wouldn 't be surprised if they were helping their old buddies at CY A sneak in some more controversial policies in the final bill. Happy to chat more in person if helpful. Let me know if there is anything I can do support. (b) (6) AMERICAN PVERSIGHT VA-19-0799-H-000314 OS 00019618 Message David Shulkin (drshulkin@aol.com) From: Sent : 10/3/2017 10:40:30 AM To : (b) (6) Subject: Re: Didn't see this (b) (6) (b) (6) gmail.com] Thanks I had not either Sent from my iPad On Oct 3, 2017 , at 4:02 ANl, (b) (6) (b) (6) (b) (6) ail.com > wrote: http://www .wcvb .com/arti cl e/va-demotes-man-for-dance-monkey-dance-comm patriots/l2769333 AMERICAN PVERSIGHT ent-towards- VA-19-0799-H-000315 OS 00019619 Message From: (b) (6) (b) (6) (b) (6) Sent : 10/3/201 7 8:02:38 AM To; David Shu Ikin [drshulkin@aol.com] Didn 't see this Subject : gmail.com) http://www.wcvb .com/article/va-demotes-rnan-for~dance-monkey-dance-comrnent-towards-patriots/12769333 AMERICAN PVERSIGHT VA-19-0799-H-000316 OS 00019620 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 9/ 30/2017 10:24:08 PM To: (b) (6) Subject: (b) (6) (b) (6) Re: Some edit suggestions Really good edits gmail.com] - thanks Sent from my iPhone > On Sep 30, 2017, at 5:30 PM, (b) (6) (b) (6) (b) (6) gmail .com> wrote: > > > > > clean . docx> VA-19-0799-H-000317 OS 00019621 Message Marisol Garcia .@frenchangel59 (b) 10/5/201711:13:14 (6) PM From: Sent : ,com] David Shu Ikin (secshulkin@gmail.com] RE: Conference Call for Sunday , Octobe r 8th at 9:00 AM To : Subject: Gr.eatl Thank you so much . From: David Shulkin [mailto:secshulkin@gmail.com] Sent: Thursday, October 05, 2017 7:13 PM To: Marisol Garcia Subject: Re: ConferenceCall for Sunday, October 8th at 9:00 AM I can do that Its good to .ask Tom Sent from my iPhone (b) @frenchangel59.com> wrote: On Oct 5, 2017 1 at 11:20 AM, Marisol Garcia wrote: On Oct 5, 2017, at 11:20 AM, Marisol Garcia Date: September 29, 20 I 7 at 6 :43 :21 PM EDT (b)(6)(6) To: 'Poonam Alaigh' ~(b) > Subject: FW: VBA Weekly Digest I Issue No. 8 Sent with Good (www.good .com ) -----Original Message----From: VHA USH ANNOUNCEMENTS Sent: Friday , September 29, 2017 04:36 PNf Eastern Standard Time To: VHA USH ANNOUNCEMENTS Subject: VHA WeekJy Digest I Issue No . 8 AMERICAN PVERSIGHT VA-19-0799-H-000321 DS_00019625 VHA I Weekly Digest September 29, 2017 I Issue No. 8 News you need to know in the Veterans Health Administration VA Priorities o Greater Choice for Veterans o Modernize Our Systems o Focus Resources More Efficiently o Improve Timeliness of Service o Suicide Prevention Hurricane Donations I can't thank you enough for all that you do for our Veterans. Being part of such a dedicated organization is priceless . After fulfilling my two year comm itment , I have decided to move on to other endeavors. As Acting Under Secretary for Health (NUSH) , I have felt privileged to work with each of you. Together , we have accomplished so much. And Dr. Clancy, who many of you know, will be carrying on this great work as the Interim Under Secretary for Health, starting on October 8th . She is ready to go. You are in great hands! o o o o Serving in this role - leading VHA - has been the greatest honor of my life. I was able to serve our Veterans , and work with you all to be part of something special and great. And together , we AMERICAN PVERSIGHT If you are interested in contr ibuting to those affected by Hurricanes Harvey, Irma, or Maria, the VCS and PenFed Foundation will now be collecting donations through October 13th. Funds will be made available to VeteransN A employees impacted . Collection jars are available near cash registers in the VCS retail, food and coffee locations. Donations can also be made via PenFed Foundation or send a check to PenFed Foundation , 2930 Eisenhower Ave , Alexandria, VA 22314 . VA-19-0799-H-000322 DS_00019626 transformed VHA for Veterans and future generations . Facility Updates (post Hurricane) o We improved access , reduced wait times , increased telehealth capabilities , overhauled and. streamlined the Choice program , and launched a new health improvement and operations center . We also introduced innovations like the LUKE Arm and Increased delivery of same day services in CBOCs . And we made a big move to modernize our systems and processes , and so much more. It seems like time has really flown ; we have done so much , so quickly . And for that , I thank you. These accomplishments will transform VHA. It was possible because of you all of you - and all of the great work that you do. The VA is a part of me. As you know , I trained here and I will continue to be a part of VA, serving at Lyons NJ, and I'll be here to support VHA. I want to leave you with something to think about. What you do here; what we all continue to do for our Veterans, affects many. It is what you do that has a lasting impact , and it does not matter what role or part you may have played , We all matter . You matter. And I am grateful for all that we have done for our Veterans , together . o o o o Program Updates Apply TODAY for the Leadership VA (LVA) Class of 2018 o o o I wish you all the best and I hope that we will cross paths in the future . Continue to take care of Veterans ; I certainly will. Poonam Alaigh, MD Follow me on Twitter @ushVHA o AMERICAN PVERSIGHT LVA is accepting applications through 11:59 PM ET October 23 , 2017 for qualified applicants in grades of GS 13 (minimum 52 weeks in grade) through GS 15 and Title 38 equivalents . Eligible applicants must occupy a full-time position and achieve an overall performance rating of Fully Successful or above To submit an application for LVA 2018 , APPLY NOW. For more information : LVA Overview . VA's Suicide Prevention Month o Events San Juan VA Medical Center is now operational . Due to some telecommunication challenges on Puerto Rico, individuals can reach San Juan VAMC by dialing 910-475-6516 or 1-800449-8729 . Locations in Comerio , Ceiba , Guayama , and Mayaguez are open for walk-in . Arecibo facility will have mobile medical staff; available 9a-1 p. Clinic locations in ponce , Utado 1 Vieques, St. Croix & St. Thomas are still closed . In partnership with the VA Center for Innovation (VACI) and NASA 1 the Gun Safety Matters Challenge launched . VA-19-0799-H-000323 DS_00019627 o o Women in Medicine Month - We pay tribute to many women in medicine , who are there and help care for patients , and help advance the field. September is Women in Medicine Month , the theme for this year is "Women in medicine: Born to lead." National Service Dog Month- September is National Service Dog Month . Service Dogs are trained partners for Veterans with substantial mobility limitations. Learn more about the service dog veterinary benefit. o o Quick Update on Access o o o o Since February, time sensitive appointment scheduling has increased to 89% (from 69%) for appointments scheduled no later the provider recommended date . Since February, the number of CBOCs with same day services in primary care and mental health has improved from 90% to 99%. That's amazing! Since February , Stat Consults at all levels decreased from 2 .63 to 1.4 days (cut the time in half!) Thank you to everyone for all that you have done to make this all possible - we (and Veterans) greatly appreciate everything! In the News ... o o o The Challenge is open to the public and is expected to find innovative and comprehensive plans for the safe storage of firearms , especially during periods of distress. Learn more. Kayla Williams , Director of the Center for Women Veterans , contributed a #BeThere blog: Committing Yourself to Prevent Suicide of Women Veterans . Webinars were conducted that included Community Veterans Engagement Boards (CVEB), the Community Action Boards , and the Veteran Community Partnerships (VCP). The recorded webinar and toolkit are expected to be available on the CVEB website soon. VA convened a Twitter chat with the American Foundation for Suicide Prevention (AFSP) ; Substance Abuse and Mental Health Services Administration (SAMHSA) ; Team Red, White , and Blue; Iraq And Afghanistan Veterans Of America (IAVA); and Team Rubicon on the main VA Twitter page. Consider changing your signature block to: Suicide Prevention is Everyone 's Business. #BeThere . In the Star Tribune : Vet's Phone call was inspired by strong feelings toward the VA. Did you know ... o AMERICAN PVERSIGHT We are proud to join the international peer support community in recognizing Peer VA-19-0799-H-000324 OS 00019628 o Specialists on the third anniversary of Peer Specialist Global Recognition Day. What began as a small number of peers at a few facilities in 2007 has grown to close 1,100 peers , with peer support now available at all medical centers . Office of Community Care o o lnteragency Rotation Program o o o o o o Do you know someone with the desire , determination , and drive for growth , and able to comm it to a 6-mo . interagency rotation? The President 's Management Council (PMC) lnteragency Rotation Program can assist them with developing or enhanc ing specific leadership competencies . The next application cycle for Cohort 14 of the PMC will open in October 2017 . PMC enables emerging Federal leaders to expand management skills, broaden their organizational experience , and foster networks . This is an excellent opportunity to assist emerging leaders in stretching their leadership skills and providing professiona l development opportun ities across governmen t. For questions , please contact vacopmc@va .gov Special Announcement o All VA employees who wish to volunteer in an official capacity as part of the Puerto Rico relief efforts should contact the facility emergency manager or reach out to your DEMPS coordinator . o Patient Experience (PX) Office o o o o o PVERSIGHT VA PX is delivering tools to improve the patient experience across VHA facilities. This week , VA PX's Employee Badge Connection (EBC) toolkit is being highlighted. VA PX will facilitate the EBC toolkit through virtua l means , connecting to VHA fac ilities. Employee PX will faci litate the EBC toolkit through virtual means , connecting to VHA facilities . Visit VA PX Pulse to access the EBC toolkit and other toolkits or to become a pilot site. The Offices of Nursing Services (ONS) and Workforce Management and Consulting (WMC) o AMERICAN VA is rolling out a new community care operat ing model that affects how Veterans are referred to community providers . The new model clarifies roles and responsib lities, improves consistency of processes, strengthens partnerships , standardizes care coordination and improves customer service . Watch this video to learn more and hear from Orlando VAMC staff on how the new model is improving services for Veterans , The offices of ONS and WMC are leading an effort to recruit VA-19-0799-H-000325 OS 00019629 o o o o Nurse Practitioners through a campaign to improve access. Medical facilities have agreed to participate in this campaign and provided the number of Nurse Practitioners that are being targeted for hire . WMC posted a national job announcement for all of the participating facilities. The national JOA closed July 19, 2017 and resulted in 1,693 nurse practitioner applications. Through this announcement and other recruitment sources , 1,363 qualified Nurse Practitioner applicants were referred to 78 facilities for consideration. All facilities participating are required to ensure the Nurse Practitioners are hired by October 1, 2017 . o announcemer:1t VH View as a Web Page U S Department of Vetera11s Affairs I Veterans Health Admin1strat1011 81 0 Vermont Ave NW, Washington, D.C. 20420 AMERICAN PVERSIGHT VA-19-0799-H-000326 OS 00019630 Message Bruce Moskowitz [brucem (b) (6) (b) mac.com] 9/30/2017 1:30:41 PM (6) Poonam Alaigh (b) otmail.com] (b)(6)(6) (b) (6) (b) (6) mb...gmail.com; Laurie Perlmutter [lper-@gmail.com]; Drshul ki n@aol .com Re: Thank you to this fabulous group Frotn: Sent : To : CC: Subject: Ike Perlmutt ,er -frenchangel59.com]; ( (b) (6) b ) ( 6 ) Without question you have accomplished an impressive amount in a very short timeframe . Your dedication and organizational skills are exceptional as is your work ethic. lf I can be of any assistance In the future,feel free to contact me anytime . Sent from my iPad Bruce Moskowitz M .D . (b)(6)(6) On Sep 30, 2017 , at 9 :17 AM, Poonam Alaigh ~(b) > wrote : I am stepping down next week and leaving the VA on October 13th . Please see below the final announcement I sent out via a newsletter communication yesterday . Thanks and all the accomplishments I have been part of have happened in a significant way because of all of you giving us the backing , advice and support to move forward, and at a speed that no one has ever experienced in the VA before. It has been a true privilege and honor knowing aJl of you. Hoping our paths .will cross again . Take care, Poonam Sent from my iPad Begin forwarded message : - > From: "Alaigh, Poonam , M .D ." Date: September 29, 2017 at 6:43 :21 PM EDT (b) (6) To: 'Poonam Alaigh' (b) (6) Subject: FW: VHA Weekly Digest IIssue No. 8 Sent with Good (www .good .com ) -----Original Message----From: VHA USH ANNOUNCEMENTS Sent: Ftiday, September 29 , 2017 04~36 PM Eastern Standard Time To: VHA USH ANNOUNCEMENTS Subject: VHA Weekly Digest IIssue No . 8 AMERICAN PVERSIGHT VA-19-0799-H-000328 DS 00019632 September 29, 2017 I Issue No. 8 News you need to know in the Veterans Health Administration A Special and Sincere Thank You from our Acting USH Dr. Alaigh VA Priorities Greater Choice for Veterans I can't thank you enough for all that you do for our Veterans . Being part of such a dedicated organization is priceless . Modernize Our Systems Focus Resources More Efficiently After fulfilling my two year commitmen t, I have decided to move on to other endeavors . As Acting Under Secretary for Health (A/USH) , I have felt privileged to work with each of you . Together , we have accompl ished so much . And Dr. Clancy , who many of you know , will be carrying on this great work as the Interim Under Secretary for Health, starting on October 8th . She is ready to go. You are in great hands ! Serving in this role - leading VHA has been the greatest honor of my life. I was able to serve our Veterans , and work with you all to be part of something special and great. And together , we transformed VHA for Veterans and future generat ions. We improved access , reduced wait times , increased telehealth capabi lities, overhauled and streamlined the Choice program , and launched a new health improvement and operations center. We also introduced innovations like the LUKE Arm and increased delivery of same day services in CBOCs . And we made a big move to modern ize our AMERICAN PVERSIGHT Improve Timeliness of Service Suicide Prevention Hurricane Donations 1. If you are interested in contributing to those affected by Hurricanes Harvey , Irma, or Maria, the VCS and PenF ed Foundation will now be collecting donations through October 13th. 2. Funds will be made available to VeteransN A employees impacted . 3. Collection j ars are available near cash registers in the VCS retail, food and coffee locations . 4. Donations can also be made via PenFed Foundation or send a check to PenFed Foundation, 2930 Eisenhower Ave , Alexandria , VA 22314 . Facility Updates ( ost Hurricane) VA-19-0799-H-000329 DS_00019633 systems and processes , and so much more . It seems like time has really flown ; we have done so much , so quickly. And for that , I thank you . These accomplishments will transform VHA. It was poss ible because of you all of you - and all of the great wo rk that you do . The VA is a part of me . As you know , I trained here and I will continue to be a part of VA , serving at Lyons NJ , and I'll be .here to support VHA. I want to leave you with something to think about. What you do here ; what we all continue to do for our Veterans , affects many . It is what you do that has a lasting impact , and it does not matter what role or part you may have played . We all matter . You matter . And I am grateful for all that we have done for our Veterans , togethe r. I wish you all the best and I hope that we will cross paths in the future . Continue to take care of Veterans : I certainly will. Poonam Alaigh, MD Follow me on Twitter @ushVHA Events Women in Medicine Month - We pay tribute to many women in medic ine, who are there and help care for patients , and help advance the field . September is Women in Med icine Month , the theme for this year is "Women in medicine : Born to lead ." 2. National Service Dog Month- September is National Serv ice Dog Month . Service Dogs are trained partners for AMERICAN PVERSIGHT 1. San Juan VA Medical Center is now operationa l. 2. Due to some telecommunication challenges on Puerto Rico , individuals can reach San Juan VAMC by dia ling 910-475-6516 or 1-800-449-8729 , 3. Locations in Comerio , Ceiba , Guayama , and Mayaguez are open for wa lk-in. 4. Arecibo facility will have mobile medical staff ; available 9a-1 p. 5. Clinic locations in ponce , Utado , Vieques , St. Croix & St. Thoma s are still closed . Program Updates Apply TODAY for the Leadership VA (LVA) Class of 2018 1. LVA is accepting applications through 11 :59 PM ET October 23 , 20 17 for qual ified applicants in grades of GS 13 (minimum 52 weeks in grade) through GS 15 and Title 38 equivalents . 2. Eligible applicants must occupy a full-time position and achieve an overall performance rating of Fully Successful or above 3. To submit an application for LVA 2018 , APPLY NOW . 4. For more informat ion : LVA Overview . VA's Suicide Prevention Month 1. In partnersh ip with the VA Center for Innovation (VAC I) and NASA , the Gun Safety Matters Challenge launched. The Challenge is open to the public and is expected to find innovative and comprehensive plans for the safe storage of VA-19-0799-H-000330 DS_00019634 Veterans with substantial mobili ty limitations . Learn more about the service dog veter inary benefit. 2. Quick Update on Access 1. Since February , time sensitive appointment schedul ing has Increased to 89% (from 69%) for appo intments scheduled no later the provider recommended date . 2 . Since February , the number of CBOCs with same day services in primary care and mental health has improved from 90% to 99% . That 's amazing ! 3 . Since February , Stat Consults at all levels decreased from 2.63 to 1.4 days (cut the time in half!) 4. Thank you to everyone for all that you have done to make this all possible -we (and Veterans) greatly appreciate everything! 3. 4. In the News ... 5. 1. In the Star Tribune : Vet's Phone call was inspired by strong feelings toward the VA firearms , especially during periods of distress . Learn more . Kayla Williams , Director of the Cente r for Women Veterans , contributed a #BeThere blog : Committing Yourself to Prevent Suicide of Women Veterans . Webinars were conducted that included Community Veterans Engagement Boards (CVEB) , the Community Action Boards , and the Veteran Community Partnersh ips (VCP) . The recorded webinar and toolkit are expected to be available on the CVEB website soon . VA convened a Twitter chat with the American Foundation for Suicide Prevention (AFSP) ; Substance Abuse and Mental Health Services Adm inistration (SAMHSA) ; Team Red, White , and Blue ; Iraq And Afghanistan Veterans Of Amer ica (IAVA); and Team Rubicon on the main VA Twitter page . Conside r chang ing your signature block to: uicide Preventionis Everyone's ,usiness. #BeThere . Did you know ... image003.jpg > We are proud to join the internationa l peer support community in recognizing Peer Spec ialists on the third anniversary of Peer Specialist Global Recognit ion Day . 2. What began as a small number of peers at a few facilities in 2007 has grown to close 1,100 peers, with peer support now available at all medical centers. lnteragency Rotation Program AMERICAN PVERSIGHT Office of Community Care l. VA is rolling out a new community care operating mode l that affects how Veterans are referred to community providers . 2. The new model clarifies roles and responsibilities , improves consistency of processes , strengthens partnerships , VA-19-0799-H-000331 DS_00019635 1. Do you know someone with the desire, determination, and drive for growth, and able to commit to a 6-mo. interagency rotation? 2. The President's Management Council (PMC) lnteragency Rotation Program can assist them with developing or enhancing specific leadership competencies . 3. The next application cycle for Cohort 14 of the PMC will open In October 2017. 4. PMC enables emerging Federal leaders to expand management skills , broaden their organizational experience , and foster networks . 5. This is an excellent opportunity to assist emerging leaders in stretching their leadership skills and providing professional development opportunities across government. 6. For questions, please contact vacopmc@va .gov Special Announcement 1. All VA employees who wish to volunteer in an official capacity as part of the Puerto Rico relief efforts should contact the facility emergency manager or reach out to your DEMPS coordinator. AMERICAN PVERSIGHT standardizes care coordination and improves customer service . 3. Watch this video to learn more and hear from Orlando VAMC staff on how the new model is improving services for Veterans . Patient Experience (PX) Office l . VA PX is delivering tools to improve the patient experience across VHA facilities . 2 . This week, VA PX's Employee Badge Connection (EBC) toolkit is being highlighted . 3. VA PX will facilitate the EBC toolkit through virtual means , connecting to VHA facilities. 4. Employee PX will facilitate the EBC toolkit through virtual means, connecting to VHA facilities . 5. Visit VA PX Pulse to access the EBC toolkit and other toolkits or to become a pilot site . The Offices of Nursing Services (ONS) and Workforce Management and Consulting (WMC) l . The offices of ONS and WMC are leading an effort to recruit Nurse Practitioners through a campaign to improve access . 2. Medical facilities have agreed to participate in this campaign and provided the number of Nurse Practitioners that are being targeted for hire. 3 . WMC posted a national job announcement for all of the participating facilities. The national JOA closed July 19, 2017 and resulted in 1,693 nurse practitioner applications. 4. Through this announcement and other recruitment sources , 1,363 VA-19-0799-H-000332 DS_00019636 qualified Nurse Practitioner applicants were referred to 78 facilities for consideration . 5. All facilities participating are required to ensure the Nurse Practitioners are hired by October 1, 2017 . 6. announcement View as a Web Page IJ S Department of Veterans Affairs I Veterans Health Administration 810 Vermont Ave NW, Washington, DC 20420 AMERICAN PVERSIGHT VA-19-0799-H-000333 OS 00019637 Message Poonam Alaigh (b) otmail.com] (b)(6)(6) 9/30/2017 1:17:59 PM (b) (6) (b) (6) mb...gmail.com; Laurie Perlmutter [lper-@gmail (b) (6) .com Drshulkin@aol.com; brucemcll...mac(b) Thank you to th is fabulous group (6) From: Sent : .com]; Ike Perlmutter -frenchangel59 .com]; ( (b) b (6) Subject: ) ( 6 I am stepping down next week and leaving the VA on October 13th. Please see below) the final announcement l To : sent out via a newsletter communication yesterday . Thanks and all the accomplishments I have been part of, have happened in a significant way because of all of you giving us the backing , advice and support to move forward , and at a speed that no one has ever experienced in the VA before. It has been a true privilege and honor knowing all of you . Hoping our paths will cross again . Take care, Poonan1 Sent from my iPad Begin forwarded message : - > From: 11Alaigh , Poonam , M .D. 11 Date: September 29, 2017 at 6 :43 :21 PM EDT (b) (6) To: 'Poonam Alaigh 1 (b) (6) Subject: FW: VHA Weekly Digest I Issue No. 8 Sent with Good (www .good.com ) -----Original Message----From: VHA USH ANNOUNCEMENTS Sent: Friday , September 29, 2017 04 :36 PM Eastern Standard Time To: VHA USH ANNOUNCEMENTS Subject: VHA Weekly Digest I Issue No . 8 VHA IWeekly Digest September 29, 2017 AMERICAN PVERSIGHT I Issue No. 8 VA-19-0799-H-000334 DS 00019638 News you need to know in the Veterans Health Administration VA Priorities Greater Choice for Veterans Modernize Our Systems Focus Resources More Efficiently Improve Timeliness of Service Suicide Prevention I can't thank you enough for all that you do for our Veterans. Being part of such a dedicated organization is priceless Hurricane Donations 1. lf you are interested in After fulfill ing my two year comm itment , I have decided to move on to other endeavors. As Acting Under Secretary for Health (A/USH) , I have felt privileged to work with each of you. Together , we have accomplished so much. And Dr. Clancy , who many of you know, will be carrying on this great work as the Interim Under Secretary for Health, starting on October 8th . She is ready to go. You are in great hands ! Serving in this role - leading VHA - has been the greatest honor of my life. I was able to serve our Veterans , and work with you all to be part of something special and great. And together , we transfo rmed VHA for Veterans and future gene rations. contr ibuting to those affected by Hurricanes Harvey, Irma, or Maria , the VCS and PenFed Foundation will now be collecting donations through Octobe r 13th. 2. Funds will be made available to VeteransNA employees impacted. 3. Collection jars are available near cash registers in the VCS retail, food and coffee locations . 4. Donations can also be made via PenFed Foundation or send a check to PenFed Foundation , 2930 Eisenhower Ave, Alexandria , VA 22314 . Facility Updates (post Hurricane) We improved access , reduced wa it times , increased telehealth capabil ities, overhauled and stream lined the Choice program , and launched a new health improvement and operations center . We also introduced innovations like the LUKE Arm and increased delivery of AMERICAN PVERSIGHT 1. San Juan VA Medical Center is now operational. 2. Due to some telecommunication challenges on Puerto Rico, individuals can reach San Juan VAMC by VA-19-0799-H-000335 OS 00019639 same day services in CBOCs . And we made a big move to modernize our systems and processes , and so much more . It seems like time has really flown ; we have done so much , so quickly. And for that , I thank you. These accomplishments will transform VHA. It was possible because of you all of you - and all of the great work that you do . dialing 910-475-6516 or 1-800449-8729 . 3. Locations in Comerio , Ceiba , Guayama , and Mayaguez are open for walk- In. 4. Arecibo facility will have mobile medical staff ; available 9a-1 p. 5. Clinic locations in ponce , Utado , Vieques, St Croix & St. Thomas are still closed . Program Updates The VA is a part of me. As you know, I trained here and I will continue to be a part of VA , serving at Lyons NJ , and I'll be here to support VHA. I want to leave you with something to think about. What you do here; what we all continue to do for our Veterans, affects many . It is what you do that has a lasting impact , and it does not matter wha t role or part you may have played . We all matter . You matte r. And I am grateful for all that we have done for our Veterans , together . I wish you all the best and I hope that we will cross paths in the future . Continue to take care of Veterans ; I certainly will. Poonam Alaigh , MD Follow me on Twitter @ushVHA Apply TODAY for the Leadership VA (LVA) Class of 2018 1. LVA is accepting applications through 11 :59 PM ET October 23 , 2017 for qualified applicants in grades of GS 13 (minimum 52 weeks in grade ) through GS 15 and Title 38 equiva lents. 2. Eligible applicants must occupy a full-time position and achieve an overall performance rating of Fully Successful or above 3. To submit an appl ication for LVA 2018, APPLY NOW . 4 . For more information : LVA Overview . VA's Suicide Prevention Month Events I . Women in Medicine Month - We pay tribute to many women in medic ine, who are there and help care fo r patients , and help advance the field. September is Women in Medicine Month , the theme for this year is "Women in medicine : Born to lead. " 2. National Service Dog Month- September is National Service Dog Month . Service Dogs AMERICAr-... pVERSIGHT I . In partnership with the VA Center for Innovation (VACI ) and NASA. the Gun Safety Matters Challenge launched . The Challenge is open to the public and is expected to find innovative and comprehensive plans for the safe storage of firearms , especially during periods of distress . Learn more . VA-19-0799-H-000336 DS_00019640 are trained partners for Veterans with substan tial mobility limitations. Learn more about the service dog veterinary benefit. Quick Update on Access 1. Since February, time sensitive appointment scheduling has increased to 89% (from 69%) for appointments scheduled no later the provider recommended date . 2. Since February , the number of CBOCs with same day services in primary care and mental health has improved from 90% to 99%. That's amazing! 3. Since February , Stat Consults at all levels decreased from 2.63 to 1.4 days (cut the time in half!) 4. Thank you to everyone for all that you have done to make this all possible - we (and Veterans) greatly appreciate everything! In the News ... 1. In the Star Tribune : Vet's Phone call was inspired by strong feelings toward the VA. 2. Kayla Williams , Director of the Center for Women Veterans , contributed a #BeThere blog : Committing Yourself to Prevent Suicide of Women Veterans. 3. Webinars were conducted that included Commun ity Veterans Engagement Boards (CVEB) , the Community Action Boards , and the Veteran Community Partnerships (VCP). The recorded webinar and toolkit are expected to be available on the CVEB website soon. 4. VA convened a Twitter chat with the American Foundation for Suicide Prevention (AFSP) ; Substance Abuse and Mental Health Services Admin istration (SAMHSA) ; Team Red, White , and Blue; Iraq And Afghanistan Veterans Of America (IAVA) ; and Team Rubicon on the main VA Twitter page . 5. Consider changing your signature block to: uicide Prevention is Everyone's usiness. #BeThere . Did you know ... I . We are proud to join the international peer support commun ity in recognizing Peer Specialists on the third anniversary of Peer Specialist Global Recognition Day . 2. What began as a small number of peers at a few facilities in 2007 has grown to close 1,100 peers , with peer support now available at all medical centers . lnteragency Rotation Program AMERICAr-... pVERSIGHT n oooVete ans -, : : : CrisisLine 1-800-273 -8255 PRESS O Office of Community Care 1. VA is rolling out a new community care operating model that affects how Veterans are referred to community providers . VA-19-0799-H-000337 D8_00019641 l . Do you know someone with the 2. "' 4. 5. 6. desire , determination , and drive for growth, and able to commit to a 6-mo . interagency rotation? The President's Management Council (PMC) lnteragency Rotation Program can assist them with developing or enhancing specific leadership competencies The next application cycle for Cohort 14 of the PMC will open in October 201 7. PMC enables emerging Federal leaders to expand management skills, broaden their organizational experience, and foster networks. This is an excellent opportunity to assist emerging leaders in stretching their leadership skills and providing professional development opportunities across government. For questions , please contact vacopmc@va.gov Special Announcement 1. All VA employees who wish to volunteer in an official capacity as part of the Puerto Rico relief efforts should contact the facility emergency manager or reach out to your DEMPS coordinator 2. The new model clarifies roles and responsibilities , improves consistency of processes, strengthens partnerships, standardizes care coordination and improves customer service . 3. Watch this video to learn more and hear from Orlando VAMC staff on how the new model is improving services for Veterans . Patient Experience (PX) Office J. VA PX is delivering tools to improve the patient experience across VHA facilities. 2. This week , VA PX's Employee Badge Connection (EBC) toolkit is being highlighted . 3. VA PX will facilitate the EBC toolkit through virtual means , connecting to VHA facilities. 4. Employee PX will facilitate the EBC toolkit through virtual means , connecting to VHA facilities . 5. Visit VA PX Pulse to access the EBC toolkit and other toolkits or to become a pilot site . The Offices of Nursing Services (ONS) and Workforce Management and Consulting (WMC) l . The offices of ONS and WMC are leading an effort to recruit Nurse Practitioners through a campaign to improve access . 2. Medical facilities have agreed to participate in this campaign and provided the number of Nurse Practitioners that are being targeted for hire. AMERICAN PVERSIGHT VA-19-0799-H-000338 DS 00019642 3. WMC posted a national job announcement for all of the participating facilities. The national JOA closed July 19, 2017 and resulted in 1,693 nurse practitioner applications. 4. Through this announcement and other recruitment sources , 1,363 qualified Nurse Practitioner applicants were referred to 78 facilities for consideration . 5. All facilities participating are required to ensure the Nurse Practitioners are hired by October 1, 2017 . 6. .- - announceme o View as a Web Page U S. Department of Veterans Affairs I Veterans Health Administration 810 Vermont Ave NW, Washington, DC 20420 AMERICAr-... pVERSIGHT VA-19-0799-H-000339 DS_00019643 Message From: Sent: To: David shulkin [Drshulkin@aol.com] 10/6/2017 12:29:36 AM Ike Perlmutter -frenchangel59.com] ( (b) (6) b ) ( Im having dinner with your6 friend ) Sent from my iPhone AMERICAN PVERSIGHT peter seligman from the conservation board VA-19-0799-H-000340 OS 00019644 Message From: (b) (6) (b) (6) Sent : To : 10/6/2017 4:45 :10 PM drshulkin@aol.com Subject: More va newsmakers video s (b) (6) gmail.com) http ://comcastnewsmakers .com/tag/va/ AMERICAN PVERSIGHT VA-19-0799-H-000341 DS 00019645 Message From: Sent: To: Subject: Bruce Moskowit z [brucem (b) mac.com] 10/3/2017 2:12:32 PM (6) DavidShulkin [secshulkin@gmail.com] Re: Choice Program Will await your direction (b) (6) to get both done at no cost to system Sent from my iPad Bruce Moskowitz M.D. > on Oct 3, 2017, at 10 :09 AM, David Shulkin wrote: > > That would be amazing > > sent from my iPhone > (b) (6) (b) >> on Oct 3, 2017 , at 7: 59 AM, Bruce Moskowitz wrote: >> (6) >> This program for the choice program could probably be donated at no cost to the VA. Just our not for profit that works with DR. Matheny at Vanderbilt VA and DR. Resnic at Harvard system of tracking up and running a device registry and can donate it to the VA and do the implementation for free. Terry Fadem is President of the Biomedical Education and Research and has the expertise to get it done . as important , have the rest of the foundation >> >> sent from my iPad >> Bruce Moskowitz M.D. >> >>> on Oct 3, 2017 , at 7 :4 8 AM, David shulkin wrote : >>> >>> Bruce-this looks good and something we need to do for sure >>> >>> we are working an interagency agreement with ems to go faster since they already do this >>> >>> If not we need an rfi and rfp to award which we will include this group and others >>> >>> >>> >>> sent from my iPhone >>> (b) (6) (b) >>>> on Oct 2, 2017 , at 10:12 AM, Bruce Moskowitz wrote : >>>> (6) >>>> This is an important aspect for monitoring and holding down the cost of the program. >>>> >>>> >>>> >>>> >>>> >>>> sent from my iPad >>>> Bruce Moskowitz M. D. AMERICAN PVERSIGHT VA-19-0799-H-000342 OS 00019646 Message From: Sent: To: Subject: DavidShulkin [secshulkin@gmail.com] 10/3/2017 2:09:00 PM (b) (6) (b) mac . com] Bruce Moskowit z [brucemcll???? Re: Choice Program (6) That would be amazing Sent from my iPhone (b) (6) > on Oct 3, 2017, at 7:59 AM, Bruce Moskowitz wrote: (b) > (6) > This program for the choice program could probably be donated at no cost to the VA. Just as important , our not for profit that works with DR. Matheny at Vanderbilt VA and DR. Resnic at Harvard have the system of tracking up and running a device registry and can donate it to the VA and do the rest of the implementation for free. Terry Fadem is President of the Biomedical Education and Research foundation and has the expertise to get it done. > > sent from my iPad > Bruce Moskowitz M. D. > >> on Oct 3, 2017 , at 7: 48 AM, David shulkin wrote: >> >> Bruce-this looks good and something we need to do for sure >> >> we are working an interagency agreement with ems to go faster since they already do this >> >> If not we need an rfi and rfp to award which we will include this group and others >> >> >> >> sent from my iPhone >> (b) (6) (b) >>> on Oct 2, 2017, at 10 :12 AM, Bruce Moskowitz wrote: >>> (6) >>> This is an important aspect for monitoring and holding down the cost of the program . >>> >>> >>> >>> >>> >>> sent from my iPad >>> Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000343 OS 00019647 Message (b) (6) Bruce Moskowit z [brucem~mac .com] (b) (6) Sent: 10/3/2017 11:59:56 AM To: DavidShulkin [secshulkin@gmail.com] (b) (6) (b) (6) CC: ( (b) l.com] Ike Perlmutt er [-renchangel59.com]; mb-gmai l.com; L Perl [lper-@gmai Re: Choice Program b (6) Subject: ) ( 6 This program for the choice ) program could probably be donated at no cost to the VA. Just as important, our not for profit that works with DR. Matheny at Vanderbilt VA and DR. Resnic at Harvard have the system of tracking up and running a device registry and can donate it to the VA and do the rest of the implementation for free. Terry Fadem is President of the Biomedical Education and Research foundation and has the expertise to get it done. From: sent from my iPad Bruce Moskowitz M.D. > on Oct 3, 2017, at 7 :48 AM, David shulkin wrote: > > Bruce - this looks good and something we need to do for sure > > we are working an interagency agreement with ems to go faster since they already do this > > If not we need an rfi and rfp to award which we will include this group and others > > > > sent from my iPhone > (b) (6) (b) >> on Oct 2, 2017, at 10:1 2 AM, Bruce Moskowitz wrote: >> (6) >> This is an important aspect for monitoring and holding down the cost of the program . >> >> >> >> >> >> sent from my iPad >> Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000344 OS 00019648 Message From: Sent: To: CC: Subject: David Shulkin [secshulk in@gma il.com] 10/3/2017 11:48:14 AM (b) (6) Bruce Mosko w it z [brucem~mac (b) (6) Ike Perlmu tt er [-renchangel59.com] ( (b) b (6) Re: Choice Program .com] ) ( 6 Bruce- this looks good and) something we need to do for sure We are working an interagency agreement with ems to go faster If not we need an rfi and rfp to award which we will include since they already this do this group and others sent from my iPhone (b) (6) > on Oct 2 , 2017 , at 10: 12 AM, Bruce Moskowitz > This is an important > > wrote: (6) and holding down the cost of the program . to s ec General_ DRAFT-v 3.doc x> > > > > sent from my iPad > Bruce Moskowitz M. D. AMERICAN PVERSIGHT VA-19-0799-H-000345 OS 00019649 Message DavidShulkin [secshulkin@gmail.com] 10/3/2017 2:00:28 AM (b) (6) (b) mac . com] Bruce Moskowitz [brucemcll???? Re: Choice Program (6) From: Sent: To: Subject: Bruce- ill review Sent from my iPhone (b) (6) > on Oct 2, 2017, at 10:12 AM, Bruce Moskowitz wrote: (b) > (6) > This is an important aspect for monitoring and holding down the cost of the program . > > > > > > sent from my iPad > Bruce Moskowitz M. D. AMERICAN PVERSIGHT VA-19-0799-H-000346 OS 00019650 Message David Shulkin [secshulkin@gmail.com] Frotn: Sent : 10/3/2017 2:00 :14 AM To : (b) (6) @va.gov Subject: Fwd: Choice Program Attachments : Emergent needs Letter to Sec General_DRAFT-\/3.docx,; Untitled attachment 84751.htm Print Sent from tny iPhone Begin forwarded message : (b) From: Bruce Moskowitz Subject: Choice Program mac .com> This is an important aspect for monitoring and holdin,g down the cost of the program . AMERICAN PVERSIGHT VA-19-0799-H-000347 DS 00019651 Cognizant Emergent needs to be addressed: Openi ng access for Veterans to non-Adm i nistrat ion run facilities has helped many receive the care that they need in a timely manner. However, that has also opened the door for fraud and over billing of services for those receiving care. In the end this raises the cost of care for all vete rans. There is also a need to manage and monitor the prescribing of Opioids to the veteran population. Using a simple yet elegant rules engine based on care management logic and clinical relevance our tool can aid in com batting both of these areas for a fraction of the cost and have the ability to store and detect fraud. This system is available 24/7, 365 days a year without human interaction . This service level is paramount to the delivery of care and the management of funding for all veterans. On Fraud: TriZetto Touchless Authorization Processing (TTAP} detects abuse or fraud by analyzing the incom ing prior authorization requests. The engine looks at combination of factors including the referring physician, servicing provider, procedure/drug codes, diagnosis codes and answers to any questions that the referring provider might be required to answer. Based on history and analytics the system is able to determine potential abuse or fraud, and flag the request to be further examined. One case study is home health. Home health requ ires multiple visits and multiple agencies at a time to be approved and managed. This creates multiple points for fraud to occur and increase costs. Our system is uniquely positioned to stop this with business rules defined by the Administration and medical necessity crite ria to support the decision . On the Technology: TTAP is an end-to-end real-time automated solution for authorization of medical and pharmacy care that is based on the EDI 278/275 standard. The authorization engine fully automates a payers business as well as medical necessity criteria to enable touch less processing of prior authorizations. The standards based approach addresses the concern of provider adoption very effectively to off er a systen1 that is not only able to process prior authorization request in real time and in a touch less fashion but with Fraud and Abuse analytics is able to flag any requests that are potentially suspect. Addressing both payer as well as provider sides makes this utilization management and fraud detection solution unique, efficient and easy to deploy with no resistance to provider adoption. In Summary: Our solution addresses the need for management and fraud prevention the is currently burdening the Veterans Admin istration. Having an automated solution will drive out waste and fight against abuse system wide. All of this at a fraction of the cost of hiring lO0's of utilization review staff to do the same work. Attached is a pilot conducted around Prior Authorizations. As a part of that study home health and the complexity of those services are being managed in the rulesets. The return on investment of TTAP is significant and we would enjoy the opportunity to discuss more at detail with your team. AMERICAr-... pVERSIGHT VA-19-0799-H-000348 DS 00019652 Sent from my iPad Bmce Moskowitz MD. Message From: Bruce Moskowitz [brucem (b) (6) (b) (6) mac.com] Sent: 10/2/2017 2:12:39 PM To: David Shulkin [secshul kin@gma il.com] Choice Program Emergent needs Letter to Sec General_DRAFT-v3.docx; Untitled attachment 84757 .txt Subject: Attachments: This is an important AMERICAN PVERSIGHT aspect for monitoring and holding down the cost of the program. VA-19-0799-H-000350 OS 00019654 Cognizant Emergent needs to be addressed: Openi ng access for Veterans to non-Adm i nistrat ion run facilities has helped many receive the care that they need in a timely manner. However, that has also opened the door for fraud and over billing of services for those receiving care. In the end this raises the cost of care for all vete rans. There is also a need to manage and monitor the prescribing of Opioids to the veteran population. Using a simple yet elegant rules engine based on care management logic and clinical relevance our tool can aid in com batting both of these areas for a fraction of the cost and have the ability to store and detect fraud. This system is available 24/7, 365 days a year without human interaction . This service level is paramount to the delivery of care and the management of funding for all veterans. On Fraud: TriZetto Touchless Authorization Processing (TTAP} detects abuse or fraud by analyzing the incom ing prior authorization requests. The engine looks at combination of factors including the referring physician, servicing provider, procedure/drug codes, diagnosis codes and answers to any questions that the referring provider might be required to answer. Based on history and analytics the system is able to determine potential abuse or fraud, and flag the request to be further examined. One case study is home health. Home health requ ires multiple visits and multiple agencies at a time to be approved and managed. This creates multiple points for fraud to occur and increase costs. Our system is uniquely positioned to stop this with business rules defined by the Administration and medical necessity crite ria to support the decision . On the Technology: TTAP is an end-to-end real-time automated solution for authorization of medical and pharmacy care that is based on the EDI 278/275 standard. The authorization engine fully automates a payers business as well as medical necessity criteria to enable touch less processing of prior authorizations. The standards based approach addresses the concern of provider adoption very effectively to off er a systen1 that is not only able to process prior authorization request in real time and in a touch less fashion but with Fraud and Abuse analytics is able to flag any requests that are potentially suspect. Addressing both payer as well as provider sides makes this utilization management and fraud detection solution unique, efficient and easy to deploy with no resistance to provider adoption. In Summary: Our solution addresses the need for management and fraud prevention the is currently burdening the Veterans Admin istration. Having an automated solution will drive out waste and fight against abuse system wide. All of this at a fraction of the cost of hiring lO0's of utilization review staff to do the same work. Attached is a pilot conducted around Prior Authorizations. As a part of that study home health and the complexity of those services are being managed in the rulesets. The return on investment of TTAP is significant and we would enjoy the opportunity to discuss more at detail with your team. AMERICAr-... pVERSIGHT VA-19-0799-H-000351 DS 00019655 Sent Bruce from my iPad Moskowi tz AMl H CAt\ pVERSIGHT M.D. VA-19-0799-H-000352 DS_ 00019656 Message From: (b) (6) Sent: 9/29/2017 10:57:02 AM To : David Shu Ikin (drshulkin@aol.com] Re: Subject: (b) (6) (b) (6) gmail.com) Ok On Thu, Sep 28, 2017 at 11:21 PM David Shulk:in wrote : Canu print http ://www .huffi ngtonpost .com/ entry/trump-terribl e-10-espn-european-honeymoon-i diotediti on us 59bbe55ee4b06b71800c3887 Sent from my iPad Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000353 OS 00019657 Message From: David Shulkin [drshulk in@aol.c om] Sent : 9/29/2017 3:21:30 AM To : (b) (6) (b) (6) (b) (6) gmail.com] Canu print http:/ /www. huffi ngton post. com/ entry/trump-terri b le-10-espn-european-hon eym oon-idi atedition us 59bbe55ee4b06b71800c3887 Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000354 OS 00019658 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 10/3/2017 11:23:06 PM To: (b) (6) Bruce Moskowitz [brucem~mac Re: Suicide prevention Subject: (b) (6) .com] Thanks for sharing Very relevant Sent from my iPhone (b) (6) > on Oct 3, 2017, at 7:29 AM, Bruce Moskowitz > This is from Chief at PENN (b) (6) . com> wrote: > > > > > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000355 OS 00019659 Message From: Sent: To: Subject: Attachments: Bruce Moskowitz [brucem (b) (6) (b) mac.com] 10/3/2017 11:29:48 AM (6) David Shulkin [secshul kin@gma il.com] Suicide prevent ion Penn Veteran Suicide Prevention Program 09 25 2017 .docx; Unt itled attachment 85122.txt This is fr om Chief at PENN AMERICAN PVERSIGHT VA-19-0799-H-000356 OS 00019660 Implementing Suicide Prevention and Improving Veteran Access to Care in the Community Perelman School of Medicine, University of Pennsylvania (Penn) A stunning, but little known, fact is that most Veteran suicides occur among those not receiving health care at the VA. In fact, because about 60% of Veterans receive their healthcare in the community, the Secretary's strategic goals of improving access to high quality mental health (MH) care and suicide prevention within the VA may fall short in reducing suicide risk. Penn has a long-standing commitment to Veterans' health and has conducted ground-breaking research on the newest and best clinical and neurobiological methods to identify and treat individuals and populations at risk. To increase Veteran access to MH care and enhance suicide prevention efforts in the community, we propose three inter-related, yet independent projects. If successful, the resulting advances could be implemented on widely to reduce the rate of suicide among Veterans. Project 1. Improving Access to MH Care and Lethal Means (LM) Reduction. We propose to implement and evaluate a program to improve access to Veteran MH care in tandem with a public health initiative to promote firearm safety. The University of Pennsylvania Hospital System (UPHS), which covers most of Southeastern Pennsylvania, parts of Delaware, and much of New Jersey, is in a unique position to reduce Veteran suicide risk in the community. UPHS conducts nearly 4 million outpatient visits a year and many of our patients are Veterans who would benefit from this initiative . To improve access, we would target MH care to Veterans seen within UPHS using a shared electronic health record to deliver evidence-based practices such as collaborative care, medication-assisted management of addiction, access to the Cohen Veterans Military Family Clinic for short-term, intensive psychotherapy, care management services, and enhanced Safety Planning with Lethal Means (LM) counseling. What makes this feasible is our experience in providing care virtually (via video and telephone), which substantially reduces the number of staff required to deliver services across a broad geographic area. Virtual care also improves the quality of services by increasing fidelity to treatment algorithms and standardizing provider competencies, including military cultural competencies. Because about 67% of Veteran suicides occur using firearms, we will work with key stakeholders to develop and evaluate an LM counseling approach. We will combine LM with a targeted public health messaging campaign to improve access and will evaluate the effectiveness and scalability of these two approaches. We anticipate that this program will take 6-18 months to rollout across the system and we will evaluate outcomes across 6 years . The total cost of this project is estimated at $3 million per year for 7 years . Project 2: Pain, Opioid Use Disorder (OUD) and Suicide Risk in Veterans. The burgeoning rate of opioid abuse and opioid-related deaths parallels an epidemic of suicide deaths in Veterans with OUD . This relationship is compounded by chronic non-cancer pain (CNCP), which doubles suicide risk. Emerging evidence shows that buprenorphine (BUP), in addition to its value in treating OUD, has antidepressant effects. Low-dose BUP can decrease and in some cases completely relieve acute suicidal Ideation (SI). Importantly, the antidepressant and anti-suicidal effects of BUP may be most useful in patients with both OUD and CNCP. We propose to assess the efficacy of BUP in combination with Cognitive Therapy for Suicide Prevention (CTSP) in reducing the frequency and severity of suicidal ideation and reducing suicide attempts in 400 Veterans with OUD. The cost of this project will be $800,000 per year for 5 years. Project 3: Improving Outcomes in Depressed Patients at Extremely High Risk for Suicide: Sequential Intravenous Ketamine and Cognitive Therapy for Suicide Prevention (CT-SP) . Veterans hospitalized with suicidal ideation or following suicide attempts constitute one of the highest risk groups for subsequent suicidal behavior and suicide, with the first 6 months after hospitalization being the time of highest risk. Two therapies have been shown to significantly reduce suicidal ideations and behaviors during this time period - intravenous ketamine and CT-SP. As preclinical evidence suggests that ketamine restores neuronal connectivity, we predict that sequential delivery of these interventions will have additive or synergistic effects. We propose to conduct a pilot study to assess the feasibility and potential clinical utility of such a program. Over two years, we will identify 20 veterans, ages 21-75, hospitalized because of a suicidal crisis through the emergency services at one of the UPHS hospitals. Within 48 hours of admission, participants will receive the first of 6 intravenous ketamine infusions; subsequent infusions will be administered every 3-4 days. On alternating days, a qualified CT-SP therapist will begin treatment (delivering up to 20 individual sessions over 6 months) . Outcomes of interest will include the duration of the index hospitalization, measures of suicidal ideation and depressive symptoms , and the incidence of subsequent suicidal behaviors or re-hospitalization. Our aim is to demonstrate the rapid resolution of suicidal ideation and we will examine the persistence of beneficial effects for 6 months post-hospitalization (i.e. , aiming for a readmission rate of <10%). The total cost of this program will be $700,000 per year for two years. Should this pilot project achieve its goals, a large-scale, randomized, controlled trial using either placebo infusions or a treatment as usual control condition will be proposed. AMERICAN PVERSIGHT VA-19-0799-H-000357 OS 00019661 Sent Bruce from my iPad Moskowi tz AMl H CAt\ pVERSIGHT M.D. VA-19-0799-H-000358 DS_ 00019662 Message @aol.com [(b) (6) From: (b) (6) Sent: To: 9/28/2017 1:25:01 PM DJS [drshulkin@aol.com] Subject: Poonam reception @aol.com] I know you will be coming to Poonam's reception helpful. Funny story ? Thanks today. If you could help us keep it light that would be Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000359 OS 00019663 Message From: (b) (6) Sent: 9/27/2017 11:47:47 PM (b) (6) (b) mac . com] Bruce Moskowitz [brucemcll???? To: CC: Subject: @aol.com (b) (6) @aol.com] David Shulkin [secshulk in@gmail.com] (6) Re: Apple understood. Sent from my iPhone (b) (6) (b) > on Sep 27, 2017, at 7:37 PM, Bruce Moskowitz wrote: > (6) > Aware of all my only role is to make sure that my group is pleased with the outcome . Geotagging needs to be dynamic not static. Feedback if appointments can not be accessed. > > sent from my iPad > Bruce Moskowitz M.D. > (b) (6) >> on Sep 27, 2017, at 7:01 PM, -@aol.com wrote: >> >> Hi Dr Moskowitz, There has been progress on the EHRelements and the team is due to provide an update which I will forward by Friday. The geotagging project specs are making progress but need additional work by a data engineer which will take a bit more time (within 10 days)(time is based on engineer availability, not his actual work time to do his part). Alternately, we could forward your specs to the Apple team to move things along. As I am sure you know, both Dr Alaigh and Rob Thomas are (b) ~ leaving the organization . >> (6) >> sent from my iPhone >> (b) (6) (b) >>> on Sep 27 , 2017, at 12:52 PM, Bruce Moskowitz >>> (6) >>> Any update? >>> >>> sent from my iPad >>> Bruce Moskowitz M. D. wrote: >> AMERICAN PVERSIGHT VA-19-0799-H-000360 OS 00019664 Message From: Bruce Moskowitz [brucem (b) (6) (b) (6) Sent: 9/27/2017 11:37:49 PM To: (b) (b) --@aol.com David(6) Shulkin [secshulk in@gmail.com] (6) Re: Apple CC: Subject: mac.com] Aware of all my only role is to make sure that my group is pleased with the outcome. Geotagging needs to be dynamic not static. Feedback if appointments can not be accessed. Sent from my iPad Bruce Moskowitz M.D. (b) (6) > on Sep 27, 2017 , at 7:01 PM, -@aol.com wrote: > > Hi Dr Moskowitz, There has been progress on the EHRelements and the team is due to provide an update which I will forward by Friday . The geotagging project specs are making progress but need additional work by a data engineer which will take a bit more time (within 10 days) (time is based on engineer availability, not his actual work time to do his part). Alternately, we could forward your specs to the As I am sure you know, both Dr Alaigh and Rob Thomas are leaving the Apple team to move things along . (b) ~ organization. > (6) > sent from my iPhone > (b) (6) (b) wrote: >> on Sep 27, 2017, at 12:52 PM, Bruce Moskowitz >> (6) >> Any update? >> >> sent from my iPad >> Bruce Moskowitz M.D. > AMERICAN PVERSIGHT VA-19-0799-H-000361 OS 00019665 Message Subject: Alaigh, Poonam, M.D. [Poonam.Alaigh@va.gov] 9/27/2017 11:36:09 AM (b) (6) otma il.com; drshulkin@aol.com (b) (6) FW: AQ06(P)Telehealth Rule I ts strange how the folks From: Sent: To: that you expect the least from give you so much -----original Message----From: Lapuz, Miguel H. Sent: Wednesday, September 27, 2017 7:33 AM To: Alaigh , Poonam, M. D. subject : FW: AQ06( P) Telehealth Rule Just another it . example of how VA will be different in the future due to your vision . Feel very good about --- - - Original Message- ---From: Clancy , Carolyn sent .....Tuesda Se temb~r 26, 2017 8 :31 PM To: (b) (6) Ala1gh , Poonam, M.D. ; Pape , Lisa M.; Lapuz, Miguel H.; Hyduke, Barbara Cc: VHA B Subject: RE: AQ06( P) Telehealth Rule Yahoo! sent with Good (www.good.com) -----0---i in al Message----From: (b) (6) sent: Tues ay , September 26, 2017 03:1 4 PM Eastern Standard Time To: Alaigh , Poonam, M. D. ; Clancy , Carolyn ; Pape, Lisa M. ; Lapuz , Miguel H. ; Hyduke , Barbara Cc: VHAlOB Subject : FW: AQ06( P) Telehealth Rule For awareness : 0MBhas cleared the telehealth licensure action all VA telehealth providers should publish no later than Monday 10/ 2. regulation , which proposes to protect from adverse State under the supremacy clause of the U.S. constitution, and It ' s been a long , hard slog ! (b) (6) From: (b) (6) sent : To: (b) (6) Cc: (b) (6) (OGC ) PM (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) Lee , Jennifer s . (VACO ); Cordeiro, Team, Drum roll ............OMBhas concluded their review of the AQ06( P) - Authority Practice Telehealth proposed regulation (attached ). AMERICAN PVERSIGHT of Health care Providers to VA-19-0799-H-000362 OS 00019666 It was successfully submitted to the Federal Register (FR) for publication today. Since I submitted it right on the cusp of 2:00pm, I'm not sure if it will publish on Friday or Monday, but I'm confident it will publish before Tuesday (SECVA's presentation), depending on the FR's edits. NOTE: We will notify you of a confirmed publication publication date(s) until we confirm with the FR. Thanks to everyone for all your hard work and attention date this to this From: noreply@fedreg.gov [mailto:noreply@fedreg.gov] Sen ember 26, 2017 1:55 PM To: (b) (6) (OGC) subj office of the federal Register : submission submission week, so please priority don't regulation. release a Thanks Status : ID:W9262017135417494 ID: W9262017135417494 File Name validation Result Handling File validation Result Upload Status Remarks AQ06( P) - Reg to FR ( 9-26 - 17) VHA-Telehealth.doc x .p7m PASSED PASSED AMERICAN PVERSIGHT VA-19-0799-H-000363 OS 00019667 Message IP -frenchangel59 ( (b) From: Sent: To: Subject: Attachments: .com] 10/12/2017 1:09:31 PM b (6) David ) Shulkin [drshulkin@aol.com] RE:( 6 WhatSoftwareMixlsBest .pdf ) David, Thank you for the update. we worked with her yesterday and shared the attachment. Also thank you for bringing the issue with Tom Hanks to my attention. now the finish product is beautiful. I will call you later this morning to discuss we figured how to correct this and a few other things . Best, Ike -----original Message----From: David shulkin [mailto:drshulkin@aol .com] sent: Wednesday, October 11, 2017 10:59 PM To: IP subject: IkeI'll our group has now connected with Ms -(b) (6) at Wilmer hale let you know when I hear more David sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000364 OS 00019668 What Software Mix Is Best for the VA What are the products: Inpatient Care: Inpatient EHR, ICU, Operating Room, Anesthesia, Infection Control, Pharmacy Ambu latory Care: Ambu latory EHR, Patient Portal, Population Health, Home Health, Behavioral Health, Community and Social Care, Telehealth Patient Administrat ion: Schedu ling, Patient Access, Referrals, Registration, Billing, Health Plan, Claims Thereare two choices: 1. Cernerdo InpatientCare;Epicdo AmbulatoryCareand PatientAdministration Epic has a slightly larger inpatient market share than Cerner. However, Epic has a much larger share of the ambulatory market. Cerner has not had much success in ambulatory care and has a sma ll market share. Most organizations that use Cerner for inpatient care use a different vendor for ambulatory. With about 66% of patients in the U.S. having a record in Epic, as compared to only about 13% in Cerner, using Epic at the VA for ambulatory care would dramatica lly improve interoperability (the lifetime patient care story) for veterans. Epic's extensive history and success in ambulatory care will also provide clinic ians a much more usable EHR solut ion, which is important as we combat physic ian burnout. Both Cerner and Epic can pu ll data from DoD into the VA via an interface. Interoperab ility between DoD and Epic would work well because it would be a one-time interface between two well-defined systems. Most of the interoperabil ity demands will not be DoD to VA. The veteran may go to another healthcare o rganization by choice. Or, by contract the VA may refer the veteran to other well-respected health care organizations in the U.S. Most will be using Epic. If the VA uses Epic for ambu lat ory care, then interoperability to another Epic sit e will be quick, easy, and in-depth. If the recipient site does not use Epic, the VA can interoperate if it knows the digital address of the other site . Otherw ise, the veterans can, by t hemselves, make their information available to the recipient site, at no cost, via Epic's patient controlled interoperability. If the desire is to give some parts of the VA to Cerner and some parts to Epic, then it makes most sense to give inpatient parts to Cerne r and ambulatory care parts to Epic. Patient Administration should go to Epic because Epic is strong in all the components but Cerner is not (see lawsuits) . 2. Epicdo bothAmbulatoryand InpatientCareand PatientAdministration Many organizations have used Cerner for inpatient and Epic for ambulatory care. This does work. However, almost all organizations over time have de-insta lled Cerner and became all Epic. (Note : none have become all Cerner.) Having one natively integrated system, built by the same vendor, all modules sharing the data, brings clinica l and economic benefits to the organizat ion if the system is strong in both inpatient and ambulatory care. This alternative is best for the patient/veteran AMERICAN PVERSIGHT and the caregivers if it's po litically acceptable. VA-19-0799-H-000365 OS 00019669 Message From: DavidShulkin [drshulkin@aol.com] Sent: 10/12/2017 2:58:44 AM Ike Perlmutter -frenchangel59.com] ( (b) b (6) ) ( Ike- our group has now connected with Ms -(b) (6) 6 I'll let you know when I )hear more To: at Wilmer hale David sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000366 OS 00019670 Message From: Sent : To : Subject: Marisol Garcia.@frenchangel59.com] (b) 10/7/2017 9:27:27 (6) PM (b) (6) lper-@gma il.com; (b) (6) @yahoo.com;David Shulkin [secshulkin@gmail.com]; (b) (6) brucemcllll--mac.com; mb (b) (6) gmail.com; IP !l@frenchangel59 .com] (b) ( REMINDER--- VA(6) UPDATE- Conference Call for Sunday, October b 8th at 11:00 AM ) ( 6 ) Sunday, October 8th 11:00 AM - 11:45 AM EST Dia1-in Information: US: 1-866-244- (b) (6) lnternational: 719-457 (b) (6) (b) (6) Passcode: Participants: Laurie Perlmutter, Secretary David Shulkin, Tom Bowman, Dr. Bruce Moskowitz, Marc Sherman and Ike Thank you, Marisol Garcia (b) (6) (b) (6) (Office) (Cell) (b) ?@frenchangel59.com (6) AMERICAN PVERSIGHT VA-19-0799-H-000367 DS 00019671 Message From: IP -frenchangel59 ( (b) Sent: 9/26/2017 4:06:38 PM b (6) To: David ) Shulkin [secshulkin@gmail.com] RE:( 6 ) Subject: .com] Agree. The opening Bell is the best time. Thank you -----original Message----From: David shulkin [mailto:secshulkin@gmail .com] Sent: Tuesday, September 26, 2017 11:57 AM To: IP subject : Ike- the morning on wall street on nov 7th would work best Thanks sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000368 OS 00019672 Message From: Sent: To: David Shulkin [secshulk in@gma il.com] 9/26/2017 3:57: 18 PM Ike Perlmutter [-renchangel59.com] ( (b) Ike - the morning on wall Thanks (6) b ) ( street 6 ) on nov 7th would work best Sent f rom my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000369 OS 00019673 Message From: Sent: To: otmail.com] Poonam Alaigh (b) (b)(6)(6) 9/26/2017 8:51:40 AM David Shulkin [drshulkin@aol.com] Will we have no time together before I leave - I guess it's best that it ends this way Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000370 OS 00019674 Message -(b) (b) (6) hotmail.com) 9/26/2017 2:55:01 AM (6) From: Sent : David shulkin [Drshulkin@aol.com] Re: Trip Draft To : Subject: UghQ (b) (6) -M.D . On Sep 25, 2017, at I 0:53 PM, David shulkin wrote : Your in government now- of course not Sent from my iPhone On Sep 25, 2017 at 10:51 PM, _(b) (6) (b) (6) hotmail.com > wrote : Is there any free time to see areas? (b) (6) -M .D. On Sep 25.., 2017 at 10:47 PM. Davjd shulkjn wrote : Loo.ks really good Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) (b) (6) ail.com> Date: September 25, 2017 at3 :54:02PMEDT To: David Shulkin Subject: Trip Draft This is only a draft of the trip coming up in October overseas . The congressional reps staff shared with me over the phone , and l quickly jotted down the notes . I'll have to research the names tmrw be I'm sure 1 spelled it wrong . Fly 10/14 Saturday l 0/15 Sunday arrive in Brussels (2hours executive time upon arrival) Visit Flanders field in Belgium Evening dinner 10/ 16 Monday 3 hours of meetings with NATO an Belgium Lunch AMERICAN PVERSIGHT VA-19-0799-H-000371 DS 00019675 Depart for Henry Chapel Cemetery 2hours at cemetery Depart back to Brussels Travel from Brussels to Paris via train or mil air Arrive Paris evening 10/17 Tuesday 8am NATO meetings in French Mid morning depart for chateau Paris American monument 2hours east (stay 30 minutes) Depart for arisen-Mame American cemetery Depart for blue wood American cemetery Return to Paris evening Delegation dinner at pershising hall 10/18 Wednesday Visit Lafayette escadrall cemetery TBD follow up to meetings from TBD (antiTerrorism updates) TBD tour Paris 10/19 Thursday Travel To Normandy by Bus Omaha Beach Do an Audio tour (meals on bus) Depart carpitquite (air flight to Naples) 10/20 Friday Visit naval air station in Naples Breakfast with Troops (transitioning troops to VA services) Early afternoon flight back to DC Don't know any of the hotels right now, house liaison sent this rough sketch to state department for hotel recommendations. AMERICAN PVERSIGHT VA-19-0799-H-000372 OS 00019676 Message David shulkin [Drshulkin@aol.com] From: Sent : 9/26/2017 2:53 :21 AM - (b) (b) (6) ?--?hotmail.com] Re: Trip Draft (6) To: Subject: Y om in government now- of course not Sent from my iPhone On Sep 25, 20 17, at 10:51 PM. -(b) (6) (b) (6) hotmail.com > wrote : Is there any free time to see areas ? (b) (6) -M .D . On Sep 25, 2017, at 10:4 7 PM , David shulkin wrote : Looks really good Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) From: (b) (6) Date: September 25, 2017 at 3 :54:02 PM EDT To: David Shulkin Sub,iect: Trip Draft ail .com > This is only a draft of the trip coming up in October overseas . The congressional reps staff sha red with me over the phone , and I quickl y jotted down the notes . I'll have to research the names tmrw be I'm sure I spelled it wrong . Fly 10/14 Saturday 10/ 15 Sun day arrive j n B russeJ s (2hours executive time upon arriva l) Visit Flanders field in Belgium Evening dinner 10/ 16 Monday 3 hours of meetings with NATO an Belgium Lunch Depart for Henry Chapel Cemetery 2hours at cemetery Depart back to Brussels Travel fr om Brussels to Paris via train or mil air Arrive Paris evening 10/ 17 Tuesday 8am NATO meetings in French AMERICAN PVERSIGHT VA-19-0799-H-000373 DS 00019677 Mid morning depart for chateau Paris American monument 2hours east (stay 30 minutes) Depart for arisen-Mame American cemetery Depart for blue wood American cemetery Return to Paris evening Delegation dinner at pershising hall 10/18 Wednesday Visit Lafayette escadrall cemetery TBD follow up to meetings from TBD (anti Terrorism updates) TBD tour Paris 10/19 Thursday Travel To Normandy by Bus Omaha Beach Do an Audio tour (meals on bus) Depart carpitquite (air flight to Naples) 10/20 Friday Visit naval air station in Naples Breakfast with Troops (transitioning troops to VA services) Early afternoon flight back to DC Don't know any of the hotels right now, house liaison sent this rough sketch to state department for hotel recommendations. AMERICAN PVERSIGHT VA-19-0799-H-000374 OS 00019678 Message -(b) (b) (6) hotmail.com) 9/26/2017 2:51:58 AM (6) From: Sent : To: David shulkin [Drshulkin@aol.com] Re: Trip Draft Subject: Is there any free time to see areas? (b) (6) -M.D . On Sep 25, 2017, at 10:47 PM, David shulki n wrote : Looks really good Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) From: (b) (6) Date: September 25_, 2017 at 3:54 :02 PM EDT To: David Shulkin Subject: Trip Draft mail .com > This is only a draft of the trip coming up in October overseas . The congressional reps staff shared with me over the phone, and I quick]y jotted down the notes . I'll have to research the names tmrw be I'm sure I spelled it wrong. Fly l 0/14 Saturday 10/15 Sunday arrive in Brussels (2hours executive time upon arrival) Visit Flanders field in Belgium Evening dinner 10/16 Monday 3 hours of meetings with NATO an Belgium Lunch Depart for Henry Chapel Cemetery 2hours at cemetery Depart back to Brussels Travel from Brussels to Paris via train or mil Arrive P<;l!iSevening rur 10/17 Tuesday 8am NATO meetings in French Mjd morning depart for chateau Par is American monument 2hours east (stay 30 minutes) Depart for arisen-Marne American cemetery Depart for blue wood American cemetery Return to Paris evening Delegation dinner at pershising hall AMERICAN PVERSIGHT VA-19-0799-H-000375 DS 00019679 10/18 Wednesday Visit Lafayette escadrall cemetery TBD follow up to meetings from TBD (anti Terrorism updates) TBD tour Paris 10/19 Thursday Travel To Normandy by Bus Omaha Beach Do an Audio tour (meals on bus) Depart carpitquite (air flight to Naples) 10/20 Friday Visit naval air station in Naples Breakfast with Troops (transitioning troops to VA services) Early afternoon flight back to DC Don't know any of the hotels right now, house liaison sent this rough sketch to state department for hotel recommendations. AMERICAN PVERSIGHT VA-19-0799-H-000376 OS 00019680 Message David shulkin lDrshulkin@aol.com] From: 9/26/2017 2:47:16 AM Sent : - (b) (b) (6) ?--?hotmail.com] Fwd: Trip Draft (6) To: Subject: Looks really good Sent from my iPhone Begin forwarded message: (b) (6) (b) (6) From: (b) (6) Date: September 25, 20 I 7 at 3 :54: 02 PM EDT To: David Shulkin Subject: Trip Draft mail.com> This is only a draft of the trip coming up in October overseas . The congressional reps staff shared with me over the phone, and I quickly jotted down the notes. I'll have to research the names tmrw be. I'm sure l spelled it wrong . Fly 10/14 Saturday 10/15 Sunday anive in Brussels (2hours executive time upon arrival) Visit Flanders field in Belgium Evening dinner 10/16 Monday 3 hours of meetings witb NATO an Belgium Lunch Depart for Henry Chapel Cemetery 2hours at cemetery Depart back to Brussels Travel from Brussels to Paris via train or mil air Arrive Paris evening 10/17 Tuesday 8am NATO meetings in French Mid morning depart for cbateau Paris American monument 2hours east (stay 30 minutes) Depart for arisen-Marne American cemetery Depa1t for blue wood American cemetery Return to Paris evening Delegation dinner at pershising hall 10/18 Wednesday Visit Lafayette escadrall cemetery TBD follow up to meetings. from TBD (antiTerrorism updates) TBD tour Paris 10/19 Thursday Travel To Nom1andy by Bus AMERI .,, I PVERSIGHT VA-19-0799-H-000377 DS 00019681 Omaha Beach Do an Audio tour (meals on bus) Depart carpitquite (air flight to Naples) 10/20 Friday Visit naval air station in Naples Breakfast with Troops (transitioning troops to VA services) Early afternoon flight back to DC Don't know any of the hotels right now, house liaison sent this rough sketch to state department for hotel recommendations. AMERICAN PVERSIGHT VA-19-0799-H-000378 OS 00019682 Message From: (b) (6) (b) (6) Sent : To: 9/25/2017 7:54:41 PM David ShuIkin (drshulkin@aol.com);- (b) Subject: Re: Trip Draft (b) (6) gmail.com) (b) (6) ?--?hotmail.comj (6) Sony adding- (b) (6) to the draft . (b) (6) (b) (6) On Sep 25, 2017 3:54PM , 11(b) (6) amail.com > wrote: This is only a draft of the trip coming up in October overseas . The congressionaJ reps staff shared with me over the phone, and r quickly jotted down the notes . 1111 have to research the names tmrw be rm sure I spelled it wrong . Fly 10/ 14 Saturday 10/15 Sunday arrive in Brussels (2bours executive time upon arrival) Visit Flanders field in Belgium Evening dinner 10/16 Monday 3 hours of meetings with NATO an Belgium Lunch Depart for Henry Chapel Cemetery 2bo urs at cemetery Depart back to Brussels Travel from Brussels to Paris via train or mil air Arrive Paris evening 10/17 Tuesday 8am NATO meetings in Frnnch Mid morning depa1t for chateau Paris American monument 2hours east (stay 30 minutes) Depart for arisen-Marne American cemetel) ' Depa1i for blue wood American cemetery Return to Paris evening Delegation dinner at pershising hall 10/18 Wednesday Visit Lafayette escadraJI cemetery TBD follow up to meetings from TBD (antiTerrorism updates) TBD tour Paris 10/19 Thursday Travel To Normandy by Bus Omaha Beach Do an Audio tour (meals on bus) Depart carpitquite (air flight to Naples) 10/20 Friday Visit navaJ air station in Naples Breakfast with Troops (transitioning troops to VA services) AMERICAN PVERSIGHT VA-19-0799-H-000379 DS 00019683 Early afternoon flight back to DC Don't know any of the hotels right now, house liaison sent this rough sketch to state department for hotel recommendations. A\llERICAN PVERSIGHT VA-19-0799-H-000380 OS 00019684 Message From: (b) (6) Sent: 9/25/2017 7:54:02 PM To: David Shulkin [drshulkin@aol.com] Trip Draft Subject: (b) (6) (b) (6) gmail.com] This is only a draft of the trip coming up in October overseas. The congressional reps staff shared with me over the phone, and I quickly jotted down the notes. I'll have to research the names tmrw be I'm sure I spelled it wrong. Fly 10/14 Saturday 10/15 Sunday arrive in Brussels (2hours executive time upon arrival) Visit Flanders field in Belgium Evening dinner 10/16 Monday 3 hours of meetings with NATO an Belgium Lunch Depart for Henry Chapel Cemetery 2hours at cemetery Depart back to Brussels Travel from Brussels to Paris via train or mil air Arrive Paris evening 10/17 Tuesday 8am NATO meetings in French Mid morning depart for chateau Paris American monument 2hours east (stay 30 minutes) Depart for arisen-Mame American cemetery Depart for blue wood American cemetery Return to Paris evening Delegation dinner at pershising hall 10/18 Wednesday Visit Lafayette escadrall cemetery TBD follow up to meetings from TBD (anti Terrorism updates) TBD tour Paris 10/19 Thursday Travel To Normandy by Bus Omaha Beach Do an Audio tour (meals on bus) Depart carpitquite (air flight to Naples) 10/20 Friday Visit naval air station in Naples Breakfast with Troops (transitioning troops to VA services) Early afternoon flight back to DC AMERICAN PVERSIGHT VA-19-0799-H-000381 OS 00019685 Don't know any of the hotels right now, house liaison sent this rough sketch to state department for hotel recommendations. AMERICAN PVERSIGHT VA-19-0799-H-000382 OS 00019686 Message From: Sent: To: Subject: (b) (6) Bruce Moskowit z [brucem~mac (b) (6) 9/26/2017 12:50:01 PM DavidShulkin [secshulkin@gmail.com] Re:(b) (6) MD Ok shoot me her email and I will .com] arrange Sent from my iPad Bruce Moskowitz M.D. > On Sep 25, 2017 , at 11 : 01 PM, David Shulki n wrote: > > Thats great > > The other person who i spoke to today is dr kita franklin who heads the did suicide coming to VA to run our office- id like to put them together office and oct 1 is > > sent from my iPhone > (b) (6) (b) >> on Sep 25, 2017, at 10 :49 AM, Bruce Moskowitz wrote: >> (6) (b) (6) >> DR~is able to mobilize enough resources to assist the VA and the DODfor implanting actio icide and opioid dependence. I have spoken to her several times and arranged (b) (6) with (b) (6) further a call >> >> https :// www.pennmedicine.org / news/ news-releases / 2016/ march/ penn-medicine-announces-appoin >> >> >> sent from my iPad >> Bruce Moskowitz M. D. AMERICAN PVERSIGHT VA-19-0799-H-000383 OS 00019687 Message From: Sent: To: Subject: DavidShulkin [secshulkin@gmail.com] 9/26/2017 3:0 1:54 AM (b) (6) (b) mac . com] Bruce Moskowit z [brucemcll???? (b) (6) (6) Re : ??????IMD Thats great The other person who i spoke to today is dr kita franklin who heads the did suicide coming to VA to run our office- id like to put them together office and oct 1 is sent from my iPhone (b) (6) > on Sep 25, 2017 , at 10: 49 AM, Bruce Moskowitz wrote: (6) > DR. -(b) (6) is able to mobilize enough resources to assist the VA and the DODfor implanting further actionto"""r'e'duce s uicide and opioid dependence . I have spoken to her several times and arranged a call (b)(6)(6) with (b) > > > https :// www.pennmedicine . org / news/ news-releases / 2016/ march/ penn-medicine-announces-appoin > > > sent from my iPad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000384 OS 00019688 Message From: Sent: To: Subject: (b) (6) Bruce Moskowitz [brucem~mac (b) (6) 9/25/2017 2:49:42 PM DavidShulkin [secshulkin@gmail.com] (b) (6) .com] MD DR. -(b) (6) is able to mobilize enough resources to assist the VA and the DODfor implanting further action to reduce suicide and opioid dependence. I have spoken to her several times and arranged a call (b) (6) with (b) (6) https://www.pennmedicine.org/news/news-releases/2016/march/penn-medicine-announces-appoin sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000385 OS 00019689 Message From: (b) (6) Sent : 9/25/2017 4:34 :47 PM drsh ulkin@aol.com Read this picture To : Subject: (b) (6) (b) (6) gmail.com] 202-602~1.705 Reporter September 15, 2017 Good morning. Thi os a request for copies of and the opportunity to inspect records under the Freedomof Information Act (''FOlA'1, 5 U.S.C.? 552 and the Privacy Act 5 U.S.C.? 552a.This request should b con ldered under both statutes to maxlmlze the release of records. RECORDSSOUGHT l) All electronic me age sent to or from the email addr s dr hulkmwaoJ.com In addition, pl as limit oour search to F hru11ry! 3, 2017 through rhe date 1hL search -~ condu.cted. EXPEDITED PROCESSING llndcr 5 .S.C.? SS2(aJ(6)(E), a reque t I to be given expedited request 1equ1; r t. monstra\t'S J" p1 oce ingwhf'n the ompelling need." I am se oking e"pedited treatment for th1 -.- We can't trust these people. Will have to talk to you tomorrow about the other emails too . No one is sitting the information , they are just forwarding and this is why we get stuff like this. AMERICAN PVERSIGHT VA-19-0799-H-000386 OS 00019690 Message Davidshulkin [Drshulkin@aol.com] From: Sent: 9/25/2017 11:22: 17 AM To: (b) (6) Subject: Re: Call at 3:30 today (b) (6) (b) (6) gmail.com] Ok Sent from my iPhone > On Sep 25, 2017, at 6:28 AM, (b) (6) > > call with Keita Fran klin is at 3: 30, will (b) (6) (b) (6) gmail .com> wrote: send to your phone and email ( calendar ) z > > sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000387 OS 00019691 Message From: (b) (6) Sent: 9/25/2017 10:28:40 AM To: David Shulkin [drshulkin@aol.com] Call at 3:30 today Subject: (b) (6) (b) (6) gmail.com] Call with Keita Franklin is at 3 :30, will send to your phone and email (calendar)z Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000388 OS 00019692 Message From: SreyRam Kuy (b) (6) @gmail.com] Sent : 9/25/2017 2:04 :13 PM To: David shulkin [drshulkin@aol.com]; vacodjsl@va.gov Re: Subject: Secretary Shulkin Thank you so much for all you do every day to build a VA system that tru1y serves our nation's heroes . It's an honor to serve under a inspiring leader like you. Thank you . As you consider candidates for pe1manent appointment as your VA Under Secretary for Health, I'd like to respectfully say that I am passionate about serving our nation's heroes , deeply committed to supporting your mission and goals of making the VA the leading standard in healthcare, have more than 1S years of experience in the VA from ground up, and have experience in running complex, large health care systems . I'm nonpartisan , and garnered support & praise form y work from two former presidents from both sides of tbe aisle, and received bipartisan suppo1tfrom leadership at their respective institute and foundations , who would be willing to speak on my behalf. I hope you'll consider me among the many names you 1re reviewing . I'm going to be in DC Monday and Tuesday Oct 2-3 next week, for an award received from the Points of Lights Foundation, and will be donating the $10,000 prize to veteran service organizations . I would love any opportunity to have a few minutes to say hello and catch up at your convenience , if at all possible , Regardless , I wanted to say thank you so much for all you do for our veterans . You truly inspire me. -SteyRam (b) (6) (b) (6) SreyRamKuy , MD, MHS, FACS Associate Chief of Staff Michael E DeBakey Houston VA On Aug 31, 2017, at 6:07 AM, DJS wrote : Thanks so much It may be a good time My team will be in touch soon Thanks again Sent with Good (www.good .com ) AMERICAN PVERSIGHT VA-19-0799-H-000389 DS 00019693 -----Original Message----From: SreyRam Ku y ~(b) (6) Sent: Wedne sday, August 30, 20 17 11 :25 PM Eastern Standard Time To: Da vid shulkin ; DJS Subject: [EXTERNAL] Re : Secretary Shulkin, Thank you so much for all your support and concern for Ule Houston vclcralls and VA stafTgoing U,rough Harvey, H means a great deal, Thank yotL And Umnks for so graciously lwecting out my blog post about the heroic efforts of the Houston VA fronOioe staff. Your support means so much, It's ai1 honor to care for our veterailS, and a privilege to serve under yotL I did want to say that jf an oppmtunity opens up to serve o w. vete rans on a national level, pleas e do keep me in mind . My sentime nts still hold lnte and are still the same . Whether in a fom1al rol e or as ru1advisor or some 0U1er -per iences llild Lrai1lill g to help , when the right role opeus up at Uie capacity, l would lo ve ilie opportunit y to use my e11. right time. Again , thank you for all you do for our na tion's heroes! You are a!linspiration to us all Respectfully, SreyRam RWJ CSP Class of 2009 SreyRam Kuy, MD, MRS. F ACS Associate Chief of Staff Michael E DcBakey Houston VA > On Ju.I30, 20 17, at 2:45 PM. Da vid shulk in wrote : > > Thanks for your note - it was much appreciated > > Tlove your attitude and pcrsistru1ce > > Tam looking for tJ1erighl way you can help > > Sent from my iPhone AMERICAr-... pVERSIGHT VA-19-0799-H-000390 DS 00019694 Message (b) (6) SreyRamKuy [-@gmail .com] 8/31/2017 3:25:22 AM Davidshulkin [Drshulkin@aol.com]; vacodjsl@va.gov Re: From: Sent: To: Subject: Secretary Shulkin, Thank you so much for all your support and concern for the Houston veterans and VA staff going through Harvey. It means a great deal. Thank you. And thanks for so graciously tweeting out my blog post about the heroic efforts of the Houston VA frontline staff. Your support means so much. It's an honor to care for our veterans, and a privilege to serve under you. I did want keep me in an advisor help, when to say that if an opportunity opens up to serve our veterans on a national level , please do mind . My sentiments still hold true and are still the same. Whether in a formal role or as or some other capacit y, I would love the opportunity to use my experiences and training to the right role opens up at the right time . Again , thank you for all Respectfully, Srey Ram RWJ CSP class you do for our nation ' s heroes! You are an inspiration to us all . of 2009 SreyRam Kuy, MD, MHS, FACS Associate chief of Staff Michael E DeBakey Houston VA > on Jul 30 , 201 7 , at 2 :4 5 PM, David shulkin wrote: > > Thanks for your note - it was much appreciated > > I love your attitude > and persistance > I am loo king for the right way you can help > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000391 OS 00019695 Message From: Sent: To: Davidshulkin [Drshulkin@aol.com] 7/30/2017 7:45:46 PM SreyRam Kuy I(b) (6) :@gma ii.com] Thanks for your note - it was much appreciated I love your attitude I am looking and persistance for the right way you can help Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000392 OS 00019696 Message From: DavidShulkin [secshulkin@gmail.com] Sent: To: 9/25/2017 1:02: 15 PM (b) (6) (b) mac . com] Bruce Moskowit z [brucemcll???? Subject: Re: Kushner email (6) Ok that would help for sure Sent from my iPhone (b) (6) > on Sep 25, 2017, at 7:46 AM, Bruce Moskowitz wrote: (b) > (6) > The metrics that either Mayo, cc , or Kaiser use to asses their affiliated hospitals should suffice. > > sent from my iPad > Bruce Moskowitz M.D. > >> on Sep 25, 2017 , at 7 :44 AM, David shulkin wrote : >> >> Bruce- how would we be able to get private sector comparisons ? >> >> sent from my iPhone >> (b) (6) (b) >>> on Sep 25 , 2017, at 6 : 52 AM, Bruce Moskowitz wrote : >>> (6) >>> The only format that I believe will accurately provide information to asses the individual VA Hospitals is a team that I originally proposed: >>> Emergency room physician >>> vascular surgeon >>> ICU specialist >>> cardiologist >>> Infectious disease Specialist >>> Nursing supervisor >>> Hospital Administrator >>> All should have the criteria that they have served on the executive committee of a hospital and participated in the inspection process. >>> The evaluations should be random and unannounced >>> >>> >>> sent from my iPad >>> Bruce Moskowitz M. D. AMERICAN PVERSIGHT VA-19-0799-H-000393 OS 00019697 Message Bruce Moskowit z [brucem mac.com] (b) 9/25/2017 11:46:22 AM (6) DavidShulkin [secshulkin@gmail.com] Re: Kushner email From: Sent: To: Subject: The metrics that either (b) (6) Mayo, cc, or Kaiser use to asses their affiliated hospitals should suffice. Sent from my iPad Bruce Moskowitz M.D. > on Sep 25, 2017, at 7: 44 AM, David shulkin wrote: > > Bruce - how would we be able to get private sector comparisons ? > > sent from my iPhone > (b) (6) (b) >> on Sep 25, 2017, at 6 : 52 AM, Bruce Moskowitz wrote: >> (6) >> The onl y format that I believe will accurately provide information to asses the individual VA Hospitals is a team that I originally proposed: >> Emergency room physician >> vascular surgeon >> ICU specialist >> cardiologist >> Infectious disease Specialist >> Nursing supervisor >> Hospital Administrator >> All should have the criteria that they have served on the executive committee of a hospital and participated in the inspection process. >> The evaluations should be random and unannounced >> >> >> sent from my iPad >> Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000394 OS 00019698 Message From: DavidShulkin [secshulkin@gmail.com] Sent: To: 9/25/2017 11 :44 :25 AM (b) (6) (b) mac . com] Bruce Moskowitz [brucemcll???? Subject: Re: Kushner email Bruce- (6) how would we be able to get private sector comparisons? Sent from my iPhone (b) (6) > on Sep 25, 2017, at 6:52 AM, Bruce Moskowitz wrote: (b) > (6) > The only format that I believe will accuratel y provide information to asses the individual VA Hospitals is a team that I originally proposed: > Emergency room physician > vascular surgeon > ICU specialist > cardiologist > Infectious disease Specialist > Nursing supervisor > Hospital Administrator > All should have the criteria that they have served on the executive committee of a hospital and participated in the inspection process. > The evaluations should be random and unannounced > > > sent from my iPad > Bruce Moskowitz M. D. AMERICAN PVERSIGHT VA-19-0799-H-000395 OS 00019699 Message (b) (6) Bruce Moskowitz [brucem~mac .com] (b) (6) Sent: 9/25/2017 10:52:38 AM To: DavidShulkin [secshulkin@gmail.com] (b) (6) CC: ( (b) (b) (6) L Perl [-gmail.com]; mb-gma il.com IP [-renchangel59.com]; b (6) Kushner email Subject: ) ( 6 The only format ) that I believe will accurately provide information to asses the individual VA Hospitals is a team that I originally proposed: Emergency room physician Vascular surgeon ICU specialist cardiologist Infectious disease Specialist Nursing supervisor Hospital Administrator All should have the criteria that they have served on the executive committee of a hospital and participated in the inspection process. The evaluations should be random and unannounced From: sent from my iPad Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000396 OS 00019700 Message DavidShulkin [secshulkin@gmail.com] Sent: 9/23/2017 1:27:17 AM ( (b) To: Ike Perlmutter [-renchangel59.com] b (6) ) ( Ike - i saw you called earlier - i was tied up 6 All day - Im up till 11 am and then around from 8-10 am in the morning ) Melania and I are traveling to Canada tomorrow at 10 am and then im around all From: Sunday shanah Tova sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000397 OS 00019701 Message From: (b) (6) Sent : 9/21/20176:01 :47 PM David Shu Ikin (drshulkin@aol.com] Re: prostate canrnr To : Subject: (b) (6) (b) (6) gma ll.com] Yes, Ed sent you the analysis from what I gave him . You speak twice . It is better to speak from slides for the retreat and use cards for the reception On Sep 2 1, 2017 1:47 PM, 11David Shulkin" wrote : -(b) (6) I think I had sent you some earlier thoughts on the prostate cancer foundation talk (20 minutes) such as we need to talk about how many patients we have with prostate cancer in the VA, etc. -1 also think we need to talk about the work that PCF plans to do with us and having the speechwriters reach out again to Dr. Jonathon Simmons if they need to---- would be fine But here are some additional slides with content that they may want to incorporate. I don't know whether we think its best to use slides or not - either way this might be helpful. AMERICAN PVERSIGHT VA-19-0799-H-000398 DS 00019702 Message From: Sent: To: Subject: Attachments: David Shulkin [drshulkin@aol.com] 9/21/2017 5:47:55 PM (b) (6) gmail.com (b) (6) prostate cancer prostatecancer.pptx (b) (6) I think I had sent you some earlier thoughts on the prostate cancer foundation talk (20 minutes) such as we need to talk about how many patients we have with prostate cancer in the VA, etc. - I also think we need to talk about the work that PCF plans to do with us and having the speechwriters reach out again to Dr. Jonathon Simmons if they need to----- would be fine But here are some additional slides with content that they may want to incorporate . I don't know whether we think its best to use slides or not - either way this might be helpful. AMERICAN PVERSIGHT VA-19-0799-H-000399 OS 00019703 VA Prostate Cancer LLS. Utrpz'lrtm?nl Affairs The VA National Precision Oncology Program o Tumor tissue is molecularly profiled using standard panel o Cancer treatment guided by results of the profile o Molecular Oncology Consultation- 80 Genetic Counselors work with VA Clinicians to Determine Treatments o New drugs made available through research partnerships o NCINA partnership supports 5 research fellows at 6 sites , expanding to 12 ' \IA / 11:fVI"\ "'A ' i .. V, -:\ ~. )' 1 I~'" [>, II I II HII I "' \, 1, 1 111o l 111.i,rs Extensive research, planning and development has occurred to clarify and prioritize VHA audience needs , key messages , and other strategic communications considerations . The Segmented Audience Study & Analysis, which I will explain further on the next slide, together with two Veteran focus groups, has provided the foundatio n for strategic VHA Communications planning and the development of two separate communications plans (and supp lemental materials) . The VHA Integrated Strategic Communications Plan provides a path to build a comprehensive infrastructure and functional capacity to execute the VHA Communications program . The VHA Brand Identity & Style Guide will provide the framework for all communications mater ials to be produced under the VHA brand. The VHA Health & Healing Communications Plan was developed as a sub-strategy of the overarching communications plan, and seeks to deliver messages that encourage Veterans to be actively engaged in their own health, healing and health care. The plan places particular emphasis on messages regarding healthy living, disease prevention , and chronic disease management. This effort aims to reach Veterans at every stage of health and promote healthy behavioral choices . A Health & Healing Brand Identity & Style Guide is currently in development. AMERICAN PVERSIGHT VA-19-0799-H-000401 D8_00019705 Million Veteran Program: A Partnership with Veterans AMERICAN PVERSIGHT VA-19-0799-H-000402 DS_00019706 MVP and PMI Summary Objectives: MVP participation available to all Veterans and DoD Survey Responses Veterans MVP I' DoD o o o o o State-of-the-art computational environment Participants Genomic Data Medical Records Data access leading to scientific discoveries and publications +-+ +-+ +-+ +-+ +-+ +-+ +-+ +-+ +-+ +-+ +-+ +-+ VA Investigators Non-VA Investigators Current enrollment 470,000 Veterans (500 ,000 by Summer) Enroll at least 1 Million by 2020 Expand secure computational capacity to serve >1000 simultaneous VA and non-VA researchers by 2020 Safe/secure, CLIA-compliant biorepository with back-up Establish mechanisms to return results responsibly to : Providers, EHR and Participants AMERICAN PVERSIGHT VA-19-0799-H-000403 OS 00019707 IBM Watson Health -- ----_ ... ----------=--==:-- AMERICAN PVERSIGHT '- (R) VA-19-0799-H-000404 OS 00019708 The VA National Precision Oncology Program o Tumor tissue is molecularly profiled using standard panel o Cancer treatment guided by results of the profile o Molecular Oncology Consultation- 80 Genetic Counselors work with VA Clinicians to Determine Treatments o New drugs made available through research partnerships o NCINA partnership supports 5 research fellows at 6 sites , expanding to 12 ' \IA / 11:fVI"\ "'A ' i .. V, -:\ ~. )' 1 I~'" [>, II IIIHIII "' \, 1, 1 111o ll 111.i,rs Extensive research, planning and development has occurred to clarify and prioritize VHA audience needs , key messages , and other strategic communications considerations . The Segmented Audience Study & Analysis, which I will explain further on the next slide, together with two Veteran focus groups, has provided the foundatio n for strategic VHA Communications planning and the development of two separate communications plans (and supp lemental materials) . The VHA Integrated Strategic Communications Plan provides a path to build a comprehensive infrastructure and functional capacity to execute the VHA Communications program . The VHA Brand Identity & Style Guide will provide the framework for all communications mater ials to be produced under the VHA brand. The VHA Health & Healing Communications Plan was developed as a sub-strategy of the overarching communications plan, and seeks to deliver messages that encourage Veterans to be actively engaged in their own health, healing and health care. The plan places particular emphasis on messages regarding healthy living, disease prevention , and chronic disease management. This effort aims to reach Veterans at every stage of health and promote healthy behavioral choices . A Health & Healing Brand Identity & Style Guide is currently in development. AMERICAN PVERSIGHT VA-19-0799-H-000405 DS 00019709 Precision Medicine Initiative: NIH/DOD NIH o Collaboration with the NIH to enroll Veterans in the PMI Cohort Program (PMI-CP) o Draft interagency agreement (IAA) and proposal submitted to NIH on March 15, 20 16 o Goal to have signed IAA by end of June DOD o Development of IAA with DoD underway under the President 's PMI : - Collaboration with DoD to enroll active duty members from Millenn ium Coho rt Study into MVP beginning in FY16 o Await ing sign-off at DoD AMERICAN PVERSIGHT VA-19-0799-H-000406 DS 00019710 Partnership with DOE: MVP-CHAMPION o Leverage DOE's computing capabilities and VA's genomic expertise to unlock to develop better ways to prevent , detect , treat , and cure disease o VA and DOE sign Inter-agency Agreement (IAA) to establ ish governance throughout the 5 year relationship o Pilot launch June 1, 2017 o Joint Program Named MVP Champion o Requires $3.5 Million OIT Funding FY16 to Launch o Requires sustainment funding annually over lifetime AMERICAN PVERSIGHT VA-19-0799-H-000407 OS 00019711 VA Collaborations NCI and FDA NCI Met with NCI SPORE (Specialized Programs of Research Excellence) to improve predictive models for progression of prostate cancer VA-DOE collaboration would work With NCI to take advantage of big data from VA EMR and genomics Goal: Develop improved risk model and prediction algorithm for cancer screening and predictions of progression of prostate cancer FDA FDA "INFORMED " initiative launched in 2015 in Office of Hematology and Oncology Products - Standardize clinical trial data to support research and regu latory science Integrate EHR data to reflect real world experience with approved drugs VHA and DOD medical and administrative records are highly valuable sources of evidence reflecting patient outcomes in the real world Initial FDA-VA discussion on pilot project in lung cancer or hematological malignancy AMERICAN PVERSIGHT VA-19-0799-H-000408 DS 00019712 Message Poonam Alaigh (b) otmail.com] (b)(6)(6) 9/25/2017 7:32 :35 AM David Shu Ikin [drshulkin@aol.com] Re: [EXTERNAL]Re: [Non-DoD Source] AMSUS Quarterly Policy and Strategy Forums Drscussion Frotn: Sent : To : Subject: l always said I could deal with anything as long as I had you to support me- but I didn't have you and hence the consequence Sent from my iPhone On Sep 24, 2017, at 10:47 PM, David Shullcin wrote : You've made a lasting impact and have your well deserved reputation Look at tom price now Sent from my iPad (b) (6) On Sep 24, 2017, at 6:01 PM, Poonam Alaigh - (b) (6) wrote : You are not al one- a growing club that has already written me off and for whom I have already rusappeared Sent from my iPad On Sep 24, 20 17, at 5:57 PM, Alaigh, Poonam, 1vI.D. wrote : Sent with Good (www .good .com ) -----Ori gi naJ Message----From: (b) (6) Sent: Sunday, September 24, 2017 05:51 PM Eastern Standard Time To: 'Bono , Raquel CV ADM USN DHA (US)' ; (b) (6) Cc: 'Smith . David J SES OSD OUSD P-R (US)'; Alaigh , Poonam, M.D .; 1Ediger , Mark A Lt G~n USAF AF-SG (US)' ; 'West , Nadja Y LTG USARMY HQDA OTSG (US) \ Lapuz, Miguel H.; 'Thomas, Richard W (Tom) SES (US)' ; (b) (6) 'Faison , C Forrest (Forrest) V ADM USN BUMED FCH VA (US)' ; 'Chinn, Colin G RADM USN JS OCJCS (US)' ; 'Adams, Jerome M (b) (6) VADM USPHS (US)' ; Clancy, Carolyn Subject: RE : [EXTERNAL] Re : [Non-DoD Source) AMSUS Quarter! y Policy and Strategy F onrms Discussion Adding Dr Carolyn Clancy , VB.A acting USH to this string ! Thanks,_(b) (6) AMERICAN PVERSIGHT VA-19-0799-H-000409 DS 00019713 Sent with Good (www.good.com ) --..:Original Message----From: Bono, Raquel C VADMUSNDHA(US) (b) (6) mail.mil] Sent: Sunday, September 24, 20 17 05:27 PM Eastern Standard Time To: (b) (6) Cc: Smith, David J SES OSD OUSD P-R (US) : Alaigh , Poonam , M.D.; (b) (6) Ediger, Mark A Lt Gen USAF AF-SG (US) ; West, Nadja Y LTG USARMY HQDA OTSG (US) ; Lapuz > Miguel H. ; Thomas , Richard W (Tom) SES (US); Sylvia TrentAdams; Faison , C Fon-est (Forrest) VADM USN BUMED FCH VA (US) ~Chinn , Colin G RADM USN JS OCJCS (US) ; Adams, Jerome M V ADM USPHS (US); -(b) (6) Subj.ect: [EXTERNAL] Re: [Non-DoD Source] AMSUS Quarterl y Policy and Strategy Forums Discussion Mike , Thank you for making these quarterly fora avaiJable. The topics and attendees have created some dynamic conversations . Ifyou are looking for topics that have direct medical/health care relevance, I wouJd suggest looking at the current state ofvaluebased care and value-based purchasing . There are evolving effort s in both CMS and private health plans towards value-based care in the that are yielding a range of practices (capitation, bundling , IPUs, waste management, etc) with similar ranges of savings and efficiencies. Some of these are taking significant hold (BCBS Massachusetts, to name one) and will likely influence our contracting for care and delivery of care in our MTFs . A broader topic, but one that will have definite impact on the MRS jg how DoD is being pressurized in other ways - e.g. SecDefs Reform and Rebuild initiatives (that include health care); or the reorganization ofDCMO and the refonn efforts they will undertake , to include health care management. Finally, the recent DHITS and MHSRS symposia were well attended and provided a venue for exploring potential solution set s for emerging or anticipated challenges - i.e. interoperability of our medical devices , prolonged field care in austere environments . There may be some interest in bringing some of those topics for discussion with the EAB as they may have insight and influence on the solutions sets we pursue Thanks for asking. AMERICAr-... pVERSIGHT VA-19-0799-H-000410 D8_00019714 Best , Rocky VADM Raquel Cruz Bono, IvID, MBA, F ACS Director , Defense Health Agency ol (b) (6) On Sep 22, 2017, at 2:52 PM , (b) (6) (b) (6) (b) (6) amsus .or 0 > wrote: All active links contained in this email were disab led. Please verify the identity of the sender , and confirm the authenticity of all links contained within the message prior to copying and pasting the address to a Web browser. Greetings Members of the EAC, In advance of our meet ing on 2 October , I am seeking your advice and good counsel as we strive to ever increase the value of AMSUS. We have added to the meeting agenda an item discuss ing our new AMSUS Quarterly Policy and strategy Forums and how best to ask the EAC to inform the content of those sessions . Background: The Policy and Strategy Forums began last February 1 guided by a group of leaders from the private sector called the AMSUS Executive Advisory Board (EAB)* They successfully guided us through 3 Forums: overviews of the MHS and VHA respectively followed by a deep dive into the issue of "Zero Preventab le Deaths ," and the concepts of military-civilian cooperation in trauma systems . Speakers have included VADM Bono , USDVHA (Acting) Dr, Poonam Alaigh , and Mr. Guy Kiyokawa , among other senior leaders and subject matter experts . The Proceed ings are published in Military Medicine and will also be published further in our new AMSUS Magaz ine,Health21 . AMERICAN PVERSIGHT VA-19-0799-H-000411 OS 00019715 We are pleased with the results of these Forums to date, but not content. The input of the EAC for future topics and focus of future events would increase the value to everyone. Request: Please give consideration to how the EAC can best provide input and advice to AMSUS for these events in preparation for a brief discussion at the upcoming EAC meeting . The simplest solution would be joint EAB/EAC a planning session but government ethical rules make that problematic. Bottom line: AMSUS is a pretty good XX:st Century AMSUS but times have changed and to be a good XX:lst Century AMSUS , we need to continually seek to add additional value . Our Quarterly Forums, bringing publ ic and private sector decision makers together for discuss ions on the important issues of the day have proven to serve a valuable purpose. With your assistance , we will only do a better job of it in the future. Thank you as always for your continued encouragement and support. I would welco me any opportunity to discuss or answer any questions prior to the meeting. I am availab le at your convenience. *The EAB is currently comprised of designated senior executives and experts from: Humana , HealthNet , TriWest, United Healthcare/Optum, UCB, Gerner, Northrop Grumman IT, Cognosante, ByLight, TLIF, LMI and Henry Jackson Foundation. (b) (6) (b) (6) MD, VADM USN (Ret) AMSUS Executive Director AMERICAr-... pVERSIGHT VA-19-0799-H-000412 DS 00019716 (b) (6) Office : (b) (6) (b) (6) (b) (6) AMERICAr-... pVERSIGHT ( b ) ( 6 ) (b) (6) VA-19-0799-H-000413 D8_00019717 Message Poonam Alaigh (b) otmail.com] (b)(6)(6) 9/25/2017 7:31:04 AM David Shu Ikin (drshulkin@aol.com] Re: [EXTERNAL]Re: [Non-DoD Source] AMSUS Quarterly Policy and Strategy Forums Drscussion Frotn: Sent: To: Subject: Tom price did something- I didn't Sent from my iPhone On Sep 24, 2017 , at 10:47 PM , David Shulkin wrote : You've made a lastjng impact and have your weU deserved reputation Look at tom price now Sent from my iPad - (b)(6)(6) On Sep 24, 2017, at 6 :01 PM, Poonam Alaigh (b) > wrote : You are not alone- a growing club that has already written me off and for whom I have already disappeared Sent from my iPad On Sep 24, 2017 , at 5: 57 PM, Alaigh, Poonam , NI.D. wrote: Sent with Good (www.good .com ) -----Origina l Message----From: (b) (6) Sent: Sunday, September 24 , 2017 05 :51 PM Eastern Standard Time To: 1B0110 , Raquel C V ADM USN DHA (US)' ; (b) (6) Cc: 'Smith, David J SES OSD OUSD P-R (US)' ; Alaigh, Poona~ M.D .; 'Ediger, Mark A Lt Gen USAF AF-SG (US)1; 'West, Nadja Y LTG USARMY HQDA OTSG (US)'; Lapuz, Miguel H. . 'Thomas , Richard W (Tom) SES (US)' ; (b) (6) 'Faison , C Forrest (Fo1Test) VADM USN BUMED FCH VA (US)' , 'Chinn , Colin G RADM USN JS OCJCS (US)' ; 'Adams, Jerome M (b) (6) VADM USPHS (US)'; Clancy, Carolyn Subject: RE : [EXTERNAL] Re: [Non-Do D Source] AMSUS Quarterly Policy and Strategy Forums Discussion Adding Dr Carolyn Clancy , VHA acting USH to this st1ing! Thanks,_(b) (6) AMERICAN PVERSIGHT VA-19-0799-H-000414 DS_00019718 Sent with Good (www.good.com ) -----Original Message---From: Bono , Raquel C VADMUSNDHA (US) (b) (6) mail.mil Sent: Sunday, September 24 , 2017 05:27 PM Eas tern Standard Time To: (b) (6) Cc: Smith, David J SES OSD OUSD P-R (US); Alaigb , Poonam , M.D .; (b) (6) Ediger, Mark A Lt Gen USAF AF-SG (US); West, Nadja Y LTG USARMY HQDA OTSG (US ); La pu z, Miguel H.~Thomas , Richard W (Tom) SES (US); Sylvia TrentAdarns ; Faiso n, C Forrest (Forrest) V ADM USN BUMED FC H VA (US); Chinn, Col in G RADM USN JS OCJ CS (US) ; Adams, Jerome M V ADM USPHS (USt -(b) (6) Subject: [EXTERNAL] Re : [Non- DoD Source] AMSUS Quarterly Policy and Strategy Forums Djscussion Mike, Thank you for making these quarterl y fora available. The topics and attendees have created some dynamic conviersations. If yo u are looking for topics that have direct medical/health care relevanc e, I wou ld suggest loo king at the current state of valuebased care and value-based purchasing . There are evolving efforts in both CM S and pri va te health plans towa rd s value-based care in the that are yielding a range of practice s (capitation, bundlin g, fPUs, waste mana ge ment , etc) with similar range s of savings and efficiencies. Some of these are taking signifi ca nt hold (BCBS Massachusetts , to name one) and will likely influen ce ollt contracting for care and delivery of care in our MTFs . A bro ade r topic . but one that will ha ve definite imp act on the MHS is how DoD is being pres surized in other ways - e.g . SecDef s Refonn and Rebuild initiativ es (that include health care) ; or the reorganization of DCMO and the refom1 efforts they will undertal wrote : All active links conta ined in this email were clisabled.Please verify the identity of the sender , and confim1 the authenticity of all links contained within the message prior to copying and pasting the address to a Web browser . Greetings Members of the EAC, In advance of our meeting on 2 Octobe r, I am seeking your advice and good counsel as we strive to ever increase the value of AMSUS. We have added to the meeting agenda an item discuss ing our new AMSUS Quarterly Policy and strategy Forums and how best to ask the EAC to inform the content of those sessions . Background: The Policy and Strategy Forums began last February , guided by a group of leaders from the private sector called the AMSUS Executive Advisory Board (EAB)* They success fully guided us through 3 Forums : overviews of the MHS and VHA respect ively followed by a deep dive into the issue of "Zero Preventab le Deaths ," and the concepts of military-civilian coope ration in trauma systems . Speakers have included VADM Bono , USDVHA (Acting) Dr. Poonam Alaigh , and Mr. Guy Kiyokawa , among other senior leaders and subject matter experts. The Proceed ings are published in Military Medicine and will also be published furthe r in our new AMSUS Magaz ine,Hea/th21 " We are pleased with the results of these Forums to date , but riot content. The input of the EAC for future topics and focus of future events would increase the value to everyone . AMERICAN PVERSIGHT VA-19-0799-H-000416 OS 00019720 Request: Please give consideration to how the EAC can best provide input and advice to AMSUS for these events ln preparation for a brief discussion at the upcoming EAC meeting . The simplest solution would be joint EAB/EAC a planning session but government ethical rules make that problematic. Bottom line: AMSUS is a pretty good XXst Century AMSUS but times have changed and to be a good XXlst Century AMSUS , we need to continually seek to add additional value . Our Quarterly Forums, bringing public and private sector decision makers together for discussions on the important issues of the day have proven to serve a valuable purpose . With your assistance , we will only do a better job of it in the future. Thank you as always for your continued encouragement and support. I would welcome any opportunity to discuss or answer any questions prior to the meeting. I am available at your convenience . *The EAB is currently comprised of designated senior executives and experts from: Humana , HealthNet , TriWest, United Healthcare/Optum , UCB, Gerner, Northrop Grumman IT, Cognosante , ByLight. TLIF, LMI and Henry Jackson Foundation. (b) (6) (b) (6) MD, V ADM USN (Ret) AMSUS Executive Director (b) (6) AMERICAr-... pVERSIGHT VA-19-0799-H-000417 DS 00019721 Office : (b) (6) I Cell: (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) AMERICAr-... pVERSIGHT VA-19-0799-H-000418 D8_00019722 Message David Shulkin [drshulk i'n@aol.com) 9/2S/2017 2:47:S3 AM (b) (6) Poonam Alaigh --~otmail.com] (b) (6) Re: [EXTERNAL]Re: [Non-DoD Source] AMSUS Quarterly Policy and Strategy Forums Drscussion From: Sent : To: Subject: You 1ve made a lasting impact and have your well deserved reputation Look at tom price now Sent from my iPad (b) (6) On Sep 24, 2017, at 6 :01 PM, Poonam Alaigh - (b) (6) wrote : You are not alone- a growing club that has already written me off and for whom I have already disappeared Sent from my iPad On Sep 24 , 2017, at 5:57 PM, Alaigh , Poonarn, M.D .< Poonam .A1aigh@va .gov > wrote : Sent witl1 Good (www .good .com ) ----Original Message----From: (b) (6) Sent: Sunday , September 24, 2017 05:51 PM Eastern Standard Time To: 'Bono, Raquel C V ADM USN DHA (US)' ; (b) (6) Cc: 'Smith, David J SES OSD OUSD P-R (US)' ; AJaigb, Poonam , M .D .; 'Ediger , Mark A Lt Gen USAF AF-SG (US) 1; 'West , Naclja Y LTG USARMY HQDA OTSG (US)'; Lapuz , Miguel H.; 'Thomas , Richard W (Tom) SES (US)' ; -(b) (6) 'Faison , C Forrest (Forrest) V ADM USN BUMED FCH VA (US)' ; 'Chinn, Colin G RADM USN JS OCJCS (US)'; 'Adams, Jerome M V ADM (b) (6) USPHS (US)1; Clancy , Carolyn Subject: RE : [EXTERNAL] Re : [Non-DoD Source] AMSUS Quarterly Policy and Strategy Forums Discussion Adding Dr Carolyn Clancy , VHA acting USH to this. string! Thanks,_(b) (6) Sent with Good (www .good.com ) ~-~-Original Message----From: Bono , Raque] CV ADM USN DHA (US) (b) (6) mail.mil ] Sent: Sunday , September 24 , 2017 05 :27 PM Eastern Standard Time To: (b) (6) Cc: Smith , David J SES OSD OUSD P-R (US); Alaigh , Poonam , M.D .~ AMERICAN PVERSIGHT VA-19-0799-H-000419 DS 00019723 (b) (6) Ediger; Mark A Lt Gen USAF AF-SG (US) ; West, Nadja Y LTG US ARMY HQDA OTSG (US}; Lapuz, Miguel 8.; Thomas, Richard W (Tom) SES (US); (b) (6) Faison, C Forrest (Forrest) VADM US BUNIED FCH VA (US) : Chinn , Colin G RADM US JS OCJCS (US); Adams , JeromeNIVADM U.SPHS(US);-(b) (6) Subject: [EXTERNAL] Re ; [Non-DoD Source] AMSUS Quarterly Policy and Strategy Forums Discussion Mike, Thankyou for making these quarterly fora available . The topics and attendees have created some dynamic conversations . If you are look ing for top ics that have direct medical/health care relevance , Lwould suggest looking at the current state of value-based care and value-based purchasing . There are evolving efforts in both CMS and private health plans towards val ue-based care in the that are yie lding a range.of practices (cap itation , bundling, lPUs, waste management, etc) with similar ranges of savings and efficiencies . Some of these are taking significant hold (BCBS Massachusetts , to name one) and will likely influence our contracting for care and delivery of care in our MTFs .. A broader topic, but one that will have definite impact on the MHS is how DoD i being pressurized in other ways - e.g. SecDefs Reform and Rebuild initiatives (that incJude health care); or the re-orga11izatio11of DCMO and the refonn efforts they \.viiiundertake, to include health care management. Finally the recentDHITS and MHSRS symposia were well attended and provided a venue for exploring potential solution sets for emerging or anticipated challenges - i.e. interoperab ility of our medical devices, prolonged field care in austere environments . There may be some intere st in bringing some of those topics for discussion with the EAB as they may have insight and infl uence oh the solutions sets we pursue . Thanks for asking . Best, Rocky V ADM Raquel Cruz Bono, MD , NIBA, FAGS Director , Defense Health Agency ol (b) (6) On Sep 22, 2017, at 2:52 PM, (b) (6) wrote: (b) (6) (b) (6) AJIactive links contained in this email were disabled. Please verify the identity of the sender , and confirm the authenticity of all links contained within the message prior to copying and pasting the address to a Web browser . Greetings Members of the EAC, AMERICAN PVERSIGHT VA-19-0799-H-000420 DS 00019724 In advance of our meeting on 2 October, I am seeking your advice and good counsel as we strive to ever increase the value of AMSUS. We have added to the meeting agenda an item discussing our new AMSUS Quarterly Policy and strategy Forums and how best to ask the EAC to inform the content of those sessions. Background: The Policy and Strategy Forums began last February, guided by a group of leaders from the private sector called the AMSUS Executive Advisory Board (EAB)* They successfully guided us through 3 Forums: overviews of the MHS and VHA respectively followed by a deep dive into the issue of "Zero Preventable Deaths," and the concepts of military-civilian cooperation in trauma systems. Speakers have included VADM Bono, USDVHA (Acting) Dr. Poonam Alaigh, and Mr. Guy Kiyokawa, among other senior leaders and subject matter experts . The Proceedings are published in Military Medicine and will also be published further in our new AMSUS Magazine,Hea/th21. We are pleased with the results of these Forums to date, but not content. The input of the EAC for future topics and focus of future events would increase the value to everyone. Request: Please give consideration to how the EAC can best provide input and advice to AMSUS for these events in preparation for a brief discussion at the upcoming EAC meeting. The simplest solution would be joint EAB/EAC a planning session but government ethical rules make that problematic. Bottom line: AMSUS is a pretty good XXst Century AMSUS but times have changed and to be a good XXlst Century AMSUS, we need to continually seek to add additional value. Our Quarterly Forums, bringing public and private sector decision makers together for discussions on the important issues of the day have proven to serve a valuable purpose. With your assistance, we will only do a better job of it in the future. AMERICAN PVERSIGHT VA-19-0799-H-000421 DS 00019725 Thank you as always for your continued encouragement and support. I would welcome any opportunity to discuss or answer any questions prior to the meeting. I am available at your convenience. *The EAB is currently comprised of designated senior executives and experts from : Humana , HealthNet, TriWest, United Healthcare/Optum , UCB, Gerner, Norihrop Grumman IT, Cognosante ~ ByLight, TLIF, LMI and Henry Jackson Foundation . (b) (6) (b) (6) MD , VADM USN (Ret) AMSUS Executive Oirecto1. (b) (6) Office: (b) (6) (b) (6) AMERICAr-... pVERSIGHT ( b ) ( 6 ) (b) (6) (b) (6) (b) (6) amsus .oro > VA-19-0799-H-000422 D8_00019726 Message Poonarn Alaigh (b) otmail.com] (b)(6)(6) 9/24/201710 :01:19 PM David shulkin [Drshulkin@aol.com] Re: [EXTERNAL]Re: [Non-DoD Source] AMSUS Quarterly Policy and Strategy Forums Discussion Frotn: Sent : To : Subject: You are not alone- a growing club that has already written me off and for whom I have already disappeared Sent from my iPad On Sep 24, 20 17, at 5'.57 PM , Alaigh , Poonam , M .D. wrote : Sent with Good (www .good.com ) -----Original Message----From: (b) (6) Sent: Sunday , September 24, 2017 05 :51 PM Eastern Standard Time To: 1Bono , Raquel C V ADM USN DHA (US) '; (b) (6) Cc: 1Smith, Davi d J SES OSD OUSD P-R (US)1-Alaigh, Poonam, M.D. ; 'Ediger , Mark A Lt Gen USAF AF-SG (US)': 'West , Nadja Y LTG USARMYHQDA OTSG (US)' ; Lapuz Miguel H.: 'Thomas, Richard W (Tom) SES (US)' ; (b) (6) 'Faison , C Forrest (Forrest) V ADM USN BUMED FCH VA (US)' ; 'Chinn, Colin G RADM USN JS OCJCS (US)'; 'Adams , JeromeM VADMUSPHS (US)' ; -(b) (6) Clancy , Carolyn Subject: RE : [EXTERNAL] Re : [Non-DoO Sour ce] AMSUS Quarterly Policy and Strategy Forums Discussion Adding Dr Carolyn Clancy, VHA acting USH to this string! Thanks,_(b) (6) Sent with Good (www .good.com ) -----Original Message----From: Bono , Raquel CV ADM USN DHA (US) (b) (6) mail.mil Sent: Sunday , September 24 , 2017 05 :27 PM Eastern Standard Time To: (b) (6) Cc: Smith, David J SES OSD OUSD P-R (US); Alaigh , Poonam , M.D .; (b) (6) Ediger , Mark A Lt Gen USAF AF-SG (US) ; West , Nadja Y LTG USARMY HQDA OTSG Faison, C (US) ; Lapuz , Miguel H.; Thomas. Richard W (Tom) SES (US) ; (b) (6) Forrest (Forrest) VADM USN BUMED FCH VA (US} Chinn , Colin G RADJ\tlUSN JS OCJCS (US); Adams , Jerome M V ADM USPHS (US) ; _(b) (6) Subject: [EXTERNAL] Re : [Non-DoD Source] AMSUS Quarterly Policy and Strateg y Forums Discussion Mike, AMERICAN PVERSIGHT VA-19-0799-H-000423 DS 00019727 Thank you for making these quarterly fora available . The topics and attendees have created some dynamic conversations . ff you are looking for topics that have direct medical/health care relevance, I would suggest looking at the current state of value-ba ed care and value-based purchasing . There are evolving efforts in both ClVISand private health plans towards valuebased care in the that are yielding a range of practices (capitation, bundling , IPUs , waste management, etc) with similar ranges of savings and effic1enoies . Some of these are taking significant hGld (BCBS Massachusetts, to name one) and will likely influence our contracting for care and delivery of care in our MTFs . A broader topic , but one that will have defit1ite impact on the MHS js how DoO is being pressurized in other ways - e.g. SecDers Refonn and Rebuild initiatives (that include health care); or the re-organization ofDCMO and the reform efforts they will undertake , to include health care management. Fina lly, the recent DHITS and MHSRS symposia were well attended and provided a venue for exploring potential solution sets for emerging or anticipated challenges - i.e. interoperability of our medical devices, prolonged field care in austere environments . There may be some interest in bringing some of those topics for discussion with the EAB as they may have insight and influence on the solutions sets we pursue . Thanks for asking. Best, Rocky VADM Raquel Cruz B0110 , MD, MBA , FACS Director Defense Health Agency o/ (b) (6) On Sep 22, 2017 at 2 :52 PM, (b) (6) (b) (6) (b) (6) A11active links contained in this email were disabled . Please verify the identity of the sender, and confirm the authenticity of all links contained within the message prior to copying and pasting the address to a Web browser . Greeting .s Members of the EAC, In advance of our meeting on 2 October, I am seeking your advice and good counsel as we strive to ever increase the value of AMSUS . We have added to the meeting agenda an item discussing our new AMSUS Quarterly Policy and strategy Forums and how best to ask the EAC to inform the content of those sessions. Background: The Policy .and Strategy Forums began last February , guided by a group of leaders from the private sector called the AMSUS Executive Advisory Board (EAB)* They successfully guided us through 3 Forums : overviews of the MHS and AMEH1Vr\l PVERSIGHT VA-19-0799-H-000424 DS 00019728 VHA respectively followed by a deep dive into the issue of "Zero Preventable Deaths," and the concepts of military-civilian cooperation in trauma systems. Speakers have included VADM Bono, USDVHA (Acting) Dr. Poonam Alaigh , and Mr. Guy Kiyokawa , among other senior leaders and subject matter experts. The Proceedings are published in Military Medicine and will also be published further in our new AMSUS Magazine,Health21 . We are pleased with the resu lts of these Forums to date , but not content. The input of the EAC for future topics and focus of future events would increase the value to everyone . Request: Please give consideration to how the EAC can best provide input and adv ice to AMSUS for these events in preparat ion for a brief discussion at the upcom ing EAC meeting. The simplest solution would be joint EAB/EAC a planning session but government ethical rules make that problematic . Bottom line: AMSUS is a pretty good XXst Century AMSUS but times have changed and to be a good XXlst Century AMSUS , we need to continually seek to add addit ional value . Our Quarterly Forums , bringing public and private sector decision makers together for discussions on the important issues of the day have proven to serve a valuable purpose . With your assistance , we will only do a better job of it in the future . Thank you as always for your continued encouragement and support. I would welcome any opportu nity to discuss or answer any questions prior to the meet ing. I am available at your convenience . *The EAB is currently comprised of designated senior executives and experts from: Humana , HealthNet , TriWest, United Healthcare/Optum, UCB, Gerner, Northrop Grumman IT, Cognosante, ByLight, TLIF, LMI and Henry Jackson Foundation . (b) (6) (b) (6) AMERICAr-... pVERSIGHT MD, VADM USN (Ret) VA-19-0799-H-000425 OS 00019729 AMSUS Eucutive Director (b) (6) Office : (b) (6) (b) (6) AMERICAr-... pVERSIGHT ( b ) ( 6 ) (b) (6) (b) (6) (b) (6) VA-19-0799-H-000426 D8_00019730 Message From: David Shulkin [drshulkin@aol.com] Sent: To; 9/23/2017 2:18 :38 AM Ike Perlmutter -frenchangel59.com] ( (b) Subject: US Digital Service b (6) ) ( 6 groups of private sector people the government brought in to help transform Ike- here is a link about two ) government The US Digital Service now works closely with Jared (remember HaJey- she headed it until she left) https: //www .washingtonpost.com/news/the-swi tch/wp/2014/08/ l l /white-house-launches-u-s-digi tal-servicewi th-heal thcare-gov-fi xer-at-the-hel m/?utm term = .ef80bcbfda3 8 The idea would be to use Jared's group to bring in 50 people from the private sector to fix VA- think about a VA Corps IT Human Resources , Procurement and logistics, Facilities , Finance, Capital Assets, Research, and General Operations Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000427 DS 00019731 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 9/22/2017 5:0 1:49 PM To: Poonam Alaigh (b) otmail.com] (b)(6)(6) Re: RFPCommunityCare Subject: Ok first i am hearing about it as well Sent from my iPhone (b) (6) (b) (6) > on Sep 22, 2017, at 12:05 PM, Poonam Alaigh <-otmail .com> wrote: > > Baligh has all along committed to us awarding the contract first in Sept , then Oct and now Nov. He has been on this timeline all along, and today frantically calls me for the first time in a very long time that there is another delay and the timeline now is February and is blaming the contracting and legal fol ks for this. He will be presenting this to you on Tuesday- and is the first time he has escalated this issue , so we are missing the mark again , which has implications to our choice spend as there will be no UMin place for 3/4 th of the next fiscal year at least. This is a problem with not only missing deadlines repeatedly , but also downstream ramifications. > > He has never discussed anything related to community care with me for months and feels accountable to you directly and now that he is in a hole and he is coming to me. he is > > Regardless of his mismanagement and inability to deliver , you need to rescue this as a priority and get the team to dedicate all its resources to meeting our deadline , otherwise there is a domino negative impact on the entire community care program - wanted to give you a heads up. Maybe even get a discussion going today if you can . > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000428 OS 00019732 Message From: Poonam Alaigh (b) (b)(6)(6) Sent: 9/22/2017 4:05:04 PM To: Davidshulkin [Drshulkin@aol.com] RFPCommunity Care Subject: otmail.com] Baligh has all along committed to us awarding the contract first in Sept, then Oct and now Nov. He has been on this timeline all along, and today frantically calls me for the first time in a very long time that there is another delay and the timeline now is February and is blaming the contracting and legal folks for this. He will be presenting this to you on Tuesday - and is the first time he has escalated this issue, so we are missing the mark again, which has implications to our choice spend as there will be no UMin place for 3/4th of the next fiscal year at least. This is a problem with not only missing deadlines repeatedly, but also downstream ramifications . He has never discussed anything related to community care with me for months and feels to you directly and now that he is in a hole and he is coming to me. he is accountable Regardless of his mismanagement and inability to deliver , you need to rescue this as a priority and get the team to dedicate all its resources to meeting our deadline , otherwise there is a domino negative impact on the entire community care program- wanted to give you a heads up . Maybe even get a discussion going today if you can. sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000429 OS 00019733 Message From: -(b) (6) Sent: 9/22/2017 5:22:58 PM To: Davidshulkin [Drshulkin@aol.com] (b) (6) (b) (6) Re:-and- Subject: sounds great! (b) (6) (b) (6) [-opeunseen.com] Look forward to connecting Sent from my iPhone > on Sep 21, 2017, at 9:55 AM, David shulkin wrote: > >T errific-my office will reach out to you > > sent from my iPhone > >> on Sep 21 , 2017, at 11 : 23 AM,(b) (6) >> (b) (6) (b) (6) <-hopeunseen . com> wrote : (b) (6) and I will be attending the Veteran care summit next week. we will be at the luncheon on ;; ~ Wed~ September 27th, we look forward to hearing your remarks. we would love to connect either after the luncheon , or at VA HQ ' slater if you have availability. we will be in DC 27th - 29th . >> ~nk -(b) (6) you for all your tireless efforts , you are making a huge impact and unprecedented change . and his fellow combat Veterans are beyond grateful for your direct action for change. >> >> we look forward to connecting . >> >> All our best , >> (b) (6) (b) (6) >> -and> AMERICAN PVERSIGHT VA-19-0799-H-000430 OS 00019734 Message Davidshulkin [Drshulkin@aol.com] From: Sent: 9/21/2017 4:55:29 PM To: (b) (6) Subject: Terrific- (b) (6) (b) (6) (b) (6) my office hopeunseen.co m] (b) (6) will reach out to you Sent from my iPhone > On Sep 21, 2017, at 11:23 AM, (b) (6) (b) (6) -hopeunseen . com> wrote: > (b) (6) and I will be attending the Veteran care summit next week. we will be at the luncheon on ; ~ we~y September 27th , we loo k forward to hearing your remar ks . we would love to connect either after if you have availability . we will be in DC 27th-29th. the luncheon, or at VA HQ ' slater > > Thank you for all your tireless efforts, you are making a huge impact and unprecedented and his fellow combat Veterans are beyond grateful for your direct action for change . change. -(b) (6) > > we loo k forward to connecting. > > All our best, > (b) (6) > -and- AMERICAN (b) (6) PVERSIGHT VA-19-0799-H-000431 OS 00019735 Message David shulkin LDrshulkin@aol.com] From: Sent : 9/21/2017 4:54:50 PM To : (b) (6) Subject: (b) (6) Fwd:-and (b) (6) va.gov (b) (6) Does she mean the cohen network meeting ? Not sure if we can grab a few minutes with them Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) From: (b) (6) ho eunseen .com> Date: September 21, 2017 at 11:23:59 AM EDT To: David shulkin (b) (6) (b) (6) Subject: and David , -(b) (6) and I will be attending the Veteran Care Summit next week. We will be at the luncheon on Wednesday September 27th, we look forward to hearing your remarks . We would love to connect either after the luncheon, or at VA HQ 'slater if you have availability . We will be in DC 27th-29th. Thank you for all your tireless efforts, you are making a huge impact and unp receden ted change . -(b) (6) and his fellow Combat Veterans are beyond grateful for your direct action for change . We look forward to connecting . All our best, (b) (6) -and- AMERICAN PVERSIGHT (b) (6) VA-19-0799-H-000432 DS 00019736 Message hopeunseen.com] (b) 9/21/2017 3:23:59 (6) PM Davidshulkin [drshulkin@aol.com] (b) (6) (b) (6) -and (b) (6) From: Sent: To: Subject: (b) (6) David -(b) (6) and I will be attending the Veteran care summit next week. We will be at the luncheon on Wednesday September 27th, we look forward to hearing your remarks. We would love to connect either after the luncheon, or at VA HQ 'slater if you have availability. We will be in DC 27th - 29th. Thank you for all your tireless and his fellow combat Veterans efforts , you are making a huge impact and unprecedented are beyond grateful for your direct action for change. change. -(b) (6) we look forward to connecting . All our best , (b) (6) -and- (b) (6) AMERICAN PVERSIGHT VA-19-0799-H-000433 OS 00019737 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 9/21/2017 1:53:31 AM To: Poonam Alaigh (b) (b)(6)(6) Re: Miguel Subject: otmail.com] Yes i agree -thanks Sent from my iPhone (b) (6) > on Sep 20, 2017, at 9:41 PM, Poonam Alaigh <-otmail (b) (6) .com> wrote: > > work AMERICAN PVERSIGHT VA-19-0799-H-000434 OS 00019738 Message From: (b) (6) Poonam Alaigh [_,otmail.com] (b) (6) Sent: 9/21/2017 To: Davidshulkin [Drshulkin@aol.com] Miguel Subject: 1:41:50 AM Had a 2 . 5 hour dinner with Miguel. He was completely devastated and shattered after the announcement and in a way felt betrayed by me since I never gave him a heads up. He was all set to stay with me and was 100% certain I was going to be in this role. After a heart to heart, he finally opened up . Although Vivieca thinks we should replace him, I strongly believe that he should stay. He understands where we were heading with the different initiatives , your urgency to change / act and most importantly , he has your bac k. I was thinking about this all evening- and more than anything else, I need someone who is going to be loyal to you. It ' s not about an offensive strategy right now, its a defensive strategy with all the vulnerabilities you have thanks to theo He also doesn't take anything personally when you get upset at him. Anyone else including -(b) (6) ..(b) (6) (who you cannot trust and knows that you are not fond of him) or another would not know your y , the dangerous players and likely not be trustworthy since not groomed by me. Given the ineffectiveness of Carolyn , you need Miguel and Steve to be loyal to you so that VHAdoesn't become a liability. Most importantly, they have been groomed by me and understand the dynamics . If you agree - I will work Steve the same way when he is back in town. we can discuss very strongly that Miguel is key to the continuity, stability and your protection. more, but I feel sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000435 OS 00019739 Message From: (b) (6) Sent : 9/24/2017 2:57:43 PM (b) (6) (b) (6) To : David Shu Ikin (drshulkin@aol.com) Subject: True? gmail.com) http://jezebel.com/conspiracy-prince-hany-meets-melania-makes-the-sign-1818693372 Did you take it thi.s way? AMERICAN PVERSIGHT VA-19-0799-H-000436 OS 00019740 Message From: Sent: To: Subject: (b) (6) Bruce Moskowit z [brucem~mac .com] (b) (6) 9/20/2017 8:19:06 PM DavidShulkin [secshulkin@gmail.com] Re: VA and EHRNew EnglandJournal article Yes she is excellent Sent from my iPhone > on Sep 20, 2017, at 3:49 PM, David shulkin wrote: > > Terry is now on board and i agree this is a necessary path > > I am drowning though and now thst Poonam is going its rea 77y tough > can help as she is one of the few i trust to do this > I hope you think~ (b) -(b) (6) > (6) > sent from my iPhone > (b) (6) (b) >> on Sep 18 , 201 7 , at 9 :0 7 AM, Bruce Moskowitz wrote: >> (6) >> The lead article today in our most respected journal called on the VA and the DODto "be the model of inno vations that promote the seamless flow of information for care deli very" . I know the authors of the article and agree with them that this will not get done if the VA does not do more partnering with the academic centers. >> unless the VA is willing to put together a working group with myself and the 5 academic partners (along with Terry Fadem insure from the beginning, VA intellectual capital is protected ) the VA will loose the opportunity. >> >> sent from my iPad >> Bruce Moskowitz M. D. AMERICAN PVERSIGHT VA-19-0799-H-000437 OS 00019741 Message From: Sent: To: Subject: DavidShulkin [secshulkin@gmail.com] 9/20/2017 7:49:48 PM (b) (6) Bruce Moskowit z [brucem~mac .com] (b) Re: VAand EHRNew EnglandJournal (6)article Terry is now on board and i agree this I am drowning though and now thst (b) I hope you think 1111111 -(b) (6) is a necessary Poonam is going its path really tough can help as she is one of the few i trust to do this (6) sent from my i Phone (b) (6) > on Sep 18 , 2017 , at 9 :0 7 AM, Bruce Moskowitz wrote: (6) > The lead article today in our most respected j ournal called on the VA and the DODto "be the model of inno vations that promote the seamless flow of information for care deli very " . I know the authors of the article and agree with them that this will not get done if the VA does not do more partnering with the academic centers . > unless the VA is willing to put together a working group with myself and the 5 academic partners (along with Terry Fadem insure from the beginning , VA intellectual capital is protected ) the VA will loose the opportunity . > > > sent from my i Pad > Bruce Moskowitz M.D. AMERICAN PVERSIGHT VA-19-0799-H-000438 OS 00019742 Message (b) (6) Bruce Moskowit z [brucem~mac (b) .com] (6) Sent: 9/18/2017 1:07:32 PM ( (b) (b) (6) To: DavidShulkin [secshulkin@gmail.com]; IP [-renchange l59.com]; LPerl [-gmai l.com]; (b) (6) b (6) mb-gmail .com VAand EHRNew England Journal article ) Subject: ( 6 ) The lead article today in our most respected journal called on the VA and the DODto "be the model of innovations that promote the seamless flow of information for care delivery". I know the authors of the article and agree with them that this will not get done if the VA does not do more partnering with the academic centers. unless the VA is willing to put together a working group with myself and the 5 academic partners (along with Terry Fadem insure from the beginning , VA intellectual capital is protected ) the VA will loose the opportunit y . From: sent from my iPad Bruce Moskowitz M. D. AMERICAN PVERSIGHT VA-19-0799-H-000439 OS 00019743 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 9/22/2017 11:43: 19 AM To: DavidShulkin [drshulkin@aol.com] (b) (6) Poonam Alaigh [_,otmail.com] (b) (6) CEOsearch BCC: Subject: Knox - i hope all is well and I know these are busy times as you are preparing for your trans1t1on the next few months. I know you have alot of things you want to do once we get some time over sue told me you've got a number of internal candidates and that you asked her to reach out to me- as you know the timing isnt right for me but i do have a recommendation. My closest colleague , Dr Poonam Alaigh , may be interested and if so would be a perfect fit for leading your organization and in working with you on a successful transition . ive worked very closel y with Poonam for over five years and she is an extraordinary leader who has vision , opEratio Nal strength, and pAssion for excellence. she recently was the acting undersecretary for VA and did an outstanding j ob . You couldn't do better than her and she has my strongest recommendation~ . If you are serious about external candidates your team should (b) (6) .com meet her - Her direct email is 1111111111111totmail Let me know if i can help in any other way Best Regards David s hulkin sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000440 OS 00019744 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 9/21/2017 12:04:02 PM To: (b) (6) Poonam Alaigh [_,ot (b) (6) Re: Exitdate Subject: I want you to do everything mail.com] by the books- Did you decide to delay your vacationthe 6th its imperative if so thats fine to transition cleanly if not my advice start Are you still planning on working virtually next week or are you planning Either way its fine but you had said virtual in our last conversation using your vacation on now being in the office? sent from my iPhone (b) (6) (b) (6) > on Sep 21, 2017, at 4 : 34 AM, Poonam Alaigh <-otmail . com> wrote: > > And this ? > > sent from my iPhone > (b) (6) (b) (6) >> on Sep 20, 2017 , at 9:29 PM, Poonam Alaigh <-otmail .com> wrote: >> >> I want my last day in the office to be October 5th with Carolyn taking over as of October 6th. I will then finish the pay period and work remotely the week of October 9th and use this as a transition week for the team . Starting October 16th I will have transitioned out of VACO.Does that work- if so, will send it to you on the va email and copy Vivieca so we are all on the same page . >> >> sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000441 OS 00019745 Message From: Sent: To: Subject: otmail.com] Poonam Alaigh (b) (b)(6)(6) 9/21/2017 8:34:32 AM David shulkin [Drshulkin@aol.com] Re: Exit date And this? Sent from my iPhone (b) (6) > on Sep 20, 2017, at 9:29 PM, Poonam Alaigh <-otmail (b) (6) > .com> wrote: > I want my last day in the office to be October 5th with Carolyn then finish the pay period and work remotely the week of October for the team. Starting October 16th I will have transitioned out send it to you on the va email and copy Vivieca so we are all on taking over as of October 6th . I will 9th and use this as a transition week of VACO.Does that work- if so, will the same page. > > sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000442 OS 00019746 Message From: Sent: To: Subject: otmail.com] Poonam Alaigh (b) (b)(6)(6) 9/21/2017 1:29:33 AM David shulkin [Drshulkin@aol.com] Exit date I want my last day in the office to be October 5th with Carolyn taking over as of October 6th. I will then finish the pay period and work remotely the week of October 9th and use this as a transition week for the team. Starting October 16th I will have transitioned out of VACO. Does that work- if so, will send it to you on the va email and copy Vivieca so we are all on the same page. sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000443 OS 00019747 Message David shulkin [Drshulkin@aol.com] From: 9/19/2017 1:13:07 AM Sent: - (b) (6) (b) (b) (6) (b) (6) .oo?hotmail.com];Fwd: (6) To : Subject: @gmail.com] Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) From: (b) (6) Date: September I 8, 2017 at 8:09 :14 PM EDT To: David Shulkin ail.com > http://theweek.com/ arti cl es/7248 70/steven-mnuchi n-window~i nto-m ost-corrupt-white-househi story AMERICAN PVERSIGHT VA-19-0799-H-000444 DS_00019748 Message From: (b) (6) (b) (6) (b) (6) Sent : 9/19/2017 12:09: 14 AM To : David Shu Ikin (drshulkin@aol.com] gmail.com) http://theweek .com/ arti cl es/7248 70/steven-mnuchi n-wi ndow-i nto-most-corrupt-white-house-history AMERICAN PVERSIGHT VA-19-0799-H-000445 OS 00019749 Message David shulkin lDrshulkin@aol.com] Frotn: Sent : 9/21/2017 7:00:33 PM To: (b) (6) (b) (6) (b) (6) (b) (6) (b) (6) Subject: Re: [EXTERNAL] Fwd: - and va.gov] (b) (6) K- Sent from my iPhone On Sep 21, 2017. at 1:44 PM, (b) (6) -R. (b) (6) (b) (6) (b) (6) I think we can work something out, may not be on the 27th unJess it 1s well into the afternoon, it is such a demanding day for you. However, I'll look at another day to connect with them after the talk . -----Original Message----From: David shulkin [Drshulkin@aol.com] Sent: Thursday, September21, 201712 :55 PM Eastern Standard Time (b) (6) To: (b) (6) and (b) (6) Subject: [EXTERNAL] Fwd: (b) (6) Does she mean the cohen network meeting? Not sure if we can grab a few minutes with them Sent from my iPhone Begin forwarded message: (b) (6) (b) (6) From: (b) (6) ho eunseen.com> Date: September 21, 201 7 at 11 :23: 59 AM EDT To: David shulkin (b) (6) (b) (6) Subject: and David, -(b) (6) and I wilJ be attending the Veteran Care Summit next week. We will be at the luncheon on Wednesday September 27th, we look fo1ward to hearing your remarks. We would love to connect either after the luncheon or at VA HQ 'slater if you have availability. We will be in DC 27th-29th. Thank you for all your tireless efforts, you are making a huge impact and unprecedented change. -(b) (6) and his fellow Combat Veterans are beyond grateful for your direct action for change, We look forward to connecting. -andAll our best, (b) (6) AMERICAN PVERSIGHT (b) (6) VA-19-0799-H-000446 DS 00019750 Message (b) (6) (b) (6) From: (b) (6) Sent : 9/21/2017 5:44 :44 PM 'David shulkin' [Drshulkin@aol.com] RE: [EXTERNAL]Fwd:-(b) (6) and (b) (6) To : Subject: (b) (6) va.gov] l think we can work something out, may not be on the 27th unless it's well into the afternoon, it is such a demanding day for you . However , I'll look at another day to connect with them after the tal k. ----Original Message----From: David shulkin [Drshulkin@aoLcom ] Sent: Thursday , September 21, 2017 12:55 PM Eastern Standard Time (b) (6) To: (b) (6) and (b) (6) Subject: [EXTERNAL] Fwd : (b) (6) Does she mean the cohen network meeting ? Not sure ifwe can grab a few minutes with them Sent from my iPhone Begin forwarded message : (b) (6) (b) (6) (b) (6) ho eunseen .com> Date: September 21, 2017 at 11:23:59 AM EDT To: David shulkin (b) (6) (b) (6) Subject: and Fro01: David , and l will be attending the Veteran Care Summit next week. We will be at the luncheon on Wednesday September 27th, we look forward to hearing your remarks . We would love to connect either after the luncheon, or at VAHQ 'slater if you have availability. We will be in DC 27th-29th. (b) (6) Thank you for all your tireless efforts , you are making a huge.impact and unprecedented change . -(b) (6) and bis fellow Combat Veterans are beyond grateful for your direct action for change . We look forward to connecting . (b) (6) -and- AMERICAN PVERSIGHT (b) (6) VA-19-0799-H-000447 DS 00019751 Message From: (b) (6) (b) (6) Sent: 9/29/2017 8:28:33 PM To: David Shulkin [drshulkin@aol.com] (b) (6) gmail.com] These are the questions you will be asked on sunday by the Johnson and Johnson people. Make sure you look at them 60 minute interview time. They want to discuss the partnership on veteran suicide prevention , which began back when President Trump and Sec. Shulkin asked J&J CEO and West Point grad Alex Gorsky to lead this public-private partnership and identify three major work streams : 1. Integrated marketing campaign (the Hanks PSA) 2. Clinical trial collaboration 3. Precision medicine efforts to identify through analytics those most at risk Questions o The VA has deemed suicide prevention its highest clinical priority, can you explain why suicide prevention is such an important issue to tackle? o How is the VA working with public and private organizations to address the health issues that disproportionately affect Veterans and Service members? o What is this significance of private and public partnerships when trying to address an issue of this magnitude? o Why is the VA partnering with Johnson & Johnson on this initiative? o What role do you believe stigma plays in deterring Veterans and Service members from seeking care for mental illness? o How can greater awareness of this issue help encourage Veterans and Service members seek care for mental illness? How can encouraging treatment seeking ultimately reduce the rate of Veteran suicide? o What can the community do to support Veterans and Service members? o What does it mean to "Be There " for a veteran? How are ways the VA is fostering connectivity with veterans? o How can someone reach out to a Veteran or Service member in their neighborhood, workplace or family? AMERll.,, I PVERSIGHT VA-19-0799-H-000448 OS 00019752 o For those who feel they don't have a direct connection to a Veteran or Service member, how can they make a difference? o What does "No Veteran Left Behind" mean? How can the community take this pledge? AMERICAN PVERSIGHT VA-19-0799-H-000449 OS 00019753 Message From: Jared Kushner (b) (6) Sent: 9/18/2017 11:46:54 (6) AM To : David Shu Ikin (drshulk in@aol.com] Re: From David Shulkjn Subject: We entering a new phase! Sent from my iPhone On Sep 17, 2017 , at 11 :04 PM David Shulkin wrote : In case you did not see- the video clip is incredible http://m .j post. com/mid die-east/bahrai n-king-den ounces-arab-boycott-of-i srael-says-countrymenmay-vi sit-505308 Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000450 DS 00019754 Message From: David Shulkin [drshulkin@aol.com) Sent: 9/18/2017 3:03:55 AM To : Jared Kushner (b) (6) From David Shulkin (6) Subject: In case you did not see- the video clip is incredible http: IIm.jpost. com/mi ddle-east/bahrai n-ki ng-denounces-arab-boycott-of-i srael-says-countrymen-may-vi sit505308 Sent from my iPad AMERICAN PVERSIGHT VA-19-0799-H-000451 DS_00019755 Message From: Darin Selnick (b) (6) Sent : 9/17/2017 3:21:13 PM To : David shulkin [Drshulkin@aol.com] Re: va-onl y-fil Ii ng-half-of-its-medica 1-a ppoi ntm ents-wh ii e-veterans-wa it-for-weeks Subject: @gmail.com] Great choice Darin On Sun, Sep 17, 2017 at 8: 10 AM, Dav id shulkin wrote : Jen Lee is going to be working on this Sent from my iPhone On Sep 17, 2017 , at 9:56 AM, Darin Selnick (b) (6) mail.corn > wrote : great, it would be helpful if someone from VHA could brief me on it. Thanks Darin On Sun, Sep 17, 2017 at 6 :39 AJ'vf,David Shulkin wrote: I've got a big project working to fill unused spots (and no shows) Sent from my iPad On Sep 17, 2017 , at 8:53 AM, Darin Selnick (b) (6) 1 thought you would want to see this from the Washington Examiner . http ://www.washingtonexaminer.com/va-onJy-filling-half-of-its-medicalappointments-whiJe-veterans-wait-for-weeks/article/2634652 Darin AMERICAN PVERSIGHT VA-19-0799-H-000452 DS 00019756 Message From: David shulkin [Drshulkin@aol.com] Sent : 9/17/2017 3:10 :18 PM To : (b) (6) Darin Selnick ???-@gmail.com] Re: va-onl y-fil Ii ng-half-of-its-medica loa ppoi n tm ents-wh ii e-veterans-wa it-for-weeks Subject: Jen Lee is going to be working on this Sent from my iPhone On Sep 17, 2017 , at 9 '.56 AM, Darin Selnick (b) (6) mail.com > wtote: great, it would be helpful if someone from VHA could brief me on it. Thanks Da1in On Sun, Sep 17, 2017 at 6 :39 AM, David Shulkin wrote: I've got a big project working to fill unused spots (and no shows) Sent from my iPad On Sep 17, 2017, at 8:53 AM, Darin Selnick (b) (6) I thought you would want to see this from the Washington Examiner. http :/ /www .washingtonexaminer .com/va-only-filling-half-of-its-medi calappointments-while-veterans-wait-for-weeks/article/2634652 Darin AMERICAN PVERSIGHT VA-19-0799-H-000453 OS 00019757 Message From: Darin Selnick (b) (6) Sent: 9/17/2017 1:56 :06 PM To : David Shu Ikin [drshulkin@aol.com] Re: va-onl y-fil Ii ng-half-of-its-medica 1-a ppoi n tm ents-wh ii e-veterans-wa it-for-weeks Subject: @gmail.com] great , it would be helpfuJ if someone from VHA could brief me on it. Thanks Darin On Sun, Sep 17, 2017 at 6:39 AM, David Shulkin < drshu1lcin@aol.com > wrote: I've got a big project working to fill unused spots (and no shows) Sent from my iPad On Sep 17, 20 17, at 8:53 AM, Darin Selnick (b) (6) ail.com > wrote: I thought you would want to see this from the Washington ExamineL http ://www.washingtonexaminer .com/va-onlv-filling-half-of-its-medical-appointments-whileveterans-wait-for-weeks/ arti cle/263 4652 Darin AMERICAN PVERSIGHT VA-19-0799-H-000454 OS 00019758 Message From: David Shulkin [drshulkin@aol.com] Sent : 9/17/2017 1:39:22 PM To : (b) (6) Darin Selnick ???-@gmail.com] Re: va-onl y-fil Ii ng-half-of-its -medica loa ppoi n tm ents-wh ii e-veterans-wa it-for-weeks Subject: rve got a big project worlcing to fill unused spots (and no shows) Sent from my iPad On Sep 17, 2017, at 8:53 AM, Darin Selnick (b) (6) mail.corn> wtote: I thought you would want to see this from the Washington Examiner. http ://www.washingtonexaminer .com/va-only-filling-half-of-its-medical-appointments-whileveterans-wait-for-weeks/article/2634652 Darin AMERICAN PVERSIGHT VA-19-0799-H-000455 DS 00019759 Message From: Darin Selnick (b) (6) Sent: 9/17/2017 12:53:23 PM To : David shulkin [Drshulkin@aol.com] va-onl y-fil Ii ng-ha lf-of-its-m edi caI-ap poi ntm ents-wh i le-veterans-wait-for-weeks Subject: @gmail.com] I thought you would want to see this from the Washington Examiner. http://www .washingtonexaminer.com/va-only-filling-half-of-its-medica1-appointments-while-veterans-wait-forweeks/article/2634652 Darin AMERICAN PVERSIGHT VA-19-0799-H-000456 OS 00019760 Message From: (b) (6) Sent : 9/25/2017 4:28:25 PM To : drshulkin@aol.com Dog article Subject: (b) (6) (b) (6) gmail.com) Full story, being printed by front office staff in NYC http:/ I amp. usatoda y .com/ story/69068400 I/ AMERICAN PVERSIGHT VA-19-0799-H-000457 DS_00019761 Message To: Davidshulkin [Drshulkin@aol.com] 9/19/2017 11:03:33 AM Carolyn Clancy (b) (6) @gmail.com] Subject: Re: From: Sent: Ok lets catch up Sent from my iPhone > on Sep 19, 2017, at 5:43 AM, Carolyn Clancy <-@gmail.com> (b) (6) wrote: > > Yes -- I was in Manchester testifying at the field hearing. > > Will be there today > >> On Sep 18 , 2017, at 9 : 21 PM, David shulkin wrote : >> >> Carolynmissed you at the senior leaders meeting today - is everything ok? >> >> David >> >> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000458 OS 00019762 Message To: Carolyn Clancy (b) (6) @gmail.com] 9/19/2017 9:43:38 AM Davidshulkin [Drshulkin@aol.com] Subject: Re: From: Sent: Yes -- I was in Manchester testifying Will be there at the field today > on Sep 18, 2017, at 9:21 PM, David shulkin > > Carolyn- hearing. missed you at the senior leaders wrote: meeting today- is everythin g ok? > > David > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000459 OS 00019763 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 9/19/2017 1:21:03 AM To: Carolyn Clancy (b) (6) Carolyn- missed you at the senior @gmail.com] leaders meeting today- is everything ok? David Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000460 OS 00019764 Message From: David Shulkin [drshulkin@aol.com] Sent: 9/16/2017 5:58:00 PM To: (b) (6) Subject: zeetma slides zeetma.pptx Attachments: (b) (6) gmail.com -(b) (6) this is my slide deck for my talk on Tuesday. I need to have you or the speechwriters plug in slides from the senior leaders slide deck where I have put placeholders in the above attached document. Then we should be set. Thanks AMERICAN PVERSIGHT VA-19-0799-H-000461 OS 00019765 VA LLS. Department I of \f'clura A [Ta i r5 U.S. Department of Veterans Affairs David J. Shulkin, MD Secretary of Veterans Affairs April 19, 201? battle, and for his widow and his orphan.? Abraham Lincoln, 1855 ?To care for him who a? shaii have borne the (F 1 .J Our Mission To care for those who have "borne the battle? and for their families and survivors. f? r; Largest Educator of Health Professionals o Over 1,800academic and institutionalpartners o 120,000healthcare workers trained each year: ~60,000medicalstudents and residents ~30,000nursingstudents ~30,000students in other health fields o An estimated 70%of all U.S.doctors have trained with VA. 3 AMERICAN PVERSIGHT ,1A VN. ~ ) ~~ 1 llS. J)ppnrtment or\'('ll..!rnns/\rTairs VA-19-0799-H-000464 OS 00019768 VA Innovation 8 Lasker Awards Nicotine Patches First Liver Transplant Barcoding of Medications Cardiac Pacemaker 3 Nobel Prizes 4 Artificial Kidney CT Scanner ,1A V,.., ~ ~ .\ !,;./ 1 l l.S. l)(oJltlrlmrlmrnl ol\',oLL.!rnns/\rfnirs VA-19-0799-H-000470 OS 00019774 Reduction in Opioid Use ~M t----------------- Overall opioid use: Long-term Opioid Therapy Benzo co-prescribing: High dose: 1S7,300~worVotorans 361'd1<1Hl8 EUR ~ e ~ ~ ~ e ~ 0 1~ ~ ~ ? I ~ 0 ~; 0 ! : } e ~ Annual drug screening: 86% Decline in Veterans on long-term opioid therapy, 40 FY 2012 to 10 FY 2017. Overall opioid use down 31% in the same period. AMERICAN PVERSIGHT VA-19-0799-H-000471 DS_00019775 Population-based Hepatitis C treatment >100,000 Veterans treated 90% cure rate 2,500 treated each month Poised to eliminate Hep C among Veterans Decline in Veterans on long-term opioid therapy , 40 FY 2012 to 10 FY 2017 . Overall opioid use down 31% in the same period . AMERICAN PVERSIGHT VA-19-0799-H-000472 OS 00019776 Decline in Homelessness 80,000 70,00 0 ~ .087 ~ 5 455 60 ,579 60,000 ~s;t;~ ---!_9 , 68 !) n ,2 50,00 0 -..... 43 437 40,000 30,000 40,033 35,l ifl - 30 ,650 =,o~ 34,909 ug 31,505 o~- "'..16,220 ~2 Z>,43 b 20,710 20,000 10,000 - 0 2010 ? Tota l Homeless Vete rans AMERICAN PVERSIGHT 2012 2011 e 2013 Sheltered Veterans 2014 2015 Unshelte red Veteran s ' ' VA-19-0799-H-000473 OS 00019777 Not the Best of Tiilles "VA is a vast dehumanized, embedded in mountains of red tape, ingrown with entrenched mediocrity, undemocratically operated under autocratic control centered in Washington DC, and rigidly resistant to proposed reforms'' - New York Magazine AMERICAN PVERSIGHT VA-19-0799-H-000474 OS 00019778 The Current State of VA VA: The Most Transparent Organization in Government AMERICAN PVERSIGHT VA-19-0799-H-000475 OS 00019779 13 Risks 1. Access to Care 2. Paying Providers 3. Community Care 4. Quality of VA Care 8. Construction 9. Accountability 10. Staffing 5. Disability Claims & Appeals 11. Bureaucracy 6. Information Technology 12. Fraud, Waste & Abuse 7. Capital Assets 13. Veteran Suicides VA ~\ \q, !.,' AMERICAN PVERSIGHT 1 l l.S. Dl'JlElrLmrnl o(\',oLL!mnsJ\ffn)rs 15 VA-19-0799-H-000476 DS_00019780 The Secretary's 5 Priorities 1. Greater Choice for Veterans 4. Improve Timeliness of Services 2. Modernize our Systems 5. Suicide Prevention 3. Focus Resources More Efficiently 16 ,1A V,.., ~'\ 'q, !.,I 1 l l.S . l)lopnrlm< o(\'1oLL!mn onl ."!i-J\ffnirs I AMERICAN PVERSIGHT VA-19-0799-H-000477 OS 00019781 1. Greater Choice: Veteran CARE Program Clinically based decisions on when and where Veterans receive care ,~--------------------------, \ I I I I I I I I I I ' I ~-------------------------' ' J COMMUNITYCARE AMERICAN PVERSIGHT ,1A V,.., ~\ 1 \q, !.,' l l.S. Dl'JlElrLmrnl o(\',oLL!mns/\rfnlrs 17 VA-19-0799-H-000478 DS 00019782 Competition Slide 2. Modernize o EMR interoperability and IT modernization Our Systeins MtffS. CiENESIS ~ Ri08iM-i#:?JPY1Uii=UHiiA?I Modern.Secure.Connected. ,1A Vl-'l AMERICAN PVERSIGHT ~\ ~~ 1 l l..""i.DPp11rlment of\ '1olL:rnnsJ\GBPTuirs 19 VA-19-0799-H-000480 OS 00019784 Improving our Infrastructure Draft/ Pre-decisional/ AMERICAN PVERSIGHT For Internal VA Use Only 20 ,1A V"" ~) Slide ~ !,. , LI.S. Dl'pE>rtment of\ ',ol~runs ,\lfalrs VA-19-0799-H-000481 OS 00019785 3. Improving Timeliness Same Day Services Slide Draft/ Pre-decisional/ For Internal VA Use Only AMERICAN PVERSIGHT 21 ,1A V"" ~) ~ !,. , l l.S. DPp.,r1mrn1 of\',ol~mns ,\ffnlrs VA-19-0799-H-000482 OS 00019786 Transparency Wait times at local facilities WaT!n-...lor~o VAF of Access What Veterans are saying about access ~t Vetan,nsSayAboutAccessto ea,., al VAlac -es ,1A VI-I AMERICAN PVERSIGHT ~~ ~ !/ 1 l l.S. ll (ounr l m '-a Y 1 uf\'l'krn nt .ns J\ffmrs 24 VA-19-0799-H-000485 OS 00019789 Transparency of Quality 25 AMERICAN PVERSIGHT ,1A Vl'"'l ~ ~ !, ) , l l.S . l)pp.,rLmtont nf\'1oLL.!rnns/\rfalr-s VA-19-0799-H-000486 OS 00019790 VA Whistle blower and Accountability Act Slide 26 AMERICAN PVERSIGHT 'IA V"" f:"") ' '-a,S, l l.S. n,op<>rlmrnl of\',oLL:mns/\ffnirs VA-19-0799-H-000487 OS 00019791 Transparency of Accountability ffice of ccoun tability and Whistleblower Prote tion VAi .S. 0 parlm of VeteransA ' WHAT IS TI-fE OF FICE O F ACCOUNTABILITY ANO WHJSTL.EBL.OWERPROTE CTlON fllf! t! OIiol< 14 oa~s 1)2,01f.2017 VHA VIS N: 22 ME 14 Days 0 1/22/20 17 VHA VIS N:22 Healill Ted\n ldan SUspenSIOn > 14 Days 02t l9/2017 VHA VlS N:22 Secretary Removal 04/ 10f20 17 VHAVIS N:22 IT """"""'" Ri:::moval D.'i/12'20 17 VHAVlS N. 22 Senio< Re.,.,.,al 05'll6/20 17 VHA VIS N. 22 l' fl - Remcwal 05'05/20 17 VHI\ VlSN: 23 LPN SUspenSIOn > 14 Days 06/23/20 17 VHA VIS N: 23 Pttysjda:1 Removal 02/ 10f20 17 VHA VlS N: 23 C"'1nie 1-1Days 02/24f.2017 VHA VlS N: 23 SCnlOfLeaclCr oemolJOO 06/ 19f.2017 i..i,ade rJ ,1A Vl"'I AMERICAN PVERSIGHT OS,17(R)1 7 ~ \ '-q,!,../ 1 l l.S. Dl'JlEHLmr nl o( \', oLL!rnns/\rfnl rs 27 VA-19-0799-H-000488 OS 00019792 Caregiver Moonshot Slide Draft/ Pre-decislonal / For Internal VA Use Only AMERICAN PVERSIGHT 28 ,1A VI"'\ ~) '-.!l > 1 ll .s. n<'p"rtment of\',oL~rnns ,\lfalrs VA-19-0799-H-000489 OS 00019793 Impact of VA Care on Suicide Rates o.o us ffl o VETERANS t RECENTLYUSED VA Services NO RECENTUSE OF VA Services 5.4% 38.40/ot I VETERAN MALES t 8% 35.50/ot o VETERAN FEMALES o 2.6% 81.60/ot ' 2001-2014 'IA V"" f:!"") ' '-a,S, l l.S. n ,op<>rlmr nl of \', oLL:mnsJ\ffn)rs 29 I AMERICAN PVERSIGHT VA-19-0799-H-000490 OS 00019794 REACH VET Predictive ? Modeling Uses data to identify Veterans at high risk for suicide ? Notifies VA providers of the risk assessment ? Allows providers to reevaluate and enhance the Veteran's care ,1A V,.., AMERICAN PVERSIGHT ~ ~ !/ \ 1 l l.S. l)(out,rlm< ont or\',oL~rnns/\rfnlrs 30 VA-19-0799-H-000491 OS 00019795 Veterans Crisis Line Blocked calls down from over 30% in January to less than 1% today ,1A V,.., AMERICAN PVERSIGHT ~) '-q.:!.,. , LI.S. n,opnr1mrn1 o(\'1oLL:mns ,\ffnlrs 31 VA-19-0799-H-000492 OS 00019796 Other Than Honorable NilcolausCoains VA AMERICAN PVERSIGHT ~ --~ ~ s, i -- l l.S. l ltipnrlm< or\'lol~rnns onl Affnlrs 32 VA-19-0799-H-000493 DS_00019797 Suicide Prevention 33 , IA Vl"'I f....,'I , '.!1.Y LIS . ll ,opnrlm<' lll orVl'k rnns Affmrs The video will play as soon as you cue the next slide . AMERICAN PVERSIGHT VA-19-0799-H-000494 OS 00019798 ThankYou 34 AMERICAN PVERSIGHT v,...,I'-,.-.;~ rA LIS . ll,opnrlm,ont ~ !,:,1 1 orVtokrn11s ,\ffo1rs VA-19-0799-H-000495 OS_ 00019799 Message From: David Shulkin [drshulkin@aol.com] Sent: 9/16/2017 9:27:16 PM To: (b) (6) Subject: Attachments: AMERICAN (b) (6) gmail.com able award comments to print out PVAableawards .docx PVERSIGHT VA-19-0799-H-000496 OS 00019801 PVA (b) (6) thank you for the kind introduction Everyone- thank you for that warm welcome Governor McAulifee- thank you for your support of Veterans, PVA, and Mission Able. I used to thin that being Governor would be a cush job- but after watching Terry he has taken it to a new level- including jumping our of airplanes and even doing some matchmaking on the side- I think he is a very special person I want to recognize (b) (6) the new National President of PVA (b) (6) -Thank you for your ongoing service to Veterans . (b) (6) of Desert Storm. is an Air Force Combat Veteran (b) (6) the combat experience should come in Handy in working with (b) (6) AMERICAN PVERSIGHT VA-19-0799-H-000497 OS 00019802 To (b) (6) and the entire leadership team and their staff- thank you for fighting hard every day. Nobody is tougher and more Tenacious than (b) (6) (b) (6) is that guy who is in the crowd and everyone sees something that is wrong but no one wants to say something. Well (b) (6) (b) (6) raises his hand and speaks out. than you for your courage and your passion to do what is right. Earlier Today I was with the leaders of VA facilities from all around the country and I had a chance to address them. I started by reading them a description of VA from the Press. Somedays its just hard to pick up a newspaper or turn on the TV the press is so brutal. What I read was one of those days. It said "The VA is a vast dehumanized beaurcrasy, embedded in mountains of red AMERICAN PVERSIGHT VA-19-0799-H-000498 OS 00019803 tape, ingrown with entrenched mediocrity, undemocratically operated under autocratic control centered in Washington DC, and rigidly resistant to proposed reforms"- This was written in 1940 But it shows that the problems that we face in VA are not new and many have been entrenched for decades. Tackling these problems that have been kicked down the road is exactly what we are doing in this administration. A few weeks ago, President Trump signed legislation modernizing VA's appeals processes - bringing them into the 21st century. It thoroughly overhauls and modernizes our claims appeals and was right there in Reno to sign this with the President. The law (b) (6) AMERICAN PVERSIGHT VA-19-0799-H-000499 OS 00019804 had last been updated in the 1930s. Without PVA's contributions at the very beginning, veterans would'nt have this legislation. We also counted on PVA's support to get accountability legislation that we have needed for decades. We now have the ability to fire people that have lost the right to the privilege to serve veterans. It was PVA's feedback and input that helped me establish our priorities for fixing VA. One of these priorities is to focus our resources on those services that are critical to veterans- such as spinal cord injury or treatment of PTS. We're moving tens of millions of dollars into these services. Were divesting of vacant and underutilized buildings to reinvest in facilities that veterans use. AMERICAN PVERSIGHT VA-19-0799-H-000500 OS 00019805 The President signed a new GI Bill with expanded benefits and PVA was there to support this. We've authorized mental health care to those veterans with 0TH discharges address the veteran suicide rate. We've begun to remove unnecessary regulations to help us build facilities faster and cheaper and we have reduced regulations that have been barriers to needed technology like telehealth. We've reduced opioid use among veterans by 25%, we've reduce veteran homelessness by clost to 50%, and we're made dramatic progress in curing hepatitis C from veterans using VA Our most important job this fall will be to get our CHOICElegislation fixed. I know PVA shares our goal to get veterans care in a less complex and streamlined way. Our current system is driven by administrative rules and far too AMERICAN PVERSIGHT VA-19-0799-H-000501 OS 00019806 confusing so we are going to dramatically change how veterans access care. Its called CARE-coordinated Access and Rewarding . expenences. And so while there remains so much to do, lets not forget that there is so much that goes on in VA that is incredible. If you have never been to the Wheelchair games you are missing something. Now in their 37 th year these games are changing the lives of hundreds of veteransand PVA of course is one of the key supporters. PVA also providers scholarships to VA clinicians to attend essential continuing medical education events and they bring their experts to our 24 spinal cord injury centers to help us get better and stronger. AMERICAN PVERSIGHT VA-19-0799-H-000502 OS 00019807 VA's research is bringing new prosthetics to the market, that is finding new ways to help people with spinal cord injury function- like our Braingate work- and our partnerships that gave veterans the exoskeleton so they could walk . again. But If we are truly going to fix VA- and we arewe're going to need strong partners like PVA. VA couldnt have a better partner than PVA - so and thank you for your leadership and thank you all again for your time and support. (b) (6) AMERICAN PVERSIGHT (b) (6) VA-19-0799-H-000503 OS 00019808 Message From: Sent: To: Subject: Attachments: AMERICAN David Shulkin [drshulkin@aol.com] 9/21/2017 7:15:41 PM (b) (6) gmai l.com (b) (6) telehea lth slides for a start telehea lthpresentat ion .pptx PVERSIGHT VA-19-0799-H-000504 OS 00019809 VAl~I U.S. Departm ent of Veterans Affairs Presentation at American Telemedicine Association David Shulkin, MD Secretary Veterans Health Admini stration AMERICAr-... pVERSIGHT VA-19-0799-H-000505 DS_00019810 Fulfilling our Mission 1? To care for him who shall have borne the battle and for his widow, and his orphan. 1 FulfillingOur Mission Clinical Care Benefits and Services Cemeteries and Legacy Education Research Emergency Preparedness AMERICAN PVERSIGHT VA-19-0799-H-000507 OS 00019812 Telehealth's Role in Delivering on Our Mission ' ' Making-No Funding Impact AMERICAN PVERSIGHT VA-19-0799-H-000508 OS 00019813 ~ v I U.S. Department of Veterans Affairs X'ected o" (.J c Telemedicine Telehealth Virtual Care mHealth (mobile) Patient Portals eHealth Digital Health ~;. (t) 5 AMERICAN PVERSIGHT VA-19-0799-H-000509 DS_00019814 Largest Educator of Health Professiona ls o over 1,800academicand institutionalpartners o 120,000healthcareworkerstrainedeachyear: ~60,000medicalstudentsand residents ~30,000nursingstudents ~30,000studentsin otherhealthfields o An estimated70%of all U.S.doctorshavetrainedwith VA. Ii AMERICAN PVERSIGHT VA-19-0799-H-000510 OS 00019815 Emergency Preparedness and Telehealth - Florida Keys AMERICAN PVERSIGHT VA-19-0799-H-000511 OS 00019816 Not the Best of Times "VA is a vast dehumanized, embedded in mountains of red tape, ingrown with entrenched mediocrity, undemocratically operated under autocratic control centered in Washington DC, and rigidly resistant to proposed reforms" - New York Magazine 8 AMERICAN PVERSIGHT VA-19-0799-H-000512 OS 00019817 The Current State of VA UsingTelehealth to AddressOur BiggestVulnerabilities AMERICAN PVERSIGHT VA-19-0799-H-000513 OS 00019818 13 Risks 1. Access to Care 2. Paying Providers 3. Community Care 4. Quality of VA Care 5. Disability Claims & Appeals 8. Construct ion 9. Accountability 10. Staffing 11. Bureaucracy 6. Information Technology 12. Fraud, Waste & Abuse 7. Capital Assets 13. Veteran Suicides AMERICAN PVERSIGHT VA-19-0799-H-000514 DS_00019819 VA will be the Most Transparent Organization in Government AMERICAN PVERSIGHT VA-19-0799-H-000515 OS 00019820 The Secretary's 5 Priorities Greater Choice Modernize Systems ~0 Improve Timeliness AMERICAN PVERSIGHT Focus Resources ooo ooo ooo Suicide Prevention VA-19-0799-H-000516 OS 00019821 Best Practices Everywhere (Get Picture of Book Cover) 13 AMERICAN PVERSIGHT VA-19-0799-H-000517 OS 00019822 1. Greater Choice OOMPETITION 8 Quality and Service Wil Drive Choice A ? AMERICAN PVERSIGHT VA-19-0799-H-000519 OS 00019824 VA Telehealth Services 2.14 Million Episodes to 677,000 Veterans (12%) 156,000 Veterans Store & Forward 298,000 Veterans 45% of our Telehealth Services are for Rural Veterans 336,000 Telemental health vis its 16 Clinical Video Telehealth (CVT) - Real-time video consultation that covers over 45 clinical specialties including: Telelntensive Care , TeleMental Health, TeleCardiology, TeleNeurology , TeleSurgery, Women 's Telehealth , Tele-Primary Care, TeleSCI/D , TeleAmputation , TeleAudiology , TeleSpeech, Remote Nursing Home Consultation , TelePatho logy , etc . Home Telehealth (HT) - Care and case management of chronic conditions and provision of non-institutional care support to patients. Uses in-home and mobile technologies to manage diabetes, chronic heart failure, hypertension, obesity, traumatic brain injury , depression , etc . Store-and-Forward Telehea lth (SFT) - TeleRetinal Imaging , TeleDermatology , TeleWound Care , TeleSpirometry , TeleSleep Studies AMERICAN PVERSIGHT VA-19-0799-H-000520 DS_00019825 VATelehealth o Healthcare Anywhere to Anywhere o 11 Tele-mental Health Hubs o Teleprimary Care ~i ~ ~ ; ! o ~~oir=~~lty 17 AMERICAN PVERSIGHT VA-19-0799-H-000521 DS_00019826 Video Connect Mobile to Mobile Text Messaging Annie- a mobile messaging system that promotes self-care for Veterans. Ann1e sends regular, automated text message rem ind ers to Veterans to help them track healt h information their VA care teams have requested. Annie can also can send Veterans rem inders and messages from t heir local VA facility. learn Mo re: https://www.youtube.com/watch AMERICAN PVERSIGHT ?v=zkekNr6DeQY&featu re=youtu. be VA-19-0799-H-000523 DS_00019828 2. Modernize o EMR interoperability and IT modernization Our Systents Mi+fS . CiENESIS ~ M081@;1#:?:if.o8i:Uil-.H?MI Modern.Secure.Connected. AMERICAN PVERSIGHT VA-19-0799-H-000524 OS 00019829 I The Wall Street JO\lmal o OfflC~I tor 2 Months &te s, ubo!Dw,Slk-0'1'9,if/kll &OMV.,.,. .... l'l'lbtnJt,,c:I 0,.0~ AMERICAN PVERSIGHT VA-19-0799-H-000525 DS_00019830 Tele-ICU Hubs VHA Tele-ICU Fact Sheet VISN 10 Te le-ICU program (Cinc1nnati) Connects to orti~r fac-lllties ln~05rl~ careUmts VISN 23 Tele-ICU Program (M inneapo lis) Connectsto oth~fadhties' lntem~~eCare Un)t:s n Tele-ICU is the delivery of Critical Care Services across a geographic distance through the use of electronic interfaces and videoconferencing A typical Tele-ICU workstation has connections into each facility's electronic medical record (CPRSNistA), lab reports , radiology viewing system (to pull diagnostic images) , and the real-time vital signs waveforms from the patient monitors A high-resolution camera installed over the patient's bed can be controlled in the Tele -ICU to allow close-up examination of the patient or equipment in the room Video from the Tele-ICU is NEVER recorded Tele-ICU does not replace the bedside team , but augments care with instantaneously available experienced critical care practitioners and proactive rounding to identify patients at risk of complications Tele-ICU is staffed by experienced, credentialed ICU nurses and intensivist physicians with subspecialty training in critical care medicine In many critical access , rura l facilities intensivist physicians were not available to ICU patients prior to Tele-ICU In 2017, Tele-ICU will be expanding to: Kansas City Columbia , MO White River Junction, VT Fort Wayne , IN Wilmington , DE Muskogee , OK Mountain Home , TN Maine VA Health Care System AIVlt-Hll.,AI PVERSIGHT VA-19-0799-H-000526 DS_00019831 Nellis Air Force Base (DoD JIF Funding) Langley Air Force Base (DoD JIF Funding) Keesler Air Force Base (DoD JIF Funding) Wright Patterson Air Force Base (DoD JIF Funding) Elmendorf Air Force Base (DoD JIF Funding) AMERICAN PVERSIGHT VA-19-0799-H-000527 OS 00019832 Your Life Your Health Your Schedule AMERICAN PVERSIGHT Veteran Appointment Request App VA-19-0799-H-000528 DS_00019833 Veteran's Portal- MyHealtheVet I ,.\GBP ...,,,'''' VA I ,.... 1"~" Se.srdl Q. ,,11, ~.-..,..,\Lo.1o I ::',>.3.HBOARDPHARtAACV APPODffl.fDlT'5 ~!Si HE:Al.nl RE:COR.DSRGBPS0URCGBPS My HealtheVet Statistics Registrants: 3.6 million Secure Messaging users: 1.7 million Rx Refill Requests: 81 million Resources ~ o Yt;t,r,ns, t!Hlth ~ VA Blue Button Downloads: 1.4 Million - Notifications Muhhyl.Mng r:nttultl,fll~h:no ~ ::1Mr;~u. ,rioonl :.i."'cr~1, tMICo~:or,,i ~o9"Q,-JPY? ..,E:i~ Change in Appointment Viewers from December 2014 to December 2015: 32% Increase o statistics as of March 2016 24 AMERICAN PVERSIGHT VA-19-0799-H-000529 OS 00019834 3. Timeliness VA Putting Veterans First Same-Day Access Improving Timeliness of Services Same-Day Healthcare Services and Other Options at VA Facilities - .L ::t:- t~f~ - ::hk7a 0 .__ 97% of .appointments are now -~ -_ - completecl within 30 days of the ~'!.?:... ? - -- - . - ;. - - - Vetera.n':s-preferr-ed -d =ate... o- 8~/4 . .-- - - - ~~ .. =.~:._-:.~ t~-s:~ areWithin - Z days . [ ~ 21% are same-day -irppointments i~o AMERICAN PVERSIGHT VA-19-0799-H-000531 OS 00019836 Transparency Wait times at local facilities Wa Tffilt,for~otVAFac, AMERICAN PVERSIGHT of Access What Veterans are saying about access Whal Veteran, SeyAbo Subject: Article ail.com> http ://www. politico.com/ story/20 l 7/09/15/kel Iy-1ooks-at-shaking-u p-white-house-pol iticaloperation-242788 Background as you read : Office of political affairs is the office that sends us requests for you to host these listening sessions Office of the public liaison, is where-(b) (6) AMERICAN PVERSIGHT is out of. VA-19-0799-H-000544 DS 00019849 Message From: (b) (6) Sent : 9/16/2017 3:36:03 PM To : David Shu Ikin (drshulkin@aol.com] Art icle Subject: (b) (6) (b) (6) gmail.com) http:/ /www.politico.com/story/2017 /09/ 15/kelly-looks-at-shaking-up-white-house-political-operation-242 788 Background as you read : Office of political affairs is the office that sends us requests for you to host these listening sessions Office oftbe public liaison, is where-(b) (6) AMERICAN PVERSIGHT is out of. VA-19-0799-H-000545 DS 00019850 Message From: Sent: To: Subject: Davidshulkin [Drshulkin@aol.com] 9/21/2017 11:59:24 AM Poonam Alaigh (b) ot mail.com] (b)(6)(6) Re: Veterans Day I know Sent from my iPhone (b) (6) > on Sep 21, 2017, at 6:21 AM, Poonam Alaigh <-otmail (b) (6) > > It's a bad day again today- just feeling down realizing .com> wrote: I am going to miss Veterans Day celebrations and so much- > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000546 OS 00019851 Message From: Sent: To: Subject: Poonam Alaigh (b) otmail.com] (b)(6)(6) 9/21/2017 10:21:10 AM David Shulkin [drshulkin@aol.com] Veterans Day It's a bad day again todayfeeling down just realizing I am going to miss Veterans Day celebrations and so much- Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000547 OS 00019852 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 9/24/2017 3:25:43 PM To: (b) (6) ViviecaSimpson -@g mail.com] Vivieca - the security detail issues continues to be unresolved - i dont know if you want to handle - if you want me to meet with Don and Kevin or if you want to pull in Tom bowman There are two issues now 1) Tim has now capped out till January on his hours and 3-4 others will soon do the same. This has never happened before but since we have been down jerry Brown, joe B, mark, and schmidy retired this has occurred. This is directly impacting on my protectioni no longer have a chase car with me and when you look at what happened to Steve Scalise its clear they needed two agents. Since noone is doing anything i have to intervene I had suggested that mark come and help the deputy Until we figure agents time this out i am recommending that we pull the advance from the deputy - which will free up I would also like to see if it is within our authority to approve an authorized absence on Monday for the agents that are not traveling with me or the deputy to acknowledge the hard work they have been doingif thats not within our authority then lets not do it. Thanks sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000548 OS 00019853 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 9/14/2017 6:00:41 PM To: (b) (6) Bruce Moskowit z [brucem~mac (b) (6) Re:-buffalo Subject: (b) (6) .com] Ok thanks Sent from my iPhone (b) (6) (b) > on Sep 13, 2017, at 5:00 PM, Bruce Moskowitz wrote: > (6) > He is head of board Jacobs institute worth a visit while there to see how that MI handle acute stro ke and > (b) (6) >< -VCf > > > > > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000549 OS 00019854 Message From: Bruce Moskowitz [brucem Sent: 9/13/2017 9:00:06 PM To: Subject: Attachments: (b) (6) mac.com] David Shulkin [secshulkin@gma il.com] buffa lo (b) (6) vcf; Untitled attachment 87345 .txt (b) (6) He is head of board Jacobs institute AMERICAN (b) (6) PVERSIGHT worth a visit while there to see how that handle acute stroke and MI VA-19-0799-H-000550 OS 00019855 Contact Full Name: (b) (6) Last Name: First Name: (b) (6) (b) ? E-mail: (b) (6) @immco.com (6) AMERICAN PVERSIGHT VA-19-0799-H-000551 DS_00019856 Sent from my iPhone Message From: Sent: To: Subject: Attachments: AMERICAN Bruce Moskowitz [brucem (b) (6) (b) mac.com] 9/13/2017 8:53:11 PM (6) David Shulkin [secshulkin@gma il.com] (b) (6) buffa lo (b) (6) vcf; Untitled attachment 87351.txt PVERSIGHT VA-19-0799-H-000553 OS 00019858 Contact Full Name: (b) (6) Last Name: First Name: (b) (6) (b) ? E-mail: (b) (6) @jacobsinstitute.com (6) AMERICAN PVERSIGHT VA-19-0799-H-000554 DS_00019859 Sent from my iPhone Message From: (b) (6) (b) (6) Sent: To : 9/16/2017 7:31:11 PM David ShuIkin (drshulkin@aol.com] Subject: Re: Cleveland (b) (6) gmail.com] :-) ok got it. 1 really hope you go and develop even better relationships with the committee. Such a great opportunity for you and va. On Sat, Sep 16, 2017 at 3:19 PNl (b) (6) (b) (6) (b) (6) ail.com > wrote : -------~-- Forwarded message--------From : David Shulkin Date : Sat, Sep 16 2017 at 3 :18 PM Subject: Cleveland (b)(6)(6) 0 To: (b) ail.com > No its not a request for more peach pie- but rather I want to get on top of my presentations- particularly if I go on the Godel Th is is the framework for the Cleve land Clinic Presentation- I need to fill in the slides that are space holders attached We need a picture of Best Care Everywhere book and we need a better picture of the HIC and then find the other slides from past presentations that you have. Thanks Sent from Gmai] Mobile Sent from Gmail Mobile Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000556 DS 00019861 Message From: David Shulkin [drshulkin@aol.com] Sent: 9/16/2017 7:18:50 PM To: (b) (6) Subject: Attachments: (b) (6) gmail.com Cleveland clevelandinnovat ion .pptx No its not a request for more peach pie- but rather I want to get on top of my presentations- particularly if I go on the Godel This is the framework for the Cleveland Clinic Presentation- I need to fill in the slides that are space holders attached We need a picture of Best Care Everywhere book and we need a better picture of the HIC and then find the other slides from past presentations that you have . Thanks AMERICAN PVERSIGHT VA-19-0799-H-000557 OS 00019862 5 ?1 \n - mew, ?~32 VA i LLS. Department I of \f'ctura i re; U.S. Department of Veterans Affairs Innovations Summit David J. Shulkin, MD Secretary of Veterans Affairs April 19, 201? battle, and for his widow and his orphan.? Abraham Lincoln, 1855 f? ?To care for him who if?: shaii have borne the (F 1 .J Our Mission To care for those who have "borne the battle? and for their families and survivors. \V atching the Mission in Action FinalSalute'honor Holocaustsurvivor Veteran AMERICAN PVERSIGHT VA-19-0799-H-000560 OS 00019865 Learning About VA On the Ski Slopes ,1A 4 AMERICAN PVERSIGHT v.... t'-.,.,~ , ~ y LI S. ll rtmtont of\ '1olL:rnn.~J\rfair-s VA-19-0799-H-000571 OS 00019876 2. Modernize o EMR interoperability and IT modernization Our Systeins MtffS. CiENESIS ~ Ri08iM-i#:?JPY1Uii=UHiiA?I Modern.Secure.Connected. ,1A V,..., AMERICAN PVERSIGHT ~\ ~ !.,I 1 l l..""i.DPp11rlment of\ '1'll.!rnns/\GBPTair.... 15 VA-19-0799-H-000572 OS 00019877 Robotics Draft/ Pre-decisional / For Internal VA Use Only AMERICAN PVERSIGHT 16 vl""I.~ y rA ~\ l 1 S lll'JltHLm< I onl oi\ ;,oL~rnn~,u \rfnirs VA-19-0799-H-000573 DS_00019878 Whole Health Model of Care Draft/ Pre-decislonal / For Internal VA Use Only AMERICAN PVERSIGHT 17 ,1A VI"'\ ~) '-.!l > 1 ll .s. n<'p"rtment ,\lfalrs of\',oL~rnns VA-19-0799-H-000574 OS 00019879 3. Improving Timeliness Same Day Services Slide Draft/ Pre-decisional/ AMERICAN PVERSIGHT For Internal VA Use Only 18 ,1A V"" ~) ~ !,. , l l.S. DPp.,r1mrn1 of\',ol~mns ,\ffnlrs VA-19-0799-H-000575 OS 00019880 Transparency Wait times at local facilities WaT!n-...lor~o VAF of Access What Veterans are saying about access ~t Vetan,nsSayAboutAccessto ea,., al VAlac -es ,1A VI-I AMERICAN PVERSIGHT ~~ '-!A,!/ 1 l l.S. ll (ounr LmP nt ,\ rfnlrs orv...tL::rnns. 19 VA-19-0799-H-000576 OS 00019881 VA Telehealth o 9 Million episodes of Telehealth o 717,000 Veterans using Telehealth o 336,000 Telementa l health visits o Over 5000 Tele-ICU patients ,1A Vl"'I AMERICAN PVERSIGHT ~ .'\ ~ Y 1 l l.S. l)l'Jl [lrlm< onl of\',oLL:mns/\rf nl rs 20 VA-19-0799-H-000577 OS 00019882 4. Focus our Resources ,1A Vl""I. AMERICAN PVERSIGHT t,....-.;,Ll S . 1l(o1.mrlm<> '-a Y 1 uf\'l'krn nt .ns J\ffmrs 21 VA-19-0799-H-000578 OS 00019883 Get Professional Photo of the Healthcare Operations Center 22 AMERICAN PVERSIGHT ,1A V,.., f:"") , '-a S. l l.S. n,oprtment of\ '1olL:rnn.~J\GBPTuirs VA-19-0799-H-000580 OS 00019885 Caregiver Moonshot Slide Draft/ Pre-decislonal / For Internal VA Use Only AMERICAN PVERSIGHT 24 ,1A VI"'\ ~) '-.!l > 1 ll .s. n<'p"rtment ,\lfalrs of\',oL~rnns VA-19-0799-H-000581 OS 00019886 5. Suicide Prevention 25 , IA Vl"'I f....,'I , '.!1.Y LIS . ll ,opnrlm<' lll orVl'k rnns Affmrs The video will play as soon as you cue the next slide . AMERICAN PVERSIGHT VA-19-0799-H-000582 OS 00019887 Tom Hanks PSA Here 26 AMERICAN PVERSIGHT ,1A Vl""l ~\ ~ Y 1 l l S.DPpnrLment of\'t'll..!rnn.~J\rTairs VA-19-0799-H-000583 OS 00019888 Impact of VA Care on Suicide Rates o.o us ffl o VETERANS t RECENTLYUSED VA Services NO RECENTUSE OF VA Services 5.4% 38.40/ot I VETERAN MALES t 8% 35.50/ot o VETERAN FEMALES o 2.6% 81.60/ot ' 2001-2014 'IA V"" f:!"") ' '-a,S, l l.S. n,op<>rlmrnl of\',oLL:mns/\rfn)rs 27 I AMERICAN PVERSIGHT VA-19-0799-H-000584 OS 00019889 REACH VET Predictive ? Modeling Uses data to identify Veterans at high risk for suicide ? Notifies VA providers of the risk assessment ? Allows providers to reevaluate and enhance the Veteran's care ,1A V,.., AMERICAN PVERSIGHT ~ ~ !/ \ 1 l l.S. l)(out,rlm< ont or\',oL~rnnsJ\rfnirs 28 VA-19-0799-H-000585 OS 00019890 ThankYou 29 AMERICAN PVERSIGHT v,...,I'-,.-.;~ rA LIS . ll,opnrlm,ont ~ !,:,1 1 orVtokrn11s ,\ffo1rs VA-19-0799-H-000586 DS_00019891 Message From: Sent: To: Subject: Ecard from AmericanGreetings.com [ecards@americangreetings.com] 9/22/2017 4:30:40 AM secshulkin@gmail.com Reminder: Your ecard from Laura is waiting for you at AmericanGreetings.com We not~ou (b) (6) Laura ~gmail haven't picked up your greeting that .com) sent to you on 09/17/2017. To view your ecard, click on the link below: https://www.americangreetings.com/ecards/view/rf04646b4f29b4db582a8f4a7b2f9cae5?source=ag994&utm nternal_email&utm_source=pickup&utm_campaign=rmdreceiver4 _medium=i For your security , if you'd prefer not to click on links within this email : 1. 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Your friends AMERICAN at AmericanGreetings . com PVERSIGHT VA-19-0799-H-000587 OS 00019892 Message (b) (6) From: Sent : (b) (6) (b) (6) gmall.com] 10/9/2017 3:36:09 PM David ShuIkin (drshulkin@aol.com] Re: Press Club Talk To : Subject: Sure, wil I have this scheduled this for .10/'16. On Oct 9, 2017 11 :27 AM, "David Shul kintt wrote : -(b) (6) I want to try to work up a policy talk on benefits reform for the national press club address on November 6th I am attaching some initial slides. Were going to have to meet With both VBA and the speechwrtters to get this where we need it to be. The real substance starts about slide 28 and we need help with the data alild the next steps . Can we meet with then in the next 1O days so they can begin work on this? AMERICAN PVERSIGHT VA-19-0799-H-000588 OS 00019893 Message From: Sent: To: Subject: Attachments: -(b) (6) David Shulkin [drshulkin@aol.com] 10/9/2017 3:27:33 PM (b) (6) gmail.com (b) (6) Press Club Talk nationa lpresscl ubhistor y.pptx I want to try to work up a policy talk on benefits reform for the national press club address on November 6th I am attaching some initial slides. Were going to have to meet with both VBA and the speechwriters to get th is where we need it to be. The real substance starts about slide 28 and we need help with the data and the next steps . Can we meet with then in the next 1O days so they can begin work on this? AMERICAN PVERSIGHT VA-19-0799-H-000589 OS 00019894 IS IT TIME TO RE-THINK VA Na?onal Press Club David Shulkin, M.D. Secretary, US Deparimenf of Veierun Affairs 9895 Romans were the first to provide benefits for veterans AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000591 DS 00019896 Our roots really go back to 1636, when the Pilgrims of Plymouth Colony were at wa r with the Pequot Indians . The Pilgrims passed a law that stated that disabled soldiers would be supported by the colony. Virginia followed in 1644 and Maryland next in 1661 AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000592 DS 00019897 ...... ----~~- .;;.--~ . .:-,- -- In 1776, the Continental Congress provided pensions to disabled soldiers . But the paper money was worthless and many soliders were destitute In 1778 officers were offered one half of their pay for life during peacetime but again The treasury has not money so it was issued in IOUs. AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000593 DS_ 00019898 The first home for veterans was the naval home in Philadelphia in 1812. AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000594 DS 00019899 Preisdent Monroe introduced a veteran pensio n benefit- it was $20/mont h for life for officer and $8/mon th for enlisted soliders. Congress had believed the total cost would be $500,000 since they believed few would apply. But the actual cost was much higher As more than 6 times as many veterans applied as expected. In 1820, Congress then ammened the pension to include only those that were indigent AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000595 DS 00019900 In 1829 President Jackson tried to increase the pensions to veterans but Congress defeated it. AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000596 DS 00019901 A congressiona l comm ittee in 1834 found that there were 32,900 veterans from the Revolutionary war receiving pensions And concluded that there was extensive fraud and abuse in the system . AMERICAN PVERSIGHT VA-19-0799-H-000597 OS 00019902 "BASIC"' ELIGIBILITY FACTORS _, \\' 1doyM. \\o(totill ::So!LJM.ll.ll:!.'..(IDi.w:dl.11...e,~ 'f.<.o SJw1,oDP!!'l.1.SUU1 65..r,,ln1it ..... Uadff-6$ ll d-Hu:;~ P{T C>1J;1bltd Ad1us:~ loo0a1" 01:W1L~}Ht l.ba1:1 ~_to ~1o~irat.1m l nJUJijl Pt'!lll,lOIIX11l111: AMERICAN PVERSIGHT Adjwml lt~t,:m~ m~, bot-kn Uw\ ~f1n.i1n11mJin111.1;;1 I t' tr.KIII ~cl ~\or1h : b tP 'l'ofll)(!iti1,em...,1tltm111.\Ilidr VA-19-0799-H-000598 OS 00019903 Ttl[rol E XI CAN ERICAN WAR In 1849 veterans from the Mexican American war begin to require extensive services and in 1851 soliders homes Began to be constructed . AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000599 DS 00019904 On March 3, 1865, President Lincoln, a month before the end of the Civil W ar, signed into law a bill to establish a national soldiers and sailors asylum. Following the decade after the civil war Pensions for veterans were increased 10 times AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000600 DS_ 00019905 If the veteran decide to forgo payment they would be given an artificial limb with a replacement every 3 years AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000601 DS 00019906 VSO's were fonned at this time to lobby congress for more help for veterans and to build more soliders homes AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000602 DS_ 00019907 Morphine was deve loped in 1865 as was the hypodermic needle and drug abuse among veterans became a big issue Affecting more tha n 45,000 veterans . Veterans with drug and alcohom abuse or mental issue were not reviewed as wounded in wa r but As criminals or weak and were shunned by families and society AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000603 DS_ 00019908 In 1878 the Secretary of the Treasury John Sherman estiabmed that claims from vete rans could be as much as $150 million President Rutherford expanded benefits by signing the Arrears act which extended disability claims beyond 5 years In 1878 were there 25,904 claims for pensions filed .. By 1880, this had gone up to 138, 195 claims filed. AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000604 DS_00019909 In 1895 when Grover Clevland took office pensions for soliders we re the single largest item in the US budget He signed an additional 1453 veteran benefit bills In 1887 howerever he vetoed the Dependent Pension Bill to grant benefits whether veterans were service connected or not and This was singled as the major reason he was defeated in the election the next year. AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000605 DS 00019910 Dependent and Disability Pension Act In 1890 Congress passed the Dependent pension act so that any veteran who served more than 90 days would receive a pension Reglardless of financial status In 1907 and again in 1912 Congress graduated payments by age and length of service AMERICAN PVERSIGHT VA-19-0799-H-000606 OS 00019911 In 1917, as the US entered World War I, Congress established a new system of disab ility compensation and vocational rehabil itation for the disabled. More than 300,000 soliders were wounded but most claims denied-with only 47K being approved. AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000607 DS_00019912 The first conso lidation of federal veterans programs took place August 9, 1921, when Congress combined all veterans programs to create the Veterans Bureau. The budget at the time was 477 million Colonel Forbes was put in charge of the bureau and in 1922 set about a large construction program of VA hospitals to address the needs of World War I veterans by expanding our long-term care capacity to deal with tuberculosis and psychiatric disorders . AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000608 DS_00019913 Admission to the national homes for veterans were extended to women in 1928. AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000609 DS 00019914 The second consolidation of veterans programs took place on July 21 , 1930, when President Hoover elevated the Veterans Bureau to the Veterans Administration . At that time 32,000 veterans were in VA hospitals and 23,000 veterans were in solidershomes. AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000610 DS_00019915 In 1931 President Hoover vetoed the War Compensation act which was to allow beterans to borrow up to 50% of their life lnsurace value but congress overroad the veto and more than 3 millionveterans took the advance on their policies In 1935, Presidnet Franlkin vetoed a bonus bill for veterans to give an addition 2.5 billion to veterans but the veto wsa overturned by Congress AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000611 DS 00019916 1943, Vocational RehabilitationAct o Public Law 78-16 o Provided assistance to disabled veterans returning home from WW II ~ 4'Lt110 The vocational rehabilitation act of 1943 was passed for service connected veterans. More than 60000 vets from WWII took advantage AMERICAN PVERSIGHT VA-19-0799-H-000612 OS 00019917 ::e=======-=-=-,,.-=-=-,.-=-== -=-=o= -=-= -=== ::1n~~:n'!a!. UNOROOSEVELT SIGNS ::::.'! ..~;Lu'= .RRIER 'G.LBILL OFRIGHTS ' ~n;=:.:-;r Adl'nlrn.1 Cbeat, th.o eye.A oC OUl'I' e.a the battle r Jptlon t o And Asks Tha t Broad Benefi t s o f or Given Arme d Forces Be Extended to Me rchant Marine 11,not.h c ~lass hlta . n,CC carrt tY d "'.r\vo mof"n o.no -ec ii.pd. .o. cruiser bon"lb8 O'I" lOr lllD.TY, 'Vif!1t$ la and ir~lti> t"lbl . Nirw-Yo&Jr"TDl:Q.. W.A.SHI::NC'rON . ..Tun0 22-P:rcelth e dent Roon . v It t1ig n~d loda,_y, ln o. 0 acin l--publh :: cor~ony. the o,o ... l . which nuthorlz.ea r:d. !!d~ B.ll l c,.f rugb ta;. cOonougb a broad pavg'l:'1llll. o'f b netl'tll tor 1 bo pu.r- votor anft of thlfl war. OOO eub-Colnctdcmt with tl1n .slgntng. ho o W"ar rC!ad a nto.temc.nt 1n "W'htch he: oxpr aaJScd the bopo th.at lho Congre.88 would ooon provldo compa.ro.blo Chant- t bcn e.to t a tor t.ha rnembora of tho morcho.nt. n,erJn o.. :n.n(I thco prcu loca.ted to on to coJUJfdor lcgi&1D.Uon nuurtng er. al-- the smooth tro.nattlon or.: work r e and due from war fobs to peo.cotlmo one.a. da.rnoged n.nd twenty destroyed ln Our loaa t'!IJ"!\ -gmll.11 cooelde wrougbt--onl trom which h.o...vo b en rThc Ta todny n,n l. communJqu or n Jopo 1 two on ln n.n e.ngu The GI Bill was signed on June 22, 1944, and represented a major commitment to veterans benefits . The GI bill also included unemployme nt benefits for veterans . Compensation for unemployed veterans was $20/wk . 7.8 million world war 11veterasn took advantage of educational benefits at a cost of 14.5 billion . AMERICAN PVERSIGHT VA-19-0799-H-000613 OS 00019918 **HO E LOANS** jA, \iW~k The VA home-loan guaranty program helped build one fifth of all single family residences between 1944 through 1993. AMERICAN PVERSIGHT VA-19-0799-H-000614 OS 00019919 In 1955, the Second Hoover Commission found widespread waste and poor care in the VA - and recomme nded closing or selling many VA hosp itals and making Veterans pay fo r non-service-co nnected care and some benefits . AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000615 DS 00019920 In 1988, President Regan elevated the VA to a cabinet-level department. AMf:::RICAr-... pVERSIGHT VA-19-0799-H-000616 DS 00019921 Growth of VA Mandatory Bene?ts COMPLEX SYSTEM OF BENEFITS AND EXAMINATIONS AND DETERMAINATIONS PRIORITY GROUPINGS I-8 SYSTEM OF RATINGS AND RE-RATINOS APPEALS PROCESSES VA-1 9-0799-H-00061 8 Growth in Administrui?ve Costs for Bene?ts 9 DAYS TO PROCESS A CLAIM Growth in Appeals Growth in VBA Employees .LEIOCIDS 8(1le 1.838 01 0803 NI EIS GWHOM VA .LVHM EDIVW Oi 139C308 3H1 SA A WOEH .LEIOGHEI VA d0 MOHS Oi 1| 8| WhoI We'v Learned from HlsIory LIS NEVER FULLY FDR IMPACT OF ET RA TIE TO BEHEHTS BE IN A 3. EA 5T HATES Ii: '13 LITC 17.3 E3 BE ME FIT 1'3? BOW-IE EMA BLE E35.- GT E25 LESS 11BEE-I EFXTS :4 A. ET .r-x A IS .v'iMOST SUCCESSFUL PROGRAMS HAVE BEEN ENABLERS GI EELL Home Loan-3 130.?: [:11 E: [:21 l?r :6 (3:131:33 5:23-75; BENEFITS PROGRAMS SHOULD FACILITATE SECURITY, WELL BEING, AND IMPROVED FUNCTIONING Policy Implications for Benefiis Reform SIMPLIFY BENEFITS DETERMINATIONS SERVICE CONNECTNESS SHOULD BE MAINTAINED ELIMINATE POLICY OF RE-RATINGS TO PROVIDE GREATER CONTINUITY BENEFITS SHOULD BE DF FAT I POTENTIAL SOLUTIONS DAY OF DISCHARGE DETERMINATIONS INSTANT ADJUDICATIONS WELLNESS AND INDEPENDENCE BENEFIT DESIGN VA STAFF AS ADVOCATES AND FACILITATORS NOT - DEPARTMENT OF VETERANS AFFAIRS 2017- 2030 Message From: (b) (6) Sent : 9/25/2017 4:14:03 PM To : David Shulkin (drshulkin@aol.com] FYI Subject: (b) (6) (b) (6) gmall.com] Hey we have to stop using drshulkin@aol.com for va business . We just got a foia request from a reporter asking for all the emails sent from that email to our va accounts . People forward your messages Sent from Gmai l Mobile AMERICAN PVERSIGHT VA-19-0799-H-000630 DS 00019940 Message From: David Shulkin [drshulkin@aol.com] Sent: 9/16/2017 7:37:34 PM To: (b) (6) Subject: Attachments: AMERICAN (b) (6) gmail.com use this as my compet it ion slide in the presentat ions I sent competition.pptx PVERSIGHT VA-19-0799-H-000631 OS 00019941 Veterans Spea1k with VA is Able to Compete a,nd Grow their Feet lncrementalism .snot the answer to additional Improvements VA and Veterans need. AMERICAN PVERSIGHT VA-19-0799-H-000632 OS 00019942 Message David shulkin LDrshulkin@aol.com] From: Sent : 10/30/2017 1:03:42 PM To : (b) (6) Subject: Re: (b) (6) (b) (6) gmail.c.om) We will need to reset unfortunately Sent from my iPhone On Oct 29, 2017, at 12:09 PM, (b) (6) (b) (6) (b) (6) amail .com> wrote: Hi, Sure . Iron key I thought was your wedding date 9-8-1987, if that doesn ' t work, I'll have it changed tomorrow . Re: -(b) (6) the office. I will tell them he will be with you . However, I don ' t believe that should be shared in On Sun, Oct 29, 2017 at 12:06 PNI David shulkin wrote: Hope you enjoying a soggy sunday Two things Can you send me the full password for the iron key- i did not understand the clues Second can we ask if-(b) (6) can come witl1 me on nov 6th to the comedy event at madison square garden in ny next week? Sent from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000633 DS 00019943 Message David shulkin lDrshulkin@aol.com] From: Sent: 10/29/2017 4:28:30 PM To : (b) (6) Subject: Re: (b) (6) (b) (6) gmail.c.om) Ok Sent from my iPhone On Oct 29, 2017, at 12:09 PM, (b) (6) (b) (6) (b) (6) wrote : Hi, Sure . Iron key I thought was your wedding date 9-8-1987, if that doesn ' t work, I'll have it changed tomorrow . Re :-(b) (6) I will tell them he will be with you . However , I don 't believe that should be shared in the office . On Sun, Oct 29 , 2017 at 12:06 PNIDavid shulkin wrote: Hope you enjoying a soggy sunday Two things Can you send me the full password for the iron key- i did not understand the clues Second can we ask if-(b) (6) can come witl1 me on nov 6th to the comedy event at madison square garden in ny next week ? Sent from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000634 DS 00019944 Message From: (b) (6) Sent : 10/29/2017 4:09:18 PM To : David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) (b) (6) gmall.com] Hj Sure . Iron key l thought was your wedding date 9-8-1987, if that doesn ' t work , I'll have it changed tomorrow . Re:-(b) (6) 1 will tell them he will be with you . However, I don 't believ e that sl1ould be shared in the office , Ou Sun , Oct 29~2017 at l2 :06 PM Dav.id shulkin wrote: Hope you enjoying a soggy sunday Two things Can you send me the full password for the iron key- i did not understand the clues Second can we ask if-(b) (6) ny next week? can come with me oh nov 6th to the comedy event at madison squate garden in Sent from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000635 OS 00019945 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 10/29/2017 4:06:35 PM To: (b) (6) Hope you enjoying [(b) (b)(6)(6) gmail.com] a soggy sunday Two things can you send me the full Second can we ask if -(b) (6) ny next week? password for the iron key- i did not understand can come with me on nov 6th the clues to the comedy event at madison square garden in sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000636 OS 00019946 Message From: David shulkin lDrshulkin@aol.com] Sent : To: 9/17/2017 8:41:25 PM (b) (6) Darin Selnick ???? @gmail.com] Subject: Re: The Lessons of Kizer on Bold VA Health care Reform This was 11same page" l no longer can guarantee being sane Sent from my iPhone On Sep 17, 2017, at 3:55 PM , David shulkin wrote : I am completely on the sane page with the bold moves First we have to plug the dike- but that wont last long unless we act bold] y I also agree it must be on the eligibility and funding side. Lets plan on a lunch as dinner times are scarce for me Give-(b) (6) some dates Sent from my iPhone On Sep I 7, 2017, at 2:59 PM, Darin Selt1ick(b) (6) mail .com> wrote : As we work witl1 the Hill and VSOs on making bold VA healthcare reform , and keeping POTIJS commitment to Choice . I provide this reminder of the-fixes and flaws from Kizer and Congress from over 20 years ago, and a couple of suggestions as some food for thought. Commissioo on Care Pages 213 1994-1999 - During a 5-year period , Kizer dramatically changed almost every major VHA management system and improved operational performance through the use of performance measures and contracts . He closed nea.-ly 29,000 acute care beds, merged 52 medical centers into 25 multi-campus facilities , reduced staffing by lllmost 26,000, opened more than 300 community -based outpatient clinics, and treated 24 percent more patients . In addition to bringing measurable quality into VA health care, Kizer achieved marked reductions in waiting times and medical errors. Note: This is how w e pay for Choice: But where is the plan to do this type of bold VHA healthcare reforms? Our CARE Plan is good, but not very bold . Kizer was much bolder in reform than we are being today , and he spelled it out in his vision paper and then did it. We need for VHA a vision paper like Kizer produced in 1995, https://www.va.gov/HEAL THPOLlCYPLANNING/VISION /2CHAP l .pdf AMERICAN PVERSIGHT VA-19-0799-H-000637 DS 00019947 Commission on Ca re Pages 214 The law ' s priority-based enrolJment syste m was intended to give VA a tool to align demand for care with its fundin g level. The law in stead unle ashed political pressu re to expand enro llment , opening the door to an influt. of veterans who historically had not been VA health care users and many of whom were already cove red under military retirement benefits , private insurance, or Medicare. No te: This is why we shouJd get Medicare and TRICARE reimbursement and fix eligibi lity: Thi.s is what the E ligibility and Benefit Task-force wou ld fix! Historical VA budget 1995 - start of VHA refo rms - 36 .7B 1998 -refor ms being carried out- 4 1.7 B - VHA 17.5 B, a decrease from FY 97 of5 4M . https://fas.org/sgp/crs/misc/RS22897 .pdf VHA Funding -Pa ge 10 The preside nt's budget request of $17.5 billion for FY 1998, although presented as an increase over FY 1997 leve ls, actually repres ented a decrease of more than $54 million . http ://nhpf .modernsignal .net/library/issue-briefs/IB7 l6 VA 3-25-98.pdf Although I am over at DPC, I am always avai lable to assist and advise you on the bold reforms and fixes you want for VA, ju st let me know what you need . Perhaps a private conversation over lunc h or dinner on both what is going on in VA and with WH/OJvIB, if that.is something you wou ld like to do in the future . Darin AMERICAr-... pVERSIGHT VA-19-0799-H-000638 D8_0001994 8 Message From: Darin Selnick (b) (6) Sent : 9/17/2017 8:19:33 PM To: David shulkin [Drshulkin@aol.com] Re: The Lessons of Kizer on Bold VA Health care Reform Subject: @gmail.com] OK, thanks Darin On Sun, Sep 17, 2017 at 12:55 PM, David shulkitt wrote : I am completely on the sane page with the bold moves First we have to plug the dike- but that wont last long unless we act boldly . I also agree it must be on the eligibility and fundin_g side .. Lets plan on a lunch as dinner times are scarce for me Give-(b) (6) some dates Sent from my iPhone On Sep 17, 2017 , at 2:59 PM, Darin Selnick (b) (6) ail .com> wrote: As we work with the Hill and VSOs on making bold VA healthcare reform, and keeping POTUS commitment to Choice. I provide this reminder of the fixes and flaws from Kizer and Congress from over 20 years ago, and a couple of suggestions as some food for thought. Commission on Care Pages 213 1994-1999 - During a 5-year period, Kizer dramatically cbang,ed almost every major VHA management system and improved operational performance through the use of performance measures and contracts . He closed nearly 29,000 acute care beds merged 52 medical centers , opened more than 300 into 25 multi-campus facilities , re,luced st,~{fing by almost 26JOOO community -based outpatient clinics, and treated 24 percent more patients . In addition to bringing measurable quality into VA health care, Kizer achieved marked reductions in waiting times and medical errors. Note: This is how we pay for Choice: But where is the plan to do this type of bold VHA healthcare reforms? Our CARE Plan is good, but not very bold . Kizer was much bolder in reform than we are being today, and he spelled it out in his vision paper and then did it We need for VHA a vision paper like Kizer produced in 1995, https ://www .va.gov/HEAL THPOLJCYPLANNINGNISION/2CHAP1 .pdf Commission on Care Pages 214 The law's priority-based enrollment system was intended to give VA a tool to align demand for cm.e with its funding level. The law instead unleashed political pressure to expand enrollment opening the door to an influx of veterans who historically had not been VA heaJth care users and many of whom were already covered under miJitary retirement benefits, private i.nsurance, or Medicare. AMERI .,, I PVERSIGHT VA-19-0799-H-000639 DS 00019949 Note: This is why we should get Medicare and TRICARE reimbursement and fix eligibility: This is what the Eligibility and Benefit Taskforce would fix! Historical VA budget 1995 - start of VHA reforms - 36.7B 1998 - reforms being carried out - 41.7 B - VHA 17.5 B, a decrease from FY 97 of 54M. https ://fas. org/sgp/ crs/misc/RS22 897 .pdf VHA Funding - Page 10 The president's budget request of $17.5 billion for FY 1998, although presented as an increase over FY 1997 levels, actually represented a decrease of more than $54 million . http ://nhpf.modemsignal.net/1ibrary/issue-briefs/IB7l6 VA 3-25-98.pdf AJthough I am over at DPC, I am always available to assist and advise you on the bold reforms and fixes you want for VA just let me know what you need. Perhaps a private conversation over lunch or dinner on both what is going on in VA and with WH/OMB if that is something you would like to do in the future . Darin AMERICAN PVERSIGHT VA-19-0799-H-000640 DS 00019950 Message From: David shulkin lDrshulkin@aol.com] Sent : To: 9/17/2017 7:55:45 PM (b) (6) Darin Selnick ???? @gmail.com] Subject: Re: The Lessons of Kizer on Bold VA Health care Reform I am completely on the sane page with the bold moves First we have to plug the dike- but that wont last long unless we act boldly . 1 also agree it must be on the eligibility and funding side Lets plan on a lunch as dinner times are scarce for me Give_(b) (6) ,some dates Sent from my iPhone On Sep 17, 2017, at 2 :59 PM , Darin Selnick (b) (6) mail .com> wrote: As we work with the llill and VSOs on making bold VA healthcare reform, and keeping POTUS commitment to Choice. I provide this reminder of the fixe s and flaws from Kizer and Congress from over 20 years ago, and a couple of suggestjons as some food for though t. Commission on Care Pages 213 1994-1999 - During a 5-year period, Kizer drama tically changed almost every major VHA management system and improved operational performance through the use of performance measures and contracts . He closed nearly 29,000 acute care beds , merged 52 medica l centers into 25 multi-campus facilities , re,luced st<~ffingby almost 26,000 , opened more than 300 community -based outpatient clinics, and treated 24 percent more patients . In addition to bringing measurable quality into VA health care, Kizer achieved marked reductions in waiting times and medical errors. Note: Thi is how we pay for Choice: But where is the plan to do this type of bold VHA healthcare refonns ? Our CARE Plan is good, but not very bold . Kizer was.much bolder in reform than we are being today , and he spe11edit out in his vision paper and then did it. We need for VHA a visjon paper like Kizer produced in 1995, https:/ /www .va .gov/HEAL THPOLICYPLANNING/VISION/2CHAP 1.pdf Commission on CarePages 214 The law 's priority-based enrollment system was intended to give VA a tool to align demand for care with its funding level. The law instead unleashed political pressure to expand enrollment, opening the door to an influx of veterans who historically had not been VA health care users and many of wh.om were already covered under 01ilitary retire01eot benefits , private insurance, or Medicare. Note : This is why we should get Me dicare and TRICARE reim bursement and fix eligibility: This is what the Eligibility and Benefit Taskforce would fix! AMERICAN PVERSIGHT VA-19-0799-H-000641 DS 00019951 Histor ical VA budget 1995 - start of VHA reforms - 36.7B 1998 - reforms being carried out - 41.7 B - VHA 17.5 B, a decrease from FY 97 of 54M. https://fas .org/sgp/crs/misc/RS22897.pdf VHA Funding - Page 10 The president's budget reque st of $17 .5 billion for FY 1998 , although presented as an increase over FY 1997 levels, actually represented a decrease of more than $54 million . http://nhpf.modernsignal.net/library/issue-briefs/IB7l6 VA 3-25-98.pdf Although I am over at DPC, I am always available to assist and advise you on the bold refonns and fixes you want for VA, just let me know what you need . Perhap s a private conversatio n over lw1ch or dinner on both what is going on in VA and with WH/OMB , if that is something you wou ld like to do in the future. Darin AMERICAr-... pVERSIGHT VA-19-0799-H-000642 D8_00019952 Message From: Darin Selnick (b) (6) Sent : 9/17/2017 6:59:00 PM To: David shulkin [Drshulkin@aol.comJ The Lessons of Kizer on Bold VA Health care Reform Subject: @gmail.com] As we work with the Hill and VSOs on making bold VA healthcare refom1, and keeping POTUS commitment to Choice. I provide this reminder oftbe fixes and flaws from Kizer and Congress from over 20 years ago, and a couple of suggestions as some food for thought. Commission on Care Pages 213 1994-1999 - During a 5-year period , Kizer dramatically changed almost every major VHA management system and improved operational performance through the use of performance measures and contracts . He closed neaJ.ly 29,000 acute care beds, merged 52 medical centers into 25 multi-caw pus facilities , reduced staffing by lllnwst 26,(J00,opened more than 300 community-based outpatient clinics, and treated 24 percent more patients . In addition to bringing measurable quality into VA health care, Kizer achieved marked reductions in waiting times and medical errors. Note.. This is how we pay jar Choice: But where is the plan to do thjs type of bold VHA healthcare reforms ? Our CARE Plan is good , but not very bold . Kizer was much bolder in reform than we are being today , and he spelled it out in his vision paper and then did it. We need for VHA a vision paper like Kizer prodl.lced in 1995, https://www .va .gov/HEALTHPOLICYPLANN1NG/VfSION/2CHAPLpdf Commission on Care Pages 214 The law ' s priority-based enro11ment system was intended to give VA a tool to align demand for care with its funding level. The law instead unleashed politicaJ pressure to expand enrollment, opening the door to an influx of veterans who historically had not been VA health care users and many of whom were already covered under military retirement benefits, private insm.ance, or .Medicare. Note : This is why we should get Medicare and TRICARE reimbursement and fix eligibility : This is what the Eligibility and Benefit Taskforce would fix ! Historical VA budget 1995 - start of VHA reforms - 36 .7B 1998 - reforms being carried out - 4 l. 7 B - VHA 1 7. 5 B, a decrease from FY 97 of 54M. https://fas .org/sgp/crs/misc/RS22897.pdf VRA Funding - Page 10 The president 's budget request of $17 .5 billion for FY 1998, although presented as an increase over FY 1997 levels , actually represented a decrease of more than $54 million . http://nhpf.modemsignal .net/libranr/issue-briefs/IB716 AMERICAN PVERSIGHT VA 3-25-98.pdf VA-19-0799-H-000643 DS 00019953 Although I am over at DPC, I am always available to assist and advise you on the bold reforms and fixes you want for VA, just let me know what you need. Perhaps a private conversation over lunch or dinner on both what is going on in VA and with WH/OMB, if that is something you would like to do in the future. Darin AMERICAN PVERSIGHT VA-19-0799-H-000644 OS 00019954 Message (b) (6) (b) Bruce Moskowit z [brucem~mac .com] (6) Sent: 9/14/2017 6:11:26 PM To: DavidShulkin [secshulkin@gmail.com] ( (b) CC: Ike Perlmutt er [-renchangel59.com] b (6) Subject: Re: ) ( 6 Yes it is phenomenal and )indeed the only chance for health partnerships . From: care improvement would be by expanding Sent from my iPad Bruce Moskowitz M.D. > on Sep 14, 2017, at 1 :02 PM, David shul kin wrote: > > Just spent sone time with -(b) and his team at the cleveland i thin k we can partner with them (6) clinic visiting their innovation center- > > sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000645 OS 00019955 Message From: DavidShulkin [secshulkin@gmail.com] Sent: 9/14/2017 6:02:27 PM To: (b) (6) Bruce Moskowitz [brucem~mac Just spent sone time with -(b) think we can partner with~ (6) (b) (6) ( (b) .com]; Ike Perlmutter [-renchange b (6) ) ( and his team at the cleveland clinic 6 visiting ) l59.com] their innovation center - Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000646 OS 00019956 Message (b) (6) Bruce Moskowit z [brucem~mac (b) (6) 9/13/2017 2:50:46 AM DavidShulkin [secshulkin@gmail.com] Re: Choice Program From: Sent: To: Subject: Perfect .com] than ks Sent from my iPhone > on Sep 12, 2017, at 6:50 PM, David shulkin wrote: > > Is your home ok in fla ? > > sent from my iPhone > (b) (6) >> on Sep 12 , 2017, at 8 :18 PM, Bruce Moskowitz > >> Flying on Thursday tomorrow ok (b) (6) . com> wrote : >> >> sent from my iPad >> Bruce Moskowitz M.D. >> >>> on Sep 12 , 2017, at 3: 55 PM, David shulkin wrote: >>> >>> Bruce - sounds like i should get more involved to help - can i call you tommorow afternoon or thursday ? >>> >>> sent from my iPhone >>> (b) (6) (b) >>>> on Sep 11, 2017, at 10:13 PM, Bruce Moskowitz wrote : >>>> (6) >>>> I need an update of who is in charge since if the following pathway is not completed soon the quality of care , prolonged waiting time and cost will be critical factors going forward. >>>> The group we have access to fi x this is not going to wait indefinitely nor is the group assisting Apple . >>>> Thank you >>>> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000647 OS 00019957 Message From: Sent: To: Subject: DavidShulkin [secshulkin@gmail.com] 9/13/2017 1:50:19 AM (b) (6) (b) mac . com] Bruce Moskowitz [brucemcll???? Re: Choice Program (6) I s your home ok in fla? Sent from my iPhone (b) (6) > on Sep 12, 2017, at 8:18 PM, Bruce Moskowitz (b) > (6) > Flying on Thursday tomorrow ok wrote: > > sent from my iPad > Bruce Moskowitz M.D. > >> on Sep 12, 2017 , at 3 : 55 PM, David shulkin wrote : >> >> Bruce-sounds like i should get more in vol ved to help- can i call you tommorow afternoon or thursday ? >> >> sent from my iPhone >> >>> on Sep 11 , 2017, at 10:13 PM, Bruce >>> >>> I need an update of who is in charge of care , prolonged waiting time and cost >>> The group we have access to fi x this Apple. >>> Thank you >>> sent from my iPhone AMERICAN PVERSIGHT (b) (6) (b) Moskowitz wrote : (6) since if the following pathway is not completed soon the quality will be critical factors going forward. is not going to wait indefinitely nor is the group assisting VA-19-0799-H-000648 OS 00019958 Message From: Sent: To: Subject: (b) (6) Bruce Moskowit z [brucem~mac (b) (6) 9/13/2017 12:18:39 AM DavidShulkin [secshulkin@gmail.com] Re: Choice Program .com] Flying on Thursday tomorrow ok Sent from my iPad Bruce Moskowitz M.D. > on Sep 12, 2017, at 3: 55 PM, David Shulkin wrote: > > Bruce-sounds like i should get more in vol ved to help- can i call you tommorow afternoon or thursday ? > > sent from my iPhone > (b) (6) (b) >> on Sep 11, 2017, at 10: 13 PM, Bruce Moskowitz wrote: >> (6) >> I need an update of who is in charge since if the following pathway is not completed soon the quality of care , prolonged waiting time and cost will be critical factors going forward. >> The group we have access to fi x this is not going to wait indefinitely nor is the group assisting Apple. >> Thank you >> sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000649 OS 00019959 Message From: Sent: To: Subject: DavidShulkin [secshulkin@gmail.com] 9/12/2017 10:55:08 PM (b) (6) Bruce Moskowit z [brucem~mac (b) Re: Choice Program (6) .com] Bruce- sounds like i should get more involved to help- can call you tommorow afternoon or thursday? Sent from my iPhone (b) (6) > on Sep 11, 2017, at 10:13 PM, Bruce Moskowitz wrote: (b) (6) > I need an update of who is in charge since if the following pathway is not completed soon the quality of care , prolonged waiting time and cost will be critical factors going forward. > The group we have access to fi x this is not going to wait indefinitely nor is the group assisting Apple. > Thank you > sent from my iPhone > AMERICAN PVERSIGHT VA-19-0799-H-000650 OS 00019960 Message (b) mac.com] Sent: 9/12/2017 2:13:20 AM (6) To: DavidShulkin [secshulkin@gmail.com] gmail.com CC: IP -frenchangel59.com]; L Perl (b) (6) gmail.com]; mb (b) (6) ( (b) Choice Subject: b Program (6) ) ( 6 I need an update of who is in charge since if the following pathway is not completed soon the quality of care, prolonged ) waiting time and cost will be critical factors going forward. The group we have access to fix this is not going to wait indefinitely nor is the group assisting Apple. Thank you sent from my iPhone From: AMERICAN Bruce Moskowitz [brucem PVERSIGHT (b) (6) VA-19-0799-H-000651 OS 00019961 Message From: Sent: To: Subject: Attachments: David Shulkin [drshulkin@aol.com] 9/17/2017 3:00:24 PM (b) (6) gmail.com (b) (6) slides for cohen vetrans network cohen2017.pptx There are a few placeholders to fill in for this presentation AMERICAN PVERSIGHT VA-19-0799-H-000652 OS 00019962 "-3:<213 ,1 ,a 35 (when Veteran: VA L.I.S.l)cparl.nmnt. - 3" care summlt of \f'clura [Ta i rs. U.S. Department of Veterans Affairs David J. Shulkin, MD Secretary of Veterans Affairs April 19, 201? battle, and for his widow and his orphan.? Abraham Lincoln, 1855 f? ?To care for him who if?: shaii have borne the (F 1 .J Our Mission To care for those who have "borne the battle? and for their families and survivors. FinalSalute honors Holocaustsurvivor, Veteran 3 AMERICAN PVERSIGHT ,1A Vl1. /'-...,~ , LIS . ll ,opnrlm, ont '-!l.Y orVl'lv rnns ,\ffmr;. VA-19-0799-H-000655 OS 00019965 Much of What I Learned About VA Was on the Ski Slopes ,1A 4 AMERICAN PVERSIGHT v.... t'-.,.,~ , ~ y LI S. ll rlmrnl ol\',oLL.!rnns/\rfnirs VA-19-0799-H-000657 OS 00019967 VA Innovation 8 Lasker Awards Nicotine Patches First Liver Transplant Barcoding of Medications Cardiac Pacemaker 3 Nobel Prizes 6 AMERICAN PVERSIGHT Artificial Kidney CT Scanner ,1A V,.., ~ ~ .\ !,;./ 1 l l.S. l)(oJltlrlm100,000 Veterans treated 90% cure rate 2,500 treated each month Poised to eliminate Hep C among Veterans Decline in Veterans on long-term opioid therapy , 40 FY 2012 to 10 FY 2017 . Overall opioid use down 31% in the same period . AMERICAN PVERSIGHT VA-19-0799-H-000663 OS 00019973 Decline in Homelessness 80,000 70,00 0 ~ .087 ~ 5 455 60 ,579 60,000 ~s;t;~ ---!_9 , 68 !) n ,2 50,00 0 -..... 43 437 40,000 30,000 40,033 35,l ifl - 30 ,650 =,o~ 34,909 ug 31,505 o~- "'..16,220 ~2 Z>,43 b 20,710 20,000 10,000 - 0 2010 ? Tota l Homeless Vete rans AMERICAN PVERSIGHT 2012 2011 e 2013 Sheltered Veterans 2014 2015 Unshelte red Veteran s ' ' VA-19-0799-H-000664 DS_00019974 The Current State of VA VA: The Most Transparent Organization in Government AMERICAN PVERSIGHT VA-19-0799-H-000665 OS 00019975 Progress at VA Choice Bill Extension Accountability Bill Appeals Modernization GI Bill Expansion Telehealth De-Regulation Emergency Mental Health-Other Than Honorable Discharge Vacant and Underutilized Buildings 28 New Facilities and Public Private Partnerships (Omaha), Easing Federal Requirements for States Veterans Crisis Line Expansion Publishing Wait Times, Quality, and Satisfaction Data EMR Selection to Integrate with DOD and Community Partners Increased Support for Foundational Services Revision of Caregiver Program Expansion of Community Partnerships Draft/ Pre -dec,smnal / For Int e rnal VA Use Only AMERICAN PVERSIGHT 14 I. IA V"' ~ -\ \ I.~ n,opnrtnwnt \~ ?. , nl'Vrh.runs ,\lfa1t, VA-19-0799-H-000666 OS 00019976 The Secretary's 5 Priorities 1. Greater Choice for Veterans 4. Improve Timeliness of Services 2. Modernize our Systems 5. Suicide Prevention 3. Focus Resources More Efficiently 15 ,1A V,.., ~'\ 'q, !.,I 1 l l.S . l)lopnrlm< o(\'1oLL!mn onl ."!i-J\ffnirs I AMERICAN PVERSIGHT VA-19-0799-H-000667 OS 00019977 1. Greater Choice: Veteran CARE Program Clinically based decisions on when and where Veterans receive care ,~--------------------------, \ I I I I I I I I I I ' I ~-------------------------' ' J COMMUNITYCARE AMERICAN PVERSIGHT ,1A V,.., ~\ 1 \q, !.,' l l.S. Dl'JlElrLmrnl o(\',oLL!mns/\ffnlrs 16 VA-19-0799-H-000668 DS 00019978 Competition Slide 17 AMERICAN PVERSIGHT ,1A V'"' ~\ ~ !v' 1 l l S . DPp11rLment of\'t'll!rnns/\rfairs VA-19-0799-H-000669 OS 00019979 2. Modernize o EMR interoperability o and IT modernization will help with the transition from Service Our Systeins MtffS. CiENESIS ~ iMo8iM-i##iil-Hii.: ?iii-iiiA?I Modern.Secure.Connected. ,1A V"" AMERICAN PVERSIGHT ~) ~ S, ' LI.S. n,op,,r1mrnl of\'roLL:mnsJ\ffnlrs 18 VA-19-0799-H-000670 OS 00019980 3. Improving Timeliness Same Day Services Slide Draft/ Pre-decisional/ For Internal VA Use Only AMERICAN PVERSIGHT 19 ,1A V"" ~) ~ !,. , l l.S. DPp.,r1mrn1 of\',ol~mns ,\ffnlrs VA-19-0799-H-000671 OS 00019981 Transparency Wait times at local facilities WaT!n-...lor~o VAF of Access What Veterans are saying about access ~t Vetan,nsSayAboutAccessto ea,., al VAlac -es ,1A VI-I AMERICAN PVERSIGHT ~~ '-!!, !/ 1 l l.S. ll(ounrlm< ont or\'Plt.:!rnn s. t\ffn i rs 20 VA-19-0799-H-000672 OS 00019982 4. Focus our Resources ,1A Vl""I. AMERICAN PVERSIGHT t,....-.;,Ll S . 1l(o1.mrlm<> '-a Y 1 uf\'l'krn nt .ns J\ffmrs 21 VA-19-0799-H-000673 OS 00019983 5. Suicide Prevention Tom Hanks PSA 22 AMERICAN PVERSIGHT ,1A V.rllll ~\ ~ !.,' 1 l l..""i. DPpEHLment 1>f\ '1'll.!rnns 1\GBPTatrs VA-19-0799-H-000674 OS 00019984 Add other suicide slide from senior leaders slide deck 23 AMERICAN PVERSIGHT , IA Vl"'l f:!"") , ~ !, LI.S. n,opnr1mrn1 or\'1olla!mns/\ffnirs VA-19-0799-H-000675 OS 00019985 Impact of VA Care on Suicide Rates o.o us ffl o VETERANS t RECENTLYUSED VA Services NO RECENTUSE OF VA Services 5.4% 38.40/ot I VETERAN MALES t 8% 35.50/ot o VETERAN FEMALES o 2.6% 81.60/ot ' 2001-2014 ,1A V"" f:!"") , '-a,S, LI.S. n,op<>rim, ont of\',oLL:mns/\rfnirs 24 I AMERICAN PVERSIGHT VA-19-0799-H-000676 OS 00019986 REACH VET Predictive ? Modeling Uses data to identify Veterans at high risk for suicide ? Notifies VA providers of the risk assessment ? Allows providers to reevaluate and enhance the Veteran's care ,1A V,.., AMERICAN PVERSIGHT ~ ~ !/ \ 1 l l.S. l)(out,rlm< onl or\',oL~rnnsi\rfn)rs 25 VA-19-0799-H-000677 OS 00019987 Be There Commitments Autoenrollment with DOD SAFE training Dial 7 Expansion No Wrong Door Buddy Systems Doubling Reach Vet WHOLE Health 26 AMERICAN PVERSIGHT ,1A Vl"'I ~\ \q, !.,/ 1 l l.S. Dl'Jl!lrlmt~nt o(\',oLL!rnns ,\rftdrs VA-19-0799-H-000678 DS 00019988 Veterans Crisis Line Blocked calls down from over 30% in January to less than 1% today ,1A V,.., AMERICAN PVERSIGHT ~ ) , LI.S. n ,opnr1mr n1 '-q.:!.,. o( \'1 oLL:mnsJ\rfnirs 27 VA-19-0799-H-000679 OS 00019989 Partnershi HEROIC MISSION DEDICATED RESPECT SERVICE COUNTRY READY DEFEND COURAGEOUS INTEGRITY :?Lf l'k- mert'm Draft! Pre-decisional I For InternaI VA Use Univ 9990 ThankYou 29 AMERICAN PVERSIGHT v,...,I'-,.-.;~ rA LIS . ll,opnrlm,ont ~ !,:,1 1 orVtokrn11s ,\ffo1rs VA-19-0799-H-000681 DS_00019991 Suicide Prevention 30 , IA Vl"'I f....,'I , '.!1.Y LIS . ll ,opnrlm<' lll orVl'k rnns Affmrs The video will play as soon as you cue the next slide . AMERICAN PVERSIGHT VA-19-0799-H-000682 OS 00019992 Message From: (b) (6) Sent: 9/13/201712 :37:ll AM To : David shulkin [Drshulkin@aol.comJ Re: Subject: (b) (6) (b) (6) gmall.com] 1 sent it to your djs, yes can attend . On Tue , Sep 12, 2017 at 6:22 PM David shulk.in wrote : Did we hear anything on clearance about the ford theatre event (same night as sammies) Sent from my iPhone Sent from Gmail Mobile AMERICAN PVERSIGHT VA-19-0799-H-000683 DS 00019994 Message From: Davidshulkin [Drshulkin@aol.com] Sent: 9/12/2017 10:22:55 PM To: (b) (6) Did we hear anything (b) (6) (b) (6) gmail.com] on cl earance about the ford theatre event (same night as sammies) Sent from my iPhone AMERICAN PVERSIGHT VA-19-0799-H-000684 OS 00019995 Message From: David Shulkin [secshulkin@gmail.com] Sent : 9/12/2017 10:53:31 PM To : IP -frenchangel59.com] ( (b) Re:(6) bArticle out today Subject: ) ( Ike- no data has 6been sent to J and J yet- they are still working through an agreement ) Sent from my iPhone (b frenchangel59.com> wrote : (b) On Sep 8, 2017 , at 1:55 PM , IP wrote: A tremendous loss of a person with integr ity, expertise and dedication. L Sent from my iPhone On Sep 8, 2017 , at l L56 ANLDavid Shulkin wrote : http://roi-nj.com/?utm medium=Social&utm souroe=TwitterROI&utm campaigw=BreakingNewsl&utm content=Contentl&u tm term =Terml Sent from my iPhone (b frenchangel59.com> wrote : (b) On Sep 1, 2017, at 1: 11 PM, IP wrote : b (6) ) Bruce. This is a huge loss. I agree 100% with Laurie and ( 6) Poonam, I would love to speak to you. I will give you a call tomorrow. From: BruceMoskowitz mailto:brucem(b) (6) Sent: Friday,September08, 2017 12:23 PM (b) (6) mac.com To: L Perl Cc: David Shulkin; IP; PoonamAlaigh; Marc Sherman Subject: Re: Article out today On a plane just saw thjs , a loss that w ill be hard if not impossible to replace with someone of the same derucat ion and perseverance to get the job done . Sent from my i.Pad Bruce Moskowitz M .D . On Sep 8, 2017 , at 12:15 PM, L Per l - (b) (6) > wrote: A tremendous loss of a person with integr ity, expertise and derucation. L Sent from my iPhone On Sep 8 2017 , at 11 :56 AM , David Shulkin wrote: http://roi-nj .com/?utm medium=Social&utm source=TwitterROI&utm campaign == BreakingNewsl&utm conten t=Content l&u tm term=Terml Sent from my iPhone On Sep 1, 2017 , at 1: 11 PM , IP ~((b) frenchangel59 .com> wrote : I -----Original Message----From : AMERICAN PVERSIGHT (6) b ) ( 6) VA-19-0799-H-000686 OS 00019997 Sent?IHnInyiPhone Message From: IP -frenchangel59.com ( (b) Sent : 9/8/2017 5 :55:40 PM b (6) To : Bruce gmail.com] ) Moskowitz [brucem (b) (6) (b) mac.com]; L Perl (b) (6) ( Shulkin [secshulkin@gmail.com] David (6) ; Poonam Alaigh (b) (b)(6)(6) . otmail.com]; Marc Sherman (b) (6) [mb6...gmail.com] RE:)Article out today CC: Subject : ] I agree 100% with Laurie and Bruce. This is a huge loss. Poonam, I would love to speak to you . I will give you a call tomorrow . (b) (6) (b) From: Bruce Moskowitz [mailto:brucem-mac.com] Sent: Friday, September 08, 2017 12:23 PM (6) To: L Perl Cc: David Shulkin; IP; Poonam Alaigh; Marc Sherman Subject: Re: Article out today On a plane just saw this, a loss that will be hard if not impossib le to replace with someone of the same dedication and perseverance to get the job done . Sent from my iPad Brnce Moskowitz M .D . (b) (6) On Sep 8, 2017, at 12:15 PM, L Perl ~ wrote : A tremendous loss of a person with integrity , expertise and dedication. L Sent from my iPhone On Sep 8, 2017, at 11:56 A.NI,David Sbulkin wrote : httpJ/roi-nj .com/?utm medium =Social&utm source =TwitterROI&utmcampaign=BreakingNewsl&utm content=Contentl&utm I term=Term Sent from my iPhone (b) frenchangel59.com> wrote : (b On Sep 1, 2017 , at 1:11 PM, IP wrote: http://roi-nj .com/?utm medium =Social&utm source=TwitterROI&utm campaign =BreakingNewsl&utm content=Contentl&utm term =Term l Sent from my iPhone (b) (b) frenchangel On Sep 1, 201 7, at 1:11 PM, IP lllll 59. com > wrote : (6) (6) I -----Original Message----From: Sent from my iPhone AMERICAN PVERSIGHT ( b ) ( 6 ) VA-19-0799-H-000689 DS 00020000