DEPARTMENT OF VETERANS AFFAIRS
Washington DC 20420
February 3, 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 Fourth Initial 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.”
Fourth 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
addresses. OSVA now releases to you one thousand nine hundred fifty-four (1,954) pages,
Bates-numbered 1659-3638.
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, and Clifford Ko, 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 fifty-four (1,954) pages, Bates-numbered 16593638, 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 a contractor deliverable for the government, proposals, proposed technical
approaches, proposed solutions, teaming or partnership agreements, and assessment
methodology. Contractors typically treat such as commercially private information or having
received an assurance of privacy from the VA.
Austin Evers
Page 2
February 3, 2020
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. For information on
five (5) pages, VA redacts communications between the VA and the President’s advisers. The
presidential communications privilege protects agency communications to or from 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 the four
thousand one hundred fifty-two (4,152) pages released to you, OSVA redacted information per
the presidential communications privilege on only twenty-one (21) 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, and unsubstantiated
allegations, 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, or unsubstantiated allegations. 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 or decision-making
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 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
Austin Evers
Page 3
February 3, 2020
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, resume
details, medical details, and photographs 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, resume details, medical details, and photographs 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 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).
Austin Evers
Page 4
February 3, 2020
Out of the twenty-two thousand (22,000) pages received, OSVA has now reviewed about ten
thousand two hundred (10,200) pages, of which OSVA has released four thousand one hundred
fifty-two (4,152) redacted pages. About six thousand (6,000) pages predate November 9, 2019
and, thus, are non-responsive to your FOIA request. Of the released four thousand one
hundred fifty-two (4,152) pages, one thousand five hundred thirty-eight (1,538) relate to the
three (3) informal advisors.
On or about January 14, 2020, OSVA released seven hundred six (706) pages to you, redacted
with FOIA Exemptions 5 and 6. On January 6, 2020, OSVA released to you five hundred fortythree (543) pages, non-consecutively 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 nonresponsive to your FOIA request. On January 6, 2020, OSVA also re-released to you nine
hundred forty-nine (949) pages, Bates-numbered 1-949, released to you on November 21,
2019, but with fewer redactions.
Approximate 25,000 Pages of Emails Received on or About 1/15/2020
On or about January 15, 2020, Mr. Shulkin submitted approximately twenty-five (25,000)
thousand pages of emails in which he copied another VA employee. 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 another OSVA Senior Executive. 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 another OSVA Senior Executive.
Those twenty-five thousand (25,000) pages, with Shulkin copying another VA employee, are
compliant with the Federal Records Act. Those emails entered VA Systems of Records and
servers at time of transmission and are agency records, not personal emails. As such, those
twenty-five thousand (25,000) pages are non-responsive to your 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
Austin Evers
Page 5
February 3, 2020
FOIA Appeal
This concludes OSVA’s Fourth 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 fifty-four (1,954) pages
Message
From:
Darin Selnick [(b) (6)
Sent:
4/25/2017 1:42:25 AM
To:
David shulkin [Drshulkin@aol.com]
Fwd: VA question
Subject:
@gmail.com]
I wanted to confirm with you that the two statements from the speechwriter is correct.
Darin
---------- Forwarded message---------EOP/WHO <(b) (6)
From: (b) (6)
Date: Mon, Apr 24, 2017 at 6:37 PM
Subject: RE: VA question
To: Darin Selnick <(b) (6)
@gmail.com>, "(b) (6)
(b)
(6)
<
who.eop.gov>
Cc: Darin Selnick
who.eop.gov>
EOP/WHO"
Thanks. Are the following statements (b) (5)
From: Darin Selnick [mailto:(b) (6)
@gmail.com ]
Sent: Monday, April 24, 2017 9:31 PM
To: (b) (6)
EOP/WHO <(b) (6)
Cc: (b) (6)
EOP/WHO <(b) (6)
Subject: Re: VA question
who.eop.gov>
who.eop.gov>; Darin Selnick
Hi (b)
(6)
(b) (5)
.
Darin
VA-19-0799-D-000001
OS 00001659
On Mon, Apr 24, 2017 at 6: 12 PM, (b) (6)
EOP/WHO <(b) (6)
who.eop.gov> wrote:
Hi Darin can you answer this question from (b) (5)
Thanks
> On Apr 24, 2017, at 9:06 PM, (b) (6)
wrote:
>
> (b) (5)
EOP/WHO <(b) (6)
who.eop.gov>
VA-19-0799-D-000002
OS 00001660
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/25/2017 2:27:18 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Meeting
Who is best to present the inventory system we use?
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 24, 2017 at 6:57:56 PM EDT
To: Poonam Alaigh <(b) (6)
hotmail.com>
Cc: David shulkin
Subject: Re: Meeting
mac.com>
We will make it another time.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 24, 2017, at 6:56 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Bruce - good idea but we are having an offsite strategy retreat with the field and
medical center leadership to engage them and galvanize them around
performance, accountability and David/Presidents priorities that day - I will leave
the meeting to make it just in time for the Presidents visit. Let's plan time right
after the event if we can make it work
Sent from my iPhone
On Apr 24, 2017, at 11 :03 AM, Bruce Moskowitz
<(b) (6)
mac.com> wrote:
Prior to signing If it helps to have a breakfast meeting to discuss
inventory initiative in detail let me know. Also how we prevent
over utilization in private sector. Any other issues up to you
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000003
OS 00001661
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/24/2017 10:57:56 PM
Poonam Alaigh [(b) (6)
hotmail.com]
David shulkin [drshulkin@aol.com]
Re: Meeting
We will make it another time.
Sent from my iPad
Bruce Moskowitz M.D.
> on Apr 24, 2017, at 6:56 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Bruce - good idea but we are having an offsite strategy retreat with the field and medical center
leadership to engage them and galvanize them around performance, accountability and David/Presidents
priorities that day - I will leave the meeting to make it just in time for the Presidents visit. Let's
plan time right after the event if we can make it work
>
> Sent from my iPhone
>
>> on Apr 24, 2017, at 11:03 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>>
>> Prior to signing If it helps to have a breakfast meeting to discuss inventory initiative in detail let
me know. Also how we prevent over utilization in private sector. Any other issues up to you
>>
>> Sent from my iPad
>> Bruce Moskowitz M.D.
VA-19-0799-D-000004
OS 00001662
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/22/2017 6:13:10 PM
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
[(b) (6)
gmail.com]; Bruce Moskowitz [(b) (6)
Press is covering us better
gmail.com]; Marc Sherman
(b) (6) [(b) (6)
mac.com]; (b) (6)
mayo.edu]
http ://www.bradenton.com/opinion/editorials/article 145999214.html
Sent from my iPhone
VA-19-0799-D-000005
OS 00001663
Message
David shulkin [Drshulkin@aol.com]
4/23/2017 4:59:44 PM
[(b) (6)
va.gov]
(b) (6)
(b) (6)
[(b) (6)
va.gov]
Re: [EXTERNAL] Re: Hepatitis paper -Final version for submission
From:
Sent:
To:
CC:
Subject:
Ok thanks
(b) (6) please print
Sent from my iPhone
On Apr 23, 2017, at 11 :31 AM, (b) (6)
(b) (6)
va.gov> wrote:
Attached is the cover letter - with your signature Dr. Shulkin. (Please make sure I have your contact
information correct, and feel free to edit if you see fit).
Once you approve, I will plan to submit directly to the journal.
(b)
(6)
From: David shulkin [ mailto:Drshulkin@aol.com]
Sent: Friday, April 21, 2017 3:27 AM
To: (b) (6)
Cc: Poonam Alaigh; (b) (6)
Subject: [EXTERNAL] Re: Hepatitis paper -Final version for submission
Looks great- congratulations
I do not need to be the corresponding author but the cover should come from me as i am known
to the Editors- i had an article there this week
Thanks again
Sent from my iPhone
On Apr 21, 2017, at 1:47 AM, (b) (6)
(b) (6)
va.gov> wrote:
Hi,
I am attaching the final version of the Hepatitis C paper for your approval before
submitting for publication. As mentioned, I would suggest we try and submit to Annals
of Internal Medicine given that they have recently published the piece on the National
Strategy for hepatitis Elimination. We can submit under their "Medicine and Public
Issues" section (Articles related to the economic, ethical, sociological, or political
environment in medicine [Peer reviewed] ).
http://annals.org/aim/pages/authors. If it comes back then we can submit to a clinical
hepatology journal.
VA-19-0799-D-000006
OS 00001664
I have it set up to the Annals of Internal Medicine specifications (2500 words) and have
added the abstract. Also added figure descriptions.
Please double check the title page to make sure I have the affiliations and disclosures
correct.
Dr. Shulkin, would you like to be the corresponding author? Also, I can create a cover
letter, but would you like the cover letter to have your signature on it?
Just let me know either way, what you prefer.
There are two versions - one clean copy and one with the tracked changes so you can
see the final edits. These edits were made to bring it down to meet the required word
count. Because there are no author limits, we have added Dr. (b) (6)
as an author
given his role as Director of the HCV program and his spearheading of these initiatives.
Thankyouforyoursupport!
(b)
(6)
(b) (6)
'Pfiarm'D, 'BC'PS, .JL'A.J-lYV'P
National Public Health Clinical Pharmacy Specialist
Patient Care Services/Population Health (10P4V)
Department of Veterans Affairs
Phone: 310-922-(b)
310-478-(b) (6)
Email: (b) (6)
va.gov
(6)
From: Poonam Alaigh [ mailto:(b) (6)
hotmail.com]
Sent: Tuesday, April 18, 2017 4:24 AM
To: David shulkin
(b (b) (6)
Cc:
)
Subject: Re: [EXTERNAL]
Hepatitis paper
I am in concurrence with Dr Shulkin- thanks
Sent from my iPhone
On Apr 18, 2017, at 7: 16 AM, David shulkin wrote:
Thank you
Sent from my iPhone
On Apr 18, 2017, at 1:06 AM, (b) (6)
<(b) (6)
va.gov> wrote:
Hi Dr. Shulkin and Dr. Alaigh,
VA-19-0799-D-000007
OS 00001665
Please find attached the data on the number of
veterans we have treated and our SVR (cure) rates
among those we have treated since the availability of
the oral DAAs.
In the attached spreadsheet (HCV VA data sources.xis),
please find three tabs:
Tab 1 shows the daily cumulative total of veterans
starting on oral HCV DAAs. We started prescribing in VA
in Jan 2014, though they were FDA approved in Nov
2013. This summary graph is also posted and is available
at the first link listed below.
Number of veterans treated since DAA availability:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth
/pophealth/hcvantivirals/default.aspx
Tab 2 of the spreadsheet shows the number of veterans
awaiting treatment at periodic intervals beginning with
FY14 ( DAAs introduced in VA in Q2 FY14). This is data
captured from the HCV Clinical Case Registry. Those in
the paper reflect the end of March (Q2 FY17).
This data is also posted and is available at the link listed
below:
Numbers awaiting treatment - this is updated
quarterly.
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth
/pophealth/hcvantivirals/HCV%20Viremic/viremicfib4.aspx
Tab 3 of the spreadsheet shows the raw data that
relates to the "Cascade of HCV Care" (figure 3) with a
brief sentence about the methods used to calculate
each "step". For more detailed methods, refer to the
attached Maier et al paper. We used the same
methods for the current cascade as we did in this
previously published paper. Note that the cascade
numbers represent all HCV patients in care ever
treated (even with earlier non-DAA regimens
before 2014) which is why the SVR percentages in
the cascade graph are lower than what the SVR
rates are with all oral DAA regimens (shown in link
below - which represent SVR rates of only oral DAA
regimens from 2014 and beyond).
SVR (cure) rates with all oral DAA regimens are posted
here and updated every two weeks:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth
/pophea lth/hcva ntivi ra ls/HCV%20Antivi ra ls%20Tests/H
CV Direct Acting Antivirals.aspx
VA-19-0799-D-000008
OS 00001666
From table at above link, SVR rate calculated
as SVR12/(NoSVR+SVR12) = 94.98%; Published data on
SVR rates available in the attached article.
HCV testing rates are updated and posted quarterly,
(those in the paper reflect the end of March, Q2 FY17) :
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth
/pophealth/hcvbirthcohort/hcv cohorts fiscal year/def
ault.aspx
Please let me know if you have any additional questions
about the data or would like to have copies of any of
the other references in the paper.
Best,
(b)
(6)
From: David Shulkin [ mailto:drshulkin@aol.com]
Sent: Sunday, April 16, 2017 9:59 AM
(b) (6)
To: (b) (6)
(b) (6)
hotmail.com
Subject: [EXTERNAL] Hepatitis paper
(b) and (b) (6) and Poonam- you did a spectacular
job writing this up and its a remarkable story that has
(6)
occurred at VA.
I think this is exactly the type of manuscript that is
needed so others can benefit from your experience and
also
that VA can be appropriately recognized for its'
leadership in this area.
I surprisingly made very few edits or corrections in the
paper which is a real tribute to you all.
Please take a look and make sure you agree with these
few changes.
The one request I would make is to be an author on this
paper I feel it is important that I review the data
that you used to put the statistics in the paper about how
many veterans we treated and our success rates.
Do you have any reports or data that you could share so
Dr. Alaigh and I can review before we put our names on
the manuscript?
I don't know if Dr. Alaigh has had time yet to review.
The annals seems appropriate or if not a hepatology
journal surely would be interested.
Thanks so much for your leadership here
VA-19-0799-D-000009
OS 00001667
David Shulkin MD
VA-19-0799-D-000010
OS 00001668
Message
(b) (6)
From:
Sent:
To:
CC:
Subject:
Attachments:
[(b) (6)
va.gov]
4/23/2017 3:31:59 PM
David shulkin [Drshulkin@aol.com]; Shulkin, David J., MD [David.Shulkin@va.gov]
Poonam Alaigh [(b) (6)
hotmail.com]; (b) (6)
[(b)
va.gov]
(b)(6)(6)
RE: [EXTERNAL] Re: Hepatitis paper -Final version for submission
Cover Letter Curing HCV in VA.docx
Attached is the cover letter - with your signature Dr. Shulkin. (Please make sure I have your contact information correct,
and feel free to edit if you see fit).
Once you approve, I will plan to submit directly to the journal.
(b)
(6)
From: David shulkin [mailto:Drshulkin@aol.com]
Sent: Friday, April 21, 2017 3:27 AM
To: (b) (6)
Cc: Poonam Alaigh; (b) (6)
Subject: [EXTERNAL] Re: Hepatitis paper -Final version for submission
Looks great- congratulations
I do not need to be the corresponding author but the cover should come from me as i am known to the Editorshad an article there this week
Thanks again
Sent from my iPhone
On Apr 21, 2017, at 1:47 AM, (b) (6)
(b) (6)
va.gov> wrote:
Hi,
I am attaching the final version of the Hepatitis C paper for your approval before submitting for
publication. As mentioned, I would suggest we try and submit to Annals of Internal Medicine given that
they have recently published the piece on the National Strategy for hepatitis Elimination. We can submit
under their "Medicine and Public Issues" section (Articles related to the economic, ethical, sociological,
or political environment in medicine [Peer reviewed] ).
http://annals.org/aim/pages/authors. If it comes back then we can submit to a clinical hepatology
journal.
I have it set up to the Annals of Internal Medicine specifications (2500 words) and have added the
abstract. Also added figure descriptions.
Please double check the title page to make sure I have the affiliations and disclosures correct.
Dr. Shulkin, would you like to be the corresponding author? Also, I can create a cover letter, but would
you like the cover letter to have your signature on it?
Just let me know either way, what you prefer.
VA-19-0799-D-000011
OS 00001669
There are two versions - one clean copy and one with the tracked changes so you can see the final edits.
These edits were made to bring it down to meet the required word count. Because there are no author
limits, we have added Dr. (b) (6)
as an author given his role as Director of the HCV program and his
spearheading of these initiatives.
Thankyouforyoursupport!
(b)
(6)
(b) (6)
'Pfiarm'D, 'BC'PS, .JL'A.J-lYV'P
National Public Health Clinical Pharmacy Specialist
Patient Care Services/Population Health (10P4V)
Department of Veterans Affairs
Phone: 310-922-(b)
310-478-(b) (6)
Email: (b) (6)
va.gov
(6)
From: Poonam Alaigh [ mailto:(b) (6)
hotmail.com]
Sent: Tuesday, April 18, 2017 4:24 AM
To: David shulkin
(b (b) (6)
Cc:
)
Hepatitis paper
Subject: Re: [EXTERNAL]
I am in concurrence with Dr Shulkin- thanks
Sent from my iPhone
On Apr 18, 2017, at 7: 16 AM, David shulkin wrote:
Thank you
Sent from my iPhone
On Apr 18, 2017, at 1:06 AM, (b) (6)
wrote:
(b) (6)
va.gov>
Hi Dr. Shulkin and Dr. Alaigh,
Please find attached the data on the number of veterans we have
treated and our SVR (cure) rates among those we have treated since the
availability of the oral DAAs.
In the attached spreadsheet (HCV VA data sources.xis), please find three
tabs:
Tab 1 shows the daily cumulative total of veterans starting on oral HCV
DAAs. We started prescribing in VA in Jan 2014, though they were FDA
VA-19-0799-D-000012
OS 00001670
approved in Nov 2013. This summary graph is also posted and is
available at the first link listed below.
Number of veterans treated since DAA availability:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
antivirals/default.aspx
Tab 2 of the spreadsheet shows the number of veterans awaiting
treatment at periodic intervals beginning with FY14 ( DAAs introduced in
VA in Q2 FY14). This is data captured from the HCV Clinical Case
Registry. Those in the paper reflect the end of March (Q2 FY17).
This data is also posted and is available at the link listed below:
Numbers awaiting treatment - this is updated quarterly.
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
antivirals/HCV%20Viremic/viremic-fib4.aspx
Tab 3 of the spreadsheet shows the raw data that relates to the
"Cascade of HCV Care" (figure 3) with a brief sentence about the
methods used to calculate each "step". For more detailed methods,
refer to the attached Maier et al paper. We used the same
methods for the current cascade as we did in this previously
published paper. Note that the cascade numbers represent all
HCV patients in care ever treated (even with earlier non-DAA
regimens before 2014) which is why the SVR percentages in the
cascade graph are lower than what the SVR rates are with all oral
DAA regimens (shown in link below - which represent SVR rates
of only oral DAA regimens from 2014 and beyond).
SVR (cure) rates with all oral DAA regimens are posted here and
updated every two weeks:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
antivirals/HCV%20Antivirals%20Tests/HCV Direct Acting Antivirals.asp
X
From table at above link, SVR rate calculated as SVR12/(NoSVR+SVR12)
= 94.98%; Published data on SVR rates available in the attached article.
HCV testing rates are updated and posted quarterly, (those in the paper
reflect the end of March, Q2 FYl 7) :
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
birthcohort/hcv cohorts fiscal year/default.aspx
Please let me know if you have any additional questions about the data
or would like to have copies of any of the other references in the paper.
Best,
(b)
(6)
From: David Shulkin [ mailto:drshulkin@aol.com]
Sent: Sunday, April 16, 2017 9:59 AM
VA-19-0799-D-000013
OS 00001671
(b (b) (6)
To:
Subject: [EXTERNAL]) Hepatitis paper
(b) (6)
hotmail.com
(b) and (b) (6) and Poonam- you did a spectacular job writing this up
and its a remarkable story that has occurred at VA.
(6)
I think this is exactly the type of manuscript that is needed so others can
benefit from your experience and also
that VA can be appropriately recognized for its' leadership in this area.
I surprisingly made very few edits or corrections in the paper which is a
real tribute to you all.
Please take a look and make sure you agree with these few changes.
The one request I would make is to be an author on this paper I feel it is
important that I review the data
that you used to put the statistics in the paper about how many veterans
we treated and our success rates.
Do you have any reports or data that you could share so Dr. Alaigh and I
can review before we put our names on the manuscript?
I don't know if Dr. Alaigh has had time yet to review.
The annals seems appropriate or if not a hepatology journal surely would
be interested.
Thanks so much for your leadership here
David Shulkin MD
VA-19-0799-D-000014
OS 00001672
Christine Laine, ~ID, MPH
Editor in Chief, Annals of Internal Medicine
RE: Manuscript submission
April 24, 2017
Dear Dr. Laine,
We wish to respectfully submit the manuscript entitled "Curing Hepatitis C Infection: Best
Practices from the Department of Veterans Affairs" for consideration for publication in Annals of
Internal Medicine as a Medicine and Public Issues article.
This manuscript directly addresses a recently published April 4th Annals of Internal A1edicine
Ideas and Opinions article by Buckley et al, which summarized the National Academies of
Sciences, Engineering, and Medicine expert committee Report on a National Strategy for the
Elimination of Viral Hepatitis. With VA' s advancements and progress in treating veterans with
hepatitis C virus infection (HCV), and as the nation's largest provider of care to patients with
HCV, VA is uniquely suited to inform this Strategy.
In the attached manuscript we have highlighted VA's successes and best practices relating to
each of the 5 areas identified in the National Strategy report that can be extended to other
healthcare organizations and providers delivering hepatitis C care. The work underway in VA
over the past 3 years has focused on a comprehensive approach to identify and manage veterans
with hepatitis C. This manuscript informs the readers of our experiences, innovations, and
outcome metrics across the care continuum for this population which has led to the successful
treatment of over 86,000 veterans in 3 years.
This manuscript has not been previously published nor is it being considered for publication
elsewhere. I attest to the fact that all authors have had a significant intellectual contribution to this
work and have read and approved the submitted manuscript.
Thank you in advance for the consideration shown to this manuscript. We would appreciate the
opportunity to contribute to Annals qfInternal Medicine.
Sincerely,
David J. Shulkin MD
Secretary of Veterans Affairs
Office of the Secretary for Health
Department of Veterans Affairs
Washington, DC
202-461 -7000
David.Shulkin@va.gov
VA-19-0799-D-000015
OS 00001673
Message
David shulkin [Drshulkin@aol.com]
4/21/2017 10:26:31 AM
[(b) (6)
va.gov]
(b) (6)
Poonam Alaigh [(b) (6)
hotmail.com]; (b) (6)
Re: Hepatitis paper -Final version for submission
From:
Sent:
To:
CC:
Subject:
[(b)
(b)(6)(6)
va.gov]
Looks great- congratulations
I do not need to be the corresponding author but the cover should come from me as i am known to the Editorshad an article there this week
Thanks again
Sent from my iPhone
On Apr 21, 2017, at 1:47 AM, (b) (6)
(b) (6)
va.gov> wrote:
Hi,
I am attaching the final version of the Hepatitis C paper for your approval before submitting for
publication. As mentioned, I would suggest we try and submit to Annals of Internal Medicine given that
they have recently published the piece on the National Strategy for hepatitis Elimination. We can submit
under their "Medicine and Public Issues" section (Articles related to the economic, ethical, sociological,
or political environment in medicine [Peer reviewed] ).
http://annals.org/aim/pages/authors. If it comes back then we can submit to a clinical hepatology
journal.
I have it set up to the Annals of Internal Medicine specifications (2500 words) and have added the
abstract. Also added figure descriptions.
Please double check the title page to make sure I have the affiliations and disclosures correct.
Dr. Shulkin, would you like to be the corresponding author? Also, I can create a cover letter, but would
you like the cover letter to have your signature on it?
Just let me know either way, what you prefer.
There are two versions - one clean copy and one with the tracked changes so you can see the final edits.
These edits were made to bring it down to meet the required word count. Because there are no author
limits, we have added Dr. (b) (6)
as an author given his role as Director of the HCV program and his
spearheading of these initiatives.
Thankyouforyoursupport!
(b)
(6)
(b) (6)
'Pfiarm'D, 'BC'PS, .JL'A.J-lYV'P
National Public Health Clinical Pharmacy Specialist
Patient Care Services/Population Health (10P4V)
Department of Veterans Affairs
Phone: 310-922-(b)
310-478-(b) (6)
Email: (b) (6)
va.gov
(6)
VA-19-0799-D-000016
OS 00001674
From: Poonam Alaigh [ mailto:(b) (6)
hotmail.com]
Sent: Tuesday, April 18, 2017 4:24 AM
To: David shulkin
(b (b) (6)
Cc:
)
Hepatitis paper
Subject: Re: [EXTERNAL]
I am in concurrence with Dr Shulkin- thanks
Sent from my iPhone
On Apr 18, 2017, at 7: 16 AM, David shulkin wrote:
Thank you
Sent from my iPhone
On Apr 18, 2017, at 1:06 AM, (b) (6)
wrote:
(b) (6)
va.gov>
Hi Dr. Shulkin and Dr. Alaigh,
Please find attached the data on the number of veterans we have
treated and our SVR (cure) rates among those we have treated since the
availability of the oral DAAs.
In the attached spreadsheet (HCV VA data sources.xis), please find three
tabs:
Tab 1 shows the daily cumulative total of veterans starting on oral HCV
DAAs. We started prescribing in VA in Jan 2014, though they were FDA
approved in Nov 2013. This summary graph is also posted and is
available at the first link listed below.
Number of veterans treated since DAA availability:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
antivirals/default.aspx
Tab 2 of the spreadsheet shows the number of veterans awaiting
treatment at periodic intervals beginning with FY14 ( DAAs introduced in
VA in Q2 FY14). This is data captured from the HCV Clinical Case
Registry. Those in the paper reflect the end of March (Q2 FY17).
This data is also posted and is available at the link listed below:
Numbers awaiting treatment - this is updated quarterly.
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
antivirals/HCV%20Viremic/viremic-fib4.aspx
VA-19-0799-D-000017
OS 00001675
Tab 3 of the spreadsheet shows the raw data that relates to the
"Cascade of HCV Care" (figure 3) with a brief sentence about the
methods used to calculate each "step". For more detailed methods,
refer to the attached Maier et al paper. We used the same
methods for the current cascade as we did in this previously
published paper. Note that the cascade numbers represent all
HCV patients in care ever treated (even with earlier non-DAA
regimens before 2014) which is why the SVR percentages in the
cascade graph are lower than what the SVR rates are with all oral
DAA regimens (shown in link below - which represent SVR rates
of only oral DAA regimens from 2014 and beyond).
SVR (cure) rates with all oral DAA regimens are posted here and
updated every two weeks:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
antivirals/HCV%20Antivirals%20Tests/HCV Direct Acting Antivirals.asp
X
From table at above link, SVR rate calculated as SVR12/(NoSVR+SVR12)
= 94.98%; Published data on SVR rates available in the attached article.
HCV testing rates are updated and posted quarterly, (those in the paper
reflect the end of March, Q2 FYl 7) :
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
birthcohort/hcv cohorts fiscal year/default.aspx
Please let me know if you have any additional questions about the data
or would like to have copies of any of the other references in the paper.
Best,
(b)
(6)
From: David Shulkin [ mailto:drshulkin@aol.com]
Sent: Sunday, April 16, 2017 9:59 AM
(b) (6)
(b) (6)
To: (b) (6)
Subject: [EXTERNAL] Hepatitis paper
hotmail.com
(b) and (b) (6) and Poonam- you did a spectacular job writing this up
and its a remarkable story that has occurred at VA.
(6)
I think this is exactly the type of manuscript that is needed so others can
benefit from your experience and also
that VA can be appropriately recognized for its' leadership in this area.
I surprisingly made very few edits or corrections in the paper which is a
real tribute to you all.
Please take a look and make sure you agree with these few changes.
The one request I would make is to be an author on this paper I feel it is
important that I review the data
that you used to put the statistics in the paper about how many veterans
we treated and our success rates.
VA-19-0799-D-000018
OS 00001676
Do you have any reports or data that you could share so Dr. Alaigh and I
can review before we put our names on the manuscript?
I don't know if Dr. Alaigh has had time yet to review.
The annals seems appropriate or if not a hepatology journal surely would
be interested.
Thanks so much for your leadership here
David Shulkin MD
VA-19-0799-D-000019
OS 00001677
Message
From:
Sent:
To:
CC:
Subject:
Attachments:
(b) (6)
[(b) (6)
va.gov]
4/21/2017 5:47:57 AM
Poonam Alaigh [(b) (6)
hotmail.com]; David shulkin [Drshulkin@aol.com]
[(b)
va.gov]
(b) (6)
(b)(6)(6)
RE: Hepatitis paper -Final version for submission
Curing hepatitsC 4-20-17 clean.docx; Curing hepatitsC 4-20-17 tracked changes.docx
Hi,
I am attaching the final version of the Hepatitis C paper for your approval before submitting for publication. As
mentioned, I would suggest we try and submit to Annals of Internal Medicine given that they have recently published
the piece on the National Strategy for hepatitis Elimination. We can submit under their "Medicine and Public Issues"
section (Articles related to the economic, ethical, sociological, or political environment in medicine [Peer reviewed] ).
http://annals.org/aim/pages/authors. If it comes back then we can submit to a clinical hepatology journal.
I have it set up to the Annals of Internal Medicine specifications (2500 words) and have added the abstract. Also added
figure descriptions.
Please double check the title page to make sure I have the affiliations and disclosures correct.
Dr. Shulkin, would you like to be the corresponding author? Also, I can create a cover letter, but would you like the cover
letter to have your signature on it?
Just let me know either way, what you prefer.
There are two versions - one clean copy and one with the tracked changes so you can see the final edits. These edits
were made to bring it down to meet the required word count. Because there are no author limits, we have added Dr.
as an author given his role as Director of the HCV program and his spearheading of these initiatives.
(b) (6)
Thank you for your support!
(b)
(6)
'(b) (6)
'Pfiarm'D, 'BC'PS, .JL'A.J-lYV'P
National Public Health Clinical Pharmacy Specialist
Patient Care Services/Population Health (10P4V)
Department of Veterans Affairs
Phone: 310-922-(b)
310-478-(b) (6)
Email: (b) (6)
va.gov
(6)
From: Poonam Alaigh [mailto:(b) (6)
hotmail.com]
Sent: Tuesday, April 18, 2017 4:24 AM
To: David shulkin
(b (b) (6)
Cc:
)
Hepatitis paper
Subject: Re: [EXTERNAL]
VA-19-0799-D-000020
OS 00001678
I am in concurrence with Dr Shulkin- thanks
Sent from my iPhone
On Apr 18, 2017, at 7: 16 AM, David shulkin wrote:
Thank you
Sent from my iPhone
On Apr 18, 2017, at 1:06 AM, (b) (6)
(b) (6)
va.gov> wrote:
Hi Dr. Shulkin and Dr. Alaigh,
Please find attached the data on the number of veterans we have treated and our SVR
(cure) rates among those we have treated since the availability of the oral DAAs.
In the attached spreadsheet (HCV VA data sources.xis), please find three tabs:
Tab 1 shows the daily cumulative total of veterans starting on oral HCV DAAs. We
started prescribing in VA in Jan 2014, though they were FDA approved in Nov 2013. This
summary graph is also posted and is available at the first link listed below.
Number of veterans treated since DAA availability:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvantivirals/defaul
t.aspx
Tab 2 of the spreadsheet shows the number of veterans awaiting treatment at periodic
intervals beginning with FY14 ( DAAs introduced in VA in Q2 FY14). This is data captured
from the HCV Clinical Case Registry. Those in the paper reflect the end of March (Q2
FY17).
This data is also posted and is available at the link listed below:
Numbers awaiting treatment - this is updated quarterly.
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvantivirals/HCV%
20Viremic/viremic-fib4 .aspx
Tab 3 of the spreadsheet shows the raw data that relates to the "Cascade of HCV Care"
(figure 3) with a brief sentence about the methods used to calculate each "step". For
more detailed methods, refer to the attached Maier et al paper. We used the same
methods for the current cascade as we did in this previously published paper.
Note that the cascade numbers represent all HCV patients in care ever treated
(even with earlier non-DAA regimens before 2014) which is why the SVR
percentages in the cascade graph are lower than what the SVR rates are with all
oral DAA regimens (shown in link below - which represent SVR rates of only oral
DAA regimens from 2014 and beyond).
SVR (cure) rates with all oral DAA regimens are posted here and updated every two
weeks:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvantivirals/HCV%
20Antivirals%20Tests/HCV Direct Acting Antivirals.aspx
From table at above link, SVR rate calculated as SVR12/(NoSVR+SVR12) =
94.98%; Published data on SVR rates available in the attached article.
VA-19-0799-D-000021
OS 00001679
HCV testing rates are updated and posted quarterly, (those in the paper reflect the end
of March, Q2 FY17):
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvbirthcohort/hcv
cohorts fiscal year/default.aspx
Please let me know if you have any additional questions about the data or would like to
have copies of any of the other references in the paper.
Best,
(b)
(6)
From: David Shulkin [ mailto:drshulkin@aol.com]
Sent: Sunday, April 16, 2017 9:59 AM
(b) (6)
(b) (6)
To: (b) (6)
Subject: [EXTERNAL] Hepatitis paper
hotmail.com
(b) and (b) (6) and Poonam- you did a spectacular job writing this up and its a
remarkable story that has occurred at VA.
(6)
I think this is exactly the type of manuscript that is needed so others can benefit from
your experience and also
that VA can be appropriately recognized for its' leadership in this area.
I surprisingly made very few edits or corrections in the paper which is a real tribute to you
all.
Please take a look and make sure you agree with these few changes.
The one request I would make is to be an author on this paper I feel it is important that I
review the data
that you used to put the statistics in the paper about how many veterans we treated and
our success rates.
Do you have any reports or data that you could share so Dr. Alaigh and I can review
before we put our names on the manuscript?
I don't know if Dr. Alaigh has had time yet to review.
The annals seems appropriate or if not a hepatology journal surely would be interested.
Thanks so much for your leadership here
David Shulkin MD
VA-19-0799-D-000022
OS 00001680
Curing Hepatitis C Infection: Best Practices from the Department of Veterans Affairs
Pamela S. Belperio PharmD1, Maggie Chartier PsyD MPH2, David B. Ross MD PhD MBI2, Poonam
Alaigh, MD 3 , David Shulkin MD4
1
Population Health Services, Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto,
CA
2
Office of Specialty Care Services, Department of Veterans Affairs, Washington DC
3
Office of the Under Secretary for Health, Department of Veterans Affairs, Washington DC
4
Office of the Secretary, Department of Veterans Affairs, Washington DC
Short Running Title: HCV Best Practices in VA
Financial Support and Disclosures: This work was prepared independently without financial
support. Drs. Belperio, Chartier, Ross, Alaigh, and Shulkin have no financial, professional or
personal disclosures to report.
Corresponding Author-
Pamela S. Belperio, Pharm D, Patient Care Services/Population Health Services, Veterans
Affairs Palo Alto Health Care System, 3801 Miranda Avenue (132), Palo Alto, CA 94304
Phone: 310-478-371 lx4471 l, Fax: 650-849-0266, Email: Pamela.Belperio@va.gov
Word Count: 2499
Keywords: Veteran, access, direct acting antiviral, cascade
1
VA-19-0799-D-000023
OS 00001681
Abstract (245)
The Department of Veterans Affairs (VA) is the nation's largest care provider to patients infected with
hepatitis C vims (HCV) and is uniquely suited to inform national efforts to eliminate HCV. An extensive
array of delivery of services, policy guidance, outreach efforts and funding has broadened the reach and
capacity of VA to deliver direct acting antiviral (DAA) HCV therapy, supported by an infraslmcture lo
effectively implement change and informed by e:s.1:ensive population health data analysis. VA has treated
over 86,000 HCV-infected veterans since the availability of all-oral DAAs in January 2014 with cure
rates exceeding 90%; only 58,000 known veterans in VA care remain potentially eligible for treatment.
Key actions advancing VA's aggressive treatment ofHCV include: expanding treatment capacity with
non-physician providers, video telehealth and electronic technologies; expansion of integrated care to
address psychiatric and substance use co-morbidities; and electronic data tools for patient tracking and
outreach. Critical to effective implementation has been building infrastmcture through the creation of
regional multidisciplinary HCV Innovation Teams whose systems redesign efforts have produced
innovative HCV practice models addressing gaps in care while providing more efficient and effective
HCV management for the populations they serve. Financing for HCV treatment and infrastmcture
resources coupled with reduced dmg pricing has been paramount lo VA's success in curing HCV. VA is
well poised to share and extend best HCV practices to other healthcare organizations and providers
delivering HCV care, contributing to a concerted effort to reduce the burden of HCV.
2
VA-19-0799-D-000024
OS 00001682
Introduction
Since the introduction of Direct Acting Antivirals (DAAs) for hepatitis C virus (HCV), the Department of
Veterans Affairs (VA) has made e:s.1:ensive progress in advancing HCV care and curing substantial
numbers ofHCV-infected veterans in VA care. As the nation's largest provider of care to patients with
HCV, VA is uniquely suited to inform the recently released National Strategy for the Elimination of Viral
Hepatitis, produced by a National Academies of Sciences, Engineering, and Medicine expert committee,
which emphasizes prevention, screening, and universal treatment ofHCV-- areas in which VA has
become a recognized leader (1-3). The National Strategy presents specific actions to reduce the burden of
HCV and outlines 5 distinct areas-Information, Interventions, Service delivery, Financing, and Research
(1,2). VA's best practices and successes, informed by extensive population health data analysis
capabilities and national guidance and policies, may be useful for other healthcare providers and
organizations to reduce the burden of HCV in their populations.
VA has made a substantial commitment to prioritizing HCV care as ret1ected in dedicated funding for
HCV treatment in VA, unrestricted access to DAAs, detailed guidance on individualizing care and the
establishment of Veterans Integrated Service Network (VISN) Hepatitis C Innovation Teams (HITs) (4).
This work, in collaboration with other key VA offices. is largely supported by the VA's National Viral
Hepatitis Program which also develops national guidance and policy. trainings, and resources for patients
and providers, easily accessible on its comprehensive website (5).
The significant resources and efforts VA and its HCV providers have dedicated to prioritizing this disease
at every level of the organization are being tangibly realized. Between January 2014 and March 2017,
86,000 HCV-infected veterans in VA care have received oral DAA treatment, achieving cure rates of over
90% (6-8). Currently, only 58,000 knovvn veterans in VA care remain potentially eligible for treatment,
3
VA-19-0799-D-000025
OS 00001683
compared to over 168,000 three years ago (9, 10). While elimination appears attainable, VA recognizes
the reality of the HCV epidemic and population; namely, many of those in care remaining to be treated
have complex substance use, mental health, and medical co-morbidities, and many are challenged by
homelessness, transportation, and rurality which pose significant barriers to engagement in care and
treatment. The curve of elimination for HCV in VA will include a long tail of persistence driven by
system, patient and care delivery determinants (Figure 1).
Information: Population Health Management
Using national databases and analytics, VA employs population health management strategies to measure,
monitor and identify trends in HCV care, gaining insight into patterns of access and tailoring care
provision programs accordingly. Veterans in VA care diagnosed with HCV are followed in VA' s
National Hepatitis C Clinical Case Registry (CCR), developed in part to ensure veterans with chronic
HCV were linked to care (11). The HCV CCR, used for both local and national population reporting,
provides data on the number of patients lmovm to be infected with HCV together with critical clinical
information such as patient and disease characteristics, where care is received, receipt ofDAA treatment
and clinical outcomes. The VA's Central Data Warehouse, a repository of electronic medical record data,
has spurred the creation of local and regional HCV dashboards which offer providers access to patientspecific data reports for real-time intervention and tracking. These sources allow for comprehensive
monitoring of incidence, prevalence, and disease course to identify and address barriers and assess
outcomes. National, regional and individual facility level data is posted regularly, allowing providers,
teams, and leadership to assess progress and goals. This leveraging of health systems data transforms
numbers into knowledge and guides providers and the VA toward more informed and effective delivery
of care for each veteran.
4
VA-19-0799-D-000026
OS 00001684
Essential Interventions
Diagnosis and Testing
Improved case idenii/zcation: A critical first step for improving HCV care is to identify those infected. In
2012, the Centers for Disease Control and Prevention (CDC) and subsequently the United States
Preventive Services Task Force developed recommendations for testing any person born between 19451965, a cohort determined to have the highest HCV prevalence (12, 13). Prior to 2014, VA guidance
recommended risk-based testing and testing of Vietnam-era veterans, a group which largely overlaps with
the 1945-1965 birth cohort (3). Using information systems lo track screening, VA has been able to
identify and target additional populations at risk for HCV, which include: African American males, for
which the prevalence is double that of Caucasians (17.7% versus 8.3%); the homeless, for which the
prevalence is over three times higher when compared to non-homeless (13.4% versus 3.5%); and persons
who inject drugs (14, 15).
Most recently, VA has screened over 78% of the 2.5 million veterans in the 1945-1965 birth cohort, and
of note, 89.6% of its homeless population (15). Using updated annual prevalence calculations, VA
estimates there are only approximately 15,000 remaining veterans in VA care who would test positive for
HCV if the entire at-risk population were screened.
Testing initiatives: Several initiatives undertaken within VA lo increase HCV testing have significantly
impacted these results. These include national electronic point-of-care clinical reminders for HCV risk
assessment and testing, automated letters recommending HCV testing which dually serve as a laboratory
order when presented to a VA lab, weekly primary care panel reviews identifying patients with upcoming
appointments who require testing, and calling patients directly. To emphasize this as a priority, VA added
5
VA-19-0799-D-000027
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birth cohort testing as a national performance measure in 2015 and reports quarterly screening rates by
facility and region. To ensure complete testing while simultaneously providing an efficient and patientcentered approach, VA adopted CDC recommendations into policy so all patients tested for HCV with a
positive antibody automatically had reflex confirmatory HCV RNA testing performed with the same
laboratory sample, with over 97% compliance in 2015. As a result of these collective factors, the
proportion of veterans in VA care screened for HCV have increased annually by 3% to 4% and are
substantially higher than other large healthcare systems (16).
Building Infrastructure
Hepaiitis Innovation Team (HIT) Collaborative: Recognizing that care is not delivered the same way in
all settings, regional HITs, comprising a multidisciplinary group of 15-30 healthcare providers,
administrators, information technology and system redesign specialists, have implemented Lean Process
Improvement methods to maximize clinical expertise and redesign the process of HCV testing, treatment,
and management to provide care in the most efficient and effective way possible for the populations they
serve (17). The HIT Collaborative has enabled a clinically focused foundation to share and implement
best practices across and within teams, supported by local and regional administrators. The development
of the HIT infrastructure which has leveraged and supported the work of dedicated VA providers has been
a critical implementation arm that has allowed VA to respond to challenges in funding variability and
other access issues that have arisen since the introduction of DAA.s.
Service Deliverv: Improving Linkage and Access
Population health data, the HIT infrastructure, and legions of dedicated providers on the ground have
been instrumental in enhancing VA' s outreach and engagement. Efforts have focused on raising provider
6
VA-19-0799-D-000028
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and staff awareness about HCV testing and treatment availability, promoting direct outreach to at-risk
veterans leveraging technologies like mobile phone applications and secure messaging. as well as
outreach to the veteran community more broadly through national and local social media and advertising
campaigns.
Expanding Capaci(y
Telemedicine and electronic technologies: VA has focused on increasing specialist capacity through
telemedicine and clinical video telehealth (CVT), or real-time video teleconferencing, whereby HCV
clinicians provide care lo patients and/or consultation lo other providers at another location. Largely
modeled off of the ECHO project (18), the expanded HCV VA-ECHO model includes urban and rural
sites, homeless care clinics, incorporates a pharmacist-led provider program, and a mental health and
substance use program to aid providers in treating HCV in patients with these co-morbidities. Leveraging
electronic databases HCV teams identify potential treatment candidates, notify primary care providers
through the electronic medical record and provide HCV management recommendations. Similarly,
primary care providers can efficiently consult HCV specialists regarding HCV care management aud
treatment recommendations via inter-provider electronic consults, eliminating the need for a specialty
visit.
Non-physician advanced practice providers: VA has emphasized the expansion of HCV care beyond
specialty providers. A substantial portion of HCV treatment has shifted outside of liver and infectious
disease specialty care clinics at larger medical centers to primary care aud community clinics. Treatment
is often being delivered by non-physician providers such as Clinical Pharmacy Specialists, Nurse
Practitioners aud Physician Assistants, who have been recognized as delivering the same quality of care
aud providing more timely access to HCV treatment (19,20).
7
VA-19-0799-D-000029
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In 2016, almost one-third of VA DAA prescriptions were initiated by a network of nearly 200 Clinical
Pharmacy Specialists (21 ). VA has also recently granted foll practice authority to nurse practitioners
therefore expanding the potential for further use of these providers in providing hepatitis care. Targeted
use of the limited number of specialists while expanding non-physician provider roles is an important
practice that can be adapted from the VA system into other healthcare systems ( 19).
Barriers to Care
Based on VA HCV provider data collected in 2014 and 2015, it was estimated that up to 30% of veterans
awaiting treatment were not currently willing or were unable to initiate HCV treatment. Major reported
reasons included active alcohol/substance use, serious mental illness, documented non-adherence to
medical appointments or treatment, unstable/uncontrolled medical comorbidities, inability to contact a
veteran and veterans unwillingness to start treatment. As VA continues to treat more patients. an
increasing number of those remaining in the untreated pool present with these challenges and
accompanying resource demands to potentially modify these patient, system, or care delivery factors.
Frequent reassessment is required of healthcare systems and providers to adapt their approach and
resources as the barriers in untreated HCV populations shift overtime.
Addressing substance use: Recognizing alcohol and substance use as a considerable barrier to HCV
treatment, VA took aggressive steps to eliminate non-evidence based, abstinence policies for HCV
treatment and provided clinical guidance on effectively assessing alcohol and substance use, matching a
patient's use with the actual risk of non-adherence. VA studies have consistently shown cure rates
achieved among veterans with alcohol, substance use and mental health disorders are similar to those
without these conditions (7,22).
8
VA-19-0799-D-000030
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Integrated care: Accessible mental health and addiction specialists, care coordinators, case managers and
social workers are invaluable resources to address the significant impediments to HCV treatment for
VA' s most vulnerable populations so that a veteran's treatment candidacy may be reassessed as barriers
are addressed. VA has emphasized that integrated care practice models be implemented where resources
permit. For facilities with more limited resources, individual aspects of this comprehensive care can be
leveraged within the facility, or region via innovative practice models as detailed above.
Financing HCV Treatment
VA has faced significant financial challenges as a result of highly priced DAAs. With strong advocacy
from VA HCV providers, veterans and VA leadership, expanded special purpose funding for HCV
medications was made available through Congressional appropriations (4,23). Dramatic reductions in
DAA pricing made possible by the steadfast negotiations of VA Pharmacy Benefits Management
leadership in early 2016, simultaneous enactment of additional appropriations and removal of restrictions
based on stage of Ii ver disease solidified VA' s ability to provide consistent access to HCV treatment for
all veterans. Figure 2 depicts the significant impact of funding variability on DAA uptake in VA in recent
years.
To comprehensively address HCV infection VA recognized e;,,.1:ending resources beyond purchasing
medications would be required. In 2016, VA boldly allocated 5% of the HCV dmg budget for each VA
medical center to non-dmg HCV clinical resources and infrastmcture. This has allowed medical facilities
to independently address local barriers and identify tangible solutions to increase treatment by dedicating
resources towards the initiatives described above.
9
VA-19-0799-D-000031
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Research to Inform
The comprehensive data sources within VA and the VA's diverse HCV population provides a broad
milieu for examining scientific and clinical outcomes, cost-effectiveness, patterns of care, and the impact
of specific interventions. For decades, VA HCV researchers have actively contributed to the medical
literature influencing and informing patient care, implementation strategies, operations and policy. Given
the large number of BCV-infected veterans treated, real-world outcomes in special populations can be
assessed to a greater degree than in many other healthcare environments thus providing valuable insight
for other payors and healthcare systems.
Cascade of HCV Care in VA
The impact ofDAAs on HCV has been transformational, making elimination seem a tangible goal, as the
National Academies of Sciences, Engineering, and Medicine report highlights. Elimination can only
occur when every individual with HCV infection is identified, linked to care. treated with HCV antivirals
and achieves a sustained virologic response (SVR), or cure. These steps comprise the "hepatitis C cascade
of care", a series of key components describing a population health approach to HCV care and a
mechanism lo assess performance (10, 16,24-26).
Figure 3 depicts VA's HCV care advancements in each of the cascade steps between 2014 and 2016. VA
estimates that 92% of veterans with HCV who have come to the VA for care in 2016 have been
diagnosed, and of those, 93% have been linked to HCV care. The most significant change in the cascade
has occurred in the treatment step. Among HCV-infected veterans in VA care in 2014, 27% of those
linked to HCV care had ever received HCV treatment -- including all veterans treated prior to the
10
VA-19-0799-D-000032
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availability of DAAs. At that time, 51 % of those ever treated had achieved SVR. By comparison, among
BCV-infected veterans in VA care in 2016, 59% of those linked to HCV care had ever received HCV
treatment, with 84% ever receiving HCV treatment achieving SVR. Overall, 84,192 BCV-infected
veterans in VA care in 2016 who had ever received HCV treatment had been cured.
Summary
The widespread availability of curative oral DAA medications have made the possibility of HCV
elimination seem achievable. VA is steadily approaching this goal and remains committed to diagnosing
and treating all veterans with HCV who are willing and able lo be treated. An extensive array of delivery
of services, policy guidance, outreach efforts and funding has broadened the reach and capacity of VA lo
deliver treatment, supported by an infrastructure to effectively implement change. The key actions that
have advanced VA' s HCV elimination efforts include: expanding treatment capacity with non-physician
providers; use of video telehealth and modified ECHO models to expand treatment; expansion of
integrated care and improvement in addressing psychiatric, substance use and medical co-morbidities; use
of electronic data tools for patient tracking and outreach; and dissemination and implementation of best
practices developed through the Systems Redesign efforts of regional HITs. However, it must be
underscored that financing for HCV treatment and infrastrncture resources coupled with reduced drug
pricing has been paramount to VA's success in curing HCV and is the lynchpin in achieving elimination
for any health care system and the US nationally. Recognizing the resources necessary to realize this goal
and the infrastrncture and innovations that could make it possible, VA is well poised to share and extend
best practices to other healthcare organizations and providers delivering HCV care.
11
VA-19-0799-D-000033
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!Acknowledgments: ' he authors would like to acknowledge Dr. Lisa Backus for her
Commented [PB1]:
Unfortunately we wont be able to
include this acknowledgement to veterans and providers and
congress. Based on author guidelines only the following is
contributions related to the generation of data used for reporting HCV testing rates, treatment
allowed:
Acknowledge only persons who have contributed to the
scientific content or provided technical support. Authors must
rates, and cascade of care steps.
obtain written permission from anyone they list in the
Acknowledgments section, including confirmation of the nature
of the contribution.
I would really like to add Lisa Backus since she generated much
of the data for the cascade and uptake utilization
Commented [MC2]: Love it, if we can't include David as an
author- we should include him here as well:
Suggested language ... The authors would also like to
acknowledge, Dr.
for his advocacy of HCV and vision
for how VA could become a national international leader in
HCV testing, care and treatment.
(b)
12
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References
I. National Academies of Sciences, Engineering, and Medicine. A national strategy for the elimination
of hepatitis Band C: Phase Two Report Phase Two Reportphase nvo report. Washington, DC: The
National Academies Press; 2017. doi: 10.17226/24731. Available from:
http://www.nationalacademies.org/hmd/Reports/2017 /national-strategy-for-the-elimination-ofhepatitis-b-and-c.aspx
2.
Buckley GJ, Strom BL. A National Strate6'Y for the Elimination of Viral Hepatitis Emphasizes
Prevention, Screening, and Universal Treatment of Hepatitis C. Ann Int Med. 2017; Apr 4. doi:
10. 7326/M 17-0766. http://annals.org/aim/article/2616344/national-strategy-eliminati on-viralhepatitis-emphasizes-prevention-screening-uni versal-treatment
3.
Beste LA, Ioannou GN. Prevalence and treatment of chronic hepatitis C vims infection in the US
Department of Veterans Affairs. Epidemiol Rev.2015; 37: 131-143.
4.
H.R.3236 - Surface Transportation and Veterans Health Care Choice Improvement Act of 2015,
114th Congress (2015-2016).
5. US Department of Veterans Affairs Viral Hepatitis Website. https:/hvvvw.hepatitis.va.gov/
6. Veterans Health Administration Patient Care Services/Population Health. Hepatitis C Antiviral
Uptake Report. March 31, 2017.
7.
Backus LI, Belperio PS, Shahoumian TA, Loomis TP, Mole LA. Real-world effectiveness and
predictors of sustained virological response with all-oral therapy in 21,242 hepatitis C genotype-I
patients. Antivir Ther. 2016 Dec 9. doi: 10.3851/IMP3117.
8.
Ioannou GN, Beste LA, Chang MF, Green PK, Lowy E, Tsui JI, et al. Effectiveness of sofosbuvir,
ledipasvir/sofosbuvir, or paritaprevir/ritonavir/ombitasvir and dasabuvir regimens for treatment of
patients with hepatitis C in the veterans affairs national health care system. Gastroenterology.
2016;151:457-471.
13
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9. Veterans Health Administration Patient Care Services/Population Health. HCV Viremic Veterans in
VHA Care Awaiting Treatment Report. April 10, 2017.
10. Maier MM, Ross DB, Chartier M, Belperio PS, Backus LI. Cascade of care for hepatitis C virus
infection within the US Veterans Health Administration. Am J Public Health. 2016; 106:353-358.
11. Backus LI, Gavrilov S, Loomis TP, Halloran JP, Phillips BR, Belperio PS, Mole LA. Clinical case
registries: simultaneous local and national disease registries for population quality management. J Am
Med Inform Assoc. 2009; 16:775-783.
12. Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Teo CG, et al. Recommendations
for the identification of chronic hepatitis C virus infection among persons born during 1945-1965.
MMWR Recomm Rep. 2012;6l(RR-4): 1-32.
13. Moyer VA; U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in adults:
U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013:159:349-357.
14. Backus LI, Belperio PS, Loomis TP, Mole LA Impact of race/ethnicity and gender on HCV
screening and prevalence among U.S. veterans in Department of Veterans Affairs Care. Am J Public
Health. 2014;104 Suppl 4:S555-561.
15. NoskaAJ, Belperio PS, Loomis TP, O'Toole TP, Backus LI. Engagement in the hepatitis C care
cascade among homeless veterans, 2015. Public Health Rep. 2017; 132: 136-139.
16. Jonas MC, Rodriguez CV, Redd J, Sloane DA, Winston BJ, Loftus BC. Streamlining screening to
treatment: the hepatitis C cascade of care at Kaiser Permanente mid-Atlantic states. Clin Infect Dis.
2016;62: 1290-1296.
17. Ross DB. Best practices in HCV screening, diagnosis, and treatment. Federal Practitioner. 2017;
February I.
18. Arora S, Kalishman S, Thornton K, Dion D, Murata G, Deming P, et al. Expanding access lo hepatitis
C virus treatment--Extension for Community Healthcare Outcomes (ECHO) project: disruptive
innovation in specialty care. Hepatology. 2010;52: 1124-1133.
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19. Rongey C, Shen H, Hamilton N, Backus LI, Asch SM, Knight S. Impact of rural residence and health
system structure on quality of liver cam PLoS One.2013;8:e84826.
20. Backus LI, Belperio PS, Shahoumian TA, Mole LA Impact of provider type on hepatitis C outcomes
with boceprevir-based and telaprevir-based regimens. J Clin GastroenteroL 2015;49:329-335.
21, Ourth H, Groppi J, Morreale AP, Quicci-Roberls K. Clinical pharmacist prescribing activities in the
Veterans Health Administration. Am J Health Sysl Pharm. 2016;73: 1406-1415.
22. Tsui JI, Williams EC. Green PK, Berry K, Su F, Ioannou GN, Alcohol use and hepatitis C virus
treatment outcomes among patients receiving direct antiviral agents. Drug Alcohol Depend.
2016; 169: 101-109,
23. US Department of Veterans Affairs. VA expands hepatitis C drug treatment Published March 9,2016.
https://vvww. va.gov/opa/pressrel/pressrelease.cfm ?id~2762, Accessed April I 0, 2017,
24. Yehia BR, Schranz AJ, Umscheid CA Lo RY The treatment cascade for chronic hepatitis C virus
infection in the United States: a systematic review and meta-analysis. PLoS One. 2014;9:e101554.
doi: 10.1371~joumaLpone.0101554.
25. Spradling PR, Rupp L, Moorman AC, et aL Hepatitis Band C virus infection among L2 million
persons with access to care: factors associated with testing and infection prevalence. Clin Infect Dis.
2012;55: 1047-1055,
26. Holmberg SD, Spradling PR, Moorman AC. Denniston MM. Hepatitis C in the United States. N Engl
J Med. 2013;368: 1859-186L
15
VA-19-0799-D-000037
OS 00001695
180,000
u
"'
:;::
:;::
160,000
+-'"""'__,,_.--________________________
140,000
+ - - - -• ,:-- - - - - - - - - - - - - - - - - - - - - -
C.
1"' ... 120,000
..
+ - - - - -~ ~ . ....-- - - - - - - - - - - - - - - - - - -
C:
:~ ~100,000
~
~
...~ 80,000
60,000
+ - - - - - - - - --"Ilk : - - - - - - - - - - - - - - - - - -
+ - - - - - - - - - - -=- -"""_,_ _ _ _ _ _ _ _ _ _ _ __
40,000 + - - - - - - - - - 20,000
+ - - - - - - - - - - - - - - - - - - - - - - --=----.;;
0 +---~---+----~-----+---~----+---~------i
10/1/2013
10/1/2015
10/1/2017
10/1/2019
10/1/2021
Figure 1. Number of Veterans with hepatitis C virus (HCV) in Veterans Affairs (VA) Care,
reqniring HCV antiviral treatment over time. In October 2013, 168,708 veterans in VA care were
identified with chronic HCV and requiring treatment; by March 31, 2017, 58,406 veterans in VA care
were identified as having chronic HCV and requiring treatment. R 2 , coefficient of determination.
16
VA-19-0799-D-000038
OS 00001696
2000
_..,1800
.,.,
:S:1500
:.
b. Limited use of
funds for
HCV drugs made avilable through
c. Enactment of
additional
C.
f 1400
.
.
tii
E1200
~
1!!1000
f-
"ii!
·s;
.,
800
C:
<(
.,.,u"'
.
.,
600
400
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0
............: ... , .... , .. ··:····,····
Figure 2. bnpact of hepatitis C virus (HCV) drug funding availability on HCV treatment starts per
week within Veterans Affairs
17
VA-19-0799-D-000039
OS 00001697
200,000
"'C
~
~
150,000
-.,
0
.c
§ 100,000
z
50,000
Chronic HCV
(estimated)*
Di agnosed with
chronic HCVt
Linked to HCV
caret
Treated with HCV
antivira ls§
Achieved SVR 11
Figure 3. Cascade of HCV care in the Veterans Health Administration (VHA) in 2014, 2015, and
2016. The proportion of patients in each step of the cascade from the patients in the preceding step is
presented in the arrows between each bar. SVR ~ sustained virologic response
*Estimated from diagnosed plus the ratio of prevalence in birth cohort strata in those tested in prior two
years applied to those still untested
tDiagnosed with chronic HCV defined as ever had a detectable HCV RNA or genotype.
tLinked to HCV care required an outpatient visit in the year, entry in the VHA's HCV registry and HCV
entered on the patient's medical record problem list.
§Treated with HCV antivirals defined as ever received HCV antivirals from VHA as of31 December of
the year.
IIAchieved SVR defined as undetectable HCV RNA on all tests after end of treatment including at least
one test at least 12 weeks after the end of treatment
18
VA-19-0799-D-000040
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Curing Hepatitis C Infection: Best Practices from the Department of Veterans Affairs
Pamela S. Belperio PharmD1 , Maggie Chartier PsyD MPH2, David B. Ross MD PhD MBI2,Poonam
Alaigh, MD 3 , David Shulkin MD4
1
Population Health Services, Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto,
CA
2
Office of Specialty Care Services, Department of Veterans Affairs, Washington DC
3
Office of the Under Secretary for Health, Department of Veterans Affairs, Washington DC
4
Office of the Secretary, Department of Veterans Affairs, Washington DC
Short Running Title: HCV Best Practices in VA
Financial Support and Disclosures: This work was prepared independently without financial
support. Drs. Belperio, Chartier, Alaigh, and Shulkin have no financial, professional or personal
disclosures to report.
Corresponding Author:
Pamela S. Belperio, Pharm D, Patient Care Services/Population Health Services, Veterans
Affairs Palo Alto Health Care System, 3801 Miranda Avenue (132), Palo Alto, CA 94304
Phone: 310-478-371 lx4471 l, Fax: 650-849-0266, Email: Pamela.Belperio@va.gov
Word Count: 2499
Keywords: Veteran, access, direct acting antiviral, cascade
1
VA-19-0799-D-000041
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Abstract (245)
The Department of Veterans Affairs (VA) is the nation's largest care provider to patients infected with
hepatitis C vims (HCV) and is uniquely suited to inform national efforts to eliminate HCV. An extensive
array of delivery of services, policy guidance, outreach efforts and funding has broadened the reach and
capacity of VA to deliver direct acting antiviral (DAA) HCV therapy, supported by an infraslmcture lo
effectively implement change and informed by e:s.1:ensive population health data analysis. VA has treated
over 86,000 HCV-infected veterans since the availability of all-oral DAAs in January 2014 with cure
rates exceeding 90%; only 58,000 known veterans in VA care remain potentially eligible for treatment.
Key actions advancing VA's aggressive treatment ofHCV include: expanding treatment capacity with
non-physician providers, video telehealth and electronic technologies; expansion of integrated care to
address psychiatric and substance use co-morbidities; and electronic data tools for patient tracking and
outreach. Critical to effective implementation has been building infrastmcture through the creation of
regional multidisciplinary HCV Innovation Teams whose systems redesign efforts have produced
innovative HCV practice models addressing gaps in care while providing more efficient and effective
HCV management for the populations they serve. Financing for HCV treatment and infrastmcture
resources coupled with reduced dmg pricing has been paramount lo VA's success in curing HCV. VA is
well poised to share and extend best HCV practices to other healthcare organizations and providers
delivering HCV care, contributing to a concerted effort to reduce the burden of HCV.
2
VA-19-0799-D-000042
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Introduction
Since the introduction of Direct Acting Antivirals (DAAs) for hepatitis C virus (HCV), the Department of
Veterans Affairs (VA) has made extensive progress in advancing HCV care and curing substantial
number~ of HCV-infected veterans in VA care with hepatitis C virus (HGV) infeetion. As the nation's
single-largest provider of care to patients with HCV, VA is uniquely suited to inform the recently released
National Strategy for the Elimination of Viral Hepatitis, produced by a National Academies of Sciences,
Engineering, and Medicine expert committee, which emphasizes prevention, screening, and universal
treatment of HCV-- areas in which VA has become a recognized leader (1-3). The National Strategy
presents specific actions to reduce the burden of HCV and outlines 5 distinct areas-Information,
Interventions, Service delivery, Financing, and Research (1,2). VA' s best practices and successes,
informed by extensive population health data analysis capabilities and national guidance and policies,
may be useful for other healthcare providers and organizations to reduce the burden of HCV in their
populations.
Based on US :National Health and :NHtrition Eirnmination Survey data from 2010, it was estimated that
appro1Eimately 13°'6 of all patients diagnosed with HGV in the United States (US) rneeive ears within the
VA, highlighting the disproportionate lmrden among veterans.(3,4} In 2013, before the availability of
HGV DAAs, there were approximately 1€ig,ooo veterans diagnosed with HGV infeetion in VA earn who
were potentially eligible for treatment and an additional estimated 45,000 Hndiagnosed in eare.(5)
With sHpport from the US HoHse and Senate Appropriations Committees (4), VA has made a substantial
commitment to prioritizing HCV care as reflected in dedicated funding for HCV treatment in VA,
Hniversal unrestricted access to DAAs, detailed guidance on individualizing care and the establishment of
Veterans Integrated Service Network (VISN) Hepatitis C Innovation Teams (HITs) (LI)_. This work, in
3
VA-19-0799-D-000043
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collaboration with other key VA offices, is largely supported by the VA's National Viral Hepatitis
Program which also develops national guidance and policy, teels,trainings, and resources for patients and
providers, easily accessible through illtemal ehanllols and on its comprehensive website (5). VA's sueeess
and best praetiees am illformed by si..tellsive populatioll health data analysis eapaliilities and llatiollal
guidanee and polieios.
The significant resources and efforts VA and its HCV providers have dedicated to prioritizing this disease
at every level of the organization are being tangibly realized. Between January 2014 and March 2017,
86,000 BCV-infected veterans ~
cure rates of over 90% (6-8).
in VA care have received pe-teat-oral DAA treatment, achieving
As of Marsh 2017Currently, only 58,000 known veterans in VA care
romaill to boremain potentially eligible for treatmentoo, compared to over 168,000 three years ago (9, 10).
While elimination appears attainable, VA recognizes the reality of the HCV epidemic and population;
namely, many of those in care remaining to be treated have complex substance use, mental health, and
medical co-morbidities, and many are challenged by homelessness, transportation, and rurality which
pose significant barriers to engagement in care and treatment. The curve of elimination for HCV in VA
will include a long tail of persistence driven by system, patient and care delivery determinants (Figure 1).
Information: Population Health Management
Using national databases and analytics, VA employs population health management strategies to measure,
monitor and identify trends in HCV care, gaining insight into patterns of access and tailoring care
provision programs accordingly. Veterans in VA care diagnosed with HCV are followed in VA' s
National Hepatitis C Clinical Case Registry (CCR), developed in part to ensure veterans with chronic
HCV were linked to care (11). The HCV CCR, used for both local and national population reporting,
provides data on the number of patients known to be infected with HCV together with critical clinical
4
VA-19-0799-D-000044
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information such as patient and disease characteristics, where care is received, receipt ofDAA treatment
aud clinical outcomes. The VA's Central Data Warehouse, a repository of electronic medical record data,
has spurred the creation of local and regional HCV dashboards which offer providers access to patientspecific data reports for real-time intervention and tracking. These sources allow for comprehensive
monitoring of incidence, prevalence, and disease course to identify and address barriers and assess
outcomes. National, regional and individual facility level data is posted regularly, allowing providers,
teams, and leadership to assess progress and goals. This leveraging of health systems data transforms
numbers into knowledge and guides providers and the VA toward more informed and effective delivery
of care for each veteran.
Essential Interventions
Diagnosis and Testing
Improved case identification: A critical first step for improving HCV care is to identify those infected. In
2012, the Centers for Disease Control and Prevention and subsequently the United States Preventive
Services Task Force developed recommendations for testing any person born between 1945-1965, a
cohort determined to have the highest HCV prevalence (12,13). Prior to 2014, VA had-guidance H!flaee
whi£h-recommended risk-based testing as well as aud testing of Vietnam-era veterans, a group which
largely overlaps with the 1945-1965 birth cohort (3). Using FOOHS-t-information systems to track
screening, VA has been able to identify and target additional populations at risk for HCV, which include:
African American males, for which the prevalence is double that of Caucasians (17. 7% versus 8.3%); the
homeless, for which the prevalence is over three times higher when compared to non-homeless (13.4%
versus 3.5%); aud persons who inject drugs (14,15).
5
VA-19-0799-D-000045
OS 00001705
gilloo tho rapid adoptioll of those oiqiandod sornollillg rnoommolldatiolls, Most recently, VA has screened
over 78% of the 2.5 million veterans in the 1945-1965 birth cohort, and Qf particular note, ~
sornollod 89.6% of its homeless population (15). Using updated annual prevalence calculations from tho
Humber ofllow illfootiolls amollg those tested, VA estimates there are only approximately 15,000
remaining veterans in VA care who would test positive for HCV if the entire at-risk population were
screened.
Testing initiatives: Several initiatives undertaken within VA to increase HCV testing have significantly
impacted these results. These include national electronic point-of-care clinical reminders for HCV risk
assessment and testing, automated letters recommending HCV testing which dually serve as a laboratory
order when presented to a VA lab, weekly primary care panel review~ identifying patients with upcoming
appointments who require testing, and calling patients directly. To emphasize this as a priority, VA added
birth cohort testing as a national performance measure in 2015 and reports quarterly screening rates by
facility and region. To ensure complete testing while simultaneously providing an efficient and patientcentered approach, VA developed ado ted CDC recommendations into olicy ill 2009 whoroliyN all
patients tested for HCV with a positive antibody automatically hae-had reflex confirmatory HCV RNA
testing performed with the same laboratory sample, with over 97% compliance in 2015. As a result of
these collective factors, the proportion of veterans in VA care screened for HCV have increased annually
by 3% to 4% and are substantially higher than other large healthcare systems (16).
Building Infrastructure
Hepatitis Innovation Team (HIT) Collaborative: Recognizing that care is not delivered the same way in
all settings, regional HITs, comprising a multidisciplinary group of 15-30 healthcare providers,
administrators, information technology and system redesign specialists, have implemented Lean Process
6
VA-19-0799-D-000046
OS 00001706
Improvement methods to maximize clinical expertise and redesign the process of HCV testing, diagnosis,
treatment, and management to provide care in the most efficient and effective way possible for the
populations they serve (17). The HIT Collaborative has enabled a clinically focused foundation to share
and implement best practices across and within teams, supported by local and regional administrators.
The development of the HIT infrastructureon the ground which has leveraged and supported the work of
dedicated VA providers, has been one of the 1Lcritical implementation arm that has allowed VA to
respond to challenges in funding variability and other 6fiti£al-access issues that have arisen since the
introduction ofDAAs.
Service Delivery: Improving Linkage and Access
Ones an enrolled veteran is diagnosed with HGV, the emphasis shifts to timely linkage to evaluation and
rnfeFFal for appropriate treatment. Robust p):'.opulation health data, the HIT infrastructure of the HIT
eollaborativs, and legions of dedicated providers on the ground have been instrumental in enhancing
VA's outreach and engagement~
. Efforts have focused on raising provider and staff awareness
among providers and staff about the need for HCV testing and treatment availability of trnatmsnt, as-wellas--promoting direct outreach to at-risk veterans leveraging technologies like mobile phone applications
and secure messaging, as well as outreach to the veteran community more broadly through national and
local social media and advertising campaignG, mobile phone applieations, and seeUFe messaging.
Expanding Capacity
Telemedicine and electronic technologies: VA has focused on increasing specialist capacity through
telemedicine and clinical video telehealth (CVT), or real-time video teleconferencing, whereby HCV
clinicians provide care to patients and/or consultation to other providers at another location. Largely
7
VA-19-0799-D-000047
OS 00001707
modeled off of the University oOfow Meirieo ECHO project (18), the expanded HCV VA-ECHO model
includes urban and rural sites, homeless care clinicsLincorporates a pharmacist-led provider program
sines mush of HGV treatment in VA is managed liy elinieal pharmaeists, and an---MC-¥-1!_mental health and
substance use program to aid providers in treating HCV in patients with these co-morbidities. Interprovider eleetronie eonsults offer another effeetive and effieient way to prepare patients for treatment
avoiding the need for additional appointments. Using Leveraging electronic databases, registries or
dashboards, _HCV teams team members ean identify potential treatment patients who may lie candidates,
for treatment_notify primary care providers eleetronieally through the electronic medical record ~
withand provide- HCV reeommend management recommendations. Similarly, primary care providers can
efficiently consult HCV specialists regarding HCV care management and treatment recommendations via
inter-provider electronic consults, eliminating the need for a specialty visit.
Non-physician advanced practice providers: Importantly, VA has emphasized the expansion of HCV care
beyond specialty providers. A substantial portion of HCV treatment management has shifted, partieularly
treatment, outside of liver and infectious disease specialty care clinics at larger medical centers to primary
care and community clinics. Furthermore, this earn Treatment is often being delivered by non-physician
providers such as Clinical Pharmacy Specialists, Nurse Practitioners and Physician Assistants, who have
been recognized as delivering the same quality of care and providing more timely access to HCV
treatment (19 ,20).
In 2016, almost one-third of VJ\. all HGV antiviral DAA prescriptions were initiated by a network of
nearly 200 Clinical Pharmacy Specialists (21). VA has also recently granted full practice authority to
nurse practitioners therefore expanding the potential for further use of these providers in providing
hepatitis care. Targeted use of the limited number of specialists while expanding the skills of non-
8
VA-19-0799-D-000048
OS 00001708
physician provider roles is ans of ths most an important practice that can be adapted from the VA system
into other healthcare systems (19).
Chall.enging Populaiions Barriers to Care
EarrieFs te Cal'/3: Based on VA HCV provider data collected in 2014 and 2015, it was estimated that up
to 30% of veterans awaiting treatment were not currently willing or were unable to initiate HCV
treatment. Major reported reasons included active alcohol/substance use, serious mental illness,
documented non-adherence to medical appointments or treatment, unstable/uncontrolled medical
comorbidities, inability to contact a veteran and, in some eases, _veterans unwillingness to start treatment.
As VA continues to treat more patients, an increasing number of those remaining in the untreated pool
present with these challenges aud accompanying resource demands to potentially modify these patient,
system, or care delivery factors. Frequent reassessment and refoeusing is required of healthcare systems
aud providers to adapt their approach and resources as the 1IBOOS-barriers inef-its untreated HCV
population!, and barriers to initiating treatment ehangeshift overtime.
Addressing substance use: Recognizing alcohol and substance use as a considerable barrier to HCV
treatment, VA took aggressive steps to eliminate non-evidence based, abstinence policies for HCV
treatment and provided clinical guidance on effectively assessing alcohol and substance use, matching a
patient's use with the actual risk of non-adherence. VA studies have consistently shown cure rates
achieved among veterans with alcohol, substance use and mental health disorders are similar to those
without these conditions (7,22).
9
VA-19-0799-D-000049
OS 00001709
Integrated care: Accessible mental health and addiction specialists, care coordinators, case managers and
social workers are invaluable resources to address the significant impediments to HCV treatment for
VA's most vulnerable populations so that a veteran's treatment candidacy may be reassessed as barriers
are addressed. Where resoHrees permit, VA has emphasized that integrated care, practice models earo
eoordination, ease management, and mental health and sHbstaneo Hse sorvieos are in plaeebc implemented
where resources permit to address factors that pose significant impediments to HGV treatment for
YHlnerable popHlations. For faci lities with more limited resources, individual aspects of this
comprehensive care can be leveraged within the facility, or region via innovative practice models as
detailed above .. This eomprehonsivo management approaeh faeilitates earn sHeh that veterans' treatment
candidacy can be reassessed. This has boon particHlarly important for "lllnorablo popHlations. Accessible
mental health and addietion speeialists, earo eoordinators, case managers and social workers are
ill'ralHablo resoHrees to meet the individHalized needs of this popHlation.
Financing HCV Treatment
Like all healtheare systems, VA has faced significant financial challenges as a result of highly priced
DAAs. With strong advocacy from VA HCV providers, veterans and VA leadership, expanded special
purpose funding for HCV medications was made available through Congressional appropriations (4,23).
]2Th0-dramatic reductions in the price of DAA pricing made possible by-¥A the steadfast negotiations of
VA Pharmacy Benefits Management leadership steadfast negotiations in early 2016, simultaneous
enactment of additional appropriations and removal of restrictions based on stage of liver disease
solidified VA~s ability to provide consistent access to HCV treatment for all veterans. GHrrently, VA has
no restrictions on DAAs which are available to all HGV patients regardless of stage of liver disease.
Figure 2 depicts the significant impact of funding variability on DAA uptake in VA 0¥SF-in recent years.
10
VA-19-0799-D-000050
OS 00001710
Reeognizing that in order tio comprehensively and sueeessfully treat address HCV infection in--¥A,--VA
recognized extending resources beyond purchasing medications would be required. In 2016, VA boldly
allocated 5% of the HCV drug budget for each VA medical center to non-drug HCV clinical resources
and infrastructure to further inerease treatment starts. This has allowed VUlN HITs medical facilities to
independently address local barriers and identify tangible solutions to increase treatment by dedicating
resources towards the initiatives described above .
. These funds have sueeessfully been used to Sl(fland HGV or liver disease Vl1, ECHO programs, inerease
treatment eapaeity through a Clinieal Pharmaey Speeialist initiative, inerease integrated earn, implement
HIT innovations, host HGV testing events and fund loeal testing and treatment advertising eampaigns.
Research to Inform
The comprehensive data sources within VA and the VA's diverse HCV population provides a broad
milieu for examining scientific and clinical outcomes, cost-effectiveness, patterns of care, and the impact
of specific interventions. For decades, VA HCV researchers have actively contributefl to the medical
literature influencing and informing patient care, implementation strategies, operations and policy. Given
the large number of BCV-infected veterans treated, real-world outcomes in special populations can be
assessed to a greater degree than in many other healthcare environments thus providing valuable insight
for other payors and healthcare systems.
Cascade of HCV Care in VA
11
VA-19-0799-D-000051
OS 00001711
The impact of DAAs on BCV has been miivorsally transformational, making elimination seem a tangible
goal, as the National Academies of Sciences, Engineering, and Medicine report highlights. Elimination
can only occur when every individual with BCV infection is identified, linked to care, treated with BCV
antivirals and achieves a sustained virologic response (SVR), or cure. These steps comprise the "hepatitis
C cascade of care", a series of key eare-components !!S6El-t& on Apr 24, 2017, at 3:43 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> Yes I am concerned about this
>
> Sent from my iPhone
>
>> on Apr 24, 2017, at 3:42 PM, David
>>
>> Would you be interested in meeting
the WH is going a different direction
room? I wont be able to join you but
shulkin wrote:
with Darin selnick about the Apple strategy? Im a little nervous
than you want and maybe its good for everyone to get in the same
i can arrange
>>
>> David
>>
>> Sent from my iPhone
VA-19-0799-D-000061
OS 00001723
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/24/2017 7:54:08 PM
To:
CC:
Bruce Moskowitz [(b) (6)
mac.com]
Ike Perlmutter [(b) (6) frenchangel59.com]
Subject:
Re:
Me too
Sent from my iPhone
> on Apr 24, 2017, at 3:43 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> Yes I am concerned about this
>
> Sent from my iPhone
>
>> on Apr 24, 2017, at 3:42 PM, David
>>
>> Would you be interested in meeting
the WH is going a different direction
room? I wont be able to join you but
shulkin wrote:
with Darin selnick about the Apple strategy? Im a little nervous
than you want and maybe its good for everyone to get in the same
i can arrange
>>
>> David
>>
>> Sent from my iPhone
VA-19-0799-D-000062
OS 00001724
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/24/2017 7:43:27 PM
To:
CC:
David shulkin [Drshulkin@aol.com]
Ike Perlmutter [(b) (6) frenchangel59.com]
Subject:
Re:
mac.com]
Yes I am concerned about this
Sent from my iPhone
> on Apr 24, 2017, at 3:42 PM, David shulkin wrote:
>
> Would you be interested in meeting with Darin selnick about the Apple strategy? Im a little nervous
the WH is going a different direction than you want and maybe its good for everyone to get in the same
room? I wont be able to join you but i can arrange
>
> David
>
> Sent from my iPhone
VA-19-0799-D-000063
OS 00001725
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/24/2017 7:42:22 PM
Bruce Moskowitz [(b) (6)
mac.com]; Ike Perlmutter [(b) (6) frenchangel59.com]
Would you be interested in meeting with Darin selnick about the Apple strategy? Im a little nervous the
WH is going a different direction than you want and maybe its good for everyone to get in the same room?
I wont be able to join you but i can arrange
David
Sent from my iPhone
VA-19-0799-D-000064
OS 00001726
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/24/2017 8:00:27 PM
Ike Perlmutter [(b) (6) frenchangel59.com]
Roe accepted dinner
Issakson is trying but due to health no confirmation yet
Sent from my iPhone
VA-19-0799-D-000065
OS 00001727
Message
David shulkin [Drshulkin@aol.com]
4/24/2017 7:16:07 PM
IP [(b) (6) frenchangel59.com]
Poonam Alaigh [(b) (6)
hotmail.com];
Re: Dinner Attendees
From:
Sent:
To:
CC:
Subject:
(b) (6)
frenchangel59.com
Ive extended the invites- waiting to hear
Working on the DoD nsme
Email is vacodjsl@va.gov
Sent from my iPhone
On Apr 24, 2017, at 1:07 PM, IP <(b) (6) frenchangel59.com > wrote:
Poonam and David:
We need to know the information below:
1.
2.
3.
Please let us know if you invited Senator Isakson and
Representative Roe to the dinner and if they accepted.
Please let us know the name of the gentleman in the DOD
that you would like the White House to invite.
David, please let Marisol know your business email address
so she can share with Johnson and Johnson
Thank you,
Ike
VA-19-0799-D-000066
OS 00001728
Message
IP [(b) (6) frenchangel59.com]
4/24/2017 5:07:54 PM
Poonam Alaigh [(b) (6)
hotmail.com]; David shulkin [drshulkin@aol.com]
(b) (6) frenchangel59.com
Dinner Attendees
From:
Sent:
To:
CC:
Subject:
Poonam and David:
We need to know the information below:
1.
2.
3.
Please let us know if you invited Senator Isakson and Representative Roe to the dinner and if they accepted.
Please let us know the name of the gentleman in the DOD that you would like the White House to invite.
David, please let Marisol know your business email address so she can share with Johnson and Johnson
Thank you,
Ike
VA-19-0799-D-000067
OS 00001729
Message
David Shulkin [drshulkin@aol.com]
4/25/2017 1:47:59 AM
(b) (6)
[(b) (6)
Fwd: Non-addictive pain meds
From:
Sent:
To:
Subject:
gmail.com]
Print
Sent from my iPad
Begin forwarded message:
From: "(b) (6)
(NIH/OD) [E]" <(b) (6)
od.nih.gov>
Date: April 24, 2017 at 8:58: 19 PM EDT
To: "drshulkin@aol .com"
Cc: "(b) (6)
(NIH/NIDA) [E]" <(b) (6)
nida.nih.gov>, (b) (6)
(b) (6)
<
speakergingrich.com>
Subject: Non-addictive pain meds
Hi David,
Newt shared with me your ideas about having the VA join the effort to deploy non-addictive pain
meds. NIH is organizing a series of three workshops with industry and FDA in the next three months to
make a plan. Can you recommend one or two VA experts in pain management who might be interested
and available to attend?
Best, F(b)
(6)
From: (b) (6)
[mailto:(b) (6)
speakergingrich.com1
Sent: Monday, April 24, 2017 1:17 PM
To: (b) (6)
(NIH/OD) [El <(b) (6)
od.nih.gov>; Jared Kushner
<
WHO.EOP.GOV>
Subject: Shulkin eager to collaborate on non addictive pain effort see below newt
(b) (6)
Sent from my iPad
Begin forwarded message:
From: David shulkin
Date: April 19, 2017 at 7:24: 18 PM EDT
To: (b) (6)
<(b) (6)
speakergingrich.com>
Subject: Re: Ending the Opioid Crisis fyi newt
Newt- this is very effective and well stated.
Pain is such a big issue in VA- what about making VA a fast tract FDA site to get
help to veterans faster? We dont want to be experimenting on veterans but why
not let veterans have the choice to receive these breakthroughs first?
VA-19-0799-D-000068
OS 00001730
Also VA researchers could join your list of those than can help speed further
discoveries.
Great job- keep it up!
David
Sent from my iPhone
On Apr 19, 2017, at 4:52 PM, (b) (6)
<(b) (6)
speakergingrich.com> wrote:
Sent from my iPad
VA-19-0799-D-000069
OS 00001731
Message
David shulkin [Drshulkin@aol.com]
4/25/2017 1:33:55 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Non-addictive pain meds
From:
Sent:
To:
Subject:
(b)(6)(6)
Can you get me names? (b)
Sent from my iPhone
Begin forwarded message:
From: "(b) (6)
(NIH/OD) [E]" <(b) (6)
od.nih.gov>
Date: April 24, 2017 at 8:58: 19 PM EDT
To: "drshulkin@aol .com"
Cc: "(b) (6)
(NIH/NIDA) [E]" <(b) (6)
nida.nih.gov>, (b) (6)
(b) (6)
<
speakergingrich.com>
Subject: Non-addictive pain meds
Hi David,
Newt shared with me your ideas about having the VA join the effort to deploy non-addictive pain
meds. NIH is organizing a series of three workshops with industry and FDA in the next three months to
make a plan. Can you recommend one or two VA experts in pain management who might be interested
and available to attend?
Best, F(b)
(6)
From: (b) (6)
[mailto:(b) (6)
speakergingrich.com1
Sent: Monday, April 24, 2017 1:17 PM
To: (b) (6)
(NIH/OD) [El <(b) (6)
od.nih.gov>; Jared Kushner
<
WHO.EOP.GOV>
Subject: Shulkin eager to collaborate on non addictive pain effort see below newt
(b) (6)
Sent from my iPad
Begin forwarded message:
From: David shulkin
Date: April 19, 2017 at 7:24: 18 PM EDT
To: (b) (6)
<(b) (6)
speakergingrich.com>
Subject: Re: Ending the Opioid Crisis fyi newt
Newt- this is very effective and well stated.
Pain is such a big issue in VA- what about making VA a fast tract FDA site to get
help to veterans faster? We dont want to be experimenting on veterans but why
not let veterans have the choice to receive these breakthroughs first?
VA-19-0799-D-000070
OS 00001732
Also VA researchers could join your list of those than can help speed further
discoveries.
Great job- keep it up!
David
Sent from my iPhone
On Apr 19, 2017, at 4:52 PM, (b) (6)
<(b) (6)
speakergingrich.com> wrote:
Sent from my iPad
VA-19-0799-D-000071
OS 00001733
Message
Blackburn, Scott R. [Scott.Blackburn@va.gov]
4/26/2017 2:22:20 AM
David Shulkin [drshulkin@aol.com]
(b) (6)
[(b) (6)
gmail.com]; Wright, Vivieca (Simpson) [Vivieca.Wright@va.gov]
RE: [EXTERNAL] Fwd: MyVA Advisory Committee
From:
Sent:
To:
CC:
Subject:
This is great. This shouldn't be a problem.
From: David Shulkin [mailto:drshulkin@aol.com]
Sent: Tuesday, April 25, 2017 10:17 PM
To: Blackburn, Scott R.
Cc: (b) (6)
Wright, Vivieca (Simpson)
Subject: [EXTERNAL] Fwd: MyVA Advisory Committee
I said yes
Sent from my iPad
Begin forwarded message:
[JJCUS]" <(b) (6)
its.jnj.com >
From: "(b) (6)
Date: April 25, 2017 at 3:59:42 PM EDT
To: "' Drshulkin@aol.com '"
Subject: MyVA Advisory Committee
Dear Secretary Shulkin,
Thank you for your warm invitation to serve on the MyVA Advisory Committee. It is a
true honor to be considered for such a role-one that helps rebuild trust with veterans
and other stakeholders, improve service delivery focusing on veteran outcomes and set
the course for longer-term excellence and reform.
As a veteran, I share your strong commitment to improving the lives of all veterans
through a healthy and well-functioning VA system. I am also pleased with your focus on
reconstituting the MVAC to develop a comprehensive approach toward these goals, by
sharing innovative approaches and ideas from many different areas across government,
academia, and the private sector. Sharing best practices through the MVAC will help
significantly advance your objectives of improving and building a world-class VA
system.
While I would be honored to serve on the MVAC, given the other commitments I have
on my calendar, I am concerned about being able to commit the time to attend every
meeting throughout the year. Although I would certainly be able to arrange my schedule
to participate in several of the meetings, I would ask if it would be possible to also
designate one of Johnson & Johnson's senior leaders to serve as my proxy for those
meetings I am unable to attend. Please let me know if this is possible.
Thank you and best wishes for continued success in your role as secretary.
Sincerely,
VA-19-0799-D-000072
DS 00001734
(b) (6)
•
Chairman and Chief Executive Officer
Tel: (732) 524-(b)
(b)
Fax: (732) 524-(6)
New E-mail: (b) (6)
its.jnj.com
(6)
VA-19-0799-D-000073
DS_00001735
Message
David Shulkin [drshulkin@aol.com]
4/26/2017 2:17:13 AM
Scott R. Blackburn [Scott.Blackburn@va.gov]
(b) (6)
[(b) (6)
gmail.com]; Vivieca Wright Simpson [vivieca.Wright@va.gov]
Fwd: MyVA Advisory Committee
From:
Sent:
To:
CC:
Subject:
I said yes
Sent from my iPad
Begin forwarded message:
From: "(b) (6)
[JJCUS]" <(b) (6)
its.jnj.com>
Date: April 25, 2017 at 3:59:42 PM EDT
To: "' Drshulkin@aol.com '"
Subject: MyVA Advisory Committee
Dear Secretary Shulkin,
Thank you for your warm invitation to serve on the MyVA Advisory Committee. It is a
true honor to be considered for such a role-one that helps rebuild trust with veterans
and other stakeholders, improve service delivery focusing on veteran outcomes and set
the course for longer-term excellence and reform.
As a veteran, I share your strong commitment to improving the lives of all veterans
through a healthy and well-functioning VA system. I am also pleased with your focus on
reconstituting the MVAC to develop a comprehensive approach toward these goals, by
sharing innovative approaches and ideas from many different areas across government,
academia, and the private sector. Sharing best practices through the MVAC will help
significantly advance your objectives of improving and building a world-class VA
system.
While I would be honored to serve on the MVAC, given the other commitments I have
on my calendar, I am concerned about being able to commit the time to attend every
meeting throughout the year. Although I would certainly be able to arrange my schedule
to participate in several of the meetings, I would ask if it would be possible to also
designate one of Johnson & Johnson's senior leaders to serve as my proxy for those
meetings I am unable to attend. Please let me know if this is possible.
Thank you and best wishes for continued success in your role as secretary.
Sincerely,
(b) (6)
VA-19-0799-D-000074
DS 00001736
Chairman and Chief Executive Officer
Tel : (732) 524-(b)
(b)
Fax: (732) 524-(6)
New E-mail: (b) (6)
its .jnj.com
(6)
VA-19-0799-D-000075
DS_00001737
Message
IP [(b) (6) frenchangel59.com]
4/23/2017 4:50:14 PM
Poonam Alaigh [(b) (6)
hotmail.com]; David shulkin [drshulkin@aol.com]
(b) (6)
FW: (b) (6)
I Time.com
From:
Sent:
To:
Subject:
fyi
EOP/WHO [mailto:(b) (6)
From: (b) (6)
Sent: Sunday, April 23, 2017 12:19 PM
To: (b) (6)
EOP/WHO; IP
Cc: Kushner, Jared C. EOP/WHO; (b) (6)
(b) (6)
Subject: RE: (b) (6)
I Time.com
who.eop.gov]
EOP/WHO
Reaching out to NIH on the below. The institutions/ leaders that Ike assembled is literally
second to none.
From:
(b) (6)
EOP/WHO
Sent: Saturday, April 22, 2017 7:09 PM
To: IP <(b) (6) frenchangel59.com >
Cc: Kushner, Jared C. EOP/WHO <(b) (6) who.eop.gov>;
<(b) (6)
who.eop.gov>; (b) (6)
(b) (6)
Subject: Re: (b) (6)
I Time.com
Adding (b) (6)
(b) (6)
EOP/WHO <(b) (6)
EOP/WHO
who.eop.gov>
also
Sent from my iPhone
On Apr 22, 2017, at 6:56 PM, IP <(b) (6) frenchangel59.com > wrote:
The following session was just brought to my attention. It would benefit your program if all of
the five CEOs from the Academic Medical Centers that are helping us with the VA effort and
The Health Care Reform were to participate. They are (b) (6)(b) (6)
from The Mayo Clinic,
(b) (6) (b) (6)
from Johns Hopkins, (b) (6) (b) (6)
from The Cleveland Clinic, (b) (6)
from Partners Healthcare. Are
from Kaiser (about whom I just wrote you) and (b) (6) (b) (6)
you able to include them on the invite list?
https://www.bloomberg.com/politics/articles/2017-04-21 /white-house-to-meet-biotech-researchchi efs-after-cuts-proposed
From: (b) (6)
EOP/WHO [ mailto:(b)
(b)(6)(6)
Sent: Friday, April 21, 2017 6:29 PM
To: IP
Cc: Kushner, Jared C. EOP/WHO; (b) (6)
(b) (6)
Subject: Re: (b) (6)
I Time.com
who.eop.gov]
EOP/WHO
Thanks for sending this along.
VA-19-0799-D-000076
OS 00001738
On Apr 21, 2017, at 6:24 PM, IP <(b) (6) frenchangel59.com > wrote:
Jared,
(b) (6)
and (b) (6)
(b) (6)
I would like to share with you an article on (b) (6)
the Chairman
and CEO of Kaiser Permanente and one of the 5 Academic Medical
Center CEOs who are helping us in our effort.
(b) (6)
has been named by TIME magazine as one of the 100 most
influential people in the world. This is a wonderful recognition of his work
and his impact on the Heath Care industry. In 2016, he was named the
2nd most influential person in Health Care by Modern Healthcare.
(b) (6)
is one of the top leaders in the health care industry and has also
been a tremendous advisor and resource in our work with the VA He a
strong advocate on mental health issues and supporter for the expanded
use of technology in medicine. He advocates that the right technology
ensures clean, aggregated data from patients' health care records which is
used to avoid inconsistent treatment and errors. This is a major focus of
ours which prompted our discussions with (b) (6)
and Apple.
Working with (b) (6)
together with the others, has allowed us to make
such great progress in such a short period of time.
All my Best,
Ike
http:!/time. com/collection/2017 -time-100/4 7427 45/bernard-j-tyson/
https://share.kaiserpermanente.org/article/chairman-ceo-bemard-j-tyson-kaiserpermanente-named-no-2-modem-healthcare-list-influential-health-care-leaders/
https://www.bloomberg.com/ graphics/2015-how-did-i-get-here/bemardtyson.html
VA-19-0799-D-000077
OS 00001739
Message
IP [(b) (6) frenchangel59.com]
4/22/2017 11:52:48 PM
Poonam Alaigh [(b) (6)
hotmail.com]; David shulkin [drshulkin@aol.com]
(b) (6)
FW: (b) (6)
I Time.com
From:
Sent:
To:
Subject:
FYI - this is for the May 8th summit.
From: (b) (6)
EOP/WHO [ mailto:(b) (6)
Sent: Saturday, April 22, 2017 7:09 PM
To: IP
Cc: Kushner, Jared C. EOP/WHO; Bremberq, (b) (6)
(b) (6)
Subject: Re: (b) (6)
I Time.com
Adding (b) (6)
who.eop.gov]
P. EOP/WHO; (b) (6)
EOP/WHO
also
Sent from my iPhone
On Apr 22, 2017, at 6:56 PM, IP <(b) (6) frenchangel59.com > wrote:
The following session was just brought to my attention. It would benefit your program if all of
the five CEOs from the Academic Medical Centers that are helping us with the VA effort and
The Health Care Reform were to participate. They are (b) (6)(b) (6)
from The Mayo Clinic,
(b) (6) (b) (6)
from Johns Hopkins, (b) (6) (b) (6)
from The Cleveland Clinic, (b) (6)
from Partners Healthcare. Are
from Kaiser (about whom I just wrote you) and (b) (6) (b) (6)
you able to include them on the invite list?
https://www.bloomberg.com/politics/articles/2017-04-21 /white-house-to-meet-biotech-researchchi efs-after-cuts-proposed
P. EOP/WHO [ mailto:(b)
From: Bremberq, (b) (6)
(b)(6)(6)
Sent: Friday, April 21, 2017 6:29 PM
To: IP
Cc: Kushner, Jared C. EOP/WHO; (b) (6)
(b) (6)
I Time.com
Subject: Re: (b) (6)
who.eop.gov]
EOP/WHO
Thanks for sending this along.
On Apr 21, 2017, at 6:24 PM, IP <(b) (6) frenchangel59.com > wrote:
Jared,
(b) (6)
and (b) (6)
(b) (6)
I would like to share with you an article on (b) (6)
the Chairman
and CEO of Kaiser Permanente and one of the 5 Academic Medical
Center CEOs who are helping us in our effort.
(b) (6)
has been named by TIME magazine as one of the 100 most
influential people in the world. This is a wonderful recognition of his work
VA-19-0799-D-000078
OS 00001740
and his impact on the Heath Care industry. In 2016, he was named the
2nd most influential person in Health Care by Modern Healthcare.
(b) (6)
is one of the top leaders in the health care industry and has also
been a tremendous advisor and resource in our work with the VA. He a
strong advocate on mental health issues and supporter for the expanded
use of technology in medicine. He advocates that the right technology
ensures clean, aggregated data from patients' health care records which is
used to avoid inconsistent treatment and errors. This is a major focus of
ours which prompted our discussions with (b) (6)
and Apple.
Working with (b) (6)
together with the others, has allowed us to make
such great progress in such a short period of time.
All my Best,
Ike
http:!/time. com/collection/2017 -time-100/4 7427 45/bernard-j-tyson/
https://share.kaiserpermanente.org/article/chairman-ceo-bemard-j-tyson-kaiserpermanente-named-no-2-modem-healthcare-list-influential-health-care-leaders/
https://www.bloomberg.com/ graphics/2015-how-did-i-get-here/bemardtyson.html
VA-19-0799-D-000079
OS 00001741
Message
Marc Sherman [(b) (6)
gmail.com]
4/24/2017 2:22:43 PM
David shulkin [Drshulkin@aol.com]
Bruce Moskowitz [(b) (6)
mac.com]; L Perl [(b) (6)
(b)
(6)
(b)
(6)
[
hotmail.com]; IP [
frenchangel59.com]
Re: Hopkins
From:
Sent:
To:
CC:
Subject:
gmail.com]; Poonam Alaigh
Or dinner reservation is confirmed for 7pm at i Ricchi on Wednesday evening. Once we know who is attending
I can send out specifics. Everyone on this email knows where to go or has me with them as a guide.
Marc Sherman
(202) 758-(b) (6)
On Apr 23, 2017 4:43 PM, "David shulkin" wrote:
Sounds like a great plan- with the pilot starting in baltimore
Sent from my iPhone
On Apr 23, 2017, at 11 :06 AM, Bruce Moskowitz <(b) (6)
(b) (6)
mac.com> wrote:
(b) (6)
is part of the team we need to advance the plan I proposed in the document at
the end of the email. He has the ability to adapt to any existing or future EMR platform so we
do not lose time on critical issues. The other part is the team that has the device registry and the
team from responsive health.org will be critical to have all 3 in the meeting at the Baltimore
VA At the end of the day we will have a unique product that will be of great interest to all
health care systems.
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
(b) (6)
From: (b) (6)
<(b) (6)
cs.jhu.edu>
Date: April 23, 2017 at 10:40:51 AM EDT
To: Bruce Moskowitz <(b) (6)
mac.com>
Cc: Aaron Moskowitz <(b) (6)
brefnet.org>
Subject: Re: VA
Thanks for sharing!
As promised, here is a first draft of a one-pager on accelerating data-driven
advances in healthcare. This a quick synopsis of my thinking. If you think it has
legs, I can also bring in more of a brain trust around it.
Look forward to your thoughts/comments.
(b) (6)
(b) (6)
(b) (6)
Director, Malone Center for Engineering in Healthcare
VA-19-0799-D-000080
OS 00001742
Mandell Bellmore Professor, Dept. of Computer Science
Assistant: (b) (6)
((b) (6)
jhu.edu)
On Apr 22, 2017, at 2:44 PM, Bruce Moskowitz
<(b) (6)
mac.com> wrote:
This is what I sent the Secretary David Shulkin. Aaron and his
team have the device registry part. The Secretary wants to move
quickly and for everyone to see what they have at the Baltimore
VA This should be looked at as a business that you all put
together and own. I believe if done correctly it will be widely
purchased throughout the medical industry. I welcome your trouts
and additions to this plan
The usual is to have a management system in place that does
central purchasing keeping strict control of cost and distribution.
We want to go beyond this and have:
24-7 alert for device recalls that not only goes to central
purchasing and automatically checks if the device is still on the
shelf and if it was implanted, directly alerting the physician and
the patient.
A device registry that barcodes every device and adds it to the
patient record. An added feature to tract over utilization of
implantable devices or physicians who are receiving stipends
from a device manufacturer.
Tract if a particular VA is using more inventory than could be
explained by patient volume to prevent pilfering of supplies.
Aside from this we are looking how to tract patients who are
being treated in the private sector from having unnecessary
testing, surgery or medical treatment.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 22, 2017, at 11 :07 AM, Poonam Alaigh
<(b) (6)
hotmail.com> wrote:
Sent from my iPad
VA-19-0799-D-000081
OS 00001743
Bruce Moskowitz MD.
Message
David shulkin [Drshulkin@aol.com]
4/23/2017 8:32:41 PM
Bruce Moskowitz [(b) (6)
mac.com]
Poonam Alaigh [(b) (6)
hotmail.com]; (b) (6)
[(b) (6)
gmail.com]
Re: Hopkins
From:
Sent:
To:
CC:
Subject:
gmail.com; IP [(b) (6) frenchangel59.com]; L Perl
Sounds like a great plan- with the pilot starting in baltimore
Sent from my iPhone
On Apr 23, 2017, at 11 :06 AM, Bruce Moskowitz <(b) (6)
(b) (6)
mac.com> wrote:
(b) (6)
is part of the team we need to advance the plan I proposed in the document at the
end of the email. He has the ability to adapt to any existing or future EMR platform so we do not
lose time on critical issues. The other part is the team that has the device registry and the team
from responsive health.org will be critical to have all 3 in the meeting at the Baltimore VA At
the end of the day we will have a unique product that will be of great interest to all health care
systems.
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
(b) (6)
From: (b) (6)
<(b) (6)
cs.jhu.edu>
Date: April 23, 2017 at 10:40:51 AM EDT
To: Bruce Moskowitz <(b) (6)
mac.com>
Cc: Aaron Moskowitz <(b) (6)
brefnet.org>
Subject: Re: VA
Thanks for sharing!
As promised, here is a first draft of a one-pager on accelerating data-driven
advances in healthcare. This a quick synopsis of my thinking. If you think it has
legs, I can also bring in more of a brain trust around it.
Look forward to your thoughts/comments.
(b) (6)
(b) (6)
(b) (6)
Director, Malone Center for Engineering in Healthcare
Mandell Bellmore Professor, Dept. of Computer Science
Assistant: (b) (6)
((b) (6)
jhu.edu)
VA-19-0799-D-000083
OS 00001745
On Apr 22, 2017, at 2:44 PM, Bruce Moskowitz
<(b) (6)
mac.com> wrote:
This is what I sent the Secretary David Shulkin. Aaron and his
team have the device registry part. The Secretary wants to move
quickly and for everyone to see what they have at the Baltimore
VA This should be looked at as a business that you all put together
and own. I believe if done correctly it will be widely purchased
throughout the medical industry. I welcome your trouts and
additions to this plan
The usual is to have a management system in place that does
central purchasing keeping strict control of cost and distribution.
We want to go beyond this and have:
24-7 alert for device recalls that not only goes to central
purchasing and automatically checks if the device is still on the
shelf and if it was implanted, directly alerting the physician and
the patient.
A device registry that barcodes every device and adds it to the
patient record. An added feature to tract over utilization of
implantable devices or physicians who are receiving stipends from
a device manufacturer.
Tract if a particular VA is using more inventory than could be
explained by patient volume to prevent pilfering of supplies.
Aside from this we are looking how to tract patients who are being
treated in the private sector from having unnecessary testing,
surgery or medical treatment.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 22, 2017, at 11 :07 AM, Poonam Alaigh
<(b) (6)
hotmail.com> wrote:
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000084
OS 00001746
Message
From:
Sent:
To:
CC:
Subject:
Attachments:
(b) (6)
Bruce Moskowitz [(b) (6)
mac.com]
4/23/2017 3:06:14 PM
David shulkin [drshulkin@aol.com]; Poonam Alaigh [(b) (6)
hotmail.com]
mbs(b) (6)
@gmail.com; IP [(b) (6) frenchangel59.com]; L Perl [(b) (6)
gmail.com]
Hopkins
FourSteps-Moscovitz-Healthcare-Vl.docx; Untitled attachment 04128.htm
(b) (6)
is part of the team we need to advance the plan I proposed in the document at the end of the
email. He has the ability to adapt to any existing or future EMR platform so we do not lose time on critical
issues. The other part is the team that has the device registry and the team from responsive health.org will be
critical to have all 3 in the meeting at the Baltimore VA At the end of the day we will have a unique product
that will be of great interest to all health care systems.
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
(b) (6)
From: (b) (6)
<(b) (6)
cs.jhu.edu>
Date: April 23, 2017 at 10:40:51 AM EDT
To: Bruce Moskowitz <(b) (6)
mac.com>
(b) (6)
Cc: Aaron Moskowitz <
brefnet.org>
Subject: Re: VA
Thanks for sharing!
As promised, here is a first draft of a one-pager on accelerating data-driven advances in
healthcare. This a quick synopsis of my thinking. If you think it has legs, I can also bring in more
of a brain trust around it.
Look forward to your thoughts/comments.
(b) (6)
(b) (6)
(b) (6)
Director, Malone Center for Engineering in Healthcare
Mandell Bellmore Professor, Dept. of Computer Science
Assistant: (b) (6)
((b) (6)
jhu.edu)
VA-19-0799-D-000085
OS 00001747
A Four Step Plan to Advance High-Value Healthcare
(b) (6)
(b) (6)
Draft 1: 4/23/17
Today's healthcare landscape is fragmented, inconsistent, and costly. The same patient can go to
two different clinics, get two different diagnoses and treatments, and pay two (sometimes startlingly) different costs. This is wrong for the patient individually, and costs the nation as a whole.
Thus, the key question we seek to address is:
How can we ensure that every patient can go into any clinic or hospital and ensure that patient
gets the same high quality of care for the same cost no matter where they go?
There is only one answer to this question: data describing both patient and the performance of
healthcare organizations must be made accessible, sharable and actionable. We must promote a
culture of openness, discovery, sharing, and action, and create an innovation system that finds
value in data, and drives that value into the world. The solution must bridge the gap between
existing health records systems, which are typically unique to an organization, and the power of
private-sector innovation to mine, structure, and produce actionable results from data.
To make this operational, we need to spur private-sector R&D to address immediate, high-priority challenges that exist today, and expand those efforts to "get ahead of the curve" and address
the challenges of tomorrow now.
Our proposal has four key points:
1) Create very low barriers to entry to healthcare data for both the private sector and research organizations so that more organizations can rapidly explore the opportunity
space. Accelerate this by creating consistent and standardized linkages into existing EHR
systems to reduce needless replication of effort.
2) Create a standardized value return system, together with standardized legal and privacy
safeguards, for all stakeholders. More specifically, any value created by a company from
the EHR that is adopted and scaled will be returned, in part, to the providers of the data.
The government can help spur this development through public/private partnerships that
define and create common infrastructure and convene a group to define the "rules of
engagement."
3) Create a "clearing house" of high priority problems for the VA as a starting point, and
develop 3-5 focused "loss-leader" pilot projects that can identify common barriers and
which can explore the common infrastructure and policy issues necessary to address
them.
4) Define mechanisms for external companies to implement with healthcare organizations
to accelerate deployment and testing of new technologies in patient monitoring and care.
VA-19-0799-D-000086
OS 00001748
On Apr 22, 2017, at 2:44 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
This is what I sent the Secretary David Shulkin. Aaron and his team have the device registry part. The Secretary wants to move quickly
and for everyone to see what they have at the Baltimore VA This should be looked at as a business that you all put together and own. I
believe if done correctly it will be widely purchased throughout the medical industry. I welcome your trouts and additions to this plan
The usual is to have a management system in place that does central purchasing keeping strict control of cost and distribution.
We want to go beyond this and have:
24- 7 alert for device recalls that not only goes to central purchasing and automatically checks if the device is still on the shelf and if it was
implanted, directly alerting the physician and the patient.
A device registry that barcodes every device and adds it to the patient record. An added feature to tract over utilization of implantable
devices or physicians who are receiving stipends from a device manufacturer.
Tract if a particular VA is using more inventory than could be explained by patient volume to prevent pilfering of supplies.
Aside from this we are looking how to tract patients who are being treated in the private sector from having unnecessary testing, surgery
or medical treatment.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 22, 2017, at 11:07 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000087
OS 00001749
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/24/2017 7:09:56 PM
To:
(b) (6)
Subject:
Attachments:
gmail.com
slides
april25thtoppriorities.pptx
VA-19-0799-D-000088
OS 00001750
, IA
V'"'
I U.S. Department
ofVeterans Affairs
Leadership Priorities for VA
David J. Shulkin, MD
Secretary of Veterans Affairs
April 19, 2017
VA-19-0799-D-000089
OS 00001751
Don't Plan on Incremental Change
38
,1A
V,..._
I
~
\
~!/
1
US l)ppartmcnl
ofVctc.-an~ ,\ffa 1r~
VA-19-0799-D-000090
OS 00001752
The Next Phoenix?
Draft/ Pre-dec1s1onal / For Internal VA Use Only
3
,1A
V'"'-
I
~
\
~!,I
1
US l)ppartmcnl
ofVcLcrar1s Mfa ,rs
VA-19-0799-D-000091
OS 00001753
Ask the Right Questions
Two Things Every Leader Needs to Know:
• Am I pushing too hard or not hard enough?
• What don't I know that is likely to damage
the organization?
4
,1A
VI-I.
I
~
\
~!/
1
US l)ppartmcnl
ofVctc.-an~ ,\ffa 1r~
VA-19-0799-D-000092
OS 00001754
"What Else Don't "We Know?
Identify the Risk
•
Wait Times- 144 sites with Primary Care waits greater than 30 days
51 sites with Mental Health waits greater than 30 days
68 sites with Specialty care waits greater than 30 days
•
Infrastructure and Equipment- 1.4 Billion in projects on hold
•
Systems- Inventory Control
•
Staffing- Loss of nurses in Buffalo
•
What Else?
Draft/ Pre-dec1s1onal / For Internal VA Use Only
5
,1A
V'"'-
I
~
\
~!,I
1
US l)ppartmcnl
ofVcLcrar1s Mfa ,rs
VA-19-0799-D-000093
OS 00001755
Why Wow?
What happens if we don't change?
/
I
BUSINESS
AS USUAL
Draft/ Pre-dec1s1onal / For Internal VA Use Only
6
,1A
V'"'-
I
~
\
~!,I
1
US l)ppartmcnl
ofVcLcrar1s Mfa ,rs
VA-19-0799-D-000094
DS_00001756
7
,1A
VI-I.
I
~
\
~!/
1
US l)ppartmcnl
ofVctc.-an~ ,\ffa 1r~
VA-19-0799-D-000095
DS_00001757
Making Tough Decisions (Quicker)
8
,1A
VI-I.
I
~
\
~!/
1
US l)ppartmcnl
ofVctc.-an~ ,\ffa 1r~
VA-19-0799-D-000096
OS 00001758
United's Response
Ill
r'::itertJayseDavid
4:51 PM ET
UNITED DRAGS PASSENGER FROM OVERBOOKED FLIGHT
THE LEAD
Draft/ Pre-dec1s1onal / For Internal VA Use Only
9
,1A
V'"'-
I
~
\
~!,I
1
US l)ppartmcnl
ofVcLcrar1s Mfa ,rs
VA-19-0799-D-000097
OS 00001759
Draft/ Pre-dec1s1onal / For Internal VA Use Only
10
,1A
V'"'-
I
~
\
~!,I
1
US l)ppartmcnl
ofVcLcrar1s Mfa ,rs
VA-19-0799-D-000098
DS_ 00001760
Demonstrate Your Commitment to the Mission
11
,1A
VI-I.
I
~
\
~!/
1
US l)ppartmcnl
of Veter-an~ ,\ffa 1r~
VA-19-0799-D-000099
OS 00001761
Take on the Tough Issues
Run Towards the Gun Fire
12
,1A
VI-I.
I
~
\
~!/
1
US l)ppartmcnl
of Veter-an~ ,\ffa 1r~
VA-19-0799-D-000100
OS 00001762
From: Inc. United Airlines
To: Vet eran Sm ith
Important update about your checked
baggage
Today at 9:09 AM
We're sorry, but your checked bag will arrive
on a later fl ight to Philadelph ia. When you
arrive, please see a Baggage Service
representative in Baggage Claim to arrange
your choice of delivery or pickup. We
apologize for this disruption to your plans
today.
VA-19-0799-D-000101
OS 00001763
Focus On Your People
I,_
My VA Organizational Hicrard1y _ ~
• .._
( .,
~
Dr D111ld Shulkln, VA Under Se
Sent: Saturday, April 22, 2017 11:56 AM
To: Poonam Alaigh
Subject:
This morning
http://www.cbsnews.com/videos/va-secreta ry-david-sh u Ikin-on-cha Ile nges-faci ng-the-age ncy/?ftag=CN M-0010aa b4i
VA Secretary David Shulkin on challenges
facing the agency
www.cbsnews.com
President Trump signed a law this week extending a pilot
program on health care for veterans that allows some to
receive treatment through private providers. Veterans
Affairs Secretary David Shu Ikin joins "CBS This Morning:
Saturday" to discuss the challenges facing the agency and
the issues affecting veterans.
--------------------·································································································································································································
Sent from my iPhone
VA-19-0799-D-000126
OS 00001788
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/22/2017 3:56:28 PM
Poonam Alaigh [(b) (6)
hotmail.com]
This morning
http ://www. cb snews.com/vi deos/va-secretary-davi d-shulkin-on-chall enges-facing-the-agency/?ftag=CNM-00l 0aab4 i
Sent from my iPhone
VA-19-0799-D-000127
OS 00001789
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/21/2017 10:42:20 AM
David shulkin [Drshulkin@aol.com]
Re: What do you think
I thought your view on consultants had changed- anyway, we should discuss this on the train- if we
collectively have to succeed- we need the right team - otherwise our traction will only be short lived this has to be our #1 priority - surrounding ourselves with the right people!!
Sent from my iPhone
> on Apr 21, 2017, at 6:24 AM, David shulkin wrote:
>
> You of course can do what you want
>
> I think you need a strong pdush and dushom for what you need
>
> Cos needs to be string too but cannot manage your issues outside- where the crises occur
>
what has he done? what is he
> Blackburn wont do it and even if he would dont see him as strong
doing?
He is a consultant that talks a good game but does very little
>
> Sent from my iPhone
>
>> on Apr 21, 2017, at 6:04 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>>
>> Jon Perlin and I had lunch together yesterday and one big advice he gave was regarding the criticality
of the chief of staff- I don't think I have the right executive in that role - I have been thinking about
it all night- suddenly it struck me that scott Blackburn could do it- what do yuh think - I trust him, he
has somewhat of a strategic sense and I think because of his other roles, he will be able to implement
and address things - Jon spent the entire lunch helping me understand how we needed to elevate this role
from a "super secretary" to an executive that is the #2 person. I realize now that I have been drowning
because I am working with supersecrtaries
>>
>> Sent from my iPhone
>
VA-19-0799-D-000128
OS 00001790
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/21/2017 10:24:27 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: What do you think
You of course can do what you want
I think you need a strong pdush and dushom for what you need
Cos needs to be string too but cannot manage your issues outside- where the crises occur
Blackburn wont do it and even if he would dont see him as strong He is a consultant that talks a good game but does very little
what has he done? what is he doing?
Sent from my iPhone
> on Apr 21, 2017, at 6:04 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Jon Perlin and I had lunch together yesterday and one big advice he gave was regarding the criticality
of the chief of staff- I don't think I have the right executive in that role - I have been thinking about
it all night- suddenly it struck me that scott Blackburn could do it- what do yuh think - I trust him, he
has somewhat of a strategic sense and I think because of his other roles, he will be able to implement
and address things - Jon spent the entire lunch helping me understand how we needed to elevate this role
from a "super secretary" to an executive that is the #2 person. I realize now that I have been drowning
because I am working with supersecrtaries
>
> Sent from my iPhone
VA-19-0799-D-000129
OS 00001791
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/21/2017 10:04:03 AM
David Shulkin [drshulkin@aol.com]
What do you think
Jon Perlin and I had lunch together yesterday and one big advice he gave was regarding the criticality of
the chief of staff- I don't think I have the right executive in that role - I have been thinking about it
all night- suddenly it struck me that scott Blackburn could do it- what do yuh think - I trust him, he
has somewhat of a strategic sense and I think because of his other roles, he will be able to implement
and address things - Jon spent the entire lunch helping me understand how we needed to elevate this role
from a "super secretary" to an executive that is the #2 person. I realize now that I have been drowning
because I am working with supersecrtaries
Sent from my iPhone
VA-19-0799-D-000130
OS 00001792
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/22/2017 3:13:09 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Aww
No its not easy
Sent from my iPhone
On Apr 22, 2017, at 11: 10 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
In addition, his wife is leading an organization that is pro- ACA- not an easy situation
From: David shulkin
Sent: Saturday, April 22, 2017 8:28 AM
To: Poonam Alaigh
Subject: Fwd: Aww
http://m.ndtv.com/world-news/i nd ia n-a me rica n-su rgeon-ge ne ra I-asked-to-ste pdown-by-tru m p-government-1684567
Trump Admini strati on Asks IndianAmerica n Surgeon General To Step
Down
m.ndtv.com
Indian-American Surgeon General Vivek Murthy, app
by the previous Obama regime, has been asked to st
down by the Trump administration to put its own lea
in place.
VA-19-0799-D-000131
OS 00001793
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/22/2017 3:10:13 PM
David shulkin [Drshulkin@aol.com]
Re: Aww
In addition, his wife is leading an organization that is pro- ACA- not an easy situation
From: David shulkin
Sent: Saturday, April 22, 2017 8:28 AM
To: Poonam Alaigh
Subject: Fwd: Aww
http://m.ndtv.com/world-news/indian-american-surgeon-general-asked-to-step-down-bytrump-government-1684567
Trump Administration Asks IndianAmerican Surgeon General To Step
Down
m.ndtv.com
Indian-American Surgeon General Vivek Murthy, appointed
by the previous Obama regime, has been asked to step
down by the Trump administration to put its own leadership
in place.
VA-19-0799-D-000132
OS 00001794
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/22/2017 12:33:44 PM
(b) (6)
[(b) (6)
Re: Aww
gmail.com]
How long is the aha presentation for?
Sent from my iPhone
On Apr 22, 2017, at 8: 15 AM, (b) (6)
<(b) (6)
gmail.com> wrote:
http ://m.ndtv.com/world-news/indian-american-surgeon-general-asked-to-step-down-by-trumpgovemment-1684567
VA-19-0799-D-000133
OS 00001795
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/22/2017 12:28:55 PM
(b) (6)
[(b) (6)
Re: Aww
gmail.com]
I heard this am
Sent from my iPhone
On Apr 22, 2017, at 8: 15 AM, (b) (6)
<(b) (6)
gmail.com> wrote:
http ://m.ndtv.com/world-news/indian-american-surgeon-general-asked-to-step-down-by-trumpgovemment-1684567
VA-19-0799-D-000134
OS 00001796
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/22/2017 12:28:43 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Aww
http ://m.ndtv.com/world-news/indian-american-surgeon-general-asked-to-step-down-by-trumpgovemment-1684567
VA-19-0799-D-000135
OS 00001797
Message
From:
(b) (6)
Sent:
4/22/2017 12:15:47 PM
David Shulkin [drshulkin@aol.com]
Aww
To:
Subject:
[(b) (6)
gmail.com]
http ://m.ndtv.com/world-news/indian-american-surgeon-general-asked-to-step-down-by-trump-government1684567
VA-19-0799-D-000136
OS 00001798
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/19/2017 10:24:53 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re:Today
Ok
Sent from my iPhone
> on Apr 19, 2017, at 6:06 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Would've been so sweet for me to be with you when Brian is there - want so much for that!! Next
opportunity for sure!
>
> Sent from my iPhone
VA-19-0799-D-000137
OS 00001799
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/19/2017 10:06:27 AM
David Shulkin [drshulkin@aol.com]
Today
Would've been so sweet for me to be with you when Brian is there - want so much for that!! Next
opportunity for sure!
Sent from my iPhone
VA-19-0799-D-000138
OS 00001800
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
6/11/2017 2:09:59 PM
Marisol Garcia [(b) (6) frenchangel59.com]
L Perl [(b) (6)
gmail.com]; (b) (6)
hotmail.com; David shulkin [Drshulkin@aol.com]; mbs(b) (6)
@gmail.com;
(b) (6) frenchangel59.com
Re: PRE-CONFERENCE CALL TODAY SUNDAY, JUNE 11TH AT 10:30 AM -- PLEASE NOTE THAT WE HAVE A DIFFERENT
CONFERECE TELEPHONE NUMBER FOR THIS CALL
Saw this will use this call in
Sent from my iPad
Bruce Moskowitz M.D.
On Jun 11, 2017, at 10:02 AM, Marisol Garcia <(b) (6) frenchangel59.com > wrote:
(b) (6)
Good morning - Any questions please call me at 212-576Sunday, June 11th
10:30 AM - 10:50 AM EST
Dial-in Information:
US: 1-605-475-5604
Passcode:521933#
Participants:
Laurie (Optional)
Marc Sherman - Not sure if able to participate
Secretary David Shulkin and Poonam Alaigh
Dr. Bruce Moskowitz and Ike
All my Best,
Marisol
212-576-(b) (6) (Office)
212-576-(b) (6) (Weekend)
646-668-(b) (6) (Cell)
Email: (b) (6) frenchangel59.com
VA-19-0799-D-000139
OS 00001801
Message
From:
Sent:
To:
Subject:
Marisol Garcia [(b) (6) frenchangel59.com]
6/11/2017 2:02:12 PM
L Perl [(b) (6)
gmail.com]; (b) (6)
hotmail.com; David shulkin [Drshulkin@aol.com]; Bruce Moskowitz
(b)
(6)
[
mac.com]; mbs(b) (6)
@gmail.com; (b) (6) frenchangel59.com
PRE-CONFERENCE CALL TODAY SUNDAY, JUNE 11TH AT 10:30 AM -- PLEASE NOTE THAT WE HAVE A DIFFERENT
CONFERECE TELEPHONE NUMBER FOR THIS CALL
(b) (6)
Good morning -Any questions please call me at 212-576Sunday, June 11th
10:30 AM - 10:50 AM EST
Dial-in Information:
US: 1-605-475(b) (6)
(b) (6)
Passcode:
Participants:
Laurie (Optional)
Marc Sherman - Not sure if able to participate
Secretary David Shulkin and Poonam Alaigh
Dr. Bruce Moskowitz and Ike
All my Best,
Marisol
212-576-(b) (6) (Office)
212-576-(b) (6) (Weekend)
646-668-(b) (6) (Cell)
Email: (b) (6) frenchangel59.com
VA-19-0799-D-000141
OS 00001803
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/23/2017 2:39:08 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Stan
sure
Sent from my iPhone
> on Apr 23, 2017, at 9:23 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Do you have time to Join stan and I for dinner on 5/22- Monday. He called yesterday, has been going
through a lot- he will be in de that day
>
> Sent from my iPhone
VA-19-0799-D-000142
OS 00001804
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/23/2017 1:23:18 PM
David Shulkin [drshulkin@aol.com]
Stan
Do you have time to Join stan and I for dinner on 5/22- Monday. He called yesterday, has been going
through a lot- he will be in de that day
Sent from my iPhone
VA-19-0799-D-000143
OS 00001805
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/26/2017 2:39:26 AM
(b) (6)
[(b) (6)
hotmail.com]
Re: [EXTERNAL] RE: two questions
645- I may get home sooner
Sent from my iPad
On Apr 25, 2017, at 10:08 PM, (b) (6)
<(b) (6)
hotmail.com> wrote:
Great what time do u pick me up?
Sent from my iPhone
On Apr 25, 2017, at 10:04 PM, David shulkin wrote:
Sent from my iPhone
Begin forwarded message:
(b) (6)
(b) (6)
From: "(b) (6)
<(b) (6)
va.gov>
Date: April 25, 2017 at 6:58:45 PM EDT
To: 'drshulkin'
Subject: FW: [EXTERNAL] RE: two questions
-----Original Message----From: Marisol Garcia [(b) (6) frenchangel59.com]
Sent: Tuesday, April 25, 2017 06:29 PM Eastern Standard Time
(b) (6)
To: (b) (6)
(b) (6)
Cc:
Subject: RE: [EXTERNAL] RE: two questions
Yes. We have (b) (6)
From:
(b) (6)
as attending. Thank you
(b) (6)
[ mailto:(b) (6)
(b) (6)
va.gov]
Sent: Tuesday, April 25, 2017 12:25 PM
To: 'Marisol Garcia'
Cc: (b) (6)
Subject: RE: [EXTERNAL] RE: two questions
VA-19-0799-D-000144
OS 00001806
Dr. Shulkin' s wife -
(b) (6)
Shulkin
From: Marisol Garcia [mailto:(b)
@frenchanqel59.com]
(6)
Sent: Tuesday, April 25, 2017 12:24 PM
(b) (6)
To: (b) (6)
Cc: (b) (6)
Subject: [EXTERNAL] RE: two questions
I am sorry who is (b) (6)
We are trying to get the names of the CEO's as soon as possible.
Thank you
From:
(b) (6)
(b) (6)
[ mailto:(b) (6)
(b) (6)
a.gov]
Sent: Tuesday, April 25, 2017 11:51 AM
To: Marisol Garcia ((b)
@frenchanqel59.com)
(6)
Cc: (b) (6)
Subject: two questions
Hi Marisol,
Would it be ok for (b) (6)
with Ike, Jared etc?
to attend the dinner tomorrow at 7pm
Do you know the names of the ceo's that want to attend with Ike
on Thursday here at VA for the Potus event? The Secretary
mentioned- (b) (6)
and (b) (6) (b) (6)
Thanks
VA-19-0799-D-000145
OS 00001807
(b) (6)
MBA
Special Advisor to the Secretary
Department of Veterans Affairs
202-461-(b) (6)
202-834-(b) (6)
VA-19-0799-D-000146
OS 00001808
Message
From:
Sent:
To:
Subject:
(b) (6)
[(b) (6)
hotmail.com]
4/26/2017 2:08:14 AM
David shulkin [Drshulkin@aol.com]
Re: [EXTERNAL] RE: two questions
Great what time do u pick me up?
Sent from my iPhone
On Apr 25, 2017, at 10:04 PM, David shulkin wrote:
Sent from my iPhone
Begin forwarded message:
(b) (6)
From: "(b) (6)
<(b) (6)
Date: April 25, 2017 at 6:58:45 PM EDT
To: 'drshulkin'
Subject: FW: [EXTERNAL] RE: two questions
va.gov>
-----Original Message----From: Marisol Garcia [(b) (6) frenchangel59.com]
Sent: Tuesday, April 25, 2017 06:29 PM Eastern Standard Time
(b) (6)
To: (b) (6)
(b) (6)
Cc:
Subject: RE: [EXTERNAL] RE: two questions
Yes. We have (b) (6)
as attending. Thank you
(b) (6)
[ mailto:(b) (6)
From: (b) (6)
Sent: Tuesday, April 25, 2017 12:25 PM
To: 'Marisol Garcia'
a.gov]
Cc: (b) (6)
Subject: RE: [EXTERNAL] RE: two questions
Dr. Shulkin' s wife -
(b) (6)
Shulkin
@frenchanqel59.com ]
From: Marisol Garcia [mailto:(b)
(6)
Sent: Tuesday, April 25, 2017 12:24 PM
(b) (6)
To: (b) (6)
VA-19-0799-D-000147
OS 00001809
Cc: (b) (6)
Subject: [EXTERNAL] RE: two questions
I am sorry who is (b) (6)
We are trying to get the names of the CEO's as soon as possible.
Thank you
(b) (6)
[ mailto:(b) (6)
From: (b) (6)
Sent: Tuesday, April 25, 2017 11:51 AM
To: Marisol Garcia ((b)
q@frenchanqel59.com)
(6)
va.gov]
Cc: (b) (6)
Subject: two questions
Hi Marisol,
Would it be ok for (b) (6)
etc?
to attend the dinner tomorrow at 7pm with Ike, Jared
Do you know the names of the ceo's that want to attend with Ike on Thursday
here at VA for the Potus event? The Secretary mentioned - (b) (6)
and
(b) (6)
(b) (6)
Thanks
(b) (6)
MBA
Special Advisor to the Secretary
Department of Veterans Affairs
202-461-(b) (6)
202-834-(b) (6)
VA-19-0799-D-000148
OS 00001810
9-0799-D-000149
1
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/26/2017 1:59:38 AM
To:
(b) (6)
Subject:
[(b) (6)
hotmail.com]
Fwd: [EXTERNAL] RE: two questions
Sent from my iPhone
Begin forwarded message:
(b) (6)
From: "(b) (6)
<(b) (6)
Date: April 25, 2017 at 6:58:45 PM EDT
To: 'drshulkin'
Subject: FW: [EXTERNAL] RE: two questions
va.gov>
-----Original Message----From: Marisol Garcia [(b) (6) frenchangel59.com]
Sent: Tuesday, April 25, 2017 06:29 PM Eastern Standard Time
(b) (6)
To: (b) (6)
(b) (6)
Cc:
Subject: RE: [EXTERNAL] RE: two questions
Yes. We have (b) (6)
as attending. Thank you
(b) (6)
[ mailto:(b) (6)
From: (b) (6)
Sent: Tuesday, April 25, 2017 12:25 PM
To: 'Marisol Garcia'
va.gov]
Cc: (b) (6)
Subject: RE: [EXTERNAL] RE: two questions
Dr. Shulkin' s wife -
(b) (6)
Shulkin
@frenchanqel59.com ]
From: Marisol Garcia [mailto:(b)
(6)
Sent: Tuesday, April 25, 2017 12:24 PM
(b) (6)
To: (b) (6)
Cc: (b) (6)
Subject: [EXTERNAL] RE: two questions
I am sorry who is (b) (6)
VA-19-0799-D-000150
OS 00001812
We are trying to get the names of the CEO's as soon as possible.
Thank you
(b) (6)
[ mailto:(b) (6)
From: (b) (6)
Sent: Tuesday, April 25, 2017 11:51 AM
To: Marisol Garcia ((b)
@frenchanqel59.com)
(6)
a.gov]
Cc: (b) (6)
Subject: two questions
Hi Marisol,
Would it be ok for (b) (6)
to attend the dinner tomorrow at 7pm with Ike, Jared etc?
Do you know the names of the ceo's that want to attend with Ike on Thursday here at VA for the
Potus event? The Secretary mentioned - (b) (6)
and (b) (6) (b) (6)
Thanks
(b) (6)
MBA
Special Advisor to the Secretary
Department of Veterans Affairs
202-461-(b) (6)
202-834-(b) (6)
VA-19-0799-D-000151
OS 00001813
Message
From:
(b) (6)
Sent:
4/25/2017 10:58:45 PM
'drshulkin' [drshulkin@aol.com]
FW: [EXTERNAL] RE: two questions
To:
Subject:
(b) (6)
[(b) (6)
va.gov]
-----Original Message----From: Marisol Garcia [(b) (6) frenchangel59.com]
Sent: Tuesday, April 25, 2017 06:29 PM Eastern Standard Time
(b) (6)
To: (b) (6)
(b) (6)
Cc:
Subject: RE: [EXTERNAL] RE: two questions
Yes. We have (b) (6)
as attending. Thank you
(b) (6)
From: (b) (6)
[mailto:(b) (6)
Sent: Tuesday, April 25, 2017 12:25 PM
To: 'Marisol Garcia'
va.gov]
Cc: (b) (6)
Subject: RE: [EXTERNAL] RE: two questions
Dr. Shulkin's wife -
(b) (6)
Shulkin
From: Marisol Garcia [ mailto:(b) (6) renchangel59.com ]
Sent: Tuesday, April 25, 2017 12:24 PM
(b) (6)
To: (b) (6)
Cc: (b) (6)
Subject: [EXTERNAL] RE: two questions
I am sorry who is (b) (6)
We are trying to get the names of the CEO's as soon as possible.
Thank you
(b) (6)
From: (b) (6)
[ mailto:(b) (6)
Sent: Tuesday, April 25, 2017 11:51 AM
To: Marisol Garcia ((b)
@frenchanqel59.com)
(6)
va.gov]
Cc: (b) (6)
Subject: two questions
Hi Marisol,
Would it be ok for (b) (6)
to attend the dinner tomorrow at 7pm with Ike, Jared etc?
Do you know the names of the ceo's that want to attend with Ike on Thursday here at VA for the Potus event? The
Secretary mentioned - (b) (6)
and (b) (6) (b) (6)
Thanks
VA-19-0799-D-000152
OS 00001814
(b) (6)
MBA
Special Advisor to the Secretary
Department of Veterans Affairs
202 -461 ·(b) (6)
202·834· (b) (6)
VA-19-0799-D-000153
DS_00001815
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
5/3/2017 12:48:32 AM
(b) (6)
@gmail.com
Re: Senate Accountability Bill
That's good news.
-----Original Message----From: Darin Selnick <(b) (6)
@gmail.com>
To: David Shulkin
Sent: Tue, May 2, 2017 7:12 pm
Subject: Senate Accountability Bill
I am told by Rubio staff to keep this confidential, but there will be a surprise announcement by noon tomorrow on an
agreed upon accountability bill sponsored by Rubio, Tester and Isakson.
Darin
Sent from my iPhone
VA-19-0799-D-000154
OS 00001816
Message
From:
Darin Selnick [(b) (6)
Sent:
5/2/2017 11:12:00 PM
To:
David Shulkin [Drshulkin@aol.com]
Senate Accountability Bill
Subject:
@gmail.com]
I am told by Rubio staff to keep this confidential, but there will be a surprise announcement by noon
tomorrow on an agreed upon accountability bill sponsored by Rubio, Tester and Isakson.
Darin
Sent from my iPhone
VA-19-0799-D-000155
OS 00001817
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/29/2017 2:35:05 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: This was the clip that they played introducing me Thursday
That was so perfect
Sent from my iPad
On Apr 28, 2017, at 7:00 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Miguel found this on Y ouTube and surprised me as part of the intro to my opening session
https://m.youtube .com/watch?v=dhj GO XeWRDM
Sent from my iPad
VA-19-0799-D-000156
OS 00001818
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/28/2017 11:00:25 PM
Drshulkin@aol.com
This was the clip that they played introducing me Thursday
Miguel found this on Y ouTube and surprised me as part of the intro to my opening session
https ://m.youtube.com/watch?v=dhjGOXeWRDM
Sent from my iPad
VA-19-0799-D-000157
OS 00001819
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/20/2017 2:47:54 AM
brucem(b)(b) (6)
@mac.com
(6)
Re: [EXTERNAL] Forwarding Email with Attachments on Behalf of (b) (6)
Diabetes Centers Inc.
MD - Sa lick Comprehensive
Sounds good- Let me see what he proposes specifically and forward to youDavid
-----Original Message----From: Bruce Moskowitz <(b) (6)
mac.com>
To: David shulkin
Sent: Wed, Apr 19, 2017 7:45 pm
Subject: Re: [EXTERNAL] Forwarding Email with Attachments on Behalf of (b) (6)
Diabetes Centers Inc.
MD - Salick Comprehensive
I know him very well. Perhaps when you get these offers I can assist in nicely telling them if they want to donate their
expertise great.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 19, 2017, at 7:11 PM, David shulkin wrote:
Bruce- any thoughts on this before I respond?
David
Forwarding Email with Attachments on Behalf of (b) (6)
Centers Inc.
MD - Salick Comprehensive Diabetes
Dear Dr. Shulkin,
Forwarding the attached to you on behalf of (b) (6)
M.D. as follows:
1. Letter Dated April 19, 2017
2. (b) (6)
M.D. - Bio
3. Salick Comprehensive Diabetes Centers, Inc. - Executive Summary
I have also listed Dr.
(b) (6)
contact information:
(b) (6)
M.D.
Chairman of the Board
Chief Executive Officer
Salick Comprehensive Diabetes Centers, Inc.
9777 Wilshire Boulevard, Suite 512
Beverly Hills, California 90212
Direct: 310-967-(b) (6) Fax: 310-967-(b) (6)
Mobile: 310-729-(b) (6) 310-729-(b) (6)
(b) (6)
aol.com
Please respond directly to (b) (6)
at: (b) (6)
aol.com
Thank you.
VA-19-0799-D-000158
OS 00001820
Sincerely,
Sent Via Assistant's Email
(b) (6)
Executive Assistant to: Dr. (b) (6)
Salick Comprehensive Diabetes Centers, Inc.
9777 Wilshire Boulevard, Suite 512
Beverly Hills, California 90212
(b) (6)
salickcenters.com
310-967-(b) (6) (0)
310-967-(b) (6) (Fax)
This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may
be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its
attachments, please be advised that you have received this email in error and that any use, dissemination,
distribution, forwarding, printing, or copying of this email or any attached files is strictly prohibited. If you have
received this email in error, please immediately purge it and all attachments and notify the sender by reply email
or contact the sender at the number listed.
<(b) (6)
MD Bio.pdf>
VA-19-0799-D-000159
OS 00001821
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/19/2017 11:45:31 PM
To:
David shulkin [Drshulkin@aol.com]
Re: [EXTERNAL] Forwarding Email with Attachments on Behalf of (b) (6)
Diabetes Centers Inc.
Subject:
mac.com]
MD - Sa lick Comprehensive
I know him very well. Perhaps when you get these offers I can assist in nicely telling them if they want to
donate their expertise great.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 19, 2017, at 7: 11 PM, David shulkin wrote:
Bruce- any thoughts on this before I respond?
David
Forwarding Email with Attachments on Behalf of (b) (6)
Diabetes Centers Inc.
MD - Salick Comprehensive
Dear Dr. Shulkin,
Forwarding the attached to you on behalf of (b) (6)
M.D. as follows:
1. Letter Dated April 19, 2017
2.
(b) (6)
M.D. - Bio
3. Salick Comprehensive Diabetes Centers, Inc. - Executive Summary
I have also listed Dr.
(b) (6)
contact information:
(b) (6)
M.D.
Chairman of the Board
Chief Executive Officer
Salick Comprehensive Diabetes Centers, Inc.
9777 Wilshire Boulevard, Suite 512
Beverly Hills, California 90212
VA-19-0799-D-000160
OS 00001822
Direct: 310-967-(b) (6) Fax: 310-967-(b) (6)
Mobile: 310-729-(b) (6) 310-729-(b) (6)
(b) (6)
aol.com
Please respond directly to (b) (6)
at: (b) (6)
aol.com
Thank you.
Sincerely,
Sent Via Assistant's Email
(b) (6)
Executive Assistant to: Dr. (b) (6)
Salick Comprehensive Diabetes Centers, Inc.
9777 Wilshire Boulevard, Suite 512
Beverly Hills, California 90212
(b) (6)
salickcenters.com
310-967-(b) (6) (0)
310-967-(b) (6) (Fax)
This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may
be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its
attachments, please be advised that you have received this email in error and that any use, dissemination,
distribution, forwarding, printing, or copying of this email or any attached files is strictly prohibited. If you have
received this email in error, please immediately purge it and all attachments and notify the sender by reply email
or contact the sender at the number listed.
<(b) (6)
MD Bio.pd±>
VA-19-0799-D-000161
OS 00001823
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/19/2017 11:11:23 PM
Bruce Moskowitz [(b) (6)
mac.com]
Fwd: [EXTERNAL] Forwarding Email with Attachments on Behalf of (b) (6)
Diabetes Centers Inc.
April 19 2017 Shulkin Letter.pdf; Untitled attachment 04290.htm; (b) (6)
04293.htm; SCDC Executive Summary.pdf; Untitled attachment 04296.htm
MD - Sa lick Comprehensive
MD Bio.pdf; Untitled attachment
Bruce- any thoughts on this before I respond?
David
Forwarding Email with Attachments on Behalf of (b) (6)
Centers Inc.
MD - Salick Comprehensive Diabetes
Dear Dr. Shulkin,
Forwarding the attached to you on behalf of (b) (6)
M.D. as follows:
1. Letter Dated April 19, 2017
2.
(b) (6)
M.D. - Bio
3. Salick Comprehensive Diabetes Centers, Inc. - Executive Summary
I have also listed Dr.
(b) (6)
contact information:
(b) (6)
M.D.
Chairman of the Board
Chief Executive Officer
Salick Comprehensive Diabetes Centers, Inc.
9777 Wilshire Boulevard, Suite 512
Beverly Hills, California 90212
Direct: 310-967-(b) (6) Fax: 310-967-(b) (6)
Mobile: 310-729-(b) (6) 310-729-(b) (6)
(b) (6)
aol.com
Please respond directly to (b) (6)
at: (b) (6)
aol.com
VA-19-0799-D-000162
OS 00001824
Thank you.
Sincerely,
Sent Via Assistant's Email
(b) (6)
Executive Assistant to: Dr. (b) (6)
Salick Comprehensive Diabetes Centers, Inc.
9777 Wilshire Boulevard, Suite 512
Beverly Hills, California 90212
(b) (6)
salickcenters.com
310-967-(b) (6) (0)
310-967-(b) (6) (Fax)
This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only
by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you
have received this email in error and that any use, dissemination, distribution, forwarding, printing, or copying of this email or any
attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify
the sender by reply email or contact the sender at the number listed.
VA-19-0799-D-000163
OS 00001825
SALi CK
COMPREHENSIVE DIABETES CENTERS, \NC.
April 19, 2017
Via Priority Federal Express and Email
David Shulkin, M.D.
Secretary of Veteran's Affairs
Department of Veteran's Affairs
810 Vermont Avenue, NW
Washington DC 20420
Dear David:
Congratulations on your appointment as the head of the Veterans Administration! I recently
called (b) (6)
and (b) (6)
, both dear friends of ours, so that I could get your private
email, and quickly speak to you, to avoid inevitable delays in governmental systems. Stan,
Steve, and I agree that there is no better person than you to run the Veterans Administration
health care system, with your background, credibility, and experience in all aspects of medicine.
I remember being involved with you a number of times when I was back East, negotiating with a
variety of New York and New Jersey health systems including Continuum (Beth Israel,
Maimonides) and Montefiore Medical Center and adjoining areas. My company, Salick
Healthcare, Inc, (SHC), was one of your first clients for Doctor Quality, and I know we benefited
from our mutual relationship as we both sought to increase transparency in health care.
As you may remember, I have been a pioneer in the creation of successful comprehensive
outpatient diagnostic and treatment centers for catastrophic diseases such as cancer, end-stage
renal disease (ESRD), and now diabetes mellitus, for the past 50+ years, I was able to open the
first 24/7 outpatient comprehensive cancer center at Cedars Sinai Medical Center in Los
Angeles, subsequently developing 18 cancer centers around the USA and eventually selling my
company for $500mm to AstraZeneca. After leaving AstraZeneca because I rejected an
emeritus position, I continued as Bentley Health Care for several years. Throughout my career, I
have dealt with private, for-profit, academic centers, governmental agencies such as the National
Health Service (NHS) in the UK, CMS (Medicare), and the archdioceses of New York and
Brooklyn, and the Daughters of Charity in California.
I have continued to explore the establishment of Salick Health Care-type facilities at academic
centers and private carriers throughout the country. l have focused my attention to the diagnosis
and treatment of diabetes mellitus, especially its microvascular complications, which I now
believe is, in my opinion, the most important and catastrophic illness, both for patient morbidity,
mortality, and increasing financial costs. I was offered the CEO position at Harvard's Joslin
Clinic in Boston by its then CEO and board, approximately five years ago. I rejected this offer
because Joslin did not provide the kind of comprehensive approach which I had already
9111 WILSHIRE BOULEVMW, 5U!TE ; 12, !.lEVl.aRLY 1-HlLS, CAUFORN!A 90212
l'HONE 3l0 967.(b) (6)
FAX J!O 961.(b) (6)
VA-19-0799-D-000164
OS 00001826
developed at Salick Health Care. I have spent the last several years learning more about the
disease and care delivery in multiple settings, and have met with many health care providers and
academic centers throughout the country, to present my new paradigm to greatly improve the
quality and lower the cost of care, similar to the methods I had employed at SHC.
I was dismayed to learn, having participated in both teaching and research at the VA-Sawtelle
system in Los Angeles during my training, is the tremendous incidence of diabetes and
complications of diabetes in the Veteran population, likely the single biggest disease driver of
morbidity and costs for the VA. I believe I could add my methodology to the VA system with
dramatic improvements in both the cost and quality of care of the disease. I could also
significantly develop a capitated program with assumption of financial risk, based on practice
guidelines and outcome measurements ("value health") as I have done at my SHC facilities. I
have already discussed with a leading health care insurance provider to have them support me in
my risk assumption.
I am committed to my successful model of diagnosis and treatment of catastrophic illness, and
am confident we can be successful in working together using this model to provide all aspects of
diabetic care to patients with diabetes mellitus (Type 1 and Type 2).
I would very much like to discuss a potential relationship with the VA. I have already met with
some of the VA leadership in diabetes in Washington DC, including Leonard Pogach and Rajiv
Patel two or three years ago. Dr. Patel recommended that it would be useful for me to meet with
the Department of Defense (DOD), since their system of health care services was a very different
system from the VA. He thought I might also provide a combined proposal to the DOD and the
VA. I have also met with Mr. Guy Kiyokawa of the DOD at the Pentagon, and with senior
officials of their own insurance provider, Tri Care. I was accompanied to these meetings by
members ofmy team, and with Congressman Henry Waxman, a long-time consultant and friend.
I had follow up phone conferences with all of them. I also met with Congressman Mac
Thornberry, Chairman of the House Armed Services Committee, in Washington D.C. My staff
has.also had discussions with Representative Kay Granger, who is the Chairperson of the House
Defense Appropriations Subcommittee in Health Care.
I am hoping to speak with you to share details of my program, and to meet with you. Salick
Comprehensive Diabetes Centers, Inc. ('"SCDC"), is a national diabetes program, which includes
a network of comprehensive outpatient diabetes centers in affiliation with academic centers for
inpatient services, research, and teaching, and a national dialysis provider of dialysis services for
ESRD. The network will be affiliated with academic medical centers and/or major for-profit
providers of health care services. The network will focus on the prevention, diagnosis, and
treatment of all forms of diabetes mellitus, with the major emphasis being on the microvascular
complications of diabetes (retinopathy, cardiovascular disease and peripheral cardiovascular
disease, and ESRD). Approximately 93% of the $250 billion annual cost of health care in
diabetes are secondary to these complications.
VA-19-0799-D-000165
DS_00001827
(b) (6)
and (b) (6)
who are very familiar with all my programs, send their best wishes to you.
Best personal regards.
Very truly yours,
(b) (6)
M.D.
Chairman of the Board
Chief Executive Officer
Salick Comprehensive Diabetes Centers, Inc.
BS:GS
encl: (b) (6)
M.D. Bio; Executive Summary
VA-19-0799-D-000166
OS 00001828
(b) (6)
(b) (6)
M.D.
Chairman of the Board and Chief Executive Officer
Salick Comprehensive Diabetes Centers, Inc.
Dr. (b) (6)
is widely recognized as a visionary, pioneer, and leading expert in the field of diseasestate management. The founder and former Chainnan and CEO of Salick Health Care, Inc., he developed
industry-changing concepts and solutions that fundamentally transformed how patients with chronic and
catastrophic illnesses are diagnosed and treated. While leading Salick Health Care, Inc., he created a
managed care subsidiary, the first to offer fixed-price insurance products for the treatment of catastrophic
diseases such as cancer and end-stage renal disease. He established a series of practice guidelines and
outcome measurements for cancer treatment which were instituted nationwide at the eleven Comprehensive
Cancer Centers, and the eight Comprehensive Breast Centers operated by Salick Health Care, Inc. These
diagnostic and treatment centers were open 24 hours a day, seven days a week, providing quick, userfriendly, and high quality out-patient care in a cost-effective manner.
In 1997, Salick Health Care, Inc. was sold to Zeneca PLC (Astra-Zeneca). (b) (6)
then created Bentley
Health Care, providing diagnostic and therapeutic services to patients with chronic and catastrophic illness
including cancer, end-stage renal disease, and AIDS. Bentley Health Care, Inc. and all of (b) (6)
health care companies, are dedicated to advancing the field of disease-state management through innovative
and unique solutions to patients, physicians, and payors seeking quality care and cost-effective, diseasestate programs.
Based on his disease-specific paradigm that he has previously pioneered, he developed the concept of
Comprehensive Cardiovascular Centers. Salick Cardiovascular Centers, Inc. in affiliation with Private
Equity Partners, proposed a broad range of innovative services for the diagnosis and treatment of
cardiovascular disease (including cerebrovascular, coronary artery, coronary heart and peripheral vascular
disease) and cardiovascular end-stage renal disease on an out-patient basis, with in-patient affiliations.
These centers will offer state-of-the-art procedures and techniques for the treatment and diagnosis of
cardiovascular disease, including surgery, angioplasty, angiography, electrophysiologic procedures,
sophisticated radiology, and other diagnostic testing and medical services. Leading practitioners,
to develop the
researchers and educators in the cardiovascular field indicated their desire to join (b) (6)
Centers on a national basis. These essential services will be available to patients, physicians and payors in a
multidisciplinary, high quality, user-friendly, cost-efficient environment, open 24 hours a day, seven days a
week and will be incorporated with the Salick Comprehensive Diabetes Centers, Inc.
In addition, (b) (6)
worked with Members of the Harvard Business School and Harvard Medical School
Faculty in developing a plan for a Personalized Medicine Molecular Biology entity headed by Dr. (b) (6)
(b) (6)
received his B.S. degree from Queens College, New York in 1960, and his M.D. from the
University of Southern California in 1964. He completed his internship and residency in Internal Medicine
at Cedars-Sinai Medical Center and a National Institutes of Health Postdoctoral Fellowship in Nephrology
at Cedars-Sinai Medical Center and the University of California, Los Angeles. (b) (6)
is currently
licensed in California, New York, and New Jersey. He has served on the board of the Queens College
Foundation, and Crossroads School for Arts and Sciences in Santa Monica. He is and has been a member
of the Visiting Committee and the Leadership Council of the Harvard School of Public Health.
VA-19-0799-D-000168
OS 00001830
He is a regular visiting lecturer at and has been a member of the Healthcare Initiative Advisory Board and
served on both the Harvard
the Centennial Committee of the Harvard Business SchooL In 2005, (b) (6)
Business School panel for the Healthcare Innovation and Opportunities in Southeast Asia and also was a
guest speaker for the India and Its Neighbors Conference, He served on the Board of Directors of Nephros,
Inc. (AMEX:NEP) from 2005 to 2007 and in addition, he served as a member of the Board of Trustees for
established a
the United States Equestrian Team Foundation from 1991 to 2011. In 2004, (b) (6)
fellowship at Harvard School of Public Health to provide annual scholarships for selected students pursuing
studies related to cancer and/or cardiovascular disease, He also provides funds for fellowships and
scholarships at Yeshiva University, Queens College, and Stuyvesant High School,
was offered the position of Chief Executive Officer of Harvard's Joslin Clinic by its
ln 2010, (b) (6)
Board of Trustees, an offer that (b) (6)
declined, (b) (6)
is presently working on the development of
(b) (6)
a nationwide program of Comprehensive Diabetes Centers.
received his academic appointment
as Professor of Medicine, Cedars-Sinai Medical Center on January l, 2017,
(b) (6)
and his wife Gloria reside in Los Angeles and New York, They have three daughters who have
each completed graduate school in New York and post-graduate school in New York and in Washington,
DC. (b) (6)
and (b) (6)
presently have five grandchildren.
Tribute by Shlomo Melmed, M,D.
Honoring (b) (6)
M.D, ,,, Alumnus of the Year
Cedars-Sinai Alumni Association
Cedars-Sinai Medical Center
December 2, 20 I0
.Jfis a pleasure for me to honor (b) (6)
here tonight.
(b) (6)
has had a major impact
nationally and internationally in the development of new clinical programs for the diagnosis and
treatment of patients in many areas of medicine Including Nephro!ogy, Cancer, Organ Transplant,
Cardlovascular Dlsease, and Personalized Medicine. He is a world renowned medical entrepreneur
whose companies have striven to provide compassionate and advanced care to patlents with
catastrophic diseases in a user-friendly, high quality outpatient care in a cost effective manner.
He early on realized the benefits of a 24-hour a day, outpatient diagnosis and treatment center.
His clinics developed standards for care of cancer treatments lndudlng a vast database of cancer
drug use and treatment outcomes such as chemotherapy for colon cancer, bone marrow transplants
for breast cancer, and the use of antl-nausea drugs, He has been intimately involved in developing
these centers with academic medical centers and governments throughout the United States, the
United Kingdom, Europe, Israel, and Southeast Asia, Proudly, he developed the first Cancer Center
at Cedars-Sinai, dedicated to excellence in patient care, and delivery of 24/7 service,
Regarded by fellow professionals as one of the nation's leading and most innovative health care
entrepreneurs, (b) (6) also boasts an lmpresslve career as a physician and leader of many national
civic causes, He has served on multiple committees at Harvard University Schoo! of Public Health,
Business School, and Medical School. He has served cm the National Advisory Board for the
National Kidney Foundation (1988-1990}, was a member of the Board of Directors for American
Woman's Economic Development Corporation (1990-1991) and Nephros, Inc. {2005-2007),
and was on the Board of Trustees for the Hereditary Disease Foundation {1975-1985).
(b) (6)
has been instrumental in providing a unique mode! of innovative and effective treatment
for patients with catastrophic diseases. He Is a world renowned health care innovator who has had
tremendous Impact on national and worldwide medical delivery practices, I congratulate him and
Glo for this we!! deserved honor, as a veteran member of the Cedars~Sinai family, Cedars Sinai
is proud of you, (b) (6)
and we wish you good health and energy to continue contributing to
society wlth your unique passion and energy,
(b) (6)
, MD
Senior Vice President of Academic Affairs, Dean of the Medical Faculty
Cedars-Sinai Medical Center
9
Re11: Apr!l 19, 2017
VA-19-0799-D-000169
OS 00001831
SALi
CK
■
COMPREHENSIVE DIABETES CENTER S, I
<: .
EXECUTIVE SUMMARY
(b) (6), (b) (4)
(b) (6)
1
Revised: April 19, 2017
STRICTLY CONFIDENTIAL
VA-19-0799-D-000171
DS_00001833
(b) (6), (b) (4)
(b) (6)
(b) (6)
(b) (6)
2
Revised:April19,2017
STRICTLY CONFIDENTIAL
VA-19-0799-D-000172
OS 00001834
(b) (6), (b) (4)
(b) (6)
3
Revised:April 19, 2017
STRICTLY CONFIDENTIAL
VA-19-0799-D-000173
DS_00001835
Message
Poonam Alaigh [(b) (6)
hotmail.com]
5/3/2017 3:00:09 AM
brucem(b) (6)
@mac.com
David Shulkin [drshulkin@aol.com]
Fwd: Top 5 disability problems in our patients
From:
Sent:
To:
CC:
Subject:
Bruce - you are right to focus on Tinnitus- please see below, the top disability. The rest of the 9 disability areas
are listed. Let's try to schedule the call with the ENT researcher next week - thanks
Sent from my iPhone
Begin forwarded message:
From: "Alaigh, Poonam, M.D."
Date: May 2, 2017 at 10:53:15 PM EDT
To: 'Poonam Alaigh' <(b) (6)
hotmail.com>
Subject: FW: Top 5 disability problems in our patients
Sent with Good (www.good.com)
-----Original Message----From: Crump, Regan
Sent: Tuesday, May 02, 2017 08:58 AM Eastern Standard Time
To: Alaigh, Poonam, M.D.
(b) (6)
Cc: (b) (6)
Hyduke, Barbara; (b) (6)
Subject: Top 5 disability problems in our patients
Dr. Alaigh:
Here are the top 5, plus the next 5. We used the latest update from VBA in their end of year
FY2014 data and found the following most prevalent Service Connected Disabling
conditions. Recent conversations with VBA indicate that these conditions remain the most
common conditions. They are specifically rated as disabling and compensable by VBA, though
they do not represent a list of the top most expensive chronic disabilities in the general VHA
population. The most expensive conditions will be available tomorrow.
Diagnosis
6260
9411
7913
5237
Description
Tinnitus, Recurrent.
Posttraumatic Stress
Disorder.
Diabetes Mellitus.
Lumbosacral Or Cervical
Strain.
Category
The Ear
Neurological Conditions And Convulsive
Disorders
The Endocrine System
The Musculoskeletal System
Number of
Diagnoses
1,271,638
Most
Frequent
Rating
Level
10%
772,274
482,112
70%
20%
436,328
10%
VA-19-0799-D-000175
OS 00001837
8520
Sciatic Nerve, Paralysis.
Neurological Conditions And Convulsive
Disorders
435,754
10%
5260
5242
6100
5010
5271
Leg, Limitation Of Flexion.
Degenerative Arthritis.
Hearing Loss
Arth~~.DueToTrauma.
Ankle, Limited Motion.
The
The
The
The
The
405,995
331,252
318,213
282,611
260,711
10%
10%
10%
10%
10%
Musculoskeletal
Musculoskeletal
Ear
Musculoskeletal
Musculoskeletal
System
System
System
System
Note that these conditions are the most prevalent service-connected conditions. They do not
include conditions that are not related the veteran's service. The list does not make any
adjustment for severity of the condition, or the cost to treat the condition.
-----Original Message----From: Alaigh, Poonam, M.D.
Sent: Monday, May 01, 2017 06:37 PM Eastern Standard Time
To: Crump, Regan
Subject: RE: Top 5 disability problems in our patients
Any update on this?
Sent with Good (www.good.com)
-----Original Message----From: Crump, Regan
Sent: Saturday, April 29, 2017 10:46 PM Eastern Standard Time
To: Alaigh, Poonam, M.D.
Subject: RE: Top 5 disability problems in our patients
Thank you.
Regan
From: Alaigh, Poonam, M.D.
Sent: Saturday, April 29, 2017 4:08 PM
To: Crump, Regan; Hyduke, Barbara
Subject: RE: Top 5 disability problems in our patients
VA-19-0799-D-000176
OS 00001838
Let's just use your data based on VBA info
Sent with Good (www. good.com)
-----Original Message----From: Crump, Regan
Sent: Saturday, April 29, 2017 01 :38 PM Eastern Standard Time
To: Alaigh, Poonam, M.D.; Hyduke, Barbara
Subject: RE: Top 5 disability problems in our patients
We can and will use our VBA data on service-connected condition determination to answer the
question by Wednesday. Ours is based on official disability determinations for veterans by VBA,
not utilization or cost.
If you want prevalence data on the conditions or diagnoses noted when the enrolled Veteran
population presents for treatment, the data source for that question rests within 10P4, Patient
Care Services, or in l0E, with the analytics group led by Dr. Joe Francis.
Would you like us to ask them or do you want to just ask them directly to get that other more
proximal assessment on top 5 disability problems? You asking might clarify the importance.
Regan
Sent with Good (www.good.com)
-----Original Message----From: Alaigh, Poonam, M.D.
Sent: Saturday, April 29, 2017 11 :47 AM Eastern Standard Time
To: Hyduke, Barbara; Crump, Regan
Subject: RE: Top 5 disability problems in our patients
Can we look at it both ways and that way can also see if there is an overlap
Sent with Good (www.good.com)
-----Original Message----From: Hyduke, Barbara
Sent: Saturday, April 29, 2017 10:23 AM Eastern Standard Time
To: Crump, Regan; Alaigh, Poonam, M.D.
Subject: RE: Top 5 disability problems in our patients
Dr. Alaigh - please advise - thanks
VA-19-0799-D-000177
DS 00001839
From: Crump, Regan
Sent: Saturday, April 29, 2017 10:14 AM
To: Hyduke, Barbara; Alaigh, Poonam, M.D.
Subject: RE: Top 5 disability problems in our patients
Are you talking about service connected disabilities or do you mean most costly patients with
multiple chronic disabling conditions? What's the context so I ask the right question?
Sent with Good (www.good.com)
-----Original Message----From: Hyduke, Barbara
Sent: Saturday, April 29, 2017 09:31 AM Eastern Standard Time
To: Alaigh, Poonam, M.D.; Crump, Regan
Subject: RE: Top 5 disability problems in our patients
Sure- will tap Regan's team for this information
-----Original Message----From: Alaigh, Poonam, M.D.
Sent: Saturday, April 29, 2017 9:31 AM
To: Hyduke, Barbara
Subject: Top 5 disability problems in our patients
Can we get information on that
Sent with Good (www.good.com)
VA-19-0799-D-000178
OS 00001840
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/20/2017 1:45:29 AM
Bruce Moskowitz [(b) (6)
mac.com]
David Shulkin [drshulkin@aol.com]
Re: Internship slots
I have had some initial discussion with our Office of Academic Affairs. Unfortunately our lead for this area has
been diagnosed with a grave illness so things have slowed a bit. However, some members of his team are
coming to meet me in DC early May when I was planning to discuss with them in person the possible
opportunities since you had secured a funding source. If you think its time sensitive on your end, I will
expedite the discussions, otherwise we should have more information on this early May.
From: Bruce Moskowitz <(b) (6)
mac.com>
Sent: Wednesday, April 19, 2017 7:33 AM
To: Poonam Alaigh
Subject: Internship slots
Any update?
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000179
OS 00001841
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/24/2017 7:12:30 PM
To:
brucem(b) (6)
Re: Thursday
Subject:
@mac.com
I am trying to get the executive order that they have prepared so we can see it.
I am pretty sure they are going to use the one that established an Accountability Office for VA
but I am confirming this.
-----Original Message----From: Bruce Moskowitz <(b) (6)
To: David shulkin
Sent: Mon, Apr 24, 2017 1:34 pm
Subject: Thursday
mac.com>
What bill is being signed
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000180
OS 00001842
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/24/2017 5:33:17 PM
To:
David shulkin [drshulkin@aol.com]
Thursday
Subject:
mac.com]
what bill is being signed
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000181
OS 00001843
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/21/2017 1:08:29 AM
Bruce Moskowitz [(b) (6)
mac.com]; Marc Sherman [(b) (6)
gmail.com]
(b)
(6)
L Perl [
gmail.com]; David shulkin [drshulkin@aol.com]; IP [(b) (6) frenchangel59.com]
Re: Kaiser Permanente
Bruce, I have reviewed the article and know that we at the VA have similar pharmacist detailing programs,
controlled substance contracts, dispensing of these medications in small quantities, pain management teams,
and opioid prescribing reviews. But I do think there is significant value in getting our VA team together with
the Kaiser team on the phone so that we can share our mutual practices for additional learning. This is
especially a critical part of our suicide prevention program. Really appreciate this, as we collectively work on
improving the care for our Veterans.
How do you suggest proceeding Bruce?
From: Bruce Moskowitz <(b) (6)
mac.com>
Sent: Thursday, April 20, 2017 1:21 PM
To: Marc Sherman
Cc: L Perl; David shulkin; Poonam Alaigh; IP
Subject: Re: Kaiser Permanente
I have all the information and can set up a call after article is reviewed
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 20, 2017, at 12:50 PM, Marc Sherman <(b) (6)
gmail.com > wrote:
Should we first have (b) (6)
introduce is to the person in charge of that effort and pick his/her
brain. Then we can put a plan together from what we learn.
Marc Sherman
(202) 758-(b) (6)
On Apr 20, 2017 11:04 AM, "Bruce Moskowitz" <(b) (6)
mac.com > wrote:
This is a good wake up call. Our academic partner Kaiser Permanente has in place an
important program to prevent and treat opioid addiction since 2010! !
We need to form a committee see what is available and borrow it. This would be the best
chance to fix problems in an expedited way. The article appeared in the NEJM today.
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000182
OS 00001844
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/20/2017 10:50:20 PM
Bruce Moskowitz [(b) (6)
Re: Kaiser Permanente
mac.com]
Ill review this weekend
We are part if christies committee on opiod addiction and can help lead the way
Sent from my iPhone
> on Apr 20, 2017, at 11:04 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> This is a good wake up call. our academic partner Kaiser Permanente has in place an important program
to prevent and treat opioid addiction since 2010! !
> We need to form a committee see what is available and borrow it. This would be the best chance to fix
problems in an expedited way. The article appeared in the NEJM today.
>
>
>
>
>
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-000183
OS 00001845
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/20/2017 10:49:35 PM
(b) (6)
[(b) (6)
va.gov]
Fwd: Kaiser Permanente
Untitled attachment 04327.pdf; Untitled attachment 04330.htm
Print
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
mac.com>
Date: April 20, 2017 at 11 :04:23 AM EDT
To: David shulkin , Poonam Alaigh <(b) (6)
hotmail.com>
gmail.com>, mbs(b) (6)
@gmail.com
Cc: IP <(b) (6) frenchangel59.com>, L Perl <(b) (6)
Subject: Kaiser Permanente
This is a good wake up call. Our academic partner Kaiser Permanente has in place an important
program to prevent and treat opioid addiction since 2010! !
We need to form a committee see what is available and borrow it. This would be the best chance
to fix problems in an expedited way. The article appeared in the NEJM today.
VA-19-0799-D-000184
OS 00001846
ADDRESSING THi:'. OP!O!D !£Pl DEM IC
PERSPECTIVE
Addressing the Opioid Epidemic- Opportunities
in the Postmarketing Setting
Bruce M. Psaty, M.D., Ph.D., and Joseph 0. Merrili, M.D., M.P.H.
T
he Food and Drug Administration (FDA) recently devel~
oped a multipart action plan in
response to the opioid epidemic.1
As part of that initiative, it invited
recommendations from the National Academy of Medicine about
a regulatory framework that might
allow public health considerations
to be factored into drug-approval
decisions. The FDA, however; may
already be able to take some
public health-related actions in
the postmarketing setting, includ~
ing those related to the generation
of evidence and the regulation of
marketing.
The preapproval evaluation of
drugs is meant to ensure that
they are safe and effective for their
intended use. Nonetheless, vvidespread use of approved drugs
often leads to identification of
safety issues, including rare ad-verse events that may not be d~
tected in preapproval trials. Black:box warnings are not uncommon,
and a small percentage of dl'Ugs
are withdta\vn from the market.
Prescription opioids, however, are
outliers when it comes to safety:
since 1999, they have been implicated in 165~000 overdose deaths.
By the mid-20th century, legal
restrictions on opioid pr.escribing
had led to widespread unde1trear:ment of pain. In the late 1980s
and early 1990s, it was argued
"largely on Ul(ltal grounds" that
opioids should be available for
chronic pain.1 The management
m9dd that \Vas adopted was
based on the success of opfoids
for acute and end-o:f.Ufe pain; a
"titrate-to-effect" principle was
applied, and a numerical rating
became the chief metric. Pain
came to be kuovvn as the "fifth
vital sign."
In this setting, the combination of aggressive marketing of
prescription opioids by manufacturers, promotion by marquee professors, and endorsement by pa.in
societies contributed to a cultural
transformation. The long--standing
convention of trying to avoid opioids for chronic pain gave way to
a new culture in which the drugs
were favored for chronic noncancer pain, despite a lack of evidence
to support their use.
A 2009 article summarized the
promotlon of O:xyContin (oxycodone) by Purdue Pharma between
1996 and 200:l.3 Those efforts included hosting 40 all-expensespaid speaker-training conferences
for 5000 practitioners, as well as
20,000 pain "education" programs.
Purdue used physician profiling
to target high-volume opioid prescribers ,,vi.th sales representatives
who were encouraged by a generous bonus system. Branded promotional items and free starter
coupons for patients were available. The company also misrepresented the addiction risk posed
by O:xyContin in its materials fur
patients and physicians?
The campaign paid off: annual
sales increased from $48 million to $1.1 billion. Misleading
statements about addiction risk
amounted to misbranding, and
they eventually cost the manufacturer and executives $634 million
in fines. But evidence-based trea~
ment fur opioid addiction in patients whose addictions derived
from treatment for chronic pain
has been slow to emerge. And
promotional efforts continue even now, a manuJ:acturer's coupon for 80% off OxyContin is
available online.
In the United States, direcHer
consumer advertising promoting
"a pill for every ill" has helped
create ru:i epidemic of prescription-drug use, ;,vith U.S. sales reach~
ing $425 billion in 2015. As part
of tbat trend, a whole generation
of physicians was trained to t11rn
readily to opioids w,hen patients
talked about pain. _Between 1999
and 2009, both opioid sales and
opioid-related deaths increased
fourfold. In the process, some
clinics unintentionally became pill
mills. At our clinic in Seattle, the
low threshold for prescribing opioids attracted same young, healthy
drug users who considered it an
easy place to obtain narcotics.
Even today, the risk-benefit
profile of opioids used for chronic
pain remains unknown. A recent
review identified no studies lasting longer_ than 1 year tbat eva.lu, ated pain, function, or quality of
life as a primary ontcome.4 The
harms associated with opioid use,
however, are well documented
and often dose~dependent. They
include abuse, addiction, hyper~
algesia., overdose, fracture, pneumonia, erectile dysfunction, motor
vehicle crashes, cardiovascular
events, and death. Drug labels
need to point clearly to the known
VA-19-0799-D-000185
DS_00001847
APDRSS51NG THE OP!O!D El'IOEMIC
PERSPECTIVE
harms and limited e1ridence of abuse, the FDA should have the
efficacy for long-term opioid use, povver to limit or prohibit prescribespecially in high doses.
er profiling and off.label promoWhen safuty signals are detect- tion as well as the use of coupons
ed, the FDA can mandate post- or other forms of direct-to-con-marketing studies, including clin- sumer marketing. In light of the
k.al trials, to better assess the ongoing opioid epidemic, the rasafety of approved products. Long~ _tlonale for permitting aggressive
term, placebo--ccmtrolied, random- sales efforts is unclear. Although
ized studies of opioids are diffi- the FD.Ns authority w regalate off..
cult to conduct, hmvever, because label marketing is the subject of
of high dropout rates. An unan- several active cmrrt cases, opioids
swered question, for example, is represent a special case, given the
whether to start patients with devastation and death they have
chronic pain on short-acting or caused. First Amendment argu-long-acting opioids. Although ments fur reducing the amount
long-acting agents are valuable for of evidence required for market:asymptomatic conditions such as ing drugs fur ofiHabel uses do not
hypertension, in which patients rise above the compelling public
may not adhere to frequent dos- health arguments favoring limiing, they may be unnecessary in t:ations on opioid marketing. If the
treating pain. And given that func- FDA were to require new st:atetion is also an outcome of inter- ments on opioid labels about the
est, do long-acting or extended- absence of evidence of long-term
release opioids add value or just safety and efficacy in order to
toxicity? In this case, the FDA limit or prohibit companies from
could call for a randomized trial marketing those drugs for o.fFfabel
similar to the l?RECISION trial, uses such as long~term treatment
v,rhkh it mandated to assess the of chronic noncancer pain, physi-cardiovascular safety of the non- cians' prescribing options wouldn't
steroidal antiinflammatory drug necessarily be limited. If it's not
celecoxib.5 Also needed, but out- clear that the EDA has the authorside the jurisdiction of FDA-man,- ity to limit the off.label marketing
dated safety studies, are trials at of controlled substance~, Congress
the health-system level that evalu- could expand the agency's author~
ate the best methods for reducing ity to modify what has been one
opioid prescribing while retaining of the main drivers of the opioid
patients in care and adequately epidemic.
controlling their pain.
Most interventions available to
The epidemic of opioid abuse the FDA to limit opioid prescriband addiction has its origins in ing and abuse are no match for
the pharmaceutical industry and the force of the culture that
the meqica1 community. The FDA emerged ffom the confluence of
regulates industry, not medical interests of industry, influential
practice. It may be possible, how- academ!cs, and pa.in societies durever, for the agency to use label~ ing the 2000s. Now that opioid
in.g changes to affect marketing prescribing is widespread, systemand promotion - and thereby level and not simply individualinfluence prescribing p:atte.ms.
level interventions will be required
For controlled substances that to change medical practice.
pose a high risk of addiction and
Beginning around 2010, our
N >iNGLJ MEO '.l7e;:u;
NEJM,om::;
APRIL 20, ;1.0l7
clinic made several changes to
improve the risk-benefit profile
for management of chronic pain.
We adopted controlled--subst.ances
agreements, implemented urine
testing and prescription-drugmonitoring programs, convened
an opioid review committee to
assist clinicians -with difficult
cases, started using pharmacists
to help oversee opioid prescriptions
at the clinic level, and provided
education, support, and access to
pain,,mauagement specialists. More
recently, we fully integrated medication-assisted treatment fur addiction into the primary care setting,
providing a crucial evidence-based
tool for treating high-risk patients.
These system- and cliuidevel
activities have shifted the culture
surrounding pain management in
a way that could never have been
accomplished by providing only
continuing medical education
about opioids to individual physicians. fu':ports describing the re~
sults of systemwide interventions
at other facilities have come to
similar conclusions. Reducing unnecessary exposure to opioids and
impro1ring physician education
about pain management (not
limited to opioid IJrescribing)i as
recommended in recent guidelines
from the Centers for Disease Con~
trol and Prevention, represent ad~
ditional and important primary
prevention efforts.
Disclosure forms pro•,rided b}, the authors
are available at NJW,Lorg.
From the Card!ovasc:ular Health Research
Unit (B, M.P.) and the Departments of Medicine (B.M.!'., J.O.M.) and Epidemiology ,md
Health Services (ELM.P.), University ofWashington, and the Kaiser Permanente Washington Health Research Institute (B.M,P.}
- both in Seattle.
'
1. DliffKM, Woodcock I, OstroffS. A pro·
""live response to prescr.iptlon opioid B.buse.
N Engl J Med 2016;374:1480-5.
2.
Ballantyne JC, Su:lliv:m MD. Intensicy of
'.l.503
VA-19-0799-D-000186
DS_ 00001848
Sent from my iPad
Bmce Moskowitz MD.
87
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/20/2017 5:21:34 PM
Marc Sherman [(b) (6)
gmail.com]
L Perl [(b) (6)
gmail.com]; David shulkin [drshulkin@aol.com]; Poonam Alaigh [(b) (6)
[(b) (6) frenchangel59.com]
Re: Kaiser Permanente
hotmail.com]; IP
I have all the information and can set up a call after article is reviewed
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 20, 2017, at 12:50 PM, Marc Sherman <(b) (6)
gmail.com> wrote:
Should we first have (b) (6)
introduce is to the person in charge of that effort and pick his/her
brain. Then we can put a plan together from what we learn.
Marc Sherman
(202) 758-(b) (6)
On Apr 20, 2017 11 :04 AM, "Bruce Moskowitz" <(b) (6)
mac.com> wrote:
This is a good wake up call. Our academic partner Kaiser Permanente has in place an important
program to prevent and treat opioid addiction since 2010! !
We need to form a committee see what is available and borrow it. This would be the best
chance to fix problems in an expedited way. The article appeared in the NEJM today.
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000188
OS 00001850
Message
From:
Sent:
To:
CC:
Subject:
Attachments:
Bruce Moskowitz [(b) (6)
mac.com]
4/20/2017 3:04:23 PM
David shulkin [drshulkin@aol.com]; Poonam Alaigh [(b) (6)
hotmail.com]
IP [(b) (6) frenchangel59.com]; l Perl [(b) (6)
gmail.com]; mbs(b) (6)
@gmail.com
Kaiser Permanente
Untitled attachment 04338.pdf; Untitled attachment 04341.txt
This is a good wake up call. our academic partner Kaiser Permanente has in place an important program to
prevent and treat opioid addiction since 2010! !
We need to form a committee see what is available and borrow it. This would be the best chance to fix
problems in an expedited way. The article appeared in the NEJM today.
VA-19-0799-D-000189
OS 00001851
ADDRESSING THi:'. OP!O!D !£Pl DEM IC
PERSPECTIVE
Addressing the Opioid Epidemic- Opportunities
in the Postmarketing Setting
Bruce M. Psaty, M.D., Ph.D., and Joseph 0. Merrili, M.D., M.P.H.
T
he Food and Drug Administration (FDA) recently devel~
oped a multipart action plan in
response to the opioid epidemic.1
As part of that initiative, it invited
recommendations from the National Academy of Medicine about
a regulatory framework that might
allow public health considerations
to be factored into drug-approval
decisions. The FDA, however; may
already be able to take some
public health-related actions in
the postmarketing setting, includ~
ing those related to the generation
of evidence and the regulation of
marketing.
The preapproval evaluation of
drugs is meant to ensure that
they are safe and effective for their
intended use. Nonetheless, vvidespread use of approved drugs
often leads to identification of
safety issues, including rare ad-verse events that may not be d~
tected in preapproval trials. Black:box warnings are not uncommon,
and a small percentage of dl'Ugs
are withdta\vn from the market.
Prescription opioids, however, are
outliers when it comes to safety:
since 1999, they have been implicated in 165~000 overdose deaths.
By the mid-20th century, legal
restrictions on opioid pr.escribing
had led to widespread unde1trear:ment of pain. In the late 1980s
and early 1990s, it was argued
"largely on Ul(ltal grounds" that
opioids should be available for
chronic pain.1 The management
m9dd that \Vas adopted was
based on the success of opfoids
for acute and end-o:f.Ufe pain; a
"titrate-to-effect" principle was
applied, and a numerical rating
became the chief metric. Pain
came to be kuovvn as the "fifth
vital sign."
In this setting, the combination of aggressive marketing of
prescription opioids by manufacturers, promotion by marquee professors, and endorsement by pa.in
societies contributed to a cultural
transformation. The long--standing
convention of trying to avoid opioids for chronic pain gave way to
a new culture in which the drugs
were favored for chronic noncancer pain, despite a lack of evidence
to support their use.
A 2009 article summarized the
promotlon of O:xyContin (oxycodone) by Purdue Pharma between
1996 and 200:l.3 Those efforts included hosting 40 all-expensespaid speaker-training conferences
for 5000 practitioners, as well as
20,000 pain "education" programs.
Purdue used physician profiling
to target high-volume opioid prescribers ,,vi.th sales representatives
who were encouraged by a generous bonus system. Branded promotional items and free starter
coupons for patients were available. The company also misrepresented the addiction risk posed
by O:xyContin in its materials fur
patients and physicians?
The campaign paid off: annual
sales increased from $48 million to $1.1 billion. Misleading
statements about addiction risk
amounted to misbranding, and
they eventually cost the manufacturer and executives $634 million
in fines. But evidence-based trea~
ment fur opioid addiction in patients whose addictions derived
from treatment for chronic pain
has been slow to emerge. And
promotional efforts continue even now, a manuJ:acturer's coupon for 80% off OxyContin is
available online.
In the United States, direcHer
consumer advertising promoting
"a pill for every ill" has helped
create ru:i epidemic of prescription-drug use, ;,vith U.S. sales reach~
ing $425 billion in 2015. As part
of tbat trend, a whole generation
of physicians was trained to t11rn
readily to opioids w,hen patients
talked about pain. _Between 1999
and 2009, both opioid sales and
opioid-related deaths increased
fourfold. In the process, some
clinics unintentionally became pill
mills. At our clinic in Seattle, the
low threshold for prescribing opioids attracted same young, healthy
drug users who considered it an
easy place to obtain narcotics.
Even today, the risk-benefit
profile of opioids used for chronic
pain remains unknown. A recent
review identified no studies lasting longer_ than 1 year tbat eva.lu, ated pain, function, or quality of
life as a primary ontcome.4 The
harms associated with opioid use,
however, are well documented
and often dose~dependent. They
include abuse, addiction, hyper~
algesia., overdose, fracture, pneumonia, erectile dysfunction, motor
vehicle crashes, cardiovascular
events, and death. Drug labels
need to point clearly to the known
VA-19-0799-D-000190
DS_ 00001852
APDRSS51NG THE OP!O!D El'IOEMIC
PERSPECTIVE
harms and limited e1ridence of abuse, the FDA should have the
efficacy for long-term opioid use, povver to limit or prohibit prescribespecially in high doses.
er profiling and off.label promoWhen safuty signals are detect- tion as well as the use of coupons
ed, the FDA can mandate post- or other forms of direct-to-con-marketing studies, including clin- sumer marketing. In light of the
k.al trials, to better assess the ongoing opioid epidemic, the rasafety of approved products. Long~ _tlonale for permitting aggressive
term, placebo--ccmtrolied, random- sales efforts is unclear. Although
ized studies of opioids are diffi- the FD.Ns authority w regalate off..
cult to conduct, hmvever, because label marketing is the subject of
of high dropout rates. An unan- several active cmrrt cases, opioids
swered question, for example, is represent a special case, given the
whether to start patients with devastation and death they have
chronic pain on short-acting or caused. First Amendment argu-long-acting opioids. Although ments fur reducing the amount
long-acting agents are valuable for of evidence required for market:asymptomatic conditions such as ing drugs fur ofiHabel uses do not
hypertension, in which patients rise above the compelling public
may not adhere to frequent dos- health arguments favoring limiing, they may be unnecessary in t:ations on opioid marketing. If the
treating pain. And given that func- FDA were to require new st:atetion is also an outcome of inter- ments on opioid labels about the
est, do long-acting or extended- absence of evidence of long-term
release opioids add value or just safety and efficacy in order to
toxicity? In this case, the FDA limit or prohibit companies from
could call for a randomized trial marketing those drugs for o.fFfabel
similar to the l?RECISION trial, uses such as long~term treatment
v,rhkh it mandated to assess the of chronic noncancer pain, physi-cardiovascular safety of the non- cians' prescribing options wouldn't
steroidal antiinflammatory drug necessarily be limited. If it's not
celecoxib.5 Also needed, but out- clear that the EDA has the authorside the jurisdiction of FDA-man,- ity to limit the off.label marketing
dated safety studies, are trials at of controlled substance~, Congress
the health-system level that evalu- could expand the agency's author~
ate the best methods for reducing ity to modify what has been one
opioid prescribing while retaining of the main drivers of the opioid
patients in care and adequately epidemic.
controlling their pain.
Most interventions available to
The epidemic of opioid abuse the FDA to limit opioid prescriband addiction has its origins in ing and abuse are no match for
the pharmaceutical industry and the force of the culture that
the meqica1 community. The FDA emerged ffom the confluence of
regulates industry, not medical interests of industry, influential
practice. It may be possible, how- academ!cs, and pa.in societies durever, for the agency to use label~ ing the 2000s. Now that opioid
in.g changes to affect marketing prescribing is widespread, systemand promotion - and thereby level and not simply individualinfluence prescribing p:atte.ms.
level interventions will be required
For controlled substances that to change medical practice.
pose a high risk of addiction and
Beginning around 2010, our
N >iNGLJ MEO '.l7e;:u;
NEJM,om::;
APRIL 20, ;1.0l7
clinic made several changes to
improve the risk-benefit profile
for management of chronic pain.
We adopted controlled--subst.ances
agreements, implemented urine
testing and prescription-drugmonitoring programs, convened
an opioid review committee to
assist clinicians -with difficult
cases, started using pharmacists
to help oversee opioid prescriptions
at the clinic level, and provided
education, support, and access to
pain,,mauagement specialists. More
recently, we fully integrated medication-assisted treatment fur addiction into the primary care setting,
providing a crucial evidence-based
tool for treating high-risk patients.
These system- and cliuidevel
activities have shifted the culture
surrounding pain management in
a way that could never have been
accomplished by providing only
continuing medical education
about opioids to individual physicians. fu':ports describing the re~
sults of systemwide interventions
at other facilities have come to
similar conclusions. Reducing unnecessary exposure to opioids and
impro1ring physician education
about pain management (not
limited to opioid IJrescribing)i as
recommended in recent guidelines
from the Centers for Disease Con~
trol and Prevention, represent ad~
ditional and important primary
prevention efforts.
Disclosure forms pro•,rided b}, the authors
are available at NJW,Lorg.
From the Card!ovasc:ular Health Research
Unit (B, M.P.) and the Departments of Medicine (B.M.!'., J.O.M.) and Epidemiology ,md
Health Services (ELM.P.), University ofWashington, and the Kaiser Permanente Washington Health Research Institute (B.M,P.}
- both in Seattle.
'
1. DliffKM, Woodcock I, OstroffS. A pro·
""live response to prescr.iptlon opioid B.buse.
N Engl J Med 2016;374:1480-5.
2.
Ballantyne JC, Su:lliv:m MD. Intensicy of
'.l.503
VA-19-0799-D-000191
DS_ 00001853
Sent from my iPad
Bruce Moskowitz M.D.
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/22/2017 3:28:50 PM
(b) (6)
[(b) (6)
gmail.com]
http ://www. cb snews.com/vi deos/va-secretary-davi d-shulkin-on-chall enges-facing-the-agency/?ftag=CNM-00l 0aab4 i
Sent from my iPhone
VA-19-0799-D-000193
OS 00001855
Message
From:
IP [(b) (6) frenchangel59.com]
Sent:
4/25/2017 5:07:19 PM
To:
'David shulkin' [Drshulkin@aol.com]
RE: Thinking about thursday
Subject:
David,
We are working to get you the answers you need.
Please let me know what time we need to be available for the tour of Walter
Reed.
Thank you,
Ike
-----original Message----From: David shulkin [mailto:Drshulkin@aol .com]
Sent: Tuesday, April 25, 2017 9:46 AM
To: Ike Perlmutter; Marc Sherman; Bruce Moskowitz; Laurie Perlmutter
subject: Thinking about thursday
I want to use our time on thursday as valuable as possible - and trying to
balance this with what is also a very full schedule that I already had
planned- here are some suggestionsId like your feedback:
I have a breakfast with all veteran service groups in the morning I cannot
cancel - after that I have a long planned tour of Walter Reed thursday mid
morning - ive been hearing about the amazing medical and rehab services they
have for soldiers and they want to show it to me- one possibility would be
for you all to join me
We can also set up brief meetings on
Inventory control
Telehealth
eMR planning
Access/Wait time issues
Apple
Facility planning
Would any of these be of particular interest?
Finally- i was thinking of holding a reception in the afternoon for you all
and members of congress and wounded warriors- we have to be seated an hour
before the president arrives (secret service requires) soi would limit it
to 30 minutes
Too much to do in a day so
wanted to get your feedback
David
Sent from my iPhone
VA-19-0799-D-000194
OS 00001856
Message
From:
Sent:
To:
CC:
Subject:
Marc Sherman [(b) (6)
gmail.com]
4/20/2017 12:23:45 AM
David shulkin [Drshulkin@aol.com]
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
[(b) (6)
mac.com]
Re: From John Ullyot -- CBS News Response
gmail.com]; Bruce Moskowitz
That is great. Congratulations. The problem is so obvious, trying to hide from it just compounds the problem
and PR nightmare. Very well done the way you handled it.
I had just seen the CBS piece and was about to email you as I was opening your email. I am looking forward to
seeing the later edition to see if/how they handle it.
On Wed, Apr 19, 2017 at 6:59 PM, David shulkin wrote:
Just had a major story tonight on cbs news - a story of a veteran waiting way too long for prosthetic legs- our
PR team put out a draft statement on how we deliver the best care etc etc. i ripped it up and said I wanted to
say that there were no excuses for this- see below and CB S's surprise at our response
We are sending a strong message to VA and the country that this is not acceptable
David
Subject: FW: From John Ullyot -- CBS News Response
Dr. Shulkin:
See below response based on our conversation with you on the request from CBS News' David
Martin we received this afternoon.
As you can see, we informed the WH and they (b) (5)
.
FYI the reporter David Martin called us right back once he received it and said, "Just wanted
you to know, this is an incredibly forthright statement. Congratulations."
The piece will air on tonight's CBS Evening News.
Thanks again for your prompt and clear direction to us on this inquiry.
All the best,
John U.
From: "Hutton, James"
Date: Wednesday, April 19, 2017 at 4:06 PM
To: " (b) (6)
who.eop.gov" (b)(b)(6)(6)
who.eop.gov>, " (b) (6)
who.eop.gov"
(b) (6)
<
who.eop.gov>
Cc: Department of Veterans Affairs Department of Veterans Affairs ,
"Leinenkugel, Jake" , "Tallman, Gary"
VA-19-0799-D-000195
OS 00001857
Subject: From John Ullyot -- CBS Response
Kaelan (from John Ullyot):
FYI -- per John's call with you right now:
CBS News (David Martin) is doing a piece for tonight's Evening News about a former USMC
SgtMaj who is a double amputee and who has had to wait up to 3 months at a time (up to 6
separate occasions) for replacement prosthetics from VA Medical Center in Fayetteville NC,
whereas the same Veteran happened to visit Walter Reed Medical Center (DoD) and received
same-day service there for new prosthetics.
David knows we can't comment on a specific patient, but is asking for comment on why VA
takes so much longer than DoD to take care of our Veteran amputees?
We spoke with Dr. Shulkin and, based on his input, we have drafted the following statement,
attributed to the Department:
Statement by Department of Veterans Affairs
April 19, 2017
At VA, we do not believe Veterans should have to wait for care when they are in need, as in the
case of this Veteran.
This President and this Secretary of Veterans Affairs stand committed to fixing wait-time issues
at VA, and to providing our Veterans with the best possible care.
VA-19-0799-D-000196
OS 00001858
VA has been under-resourced for a long time in this area, but that's no excuse - we own these
issues and our job is fixing them as quickly as possible for our Veterans.
Thanks,
John U.
202-701-0138
James Hutton
Deputy Assistant Secretary (Acting)
Office of Public Affairs
Department of Veterans Affairs
810 Vermont Ave, NW
Washington, D.C. 20420
Office: 202-461-7558
Email: james.hutton@va.gov
Twitter: @jehutton
VA on Face book . Twitter . Y ouTube . Flickr . Blog:
VA-19-0799-D-000197
OS 00001859
Message
From:
Sent:
To:
BCC:
Subject:
David shulkin [Drshulkin@aol.com]
4/19/2017 10:59:58 PM
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
gmail.com]; Bruce Moskowitz
[(b) (6)
mac.com]; Marc Sherman [(b) (6)
gmail.com]; David Shulkin [drshulkin@aol.com]
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: From John Ullyot -- CBS News Response
Just had a major story tonight on cbs news - a story of a veteran waiting way too long for prosthetic legs- our
PR team put out a draft statement on how we deliver the best care etc etc. i ripped it up and said I wanted to say
that there were no excuses for this- see below and CB S's surprise at our response
We are sending a strong message to VA and the country that this is not acceptable
David
Subject: FW: From John Ullyot -- CBS News Response
Dr. Shulkin:
See below response based on our conversation with you on the request from CBS News' David
Martin we received this afternoon.
As you can see, we informed the WH and they (b) (5)
.
FYI the reporter David Martin called us right back once he received it and said, "Just wanted you
to know, this is an incredibly forthright statement. Congratulations."
The piece will air on tonight's CBS Evening News.
Thanks again for your prompt and clear direction to us on this inquiry.
All the best,
John U.
From: "Hutton, James"
Date: Wednesday, April 19, 2017 at 4:06 PM
To: " (b) (6)
who.eop.gov" <(b) (6)
who.eop.gov>, " (b) (6)
who.eop.gov"
<(b) (6)
who.eop.gov>
Cc: Department of Veterans Affairs Department of Veterans Affairs , "Leinenkugel,
Jake" , "Tallman, Gary"
Subject: From John Ullyot -- CBS Response
Kaelan (from John Ullyot):
VA-19-0799-D-000198
OS 00001860
FYI -- per John's call with you right now:
CBS News (David Martin) is doing a piece for tonight's Evening News about a former USMC
SgtMaj who is a double amputee and who has had to wait up to 3 months at a time (up to 6
separate occasions) for replacement prosthetics from VA Medical Center in Fayetteville NC,
whereas the same Veteran happened to visit Walter Reed Medical Center (DoD) and received
same-day service there for new prosthetics.
David knows we can't comment on a specific patient, but is asking for comment on why VA
takes so much longer than DoD to take care of our Veteran amputees?
We spoke with Dr. Shulkin and, based on his input, we have drafted the following statement,
attributed to the Department:
Statement by Department of Veterans Affairs
April 19, 2017
At VA, we do not believe Veterans should have to wait for care when they are in need, as in the
case of this Veteran.
This President and this Secretary of Veterans Affairs stand committed to fixing wait-time issues
at VA, and to providing our Veterans with the best possible care.
VA has been under-resourced for a long time in this area, but that's no excuse - we own these
issues and our job is fixing them as quickly as possible for our Veterans.
VA-19-0799-D-000199
OS 00001861
Thanks,
John U.
202-701-0138
James Hutton
Deputy Assistant Secretary (Acting)
Office of Public Affairs
Department of Veterans Affairs
810 Vermont Ave, NW
Washington, D.C. 20420
Office: 202-461-7558
Email: james.hutton@va.g:ov
Twitter: @ jehutton
VA on Face book . Twitter . Y ouTube . Flickr . Blog:
VA-19-0799-D-000200
OS 00001862
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
4/20/2017 1:50:34 AM
Bruce Moskowitz [(b) (6)
Marc Sherman [(b) (6)
Re: Thanks
hotmail.com]
mac.com]; IP [(b) (6) frenchangel59.com]
gmail.com]; David shulkin [Drshulkin@aol.com]; L Perl [(b) (6)
gmail.com]
Also, if you have some names of folks that would be good to be part of the Fraud task force, please send them
along. I know Marc is also working on it as we add to a potential list of candidates.
From: Bruce Moskowitz <(b) (6)
mac.com>
Sent: Wednesday, April 19, 2017 8:16 AM
To: IP
Cc: Marc Sherman; David shulkin; Poonam Alaigh; L Perl
Subject: Re: Thanks
If you proceed with a fraud prevention unit you need people on the factory floor who are in active practice
and are up to date with new tactics of deception. There is a huge disconnect in previous approaches of using
semiretired CEO's or physicians who want big incomes and have no clue of current deceptive practices. Those
physicians I know who have the street smarts are passionate about this issue and would do it for free as a
public service.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 19, 2017, at 7:58 AM, IP <(b) (6) frenchangel59.com > wrote:
I agree with Bruce and I recommend to sell off all the rea l estate as well.
From: Bruce Moskowitz [ mailto:(b) (6)
Sent: Wednesday, April 19, 2017 7:27 AM
To: Marc Sherman
mac.com]
Cc: David shulkin; Poonam Alaigh; L Perl; IP
Subject: Re: Thanks
My recommendation is you lead an independent fraud unit and it should have a fix it before it
breaks mission.
We have two major problems the internal one is the easiest and external contracts especially with
medical devices will be the most difficult. My concern is the device manufacturers have so many
ways to game the system. The other area is when VA patients are seen outside the VA
Sent from my iPad
VA-19-0799-D-000201
OS 00001863
Bruce Moskowitz M.D.
On Apr 18, 2017, at 9:34 PM, Marc Sherman <(b) (6)
gmail.com> wrote:
Thanks for the responses. I got home so late last night I didn't get a chance to
send the dinner agenda as promised ... sorry Poonam -- see attached.
An EO on the competitive salaries could also have a dual benefit with some good
White House PR impact as well as serving to solve your staffing leakage.
I gave Ike an update on the possible real estate plan tonight that you shared with
me, including the congressional committee. I am available to serve on it as we
discussed and ready to help formulate more thoughts about it when you are
ready. Also ready to help with the Fraud plan.
On Tue, Apr 18, 2017 at 9: 17 PM, David shulkin wrote:
Sent from my iPhone
On Apr 18, 2017, at 7: 10 AM, Marc Sherman <(b) (6)
gmail.com> wrote:
I totally agree. Thanks for taking the time. I will send the plan in
Word when I get to into the office in a while. I was also thinking
about a few other things that we should catch up on.
1. Why can't you match the nursing salaries in a competitive
market personnel crisis?
We can- its a process- first we have to do a market survey to show OPM- we
need our leadership to do this sooner and more aggressively
Can an EO give you the authority, or can that be part of the Accountability bill it goes both ways?
VA-19-0799-D-000202
OS 00001864
Eo might be an idea here- we will explore and see if this works - the key is to
speed up our process
2. We didn't have time to discuss fraud and real estate last night. We need to do
that right away for practical (Medicare system review) and messaging purposes.
Agree - we are standing up a Committee and we need to message this effort - we
are talking to the White House about this tommoroW
3. We didn't discuss all steps in my agenda on the crisis plan last night since we
ran out of time. We should discuss the rest of the items to see ifwe can figure out
which ones are valuable to implement and then discuss them so we can come to
the best approach on each.
Ok- lets plan on another get together soon
Marc Sherman
(202) 758-(b) (6)
On Apr 18, 2017 4:38 AM, "Poonam Alaigh" <(b) (6)
hotmail.com> wrote:
Marc- it was so good catching up in a relaxed setting with an incredible ambiance
where we could simply brainstorm and problem solve as we together bring about
the transformation of the organization. Let's try to meet regularly, monthly if
possible. Also, please send the proposed approach/plan as an attachment so that
we can start to activate it. Thanks again, all of you are helping us serve our
nations heroes better- and we can't possibly achieve what we are/will without
your invaluable support and input.
David and Poonam
Sent from my iPhone
> On Apr 17, 2017, at 9:28 PM, Marc Sherman <(b) (6)
>
> Thanks for the great conversation ... And humoring me.
gmail.com> wrote:
VA-19-0799-D-000203
OS 00001865
>
> Marc Sherman
> (202) 758-(b) (6)
VA-19-0799-D-000204
OS 00001866
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/19/2017 12:58:01 PM
To:
David shulkin [Drshulkin@aol.com]
mbs(b) (6)
@gmail.com; IP [(b) (6) frenchangel59.com]
Re: Thanks
CC:
Subject:
mac.com]
Yes and what I would recommend is a multi specialty panel. Also it needs to represent different geographic
regions to be effective. Also it is a mix of seasoned active physicians in private practice and academic center
practice combined with those who are in practice just a few years who are more tech savvy. They love the
challenge and that is why they would donate their time.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 19, 2017, at 8:45 AM, David shulkin wrote:
Can you suggest some names?
Sent from my iPhone
On Apr 19, 2017, at 8: 16 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
If you proceed with a fraud prevention unit you need people on the factory floor
who are in active practice and are up to date with new tactics of deception. There
is a huge disconnect in previous approaches of using semiretired CEO's or
physicians who want big incomes and have no clue of current deceptive practices.
Those physicians I know who have the street smarts are passionate about this
issue and would do it for free as a public service.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 19, 2017, at 7:58 AM, IP <(b) (6) frenchangel59.com> wrote:
I agree with Bruce and I recommend to sell off all the real estate as well.
From: Bruce Moskowitz [ mailto:(b) (6)
Sent: Wednesday, April 19, 2017 7:27 AM
To: Marc Sherman
mac.com]
Cc: David shulkin; Poonam Alaigh; L Perl; IP
Subject: Re: Thanks
My recommendation is you lead an independent fraud unit and it
should have a fix it before it breaks mission .
We have two major problems the internal one is the easiest and
external contracts especially with medical devices will be the most
difficult. My concern is the device manufacturers have so many
ways to game the system. The other area is when VA patients are
seen outside the VA
VA-19-0799-D-000205
OS 00001867
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 18, 2017, at 9:34 PM, Marc Sherman
<(b) (6)
gmail .com> wrote:
Thanks for the responses. I got home so late last
night I didn't get a chance to send the dinner agenda
as promised ... sorry Poonam -- see attached.
An EO on the competitive salaries could also have a
dual benefit with some good White House PR
impact as well as serving to solve your staffing
leakage.
I gave Ike an update on the possible real estate plan
tonight that you shared with me, including the
congressional committee. I am available to serve
on it as we discussed and ready to help formulate
more thoughts about it when you are ready. Also
ready to help with the Fraud plan.
On Tue, Apr 18, 2017 at 9: 17 PM, David shulkin
wrote:
Sent from my iPhone
On Apr 18, 2017, at 7: 10 AM, Marc Sherman
<(b) (6)
gmail.com> wrote:
I totally agree. Thanks for taking the
time. I will send the plan in Word
when I get to into the office in a
while. I was also thinking about a
few other things that we should catch
up on.
1. Why can't you match the nursing
salaries in a competitive market
personnel crisis?
We can- its a process- first we have to do a market
survey to show OPM- we need our leadership to do
this sooner and more aggressively
VA-19-0799-D-000206
OS 00001868
Can an EO give you the authority, or can that be
part of the Accountability bill - it goes both ways?
Eo might be an idea here- we will explore and see if
this works - the key is to speed up our process
2. We didn't have time to discuss fraud and real
estate last night. We need to do that right away for
practical (Medicare system review) and messaging
purposes.
Agree - we are standing up a Committee and we
need to message this effort - we are talking to the
White House about this tommoroW
3. We didn't discuss all steps in my agenda on the
crisis plan last night since we ran out of time. We
should discuss the rest of the items to see ifwe can
figure out which ones are valuable to implement
and then discuss them so we can come to the best
approach on each.
Ok- lets plan on another get together soon
Marc Sherman
(202) 758-(b) (6)
On Apr 18, 2017 4:38 AM, "Poonam Alaigh"
<(b) (6)
hotmail.com> wrote:
Marc- it was so good catching up in a relaxed
setting with an incredible ambiance where we could
simply brainstorm and problem solve as we together
bring about the transformation of the organization.
Let's try to meet regularly, monthly if possible.
Also, please send the proposed approach/plan as an
attachment so that we can start to activate it. Thanks
again, all of you are helping us serve our nations
heroes better- and we can't possibly achieve what
we are/will without your invaluable support and
input.
David and Poonam
VA-19-0799-D-000207
OS 00001869
Sent from my iPhone
> On Apr 17, 2017, at 9:28 PM, Marc Sherman
<(b) (6)
gmail .com> wrote:
>
> Thanks for the great conversation ... And humoring
me.
>
> Marc Sherman
> (202) 758-(b) (6)
VA-19-0799-D-000208
OS 00001870
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/19/2017 12:45:57 PM
To:
Bruce Moskowitz [(b) (6)
Re: Thanks
Subject:
mac.com]
Can you suggest some names?
Sent from my iPhone
On Apr 19, 2017, at 8: 16 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
If you proceed with a fraud prevention unit you need people on the factory floor who are in
active practice and are up to date with new tactics of deception. There is a huge disconnect in
previous approaches of using semiretired CEO's or physicians who want big incomes and have
no clue of current deceptive practices. Those physicians I know who have the street smarts are
passionate about this issue and would do it for free as a public service.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 19, 2017, at 7:58 AM, IP <(b) (6) frenchangel59 .com> wrote:
I agree with Bruce and I recommend to sell off all the real estate as well.
From: Bruce Moskowitz [ mailto:(b) (6)
Sent: Wednesday, April 19, 2017 7:27 AM
To: Marc Sherman
mac.com]
Cc: David shulkin; Poonam Alaigh; L Perl; IP
Subject: Re: Thanks
My recommendation is you lead an independent fraud unit and it should have a
fix it before it breaks mission .
We have two major problems the internal one is the easiest and external contracts
especially with medical devices will be the most difficult. My concern is the
device manufacturers have so many ways to game the system. The other area is
when VA patients are seen outside the VA
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 18, 2017, at 9:34 PM, Marc Sherman <(b) (6)
gmail.com> wrote:
Thanks for the responses. I got home so late last night I didn't get
a chance to send the dinner agenda as promised ... sorry Poonam -see attached.
An EO on the competitive salaries could also have a dual benefit
with some good White House PR impact as well as serving to
solve your staffing leakage.
VA-19-0799-D-000209
OS 00001871
I gave Ike an update on the possible real estate plan tonight that
you shared with me, including the congressional committee. I am
available to serve on it as we discussed and ready to help formulate
more thoughts about it when you are ready. Also ready to help
with the Fraud plan.
On Tue, Apr 18, 2017 at 9: 17 PM, David shulkin
wrote:
Sent from my iPhone
On Apr 18, 2017, at 7: 10 AM, Marc Sherman
<(b) (6)
gmail .com> wrote:
I totally agree. Thanks for taking the time. I will
send the plan in Word when I get to into the office
in a while. I was also thinking about a few other
things that we should catch up on.
1. Why can't you match the nursing salaries in a
competitive market personnel crisis?
We can- its a process- first we have to do a market survey to
show OPM- we need our leadership to do this sooner and more
aggressively
Can an EO give you the authority, or can that be part of the
Accountability bill - it goes both ways?
Eo might be an idea here- we will explore and see if this works the key is to speed up our process
2. We didn't have time to discuss fraud and real estate last
night. We need to do that right away for practical (Medicare
system review) and messaging purposes.
Agree - we are standing up a Committee and we need to message
this effort - we are talking to the White House about this
tommoroW
3. We didn't discuss all steps in my agenda on the crisis plan last
night since we ran out of time. We should discuss the rest of the
VA-19-0799-D-000210
OS 00001872
items to see if we can figure out which ones are valuable to
implement and then discuss them so we can come to the best
approach on each.
Ok- lets plan on another get together soon
Marc Sherman
(202) 758-(b) (6)
On Apr 18, 2017 4:38 AM, "Poonam Alaigh"
<(b) (6)
hotmail.com> wrote:
Marc- it was so good catching up in a relaxed setting with an
incredible ambiance where we could simply brainstorm and
problem solve as we together bring about the transformation of the
organization. Let's try to meet regularly, monthly if possible. Also,
please send the proposed approach/plan as an attachment so that
we can start to activate it. Thanks again, all of you are helping us
serve our nations heroes better- and we can't possibly achieve what
we are/will without your invaluable support and input.
David and Poonam
Sent from my iPhone
> On Apr 17, 2017, at 9:28 PM, Marc Sherman
<(b) (6)
gmail .com> wrote:
>
> Thanks for the great conversation ... And humoring me.
>
> Marc Sherman
> (202) 758-(b) (6)
VA-19-0799-D-000211
OS 00001873
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/19/2017 12:16:03 PM
IP [(b) (6) frenchangel59.com]
Marc Sherman [(b) (6)
gmail.com]; David shulkin [Drshulkin@aol.com]; Poonam Alaigh
[(b) (6)
hotmail.com]; L Perl [(b) (6)
gmail.com]
Re: Thanks
If you proceed with a fraud prevention unit you need people on the factory floor who are in active practice and
are up to date with new tactics of deception. There is a huge disconnect in previous approaches of using
semiretired CEO's or physicians who want big incomes and have no clue of current deceptive practices. Those
physicians I know who have the street smarts are passionate about this issue and would do it for free as a public
service.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 19, 2017, at 7:58 AM, IP <(b) (6) frenchangel59 .com> wrote:
I agree with Bruce and I recommend to sell off all the real estate as well.
From: Bruce Moskowitz [ mailto:(b) (6)
Sent: Wednesday, April 19, 2017 7:27 AM
To: Marc Sherman
mac.com]
Cc: David shulkin; Poonam Alaigh; L Perl; IP
Subject: Re: Thanks
My recommendation is you lead an independent fraud unit and it should have a fix it before it
breaks mission.
We have two major problems the internal one is the easiest and external contracts especially with
medical devices will be the most difficult. My concern is the device manufacturers have so many
ways to game the system. The other area is when VA patients are seen outside the VA
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 18, 2017, at 9:34 PM, Marc Sherman <(b) (6)
gmail.com> wrote:
Thanks for the responses. I got home so late last night I didn't get a chance to
send the dinner agenda as promised ... sorry Poonam -- see attached.
An EO on the competitive salaries could also have a dual benefit with some good
White House PR impact as well as serving to solve your staffing leakage.
I gave Ike an update on the possible real estate plan tonight that you shared with
me, including the congressional committee. I am available to serve on it as we
discussed and ready to help formulate more thoughts about it when you are
ready. Also ready to help with the Fraud plan.
VA-19-0799-D-000212
OS 00001874
On Tue, Apr 18, 2017 at 9: 17 PM, David shulkin wrote:
Sent from my iPhone
On Apr 18, 2017, at 7: 10 AM, Marc Sherman <(b) (6)
gmail.com> wrote:
I totally agree. Thanks for taking the time. I will send the plan in
Word when I get to into the office in a while. I was also thinking
about a few other things that we should catch up on.
1. Why can't you match the nursing salaries in a competitive
market personnel crisis?
We can- its a process- first we have to do a market survey to show OPM- we
need our leadership to do this sooner and more aggressively
Can an EO give you the authority, or can that be part of the Accountability bill it goes both ways?
Eo might be an idea here- we will explore and see if this works - the key is to
speed up our process
2. We didn't have time to discuss fraud and real estate last night. We need to do
that right away for practical (Medicare system review) and messaging purposes.
Agree - we are standing up a Committee and we need to message this effort - we
are talking to the White House about this tommoroW
3. We didn't discuss all steps in my agenda on the crisis plan last night since we
ran out of time. We should discuss the rest of the items to see ifwe can figure out
which ones are valuable to implement and then discuss them so we can come to
the best approach on each.
Ok- lets plan on another get together soon
Marc Sherman
(202) 758-(b) (6)
On Apr 18, 2017 4:38 AM, "Poonam Alaigh" <(b) (6)
hotmail.com> wrote:
VA-19-0799-D-000213
OS 00001875
Marc- it was so good catching up in a relaxed setting with an incredible ambiance
where we could simply brainstorm and problem solve as we together bring about
the transformation of the organization. Let's try to meet regularly, monthly if
possible. Also, please send the proposed approach/plan as an attachment so that
we can start to activate it. Thanks again, all of you are helping us serve our
nations heroes better- and we can't possibly achieve what we are/will without
your invaluable support and input.
David and Poonam
Sent from my iPhone
> On Apr 17, 2017, at 9:28 PM, Marc Sherman <(b) (6)
>
> Thanks for the great conversation ... And humoring me.
>
> Marc Sherman
> (202) 758-(b) (6)
gmail.com> wrote:
VA-19-0799-D-000214
OS 00001876
Message
From:
Sent:
To:
CC:
Subject:
IP [(b) (6) frenchangel59.com]
4/19/2017 11:58:48 AM
'Bruce Moskowitz' [(b) (6)
mac.com]; 'Marc Sherman' [(b) (6)
gmail.com]
'David shulkin' [Drshulkin@aol.com]; 'Poonam Alaigh' [(b) (6)
hotmail.com]; 'L Perl' [(b) (6)
RE: Thanks
gmail.com]
I agree with Bruce and I recommend to sell off all the real estate as well.
From: Bruce Moskowitz [mailto:(b) (6)
Sent: Wednesday, April 19, 2017 7:27 AM
To: Marc Sherman
mac.com]
Cc: David shulkin; Poonam Alaigh; L Perl; IP
Subject: Re: Thanks
My recommendation is you lead an independent fraud unit and it should have a fix it before it breaks mission .
We have two major problems the internal one is the easiest and external contracts especially with medical
devices will be the most difficult. My concern is the device manufacturers have so many ways to game the
system. The other area is when VA patients are seen outside the VA
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 18, 2017, at 9:34 PM, Marc Sherman <(b) (6)
gmail.com> wrote:
Thanks for the responses. I got home so late last night I didn't get a chance to send the dinner
agenda as promised ... sorry Poonam -- see attached.
An EO on the competitive salaries could also have a dual benefit with some good White House
PR impact as well as serving to solve your staffing leakage.
I gave Ike an update on the possible real estate plan tonight that you shared with me, including
the congressional committee. I am available to serve on it as we discussed and ready to help
formulate more thoughts about it when you are ready. Also ready to help with the Fraud plan.
On Tue, Apr 18, 2017 at 9: 17 PM, David shulkin wrote:
Sent from my iPhone
On Apr 18, 2017, at 7: 10 AM, Marc Sherman <(b) (6)
gmail.com> wrote:
I totally agree. Thanks for taking the time. I will send the plan in Word when I
get to into the office in a while. I was also thinking about a few other things that
we should catch up on.
1. Why can't you match the nursing salaries in a competitive market personnel
crisis?
VA-19-0799-D-000215
OS 00001877
We can- its a process- first we have to do a market survey to show OPM- we need our
leadership to do this sooner and more aggressively
Can an EO give you the authority, or can that be part of the Accountability bill - it goes both
ways?
Eo might be an idea here- we will explore and see if this works - the key is to speed up our
process
2. We didn't have time to discuss fraud and real estate last night. We need to do that right away
for practical (Medicare system review) and messaging purposes.
Agree - we are standing up a Committee and we need to message this effort - we are talking to
the White House about this tommoroW
3. We didn't discuss all steps in my agenda on the crisis plan last night since we ran out of
time. We should discuss the rest of the items to see ifwe can figure out which ones are valuable
to implement and then discuss them so we can come to the best approach on each.
Ok- lets plan on another get together soon
Marc Sherman
(202) 758-(b) (6)
On Apr 18, 2017 4:38 AM, "Poonam Alaigh" <(b) (6)
hotmail.com> wrote:
Marc- it was so good catching up in a relaxed setting with an incredible ambiance where we
could simply brainstorm and problem solve as we together bring about the transformation of the
organization. Let's try to meet regularly, monthly if possible. Also, please send the proposed
approach/plan as an attachment so that we can start to activate it. Thanks again, all of you are
helping us serve our nations heroes better- and we can't possibly achieve what we are/will
without your invaluable support and input.
David and Poonam
Sent from my iPhone
> On Apr 17, 2017, at 9:28 PM, Marc Sherman <(b) (6)
>
> Thanks for the great conversation ... And humoring me.
>
> Marc Sherman
> (202) 758-(b) (6)
gmail.com> wrote:
VA-19-0799-D-000216
OS 00001878
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/19/2017 11:27:05 AM
Marc Sherman [(b) (6)
gmail.com]
David shulkin [Drshulkin@aol.com]; Poonam Alaigh [(b) (6)
[(b) (6) frenchangel59.com]
Re: Thanks
hotmail.com]; L Perl [(b) (6)
gmail.com]; IP
My recommendation is you lead an independent fraud unit and it should have a fix it before it breaks mission .
We have two major problems the internal one is the easiest and external contracts especially with medical
devices will be the most difficult. My concern is the device manufacturers have so many ways to game the
system. The other area is when VA patients are seen outside the VA
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 18, 2017, at 9:34 PM, Marc Sherman <(b) (6)
gmail.com> wrote:
Thanks for the responses. I got home so late last night I didn't get a chance to send the dinner
agenda as promised ... sorry Poonam -- see attached.
An EO on the competitive salaries could also have a dual benefit with some good White House
PR impact as well as serving to solve your staffing leakage.
I gave Ike an update on the possible real estate plan tonight that you shared with me, including
the congressional committee. I am available to serve on it as we discussed and ready to help
formulate more thoughts about it when you are ready. Also ready to help with the Fraud plan.
On Tue, Apr 18, 2017 at 9: 17 PM, David shulkin wrote:
Sent from my iPhone
On Apr 18, 2017, at 7: 10 AM, Marc Sherman <(b) (6)
gmail.com> wrote:
I totally agree. Thanks for taking the time. I will send the plan in Word when I
get to into the office in a while. I was also thinking about a few other things that
we should catch up on.
1. Why can't you match the nursing salaries in a competitive market personnel
crisis?
We can- its a process- first we have to do a market survey to show OPM- we need our
leadership to do this sooner and more aggressively
VA-19-0799-D-000217
OS 00001879
Can an EO give you the authority, or can that be part of the Accountability bill
- it goes both ways?
Eo might be an idea here- we will explore and see if this works - the key is to speed up our
process
2. We didn't have time to discuss fraud and real estate last night. We need to do
that right away for practical (Medicare system review) and messaging purposes.
Agree - we are standing up a Committee and we need to message this effort - we are talking to
the White House about this tommoroW
3. We didn't discuss all steps in my agenda on the crisis plan last night since we
ran out of time. We should discuss the rest of the items to see ifwe can figure
out which ones are valuable to implement and then discuss them so we can come
to the best approach on each.
Ok- lets plan on another get together soon
Marc Sherman
(202) 758-(b) (6)
hotmail.com> wrote:
On Apr 18, 2017 4:38 AM, "Poonam Alaigh" <(b) (6)
Marc- it was so good catching up in a relaxed setting with an incredible
ambiance where we could simply brainstorm and problem solve as we together
bring about the transformation of the organization. Let's try to meet regularly,
monthly if possible. Also, please send the proposed approach/plan as an
attachment so that we can start to activate it. Thanks again, all of you are
helping us serve our nations heroes better- and we can't possibly achieve what
we are/will without your invaluable support and input.
David and Poonam
Sent from my iPhone
> On Apr 17, 2017, at 9:28 PM, Marc Sherman <(b) (6)
wrote:
>
> Thanks for the great conversation ... And humoring me.
>
> Marc Sherman
> (202) 758-(b) (6)
gmail.com>
VA-19-0799-D-000218
OS 00001880
Message
David shulkin [Drshulkin@aol.com]
4/19/2017 1:50:21 AM
Marc Sherman [(b) (6)
gmail.com]
Re: Thanks
From:
Sent:
To:
Subject:
Ok thanks
Sent from my iPhone
On Apr 18, 2017, at 9:34 PM, Marc Sherman <(b) (6)
gmail.com> wrote:
Thanks for the responses. I got home so late last night I didn't get a chance to send the dinner
agenda as promised ... sorry Poonam -- see attached.
An EO on the competitive salaries could also have a dual benefit with some good White House
PR impact as well as serving to solve your staffing leakage.
I gave Ike an update on the possible real estate plan tonight that you shared with me, including
the congressional committee. I am available to serve on it as we discussed and ready to help
formulate more thoughts about it when you are ready. Also ready to help with the Fraud plan.
On Tue, Apr 18, 2017 at 9: 17 PM, David shulkin wrote:
Sent from my iPhone
On Apr 18, 2017, at 7: 10 AM, Marc Sherman <(b) (6)
gmail.com> wrote:
I totally agree. Thanks for taking the time. I will send the plan in Word when I
get to into the office in a while. I was also thinking about a few other things that
we should catch up on.
1. Why can't you match the nursing salaries in a competitive market personnel
crisis?
We can- its a process- first we have to do a market survey to show OPM- we need our
leadership to do this sooner and more aggressively
Can an EO give you the authority, or can that be part of the Accountability bill
- it goes both ways?
VA-19-0799-D-000219
OS 00001881
Eo might be an idea here- we will explore and see if this works - the key is to speed up our
process
2. We didn't have time to discuss fraud and real estate last night. We need to do
that right away for practical (Medicare system review) and messaging purposes.
Agree - we are standing up a Committee and we need to message this effort - we are talking to
the White House about this tommoroW
3. We didn't discuss all steps in my agenda on the crisis plan last night since we
ran out of time. We should discuss the rest of the items to see ifwe can figure
out which ones are valuable to implement and then discuss them so we can come
to the best approach on each.
Ok- lets plan on another get together soon
Marc Sherman
(202) 758-(b) (6)
hotmail.com> wrote:
On Apr 18, 2017 4:38 AM, "Poonam Alaigh" <(b) (6)
Marc- it was so good catching up in a relaxed setting with an incredible
ambiance where we could simply brainstorm and problem solve as we together
bring about the transformation of the organization. Let's try to meet regularly,
monthly if possible. Also, please send the proposed approach/plan as an
attachment so that we can start to activate it. Thanks again, all of you are
helping us serve our nations heroes better- and we can't possibly achieve what
we are/will without your invaluable support and input.
David and Poonam
Sent from my iPhone
> On Apr 17, 2017, at 9:28 PM, Marc Sherman <(b) (6)
wrote:
>
> Thanks for the great conversation ... And humoring me.
>
> Marc Sherman
> (202) 758-(b) (6)
gmail.com>
VA-19-0799-D-000220
OS 00001882
Message
From:
Sent:
To:
CC:
Subject:
Attachments:
Marc Sherman [(b) (6)
gmail.com]
4/19/2017 1:34:59 AM
David shulkin [Drshulkin@aol.com]
Poonam Alaigh [(b) (6)
hotmail.com]; L Perl [(b) (6)
(b)
(6)
Moskowitz [
mac.com]
Re: Thanks
Dinner Discussion Agenda 041717.docx
gmail.com]; IP [(b) (6) frenchangel59.com]; Bruce
Thanks for the responses. I got home so late last night I didn't get a chance to send the dinner agenda as
promised ... sorry Poonam -- see attached.
An EO on the competitive salaries could also have a dual benefit with some good White House PR impact as
well as serving to solve your staffing leakage.
I gave Ike an update on the possible real estate plan tonight that you shared with me, including the
congressional committee. I am available to serve on it as we discussed and ready to help formulate more
thoughts about it when you are ready. Also ready to help with the Fraud plan.
On Tue, Apr 18, 2017 at 9: 17 PM, David shulkin wrote:
Sent from my iPhone
On Apr 18, 2017, at 7: 10 AM, Marc Sherman <(b) (6)
gmail.com> wrote:
I totally agree. Thanks for taking the time. I will send the plan in Word when I get to into the
office in a while. I was also thinking about a few other things that we should catch up on.
1. Why can't you match the nursing salaries in a competitive market personnel crisis?
We can- its a process- first we have to do a market survey to show OPM- we need our leadership to do this
sooner and more aggressively
Can an EO give you the authority, or can that be part of the Accountability bill - it goes both
ways?
Eo might be an idea here- we will explore and see if this works - the key is to speed up our process
2. We didn't have time to discuss fraud and real estate last night. We need to do that right away
for practical (Medicare system review) and messaging purposes.
VA-19-0799-D-000221
OS 00001883
Agree - we are standing up a Committee and we need to message this effort - we are talking to the White
House about this tommoroW
3. We didn't discuss all steps in my agenda on the crisis plan last night since we ran out of
time. We should discuss the rest of the items to see ifwe can figure out which ones are
valuable to implement and then discuss them so we can come to the best approach on each.
Ok- lets plan on another get together soon
Marc Sherman
(202) 758-(b) (6)
hotmail.com> wrote:
On Apr 18, 2017 4:38 AM, "Poonam Alaigh" <(b) (6)
Marc- it was so good catching up in a relaxed setting with an incredible ambiance where we
could simply brainstorm and problem solve as we together bring about the transformation of
the organization. Let's try to meet regularly, monthly if possible. Also, please send the
proposed approach/plan as an attachment so that we can start to activate it. Thanks again, all of
you are helping us serve our nations heroes better- and we can't possibly achieve what we
are/will without your invaluable support and input.
David and Poonam
Sent from my iPhone
> On Apr 17, 2017, at 9:28 PM, Marc Sherman <(b) (6)
>
> Thanks for the great conversation ... And humoring me.
>
> Marc Sherman
> (202) 758-(b) (6)
gmail.com> wrote:
VA-19-0799-D-000222
OS 00001884
Dinner Discussion Agenda
Reputation on the line
I 21 months I Ammunition (see article highlights below)
Crisis Management Discussion
1.
2.
3.
System is in crisis - Engage crisis management program - URGENCY
Can't afford another DC
I Almost guaranteed
Need Crisis plan - EXECUTE NOW
a.
Need to understand the immediate risks NOW
b.
ID trusted people in field I reassign I increase filed based reliable intelligence
i. Wharton's Mack Center for administrator assessment
c.
NLC NOW - Use DC as a catalyst to show urgency and send message
d.
Make managers/administrators responsible I Report Card (back to HQ)
e.
ID problems now
i.
Outside quality/ standards reviewers - report back to HQ with immediate
action (Bruce can help to arrange - SEE OUTSIDE QUALITY REVIEW STANDARDS
LIST BELOW)
f.
ii.
Talk to medical staff in private
iii.
Fix problems immediately
iv.
Understaff
v.
Reduce each facility to available skills and resources
Curtail risks
stage)
g.
I Procedural experience I shutdown &
ID alternatives
I Publicize new sheriff's in town I Reduce blame ammo (DC article sets the
I Partner with Tester etc to manage risk and get authority
Plan progress within next week
Restructure Discussion
1.
2.
Telemedicine Exec Order
I Opioid impact
Corruption of Supply Chain I Purchasing
a.
Expect significant deviation from expectations
b.
Need full assessment of existing system
c.
d.
Revamp system to remove risks
Examine P-Cards to curtail cost and quality issues
e.
Tie in Device Registry
f.
Tie in inventory system
Other Discussion Items
1.
2.
3.
4.
Real Estate (continuation of last week's I Congressional Commission
FW&A (Medicare system - participate in program demo
Cerner vs EPIC - Procurement issues
CIO
VA-19-0799-D-000223
OS 00001885
OUTSIDE QUALITY REVIEW STANDARDS (first cut)
•
Arrive unannounced and tour all areas of the hospital WITHOUT THE ADMINISTRATIVE STAFF so
staff can speak freely of their concerns.
•
Spot check for adequate supplies in every department
•
Account for adequacy and quality of equipment in the ED, radiology, pathology, ICU, OR, LABS,
cardiac cath lab and cardiac monitoring.
•
Review medical personnel staffing and close any area of the hospital that would jeopardize
•
Suspend any low volume procedure that does not meet proficiency of care standards. For
patient care from understaffing.
instance if the cath lab does not have the volume found safe by the American College of
Cardiology.
•
From the administrative staff request to see any personnel issues that are now under report and
if those critical to patient care have been suspended from current patient care.
•
Review all onsite and off-site storage units and inventory system operations and how recalled
medical equipment has been accounted for.
•
Review narcotics inventory and management system and reporting, Review all reported
breaches in securing or prescribing addictive medication
•
Review all patient and staff reported concerns regarding quality of care issues .
•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
EXCERPTS FROM MARCH 12, 2017 ARTICLE
A downplayed risks at Chicago facility, watchdog says
By Drew Griffin and Curt Devine CNN Investigations
Updated 3:34 PM ET, Sun March 12, 2017
Story highlights
•
•
Doctor alleged life-threatening delays in care and unnecessary heart procedures at VA
hospital
Watchdog agency disputes VA findings of no "specific danger to public health or safety"
(CNN) Six years after a whistleblower warned of poor care at a VA hospital near Chicago, a top
government watchdog is warning that the Department of Veterans Affairs downplayed the risks.
The concerns were first raised in 2011 by Dr. Lisa Nee, a cardiologist at Edward Hines Jr. VA
Hospital, just west of Chicago.
VA-19-0799-D-000224
OS 00001886
Her claims: Veterans were being subjected to unnecessary coronary artery bypass surgeries. She
also said that the hospital's echocardiogram laboratory had a one-year backlog and that many
patients had died or suffered complications before their echocardiograms were reviewed.
She says her concerns were ignored and she left the VA in 2013. Nee became a whistleblower
and took her case to the U.S. Office of Special Counsel, which protects government workers who
report damaging information about the agencies where they work.
"I have absolutely no doubt patients died as a result of the care they did not get at the VA Hines
facility," Nee told CNN from Chicago, where she now works as chief medical officer for a
medical start-up. No VA investigation has made that determination.
The letter also described a "lack of accountability," stating that the V A's medical inspector
identified repeated errors by one physician without taking any disciplinary action. The physician
is still at Hines.
The Office of Special Counsel's letter says the VA took some corrective actions, but added that
Nee had raised unresolved issues.
A Hines VA spokesperson said in a statement to CNN that the facility has hired additional
cardiologists and responded to recommendations by the Inspector General by changing
diagnostic and post-procedure review processes.
"Providing a safe environment and quality care for our Veterans is the top priority at the Hines
VA Hospital," the statement said. "All Cardiology Peripheral Vascular procedures in 2016 were
completed without adverse complications and with good outcomes. Hines V AH has implemented
an ongoing Cardiology Quality Improvement Plan that includes validation of the accuracy of the
interpretation and technical quality of echocardiography studies, and ensures that all
echocardiography technicians have the opportunity for continuing education and training."
Recently sworn-in VA Secretary David Shulkin has vowed to improve patient access to quality
VA health care. "I think that we have a system that is doing terrific things with very dedicated
people, but we all know we have a lot of work to do and that's what I plan to do as secretary,"
Shulkin said in February.
Nee is not convinced, and is disappointed no one from the Trump administration or transition
team has met with her regarding her allegations.
"You can't have a system that is supposed to take care of patients, and have a system that never
takes account for its own mistakes," said Nee.
VA-19-0799-D-000225
OS 00001887
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/19/2017 1:17:00 AM
Marc Sherman [(b) (6)
gmail.com]
Poonam Alaigh [(b) (6)
hotmail.com]; L Perl [(b) (6)
Moskowitz [(b) (6)
mac.com]
Re: Thanks
gmail.com]; IP [(b) (6) frenchangel59.com]; Bruce
Sent from my iPhone
On Apr 18, 2017, at 7: 10 AM, Marc Sherman <(b) (6)
gmail.com> wrote:
I totally agree. Thanks for taking the time. I will send the plan in Word when I get to into the
office in a while. I was also thinking about a few other things that we should catch up on.
1. Why can't you match the nursing salaries in a competitive market personnel crisis?
We can- its a process- first we have to do a market survey to show OPM- we need our leadership to do this
sooner and more aggressively
Can an EO give you the authority, or can that be part of the Accountability bill - it goes both
ways?
Eo might be an idea here- we will explore and see if this works - the key is to speed up our process
2. We didn't have time to discuss fraud and real estate last night. We need to do that right away
for practical (Medicare system review) and messaging purposes.
Agree - we are standing up a Committee and we need to message this effort - we are talking to the White House
about this tommoroW
3. We didn't discuss all steps in my agenda on the crisis plan last night since we ran out of
time. We should discuss the rest of the items to see ifwe can figure out which ones are valuable
to implement and then discuss them so we can come to the best approach on each.
Ok- lets plan on another get together soon
Marc Sherman
(202) 758-(b) (6)
VA-19-0799-D-000226
OS 00001888
On Apr 18, 2017 4:38 AM, "Poonam Alaigh" <(b) (6)
hotmail.com> wrote:
Marc- it was so good catching up in a relaxed setting with an incredible ambiance where we
could simply brainstorm and problem solve as we together bring about the transformation of the
organization. Let's try to meet regularly, monthly if possible. Also, please send the proposed
approach/plan as an attachment so that we can start to activate it. Thanks again, all of you are
helping us serve our nations heroes better- and we can't possibly achieve what we are/will
without your invaluable support and input.
David and Poonam
Sent from my iPhone
> On Apr 17, 2017, at 9:28 PM, Marc Sherman <(b) (6)
>
> Thanks for the great conversation ... And humoring me.
>
> Marc Sherman
> (202) 758-(b) (6)
gmail.com> wrote:
VA-19-0799-D-000227
OS 00001889
Message
From:
Marc Sherman [(b) (6)
Sent:
4/18/2017 11:10:27 AM
To:
Poonam Alaigh [(b) (6)
hotmail.com]
L Perl [(b) (6)
gmail.com]; IP [(b) (6) frenchangel59.com]; David shulkin [drshulkin@aol.com]; Bruce Moskowitz
[(b) (6)
mac.com]
Re: Thanks
CC:
Subject:
gmail.com]
I totally agree. Thanks for taking the time. I will send the plan in Word when I get to into the office in a
while. I was also thinking about a few other things that we should catch up on.
1. Why can't you match the nursing salaries in a competitive market personnel crisis? How can we change
that? Let's brainstorm. Can an EO give you the authority, or can that be part of the Accountability bill - it goes
both ways?
2. We didn't have time to discuss fraud and real estate last night. We need to do that right away for practical
(Medicare system review) and messaging purposes.
3. We didn't discuss all steps in my agenda on the crisis plan last night since we ran out of time. We should
discuss the rest of the items to see ifwe can figure out which ones are valuable to implement and then discuss
them so we can come to the best approach on each.
Marc Sherman
(202) 758-(b) (6)
hotmail.com> wrote:
On Apr 18, 2017 4:38 AM, "Poonam Alaigh" <(b) (6)
Marc- it was so good catching up in a relaxed setting with an incredible ambiance where we could simply
brainstorm and problem solve as we together bring about the transformation of the organization. Let's try to
meet regularly, monthly if possible. Also, please send the proposed approach/plan as an attachment so that we
can start to activate it. Thanks again, all of you are helping us serve our nations heroes better- and we can't
possibly achieve what we are/will without your invaluable support and input.
David and Poonam
Sent from my iPhone
> On Apr 17, 2017, at 9:28 PM, Marc Sherman <(b) (6)
>
> Thanks for the great conversation ... And humoring me.
>
> Marc Sherman
> (202) 758-(b) (6)
gmail.com> wrote:
VA-19-0799-D-000228
OS 00001890
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/18/2017 8:38:27 AM
Marc Sherman [(b) (6)
gmail.com]
David shulkin [drshulkin@aol.com]; (b) (6)
Perlmutter [(b) (6)
gmail.com]
Re: Thanks
mac.com; Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie
Marc- it was so good catching up in a relaxed setting with an incredible ambiance where we could simply
brainstorm and problem solve as we together bring about the transformation of the organization. Let's try
to meet regularly, monthly if possible. Also, please send the proposed approach/plan as an attachment so
that we can start to activate it. Thanks again, all of you are helping us serve our nations heroes
better- and we can't possibly achieve what we are/will without your invaluable support and input.
David and Poonam
Sent from my iPhone
> on Apr 17, 2017, at 9:28 PM, Marc Sherman <(b) (6)
gmail.com> wrote:
>
> Thanks for the great conversation ... And humoring me.
>
> Marc Sherman
> (202) 758-(b) (6)
VA-19-0799-D-000229
OS 00001891
Message
David shulkin [Drshulkin@aol.com]
4/19/2017 11:27:06 PM
(b) (6)
[(b) (6)
(b)
Fwd: Invitation - (from (6)
From:
Sent:
To:
Subject:
gmail.com]
Intrepid Salute to Freedom Gala Info (Thurs May 25, 2017)
Lets discuss
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
cushwake.com >
Date: April 19, 2017 at 11:39:54 AM EDT
To: "David Shulkin (DRShulkin@aol.com )"
Subject: Invitation - {from (b) (6)
Intrepid Salute to Freedom Gala Info {Thurs May 25, 2017)
Good Afternoon Sec. Shulkin,
Bruce invites you and your wife to join his table at the Intrepid Salute to Freedom Gala, held on
Thursday May 25 th , 2017.
The event takes place in New York City, onboard the Intrepid Museum itself. Below are further details
regarding this gala.
Kindly please RSVP directly to this email.
Thank you,
(b)
(6)
VA-19-0799-D-000230
OS 00001892
INTREPID SEA, AIR & SPACE MUSEUM
HONOR. EDUCATE. INSPIRE.
THURSDAY, MAY 25, 2017
aboard the historic aircraft carrier Intrepid
HONORING
(b) (6)
Chief Executive Officer, SL Green Realty
Intrepid Salute Award
(b) (6)
(b) (6)
President, SL Green Realty
Intrepid Salute Award
THE HONORABLE JOHN F. KELLY
Secretary of Homeland Security
Intrepid Freedom Award
AND THE MEN AND WOMEN
OF THE UNITED STATES ARMED FORCES
SALUTE TO FREEDOM 2017 GALA CHAIRMEN
I
(b) (6)
Fisher Brothers
(b) (6)
I
Cushman & Wakefield
(b) (6)
Paul Hastings LLP
Cocktails: 6:00pm
Dinner & Awards : 7:00pm
INTREPID SEA, AIR & SPACE MUSEUM
W 46th Street and 12th Avenue, New York City
VA-19-0799-D-000231
OS 00001893
The information contained in this communication is confidential, may be privileged and is
intended for the exclusive use of the above named addressee(s). If you are not the intended
recipient(s), you are expressly prohibited from copying, distributing, disseminating, or in any
other way using any information contained within this communication. If you have received this
communication in error please contact the sender by telephone or by response via mail.
We have taken precautions to minimize the risk of transmitting software viruses, but we advise
you to carry out your own virus checks on any attachment to this message. We cannot accept
liability for any loss or damage caused by software viruses.
VA-19-0799-D-000232
OS 00001894
Message
From:
Poonam Alaigh [(b) (6)
Sent:
4/24/2017 12:43:15 AM
To:
IP [(b) (6) frenchangel59.com]
David shulkin [drshulkin@aol.com]
Re: Thank you
CC:
Subject:
hotmail.com]
Thanks Ike- a very important meeting with all the key areas needed to be discussed. David and I will see if there
is anything else to add to the agenda, but looks really good thus far.
Sent from my iPhone
On Apr 23, 2017, at 5:26 PM, IP <(b) (6) frenchangel59.com> wrote:
From: IP [mailto:(b) (6) renchanqel59.com ]
Sent: Sunday, April 23, 2017 5:25 PM
To: (b) (6)
ho.eop.gov
Cc: (b) (6)
Subject: Thank you
@who.eop.gov
Jared,
Thank you for getting back to me and for committing the time to join us for dinner on
Wednesday, April 26 th . Especially thank you for the generous invitation to dine at your house.
We expect between IO to 13 people in total. The final number will depend on whether Senator
Isakson and Representative Roe accept our invitation. I totally understand if that is too large a
group to host and hope you will be honest about your willingness and ability now that you know
how big it is.
Best,
Ike
DRAFT Agenda Items to be defined around finalized attendee list. Attendee list and agenda
items subject to change.
VA-19-0799-D-000233
OS 00001895
Message
From:
Sent:
To:
Subject:
IP [(b) (6) frenchangel59.com]
4/23/2017 9:25:49 PM
Poonam Alaigh [(b) (6)
hotmail.com]; David shulkin [drshulkin@aol.com]
FW: Thank you
From: IP [mailto:(b) (6) frenchangel59.com]
Sent: Sunday, April 23, 2017 5:25 PM
To: (b) (6)
who.eop.gov
Cc:(b
)
Subject:
Thank you
@who.eop.gov
Jared,
Thank you for getting back to me and for committing the time to join us for dinner on Wednesday, April
26th . Especially thank you for the generous invitation to dine at your house. We expect between IO to 13 people
in total. The final number will depend on whether Senator Isakson and Representative Roe accept our
invitation. I totally understand if that is too large a group to host and hope you will be honest about your
willingness and ability now that you know how big it is.
Best,
Ike
DRAFT Agenda Items to be defined around finalized attendee list. Attendee list and agenda items subject to
change.
VA-19-0799-D-000234
OS 00001896
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lnven o,y managemt!n sys ms, de ce reg1 ry and supplyc.haln- also a
procuremen mue
lte 1-buse
Congressmen
Telemedidne Ex nr ive Orde
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2.. Identified Ph scan PTSD
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i e House
2. cong,ess
1. Call)e ' ti11e medic.a l hiri~ e ·bni .
2. Accou ability
VA-19-0799-D-000235
OS 00001897
Message
From:
(b) (6)
Sent:
4/19/2017 10:49:52 PM
Bruce Moskowitz [(b) (6)
mac.com]
David Shulkin [drshulkin@aol.com]; (b) (6)
phone numbers and email?
To:
CC:
Subject:
[(b) (6)
gmail.com]
(b) (6)
va.gov]
Good evening Dr. Moskowitz,
By chance would you have an email or phone number for the following - we are working to get these schedule
and notice their resumes do not have any contact information,
Dr.
Dr.
(b) (6)
(b) (6)
- Yale
- Yale University
thanks,
(b) (6)
VA-19-0799-D-000236
OS 00001898
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/21/2017 1:08:09 PM
To:
Bruce Moskowitz [(b) (6)
Re: Meeting at Whitehouse
Subject:
mac.com]
Were looking into the presidents flexability
Sent from my iPhone
On Apr 21, 2017, at 8:20 AM, Bruce Moskowitz <(b) (6)
So far only (b) (6)
mac.com> wrote:
responded to positive for following week
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
(b) (6)
From: "(b) (6)
<(b) (6)
ccf.org>
Date: April 21, 2017 at 8: 18:52 AM EDT
To: Bruce Moskowitz <(b) (6)
mac.com>
Subject: RE: Meeting at Whitehouse
Unfortunately I would be unable to attend either day because of commitments
here at Cleveland Clinic I cannot move.
(b) (6)
(b) (6)
(b) (6)
MD
CEO and President
9500 Euclid Avenue, NA4
Cleveland, OH 44195
Phone: (216) 444-(b) (6)
Fax: (216) 444-(b) (6)
(b) (6)
@ccf.org
-----Original Message----F rom: Bruce Moskowitz [mailto:(b) (6)
Sent: Thursday, April 20, 2017 6:42 PM
To: (b) (6)
partners.org; (b) (6)
(b) (6)
(b) (6)
<
jhmi.edu>; (b) (6)
<(b) (6)
mayo.edu>; (b) (6)
(b) (6)
(b) (6)
.
kp .org
Subject: Meeting at Whitehouse
mac.com]
(b) (6)
<(b) (6)
ccf.org>; (b) (6)
M.D.
(b) (6)
(b) (6)
<
mayo.edu>;
What is chance of feet in everyone to be at a bill signing and half day meeting
with President and we would try to get Tim Price there either next Thursday or
following Tuesday
VA-19-0799-D-000237
OS 00001899
Sent from my iPhone
Please consider the environment before printing this e-mail
Cleveland Clinic is ranked as one of the top hospitals in America by US.News &
World Report (2015).
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.
VA-19-0799-D-000238
OS 00001900
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/21/2017 12:20:31 PM
To:
David shulkin [drshulkin@aol.com]
Fwd: Meeting at Whitehouse
Subject:
So far only (b) (6)
mac.com]
responded to positive for following week
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
(b) (6)
From: "(b) (6)
<(b) (6)
ccf.org>
Date: April 21, 2017 at 8: 18:52 AM EDT
To: Bruce Moskowitz <(b) (6)
mac.com>
Subject: RE: Meeting at Whitehouse
Unfortunately I would be unable to attend either day because of commitments here at Cleveland
Clinic I cannot move.
(b) (6)
(b) (6)
(b) (6)
MD
CEO and President
9500 Euclid Avenue, NA4
Cleveland, OH 44195
Phone: (216) 444-(b) (6)
Fax: (216) 444-(b) (6)
(b) (6)
@ccf.org
-----Original Message----From: Bruce Moskowitz [mailto:(b) (6)
Sent: Thursday, April 20, 2017 6:42 PM
To: (b) (6)
partners.org; (b) (6)
(b) (6)
<
jhmi .edu>; (b) (6)
(b) (6)
(b) (6)
<
mayo.edu>; (b) (6)
Subject: Meeting at Whitehouse
mac.com]
(b) (6)
<(b) (6)
ccf.org>; (b) (6) (b) (6)
(b) (6)
M.D.<
mayo.edu>; (b) (6)
kp .org
What is chance of feet in everyone to be at a bill signing and half day meeting with President and
we would try to get Tim Price there either next Thursday or following Tuesday
Sent from my iPhone
Please consider the environment before printing this e-mail
Cleveland Clinic is ranked as one of the top hospitals in America by US.News & World Report
VA-19-0799-D-000239
OS 00001901
(2015).
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.
VA-19-0799-D-000240
OS 00001902
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/20/2017 2:43:46 AM
To:
(b) (6)
Subject:
amazon
amazon.docx
Attachments:
gmail.com
Please print
VA-19-0799-D-000241
OS 00001903
amazon.com
" ,;,
I've been reminding peo le that it's Day 1 for a cou le of decades. I work in an Amazon building named Day 1,
and when I moved buildings, I took the name with me.
"Day 2 is stasis. Followed by irrelevance. Followed by excruciating, painful decline. Followed by death. And
that is why it is always Day l."
ifo be sure, this kind of decline would ha1men in extreme slow motion. An established company might harvest
Day 2 for decades, but the final result would still come.
I'm interested in the question, how do you fend off Day 2? How do you kee the vitality of Day 1, even inside a
farge organization?
I don't know the whole answer, but I may know bits ofit. Here's are some essentials for Day 1 defense: customer
obsession, and high-velocity decision making.
'1'here are many ways to center a business. You can be competitor focused, you can be roduct focused, you can
be technology focused, you can be business model focused, and there are more. But in my view, obsessive
customer focus is by far the most rotective of Day 1 vitality.
Why? There are many advantages to a customer-centric approach, but here's the big one: customers are alway_s,
beautifully, wonderfully dissatisfied, even when they report being ha py and business is great. Even when they
don't yet know it, customers want something better, and your desire to delight customers will drive you to invent
on their behalf.
Staying in Day 1 reguires you to experiment patiently, accept failures plant seeds protect saplings, and double
down when you see customer delight. A customer-obsessed culture best creates the conditions where all of that
can hapP,en.
Day 2 companies make high- uality decisions, but they make high-guality decisions slowly. To keep the energy
and dynamism of Day 1, you have to somehow make high- uality, high-velocity decisions. Easy for start-u sand
very challenging for large organizations. The senior team at Amazon is determined to keep our decision-making
velocity high. S eed matters in business - plus a high-velocity decision making environment is more fun too. We
don't know all the answers, but here are some thoughts.
Most decisions should robably be made with somewhere around 70% of the information you wish you had. If
you wait for 90%, in most cases, you're probably being slow. Plus, either way, you need to be good at quickly
recognizing and correcting bad decisions. If you're good at course correcting, being wrong may be less costly
than you think, whereas being slow is going to be expensive for sure.
Second, use the hrase "disagree and commit." This hrase will save a lot of time. If you have conviction on a
articular direction even though there's no consensus, it's hel ful to say, "Look, I know we disagree on this but1
will you gamble with me on it? Disagree and commit
I disagree and commit all the time. We recently greenlit a articular Amazon Studios original. I told the team my
view: debatable whether it would be interesting enough, coml)licated to J)roduce, the business terms aren't that
good, and we have lots of other op__22rtunities. They had a completely different opinion and wanted to go ahead. I
wrote back right away with "I disagree and commit and hope it becomes the most watched thing we've ever
VA-19-0799-D-000242
OS 00001904
made." Consider how much slower this decision cycle would have been if the team had actually had to convince
me rather than simply get my commitment.
iNote what this exam le is not: it's not me thinking to myself"well, these guys are wrong and missing the point,
but this isn't worth me chasing." It's a genuine disagreement of 02inion, a candid ex2ression ofmy view, a
chance for the team to weigh my view, and a uick, sincere commitment to go their way. And given that this
team has already brought home 11 Emmys, 6 Golden Globes, and 3 Oscars, I'm just glad they let me in the room
at all!
'1'hird, recognize true misalignment issues early and escalate them immediately. Sometimes teams have differen~
objectives and fundamentally different views. They are not aligned. No amount of discussion, no number of
meetings will resolve that dee misalignment. Without escalation, the default dispute resolution mechanism for
this scenario is exhaustion.
(b) (6)
(b) (6)
Founder and Chief Executive Officer
Amazon.com, Inc.
1997LETTERTOSHAREHOLDERS
(Reprinted from the 1997 Annual Report)
Amazon.com, Inc.
VA-19-0799-D-000243
OS 00001905
Message
From:
Sent:
To:
Subject:
With
(b) (6)
David shulkin [Drshulkin@aol.com]
4/19/2017 10:24:33 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Train on Sunday
Dad im not sure yet
Sent from my iPhone
> on Apr 19, 2017, at 6:13 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Let me know what and if you are taking the train on Sunday
>
> Sent from my iPhone
VA-19-0799-D-000244
OS 00001906
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/19/2017 10:13:56 AM
David Shulkin [drshulkin@aol.com]
Train on Sunday
Let me know what and if you are taking the train on Sunday
Sent from my iPhone
VA-19-0799-D-000245
OS 00001907
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/16/2017 1:24:12 PM
To:
Marc Sherman [(b) (6)
gmail.com]
Bruce Moskowitz [(b) (6)
mac.com]; L Perl [(b) (6)
(b)
(6)
[
frenchangel59.com]
Re: From yesterday's discussion
CC:
Subject:
gmail.com];
(b) (6)
hotmail.com; IP
This is a great start- Lets us work on a checklist like this and get back to you
Sent from my iPhone
On Apr 16, 2017, at 8:35 AM, Marc Sherman <(b) (6)
gmail.com> wrote:
Totally agree. Great ideas. From my non-medical perspective, couldn't agree more with the
"tour... WITHOUT THE ADMINISTRATIVE STAFF" approach.
Marc Sherman
(202) 758-(b) (6)
mac.com> wrote:
On Apr 16, 2017 8: 12 AM, "Bruce Moskowitz" <(b) (6)
Ifwe adapt the fix it before it breaks slogan then the 18 regional managers need to be held
accountable for the following (probably many if not all are in place now):
That they arrived unannounced and proceeded to tour all areas of the hospital WITHOUT THE
ADMINISTRATIVE STAFF so staff can speak freely of their concerns.
Personally spot checked for adequate supplies in every department
Account for the radiology, lab, pathology, intensive care units and surgical suites and cardiac
monitoring units have updated equipment to meet the new standards of care.
Review medical personnel staffing and close any area of the hospital that would jeopardize
patient care from understaffing.
Suspend any low volume procedure that does not meet proficiency of care standards. For
instance if the cath lab does not have the volume found safe by the American College of
Cardiology.
From the administrative staff request to see any personnel issues that are now under report and
if those critical to patient care have been suspended from current patient care.
Request to see all onsite and off site storage units and how recalled medical equipment has been
accounted for.
Request to see any reported breach in securing or prescribing addictive medication
Request to see patient or staff reported concerns regarding quality of care issues.
VA-19-0799-D-000246
DS 00001908
Bruce Moskowitz MD.
Message
From:
Sent:
To:
CC:
Subject:
Marc Sherman [(b) (6)
gmail.com]
4/16/2017 12:35:39 PM
Bruce Moskowitz [(b) (6)
mac.com]
L Perl [(b) (6)
gmail.com]; David shulkin [drshulkin@aol.com]; (b) (6)
[(b) (6) frenchangel59.com]
Re: From yesterday's discussion
hotmail.com; IP
Totally agree. Great ideas. From my non-medical perspective, couldn't agree more with the "tour ... WITHOUT
THE ADMINISTRATIVE STAFF" approach.
Marc Sherman
(202) 758-(b) (6)
mac.com> wrote:
On Apr 16, 2017 8:12 AM, "Bruce Moskowitz" <(b) (6)
Ifwe adapt the fix it before it breaks slogan then the 18 regional managers need to be held accountable for the
following (probably many if not all are in place now):
That they arrived unannounced and proceeded to tour all areas of the hospital WITHOUT THE
ADMINISTRATIVE STAFF so staff can speak freely of their concerns.
Personally spot checked for adequate supplies in every department
Account for the radiology, lab, pathology , intensive care units and surgical suites and cardiac monitoring units
have updated equipment to meet the new standards of care.
Review medical personnel staffing and close any area of the hospital that would jeopardize patient care from
understaffing.
Suspend any low volume procedure that does not meet proficiency of care standards. For instance if the cath
lab does not have the volume found safe by the American College of Cardiology.
>From the administrative staff request to see any personnel issues that are now under report and if those
critical to patient care have been suspended from current patient care.
Request to see all onsite and off site storage units and how recalled medical equipment has been accounted for.
Request to see any reported breach in securing or prescribing addictive medication
Request to see patient or staff reported concerns regarding quality of care issues.
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000248
DS 00001910
Message
David shulkin [Drshulkin@aol.com]
4/16/2017 8:17:12 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Questions about DC VAMC
From:
Sent:
To:
Subject:
Lets discuss
Sent from my iPhone
Begin forwarded message:
From: "Slack, Donovan"
Date: April 16, 2017 at 4:08:08 PM EDT
To: David Shulkin
Subject: Fwd: Questions about DC VAMC
I wanted to tell you personally what I am up to here with these questions below. I am turning my sites
on those layers of bureaucracy between u, dr Alleigh and the field. I hope and pray you see it as a gift to
drive internal change : )
D
Donovan Slack
White House and Veterans Affairs Correspondent
USA TODAY
dslack@usatoday.com
(703) 854-8926 Office
(202) 415-9493 Cell
Begin forwarded message:
From: "Slack, Donovan"
Date: April 14, 2017 at 4:34:35 PM EDT
(b) (6)
To: "(b) (6)
((b) (6)
va.gov)" <(b) (6)
"Hutton, James (James.Hutton@va.gov)"
Subject: Questions about DC VAMC
va.gov>,
(b) (6)
and James,
I have some questions below about the DC VAMC and what led up to this week's crisis.
Can I speak with someone about this? My deadline is end of business Monday.
Thanks,
Donovan
-According to the IG report, the VHA Procurement and Logistics Office, policy assistance
and quality, found no VA approved inventory management system in place and infection
control issues in multiple clinical supply areas at DC VAMC Jan. 24-26, 2017.
-The Deputy Undersecretary for Health for Operations and Management, Steven W.
Young, sent a memo on March 21, 2017, directing the VISN 5 Director and the medical
center director to provide a corrective action plan.
VA-19-0799-D-000249
OS 00001911
1) Why did Mr. Young wait two months to ask for this?
2) What prompted him to ask for it?
3) According to the timeline (see below), the VISN took the lead in addressing issues at
VAMC and repeatedly suggested they were being remediated, so why was the medical
center director relieved of duty pending investigation and not the VISN officials?
4) Is VISN director Joseph A. Williams, Jr., being held accountable and how? If not, why
not?
5) He was previously assistant deputy undersecretary for health for operations and
management. Why the demotion and when?
6) Who is the VISN deputy chief medical officer that visited DC VAMC on March 22,
March 30 and March 31? (And who was asked to help get vascular patches but didn't) Is
he or she being held accountable? How and why or why not?
7) Why were the deficiencies noted by the IG missed or not remedied by all the various
VISN officials?
7) Did the various VACO officials who received VISN reports have confidence in them?
Why or why not and what did they do? (Deputy Undersecretary for Health for
Operations and Management, Steven W. Young; Thomas lynch, Assistant Deputy Under
Secretary for Health for Clinical Operations at Department of Veterans Affairs; Tammy
Czarnecki, Assistant Deputy USH for Administrative Operations; (b) (6)
Director of the National Center for Patient Safety; Ricky Lemmon, Acting Chief
Procurement and logistics Officer; Sharon Ridley, executive director network support)
8) Did the Deputy Undersecretary for Health for Operations and Management, Steven
W. Young, brief the (acting) Undersecretary for Health Dr. Poonam Aleigh? If so, when
and what did she do about it? If not, why not?
9) Did Dr. Aleigh brief Secretary Shulkin? If not, why not? If so, what did he do about it
and when?
10) How will he prevent this from happening again?
TIMELINE:
-On March 21, 2017, VISN 5 submits an "issue brief" on the situation that says a
"comprehensive action plan" has been created and is being executed. VISN 5 supply
chain office is migrating to new inventory management system, staffing within DC
supply chain was 45% vacant and positions were posted, says the VISN 5 Supply Chain
Office will "continue to review all facets of the supply chain, and provide guidance and
assistance in rectifying any deficiencies that exist."
These people were part of the communication on the brief: Raymond Chung, MD, Chief
Quality Management Officer, VISN 5; (b) (6)
Medical Officer, VISNS; (b) (6)
, patient safety officer
, deputy network director, VISN 5; and (b) (6)
VISNS.
These people received the brief: Deputy Undersecretary for Health for Operations and
Management, Steven W. Young; Thomas lynch, Assistant Deputy Under Secretary for
Health for Clinical Operations at Department of Veterans Affairs; Tammy Czarnecki,
Director of the
Assistant Deputy USH for Administrative Operations; (b) (6)
National Center for Patient Safety; Ricky Lemmon, Acting Chief Procurement and
logistics Officer; Sharon Ridley, executive director network support.
-On March 22, VISN S's deputy chief medical officer and patient safety officer conducted
a "focused review" at the DC VAMC and found ... "no issues were identified that posed
an immediate risk to patient safety, however, several policy and practice inconsistencies
and Environment of Care concerns were validated that could potentially impact patient
safety," but said immediate risks were corrected at time of review
VA-19-0799-D-000250
OS 00001912
-On March 30-31, VISN 5 deputy chief medical officer again visited the DC VAMC to
"check the status of critical supplies that if not present, could adversely affect patient
care and put patients at risk"
-Over the April 1-2 weekend, the "Tiger team" working at the DC VAMC included the
VISN 5 chief logistics officer, VISN 5 deputy chief logistics officer (and eight logistics
employees from Martinsburg VAMC)
-Per the IG, on March 30, facility ran out of dialyzer bloodlines, and other equipment
deficiencies on April 4, 5 and 11 (OR runs out of vascular patches despite asking VISN 5
deputy chief medical officer two weeks earlier)
###
Donovan Slack
White House and Veterans Affairs Correspondent
USA TODAY
(703) 854-8926 office
(202) 415-9493 cell
VA-19-0799-D-000251
OS 00001913
Message
From:
Sent:
To:
Subject:
(b
)
[(b) (6) frenchangel59.com]
4/18/2017 12:01:59 PM
David shulkin [drshulkin@aol.com]
FW: WSJ - Trump's Promise to Veterans
Lets discuss before I answer. Thank you
https://www.wsj.com/articles/trumps-promise-to-veterans-1492123100
Trump's Promise to Veterans
Corruption at the VA isn't punished, while the Pentagon claws back signing
bonuses.
VA headquarters in Washington, D.C. PHOTO: ASSOCIATED PRESS
By
Rebecca Burgess
April 13, 2017 6:38 p.m. ET
71 COMMENTS
Donald Trump pitched himself as a friend to the American military, and to veterans in
particular. His campaign pledged to fix the Department of Veterans Affairs "by firing the
VA-19-0799-D-000252
OS 00001914
corrupt and incompetent VA executives who let our veterans down." Since taking office,
however, President Trump hasn't defined what, if anything, his administration will do to make
good on that promise. Here are a couple of obvious wrongs he can easily make right.
In 2015, a pair of senior VA officials were accused of defrauding the department to the tune of
$400,000. Diana Rubens and Kimberly Graves, the directors of two regional VA offices, had
allegedly manipulated the department's hiring and transfer systems for personal financial gain.
Ms. Rubens was accused of pressuring a subordinate to leave the VA's Philadelphia office so
she could take the job herself, move from Washington, and collect a $288,000 relocation
payout. Similarly, Ms. Graves received more than $129,000 by engineering a move from
Philadelphia to St. Paul, Minn.
Allison Hickey resigned in October 2015 as the VA undersecretary for benefits amid
investigations into her role in the scheme. Ms. Rubens and Ms. Graves were called to appear
before the House Veterans Affairs Committee that November, but they refused to testify,
invoking their Fifth Amendment right against self-incrimination. Instead of being fired, the pair
were demoted. Due to a VA "paperwork mistake," however, the demotion had to
be rescinded in December 2015 and reissued.
♦
-
ADVERTISEMENT -
111.1
Then the two got a reprieve from the Merit Systems Protection Board, the quasijudicial agency
whose mission, in part, is to review the disciplining of federal employees. The MSPB is the
successor of the U.S. Civil Service Commission, originally set up to protect federal workers
from partisan recrimination.
VA-19-0799-D-000253
OS 00001915
In early 2016 the MSPB fully reversed the punishments of Ms. Rubens and Ms. Graves.
Furthermore, the VA did not to try to recover the taxpayer funds that the pair had collected for
relocating. It seems that since "senior officials" approved the $400,000, it would have been
somehow improper to ask for the money back.
Yet the Los Angeles Times revealed in October 2016 that the Defense Department had been
forcing National Guard veterans to repay re-enlistment bonuses-sometimes up to $20,000they had received during the mid-2000s. The Pentagon said the bonuses were improperly
awarded. Nearly 10,000 soldiers, the Times reports, have faced everything from retroactive
interest to wage garnishment to tax liens. Debt collectors and tanked credit scores, the result of
the retroactive action, will haunt many of them for the foreseeable future.
Unlike the senior VA officials, these soldiers weren't accused of conspiring to game the system.
Rather, each signed a service contract and happily took the bonus that the military, under
pressure to make up enlistment shortfalls, was eagerly offering. Many consequently deployed
for multiple tours. What a way to thank them for their service.
Auditors later determined that the incentive program of the California Army National Guard
had been operated like a slush fund, with as much as $100 million misspent. The program's
onetime leader, former Master Sgt. Toni Jaffe, was sentenced in May 2012 to 30 months in
prison after pleading guilty to filing $15.2 million in false claims. Three other officers were put
on probation and forced to pay restitution.
Yet, for some reason, the Pentagon decided to claw back money from the veterans who had
received the bonuses. Congress, it turns out, knew about the situation-or at least the California
delegation did. When the story hit the press, then-Defense Secretary Ash Carter ordered a halt
to the bonus hunting. But the order focused mostly on reviewing and streamlining the process.
'This process has dragged on too long, for too many service members," Mr. Carter's statement
said. 'Too many cases have languished without action." Little was said about the underlying
injustice of the matter.
Process is certainly important. As Alexander Pope mused: "For Forms of Government let fools
contest; Whate'er is best administer'd is best." But Alexander Hamilton countered the point in
Federalist 68. 'The true test of a good government," he wrote, "is its aptitude and tendency to
produce a good administration."
The rules at the Defense Department and the VA must apply to senior officials and enlisted
soldiers alike. Without consistency, even the best process fails from the standpoint of justice.
VA-19-0799-D-000254
OS 00001916
Exhibit A: the VA, where employees are rewarded because they technically followed a process.
Exhibit B: the Pentagon, which cou]d not protect even itself with its own processes. Ifl\t1r.
Trump wants to do right by veterans and the mihtmy, he could begin by insisting on
consistency.
A1s. Burgess manages the Program on American Citizenship at the American Enterprise
institute.
Appeared in the Apr. 14, 2017, print edition as 'Trump's Promise to Veterans. 1
VA-19-0799-D-000255
OS 00001917
Message
From:
Sent:
To:
Subject:
(b) (6)
[(b) (6)
hotmail.com]
4/21/2017 10:29:44 PM
David [drshulkin@aol.com]
Fwd: The Alaigh's Celebration of Friendship
We cant go, should i rsvp
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
and Poonam Alaigh
Date: April 21, 2017 at 5:58: 19 PM EDT
To: David Shulkin <(b) (6)
hotmail.com>
Subject: The Alaigh's Celebration of Friendship
hotmail.com>
Reply-To: Evite <(b) (6)
~Vite™
You're Invited
The Alaigh's Celebration of Friendship
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VA-19-0799-D-000257
OS 00001919
Message
David shulkin [Drshulkin@aol.com]
From:
Sent:
4/18/2017 11:05:39 AM
To:
(b) (6)
CC:
(b) (6)
[(b) (6)
hotmail.com; (b) (6)
Re: [EXTERNAL] Hepatitis paper
Subject:
va.gov]
[(b)
(b)(6)(6)
va.gov]
Thank you
Sent from my iPhone
On Apr 18, 2017, at 1:06 AM, (b) (6)
(b) (6)
va.gov> wrote:
Hi Dr. Shulkin and Dr. Alaigh,
Please find attached the data on the number of veterans we have treated and our SVR (cure) rates
among those we have treated since the availability of the oral DAAs.
In the attached spreadsheet (HCV VA data sources.xis), please find three tabs:
Tab 1 shows the daily cumulative total of veterans starting on oral HCV DAAs. We started prescribing in
VA in Jan 2014, though they were FDA approved in Nov 2013. This summary graph is also posted and is
available at the first link listed below.
Number of veterans treated since DAA availability:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvantivirals/default.aspx
Tab 2 of the spreadsheet shows the number of veterans awaiting treatment at periodic intervals
beginning with FY14 ( DAAs introduced in VA in Q2 FY14). This is data captured from the HCV Clinical
Case Registry. Those in the paper reflect the end of March (Q2 FYl 7).
This data is also posted and is available at the link listed below:
Numbers awaiting treatment - this is updated quarterly.
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvantivirals/HCV%20Viremic/virem
ic-fib4.aspx
Tab 3 of the spreadsheet shows the raw data that relates to the "Cascade of HCV Care" (figure 3) with a
brief sentence about the methods used to calculate each "step". For more detailed methods, refer to
the attached Maier et al paper. We used the same methods for the current cascade as we did in
this previously published paper. Note that the cascade numbers represent all HCV patients in
care ever treated (even with earlier non-DAA regimens before 2014) which is why the SVR
percentages in the cascade graph are lower than what the SVR rates are with all oral DAA
regimens (shown in link below -which represent SVR rates of only oral DAA regimens from
2014 and beyond).
SVR (cure) rates with all oral DAA regimens are posted here and updated every two weeks:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvantivirals/HCV%20Antivirals%20
Tests/HCV Direct Acting Antivirals.aspx
From table at above link, SVR rate calculated as SVR12/(NoSVR+SVR12) = 94.98%; Published data on
SVR rates available in the attached article.
VA-19-0799-D-000258
OS 00001920
HCV testing rates are updated and posted quarterly, (those in the paper reflect the end of March, Q2
FY17):
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvbirthcohort/hcv cohorts fiscal
year/default.aspx
Please let me know if you have any additional questions about the data or would like to have copies of
any of the other references in the paper.
Best,
(b)
(6)
From: David Shulkin [ mailto:drshulkin@aol.com]
Sent: Sunday, April 16, 2017 9:59 AM
To: (b) (6)
(b) (6)
(b) (6)
Subject: [EXTERNAL] Hepatitis paper
hotmail.com
(b) and (b) (6) and Poonam- you did a spectacular job writing this up and its a remarkable story that
has occurred at VA.
(6)
I think this is exactly the type of manuscript that is needed so others can benefit from your experience and
also
that VA can be appropriately recognized for its' leadership in this area.
I surprisingly made very few edits or corrections in the paper which is a real tribute to you all.
Please take a look and make sure you agree with these few changes.
The one request I would make is to be an author on this paper I feel it is important that I review the data
that you used to put the statistics in the paper about how many veterans we treated and our success
rates.
Do you have any reports or data that you could share so Dr. Alaigh and I can review before we put our
names on the manuscript?
I don't know if Dr. Alaigh has had time yet to review.
The annals seems appropriate or if not a hepatology journal surely would be interested.
Thanks so much for your leadership here
David Shulkin MD
VA-19-0799-D-000259
OS 00001921
Message
From:
Sent:
To:
CC:
Subject:
Attachments:
(b) (6)
[(b) (6)
va.gov]
4/18/2017 5:06:43 AM
David Shulkin [drshulkin@aol.com]; (b) (6)
hotmail.com
[(b)
va.gov]
(b) (6)
(b)(6)(6)
RE: [EXTERNAL] Hepatitis paper
HCV VA data sources.xlsx; Maier_AJPH201512546R3_2nd_ProofCXs.pdf
Hi Dr. Shulkin and Dr. Alaigh,
Please find attached the data on the number of veterans we have treated and our SVR (cure) rates among those we have
treated since the availability of the oral DAAs.
In the attached spreadsheet (HCV VA data sources.xis), please find three tabs:
Tab 1 shows the daily cumulative total of veterans starting on oral HCV DAAs. We started prescribing in VA in Jan 2014,
though they were FDA approved in Nov 2013. This summary graph is also posted and is available at the first link listed
below.
Number of veterans treated since DAA availability:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvantivirals/default.aspx
Tab 2 of the spreadsheet shows the number of veterans awaiting treatment at periodic intervals beginning with FY14 (
DAAs introduced in VA in Q2 FY14). This is data captured from the HCV Clinical Case Registry. Those in the paper reflect
the end of March (Q2 FY17).
This data is also posted and is available at the link listed below:
Numbers awaiting treatment - this is updated quarterly.
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvantivirals/HCV%20Viremic/viremic-fib4.aspx
Tab 3 of the spreadsheet shows the raw data that relates to the "Cascade of HCV Care" (figure 3) with a brief sentence
about the methods used to calculate each "step". For more detailed methods, refer to the attached Maier et al
paper. We used the same methods for the current cascade as we did in this previously published paper. Note
that the cascade numbers represent all HCV patients in care ever treated (even with earlier non-DAA regimens
before 2014) which is why the SVR percentages in the cascade graph are lower than what the SVR rates are
with all oral DAA regimens (shown in link below -which represent SVR rates of only oral DAA regimens from
2014 and beyond).
SVR (cure) rates with all oral DAA regimens are posted here and updated every two weeks:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcvantivirals/HCV%20Antivirals%20Tests/HCV Direc
t Acting Antivirals.aspx
From table at above link, SVR rate calculated as SVR12/(NoSVR+SVR12) = 94.98%; Published data on SVR rates available
in the attached article.
HCV testing rates are updated and posted quarterly, (those in the paper reflect the end of March, Q2 FYl 7) :
https://vaww. vha. vaco.portal. va.gov /sites/PublicHealth/pophealth/hcvbirthcohort/hcv cohorts fiscal year/ default.asp
~
Please let me know if you have any additional questions about the data or would like to have copies of any of the other
references in the paper.
VA-19-0799-D-000260
OS 00001922
Best,
(b)
(6)
From: David Shulkin [mailto:drshulkin@aol.com]
Sent: Sunday, April 16, 2017 9:59 AM
(b) (6)
(b) (6)
To: (b) (6)
Subject: [EXTERNAL] Hepatitis paper
hotmail.com
(b) and (b) (6) and Poonam- you did a spectacular job writing this up and its a remarkable story that has occurred at
VA.
(6)
I think this is exactly the type of manuscript that is needed so others can benefit from your experience and also
that VA can be appropriately recognized for its' leadership in this area.
I surprisingly made very few edits or corrections in the paper which is a real tribute to you all.
Please take a look and make sure you agree with these few changes.
The one request I would make is to be an author on this paper I feel it is important that I review the data
that you used to put the statistics in the paper about how many veterans we treated and our success rates.
Do you have any reports or data that you could share so Dr. Alaigh and I can review before we put our names on the
manuscript?
I don't know if Dr. Alaigh has had time yet to review.
The annals seems appropriate or if not a hepatology journal surely would be interested.
Thanks so much for your leadership here
David Shulkin MD
VA-19-0799-D-000261
OS 00001923
RESEARCH AND PRACTICE
Cascade of Care for Hepatitis CVirus Infection
Within the US Veterans Health Administration
I Marissa M. Maier, MD, David B. Ross, MD, PhD, MBI, Maggie Chartier, PsyD, MPH, Pamela S. Belperio, PharmD, and Lisa
Hepatitis C virus infection is the most common
blood-borne infection in the United States.
An estimated 2.7 to 3.9 million Americans
are chronically infected, representing 1.0% to
1.5% of the US population.1·2 The Veterans
Health Administration (VHA) is the single
largest provider of HCV care in the United
States. The burden of chronic HCV is known to
be higher among patients seen in the VHA than
among the general population. 3
Prior to 2014, HCV antiviral therapies required long treatment durations, had numerous treatment-limiting side effects, and resulted
in sustained virologic response (SVR) or cure
rates of approximately 500/o overall; cure rates
were even lower among those with genotype 1
infection, 4 ·5 the most common genotype in the
United States. New direct-acting antiviral
agents require shorter durations of therapy,
have favorable side effect profiles, and yield
cure rates of greater than 900/o in clinical trials,
even among genotype 1-infected patients. 6 ·7
Curing chronic HCV is associated with reduced
all-cause mortality. 8 - 10
With widespread use of more efficacious
treatment regimens, it is helpful to use a population health approach to assess a health care
system's ability to identify individuals with
chronic HCV, link them to care, provide antiviral treatment, and achieve clinical cure.
Doing so allows for identification of gaps in
care and of foci for improvement. Yehia et al.
proposed a 7-step cascade of care methodology
that estimated that among individuals in the
United States with chronic HCV, 160/o had
received antiviral therapy and 90/o had
achieved SVR.11
The cascade proposed by Yehia et al. may be
limited in its applicability to large health care
systems. For example, insurance status was
used as a marker of access to outpatient care,
which may not be applicable for a health care
system trying to assess performance across
the Cascade of Care among enrolled patients
who, by definition, have health insurance. In
Published online ahead of print November 12, 2015
I. Backus, MD, PhD
Objectives. We measured the quality of HCV care using a cascade of HCV care
model.
Methods. We estimated the number of patients diagnosed with chronic HCV,
linked to HCV care, treated with HCV antivirals, and having achieved a sustained
virologic response (SVR) in the electronic medical record data from the Veterans
Health Administration's Corporate Data Warehouse and the HCV Clinical Case
Registry in 2013.
Results. Of the estimated 233898 patients with chroni c HCV, 77% (181168)
were diagnosed , 69% (160794) were linked to HCV care, 17% (39388) were
treated with HCV antivirals, and 7% (15983) had achieved SVR .
Conclusions. This Cascade of HCV Care provides a clinically relevant model to
measure the quality of HCV care within a health care system and to compare HCV
care across health systems. (Am J Public Health . Published on line ahead of print
November 12, 2015: e1-e6 . doi :10.2105/AJPH .2015.302927)
addition, liver biopsy was included in their
model, which in many cases may no longer
be indicated. Finally, because their model
concentrated on the entire US population,
national seroprevalence surveys and patient
self-reported survey data were used, which is
not routinely available in a health care system.
We sought to create a cascade ofHCV
care that captured the current state of HCV
care using steps applicable to a large health care
system and that could be calculated with data
generally available from an electronic medical
record. We included an assessment oflinkage to
HCV-specific care because it is a more stringent
measure than access to insurance or general
medical care. We did not include patient
awareness of infection, access to care, or liver
biopsy as steps in our cascade. We developed
and applied our cascade of HCV care in the
VHA health care system.
METHODS
To create our cascade of HCV care, we
determined the following:
1. number of patients with chronic HCV,
2. number of patients diagnosed with
chronic HCV,
3. number of patients linked to HCV care,
I
American Journal of Public Health
4. number of patients treated with HCV
antivirals, and
5. number of patients with an SVR.
For the first 2 steps, we used the VHA's
Corporate Data Warehouse, a national database that captures birth dates, gender, race,
ethnicity, health care encounters, and laboratory tests from October 1, 1999, onward for
patients who received VHA care. The analysis
included all patients in VHA care in 2013,
where "in care" was defined as having at least 1
VHA outpatient visit (including telehealth) in
2013. We required only 1 outpatient visit in
2013 to capture as broad a population as
possible while still ensuring that the patients
were using VHA health care to some extent.
We identified all HCV antibody, viral load, and
genotype tests that had been obtained between
October 1, 1999, and December 31, 2013,
for patients in care in 2013. We considered
individual test results "informative" if the result
could be categorized as negative or positive
for antibody tests, detectable or undetectable
for viral load tests, and detectable for genotype
tests if a recognized HCV genotype was reported. For each patient in care in 2013, we
detemiined if the patient ever had positive or
negative antibody tests, and detectable or undetectable HCV RNA testing from all identified
Maier et al.
I Peer
Reviewed
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VA-19-0799-D-000262
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RESEARCH AND PRACTICE
tests. We considered patients with a positive
enzyme immunoassay HCV antibody test
result who had a subsequent negative recombinant immunoblot assay test result to have
negative antibody testing. For this analysis, we
accessed Corporate Data Warehouse data on
January 15, 2014.
Number of Patients With Chronic HCV
The estimated total number of patients
with chronic HCV in the population receiving
VHA health care in 2013 is the sum of 3
subgroups: (1) those already identified with
chronic HCV, (2) estimated additional cases
from the projected prevalence among HCV
antibody-positive patients who had not received RNA testing, and (3) estimated additional cases from the projected prevalence
among the untested population.
Patients already identified with chronic HCV
Patients were considered to have chronic HCV
if they ever had positive RNA-based testing
(a detectable viral load or genotype).
Estimated additional cases from the projected
prevalence among HCV antibody-positive
patients who had not received RNA testing. We
applied the observed prevalence of chronic
HCV among HCV antibody-positive patients
who had received RNA testing to the population that was HCV antibody positive but had
not received RNA testing to estimate the
prevalence of HCV in the latter population.
Estimated additional cases from the projected
prevalence among the untested population. To
project the prevalence of HCV among untested
individuals (i.e., individuals without any HCV
antibody, viral load, or genotype tests), we first
determined chronic HCV incident diagnosis
rates per year of testing for those in care in
2013 (i.e., the number of people with their first
detectable HCV RNA test result in the year
divided by the total number of people with
informative HCV testing in the year). Since
chronic HCV prevalence is known to vary by
gender, race/ethnicity, and birth cohort (born
before 1945, born 1945-1965, and born
after 1965),12 .1 3 we determined incident diagnosis rates separately among these demographic subgroups.
In addition, since incident diagnosis rates
in the VHA are decreasing over time as more
people undergo HCV testing, we approximated the estimated prevalence rate for the
e2
I
Research and Practice
I
Peer Reviewed
I
also extracts information from the VHA
electronic medical record, which includes
laboratory results, pharmacy information,
and ICD-9 diagnosis codes from inpatient
hospitalizations, outpatient visits, and problem lists of HCV-infected patients seen at all
VHA medical facilities. HCV Clinical Case
Registry data for this analysis was available
through December 31, 2013.
We considered a patient with an outpatient
visit in 2013 to be linked to HCV care if the
patient was entered into the HCV Clinical Case
Registry and had HCV entered on his or her
problem list in the electronic medical record.
untested population as the incident diagnosis
rate in 2013 multiplied by the ratio of the
2013:2012 rates. 12 For those subgroups for
which the incident diagnosis rate in 2013 was
actually higher than the rate in 2012, we used
the 2013 rate as the estimated prevalence
rate for the untested population. We calculated estimates of the projected prevalence of
chronic HCV in the untested population by
applying the projected prevalence rate to
the people in the untested population. For
example, among non-Hispanic White men
born from 1945 to 1965 who were in care in
2013, 72 723 had their first informative HCV
testing in 2012, of whom 3686 had detectable HCV RNA, for an incident diagnosis rate
of 5.07; 77 083 had their first informative
HCV testing in 2013, of whom 3304 had
detectable HCV RNA, for an incident
diagnosis rate of 4.29. Thus, the projected
prevalence rate among those untested in
this demographic cohort is the ratio of the
2013:2012 rates multiplied by the rate in
2013 ([4.29/5.07] x 4.29=3.62). Applying
the projected prevalence rate of 3.62 to the
567 756 non-Hispanic White men born
between 1945 and 1965 in care in 2013
and untested for HCV yields 20 553 additional cases of chronic HCV that would be
found with complete testing of this demographic cohort.
Number of Patients Treated With HCV
Antivirals
Among patients in the HCV Clinical Case
Registry linked to HCV care in 2013, we
determined the number who had ever received
HCV antiviral medications, including boceprevir, consensus interferon, interferon, pegylated
interferon, ribavirin, and telaprevir, from the
VHA at any time up to and including December
31, 2013.
Number of Patients With an SVR
We evaluated SVR rates using all HCV RNA
results available after the end of treatment for
those patients linked to HCV care in 2013 who
had a calculated end of treatment included in
the available data. We calculated the end of
treatment as the last day covered by any HCV
antiviral medication, using the cumulative
number of days of medication supplied and the
dispensed dates. We considered that patients
with an undetectable HCV RNA on all tests
after the end of treatment, including at least 1
test 12 weeks or more after the end of
treatment, had achieved SVR; patients with
a detectable HCV RNA after the end of treatment were considered not to have SVR. SVR
status could not be definitively determined for
patients who were still on treatment at the end
of the available date, who had not had HCV
RNA testing after the end of treatment, or who
had an undetectable HCV RNA result after the
end of treatment but no test 12 weeks or more
after that date. We then applied the SVR rate
among those evaluable for SVR to all those
who had started HCV antiviral treatment to
determine the number of patients in care in
2013 who would be expected to achieve SVR.
Number of Patients Diagnosed With
Chronic HCV
The number of patients in care in 2013
diagnosed with chronic HCV included those
patients who had ever had a detectable viral
load or genotype.
Number of Patients Linked to HCV Care
The VHA maintains a registry of HCV
patients known as the HCV Clinical Case
Registry, which was originally designed in part
to ensure that patients with chronic HCV were
linked to HCV care. 14 The registry software
identifies patients as potentially having HCV on
the basis of International Classification of Diseases, Ninth Revision (ICD-9) 15 codes or laboratory results and adds such patients to the list
of "pending" patients. HCV Clinical Case Registry coordinators at each facility review the
lists of pending patients to confirm the diagnosis of HCV. The HCV Clinical Case Registry
Maier et al.
American Journal of Public Health
I
Published online ahead of print November 12, 2015
VA-19-0799-D-000263
OS 00001926
RESEARCH AND PRACTICE
an additional 20 124 patients with chronic
HCV from RNA testing without preceding
antibody testing. Overall, we identified
181 168 individuals who had an outpatient
visit in 2013 as ever having chronic HCV, for
a prevalence of 5.8% among those with informative testing.
Estimated additional cases from the projected
prevalence among HCV antibody-positive
patients who had not received RNA testing.
Among those with positive antibody results,
9218 patients did not have RNA-based testing.
Applying the observed prevalence among HCV
antibody-positive individuals who did have
RNA-based testing (77.1%) to the 9218 who
did not have RNA-based testing, we estimated
that an additional 7107 individuals would be
identified with chronic HCV by RNA-based
testing of these individuals.
Estimated additional cases from the projected
prevalence among the untested population. Of the
patients in VHA care in 2013, 2 460 782 had
not been tested for HCV (excluding the 552
RESULTS
Results for the 5 steps of our cascade of
HCV care appear in Figure 1. Comparisons
to national estimates for these same 5 steps
appear in Figure 2.
Number of Patients With Chronic HCV
Overall, 5 596 178 patients had a VHA
outpatient visit in 2013 and 3 135 396
(56.0%) had ever had any HCV testing (HCV
antibody, viral load, or genotype) in the VHA;
3 11 7 014 (9 9.4% of those with any testing)
had HCV antibody testing, 502 378 (16.0%)
had viral load testing, and 191 552 (6.1 %) had
genotype testing.
Patients already identified with chronic HCV
Of 218 111 patients with positive antibody
tests, 208 893 (95.8%) had RNA-based testing
for chronic HCV. Of those with positive antibody tests who received RNA-based testing,
161 044 (77.1 %) had positive RNA test results
and therefore had chronic HCV. We identified
250000
233898
(100%)
200000
...,
V,
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Cl)
.::;
Number of Patients Linked to HCV Care
In 2013, 172 857 patients in the HCV Clinical
Case Registry had at least 1 outpatient visit in the
year. Of these, 160 794 had HCV entered on
their problem list By this definition, 88.8% of all
patients in VHA care in 2013 with diagnosed
chronic HCV had been linked to HCV care.
Number of Patients Treated With HCV
Antivirals
Of the 160 794 patients linked to HCV care,
39 388 (24.5%) had ever received VHA HCV
antiviral therapy as of December 31, 2013.
CL
......
d
Number of Patients Diagnosed With
Chronic HCV
As noted in the previous paragraph,
181 168 (79.9%) of an estimated 233 898
patients in VHA care in 2013 with chronic
HCV had been diagnosed with chronic HCV.
1 50000
(\J
0
patients without gender [n = 26] or birth-date
information [n = 526]). If the projected prevalence rates in each demographic cohort were
applied, an estimated additional 45 623 patients
with chronic HCV would be identified among
the untested population in VHA care (Table 1).
The estimated total number of patients with
chronic HCV (n=233 898) thus reflects the
sum of (1) those already identified with chronic
HCV (n= 181168), (2) estimated additional
cases among those known to have positive
HCV antibody without RNA testing (n = 7107),
and (3) estimated additional cases among
untested patients (n=45 623).
100000
z
50000
0
Chronic HCV Diagnosed with
(estimated)'
chronic HCVb
Linked to
HCV care'
Treated with Achieved SVR'
HCV antiviralsa
Cascade Steps
Note. SVR = sustained virologic response. The proportion of patients in each step of the cascade from the patients in the
preceding step is presented in the arrows between each bar.
'Chronic HCV was estimated from the sum of those already identified with chronic HCV plus estimated additional cases from
projected prevalence among HCV antibody-positive patients who had not had RNA testing plus estimated additional cases
from projected prevalence among the untested population.
b"Diagnosed with chronic HCV" was defined as ever had a detectable HCV RNA or genotype.
c"Linked to HCV care" required an outpatient visit in 2013, entry in the VHA's HCV registry, and HCVentered on the patient's
medical record problem list.
d"Treated with HCV antivirals" was defined as ever received HCV antivirals from the VHA as of December 31, 2013.
'"Achieved SVR" was defined as undetectable HCV RNA on all tests after end of treatment, including at least 1 test at least 12
weeks after the end of treatment, with the SVR rate among those evaluable for SVR applied to those without definitive SVR
status.
FIGURE 1-Cascade of HCV care in the Veterans Health Administration (VHA) in 2013
(n = 233 898).
Published online ahead of print November 12, 2015
I
American Journal of Public Health
Number of Patients With an SVR
Of the 39 388 patients in care in 2013 who
had ever received HCV antivirals from the
VHA, SVR status could be determined for
37 069, of whom 15 041 (40.6%) achieved
SVR. Conservatively, applying this SVR rate to
the 2319 who did not have definitive SVR
status and adding it to those known to have
SVR, the projected number with SVR among
those in care in 2013 who had received HCV
antivirals was 15 983, or 6.8% of the entire
population projected to have chronic HCV.
DISCUSSION
The high prevalence of chronic HCV, the
rapidly changing treatment climate, and the
Maier et al.
I Peer
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Research and Practice
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VA-19-0799-D-000264
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RESEARCH AND PRACTICE
measure of "linked to care" is difficult to define;
we believe our definition is most appropriate
given the availability of the Clinical Case
Registry as a resource, as well as the relative
ease of using electronic medical records to
extract problem list entries.
This cascade illuminates important opportunities to improve care within a health care
system. Within the VHA, as of the end of 2013
before the availability of interferon-free regimens, only 1 7% of patients with chronic HCV
(24% of those linked to HCV care) had received antiviral treatment. This figure is similar
to that of Yehia et al., who estimated that 160/o
of HCV-infected individuals have received
treatment in the United States.11 The model
also documents the historically low SVR rates
from prior interferon-based HCV antiviral
regimens. In the VHA, approximately 410/o of
the patients who had ever been treated with
HCV antivirals through Dec 31, 2013-and
7% of all patients with chronic HCV-achieved
SVR, comparable to the estimated national
SVR rates of 9%.11 Although all steps of the
cascade require attention, within the VHA
health care system increasing treatment initiation will have the largest impact on increasing
cure rates. Both the treatment rates and SVR
rates have already improved markedly with
the availability of shorter-duration, highly
efficacious treatment regimens.
This cascade provides a health care system
with a method to assess and monitor over time
the quality of its HCV care and to identify
performance metrics that require improvement. The information this model generates is
useful across a broad range of reporting units,
so that a large health care system may identify
variation between regions or facilities and
appropriate targets for performance improvement interventions. The cascade uses data
that are typically available within a health
care system's electronic medical record,
thereby encouraging health care systems to use
this model to monitor their own HCV care
and enabling them to compare the quality of
their HCV care with that of other systems.
Additionally, since it mirrors the flow of clinical
care from diagnosis to cure, it provides relevant
information to clinicians and administrators:
How many patients do we have with chronic
hepatitis C? How many have been treated?
How many have been cured?
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I-
0
Diagnosed with
chronic HCV'
Linked to
HCV careb
Treated with HCV
antivirals'
Achieved SVRa
Cascade Steps
Note. SVR = sustained virologic response. Total estimated chronic HCV population in the VHA in 2013 was 233 898.
Source. National US estimates were derived from the following sources: diagnosed with chronic HCV, 16 linked to HCV care, 17
treated with HCV antivirals and achieved SVR. 11 VHA estimates were derived from the VHA Corporate Data Warehouse and the
HCV Clinical Case Registry.
'"Diagnosed with chronic HCV" was defined as ever had a detectable HCV RNA or genotype.
b"Linked to HCV care" required an outpatient visit in 2013, entry in the VHA's HCV registry, and HCV entered on the patient's
medical record problem list.
c"Treated with HCV antivirals" was defined as ever received HCV antivirals from the VHA as of December 31, 2013.
d"Achieved SVR" was defined as undetectable HCV RNA on all tests after end of treatment, including at least 1 test at least 12
weeks after the end of treatment, with the SVR rate among those evaluable for SVR applied to those without definitive SVR
status.
*P < .001.
FIGURE 2-Cascade of HCV care within the Veterans Health Administration (VHA) and
relative to national US estimates in 2013.
high cost of antiviral therapies all warrant the
use of a population health approach to HCV
care. Our cascade of HCV care demonstrates
that the VHA performs very well in the initial
steps of the cascade and outperforms national
US estimates (Figure 2). For example, the VHA
has diagnosed an estimated 77.5% of its
patients in care with chronic HCV. This compares with national US estimates from the
Chronic Hepatitis Cohort Study that suggest
that only 5 7% of those with chronic HCV have
been diagnosed. 16 The VHA also performs well
in linking patients to HCV care: 690/o of
patients with chronic HCV (89% of those with
diagnosed chronic HCV) have been linked to
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HCV care. National US estimates indicate that
only 380/o of patients with chronic HCV (77%
of those with diagnosed chronic HCV) have
been linked to HCV care, when linkage to care
is defined as self-reporting a visit with a health
care provider after receiving a positive HCV
test.17 We posit that the decrement between
being diagnosed with chronic HCV and being
linked to HCV care is smaller within the VHA
(a decrement from 77% to 690/o within VHA,
vs 570/o to 380/o within the United States;
Figure 2), in part because of higher HCV
diagnosis rates within VHA, as well as differences in definitions of "linked to care." A
clinically meaningful, readily accessible
Maier et al.
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TABLE 1-Projected Prevalence of HCV in 2013 Among Veterans Health Administration Patients Who Were Previously Untested, by
Sociodemographic Characteristics: United States
Born Between 1945-1965
Born Before 1945
Characteristic
Projected
Prevalence,' %
No.
Estimated No.
of Cases
No.
Projected
Prevalence,' %
Born After 1965
Estimated No.
of Cases
No.
Projected
Prevalence,' %
Estimated No.
of Cases
Women
American Indian/Alaska Native
122
0.00
0
618
0.84
5
819
0.00
Asian
99
0.00
0
505
0.90
5
1447
0.00
0
0
Black
1184
0.00
0
16 940
1.18
200
19 323
0.13
25
White
15190
0.05
8
34294
1.04
357
33 605
0.54
181
Hispanic
390
0.00
0
2103
0.64
13
6136
0.13
8
Native Hawaiian/Pacific Islander
148
0.00
0
443
0.50
2
687
0.00
0
2 675
1.52
41
8 514
1.92
163
10 896
0.22
24
Mixed, other, or unknown
Subtotal
49
745
238
Men
American Indian/Alaska Native
4 497
1.71
77
6 379
5.87
374
3185
0.26
Asian
6157
0.58
36
6 734
0.72
48
5 728
0.11
6
Black
66442
1.86
1236
122 370
6.85
8382
53 566
0.27
145
White
820 785
0.45
3694
567 756
3.62
20553
198 289
0.80
1586
29245
1.57
459
35 512
4.84
1 719
28 687
0.41
118
6445
0.67
43
5529
1.70
94
2 811
0.23
6
169155
0.86
1455
113 287
3.90
4 418
51533
0.26
134
Hispanic
Native Hawaiian/Pacific Islander
Mixed, other, or unknown
Subtotal
7 000
35588
8
2 003
Note. The total estimated number of HCV cases among those untested was 45 623.
'Projected prevalence is based on the incident diagnosis rate in those first tested in 2013 multiplied by the ratio of the 2013:2012 incident diagnosis rates.
Although our model offers many benefits,
there are limitations to this approach. Even
after incorporating the decline in incident diagnosis rates from 2012 to 2013 and the
variability by gender, race/ethnicity, and birth
cohort, the projected prevalence rates for the
untested likely still overestimate the number of
additional cases that would be identified with
complete population testing, particularly in the
birth cohorts born before 1945 and after
1965. For these 2 cohorts, risk-based screening is recommended.18 Thus, the observed
incident diagnosis rates are likely higher for
these patients who have been identified as at
risk and tested compared with the rate that
would be observed among those who are
untested and theoretically not at risk. Even
with this overestimation, however, only 9290
(20.4%) of the estimated 45 623 additional
cases that would be found with testing the
untested occur among those born outside the
1945 to 1965 birth cohort. Although changes
in the estimates of the undiagnosed would
change the absolute percentages, the
Published online ahead of print November 12, 2015
percentage changes from preceding steps along
the cascade would not change. The percentages
of each preceding step provide useful information for identifying gaps in care-for example,
regardless of the estimate of the undiagnosed,
only 240/o of those linked to HCV care have
received antivirals.
Another limitation is that our definition of
"linked to care" relies partly on the entry of
patients with chronic HCV into the HCV
Clinical Case Registry, a VHA registry of individuals with chronic HCV that is not available in other health care systems. However,
other health care systems may have similar
ways of tracking HCV among their patient
populations. Finally, the SVR estimates provided here reflect a static number that relies
heavily on patients who received therapy
during a period of less efficacious interferonbased treatments. Although SVR rates are
increasing with the rapid uptake of more
efficacious regimens, there will be a delay in
observing the impact of this increased effectiveness at the population level. Moreover, our
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American Journal of Public Health
SVR estimates would not capture patients who
received HCV antiviral therapy and achieved
SVR outside the Department of Veterans Affairs health care system.
Our cascade of HCV care offers health care
systems the ability to readily measure and
monitor performance during a period of rapid
change in the field of HCV treatment and care.
The dramatic improvements in HCV treatment
effectiveness pose parallel challenges to public
and private health care systems grappling with
high treatment costs and inadequate numbers
of trained providers to meet the demand for
HCV care. This cascade is a useful tool for
systems aimed at maximizing provider and
fiscal resources to improve the overall quality
of HCV care. ■
About the Authors
Marissa M Maie:r is with the VA Portland Health Care
System, Veterans Health Administration (VHA), Portland,
OR, and the Office of Public Health/HIV, Hepatitis, and
Public Health Pathogens Programs, VHA, Washington, DC.
David B. Ross is with the VA Washington DC Health Care
System, and the Office ofPublic Health/HIV, Hepatitis, and
Maier et al.
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RESEARCH AND PRACTICE
Public Health Pathogens Programs, VHA, Washington, DC.
Maggie Chartier is with the VA San Francisco Health Care
System, VHA, San Francisco, CA, and the Office of Public
Health/HIV, Hepatitis, and Public Health Pathogens Programs, VHA, Washington, DC. Pamela S. Belperio is with
the VA Greater Los Angeles Health Care System, VHA, Los
Angeles, CA, and the Office of Public Health/Population
Health, VHA, Washington, DC. Lisa I. Backus is with the
VA Palo Alto Health Care System, VHA, Palo Alto, CA,
and the Office of Public Health/Population Health, VHA,
Washington, DC.
Correspondence should be sent to Marissa M Maier, MD,
VA Portland Health Care System, 3710 SW US Veterans
Hospital Rd, Mail Code P3ID, Portland, OR 97239
(e-mail: Marissa.Maier@va.gov). Reprints can be ordered at
http://www.ajph.org by clicking the "Reprints" link.
This article was accepted September 28, 2015.
Contributors
MM. Maier and M. Chartier contributed to data analysis.
P. S. Belperio and L. I. Backus were instrumental to data
production and analysis. All of the authors contributed
to the study design and the preparation and revision of
the article.
Acknowledgments
We are indebted to Timothy Loomis, PhD, who compiled
the HCV screening data from the Computerized Data
Warehouse and who is instrumental in maintaining the
Clinical Case Registry.
Human Participant Protection
Under guidance from the VHA Office of Research
Oversight, the Office of Public Health has the authority to
perform the analyses presented here as part of their
health care operations work, which does not require
institutional review board approval.
References
1. Denniston MM, Jiles RB, Drobeniuc J, et al. Chronic
hepatitis C virus infection in the United States, National
Health and Nutrition Examination Survey 2003-2010.
Ann Intern Med. 2014;160(5):293-300.
2. Armstrong GL, Wasley A, Simard EP, McQuillan
GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C
virus infection in the United States, 1992 through 2002.
Ann Intern Med. 2006;144(10):705-714.
8. Dieperink E, Pocha C, Thuras P, Knott A, Colton S,
Ho SB. All-cause mortality and liver-related outcomes
following successful antiviral treatment for chronic hepatitis C. Dig Dis Sci. 2014;59(4):872-880.
9. Backus LI, Boothroyd DB, Phillips BR, Belperio P,
Halloran J, Mole LA A sustained virologic response
reduces risk of all-cause mortality in patients with
hepatitis C. Clin Gastroenterol Hepatol. 2011 ;9(6):509.
el-516.el.
10. Morgan TR, Ghany MG, Kirn H, Snow KK, Shiflinan
ML, De Santo JL. Outcome of sustained virological
responders with histologically advanced hepatitis C.
Hepatology. 2010;52(3):833-844.
11. Yehia BR, Schranz AJ, Umscheid CA, Lo RV. The
treatment cascade for chronic hepatitis C virus infection
in the United States: a systematic review and meta-analysis.
PLoS One. 2014;9(7):e101554.
12. Backus LI, Belperio PS, Loomis TP, Mole LA Impact
of race/ethnicity and gender on HCV screening and
prevalence among US veterans in Department of Veterans
Affairs care. Am] Public Health. 2014;104(suppl 4):
S555-S561.
13. Smith BO, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C
virus infection among persons born 1945-1965.
MMWR Recomm Rep. 2012;61(RR-4):l-32.
14. Backus LI, Gavrilov S, Loomis TP, et al. Clinical case
registries: simultaneous local and national disease registries for population quality management. J Am Med
Inform Assoc. 2009; 16(6):775-783.
15. International Classification of Diseases, Ninth Revision. Geneva, Switzerland: World Health Organization;
1980.
16. Spradling PR, Rupp L, Moorman AC, et al. Hepatitis
B and C virus infection among 1.2 million persons with
access to care: factors associated with testing and infection
prevalence. Clin Infect Dis. 2012;55(8):1047-1055.
1 7. Holmberg SD, Spradling PR, Moorman AC,
Denniston MM. Hepatitis C in the United States. N Engl]
Med 2013;368(20):1859-1861.
18. Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C
virus (HCV) infection and HCV-related chronic disease.
MMWR Recomm Rep. 1998;47(RR-19):l-39.
3. Backus LI, Belperio PS, Loomis TP, Yip GH, Mole
LA Hepatitis C virus screening and prevalence among US
veterans in Department of Veterans Affairs care. JAMA
Intern Med 2013;173(16):1549-1552.
4. Fried MW, Shiffman ML, Reddy KR, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus
infection. N Engl] Med. 2002;347(13):975-982.
5. Manns MP, McHutchinson JG, Gordon SC, et al.
Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of
chronic hepatitis C: a randomised trial. Lancet 2001;
358(9286):958-965.
6. Afdhal N, Reddy KR, Nelson DR, et al. Ledipasvir
and sofosbuvir for previously treated HCV genotype 1
infection. N Engl] Med. 2014;370(16):1483-1493.
7. Afdhal N, Zuezem S, Kwo P, et al. Ledipasvir and
sofosbuvir for untreated HCV genotype 1 infection.
N Engl] Med. 2014;370(20):1889-1898.
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Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
To:
(b) (6)
Subject:
Attachments:
4/16/2017 4:59:22 PM
va.gov; (b)
(b)(6)(6)
va.gov; (b) (6)
hotmail.com
Hepatitis paper
hepatitsC.docx
(b) and (b) (6) and Poonam- you did a spectacular job writing this up and its a remarkable story that has occurred at
VA.
(6)
I think this is exactly the type of manuscript that is needed so others can benefit from your experience and also
that VA can be appropriately recognized for its' leadership in this area.
I surprisingly made very few edits or corrections in the paper which is a real tribute to you all.
Please take a look and make sure you agree with these few changes.
The one request I would make is to be an author on this paper I feel it is important that I review the data
that you used to put the statistics in the paper about how many veterans we treated and our success rates.
Do you have any reports or data that you could share so Dr. Alaigh and I can review before we put our names on the
manuscript?
I don't know if Dr. Alaigh has had time yet to review.
The annals seems appropriate or if not a hepatology journal surely would be interested.
Thanks so much for your leadership here
David Shulkin MD
VA-19-0799-D-000268
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Curing Hepatitis C Infection: Best Practices from the Department of Veterans Affairs
David J. ghHlkin MD+, Poonam L. Alaigh, MD~,~Maggie Chartier PsyD MPH~, Pamela S. Belperio
PharmD Poonam Alaigh, MD, David Shulkin MD4
Office of Specialty Care Services, Department of Veterans Affairs, Washington DC
4
Population Health Services, Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto,
CA
Office of the Under Secretary for Health, Department of Veterans Affairs, Washington DC
1
Office of the Secretary, Department of Veterans Affairs, Washington DC
~
Offise of the Under gosretary for Health, Department of Veterans Affairs, Washington DC
~
Offise of gposialty Care gervises, Department of Veterans Affairs, Washington DC
4
PopHlation Health gervisos, Department of Veterans Affairs, Palo Alto Health Care gystem, Palo Alto,
CA
Keywords: Veteran, access, direct acting antiviral, cascade
Corresponding Author:
Pamela S. Belperio, Pharm D, Patient Care Services/Population Health Services, Veterans Affairs Palo
Alto Health Care System, 3801 Miranda Avenue (132), Palo Alto, CA 94304
1
VA-19-0799-D-000269
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Phone: 310-478-37 llx44 711, Fax: 650-849-0266, Email: Pamela.Belperio@va.gov
Word count: 2729
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Introduction
Since the introduction of Direct Acting Antivirals (DAAs) in 2014, the Department of Veterans Affairs
(VA) has made substantial progress in curing the large number of veterans in VA care with hepatitis C
virus (HCV) infection. As the nation's single largest provider of care to patients with HCV, VA is
uniquely suited to inform the recently released National Strategy for the Elimination of Viral Hepatitis,
produced by a National Academies of Sciences, Engineering, and Medicine expert committee, which
emphasizes prevention, screening, and universal treatment ofHCV-- areas in which VHA has become a
recognized leader. 1.2 The proposed national strategy presents specific actions to reduce the burden of
HCV and outlines 5 distinct areas-Information, Interventions, Service delivery, Financing, and
Research. 1.2 Merein-,-VA's best practices and successes may be useful to other healthcare providers and
organizations in helping to reduce the burden of hepatitis C infection. in eaeh of these areas are
highlighted.
Based on US National Health and Nutrition Examination Survey (NHANES) data from 2010, it was
estimated that approximately 13% of all patients diagnosed with HCV in the United States (US) receive
care within the VA, highlighting the disproportionate burden among veterans. 3 •4 In 2013, before the
availability ofHCV DAAs, there were approximately 168,000 veterans diagnosed with HCV infection in
VA care who were potentially eligible for treatment and an additional estimated 45,000 undiagnosed in
care. 5
With support from the US House and Senate Appropriations Committees, VA has made a substantial
commitment to prioritizing HCV care as reflected in dedicated funding for HCV treatment in VA,
universal access to DAAs, detailed guidance on individualizing care and the establishment of Veterans
3
VA-19-0799-D-000271
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Integrated Service Network (VISN) Hepatitis C Innovation Teams (HITs). 6 This work, in collaboration
with other key VA offices, is largely supported by the VA's National Viral Hepatitis Program which also
develops policy, tools, trainings, and resources for patients and providers, easily accessible through
internal channels and on its comprehensive website. 7 VA' s success and best practices, informed by
extensive population health data analysis capabilities, and national teel-s;--guidance and policieG, is
the dedicated providers a!!d teams
011
ooe to
the grmmd.
The significant resources and efforts VA and its HCV providers have dedicated to prioritizing this disease
at every level of the organization are being tangibly realized. Between January 2014 and March 2017,
86,000 BCV-infected veterans enrolled in VA care have received potent oral DAA treatment, achieving
cure rates of over 90%. As of March 2017, only 58,000 known veterans in VA care remain to be treated,
compared to over 168,000 three years ago. While elimination appears attainable, VA recognizes the
reality of the HCV epidemic and population; namely, many of those in care remaining to be treated have
complex substance use, mental health, and medical co-morbidities, and many are challenged by
homelessness, transportation, and rurality which pose significant barriers to engagement in care and
treatment. The curve of elimination for HCV in VA will include a long tail of persistence driven by
system, patient and care delivery determinants (Figure !).
Information: Population Health Management
Using relmst-national databases and analytics, VA employs population health management strategies to
efficie11tly track, measure, monitor and identify trends in HCV care, gaining insight into patterns of access
and tailoring care provision programs accordingly. Every-Veteran§. in VA care diagnosed with HCV is
followed in VA's National Hepatitis C Clinical Case Registry (CCR), developed in part to ensure
veterans with chronic HCV were linked to care .8 The HCV CCR, used for both local and national
4
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population reporting, provides data on the number of patients known to be infected with HCV together
with critical clinical information such as patient and disease characteristics, where care is received, receipt
of DAA treatment and clinical outcomes. The VA' s Central Data Warehouse, a repository of electronic
medical record data, has spurred the creation oflocal and regional HCV dashboards which offer providers
access to patient-specific data reports for real-time intervention and tracking. These sources allow for
comprehensive monitoring of incidence, prevalence, and disease course to identify and address barriers
and assess outcomes. National, regional and individual facility level data is posted regularly, allowing
providers, teams, and leadership to assess progress and goals. This leveraging of health systems data
transforms numbers into knowledge and guides providers and the VA toward more informed and effective
delivery of care for each veteran.
Essential Interventions
Diagnosis and Testing
Improved case identification: A critical first step for improving HCV care is to identify those infected. In
2012, the Centers for Disease Control and Prevention (CDC) and subsequently the United States
Preventive Services Task Force (USPSTF) developed recommendations for testing evoryolleveterans born
between 1945-1965, a cohort determined to have the highest HCV prevalence _9- 10 Prior to 2014, VA had
guidance in place which recommended risk-based testing as well as testing of Vietnam-era veterans, a
group which largely overlaps with the 1945-1965 birth cohort. 3 Using robust information systems to track
screening, VA has been able to identify and target additional populations at risk for HCV, which include:
African American males, for which the prevalence is double that of Caucasians (17. 7% versus 8.3%); the
homeless, for which the prevalence is over three times higher when compared to non-homeless (13.4%
versus 3.5%); and persons who inject drugs.11· 12
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Since the rapid adoption of these expanded screening recommendations, VA has sueeessfally screened
over 78% of the 2.5 million veterans in the 1945-1965 birth cohort. Of particular note, VA has screened
89 .6% of its homeless population. 12 Using updated annual prevalence calculations from the number of
new infections among those tested, VA estimates that there are only approximately 15,000 remaining
veterans in VA care who would test positive for HCV if the entire at-risk population were screened.
Testing initiatives: Several initiatives undertaken within VA to increase HCV testing have significantly
impacted these results. These include national electronic point-of-care clinical reminders for HCV risk
assessment and testing, automated letters recommending HCV testing which dually serve as a laboratory
order when presented to a VA lab, weekly primary care panel review identifying patients with upcoming
appointments who require testing, and calling patients directly. To emphasize this as a priority, VA added
birth cohort testing as a national performance measure in 2015 and reports quarterly screening rates by
facility and region. To ensure complete testing while simultaneously providing an efficient and patientcentered approach, VA developed policy in 2009 whereby all patients tested for HCV with a positive
antibody automatically had reflex confirmatory HCV RNA testing performed with the same laboratory
sample, with over 97% compliance in 2015. As a result of these collective factors, the proportion of
veterans in VA care screened for HCV have increased annually by 3% to 4% and are substantially higher
than any-other large healthcare system§..13
Building Infrastructure
Hepatitis Innovation Team (HIT) Collaborative: Recognizing that care is not delivered the same way in
all settings, regional HITs, comprising a multidisciplinary group of 15-30 healthcare providers,
administrators, information technology and system redesign specialists, have implemented Lean Process
Improvement methods to maximize their clinical expertise and redesign the process ofHCV testing,
diagnosis, treatment, and management to provide care in the most efficient and effective way possible for
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the populations they serve. 14 The HIT Collaborative has enabled a clinically focused foundation to share
and implement best practices across and within teams, supported by local and regional administrators.
The development of the HIT infrastructure on the ground which has leveraged and supported the work of
dedicated VA providers has been one of the critical implementation arms that has allowed VA to lli-mhly
respond to challenges in funding variability and other critical access issues that have arisen since the
introduction ofDAAs.
Service Delivery: Improving Linkage and Access
Once an enrolled veteran is diagnosed with HCV, the emphasis shifts to timely linkage to evaluation and
referral for appropriate treatment. Robust population health data, the infrastructure of the HIT
collaborative, and legions of dedicated providers on the ground have been instrumental in enhancing
VA's outreach and engagement efforts. Efforts have focused on raising awareness among providers and
staff about the need for HCV testing and availability of treatment, as well as promoting direct outreach to
at-risk veterans and the veteran community more broadly through national and local social media and
advertising campaigns, mobile phone applications, and secure messaging.
Expanding Capacity
Telemedicine and electronic technologies: VA has focused on increasing specialist capacity through
telemedicine and clinical video telehealth (CVT), or real-time video teleconferencing, whereby HCV
clinicians provide care to patients and/or consultation to other providers at another location. Largely
modeled off of the University of New Mexico ECHO project,15 the expanded VA-ECHO model includes
urban and rural sites, homeless care clinics and incorporates a pharmacist-led provider program since
much of HCV treatment in VA is managed by clinical pharmacists and an HCV mental health and
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substance use program to aid providers in treating patients with these co-morbidities. Inter-provider
electronic consults offer another effective and efficient way to prepare patients for treatment avoiding the
need for additional appointments. Using electronic databases, registries or dashboards, HCV team
members can identify patients who may be candidates for treatment, notify primary care providers
electronically through the medical record of their eligibility and recommend management. Similarly,
primary care providers can efficiently consult HCV specialists regarding HCV care management and
treatment recommendations eliminating the need for a specialty visit.
Non-physician advanced practice providers: Importantly, VA has also emphasized the expansion of HCV
care beyond specialty providers. A substantial portion of HCV management has shifted, particularly
treatment, outside of liver and infectious disease specialty care clinics at larger medical centers to primary
care and community clinics. Furthermore, this care is often being delivered by non-physician providers
such as Clinical Pharmacy Specialists, Nurse Practitioners and Physician Assistants, who have been
recognized as delivering the same quality of care and providing more timely access to HCV treatment. 16· 17
In 2016, almost one-third of all HCV antiviral prescriptions were initiated by a network of nearly 200
Clinical Pharmacy Specialists. 18 Targeted use of the limited number of specialists while expanding the
skills of non-physician providers is one of the most important practices that can be adapted from the VA
system into other healthcare systems. 16 VA has recently granted full practice authority to nurse
practitioners therefore expanding the potential for further use of these providers in providing hepatitis
Challenging Populations
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Barriers to Care: Based on VA HCV provider data collected in 2014 and 2015, it was estimated that up
to 30% of veterans awaiting treatment were not currently willing or were unable to initiate HCV
treatment. Major reported reasons included active alcohol/substance use, serious mental illness,
documented non-adherence to medical appointments or treatment, unstable/uncontrolled medical
comorbidities, inability to contact a veteran and, in some cases, veterans being unwilling to start
treatment. As VA continues to treat more patients, an increasing number of those remaining in the
untreated pool present more challenges. with accompanying resource demands to potentially modify these
patient, system, or care delivery factors. Frequent reassessment and refocusing is required of healthcare
systems and providers to adapt their approach and resources as the needs of its HCV population and
barriers to initiating treatment change.
Addressing substance use: Recognizing alcohol and substance use as a considerable barrier to HCV
treatment, VA took aggressive steps to eliminate non-evidence based, abstinence policies for HCV
treatment and provided clinical guidance on effectively assessing alcohol and substance use, matching a
patient's use with the actual risk of non-adherence. VA studies have consistently shown cure rates
achieved among veterans with alcohol. substance use and mental health disorders are similar to those
without these conditions. 19· 20
Integrated care: Where resources permit, VA has emphasized that integrated care, care coordination, case
management, and mental health and substance use services are in place to address factors that pose
significant impediments to HCV treatment. This comprehensive management approach facilitates care
such that veterans' treatment candidacy can be reassessed. This has been particularly important for
vulnerable populations. Accessible mental health and addiction specialists, care coordinators, case
managers and social workers are invaluable resources to meet the individualized needs of this population.
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Financing HCV Treatment
Like all healthcare systems, VA has faced significant financial challenges as a result of highly priced
DAAs. With strong advocacy from VA HCV providers. veterans and VA leadership expanded special
purpose funding for HCV medications was made available through Congressional appropriations. 6 .2 1 The
dramatic reductions in the price of DAAs made possible by VA Pharmacy Benefits Management
leadership steadfast negotiations in early 2016, simultaneous enactment of additional appropriations and
removal of restrictions based on stage of Ii ver disease solidified VAs ability to provide consistent access
to HCV treatment. Currently, VA has no restrictions on DAAs which are available to all HCV patients
regardless of stage of Ii ver disease. Figure 2 depicts the significant impact of funding variability on DAA
uptake in VA over recent years.
Recognizing that in order to comprehensively and successfully treat HCV infection in VA, resources
beyond purchasing medications would be required. In 2016, VA boldly allocated 5% of the HCV dmg
budget for each VA medical center to 11011-dmg clinical resources and infrastructure to further increase
treatment starts. This has allowed VISN HITs to independently address local barriers and identify tangible
solutions to increase treatment. These funds have successfully been used to expand HCV or liver disease
VA-ECHO programs, increase treatment capacity through a Clinical Pharmacy Specialist initiative,
increase integrated care, implement HIT innovations, host HCV testing events and fund local testing and
treatment advertising campaigns.
Research to Inform
10
VA-19-0799-D-000278
OS 00001941
The comprehensive data sources within VA and the VA' s diverse HCV population provides a broad
milieu for examining scientific and clinical outcomes, cost-effectiveness, patterns of care, and the impact
of specific interventions. VA HCV researchers actively contribute to the medical literature influencing
and informing patient care, implementation strategies, operations and policy. Given the large number of
BCV-infected veterans treated, real-world outcomes in special populations can be assessed to a greater
degree than in many other healthcare environments thus providing valuable insight for other payors and
healthcare systems.
Cascade of HCV Care in VA
The impact ofDAAs on HCV has been universally transformational, making elimination seem a tangible
goal, as the National Academies of Sciences, Engineering, and Medicine report highlights. Elimination
can only occur when every individual with HCV infection is identified, linked to care, treated with HCV
antivirals and achieves a sustained virologic response (SVR), or cure. These steps comprise the "hepatitis
C cascade of care", a series of key care components used to describe the population health approach to
HCV care and a mechanism to assess performance_ 5.1 3 .2 2 -24
Figure 3 depicts VA's HCV transformation since the availability ofDAAs and the impact on each of the
steps of the care cascade from 2014-2016. As of 2016, VA estimates that 92% of veterans with HCV in
care have been diagnosed, and of those, 93% have been linked to care. The most significant change in the
cascade has occurred in the treatment step. In 2014, the VA had initiated HCV treatment in 27% of
veterans linked to VA care. In tum, 51 % achieved SVR. By the end of 2016, HCV treatment had been
initiated in 59% of veterans linked to VA care, and 84% of the veteran population ever receiving HCV
treatment had achieved SVR. Overall, 84,] 92 veterans have been cured ofHCV, the overwhelming
majority since 2014.
11
VA-19-0799-D-000279
OS 00001942
Summary
The widespread availability of oral DAA medications that cure HCV have made the possibility of
elimination seem achievable. VA is steadily approaching this goal and remains committed to diagnosing
and treating all veterans with HCV who are willing and able to be treated. An extensive array of delivery
of services, policy guidance, outreach efforts and funding has broadened the reach and capacity of VA to
deliver these disease-curing medications, supported by an infrastructure to effectively implement change.
The key actions that have advanced VA 's HCV elimination efforts include: expanding treatment capacity
with non-MD providers; use of video telehealth and modified ECHO models to expand treatment;
widespread use of integrated care and improvement in addressing psychiatric, substance use and medical
co-morbidities; use of electronic data tools for patient tracking and outreach; and dissemination and
implementation of best practices developed through the Systems Redesign efforts of regional HITs.
However, it must be underscored that financing for HCV treatment and infrastructure resources coupled
with reduced drug pricing has been paramount lo VA's success in curing HCV and is the lynch pin in
achieving elimination for any health care system and the US nationally. Recognizing the resources
necessary to realize this goal and the infrastructure and innovations that could make it truly possible, VA
is well poised to share and extend best HCV practices to other healthcare organizations and providers
delivering HCV care.
12
VA-19-0799-D-000280
OS 00001943
References
1. National Academies of Sciences, Engineering, and Medicine. 2017. A national strategy for the
elimination of hepatitis B and C. Washington, DC: The National Academies Press.
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hepatitis-b-and-c.aspx
2.
Gillian J. Buckley, PhD, MPH; Brian L. Strom, MD, MPH. A National Strategy for the Elimination
of Viral Hepatitis Emphasizes Prevention, Screening, and Universal Treatment of Hepatitis C. Ann
-------l Formatted: Default Paragraph Font
Int Med 4 April 2017. Jittp://annals.org/aim/article/2616344/national-strategy-elimination-viralhepatitis-emphasizes-prevention-screening-universal-treatment
3.
Beste LA, Ioannou GN. Prevalence and Treatment of Chronic Hepatitis C Virus Infection in the US
Department of Veterans Affairs. Epidemiol Rev (2015) 37 (1): 131-143.
4.
Denniston MM, Jiles RB, Drobeniuc J, et al. Chronic hepatitis C virus infection in the United States,
National Health and Nutrition Examination Survey 2003---2010. Ann Intern Med. 2014; 160(5):293300.
5.
Maier MM, Ross DB, Chartier M, Belperio PS, Backus LI. Cascade of Care for Hepatitis C Virus
Infection Within the US Veterans Health Administration. Am J Public Health. 2016 Feb; 106(2):353358.
6.
H.R.3236 - Surface Transportation and Veterans Health Care Choice Improvement Act of 2015,
114th Congress (2015-2016).
7.
US Department of Veterans Affairs Viral Hepatitis Website. Jittps://www.hepatitis.va.gov/
8.
Backus LI, Gavrilov S, Loomis TP, Halloran JP, Phillips BR, Belperio PS, Mole LA. Clinical Case
-------l Formatted: Default Paragraph Font
Registries: simultaneous local and national disease registries for population quality management. J
Am Med Inform Assoc. 2009 Nov-Dec; 16(6):775-83.
13
VA-19-0799-D-000281
OS 00001944
9.
Smith BD, Morgan RL Beckett GA, et al. Recommendations for the identification of chronic
hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rep.
2012;6l(RR-4): 1-32.
10. Moyer VA; U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in adults:
U.S. Preventive Services Task Force recommendation statement. Ann Intern Med.2013 Sep
3; 159(5) 349-57.
11. Backus LI, Belperio PS. Loomis TP, Mole LA Impact of race/ethnicity and gender on HCV
screening and prevalence among U.S. veterans in Department of Veterans Affairs Care. Am J Public
Health. 2014 Sep;104 Suppl 4:S555-61.
12. NoskaAJ. Belperio PS, Loomis TP, O'Toole TP, Backus LI. Engagement in the Hepatitis C Care
Cascade Among Homeless Veterans, 2015. Public Health Rep. 2017 Mar/Apr; 132(2): 136-139.
13. Jonas MC, Rodriguez CV. Redd J, Sloane DA, Winston BJ. Loftus BC. Streamlining screening to
treatment: the hepatitis C cascade of care at Kaiser Permanente mid-Atlantic states. CID 2016; 62
1290-1296.
14. Ross DB. Best Practices in HCV Screening,Diagnosis, and Treatment. Federal Practitioner 2017.
February 1.
15. Arora S, Kalishman S, Thornton K, Dion D, Murata G, Deming P, Parish B, Brown J, Komaromy M,
Colleran K, Bankhurst A, Katzman J, Harkins M, Curet L, Cosgrove E, Pak W. Expanding access to
hepatitis C virus treatment--Extension for Community Healthcare Outcomes (ECHO) project:
disruptive innovation in specialty care. Hepatology. 2010 Sep;52(3): 1124-33.
16. Rongey C, Shen H, Hamilton N, Backus LI. Asch SM. Knight S. Impact of rural residence and health
system structure on quality of liver care. PLoS One. 2013 Dec 26;8(12):e84826.
17. Backus LI, Belperio PS, Shahoumian TA, Mole LA. Impact of provider type on hepatitis C outcomes
with boceprevir-based and telaprevir-based regimens.J Clin Gastroenterol. 2015 Apr:49(4):329-35.
18. Ourth H, Groppi J, Morreale AP, Quicci-Roberts K. Clinical pharmacist prescribing activities in the
Veterans Health Administration. Am J Health Syst Pharm. 2016 Sep 15;73(18): 1406-15.
14
VA-19-0799-D-000282
OS 00001945
19. Tsui JI, Williams EC, Green PK, Berry K, Su F, Ioannou GN, Alcohol use and hepatitis C virus
treatment outcomes among patients receiving direct antiviral agents.Drug Alcohol Depend. 2016 Dec
1;169:101-109.
20. Backus Ll, Belperio PS, Shahoumian TA, Loomis TP, Mole LA Real-world effectiveness and
predictors of sustained virological response with all-oral therapy in 21,242 hepatitis C genotype-I
patients. Antivir Ther, 2016 Dec 9.
21. US Department of Veterans Affairs. VA expands hepatitis C drug treatment
http://www.va.gov/opa/pressrel/pressrelease.cfm?id~2762. Published March 9,2016. Accessed April
10, 2017.
22. Yehia BR, Schranz AJ, Umscheid CA, Lo RV. The treatment cascade for chronic hepatitis C virus
infection in the United States: a systematic review and meta-analysis. PLoS One. 2014;9(7):e101554.
23. Spradling PR, Rupp L, Moorman AC, et aL Hepatitis Band C virus infection among 1.2 million
persons with access to care: factors associated with testing and infection prevalence. Clin Infect Dis.
2012;55(8): 1047-1055.
24. Holmberg SD, Spradling PR, Moorman AC, Denniston MM. Hepatitis C in the United States. N Engl
J Med.2013;368(20): 1859-186 l.
15
VA-19-0799-D-000283
OS 00001946
Figure 1. Number of Veterans with HCV in VA Care Reqniring Antiviral Treatment Over Time
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16
VA-19-0799-D-000284
OS 00001947
Figure 2. Availability of Funding and Impact on HCV Treatment Starts per Week
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C:
Date: April 18, 2017 at 7 :23 :40 AM EDT
To: David shulkin
Cc: "(b) (6)
<(b) (6)
va.gov>, "(b) (6)
(b) (6)
(b)
(6)
<
va.gov>
Subject: Re: [EXTERNAL] Hepatitis paper
I am in concurrence with Dr Shulkin- thanks
Sent from my iPhone
On Apr 18, 2017, at 7: 16 AM, David shulkin wrote:
Thank you
Sent from my iPhone
On Apr 18, 2017, at 1:06 AM, (b) (6)
wrote:
(b) (6)
va.gov>
Hi Dr. Shulkin and Dr. Alaigh,
Please find attached the data on the number of veterans we have
treated and our SVR (cure) rates among those we have treated since the
availability of the oral DAAs.
In the attached spreadsheet (HCV VA data sources.xis), please find three
tabs:
Tab 1 shows the daily cumulative total of veterans starting on oral HCV
DAAs. We started prescribing in VA in Jan 2014, though they were FDA
approved in Nov 2013. This summary graph is also posted and is
available at the first link listed below.
Number of veterans treated since DAA availability:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
antivirals/default.aspx
VA-19-0799-D-000288
OS 00001954
Tab 2 of the spreadsheet shows the number of veterans awaiting
treatment at periodic intervals beginning with FY14 ( DAAs introduced in
VA in Q2 FY14). This is data captured from the HCV Clinical Case
Registry. Those in the paper reflect the end of March (Q2 FY17).
This data is also posted and is available at the link listed below:
Numbers awaiting treatment - this is updated quarterly.
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
antivirals/HCV%20Viremic/viremic-fib4.aspx
Tab 3 of the spreadsheet shows the raw data that relates to the
"Cascade of HCV Care" (figure 3) with a brief sentence about the
methods used to calculate each "step". For more detailed methods,
refer to the attached Maier et al paper. We used the same
methods for the current cascade as we did in this previously
published paper. Note that the cascade numbers represent all
HCV patients in care ever treated (even with earlier non-DAA
regimens before 2014) which is why the SVR percentages in the
cascade graph are lower than what the SVR rates are with all oral
DAA regimens (shown in link below - which represent SVR rates
of only oral DAA regimens from 2014 and beyond).
SVR (cure) rates with all oral DAA regimens are posted here and
updated every two weeks:
https://vaww.vha.vaco.portal.va.gov/sites/PublicHealth/pophealth/hcv
antivirals/HCV%20Antivirals%20Tests/HCV Direct Acting Antivirals.asp
X
From table at above link, SVR rate calculated as SVR12/(NoSVR+SVR12)
= 94.98%; Published data on SVR rates available in the attached article.
HCV testing rates are updated and posted quarterly, (those in the paper
reflect the end of March, Q2 FYl 7) :
https://vaww. vha. vaco. portal. va .gov/sites/Pu bl icHealth/pophealth/hcv
birthcohort/hcv cohorts fiscal year/default.aspx
Please let me know if you have any additional questions about the data
or would like to have copies of any of the other references in the paper.
Best,
(b)
(6)
From: David Shulkin [ mailto:drshulkin @aol.com]
Sent: Sunday, April 16, 2017 9:59 AM
(b) (6)
(b) (6)
To: (b) (6)
Subject: [EXTERNAL] Hepatitis paper
hotmail.com
(b) and (b) (6) and Poonam- you did a spectacular job writing this up
and its a remarkable story that has occurred at VA.
(6)
I think this is exactly the type of manuscript that is needed so others can
benefit from your experience and also
that VA can be appropriately recognized for its' leadership in this area.
VA-19-0799-D-000289
OS 00001955
I surprisingly made very few edits or corrections in the paper which is a
real tribute to you all.
Please take a look and make sure you agree with these few changes.
The one request I would make is to be an author on this paper I feel it is
important that I review the data
that you used to put the statistics in the paper about how many veterans
we treated and our success rates.
Do you have any reports or data that you could share so Dr. Alaigh and I
can review before we put our names on the manuscript?
I don't know if Dr. Alaigh has had time yet to review.
The annals seems appropriate or if not a hepatology journal surely would
be interested.
Thanks so much for your leadership here
David Shulkin MD
VA-19-0799-D-000290
OS 00001956
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/18/2017 6:35:54 PM
To:
(b) (6)
(b) (6)
CC:
IP [
Subject:
J&J
mac.com]
[(b) (6)
its.jnj.com]
frenchangel59.com]; Poonam Alaigh [(b) (6)
hotmail.com]; David shulkin [drshulkin@aol.com]
Thank you for taking the time to discuss with me how to move this important mental health initiative
forward in time for mental health awareness month.
As we discussed both your CEO (b) (6)
and my
CEO's representing the five academic centers know and respect Terry Fadem's ability to get the precision
medicine, clinical trials and preventive medicine done in a timely manor. Let's move quickly on the
narrative and marketing material as discussed. Again I am available 24-7 to assist.
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000291
OS 00001957
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/22/2017 3:29:16 PM
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
gmail.com]
From this morning
http ://www. cb snews.com/vi deos/va-secretary-davi d-shulkin-on-chall enges-facing-the-agency/?ftag=CNM-00l 0aab4 i
Sent from my iPhone
VA-19-0799-D-000292
OS 00001958
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/20/2017 1:37:32 AM
To:
(b) (6)
Subject:
Attachments:
gmail.com
Fwd:
healthdatapoolza.pptx
You did a good job. Attached are my revisions
Good to go if you can fill in the big data announcement slide and make sure the clip works
VA-19-0799-D-000293
OS 00001959
U.S. Department
of Veterans Affairs
Health DataPalooza
David J. Shulkin, MD
Secretary of Veterans Affairs
April 25, 2017
VA-19-0799-D-000294
OS 00001960
ff .
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"To care for him who
shall have borne the
·
battle, and for his
widow and his orphan."
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Lincoln, 1865
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borne the battle" and for their
families and their survivors.
VA Today
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?Out of crisis
comes clarity.?
Randolph O?Toole
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VA-19-0799-D-000297
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1-
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• Redesign the 40/30 Rule
• Build a high-performing,
integrated network of
care
• Empower Veterans
through transparency of
information
VAi
U.S. Department
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VA-19-0799-D-000298
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VA-19-0799-D-000306
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patients?
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VA-19-0799-D-000307
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foundational services in VA
• VA/DOD/Community
coordination
• Deliver on accountability and
effective management
practices
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ofVeterans Affairs
VA-19-0799-D-000309
OS 00001975
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therapies after traditional treatments have not been successful
VA-19-0799-D-000317
OS 00001983
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Nicotine
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First Liver Transplant
Barcoding of Medications
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25
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OS 00001986
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VA-19-0799-D-000321
OS 00001987
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/16/2017 7:10:02 PM
(b) (6)
hotmail.com; brucem(b) (6)
Re: Buffalo VA
@mac.com
Thanks Poonam
-----Original Message----From: Poonam Alaigh <(b) (6)
hotmail.com>
To: Bruce Moskowitz <(b) (6)
mac.com>; David shulkin
Sent: Sun, Apr 16, 2017 1:43 pm
Subject: Re: Buffalo VA
Bruce and David, my team just concluded speaking to Medical Center Director, COS for Asst Sec of IT, the local
Administrator on Duty, and the ED with the following facts :
•
•
•
There are no tickets or reports of any IT issues in the VA Medical Center or Clinics in Buffalo with all
systems operating normally
There are some routine switch replacements occurring in the Buffalo VA with periodic blips in system,
but all this is routine, planned with no disruption in patient care services or problems reported
However, the Erie County Medical Center did take their system down earlier this week because of
attempts to infiltrate, presumably by hackers and are slowly brining it back on line.
It is safe to say that everything is operating appropriately at Buffalo VA between the on the ground
confirmation and the medical center directors validation at this time.
Thanks Bruce, really appreciate the heads up so that we can fix any issues preemptively.
From: Bruce Moskowitz <(b) (6)
mac.com >
Sent: Sunday, April 16, 2017 12:39 PM
To: David shulkin; Poonam Alaigh
Subject: Buffalo VA
Are you aware of the hacking they can't use the computer system?
Sent from my iPhone
VA-19-0799-D-000322
OS 00001988
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
4/16/2017 5:43:06 PM
Bruce Moskowitz [(b) (6)
Re: Buffalo VA
hotmail.com]
mac.com]; David shulkin [drshulkin@aol.com]
Bruce and David, my team just concluded speaking to Medical Center Director, COS for Asst Sec of IT, the local
Administrator on Duty, and the ED with the following facts :
•
•
•
There are no tickets or reports of any IT issues in the VA Medical Center or Clinics in Buffalo with all
systems operating normally
There are some routine switch replacements occurring in the Buffalo VA with periodic blips in system,
but all this is routine, planned with no disruption in patient care services or problems reported
However, the Erie County Medical Center did take their system down earlier this week because of
attempts to infiltrate, presumably by hackers and are slowly brining it back on line.
It is safe to say that everything is operating appropriately at Buffalo VA between the on the ground
confirmation and the medical center directors validation at this time.
Thanks Bruce, really appreciate the heads up so that we can fix any issues preemptively.
From: Bruce Moskowitz <(b) (6)
mac.com>
Sent: Sunday, April 16, 2017 12:39 PM
To: David shulkin; Poonam Alaigh
Subject: Buffalo VA
Are you aware of the hacking they can't use the computer system?
Sent from my iPhone
VA-19-0799-D-000323
OS 00001989
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/16/2017 4:51:39 PM
To:
brucem(b) (6)
Re: Buffalo VA
Subject:
@mac.com
no not sure what this is about
-----Original Message----From: Bruce Moskowitz <(b) (6)
mac.com>
To: David shulkin ; Poonam Alaigh <(b) (6)
Sent: Sun, Apr 16, 201712:39 pm
Subject: Buffalo VA
hotmail.com>
Are you aware of the hacking they can't use the computer system?
Sent from my iPhone
VA-19-0799-D-000324
OS 00001990
Message
From:
Sent:
To:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/16/2017 4:39:15 PM
David shulkin [drshulkin@aol.com]; Poonam Alaigh [(b) (6)
Buffalo VA
hotmail.com]
Are you aware of the hacking they can't use the computer system?
Sent from my iPhone
VA-19-0799-D-000325
OS 00001991
Message
To:
Bob McDonald [(b) (6)
gmail.com]
4/16/2017 8:54:56 PM
'David shulkin' [Drshulkin@aol.com]
Subject:
RE:
From:
Sent:
Thanks for your note, David. I wish you all well. Getting the right team in
place is the most difficult, most time-consuming, and most important thing
to do. I regret it took me so long in every job I have held. Please say hi
to everyone for me. Thanks again. Bob
-----original Message----From: David shulkin [mailto:Drshulkin@aol .com]
Sent: Sunday, April 16, 2017 4:16 PM
To: bob mcDonald <(b) (6)
gmail.com>
subject:
Bob- just a quick
note to say hello and let you know I think of you often.
Scott and I are holding the fort and continuing to build on the progress you
madeNo doubt your missed but everyone knows that you'd want us to carry
on.
There is so much going on and without a full team i am so busy that time
rushes by- but i wanted to let you know that i hope you are doing well and
hope to see you soon
David
Sent from my iPhone
VA-19-0799-D-000326
OS 00001992
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/16/2017 8:15:31 PM
To:
bob mcDonald [(b) (6)
Bob- just a quick
gmail.com]
note to say hello and let you know I think of you often.
Scott and I are holding the fort and continuing to build on the progress you madebut everyone knows that you'd want us to carry on.
No doubt your missed
There is so much going on and without a full team i am so busy that time rushes by- but i wanted to let
you know that i hope you are doing well and hope to see you soon
David
Sent from my iPhone
VA-19-0799-D-000327
OS 00001993
Message
David shulkin [Drshulkin@aol.com]
4/19/2017 7:30:41 PM
Ike Perlmutter [(b) (6) frenchangel59.com]
Fwd: Florida Governor Joins Trump To Sign Veterans Bill At White House - CBS Miami
From:
Sent:
To:
Subject:
Clip below
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
gmail.com>
Date: April 19, 2017 at 3 :29:06 PM EDT
To: David Shulkin
Subject: Florida Governor Joins Trump To Sign Veterans Bill At White House - CBS
Miami
http ://miami .cbslocal .com/2017/04/ 19/florid-governor-trump-sign-veterans-bill-whitehouse/amp/
VA-19-0799-D-000328
OS 00001994
Message
From:
(b) (6)
Sent:
4/19/2017 7:29:06 PM
David Shulkin [drshulkin@aol.com]
Florida Governor Joins Trump To Sign Veterans Bill At White House - CBS Miami
To:
Subject:
[(b) (6)
gmail.com]
http ://miami .cbslocal .com/2017/04/ 19/florid-governor-trump-sign-veterans-bill-white-house/amp/
VA-19-0799-D-000329
OS 00001995
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/18/2017 1:17:25 AM
To:
IP [(b) (6) frenchangel59.com]
Re: RE:
Subject:
Thanks Ike
Sent from my iPhone
> on Apr 17, 2017, at 8:47 PM, IP <(b) (6) frenchangel59.com> wrote:
>
> David,
>
>Weare very happy that the Senator is willing to help.
>
> We definitely can use his help.
>
> We have "fires" in too many locations.
>
> We need all the support we can get.
>
> Please note you copied the wrong Marc.
>
> Please send to Marc Sherman.
> (b) (6)
gmail.com
>
>
>
>
>
>
>
>
Thank you,
Ike
-----original Message----From: David shulkin [mailto:Drshulkin@aol .com]
Sent: Monday, April 17, 2017 8:10 PM
To: Ike Perlmutter; Laurie Perlmutter; Bruce Moskowitz;
subject:
(b) (6)
>
it
> Not sure if i told you I had a good conversation with Senator Tester
> was a great suggestion of all of you to make- he wants to work with us on
> accountability
>
>Bruce-if you get the Annals of internal medicine> (on line) on Veteran wait times
have an article today
>
> David
>
> Sent from my iPhone
>
VA-19-0799-D-000330
OS 00001996
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/18/2017 12:59:15 AM
To:
IP [(b) (6) frenchangel59.com]
David shulkin [Drshulkin@aol.com]
Re: RE:
CC:
Subject:
mac.com]
Excellent will look at article
Sent from my iPhone
> on Apr 17, 2017, at 8:47 PM, IP <(b) (6) frenchangel59.com> wrote:
>
> David,
>
>Weare very happy that the Senator is willing to help.
>
> We definitely can use his help.
>
> We have "fires" in too many locations.
>
> We need all the support we can get.
>
> Please note you copied the wrong Marc.
>
> Please send to Marc Sherman.
> (b) (6)
gmail.com
>
>
>
>
>
>
>
>
Thank you,
Ike
-----original Message----From: David shulkin [mailto:Drshulkin@aol .com]
Sent: Monday, April 17, 2017 8:10 PM
To: Ike Perlmutter; Laurie Perlmutter; Bruce Moskowitz;
subject:
(b) (6)
>
it
> Not sure if i told you I had a good conversation with Senator Tester
> was a great suggestion of all of you to make- he wants to work with us on
> accountability
>
>Bruce-if you get the Annals of internal medicine> (on line) on Veteran wait times
have an article today
>
> David
>
> Sent from my iPhone
>
VA-19-0799-D-000331
OS 00001997
Message
From:
Sent:
To:
CC:
Subject:
IP [(b) (6) frenchangel59.com]
4/18/2017 12:47:17 AM
'David shulkin' [Drshulkin@aol.com]
(b) (6)
mac.com
RE:
David,
We are very happy that the Senator is willing to help.
We definitely can use his help.
We have "fires" in too many locations.
We need all the support we can get.
Please note you copied the wrong Marc.
Please send to Marc Sherman.
gmail.com
(b) (6)
Thank you,
Ike
-----original Message----From: David shulkin [mailto:Drshulkin@aol .com]
Sent: Monday, April 17, 2017 8:10 PM
To: Ike Perlmutter; Laurie Perlmutter; Bruce Moskowitz;
subject:
(b) (6)
Not sure if i told you I had a good conversation with Senator Tester
it
was a great suggestion of all of you to make- he wants to work with us on
accountability
Bruce- if you get the Annals of internal medicine(on line) on Veteran wait times
have an article today
David
Sent from my iPhone
VA-19-0799-D-000332
OS 00001998
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/18/2017 12:09:59 AM
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
[(b) (6)
mac.com]; (b) (6)
gmail.com]; Bruce Moskowitz
yahoo.com]
Not sure if i told you I had a good conversation with Senator Tester
of you to make- he wants to work with us on accountability
it was a great suggestion of all
Bruce- if you get the Annals of internal medicine- i have an article today (on line) on Veteran wait
times
David
Sent from my iPhone
VA-19-0799-D-000333
OS 00001999
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/23/2017 12:34:14 PM
Darin Selnick [(b) (6)
@gmail.com]
Re: DPC and other Updates
Thanks
I think just pushing the senate is all we need from Potus
I agree with you comments on the majority bill
I think I agree with your recommendation but I'd like to review it with you in person- maybe we can get the
design group together again soon
Sent from my iPad
On Apr 22, 2017, at 7: 15 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
WH Thursday event: (b) (6)
from DPC called me. He wanted to know for the WH event on
Thursday if there was anything specific you wanted the President to say about the Accountability
bill stalled in the Senate. They are still firming up his remarks and this is a good opportunity to
push again on the Senate bill.
SVAC draft "Veterans Choice Act of 2017": Just a heads up that I received from (b) (6) from McCain a
copy of the new red lined version of SVAC majority draft choice legislation. It is terrible and would cost a
fortune. Basically veterans can pick any provider in the network when they want, no cost mitigation, VA is
primary payer and can only collect from OHi on the back end for non-service connected. Here is a couple
of quotes:
"the decision to receive care or services under this section , including the decision to receive care or
services from a particular individual or entity health care provider specified in subsection (c) , shall be at
the election of the veteran ."
h) Treatment of Other Health-care Plans.-(1) In any case in which a covered veteran is
furnished care or services under this section with an individual or entity specified in subsection (c)(S) if
the individual or entity meets criteria established by the Secretary for purposes of this section. for a nonservice-connected disability described in subsection (a)(2) of section 1729 of this title , the
Secretary may recover or collect reasonable charges for such care or services from a health-care
plan described in paragraph (3) in accordance with such section.
I expect this to be rejected immediately from conservative Senators like Lee and in the House like Dr.
Roe. CBO score will be huge. Staff from McCain and Moran have indicated this plan is just a starting
point. I will be meeting with them on Friday to discuss.
Choice 2.0. recommendation: In order to maximize our revenue at the VAMC and minimize the
payout in Choice 2.0., we should be more like the private sector and follow what the independent
assessment recommended.
- All enrolled veterans must be required to declare their OHi and we should check and update our
records when they see their providers. All staff should be required to ask the OHi question. To make
Choice affordable, VA needs to collect from the 80% OHi as much as possible at the VAMC and for
Community Care have OHi pay as much as possible upfront to reduce our spend.
- All VAMC providers should be required to more narrowly and correctly identify all treatments that are
service-connected. Poonam gives the example how she just checks off routinely service
VA-19-0799-D-000334
OS 00002000
connected. That practice must stop if in 2.0. we are going to collect all we can from OHi. If a private
sector provider like what I used to work for had that restriction, they would be making sure they were
collecting every dollar they could, and so should we. Part of changing the culture to a private sector
mentality.
Darin
VA-19-0799-D-000335
OS 00002001
Message
From:
Sent:
To:
Subject:
Darin Selnick [(b) (6)
@gmail.com]
4/22/2017 11:15:48 PM
David shulkin [Drshulkin@aol.com]
DPC and other Updates
WH Thursday event: (b) (6)
from DPC called me. He wanted to know for the WH event on Thursday if
there was anything specific you wanted the President to say about the Accountability bill stalled in the
Senate. They are still firming up his remarks and this is a good opportunity to push again on the Senate bill.
SVAC draft "Veterans Choice Act of 2017": Just a heads up that I received from (b) (6) from McCain a copy of the new
red lined version of SVAC majority draft choice legislation. It is terrible and would cost a fortune. Basically veterans can
pick any provider in the network when they want, no cost mitigation, VA is primary payer and can only collect from OHi on
the back end for non-service connected. Here is a couple of quotes:
"the decision to receive care or services under this section , including the decision to receive care or services from a
particular individual or entity health care provider specified in subsection (c), shall be at the election of the veteran."
h) Treatment of Other Health-care Plans.-(1) In any case in which a covered veteran is furnished care or
services under this section with an individual or entity specified in subsection (c)(S) if the individual or entity meets criteria
established by the Secretary for purposes of this section. for a non-service-connected disability described in
subsection (a)(2) of section 1729 of this title, the Secretary may recover or collect reasonable charges for such
care or services from a health-care plan described in paragraph (3) in accordance with such section.
I expect this to be rejected immediately from conservative Senators like Lee and in the House like Dr. Roe. CBO score
will be huge. Staff from McCain and Moran have indicated this plan is just a starting point. I will be meeting with them on
Friday to discuss.
Choice 2.0. recommendation: In order to maximize our revenue at the VAMC and minimize the payout in Choice
2.0., we should be more like the private sector and follow what the independent assessment recommended.
- All enrolled veterans must be required to declare their OHi and we should check and update our records when they
see their providers. All staff should be required to ask the OHi question. To make Choice affordable, VA needs to collect
from the 80% OHi as much as possible at the VAMC and for Community Care have OHi pay as much as possible upfront
to reduce our spend.
- All VAMC providers should be required to more narrowly and correctly identify all treatments that are serviceconnected. Poonam gives the example how she just checks off routinely service connected. That practice must stop if in
2.0. we are going to collect all we can from OHi. If a private sector provider like what I used to work for had that
restriction, they would be making sure they were collecting every dollar they could, and so should we. Part of changing
the culture to a private sector mentality.
Darin
VA-19-0799-D-000336
OS 00002002
Message
From:
Sent:
To:
CC:
David shulkin [Drshulkin@aol.com]
4/18/2017 11:56:13 PM
Jennifer Lee [(b) (6)
gmail.com]
Poonam Alaigh [(b) (6)
hotmail.com]
Lets discuss the telehealth eo in the am
Sent from my iPhone
VA-19-0799-D-000338
OS 00002004
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/18/2017 11:34:38 AM
(b) (6)
[(b) (6)
va.gov]
Fwd: Today's JAMA article on VA hospitals outperforming non VA hospitals
Please print article
Sent from my iPhone
Begin forwarded message:
From: Poonam Alaigh <(b) (6)
hotmail.com>
Date: April 18, 2017 at 5:26:55 AM EDT
To: Marc Sherman <(b) (6)
gmail.com>, Laurie Perlmutter <(b) (6)
gmail.com>, Ike
(b) (6)
Perlmutter <
frenchangel59.com>, "brucem(b) (6)
@mac.com"
Cc: David Shulkin
Subject: Today's JAMA article on VA hospitals outperforming non VA hospitals
http ://www.beckershospitalreview.com/quality/va-hospitals-outperform-non-va-hospitals-onpati ent-outcome-measures .html
Ideas for communicating this?
Sent from my iPhone
VA-19-0799-D-000339
OS 00002005
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/18/2017 11:24:20 AM
Marc Sherman [(b) (6)
gmail.com]
David shulkin [Drshulkin@aol.com]; L Perl [(b) (6)
gmail.com]; IP [(b) (6) frenchangel59.com]; Poonam Alaigh
(b)
(6)
[
hotmail.com]
Re: Today's JAMA article on VA hospitals outperforming non VA hospitals
The way data is collected raised every red flag among my colleagues and even discussed in the article. It is easy
to show how easily the data can be manipulated and proved to be a false outcome. However the VA does do
somethings in the article that is better than the whole sum of the private sector. I am afraid that will get lost in
the rebuttal. There are articles like the VA telemedicine for mental health study that is research excellence that
had no coverage and of great importance.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 18, 2017, at 7: 17 AM, Marc Sherman <(b) (6)
gmail.com> wrote:
But it is also a tool of great value. We should discuss live.
Marc Sherman
(202) 758-(b) (6)
On Apr 18, 2017 7:09 AM, "David shulkin" wrote:
Ok thanks Bruce- we will be cautious
Sent from my iPhone
On Apr 18, 2017, at 6:47 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
I would be concerned about communicating this I read the full article and letter.
Both point out the data may be incorrect for a variety of reasons. Also the full
article points to the many deficiencies.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 18, 2017, at 5:26 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
http ://www.beckershospitalreview.com/quality/va-hospitalsoutperform-non-va-hospitals-on-patient-outcome-measures.html
Ideas for communicating this?
Sent from my iPhone
VA-19-0799-D-000340
OS 00002006
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/18/2017 11:04:54 AM
Bruce Moskowitz [(b) (6)
mac.com]
Poonam Alaigh [(b) (6)
hotmail.com]; Marc Sherman [(b) (6)
gmail.com]; Laurie Perlmutter
[(b) (6)
gmail.com]; Ike Perlmutter [(b) (6) frenchangel59.com]
Re: Today's JAMA article on VA hospitals outperforming non VA hospitals
Ok thanks Bruce- we will be cautious
Sent from my iPhone
On Apr 18, 2017, at 6:47 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
I would be concerned about communicating this I read the full article and letter. Both point out
the data may be incorrect for a variety of reasons. Also the full article points to the many
deficiencies.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 18, 2017, at 5:26 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
http ://www.beckershospitalreview.com/quality/va-hospitals-outperform-non-vahospitals-on-patient-outcome-measures.html
Ideas for communicating this?
Sent from my iPhone
VA-19-0799-D-000341
OS 00002007
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/18/2017 10:47:42 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Marc Sherman [(b) (6)
gmail.com]; Laurie Perlmutter [(b) (6)
gmail.com]; Ike Perlmutter
(b)
(6)
[
frenchangel59.com]; David Shulkin [drshulkin@aol.com]
Re: Today's JAMA article on VA hospitals outperforming non VA hospitals
I would be concerned about communicating this I read the full article and letter. Both point out the data may be
incorrect for a variety of reasons. Also the full article points to the many deficiencies.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 18, 2017, at 5:26 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
http ://www.beckershospitalreview.com/quality/va-hospitals-outperform-non-va-hospitals-onpati ent-outcome-measures .html
Ideas for communicating this?
Sent from my iPhone
VA-19-0799-D-000342
OS 00002008
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/18/2017 9:26:55 AM
Marc Sherman [(b) (6)
gmail.com]; Laurie Perlmutter [(b) (6)
(b)
(6)
(b)
(6)
[
frenchangel59.com];
mac.com
David Shulkin [drshulkin@aol.com]
Today's JAMA article on VA hospitals outperforming non VA hospitals
gmail.com]; Ike Perlmutter
http ://www.beckershospitalreview.com/quality/va-hospitals-outperform-non-va-hospitals-on-patient-outcomemeasures.html
Ideas for communicating this?
Sent from my iPhone
VA-19-0799-D-000343
OS 00002009
Message
From:
(b) (6)
[(b) (6)
Sent:
To:
5/21/2017 8:16:30 PM
David shulkin [Drshulkin@aol.com]
Subject:
Re:
gmail.com]
Ok
On May 21, 2017 4: 12 PM, "David shulkin" wrote:
For tommorow with (b) (6) lets add
Telehealth comms plans
Other active Executive orders Sent from my iPhone
VA-19-0799-D-000344
OS 00002010
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
5/21/2017 8:12:27 PM
To:
(b) (6)
For tommorow with
[(b) (6)
(b) (6)
gmail.com]
lets add
Telehealth comms plans
other active Executive orders Sent from my iPhone
VA-19-0799-D-000345
OS 00002011
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/18/2017 8:35:56 PM
Jennifer Lee [(b) (6)
gmail.com]
Younshould get the myva meetings on yiur calander
Sent from my iPhone
VA-19-0799-D-000346
OS 00002012
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/16/2017 4:19:21 PM
To:
(b) (6)
Subject:
Attachments:
gmail.com
print please choice redesign version 2
choicedesign.pptx
VA-19-0799-D-000347
OS 00002013
C 1n1ca System Design
Clinical Analytics and Choice Eligibility Board
Clinical Groupings
with Poor
Performance
l
VA Does Not
Offer Service
Foundational
Services
Clinical Groupings
with Good or
Su ~
Full Choic
erformance
I
VA Care/Community Care
Whole Health Model of Care Coordination, Telehealth, Caregivers, Homelessness
Draft/ Pre-dec1s1onal / For Internal VA Use Only
1
,1A
V'"'-
I
~
\
~!,I
1
US l)ppartmcnl
ofVcLcrar1s Mfa ,rs
VA-19-0799-D-000348
OS 00002014
C 1n1ca System Design
VA TRIAGE SYSTEM
Urgent Issues
\
l
VA Does Not
Offer Service
Foundational
Services
Chronic Care and
Non Acute Issues
I
/
Full Access to Community
*
VA Care/Community Care
Whole Health Model of Care Coordination, Telehealth, Caregivers, Homelessness
Draft/ Pre-dec1s1onal / For Internal VA Use Only
2
,1A
V'"'-
I
~
\
~!,I
1
US l)ppartmcnl
ofVcLcrar1s Mfa ,rs
VA-19-0799-D-000349
OS 00002015
Veterans
Speak
with
their
Feet
VA must be
comparable
to the private
sector
lncrementamism is not the answer to additional improvements VA and Veterans need.
3
,1A
VI-I.
I
~
\
~!/
1
US l)ppartmcnl
ofVctc.-an~ ,\ffa 1r~
VA-19-0799-D-000350
OS 00002016
Building a Seamless (Integrated) Network
n! \l'lr'IJU?. \"Jrf?w
03330002017
Message
From:
Marc Sherman [(b) (6)
gmail.com]
Sent:
5/12/2017 9:31:22 PM
To:
David shulkin [Drshulkin@aol.com]
Subject:
Re:
On a call. Will call you when finished.
Marc Sherman
(202) 758-(b) (6)
On May 12, 2017 4:47 PM, "David shulkin" wrote:
Marc- what is your cell phone?
Sent from my iPhone
VA-19-0799-D-000352
OS 00002018
Message
To:
Marc Sherman [(b) (6)
gmail.com]
5/12/2017 9:00:13 PM
David shulkin [Drshulkin@aol.com]
Subject:
Re:
From:
Sent:
See below
Marc Sherman
(202) 758-(b) (6)
On May 12, 2017 4:47 PM, "David shulkin" wrote:
Marc- what is your cell phone?
Sent from my iPhone
VA-19-0799-D-000353
OS 00002019
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
5/12/2017 8:47:29 PM
(b) (6)
gmail.com
Marc- what is your cell phone?
Sent from my iPhone
VA-19-0799-D-000354
OS 00002020
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/20/2017 12:59:28 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Ending the Opioid Crisis fyi newt
Just fyi
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
speakergingrich.com>
Date: April 19, 2017 at 8:42:35 PM EDT
To: David shulkin
Subject: Re: Ending the Opioid Crisis fyi newt
I agree and will add to the paper newt
Sent from my iPhone
On Apr 19, 2017, at 7:29 PM, David shulkin wrote:
Newt- this is very effective and well stated.
Pain is such a big issue in VA- what about making VA a fast tract FDA site to get
help to veterans faster? We dont want to be experimenting on veterans but why
not let veterans have the choice to receive these breakthroughs first?
Also VA researchers could join your list of those than can help speed further
discoveries.
Great job- keep it up!
David
Sent from my iPhone
On Apr 19, 2017, at 4:52 PM, (b) (6)
<(b) (6)
speakergingrich.com> wrote:
VA-19-0799-D-000355
OS 00002021
Sent from my iPad
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/28/2017 1:04:45 AM
Bruce Moskowitz [(b) (6)
mac.com]
Poonam Alaigh [(b) (6)
hotmail.com]; mbs(b) (6) @gmail.com; lperl(b) (6) @gmail.com; IP [(b) (6) frenchangel59.com]
Re: Baltimore meeting for inventory
Got it
Sent from my iPhone
> on Apr 27, 2017, at 8:37 PM, Bruce Moskowitz <(b) (6)
>
> Ike wants to be sure
comes out of effort.
(b) (6)
mac.com> wrote:
is aware and provides the ability to protect any intellectual capital that
>
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-000357
OS 00002023
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/28/2017 12:37:03 AM
David shulkin [drshulkin@aol.com]; Poonam Alaigh [(b) (6)
hotmail.com]
(b) (6)
hotmail.com; mbs(b) (6)
@gmail.com; lperl(b) (6) @gmail.com; IP [(b) (6) frenchangel59.com];
drshulkin@aol.com
Baltimore meeting for inventory
Ike wants to be sure
comes out of effort.
(b) (6)
is aware and provides the ability to protect any intellectual capital that
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000358
OS 00002024
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/24/2017 3:11:14 PM
To:
(b) (6)
[(b) (6)
gmail.com]
can you get me tbe blue water navy paper they prepared for me?
Sent from my iPhone
VA-19-0799-D-000359
OS 00002025
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
5/1/2017 4:40:00 PM
To:
Bruce Moskowitz [(b) (6)
mac.com]
The ENT research looks good- we will follow
on the tinnitus test should we followup
With you or Dr (b) (6)
?
Sent from my iPhone
VA-19-0799-D-000360
OS 00002026
Message
From:
Sent:
To:
CC:
David Shulkin [drshulkin@aol.com]
4/19/2017 11:40:16 PM
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
Marc Sherman [(b) (6)
gmail.com]; Bruce Moskowitz [(b) (6)
gmail.com]
mac.com]
This is the real clip from today
https ://m.youtube.com/watch?v=AufMXIGtr-O
Sent from my iPad
VA-19-0799-D-000361
OS 00002027
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/18/2017 9:35:29 PM
To:
David shulkin [Drshulkin@aol.com]
Re: Star ratings
Subject:
mac.com]
Aware I spent the last three hours understanding what they did and it does not get us to where we need to
be. They were looking at metrics that would not pick up supply and staffing problems etc. If you need
full report I have it. From all that I read if we outsource some high priority things like the inventory
we will solve many problems.
Staffing is getting to be impossible in the private sector.
Telemedicine will solve mental health staffing problems and I am busy looking at platforms the medical
centers are using. I am meeting with (b) (6)
tonight who does your public private partnerships and
was on J&J call.
Perhaps a committee that looked at what can be outsourced or brought in from the private sector would
help.
Sent from my iPhone
> on Apr 18, 2017, at 5:21 PM, David shulkin wrote:
>
>Bruce-all facilities are jcaho approved and we have full access to all of their reports and findings
>
> Sent from my iPhone
>
>> on Apr 18, 2017, at 3:38 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>>
>> Yes reviewed it it really does not get us to where we want to see if quality measures are being
enacted and followed.
>>
>> Sent from my iPad
>> Bruce Moskowitz M.D.
>>
>>> on Apr 18, 2017, at 2:47 PM, David shulkin wrote:
>>>
>>> They already gave this
>>>
>>> Sent from my iPhone
>>>
>>>> on Apr 18, 2017, at 1:59 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>>>>
>>>> Is there any reason why we can not have every VA obtain Joint
>>>> Commission of Accreditation status?
>>>>
>>>> Sent from my iPad
>>>> Bruce Moskowitz M.D.
>>>>
>>>>> on Apr 18, 2017, at 1:52 PM, David shulkin wrote:
>>>>>
>>>>> The date that we will have comparable quality data with the private sector is July 1st.
>>>>>
>>>>> We have to rely upon Medicare to do this as its their data set. We are calling Medicare to see if
they can accelerate this.
>>>>>
>>>>> David
>>>>>
>>>>> Sent from my iPhone
>>>
>
VA-19-0799-D-000362
OS 00002028
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/18/2017 9:21:24 PM
Bruce Moskowitz [(b) (6)
Re: Star ratings
mac.com]
Bruce- all facilities are jcaho approved and we have full access to all of their reports and findings
Sent from my iPhone
> on Apr 18, 2017, at 3:38 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> Yes reviewed it it really does not get us to where we want to see if quality measures are being enacted
and foll owed .
>
> Sent from my iPad
> Bruce Moskowitz M.D.
>
>> on Apr 18, 2017, at 2:47 PM, David shulkin wrote:
>>
>> They already gave this
>>
>> Sent from my iPhone
>>
>>> on Apr 18, 2017, at 1:59 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>>>
>>> Is there any reason why we can not have every VA obtain Joint
>>> Commission of Accreditation status?
>>>
>>> Sent from my iPad
>>> Bruce Moskowitz M.D.
>>>
>>>> on Apr 18, 2017, at 1:52 PM, David shulkin wrote:
>>>>
>>>> The date that we will have comparable quality data with the private sector is July 1st.
>>>>
>>>> We have to rely upon Medicare to do this as its their data set. We are calling Medicare to see if
they can accelerate this.
>>>>
>>>> David
>>>>
>>>> Sent from my iPhone
>>
VA-19-0799-D-000363
OS 00002029
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/18/2017 7:38:31 PM
David shulkin [Drshulkin@aol.com]
Ike Perlmutter [(b) (6) frenchangel59.com]
Re: Star ratings
Yes reviewed it it really does not get us to where we want to see if quality measures are being enacted
and fo 17 owed .
Sent from my iPad
Bruce Moskowitz M.D.
> on Apr 18, 2017, at 2:47 PM, David shulkin wrote:
>
> They already gave this
>
> Sent from my iPhone
>
>> on Apr 18, 2017, at 1:59 PM, Bruce Moskowitz <(b) (6)
>>
>> Is there any reason why we can not have every VA obtain Joint
>> Commission of Accreditation status?
mac.com> wrote:
>>
>> Sent from my iPad
>> Bruce Moskowitz M.D.
>>
>>> on Apr 18, 2017, at 1:52 PM, David shulkin wrote:
>>>
>>> The date that we will have comparable quality data with the private sector is July 1st.
>>>
>>> We have to rely upon Medicare to do this as its their data set. We are calling Medicare to see if
they can accelerate this.
>>>
>>> David
>>>
>>> Sent from my iPhone
>
VA-19-0799-D-000364
OS 00002030
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/18/2017 6:47:36 PM
Bruce Moskowitz [(b) (6)
mac.com]
Ike Perlmutter [(b) (6) frenchangel59.com]
Re: Star ratings
They already gave this
Sent from my iPhone
> on Apr 18, 2017, at 1:59 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> Is there any reason why we can not have every VA obtain Joint
> Commission of Accreditation status?
>
> Sent from my iPad
> Bruce Moskowitz M.D.
>
>> on Apr 18, 2017, at 1:52 PM, David shulkin wrote:
>>
>> The date that we will have comparable quality data with the private sector is July 1st.
>>
>> We have to rely upon Medicare to do this as its their data set.
they can accelerate this.
We are calling Medicare to see if
>>
>> David
>>
>> Sent from my iPhone
VA-19-0799-D-000365
OS 00002031
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/18/2017 5:59:21 PM
To:
David shulkin [Drshulkin@aol.com]
Ike Perlmutter [(b) (6) frenchangel59.com]
Re: Star ratings
CC:
Subject:
mac.com]
Is there any reason why we can not have every VA obtain Joint
Commission of Accreditation status?
Sent from my iPad
Bruce Moskowitz M.D.
> on Apr 18, 2017, at 1:52 PM, David shulkin wrote:
>
> The date that we will have comparable quality data with the private sector is July 1st.
>
> We have to rely upon Medicare to do this as its their data set.
can accelerate this.
We are calling Medicare to see if they
>
> David
>
> Sent from my iPhone
VA-19-0799-D-000366
OS 00002032
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/18/2017 5:52:21 PM
To:
Ike Perlmutter [(b) (6) frenchangel59.com]
Bruce Moskowitz [(b) (6)
mac.com]
Star ratings
CC:
Subject:
The date that we will have comparable quality data with the private sector is July 1st.
We have to rely upon Medicare to do this as its their data set.
can accelerate this.
We are calling Medicare to see if they
David
Sent from my iPhone
VA-19-0799-D-000367
OS 00002033
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/20/2017 10:48:46 AM
Poonam Alaigh [(b) (6)
hotmail.com]; (b) (6)
(6)
Great picture
[(b) (6)
yahoo.com]
https ://www .heal thdatamanagement. com/news/va-tool-provi des-pati ent-wai t-times-quali ty-of-care-data
Sent from my iPad
VA-19-0799-D-000368
OS 00002034
Message
From:
Sent:
To:
CC:
Subject:
Marc Sherman [(b) (6)
gmail.com]
4/19/2017 12:45:01 AM
Bruce Moskowitz [(b) (6)
mac.com]
David shulkin [drshulkin@aol.com]; Poonam Alaigh [(b) (6)
[(b) (6) frenchangel59.com]
Re: (b) (6)
hotmail.com]; L Perl [(b) (6)
gmail.com]; IP
There is no equal!!!
Marc Sherman
(202) 758-(b) (6)
mac.com> wrote:
On Apr 18, 2017 8:05 PM, "Bruce Moskowitz" <(b) (6)
I am at dinner with an equal to David and Poonam. She has been with the VA 15 years and has done amazing
VA partnerships with IBM, Bristol Myers and is accomplishing in real time many of the initiatives we are
working on. Fantastically bright like David and Poonam.
Sent from my iPhone
VA-19-0799-D-000369
OS 00002035
Message
From:
(b) (6)
[(b) (6)
Sent:
To:
4/16/2017 4:04:40 PM
David Shulkin [drshulkin@aol.com]
Subject:
Re:
gmail.com]
I'll share there matrix they say it's a lot of events in May more than they have ever seen. Will print there
working sheet for you to see what they are working on. Some of it the items were not needed.
On Sun, Apr 16, 2017 at 9:20 AM David Shulkin wrote:
What could they possibly be doing? I don't get what they are doing
-----Original Message-----
From:
(b) (6)
<(b) (6)
gmail.com>
To: David Shulkin
Sent: Sat, Apr 15, 2017 7:20 pm
Subject: Re:
Yes. I told the speechwriters I would work on be they are overwhelmed.
VA-19-0799-D-000370
OS 00002036
On Sat, Apr 15, 2017 at 6:48 PM David Shulkin wrote:
Here are some slides for SMAG- we may need to fix them up
Sent from Gmail Mobile
Sent from Gmail Mobile
VA-19-0799-D-000371
OS 00002037
Message
To:
David Shulkin [drshulkin@aol.com]
4/16/2017 1:20:07 PM
(b) (6)
gmail.com
Subject:
Re:
From:
Sent:
What could they possibly be doing? I don't get what they are doing
-----Original Message----From: (b) (6)
<(b) (6)
To: David Shulkin
Sent: Sat, Apr 15, 2017 7:20 pm
Subject: Re:
gmail.com>
Yes. I told the speechwriters I would work on be they are overwhelmed.
On Sat, Apr 15, 2017 at 6:48 PM David Shulkin wrote:
Here are some slides for SMAG- we may need to fix them up
Sent from Gmail Mobile
VA-19-0799-D-000372
OS 00002038
Message
From:
(b) (6)
[(b) (6)
Sent:
To:
4/15/2017 11:20:14 PM
David Shulkin [drshulkin@aol.com]
Subject:
Re:
gmail.com]
Yes. I told the speechwriters I would work on be they are overwhelmed.
On Sat, Apr 15, 2017 at 6:48 PM David Shulkin wrote:
Here are some slides for SMAG- we may need to fix them up
Sent from Gmail Mobile
VA-19-0799-D-000373
OS 00002039
Message
From:
Sent:
To:
Attachments:
David Shulkin [drshulkin@aol.com]
4/15/2017 10:48:34 PM
(b) (6)
gmail.com
smag2017.pptx
Here are some slides for SMAG- we may need to fix them up
VA-19-0799-D-000374
OS 00002040
, IA
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ofVeterans Affairs
David J. Shulkin, MD
Secretary of Veterans Affairs
April 19, 2017
VA-19-0799-D-000375
OS 00002041
United's Response
Ill
r'::itertJayseDavid
4:51 PM ET
UNITED DRAGS PASSENGER FROM OVERBOOKED FLIGHT
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Draft/ Pre-dec1s1onal / For Internal VA Use Only
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VA-19-0799-D-000377
OS 00002043
We need Transformation Change and Actions
38
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VA-19-0799-D-000378
OS 00002044
V A'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
5
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VA-19-0799-D-000379
OS 00002045
1.
Greater Choice for Veterans
• Redesign the 40/30 Rule to use clinical
criteria for veteran choice
• Build a high-performing, integrated
network of ca re
• Empower Veterans through
transparency of information
~
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VA-19-0799-D-000380
OS 00002046
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Clinical Analytics and Choice Eligibility Board
Clinical Groupings
with Poor
Performance
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Offer Service
Foundational
Services
Clinical Groupings
with Good or
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I
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Whole Health Model of Care Coordination, Telehealth, Caregivers, Homelessness
Draft/ Pre-dec1s1onal / For Internal VA Use Only
7
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VA-19-0799-D-000381
OS 00002047
Veterans
Speak
with
their
Feet
VA must be
comparable
to the private
sector
lncrementamism is not the answer to additional improvements VA and Veterans need.
8
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VA-19-0799-D-000382
OS 00002048
Building a Seamless (Integrated) Network
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03330002049
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Modernize Our Systems
• Infrastructure improvements
and streamlining services
• EMR interoperability and IT
modernization
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VA-19-0799-D-000384
OS 00002050
Infrastructure Improvements
Gas Station
Minneapolis, MN
1932
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Circa 1895
11
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VA-19-0799-D-000385
OS 00002051
VA/DoD/Federal Coordination
VA and DoD Hospitals
12
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VA-19-0799-D-000386
OS 00002052
EMR Interoperability & Modernization
VistA Scheduling Enhancement
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The point here is VistA was outdated (left), so we've made some improvements (right), but what we really need is a new
system that's fully interoperable with what our partnering providers are already using.
VA-19-0799-D-000387
OS 00002053
3. Focus Resources More Efficiently
• Strengthening of foundational
services in VA
• VA/DOD/Community coordination
• Deliver on accountability and
effective management practices
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VA-19-0799-D-000388
OS 00002054
"World Class Foundational Services
15
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VA-19-0799-D-000389
OS 00002055
Accountability Legislation
Increased
flexibility to
remove,
demote,or
suspend VA
employees for
poor
performance or
misconduct.
Direct Hire for
Medical Center
Directors and
Network
Directors
Ability to fully
utilize our
relocation,
recruitment,
and retention
awards
Authority to
reccoop
relocation
expenses
authorized
through fraud
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Increased
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VA-19-0799-D-000390
OS 00002056
4. Improve Timeliness of Services
• Access to care and wait times
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VA-19-0799-D-000391
OS 00002057
How quickly does my VA see
patients?
How satisfied are veterans like
me with the timeliness of their
care?
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compare to other hospitals?
VA-19-0799-D-000392
OS 00002058
5- Suicide Prevention
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VA-19-0799-D-000393
OS 00002059
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VA-19-0799-D-000394
OS 00002060
Mental Health PSA
21
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The video will play as soon as you cue the next slide.
VA-19-0799-D-000395
OS 00002061
22
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VA-19-0799-D-000396
OS 00002062
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/18/2017 10:13:44 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Star ratings
Sent from my iPhone
Begin forwarded message:
From: "IP" <(b) (6) frenchangel59.com>
Date: April 18, 2017 at I :58:33 PM EDT
To: "'David shulkin"'
Cc: "'Bruce Moskowitz'" <(b) (6)
Subject: RE: Star ratings
mac.com>
Can we please do the top 30 right away? Thank you.
-----Original Message----From: David shulkin [mailto:Drshulkin@aol.com]
Sent: Tuesday, April 18, 2017 I: 52 PM
To: Ike Perlmutter
Cc: Bruce Moskowitz
Subject: Star ratings
The date that we will have comparable quality data with the private sector
is July 1st.
We have to rely upon Medicare to do this as its their data set. We are
calling Medicare to see if they can accelerate this.
David
Sent from my iPhone
VA-19-0799-D-000397
OS 00002063
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/18/2017 6:49:37 PM
To:
IP [(b) (6) frenchangel59.com]
Bruce Moskowitz [(b) (6)
mac.com]
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Star ratings
CC:
BCC:
Subject:
The problem is that we need the data on the other hospitals from Medicare- we are pushing them to give us
this faster than July 1
We are working on another way to get this soonerdeliver- but we are trying
didnt want to commit to this until I know we can
Sent from my iPhone
> on Apr 18, 2017, at 1:58 PM, IP <(b) (6) frenchangel59.com> wrote:
>
> can we please do the top 30 right away? Thank you.
>
>
>
>
>
>
>
-----original Message----From: David shulkin [mailto:Drshulkin@aol .com]
Sent: Tuesday, April 18, 2017 1:52 PM
To: Ike Perlmutter
cc: Bruce Moskowitz
subject: Star ratings
>
> The date that we will have comparable quality data with the private sector
> is July 1st.
>
> We have to rely upon Medicare to do this as its their data set.
> calling Medicare to see if they can accelerate this.
We are
>
> David
>
> Sent from my iPhone
>
VA-19-0799-D-000398
OS 00002064
Message
From:
Sent:
To:
CC:
Subject:
IP [(b) (6) frenchangel59.com]
4/18/2017 5:58:33 PM
'David shulkin' [Drshulkin@aol.com]
'Bruce Moskowitz' [(b) (6)
RE: Star ratings
mac.com]
can we please do the top 30 right away? Thank you.
-----original Message----From: David shulkin [mailto:Drshulkin@aol .com]
Sent: Tuesday, April 18, 2017 1:52 PM
To: Ike Perlmutter
cc: Bruce Moskowitz
subject: Star ratings
The date that we will have comparable quality data with the private sector
is July 1st.
We have to rely upon Medicare to do this as its their data set.
calling Medicare to see if they can accelerate this.
We are
David
Sent from my iPhone
VA-19-0799-D-000399
OS 00002065
Message
David shulkin [Drshulkin@aol.com]
4/26/2017 12:01:48 PM
Poonam Alaigh [(b) (6)
hotmail.com]
From:
Sent:
To:
(b) (6)
(b) (6)
will come
Sent from my iPhone
VA-19-0799-D-000400
OS 00002066
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/28/2017 8:04:38 PM
Poonam Alaigh [(b) (6)
hotmail.com]
David Shulkin [drshulkin@aol.com]; (b) (6)
aol.com
Re: Baltimore meeting
Thank you.
Sent from my iPad
Bruce Moskowitz M.D.
> on Apr 28, 2017, at 4:00 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Just spoke to my internal team and May 15 is confirmed on our end. We have the wheels in motion
already- you can let your team know. (b) (6) will help coordinate the effort on my behalf here. The meeting
will be at the Baltimore Medical Center. Details to follow- thanks a ton
>
> Sent from my iPhone
>
>> on Apr 28, 2017, at 2:25 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>>
>> our contingent needs to know if May 15 works especially the large group traveling form Kaiser. I would
like to get back to them this weekend if possible. Thank you
>>
>> Sent from my iPad
>> Bruce Moskowitz M.D.
VA-19-0799-D-000401
OS 00002067
Message
Poonam Alaigh [(b) (6)
hotmail.com]
4/28/2017 6:34:52 PM
David Shulkin [drshulkin@aol.com]
Fwd: Baltimore meeting
From:
Sent:
To:
Subject:
Let's discuss
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 28, 2017 at 2:25:22 PM EDT
To: Poonam Alaigh <(b) (6)
hotmail.com>
Subject: Baltimore meeting
mac.com>
Our contingent needs to know if May 15 works especially the large group traveling form Kaiser.
I would like to get back to them this weekend if possible. Thank you
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000402
OS 00002068
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/19/2017 11:36:07 PM
(b) (6)
[(b) (6)
Re: Checking In
gmail.com]
Let's look at the organization and the size of their meetings first
Sent from my iPad
On Apr 19, 2017, at 7:27 PM, (b) (6)
<(b) (6)
gmail.com> wrote:
Do you want to do this? I'll look at the date tmrw
On Wed, Apr 19, 2017 at 7:26 PM David shulkin wrote:
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
msn.com>
Date: April 19, 2017 at 12:44: 14 PM EDT
To: David Shulkin
Subject: Checking In
David, I do hope you are addressing the challenges of your position with your
usual energy and enthusiasm and drive to attain palpable results. Need to ask
how did your meeting today with Mr. Trump go?
The Hospital Planning & Marketing Society of NJ wants to present you with an
award and have you deliver the key note address at their December 1 Annual
Meeting in Princeton.
You suggested to reach out and check in when things "settled down". Are we
there yet?
Hope to hear back when you have a chance to take a breath.
Best regards
(b) (6)
Sent from Gmail Mobile
VA-19-0799-D-000403
OS 00002069
Message
From:
(b) (6)
Sent:
4/19/2017 11:27:07 PM
David shulkin [Drshulkin@aol.com]
Re: Checking In
To:
Subject:
[(b) (6)
gmail.com]
Do you want to do this? I'll look at the date tmrw
On Wed, Apr 19, 2017 at 7:26 PM David shulkin wrote:
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
msn.com>
Date: April 19, 2017 at 12:44: 14 PM EDT
To: David Shulkin
Subject: Checking In
David, I do hope you are addressing the challenges of your position with your usual energy and
enthusiasm and drive to attain palpable results. Need to ask how did your meeting today with
Mr. Trump go?
The Hospital Planning & Marketing Society of NJ wants to present you with an award and have
you deliver the key note address at their December 1 Annual Meeting in Princeton.
You suggested to reach out and check in when things "settled down". Are we there yet?
Hope to hear back when you have a chance to take a breath.
Best regards
(b) (6)
Sent from Gmail Mobile
VA-19-0799-D-000404
OS 00002070
Message
David shulkin [Drshulkin@aol.com]
4/19/2017 11:26:16 PM
(b) (6)
[(b) (6)
Fwd: Checking In
From:
Sent:
To:
Subject:
gmail.com]
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
msn.com>
Date: April 19, 2017 at 12:44: 14 PM EDT
To: David Shulkin
Subject: Checking In
David, I do hope you are addressing the challenges of your position with your usual energy and
enthusiasm and drive to attain palpable results. Need to ask how did your meeting today with
Mr. Trump go?
The Hospital Planning & Marketing Society of NJ wants to present you with an award and have
you deliver the key note address at their December 1 Annual Meeting in Princeton.
You suggested to reach out and check in when things "settled down". Are we there yet?
Hope to hear back when you have a chance to take a breath.
Best regards
(b) (6)
VA-19-0799-D-000405
OS 00002071
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/22/2017 3:47:14 PM
IP [(b) (6) frenchangel59.com]; brucem(b) (6)
@mac.com; mbs(b) (6)
@gmail.com; David shulkin
[drshulkin@aol.com]
lperl(b) (6) @gmail.com
Re: Remarks by President Trump at Signing of S. 544, The Veterans Choice Program Extension and Improvement Act
Thanks for keeping us in the loop. We are in the meantime working with a SWAT team to make sure there are
no additional vulnerabilities around patient safety related to the inventory management system especially
since there has been a recent transition of the software for the system
Hopefully we will meet next week and can catch up some more. Bruce is arranging for us to discuss with
Hopkins best practices simultaneously. It would be great if you can send along some good leads for a Chief
Logistics Officer located here in DC to be part of our team. If we meet with the Big Five this week, I will be sure
to address with them too.
Ike, I cant thank you enough for your guidance. David and I have been talking constantly to make sure with can
assemble the right and trusted team in the VA around us.
Laurie and team, looking forward to spending some quality time soon, and possibly this coming week. Also, a
gentle reminder to bring me a signed copy of Ike's book.
Thanks
From: IP <(b) (6) frenchangel59.com>
Sent: Thursday, April 20, 2017 10:53 AM
To: brucem(b) (6)
@mac.com; mbs(b) (6)
@gmail.com; Poonam Alaigh; David shulkin
Cc: lperl(b) (6) @gmail.com
Subject: FW: Remarks by President Trump at Signing of S. 544, The Veterans Choice Program Extension and
Improvement Act
FYI
From: IP [mailto:(b) (6) frenchangel59.com]
Sent: Thursday, April 20, 2017 10:38 AM
To: (b) (6)
who.eop.gov; (b) (6)
who.eop.gov; (b) (6)
who.eop.gov
Cc: (b) (6)
gmail.com
Subject: Remarks by President Trump at Signing of S. 544, The Veterans Choice Program Extension and Improvement
Act
Jared, (b) (6)
and (b) (6)
VA-19-0799-D-000406
OS 00002072
First, thank you so much for everything you have done and are doing to enhance the efforts to transform
Veterans Affairs. Your contributions are so critical to its success.
On December 27, 2016, a number of us had a meeting with the then President Elect and presented to him a
plan to transform the VA for our deserving Veterans. Step one of that plan was to extend, and then to
enhance, the Veterans Choice Program. Well, yesterday, when the President signed the extension of the
Choice Act, we entered the passageway toward making that plan a reality. And, as the media noted, the
bigger changes will come this fall when a "Choice 2.0" revamp of the program is unveiled to allow more
outside care options.
The procurement issue for the EHR contract is very closely tied to the success of the Choice Program and
especially Choice 2.0. That needs to be solved without delay if we plan to climb any further up the hill. That is
the very kind of impediment on which we need your laser focus and your continued and swift assistance and
resolution. What are your thoughts on timing to get that solved?
While yesterday's accomplishments are a pivotal achievement; in reality, we are just at the beginning of a long
uphill climb. And for that climb your help and focus on the VA is more important than ever. I hope we can
count on you to keep that focus and sense of urgency toward our shared goal of a transformed VA.
Ike
https ://m.youtube.com/watch?v=AufMXIGtr-O
Trump Signs Veterans Health Choice
Program Extension - Full Ceremony And
Remarks
m.youtube.com
President Donald Trump signed a bill Wednesday to
temporarily extend a program that lets some veterans seek
medical care in the private sector, part of an ef...
--------------------·································································································································································································
http ://www.militarytimes.com/articles/trump-va-reform-veterans-affairs-choice-card
VA-19-0799-D-000407
OS 00002073
Trump extends vets access to privatized
health care
1
www.militarytimes.com
The Choice Card program allows vets to seek medical care
outside VA facilities.
http ://www.washingtontimes.com/news/2017/apr/ 19/donald-trump-signs-extension-veterans-choice-healt/
http ://abcnews.go.com/Health/wireStory/trump-extends-private-sector-health-care-program-vets-46887778
Trump
extends
privatesector
health care
program
for vets
abcnews.go.com
President
Donald Trump
signed a bill
Wednesday to
temporarily
extend a
program that
lets some
veterans seek
medical care in
the private
sector, part of
VA-19-0799-D-000408
OS 00002074
an effort by the
president to
deliver on a
campaign
promise. The
extension will
give Veterans
Affairs Secretary
David Shulkin
time to ...
From: White House Press Office
Date: April 19, 2017 at 1 :33:08 PM EDT
Subject: Remarks by President Trump at Signing of S. 544, The Veterans Choice Program
Extension and Improvement Act
Reply-To:
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
April 19, 2017
REMARKS BY PRESIDENT TRUMP
AT SIGNING OF S. 544, THE VETERANS CHOICE PROGRAM EXTENSION AND IMPROVEMENT
ACT
Roosevelt Room
VA-19-0799-D-000409
OS 00002075
11 :32 AM. EDT
THE PRESIDENT: Good morning. We're honored to join and be joined today by some absolutely
tremendous people and great veterans. Thanks, as well -- and I have to thank them dearly -- but as well to
Representative Phil Roe. Where is he? What a job you've done. And all the members of Congress who worked
on the bill that we're about to sign. Such an important bill.
I especially want to thank Senator John McCain and Senator Johnny Isaacson. They have been incredible in
working with us. Let me also welcome my good friend, Florida Governor Rick Scott, a Navy veteran who's
here with us to represent more than a million veterans from the state of Florida. We're also joined by the leaders
of a number of veterans groups. I want to thank all of them for being here and all of the tremendous and
important work that they do. We would not be here if it weren't for them, I can tell you that.
Finally, I want to thank our Secretary of the VA, David Shulkin, who, by the way, was approved with a vote
of 100 to nothing. That's shocking, right? (Laughter.) One hundred to nothing, really. Now, you wouldn't be
getting 100 to nothing. (Laughter.)
We met earlier today in the Oval Office, and Secretary Shulkin updated me on the massive and chronic
challenge he inherited at the VA, but also the great progress that he is making. He's got a group of people that
are phenomenal at the VA It's one of my most important things. I've been telling all of our friends at speeches
and rallies for two years about the VA, how we're going to tum it around. And we're doing that.
And, actually, next week, on Thursday at 2 o'clock, we're going to have a news conference with David and
some others to tell you about all of the tremendous things that are happening at the VA and what we've done in
terms of progress and achievement.
The veterans have poured out their sweat and blood and tears for this country for so long, and it's time that
they're recognized, and it's time that we now take care of them, and take care of them properly.
That's why I'm pleased today to sign into law the Veterans Choice Program Improvement Act. So this is
called the Choice Program Improvement Act. It speaks for itself. This bill will extend and improve the
Veterans Choice Program so that more veterans can see the doctor of their choice -- you got it? The doctor of
their choice -- and don't have to wait and travel long distances for VA care. Some people have to travel five
VA-19-0799-D-000410
OS 00002076
hours, eight hours, and they'll have to do it on a weekly basis, and even worse than that. It's not going to happen
anymore.
This new law is a good start, but there is still much work to do. We will fight each and every day to deliver
the long-awaited reforms our veterans deserve, and to protect those who have so courageously protected each
and every one of us.
So we've made a lot of strides for the veterans. These are, like, the most incredible people we have in our
country as far as I'm concerned, and they have not been taken care of properly.
I want to thank David. You've done an incredible job. And you're going to see some of that on
Thursday. So thank you all very much. And we're going to sign this. And I think I'm going to have to give
this pen -- the way I look at it, we should probably give it to Phil. What do you think?
PARTICIPANT: I agree.
THE PRESIDENT: Does everybody agree? I think Phil is --
REPRESENTATIVE ROE: I'll agree with that. (Laughter.)
THE PRESIDENT: Phil agrees. But congratulations, everybody. Really fantastic. Thank you very much.
(Bill is signed.) (Applause.)
Phil, maybe you could say a few words, if you'd like.
VA-19-0799-D-000411
OS 00002077
REPRESENTATIVE ROE: Well, Mr. President, thank you very much. And this was a very, very important
bill to get started with so we can get Choice 2.0 to get to the place exactly where the President said he wanted to
be. And it's a privilege to work with all of these great people up here to help make the VA better.
I've spent the last week on the break going to Los Angeles and Phoenix to get a firsthand view of what's
going on. And what we want to do is put the veteran in charge of these choices, not the bureaucracy. And I
think Dr. Shulkin is just the person to see that happen. Mr. President, thank you so much.
THE PRESIDENT: Thank you very much. It's fantastic.
And David? Where's David?
DR. SHULKIN: Yeah, I'm right behind you, Mr. President.
THE PRESIDENT: Go ahead. I won't look back. You just talk. (Laughter.)
DR. SHULKIN: Well, first of all, I want to thank everybody here as well, and thank Congress for
seeing this done, and Mr. President to be signing this.
This is a good day for veterans. This is a great day to celebrate not only what veterans have contributed
to the country, but how we're making things better for them. And by working together, we're going to continue
this progress. I think, as the President said, we're actually going to do this a week from Thursday, Mr.
President --
THE PRESIDENT: Right.
DR. SHULKIN: -- and talk about the tremendous accomplishments, but most importantly, about the
great things that are to come to fulfill the President's commitments that he made to veterans. And so thank you
all for being here today.
VA-19-0799-D-000412
OS 00002078
THE PRESIDENT: Thank you. Great job. So again, next week, on Thursday, at 2 o'clock -- it may
change a little bit, but about that time we're going to have a conference to talk about the progress and the
achievement.
I'd like to ask Rick Scott, the governor of Florida -- he's done a fantastic job as governor, by the way,
and really understands his subject, and really understands a lot of subjects. Rick, do you want to say a few
words?
GOVERNOR SCOTT: Sure. Well, I was really proud. My father was in the 82nd Airborne, he did all
the combat jumps, and I grew up listening to all his stories about the war. I had the opportunity to serve in the
Navy. Unfortunately, in 2014, I had to sue the VA because we had -- our state healthcare agency couldn't go
inspect their hospitals when we heard all the stories about deaths, delays, and poor conditions.
And so Mr. President and I want to thank Congress for doing this to create certainty of care while we
figure out how to fix the VA system. And David, I want to thank you for what you' re doing. You've got
actually the right background to do this. I know President Trump has been focused on our veterans and our
military before he was President, and I know he's going to continue to do a great job. We have 1.5 million
veterans. I want them all to move to Florida. (Laughter.) But thank you for doing this, Mr. President.
THE PRESIDENT: Thank you very much.
Most importantly, thank you, thank all of the great veterans. Would you like to say something to all of
these people out there? You'll become a movie star tomorrow. (Laughter.)
PARTICIPANT: Well, our nation will be judged by how it treats its veterans, and I'm sure our country
will allow generations -- right now, they're children, but they're going to be our future servicemen. And so we
have to treat veterans well. It's about national security, it's about patriotism, and this is a great step forward to
doing it.
THE PRESIDENT: Thank you very much. Nobody can say it better than that, so we're going to
end. But I want to just thank you all. Thank you for being here. Thank you. (Applause.)
END
11:40 AM. EDT
VA-19-0799-D-000413
OS 00002079
Unsubscribe
The White House · 1600 Pennsylvania Avenue, NW· Washington DC 20500 · 202-456-1111
VA-19-0799-D-000414
OS 00002080
Message
From:
Sent:
To:
CC:
Subject:
IP [(b) (6) frenchangel59.com]
4/20/2017 2:53:24 PM
brucem(b) (6)
@mac.com; mbs(b) (6)
@gmail.com; Poonam Alaigh [(b) (6)
hotmail.com]; David shulkin
[drshulkin@aol.com]
lperl(b) (6) @gmail.com
FW: Remarks by President Trump at Signing of S. 544, The Veterans Choice Program Extension and Improvement Act
FYI
From: IP [mailto:(b) (6) frenchangel59.com]
Sent: Thursday, April 20, 2017 10:38 AM
(b) (6)
(b) (6)
To: (b) (6)
who.eop.gov; (b) (6)
who.eop.gov; (b) (6)
who.eop.gov
(b) (6)
Cc:
gmail.com
Subject: Remarks by President Trump at Signing of S. 544, The Veterans Choice Program Extension and Improvement
Act
Jared, (b) (6)
and (b) (6)
First, thank you so much for everything you have done and are doing to enhance the efforts to transform
Veterans Affairs. Your contributions are so critical to its success.
On December 27, 2016, a number of us had a meeting with the then President Elect and presented to him a
plan to transform the VA for our deserving Veterans. Step one of that plan was to extend, and then to
enhance, the Veterans Choice Program. Well, yesterday, when the President signed the extension of the
Choice Act, we entered the passageway toward making that plan a reality. And, as the media noted, the
bigger changes will come this fall when a "Choice 2.0" revamp of the program is unveiled to allow more
outside care options.
The procurement issue for the EHR contract is very closely tied to the success of the Choice Program and
especially Choice 2.0. That needs to be solved without delay if we plan to climb any further up the hill. That is
the very kind of impediment on which we need your laser focus and your continued and swift assistance and
resolution. What are your thoughts on timing to get that solved?
While yesterday's accomplishments are a pivotal achievement; in reality, we are just at the beginning of a long
uphill climb. And for that climb your help and focus on the VA is more important than ever. I hope we can
count on you to keep that focus and sense of urgency toward our shared goal of a transformed VA.
Ike
https ://m.youtube.com/watch?v=AufMXIGtr-O
http ://www.militarytimes.com/articles/trump-va-reform-veterans-affairs-choice-card
http ://www.washingtontimes.com/news/2017/apr/ 19/donald-trump-signs-extension-veterans-choice-healt/
http ://abcnew s.go.com/Health/wireStory/trump-extends-private-sector-health-care-program-vets-46887778
VA-19-0799-D-000415
OS 00002081
From: White House Press Office
Date: April 19, 2017 at 1:33:08 PM EDT
Subject: Remarks by President Trump at Signing of S. 544, The
Veterans Choice Program Extension and Improvement Act
Reply-To:
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
April 19, 2017
REMARKS BY PRESIDENT TRUMP
AT SIGNING OF S. 544, THE VETERANS CHOICE PROGRAM EXTENSION AND
IMPROVEMENT ACT
Roosevelt Room
11:32 A.M. EDT
THE PRESIDENT:
Good morning. We're honored to join and be joined
today by some absolutely tremendous people and great veterans.
Thanks, as
well -- and I have to thank them dearly -- but as well to Representative
Phil Roe. Where is he? What a job you've done. And all the members of
Congress who worked on the bill that we're about to sign.
Such an
important bill.
I especially want to thank Senator John McCain and Senator Johnny
Isaacson.
They have been incredible in working with us.
Let me also
welcome my good friend, Florida Governor Rick Scott, a Navy veteran who's
here with us to represent more than a million veterans from the state of
Florida. We're also joined by the leaders of a number of veterans
groups.
I want to thank all of them for being here and all of the
tremendous and important work that they do. We would not be here if it
weren't for them, I can tell you that.
Finally, I want to thank our Secretary of the VA, David Shulkin, who,
by the way, was approved with a vote of 100 to nothing.
That's shocking,
right?
(Laughter.)
One hundred to nothing, really. Now, you wouldn't be
getting 100 to nothing.
(Laughter.)
We met earlier today in the Oval Office, and Secretary Shulkin
updated me on the massive and chronic challenge he inherited at the VA,
but also the great progress that he is making. He's got a group of people
that are phenomenal at the VA.
It's one of my most important
things.
I've been telling all of our friends at speeches and rallies for
two years about the VA, how we're going to turn it around. And we're
doing that.
VA-19-0799-D-000416
OS 00002082
And, actually, next week, on Thursday at 2 o'clock, we're going to
have a news conference with David and some others to tell you about all of
the tremendous things that are happening at the VA and what we've done in
terms of progress and achievement.
The veterans have poured out their sweat and blood and tears for this
country for so long, and it's time that they're recognized, and it's time
that we now take care of them, and take care of them properly.
That's why I'm pleased today to sign into law the Veterans Choice
Program Improvement Act.
So this is called the Choice Program Improvement
Act.
It speaks for itself.
This bill will extend and improve the
Veterans Choice Program so that more veterans can see the doctor of their
choice -- you got it? The doctor of their choice -- and don't have to
wait and travel long distances for VA care.
Some people have to travel
five hours, eight hours, and they'll have to do it on a weekly basis, and
even worse than that.
It's not going to happen anymore.
This new law is a good start, but there is still much work to do. We
will fight each and every day to deliver the long-awaited reforms our
veterans deserve, and to protect those who have so courageously protected
each and every one of us.
So we've made a lot of strides for the veterans.
These are, like,
the most incredible people we have in our country as far as I'm concerned,
and they have not been taken care of properly.
I want to thank David. You've done an incredible job. And you're
going to see some of that on Thursday.
So thank you all very much. And
we're going to sign this. And I think I'm going to have to give this pen
-- the way I look at it, we should probably give it to Phil. What do you
think?
PARTICIPANT:
THE PRESIDENT:
I agree.
Does everybody agree?
REPRESENTATIVE ROE:
I'll agree with that.
THE PRESIDENT:
Phil agrees.
fantastic.
Thank you very much.
(Bill is signed.)
I think Phil is -(Laughter.)
But congratulations, everybody.
Really
(Applause.)
Phil, maybe you could say a few words, if you'd like.
REPRESENTATIVE ROE:
Well, Mr. President, thank you very much. And
this was a very, very important bill to get started with so we can get
Choice 2.0 to get to the place exactly where the President said he wanted
VA-19-0799-D-000417
OS 00002083
to be. And it's a privilege to work with all of these great people up
here to help make the VA better.
I've spent the last week on the break going to Los Angeles and
Phoenix to get a firsthand view of what's going on. And what we want to
do is put the veteran in charge of these choices, not the
bureaucracy. And I think Dr. Shulkin is just the person to see that
happen. Mr. President, thank you so much.
THE PRESIDENT:
And David?
Thank you very much.
It's fantastic.
Where's David?
DR. SHULKIN:
THE PRESIDENT:
talk.
(Laughter.)
Yeah, I'm right behind you, Mr. President.
Go ahead.
I won't look back.
You just
DR. SHULKIN: Well, first of all, I want to thank everybody here as
well, and thank Congress for seeing this done, and Mr. President to be
signing this.
This is a good day for veterans.
This is a great day to celebrate
not only what veterans have contributed to the country, but how we're
making things better for them. And by working together, we're going to
continue this progress.
I think, as the President said, we're actually
going to do this a week from Thursday, Mr. President -THE PRESIDENT:
Right.
DR. SHULKIN:
-- and talk about the tremendous accomplishments, but
most importantly, about the great things that are to come to fulfill the
President's commitments that he made to veterans. And so thank you all
for being here today.
THE PRESIDENT:
Thank you.
Great job. So again, next week, on
Thursday, at 2 o'clock -- it may change a little bit, but about that time
we're going to have a conference to talk about the progress and the
achievement.
I'd like to ask Rick Scott, the governor of Florida -- he's done a
fantastic job as governor, by the way, and really understands his subject,
and really understands a lot of subjects. Rick, do you want to say a few
words?
GOVERNOR SCOTT:
Sure. Well, I was really proud. My father was in
the 82nd Airborne, he did all the combat jumps, and I grew up listening to
all his stories about the war.
I had the opportunity to serve in the
Navy. Unfortunately, in 2014, I had to sue the VA because we had -- our
state healthcare agency couldn't go inspect their hospitals when we heard
all the stories about deaths, delays, and poor conditions.
VA-19-0799-D-000418
OS 00002084
And so Mr. President and I want to thank Congress for doing this to
create certainty of care while we figure out how to fix the VA
system. And David, I want to thank you for what you're doing. You've got
actually the right background to do this.
I know President Trump has been
focused on our veterans and our military before he was President, and I
know he's going to continue to do a great job. We have 1.5 million
veterans.
I want them all to move to Florida.
(Laughter.)
But thank you
for doing this, Mr. President.
THE PRESIDENT:
Thank you very much.
Most importantly, thank you, thank all of the great veterans. Would
you like to say something to all of these people out there? You'll become
a movie star tomorrow.
(Laughter.)
PARTICIPANT: Well, our nation will be judged by how it treats its
veterans, and I'm sure our country will allow generations -- right now,
they're children, but they're going to be our future servicemen. And so
we have to treat veterans well.
It's about national security, it's about
patriotism, and this is a great step forward to doing it.
THE PRESIDENT:
Thank you very much. Nobody can say it better than
that, so we're going to end. But I want to just thank you all.
Thank you
for being here.
Thank you.
(Applause.)
END
11:40 A.M. EDT
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The White House · 1600 Pennsylvania Avenue, NW· Washington DC 20500 · 202-456-1111
VA-19-0799-D-000419
OS 00002085
Message
From:
Sent:
To:
CC:
Subject:
Attachments:
Poonam Alaigh [(b) (6)
hotmail.com]
4/28/2017 7:17:06 PM
David Shulkin [drshulkin@aol.com]; David Shulkin [david.shulkin@va.gov]
(b) (6)
va.gov
Fwd: updated datapalooza slides
Datapalooza draft 3.pptx; ATT0000l.htm
I used these slides today- please update your access website slides
Sent from my iPhone
Begin forwarded message:
<(b) (6)
va.gov>
From: "(b) (6)
To: "VHA USH Meeting Requests"
Cc: "Alaigh, Poonam, M.D." , "Poonam Alaigh ((b) (6)
<(b) (6)
hotmail.com )"
hotmail.com >
Subject: updated datapalooza slides
VA-19-0799-D-000420
OS 00002086
Datapalooza
Presented by Dr. Poonam Alaigh, Acting Under Secretary for Health
Datapalooza
4/28/2017
VAi
Defining
HEALTH
EXCB.LENCE
CARE in the 21S1: Century
Veterans Health
Administration
0
VA-19-0799-D-000421
OS 00002087
,.,,;
$
Greater Choice
•
•
•
VA Telehealth
MyHealtheVet
VA Mobile Apps
~
Modernize Systems
.:E-0
•
•
•
eHMP
JLV
EHR
41~~
Efficiency
•
MVP
•
•
Big Data
Precision Medicine
•••
•••
•••
Improve Timeliness
Suicide Prevention
•
•
•
Accesstocare@va.gov
ReachVet
Telemental Health Hubs
VA-19-0799-D-000422
OS 00002088
Access and Quality in
V 'I_Healthcare~
........ 1.r.... ,_~
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visit AccesstoCare.va.gov
~
ACC ESSTO CARE.VA.GOV
2
VA-19-0799-D-000423
OS 00002089
AVERAGE LOCAL CLINIC
WAIT TIMES
VETERAN SATISFACTION
WITH ACCESS
Average Wait Times at Individual Facilities
What Veterans Say About Access to Care
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Show More
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VETERANS HEALTH ADMINISTRATION
3
VA-19-0799-D-000424
OS 00002090
Veterans can learn about timeliness in the VA system ...
A.ccess .md Qua ,iy in
I/A He.lllthcare~
...1111.. - .
_
•
~
Review Nati onal Data
on Wa it Times
How satisfied are Veterans
with their care in my facility?
Review National Data
on Access to Specialty Care
I
How is the VA system doing
with access nationally?
~
visit AccesstoCa re.va .gov
~
select your topic
select sub-topic
view t he res ults
Veterans can learn about average local wait times ...
How quickly can my
VA facility see me?
-Vf
~
How does care in my VA facility
compare to other hospitals in
the area?
Location ... 1
Radius ... I
Clinic Type ... I
Visit Type .. - I
How satisfied are Veterans
with their care in my facility?
visit A ccesstoCare.va.gov
~
Sort by... l
How is the VA system doing
with access nationally?
Search
se lect y o u r top ic
ente r t ex t to pinpoint d ata
~
4
VA-19-0799-D-000425
OS 00002091
•
This is a work in progress and we are working hard to make it better for
Veterans
•
If you have expertise in communicating complex information to broad
stakeholders or user testing please reach out
•
Contact VHA10E2Action@va .gov with insights, feedback, or general interest
VETERANS HEALTH ADMINISTRATION
5
VA-19-0799-D-000426
OS 00002092
Message
From:
Sent:
To:
Subject:
Marisol Garcia [(b) (6) frenchangel59.com]
4/15/2017 10:43:56 AM
L Perl [(b) (6)
gmail.com]; (b) (6)
hotmail.com; David shulkin [Drshulkin@aol.com]; Bruce Moskowitz
(b)
(6)
[
mac.com]; mbs(b) (6)
@gmail.com; (b) (6) frenchangel59.com; (b) (6)
va.gov
FRIENDLY REMINDER - VA Conference Call TODAY - Saturday, April 15th @10:00AM
Saturday, April 15 th
10:00 AM -10:45 AM ESli
Dial-in Information:
(b) (6)
US: 1-866-244-
(b) (6)
International: 719-457Passcode:
(b) (6)
Participants:
Laurie Perlmutter, Poonam Alaigh, Secretary David
Shulkin, Dr. Bruce Moskowitz, Marc Sherman and Ike
Thank you,
Marisol Garcia
212-576-(b) (6)
(646) 201-(b) (6)
(b) (6)
(Office)
(Cell)
frenchangel59.com
VA-19-0799-D-000428
OS 00002094
Message
From:
(b) (6)
Sent:
4/14/2017 9:59:18 PM
David Shulkin [drshulkin@aol.com]
Fya article from today
To:
Subject:
[(b) (6)
gmail.com]
http ://www.lehighvalleylive.com/allentown/index.ssf/2017/04/veterans affairs secretary vis.html
VA-19-0799-D-000429
OS 00002095
Message
David shulkin [Drshulkin@aol.com]
From:
Sent:
4/13/2017 4:34:18 PM
To:
(b) (6)
[(b) (6)
Fwd: [EXTERNAL] (b) (6)
Subject:
va.gov]
Fyi
Sent from my iPhone
Begin forwarded message:
RDML USN WHMO/WHMU" <(b) (6)
From: "(b) (6)
Date: April 13, 2017 at 12:20:42 PM EDT
To: David shulkin
Subject: RE: [EXTERNAL] (b) (6)
whmo.mil>
David,
Meant to send this to you yesterday. Suspect you may have intended it for the other
BTW, everyone loves what you are doing over there and you are making great headlines! Hope to see
you soon.
R/
(b) (6)
From: David shulkin [mailto:Drshulkin@aol.com ]
Sent: Wednesday, April 12, 2017 10:43 AM
To: Bruce Moskowitz <(b) (6)
mac.com >
Cc:
RDML USN WHMO/WHMU <(b) (6)
Subject: Re: [EXTERNAL] (b) (6)
(b) (6)
whmo.mil >
My office is working on it
I have a keynote to 1000 people till 2 but then could get to a meeting
We have some rearranging to do but will work on it
Sent from my iPhone
On Apr 12, 2017, at 8:58 AM, Bruce Moskowitz <(b) (6)
Mr. (b) (6)
mac.com> wrote:
asked if you can attend the Bethesda meeting.
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
From: "(b) (6)
<(b) (6)
Date: April 12, 2017 at 8:53:59 AM EDT
va.gov>
VA-19-0799-D-000430
OS 00002096
To: Bruce Moskowitz <(b) (6)
Subject: RE: [EXTERNAL] (b) (6)
Yes. Good call with (b) (6)
Meeting with (b) (6)
around 2 or 3pm.
mac.com>
Have call with (b) (6)
today.
et al: Friday, 28 April. Details TBD. Likely at
(b) (6)
805 551
(b) (6)
-----Original Message----F rom: Bruce Moskowitz [mailto:(b) (6)
Sent: Wednesday, April 12, 2017 8:40 AM
To: (b) (6)
Subject: [EXTERNAL] (b) (6)
mac.com]
Spoke to him today. When is the meeting at Bethesda?
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000431
OS 00002097
Message
From:
(b) (6)
Sent:
4/13/2017 4:20:42 PM
To:
David shulkin [Drshulkin@aol.com]
RE: [EXTERNAL] (b) (6)
Subject:
RDML USN WHMO/WHMU [(b) (6)
whmo.mil]
David,
Meant to send this to you yesterday. Suspect you may have intended it for the other
BTW, everyone loves what you are doing over there and you are making great headlines! Hope to see you soon.
R/
(b) (6)
From: David shulkin [mailto:Drshulkin@aol.com]
Sent: Wednesday, April 12, 2017 10:43 AM
To: Bruce Moskowitz <(b) (6)
mac.com>
RDML USN WHMO/WHMU <(b) (6)
Subject: Re: [EXTERNAL] (b) (6)
Cc: (b) (6)
whmo.mil>
My office is working on it
I have a keynote to 1000 people till 2 but then could get to a meeting
We have some rearranging to do but will work on it
Sent from my iPhone
On Apr 12, 2017, at 8:58 AM, Bruce Moskowitz <(b) (6)
Mr. (b) (6)
mac.com> wrote:
asked if you can attend the Bethesda meeting.
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
From: "(b) (6)
<(b) (6)
Date: April 12, 2017 at 8:53:59 AM EDT
To: Bruce Moskowitz <(b) (6)
Subject: RE: [EXTERNAL] (b) (6)
Yes. Good call with (b) (6)
Meeting with (b) (6)
3pm.
Have call with (b) (6)
va.gov>
mac.com>
today.
et al: Friday, 28 April. Details TBD. Likely at around 2 or
(b) (6)
805 551
(b) (6)
-----Original Message----VA-19-0799-D-000432
OS 00002098
From: Bruce Moskowitz [mailto:(b) (6)
Sent: Wednesday, April 12, 2017 8:40 AM
To: (b) (6)
Subject: [EXTERNAL] (b) (6)
mac.com]
Spoke to him today. When is the meeting at Bethesda?
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000433
OS 00002099
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/12/2017 2:42:36 PM
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
L. RDML USN WHMO/WHMU Jackson [(b) (6)
Re: [EXTERNAL] (b) (6)
(b) (6)
whmo.mil]
My office is working on it
I have a keynote to 1000 people till 2 but then could get to a meeting
We have some rearranging to do but will work on it
Sent from my iPhone
On Apr 12, 2017, at 8:58 AM, Bruce Moskowitz <(b) (6)
Mr. (b) (6)
mac.com> wrote:
asked if you can attend the Bethesda meeting.
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
From: "(b) (6)
<(b) (6)
Date: April 12, 2017 at 8:53:59 AM EDT
To: Bruce Moskowitz <(b) (6)
Subject: RE: [EXTERNAL] (b) (6)
Yes. Good call with (b) (6)
Meeting with (b) (6)
3pm.
va.gov>
mac.com>
Have call with (b) (6)
today.
et al: Friday, 28 April. Details TBD. Likely at around 2 or
(b) (6)
805 551
(b) (6)
-----Original Message----F rom: Bruce Moskowitz [mailto:(b) (6)
Sent: Wednesday, April 12, 2017 8:40 AM
To: (b) (6)
Subject: [EXTERNAL] (b) (6)
mac.com]
Spoke to him today. When is the meeting at Bethesda?
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000434
OS 00002100
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/12/2017 12:58:20 PM
To:
David Shulkin [drshulkin@aol.com]
Fwd: [EXTERNAL] (b) (6)
Subject:
Mr. (b) (6)
mac.com]
asked if you can attend the Bethesda meeting.
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
From: "(b) (6)
<(b) (6)
Date: April 12, 2017 at 8:53:59 AM EDT
To: Bruce Moskowitz <(b) (6)
Subject: RE: [EXTERNAL] (b) (6)
Yes. Good call with (b) (6)
Meeting with (b) (6)
va.gov>
mac.com>
Have call with (b) (6)
today.
et al: Friday, 28 April. Details TBD. Likely at around 2 or 3pm.
(b) (6)
805 551
(b) (6)
-----Original Message----From: Bruce Moskowitz [mailto:(b) (6)
Sent: Wednesday, April 12, 2017 8:40 AM
To: (b) (6)
Subject: [EXTERNAL] (b) (6)
mac.com]
Spoke to him today. When is the meeting at Bethesda?
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000435
OS 00002101
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/15/2017 2:04:40 AM
David shulkin [Drshulkin@aol.com]
Re: Musical chairs
I know, but still like to ask you
Sent from my iPad
> on Apr 14, 2017, at 6:54 AM, David shulkin wrote:
>
> You have my support to do what you feel is best
>
> Sent from my iPhone
>
>> on Apr 14, 2017, at 5:04 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>>
>> Yes, Gerry wants to try her. Don't really trust her but spoke to her yesterday and told her that I
wanted no gossip, needed to work on trust issues and no direct contact to the 10th floor now the Jen will
be there. The deputy pdush role gives me some degrees of separation while being able to leverage her
talent, and nobody reports to her. Agree about mike, although the is about to retire and this may
incentivize him to stay longer by challenging him in a new way
>>
>> Sent from my iPhone
>>
>>> on Apr 13, 2017, at 10:53 PM, David shulkin wrote:
>>>
>>> I would definitely move Dort- she adds no value- does Gerry want her or should she go to the field?
>>>
>>> I think Ash has value- it's up to u if u trust her
>>>
>>> I don't know who would take over for Mike- Pharmacy is not broken so please make sure you don't break
it by removing him
>>>
>>> Sent from my iPad
>>>
>>>> on Apr 13, 2017, at 10:43 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>>>>
>>>> With all this happening around us-thinking of making additional moves- what do you think?
>>>>
>>>> 1) Ash- deputy PDUSH- she works on all the quick hit priorities like the IG reports denoting system
wise issues like the inventory management
>>>>
>>>> 2) Mike Valentino- becomes deputy to Lu Beck
>>>>
>>>> 3) Deb Dort- moves to Gerry cox area
>>>>
>>>> Sent from my iPhone
>>>
>
VA-19-0799-D-000436
OS 00002102
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/14/2017 10:54:06 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Musical chairs
You have my support to do what you feel is best
Sent from my iPhone
> on Apr 14, 2017, at 5:04 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Yes, Gerry wants to try her. Don't really trust her but spoke to her yesterday and told her that I
wanted no gossip, needed to work on trust issues and no direct contact to the 10th floor now the Jen will
be there. The deputy pdush role gives me some degrees of separation while being able to leverage her
talent, and nobody reports to her. Agree about mike, although the is about to retire and this may
incentivize him to stay longer by challenging him in a new way
>
> Sent from my iPhone
>
>> on Apr 13, 2017, at 10:53 PM, David shulkin wrote:
>>
>> I would definitely move Dort- she adds no value- does Gerry want her or should she go to the field?
>>
>> I think Ash has value-
it's up to u if u trust her
>>
>> I don't know who would take over for Mike- Pharmacy is not broken so please make sure you don't break
it by removing him
>>
>> Sent from my iPad
>>
>>> on Apr 13, 2017, at 10:43 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>>>
>>> With all this happening around us-thinking of making additional moves- what do you think?
>>>
>>> 1) Ash- deputy PDUSH- she works on all the quick hit priorities like the IG reports denoting system
wise issues like the inventory management
>>>
»> 2) Mike Valentino- becomes deputy to Lu Beck
>>>
>>> 3) Deb Dort- moves to Gerry cox area
>>>
>>> Sent from my iPhone
>>
VA-19-0799-D-000437
OS 00002103
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/14/2017 9:04:55 AM
David Shulkin [drshulkin@aol.com]
Re: Musical chairs
Yes, Gerry wants to try her. Don't really trust her but spoke to her yesterday and told her that I wanted
no gossip, needed to work on trust issues and no direct contact to the 10th floor now the Jen will be
there. The deputy pdush role gives me some degrees of separation while being able to leverage her talent,
and nobody reports to her. Agree about mike, although the is about to retire and this may incentivize him
to stay longer by challenging him in a new way
Sent from my iPhone
> on Apr 13, 2017, at 10:53 PM, David shulkin wrote:
>
> I would definitely move Dort- she adds no value-
>
> I think Ash has value-
does Gerry want her or should she go to the field?
it's up to u if u trust her
>
> I don't know who would take over for Mike- Pharmacy is not broken so please make sure you don't break
it by removing him
>
> Sent from my iPad
>
>> on Apr 13, 2017, at 10:43 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>>
>> With all this happening around us-thinking of making additional moves- what do you think?
>>
>> 1) Ash- deputy PDUSH- she works on all the quick hit priorities like the IG reports denoting system
wise issues like the inventory management
>>
>> 2) Mike Valentino- becomes deputy to Lu Beck
>>
>> 3) Deb Dort- moves to Gerry cox area
>>
>> Sent from my iPhone
>
VA-19-0799-D-000438
OS 00002104
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/14/2017 2:53:35 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Musical chairs
I would definitely move Dort- she adds no valueI think Ash has value-
does Gerry want her or should she go to the field?
it's up to u if u trust her
I don't know who would take over for Mike- Pharmacy is not broken so please make sure you don't break it
by removing him
Sent from my iPad
> on Apr 13, 2017, at 10:43 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> With all this happening around us-thinking of making additional moves- what do you think?
>
> 1) Ash- deputy PDUSH- she works on all the quick hit priorities like the IG reports denoting system
wise issues like the inventory management
>
> 2) Mike Valentino- becomes deputy to Lu Beck
>
> 3) Deb Dort- moves to Gerry cox area
>
> Sent from my iPhone
VA-19-0799-D-000439
OS 00002105
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/14/2017 2:43:37 AM
David Shulkin [drshulkin@aol.com]
Musical chairs
With all this happening around us-thinking of making additional moves- what do you think?
1) Ash- deputy PDUSH- she works on all the quick hit priorities like the IG reports denoting system wise
issues like the inventory management
2) Mike Valentino- becomes deputy to Lu Beck
3) Deb Dort- moves to Gerry cox area
Sent from my iPhone
VA-19-0799-D-000440
OS 00002106
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/15/2017 4:52:49 PM
(b) (6)
gmail.com
Re: Smag
yes
-----Original Message----From: (b) (6)
<(b) (6)
To: David Shulkin
Sent: Sat, Apr 15, 2017 6:27 am
Subject: Smag
gmail.com>
Hi, We talked about smag last week, and you said you were just going to talk about the priorities. I wanted to double
check to see if that was still the case.
VA-19-0799-D-000441
OS 00002107
Message
From:
(b) (6)
Sent:
4/15/2017 10:27:51 AM
David Shulkin [drshulkin@aol.com]
Smag
To:
Subject:
[(b) (6)
gmail.com]
Hi, We talked about smag last week, and you said you were just going to talk about the priorities. I wanted to
double check to see if that was still the case.
VA-19-0799-D-000442
OS 00002108
Message
CC:
Poonam Alaigh [(b) (6)
hotmail.com]
6/3/2017 10:24:16 PM
David shulkin [Drshulkin@aol.com]
Vivieca Wright Simpson [vivieca.Wright@va.gov]
Subject:
Re:
From:
Sent:
To:
Agree and I concur with his guidance - surprises it's not already in place to that effect
Sent from my iPhone
On Jun 3, 2017, at 4: 14 PM, David shulkin wrote:
https://correa.house.gov/media/press-releases/rep-correa-sends-secretary-shulkin-letter-veteranuse-medical-mari juana
Can we discuss this at report
Im ok if you need sme but i think its unnecessary- i think we just need a policy clarification
about his issue
Thanks
Sent from my iPhone
VA-19-0799-D-000443
OS 00002109
Message
From:
Sent:
To:
CC:
David shulkin [Drshulkin@aol.com]
6/3/2017 8:14:43 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Vivieca Wright Simpson [vivieca.Wright@va.gov]
https ://correa.house.gov/media/press-rel eases/rep-correa-sends-secretary-shulkin-1 etter-veteran-use-medicalman 1uana
Can we discuss this at report
Im ok if you need sme but i think its unnecessary- i think we just need a policy clarification about his issue
Thanks
Sent from my iPhone
VA-19-0799-D-000444
OS 00002110
Message
To:
David shulkin [Drshulkin@aol.com]
4/25/2017 12:31:00 PM
IP [(b) (6) frenchangel59.com]
Subject:
Re: RE:
From:
Sent:
(b) (6)
Sent from my iPhone
> on Apr 25, 2017, at 7:48 AM, IP <(b) (6) frenchangel59.com> wrote:
>
> Please email me his/her name. Thank you
>
>
>
>
>
>
-----original Message----From: David shulkin [mailto:Drshulkin@aol .com]
Sent: Tuesday, April 25, 2017 6:48 AM
To: Ike Perlmutter
subject:
>
>Ike-the DoD top person for health will come to dinner Wednesday
>
> Im still working on isakkson
>
> David
>
> Sent from my iPhone
>
VA-19-0799-D-000445
OS 00002111
Message
From:
IP [(b) (6) frenchangel59.com]
Sent:
To:
4/25/2017 11:48:31 AM
'David shulkin' [Drshulkin@aol.com]
Subject:
RE:
Please email me his/her name. Thank you
-----original Message----From: David shulkin [mailto:Drshulkin@aol .com]
Sent: Tuesday, April 25, 2017 6:48 AM
To: Ike Perlmutter
subject:
Ike- the DoD top person for health will come to dinner Wednesday
Im still working on isakkson
David
Sent from my iPhone
VA-19-0799-D-000446
OS 00002112
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/25/2017 10:48:09 AM
To:
Ike Perlmutter [(b) (6) frenchangel59.com]
Ike- the DoD top person for health will come to dinner Wednesday
Im still working on isakkson
David
Sent from my iPhone
VA-19-0799-D-000447
OS 00002113
Message
From:
Poonam Alaigh [(b) (6)
Sent:
4/16/2017 1:24:28 PM
To:
David Shulkin [drshulkin@aol.com]
Re: How are things
Subject:
hotmail.com]
I am on the Acee la 2255 train- let me know if there is anything I can do.
From: David Shulkin
Sent: Sunday, April 16, 2017 9:19 AM
To: (b) (6)
hotmail.com
Subject: Re: How are things
a lot going on
-----Original Message----From: Poonam Alaigh <(b) (6)
hotmail.com>
To: David Shulkin
Sent: Sat, Apr 15, 2017 7:42 pm
Subject: How are things
On the home front
Sent from my iPhone
VA-19-0799-D-000448
OS 00002114
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/16/2017 1:19:13 PM
To:
(b) (6)
Subject:
hotmail.com
Re: How are things
a lot going on
-----Original Message----From: Poonam Alaigh <(b) (6)
hotmail.com>
To: David Shulkin
Sent: Sat, Apr 15, 2017 7:42 pm
Subject: How are things
On the home front
Sent from my iPhone
VA-19-0799-D-000449
OS 00002115
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/15/2017 11:42:21 PM
David Shulkin [drshulkin@aol.com]
How are things
on the home front
Sent from my iPhone
VA-19-0799-D-000450
OS 00002116
Message
Marc Sherman [(b) (6)
gmail.com]
4/18/2017 3:16:08 AM
David shulkin [Drshulkin@aol.com]
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
gmail.com]; Bruce Moskowitz
[(b) (6)
mac.com]
Re: PELOSI -- Remarks at Veterans Health Care Action Campaign Forum
From:
Sent:
To:
CC:
Subject:
You deserve a huge congratulations for that. Everything else she got wrong, unfortunately.
On Mon, Apr 17, 2017 at 10:05 PM, David shulkin wrote:
Of all people look what Nancy Pelosi said in yellow below
Subject: FW: PELOSI -- Remarks at Veterans Health Care Action Campaign Forum
Sir,
Leader Pelosi had a Veterans event in San Francisco at the end of last week with Michael
Blecker, Swords to Plowshares.
Her staff forwarded her remarks, which included positive things about you that are highlighted.
V/R, (b) (6)
From: Democratic Leader
Sent: Thursday, April 13, 2017 7:12 PM
Subject: PELOSI -- Remarks at Veterans Health Care Action Campaign Forum
NANCY PELOSI
O E H.OCR AT I C
L EADE R
News
FROM DEMOCRATIC LEADER NANCY PELOSI
Contact: Jorge Aguilar,
April 13, 2017
202-226-7616
VA-19-0799-D-000451
OS 00002117
Pelosi Remarks at Veterans Health Care Action Campaign Forum
San Francisco - Democratic Leader Nancy Pelosi joined Michael Blecker, Executive Director of Swords
to Plowshares, veterans and leaders qf veterans advocacy groups at the Veterans Health Care Action
Campaign Forum. Below is a transcript qf the Leader's remarks:
"Thank you, everyone. Thank you Michael [Blecker] for your great leadership and your kind words of
welcome. Thank you Paul Cox for your leadership as well, to be here with you and Michael Blecker, of
course with Suzanne Gordon, we'll all be looking forward to her speech, and Edgar Escobar thank you for
your leadership. I also want to acknowledge my daughter, Christine Pelosi who is here, she is a member of
the Democratic National Committee, and she was the leader in insisting they have Veterans desk at the
Democratic National Committee.
"Michael will tell you he wrote the dissenting view on Commission on Care. I was so very grateful. I'm
so very, very proud of him, I've seen his work for decades - as Paul has mentioned he's been working with
Swords to Plowshares for a long time, so I've been aware of his leadership for a long time on behalf of our
vets. So, I was very honored recently to appoint him to the Commission on Care, but even earlier than that
to our regular meeting with Veteran Service Organizations, going back to when I first became Leader
almost a dozen years ago, and then Speaker, and then Leader again.
"But Michael when he would come, I would say, 'I'd like to introduce you to a saint.' He would blush as
he's blushing now, but not for long. He would soon speak up on behalf of veterans there. We had our
most recent meeting just about a week or so ago before we broke for Easter and Passover, and I want to say
it was as usual very informative, a very strong meeting but this time very much focused, and that is a
decision by the vets.
"At this meeting, we focused on women veterans and the rising list of concerns that we have for women
veterans. That's a very large and growing, number as well. But we always take our agenda from what the
veterans bring, going back to our first meeting. We talked about the Veteran's Disability Tax in Congress,
issues the relate to Survivor Benefits. You name it, just a full array of issues, but saying to you prioritize,
we'll act upon it.
"When we had the Majority [in Congress], we were able to allocate the resources necessary to implement
some of the policy that we were able to achieve earlier. I was very proud of all of the - I'll put up a selfserving sign - when I was introduced the Commander said what I had done as Speaker was recognized
more than any other Speaker in terms of meeting the needs of veterans since the GI Bill. So we're very,
very excited about that. It's a recognition of your work.
VA-19-0799-D-000452
OS 00002118
"But I am here today to listen, that's definitely the most valuable thing. I learn more when I listen than
when I speak. And I come here to listen to your concerns, but I want to put it in this context.
"A couple days ago we had a social media call where we meet with all of the groups - VoteVets, Daily
Kos, Move On, Planned Parenthood, all these groups - about how we can protect the Affordable Care
Act. Well in the meantime Syria intervened, so our veterans were an even stronger voice, they're always
strong, but we had more questions for them on the call. And at the end of the call they said, 'We're talking
about vets, and we're talking about the VA, that's very important to us, but our veterans need to go beyond
the VA'
"It's about housing and how HUD is funded, it's about mental health, it's about the Affordable Care Act
and other issues. It's about Medicaid, it's about Opioids which is about the Medicaid solution that we have
in our legislation and so they said, 'there are so many other things that effect our well-being, as important
as the VA is one of the most important things that affects us is we like to have peace, so we can get well.'
[Applause]
"Because as we know, and you've heard it over and over, you've said it yourself -when you're on the
battle field you leave no soldier behind, and when they come home we leave no veteran behind. That is our
mantra, and you have to help us make that happen.
"Because as Michael said, when he was named to this Commission the issue is they're not listening to vets,
they're just talking to each other. And this threat loomed large during the Presidential campaign,
privatizing the VA is a real threat. We will not let them make money off of delivering health care to our
veterans and that's a promise.
[Applause]
"We've got to move our own health care system to a more nonprofit place, rather than moving our
Veterans Health Administration to a 'Let's make more off our Vets' place.
"So in our meeting, a group that represents nobody but has money from somebody, Conservative Veterans
of America, I don't think anyone here is part of it, but if you are I want you to hear what I have to say - the
VA-19-0799-D-000453
OS 00002119
VA and Veterans Services Organizations are unified. Now, having said that, if we're going to address
concerns that we have, making delivery of service better - do we recognize how that fits very much in our
health care system and how we need other things - need other things.
"I had one of those penchants this morning, we planted a garden to start the construction of the barrier and
net at the Golden Gate Bridge. We spent a lot of time with families who have lost their loved one - taking
their own lives. We know that that is an increasing problem across the board in our country, including
among our veterans. So, our mental health issues are very, very important, and in fact, we're very
dismayed that our colleagues across the aisle did not make addressing mental health issues - they took off
of the list of things that must be done.
"So, let's look up here: Veterans' Health Care Action Campaign. Veterans - it's about our veterans' health
care. They're taking action and having a campaign. Understand this very clearly: nothing is more eloquent
to a Member of Congress than the voice of his or her own constituents. You're my bosses, or if you're not
in my district, you're somebody else's bosses. So, let your voice be known to them, as well. Your
experience is the wisdom that we need to make the decisions when we have choices to make. Of all of the
things President Trump has done, one thing I am happy about is his choice for Secretary of Veterans'
Affairs - the secretary there. So far, so good. Wouldn't you say? So far, so good- because we thought
for sure he was going to put a privatizer at the head of the VA, and that would've been very
problematic. We'll see how we go from there.
"A couple of other thoughts - just to say, today - this spring is the 100th anniversary since our entry into
World War I, 75 years since the Bataan Death March, 14 years since the invasion oflraq. So sad. So
sad. And, so many veterans are coming home. So, we are getting hundreds of thousands of
servicemembers each year- becoming veterans, challenging our system. Over 70 percent of our nation's
21 million are over the age of 45, including the majority of veterans in San Francisco. As I mentioned,
many more women, and we need to address [each] of those concerns - and that's why we have regular
veterans service organizations' meetings, and that's why I am here to hear what you have to say, on the
ongoing but as a group here today.
"Again, we are very concerned about this issue of privatization. Privatization can virtually end the
guarantee - end the guarantee of free health care for those who have served. Privatization would see the
VA's doors closed for most of its 366,000 employees, a third of whom are veterans themselves - 100,000
of the workers in the VA are vets. While ensuring the VA can better coordinate care in a community
where there are gaps, we have to be smart, we have to be cautious. Nearly one-third percent of care is
already provided outside of the VA - you know that. Increasing the amount of care outside of the VA
could have negative impacts on comprehensive and specialty care. There are just some things the VA
knows better - combat related injuries and the rest. There are just some things they can diagnose more
readily, care for with experience in having cared for others. At the VA, veterans are treated as a whole
person. That is the only service-connected, comprehensive care culture that provides unparalleled,
personal medical expertise.
VA-19-0799-D-000454
OS 00002120
"We must lift, not load. VA privatization is not the answer. I look forward to our forum and debunking
the myth of what veterans' choice really means - what that really means. We have to hold our bedrock
promise. Again, just as the military leaves no one behind on the battlefield, we must leave no veteran
behind when they come. That is our promise - not only that, it is our values system, it is an ethical
commitment that we have to you. You make us the home of the brave and the land of the free. And while
we're doing that, we have to also consider what they're doing in the budget. The budget should be a
statement of our national values. What is important to us as a nation should be reflected in our
budget. When veterans come from [overseas], we need the biomedical research, we need these other things
that they are cutting because this is something that we all benefit from. So, as a statement of our values,
our veterans are not at that place - the place that we want them to be.
"So, it's pretty exciting to see right now - learn our lesson from the March on Washington, which many of
you participated in, all over the world, in every continent. What was good about it was: it was
spontaneous. It wasn't organized by politicians and elected officials. It was spontaneous, and different
groups joined in. And what was good about it too is that when it came time, the airports and the bans and
this and that- people showed up at the steps of the Supreme Court. People showed up. And when the
Affordable Care Act was under a threat - under a threat with a bill that they called an 'act of mercy.' It
was really an act of malice in what it did to working families in our country. The biggest transfer of weal th
- the Republican bill was the biggest - I used a partisan word, please forgive me - the biggest transfer of
wealth in the history of our country. Robin Hood in reverse - $600 or more, $600 billion lifted from
middle income families and those who aspire to the middle class to the wealthiest people in our country.
"So, as we gather here to talk about this, it comes down to budget. It comes down to budget - how we're
going to allocate resources. And that's why they want to move to privatize and say 'we're going to save
money.' No, we're here to save lives and to improve the quality of care in the lives, to honor the vision of
our Founders: life, liberty and the pursuit of happiness. We want people to have a healthier life and the
liberty to pursue their happiness. And when we do whatever we do, it has to be to honor the values of our
Founders, the sacrifice of our men and women in uniform - they are right there on par with other leaders and of course, the aspirations of our children.
"So, thank you for all that you have done for our country, for your leadership, for your service and for your
concern, not only about you but for so many other veterans as they come back home. Thank you all very
much for [giving me] the time to share some thoughts with you. I look forward to hearing what you all
have to say. Thank you all very much."
###
Press Release Link:
VA-19-0799-D-000455
OS 00002121
http://www.democraticleader.gov/newsroom/413 l 7-3/
DemocraticLeader.gov - Twitter - YouTube - Flickr - Facebook - Instagram - Medium - The Gavel
VA-19-0799-D-000456
OS 00002122
Message
David shulkin [Drshulkin@aol.com]
4/18/2017 2:05:37 AM
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
gmail.com]; Bruce Moskowitz
[(b) (6)
mac.com]; Marc Sherman [(b) (6)
gmail.com]
Fwd: PELOSI -- Remarks at Veterans Health Care Action Campaign Forum
From:
Sent:
To:
Subject:
Of all people look what Nancy Pelosi said in yellow below
Subject: FW: PELOSI -- Remarks at Veterans Health Care Action Campaign Forum
Sir,
Leader Pelosi had a Veterans event in San Francisco at the end of last week with Michael
Blecker, Swords to Plowshares.
Her staff forwarded her remarks, which included positive things about you that are highlighted.
V/R, (b) (6)
From: Democratic Leader
Sent: Thursday, April 13, 2017 7:12 PM
Subject: PELOSI -- Remarks at Veterans Health Care Action Campaign Forum
News
FROM DEMOCRATIC LEADER NANCY PELOSI
Contact: Jorge Aguilar,
April 13, 2017
202-226-7616
VA-19-0799-D-000457
OS 00002123
Pelosi Remarks at Veterans Health Care Action Campaign Forum
San Francisco - Democratic Leader Nancy Pelosi joined A1ichael Blecker, Executive Director of Swords·
to Plowshares, veterans and leaders of veterans advocacy groups at the Veterans Health Care Action
Campaign Forum. Below is a transcript of the Leader's remarks:
"Thank you, everyone. Thank you Michael [Blecker] for your great leadership and your kind words of
welcome. Thank you Paul Cox for your leadership as well, to be here with you and Michael Blecker, of
course with Suzanne Gordon, we'll all be looking forward to her speech, and Edgar Escobar thank you for
your leadership. I also want to acknowledge my daughter, Christine Pelosi who is here, she is a member of
the Democratic National Committee, and she was the leader in insisting they have Veterans desk at the
Democratic National Committee.
"Michael will tell you he wrote the dissenting view on Commission on Care. I was so very grateful. I'm
so very, very proud of him, I've seen his work for decades - as Paul has mentioned he's been working with
Swords to Plowshares for a long time, so I've been aware of his leadership for a long time on behalf of our
vets. So, I was very honored recently to appoint him to the Commission on Care, but even earlier than that
to our regular meeting with Veteran Service Organizations, going back to when I first became Leader
almost a dozen years ago, and then Speaker, and then Leader again.
"But Michael when he would come, I would say, 'I'd like to introduce you to a saint.' He would blush as
he's blushing now, but not for long. He would soon speak up on behalf of veterans there. We had our
most recent meeting just about a week or so ago before we broke for Easter and Passover, and I want to say
it was as usual very informative, a very strong meeting but this time very much focused, and that is a
decision by the vets.
"At this meeting, we focused on women veterans and the rising list of concerns that we have for women
veterans. That's a very large and growing, number as well. But we always take our agenda from what the
veterans bring, going back to our first meeting. We talked about the Veteran's Disability Tax in Congress,
issues the relate to Survivor Benefits. You name it, just a full array of issues, but saying to you prioritize,
we'll act upon it.
"When we had the Majority [in Congress], we were able to allocate the resources necessary to implement
some of the policy that we were able to achieve earlier. I was very proud of all of the - I'll put up a selfserving sign - when I was introduced the Commander said what I had done as Speaker was recognized
more than any other Speaker in terms of meeting the needs of veterans since the GI Bill. So we're very,
very excited about that. It's a recognition of your work.
VA-19-0799-D-000458
OS 00002124
"But I am here today to listen, that's definitely the most valuable thing. I learn more when I listen than
when I speak. And I come here to listen to your concerns, but I want to put it in this context.
"A couple days ago we had a social media call where we meet with all of the groups - VoteVets, Daily
Kos, Move On, Planned Parenthood, all these groups - about how we can protect the Affordable Care
Act. Well in the meantime Syria intervened, so our veterans were an even stronger voice, they're always
strong, but we had more questions for them on the call. And at the end of the call they said, 'We're talking
about vets, and we're talking about the VA, that's very important to us, but our veterans need to go beyond
the VA'
"It's about housing and how HUD is funded, it's about mental health, it's about the Affordable Care Act
and other issues. It's about Medicaid, it's about Opioids which is about the Medicaid solution that we have
in our legislation and so they said, 'there are so many other things that effect our well-being, as important
as the VA is one of the most important things that affects us is we like to have peace, so we can get well.'
[Applause]
"Because as we know, and you've heard it over and over, you've said it yourself -when you're on the
battle field you leave no soldier behind, and when they come home we leave no veteran behind. That is our
mantra, and you have to help us make that happen.
"Because as Michael said, when he was named to this Commission the issue is they're not listening to vets,
they're just talking to each other. And this threat loomed large during the Presidential campaign,
privatizing the VA is a real threat. We will not let them make money off of delivering health care to our
veterans and that's a promise.
[Applause]
"We've got to move our own health care system to a more nonprofit place, rather than moving our
Veterans Health Administration to a 'Let's make more off our Vets' place.
"So in our meeting, a group that represents nobody but has money from somebody, Conservative Veterans
of America, I don't think anyone here is part of it, but if you are I want you to hear what I have to say - the
VA-19-0799-D-000459
OS 00002125
VA and Veterans Services Organizations are unified. Now, having said that, if we're going to address
concerns that we have, making delivery of service better - do we recognize how that fits very much in our
health care system and how we need other things - need other things.
"I had one of those penchants this morning, we planted a garden to start the construction of the barrier and
net at the Golden Gate Bridge. We spent a lot of time with families who have lost their loved one - taking
their own lives. We know that that is an increasing problem across the board in our country, including
among our veterans. So, our mental health issues are very, very important, and in fact, we're very
dismayed that our colleagues across the aisle did not make addressing mental health issues - they took off
of the list of things that must be done.
"So, let's look up here: Veterans' Health Care Action Campaign. Veterans - it's about our veterans' health
care. They're taking action and having a campaign. Understand this very clearly: nothing is more eloquent
to a Member of Congress than the voice of his or her own constituents. You're my bosses, or if you're not
in my district, you're somebody else's bosses. So, let your voice be known to them, as well. Your
experience is the wisdom that we need to make the decisions when we have choices to make. Of all of the
things President Trump has done, one thing I am happy about is his choice for Secretary of Veterans'
Affairs - the secretary there. So far, so good. Wouldn't you say? So far, so good- because we thought
for sure he was going to put a privatizer at the head of the VA, and that would've been very
r.roblematic. We'll see how we go from there.
"A couple of other thoughts - just to say, today - this spring is the 100th anniversary since our entry into
World War I, 75 years since the Bataan Death March, 14 years since the invasion oflraq. So sad. So
sad. And, so many veterans are coming home. So, we are getting hundreds of thousands of
servicemembers each year- becoming veterans, challenging our system. Over 70 percent of our nation's
21 million are over the age of 45, including the majority of veterans in San Francisco. As I mentioned,
many more women, and we need to address [each] of those concerns - and that's why we have regular
veterans service organizations' meetings, and that's why I am here to hear what you have to say, on the
ongoing but as a group here today.
"Again, we are very concerned about this issue of privatization. Privatization can virtually end the
guarantee - end the guarantee of free health care for those who have served. Privatization would see the
VA's doors closed for most of its 366,000 employees, a third of whom are veterans themselves - 100,000
of the workers in the VA are vets. While ensuring the VA can better coordinate care in a community
where there are gaps, we have to be smart, we have to be cautious. Nearly one-third percent of care is
already provided outside of the VA - you know that. Increasing the amount of care outside of the VA
could have negative impacts on comprehensive and specialty care. There are just some things the VA
knows better - combat related injuries and the rest. There are just some things they can diagnose more
readily, care for with experience in having cared for others. At the VA, veterans are treated as a whole
person. That is the only service-connected, comprehensive care culture that provides unparalleled,
personal medical expertise.
VA-19-0799-D-000460
OS 00002126
"We must lift, not load. VA privatization is not the answer. I look forward to our forum and debunking
the myth of what veterans' choice really means - what that really means. We have to hold our bedrock
promise. Again, just as the military leaves no one behind on the battlefield, we must leave no veteran
behind when they come. That is our promise - not only that, it is our values system, it is an ethical
commitment that we have to you. You make us the home of the brave and the land of the free. And while
we're doing that, we have to also consider what they're doing in the budget. The budget should be a
statement of our national values. What is important to us as a nation should be reflected in our
budget. When veterans come from [overseas], we need the biomedical research, we need these other things
that they are cutting because this is something that we all benefit from. So, as a statement of our values,
our veterans are not at that place - the place that we want them to be.
"So, it's pretty exciting to see right now - learn our lesson from the March on Washington, which many of
you participated in, all over the world, in every continent. What was good about it was: it was
spontaneous. It wasn't organized by politicians and elected officials. It was spontaneous, and different
groups joined in. And what was good about it too is that when it came time, the airports and the bans and
this and that- people showed up at the steps of the Supreme Court. People showed up. And when the
Affordable Care Act was under a threat - under a threat with a bill that they called an 'act of mercy.' It
was really an act of malice in what it did to working families in our country. The biggest transfer of weal th
- the Republican bill was the biggest - I used a partisan word, please forgive me - the biggest transfer of
wealth in the history of our country. Robin Hood in reverse - $600 or more, $600 billion lifted from
middle income families and those who aspire to the middle class to the wealthiest people in our country.
"So, as we gather here to talk about this, it comes down to budget. It comes down to budget - how we're
going to allocate resources. And that's why they want to move to privatize and say 'we're going to save
money.' No, we're here to save lives and to improve the quality of care in the lives, to honor the vision of
our Founders: life, liberty and the pursuit of happiness. We want people to have a healthier life and the
liberty to pursue their happiness. And when we do whatever we do, it has to be to honor the values of our
Founders, the sacrifice of our men and women in uniform - they are right there on par with other leaders and of course, the aspirations of our children.
"So, thank you for all that you have done for our country, for your leadership, for your service and for your
concern, not only about you but for so many other veterans as they come back home. Thank you all very
much for [giving me] the time to share some thoughts with you. I look forward to hearing what you all
have to say. Thank you all very much."
###
Press Release Link:
VA-19-0799-D-000461
OS 00002127
http://www.democraticleader.gov/newsroom/413 l 7-3/
DemocraticLeader.gov - Twitter - YouTube - Flickr - Facebook - Instagram - Medium - The Gavel
VA-19-0799-D-000462
OS 00002128
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/14/2017 10:53:06 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Announcement
I think its nice of you
Sent from my iPhone
On Apr 14, 2017, at 5:34 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
I sent this to Jen last night- you may not agree with what I said, but David, I cant purposely hurt
anyone ever.
David, my true friend, you are a blessing in my life!!
Sent from my iPad
Begin forwarded message:
From: "Alaigh, Poonam, M.D."
Date: April 14, 2017 at 5:25:01 AM EDT
To: 'Poonam Alaigh' <(b) (6)
hotmail.com>
Subject: FW: Announcement
Sent with Good (www.good.com)
-----Original Message----From: Alaigh, Poonam, M.D.
Sent: Thursday, April 13, 2017 09:45 PM Eastern Standard Time
To: Lee, Jennifer S. (VACO)
Cc: Hyduke, Barbara
Subject: Announcement
Jennifer, Barbara and the team will work on the announcement tomorrow. Just got off the phone
with Lu Beck and she has agreed to step into the role as an acting deputy effective Monday.
Jennifer, I want to thank you so much your commitment and dedication in VHA, and feel the loss
already. But as you know, the boss gets what he wants. And he wants you now- more importantly,
he needs you! I know you will be successful in this new role- we will talk more tomorrow.
Thanks again for everything.
Sent with Good (www.good.com)
VA-19-0799-D-000463
OS 00002129
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
4/14/2017 9:34:24 AM
Drshulkin@aol.com
Fwd: Announcement
hotmail.com]
I sent this to Jen last night- you may not agree with what I said, but David, I cant purposely hurt anyone ever.
David, my true friend, you are a blessing in my life!!
Sent from my iPad
Begin forwarded message:
From: "Alaigh, Poonam, M.D."
Date: April 14, 2017 at 5:25:01 AM EDT
To: 'Poonam Alaigh' <(b) (6)
hotmail.com>
Subject: FW: Announcement
Sent with Good (www.good.com)
-----Original Message----From: Alaigh, Poonam, M.D.
Sent: Thursday, April 13, 2017 09:45 PM Eastern Standard Time
To: Lee, Jennifer S. (VACO)
Cc: Hyduke, Barbara
Subject: Announcement
Jennifer, Barbara and the team will work on the announcement tomorrow. Just got off the phone with Lu Beck and
she has agreed to step into the role as an acting deputy effective Monday.
Jennifer, I want to thank you so much your commitment and dedication in VHA, and feel the loss already. But as
you know, the boss gets what he wants. And he wants you now- more importantly, he needs you! I know you will be
successful in this new role- we will talk more tomorrow.
Thanks again for everything.
Sent with Good (www.good.com)
VA-19-0799-D-000464
OS 00002130
Message
David shulkin [Drshulkin@aol.com]
4/13/2017 2:11:56 AM
Darin Selnick [(b) (6)
@gmail.com]
Re: draft note
From:
Sent:
To:
Subject:
Your confidence in him was important to me
Sent from my iPhone
On Apr 12, 2017, at 9:51 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
I am forwarding this from Larry to you as he wanted to make sure it reached you. He is deeply
honored that you gave him this opportunity and the confidence you have in him.
Darin
---------- Forwarded message ---------From: Larry Connell <(b) (6)
Date: Wed, Apr 12, 2017 at 5:32 PM
Subject: draft note
To: (b) (6)
k@gmail.com
gmail.com>
Dr. Shulkin,
Just a quick note to say thanks for this one in a lifetime opportunity. I greatly appreciate your
confidence in me and my pledge to you is to ensure we regain the trust of our Veterans at the
D.C. VA Medical Center. I will make you proud.
Thanks,
Larry
Larry Connell
(b) (6)
gmail.com
(210) 764-9530
VA-19-0799-D-000465
OS 00002131
Message
From:
Sent:
To:
Subject:
Darin Selnick [(b) (6)
@gmail.com]
4/13/2017 1:51:23 AM
David shulkin [Drshulkin@aol.com]
Fwd: draft note
I am forwarding this from Larry to you as he wanted to make sure it reached you. He is deeply honored that
you gave him this opportunity and the confidence you have in him.
Darin
---------- Forwarded message---------From: Larry Connell <(b) (6)
Date: Wed, Apr 12, 2017 at 5:32 PM
Subject: draft note
To: (b) (6)
@gmail.com
gmail.com>
Dr. Shulkin,
Just a quick note to say thanks for this one in a lifetime opportunity. I greatly appreciate your confidence in
me and my pledge to you is to ensure we regain the trust of our Veterans at the D.C. VA Medical Center. I will
make you proud.
Thanks,
Larry
Larry Connell
(b) (6)
@gmail .com
(210) 764-9530
VA-19-0799-D-000466
OS 00002132
Message
David shulkin [Drshulkin@aol.com]
4/14/2017 11:54:17 PM
Marisol Garcia [(b) (6) frenchangel59.com]
Poonam Alaigh [(b) (6)
hotmail.com]; (b) (6)
va.gov
Re: Conference call for tomorrow Saturday, April 15, 2017
From:
Sent:
To:
CC:
Subject:
Yes 10
Am works
Sent from my iPhone
On Apr 14, 2017, at 4:43 PM, Marisol Garcia <(b) (6) frenchangel59.com > wrote:
Thank you - Laurie prefers 10am --David, please let me know.
From: Poonam Alaigh [ mailto:(b) (6)
Sent: Friday, April 14, 2017 4:38 PM
To: Marisol Garcia
hotmail.com]
Cc: David shulkin; (b) (6)
va.gov
Subject: Re: Conference call for tomorrow Saturday, April 15, 2017
I can make myself available at a time that works for everyone- preferably 9am or later. Thanks
Sent from my iPhone
On Apr 14, 2017, at 4:33 PM, Marisol Garcia <(b) (6) frenchangel59.com > wrote:
Poonam and David,
Laurie and Ike would like to have a call tomorrow morning.
Please let me know as soon as possible what time works best:
10:00 AM or 11:00 AM for 45 minutes
Participants:
Laura Perlmutter, Poonam Alaigh, Secretary Shu/kin, Dr. Bruce Moskowitz, Marc
Sherman and Ike
Thank you,
Marisol
VA-19-0799-D-000467
OS 00002133
Message
From:
Sent:
To:
CC:
Subject:
Marisol Garcia [(b) (6) frenchangel59.com]
4/14/2017 8:43:19 PM
'Poonam Alaigh' [(b) (6)
hotmail.com]
'David shulkin' [Drshulkin@aol.com]; (b) (6)
va.gov
RE: Conference call for tomorrow Saturday, April 15, 2017
Thank you - Laurie prefers 10am --David, please let me know.
From: Poonam Alaigh [mailto:(b) (6)
Sent: Friday, April 14, 2017 4:38 PM
To: Marisol Garcia
hotmail.com]
Cc: David shulkin; (b) (6)
va.gov
Subject: Re: Conference call for tomorrow Saturday, April 15, 2017
I can make myself available at a time that works for everyone- preferably 9am or later. Thanks
Sent from my iPhone
On Apr 14, 2017, at 4:33 PM, Marisol Garcia <(b) (6) frenchangel59.com > wrote:
Poonam and David,
Laurie and Ike would like to have a call tomorrow morning.
Please let me know as soon as possible what time works best:
10:00 AM or 11:00 AM for 45 minutes
Participants:
Laura Perlmutter, Poonam Alaigh, Secretary Shu/kin, Dr. Bruce Moskowitz, Marc Sherman and Ike
Thank you,
Marisol
VA-19-0799-D-000468
OS 00002134
Message
From:
Yehia, Baligh R. [Baligh.Yehia@va.gov]
Sent:
4/17/2017 2:58:08 AM
To:
'David Shulkin' [drshulkin@aol.com]
RE: [EXTERNAL] Fwd: draft for the choice demonstration pilots
Subject:
Sounds good. Will do.
Sent with Good (www.good.com)
-----Original Message----From: David Shulkin [drshulkin@aol.com]
Sent: Sunday, April 16, 2017 11 :03 AM Eastern Standard Time
To: Y ehia, Baligh R.
Subject: [EXTERNAL] Fwd: draft for the choice demonstration pilots
A demo as Darin defines might be good but I would like to build into the main legislation as much as we can to allow us to
bill for other health insurance and to operate with the same rules as private sector hospitals and systems. Worse case is
that it gets taken out.
-----Original Message----From: Darin Selnick <(b) (6)
@gmail.com>
To: David shulkin
Sent: Sat, Apr 15, 2017 11 :09 am
Subject: Fwd: draft for the choice demonstration pilots
FYI
Baligh asked me to draft up the ideas from Monday for the pilot demonstration pilots, so I did and sent them to him and
Poonam. The draft is rough but it gives the ideas form and structure and we will have the team build upon them so they
can be part of the legislation.
Hope you are having a good weekend with family.
Darin
---------- Forwarded message ---------From: Selnick, Darin
Date: Thu, Apr 13, 2017 at 10:31 PM
Subject: draft for the choice demonstration pilots
To: "Yehia, Baligh R."
Cc: "Alaigh, Poonam, M.D.", "(b) (6)
k@gmail.com" <(b) (6)
@gmail.com>
Hi Baligh
Attached is the draft I promised on the basics for the demonstration pilots and how conceptually it would all work. I finish
it on the plane today. This is just the basics to get it going and we will need to flush it out with the team.
Best
Darin
VA-19-0799-D-000469
OS 00002135
Darin Selnick
Senior Advisor to the Secretary
Cell 202-390-5845
VA-19-0799-D-000470
OS_00002136
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
To:
(b) (6)
Subject:
Attachments:
4/16/2017 3:03:35 PM
gmail.com
Fwd: draft for the choice demonstration pilots
Community of Care and VAMC Health Care Delivery Modernization.docx
please print this attachemnt
-----Original Message----From: David Shulkin
To: baligh.yehia
Sent: Sun, Apr 16, 2017 11 :02 am
Subject: Fwd: draft for the choice demonstration pilots
A demo as Darin defines might be good but I would like to build into the main legislation as much as we can to allow us to
bill for other health insurance and to operate with the same rules as private sector hospitals and systems. Worse case is
that it gets taken out.
-----Original Message----From: Darin Selnick <(b) (6)
@gmail.com>
To: David shulkin
Sent: Sat, Apr 15, 2017 11 :09 am
Subject: Fwd: draft for the choice demonstration pilots
FYI
Baligh asked me to draft up the ideas from Monday for the pilot demonstration pilots, so I did and sent them to him and
Poonam. The draft is rough but it gives the ideas form and structure and we will have the team build upon them so they
can be part of the legislation.
Hope you are having a good weekend with family.
Darin
---------- Forwarded message ---------From: Selnick, Darin
Date: Thu, Apr 13, 2017 at 10:31 PM
Subject: draft for the choice demonstration pilots
To: "Yehia, Baligh R."
Cc: "Alaigh, Poonam, M.D.", "(b) (6)
k@gmail.com" <(b) (6)
@gmail.com>
Hi Baligh
Attached is the draft I promised on the basics for the demonstration pilots and how conceptually it would all work. I finish
it on the plane today. This is just the basics to get it going and we will need to flush it out with the team.
Best
Darin
Darin Selnick
Senior Advisor to the Secretary
Cell 202-390-5845
VA-19-0799-D-000471
OS 00002137
Community of Care and VAMC Health Care Delivery Modernization
Demonstration Pilots
Overview of Concept
The purpose of the demonstration pilots is to see if VA can operate its healthcare system more
effectively both in access and in cost, using the best practices of the TRICARE and the private
sector, to improve the delivery of healthcare to veterans. For the demonstration pilots, VHA
would separate its payer and provider functions into two different operating units and move
them from the existing HMO staff model to a HMO mixed model.
A HMO mixed model is when the community care provider network is a combination of
delivery systems. The VA demonstration pilots HMO mixed model will offer a wide variety of
choices and broad geographic coverage to its veteran's members. Patients will have the choice
of VHA and Community Care clinics, labs, pharmacies, and hospitals as their providers of care.
In the VA demonstration pilots, the HMO mixed model would be a combination of a the VAMCs
and CBOCs operating as a group model accountable care organization, such as the Cleveland
Clinic or Kaiser Permanente, and the Community Care operating as a contracted provider
network, such as United Healthcare or TRI CARE.
Key Components
Payer: The VA demonstration payer pilots would be operated as the Veterans Health Plan
(VHP). It would have the ability to operate using the best practices from private sector health
plans and from government payers.
In addition to using the new VA community care RFP, it would have legislative relief from any
government contracting and acquisition regulations that would impede its ability to operate
and compete with private sector HMO contracted provider networks. Key operating function
would include:
• Cost mitigation using secondary payer: Like TRICARE, VHP would be secondary payer for
all veterans who have other health insurance, including for all service connected and
non-service connected services that the OHi would normally pay for as part of its
benefits package. The current estimate is that 80% of veterans enrolled in VA
healthcare have OHi. This would mean that VHP would pay after all OHi, including all
other government and private insurance programs. VHP would be primary payer for
any benefits that the veteran would be entitled to as part of the VA healthcare benefit,
but is not part of their OHi benefit.
• Primary coordinator of benefits: To ensure veterans are not balance billed, VHP would
act as the primary coordinator of benefits to ensure veterans are not charged
inappropriately by their OHi and would receive an EOB which would list the charges and
VA-19-0799-D-000473
OS 00002139
•
•
what is owed by the veteran. VHP would ensure the veterans OHi would process the
providers claim first and be responsible to settle all disputes.
Balance billing: By law, VHP like TRICARE would prohibit the practice of balance billing.
Balance billing requirements would apply to both network and non-network providers
who treat VHP beneficiaries and noncompliance would impact their VHP and/or
Medicare, Medicaid or FEHB status.
Governance - Board of Directors: An overall board of directors would provide
governance and operational oversite for the demonstration pilots. The board would
consist of the SECVA, USH, PDUSH, DUSHs, leading healthcare experts, and veteran
representation.
Provider
The VA demonstration provider pilots would be operated as the Veterans Clinic. As the
Veterans Clinic, it would be set up and have the ability to operate on a level playing field with
private sector provider healthcare organizations. It would be able to use the same best
practices that private sector provider accountable care organizations such as the Cleveland
Clinic, Mayo Clinic and Kaiser Permanente use
It would operate as a not for profit group practice with physician leadership which would be
salaried. Its governance would consist of a board of directors. Revenue would come from all
payers for all services rendered to its patients, including VHP, all other government payers, and
all private coverage. It would have legislative relief from any government personnel,
contracting, acquisition, and any other government regulations and rules that would impede its
ability to operate and compete with private sector providers. Key operating functions would
include:
• Governance - Board of Directors: An overall board of directors would provide
governance and operational oversite for the demonstration pilots. The board would
consist of the SECVA, USH, PDUSH, DUSHs, leading healthcare experts, and veteran
representation. The board of director would have oversight from Congress.
• Control of facilities and footprint: The board of directors would have complete
authority and control over its facilities and footprint. Other governmental agencies and
Congress would not be able to block lawful decisions.
• Leadership: Each demonstration pilot would have a traditional private sector provider
structure headed by a CEO that would report to the board of directors. They would
have a 5 year contract but could be terminated by the board due to poor performance.
• Revenue: The dollars would follow the patient. Each demonstration pilot would have
provider contracts with all payers, including both government (Medicare, Medicaid,
FEHB), private sector managed care and commercial. The Veterans Clinics would be
reimbursed for all services provided the same as private provider groups. If there is
excess capacity each pilot would have the option to open up to non-eligible veterans
and family members who would be pay the full premium through their OHi.
VA-19-0799-D-000474
OS 00002140
•
•
•
Benefit Package: All eligible veterans would have the same existing benefit package
they currently do. VHP would have to pay the gap between what the veteran OHi
authorized benefit package and VHP. Non-eligible veterans and families would only be
offered services that are 100% paid for by their OHi.
Efficiency: All Veterans Clinic would have to operate based on the revenue provided by
the payers. It would be expected that they would have to improve their operations to
be more efficient to match their revenue.
Accountable Care Organization functions: The Veteran Clinics would operate following
the primary characteristics of an ACO to include strong primary, specialty and hospital
care with effective cost control and quality of care:
o Capacity to manage both the cost and quality of health care services under a
range of payment systems.
o Have comprehensive, valid and reliable performance measurements, make
internal system improvements in care quality and externally report on its
performance on cost and quality of care
o Commitment to achieve quality and cost efficiencies, a physician management
structure and a culture that supports and rewards continuous quality
improvement.
o Use of health information technology to manage patients across the continuum
of care and across different institutional settings.
Demonstration pilot sites
•
•
Arizona: Senate Sponsor - Senator McCain
Washington: House Sponsor- Rep McMorris Rodgers
Time Frame
• Demonstration pilots would be required to be set up and fully operational within one
year after the legislation had been passed by congress and signed by the President.
•
Demonstration pilots after the one year set up period would run for five years with an
automatic five year extension unless congress voted to end the extensions.
VA-19-0799-D-000475
OS 00002141
Organizational
Structure
VHA - Mixed Model Demonstration Pilots
(Payer and Provider Organization)
VHA
Board of Directors
SECVA,USH,PDUSH
Demonstration Pilots
DUSHs, HC experts,
Veterans
Office
VHA Payer
Veterans Health Plan
Community Care Networks
VHA Provider
Veteran Clinic
VACO
VACO
,
Veteran Clinic
Arizona
Local -Hospital and
Clinics
Veteran Clinic
Washington
Local -Hospital and
Clinics
Community Care Providers
Arizona
Washington
VA-19-0799-D-000476
OS 00002142
Revenue Flow
VHA Revenue
(Payer and Provider)
Congressional
Funding
~-----~
- c:=J
VHA
VHA Payer
Veterans Health Plan
OHi Payer
Contracts
Gov & Private
VHA Provider
Veteran Clinic
National
Private Sector
Community Care Network
Pilot Sites
VHA - Veteran Clinic
Pilot Regional Area
VHA - Veteran Clinic
Pilot Local -Hospital and Clinics
VA-19-0799-D-000477
OS 00002143
Revenue from Payers
Veterans OHi %
Mediaaid
VHA Payer
TBD
100%
Services
Medicare
51.3%
100%
Services
Veterans
Clinic
Federal ACO
---------------------
TRICARE
18.5%
100%
Services
Board of Directors
FEHB/
Others
TBD%
100%
Services
VA-19-0799-D-000478
OS 00002144
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
To:
4/16/2017 3:02:51 PM
Subject:
Attachments:
baligh.yehia@va.gov
Fwd: draft for the choice demonstration pilots
Community of Care and VAMC Health Care Delivery Modernization.docx
A demo as Darin defines might be good but I would like to build into the main legislation as much as we can to allow us to
bill for other health insurance and to operate with the same rules as private sector hospitals and systems. Worse case is
that it gets taken out.
-----Original Message----From: Darin Selnick <(b) (6)
@gmail.com>
To: David shulkin
Sent: Sat, Apr 15, 2017 11 :09 am
Subject: Fwd: draft for the choice demonstration pilots
FYI
Baligh asked me to draft up the ideas from Monday for the pilot demonstration pilots, so I did and sent them to him and
Poonam. The draft is rough but it gives the ideas form and structure and we will have the team build upon them so they
can be part of the legislation.
Hope you are having a good weekend with family.
Darin
---------- Forwarded message ---------From: Selnick, Darin
Date: Thu, Apr 13, 2017 at 10:31 PM
Subject: draft for the choice demonstration pilots
To: "Yehia, Baligh R."
Cc: "Alaigh, Poonam, M.D.", "(b) (6)
k@gmail.com" <(b) (6)
@gmail.com>
Hi Baligh
Attached is the draft I promised on the basics for the demonstration pilots and how conceptually it would all work. I finish
it on the plane today. This is just the basics to get it going and we will need to flush it out with the team.
Best
Darin
Darin Selnick
Senior Advisor to the Secretary
Cell 202-390-5845
VA-19-0799-D-000479
OS 00002145
Community of Care and VAMC Health Care Delivery Modernization
Demonstration Pilots
Overview of Concept
The purpose of the demonstration pilots is to see if VA can operate its healthcare system more
effectively both in access and in cost, using the best practices of the TRICARE and the private
sector, to improve the delivery of healthcare to veterans. For the demonstration pilots, VHA
would separate its payer and provider functions into two different operating units and move
them from the existing HMO staff model to a HMO mixed model.
A HMO mixed model is when the community care provider network is a combination of
delivery systems. The VA demonstration pilots HMO mixed model will offer a wide variety of
choices and broad geographic coverage to its veteran's members. Patients will have the choice
of VHA and Community Care clinics, labs, pharmacies, and hospitals as their providers of care.
In the VA demonstration pilots, the HMO mixed model would be a combination of a the VAMCs
and CBOCs operating as a group model accountable care organization, such as the Cleveland
Clinic or Kaiser Permanente, and the Community Care operating as a contracted provider
network, such as United Healthcare or TRI CARE.
Key Components
Payer: The VA demonstration payer pilots would be operated as the Veterans Health Plan
(VHP). It would have the ability to operate using the best practices from private sector health
plans and from government payers.
In addition to using the new VA community care RFP, it would have legislative relief from any
government contracting and acquisition regulations that would impede its ability to operate
and compete with private sector HMO contracted provider networks. Key operating function
would include:
• Cost mitigation using secondary payer: Like TRICARE, VHP would be secondary payer for
all veterans who have other health insurance, including for all service connected and
non-service connected services that the OHi would normally pay for as part of its
benefits package. The current estimate is that 80% of veterans enrolled in VA
healthcare have OHi. This would mean that VHP would pay after all OHi, including all
other government and private insurance programs. VHP would be primary payer for
any benefits that the veteran would be entitled to as part of the VA healthcare benefit,
but is not part of their OHi benefit.
• Primary coordinator of benefits: To ensure veterans are not balance billed, VHP would
act as the primary coordinator of benefits to ensure veterans are not charged
inappropriately by their OHi and would receive an EOB which would list the charges and
VA-19-0799-D-000480
OS 00002146
•
•
what is owed by the veteran. VHP would ensure the veterans OHi would process the
providers claim first and be responsible to settle all disputes.
Balance billing: By law, VHP like TRICARE would prohibit the practice of balance billing.
Balance billing requirements would apply to both network and non-network providers
who treat VHP beneficiaries and noncompliance would impact their VHP and/or
Medicare, Medicaid or FEHB status.
Governance - Board of Directors: An overall board of directors would provide
governance and operational oversite for the demonstration pilots. The board would
consist of the SECVA, USH, PDUSH, DUSHs, leading healthcare experts, and veteran
representation.
Provider
The VA demonstration provider pilots would be operated as the Veterans Clinic. As the
Veterans Clinic, it would be set up and have the ability to operate on a level playing field with
private sector provider healthcare organizations. It would be able to use the same best
practices that private sector provider accountable care organizations such as the Cleveland
Clinic, Mayo Clinic and Kaiser Permanente use
It would operate as a not for profit group practice with physician leadership which would be
salaried. Its governance would consist of a board of directors. Revenue would come from all
payers for all services rendered to its patients, including VHP, all other government payers, and
all private coverage. It would have legislative relief from any government personnel,
contracting, acquisition, and any other government regulations and rules that would impede its
ability to operate and compete with private sector providers. Key operating functions would
include:
• Governance - Board of Directors: An overall board of directors would provide
governance and operational oversite for the demonstration pilots. The board would
consist of the SECVA, USH, PDUSH, DUSHs, leading healthcare experts, and veteran
representation. The board of director would have oversight from Congress.
• Control of facilities and footprint: The board of directors would have complete
authority and control over its facilities and footprint. Other governmental agencies and
Congress would not be able to block lawful decisions.
• Leadership: Each demonstration pilot would have a traditional private sector provider
structure headed by a CEO that would report to the board of directors. They would
have a 5 year contract but could be terminated by the board due to poor performance.
• Revenue: The dollars would follow the patient. Each demonstration pilot would have
provider contracts with all payers, including both government (Medicare, Medicaid,
FEHB), private sector managed care and commercial. The Veterans Clinics would be
reimbursed for all services provided the same as private provider groups. If there is
excess capacity each pilot would have the option to open up to non-eligible veterans
and family members who would be pay the full premium through their OHi.
VA-19-0799-D-000481
OS 00002147
•
•
•
Benefit Package: All eligible veterans would have the same existing benefit package
they currently do. VHP would have to pay the gap between what the veteran OHi
authorized benefit package and VHP. Non-eligible veterans and families would only be
offered services that are 100% paid for by their OHi.
Efficiency: All Veterans Clinic would have to operate based on the revenue provided by
the payers. It would be expected that they would have to improve their operations to
be more efficient to match their revenue.
Accountable Care Organization functions: The Veteran Clinics would operate following
the primary characteristics of an ACO to include strong primary, specialty and hospital
care with effective cost control and quality of care:
o Capacity to manage both the cost and quality of health care services under a
range of payment systems.
o Have comprehensive, valid and reliable performance measurements, make
internal system improvements in care quality and externally report on its
performance on cost and quality of care
o Commitment to achieve quality and cost efficiencies, a physician management
structure and a culture that supports and rewards continuous quality
improvement.
o Use of health information technology to manage patients across the continuum
of care and across different institutional settings.
Demonstration pilot sites
•
•
Arizona: Senate Sponsor - Senator McCain
Washington: House Sponsor- Rep McMorris Rodgers
Time Frame
• Demonstration pilots would be required to be set up and fully operational within one
year after the legislation had been passed by congress and signed by the President.
•
Demonstration pilots after the one year set up period would run for five years with an
automatic five year extension unless congress voted to end the extensions.
VA-19-0799-D-000482
OS 00002148
Organizational
Structure
VHA - Mixed Model Demonstration Pilots
(Payer and Provider Organization)
VHA
Board of Directors
SECVA,USH,PDUSH
Demonstration Pilots
DUSHs, HC experts,
Veterans
Office
VHA Payer
Veterans Health Plan
Community Care Networks
VHA Provider
Veteran Clinic
VACO
VACO
,
Veteran Clinic
Arizona
Local -Hospital and
Clinics
Veteran Clinic
Washington
Local -Hospital and
Clinics
Community Care Providers
Arizona
Washington
VA-19-0799-D-000483
OS 00002149
Revenue Flow
VHA Revenue
(Payer and Provider)
Congressional
Funding
~-----~
- c:=J
VHA
VHA Payer
Veterans Health Plan
OHi Payer
Contracts
Gov & Private
VHA Provider
Veteran Clinic
National
Private Sector
Community Care Network
Pilot Sites
VHA - Veteran Clinic
Pilot Regional Area
VHA - Veteran Clinic
Pilot Local -Hospital and Clinics
VA-19-0799-D-000484
OS 00002150
Revenue from Payers
Veterans OHi %
Mediaaid
VHA Payer
TBD
100%
Services
Medicare
51.3%
100%
Services
Veterans
Clinic
Federal ACO
---------------------
TRICARE
18.5%
100%
Services
Board of Directors
FEHB/
Others
TBD%
100%
Services
VA-19-0799-D-000485
OS 00002151
Message
From:
Darin Selnick [(b) (6)
Sent:
To:
4/15/2017 3:09:35 PM
Subject:
Attachments:
@gmail.com]
David shulkin [Drshulkin@aol.com]
Fwd: draft for the choice demonstration pilots
Community of Care and VAMC Health Care Delivery Modernization.docx
FYI
Baligh asked me to draft up the ideas from Monday for the pilot demonstration pilots, so I did and sent them to
him and Poonam. The draft is rough but it gives the ideas form and structure and we will have the team build
upon them so they can be part of the legislation.
Hope you are having a good weekend with family.
Darin
---------- Forwarded message---------From: Selnick, Darin
Date: Thu, Apr 13, 2017 at 10:31 PM
Subject: draft for the choice demonstration pilots
To: "Yehia, Baligh R."
Cc: "Alaigh, Poonam, M.D." , "(b) (6)
<(b) (6)
k@gmail .com>
@gmail.com"
Hi Baligh
Attached is the draft I promised on the basics for the demonstration pilots and how conceptually it would all
work. I finish it on the plane today. This is just the basics to get it going and we will need to flush it out with
the team.
Best
Darin
Darin Selnick
Senior Advisor to the Secretary
Cell 202-390-5845
VA-19-0799-D-000486
OS 00002152
Community of Care and VAMC Health Care Delivery Modernization
Demonstration Pilots
Overview of Concept
The purpose of the demonstration pilots is to see if VA can operate its healthcare system more
effectively both in access and in cost, using the best practices of the TRICARE and the private
sector, to improve the delivery of healthcare to veterans. For the demonstration pilots, VHA
would separate its payer and provider functions into two different operating units and move
them from the existing HMO staff model to a HMO mixed model.
A HMO mixed model is when the community care provider network is a combination of
delivery systems. The VA demonstration pilots HMO mixed model will offer a wide variety of
choices and broad geographic coverage to its veteran's members. Patients will have the choice
of VHA and Community Care clinics, labs, pharmacies, and hospitals as their providers of care.
In the VA demonstration pilots, the HMO mixed model would be a combination of a the VAMCs
and CBOCs operating as a group model accountable care organization, such as the Cleveland
Clinic or Kaiser Permanente, and the Community Care operating as a contracted provider
network, such as United Healthcare or TRI CARE.
Key Components
Payer: The VA demonstration payer pilots would be operated as the Veterans Health Plan
(VHP). It would have the ability to operate using the best practices from private sector health
plans and from government payers.
In addition to using the new VA community care RFP, it would have legislative relief from any
government contracting and acquisition regulations that would impede its ability to operate
and compete with private sector HMO contracted provider networks. Key operating function
would include:
• Cost mitigation using secondary payer: Like TRICARE, VHP would be secondary payer for
all veterans who have other health insurance, including for all service connected and
non-service connected services that the OHi would normally pay for as part of its
benefits package. The current estimate is that 80% of veterans enrolled in VA
healthcare have OHi. This would mean that VHP would pay after all OHi, including all
other government and private insurance programs. VHP would be primary payer for
any benefits that the veteran would be entitled to as part of the VA healthcare benefit,
but is not part of their OHi benefit.
• Primary coordinator of benefits: To ensure veterans are not balance billed, VHP would
act as the primary coordinator of benefits to ensure veterans are not charged
inappropriately by their OHi and would receive an EOB which would list the charges and
VA-19-0799-D-000488
OS 00002154
•
•
what is owed by the veteran. VHP would ensure the veterans OHi would process the
providers claim first and be responsible to settle all disputes.
Balance billing: By law, VHP like TRICARE would prohibit the practice of balance billing.
Balance billing requirements would apply to both network and non-network providers
who treat VHP beneficiaries and noncompliance would impact their VHP and/or
Medicare, Medicaid or FEHB status.
Governance - Board of Directors: An overall board of directors would provide
governance and operational oversite for the demonstration pilots. The board would
consist of the SECVA, USH, PDUSH, DUSHs, leading healthcare experts, and veteran
representation.
Provider
The VA demonstration provider pilots would be operated as the Veterans Clinic. As the
Veterans Clinic, it would be set up and have the ability to operate on a level playing field with
private sector provider healthcare organizations. It would be able to use the same best
practices that private sector provider accountable care organizations such as the Cleveland
Clinic, Mayo Clinic and Kaiser Permanente use
It would operate as a not for profit group practice with physician leadership which would be
salaried. Its governance would consist of a board of directors. Revenue would come from all
payers for all services rendered to its patients, including VHP, all other government payers, and
all private coverage. It would have legislative relief from any government personnel,
contracting, acquisition, and any other government regulations and rules that would impede its
ability to operate and compete with private sector providers. Key operating functions would
include:
• Governance - Board of Directors: An overall board of directors would provide
governance and operational oversite for the demonstration pilots. The board would
consist of the SECVA, USH, PDUSH, DUSHs, leading healthcare experts, and veteran
representation. The board of director would have oversight from Congress.
• Control of facilities and footprint: The board of directors would have complete
authority and control over its facilities and footprint. Other governmental agencies and
Congress would not be able to block lawful decisions.
• Leadership: Each demonstration pilot would have a traditional private sector provider
structure headed by a CEO that would report to the board of directors. They would
have a 5 year contract but could be terminated by the board due to poor performance.
• Revenue: The dollars would follow the patient. Each demonstration pilot would have
provider contracts with all payers, including both government (Medicare, Medicaid,
FEHB), private sector managed care and commercial. The Veterans Clinics would be
reimbursed for all services provided the same as private provider groups. If there is
excess capacity each pilot would have the option to open up to non-eligible veterans
and family members who would be pay the full premium through their OHi.
VA-19-0799-D-000489
OS 00002155
•
•
•
Benefit Package: All eligible veterans would have the same existing benefit package
they currently do. VHP would have to pay the gap between what the veteran OHi
authorized benefit package and VHP. Non-eligible veterans and families would only be
offered services that are 100% paid for by their OHi.
Efficiency: All Veterans Clinic would have to operate based on the revenue provided by
the payers. It would be expected that they would have to improve their operations to
be more efficient to match their revenue.
Accountable Care Organization functions: The Veteran Clinics would operate following
the primary characteristics of an ACO to include strong primary, specialty and hospital
care with effective cost control and quality of care:
o Capacity to manage both the cost and quality of health care services under a
range of payment systems.
o Have comprehensive, valid and reliable performance measurements, make
internal system improvements in care quality and externally report on its
performance on cost and quality of care
o Commitment to achieve quality and cost efficiencies, a physician management
structure and a culture that supports and rewards continuous quality
improvement.
o Use of health information technology to manage patients across the continuum
of care and across different institutional settings.
Demonstration pilot sites
•
•
Arizona: Senate Sponsor - Senator McCain
Washington: House Sponsor- Rep McMorris Rodgers
Time Frame
• Demonstration pilots would be required to be set up and fully operational within one
year after the legislation had been passed by congress and signed by the President.
•
Demonstration pilots after the one year set up period would run for five years with an
automatic five year extension unless congress voted to end the extensions.
VA-19-0799-D-000490
OS 00002156
Organizational
Structure
VHA - Mixed Model Demonstration Pilots
(Payer and Provider Organization)
VHA
Board of Directors
SECVA,USH,PDUSH
Demonstration Pilots
DUSHs, HC experts,
Veterans
Office
VHA Payer
Veterans Health Plan
Community Care Networks
VHA Provider
Veteran Clinic
VACO
VACO
,
Veteran Clinic
Arizona
Local -Hospital and
Clinics
Veteran Clinic
Washington
Local -Hospital and
Clinics
Community Care Providers
Arizona
Washington
VA-19-0799-D-000491
OS 00002157
Revenue Flow
VHA Revenue
(Payer and Provider)
Congressional
Funding
~-----~
- c:=J
VHA
VHA Payer
Veterans Health Plan
OHi Payer
Contracts
Gov & Private
VHA Provider
Veteran Clinic
National
Private Sector
Community Care Network
Pilot Sites
VHA - Veteran Clinic
Pilot Regional Area
VHA - Veteran Clinic
Pilot Local -Hospital and Clinics
VA-19-0799-D-000492
OS 00002158
Revenue from Payers
Veterans OHi %
Mediaaid
VHA Payer
TBD
100%
Services
Medicare
51.3%
100%
Services
Veterans
Clinic
Federal ACO
---------------------
TRICARE
18.5%
100%
Services
Board of Directors
FEHB/
Others
TBD%
100%
Services
VA-19-0799-D-000493
OS 00002159
Message
From:
Sent:
To:
Subject:
Attachments:
David Shulkin [drshulkin@aol.com]
4/16/2017 1:21:17 PM
(b) (6)
gmail.com
early draft for april 25th
april25thtoppriorities.pptx
There is still more to work on but so far this is what I have if we want to begin to work from this
VA-19-0799-D-000494
OS 00002160
, IA
V'"'
I U.S. Department
ofVeterans Affairs
5 Things We Need From Leadership
and 5 Priorities for VA
David J. Shulkin, MD
Secretary of Veterans Affairs
April 19, 2017
VA-19-0799-D-000495
OS 00002161
1.
38
Don't Plan for Incremental Change
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VA-19-0799-D-000496
OS 00002162
Events at the DC VA
Acting Decisively
Draft/ Pre-dec1s1onal / For Internal VA Use Only
3
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VA-19-0799-D-000497
OS 00002163
2-
4
Run Towards the Gun Fire
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VA-19-0799-D-000498
OS 00002164
Making Tough Decisions
5
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VA-19-0799-D-000499
OS 00002165
United's Response
Ill
r'::itertJayseDavid
4:51 PM ET
UNITED DRAGS PASSENGER FROM OVERBOOKED FLIGHT
THE LEAD
Draft/ Pre-dec1s1onal / For Internal VA Use Only
6
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VA-19-0799-D-000500
OS 00002166
3.
7
Demonstrate Your Commitment to the Mission
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VA-19-0799-D-000501
OS 00002167
From: Inc. United Airlines
To: Vet eran Sm ith
Important update about your checked
baggage
Today at 9:09 AM
We're sorry, but your checked bag will arrive
on a later fl ight to Philadelph ia. When you
arrive, please see a Baggage Service
representative in Baggage Claim to arrange
your choice of delivery or pickup. We
apologize for this disruption to your plans
today.
VA-19-0799-D-000502
OS 00002168
4. Focus On Your People
I,_
My VA Organizational Hicrard1y _ ~
• .._
( .,
~
Dr D111ld Shulkln, VA Under Se wrote:
David, please see below- they need me to be the project sponsor in order to move forward in the
direction below. I am getting a little concerned especially if we don't have a clear path- I think
the team needs to meet with you and we should meet with the WH again soon to ensure we have
all synced up. Also, they need a finance person on the team now- should I get Mark Yow
involved or do you want someone from Ed Murrays area?
Sent from my iPad
Begin forwarded message:
From: "Alaigh, Poonam, M.D."
Date: April 13, 2017 at 8:57:58 PM EDT
To: 'Poonam Alaigh' <(b) (6)
hotmail.com>
Subject: FW: EHRM team.
Sent with Good (www.good.com)
-----Original Message----(b) (6)
From: (b) (6)
J., Jr.
Sent: Thursday, April 13, 2017 08:54 PM Eastern Standard Time
To: Alaigh, Poonam, M.D.
Subject: EHRM team.
All,
and I met with Dr. Alaigh this evening and I was given clear marching efforts to
(b) (6)
quickly and quietly usher our EHR Modernization effort with the DoD forward. (b) (6) and I sat
down with (b) (6)
on the phone to outline our key deliverables and dates, building from the
schedule (b) (6)
established. This email outlines our roles and responsibilities in the near term.
EHRM Project Sponsor - Dr. Alaigh
Team Lead-(b) (6)
Clinical - (b) (6)
VA-19-0799-D-000521
OS 00002187
OI&T-TBA (Dr. Alaigh requested from OI&T 4-13)
Legal - (b) (6) & (b)
(6)
Contracts - (b) (6) (b) (6)
David, (b) (6) and (b) (6)
Engineering - Digital Service
Financial & Appropriation - TBD (request from Dr. Alaigh 4-13)
Conununications - via existing Mitre contract and VA Front office
I believe the following deliverables and dates are achievable, let's discuss on our daily call:
Deliverables:
Draft Due
Final Due
Apr 18
Apr 21
D&F - (b) (6)
PWS - OI&T & (b) (6) (DS)
Apr 20
Apr26
IGCE - (b) (6)
Apr 20
Apr26
RTM-(b) (6)
Apr 20
Apr26
Station Code (aka MTF Codes - OIT lead & (b) (6)
Apr 20
Apr26
Apr 21
Action Memo - (b) (6)
Apr 18
Apr26
Financial Budget & Appropriations Language Changes Apr 20
Acquisition Strategy - (b) (6)
(if required)
Tomorrow morning I have a meeting with DoD' s Program Executive Officer Stacy Cummings. I
have asked (b) (6)
and (b) (6)
to dial into that call.
I will send out a standing daily Team Call for our synchronization for 1PM EDT.
Upcoming Key Events:
D&F Signed
Team Lock Down
Vendor Meeting & PWS Review
Site Visit - VAMC NY
Site Visit - VAMC Philly
Congressional Notification
White House Public Announcement
Apr 21
Apr 24 & 25 - TAC
Apr26
Apr27
Apr28
Apr24
May 15
Please let me know if I missed anything or we need to discuss further.
Finally, I came to the VA just over a year ago to work on modernizing our EHR. This vision is
quickly becoming a reality. It is both an honor and privilege to be working with such an esteemed
TEAM on this incredibly important project for the VA and our Veterans.
Warm regards,
(b) (6)
Program Executive for EHR Modernization
- 703-587-(b) (6)
(b) (6)
VA-19-0799-D-000522
OS 00002188
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
4/14/2017 1:05:28 AM
Drshulkin@aol.com
Fwd: EHRM team.
hotmail.com]
David, please see below- they need me to be the project sponsor in order to move forward in the direction
below. I am getting a little concerned especially if we don't have a clear path- I think the team needs to meet
with you and we should meet with the WH again soon to ensure we have all synced up. Also, they need a
finance person on the team now- should I get Mark Yow involved or do you want someone from Ed Murrays
area?
Sent from my iPad
Begin forwarded message:
From: "Alaigh, Poonam, M.D."
Date: April 13, 2017 at 8:57:58 PM EDT
To: 'Poonam Alaigh' <(b) (6)
hotmail.com>
Subject: FW: EHRM team.
Sent with Good (www.good.com)
-----Original Message----(b) (6)
From: (b) (6)
J., Jr.
Sent: Thursday, April 13, 2017 08:54 PM Eastern Standard Time
To: Alaigh, Poonam, M.D.
Subject: EHRM team.
All,
and I met with Dr. Alaigh this evening and I was given clear marching efforts to quickly and quietly
(b) (6)
usher our EHR Modernization effort with the DoD forward. (b) (6) and I sat down with (b) (6)
on the phone to
outline our key deliverables and dates, building from the schedule (b) (6)
established. This email outlines our
roles and responsibilities in the near term.
EHRM Project Sponsor - Dr. Alaigh
Team Lead-(b) (6)
Clinical - (b) (6)
OI&T-TBA (Dr. Alaigh requested from OI&T 4-13)
Legal - (b) (6) & (b)
(6)
Contracts - (b) (6) (b) (6)
David, (b) (6) and (b) (6)
Engineering - Digital Service
Financial & Appropriation - TBD (request from Dr. Alaigh 4-13)
Communications - via existing Mitre contract and VA Front office
I believe the following deliverables and dates are achievable, let's discuss on our daily call:
Deliverables:
Draft Due
Final Due
Apr 21
D&F - (b) (6)
Apr 18
PWS- OI&T & (b) (6) (DS)
Apr 20
Apr 26
VA-19-0799-D-000523
OS 00002189
IGCE - (b) (6)
Apr 20
Apr26
RTM-(b) (6)
Apr 20
Apr26
Station Code (aka MTF Codes - OIT lead & (b) (6)
Apr 20
Apr 21
Action Memo - (b) (6)
Apr 18
Financial Budget & Appropriations Language Changes Apr 20
Acquisition Strategy - (b) (6)
(if required)
Apr26
Apr26
Tomorrow morning I have a meeting with DoD' s Program Executive Officer Stacy Cummings. I have asked
and (b) (6)
to dial into that call.
(b) (6)
I will send out a standing daily Team Call for our synchronization for 1PM EDT.
Upcoming Key Events:
D&F Signed
Team Lock Down
Vendor Meeting & PWS Review
Site Visit - VAMC NY
Site Visit - VAMC Philly
Congressional Notification
White House Public Announcement
Apr21
Apr 24 & 25 - TAC
Apr26
Apr27
Apr28
Apr24
May 15
Please let me know if I missed anything or we need to discuss further.
Finally. I came to the VA just over a year ago to work on modernizing our EHR This vision is quickly bec01ning a
reality. It is both an honor and privilege to be working with such an esteemed TEAM on this incredibly important
project for the VA and our Veterans.
Warm regards,
(b) (6)
Program Executive for EHR Modernization
- 703-587-(b) (6)
(b) (6)
VA-19-0799-D-000524
OS 00002190
Message
From:
(b) (6)
Sent:
To:
4/13/2017 7:01:06 PM
David Shulkin [drshulkin@aol.com]
Fwd: Re: draft for studer group
2017 04 19-3 HURON CEO FORUM.pptx; 2017 04 19 Huron (Studer) CEO Forum Audience Analysis.docx
Subject:
Attachments:
[(b) (6)
Here is a copy of the slides to review
---------- Forwarded message---------From: "Brian Mitchell" <(b) (6)
Date: Apr 13, 2017 2:52 PM
Subject: Re: draft for studer group
To: "(b) (6)
<(b) (6)
Cc:
gmail.com]
gmail.com>
gmail .com>, "(b) (6)
<(b) (6)
gmail .com>
(b) (6)
Here are the Huron slides, 51 in all, plus an audience analysis with most of what he'll need to know (bios, guest
list).
I'll be out on leave for Easter tomorrow and Monday, in church and unavailable for work most of the time. Al
will be in tomorrow, and Ed and (b) (6)
will be back Monday.
I don't expect there will be much more work for them to do. But someone will need to make the slides
available to Nushin before Wednesday (possibly by posted them on our FTP) and send (b) (6)
the suggested
questions for the Q&A, once the Secretary OK's them.
Happy Easter.
Brian
On Mon, Apr 10, 2017 at 5:40 PM, (b) (6)
I
<(b) (6)
gmail.com> wrote:
I
Hi Brian, here is the deck the Secretary wants to use for the Studer CEO speech. The slide that says "VA is
leading in Many areas", he would like to develop that slide a little bit more and get more input from the Under
Secretaries and Deputy Under Secretaries.
VA-19-0799-D-000525
OS 00002191
, IA
V'"'
I U.S. Department
ofVeterans Affairs
Lessons from the U.S. Department
of Veterans Affairs
David J. Shulkin, MD
Secretary of Veterans Affairs
April 19, 2017
VA-19-0799-D-000526
OS 00002192
2
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Paying Attention to Culture
'Final Salute' honors Holocaust survivor, Veteran
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V A's Definition of Health
Private Sector
Peer Support
9
Ve erans Health Administration
X
Crisis Lines
X
Tra nsportation
X
Caregivers
X
Homelessness Services
X
Med ication Support
X
Behaviora l Hea lt h Integration
X
Aligned Incentives
X
Lifelong Relationships
X
Single EMR Pla t form
X
Works wit h Most Lead ing
Med ica l Centers
X
Vocat iona l Support
X
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Leaders Ask the Right Questions
Two Things Every Leader Needs to Know:
• Am I pushing too hard or not hard enough?
• What don't I know that is likely to damage
the organization?
10
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Set Big Goals
you ave a nee or
primary or mental
health care right
away, you can have it
addressed ttie same
day during regular
business hours.
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2011
2012
e
2013
Sheltered Veterans
2014
2015
Unsheltered Veterans
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VA-19-0799-D-000542
OS 00002208
Focus On Our People
I,_
My VA Organizational Hicrard1y _ ~
• .._
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to lhO ~ n e y room V"1
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25
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This slide and the next two are examples of the services VA provides that the private sector often doesn't.
VA-19-0799-D-000550
OS 00002216
Choose the Harder Right
Over the Easier "Wrong
lij;lliS:::-::;i;::;:~~ID"""""'~r.--""!:"ll..,,,,
26
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VA-19-0799-D-000551
OS 00002217
Walking the Talk: Practicing in NY and Oregon
27
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VA-19-0799-D-000552
OS 00002218
Leaders Propose Solutions
Rather Than Criticize
PROPOSE
Tl-IE SOLUTION
28
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VA-19-0799-D-000553
OS 00002219
Get People To Be Part of the Solution
29
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VA-19-0799-D-000554
OS 00002220
Challenge the Status Quo
38
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VA-19-0799-D-000555
OS 00002221
To Modernize, First Understand History
31
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VA-19-0799-D-000556
OS 00002222
VA Innovations
Nicotine
Patches
First Liver Transplant
Barcoding of Medications
Cardiac
Pacemaker
3 Nobel Prizes
32
Artificial Kidney
CT Scanner
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VA-19-0799-D-000557
OS 00002223
Center for Compassionate Innovation
To enhance Veterans health and well-being by offering safe and ethical
therapies after traditional treatments have not been successful
The Power of
U._S. Department
of Veterans Affairs
COMPASSION
41
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VA-19-0799-D-000558
OS 00002224
Making Tough Decisions
34
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VA-19-0799-D-000559
OS 00002225
APRNS -
37
300,000
Comments
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VA-19-0799-D-000560
OS 00002226
Effective Organizations Break Down Silos
36
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VA-19-0799-D-000561
OS 00002227
Don't Take No For An Answer
38
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VA-19-0799-D-000562
OS 00002228
"It takes an Act of Congress"
36
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VA-19-0799-D-000563
OS 00002229
~
NOTICE
1-48 Visiting Hours
- Unlimited -
39
, IA
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VA-19-0799-D-000564
OS 00002230
VA is Leading In Many Areas
"Hospital-acquired infection is one of the country's leading causes of death, killing
75,000 people per year - more than car accidents and breast cancer combined. Yet
hospitals have only started to take prevention seriously in the last decade, most in the last
five years.
"One hospital group, however, has done more than all others. It's not the Mayo Clinic's
hospitals, nor the Cleveland Clinic's, nor Kaiser Permanente, nor Sutter, nor Geisinger.
These are all hospital chains known for their quality, but another big name leaves them in
the dust: the \I.A."
Tina Rosenberg
The New York Times
40
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VA-19-0799-D-000565
OS 00002231
Safety and Clinical Outcomes
JAMA, February 2015 : 30-day risk-adjusted mortality rates lower than those of non-VA hospitals for acute
myocardial infarction and heart failure.
American Journal of Infection Control: In five years, MRSA infections declined 81% in VA Spinal Cord Injury units (AJIC May 2013)
69% in VA Acute Care facilities (AJIC Nov 2013)
36% in VA Community Living Centers (AJIC Jan 2014)
The Independent Assessment: VA performed the same or significantly better than non-VA providers on 12 of 14
effectiveness measures in the inpatient setting, significantly better on 16 outpatient HEDIS measures compared
with commercial HMOs, and significantly better on 15 outpatient HEDIS measures compared with Medicare
HMOs.
A 2015 study published in the Psychiatric Services: VA mental health care was better than private-sector care by
at least 30 percent on all seven performance measures, with VA patients with depression more than twice as
likely as private-sector patients to get effective long-term treatment.
A 2015 UC Davis study: Outcomes for VA patients compared favorably to patients with non-VA health insurance,
with VA patients more likely to receive recommended evidence-based treatment.
41
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VA-19-0799-D-000566
OS 00002232
Reduction in Opioid Use
Overall opioid use:
Benzo co-prescribing:
420,000
395,00J
High dose:
~qooo
345,00J
~qooo
295,00J
nqooo
£
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Annual drug screening: 86%
8 8
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Decline in Veterans on long-term opioid therapy, 40 FY 2012 to 10 FY 2017. Overall opioid use down 31% in the same
period.
VA-19-0799-D-000567
OS 00002233
Our Pharmacy Is Best in Class
J.D. Power's Mail Order Pharmacy Overall
Satisfaction
Department of Veterans Affairs
871
Kaiser Perm. Mail Pharmacy
Humana RightSourceRX
Walgreens Mail Service
822
Mail Order Average 800
43
820
840
860
880
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VA-19-0799-D-000568
OS 00002234
Population-based Hepatitis C treatment
86,000 Veterans treated
77,400 cured
90% cure rate
2,000 treated each month
Poised to eliminate Hep C among Veterans in 2 Years
44
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Decline in Veterans on long-term opioid therapy, 40 FY 2012 to 10 FY 2017. Overall opioid use down 31% in the same
period.
VA-19-0799-D-000569
OS 00002235
Specialists in Our Foundational Services
45
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VA-19-0799-D-000570
OS 00002236
Veterans Crisis Line
• 2.8 million calls answered since inception in 2007
• 2,000 life-changing calls answered daily
• 60 dispatches for emergency services daily
• 463,000 referrals made to local suicide prevention
coordinators
• calls rolled over to back-up centers cut from 3,000 in
October to under 60 in January.
• Roll-over rate since January: Less than one percent.
46
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VA-19-0799-D-000571
OS 00002237
Innovative Research
REUTERS
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achieve 9reat things
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Top 25 Global Innovators - Government
M12 U.S. Department of Veterans A ffa i rs
USA
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Almost 10,000 peerreviewed studies published
last year:
1,800 on Access
577 on PTSD
386 on Suicide
230 on TBI
x._l1n1t/"
XFlNITYI' X1 Double Play
•
$680 million on research
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VA-19-0799-D-000573
OS 00002239
Largest Educator of Health Professionals
• Over 1,800 academic and institutional partners
• 120,000 healthcare workers trained each year:
~60,000 medical students and residents
~30,000 nursing students
~30,000 students in other health fields
• An estimated 70% of all U.S. doctors have trained with VA.
49
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VA-19-0799-D-000574
OS 00002240
The Secretary's 5 Priorities
1. Greater Choice for Veterans
4. Improve Timeliness of Services
Redesign the 40/30 Rule
-
Access to Care and Wait Times
Build a High-Performing Integrated Network of Care
-
Decisions on Appeals
Empower Veterans through transparency of information
-
Performance on Disability Claims
2. Modernize our Systems
-
Infrastructure Improvements and Streamlining
-
EMR Interoperability and IT Modernization
5. Suicide Prevention
Getting to Zero
3. Focus Resources More Efficiently
-
Strengthening of Foundational Services in VA
-
VA/DOD/Community Coordination
Deliver on Accountability and Effective Management
practices
50
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VA-19-0799-D-000575
OS 00002241
51
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VA-19-0799-D-000576
OS 00002242
Huron CEO Forum
Sofitel, Washington, DC
April 19, 2017
Huron is a global professional services firm committed to achieving sustainable results
in partnership with our clients. We bring a depth of expertise in strategy, operations,
advisory services, technology and analytics to drive lasting and measurable results in
the healthcare, higher education, life sciences and commercial sectors. Through focus,
passion and collaboration, Huron provides guidance to support organizations as they
contend with the change transforming their industries and businesses.
•
The audience will consist of 32 healthcare CEOs (see list below), plus a dozen or so
Huron managers.
•
Huron Managers (b) (6)
•
(b) (6)
•
You will speak from a podium with a Lavalier mic and confidence monitor.
•
You have been allotted one hour (3:45 to 4:45) for remarks and Q&A with
CEO, Carilion Clinic in Roanoke, VA
and
(b) (6)
will meet you upon your arrival.
Huron Managing Director, will introduce you. See bio below.
(b) (6)
Run of Show:
3:30-3:45
3:45-4:45
5:00
Break
You speak and then answer questions
Program ends
VA-19-0799-D-000577
DS 00002244
(b) (6)
Managing Director, Huron Consulting, has more
than 26 years of experience helping large health systems,
academic medical centers, children's hospitals and large
physician groups to substantially improve their operational
and financial performance. (b) (6) is a member of the Huron
Healthcare senior executive team, providing leadership for the
strategic direction and operations of the practice. His
leadership role includes responsibility for strategy, marketing,
and strategic relationships in addition to his role leading large,
complex client engagements.
(b) (6)
In 1995, (b) (6) joined Stockamp & Associates, which was acquired by Huron Consulting
Group in 2008, and held various leadership positions within Stockamp over his 15 years
with the company. Prior to joining Stockamp, (b) (6) had a successful nine-year consulting
career at Boaz Allen & Hamilton and at Accenture.
Prior to leading the Strategy, Marketing and Sales operations at Stockamp, (b) (6) led the
firm's Western U.S. operations. In this role he had overall responsibility for Stockamp's
client engagements, client relationships, strategic sales pursuits and strategy in the
western half of the United States.
(b) (6)
has worked with over 100 hospitals, health systems and academic medical centers,
helping them to realize millions of dollars in financial benefits and implementing
improvements in healthcare operations and IT-enabled solutions. He has a BS in
economics from Oregon State University.
(b) (6)
President and CEO of Carilion Clinic, a notfor-profit healthcare organization based in Roanoke, Va., providing
care close to home for nearly 1 million Virginians.
(b) (6)
Born at Roanoke Memorial Hospital, Ms. (b) (6) began her career in
nursing in the early 1970s, serving in various management roles
over the years. In 1996, she was appointed vice president and
gradually assumed increasing administrative and executive
leadership roles at Carilion. As Executive Vice President and Chief
Operating Officer from 2001 to 2011 , Ms. (b) (6) was at the forefront
of the successful initiative to reorganize Carilion into a patientcentered, physician-led clinic.
She supports many professional and community activities including board positions for
The American Hospital Association, The Joint Commission, Virginia Hospital and
Healthcare Association, Virginia Center for Health Innovation, Roanoke Gas Company,
HomeTown Bank, Virginia Tech Carilion School of Medicine, Rockingham Mutual
Insurance Co. and the Taubman Museum of Art. Previously, Ms. (b) (6) served on the
Radford University Board of Visitors.
Ms.
(b) (6)
and her husband,
(b) (6)
have one son,
(b) (6)
VA-19-0799-D-000578
DS 00002245
Registered Attendees
(b) (6)
(b) (6)
(b) (6)
(b) (6)
SoutheastHEAL TH
Sentara Healthcare
CHI St. Luke's Health
VCU Health
FMOL Health System
Hartford HealthCare
Woman's Hospital
UI Health
UW Medicine
Benefis Health System
Atlantic Health System
Northwestern Memorial HealthCare
Holyoke Medical Center
Spartanburg Regional Healthcare System, Apella
Health, and Guardian Research Network
Hartford HealthCare
Virginia Mason Medical Center
Sentara Healthcare
Mosaic Life Care
Carle Health System
TBD
Visiting Nurse Service of New York
Dignity Health
UNC Hospitals
NA
Navicent Health
Bon Secours Health System
Orlando Health, Inc.
Marshfield Clinic Health System, Inc.
NEW
VA-19-0799-D-000579
DS 00002246
Message
From:
Sent:
To:
Subject:
Attachments:
David Shulkin [drshulkin@aol.com]
4/8/2017 8:14:57 PM
(b) (6)
gmail.com
draft for studer group
studer2017.pptx
VA-19-0799-D-000580
OS 00002247
Lessons from the US Department
of Veterans Affairs
David J. Shulkin MD
The 9th Secretary of US Department of Veterans Affairs
VA-19-0799-D-000581
OS 00002248
fly/VA
FULFILLING OUR MISSION
WE SERVE ALL WHO SERVED.
VA
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High-Performance Organization
. High , .
Performance '
Organization
••••
Technical Competence
- -
Ii
--
- - - - - - -
-
J
- - -
Purpose, Values & Principles
- - - - - - - - - - - - - -
I
~
VA-19-0799-D-000583
OS 00002250
Share YourJourney
Living with purpose is more rewarding than meandering around
Pay Attention to Culture
'i,,1/n,~ -..all"' a holl••cry fm 1/u! m~u:al•rnrgrM/j!oo~ ar
,_,,w,/1 F !l('Cfl,r the t,;,,Jy ufH,:,/o.;;m-,/ .,...,,._., .,.., ""'' Kor,,an m,, Air !•1) 1-.:,:
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{l'h<,rcn by 1n.·~c,r&~ la)
VA-19-0799-D-000586
OS 00002253
Understand Culture By Getting Out of the Office
Learning Medicine on the Ski Slopes
VA's Definition of Health
Pnvate Sector
Veterans Health Admin1strat1on
Peer Support
X
Crisis Lines
X
Transportation
X
Caregivers
X
Homelessness Services
X
Medication Support
X
Behavioral Health Integration
X
Aligned Incentives
X
Lifelong Relationships
X
Single EMR Platform
X
Works with Most Leading
X
Medical Centers
Vocational Support
X
VA-19-0799-D-000589
OS 00002256
Ask the Right Questions
Two Things Every Leader Needs to Know
• Am I pushing too hard or am I not pushing hard enough?
• What don't I know that is likely to damage the organization?
VA-19-0799-D-000590
OS 00002257
Asking About 600,000 Veterans Waiting for Care
--,
....amw..
~ - - -~
VETERANS WAITING FOR CARE
VA-19-0799-D-000591
OS 00002258
FOCUS ON WHAT IS IMPORTANT
IQI [Jim
Set Big Goals
you ave a need or
primary or mental
health care right
away, you can have it
addressed tile same
day during regular
business hours.
~ - -it&;!!<,.
1 ~ y Y.~
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The tools you want for the care you need!
.,_
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KUIUITt1m-criQttS1bns
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NJJl ri mHfl11rr-«f.nrnrP wlH,,n..,N fN>ffl It.
VA-19-0799-D-000593
OS 00002260
.... ·-
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Will your doctor
see you at 3 am?
Open 24 hours a day. Every day.
Beth Israel Medical Group
23rd Street and 7th Avenue
VA-19-0799-D-000594
OS 00002261
Run Towards the GunFire
Be Present
Decline in Homelessness
80,000
~
037
70,000
65,455
60,579
60,000
55,61'
-
50,000
40,000
_
47,725
~
43,437
40,033
35,143
34,909
32,119
30,650
30,000
25,422
31,505
25,436
20,710
20,000
1-1,57
_ 16,220
10,000
2010
♦
17
Total Homeless Veterans
20 12
20 11
•
2013
Sheltered Veterans
20 14
•
20 15
Unsheltered Veterans
'
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VA-19-0799-D-000597
OS 00002264
~
Focus on Our People
My VA Organizational Hierarchy _,'.'.
ll\s
VAP
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.
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HO ME 1.!!:) EXPLORE•
CRun -
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-
Dr, D1vid Stlulkin, VA Under Secretary for Health
- Welcomes You to VA Pulse -
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The Coll1bor1tlon Network Open to All YA Employees!
VAPUViE VA (~••,: \~
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VA-19-0799-D-000598
OS 00002265
DS 00002266
:mom.u..u.c.-n
Rid Organizations of Bad Actors
(Stop the Detailing)
"Dealing with employee issues
can be difficult,
but n o t de a Ii n g with th e m
can be worse."
- Paul Foster, CEO and Founder, The Business Therapist,
~ Busiress·
VA-19-0799-D-000600
OS 00002267
Accountability Legislation
"•;.
--~x~ •
'~.,J·-:
✓
,,-
-
■
l,
Increased
flexibility to
remove,
demote, or
suspend VA
employees for
poor
performance or
misconduct.
Authority to
recoup bonuses
of employees
for poor
performance or
misconduct.
Authority to
recoup
relocation
expenses
authorized
through fraud
or malfeasance.
\
Authority to
reduce federal
pensions for
employees
convicted of
felonies.
•
Increased
protections for
whistleblowers.
VA-19-0799-D-000601
OS 00002268
Little Stufmc Matters
97W
Get Everyone's Ideas
Questions
Patients
Need to Ask
Getting Better Healthcare
I
Essential Information Every Patient Needs to Know
Edited By David J. Shulkin, M.D.
VA-19-0799-D-000603
OS 00002270
Invest in others and develop them
sums may?; Iinux
A
Principle Based (vs. Rules Based) Organizations
Alt,,u(lUCrque \tclCfilllS AH...,
o(fiebls $a.d a ~~eran suf erina
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VA-19-0799-D-000605
OS 00002272
Choose the Hard Right than the Easier Wrong
os_00002273
Walk the Talk?Practicing in NY and Oregon
Leaders Propose Solutions, not Criticize
PROPOSE
TJ-IE SOLUTION
VA-19-0799-D-000608
OS 00002275
Getting People to Be Part of the Solution
29
On February 2, 2016, VA hosted a summit, "Preventing Veterans Suicide -A Call to Action" to bring together Veterans,
families, federal agencies, community providers, subject matter experts, and other key stakeholders to enhance suicide
prevention efforts.
The summit generated a new framework for VA's approach to Suicide Prevention that will transform the vision and
structure of suicide prevention across VA and the community.
VA has elevated and expanded our Suicide Prevention Program to fulfill this vision, which includes:
Meeting urgent mental health needs by providing Veterans same-day evaluations and access by the end of calendar year
2016.
Building and leveraging strategic partnerships to disseminate new initiatives within VA and to reach non-VA using
Veterans.
Development and implementation of innovative life-saving programs, such as REACH-VET, which uses predictive
modeling to identify Veterans at high risk for suicide.
Continuing to partner with the Department of Defense for a seamless transition from military service to civilian life.
VA-19-0799-D-000609
OS 00002276
Challenge the Status Quo
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of
9-0799-D-000611
Innovations from VA
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CT Scanner
First Liver Transplant
Artificial Kidney
Nicotine
Patches
Cardiac
3 Nobel Prizes
Pacemaker
VA-19-0799-D-000612
OS 00002279
Center for Compassionate Innovation@ VA
To enhance veteran's health and well being by offering safe and ethical
therapies after traditional treatments have not been successful
VA-19-0799-D-000613
OS 00002280
Making Tough Decisions
9-0799-D-000614
300k comments
5
0330002232
Effective Organizations Break Down Silos
• • ooo Sprin t
LTE
7:23 PM
Done CancerMoonshot Discus .. ~
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VA-19-0799-D-000616
OS 00002283
Don?t take no for an answer
"It takes an Act of Congress?
8
Our Pharmacy is best in class
J.D. Power's Mail Order Pharmacy Overall Satisfaction
Dept. of Veterans Affairs
871
Kaiser Perm. Mail Pharmacy
Humana RightSourceRX
Walgreens Mail Service
Mail Order Average
822
800
810
820
830
840
850
860
870
880
VA-19-0799-D-000619
OS 00002286
NOTICE
1-4B Visiting Hours
- Unlimited -
VA is Leading In Many Areas
• Safety and Clinical Outcomes as good or Better than Private Sector
• Opioid Reduction of> 30%
• Population Based Hepatitis C Treatment
• Largest educator of health professionals in US
• Over 10,000 peer reviewed studies published last year
• More than 2000 veteran crisis line calls are addressed each day
VA-19-0799-D-000621
OS 00002288
The Secretary's 5 Priorities
Greater Choice for Veterans
-Revise the 40/30 Rule
-Build an Integrated Network of Care
- Empower veterans through transparency of information
Modernize our System
-Infrastructure Improvements and Consolidations
-EMR Interoperability and Modernization
Focus Resources More Efficiently
-Foundational Services in VA
-VA/DOD/Community Coordination
-Deliver on Accountability and Effective Management practices
Improve Timeliness of Services
- Wait times and Accessibility for Care
- Decisions on Appeals
- Performance on Disability Claims
Suicide Prevention
VA-19-0799-D-000622
OS 00002289
Thank You
·-------- ---·- --------------- ---· --·- ---- · - - - - - "THE PRICE OF FREEDOM IS VISIBLE HERE.
--------- ____
,,.
-------- -
------- --· .... -··--~-· - ------
·--~-
VA-19-0799-D-000623
OS 00002290
Beth Israel Medical Group
Will your doctor
see you at 3am?
Ours will.
Open 24 hours a day. Every day.
Beth Israel Medical Group
23rd Street and 7th Avenue
VA-19-0799-D-000624
OS 00002292
Message
From:
Sent:
To:
Subject:
Attachments:
David Shulkin [drshulkin@aol.com]
4/15/2017 10:49:30 PM
(b) (6)
gmail.com
slides for huron
huronupdated.pptx
VA-19-0799-D-000625
OS 00002293
, IA
V'"'
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ofVeterans Affairs
Lessons from the U.S. Department
of Veterans Affairs
David J. Shulkin, MD
Secretary of Veterans Affairs
April 19, 2017
VA-19-0799-D-000626
OS 00002294
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VA-19-0799-D-000627
OS 00002295
Largest Educator of Health Professionals
• Over 1,800 academic and institutional partners
• 120,000 healthcare workers trained each year:
~60,000 medical students and residents
~30,000 nursing students
~30,000 students in other health fields
• An estimated 70% of all U.S. doctors have trained with VA.
3
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VA-19-0799-D-000628
OS 00002296
VA Research
Nicotine
Patches
First Liver Transplant
Barcoding of Medications
Cardiac
Pacemaker
3 Nobel Prizes
4
Artificial Kidney
CT Scanner
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VA-19-0799-D-000629
OS 00002297
Current Research
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Almost 10,000 peerreviewed studies published
last year:
1,800 on Access
577 on PTSD
386 on Suicide
230 on TBI
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OS 00002310
Run Towards the Gun Fire
18
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OS 00002311
Being Present
19
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VA-19-0799-D-000644
OS 00002312
Focus On Our People
I,_
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This slide and the next two are examples of the services VA provides that the private sector often doesn't.
VA-19-0799-D-000647
OS 00002315
Choose the Harder Right
Over the Easier "Wrong
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VA-19-0799-D-000648
OS 00002316
My Board
36
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VA-19-0799-D-000649
OS 00002317
Get People To Be Part of the Solution
25
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VA-19-0799-D-000650
OS 00002318
Making Tough Decisions
26
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VA-19-0799-D-000651
OS 00002319
APRNS -
37
300,000
Comments
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VA-19-0799-D-000652
OS 00002320
Challenge the Status Quo
38
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VA-19-0799-D-000653
OS 00002321
Center for Compassionate Innovation
To enhance Veterans health and well-being by offering safe and ethical
therapies after traditional treatments have not been successful
The Power of
U._S. Department
of Veterans Affairs
COMPASSION
41
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VA-19-0799-D-000654
OS 00002322
Effective Organizations Break Down Silos
30
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VA-19-0799-D-000655
OS 00002323
Decline in Homelessness
80,000
~
087
70,000
...............65 455
60,579
60,000
50,000
40,000
30,000
-
43 437
..
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47 725
40,033
35,143
34,909
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25,436
. £>,<££
20,710
20,000
32 119
31,505
,.,,.-·
_ 16,220
10,000
o
2010
+ Total Homeless Veterans
31
2011
2012
e
2013
Sheltered Veterans
2014
2015
Unsheltered Veterans
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VA-19-0799-D-000656
OS 00002324
Reduction in Opioid Use
Overall opioid use:
Benzo co-prescribing:
420,000
395,00J
High dose:
~qooo
345,00J
~qooo
295,00J
nqooo
£
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Annual drug screening: 86%
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Decline in Veterans on long-term opioid therapy, 40 FY 2012 to 10 FY 2017. Overall opioid use down 31% in the same
period.
VA-19-0799-D-000657
OS 00002325
Population-based Hepatitis C treatment
86,000 Veterans treated
77,400 cured
90% cure rate
2,000 treated each month
Poised to eliminate Hep C among Veterans in 2 Years
33
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Decline in Veterans on long-term opioid therapy, 40 FY 2012 to 10 FY 2017. Overall opioid use down 31% in the same
period.
VA-19-0799-D-000658
OS 00002326
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
34
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VA-19-0799-D-000659
OS 00002327
Greater Choice for Veterans
• Redesign the 40/30 Rule to use clinical
criteria for
veteran choice
• Build a high-performing, integrated
network of ca re
• Empower Veterans through
transparency of information
~
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VA-19-0799-D-000660
OS 00002328
h.
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Veterans
Speak
with
their
Feet
VA must
operate
simHar to the
private sector
lncrementamism is not the answer to additional improvements VA and Veterans need.
37
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VA-19-0799-D-000662
OS 00002330
Modernize Our Systems
• Infrastructure improvements
and streamlining services
• EMR interoperability and IT
modernization
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VA-19-0799-D-000663
OS 00002331
Infrastructure Improvements
Gas Station
Minneapolis, MN
1932
Fort Thomas, KY
Circa 1895
39
Palo Alto VAMC
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VA-19-0799-D-000664
OS 00002332
Focus Resources
More Efficiently
• Strengthening of foundational
services in VA
• VA/DOD/Community coordination
• Deliver on accountability and
effective management practices
~
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VA-19-0799-D-000665
OS 00002333
"World Class Foundational Services
41
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VA-19-0799-D-000666
OS 00002334
Accountability Legislation
Increased
flexibility to
remove,
demote,or
suspend VA
employees for
poor
performance or
misconduct.
Authority to
recoup
bonuses of
employees for
poor
performance or
misconduct.
Authority to
recoup
relocation
expenses
authorized
through fraud
or malfeasance.
Authority to
reduce federal
pensions for
employees
convicted of
felonies.
Increased
protections for
whistle blowers
U.S. Departmcnl
VA i'~ ) ofVctc.-a
ns ,\ffa i rr-;
VA-19-0799-D-000667
OS 00002335
Improve Timeliness
of Services
• Access to care and wait times
• Decisions on appeals
• Performance on disability claims
~
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VA-19-0799-D-000668
OS 00002336
How quickly does my VA see
patients?
How satisfied are veterans like
me with the timeliness of their
care?
How well does my VA's care
compare to other hospitals?
VA-19-0799-D-000669
OS 00002337
5- Suicide Prevention
~
G(TTING
TO Z[RO
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VA-19-0799-D-000670
OS 00002338
Priority 8- Suicide Prevention
,
,
•
U ·• . .
......
Reach Vetenns
and their families
Expand the YA
Suicide Prevention
Office
···...
Develop innovative
prevention strategies
/!!\::':.
V
46
Build community
engagement
roundsulclde
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VA-19-0799-D-000671
OS 00002339
47
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VA-19-0799-D-000672
OS 00002340
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/16/2017 1:19:27 AM
To:
Vivieca Simpson [(b) (6)
gmail.com]
Vivieca- if i wanted to ask about a wolftrap show - who is best to ask?
Sent from my iPhone
VA-19-0799-D-000673
OS 00002342
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/13/2017 4:08:28 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Jen
of course
Sent from my i Phone
> On Apr 13, 2017, at 11: 38 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> I want to give it to Lu Beck instead of Mike Valentino- you OK?
>
> Sent from my iPhone
VA-19-0799-D-000674
OS 00002343
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/13/2017 3:38:08 PM
David Shulkin [drshulkin@aol.com]
Jen
I want to give it to Lu Beck instead of Mike Valentino- you OK?
Sent from my iPhone
VA-19-0799-D-000675
OS 00002344
Message
From:
(b) (6)
Sent:
To:
4/19/2017 10:22:07 PM
David Shulkin [drshulkin@aol.com]
health data palooza options
healthdatapoolza-Shulkin.pptx; LPW Healthdata Palooza.pptx; 2017 04 28-1 Health Datapalooza.pdf
Subject:
Attachments:
[(b) (6)
gmail.com]
Hi,
the first deck is yours.
the second deck is mine -recommendations, not fully edited, just wanted to show you a story before I edited
down
the second deck is the deck brian created from your suggestions
talk is only 15 minutes. Can edit more if you choose.
VA-19-0799-D-000676
OS 00002345
Health Datapalooza
David Shulkin, M.D.
Secretary
Department of Veterans Affairs
Q\
~
I U.S. Departme nt
ofVeterans Affairs
AAMC 11/6/15
VA-19-0799-D-000677
OS 00002346
lilyVA
LLING OUR MISSION
SERVE ALL WHO SERVED.
VA
u: ULm?a
Great Tradition: Honoring Those Who Served
'Final Salute' honors Holocaust survivor, Veteran
Smlo,i >roll ma liall•w .,,, ,M --'rml-swr1caljloorat /,,,.y/1 fl lCCjo, ,,_. t,,.,JJ<>fll.,/1,ca11Jt llrf\"IWll'-1 Kortilll Hor Air J,o,w l tlt/'11111'011I A,g'"·lc ,ok •l1ukdro 1M dn'1000 simultaneous VA and non-VA
researchers by 2020
Safe/secure, CUA-compliant biorepository with back-up
Establish mechanisms to return results responsibly to: Providers, EHR and Participants
VETERANS HEALTH ADMINISTRATION
13
VA-19-0799-D-000689
OS 00002358
Host Facility: VA Palo Alto Health Care System
Provides remote diagnostic
radiology interpretations,
with final reports uploaded
directly into the patient
electronic health record
• Serves 88 VA facilities across all service networks
• Operates from multiple reading centers to ensure 24/7 operation
VETERANS HEALTH ADMINISTRATION
14
VA-19-0799-D-000690
OS 00002359
VHA Tele-ICU Fact Sheet
VISN lO Tele-lCU program (Cincinnati)
Connects rn other fa cilit ies lnt ens.ive Car e Units
VETERANS HEALTH ADMINISTRATION
VISN 23 Tele-I CU Program (Mi nneapo lis)
Connects; t o other Facilit ies' lnt ens.ive Care Units
15
VA-19-0799-D-000691
OS 00002360
Hub in Salt Lake City:
•
Centralized Genomic Medicine
Service started in 2012
•
Reaches areas of the country
where genetic services are
generally unavailable
•
Provides direct patient
counseling and support to
local clinicians
•
Now reaches 80 VAMCs
VHA Genom ic Medic ine
0
Hub
•
Affiliated
Care delivered through CBOCs
as well as VAMCs to reach
Veterans in their communities
VETERANS HEALTH ADMINISTRATION
16
VA-19-0799-D-000692
OS 00002361
Reductions in Utilization FY 2015
■
Home Telehealth reduced bed days of care: 58%
■
Home Telehealth reduced hospital admissions: 32%
■
Clinical Video TeleMental health reduced acute psychiatric bed days
of care: 35%
Patient Satisfaction
■
Home Telehealth: 89%
■
Store-and-Forward Telehealth: 96%
■
Clinical Video Telehealth: 94%
VETERANS HEALTH ADMINISTRATION
17
VA-19-0799-D-000693
OS 00002362
VA I ,',~J1l' llcr-m,cm
~
DASHBOARD
'
Searrli Q
{1l hik1a..11~.\lla.11,
PHARMACY
APPOINTI,IDff'S
MESSAGES
HEALTII RECORDS
RESOURCT.S
My HealtheVet Statistics
Registrants: 3.6 million
Secure Messaging users: 1.7
million
Rx Refill Requests: 81 million
0
1/f.. Blue:l urui n R~c ord
t-'~ ~ lth:Summ l!l ry
Resources
~
Benefits
Notifications
.:f'
Hea lt hy Living
.g Me n tal Health
liflt Vet era n.s. Hea Ith
Libra ry
Lil
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As:se s.sme n t
'.ZL-";l r :W!E-
.NWCP..:..CT:WEH : D9DOEDT
VA Blue Button Downloads: 1.4
million
Change in Appointment Viewers
from December 2014 to December
2015: 32% increase
*Statistics as of March 2016
VETERANS HEALTH ADMINISTRATION
18
VA-19-0799-D-000694
OS 00002363
Annie - a mobile messaging system that promotes self-care
for Veterans. Annie sends regular, automated text message
reminders to Veterans to help them track health information
their VA care teams have requested. Annie can also send
Veterans reminders and messages from their local VA facility.
Learn More:
https ://www.youtube.com/watch ?v=zke kN r6DeQY &featu re=youtu. be
VETERANS HEALTH ADMINISTRATION
19
VA-19-0799-D-000695
OS 00002364
____
-
Veterans Appointment Request (VAR) Allows Veterans to directly schedule and
cancel selected primary care appointments
directly through the app
~
_..,
Veteran Appointment Usability Study
Results:
• 76% satisfied with app
• 95% believe it has the potential to
improve access to care
o°"~....,_._. ___ _.,.
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VETERANS HEALTH ADMINISTRATION
R
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http://mobile.va.gov/appstore
20
VA-19-0799-D-000696
OS 00002365
Mobile Distance Hearing Aid Fitting App
A distance hearing aid fitting application
that runs on a smartphone and allows
audiologists to perform hearing aid
adjustments remotely on hearing aids
•
·····•·················· ···············
AudiOlog>I
r., "'
'"'""""
VETERANS HEALTH ADMINISTRATION
21
VA-19-0799-D-000697
OS 00002366
https://www.youtube.com/watch?v=38pl8hc9aso&feature=youtu.be
VETERANS HEALTH ADMINISTRATION
22
VA-19-0799-D-000698
OS 00002367
Thank You
·---~ __
·- ---------- --~- - - · - - - - - - - - - - .. THE PRICE OF FREEDOM IS VISIBLE HERE ..
------ -- - - --- .........
._
~
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. ,-
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--
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VA-19-0799-D-000699
OS 00002368
U.S. Department
of Veterans Affairs
Health Data Palooza
David J. Shulkin, MD
Secretary of Veterans Affairs
April 25, 2017
VA-19-0799-D-000700
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"To care for him who
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VA-19-0799-D-000701
OS 00002370
Important Contributions to Society
VA Research
Nicotine
Patches
First Liver Transplant
Barcoding of Medications
Cardiac
Pacemaker
3 Nobel Prizes
Artificial Kidney
CT Scanner
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VA-19-0799-D-000703
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Focus Resources
••••
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VA-19-0799-D-000706
OS 00002375
Greater Choice for Veterans
• Redesign the 40/30 Rule
• Build a high-performing,
integrated network of
care
• Empower Veterans
through transparency of
information
VAi
U.S. Department
ofVeterans Affairs
VA-19-0799-D-000707
OS 00002376
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VA-19-0799-D-000708
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VA-19-0799-D-000709
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Improve Timeliness
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U.S. Department
ofVeterans Affairs
VA-19-0799-D-000710
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VA-19-0799-D-000711
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foundational services in VA
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coordination
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effective management
practices
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U.S. Department
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VA-19-0799-D-000712
OS 00002381
Delivering Care Where We Don?t Have Facilities
3
VA Telehealth Services
2.14 million episodes to 677,000 Veterans {12%}
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156,000 Veterans
Video Telehealth
282,000 Veterans
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298,000 Veterans
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336,000 TeleMental health visits
15
VA-19-0799-D-000714
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VA-19-0799-D-000716
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VA-19-0799-D-000718
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VA-19-0799-D-000721
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VA-19-0799-D-000722
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VA-19-0799-D-000724
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VA-19-0799-D-000725
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VA-19-0799-D-000726
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Suicide Prevention
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Expand the VA
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VA-19-0799-D-000727
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Predictive Analytics: REACH VET
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for suicide
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of the risk assessment
VA-19-0799-D-000728
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Center for Compassionate Innovation
To enhance Veterans health and well-being by offering safe and ethical
therapies after traditional treatments have not been successful
VA-19-0799-D-000729
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https://www.youtube.com/watch?v=38pl8hc9aso&feature=youtu.be
32
VA-19-0799-D-000731
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VA-19-0799-D-000732
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David J. Shulkin, MD
Secretary of Veterans Affairs
April 28, 2017
VA-19-0799-D-000733
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FULFILLING OUR MISSION
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VA-19-0799-D-000735
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VA Research
Nicotine
Patches
8 Lasker
Awards
First Liver Transplant
Barcoding of Medications
Cardiac
Pacemaker
3 Nobel Prizes
Artificial Kidney
CT Scanner
VA-19-0799-D-000736
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VA-19-0799-D-000754
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Mobile Distance Hearing Aid Fitting App
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audiologists to perform hearing aid
adjustments remotely on hearing aids
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VA-19-0799-D-000755
OS 00002424
MVP and PMI Summary Objectives
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Establish mechanisms to return results responsibly to providers, EHR, and participants
VA-19-0799-D-000756
OS 00002425
Predictive Analytics: REACH VET
• Rolled out nationally
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Veterans at high risk
for suicide
• Notifies VA providers
of the risk assessment
VA-19-0799-D-000757
OS 00002426
MVP Enrollment Sites
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VA-19-0799-D-000758
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28
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/26/2017 2:04:36 PM
(b) (6)
[(b) (6)
mayo.edu]
Re: Details I Thursday
I totally understand
(b) (6)
Sent from my iPhone
> on Apr 26, 2017, at 9:14 AM,
(b)
(6)
<(b) (6)
mayo.edu> wrote:
>
> Hi David - thank you for the kind offer of access to the Thursday, 4:30 p.m. event. unfortunately, I
have commitments back here at Mayo/Rochester that require that I depart DC late morning, Thursday.
>
> Hope your meeting w/ your large group of leaders continues to go well -- thank you for your continued
strong leadership of the VA and for our nation's veterans.
>
>
(b) (6)
>
> -----original Message----> From: David shulkin [mailto:drshulkin@aol .com]
> Sent: Tuesday, April 25, 2017 9:20 PM
> To: IP
(b)
> cc:
(6)
> subject: Re: Details I Thursday
>
> Sorry just getting in and now just seeing your message
>
> I have my top 500 leaders in Virginia today and this was my afternoon to tell them where we need to
change- I've been out of cell range.
>
> I'll get
(b) (6)
on the list for the event.
430 pm on Thursday
>
> We have to be in the building by 2 as per secret service
>
> David
>
>
> Sent from my iPad
>
>> on Apr 25, 2017, at 3:51 PM, IP <(b) (6) frenchangel59.com> wrote:
>>
>>
>
>
VA-19-0799-D-000761
OS 00002430
Message
(b) (6)
[(b) (6)
mayo.edu]
4/26/2017 1:14:08 PM
David Shulkin [drshulkin@aol.com]
IP [(b) (6) frenchangel59.com]
Details I Thursday
From:
Sent:
To:
CC:
Subject:
Hi David - thank you for the kind offer of access to the Thursday, 4:30 p.m. event. unfortunately, I
have commitments back here at Mayo/Rochester that require that I depart DC late morning, Thursday.
Hope your meeting w/ your large group of leaders continues to go well -- thank you for your continued
strong leadership of the VA and for our nation's veterans.
(b) (6)
-----original Message----From: David shulkin [mailto:drshulkin@aol .com]
Sent: Tuesday, April 25, 2017 9:20 PM
To: (b)
(b)
(6)
cc:
(6)
subject: Re: Details I Thursday
Sorry just getting in and now just seeing your message
I have my top 500 leaders in Virginia today and this was my afternoon to tell them where we need to
change- I've been out of cell range.
I'll get
(b) (6)
on the list for the event.
430 pm on Thursday
We have to be in the building by 2 as per secret service
David
Sent from my iPad
> on Apr 25, 2017, at 3:51 PM, IP <(b) (6) frenchangel59.com> wrote:
>
>
VA-19-0799-D-000762
OS 00002431
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/26/2017 2:20:28 AM
IP [(b) (6) frenchangel59.com]
(b) (6) [(b) (6)
mayo.edu]
Re: Details I Thursday
To:
(b) (6)
CC:
Subject:
Sorry just getting in and now just seeing your message
I have my top 500 leaders in Virginia today and this was my afternoon to tell them where we need to
change- I've been out of cell range.
I'll get
(b) (6)
on the list for the event.
430 pm on Thursday
We have to be in the building by 2 as per secret service
David
Sent from my iPad
> on Apr 25, 2017, at 3:51 PM, IP <(b) (6) frenchangel59.com> wrote:
>
>
VA-19-0799-D-000763
OS 00002432
Message
From:
IP [(b) (6) frenchangel59.com]
Sent:
4/25/2017 7:51:31 PM
To:
David shulkin [drshulkin@aol.com]
FW: Details I Thursday
Subject:
Please give me a call. Thank you
[mailto:(b) (6)
mayo.edu]
From: (b) (6)
Sent: Tuesday, April 25, 2017 3:32 PM
To: Marisol Garcia ((b) (6) frenchangel59.com)
Cc: IP ((b) (6) frenchangel59.com); Bruce Moskowitz; Marc Sherman ((b) (6)
Subject: Details I Thursday
gmail.com)
Hi Marisol - can you send what you have in terms of details for Thursday - location/timeline of meetings - if possible
before 4:45 EDT.
Thanks,
(b) (6)
Chair I Mayo Clinic Department of Public Affairs
200 First Street S.W. I Rochester, MN 55905
cell: 507 .269.(b) (6) I office: 507 .284.(b) (6)
e-mail: (b) (6)
mayo. edu
VA-19-0799-D-000764
OS 00002433
Message
From:
Sent:
To:
David Shulkin [drshulkin@aol.com]
4/14/2017 2:32:35 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Missals comments are overboard- very dissapointing he is playing to the press
https ://www.washington post. com/1ocal/dc-politi cs/highest-I evel s-of-chaos-im pair-dc-veterans-hospi talinspector-general-finds/20 l 7/04/l 3/777bc786-203 d-lle7-ad743a742a6e93a7 story. html?utm term=.298ade90d0f2
Sent from my iPad
VA-19-0799-D-000765
OS 00002434
Message
To:
David shulkin [Drshulkin@aol.com]
5/20/2017 12:31:14 AM
Bruce Moskowitz [(b) (6)
Subject:
Re:
From:
Sent:
mac.com]
This would be interesting
You know everyone!
Sent from my iPhone
On May 19, 2017, at 6:27 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
After you were off phone my next call was to (b) (6)
chairman of Bristol there are
enough managers in the pharmaceutical industry he believes to assist filling management
positions. We think between this and the business schools we can do it. Mayo has an internship
with Baylor. If you can leave Texas for Minnesota that is something!!
Sent from my iPhone
On May 19, 2017, at 6:09 PM, David shulkin wrote:
From morningjoe show today- talking up the president
http ://www.newsmax. com/t/newsmax/article/791121 ?section=Politics&keywords
=david-shulkin-veterans-affairsleaders&year=2017 &month=0S&date= l 9&id=79 l 12 l&aliaspath=%2FManage%
2F Artic1es%2FTemplate-Main&oref=www.google.com
Sent from my iPhone
VA-19-0799-D-000766
OS 00002435
Message
CC:
Bruce Moskowitz [(b) (6)
mac.com]
5/19/2017 10:27:17 PM
David shulkin [Drshulkin@aol.com]
Poonam Alaigh [(b) (6)
hotmail.com]
Subject:
Re:
From:
Sent:
To:
chairman of Bristol there are enough managers
After you were off phone my next call was to (b) (6)
in the pharmaceutical industry he believes to assist filling management positions. We think between this and
the business schools we can do it. Mayo has an internship with Baylor. If you can leave Texas for Minnesota
that is something!!
Sent from my iPhone
On May 19, 2017, at 6:09 PM, David shulkin wrote:
From morningjoe show today- talking up the president
http ://www.newsmax. com/t/newsmax/article/791121 ?section=Politics&keywords=davidshulkin-veterans-affairsl eaders&year=2017 &month=0S&date= l 9&id=79 l 12 l&aliaspath=%2FManage%2F Articles%2F
Template-Main&oref=www.google.com
Sent from my iPhone
VA-19-0799-D-000767
OS 00002436
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
5/19/2017 10:09:40 PM
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
[(b) (6)
mac.com]
gmail.com]; Bruce Moskowitz
From morningjoe show today- talking up the president
http ://www.newsmax.com/t/newsmax/article/791121 ?section=Politics&keywords=david-shulkin-veteransaffairsleaders&year=2017 &month=OS&date= l 9&id=79 l 12 l&aliaspath=%2FManage%2F Artic1es%2FTemp1ateMain&oref=www.google.com
Sent from my iPhone
VA-19-0799-D-000768
OS 00002437
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/14/2017 7:05:12 PM
To:
Bruce Moskowitz [(b) (6)
Re: Tracking inventory
Subject:
mac.com]
I look forward to meeting him- thanks
Sent from my iPhone
On Apr 14, 2017, at 9:39 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
mentioned below.
One of the CIO's your meeting April 17 is (b) (6)
The actual application that I am most interested in applying for a device registry is to insure
appropriate procurement, utilization and tracking of devices throughout the VA system. This is
any device internal and external. I have enough data to show it (not in an email) what occurred
the past few days is not an anomaly. This was also in the full report that (b) (6)
participated in
not the summary.
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
From: Aaron Moskowitz <(b) (6)
brefnet.org>
Date: April 13, 2017 at 3 :54:30 PM EDT
To: "Bruce Moskowitz M.D." <(b) (6)
mac.com>
Subject: VA call follow up
I think the group has a good framework for the clinical applications. I was in
Baltimore this morning with (b) (6)
and discussed the actual problem of
tracking devices throughout the medical system, not just in patients. Apparently
Hopkins has been so successful at this they have a company, fully owned by
Johns Hopkins, that sets up inventory management at hospitals. We brainstormed
a bit on other methods to link implant information to patient records, a "smart"
inventory system could help this process.
VA-19-0799-D-000769
OS 00002438
Message
From:
Sent:
To:
Subject:
Bruce Moskowitz [(b) (6)
4/14/2017 1:39:33 PM
Poonam Alaigh [(b) (6)
Tracking inventory
mac.com]
hotmail.com]; David Shulkin [drshulkin@aol.com]
One of the CIO's your meeting April 17 is (b) (6)
mentioned below.
The actual application that I am most interested in applying for a device registry is to insure appropriate
procurement, utilization and tracking of devices throughout the VA system. This is any device internal and
external. I have enough data to show it (not in an email) what occurred the past few days is not an anomaly.
This was also in the full report that (b) (6)
participated in not the summary.
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
From: Aaron Moskowitz <(b) (6)
brefnet.org>
Date: April 13, 2017 at 3 :54:30 PM EDT
To: "Bruce Moskowitz M.D." <(b) (6)
mac.com>
Subject: VA call follow up
I think the group has a good framework for the clinical applications. I was in Baltimore this
morning with (b) (6)
and discussed the actual problem of tracking devices throughout
the medical system, not just in patients. Apparently Hopkins has been so successful at this they
have a company, fully owned by Johns Hopkins, that sets up inventory management at
hospitals. We brainstormed a bit on other methods to link implant information to patient records,
a "smart" inventory system could help this process.
VA-19-0799-D-000770
OS 00002439
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/15/2017 2:11:49 AM
Charlie Wiggins [(b) (6)
remedyventures.com]
Re: Home - Malone Center for Engineering in Healthcare
Ok great Charlie
Sent from my iPhone
On Apr 14, 2017, at 9:30 PM, Charlie Wiggins <(b) (6)
remedyventures.com> wrote:
Secretary Shulkin,
Often times while building a new initiative I find it helpful to free-form brainstorm to capture
ideas while cultivating vision. I've found using the open source software mindnode to be one
effective way to share those ideas amongst a team, remotely.
Attached and pasted below is an initial draft of a semantic tree of sorts that captures notable
accomplishments from the VACI to date and provides some additional avenues to consider as we
move forward. It is by no means a comprehensive document, but if you don't hate the layout it
can be a way we begin to structure thought/effort as we begin working together.
Looking forward to taking the next steps and walking you through some of these concepts during
our next conversation.
Have a great weekend,
Charlie
On Wed, Apr 12, 2017 at 12:47 PM, David shulkin wrote:
Ok great
Sent from my iPhone
On Apr 12, 2017, at 3 :37 PM, Charlie Wiggins <(b) (6)
remedyventures. com> wrote:
The Malone center is onto some interesting work - the Galen System,
microsurgical robotics platform and the Kata Studio - are two that stick out as
being beneficial for patients and clinicians within the VA
I have only spoke with the White House Liaison to the VA, (b) (6)
yesterday and submitted all the necessary documentation
here: https ://apply.ptt.gov/
(b) (6)
also has a copy of the attached Bio, so I suspect he will be moving the
process along.
Please let me know what else I can do to be helpful to your internal process.
VA-19-0799-D-000771
OS 00002440
Thanks for sharing,
Charlie
On Wed, Apr 12, 2017 at 1:48 PM, David shulkin wrote:
More good stuff
Has anyone cobtacted you from VA
Sent from my iPhone
Begin forwarded message:
Date: April 12, 2017 at 1 :34:43 PM EDT
To: drshulkin@aol.com, Poonam Alaigh
<(b) (6)
hotmail .com>
Subject: Home - Malone Center for Engineering in
Healthcare
(b) (6)
Dr. (b) (6)
is Mandela Bellmore Professor of Computer
science and I will have an initial call to see if we can get their
innovative technology center to provide their expertise as a
service to their Country and the VA
https://malonecenter.jhu.edu/
Sent from my iPad
Bruce Moskowitz M.D.
Charles Wiggins
203 .856(b)
(6)
Charles Wiggins
203.856.(b)
(6)
VA-19-0799-D-000772
OS 00002441
Message
From:
Sent:
To:
Subject:
Attachments:
Charlie Wiggins [(b) (6)
remedyventures.com]
4/15/2017 1:30:21 AM
David shulkin [Drshulkin@aol.com]
Re: Home - Malone Center for Engineering in Healthcare
Veterans Administration Innovation Center.mindnode.zip
Secretary Shulkin,
Often times while building a new initiative I find it helpful to free-form brainstorm to capture ideas while
cultivating vision. I've found using the open source software mindnode to be one effective way to share those
ideas amongst a team, remotely.
Attached and pasted below is an initial draft of a semantic tree of sorts that captures notable accomplishments
from the VACI to date and provides some additional avenues to consider as we move forward. It is by no means
a comprehensive document, but if you don't hate the layout it can be a way we begin to structure thought/effort
as we begin working together.
Looking forward to taking the next steps and walking you through some of these concepts during our next
conversation.
Have a great weekend,
Charlie
•
□ *
.!.
__ ..._
-
□
-
---------
=--=
.......,iot,odt,y_......
On Wed, Apr 12, 2017 at 12:47 PM, David shulkin wrote:
Ok great
Sent from my iPhone
VA-19-0799-D-000773
OS 00002442
On Apr 12, 2017, at 3 :37 PM, Charlie Wiggins <(b) (6)
remedyventures .com> wrote:
The Malone center is onto some interesting work - the Galen System, microsurgical robotics
platform and the Kata Studio - are two that stick out as being beneficial for patients and
clinicians within the VA
I have only spoke with the White House Liaison to the VA, (b) (6)
yesterday and
submitted all the necessary documentation here: https ://apply.ptt.gov/
(b) (6)
also has a copy of the attached Bio, so I suspect he will be moving the process along.
Please let me know what else I can do to be helpful to your internal process.
Thanks for sharing,
Charlie
On Wed, Apr 12, 2017 at 1:48 PM, David shulkin wrote:
More good stuff
Has anyone cobtacted you from VA
Sent from my iPhone
Begin forwarded message:
Date: April 12, 2017 at 1 :34:43 PM EDT
To: drshulkin@aol.com, Poonam Alaigh <(b) (6)
hotmail.com>
Subject: Home - Malone Center for Engineering in Healthcare
(b) (6)
Dr. (b) (6)
is Mandela Bellmore Professor of Computer science and I
will have an initial call to see if we can get their innovative technology center
to provide their expertise as a service to their Country and the VA
https://malonecenter.jhu.edu/
Sent from my iPad
Bruce Moskowitz M.D.
Charles Wiggins
203 .856(b)
(6)
VA-19-0799-D-000774
OS 00002443
Charles Wiggins
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access to outtin g edge training a 11d equipment to
become more competitive in the job ma rrket or
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Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/13/2017 9:59:47 AM
Bruce Moskowitz [(b) (6)
mac.com]
drshulkin@aol.com
Re: Home - Malone Center for Engineering in Healthcare
sounds good Bruce- looking forward to it.
Sent from my iPad
> on Apr 12, 2017, at 1:35 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
(b) (6)
is Mandela Bellmore Professor of Computer science and I will have an initial call to
> Dr. (b) (6)
see if we can get their innovative technology center to provide their expertise as a service to their
country and the VA.
> https://malonecenter.jhu.edu/
>
>
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-000800
OS 00002471
Message
David shulkin [Drshulkin@aol.com]
4/12/2017 7:47:24 PM
Charlie Wiggins [(b) (6)
remedyventures.com]
Re: Home - Malone Center for Engineering in Healthcare
From:
Sent:
To:
Subject:
Ok great
Sent from my iPhone
On Apr 12, 2017, at 3 :37 PM, Charlie Wiggins <(b) (6)
remedyventures.com> wrote:
The Malone center is onto some interesting work - the Galen System, microsurgical robotics
platform and the Kata Studio - are two that stick out as being beneficial for patients and
clinicians within the VA
I have only spoke with the White House Liaison to the VA, (b) (6)
yesterday and
submitted all the necessary documentation here: https://apply.ptt.gov/
(b) (6)
also has a copy of the attached Bio, so I suspect he will be moving the process along.
Please let me know what else I can do to be helpful to your internal process.
Thanks for sharing,
Charlie
On Wed, Apr 12, 2017 at 1:48 PM, David shulkin wrote:
More good stuff
Has anyone cobtacted you from VA
Sent from my iPhone
Begin forwarded message:
Date: April 12, 2017 at 1 :34:43 PM EDT
To: drshulkin@aol.com, Poonam Alaigh <(b) (6)
hotmail.com>
Subject: Home - Malone Center for Engineering in Healthcare
(b) (6)
Dr. (b) (6)
is Mandela Bellmore Professor of Computer science and I
will have an initial call to see if we can get their innovative technology center to
provide their expertise as a service to their Country and the VA
https://malonecenter.jhu.edu/
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000801
OS 00002472
Charles Wiggins
203.856.-
Bio Sheet PDF.pdf>
Message
From:
Sent:
To:
Subject:
Attachments:
Charlie Wiggins [(b) (6)
remedyventures.com]
4/12/2017 7:37:36 PM
David shulkin [Drshulkin@aol.com]
Re: Home - Malone Center for Engineering in Healthcare
SKC_SES Bio Sheet PDF.pdf
The Malone center is onto some interesting work - the Galen System, microsurgical robotics platform and the
Kata Studio - are two that stick out as being beneficial for patients and clinicians within the VA
I have only spoke with the White House Liaison to the VA, (b) (6)
yesterday and submitted all the
necessary documentation here: https://apply.ptt.gov/
(b) (6)
also has a copy of the attached Bio, so I suspect he will be moving the process along.
Please let me know what else I can do to be helpful to your internal process.
Thanks for sharing,
Charlie
On Wed, Apr 12, 2017 at 1:48 PM, David shulkin wrote:
More good stuff
Has anyone cobtacted you from VA
Sent from my iPhone
Begin forwarded message:
Date: April 12, 2017 at 1 :34:43 PM EDT
To: drshulkin@aol.com, Poonam Alaigh <(b) (6)
hotmail.com>
Subject: Home - Malone Center for Engineering in Healthcare
(b) (6)
Dr. (b) (6)
is Mandela Bellmore Professor of Computer science and I will have an
initial call to see if we can get their innovative technology center to provide their expertise as a
service to their Country and the VA
https://malonecenter.jhu.edu/
Sent from my iPad
Bruce Moskowitz M.D.
Charles Wiggins
203.856.(b)
(6)
VA-19-0799-D-000803
OS 00002474
The White House
Presidential Personnel Office
SKC/SES BIO SHEET
NOTICE: Return this form to the Presidential Personnel Office as soon as complete. This information is necessary to
begin the clearance process. Return to White House Liaison when completed.
I
PART I: PERSONAL. INFORMATION (TO BE COMPLETED BY THE CANDIDATE)
1. FULL NAME (Last, First, Middle):
2. SOCIAL SECURITY NUMBER:
(b) (6)
Wiggins, Charles, Anthong
b rHS
(b) (6)
(b) (6)
D[D
tyQ
ity, State, ZIP Code)
i ZIP Code, if different than current address)
5. PLACE OF BIRTH (City, State; if not U.S., state, country)
6. GENDER
(b) (6)
8. ETHNIC HERITAGE
9. RACE
90% Scottish/Irish 10%Hungarian
White
11. HOME PHONE
(b) (6)
10. POLITICAL PARTY
(b) (6)
12. CELL PHONE
13. WORK PHONE
2038567662
2038567662
14. PERSONAL EMAIL
(b) (6)
7. DATE OF BIRTH
(b) (6)
Male
15. WORK EMAIL
(b) (6)
remedyventures.com
remedyventures.com
16. CURRENT POSITION (Title, Company)
17. WORK ADDRESS (Number, Street, City, State, Zip)
CEO, Second Cycle
160 14th Street, San Francisco, CA 94103
18. PLEASE L/.ST ALL SOCIAL MEDIAi ACCOUNTS 10r :;~Y, 11011!:l if you have none)
https:l/www. 1nked1n.com/1n/char es-w1gg1ns-016008:.:s:.:s;
19. EDU.CATION (Degree, lnstitution Year)
I
20. AWARDS
BA, University of l\llaryland, 20 08
MHA, Johns Hopkins University, 2011
1st-team All-American
A CC-Champion
21. MILITARY SERVICE (Rank, Branch, Years)
22. PREVIOUS PRESIDENTIAL APPOINTMENTS
PART II: POSITION INFORMATION (TO BE COMPLETED BY WHITE HOUSE LIAISON)
1. POSITION TITLE
2. AGENCY
2. APPOINTMENT TYPE
3. GRADE
4. OPM NUMBER
5. WH LIAISON NAME
6. WH LIAISON PHONE
7. WH LIAISON EMAIL
VA-19-0799-D-000804
OS 00002475
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/12/2017 5:48:16 PM
To:
Charlie Wiggins [(b) (6)
remedyventures.com]
Fwd: Home - Malone Center for Engineering in Healthcare
Subject:
More good stuff
Has anyone cobtacted you from VA
Sent from my iPhone
Begin forwarded message:
Date: April 12, 2017 at 1 :34:43 PM EDT
To: drshulkin@aol.com, Poonam Alaigh <(b) (6)
hotmail.com>
Subject: Home - Malone Center for Engineering in Healthcare
(b) (6)
Dr. (b) (6)
is Mandela Bellmore Professor of Computer science and I will have an
initial call to see if we can get their innovative technology center to provide their expertise as a
service to their Country and the VA.
https://malonecenter.jhu.edu/
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000805
OS 00002476
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/12/2017 5:47:35 PM
Bruce Moskowitz [(b) (6)
mac.com]
Re: Home - Malone Center for Engineering in Healthcare
Great
Sent from my iPhone
> on Apr 12, 2017, at 1:34 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
(b) (6)
> Dr. (b) (6)
is Mandela Bellmore Professor of Computer science and I will have an initial call to
see if we can get their innovative technology center to provide their expertise as a service to their
country and the VA.
> https://malonecenter.jhu.edu/
>
>
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-000806
OS 00002477
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/12/2017 5:34:43 PM
To:
drshulkin@aol.com; Poonam Alaigh [(b) (6)
hotmail.com]
Home - Malone Center for Engineering in Healthcare
Subject:
mac.com]
(b) (6)
is Mandela Bellmore Professor of Computer science and I will have an initial call to
Dr. (b) (6)
see if we can get their innovative technology center to provide their expertise as a service to their
country and the VA.
https://malonecenter.jhu.edu/
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000807
OS 00002478
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/19/2017 1:25:16 AM
Darin Selnick [(b) (6)
@gmail.com]
Re: Curt Cashour
Excellent
I thought so
Sent from my iPhone
> on Apr 18, 2017, at 9:20 PM, Darin selnick <(b) (6)
>
> I did some checking on curt, talked to a few people and
@gmail.com> wrote:
(b) (6), (b) (2)
>
> I think you have a winner in curt.
>
> Darin
VA-19-0799-D-000808
OS 00002479
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/9/2017 10:43:32 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: VA - EPIC
Advisory Committee On Veterans Healthcare.03.9.2017.docx; Untitled attachment 05084.htm; Contact
lnformation.docx; Untitled attachment 05087.htm
Just between us of course
Sent from my iPhone
Begin forwarded message:
From: "IP" <(b) (6) frenchangel59.com >
Date: April 9, 2017 at 6:15:35 PM EDT
To: "David shulkin"
Subject: FW: VA - EPIC
From: IP [mailto:(b) (6) frenchanqel59.com]
Sent: Sunday, April 09, 2017 6:12 PM
To: '(b) (6)
who.eop.gov'
Cc: (b) (6)
who.eop.gov; Ivanka Kushner ((b) (6)
Subject: VA - EPIC
(b) (6)
lperl(b) (6) @qmail.com
(b) (6)
It was pleasure meeting and having dinner with you last night. We very much look forward to
working with you on the VA.
A little more background on EPIC.
The DOD recently signed a new contract to implement a new system called Cerner with an
initial cost of $4.3 billion and a total budgeted cost of $9 billion. As I mentioned last night,
there is a push for the VA to choose the same Cerner system. What the VA needs is a system
that can speak to the private hospitals' systems with which it will be partnering for Veterans
medical care (interoperability among the Public-Private Partnership).
The top 5 Academic Medical Centers do not use Cerner and highly recommend against using it,
and instead strongly favor using another system called EPIC. EPIC is used by 50% of the
hospitals in the US and covers over 120 million patients. Using EPIC, therefore, as the VA
platform will allow seamless integration with the platform of the majority of community and
academic medical centers. As a result, when veterans access care outside the VA system (the
choice extension) there will be the necessary access and integration to vital medical
information. This means less cost, easier access to the doctors, patients and veterans and their
medical records.
In addition, the VA's doctors and doctors in training who come from the academic medical
centers and who practice part time at the VA have been trained on and use EPIC. It would be
VA-19-0799-D-000809
OS 00002480
impractical to expect them to learn two different systems. Also, the VA conducts medical
research with academic medical centers across the nation, and using something other than EPIC
would make many vital research projects more costly to integrate and collect data.
The VA has confirmed that they are on same page to pursue EPIC as their EMR of choice,
instead of Cerner.
Cerner has claimed that its system cannot talk to EPIC if the VA chooses EPIC. We, however,
believe that EPIC will allow for this cross talk. We also believe that the ability of working with
the two different platforms is, in reality, an artificial barrier by Cerner that can be resolved if
they choose.
As I discussed yesterday, the best solution is for the DOD to change to EPIC, for the good of the
DOD, the soldiers, the VA and our veterans. However, if that is not in the cards, then It is
CRITICAL that Cerner be mandated to design its DOD system to talk to (be able to share
medical records with) whatever system the VA chooses to install. It is very important that this
is resolved quickly at the DOD/Cerner level by instructions from the White House.
If you think it will be beneficial for you to talk directly to the experts at the Academic Medical
Centers, you can call one of the people working on the VA effort with me, Dr. Bruce Moskowitz,
and he will be happy to arrange discussions with the head IT leaders at any or all of the top 5
academic medical centers so you can hear their points of view and perspectives on this topic
directly. Bruce's phone number is (561) 346-(b) (6) and his email is
(b) (6)
@mac.com .
I have also attached my contact information.
Regards,
Ike
VA-19-0799-D-000810
OS 00002481
ADVISORY
ON VETERANS HEALTH CARE
1. Dr. David Shulkin, Secretary for Health for the Department of
Veterans Affairs
(b) (6)
(b) (6)
2. Dr.
President and CEO of the
Cleveland Clinic
(b) (6)
3. Dr. (b) (6)
President and CEO of the Mayo Clinic
(b) (6)
4.
Chair Department of Public Affairs of the Mayo
Clinic
(b) (6)
(b) (6)
5. Dr.
President and CEO of Partners HealthCare
(Massachusetts General and Brigham and Women's Hospitals)
(b) (6)
(b) (6)
6. Dr.
Dean and CEO of Johns Hopkins Medicine
7. Marc. B. Sherman, Senior Partner at international business
restructuring and financial consulting firm Alvarez & Marsal
(b) (6)
8. (b) (6)
Chairman and CEO of Kaiser Foundation
Health Plan, Inc. and Hospitals - known as Kaiser Permanente,
one of America's leading integrated health care providers and
not-for-profit health plans.
9. Dr. Bruce Moskowitz, who has observed in frustration over his
years as a noted Palm Beach physician in private practice the
crucial need to overhaul our system of delivering veterans'
health care.
(b) (6)
is the wife of injured Purple Heart Veteran, co10.
founder of Hope Unseen, mother, nurse BSN, news contributor,
speaker and believe that there is always joy to be uncovered.
11. Laura r'Laurie") Perlmutter, a member of the Board of
Trustees of NYU Langone Medical Center and of the Board of
Advisors of the Laura & Isaac Perlmutter Cancer Center at NYU
Langone, which she established with her husband Isaac
Perlmutter.
12. Isaac ({like") Perlmutter, a self-made and highly successful
business leader and member of the Board of Trustees of NYU
Langone whose support for medical research and care has
included the establishment, with his wife Laura of the Perlmutter
Cancer Center at NYU Langone.
VA-19-0799-D-000811
OS 00002482
Our contact Information below:
Laurie Perlmutter
561-585-(b) (6) (Home)
561-818-(b) (6) (Cell)
Email: (b) (6)
gmail.com
Ike Perlmutter
561-586-(b) (6) (Home)
561-685-(b) (6) (Cell) **Please note I rarely keep the cell "ONn - If you can't reach
me call Marisol - Marisol is able to find me any time.
Email: (b) (6) frenchangel59.com
Assistant: Marisol Garcia
212-576-(b) (6) (Office)
212-576-(b) (6) (Weekend Office)
Cell: 646-668-(b) (6) (Marisol's Cell)
Email: (b) (6) frenchangel59.com
Please feel free to email or call us any time.
VA-19-0799-D-000813
OS 00002484
Message
From:
Sent:
To:
Subject:
Attachments:
IP [(b) (6) frenchangel59.com]
4/9/2017 10:15:35 PM
David shulkin [drshulkin@aol.com]
FW: VA- EPIC
Advisory Committee On Veterans Healthcare.03.9.2017.docx; Contact lnformation.docx
From: IP [mailto:(b) (6) renchanqel59.com ]
Sent: Sunday, April 09, 2017 6:12 PM
To: '(b) (6)
who.eop.gov'
Cc:
(b) (6)
who.eop.gov; Ivanka Kushner ((b) (6)
(b) (b)
(6) (6)
(b) (6)
mail.com
Subject: VA - EPIC
(b) (6)
It was pleasure meeting and having dinner with you last night. We very much look forward to working with
you on the VA.
A little more background on EPIC.
The DOD recently signed a new contract to implement a new system called Cerner with an initial cost of $4.3
billion and a total budgeted cost of $9 billion. As I mentioned last night, there is a push for the VA to choose
the same Cerner system. What the VA needs is a system that can speak to the private hospitals' systems with
which it will be partnering for Veterans medical care (interoperability among the Public-Private Partnership).
The top 5 Academic Medical Centers do not use Cerner and highly recommend against using it, and instead
strongly favor using another system called EPIC. EPIC is used by 50% of the hospitals in the US and covers over
120 million patients. Using EPIC, therefore, as the VA platform will allow seamless integration with the
platform of the majority of community and academic medical centers. As a result, when veterans access care
outside the VA system (the choice extension) there will be the necessary access and integration to vital
medical information. This means less cost, easier access to the doctors, patients and veterans and their
medical records.
In addition, the VA's doctors and doctors in training who come from the academic medical centers and who
practice part time at the VA have been trained on and use EPIC. It would be impractical to expect them to
learn two different systems. Also, the VA conducts medical research with academic medical centers across the
nation, and using something other than EPIC would make many vital research projects more costly to integrate
and collect data.
The VA has confirmed that they are on same page to pursue EPIC as their EMR of choice, instead of Cerner.
Cerner has claimed that its system cannot talk to EPIC if the VA chooses EPIC. We, however, believe that EPIC
will allow for this cross talk. We also believe that the ability of working with the two different platforms is, in
reality, an artificial barrier by Cerner that can be resolved if they choose.
As I discussed yesterday, the best solution is for the DOD to change to EPIC, for the good of the DOD, the
soldiers, the VA and our veterans. However, if that is not in the cards, then It is CRITICAL that Cerner be
mandated to design its DOD system to talk to (be able to share medical records with) whatever system the VA
VA-19-0799-D-000815
OS 00002486
chooses to install. It is very important that this is resolved quickly at the DOD/Cerner level by instructions
from the White House.
If you think it will be beneficial for you to talk directly to the experts at the Academic Medical Centers, you can
call one of the people working on the VA effort with me, Dr. Bruce Moskowitz, and he will be happy to arrange
discussions with the head IT leaders at any or all of the top 5 academic medical centers so you can hear their
points of view and perspectives on this topic directly. Bruce's phone number is (561) 346-(b) (6) and his email
is (b) (6)
mac.com .
I have also attached my contact information.
Regards,
Ike
VA-19-0799-D-000816
OS 00002487
ADVISORY
ON VETERANS HEALTH CARE
1. Dr. David Shulkin, Secretary for Health for the Department of
Veterans Affairs
(b) (6)
2. Dr. (b) (6)
President and CEO of the
Cleveland Clinic
(b) (6)
3. Dr. (b) (6)
President and CEO of the Mayo Clinic
(b) (6)
4.
Chair Department of Public Affairs of the Mayo
Clinic
(b) (6)
(b) (6)
5. Dr.
President and CEO of Partners HealthCare
(Massachusetts General and Brigham and Women's Hospitals)
(b) (6)
(b) (6)
6. Dr.
Dean and CEO of Johns Hopkins Medicine
7. Marc. B. Sherman, Senior Partner at international business
restructuring and financial consulting firm Alvarez & Marsal
(b) (6)
8. (b) (6)
Chairman and CEO of Kaiser Foundation
Health Plan, Inc. and Hospitals - known as Kaiser Permanente,
one of America's leading integrated health care providers and
not-for-profit health plans.
9. Dr. Bruce Moskowitz, who has observed in frustration over his
years as a noted Palm Beach physician in private practice the
crucial need to overhaul our system of delivering veterans'
health care.
(b) (6)
is the wife of injured Purple Heart Veteran, co10.
founder of Hope Unseen, mother, nurse BSN, news contributor,
speaker and believe that there is always joy to be uncovered.
11. Laura r'Laurie") Perlmutter, a member of the Board of
Trustees of NYU Langone Medical Center and of the Board of
Advisors of the Laura & Isaac Perlmutter Cancer Center at NYU
Langone, which she established with her husband Isaac
Perlmutter.
12. Isaac ({like") Perlmutter, a self-made and highly successful
business leader and member of the Board of Trustees of NYU
Langone whose support for medical research and care has
included the establishment, with his wife Laura of the Perlmutter
Cancer Center at NYU Langone.
VA-19-0799-D-000817
OS 00002488
Our contact Information below:
Laurie Perlmutter
561-585-1571 (Home)
561-818-3073 (Cell)
Email: (b) (6)
gmail.com
Ike Perlmutter
561-586-6707 (Home)
561-685-8824 (Cell) **Please note I rarely keep the cell "ONn - If you can't reach
me call Marisol - Marisol is able to find me any time.
Email: (b) (6) frenchangel59.com
Assistant: Marisol Garcia
212-576-(b) (6) (Office)
212-576-(b) (6) (Weekend Office)
Cell: 646-668-(b) (6) (Marisol's Cell)
Email: (b) (6) frenchangel59.com
Please feel free to email or call us any time.
VA-19-0799-D-000818
OS 00002489
Message
From:
Sent:
To:
CC:
David shulkin [Drshulkin@aol.com]
5/1/2017 12:34:16 AM
(b) (6)
[(b) (6) erwin@va.gov]
(b) (6)
[(b) (6)
va.gov]; Poonam Alaigh [(b) (6)
hotmail.com]
and (b)
wand see if they are able to join me and dr alaigh for a
can you reach out to verna, (b) (6)
(6)
dinner mobday (tommorow night) at 630 pm at the source (at nuseum) to informally discuss choice - i know
its no notice but its my only open evening for a while- we will go if 1,2 or all 3 are able to join
Sent from my iPhone
VA-19-0799-D-000819
OS 00002490
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/10/2017 10:30:11 PM
To:
Bruce Moskowitz [(b) (6)
mac.com]
Re: VA & Epic Core Competencies in Healthcare - Draft
Subject:
Bruce- ill call you on tuesday
Happy Passover
David
Sent from my iPhone
On Apr 10, 2017, at 12:57 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
I had an excellent call with (b) (6)
and her staff. They are ready to move forward with the
integration idea that we discussed on Friday. Second they are in favor of a system that allows a total
open platform that any EMR can freely exchange records with. They believe that the Veteran should
have the ability to have medical records sent to or sent from any EM R system. Third they will donate as
a service to the Country their expertise in prevention of the opioid addiction, maternal health, mental
health and a medical device registry.
I would suggest you contact them to move forward. Thank you
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
<(b) (6)
epic.com >
From: (b) (6)
Date: April 10, 2017 at 12:33:34 PM EDT
To: "(b) (6)
mac.com " <(b) (6)
mac.com >
(b) (6)
(b) (6)
Cc:
<
epic.com >, (b) (6)
<(b) (6)
epic.com >
Subject: VA & Epic Core Competencies in Healthcare - Draft
VA-19-0799-D-000820
OS 00002491
Message
Bruce Moskowitz [(b) (6)
mac.com]
Sent:
4/10/2017 4:57:22 PM
David Shulkin [drshulkin@aol.com]; Poonam Alaigh [(b) (6)
hotmail.com]
To:
(b)
(6)
(b) (6) @epic.com]; (b) (6)
(b) (6) @epic.com]
CC:
[(b) (6)
epic.com]; (b) (6)
Subject:
Fwd: VA & Epic Core Competencies in Healthcare - Draft
Attachments: VA & Epic - Core Competencies in Healthcare VlO.docx; Untitled attachment 05099.htm
From:
and her staff. They are ready to move forward with the integration idea that
I had an excellent call with (b) (6)
we discussed on Friday. Second they are in favor of a system that allows a total open platform that any EMR can freely
exchange records with. They believe that the Veteran should have the ability to have medical records sent to or sent
from any EMR system. Third they will donate as a service to the Country their expertise in prevention of the opioid
addiction, maternal health, mental health and a medical device registry.
I would suggest you contact them to move forward. Thank you
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
<(b) (6)
epic.com >
From: (b) (6)
Date: April 10, 2017 at 12:33:34 PM EDT
To: "(b) (6)
mac.com " <(b) (6)
mac.com >
Cc: (b) (6)
<(b) (6) epic.com >, (b) (6)
<(b) (6)
epic.com >
Subject: VA & Epic Core Competencies in Healthcare - Draft
VA-19-0799-D-000821
OS 00002492
Department of Veterans Affairs: Core Competencies in Healthcare
Size and
Complexity
Lifetime Care
The Best Care
Choice Of Care
Scalability and Performance
The VA is the largest integrated healthcare
delivery system in the U.S with over 1,700
sites of care. The VA has over 20,000 beds
across 168 VA Medical Centers and
completes over 100 million outpatient
appointments annually. The VA serves
more than 8.9 million Veterans each year.
Epic Footprint
The largest integrated civilian health systems in
the U.S. run Epic, such as Kaiser Permanente,
Sutter, Mayo Clinic, Partners, and Providence.
• Kaiser Permanente serves over 11.3 million
members across 38 hospitals and 661 clinics.
• Over 336,000 physicians use Epic.
• 57% of US population has a chart in Epic.
Supporting Veterans at Every Stage
The VA supports the entire continuum of
care for all 22 million veterans, from the
time they first see the veteran to death. VA
provides services to treat all medical needs
of a veteran throughout their lifetime,
including traditional hospital-based services
such as surgery, critical care, mental health,
orthopedics, pharmacy, radiology and
physical therapy. Most VA medical centers
offer specialty services including audiology,
dermatology, dental, geriatrics, neurology,
oncology, prosthetics, urology, and vision.
Providing Quality
The VA is a benchmark of excellence, value
in health care and benefits by providing
exemplary services that are both patientcentered and evidence-based. Veterans
think highly of VA healthcare too. In 2015,
the VA scored an 86 and 80 for inpatient
and outpatient 1n customer service
satisfaction, respectively, compared to an
average of customer service satisfaction
score of 74 across private sector hospitals.
A Full Suite of Products
EpicCare clinical systems provide a single
healthcare platform to support a lifetime's worth
of care for the veteran. Regardless of when or
where the patient is seen at the VA, the clinician
have access to the entirety of the patient chart.
Modules for specialty care like Wisdom (dental),
Cupid (cardiology), and Kaleidoscope (vision) are
included as part of the enterprise Epic platform.
Veterans and their caregivers have 24/7 access
to the MyChart Patient Portal, allowing them to
check lab results, message clinicians, request an
appointment, and much more.
The Best EHR Software
Epic software helps organizations deliver the
best possible care to patients.
• Truven Top 100 - more hospitals use Epic
than any other system.
• Leapfrog Top Hospitals for Quality and
Safety - more hospitals use Epic than any
other vendor.
• KLAS surveys - healthcare organizations
rank Epic as having the #1 software suite
each year for the last seven years.
Retaining the Veteran Customer Base
With the expansion of the Choice Act,
veterans now have more options to see
care outside of the VA VA retains its patient
base by being the best. VA provides value
in health care, superb customer service, and
cutting edge care and technology to keep
veterans coming back to VA for their
hea Ith ca re.
Patients Notice the Best Software
Epic software keeps patients coming back.
Customer Success:
• A Kaiser Permanente study showed
MyChart positively impacts patient loyalty
and member satisfaction. Users are 2.6
times more likely than nonusers to remain
KP members. 85% of users rate email
encounters an 8 or a 9 on a 9-point scale.
VA-19-0799-D-000822
OS 00002493
Suicide
Prevention
Mental Health
Drug and
Opioid
Addiction
Decreasing Veteran Suicides
An average of 20 veterans die from suicide
each day. As a leader in evidence-based
care for suicide prevention, VA utilizes risk
scoring data elements and screening tools
for proactive and reactive suicide crisis care.
For preventative care, VA uses predictive
models to determine which Veterans may
be at highest risk of suicide, so providers
can intervene early. For those veterans in
suicide crisis, the Veterans Crisis Line is
available to veterans in time of need. The
Veterans Crisis Line has answered over 2.3
million calls, 55,000 texts, and made over
376,000 referrals to a Suicide Prevention
Coordinator.
Mental Health Detection and Prevention
Epic builds in preventive care and screening for
depression and suicide risk, as well as
associated follow-up plans, in physician, nurse
and clinician workflows to ensure high visibility
amongst all team members. Veterans
determined at risk for a crisis event after
assessment can be automatically referred to a
Suicide Prevention Coordinator without any
additional end user intervention. For veterans in
crisis, same-day mental health or telehealth
appointment slots are reserved for their care.
Customer Success
• Institute of Family Health reached a
depression screening rate of nearly 90%
through workflows in Epic.
Four Principles of VA Mental Health Care
Mental health is the most pervasive health
issue the VA faces on a daily basis. 50% of
all veterans face mental health issues,
according to VA Secretary David Shulkin,
with 30% of soldiers developing mental
problems within 3 to 4 months of being
The Right Data at the Right Time
Epic support of mental health workflows
ensures that whether a veteran has an acute or
a chronic condition, clinicians have the tools
keep the veteran healthy. Key lab, demographic
and assessment data are combined in a single
view for easy analysis and diagnosis.
home.
VA has developed core principles as a
foundation to improve veteran mental
health, including a 1) A Focus on Recovery,
2) Coordinator Care for the Whole Person
3) Mental Health Treatment in Primary Care
and 4) Providing Veterans with a Mental
Health Treatment Coordinator.
Customer Success
• UCLA implemented veteran mental health
Managing the Epidemic
Though all of the United States struggles
with managing the drug and opioid crisis,
the VA has a disproportionate rate of drug
and opioid issues compared to the civilian
population. Over 50% of veterans deal with
chronic pain, compared to 30% of
Americans nationwide. Veteran opioid-use
disorders spiked by 55% from 2010 to 2015,
and veterans are twice as likely to die from
accidental opioid overdoses as nonveterans. The VA provides effective,
scientifically proven drug and opioid
dependency services for all veterans, no
matter where they come for services.
•
program in partnership with Wounded
Warriors for psychological health support
JPS saw use of evidence-based protocols
on dosing, best practices, and pitfalls
increase from 6% to 95% on their Virtual
Psychiatric Service.
Addiction Care Planning Tools
Integrated clinical and pharmacy data within Epic
aids in the identification of veterans with drug
addictive behavior. Opioid reporting tools built
into the system allow organizations to monitor
and track prescriptions. Health and history
assessments drive risk scores within Epic that
detect patients with possibility of drug addiction,
and automatically flag them for support services.
Customer Success
• MetroHealth saved 500 lives with Opioid
Overdose Prevention Program through risk
scoring and care planning tools within Epic.
VA-19-0799-D-000823
DS 00002494
Prostheses and
Physical
Therapy
Women's
Health
Veteran
Housing and
Food Insecurity
Rehab and Prosthetic Care
Over 31% (2.38 million) of all Veterans
treated in VHA saw a rehabilitation care
provider and nearly half of all Veterans seen
1n VHA have received prosthetic and
sensory aids items and services. VA's
Rehabilitation and Prosthetic Services office
aligns medical expertise, clinical and
practice
guidance,
and
specialized
procurement
resources
to
provide
comprehensive rehabilitation, prosthetic
and orthotic, services across the VHA health
care system in the most, economical and
timely manner.
Rehab for the Clinician and Veteran
All veteran information from an initial prosthetic
placement or injury consults and subsequent
physical therapy visits are grouped together
under a single therapy episode for ease of data
access. Patient Goals tools allow veterans to track
and contribute to their progress without clinician
intervention, such as recording minutes walked
each day, via the MyChart.
Raising the Bar for Women Health Services
Women are the fastest growing veteran
population and VA strives to be a national
leader in the provision of health care for
women. However, there are still barriers to
women veteran care today, such as
effective outreach addressing women's
health, location and hours of women's
services, and gender sensitivity of health
care staff. The Women Veterans Health
Care program aims to break down these
barriers to ensure that timely, equitable,
comprehensive and high-quality health
care is provided in a sensitive and safe
environment at VA facilities nationwide.
Increase in Positive Health Outcomes for Women
Epic creates standard ways to document medical
histories for gender minorities, preventing
clinically relevant information from being
overlooked and helping clinicians provide
tailored care. Epic's pregnancy tools include
prenatal checklists to ensure that prenatal
checkups and education classes are completed.
Supporting the Homeless and Hungry
Veteran care delivery goes beyond the walls
of the traditional care setting. VA is serving
more Veterans than ever who are homeless
or at risk of homelessness. Since 2010, more
than 365,000 Veterans and their family
members have been permanently housed
or
prevented
from
falling
into
homelessness.
In recent years, hunger among the more
than 12 million veterans over 60 is reaching
critical levels, and estimates are that over
300,000 elderly veterans are food insecure.
Efforts at VA to keep veterans fed and with
shelter prevent more serious health events.
Epic in the Community
Epic uses social determinants of health to flag
veterans who may be at risk for food and shelter
needs to automatically enroll them in social
programs. Healthy Planet Link provides web
based tools to community organizations to
contribute health and social assessments into the
patient chart.
Customer Success:
• Hospital For Special Surgery implemented
scheduling acute care visits with Epic,
enabling a systematic approach to care
provisioning to ensure all patients are seen.
Customer Success.
• UPMC increased prevention of medicationinduced births by notifying physicians when
they order teratogenic medications for
women who could become pregnant.
• Children's Hospital Colorado saw clinicians
act on 99% of decision support reminders to
screen mothers for postpartum depressions.
Customer Success
• ProMedica implemented a screening
initiative to connect patients experiencing
hunger or food insecurity to an on-site food
pharmacy and other food resources.
• OHSU utilized Epic to identify patients for a
transitional care program, helping to
improve quality of care for the underserved
who transition from the hospital to home.
VA-19-0799-D-000824
OS 00002495
Veteran Access
to Care
Team Based
Approach to
Care
Dispersed
Patient
Population
Right Access at the Right nme
Provide timely access to veterans as
determined by their clinical needs is the
number 1 priority at VA VA has initiated a
number of programs to make sure veterans
receive the care they very much so deserve.
The partnership between the VA and CVS
in California now offers urgent care services
to more than 65,000 veterans. The Stand
Down initiative ensured 56,000-plus
identified urgent care had been successfully
resolved. Additional healthcare staff and an
increase in advanced scheduling software
has helped decrease veteran wait times.
Faster Access to Care with Scheduling Tools
Referrals provide closed-loop communication in
Epic allowing staff at VA to verify that a veteran
received care at an outside facility, such as CVS
or Wal greens. Epic's Fast Pass automated wait list
tool lets veterans receive earlier appointment
slots as they open up due to cancellations. Most
critical patients, such as those with mental health
and life threatening illnesses, are offered earlier
appointments first.
Coordination Across Care Team Members
A core strength at VA is its team-based,
Veteran-centric model of primary care that
focuses on patient-driven, proactive, and
personalized care. This patient aligned care
team - including primary care providers,
nurses, social workers, pharmacists,
nutritionists,
behavioral
health
professionals, as well as the Veteran, family
members, and caregivers - addresses not
only disease management, but also disease
prevention, wellness, and health promotion.
Communication is Key
Epic focuses on providing patient care via a
multi-disciplinary approach. Treatment planning
tools, screenings and risk scores, are embedded
throughout all clinical workflows. Clinicians utilize
a longitudinal plan of care that summarizes data
across all encounters. Secure Chat allows care
team members to send secure text messages
through desktop and mobile devices.
Access to Care Anywhere
A quarter of all Veterans in US, 5.2 million,
returned from active military careers to
reside in rural communities, Even with VA's
large footprint across the nation, veterans
may often find themselves hours from the
nearest VA healthcare facility, or out of
reach of specialist that they can regularly
see due to living in a remote or rural area.
The Office of Rural Health provides
enterprise-wide programs to veterans in
rural areas to make sure they stay healthy.
Programs include Tele-Intensive Care Units,
Telemental Health Hubs, Rural Health Social
workers, Rural Transportation Service, and
Remote, telephone-based delivery of
cardiac rehabilitation.
See Your Patients Sooner
Home Health tools in Epic allow home care
nursing staff to stay connected. Traveling staff
can communicate back to a full clinician care
team while out in the field with a veteran via real
time video and documentation needs.
Telemonitoring tools expand veteran access to
specialists regardless of where they are located.
Customer Success
• Kaiser Permanente saw a 50% reduction in
no show appointment rates for patients who
booked online using MyChart.
Customer Success:
• Bronson developed a multidisciplinary
medication reconciliation program to
decrease readmissions,
reduce case
manager workload, and improve clarity of
patient medication instructions
Customer Successes
• Mercy Health's Telehealth program reduced
inpatient length of stay and mortality rates
declined by 40 percent, while the average
cost of care significantly declined as fewer
patients require a hospital stay
• Telestroke tools and workf1ows in Epic allow
neurologists to diagnose and treat a patient
0
exhibiting stroke symptoms at a different
location using a video feed.
VA-19-0799-D-000825
OS 00002496
Veteran Care
Coordination
with DoD and
Private Sector
Research
Largest Safety
Net in the U.S.
Facilitating Data Exchange
The majority of veterans use non-VA health
care providers 1n addition to their VA
providers. The VA has been a pioneer in
healthcare IT to help connect veteran
healthcare with data from both DoD private
sector. VA has been a partner of eHealth
Exchange, a network that connects federal
agencies (including the VA, DoD, and SSA)
and nonfederal organizations to improve
patient care, streamline disability benefit
claims, and improve public health reporting
through interoperable health information
exchange. VA has enhanced coordination
1n recent years with DoD through
implementation of the Joint Legacy Viewer
(JLV), a read-only tool that lets VA and DoD
clinician see data from each system.
Facilitating Research Efforts
VA Research and Development plays a key
role in advancing the health and care of
Veterans, engaging patients and family's
altruistic desires to improve health for fellow
Veterans and others. VA fosters dynamic
collaborations both within VHA and with
external partners, such as the National
Institutes of Health, academic affiliates and
community partners. Research efforts in
the VA such as the Million Veteran Program
(MV), the largest genomic database in the
world, aim to partner with Veterans
receiving their care in the VA Healthcare
System to study how genes affect
health. The VA research partnership with
IBM uses Watson to help VA doctors tailor
cancer care.
In 2016, VA spent $1.8 billion on research.
Serving the Underserved
The VA shares many of the same
characteristics of large safety nets, and the
VA could be considered the largest of all
safety nets in the US. Health issues such as
diabetes, domestic abuse, and obesity are
disproportionality high within the veteran
population. VA responds to the needs of
the socially-disenfranchised with targeted
programs, outreach, and prevention.
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that uses a consensus-based process to enable
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networks. Cerner/commonwell, athenahealth,
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are all carequality participants.
• 90 billion transactions occur between Epic
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• No other EHR vendor has enabled 100% of
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Epic's research module natively integrates clinical
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through a nationwide patient dataset.
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• The Top 15 NIH research grants by
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VA-19-0799-D-000826
OS 00002497
Message
Bruce Moskowitz [(b) (6)
mac.com]
4/27/2017 11:09:52 AM
David shulkin [drshulkin@aol.com]; Poonam Alaigh [(b) (6)
Fwd: VA mental Heath
From:
Sent:
To:
Subject:
hotmail.com]
Sent from my iPad
Bruce Moskowitz M.D.
Begin forwarded message:
From: (b) (6)
<(b) (6)
nyspi.columbia.edu>
Date: April 26, 2017 at 11 :22:47 PM EDT
To: Bruce Moskowitz <(b) (6)
mac.com>
Subject: Re: VA mental Heath
Bruce let me know if you need the statement endorsing Mccance-Katz
nomination sent as a letter on my letter-head
(b) (6)
M.D.
Lawrence C. Kolb Professor and Chairman of Psychiatry,
Columbia University College of Physicians and Surgeons,
Director, New York State Psychiatric Institute
Psychiatrist-in-Chief,
New York Presbyterian Hospital-Columbia University Medical Center
1051 Riverside Drive - Unit #4
New York, NY, 10032
Phone (646) 774-(b) (6)
email: (b) (6)
www.(b) (6)
columbia.edu
com
VA-19-0799-D-000829
OS 00002500
Follow me on twitter~ @(b) (6)
Watch my talk on
E Q,X
T1
(b) (6)
From: (b) (6)
<(b) (6)
nyspi.columbia.edu >
Date: Wednesday, April 26, 2017 at 4:32 PM
To: Bruce Moskowitz <(b) (6)
mac.com >
Subject: Re: VA mental Heath
Bruce, see comments re our discussion on the Asst Secy appointment,
recommendations to Secy Shulkin on military mental health and
research. Sorry for the length. Let me know if you need me to send in
different format.
(b) (6)
I.
Assistant
Secretary of Mental
Health
I enthusiastically support (as does the APA
https://www.psychiatry.org/newsroom/news-releases/apa-supportsnomination-of-dr-mccance-katz-urges-senate-to-confirm) Dr. Elinore
Mccance-Katz for the Asst Secy position. She is an M.D., Ph.D. with a
background in addiction research and clinical care, who is committed to
and experienced in public mental health care. She moved from the
Univ. of California at San Francisco where she was on the faculty in the
Dept of Psychiatry, to become Medical Director of SAMHSA. After
only a year she resigned from this position because she appropriately
objected to the unscientific and wasteful activities of the agency and its
hostility to modern medicine and evidence based mental health care.
Most recently, she was the Director of Mental Health for the State of
Rhode Island. She is qualified and would be an excellent choice, despite
what Congressman Murphy has said.
VA-19-0799-D-000830
OS 00002501
2.
lmproving Military Mental
Health Care
The first attachment is a summary providing guidance to the Secretary
of the Veterans Administration on how to improve mental health care to
military personnel. Briefly, what I recommend to Secretary Shulkin is:
1.
2.
3.
3.
Convene a review committee of experts in mental health care,
services, systems and financing.
Committee to review existing scope of VA programs and services
to identify which work and are good (or could be with better
staffing and oversight) and what new services need to be
developed.
Develop a plan for implementation including resource, workforce,
training and quality control and oversight.
Disruptive Research
I believe that if funding is directed to the best scientists to carry out goal
directed research on the most urgent military mental health, gamechanging progress can be made in PTSD, suicide, aggression and TBI.
Three examples of outstanding research proposals by National Academy
of Science level researchers that have never worked on military or VA
issues and have been denied funding are summarized below.
1.
Development of Stress Resilience-Enhancing Medications as
Primary Prophylaxis against PTSD and MDD
Christine Denny, Ph.D. and Rene Hen, Ph.D.
Columbia University
VA-19-0799-D-000831
OS 00002502
Post-traumatic stress disorder (PTSD) is a leading mental health
problem that can occur after a traumatic event,
such as sexual assault, war, or injury. PTSD affects approximately 8
million adult Americans, with an annual
prevalence of 3.5% across the general population (Kessler et al.,
2005). Soldiers and veterans, however, are at
greater risk of developing PTSD. The estimated prevalence of PTSD
is 13.8% in previously deployed Operation
Enduring Freedom and Operation Iraqi Freedom (Afghanistan and
Iraq) service members, and 10.1 % in Gulf
War Veterans, and lifetime prevalence, including partial PTSD, is
over 30% in American Vietnam theater
veterans (Tanielian et al., 2008; Kang et al., 2003; National Vietnam
Veterans Readjustment Study (NVVRS)).
Department of Defense (DoD) expenditure on PTSD care for service
mem hers has increased over time,
reaching almost $300 million in 2012. In the same year, the Veterans
Affairs (VA) spent $3 billion on PTSD
care for veterans; a striking reminder of the chronic and cumulative
costs of the disease (IOM, 2014). In
addition to PTSD, depression affects 350 million people worldwide
and has now surpassed HIV/AIDS, malaria,
diabetes, and war as the leading cause of disability (Marcus et al.,
2016). Estimated at $2.5 trillion in 2010, the
global cost of mental illness is expected to rise to $6 trillion in the
next 15 years (Bloom et al., 2011).
Furthermore, rates of depression are five times higher in soldiers
than in civilians (The Army Study to Assess
VA-19-0799-D-000832
OS 00002503
Risk and Resilience in Servicemem bers (Army STARRS)).
Stress exposure is one of the greatest risk factors for both major
depressive disorder (MDD) and PTSD.
Traumatic life stress causes PTSD and is the initial trigger in 80%
of cases of MDD (Mazure, 2006).
Traditionally, affective disorders have been treated from a
symptom-suppression approach. Existing drugs aim
to mitigate the impact of these chronic diseases, but do not cure or
prevent the disease itself. There are no
known cures. Prevention, if discussed at all, is usually thought of
only in terms of behavioral interventions.
However, if drugs were developed that enhance stress resilience,
they could potentially be used in at-risk
populations to protect against stress-induced psychiatric disorders.
Describe how the proposed research project addresses one or more
of the FY16 PRMRP Topic Areas.
The proposed project is relevant to the FY16 PRI\!IRP Topic Area of
Psychotropic ~fedications. Specifically, our
research will directly address: 1) the FY16 PRMRP Area of
Encouragement: research on the use of
psychotropic medications to increase resilience in military units.We
have discovered the first resilienceenhancing
compounds that may prevent stress-related psychiatric disorders.
This proposal aims to identify and
develop novel lead compounds with potential resilience-enhancing
and prophylactic efficacy against these
disorders. This proposal also addresses: 2) the FY16 PRMRP Area
of Encouragement: research to evaluate the
VA-19-0799-D-000833
OS 00002504
use of psychotropic medications for mental health issues specific to
women in the military. All the experiments
that we have outlined will be performed in male and female mice.
This is of the utmost importance as women
respond differently to medications and are twice as likely to develop
MDD and PTSD.
The ultimate product to be developed is a psychotropic drug that
enhances resilience and provides long-lasting protection against
stress-induced psychiatric disorders, like PTSD and MDD, in a
prophylactic (or
vaccine-like) fashion. Using targeted compound screening and
subsequent hit-to-lead optimization followed by lead optimization,
this proposal aims to develop a suitable clinical candidate for a
subsequent
Investigational New Drug (IND) application.
Stress resilience: One in five soldiers returns from combat with
PTSD, combat-associated ~1DD, or both
(Tanielian et al., 2008). Perhaps more surprising, however, is that 4
out of 5 soldiers do not develop
psychopathology. This ability to adapt to stress without developing
psychopathology is known as
stress resilience. Until recently, research on stress resilience has
been predicated on the assumption that resilience is a passive
property - more or less the absence of the risk factors that make
individuals
susceptible to stress-induced pathology. Recent work in animal
models, however, suggests that the
VA-19-0799-D-000834
OS 00002505
neurobiology of stress resilience is mediated through active
processes, and often distinct, parallel
mechanisms to those of susceptibility (Krishnan et al., 2007;
Chaudhury et al., 2013; Walsh et al., 2014).
The idea that enhancing stress resilience could protect against the
development of psychiatric disorders
is an appealing one, but treatments to increase resilience are still in
their infancy. Current interventions fall
predominantly on the behavioral side, with psychotherapy, exercise,
and stress inoculation-mild stress
exposure to promote adaptive coping to subsequent severe stress
(Levine, 1957; Lyons and Parker, 2007)being the best available tools to increase resilience clinically
(l\1eredith et al., 2011). Rodent studies also
suggest a role for exercise and enriched environment in stress
resilience (Schloesser et al., 2010; Lehmann and
Herkenham, 2011; Schoenfeld, et al., 2013). Beyond behavioral
manipulations, researchers have successfully
increased resilience biochemically in mice through viral and
transgenic overexpression methods (Donahue et
al., 2014), optogenetic activation (Chaudhury et al., 2013), and
chronic blockade of stress hormones. However,
none of these interventions is directly translatable to the clinic.
Here, we propose to develop the first clinically
applicable resilience-enhancing therapeutics for the prevention of
stress-induced psychopathology.
VA-19-0799-D-000835
OS 00002506
2.
A Clinical Trial of Letrozole for the Treatment of Irritable
Aggression in PTSD
David Anderson, Ph.D.
California Institute of Technology
http://www.bbe.caltech.edu/content/david-j-anderson
Rationale: Both military trauma exposure and posttraumatic stress
disorder (PTSD) have been linked to problems with aggression. Traumarelated irritable aggression is associated with impairments in
interpersonal relationships, dysfunction at work and school, intimate
partner violence, and legal problems. Among male combat veterans of
the conflicts in Iraq and Afghanistan, 57% reported problems controlling
anger, and controlling anger was the most common post-deployment
readjustment problem reported by veterans with and without probable
PTSD (Sayer et al, 2010). More serious manifestations of aggression
affect a smaller yet substantial subpopulation: 13% of Iraq and
Afghanistan veterans reported engaging in violence towards family,
while 9% reported violence towards strangers. Violent criminal offenses
were found to be 2-3 times higher (6-8%) in veterans with PTSD
compared to those without PTSD (3%). Irritability, anger, and
aggressive behavior are often targeted for treatment in patients with
PTSD. While cognitive behavioral therapy (CBT) for PTSD modestly
reduces anger symptoms, response rates are less than optimal, and
several studies show an association between baseline anger and CBT
non-response. Further, retention of veterans in CBT for aggression can
be difficult, and those terminating early demonstrate no improvement
(Galovski et al., 2014).
For patients unwilling to engage in CBT, or who do not respond
optimally, a pharmacological option may be beneficial. However, there
are no established pharmacological treatments with clear efficacy for
irritable or impulsive aggression in PTSD. Specific effects on aggression
of serotonin reuptake inhibitors (SSRis ), the only FDA approved
medications for the treatment of PTSD, have not been investigated; in
fact, increased irritability and anxiety are potential side effects of SSRis.
VA-19-0799-D-000836
OS 00002507
Moreover, male combat veterans are often resistant to SSRis (e.g.,
Friedman et al., 2007), although ethnic differences may play a role.
Although not well-investigated, anti-adrenergic medications (e.g.,
prazosin or doxazosin) and atypical neuroleptics may counter irritable,
impulsive aggression in some veterans by antagonizing effects of stressinduced monoamine surges at noradrenergic alpha-I or serotonin (5HT)type 2 receptors in the frontal lobe or amygdala, or secondarily through
effects on sleep (Pitman et al., 2012). These agents are often avoided,
however, due to potential long-term side effects (e.g., tardive dyskinesia
or metabolic syndrome) or undesirable drug interactions (alpha-I
noradrenergic antagonists interact unsafely with drugs for erectile
dysfunction). It is therefore critical to develop new, well-tolerated, and
more effective pharmacotherapeutics for irritable impulsive aggression
in veterans.
A potential novel approach to reducing irritable aggression has arisen
recently from work in rodents (Anderson, 2012, 2016). Evidence
accumulated over the last 25 years indicates that conversion of
testosterone (T) to estrogen (E) by the enzyme aromatase (AT)
contributes to many physiological processes and behaviors in males,
including aggression. In mutant mice lacking the androgen receptor,
supplemental T restores male aggressive behavior. AT gene knockout
reduces inter-male aggression, an effect reversed by E. AT inhibitors
(Als) reduce aggression in fish, birds and rodents; thus, effects on
aggression of AT gene knockout are not due simply to developmental
effects of reduced E. AT is expressed in brain regions implicated in
aggression, including the hypothalamus, frontal cortex and amygdala.
The laboratory of our collaborator, David Anderson, Ph.D., has recently
shown that neurons in the ventromedial hypothalamus (VMH) that
promote aggression in mice express the E-1/alpha receptor (Esrl) (Lee
et al., 2014). Knockout of the Esrl gene dramatically reduces inter-male
aggression in mice, an effect that cannot be overcome by T. Similarly,
RNAi-mediated knock-down of Esrl mRNA in the VMH dramatically
reduces inter-male aggression (Sano et al., 2013).
VA-19-0799-D-000837
OS 00002508
A shift away from E to T synthesis by AI administration, even though T
and E levels may stay within the normal range (Goudrian et al., 2010),
may also influence other neurobiological systems of relevance to PTSD.
T increases, while E inhibits, synthesis of neuropeptide Y (NPY), which
in turn modulates sympathetic system reactivity, anxiety, distress, and
dissociation during stress. Baseline NPY levels and NPY responses to
sympathetic system activation are markedly low in combat veterans with
PTSD. In contrast, increased NPY responses to extreme stress correlate
positively with military performance requiring behavioral restraint and
use ofpreviously learned skills. E also upregulates 5HT 2A receptors in
the frontal cortex of males and females (e.g., Frokjaer et al., 2010).
Increases in frontal cortical 5HT 2A receptors have been observed in postmortem brain of violent suicide victims (Mann et al, 1989; Hrdina et al.,
1993 ), and by neuroimaging in the brains of impulsively aggressive dogs
(Vermeire et al., 2011) and humans (Laruelle et al., 201 0; Rosell et al.,
2010). T also upregulates allopregnanolone in males (Mitev et al., 2003),
whereas experimentally induced allopregnanolone deficits result in
mouse-on-mouse homicidal aggression (Pinna et al., 2005). An estrogen5HT 2A or 2c receptor-aggression endophenotype is supported in the PTSD
literature. Southwick et al. (1997) demonstrated that one third of
Vietnam veterans with PTSD experienced acute panic and PTSD
symptoms in response to meta-chlorophenylpiperazine (mCPP), a potent
5HT 2A, 5HT2B, and 5HT 2c receptor agonist. It thus should come as no
surprise that a loss-of-function allele of the serotonin transporter gene
that increases synaptic 5HT levels increases PTSD risk, or that SSRis
are ineffective in so many male veterans. Whether this endophenotype
manifests in women is less clear; however, a polymorphism of the Esensitive PACAP gene increase PTSD risk in women. These studies thus
suggest that reducing T to E conversion by Als may reduce irritable
aggression as well as other symptoms of PTSD.
Data so far support the safety of Aisin men (Goudriaan et al., 2010; de
Ronde and de Jong, 2011). Als are prescribed in males for a variety of
medical disorders, including infertility, short stature, and gynecomastia.
They also are used by body builders to counter the negative impact of
exogenous T. Als used widely for breast cancer chemoprevention in
women are associated with modest decreases in bone mineral density.
VA-19-0799-D-000838
OS 00002509
However, Ais appear to have less impact on bone in males, possibly
because of the high rate of T to E conversion in males. A 10-week
course of anastrozole in young eugonadal males revealed no catabolic
effects on protein metabolism, body composition, muscle strength, or
bone calcium metabolism. Also, no significant side effects or negative
effects on metabolism were observed in a 10-day trial of exemestane in
males.
3.
Role of Leaky Neuronal Ryanodine Receptors in Stress-Induced
Cognitive Dysfunction
Andrew R. Marks M.D., Ph.D.
Department of Physiology and Cellular Biophysics, Clyde and Helen
Wu Center for Molecular Cardiology
Columbia University College of Physicians and Surgeons
SUMMARY
The type 2 ryanodine receptor/calcium release channel (RyR2),
required for excitation-contraction
coupling in the heart, is abundant in the brain. Chronic stress induces
catecholamine biosynthesis
and release, stimulating b-adrenergic receptors and activating cAMP
signaling pathways in neurons.
In a murine chronic restraint stress model, neuronal RyR2 were
phosphorylated by protein kinase A(PKA),
oxidized, and nitrosylated, resulting in depletion of the stabilizing
subunit calstabin2 (FKBP12.6)
from the channel complex and intracellular calcium leak. Stressinduced cognitive dysfunction, including
VA-19-0799-D-000839
OS 00002510
deficits in learning and memory, and reduced long-term potentiation
(L TP) at the hippocampal
CA3-CA 1 connection were rescued by oral administration of S 107, a
compound developed in our laboratory
that stabilizes RyR2-calstabin2 interaction, or by genetic ablation of
the RyR2 PKA phosphorylation
site at serine 2808. Thus, neuronal RyR2 remodeling contributes to
stress-induced cognitive dysfunction.
Leaky RyR2 could be a therapeutic target for treatment of stressinduced cognitive dysfunction.
(b) (6)
M.D.
Lawrence C. Kolb Professor and Chairman of Psychiatry,
Columbia University College of Physicians and Surgeons,
Director, New York State Psychiatric Institute
Psychiatrist-in-Chief,
New York Presbyterian Hospital-Columbia University Medical Center
1051 Riverside Drive - Unit #4
New York, NY, 10032
Phone (646) 774-(b) (6)
email: (b) (6)
www.(b) (6)
columbia.edu
com
VA-19-0799-D-000840
OS 00002511
Follow me on twitter~ @(b) (6)
Watch my talk on
E Q,X
T1
From: Bruce Moskowitz <(b) (6)
mac.com >
Date: Friday, April 21, 2017 at 6:48 AM
(b) (6)
To: (b) (6)
<(b) (6)
nyspi.columbia.edu>
Subject: Re: VA mental Heath
Anytime this weekend or next week
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 21, 2017, at 2:51 AM, (b) (6)
<(b) (6)
nyspi.columbia.edu> wrote:
Hi Bruce,
Hope all is well. I have been involved with DS re VA mental
health and that interaction has gone well. Thank you for
facilitating. I would like to briefly chat with you re couple of
related issues. Please let me know when would be a
convenient time to call you or best way to arrange.
(b) (6)
(b) (6)
M.D.
Lawrence C. Kolb Professor and Chairman of Psychiatry,
VA-19-0799-D-000841
OS 00002512
Columbia University College of Physicians and Surgeons,
Director, New York State Psychiatric Institute
Psychiatrist-in-Chief,
New York Presbyterian Hospital-Columbia University Medical Center
1051 Riverside Drive - Unit #4
New York, NY, 10032
Phone (646) 774-(b) (6)
email:
(b) (6)
www.(b) (6)
columbia.edu
com
Follow me on @(b) (6)
Find me on
Watch my talk on
Watch my talk on
From: Bruce Moskowitz <(b) (6)
mac.com >
Date: Tuesday, March 14, 2017 at 7:25 PM
(b) (6)
To: (b) (6)
<(b) (6)
nyspi.columbia.edu>
Cc: David Shulkin
Subject: VA mental Heath
Thank you David and I will review.
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000842
OS 00002513
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/11/2017 11:13:09 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: USH commission
No
Sent from my iPhone
> on Apr 11, 2017, at 5:34 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Is Bruce on it
>
> Sent from my iPhone
VA-19-0799-D-000843
OS 00002514
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/11/2017 9:34:59 AM
David Shulkin [drshulkin@aol.com]
USH commission
Is Bruce on it
Sent from my iPhone
VA-19-0799-D-000844
OS 00002515
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/12/2017 11:37:11 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Thanks for this tremendous opportunity
I cannot imagine a bigger platform for us to be doing together at this time- and then after this
experience we can do something amazing as well
Sent from my iPhone
> on Apr 12, 2017, at 5:53 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> I am so emotional and probably am overreacting today, but I know you understand.
>
> In this moment, I truly and sincerely believe that it is because of you, David, that I have had a very
very small role in a huge opportunity to make a positive impact on the care of my veterans. I just want
to ingrain this moment in my memory forever. After all, this is the purpose of life- to make a positive
impact in the lives of others- and you are helping me with my purpose! I don't know how long we will be
working together and if there are other things we will accomplish together, but it has all been worth it
my dearest friend! Thank you!
>
> Sent from my iPad
VA-19-0799-D-000845
OS 00002516
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/12/2017 9:53:06 AM
Drshulkin@aol.com
Thanks for this tremendous opportunity
I am so emotional and probably am overreacting today, but I know you understand.
In this moment, I truly and sincerely believe that it is because of you, David, that I have had a very
very small role in a huge opportunity to make a positive impact on the care of my veterans. I just want
to ingrain this moment in my memory forever. After all, this is the purpose of life- to make a positive
impact in the lives of others- and you are helping me with my purpose! I don't know how long we will be
working together and if there are other things we will accomplish together, but it has all been worth it
my dearest friend! Thank you!
Sent from my iPad
VA-19-0799-D-000846
OS 00002517
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/9/2017 2:09:31 PM
To:
(b) (6)
Subject:
Re: MITRE
@gmail.com
ok that's fine- I have had no further discussions
-----Original Message----From: Darin Selnick <(b) (6)
@gmail.com>
To: David shulkin
Sent: Sun, Apr 9, 2017 9:42 am
Subject: MITRE
Did MITRE get back with you after they met with Baligh and me? Baligh and I had agreed the time to engage them would
be after we had solidified the future vision, which we did on Friday.
I think we are ready, and I recommend we bring MITRE or some one to help us use the systems approach to flush out
and develop our fully developed roadmap starting with an impact vs. feasibility assessment. This would be accomplished
at the same time we are working with Congress on legislation and with stakeholders. We really need this to finalize the
legislation so that it is air tight.
I recommend we start this process next week.
Darin
VA-19-0799-D-000847
OS 00002518
Message
To:
Darin Selnick [(b) (6)
@gmail.com]
4/9/2017 1:42:18 PM
David shulkin [Drshulkin@aol.com]
Subject:
MITRE
From:
Sent:
Did MITRE get back with you after they met with Baligh and me? Baligh and I had agreed the time to engage
them would be after we had solidified the future vision, which we did on Friday.
I think we are ready, and I recommend we bring MITRE or some one to help us use the systems approach to
flush out and develop our fully developed roadmap starting with an impact vs. feasibility assessment. This
would be accomplished at the same time we are working with Congress on legislation and with
stakeholders. We really need this to finalize the legislation so that it is air tight.
I recommend we start this process next week.
Darin
VA-19-0799-D-000848
OS 00002519
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/14/2017 1:07:03 AM
David shulkin [Drshulkin@aol.com]
Re: In the full report
Just missing someone
Sent from my iPad
On Apr 13, 2017, at 9:05 PM, David shulkin wrote:
I never saw a one word Poonam reply
Must have been a tough day!
Sent from my iPhone
On Apr 13, 2017, at 8:53 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Thanks
Sent from my iPhone
On Apr 13, 2017, at 6:26 PM, Bruce Moskowitz
<(b) (6)
mac.com> wrote:
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000849
OS 00002520
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/14/2017 1:05:06 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: In the full report
I never saw a one word Poonam reply
Must have been a tough day!
Sent from my iPhone
On Apr 13, 2017, at 8:53 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Thanks
Sent from my iPhone
On Apr 13, 2017, at 6:26 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000850
OS 00002521
Message
From:
Poonam Alaigh [(b) (6)
Sent:
4/14/2017 12:53:52 AM
To:
Bruce Moskowitz [(b) (6)
David shulkin [drshulkin@aol.com]
Re: In the full report
CC:
Subject:
hotmail.com]
mac.com]
Thanks
Sent from my iPhone
On Apr 13, 2017, at 6:26 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000851
OS 00002522
Message
From:
Sent:
To:
Subject:
IP [(b) (6) frenchangel59.com]
4/12/2017 2:35:24 PM
David shulkin [drshulkin@aol.com]
(b) (6)
FW: (b) (6)
of Kaiser Permanente - #2 Powerful man in the healthcare
FYI
EOP/WHO [mailto:(b) (6)
From: (b) (6)
Sent: Wednesday, April 12, 2017 10:31 AM
To: IP
Cc: (b) (6)
Subject: Re: (b) (6)
who.eop.gov]
EOP/WHO
of Kaiser Permanente - #2 Powerful man in the healthcare
(b) (6)
Thanks
Sent from my iPhone
On Apr 12, 2017, at 10:29 AM, IP <(b) (6) frenchangel59.com> wrote:
Please look at the links below before our call on (b) (6)
what's possible.
This will help you understand
https://share.kaiserpermanente.org/article/chairman-ceo-bernard-j-tyson-kaiser-permanentenam ed-n o-2-m od em-heal thcare-li st-influential -heal th-care-Ieaders/
https://www.bloomberg.com/ graphics/2015-how-did-i-get-here/bernard-tyson.html
VA-19-0799-D-000852
OS 00002523
Message
From:
(b) (6)
Sent:
4/12/2017 12:18:10 AM
To:
David Shulkin [drshulkin@aol.com]; Vivieca Simpson [(b) (6)
Hires
Subject:
[(b) (6)
gmail.com]
gmail.com]
http ://www.politico.com/story/201 7/04/donald-trump-white-house-staff-vacancies-23 7081
VA-19-0799-D-000853
OS 00002524
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
5/3/2017 2:30:32 AM
Bruce Moskowitz [(b) (6)
mac.com]
(b) (6)
[(b) (6) (b) (6)
@uphs.upenn.edu]; drshulkin@aol.com
Re: TinnitusMalingeringTest-bwol.docx
Is there an attachment you can send (b) (6) thanks
Sent from my iPhone
On May 2, 2017, at 1:19 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
Thank you
Sent from my iPad
Bruce Moskowitz M.D.
On May 2, 2017, at 1:13 PM, (b) (6)
<(b) (6) (b) (6)
@uphs.upenn.edu> wrote:
Bruce,
Please see the short summary that describes our development (in progress) of a test to
see if a patient is "faking tinnitus". This is different from our parallel efforts ongoing
that are focused on developing a test to confirm and potentially quantify tinnitus. This
distinction is important as while we can wean out people who are faking with this
concept I'm attaching in this email, we would need the other testing to substantiate the
claim and extent of tinnitus that I mentioned in the previous emails and summaries.
(b) (6)
(b) (6)
(b)
(6)
M.D.
Gabriel Tucker Professor and Chairman
Dept of Otorhinolaryngology - Head and Neck Surgery
Associate Vice President, Director Physician Network Development
The University of Pennsylvania Health System
3400 Spruce
Philadelphia,
215-349-(b) (6)
215-615-(b) (6)
215-615-(b) (6)
Street - 5 Ravdin
PA 19104
(Academic Office)
(Clinical Office)
(Fax)
VA-19-0799-D-000854
OS 00002525
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/12/2017 7:30:32 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Vivieca Wright Simpson [vivieca.Wright@va.gov]
Fwd: ugh
Sent from my iPhone
Begin forwarded message:
From: "Slack, Donovan"
Date: April 12, 2017 at 3: 11 :55 PM EDT
To: David shulkin
Subject: ugh
This is a big problem and growing (thousands and thousands ofreaders in the past hour alone).
Maybe consider instituting some kind of rapid response protocol for press and medical issues in
future? Not sure that's even possible in a federal agency, but throwing it out there.
https://www.usatoday.com/story/news/politics/2017/04/ 12/veterans-danger-va-hospitalwashington-dc-investigation-finds/l 003 76124/
"A spokesman for the VA did not immediately respond to a message seeking comment."
Donovan Slack
White House and Veterans Affairs Correspondent
USA TODAY
(703) 854-8926 office
(202) 415-9493 cell
-----Original Message----From: David shulkin [mailto:Drshulkin@aol.com]
Sent: Wednesday, April 12, 2017 7:19 AM
To: Slack, Donovan
Subject:
Donovan- thanks for another fair and accurate story - i truly appreciate how you do things
David Shulkin
Sent from my iPhone
VA-19-0799-D-000855
OS 00002526
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/15/2017 6:16:07 PM
To:
(b) (6)
Subject:
hotmail.com; vacodjsl@va.gov
Events DC
(b) (6)
we need a statement to be developed for release on Monday as to the facts and timelines of the events at
DC. We should develop the statement and then we can decide if we want to release and if so what if any of this is
appropriate for release.
As far as I Understand here is the timeline (VHA please confirm this as factual)- I am trying to focus on the major events
and not all of the facts:
The conversion of logistics systems back from the new system back to the old system at DC VA occurred on January 9th.
On 1/12/17 the VISN requests VHA logistics to conduct an audit of the conversion.
An audit occurs on January 24th-26th and determined there are deficiencies
In February- the VISN and VHA logistics teams were notified and the Facility CLO was detailed off the service and an AIB
was begun. A new Facility CLO was brought in and an action plan was sent to the VISN.
Assistance from the logistics team rom the VISN continues in March
At the end of March the VISN GMO rounds at the facility and identifies issues
DUSHOM sends memo with new actions on 3/21/17. In this memo it notes that the VISN contacted IG and asks for
guidance
The VHA Patient Safety team came for a site visit on 3/22/17
IG arrives for a site visit on 3/29
IG contacts the PDSUSH on 3/30/17
On 3/30/17 a 12 person tiger team arrives to assist from Martinsburg VA
An ICC is stood up in April to oversee the efforts. Rounding on units occurs 2X per day.
IG shares interim report with Secretary on 4/12/17
Medical Center Director, Associate Director removed on 4/12/17
Acting Director Larry Connell Appointed on 4/12/17
USH arrives on site for personal oversight of ICC on 4/13/17
Full investigation of events being undertaken in cooperation with IG
At this point in the investigation there is no evidence of harm to any patient
Notification of the issues to the Secretary and USH did not occur prior to the IG interim report.
VHA conducting an assessment of inventory systems across VHA.
VA-19-0799-D-000856
OS 00002527
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/11/2017 8:32:59 AM
David shulkin [Drshulkin@aol.com]
Re:Today
I will have the team check in the meantime
Sent from my iPhone
On Apr 10, 2017, at 6:22 PM, David shulkin wrote:
Sent from my iPhone
Begin forwarded message:
From: "Slack, Donovan"
Date: April 10, 2017 at 3 :35:48 PM EDT
To: David shulkin
Subject: Re: Today
Ha! No worries. James hand delivered the results page to me. I still have some
concerns - 8 days sounds awfully short. But we'll see I guess if data measures up
when site goes public.
Donovan Slack
White House and Veterans Affairs Correspondent
USA TODAY
dslack@usatoda y.com
(703) 854-8926 Office
(202) 415-9493 Cell
On Apr 10, 2017, at 2:22 PM, David shulkin
wrote:
Donovan- apparently i had not refreshed the computer as I should
have - but now I see new mental health patients at the Phoenix VA
is 8 days. Sorry about that- but as you can see I didn't rehearse
this
David
[cid:ae64df80-24b4-4c48-b0ebl aed4a330e2a@prod.exchangelabs.com]
VA-19-0799-D-000857
OS 00002528
Sent from my iPhone
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/10/2017 10:21:32 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Today
Sent from my iPhone
Begin forwarded message:
From: "Slack, Donovan"
Date: April 10, 2017 at 3 :35:48 PM EDT
To: David shulkin
Subject: Re: Today
Ha! No worries. James hand delivered the results page to me. I still have some concerns - 8 days
sounds awfully short. But we'll see I guess if data measures up when site goes public.
Donovan Slack
White House and Veterans Affairs Correspondent
USA TODAY
dslack@usatoday.com
(703) 854-8926 Office
(202) 415-9493 Cell
On Apr 10, 2017, at 2:22 PM, David shulkin wrote:
Donovan- apparently i had not refreshed the computer as I should have - but now
I see new mental health patients at the Phoenix VA is 8 days. Sorry about thatbut as you can see I didn't rehearse this
David
[cid:ae64df80-24b4-4c48-b0eb-l aed4a330e2a@prod.exchangelabs.com]
Sent from my iPhone
VA-19-0799-D-000859
OS 00002530
Message
From:
(b) (6)
Sent:
4/13/2017 6:11:51 PM
David Shulkin [drshulkin@aol.com]
Graphics slides
DHP _diagram.pptx; Top5_Priorities_0417.pptx; Top5Priorities_04112017.pdf; Access_Accountability_slides.pptx
To:
Subject:
Attachments:
[(b) (6)
gmail.com]
so you have for future use.
VA-19-0799-D-000860
OS 00002531
VA Digital Health Platform
FUTURE
DEVELOPMENTS
c1
VA~
Providers
◄Department
of Defense
\
''
.,,,,
.,,,,
'
-''
Veterans
/D
Supply
Chain
-►
'
....
1~
1
Decision
Support
Community
Providers
VA-19-0799-D-000861
OS 00002532
Greater Choice
Modernize Systems
Focus Resources
_,:::.
--.::-\;;}
Improve Timeliness
Suicide Prevention
VA-19-0799-D-000862
OS 00002533
Greater Choice for Veterans
• Redesign the 40/30 Rule
• Build a high-performing,
integrated network of care
• Empower Veterans through
transparency of information
VAi
U.S. Department
ofVeterans Affairs
VA-19-0799-D-000863
OS 00002534
Modernize Our Systents
• Infrastructure improvements
and streamlining services
• EMR interoperability and IT
modernization
VAi
U.S. Department
ofVeterans Affairs
VA-19-0799-D-000864
OS 00002535
Focus Resources
More Efficiently
• Strengthening of foundational
services in VA
• VA/DOD/Community coordination
• Deliver on accountability and
effective management practices
VAi
U.S. Department
ofVeterans Affairs
VA-19-0799-D-000865
OS 00002536
lntprove Tinteliness
of Services
• Access to ca re and wait ti mes
• Decisions on appeals
• Performance on disability claims
VAi
U.S. Department
ofVeterans Affairs
VA-19-0799-D-000866
OS 00002537
Suicide Prevention
• Getting to ZERO
VAi
U.S. Department
ofVeterans Affairs
VA-19-0799-D-000867
OS 00002538
VA
U.S. Department
of Veterans Affairs
Top 5 Priorities
U.S. Department of Veterans Affairs
1. Greater Choice for Veterans
Redesign the 40/30 rule
Build a high -performing, integrated network of care
Empower Veterans through transparency of information
2. Modernize Our Systems
Infrastructure improvements and streamlining services
EMR interoperability & IT modernization
~
~
~
-:
3. Focus Resources More Efficiently
0
Strengthening of foundational services in VA
•
VA/DOD/Community coordination
Deliver on accountability & effective management practices
4. Improve Timeliness of Services
•
Access to care and wait times
Decisions on appeals
Performance on disability claims
Suicide Prevention
Getting to zero
04/11/17
www.va.gov
VA-19-0799-D-000868
OS_00002539
Maintain a high-performing
integrated network that
includes VA, federal
partners, academic affiliates,
and community providers.
Apply industry
standards for
performance, quality
patient satisfaction,
payment models, and
health outcomes.
Increase choices for
all Veterans, starting
with those with
service connected
conditions.
Choice 2.0
Legislation
•~ n11
f11 _ nn
Ensure Veterans get
the care they need,
closer to home when
appropriate.
Optimize
coordination of VA
healthcare with the
health insurance
Veterans already
have.
\ l'il/
Assist in coordinating care
for Veterans served by
multiple providers.
Maintain affordability of
healthcare options for
low-income Veterans.
VA-19-0799-D-000869
DS_00002540
Priority #4 Accountability Legislation
-.,t+)(
:~:;t: /
'·<·I
l,
Increased
flexibility to
remove,
demote, or
suspend VA
employees for
poor
performance or
misconduct.
\
~,
--
~
Authority to
recoup bonuses
of employees
for poor
performance or
misconduct.
Authority to
recoup
relocation
expenses
authorized
through fraud
or malfeasance.
Authority to
reduce federal
pensions for
employees
convicted of
felonies.
•
Increased
protections for
whistle blowers.
VA-19-0799-D-000870
OS 00002541
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/12/2017 10:33:45 AM
David Shulkin [drshulkin@aol.com]
Jennifer's position
I am leaning towards Mike Valentino- he has a good track record of success, has a non controversial
personality, should be accepted by both the field and lOP- what do you think
Sent from my iPhone
VA-19-0799-D-000871
OS 00002542
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/17/2017 6:34:28 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Project Healthy Heroes update
HH Project Update_2017 _04_17.pptx; Untitled attachment 05290.htm
Sent from my iPhone
Begin forwarded message:
From: "(b) (6)
[JSGUS]" <(b) (6)
its.jnj .com>
Date: April 17, 2017 at2:19:21 PM EDT
To: Bruce Moskowitz <(b) (6)
mac.com>, David Shulkin ,
Ike Perlmutter <(b) (6) frenchangel5 9.com>
Subject: Project Healthy Heroes update
VA-19-0799-D-000872
OS 00002543
Healthy Heroes Project
(b) (6)
& (b) (6)
I April
17, 2017
6/19/2019 12:55 PM
05_ASM09_(b) (6)
v32.ppt
VA-19-0799-D-000873
OS 00002544
Timeline
Progress to date
~
Mar1,
2017
~
Mar10,
2017
~
Mar17,
2017
~
Mar 24,
2017
~
Apr14,
2017
May 15,
2017
(b) (4)
•
(b) (4)
•
•
•
6/19/2019 12:55 PM
05_ASM09_(b) (6)
v32.ppt
VA-19-0799-D-000874
OS 00002545
Our 10 Point Plan
(b) (4)
(b) (4)
(b) (4)
r
1 Month
(b) (4)
6/19/2019 12:55 PM
05_ASM09_(b) (6)
v32.ppt
VA-19-0799-D-000875
OS 00002546
Sent from my iPad
Message
From:
(b) (6)
Sent:
4/17/2017 6:19:21 PM
Bruce Moskowitz [(b) (6)
mac.com]; David Shulkin [Drshulkin@aol.com]; Ike Perlmutter
[( @frenchangel59.com]
Project
Healthy Heroes update
b
HH Project Update_2017 _04_17.pptx; ATT0000l.txt
To:
Subject:
Attachments:
[JSGUS] [(b) (6)
its.jnj.com]
VA-19-0799-D-000877
OS 00002548
Healthy Heroes Project
(b) (6)
& (b) (6)
I April
17, 2017
6/19/2019 12:44 PM
05_ASM09_(b) (6)
v32.ppt
VA-19-0799-D-000878
OS 00002549
Timeline
Progress to date
~
Mar1,
2017
~
Mar10,
2017
~
Mar17,
2017
~
Mar 24,
2017
~
Apr14,
2017
May 15,
2017
(b) (4)
(b) (4)
•
•
•
•
6/19/2019 12:44 PM
05_ASM09_(b) (6)
v32.ppt
VA-19-0799-D-000879
OS 00002550
Our 10 Point Plan
(b) (4)
(b) (4)
(b) (4)
1 Month
(b) (4)
6/19/2019 12:44 PM
05_ASM09_(b) (6)
v32.ppt
VA-19-0799-D-000880
OS 00002551
Sent from my iPad
Message
David shulkin [Drshulkin@aol.com]
4/8/2017 8:38:15 PM
(b) (6)
[(b) (6)
gmail.com]
Fwd: American Association for Physician Leadership Honoring you as Honorary Fellow
From:
Sent:
To:
Subject:
Do we know what time i need to be there this day for the event?
Sent from my iPhone
Begin forwarded message:
<(b) (6)
physicianleaders.org>
Date: March 9, 2017 at 1:44:44 PM EST
To: David shulkin
From:
(b) (6)
Subject: Re: American Association for Physician Leadership Honoring you as Honorary Fellow
Terrific David - thanks for considering and it will be a pleasure to have our paths cross again.
All the best - Peter
MD
Any typos - it's the phone
(b) (6)
On Mar 9, 2017, at 13:42, David shulkin wrote:
Thank you (b) (6)
this is a true honor. My mom office will reach out to you soon
David
Sent from my iPhone
On Mar 9, 2017, at 1:07 PM,
(b) (6)
<(b) (6)
physicianleaders.org> wrote:
Good Afternoon,
Please take a moment to read the attached letter from the American
Association for Physician Leadership.
Sincerely -
(b) (6)
(b) (6)
MD FRCS(C), FACS, MCCM
President and Chief Operating Officer (CEO)
American Association for Physician Leadership
Tampa, Florida, USA 33602
Inspiring Change. Together.
www .physicianleaders.org
2017 Annual Meeting I April 22-23, 2017, New York, NY
VA-19-0799-D-000882
OS 00002553
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/10/2017 11:20:20 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: FYI: URGENT I Your Input: VA Public-facing Web site
Nice
Sent from my iPhone
On Apr 10, 2017, at 7:02 PM, Poonam Alaigh <(b) (6)
hotmail.com > wrote:
Yes- thanks a ton and really appreciate you talking to us against this evening - you guys are best
Sent from my iPhone
On Apr 10, 2017, at 6:26 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
Excellent
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 10, 2017, at 5:59 PM, (b) (6)
(b) (6)
mayo.edu > wrote:
Hi-fyi. ...
From: (b) (6)
Sent: Monday, April 10, 2017 4:59 PM
(b) (6)
To: (b) (6)
(b) (6)
(b) (6)
(b) (6)
(
(b) (6)
ccf.org);
kp.org ; (b) (6)
(b) (6)
(b) (6)
(b) (6)
ccf.org ;
(b) (6)
(b) (6)
jhu.edu ; (b) (6)
kp.org ;
[RO PA]; (b) (6)
(b) (6)
Subject: URGENT I Your Input: VA Public-facing Web site
Sensitivity: Confidential
* PLEASE TREAT AS BUSINESS CONFIDENTIAL*
Hi - on Wednesday, the VA will announce a web site designed for
Veterans to make informed decisions about where they receive their
health care. The overview of the plan and the project objectives are
attached.
Dr. Bruce Moskowitz routed the plan in late March to the CEO of the
five academic medical center organizations, encouraging that the CEOs
"express support/confidence" in the plan. Several CEOs expressed in
follow-up emails that they would be willing to "voice support for the
approach, that it's reflective of the direction the VA needs to move to
best support the care of veterans, etc."
Dr. Poonam Alaigh, VA Acting Under Secretary for Health, Dr.
Moskowitz and I spoke late this afternoon - the question: as this rolls
VA-19-0799-D-000884
OS 00002555
out (going public on Wednesday), would your CEO; or someone you
designate in your organization (perhaps a Quality lead; or "digital
care/web" lead be open to speaking w/ the news media, sharing
perspective on how this reflects a step forward for veterans and reflects
what patients are seeking from healthcare providers? If not someone
from your organization, would you recommend an industry expert that
can talk to these issues w/ news media?
The timeline for this would be tomorrow (Tuesday) or Wednesday, as
this news goes public.
Thanks for your consideration.
(b) (6)
Chair I Mayo Clinic Department of Public Affairs
200 First Street S.W. I Rochester, MN 55905
cell: 507 .269.(b) (6) I office: 507 .284.(b) (6)
e-mail: (b) (6)
mayo.edu
VA-19-0799-D-000885
OS 00002556
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/10/2017 11:02:19 PM
Bruce Moskowitz [(b) (6)
mac.com]
(b) (6)
[(b) (6)
mayo.edu]; David Shulkin [drshulkin@aol.com]
Re: FYI: URGENT I Your Input: VA Public-facing Web site
Yes- thanks a ton and really appreciate you talking to us against this evening - you guys are best
Sent from my iPhone
On Apr 10, 2017, at 6:26 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
Excellent
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 10, 2017, at 5:59 PM, (b) (6)
(b) (6)
mayo.edu > wrote:
Hi-fyi. ...
From: (b) (6)
Sent: Monday, April 10, 2017 4:59 PM
(b) (6)
(b) (6)
To: (b) (6)
(b) (6)
(b) (6)
(b) (6)
ccf.org ;
jhu.edu ;
(b) (6)
(b) (6)
kp.org ; (b) (6)
(b) (6)
(b) (6)
(b) (6)
(
kp.org ;
(b) (6)
(b) (6)
ccf.org);
[RO PA];
(b) (6)
Subject: URGENT I Your Input: VA Public-facing Web site
Sensitivity: Confidential
* PLEASE TREAT AS BUSINESS CONFIDENTIAL*
Hi - on Wednesday, the VA will announce a web site designed for Veterans to make
informed decisions about where they receive their health care. The overview of the plan
and the project objectives are attached.
Dr. Bruce Moskowitz routed the plan in late March to the CEO of the five academic
medical center organizations, encouraging that the CEOs "express support/confidence"
in the plan. Several CEOs expressed in follow-up emails that they would be willing to
"voice support for the approach, that it's reflective of the direction the VA needs to
move to best support the care of veterans, etc."
Dr. Poonam Alaigh, VA Acting Under Secretary for Health, Dr. Moskowitz and I spoke
late this afternoon - the question: as this rolls out (going public on Wednesday), would
your CEO; or someone you designate in your organization (perhaps a Quality lead; or
"digital care/web" lead be open to speaking w/ the news media, sharing perspective on
how this reflects a step forward for veterans and reflects what patients are seeking from
healthcare providers? If not someone from your organization, would you recommend
an industry expert that can talk to these issues w/ news media?
VA-19-0799-D-000886
OS 00002557
The timeline for this would be tomorrow (Tuesday) or Wednesday, as this news goes
public.
Thanks for your consideration.
(b) (6)
Chair I Mayo Clinic Department of Public Affairs
200 First Street S.W. I Rochester, MN 55905
cell: 507 .269.(b) (6) I office: 507 .284.(b) (6)
e-mail: (b) (6)
mayo .edu
VA-19-0799-D-000887
OS 00002558
Message
From:
Sent:
To:
Subject:
Attachments:
IP [(b) (6) frenchangel59.com]
4/8/2017 3:08:31 PM
David shulkin [drshulkin@aol.com]
Document #2 - SEPARATE REMINDERS FOR JARED KUSHNER DINNER MEETING 4/8/2017 AT 7:30 PM
Ike dinner w Jared 040817 v3.docx
See attached. I will call you later about both attachments.
MEMORANDUM
TO:
JARED KUSHNER
FROM:
IKE PERLMUTTER
SUBJECT:
TOPICS/INITIATIVES FOR DISCUSSION
DATE:
APRIL 8, 2017
CC:
PHYSICAL INFRASTRUCTURE
1.
Concentrate on the 30% good hospitals the VA currently has
2.
Approximately 700 vacant and underutilized locations a.
Sell right away - the VA must be permitted to utilize the cash for better use.
b.
Let a third party run/manage homeless shelters. They will do a better job.
c.
Do not use the real estate to build more Homeless shelters.
INFORMATION TECHNOLOGY & ELECTRONIC MEDICAL RECORDS SYSTEM
3.
The CIO from Mayo Clinic is overseeing (and other institutions are participating in) a search for a new CIO
for the Dept. of Veterans Affairs. CIO candidates will be in DC on April 17th for interviews by the VA,
Mayo's CIO and others.
4.
DOD recently signed a new contract to implement a new system (Cerner) with an initial cost of $4.3 billion
and a total budgeted cost of $9 billion. There is a push for the VA to choose the same Cerner system.
5.
What the VA needs is a system that can talk to the private hospitals' systems with which it will be
partnering for Veterans medical care (interoperability among the Public-Private Partnership)
a.
The Top 5 Academic Medical Centers DO NOT use Cerner and highly recommend against it in favor
of another system (EPIC).
b.
EPIC is used by 50% of the hospitals in the US and covers over 120 million patients. Using EPIC,
therefore, as the VA IT platform will allow seamless integration with the platform of the majority of
community and academic medical centers. As a result, when veterans access care outside the VA
system (the choice extension) there can be the necessary access and integration to vital medical
information.
c.
This means less cost, easier access to the doctors, patients and soldiers and their medical records.
d. The VA has confirmed that they are on same page to pursue Epic as EMR of choice instead of
Cerner.
VA-19-0799-D-000888
OS 00002559
e.
Cerner has established (what we think is) an artificial barrier ... claiming that Cerner cannot talk to
EPIC if the VA chooses EPIC. We believe that EPIC will allow for this cross talk. We also believe that
the ability of working with the two different platforms is, in reality, an artificial barrier by Cerner
that can be resolved if Cerner chooses. Therefore, Cerner's DOD implementation MUST be
instructed talk to whatever system the VA chooses to install. This must be resolved NOW at the
DOD/Cerner level.
STAFFING
6.
Freeze "All Hiring" - Not only with the Secretary of the VA but throughout all agencies and
departments. Hiring should be done on a case by case basis and only upon the Secretary's approval.
7.
Institute an early retirement employee buyout program.
8.
Transfer employees from one segment of the VA to another to balance excess workforce and shortages
BUDGETING
9.
The FY17 VA budget is over $181 Billion. We are evaluating the budget to identify waste, inefficiencies and
potential surpluses.
10. The preliminary goal looks like a potential minimum reduction of $15B.
11. This should be achievable without adding any extra costs and, at the same time, improving quality of and
access to care.
PTSD
I SUICIDE PREVENTION
12. Establish mandatory new enlistee psych and physical exams (from day one when entering the military to
catch problems at the outset and prevent surprises and costs upon retirement)
13. Establish a wellness prevention program. [As an example, we administer colonoscopy exams for early
detection of cancer. If the disease is discovered early we can save lives and reduce costs]
WHITE HOUSE LIAISON
14. The VA transformation process is moving quickly and effectively by leaning on the expertise of the team I
assembled (hospital, medical and restructuring experts). The effort is more efficiently and effectively
managed as a unified, singular effort. To be most efficient (and successful) the White House staff would
contribute best if focused on opening doors and removing political obstacles, when requested, but not on
overseeing their own initiatives. Currently, our group doesn't need to inconvenience (b) (6) (b) (6) and her
group, but needs them available (on call) when requested. For our continuing needs, we can interface
with (b) (6) which will also develop him as an operator in business as well.
OTHER
15. PRESIDENT'S !NV/TA TION
a.
's initiative is gathering 500 people in Washington on April 29 th at 7:00 PM. He is
working with the Pastor, Dr (b) (6)
. The party will take place in the Trump Hotel in
Washington. It will be televised and Fox's Hannity will attend and we would like the President to
attend.
(b) (6)
VA-19-0799-D-000889
OS 00002560
MEMORANDUM
TO:
JARED KUSHNER
FROM:
IKE PERLMUTTER
SUBJECT:
TOPICS/INITIATIVES FOR DISCUSSION
DATE:
APRIL 8, 2017
CC:
PHYSICAL INFRASTRUCTURE
1.
Concentrate on the 30% good hospitals the VA currently has
2.
Approximately 700 vacant and underutilized locations a.
Sell right away - the VA must be permitted to utilize the cash for better use.
b.
Let a third party run/manage homeless shelters. They will do a better job.
c.
Do not use the real estate to build more Homeless shelters.
INFORMATION TECHNOLOGY & ELECTRONIC MEDICAL RECORDS
SYSTEM
3.
The CIO from Mayo Clinic is overseeing (and other institutions are participating in) a
search for a new CIO for the Dept. of Veterans Affairs. CIO candidates will be in DC
on April 17th for interviews by the VA, Mayo's CIO and others.
4.
DOD recently signed a new contract to implement a new system (Cerner) with an initial
cost of $4.3 billion and a total budgeted cost of $9 billion. There is a push for the VA
to choose the same Cemer system.
5.
What the VA needs is a system that can talk to the private hospitals' systems with
which it will be partnering for Veterans medical care (interoperability among the
Public-Private Partnership)
a.
The Top 5 Academic Medical Centers DO NOT use Cerner and highly
recommend against it in favor of another system (EPIC).
b.
EPIC is used by 50% of the hospitals in the US and covers over 120 million
patients. Using EPIC, therefore, as the VA IT platform will allow seamless
integration with the platform of the majority of community and academic
medical centers. As a result, when veterans access care outside the VA system
(the choice extension) there can be the necessa1y access and integration to vital
medical information.
c.
This means less cost, easier access to the doctors, patients and soldiers and their
medical records.
d.
The VA has confirmed that they are on same page to pursue Epic as EMR of
choice instead of Cerner.
e.
Cerner has established (what we think is) an artificial barrier. .. claiming that
Cerner cannot talk to EPIC if the VA chooses EPIC. We believe that EPIC will
allow for this cross talk. We also believe that the ability of working with the two
different platforms is, in reality, an artificial barrier by Cerner that can be
resolved if Cerner chooses. Therefore, Cemer's DOD implementation
VA-19-0799-D-000890
OS 00002561
MEMORANDUM
JARED KUSHNER
APRIL 8, 2017
PAGE I 2
MUST be instructed talk to whatever system the VA chooses to
install. This must be resolved NOW at the DOD /Cemer level
STAFFING
6.
Freeze "All Hiring'' - Not only with the Secretary of the VA but throughout all agencies
and departments. Hiring should be done on a case by case basis and only upon the
Secretary's approval.
7.
Institute an early retirement employee buyout program.
8.
Transfer employees from one segment of the VA to another to balance excess
workforce and shortages
BUDGETING
9.
The FYl 7 VA budget is over $181 Billion. We are evaluating the budget to identify
waste, ineHiciencies and potential surpluses.
10. The preliminary goal looks like a potential minimum reduction of $15B.
11. This should be achievable without adding any extra costs and, at the same time,
improving quality of and access to care.
PTSD
I SUICIDE PREVENTION
12. Establish mandatory new enlistee psych and physical exams (from day one when
entering the military to catch problems at the outset and prevent surprises and costs
upon retirement)
13. Establish a wellness prevention program. [As an example, we administer co!onoscop_y exams.for
detection of cancer. If the disease is disco1 ered ear!J 2ve can save ii1 es and reduce costJj
1
1
WHITE HOUSE LIAISON
14. The VA transformation process is moving quickly and effectively by leaning on the
expertise of the team I assembled (hospital, medical and restructuring experts). The
effort is more efficiently and effectively managed as a unified, singular effort. To be
most efficient (and successful) the \Vhite House staff would contribute best if focused
on opening doors and removing political obstacles, when requested, but not on
overseeing their own initiatives. Currently, our group doesn't need to inconvenience
(b) (6)
(b) (6)
and her group, but needs them available (on call) when requested. For our
continuing needs, we can interface with A vi, which will also develop him as an operator
in business as well.
OTHER
15. PRESIDENTS INVITATION
a.
(b) (6)
s initiative is gathering 500 people in Washington on April 29 th at
7:00 PM. He is working with the Pastor, Dr (b) (6)
The party will take
place in the Trump Hotel in Washington. It will be televised and Fox's Hannity
will attend and we would like the President to attend.
VA-19-0799-D-000891
OS 00002562
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/6/2017 11:32:18 AM
Bruce Moskowitz [(b) (6)
mac.com]
Ike Perlmutter [(b) (6) frenchangel59.com]
Re: VACIO Search
Wow- your amazing!
Sent from my iPhone
On Apr 6, 2017, at 7:22 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
I should have four to interview at end of today
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 6, 2017, at 7:21 AM, David shulkin wrote:
Ike- I had seen an email yesterday that Bruce was asked to try to identify some
additional
Names as a backup for CIO and i wondered if the below offer was useful to us or
not.
What do you think?
David
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 6, 2017 at 5:50:36 AM EDT
To: David Shulkin
Subject: Re: VA CIO Search
mac.com>
Ike would know more than I would
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 5, 2017, at 10:08 PM, David Shulkin
wrote:
Bruce - we can pursue this if helpful
David
VA-19-0799-D-000892
OS 00002563
-----Original Message----From: (b) (6)
[(b) (6)
ourpublicservice.org]
Sent: Wednesday, April 05, 2017
05:34 PM Eastern Standard Time
To: Blackburn, Scott R.
Subject: [EXTERNAL] VA CIO
Search
Scott:
The purpose of this note is to put
another important issue on your
radar screen. Following up on the
conversation with you and David
about your talent needs, I've spoken
to the CIO practice leaders at
Heidrick & Struggles and they have
agreed to work together on a pro
bono basis to find you the best
possible CIO candidates. I've
connected them with Gina and the
GC's office has signed off on
accepting the help under your gift
acceptance authority.
I know you have a very full plate but
I think your direct involvement with
them is most likely to lead to your
getting the best talent. They are truly
top drawer and I don't think VA is
used to having that kind of
assistance. Would it help to have a
very quick call on this?
Best,
(b) (6)
VA-19-0799-D-000893
OS 00002564
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/6/2017 11:22:32 AM
David shulkin [Drshulkin@aol.com]
Ike Perlmutter [(b) (6) frenchangel59.com]
Re: VACIO Search
I should have four to interview at end of today
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 6, 2017, at 7:21 AM, David shulkin wrote:
Ike- I had seen an email yesterday that Bruce was asked to try to identify some additional
Names as a backup for CIO and i wondered if the below offer was useful to us or not.
What do you think?
David
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 6, 2017 at 5:50:36 AM EDT
To: David Shulkin
Subject: Re: VA CIO Search
mac.com>
Ike would know more than I would
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 5, 2017, at 10:08 PM, David Shulkin wrote:
Bruce - we can pursue this if helpful
David
-----Original Message----From: (b) (6)
[(b) (6)
ourpublicservice.org1
Sent: Wednesday, April 05, 2017 05:34 PM Eastern
Standard Time
To: Blackbum, Scott R.
Subject: [EXTERNAL] VACIO Search
Scott:
VA-19-0799-D-000894
OS 00002565
The purpose of this note is to put another important
issue on your radar screen. Following up on the
conversation with you and David about your talent
needs, I've spoken to the CIO practice leaders at
Heidrick & Struggles and they have agreed to work
together on a pro bono basis to find you the best
possible CIO candidates. I've connected them with
Gina and the GC's office has signed off on
accepting the help under your gift acceptance
authority.
I know you have a very full plate but I think your
direct involvement with them is most likely to lead
to your getting the best talent. They are truly top
drawer and I don't think VA is used to having that
kind of assistance. Would it help to have a very
quick call on this?
Best,
(b) (6)
VA-19-0799-D-000895
OS 00002566
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/6/2017 11:21:28 AM
To:
Ike Perlmutter [(b) (6) frenchangel59.com]
Bruce Moskowitz [(b) (6)
mac.com]
Fwd: VACIO Search
CC:
Subject:
Ike- I had seen an email yesterday that Bruce was asked to try to identify some additional
Names as a backup for CIO and i wondered if the below offer was useful to us or not.
What do you think?
David
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 6, 2017 at 5:50:36 AM EDT
To: David Shulkin
Subject: Re: VA CIO Search
mac.com>
Ike would know more than I would
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 5, 2017, at 10:08 PM, David Shulkin wrote:
Bruce - we can pursue this if helpful
David
-----Original Message----From: (b) (6)
[(b) (6)
ourpublicservice.org1
Sent: Wednesday, April 05, 2017 05:34 PM Eastern Standard
Time
To: Blackburn, Scott R.
Subject: [EXTERNAL] VACIO Search
Scott:
The purpose of this note is to put another important issue on your
radar screen. Following up on the conversation with you and
David about your talent needs, I've spoken to the CIO practice
leaders at Heidrick & Struggles and they have agreed to work
VA-19-0799-D-000896
OS 00002567
together on a pro bona basis to find you the best possible CIO
candidates. I've connected them with Gina and the GC's office
has signed off on accepting the help under your gift acceptance
authority.
I know you have a very full plate but I think your direct
involvement with them is most likely to lead to your getting the
best talent. They are truly top drawer and I don't think VA is used
to having that kind of assistance. Would it help to have a very
quick call on this?
Best,
(b) (6)
VA-19-0799-D-000897
OS 00002568
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/6/2017 9:50:36 AM
To:
David Shulkin [drshulkin@aol.com]
Re: VACIO Search
Subject:
mac.com]
Ike would know more than I would
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 5, 2017, at 10:08 PM, David Shulkin wrote:
Bruce - we can pursue this if helpful
David
-----Original Message----From: (b) (6)
[(b) (6)
ourpublicservice.org1
Sent: Wednesday, April 05, 2017 05:34 PM Eastern Standard Time
To: Blackburn, Scott R.
Subject: [EXTERNAL] VACIO Search
Scott:
I hope all is well and the leadership retreat preparation is going well from your
perspective. I know my colleagues Tom, Chris and Michelle have very much
enjoyed working with you and the VA team.
The purpose of this note is to put another important issue on your radar
screen. Following up on the conversation with you and David about your talent
needs, I've spoken to the CIO practice leaders at Heidrick & Struggles and they
have agreed to work together on a pro bono basis to find you the best possible
CIO candidates. I've connected them with Gina and the GC's office has signed
off on accepting the help under your gift acceptance authority.
I know you have a very full plate but I think your direct involvement with them is
most likely to lead to your getting the best talent. They are truly top drawer and I
don't think VA is used to having that kind of assistance. Would it help to have a
very quick call on this?
VA-19-0799-D-000898
OS 00002569
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/6/2017 2:08:40 AM
To:
Bruce Moskowitz [(b) (6)
Fwd: VACIO Search
Subject:
mac.com]
Bruce - we can pursue this if helpful
David
-----Original Message----From: (b) (6)
[(b) (6)
ourpublicservice.org l
Sent: Wednesday, April 05, 2017 05:34 PM Eastern Standard Time
To: Blackburn, Scott R.
Subject: [EXTERNAL] VACIO Search
Scott:
I hope all is well and the leadership retreat preparation is going well from your perspective. I
know my colleagues Tom, Chris and Michelle have very much enjoyed working with you and
the VA team.
The purpose of this note is to put another important issue on your radar screen. Following up on
the conversation with you and David about your talent needs, I've spoken to the CIO practice
leaders at Heidrick & Struggles and they have agreed to work together on a pro bono basis to
find you the best possible CIO candidates. I've connected them with Gina and the GC's office
has signed off on accepting the help under your gift acceptance authority.
I know you have a very full plate but I think your direct involvement with them is most likely to
lead to your getting the best talent. They are truly top drawer and I don't think VA is used to
having that kind of assistance. Would it help to have a very quick call on this?
Best,
(b) (6)
VA-19-0799-D-000900
OS 00002571
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/7/2017 1:13:53 AM
(b) (6)
[(b) (6)
Re: Amtrak
gmail.com]
Sundays 73EA12
Sent from my iPhone
> on Apr 6, 2017, at 8:50 PM,
(b) (6)
<(b) (6)
gmail.com> wrote:
>
> Don't forget to send
VA-19-0799-D-000901
OS 00002572
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/7/2017 1:13:14 AM
(b) (6)
[(b) (6)
Re: Amtrak
gmail.com]
Reservation 7546E9
Did we ever get the travel company to add my guest rewards to my trips in the past, including monday?
Rewards (b) (6)
Sent from my iPhone
> on Apr 6, 2017, at 8:50 PM,
(b) (6)
<(b) (6)
gmail.com> wrote:
>
> Don't forget to send
VA-19-0799-D-000902
OS 00002573
Message
From:
(b) (6)
Sent:
4/7/2017 12:50:13 AM
David Shulkin [drshulkin@aol.com]
Amtrak
To:
Subject:
[(b) (6)
gmail.com]
Don't forget to send
VA-19-0799-D-000903
OS 00002574
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/7/2017 8:05:01 PM
David shulkin [Drshulkin@aol.com]
Re: The Situation Report: Is the CIO Job at VA About to Lose Its Influence?
Game changing bold move
Sent from my iPhone
On Apr 7, 2017, at 3 :46 PM, David shulkin wrote:
Sent from my iPhone
Begin forwarded message:
From: Michael Tepper (b) (6)
@yahoo.com>
Date: April 7, 2017 at 12:32:02 PM EDT
To: "David J. Shulkin"
Subject: The Situation Report: Is the CIO Job at VA About to Lose Its
Influence?
Reply-To: (b) (6)
@yahoo.com
https ://www .meri talk. com/the-si tuati on-report-i s-the-ci o-j ob-at-va-about-to-1oseits-influence/
VA-19-0799-D-000904
OS 00002575
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/7/2017 7:40:32 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: The Situation Report: Is the CIO Job at VA About to Lose Its Influence?
Sent from my iPhone
Begin forwarded message:
From: Michael Tepper <(b) (6)
@yahoo.com>
Date: April 7, 2017 at 12:32:02 PM EDT
To: "David J. Shulkin"
Subject: The Situation Report: Is the CIO Job at VA About to Lose Its Influence?
@yahoo.com
Reply-To: (b) (6)
http s://www.meri talk. com/the-si tuati on-report-is-the-ci o-j ob-at-va-ab out-to-1 ose-i ts-influence/
VA-19-0799-D-000905
OS 00002576
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/21/2017 5:31:12 PM
Bruce Moskowitz [(b) (6)
mac.com]
Poonam Alaigh [(b) (6)
hotmail.com]
Re: partnership opportunities
Bruce- i think she is definitely on target
David
Sent from my iPhone
On Apr 21, 2017, at 12:26 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
Thank you I will ask the Secretary and acting undersecretary to review with me
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 20, 2017, at 8:57 AM,
(b) (6)
(NOLA) <(b) (6)
va.gov> wrote:
Good morning, Bruce Thank you again for your interest in the work that I am leading, and I look forward to
identifying synergies to maximize our collective impact. As I mentioned, of the 20
Veterans who are dying by suicide every day, 14 are not engaged in VA care. While it is
our responsibility to support all 22 million Veterans, the greatest need (and potential
impact) is with those who are NOT engaging in VA healthcare. Pursuant to targeting
these "14", I have built relationships with leaders from organizations outlined in the
attached and have highlighted partnerships that could be expanded for greater impact.
In addition, my team is working to partner with organizations that help us reach large
concentrations of Veterans (before they are in crisis) while simultaneously developing
an integrated and comprehensive public health strategy that is executed in local
communities nationally. Specifically, we are interested in exploring opportunities in
healthcare for the following:
1.
2.
Partnerships with private sector healthcare
companies to provide training in suicide risk assessment for physicians, nurse
practitioners, and nurses working in Primary Care and Emergency Room
settings;
Partnership with professional associations
such as American Academy of Family Physicians, American Nurses Association,
etc. to promote training programs for community/private sector providers.
I look forward to any ideas that you have and the opportunity to discuss next
steps. Thank you for all that you are doing to support Veterans and VA. We must
succeed.
With sincere appreciation and respect,
(b) (6)
VA-19-0799-D-000906
OS 00002577
(b) (6)
National Director, Public-Private Partnerships (Acting)
Department of Veterans Affairs
Office for Suicide Prevention
NEW PHONE: 561-701-(b) (6)
Email: (b) (6)
va .gov
VA-19-0799-D-000907
OS 00002578
Message
Bruce Moskowitz [(b) (6)
mac.com]
4/21/2017 4:26:58 PM
(b) (6)
(NOLA) [(b) (6)
va.gov]
Poonam Alaigh [(b) (6)
hotmail.com]; David shulkin [drshulkin@aol.com]
Re: partnership opportunities
From:
Sent:
To:
CC:
Subject:
Thank you I will ask the Secretary and acting undersecretary to review with me
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 20, 2017, at 8:57 AM,
(b) (6)
(NOLA) <(b) (6)
va.gov> wrote:
Good morning, Bruce Thank you again for your interest in the work that I am leading, and I look forward to identifying
synergies to maximize our collective impact. As I mentioned, of the 20 Veterans who are dying by
suicide every day, 14 are not engaged in VA care. While it is our responsibility to support all 22 million
Veterans, the greatest need (and potential impact) is with those who are NOT engaging in VA
healthcare. Pursuant to targeting these "14", I have built relationships with leaders from organizations
outlined in the attached and have highlighted partnerships that could be expanded for greater impact.
In addition, my team is working to partner with organizations that help us reach large concentrations of
Veterans (before they are in crisis) while simultaneously developing an integrated and comprehensive
public health strategy that is executed in local communities nationally. Specifically, we are interested in
exploring opportunities in healthcare for the following:
1.
2.
Partnerships with private sector healthcare companies to
provide training in suicide risk assessment for physicians, nurse practitioners, and nurses
working in Primary Care and Emergency Room settings;
Partnership with professional associations such as American
Academy of Family Physicians, American Nurses Association, etc. to promote training programs
for community/private sector providers.
I look forward to any ideas that you have and the opportunity to discuss next steps. Thank you for all
that you are doing to support Veterans and VA. We must succeed.
With sincere appreciation and respect,
(b) (6)
(b) (6)
National Director, Public-Private Partnerships (Acting)
Department of Veterans Affairs
Office for Suicide Prevention
NEW PHONE: 561-701-(b) (6)
Email: (b) (6)
va.gov
VA-19-0799-D-000908
OS 00002579
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/7/201710:02:54 PM
Va David [vacodjsl@va.gov]
Fwd: Another CIO Yale
Biosketch_(b) (6), _2017PMC.docx; Untitled attachment 05404.htm
(b) (2)
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 7, 2017 at 3:29:07 PM EDT
To: drshulkin@aol .com
Cc: IP <(b) (6) frenchangel59.com>
Subject: Another CIO Yale
mac.com>
VA-19-0799-D-000909
OS 00002580
0MB No. 0925-0001 and 0925-0002 (Rev. 11/16 Approved Through 10/31/2018)
BIOGRAPHICAL SKETCH
Provide the following information for the Senior/key personnel and other significant contributors.
Follow this format for each person. DO NOT EXCEED FIVE PAGES.
NAME: (b) (6), (b) (2)
(b) (6), (b) (2)
eRA COMMONS USER NAME (credential, e.g., agency login):
POSITION TITLE: Professor, Yale University
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing,
include postdoctoral training and residency training if applicable. Add/delete rows as necessary.)
INSTITUTION AND LOCATION
DEGREE
(if applicable)
Completion
Date
MMNYYY
FIELD OF STUDY
(b) (6), (b) (2)
A. Personal Statement
(b) (6), (b) (2)
(b)
(6)
.
VA-19-0799-D-000910
OS 00002581
B. Positions and Honors
Positions and Employment
(b) (6), (b) (2)
National Appointments
(b) (6), (b) (2)
C. Contributions to Science
(b) (6), (b) (2)
VA-19-0799-D-000911
OS 00002582
(b) (6), (b) (2)
(b)
(6)
Complete List of Published Work in MyBibliography:
(b) (6), (b) (2)
D. Additional Information: Research Support and/or Scholastic Performance
Current Research Support
NIH Grants:
(b) (6), (b) (2)
VA-19-0799-D-000912
OS 00002583
VA Grants
3
Sent from my iPad
Bmce Moskowitz MD.
5
Message
From:
Sent:
To:
CC:
Subject:
Attachments:
Bruce Moskowitz [(b) (6)
mac.com]
4/7/2017 7:29:07 PM
drshulkin@aol.com
IP [(b) (6) frenchangel59.com]
Another CIO Yale
Biosketch_(b) (6), _2017PMC.docx; Untitled attachment 05410.txt
(b) (2)
VA-19-0799-D-000916
OS 00002587
0MB No. 0925-0001 and 0925-0002 (Rev. 11/16 Approved Through 10/31/2018)
BIOGRAPHICAL SKETCH
Provide the following information for the Senior/key personnel and other significant contributors.
Follow this format for each person. DO NOT EXCEED FIVE PAGES.
NAME: (b) (6), (b) (2)
eRA COMMONS USER NAME (credential, e.g., agency login):
(b) (6), (b) (2)
POSITION TITLE: Professor, Yale University
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing,
include postdoctoral training and residency training if applicable. Add/delete rows as necessary.)
INSTITUTION AND LOCATION
DEGREE
(if applicable)
Completion
Date
MMNYYY
FIELD OF STUDY
(b) (6), (b) (2)
A. Personal Statement
(b) (6), (b) (2)
(b)
(6)
VA-19-0799-D-000917
OS 00002588
B. Positions and Honors
Positions
and Employment
(b) (6), (b) (2)
National Appointments
(b) (6), (b) (2)
C. Contributions to Science
(b) (6), (b) (2)
VA-19-0799-D-000918
OS 00002589
(b) (6), (b) (2)
(b)
(6)
Complete List of Published Work in MyBibliography:
(b) (6), (b) (2)
D. Additional Information: Research Support and/or Scholastic Performance
Current Research Support
NIH Grants:
(b) (6), (b) (2)
VA-19-0799-D-000919
OS 00002590
VA Grants
Sent from my iPad
Bruce Moskowitz M.D.
Message
From:
Sent:
To:
Subject:
IP [(b) (6) frenchangel59.com]
4/12/2017 1:51:24 AM
'David shulkin' [Drshulkin@aol.com]
RE: Passoverseder
I love it! Thank you.
From: David shulkin [mailto:Drshulkin@aol.com]
Sent: Tuesday, April 11, 2017 6:38 PM
To: Ike Perlmutter
Subject: Fwd: Passover seder
Ike- youll enjoy this
Subject: Re: Passover seder
http ://www.timesofisrael .com/trump-a-no-show-at-white-house-seder/
Sent via the Samsung Galaxy S® 5 ACTIVE™, an AT&T 4G LTE smartphone
VA-19-0799-D-000923
OS 00002594
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/11/2017 10:37:32 PM
Ike Perlmutter [(b) (6) frenchangel59.com]
Fwd: Passover seder
Ike- youll enjoy this
Subject: Re: Passover seder
http ://www.timesofisrael .com/trump-a-no-show-at-white-house-seder/
Sent via the Samsung Galaxy S® 5 ACTIVE™, an AT&T 4G LTE smartphone
VA-19-0799-D-000924
OS 00002595
Message
From:
(b) (6)
[(b) (6)
Sent:
To:
4/15/2017 5:07:06 PM
David shulkin [Drshulkin@aol.com]
Subject:
Re:
gmail.com]
Just sent in seperate message
On Apr 15, 2017 1:05 PM, "(b) (6)
Yes stand by
<(b) (6)
gmail.com> wrote:
On Apr 15, 2017 1:04 PM, "David shulkin" wrote:
Do you have one of those screen shots from the access paper for the annals I can use for my studer slides? If
so can you send?
Sent from my iPhone
VA-19-0799-D-000925
OS 00002596
Message
From:
(b) (6)
[(b) (6)
Sent:
To:
4/15/2017 5:05:03 PM
David shulkin [Drshulkin@aol.com]
Subject:
Re:
gmail.com]
Yes stand by
On Apr 15, 2017 1:04 PM, "David shulkin" wrote:
Do you have one of those screen shots from the access paper for the annals I can use for my studer slides? If
so can you send?
Sent from my iPhone
VA-19-0799-D-000926
OS 00002597
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/15/2017 5:04:37 PM
(b) (6)
[(b) (6)
gmail.com]
Do you have one of those screen shots from the access paper for the annals I can use for my studer
slides? If so can you send?
Sent from my iPhone
VA-19-0799-D-000927
OS 00002598
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/6/2017 3:20:29 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Call me in the morning
K
Sent from my iPhone
> on Apr 5, 2017, at 11:19 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> on your way to work in the morning if that is the best time
>
> Sent from my iPhone
VA-19-0799-D-000928
OS 00002599
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/6/2017 3:19:21 AM
David Shulkin [drshulkin@aol.com]
Call me in the morning
on your way to work in the morning if that is the best time
Sent from my iPhone
VA-19-0799-D-000929
OS 00002600
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/7/2017 11:21:31 PM
To:
IP [(b) (6) frenchangel59.com]
Re: Lab Soft News: Cerner/Leidos/Accenture Secure EHR Contract for a Global Military EHR
Subject:
Bruce and I spoke and we definitely want to pursue an Epic option through one of our partners. The
Department of Defense option is worth exploring as well as Congress has been urging VA and DOD to work
together on electronic records for over a decade.
Sent from my iPhone
On Apr 7, 2017, at 6:49 PM, IP <(b) (6) frenchangel59.com> wrote:
This was posted in 2015 ....
Do you think it makes sense to share this with the people I am seeing
this weekend?
http://labsoftnews.typepad.com/lab soft news/2015/08/cerner-dod -contract-conn.html
Cerner/Leidos/Accenture Secure EHR
Contract for a Global Military EHR
I have waited about five days to comment about the success of Cerner
and its partners with the DOD EHR contract. This has allowed me to
collect my thoughts and review some of the other articles covering the
news. I thought that the best analysis I have read was by Joseph Conn of
Modern Healthcare (see: Cerner, Leidos and Accenture win massive
Defense contract for EHR system ). Below are some quotes from his
article:
For the better part of a year, Epic has been buffeted by charges from
its critics, competitors and various members of Congress about an
alleged lack of interoperability of its system .... Chris MillerJ program
executive officer of defense health management systemsJ the Defense
Department office that handled the DHMSM procurementJ said the
buyers were acutely aware of the data-blocking issue ....
VA-19-0799-D-000930
OS 00002601
Dr. Howard Landa .... previously worked in medical informatics for Kaiser
PermanenteJ including during the 2003 through 2007 period when it
switched from multiple home-grown EHRs to Epic. The worry then was
that Kaiser, with its 36 hospitals, would drain Epic's resources from its
other customers. That largely didn't happen. Now, that monkey will
be on Cerner's back....
Leidos, formerly the national security, health and engineering
business of defense contractor Science Applications International
Corp, was spun off from SAIC in 2013. In the late 1980s and early
1990s, SAIC, operating on a $1.1 billion Defense Department contract,
created and installed the Composite Health Care System for the
military health system. CHCS I; which is still in use., was based on public
domain software code provided free by the VA from an early version of
what is now the VA 's VistA EHR ....
Todd Cozzens ..., a noted venture capital firm in the information
technology industry, said interoperability is a key issue. ,,.The No. 1
focus of the DoD., the ONC and others should be., not only is this system
useful., but can it interoperateH with other vendors' EH Rs., Cozzens said.
"There's so little emphasis on making these systems interoperable/'
Cozzens said. "'We really failed as an industry to do that."....
Perhaps in anticipation of good news from the Defense Department,
Cerner stock prices jumped nearly 7.2% on the day, closing an hour
before the award was announced at $73.40 a share. Miller said the
military has more than 50 systems it is planning to replace with the new
Cerner installation.
I believe that Cerner has been preoccupied with Wall Street and its
quarterly earnings since it went public. The same charge cannot be
leveled against Epic which is privately held and generally uninterested
in marketing or hyping its product. The company depends largely on
referrals and word of mouth. This new contract is certainly good news
for Cerner stockholders because the company will now be feeding at
the "Uncle Sugar" trough for many years to come. This new
relationship with the DOD will push Cerner further down the path of a
VA-19-0799-D-000931
OS 00002602
de facto governmental contractor like its partner Leidos. I can't say that
this will necessarily hurt the services and products that Cerner provides
to its current hospital clients but I am sure that they are not going to
get any better.
As to Epic "failure" to win the contract, I suspect that there were a lot
of smiles of relief in Verona when the winner was announced. I think
that Epic was competing in the contest because everyone expected it to
do so. The Epic culture and emphasis on client control was probably a
non-starter for the military brass. Leidos/SAIC contrariwise was a
known quantity for them. Epic has almost a lock on the EHR business
for the larger and most prestigious U.S. hospitals and success with a
DOD contract would have done little to burnish the company image. It
will just keep on rolling, closing more deals in the U.S. and beefing up
its international set of clients. Here's a quote from another article
reinforcing this same idea (see: CIOs 'surprised' at Cerner DoD win ):
In addition to partner strength ... [an EHR expert] believes Cerner likely
had the upper hand in terms of sales skills. "Cerner is a selling machine
and they do a very good job of selling their product," ... [he noted].
"Epic thinks they are the de facto winner all the time and they don't
know how to sell because they haven't needed to sell. "But that's not
how the government works. They have a whole process they go
through and Epic isn't geared to deal with that.
One more thing. What's the chance of Cerner/Leidos/Accenture
actually succeeding in this huge, global EHR military/VA integration
project? I and many informed observers put the chances of success at
slim to none. Ross Koppel's quote below accurately reflects my opinion
(see: Cerner is part of team that wins huge contract to revamp
military's health records ):
Some analysts were skeptical that any of the bidders was up to the
task. In the end, the Pentagon had a choice among three finalists who
offered fairly mediocre systems for the price, said Ross Koppel, a
professor of sociology at the University of Pennsylvania who studies
health information technology. "All the systems are stunningly clunky,
VA-19-0799-D-000932
OS 00002603
the interfaces are state of the art 15 years ago, the usability is far
inferior to every other system of the modern era, and the lack of
interoperability makes a hash of the data," Koppel said.
So, here's what's I think is going to happen? A year or two from now,
Cerner/Leidos/Accenture will announce a huge victory in installing and
integrating the Cerner EHR in a large Army hospital and a few freestanding clinics. Then, total "radio silence" for five or six years. Then a
DOD spokesperson will announce that the military is unhappy with the
EHR contractors who have not lived up to the terms of the contract in
addition to being responsible for cost overruns with the cost swelling
to, say, $15 billion with little to show for it. This latter news will not
receive much media coverage.
Posted by Bruce Friedman on August 03, 2015 at 12:42 PM in Electronic
Health Record (EHR), Healthcare Business, Healthcare Delivery,
Healthcare Information Technology, Pathology Informatics I Permalink
•
•
VA-19-0799-D-000933
OS 00002604
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/7/2017 11:03:28 PM
To:
IP [(b) (6) frenchangel59.com]
Re: Lab Soft News: Cerner/Leidos/Accenture Secure EHR Contract for a Global Military EHR
Subject:
Yes
Sent from my iPhone
On Apr 7, 2017, at 6:49 PM, IP <(b) (6) frenchangel59.com> wrote:
iThis was posted in 2015 ....
Do you think it makes sense to share this with the people I am seeing
this weekend?
http://labsoftnews.typepad.com/lab soft news/2015/08/cerner-dod -contract-conn.html
Cerner/Leidos/Accenture Secure EHR
Contract for a Global Military EHR
I have waited about five days to comment about the success of Cerner
and its partners with the DOD EHR contract. This has allowed me to
collect my thoughts and review some of the other articles covering the
news. I thought that the best analysis I have read was by Joseph Conn of
Modern Healthcare (see: Cerner, Leidos and Accenture win massive
Defense contract for EHR system ). Below are some quotes from his
article:
For the better part of a year, Epic has been buffeted by charges from
its critics, competitors and various members of Congress about an
alleged lack of interoperability of its system .... Chris MillerJ program
executive officer of defense health management systemsJ the Defense
Department office that handled the DHMSM procurementJ said the
buyers were acutely aware of the data-blocking issue ....
VA-19-0799-D-000934
OS 00002605
Dr. Howard Landa .... previously worked in medical informatics for Kaiser
PermanenteJ including during the 2003 through 2007 period when it
switched from multiple home-grown EHRs to Epic. The worry then was
that Kaiser, with its 36 hospitals, would drain Epic's resources from its
other customers. That largely didn't happen. Now, that monkey will
be on Cerner's back....
Leidos, formerly the national security, health and engineering
business of defense contractor Science Applications International
Corp, was spun off from SAIC in 2013. In the late 1980s and early
1990s, SAIC, operating on a $1.1 billion Defense Department contract,
created and installed the Composite Health Care System for the
military health system. CHCS I; which is still in use., was based on public
domain software code provided free by the VA from an early version of
what is now the VA 's VistA EHR ....
Todd Cozzens..., a noted venture capital firm in the information
technology industry, said interoperability is a key issue. ,,.The No. 1
focus of the DoD., the ONC and others should be., not only is this system
useful., but can it interoperateH with other vendors' EH Rs., Cozzens said.
"There's so little emphasis on making these systems interoperable,''
Cozzens said. "'We really failed as an industry to do that."....
Perhaps in anticipation of good news from the Defense Department,
Cerner stock prices jumped nearly 7.2% on the day, closing an hour
before the award was announced at $73.40 a share. Miller said the
military has more than 50 systems it is planning to replace with the new
Cerner installation.
I believe that Cerner has been preoccupied with Wall Street and its
quarterly earnings since it went public. The same charge cannot be
leveled against Epic which is privately held and generally uninterested
in marketing or hyping its product. The company depends largely on
referrals and word of mouth. This new contract is certainly good news
for Cerner stockholders because the company will now be feeding at
the "Uncle Sugar" trough for many years to come. This new
relationship with the DOD will push Cerner further down the path of a
VA-19-0799-D-000935
OS 00002606
de facto governmental contractor like its partner Leidos. I can't say that
this will necessarily hurt the services and products that Cerner provides
to its current hospital clients but I am sure that they are not going to
get any better.
As to Epic "failure" to win the contract, I suspect that there were a lot
of smiles of relief in Verona when the winner was announced. I think
that Epic was competing in the contest because everyone expected it to
do so. The Epic culture and emphasis on client control was probably a
non-starter for the military brass. Leidos/SAIC contrariwise was a
known quantity for them. Epic has almost a lock on the EHR business
for the larger and most prestigious U.S. hospitals and success with a
DOD contract would have done little to burnish the company image. It
will just keep on rolling, closing more deals in the U.S. and beefing up
its international set of clients. Here's a quote from another article
reinforcing this same idea (see: CIOs 'surprised' at Cerner DoD win ):
In addition to partner strength ... [an EHR expert] believes Cerner likely
had the upper hand in terms of sales skills. "Cerner is a selling machine
and they do a very good job of selling their product," ... [he noted].
"Epic thinks they are the de facto winner all the time and they don't
know how to sell because they haven't needed to sell. "But that's not
how the government works. They have a whole process they go
through and Epic isn't geared to deal with that.
One more thing. What's the chance of Cerner/Leidos/Accenture
actually succeeding in this huge, global EHR military/VA integration
project? I and many informed observers put the chances of success at
slim to none. Ross Koppel's quote below accurately reflects my opinion
(see: Cerner is part of team that wins huge contract to revamp
military's health records ):
Some analysts were skeptical that any of the bidders was up to the
task. In the end, the Pentagon had a choice among three finalists who
offered fairly mediocre systems for the price, said Ross Koppel, a
professor of sociology at the University of Pennsylvania who studies
health information technology. "All the systems are stunningly clunky,
VA-19-0799-D-000936
OS 00002607
the interfaces are state of the art 15 years ago, the usability is far
inferior to every other system of the modern era, and the lack of
interoperability makes a hash of the data," Koppel said.
So, here's what's I think is going to happen? A year or two from now,
Cerner/Leidos/Accenture will announce a huge victory in installing and
integrating the Cerner EHR in a large Army hospital and a few freestanding clinics. Then, total "radio silence" for five or six years. Then a
DOD spokesperson will announce that the military is unhappy with the
EHR contractors who have not lived up to the terms of the contract in
addition to being responsible for cost overruns with the cost swelling
to, say, $15 billion with little to show for it. This latter news will not
receive much media coverage.
Posted by Bruce Friedman on August 03, 2015 at 12:42 PM in Electronic
Health Record (EHR), Healthcare Business, Healthcare Delivery,
Healthcare Information Technology, Pathology Informatics I Permalink
•
•
VA-19-0799-D-000937
OS 00002608
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/5/2017 2:03:30 AM
Bruce Moskowitz [(b) (6)
mac.com]
Re: Lab Soft News: Cerner/Leidos/Accenture Secure EHR Contract for a Global Military EHR
Interesting
Sent from my iPhone
> on Apr 4, 2017, at 6:40 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
>
> http://labsoftnews.typepad.com/lab_soft_news/2015/08/cerner-dod-contract-conn.html
>
>
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-000938
OS 00002609
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
4/4/2017 10:40:56 PM
To:
IP [(b) (6) frenchangel59.com]; mbs(b) (6)
@gmail.com
drshulkin@aol.com
Lab Soft News: Cerner/Leidos/Accenture Secure EHR Contract for a Global Military EHR
CC:
Subject:
mac.com]
http://labsoftnews.typepad.com/lab_soft_news/2015/08/cerner-dod-contract-conn.html
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000939
OS 00002610
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/25/2017 5:05:13 PM
Ike Perlmutter [(b) (6) frenchangel59.com]; Marisol [(b) (6) frenchangel59.com]
Tom Bowman will come to dinner so the senate efforts are represented. I would have invited the number 2
republican on the committee but they all are going to the senate spouses dinner
Sent from my iPhone
VA-19-0799-D-000940
OS 00002611
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
5/23/2017 11:50:29 PM
David shulkin [Drshulkin@aol.com]
Re: Terry Fadem
You will be simply great!!
Sent from my iPhone
On May 23, 2017, at 5:28 PM, David shulkin wrote:
Ok - thats a big assumption about my state of mind tommorow
Sent from my iPhone
On May 23, 2017, at 4:58 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Let's talk about this tomorrow after your hearing when you have a clearer mindwe can do it hourly - spoke to Rachel
Sent from my iPhone
On May 23, 2017, at 7:33 AM, David shulkin wrote:
Can you see if Rachels group in technology transfer has done
anything about a contract with Terry Fadem- ive asked three times
We have to be careful he would need to work for the technology
transfer group as a consultant as Bruce cannot direct his activities
since he is not a federal employee- he must work for TTp- maybe
On an hourly basis
We need to do this by the rules or lets not do it
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz
<(b) (6)
mac.com>
Date: May 23, 2017 at 6:40:45 AM EDT
To: drshulkin@aol .com
Cc: L Perl <(b) (6)
gmail.com>, IP
(b) (6)
<
frenchangel59.com>, mbs(b) (6)
@gmail .com
Subject: Terry Fadem
EMCL
VA-19-0799-D-000941
OS 00002612
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
5/23/2017 9:23:54 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Terry Fadem
Ok - thats a big assumption about my state of mind tommorow
Sent from my iPhone
On May 23, 2017, at 4:58 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Let's talk about this tomorrow after your hearing when you have a clearer mind- we can do it
hourly - spoke to Rachel
Sent from my iPhone
On May 23, 2017, at 7:33 AM, David shulkin wrote:
Can you see if Rachels group in technology transfer has done anything about a
contract with Terry Fadem- ive asked three times
We have to be careful he would need to work for the technology transfer group as
a consultant as Bruce cannot direct his activities since he is not a federal
employee- he must work for TTp- maybe On an hourly basis
We need to do this by the rules or lets not do it
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
mac.com>
Date: May 23, 2017 at 6:40:45 AM EDT
To: drshulkin@aol .com
Cc: L Perl <(b) (6)
gmail.com>, IP
(b) (6)
@gmail .com
<
frenchangel59.com>, mbs(b) (6)
Subject: Terry Fadem
EMCL
VA-19-0799-D-000942
OS 00002613
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
5/23/2017 8:58:53 PM
David shulkin [Drshulkin@aol.com]
Re: Terry Fadem
Let's talk about this tomorrow after your hearing when you have a clearer mind- we can do it hourly - spoke to
Rachel
Sent from my iPhone
On May 23, 2017, at 7:33 AM, David shulkin wrote:
Can you see if Rachels group in technology transfer has done anything about a contract with
Terry Fadem- ive asked three times
We have to be careful he would need to work for the technology transfer group as a consultant as
Bruce cannot direct his activities since he is not a federal employee- he must work for
TTp- maybe On an hourly basis
We need to do this by the rules or lets not do it
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
mac.com>
Date: May 23, 2017 at 6:40:45 AM EDT
To: drshulkin@aol .com
Cc: L Perl <(b) (6)
gmail.com>, IP <(b) (6) frenchangel59.com>,
(b) (6)
mbs
@gmail .com
Subject: Terry Fadem
EMCL
VA-19-0799-D-000943
OS 00002614
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
5/23/2017 11:33:08 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Terry Fadem
Can you see if Rachels group in technology transfer has done anything about a contract with Terry Fadem- 1ve
asked three times
We have to be careful he would need to work for the technology transfer group as a consultant as Bruce cannot
direct his activities since he is not a federal employee- he must work for TTp- maybe On an hourly basis
We need to do this by the rules or lets not do it
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
mac.com>
Date: May 23, 2017 at 6:40:45 AM EDT
To: drshulkin@aol .com
Cc: L Perl <(b) (6)
gmail.com>, IP <(b) (6) frenchangel59 .com>, mbs(b) (6)
Subject: Terry Fadem
@gmail.com
EMCL
VA-19-0799-D-000944
OS 00002615
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
5/23/2017 11:26:56 AM
To:
Bruce Moskowitz [(b) (6)
Re: Terry Fadem
Subject:
mac.com]
of course
Sent from my iPhone
> on May 23, 2017, at 7:15 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> Thank you is it possible to let him know?
>
> Sent from my iPad
> Bruce Moskowitz M.D.
>
>> on May 23, 2017, at 7:13 AM, David shulkin wrote:
>>
>> Bruce- we are working on this- i know it seems crazy but this is the toughest thing to do in
government- since it deals with procurement and you need to bid things our and give preferences to
disabled veteran owned businesses- but we are getting close
>>
>>
>>
>> Sent from my iPhone
>>
>>> on May 23, 2017, at 6:40 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>>>
>>> We need to know what is timeline for his approval. I can not get needed technology donated from the
group without his assistance. We have the following waiting for his assistance:
>>>
>>> off the shelf programs for Inventory management that do not rely on EMR and can start tracking
unnecessary spending immediately
>>> Your internal group headed by your current CIO wants the EMCL software so Veterans can access care
at reliable health care clinics and know wait times under the choice program.
>>>
>>> Program tracking opioid prescriptions and overprescribing.
>>>
>>> suicide and mental health tracking who is at risk.
>>>
>>> Thank you for the update.
>>> Sent from my iPad
>>> Bruce Moskowitz M.D.
>>
VA-19-0799-D-000945
OS 00002616
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
5/23/2017 11:15:19 AM
David shulkin [Drshulkin@aol.com]
Poonam Alaigh [(b) (6)
hotmail.com]; Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter
(b) (6)
[
gmail.com]; Marc Sherman [(b) (6)
gmail.com]
Re: Terry Fadem
Thank you is it possible to let him know?
Sent from my iPad
Bruce Moskowitz M.D.
> on May 23, 2017, at 7:13 AM, David shulkin wrote:
>
> Bruce- we are working on this- i know it seems crazy but this is the toughest thing to do in
government- since it deals with procurement and you need to bid things our and give preferences to
disabled veteran owned businesses- but we are getting close
>
>
>
> Sent from my iPhone
>
>> on May 23, 2017, at 6:40 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>>
>> We need to know what is timeline for his approval. I can not get needed technology donated from the
group without his assistance. We have the following waiting for his assistance:
>>
>> off the shelf programs for Inventory management that do not rely on EMR and can start tracking
unnecessary spending immediately
>> Your internal group headed by your current CIO wants the EMCL software so Veterans can access care at
reliable health care clinics and know wait times under the choice program.
>>
>> Program tracking opioid prescriptions and overprescribing.
>>
>> suicide and mental health tracking who is at risk.
>>
>> Thank you for the update.
>> Sent from my iPad
>> Bruce Moskowitz M.D.
>
VA-19-0799-D-000946
OS 00002617
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
5/23/2017 11:13:35 AM
Bruce Moskowitz [(b) (6)
mac.com]
Poonam Alaigh [(b) (6)
hotmail.com]; Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter
[(b) (6)
gmail.com]; Marc Sherman [(b) (6)
gmail.com]
Re: Terry Fadem
Bruce- we are working on this- i know it seems crazy but this is the toughest thing to do in governmentsince it deals with procurement and you need to bid things our and give preferences to disabled veteran
owned businesses- but we are getting close
Sent from my iPhone
> on May 23, 2017, at 6:40 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> We need to know what is timeline for his approval. I can not get needed technology donated from the
group without his assistance. We have the following waiting for his assistance:
>
> off the shelf programs for Inventory management that do not rely on EMR and can start tracking
unnecessary spending immediately
> Your internal group headed by your current CIO wants the EMCL software so Veterans can access care at
reliable health care clinics and know wait times under the choice program.
>
> Program tracking opioid prescriptions and overprescribing.
>
> suicide and mental health tracking who is at risk.
>
> Thank you for the update.
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-000947
OS 00002618
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
5/23/2017 10:40:45 AM
drshulkin@aol.com
L Perl [(b) (6)
gmail.com]; IP [(b) (6) frenchangel59.com]; (b) (6)
Terry Fadem
gmail.com
We need to know what is timeline for his approval. I can not get needed technology donated from the group
without his assistance. We have the following waiting for his assistance:
off the shelf programs for Inventory management that do not rely on EMR and can start tracking
unnecessary spending immediately
Your internal group headed by your current CIO wants the EMCL software so Veterans can access care at
reliable health care clinics and know wait times under the choice program.
Program tracking opioid prescriptions and overprescribing.
suicide and mental health tracking who is at risk.
Thank you for the update.
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000948
OS 00002619
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/8/2017 7:47:05 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Document #1 - REMINDERS FOR DINNER WITH JARED KUSHNER - Saturday, April 8th at 7:30 PM
I agree - well have to think this through
Sent from my iPhone
On Apr 8, 2017, at 3 :37 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Lost for words- had to re-read it a few times, but the good thing is that he looped you in - we just
have to find ways to meet with them face to face on a regular basis- not just the quick daily calls.
They have to get to know you over time, build trust and recognize you as the ultimate authoritynot just quick phone calls
Sent from my iPhone
On Apr 8, 2017, at 11 :20 AM, David shulkin wrote:
0mg
Sent from my iPhone
Begin forwarded message:
From: "IP" <(b) (6) frenchangel59 .com>
Date: April 8, 2017 at 11 :02:47 AM EDT
To: "David shulkin"
Subject: Document #1 - REMINDERS FOR DINNER WITH
JARED KUSHNER- Saturday, April 8th at 7:30 PM
See attached. I will call you later today.
MEMORANDUM
TO:
JARED KUSHNER
FROM:
IKE PERLMUTTER
SUBJECT:
TOPICS/INITIATIVES FOR DISCUSSION
DATE:
APRIL 8, 2017
CC:
PHYSICAL INFRASTRUCTURE
1.
Concentrate on the 30% good hospitals the VA currently
has
VA-19-0799-D-000949
OS 00002620
2.
Approximately 700 vacant and underutilized locations a.
Sell right away - the VA must be permitted to
utilize the cash for better use.
b.
Let a third party run/manage homeless
shelters. They will do a better job.
c.
Do not use the real estate to build more Homeless
shelters.
INFORMATION TECHNOLOGY
3.
The CIO from Mayo Clinic is overseeing (and other
institutions are participating in) a search for a new CIO for
the Dept. of Veterans Affairs. CIO candidates will be in DC
on April 17th for interviews by the VA, Mayo's CIO and
others.
STAFFING
4.
Freeze "All Hiring" - Not only with the Secretary of the VA
but throughout all agencies and departments. Hiring
should be done on a case by case basis and only upon the
Secretary's approval.
5.
Institute an early retirement employee buyout program.
6.
Transfer employees from one segment of the VA to
another to balance excess workforce and shortages
BUDGETING
7.
The FY17 VA budget is over $181 Billion. We are
evaluating the budget to identify waste, inefficiencies and
potentia I surpluses.
8.
The preliminary goal looks like a potential minimum
reduction of $15B.
9.
This should be achievable without adding any extra costs
and, at the same time, improving quality of and access to
care.
PTSD
I SUICIDE PREVENTION
10. Establish mandatory new enlistee psych and physical
exams (from day one when entering the military to catch
VA-19-0799-D-000950
OS 00002621
problems at the outset and prevent surprises and costs
upon retirement)
11. Establish a wellness prevention program. [As an example,
we administer colonoscopy exams for early detection of
cancer. If the disease is discovered early we can save lives
and reduce costs]
INFORMATION TECH
I ELECTRONIC MEDICAL RECORDS SYSTEM
12. DOD recently signed a new contract to implement a new
system (Cerner) with an initial cost of $4.3 billion and a
total budgeted cost of $9 billion. There is a push for the
VA to choose the same Cerner system.
13. What the VA needs is a system that can talk to the
private hospitals' systems with which it will be partnering
for Veterans medical care (interoperability among the
Public-Private Partnership)
a.
The Top 5 Academic Medical Centers DO NOT use
Cerner and highly recommend against it in favor of
another system (EPIC).
b.
EPIC is used by 50% of the hospitals in the US and
covers over 120 million patients.
c.
This means less cost, easier access to the doctors,
patients and soldiers and their medical records.
d.
Cerner's DOD implementation then MUST be
instructed talk to whatever system the VA chooses
to install.
WHITE HOUSE LIAISON
14. The VA transformation process is moving quickly and
effectively by leaning on the expertise of the team I
assembled (hospital, medical and restructuring
experts). The effort is more efficiently and effectively
managed as a unified, singular effort. To be most efficient
(and successful) the White House staff would contribute
best if focused on opening doors and removing political
obstacles, when requested, but not on overseeing their
own initiatives. Currently, our group doesn't need to
inconvenience (b) (6) (b) (6) and her group, but needs them
available (on call) when requested. For our continuing
needs, we can interface with (b) (6) which will also develop
him as an operator in business as well.
VA-19-0799-D-000951
OS 00002622
OTHER
15. PRESIDENT'S INVITATION
a.
(b) (6)
initiative is gathering 500 people
in Washington on April 29 th at 7:00 PM. He is
working with the Pastor, Dr (b) (6)
. The party
will take place in the Trump Hotel in
Washington. It will be televised and Fox's Hannity
will attend and we would like the President to
attend.
VA-19-0799-D-000952
OS 00002623
Message
Poonam Alaigh [(b) (6)
hotmail.com]
4/8/2017 7:37:10 PM
David shulkin [Drshulkin@aol.com]
Re: Document #1 - REMINDERS FOR DINNER WITH JARED KUSHNER - Saturday, April 8th at 7:30 PM
From:
Sent:
To:
Subject:
Lost for words- had to re-read it a few times, but the good thing is that he looped you in - we just have to find
ways to meet with them face to face on a regular basis- not just the quick daily calls. They have to get to know
you over time, build trust and recognize you as the ultimate authority- not just quick phone calls
Sent from my iPhone
On Apr 8, 2017, at 11 :20 AM, David shulkin wrote:
0mg
Sent from my iPhone
Begin forwarded message:
From: "IP" <(b) (6) frenchangel59.com>
Date: April 8, 2017 at 11 :02:47 AM EDT
To: "David shulkin"
Subject: Document #1 - REMINDERS FOR DINNER WITH JARED
KUSHNER- Saturday, April 8th at 7:30 PM
See attached. I will call you later today.
MEMORANDUM
TO:
JARED KUSHNER
FROM:
IKE PERLMUTTER
SUBJECT:
TOPICS/INITIATIVES FOR DISCUSSION
DATE:
APRIL 8, 2017
CC:
PHYSICAL INFRASTRUCTURE
1.
Concentrate on the 30% good hospitals the VA currently has
2.
Approximately 700 vacant and underutilized locations a.
Sell right away - the VA must be permitted to utilize the cash for
better use.
b.
Let a third party run/manage homeless shelters. They will do a
better job.
VA-19-0799-D-000953
OS 00002624
c.
Do not use the real estate to build more Homeless shelters.
INFORMATION TECHNOLOGY
3.
The CIO from Mayo Clinic is overseeing (and other institutions are
participating in) a search for a new CIO for the Dept. of Veterans
Affairs. CIO candidates will be in DC on April 17th for interviews by the
VA, Mayo's CIO and others.
STAFFING
4.
5.
6.
Freeze "All Hiring" - Not only with the Secretary of the VA but
throughout all agencies and departments. Hiring should be done on a
case by case basis and only upon the Secretary's approval.
Institute an early retirement employee buyout program.
Transfer employees from one segment of the VA to another to balance
excess workforce and shortages
BUDGETING
7.
The FY17 VA budget is over $181 Billion. We are evaluating the budget
to identify waste, inefficiencies and potential surpluses.
8.
The preliminary goal looks like a potential minimum reduction of $15B.
9.
This should be achievable without adding any extra costs and, at the
same time, improving quality of and access to care.
PTSD
I SUICIDE PREVENTION
10. Establish mandatory new enlistee psych and physical exams (from day
one when entering the military to catch problems at the outset and
prevent surprises and costs upon retirement)
11. Establish a wellness prevention program. [As an example, we administer
colonoscopy exams for early detection of cancer. If the disease is
discovered early we can save lives and reduce costs]
INFORMATION TECH
I ELECTRONIC MEDICAL RECORDS SYSTEM
12. DOD recently signed a new contract to implement a new system
(Cerner) with an initial cost of $4.3 billion and a total budgeted cost of $9
billion. There is a push for the VA to choose the same Cerner system.
13. What the VA needs is a system that can talk to the private hospitals'
systems with which it will be partnering for Veterans medical care
(interoperability among the Public-Private Partnership)
VA-19-0799-D-000954
OS 00002625
a.
The Top 5 Academic Medical Centers DO NOT use Cerner and
highly recommend against it in favor of another system (EPIC).
b.
EPIC is used by 50% of the hospitals in the US and covers over 120
million patients.
c.
This means less cost, easier access to the doctors, patients and
soldiers and their medical records.
d.
Cerner's DOD implementation then MUST be instructed talk to
whatever system the VA chooses to install.
WHITE HOUSE LIAISON
14. The VA transformation process is moving quickly and effectively by
leaning on the expertise of the team I assembled (hospital, medical and
restructuring experts). The effort is more efficiently and effectively
managed as a unified, singular effort. To be most efficient (and
successful) the White House staff would contribute best if focused on
opening doors and removing political obstacles, when requested, but not
on overseeing their own initiatives. Currently, our group doesn't need to
inconvenience (b) (6) (b) (6) and her group, but needs them available (on
call) when requested. For our continuing needs, we can interface
with (b) (6) which will also develop him as an operator in business as well.
OTHER
15. PRESIDENT'S INVITATION
a.
(b) (6)
's initiative is gathering 500 people in Washington
on April 29 at 7:00 PM. He is working with the Pastor, Dr (b) (6)
. The party will take place in the Trump Hotel in
Washington. It will be televised and Fox's Hannity will attend and
we would like the President to attend.
th
VA-19-0799-D-000955
OS 00002626
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/8/2017 3:20:47 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Document #1 - REMINDERS FOR DINNER WITH JARED KUSHNER - Saturday, April 8th at 7:30 PM
Ike dinner w Jared 040817.docx; Untitled attachment 05477.htm
0mg
Sent from my iPhone
Begin forwarded message:
From: "IP" <(b) (6) frenchangel59.com >
Date: April 8, 2017 at 11:02:47 AM EDT
To: "David shulkin"
Subject: Document #1- REMINDERS FOR DINNER WITH JARED KUSHNER- Saturday, April 8th at 7:30
PM
See attached. I will call you later today.
MEMORANDUM
TO:
JARED KUSHNER
FROM:
IKE PERLMUTTER
SUBJECT:
TOPICS/INITIATIVES FOR DISCUSSION
DATE:
APRIL 8, 2017
CC:
PHYSICAL INFRASTRUCTURE
1.
Concentrate on the 30% good hospitals the VA
currently has
2.
Approximately 700 vacant and underutilized
locationsa.
Sell right away - the VA must be permitted
to utilize the cash for better use.
b. Let a third party run/manage homeless
shelters. They will do a better job.
c. Do not use the real estate to build more
Homeless shelters.
INFORMATION TECHNOLOGY
3.
The CIO from Mayo Clinic is overseeing (and other
institutions are participating in) a search for a new CIO for the Dept. of Veterans
VA-19-0799-D-000956
OS 00002627
Affairs. CIO candidates will be in DC on April 17th for interviews by the VA, Mayo's CIO
and others.
STAFFING
4.
Freeze "All Hiring" - Not only with the Secretary of
the VA but throughout all agencies and departments. Hiring should be done on a case
by case basis and only upon the Secretary's approval.
5.
lnstitute an early retirement employee buyout
program.
6.
Transfer employees from one segment of the VA
to another to balance excess workforce and shortages
BUDGETING
7.
The FY17 VA budget is over $181 Billion. We are
evaluating the budget to identify waste, inefficiencies and potential surpluses.
8.
The preliminary goal looks like a potential
minimum reduction of $15B.
9.
This should be achievable without adding any
extra costs and, at the same time, improving quality of and access to care.
PTSD
I SUICIDE PREVENTION
10. Establish mandatory new enlistee psych and
physical exams (from day one when entering the military to catch problems at the
outset and prevent surprises and costs upon retirement)
11. Establish a wellness prevention program. [As an
example, we administer colonoscopy exams for early detection of cancer. If the disease
is discovered early we can save lives and reduce costs]
INFORMATION TECH
I ELECTRONIC MEDICAL RECORDS SYSTEM
12. DOD recently signed a new contract to implement
a new system (Cerner) with an initial cost of $4.3 billion and a total budgeted cost of $9
billion. There is a push for the VA to choose the same Cerner system.
13. What the VA needs is a system that can talk to the
private hospitals' systems with which it will be partnering for Veterans medical care
(interoperability among the Public-Private Partnership)
a.
The Top 5 Academic Medical Centers DO
NOT use Cerner and highly recommend against it in favor of another system
(EPIC).
b. EPIC is used by 50% of the hospitals in the
US and covers over 120 million patients.
c.
This means less cost, easier access to the
doctors, patients and soldiers and their medical records.
VA-19-0799-D-000957
OS 00002628
d. Cerner's DOD implementation then MUST
be instructed talk to whatever system the VA chooses to install.
WHITE HOUSE LIAISON
14. The VA transformation process is moving quickly
and effectively by leaning on the expertise of the team I assembled (hospital, medical
and restructuring experts). The effort is more efficiently and effectively managed as a
unified, singular effort. To be most efficient (and successful) the White House staff
would contribute best if focused on opening doors and removing political obstacles,
when requested, but not on overseeing their own initiatives. Currently, our group
doesn't need to inconvenience (b) (6) (b) (6) and her group, but needs them available
(on call) when requested. For our continuing needs, we can interface with (b) (6) which
will also develop him as an operator in business as well.
OTHER
15. PRf5/DfNT'5 INVITATION
a.
(b) (6)
's initiative is gathering 500
th
people in Washington on April 29 at 7:00 PM. He is working with the Pastor, Dr
(b) (6)
. The party will take place in the Trump Hotel in Washington. It will
be televised and Fox's Hannity will attend and we would like the President to
attend.
VA-19-0799-D-000958
OS 00002629
MEMORANDUM
TO:
JARED KUSHNER
FROM:
IKE PERLMUTTER
SUBJECT:
TOPICS/INITIATIVES FOR DISCUSSION
DATE:
APRIL 8, 2017
CC:
PHYSICAL INFRASTRUCTURE
1.
Concentrate on the 30% good hospitals the VA currently has
2.
Approximately 700 vacant and underutilized locations a.
Sell right away - the VA must be permitted to utilize the cash for better use.
b. Let a third party run/manage homeless shelters. They will do a better job.
c.
Do not use the real estate to build more Homeless shelters.
INFORMATION TECHNOLOGY
3.
The CIO from Mayo Clinic is overseeing (and other institutions are participating in)
a search for a new CIO for the Dept. of Veterans Affairs. CIO candidates will be in
DC on April 17th for interviews by the VA, Mayo's CIO and others.
STAFFING
4.
Freeze" All Hiring" - Not only with the Secretary of the VA but throughout all
agencies and departments. Hiring should be done on a case by case basis and only
upon tl1e Secretary's approval.
5.
Institute an early retirement employee buyout program.
6.
Transfer employees from one segment of the VA to another to balance excess
workforce and shortages
BUDGETING
7.
The FYl 7 VA budget is over $181 Billion. We are evaluating the budget to identify
waste, inefficiencies and potential surpluses.
8.
The preliminary goal looks like a potential minimum reduction of $1 SB.
9.
This should be achievable without adding any extra costs and, at the same time,
improving quality of and access to care.
PTSD I SUICIDE PREVENTION
10. Establish mandatory new enlistee psych and physical exams (from day one when
entering the military to catch problems at the outset and prevent surprises and costs
upon retirement)
VA-19-0799-D-000959
OS 00002630
MEMORANDUM
JARED KUSHNER
APRIL 8, 2017
PAGE I 2
11. Establish a wellness prevention program. fAs an example, we administer colonoscopy
examsfor ear!J detection if cancer. [/the disease is discovered ear'fy we can save lives
cost1J
INFORMATION TECH
reduce
I ELECTRONIC MEDICAL RECORDS SYSTEM
12. DOD recently signed a new contract to implement a new system (Cemer) with an
initial cost of $4.3 billion and a total budgeted cost of $9 billion. There is a push
for the VA to choose the same Cerner system.
13. What the VA needs is a system that can talk to the private hospitals' systems with
which it will be partnering for Veterans medical care (interoperability among the
Public-Private Partnership)
a.
The Top 5 Academic Medical Centers DO NOT use Cemer and highly
recommend against it in favor of another system (EPIC).
b. EPIC is used by 50% of the hospitals in the US and covers over 120 million
patients.
c.
This means less cost, easier access to the doctors, patients and soldiers and
their medical records.
d.
Cerner's DOD implementation then MUST be instructed talk to whatever
system the VA chooses to install.
WHITE HOUSE LIAISON
14. The VA transformation process is moving quickly and effectively by leaning on the
expertise of the team I assembled 01ospital, medical and restructuring experts). The
effort is more efficiently and effectively managed as a unified, singular effort. To be
most efficient (and successful) the \Vhite House staff would contribute best if
focused on opening doors and removing political obstacles, when requested, but not
on overseeing their own initiatives. Currently, our group doesn't need to
inconvenience (b) (6) (b) (6) and her group, but needs tl1em available (on call) when
requested. For our continuing needs, we can interface with (b) (6) which will also
develop him as an operator in business as well.
OTHER
15. PRESIDENTS INVITATION
a.
(b) (6)
's initiative is gathering 500 people in Washington on April
. The party
29 th at 7 :00 PM. He is working with the Pastor, Dr (b) (6)
will take place in tl1e Trump Hotel in Washington. It will be televised and
Fox's Hannity will attend and we would like the President to attend.
VA-19-0799-D-000960
OS 00002631
Message
From:
Sent:
To:
Subject:
Attachments:
IP [(b) (6) frenchangel59.com]
4/8/2017 3:02:47 PM
David shulkin [drshulkin@aol.com]
Document #1 - REMINDERS FOR DINNER WITH JARED KUSHNER - Saturday, April 8th at 7:30 PM
Ike dinner w Jared 040817.docx
See attached. I will call you later today.
MEMORANDUM
TO:
JARED KUSHNER
FROM:
IKE PERLMUTTER
SUBJECT:
TOPICS/INITIATIVES FOR DISCUSSION
DATE:
APRIL 8, 2017
CC:
PHYSICAL INFRASTRUCTURE
1.
Concentrate on the 30% good hospitals the VA currently has
2.
Approximately 700 vacant and underutilized locations a. Sell right away - the VA must be permitted to utilize the cash for better use.
b. Let a third party run/manage homeless shelters. They will do a better job.
c.
Do not use the real estate to build more Homeless shelters.
INFORMATION TECHNOLOGY
3.
The CIO from Mayo Clinic is overseeing (and other institutions are participating in) a search for a new
CIO for the Dept. of Veterans Affairs. CIO candidates will be in DC on April 17th for interviews by the
VA, Mayo's CIO and others.
STAFFING
4.
Freeze "All Hiring" - Not only with the Secretary of the VA but throughout all agencies and
departments. Hiring should be done on a case by case basis and only upon the Secretary's approval.
5.
Institute an early retirement employee buyout program.
6.
Transfer employees from one segment of the VA to another to balance excess workforce and
shortages
BUDGETING
7.
The FY17 VA budget is over $181 Billion. We are evaluating the budget to identify waste, inefficiencies
and potential surpluses.
8.
The preliminary goal looks like a potential minimum reduction of $15B.
VA-19-0799-D-000962
OS 00002633
9.
PTSD
This should be achievable without adding any extra costs and, at the same time, improving quality of
and access to care.
I SUICIDE PREVENTION
10. Establish mandatory new enlistee psych and physical exams (from day one when entering the military
to catch problems at the outset and prevent surprises and costs upon retirement)
11. Establish a wellness prevention program. [As an example, we administer colonoscopy exams for early
detection of cancer. If the disease is discovered early we can save lives and reduce costs]
INFORMATION TECH
I ELECTRONIC MEDICAL RECORDS SYSTEM
12. DOD recently signed a new contract to implement a new system (Cerner) with an initial cost of $4.3
billion and a total budgeted cost of $9 billion. There is a push for the VA to choose the same Cerner
system.
13. What the VA needs is a system that can talk to the private hospitals' systems with which it will be
partnering for Veterans medical care (interoperability among the Public-Private Partnership)
a. The Top 5 Academic Medical Centers DO NOT use Cerner and highly recommend against it in
favor of another system (EPIC).
b. EPIC is used by 50% of the hospitals in the US and covers over 120 million patients.
c.
This means less cost, easier access to the doctors, patients and soldiers and their medical
records.
d. Cerner's DOD implementation then MUST be instructed talk to whatever system the VA
chooses to install.
WHITE HOUSE LIAISON
14. The VA transformation process is moving quickly and effectively by leaning on the expertise of the
team I assembled (hospital, medical and restructuring experts). The effort is more efficiently and
effectively managed as a unified, singular effort. To be most efficient (and successful) the White
House staff would contribute best if focused on opening doors and removing political obstacles, when
requested, but not on overseeing their own initiatives. Currently, our group doesn't need to
inconvenience (b) (6) (b) (6) and her group, but needs them available (on call) when requested. For our
continuing needs, we can interface with (b) (6) which will also develop him as an operator in business as
well.
OTHER
15. PRESIDENT'S INVITATION
a.
initiative is gathering 500 people in Washington on April 29 th at 7:00 PM. He is
working with the Pastor, Dr (b) (6)
. The party will take place in the Trump Hotel in
Washington. It will be televised and Fox's Hannity will attend and we would like the President
to attend.
(b) (6)
VA-19-0799-D-000963
OS 00002634
MEMORANDUM
TO:
JARED KUSHNER
FROM:
IKE PERLMUTTER
SUBJECT:
TOPICS/INITIATIVES FOR DISCUSSION
DATE:
APRIL 8, 2017
CC:
PHYSICAL INFRASTRUCTURE
1.
Concentrate on the 30% good hospitals the VA currently has
2.
Approximately 700 vacant and underutilized locations a.
Sell right away - the VA must be permitted to utilize the cash for better use.
b. Let a third party run/manage homeless shelters. They will do a better job.
c.
Do not use the real estate to build more Homeless shelters.
INFORMATION TECHNOLOGY
3.
The CIO from Mayo Clinic is overseeing (and other institutions are participating in)
a search for a new CIO for the Dept. of Veterans Affairs. CIO candidates will be in
DC on April 17th for interviews by the VA, Mayo's CIO and others.
STAFFING
4.
Freeze" All Hiring" - Not only with the Secretary of the VA but throughout all
agencies and departments. Hiring should be done on a case by case basis and only
upon tl1e Secretary's approval.
5.
Institute an early retirement employee buyout program.
6.
Transfer employees from one segment of the VA to another to balance excess
workforce and shortages
BUDGETING
7.
The FYl 7 VA budget is over $181 Billion. We are evaluating the budget to identify
waste, inefficiencies and potential surpluses.
8.
The preliminary goal looks like a potential minimum reduction of $1 SB.
9.
This should be achievable without adding any extra costs and, at the same time,
improving quality of and access to care.
PTSD I SUICIDE PREVENTION
10. Establish mandatory new enlistee psych and physical exams (from day one when
entering the military to catch problems at the outset and prevent surprises and costs
upon retirement)
VA-19-0799-D-000964
OS 00002635
MEMORANDUM
JARED KUSHNER
APRIL 8, 2017
PAGE I 2
11. Establish a wellness prevention program. fAs an example, we administer colonoscopy
examsfor ear!J detection if cancer. [/the disease is discovered ear'fy we can save lives
cost1J
INFORMATION TECH
reduce
I ELECTRONIC MEDICAL RECORDS SYSTEM
12. DOD recently signed a new contract to implement a new system (Cemer) with an
initial cost of $4.3 billion and a total budgeted cost of $9 billion. There is a push
for the VA to choose the same Cerner system.
13. What the VA needs is a system that can talk to the private hospitals' systems with
which it will be partnering for Veterans medical care (interoperability among the
Public-Private Partnership)
a.
The Top 5 Academic Medical Centers DO NOT use Cemer and highly
recommend against it in favor of another system (EPIC).
b. EPIC is used by 50% of the hospitals in the US and covers over 120 million
patients.
c.
This means less cost, easier access to the doctors, patients and soldiers and
their medical records.
d.
Cerner's DOD implementation then MUST be instructed talk to whatever
system the VA chooses to install.
WHITE HOUSE LIAISON
14. The VA transformation process is moving quickly and effectively by leaning on the
expertise of the team I assembled 01ospital, medical and restructuring experts). The
effort is more efficiently and effectively managed as a unified, singular effort. To be
most efficient (and successful) the \Vhite House staff would contribute best if
focused on opening doors and removing political obstacles, when requested, but not
on overseeing their own initiatives. Currently, our group doesn't need to
inconvenience (b) (6) (b) (6) and her group, but needs tl1em available (on call) when
requested. For our continuing needs, we can interface with (b) (6) which will also
develop him as an operator in business as well.
OTHER
15. PRESIDENTS INVITATION
a.
(b) (6)
initiative is gathering 500 people in Washington on April
. The party
29 th at 7 :00 PM. He is working with the Pastor, Dr (b) (6)
will take place in tl1e Trump Hotel in Washington. It will be televised and
Fox's Hannity will attend and we would like the President to attend.
VA-19-0799-D-000965
OS 00002636
Message
To:
Poonam Alaigh [(b) (6)
hotmail.com]
4/8/2017 7:32:21 PM
David Shulkin [drshulkin@aol.com]
Subject:
Re:
From:
Sent:
Definitely much much better;
I) is there a way of making it into only 5- with maybe combining transparency with the Greater Choice.
2) Also, there has to be a strong "accountability" priority - maybe adding it to the "efficient use of resources".
3) Does Fraud/waste/abuse message have to be explicit or is it implicit in that Priority of efficient use of
resources?
Sent from my iPhone
On Apr 8, 2017, at 3 :02 PM, David Shulkin wrote:
Do you like this any better than the 10 priorities?- I got it to 6
VA-19-0799-D-000966
OS 00002637
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/8/2017 7:02:50 PM
To:
(b) (6)
Attachments:
hotmail.com
priorities.pptx
Do you like this any better than the 10 priorities?- I got it to 6
VA-19-0799-D-000967
OS 00002638
The Secretary's 6 Priorities
Greater Choice to Veterans
-Revise the 40/30 Rule
-Build an Integrated Network of Care
Modernize our System
-Infrastructure Improvements and Consolidations
-EMR Interoperability and Modernization
Focus Resources More Efficiently
-Foundational Services in VA
-VA/DOD/Community Coordination
Suicide Prevention
Improve Timeliness of Services
- Wait times and Accessibility for Care
- Decisions on Appeals
- Performance on Disability Claims
Deliver on Accountability and Transparency
VA-19-0799-D-000968
OS 00002639
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
To:
(b) (6)
4/18/2017 2:34:44 AM
[(b) (6)
gmail.com]
Can we ask the librarian to get a full copy
http ://annals .org/aim/article/262 l 65 l /understanding-veteran-wait-times
Sent from my iPad
VA-19-0799-D-000969
OS 00002640
Message
From:
Sent:
To:
Subject:
Ike- sorry
David shulkin [Drshulkin@aol.com]
4/6/2017 7:40:03 PM
Ike Perlmutter [(b) (6) frenchangel59.com]
Prep for your meetings
I think i missed your call and did not reach you when I tried back just now
I sent you the one executive order
We did get the choice extension through the Senate and the House this week and it will be ready for the
Presidents signature when he returns to DC
We are working on two big things. First as you know we may be able to get VA and the Department of
Defense on the same IT platform- if we did this it would both lives and money
Second we are working to eliminate the 40 mile rule soon and give veterans much greater choice. In order
to do this we need the Presidents help in the budget in years 2019-21 (we are ok in 2018). In 2019 we
need to keep our current budget and then use savings we find in our mandatory spending to keep for
greater choice for veterans. If we dont do this then we need new funds and I dont want to ask for any
new money.
In years 2020-21 I think we will be in better shape as we will realize savings from facility
closures but it will take us 1-2 years to get these done.
David
Sent from my iPhone
VA-19-0799-D-000970
OS 00002641
Message
From:
(b) (6)
[(b) (6)
Sent:
To:
4/12/2017 9:24:23 PM
David Shulkin [drshulkin@aol.com]
gmail.com]
https ://www.usatoday.com/story/news/politics/2017/04/12/veterans-danger-va-hospital-washington-dcinvestigation-finds/l 003 76124/
Your pictures are at the bottom.
VA-19-0799-D-000971
OS 00002642
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/7/201710:27:50 PM
Darin Selnick [(b) (6)
@gmail.com]
Re: Decision Memo for President
Great
Sent from my iPhone
> on Apr 7, 2017, at 6:26 PM, Darin selnick <(b) (6)
@gmail.com> wrote:
>
> FYI
>
> (b) (6) just sent me a draft decision memorandum she made up for the President to sign for the Veterans
choice Improvement Act. Her ask was for me to review and edit, which I did. A couple of sentences
needed to be reworked so that they would be more accurate, and I sent it back to her with the
corrections.
>
> Hopefully this means it gets signed very soon.
>
> Darin
>
>
VA-19-0799-D-000972
OS 00002643
Message
From:
Darin Selnick [(b) (6)
Sent:
4/7/201710:26:50 PM
To:
David shulkin [Drshulkin@aol.com]
Decision Memo for President
Subject:
@gmail.com]
FYI
(b) (6)
just sent me a draft decision memorandum she made up for the President to sign for the Veterans Choice
Improvement Act. Her ask was for me to review and edit, which I did. A couple of sentences needed to be
reworked so that they would be more accurate, and I sent it back to her with the corrections.
Hopefully this means it gets signed very soon.
Darin
VA-19-0799-D-000973
OS 00002644
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/25/2017 4:57:58 PM
Ike Perlmutter [(b) (6) frenchangel59.com]
Senator issakson cannot make the dinner since its the same night as the senate spouses dinberapologizes
he
Sent from my iPhone
VA-19-0799-D-000974
OS 00002645
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/6/2017 11:22:33 AM
To:
(b) (6)
Subject:
Fwd: (No Subject)
[(b) (6)
gmail.com]
Print
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
torreyapartners.com>
Date: April 6, 2017 at 7:21 :09 AM EDT
To: David shulkin
Subject: Re: (No Subject)
Some things below don't make much sense below. Don't all patients in all IRBs have the
central privacy review and I assume information security review is also standard or could be
added.
I disagree with the lack of benefits to the vets. They get intense state of the art monitoring and
the latest advances. In fact, in oncology, the FDA allows phaseless design -- the phase 1 goes
right to phase 2 and phase 3. Its seamless---there is a concept that if a patient responds then its a
n of one trial.
The IP issue does not make sense in an industry trial. Maybe they mean who can
publish? Industry owns the data but must release it.
Here is my suggestion to save you the most valuable asset you have -- your time. There are 2
options. One, I learned from a ceo who bought 15 biotech companies. Ask your team---how
could we set up a phase 1 unit with central IRB and one master contract. The biotech ceo would
tell his team, I know all the reasons why we should not buy x, I want to hear why we should do it
and how we do it.
Or the second is i can take these concerns/issues orally (won't ever send an email from you or
your people without your explicit approval) to jim greenwood of bio.
He would appoint a group and once they have flushed out the issues and can step up then we
have a meeting like we had on Monday with regeneron but there needs to be prep to get these
ironed out.
The win here beyond better care/options for vets is the industry does not to go to
china. Someone may like that.
Last point--The one call you should make is to rob califf. He knows the IRB issues and other
obstacles. His big issue is the govt (Medicare and medicaid) can't pay for clinical trials--he is
correct but smaller companies and the big pharma don't want to go to china/overseas and they are
VA-19-0799-D-000975
OS 00002646
glad to pay here in the US. The logistics of flying over to china and other countries and
monitoring overseas is a pain.
On Apr 5, 2017, at 11: 18 PM, David shulkin wrote:
When you get tine- let me know your thoughts
Sent from my iPhone
Begin forwarded message:
-----Original Message----From: Ramoni, Rachel
Sent: Wednesday, April 05, 2017 09:00 PM Eastern Standard
Time
To: DJS
Cc: Alaigh, Poonam, M.D.; Lee, Jennifer S. (VACO)
Subject: RE:
Dear Dr. Shulkin,
I met with my team at ORD today -- responses follow:
- Feedback from industry is that we need a truly functional central irb -- The VA
central IRB currently has 200 VA studies and 5 industry trials open. Until
recently, the VA central IRB was not allowed to do industry trials. Since that
restriction was lifted, 5 industry studies were approved. At present, an
agreement to allow industry to reimburse the central IRB for review is awaiting
Carolyn Clancy's approval -- charging industry for such review is the norm. Our
central IRB includes central privacy and information security review, necessary
steps that would not be offered by a commercial IRB. We would be very
interested to hear the specific criticisms from industry.
We should look at NCAts from NIH as a model -- I have a meeting scheduled
with Chris Adams, the head ofNCATS.
We should look at phase 1 units- do we have any currently? -- We can respond
better if we understand the motivation for increased phase I trials. In the past,
participation in such trials was discouraged because of the higher risk to
Veterans and the lower potential for benefits. The current Master CRAD A
templates do not offer any advantage IP-wise for phase I trials (we currently do
not get any IP for phase I - IV trials under the master CRADA template).
Is there already a group looking at clinical trials? Yes, we are in the process of
executing an agreement with NCI to both increase the number of NCI trials
available to our Veterans and to make the process more efficient. NCI is going
to fund this effort. We would be very happy to have industry perspectives as we
modernize our clinical trials process.
Novartis has a platform they would give us called signature platform -- I will
alert Mike Kelley (an oncologist at the Durham who is involved in the NCI trials
project as well as the APOLLO effort) to this, as it seems like the signature
platform has to do with matching patients to therapy based upon their genomic
VA-19-0799-D-000976
OS 00002647
profile. Is there a point of contact at Novartis?
Do you have plans undenvay? Yes -- with NCI. We'd like to add in multiple
industry perspectives, including smaller industry perspectives, given the more
limited marketplace for some Veteran-specific conditions. We anticipate that
there will be a number of considerations as we expand industry trials at the VA,
including the potential impact on access of shifting clinician time to clinical
trials, so this is an effort that will touch a number of points at VHA.
When will you present your strategy for research? We are having a strategic
planning meeting on April 12. A first draft of our strategy will be distributed for
input at the end of April.
With appreciation,
Rachel
-----Original Message----From: DJS
Sent: Wednesday, April 05, 2017 7:29 AM
To: Ramoni, Rachel
Cc: Alaigh, Poonam, M.D.
Subject:
Importance: High
Rachel- as you know with our Johnson and Johnson meetings we set as a goal to
increase clinical trials
Feedback from industry is that we need a truly functional central irb
We should look at NCAts from NIH as a model
We should look at phase 1 units- do we have any currently?
Is there already a group looking at clinical trials?
Novartis has a platform they would give us called signature platform
Do you have plans undenvay?
When will you present your strategy for research?
Sent with Good (www.good.com)
VA-19-0799-D-000977
OS 00002648
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/6/2017 3:20:51 AM
To:
(b) (6)
Subject:
Fwd: (No Subject)
[(b) (6)
gmail.com]
Print
Sent from my iPhone
Begin forwarded message:
From: DJS
Date: April 5, 2017 at 11: 10: 19 PM EDT
To: 'Shulkin'
Subject: FW: (No Subject)
Sent with Good (www.good.com)
-----Original Message----From: Ramoni, Rachel
Sent: Wednesday, April 05, 2017 09:00 PM Eastern Standard Time
To: DJS
Cc: Alaigh, Poonam, M.D.; Lee, Jennifer S. (VACO)
Subject: RE:
Dear Dr. Shulkin,
I met with my team at ORD today -- responses follow:
- Feedback from industry is that we need a truly functional central irb -- The VA central IRB currently has 200 VA
studies and 5 industry trials open. Until recently, the VA central IRB was not allowed to do industry trials. Since
that restriction was lifted, 5 industry studies were approved. At present, an agreement to allow industry to reimburse
the central IRB for review is awaiting Carolyn Clancy's approval -- charging industry for such review is the
norm. Our central IRB includes central privacy and information security review, necessary steps that would not be
offered by a commercial IRB. We would be very interested to hear the specific criticisms from industry.
We should look at NCAts from NIH as a model -- I have a meeting scheduled with Chris Adams, the head of
NCATS.
We should look at phase 1 units- do we have any currently? -- We can respond better ifwe understand the
motivation for increased phase I trials. In the past, participation in such trials was discouraged because of the higher
risk to Veterans and the lower potential for benefits. The current Master CRAD A templates do not offer any
advantage IP-wise for phase I trials (we currently do not get any IP for phase I - IV trials under the master CRADA
template).
Is there already a group looking at clinical trials? Yes, we are in the process of executing an agreement with NCI to
both increase the number of NCI trials available to our Veterans and to make the process more efficient. NCI is
going to fund this effort. We would be very happy to have industry perspectives as we modernize our clinical trials
process.
VA-19-0799-D-000978
OS 00002649
Novartis has a platform they would give us called signature platform -- I will alert Mike Kelley (an oncologist at the
Durham who is involved in the NCI trials project as well as the APOLLO effort) to this, as it seems like the
signature platform has to do with matching patients to therapy based upon their genomic profile. Is there a point of
contact at Novartis?
Do you have plans underway? Yes -- with NCI. We'd like to add in multiple industry perspectives, including
smaller industry perspectives, given the more limited marketplace for some Veteran-specific conditions. We
anticipate that there will be a number of considerations as we expand industry trials at the VA, including the
potential impact on access of shifting clinician time to clinical trials, so this is an effort that will touch a number of
points at VHA.
When will you present your strategy for research? We are having a strategic planning meeting on April 12. A first
draft of our strategy will be distributed for input at the end of April.
With appreciation,
Rachel
-----Original Message----From: DJS
Sent: Wednesday, April 05, 2017 7:29 AM
To: Ramoni, Rachel
Cc: Alaigh, Poonam, M.D.
Subject:
Importance: High
Rachel- as you know with our Johnson and Johnson meetings we set as a goal to increase clinical trials
Feedback from industry is that we need a truly functional central irb
We should look at NCAts from NIH as a model
We should look at phase 1 units- do we have any currently?
Is there already a group looking at clinical trials?
Novartis has a platform they would give us called signature platform
Do you have plans underway?
When will you present your strategy for research?
Sent with Good (www.good.com)
VA-19-0799-D-000979
OS 00002650
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/6/2017 11:32:48 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Hopkins
Should we connect him to neil in telehealth?
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 6, 2017 at 7:21:34 AM EDT
To: David shulkin
Cc: (b) (6)
hotmail .com
Subject: Re: Hopkins
mac.com>
I am ready anytime.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 6, 2017, at 7: 18 AM, David shulkin wrote:
We can connect with our Telehealth group when you are ready
Sent from my iPhone
On Apr 6, 2017, at 6:53 AM, Bruce Moskowitz
<(b) (6)
mac.com> wrote:
I spoke to this group at Hopkins and told them I would discuss a
pilot project on their nickel! Actually they have an impressive
record so far.
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000980
OS 00002651
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
4/6/2017 11:21:34 AM
David shulkin [Drshulkin@aol.com]
(b) (6)
hotmail.com
Re: Hopkins
mac.com]
I am ready anytime.
Sent from my iPad
Bruce Moskowitz M.D.
> on Apr 6, 2017, at 7:18 AM, David shulkin wrote:
>
> We can connect with our Telehealth group when you are ready
>
> Sent from my iPhone
>
>> on Apr 6, 2017, at 6:53 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>>
>> I spoke to this group at Hopkins and told them I would discuss a pilot project on their nickel!
Actually they have an impressive record so far.
>>
>>
>>
>>
>>
>> Sent from my iPad
>> Bruce Moskowitz M.D.
>
VA-19-0799-D-000981
OS 00002652
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/6/2017 11:18:24 AM
Bruce Moskowitz [(b) (6)
(b) (6)
hotmail.com
Re: Hopkins
mac.com]
We can connect with our Telehealth group when you are ready
Sent from my iPhone
> on Apr 6, 2017, at 6:53 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> I spoke to this group at Hopkins and told them I would discuss a pilot project on their nickel!
Actually they have an impressive record so far.
>
>
>
>
>
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-000982
OS 00002653
Message
From:
Sent:
To:
Subject:
Attachments:
Bruce Moskowitz [(b) (6)
mac.com]
4/6/2017 10:53:27 AM
drshulkin@aol.com; (b) (6)
hotmail.com
Hopkins
emocha Letter to Dr Moskowitz 04052017.pdf; Untitled attachment 05592.txt
I spoke to this group at Hopkins and told them
they have an impressive record so far.
I
would discuss a pilot project on their nickel! Actually
VA-19-0799-D-000983
OS 00002654
emocha®
M OB I LE
HEA LTH
IN C.
April 5, 2017
Dr. Bruce Moskowitz
BY EMAIL
Re: Video-based Directly Observed Therapy (DOT) for Opioid Addiction Treatment; pilot
with the VA
Dear Dr. Moskowitz,
Many thanks for our conversation yesterday. We are a mobile technology company that spun
out of Johns Hopkins School of Medicine in 2013. Our modular, HI PAA-compliant platform is
specialized in securing medication adherence and keeping patients linked to care. In addition to
having developed a world-class, proven product, our affiliation with Johns Hopkins University
has been a key factor in our success. We have had the great fortune of developing our software
with public health experts in HIV, hepatitis C, tuberculosis (TB), and opioid addiction through our
close connection to academia.
Our asynchronous solution is a novel and efficient form of telehealth focused on medication
adherence, using a video recording rather than live stream connection to achieve adherence
rates typically above 90%. The platform has been most frequently deployed to monitor TB
therapy as DOT is the accepted standard of care. emocha has been implemented in more than
twenty-five clinics all over the country, as well as in Australia and India. Our NIH-funded study
for implementing the technology among TB patients in Maryland has demonstrated rates of
medication adherence comparable to the high rates of in-person DOT, while creating significant
savings for health departments. Furthermore, qualitative interviews with staff and patients
showed a high level of acceptability. We have also recently deployed our video DOT solution in
nine clinics nationwide for monitoring adherence to 12-week, single dose HCV regimens among
injection drug using patients.
We have received a Notice of Intent to Fund a SBIR grant from NIDA to support our efforts in
opioid addiction. We believe that our asynchronous video-based DOT solution can provide
a strong support and monitoring system for patients being treated for opioid addiction
using office-based therapies such as take-home buprenorphine while serving as an
automated triage tool for providers. Patients use a smartphone or tablet to report side effects or
cravings, view their regimen, and video record themselves taking their medication at every
dose. On a secure web portal, the provider or a case manager reviews the video to assess
adherence soon after the data is submitted. Using sophisticated protocols and algorithms, the
provider is guided to efficiently and selectively engage patients who need support in order to
keep them on track. Our NIDA-funded work involves pilot testing at office-based buprenorphine
programs run by University of Washington in Seattle and Boston University. Dr. (b) (6)
,
emocha Mobile Health Inc .
I
1812 Ashland Avenue, Suite #100 Baltimore, MD 21205
I
@emochaHealth
VA-19-0799-D-000984
OS 00002655
emocha®
M OB I LE
HEA LTH
IN C.
the Director for the substance abuse program at the VA Puget Sound Health Care System, is
part of the project team.
Helping veterans struggling with opioid addiction is one of the highest priorities for the VA, and
we propose to use emocha in a pilot with a VA clinic, potentially as part of our NIDA
project. We propose implementing the technology for patients entering their buprenorphine
initiation phase. Patients will receive the application from their provider who will utilize the
application to monitor their adherence for the first 3-6 months after initiation of buprenorphine
treatment-a period when patients are at high risk to dropout and relapse to illicit opiate use.
The application can also be used at later stages if a patient is struggling to maintain abstinence
or if the provider has concerns regarding diversion. The application will also include educational
materials, appointment reminders, tailored, dynamic messaging to assuage cravings, and risk
assessments to prioritize provider intervention. Video capture will also allow providers to
visualize their patients and their environment each day. We believe this has the potential to
increase adherence, provide patient-centered social support at scale, track outcomes over time,
as well as serve as a powerful diversion mitigation strategy .. We believe partnering with a VA
medical center would be an ideal setting to implement the technology.
emocha video DOT could also be expanded to uses outside of buprenorphine. Patients with
other substance abuse or mental health issues could benefit from daily support in the proper
taking of their medications. In other cases, patients in remote areas with limited internet
connectivity could remain engaged with their provider, and helped to achieve high levels of
adherence.
We would appreciate any advice you may have and we look forward to further conversations.
Many thanks in advance for your support.
Sincerely,
(b) (6)
CEO
(b) (6)
@emocha.com
(410) 804-(b) (6)
emocha Mobile Health Inc .
I
1812 Ashland Avenue, Suite #100 Baltimore, MD 21205
I
@emochaHealth
VA-19-0799-D-000985
OS 00002656
Sent from my iPad
Bruce Moskowitz M.D.
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/7/2017 9:31:02 PM
David shulkin [Drshulkin@aol.com]
Ike Perlmutter [(b) (6) frenchangel59.com]; Marc Sherman [(b) (6)
Re: Information systems article
gmail.com]
Excellent and goes right after what we want including a device registry.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 7, 2017, at 4:27 PM, David shulkin wrote:
http s://www.meri talk. com/the-si tuati on-report-is-the-ci o-j ob-at-va-ab out-to-1 ose-i ts-influence/
Sent from my iPhone
VA-19-0799-D-000987
OS 00002658
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/7/2017 8:27:34 PM
Bruce Moskowitz [(b) (6)
[(b) (6)
gmail.com]
Information systems article
mac.com]; Ike Perlmutter [(b) (6) frenchangel59.com]; Marc Sherman
https ://www.meritalk.com/the-situation-report-is-the-cio-j ob-at-va-about-to-lose-its-influence/
Sent from my iPhone
VA-19-0799-D-000988
OS 00002659
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/5/2017 11:35:49 AM
To:
Bruce Moskowitz [(b) (6)
mac.com]
IP [(b) (6) frenchangel59.com]; mbs(b) (6)
@gmail.com
Re: Pentagon revises schedule for electronic health record roll out
CC:
Subject:
understood
Sent from my iPhone
> on Apr 5, 2017, at 6:42 AM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> As ~he Penn Professor article predicted the roll out is at one hospital system and the delays and costs
will increase.
> The bigger problem is that there will be no integration with the majority of community and academic
centers medical records. The reason why all S of our partners chose Epic independently was discussed by
Dr. (b) (6)
at our first meeting with the President. I personally do not use Epic but a program designed
by Quest Labs that integrates with other internal medicine practices.
> http://federalnewsradio.com/defense/2016/10/pentagon-revises-schedule-electronic-health-record-rolloutincluding-several-months-delays/
>
>
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-000989
OS 00002660
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/5/2017 10:42:18 AM
drshulkin@aol.com
IP [(b) (6) frenchangel59.com]; mbs(b) (6) @gmail.com
Pentagon revises schedule for electronic health record roll out
As the Penn Professor article predicted the roll out is at one hospital system and the delays and costs
will increase.
The bigger problem is that there will be no integration with the majority of community and academic
centers medical records. The reason why all S of our partners chose Epic independently was discussed by
Dr. (b) (6)
at our first meeting with the President. I personally do not use Epic but a program designed
by Quest Labs that integrates with other internal medicine practices.
http://federalnewsradio.com/defense/2016/10/pentagon-revises-schedule-electronic-health-record-rolloutincluding-several-months-delays/
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-000990
OS 00002661
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/5/2017 12:20:09 PM
(b) (6)
[(b) (6)
gmail.com]
Fwd: Proposed Article in Gladwyne Living
Can you get a high resolution photo to bob below?
From: Bob Norkus
N2
Date: April 4, 2017 at
8:57:44 AM EDT
To: (b) (6)
<(b) (6)
hotmail.
com>
Subject: Re:
Proposed Article in
Gladwyne Living
can you source us to
high resolution
photos? 300dpi Bo
b
On
Apr 4,
2017,
at 7:50
AM,
(b) (6)
<(b) (6)
h
otmail .
com>
wrote:
Bob,
there
are
several
factual
errors.
Ok for
meto
correct
VA-19-0799-D-000991
OS 00002662
them
and ill
resend
tomorr
ow?
Sent
from
my
iPhone
On
Apr 3,
2017,
at 2:01
PM,
Bob
Norkus
N2
wrote:
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VA-19-0799-D-001055
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VA-19-0799-D-001055
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VA-19-0799-D-001056
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VA-19-0799-D-001057
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VA-19-0799-D-001058
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VA-19-0799-D-001060
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VA-19-0799-D-001062
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VA-19-0799-D-001062
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VA-19-0799-D-001063
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VA-19-0799-D-001065
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VA-19-0799-D-001066
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Regards,
Bob
484-354-0287
What is N2
PUBLISHING all
about?
Learn more about
us HERE !
PLEASE VISIT THESE
WEB SITES
www.n2pub.com
www.bobnorkus.com
www.facebook.com/gladw
yneliving
www. mainlinetargetedmar
keting .com
VA-19-0799-D-001084
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3
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b
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3
1
0
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n
g
>
Regards,
Bob
484-354-0287
What is N2
PUBLISHING all
about?
Learn more about
us HERE !
PLEASE VISIT THESE
WEB SITES
www.n2pub.com
www.bobnorkus.com
www.facebook.com/gladw
yneliving
www. mainlinetargetedmar
keting .com
VA-19-0799-D-001084
OS 00002755
www.instagram.com/gladw
yneliving
Check out one of N2
events ...
Invest your resources
wisely and partner with a
Top 20 Private Media
Company
in the US by INC
Magazine for SIX Years in
a row.. and America's
leading provider
of specialty publications
for over 500 exclusive
communities across the
nation.
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VA-19-0799-D-001085
OS 00002756
www.instagram.com/gladw
yneliving
Check out one of N2
events ...
Invest your resources
wisely and partner with a
Top 20 Private Media
Company
in the US by INC
Magazine for SIX Years in
a row.. and America's
leading provider
of specialty publications
for over 500 exclusive
communities across the
nation.
<3fb931 O.png>
VA-19-0799-D-001085
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Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/5/2017 1:05:22 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: (b) (6)
documents
(b) (6)
CV (2017).doc; Untitled attachment 05659.htm; (b) (6)
(2.16.2017).docx; Untitled
attachment 05662.htm; Executive Profile (b) (6)
(11.28.2016).docx; Untitled attachment 05665.htm
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
Date: April 5, 2017 at 6:37:40 AM EDT
To: drshulkin@aol .com
Subject: (b) (6)
documents
gmail.com>
As discussed, please see attached. Thanks again Dr. Shulkin!
(b) (6)
VA-19-0799-D-001086
OS 00002757
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/5/2017 1:05:22 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: (b) (6)
documents
(b) (6)
CV (2017).doc; Untitled attachment 05659.htm; (b) (6)
(2.16.2017).docx; Untitled
attachment 05662.htm; Executive Profile (b) (6)
(11.28.2016).docx; Untitled attachment 05665.htm
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
Date: April 5, 2017 at 6:37:40 AM EDT
To: drshulkin@aol .com
Subject: (b) (6)
documents
gmail.com>
As discussed, please see attached. Thanks again Dr. Shulkin!
(b) (6)
VA-19-0799-D-001086
OS 00002757
(b) (6), (b) (2)
(b) (6), (b) (2)
(b) (6), (b) (2)
(6), (b)
, Pennington, NJ (b)
(2)
(b) (6),
@verizon.net
(b) (2)
PROFILE
(b) (6), (b) (2)
.
EXPERIENCE
(b) (6), (b) (2)
2011-2016
(b) (6), (b) (2)
.
(b) (6), (b) (2)
(2015-2016)
(b) (6), (b) (2)
(b) (6), (b) (2)
(2011-2015)
(b) (6), (b) (2)
(b) (6), (b) (2)
2008-2011
(b) (6), (b) (2)
VA-19-0799-D-001087
OS 00002758
(b) (6), (b) (2)
(b) (6), (b) (2)
(b) (6), (b) (2)
(6), (b)
, Pennington, NJ (b)
(2)
(b) (6),
@verizon.net
(b) (2)
PROFILE
(b) (6), (b) (2)
.
EXPERIENCE
(b) (6), (b) (2)
2011-2016
(b) (6), (b) (2)
.
(b) (6), (b) (2)
(2015-2016)
(b) (6), (b) (2)
(b) (6), (b) (2)
(2011-2015)
(b) (6), (b) (2)
(b) (6), (b) (2)
2008-2011
(b) (6), (b) (2)
VA-19-0799-D-001087
OS 00002758
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(b) (2)
(b) (6), (b) (2)
o
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@verizon.net
Page Two
(b) (6), (b) (2)
(b) (6), (b) (2)
1998-2008
(b) (6), (b) (2)
1986-1998
(b) (6), (b) (2)
(1991-1994)
(b) (6), (b) (2)
(1986-1991)
(b) (6), (b) (2)
.
(b) (6), (b) (2)
1984-1985
(b) (6), (b) (2)
1982-1983
(b) (6), (b) (2)
EDUCATION
(b) (6), (b) (2)
1982
1978
PUBLIC SERVICE
(b) (6), (b) (2)
1997-2008
(b) (6), (b) (2)
(b) (6), (b) (2)
1999-2007
(b) (6), (b) (2)
VA-19-0799-D-001088
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(b) (6), (b) (2)
o
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@verizon.net
Page Two
(b) (6), (b) (2)
(b) (6), (b) (2)
1998-2008
(b) (6), (b) (2)
1986-1998
(b) (6), (b) (2)
(1991-1994)
(b) (6), (b) (2)
(1986-1991)
(b) (6), (b) (2)
.
(b) (6), (b) (2)
1984-1985
(b) (6), (b) (2)
1982-1983
(b) (6), (b) (2)
EDUCATION
(b) (6), (b) (2)
1982
1978
PUBLIC SERVICE
(b) (6), (b) (2)
1997-2008
(b) (6), (b) (2)
(b) (6), (b) (2)
1999-2007
(b) (6), (b) (2)
VA-19-0799-D-001088
OS 00002759
089
089
090
090
(b) (6)
(b) (6), (b) (2)
(6), (b)
Pennington, NJ (b)
(2)
(b) (6),
609.462.(b) (2)
(b) (6),
@verizon.net
(b) (2)
To Whom It May Concern:
(b) (6), (b) (2)
I would welcome the opportunity to discuss my professional interests with you at
(6),
(6), (b)
your convenience. I can be reached at 609.462.(b)
( cell) or (b)
@verizon.net.
(b) (2)
(2)
Thank you, and best regards.
Very truly yours,
(b) (6)
VA-19-0799-D-001091
OS 00002762
(b) (6)
(b) (6), (b) (2)
(6), (b)
Pennington, NJ (b)
(2)
(b) (6),
609.462.(b) (2)
(b) (6),
@verizon.net
(b) (2)
To Whom It May Concern:
(b) (6), (b) (2)
I would welcome the opportunity to discuss my professional interests with you at
(6),
(6), (b)
your convenience. I can be reached at 609.462.(b)
( cell) or (b)
@verizon.net.
(b) (2)
(2)
Thank you, and best regards.
Very truly yours,
(b) (6)
VA-19-0799-D-001091
OS 00002762
092
092
(b) (6), (b) (2)
(b) (6),
(b) (2)
(6),
609.462.(b)
(b) (2)
@verizon.net
Profile
(b) (6), (b) (2)
Key Skills
o
(b) (6), (b) (2)
r
Major Accomplishments
o
(b) (6), (b) (2)
VA-19-0799-D-001093
OS 00002764
(b) (6), (b) (2)
(b) (6),
(b) (2)
(6),
609.462.(b)
(b) (2)
@verizon.net
Profile
(b) (6), (b) (2)
Key Skills
o
(b) (6), (b) (2)
r
Major Accomplishments
o
(b) (6), (b) (2)
VA-19-0799-D-001093
OS 00002764
094
094
Appointment
From:
Sent:
To:
Subject:
Location:
Marisol Garcia [(b) (6) frenchangel59.com]
4/4/2017 11:36:45 PM
(b) (6)
its.jnj.com; ktorokl@its.jnj.com; 'David shulkin' [Drshulkin@aol.com]; 'L Perl' [(b) (6)
gmail.com];
'Bruce Moskowitz' [(b) (6)
mac.com]; mbs(b) (6)
@gmail.com; (b) (6) frenchangel59.com;
(b) (6)
(b) (6)
va.gov; (b) (6)
va.gov; '(b) (6)
[(b) (6)
mayo.edu]; (b) (6)
(b)
(6)
(b)
(6)
(b)
(6)
(b)
(6)
[
mayo.edu]; '
[JJCUS]' [
its.jnj.com]; '
[JSGUS]'
[(b) (6)
its.jnj.com]; '(b) (6)
[JRDUS]' [(b) (6)
its.jnj.com]; (b) (6)
Bruce Moskowitz,MD'
[(b) (6)
gmail.com]; '(b) (6)
[(b) (6)
va.gov]
Conference Call with (b) (6)
(Johnson and Johnson) and Ike Perlmutter and their teams - Monday, April 17,
2017 at 2:00 PM EST (30 minutes)
Conference Call
4/17/2017 6:00:00 PM
4/17/2017 6:30:00 PM
Show Time As: Tentative
Start:
End:
Recurrence:
(none)
Monday, April 17th
2:00 PM -2:30 PM EST
Dial-in Information:
(b) (6)
US: 1-866-244-
(b) (6)
International: 719-457Passcode:
(b) (6)
Participants:
(b) (6)
(b) (6)
Chairman and CEO (Johnson & Johnson),
and Dr.
Secretary David Shulkin (White House), Dr.
(b) (6)
(b) (6)
VA-19-0799-D-001095
OS 00002766
Appointment
From:
Sent:
To:
Subject:
Location:
Marisol Garcia [(b) (6) frenchangel59.com]
4/4/2017 11:36:45 PM
(b) (6)
its.jnj.com; ktorokl@its.jnj.com; 'David shulkin' [Drshulkin@aol.com]; 'L Perl' [(b) (6)
gmail.com];
'Bruce Moskowitz' [(b) (6)
mac.com]; mbs(b) (6)
@gmail.com; (b) (6) frenchangel59.com;
(b) (6)
(b) (6)
va.gov; (b) (6)
va.gov; '(b) (6)
[(b) (6)
mayo.edu]; (b) (6)
(b)
(6)
(b)
(6)
(b)
(6)
(b)
(6)
[
mayo.edu]; '
[JJCUS]' [
its.jnj.com]; '
[JSGUS]'
[(b) (6)
its.jnj.com]; '(b) (6)
[JRDUS]' [(b) (6)
its.jnj.com]; (b) (6)
Bruce Moskowitz,MD'
[(b) (6)
gmail.com]; '(b) (6)
[(b) (6)
va.gov]
Conference Call with (b) (6)
(Johnson and Johnson) and Ike Perlmutter and their teams - Monday, April 17,
2017 at 2:00 PM EST (30 minutes)
Conference Call
4/17/2017 6:00:00 PM
4/17/2017 6:30:00 PM
Show Time As: Tentative
Start:
End:
Recurrence:
(none)
Monday, April 17th
2:00 PM -2:30 PM EST
Dial-in Information:
(b) (6)
US: 1-866-244-
(b) (6)
International: 719-457Passcode:
(b) (6)
Participants:
(b) (6)
(b) (6)
Chairman and CEO (Johnson & Johnson),
and Dr.
Secretary David Shulkin (White House), Dr.
(b) (6)
(b) (6)
VA-19-0799-D-001095
OS 00002766
Bruce Moskowitz, Marc Sherman,
Mayo Clinic) and Ike
(b) (6)
(Chair,
Thank you,
Marisol Garcia
(b) (6)
(646) 201(b) (6)
(Cell)
frenchange1S9.com
VA-19-0799-D-001096
OS 00002767
Bruce Moskowitz, Marc Sherman,
Mayo Clinic) and Ike
(b) (6)
(Chair,
Thank you,
Marisol Garcia
(b) (6)
(646) 201(b) (6)
(Cell)
frenchange1S9.com
VA-19-0799-D-001096
OS 00002767
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/7/201710:04:32 PM
Bruce Moskowitz [(b) (6)
Re: CIO
I see two from Yale and 2 from Florida.
mac.com]
I dont see a hopkins one
Sent from my iPhone
> on Apr 7, 2017, at 5:40 PM, Bruce Moskowitz <(b) (6)
>
> No go ahead we have 5 now including the one from Hopkins.
mac.com> wrote:
All excellent I can get more
>
> Sent from my iPhone
>
>> on Apr 7, 2017, at 5:26 PM, David shulkin wrote:
>>
>>Bruce-thanks for the four 0/s for CIO.
>> Is it okay to contact them yet or do you want yo have discussions with them first?
>>
>> David
>>
>> Sent from my iPhone
>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>
on Apr 7, 2017, at 3:31 PM, Bruce Moskowitz <(b) (6)
U
mac.com> wrote:
of F
<(b) (6)
Resume Mar 2017.docx>
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-001097
OS 00002768
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/7/201710:04:32 PM
Bruce Moskowitz [(b) (6)
Re: CIO
I see two from Yale and 2 from Florida.
mac.com]
I dont see a hopkins one
Sent from my iPhone
> on Apr 7, 2017, at 5:40 PM, Bruce Moskowitz <(b) (6)
>
> No go ahead we have 5 now including the one from Hopkins.
mac.com> wrote:
All excellent I can get more
>
> Sent from my iPhone
>
>> on Apr 7, 2017, at 5:26 PM, David shulkin wrote:
>>
>>Bruce-thanks for the four 0/s for CIO.
>> Is it okay to contact them yet or do you want yo have discussions with them first?
>>
>> David
>>
>> Sent from my iPhone
>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>
on Apr 7, 2017, at 3:31 PM, Bruce Moskowitz <(b) (6)
U
mac.com> wrote:
of F
<(b) (6)
Resume Mar 2017.docx>
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-001097
OS 00002768
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/7/201710:02:42 PM
Va David [vacodjsl@va.gov]
Fwd: CIO
2017 March 2 (b) (6)
CV.docx; Untitled attachment 05680.htm
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 7, 2017 at 3:29:55 PM EDT
To: drshulkin@aol .com
Subject: CIO
mac.com>
U of Fl
VA-19-0799-D-001098
OS 00002769
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/7/201710:02:42 PM
Va David [vacodjsl@va.gov]
Fwd: CIO
2017 March 2 (b) (6)
CV.docx; Untitled attachment 05680.htm
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 7, 2017 at 3:29:55 PM EDT
To: drshulkin@aol .com
Subject: CIO
mac.com>
U of Fl
VA-19-0799-D-001098
OS 00002769
CURRICULUM VITAE {PRIVATE }
(b) (6)
Name: (b) (6), (b) (2)
Department: (b) (6), (b) (2)
(b)
Health (b) (6), (b) (2)
(6),
(b)
Present
Rank: (b) (6), (b) (2)
(6), (b)
Business Address: (b) (6), (b) (2)
, Gainesville, FL (b)
(2)
(6),
Business Telephone: 352-265-(b)
(b) (2)
(b) (6),
(6), (b)
Home Address:
, Gainesville, FL (b)
(b) (2)
(2)
EDUCATIONAL RECORD:
Professional Development
(b) (6), (b) (2)
Fellowship:
(b) (6), (b) (2)
Residency:
(b) (6), (b) (2)
Medical School:
(b) (6), (b) (2)
l
VA-19-0799-D-001099
OS 00002770
CURRICULUM VITAE {PRIVATE }
(b) (6)
Name: (b) (6), (b) (2)
Department: (b) (6), (b) (2)
(b)
Health (b) (6), (b) (2)
(6),
(b)
Present
Rank: (b) (6), (b) (2)
(6), (b)
Business Address: (b) (6), (b) (2)
, Gainesville, FL (b)
(2)
(6),
Business Telephone: 352-265-(b)
(b) (2)
(b) (6),
(6), (b)
Home Address:
, Gainesville, FL (b)
(b) (2)
(2)
EDUCATIONAL RECORD:
Professional Development
(b) (6), (b) (2)
Fellowship:
(b) (6), (b) (2)
Residency:
(b) (6), (b) (2)
Medical School:
(b) (6), (b) (2)
l
VA-19-0799-D-001099
OS 00002770
Page 2 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6), (b) (2)
Graduate:
(b) (6), (b) (2)
(b) (6), (b)
(2)
Undergraduate:
(b) (6), (b) (2)
983
BOARD CERTIFICATION:
(b) (6), (b) (2)
LI CENSURE:
State
(b) (6), (b) (2)
Number
EMPLOYMENT:
Place of Employment City
Date
Title or Position
Status
Years of Empl.
(b) (6), (b) (2)
(b) (6), (b) (2)
HONORS AND/OR AW ARDS:
.
VA-19-0799-D-001100
OS 00002771
Page 2 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6), (b) (2)
Graduate:
(b) (6), (b) (2)
(b) (6), (b)
(2)
Undergraduate:
(b) (6), (b) (2)
983
BOARD CERTIFICATION:
(b) (6), (b) (2)
LI CENSURE:
State
(b) (6), (b) (2)
Number
EMPLOYMENT:
Place of Employment City
Date
Title or Position
Status
Years of Empl.
(b) (6), (b) (2)
(b) (6), (b) (2)
HONORS AND/OR AW ARDS:
.
VA-19-0799-D-001100
OS 00002771
Curriculum Vitae
Page 3 of 15
(b) (6), (b) (2)
SERVICE/PATIENT CARE LEADERSHIP:
UNIVERSITY SERVICE:
(b) (6), (b) (2)
COLLEGE OF MEDICINE SERVICE
(b) (6), (b) (2)
COLLEGE OF MEDICINE, ADMISSIONS:
(b) (6), (b) (2)
VA-19-0799-D-001101
OS 00002772
Curriculum Vitae
Page 3 of 15
(b) (6), (b) (2)
SERVICE/PATIENT CARE LEADERSHIP:
UNIVERSITY SERVICE:
(b) (6), (b) (2)
COLLEGE OF MEDICINE SERVICE
(b) (6), (b) (2)
COLLEGE OF MEDICINE, ADMISSIONS:
(b) (6), (b) (2)
VA-19-0799-D-001101
OS 00002772
Page 4 of 15
Curriculum Vitae
(b) (6), (b) (2)
COLLEGE OF MEDICINE, OTHER
(b) (6), (b) (2)
(b)
COM,
(6),
(b) (6), (b) (2)
SEARCH COMMITTEES
NATIONAL SERVICE
(b) (6), (b) (2)
COMMUNITY HOSPITAL - PATIENT LEADERSHIP
(b) (6), (b) (2)
(b) (6), (b) (2)
(b) (6), (b) (2)
HOSPITAL-FACULTY GROUP PRACTICE-
(b)
(6),
(b)
VA-19-0799-D-001102
OS 00002773
Page 4 of 15
Curriculum Vitae
(b) (6), (b) (2)
COLLEGE OF MEDICINE, OTHER
(b) (6), (b) (2)
(b)
COM,
(6),
(b) (6), (b) (2)
SEARCH COMMITTEES
NATIONAL SERVICE
(b) (6), (b) (2)
COMMUNITY HOSPITAL - PATIENT LEADERSHIP
(b) (6), (b) (2)
(b) (6), (b) (2)
(b) (6), (b) (2)
HOSPITAL-FACULTY GROUP PRACTICE-
(b)
(6),
(b)
VA-19-0799-D-001102
OS 00002773
Curriculum Vitae
Page 5 of 15
(b) (6), (b) (2)
COMMUNITY SERVICE:
(b) (6), (b) (2)
GRANT REVIEWS
(b) (6), (b) (2)
ME1\1BERSHIP IN PROFESSIONAL SOCIETIES:
(b) (6), (b) (2)
EDUCATIONAL ACTIVITIES:
Curriculum Development
(b) (6), (b) (2)
Evaluation l\!Iethods/Development
(b) (6), (b) (2)
VA-19-0799-D-001103
OS 00002774
Curriculum Vitae
Page 5 of 15
(b) (6), (b) (2)
COMMUNITY SERVICE:
(b) (6), (b) (2)
GRANT REVIEWS
(b) (6), (b) (2)
ME1\1BERSHIP IN PROFESSIONAL SOCIETIES:
(b) (6), (b) (2)
EDUCATIONAL ACTIVITIES:
Curriculum Development
(b) (6), (b) (2)
Evaluation l\!Iethods/Development
(b) (6), (b) (2)
VA-19-0799-D-001103
OS 00002774
Page 6 of 15
Curriculum Vitae
(b) (6), (b) (2)
Family Practice noon conferences series (some old, some still being given)
(b) (6), (b) (2)
Older
(b) (6), (b) (2)
RAST
(b) (6), (b) (2)
Preceptorships
(b) (6), (b) (2)
Other Lectures
(b)
(6),
(b)
VA-19-0799-D-001104
OS 00002775
Page 6 of 15
Curriculum Vitae
(b) (6), (b) (2)
Family Practice noon conferences series (some old, some still being given)
(b) (6), (b) (2)
Older
(b) (6), (b) (2)
RAST
(b) (6), (b) (2)
Preceptorships
(b) (6), (b) (2)
Other Lectures
(b)
(6),
(b)
VA-19-0799-D-001104
OS 00002775
Page 7 of 15
Curriculum Vitae
(b) (6), (b) (2)
Journal/Publication/Conference Submission Reviews
(b) (6), (b) (2)
PRESENTATIONS:
Invited Presentations, lecture, poster or other, Local, National and International
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001105
OS 00002776
Page 7 of 15
Curriculum Vitae
(b) (6), (b) (2)
Journal/Publication/Conference Submission Reviews
(b) (6), (b) (2)
PRESENTATIONS:
Invited Presentations, lecture, poster or other, Local, National and International
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001105
OS 00002776
Page 8 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001106
OS 00002777
Page 8 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001106
OS 00002777
Cur?culum Vitae Page 9 of 15
107
DS
Cur?culum Vitae Page 9 of 15
107
DS
Cur?culum Vitae Page 10 of 15
108
Cur?culum Vitae Page 10 of 15
108
Page 11 of 15
Curriculum Vitae
(b) (6), (b) (2)
LOCAL
PRESENTATIONS
(b) (6), (b) (2)
CONTRACTS AND GRANTS:
(b) (6), (b) (2)
(b)
(6)
(b)
(6)
(b) (6)
VA-19-0799-D-001109
OS 00002780
Page 11 of 15
Curriculum Vitae
(b) (6), (b) (2)
LOCAL
PRESENTATIONS
(b) (6), (b) (2)
CONTRACTS AND GRANTS:
(b) (6), (b) (2)
(b)
(6)
(b)
(6)
(b) (6)
VA-19-0799-D-001109
OS 00002780
Curriculum Vitae
Page 12 of 15
MAJOR CONSULTATIONS OUTSIDE THE UNIVERSITY:
(b) (6), (b) (2)
PUBLICATIONS:
Books
---
Published:
(b) (6), (b) (2)
VA-19-0799-D-001110
OS 00002781
Curriculum Vitae
Page 12 of 15
MAJOR CONSULTATIONS OUTSIDE THE UNIVERSITY:
(b) (6), (b) (2)
PUBLICATIONS:
Books
---
Published:
(b) (6), (b) (2)
VA-19-0799-D-001110
OS 00002781
Page 13 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
Refereed Journals
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
Non-refereed Publications
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001111
OS 00002782
Page 13 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
Refereed Journals
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
Non-refereed Publications
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001111
OS 00002782
Page 14 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
(b) (6)
Electronic Publications: (These are probably aged to the point that the links no longer work)
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001112
OS 00002783
Page 14 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
(b) (6)
Electronic Publications: (These are probably aged to the point that the links no longer work)
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001112
OS 00002783
Curriculum Vitae
Page 15 of 15
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001113
OS 00002784
Curriculum Vitae
Page 15 of 15
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001113
OS 00002784
Sent from my iPad
Bmce Moskowitz MD.
1 14
Sent from my iPad
Bmce Moskowitz MD.
1 14
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/7/201710:02:31 PM
Va David [vacodjsl@va.gov]
Fwd: CIO
2017 March 2 (b) (6)
CV.docx; Untitled attachment 05685.htm
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 7, 2017 at 3:29:55 PM EDT
To: drshulkin@aol .com
Subject: CIO
mac.com>
U of Fl
VA-19-0799-D-001115
OS 00002786
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/7/201710:02:31 PM
Va David [vacodjsl@va.gov]
Fwd: CIO
2017 March 2 (b) (6)
CV.docx; Untitled attachment 05685.htm
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 7, 2017 at 3:29:55 PM EDT
To: drshulkin@aol .com
Subject: CIO
mac.com>
U of Fl
VA-19-0799-D-001115
OS 00002786
CURRICULUM VITAE {PRIVATE }
(b) (6)
Name: (b) (6), (b) (2)
Department: (b) (6), (b) (2)
(b)
Health (b) (6), (b) (2)
(6),
(b)
Present
Rank: (b) (6), (b) (2)
(6), (b)
Business Address: (b) (6), (b) (2)
Gainesville, FL (b)
(2)
(6),
Business Telephone: 352-265-(b)
(b) (2)
(b) (6),
(6), (b)
Home Address:
, Gainesville, FL (b)
(b) (2)
(2)
EDUCATIONAL RECORD:
Professional Development
(b) (6), (b) (2)
Fellowship:
(b) (6), (b) (2)
Residency:
(b) (6), (b) (2)
Medical School:
(b) (6), (b) (2)
VA-19-0799-D-001116
OS 00002787
CURRICULUM VITAE {PRIVATE }
(b) (6)
Name: (b) (6), (b) (2)
Department: (b) (6), (b) (2)
(b)
Health (b) (6), (b) (2)
(6),
(b)
Present
Rank: (b) (6), (b) (2)
(6), (b)
Business Address: (b) (6), (b) (2)
Gainesville, FL (b)
(2)
(6),
Business Telephone: 352-265-(b)
(b) (2)
(b) (6),
(6), (b)
Home Address:
, Gainesville, FL (b)
(b) (2)
(2)
EDUCATIONAL RECORD:
Professional Development
(b) (6), (b) (2)
Fellowship:
(b) (6), (b) (2)
Residency:
(b) (6), (b) (2)
Medical School:
(b) (6), (b) (2)
VA-19-0799-D-001116
OS 00002787
Page 2 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6), (b) (2)
Graduate:
(b) (6), (b) (2)
Undergraduate:
(b) (6), (b) (2)
BOARD CERTIFICATION:
(b) (6), (b) (2)
LI CENSURE:
State
Number
Date
Status
(b) (6), (b) (2)
EMPLOYMENT:
Place of Employment City
Title or Position
Years of Empl.
(b) (6), (b) (2)
HONORS AND/OR AW ARDS:
(b) (6), (b) (2)
VA-19-0799-D-001117
OS 00002788
Page 2 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6), (b) (2)
Graduate:
(b) (6), (b) (2)
Undergraduate:
(b) (6), (b) (2)
BOARD CERTIFICATION:
(b) (6), (b) (2)
LI CENSURE:
State
Number
Date
Status
(b) (6), (b) (2)
EMPLOYMENT:
Place of Employment City
Title or Position
Years of Empl.
(b) (6), (b) (2)
HONORS AND/OR AW ARDS:
(b) (6), (b) (2)
VA-19-0799-D-001117
OS 00002788
Curriculum Vitae
Page 3 of 15
(b) (6), (b) (2)
SERVICE/PATIENT CARE LEADERSHIP:
UNIVERSITY SERVICE:
(b) (6), (b) (2)
COLLEGE OF MEDICINE SERVICE
(b) (6), (b) (2)
COLLEGE OF MEDICINE, ADMISSIONS:
(b) (6), (b) (2)
VA-19-0799-D-001118
OS 00002789
Curriculum Vitae
Page 3 of 15
(b) (6), (b) (2)
SERVICE/PATIENT CARE LEADERSHIP:
UNIVERSITY SERVICE:
(b) (6), (b) (2)
COLLEGE OF MEDICINE SERVICE
(b) (6), (b) (2)
COLLEGE OF MEDICINE, ADMISSIONS:
(b) (6), (b) (2)
VA-19-0799-D-001118
OS 00002789
Page 4 of 15
Curriculum Vitae
(b) (6), (b) (2)
COLLEGE OF MEDICINE, OTHER
(b) (6), (b) (2)
(b)
COM,
(6),
(b) (6), (b) (2)
SEARCH COMMITTEES
NATIONAL SERVICE
(b) (6), (b) (2)
COMMUNITY HOSPITAL - PATIENT LEADERSHIP
(b) (6), (b) (2)
(b) (b) (6), (b) (2)
(6),
(b) (6), (b) (2)
- (b) (6), (b) (2) HOSPITAL-FACULTY GROUP PRACTICE-
(b)
(6),
(b)
VA-19-0799-D-001119
OS 00002790
Page 4 of 15
Curriculum Vitae
(b) (6), (b) (2)
COLLEGE OF MEDICINE, OTHER
(b) (6), (b) (2)
(b)
COM,
(6),
(b) (6), (b) (2)
SEARCH COMMITTEES
NATIONAL SERVICE
(b) (6), (b) (2)
COMMUNITY HOSPITAL - PATIENT LEADERSHIP
(b) (6), (b) (2)
(b) (b) (6), (b) (2)
(6),
(b) (6), (b) (2)
- (b) (6), (b) (2) HOSPITAL-FACULTY GROUP PRACTICE-
(b)
(6),
(b)
VA-19-0799-D-001119
OS 00002790
Curriculum Vitae
Page 5 of 15
(b) (6), (b) (2)
COMMUNITY SERVICE:
(b) (6), (b) (2)
GRANT REVIEWS
(b) (6), (b) (2)
ME1\1BERSHIP IN PROFESSIONAL SOCIETIES:
(b) (6), (b) (2)
EDUCATIONAL ACTIVITIES:
Curriculum Development
(b) (6), (b) (2)
Evaluation l\!Iethods/Development
(b) (6), (b) (2)
VA-19-0799-D-001120
OS 00002791
Curriculum Vitae
Page 5 of 15
(b) (6), (b) (2)
COMMUNITY SERVICE:
(b) (6), (b) (2)
GRANT REVIEWS
(b) (6), (b) (2)
ME1\1BERSHIP IN PROFESSIONAL SOCIETIES:
(b) (6), (b) (2)
EDUCATIONAL ACTIVITIES:
Curriculum Development
(b) (6), (b) (2)
Evaluation l\!Iethods/Development
(b) (6), (b) (2)
VA-19-0799-D-001120
OS 00002791
Page 6 of 15
Curriculum Vitae
(b) (6), (b) (2)
Family Practice noon conferences series (some old, some still being given)
(b) (6), (b) (2)
Older
(b) (6), (b) (2)
RAST (Resident AS Teachers)
(b) (6), (b) (2)
Preceptorships
(b) (6), (b) (2)
Other Lectures
(b)
(6),
(b)
VA-19-0799-D-001121
OS 00002792
Page 6 of 15
Curriculum Vitae
(b) (6), (b) (2)
Family Practice noon conferences series (some old, some still being given)
(b) (6), (b) (2)
Older
(b) (6), (b) (2)
RAST (Resident AS Teachers)
(b) (6), (b) (2)
Preceptorships
(b) (6), (b) (2)
Other Lectures
(b)
(6),
(b)
VA-19-0799-D-001121
OS 00002792
Page 7 of 15
Curriculum Vitae
(b) (6), (b) (2)
Journal/Publication/Conference Submission Reviews
(b) (6), (b) (2)
PRESENTATIONS:
Invited Presentations, lecture, poster or other, Local, National and International
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001122
OS 00002793
Page 7 of 15
Curriculum Vitae
(b) (6), (b) (2)
Journal/Publication/Conference Submission Reviews
(b) (6), (b) (2)
PRESENTATIONS:
Invited Presentations, lecture, poster or other, Local, National and International
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001122
OS 00002793
Page 8 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001123
OS 00002794
Page 8 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001123
OS 00002794
Cur?culum Vitae Page 9 of 15
124
Cur?culum Vitae Page 9 of 15
124
Cur?culum Vitae Page 10 of 15
125
Cur?culum Vitae Page 10 of 15
125
Page 11 of 15
Curriculum Vitae
(b) (6), (b) (2)
.
LOCAL PRESENTATIONS
(b) (6), (b) (2)
CONTRACTS AND GRANTS:
(b) (6), (b) (2)
(b)
(6)
(b)
(6)
(b) (6)
VA-19-0799-D-001126
OS 00002797
Page 11 of 15
Curriculum Vitae
(b) (6), (b) (2)
.
LOCAL PRESENTATIONS
(b) (6), (b) (2)
CONTRACTS AND GRANTS:
(b) (6), (b) (2)
(b)
(6)
(b)
(6)
(b) (6)
VA-19-0799-D-001126
OS 00002797
Curriculum Vitae
Page 12 of 15
MAJOR CONSULTATIONS OUTSIDE THE UNIVERSITY:
(b) (6), (b) (2)
PUBLICATIONS:
Books
---
Published:
(b) (6), (b) (2)
VA-19-0799-D-001127
OS 00002798
Curriculum Vitae
Page 12 of 15
MAJOR CONSULTATIONS OUTSIDE THE UNIVERSITY:
(b) (6), (b) (2)
PUBLICATIONS:
Books
---
Published:
(b) (6), (b) (2)
VA-19-0799-D-001127
OS 00002798
Page 13 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
Refereed Journals
(b) (6)
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001128
OS 00002799
Page 13 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
Refereed Journals
(b) (6)
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001128
OS 00002799
Page 14 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
(b) (6)
Electronic Publications: (These are probably aged to the point that the links no longer work)
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001129
OS 00002800
Page 14 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
(b) (6)
Electronic Publications: (These are probably aged to the point that the links no longer work)
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001129
OS 00002800
Curriculum Vitae
Page 15 of 15
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001130
OS 00002801
Curriculum Vitae
Page 15 of 15
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001130
OS 00002801
Sent from my iPad
Bmce Moskowitz MD.
131
Sent from my iPad
Bmce Moskowitz MD.
131
Message
David shulkin [Drshulkin@aol.com]
Sent:
4/7/201710:02:19 PM
Va David [vacodjsl@va.gov]
To:
Subject:
Fwd: CIO
Attachments: (b) (6)
Resume Mar 2017.docx; Untitled attachment 05690.htm
From:
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 7, 2017 at 3 :31 :30 PM EDT
To: drshulkin@aol .com
Cc: IP <(b) (6) frenchangel59.com>
Subject: CIO
mac.com>
UofF
VA-19-0799-D-001132
OS 00002803
Message
David shulkin [Drshulkin@aol.com]
Sent:
4/7/201710:02:19 PM
Va David [vacodjsl@va.gov]
To:
Subject:
Fwd: CIO
Attachments: (b) (6)
Resume Mar 2017.docx; Untitled attachment 05690.htm
From:
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 7, 2017 at 3 :31 :30 PM EDT
To: drshulkin@aol .com
Cc: IP <(b) (6) frenchangel59.com>
Subject: CIO
mac.com>
UofF
VA-19-0799-D-001132
OS 00002803
(b) (6), (b) (2)
(b) (6)
RN, MBA
(b) (6), (b) (2)
(6), (b)
Gainesville, Florida (b)
(2)
(6),
Home Phone (352) 335-(b)
(b) (2)
(b) (6),
Cell Phone (352) 214-(b) (2)
(b) (6), (b)
@shands.ufl.edu
(2)
(b) (6), (b) (2)
@att.net
Summary:
(b) (6), (b) (2)
.
Professional Experience:
(b) (6), (b) (2)
(b) (6), (b) (2)
October 2011 - present
July 2009 - March 2010
1993 - 2011
(b) (6), (b) (2)
VA-19-0799-D-001133
OS 00002804
(b) (6), (b) (2)
(b) (6)
RN, MBA
(b) (6), (b) (2)
(6), (b)
Gainesville, Florida (b)
(2)
(6),
Home Phone (352) 335-(b)
(b) (2)
(b) (6),
Cell Phone (352) 214-(b) (2)
(b) (6), (b)
@shands.ufl.edu
(2)
(b) (6), (b) (2)
@att.net
Summary:
(b) (6), (b) (2)
.
Professional Experience:
(b) (6), (b) (2)
(b) (6), (b) (2)
October 2011 - present
July 2009 - March 2010
1993 - 2011
(b) (6), (b) (2)
VA-19-0799-D-001133
OS 00002804
(b) (6), (b) (2)
(b) (6), (b) (2)
1988 -1991
1985 - 1988
1980 - 1983
Education:
(b) (6), (b) (2)
2
VA-19-0799-D-001134
OS 00002805
(b) (6), (b) (2)
(b) (6), (b) (2)
1988 -1991
1985 - 1988
1980 - 1983
Education:
(b) (6), (b) (2)
2
VA-19-0799-D-001134
OS 00002805
Professional Licensure:
(b) (6), (b) (2)
Affiliations:
(b) (6), (b) (2)
Publications:
(b) (6), (b) (2)
(b) (6)
3
VA-19-0799-D-001135
OS 00002806
Professional Licensure:
(b) (6), (b) (2)
Affiliations:
(b) (6), (b) (2)
Publications:
(b) (6), (b) (2)
(b) (6)
3
VA-19-0799-D-001135
OS 00002806
Sent from my iPad
Bmce Moskowitz MD.
136
Sent from my iPad
Bmce Moskowitz MD.
136
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
4/7/2017 9:40:41 PM
David shulkin [Drshulkin@aol.com]
IP [(b) (6) frenchangel59.com]
Re: CIO
mac.com]
No go ahead we have 5 now including the one from Hopkins.
All excellent I can get more
Sent from my iPhone
> on Apr 7, 2017, at 5:26 PM, David shulkin wrote:
>
>Bruce-thanks for the four 0/s for CIO.
> Is it okay to contact them yet or do you want yo have discussions with them first?
>
> David
>
> Sent from my iPhone
>
>> on Apr 7, 2017, at 3:31 PM, Bruce Moskowitz <(b) (6)
>>
>> U of F
>>
>> <(b) (6)
mac.com> wrote:
Resume Mar 2017.docx>
>>
>>
>>
>> Sent from my iPad
>> Bruce Moskowitz M.D.
>
VA-19-0799-D-001137
OS 00002808
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/7/2017 9:26:30 PM
Bruce Moskowitz [(b) (6)
IP [(b) (6) frenchangel59.com]
Re: CIO
mac.com]
Bruce- thanks for the four 0/s for CIO.
Is it okay to contact them yet or do you want yo have discussions with them first?
David
Sent from my iPhone
> on Apr 7, 2017, at 3:31 PM, Bruce Moskowitz <(b) (6)
>
> U
>
mac.com> wrote:
of F
> <(b) (6)
Resume Mar 2017.docx>
>
>
>
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-001138
OS 00002809
Message
From:
Sent:
To:
CC:
Subject:
Attachments:
U
of
Bruce Moskowitz [(b) (6)
mac.com]
4/7/2017 7:31:30 PM
drshulkin@aol.com
IP [(b) (6) frenchangel59.com]
CIO
(b) (6)
Resume Mar 2017.docx; Untitled attachment 05696.txt
F
VA-19-0799-D-001139
OS 00002810
(b) (6), (b) (2)
(b) (6)
RN, MBA
(b) (6), (b) (2)
Gainesville, Florida 32608
(6),
Home Phone (352) 335-(b)
(b) (2)
(b) (6),
Cell Phone (352) 214-(b) (2)
(b) (6), (b)
@shands.ufl.edu
(2)
(b) (6), (b) (2)
@att.net
Summary:
(b) (6), (b) (2)
.
Professional Experience:
(b) (6), (b) (2)
October 2011 - present
July 2009 - March 2010
1993 - 2011
(b) (6), (b) (2)
VA-19-0799-D-001140
OS 00002811
(b) (6), (b) (2)
(b) (6), (b) (2)
1991 -1993
(b) (6), (b) (2)
1988 -1991
1985 - 1988
1980 - 1983
Education:
(b) (6), (b) (2)
2
VA-19-0799-D-001141
OS 00002812
Professional Licensure:
(b) (6), (b) (2)
Affiliations:
(b) (6), (b) (2)
Publications:
(b) (6), (b) (2)
(b) (6)
3
VA-19-0799-D-001142
OS 00002813
Sent from my iPad
Bruce Moskowitz M.D.
143
Message
From:
Sent:
To:
Subject:
Attachments:
Bruce Moskowitz [(b) (6)
mac.com]
4/7/2017 7:29:55 PM
drshulkin@aol.com
CIO
2017 March 2 (b) (6)
CV.docx; Untitled attachment 05702.txt
U of Fl
VA-19-0799-D-001144
OS 00002815
CURRICULUM VITAE {PRIVATE }
(b) (6)
Name: (b) (6), (b) (2)
Department: (b) (6), (b) (2)
(b)
Health (b) (6), (b) (2)
(6),
(b)
Present
Rank: (b) (6), (b) (2)
(6), (b)
Business Address: (b) (6), (b) (2)
, Gainesville, FL (b)
(2)
(6),
Business Telephone: 352-265-(b)
(b) (2)
(b) (6),
(6), (b)
Home Address:
, Gainesville, FL (b)
(b) (2)
(2)
EDUCATIONAL RECORD:
Professional Development
(b) (6), (b) (2)
Fellowship:
(b) (6), (b) (2)
Residency:
(b) (6), (b) (2)
Medical School:
(b) (6), (b) (2)
VA-19-0799-D-001145
OS 00002816
Page 2 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6), (b) (2)
Graduate:
(b) (6), (b) (2)
arship
Undergraduate:
(b) (6), (b) (2)
BOARD CERTIFICATION:
(b) (6), (b) (2)
LI CENSURE:
State
Number
Date
Status
(b) (6), (b) (2)
EMPLOYMENT:
Place of Employment City
Title or Position
Years of Empl.
(b) (6), (b) (2)
HONORS AND/OR AW ARDS:
(b) (6), (b) (2)
VA-19-0799-D-001146
OS 00002817
Curriculum Vitae
Page 3 of 15
(b) (6), (b) (2)
SERVICE/PATIENT CARE LEADERSHIP:
UNIVERSITY SERVICE:
(b) (6), (b) (2)
COLLEGE OF MEDICINE SERVICE
(b) (6), (b) (2)
COLLEGE OF MEDICINE, ADMISSIONS:
(b) (6), (b) (2)
VA-19-0799-D-001147
OS 00002818
Page 4 of 15
Curriculum Vitae
(b) (6), (b) (2)
COLLEGE OF MEDICINE, OTHER
(b) (6), (b) (2)
(b) (b
COM,
(6),
(b)) (6), (b) (2)
SEARCH COMMITTEES
NATIONAL SERVICE
(b) (6), (b) (2)
COMMUNITY HOSPITAL - PATIENT LEADERSHIP
(b) (6), (b) (2)
(b) (6), (b) (2)
(b) (6), (b) (2)
HOSPITAL-FACULTY GROUP PRACTICE-
(b)
(6),
(b)
VA-19-0799-D-001148
OS 00002819
Curriculum Vitae
Page 5 of 15
(b) (6), (b) (2)
COMMUNITY SERVICE:
(b) (6), (b) (2)
GRANT REVIEWS
(b) (6), (b) (2)
ME1\1BERSHIP IN PROFESSIONAL SOCIETIES:
(b) (6), (b) (2)
EDUCATIONAL ACTIVITIES:
Curriculum Development
(b) (6), (b) (2)
Evaluation l\!Iethods/Development
(b) (6), (b) (2)
VA-19-0799-D-001149
OS 00002820
Page 6 of 15
Curriculum Vitae
(b) (6), (b) (2)
.
Family Practice noon conferences series (some old, some still being given)
(b) (6), (b) (2)
Older
(b) (6), (b) (2)
RAST (Resident AS Teachers)
(b) (6), (b) (2)
Preceptorships
(b) (6), (b) (2)
Other Lectures
(b)
(6),
(b)
VA-19-0799-D-001150
OS 00002821
Page 7 of 15
Curriculum Vitae
(b) (6), (b) (2)
Journal/Publication/Conference Submission Reviews
(b) (6), (b) (2)
PRESENTATIONS:
Invited Presentations, lecture, poster or other, Local, National and International
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001151
OS 00002822
Page 8 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001152
OS 00002823
Cur?culum Vitae Page 9 of 15
153
Cur?culum Vitae Page 10 of 15
154
Page 11 of 15
Curriculum Vitae
(b) (6), (b) (2)
.
LOCAL PRESENTATIONS
(b) (6), (b) (2)
CONTRACTS AND GRANTS:
(b) (6), (b) (2)
(b)
(6)
(b)
(6)
(b) (6)
VA-19-0799-D-001155
OS 00002826
Curriculum Vitae
Page 12 of 15
MAJOR CONSULTATIONS OUTSIDE THE UNIVERSITY:
(b) (6), (b) (2)
PUBLICATIONS:
Books
---
Published:
(b) (6), (b) (2)
VA-19-0799-D-001156
OS 00002827
Page 13 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
Refereed Journals
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
Non-refereed Publications
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001157
OS 00002828
Page 14 of 15
Curriculum Vitae
(b) (6), (b) (2)
(b) (6)
(b) (6)
Electronic Publications: (These are probably aged to the point that the links no longer work)
(b) (6), (b) (2)
(b) (6)
,
(b) (6)
ASK THE EXPERT Series http: www.medscape.com
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001158
OS 00002829
Curriculum Vitae
Page 15 of 15
(b) (6), (b) (2)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
VA-19-0799-D-001159
OS 00002830
Sent from my iPad
Bruce Moskowitz M.D.
160
Message
From:
Sent:
To:
Subject:
Darin Selnick [(b) (6)
@gmail.com]
4/7/2017 12:14:31 AM
David shulkin [Drshulkin@aol.com]
Re: Draft EO on accountability and whistleblower protection
(b) (6)
sent it to me yesterday. It is the only VA EO that I have seen. Her first question to me when she
called was have you seen the EO. Then why not.
Thanks for sending it, do we have some others out there waiting for WH approval.
Darin
On Thu, Apr 6, 2017 at 4:29 PM, David shulkin wrote:
Have you seen this one?
Sent from my iPhone
Begin forwarded message:
(b) (6)
From: "(b) (6)
<(b) (6)
va.gov>
Date: April 6, 2017 at 1:56:24 PM EDT
To: 'David shulkin'
Subject: Draft EO on accountability and whistleblower protection
VA-19-0799-D-001161
OS 00002832
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/6/2017 11:30:15 PM
Ike Perlmutter [(b) (6) frenchangel59.com]
Fwd: Draft EO on accountability and whistleblower protection
Untitled attachment 05720.docx
Here is another EO
Im home now and up until 11pm
>
>
VA-19-0799-D-001162
OS 00002833
EXECUTIVE ORDER
IMPROVING ACCOUNTABILITY AND WHISTLEBLOWER PROTECTIONS AT THE
DEPARTMENT OF VETERANS AFFAIRS
By the authority vested in me as President by the
Constitution and the laws of the United States of America, it
is hereby ordered as follows:
Section 1.
Purpose.
This order is intended to improve
accountability and whistleblower protection at the Department of
Veterans Affairs
Affairs
(VA) by directing the Secretary of Veterans
(Secretary)
to appoint a Special Assistant to serve as
Executive Director of a newly-created VA Office of
Accountability, Civil Rights, and Whistleblower Protection.
Sec. 2.
Establishing a VA Office of Accountability, Civil
Rights, and Whistleblower Protection.
(a)
Within 45 days of
the date of this order, the Secretary shall establish a new VA
Office of Accountability, Civil Rights, and Whistleblower
Protection (Office), and shall appoint a Special Assistant,
reporting directly to the Secretary, to serve as Executive
Director (Executive Director) of the Office.
(b)
The Executive Director shall advise and assist the
Secretary in using all available authorities to discipline or
terminate any VA manager or employee who has violated the
public's trust and failed to carry out his or her duties on
behalf of Veterans.
(c)
The Executive Director shall work closely with Congress
to identify options for legislative change to improve the
Secretary's authority to discipline or terminate any employee
who has jeopardized the health, safety, or well-being of a
Veteran.
VA-19-0799-D-001163
OS 00002834
2
(d) The Executive Director shall work closely with the
White House Veterans hotline to ensure swift and effective
resolution of Veterans' complaints of wrongdoing at the VA.
(e) The Executive Director will ensure adequate
investigation and correction of wrongdoing throughout VA, and
will ensure that honest employees who highlight wrongdoing are
protected from retaliation.
(f)
In establishing the Office described in paragraph 2(a)
above, the Secretary shall consider, in addition to any other
relevant factors:
(i)
whether some or all of the functions of the
Office are currently being performed by an existing VA
office, component, or program
(ii)
whether certain administrative capabilities
necessary for operating the Office are redundant with
those of another VA office, component, or program;
(iv)
whether combining the Office with another VA
office, component, or program may improve VA's
efficiency, effectiveness, or accountability.
Sec. 3.
General Provisions.
(a)
This order shall be
implemented consistent with applicable law and subject to the
availability of appropriations.
(b)
This order is not intended to, and does not, create
any right or benefit, substantive or procedural, enforceable at
law or in equity by any party against the United States, its
departments, agencies, or entities, its officers, employees, or
agents, or any other person.
THE WHITE HOUSE,
VA-19-0799-D-001164
OS 00002835
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
To:
4/6/2017 11:29:16 PM
Subject:
Attachments:
Darin Selnick [(b) (6)
@gmail.com]
Fwd: Draft EO on accountability and whistleblower protection
Untitled attachment 05725.docx; Untitled attachment 05728.htm
Have you seen this one?
Sent from my iPhone
Begin forwarded message:
(b) (6)
From: "(b) (6)
<(b) (6)
va.gov>
Date: April 6, 2017 at I :56:24 PM EDT
To: 'David shulkin'
Subject: Draft EO on accountability and whistleblower protection
VA-19-0799-D-001165
OS 00002836
EXECUTIVE ORDER
IMPROVING ACCOUNTABILITY AND WHISTLEBLOWER PROTECTIONS AT THE
DEPARTMENT OF VETERANS AFFAIRS
By the authority vested in me as President by the
Constitution and the laws of the United States of America, it
is hereby ordered as follows:
Section 1.
Purpose.
This order is intended to improve
accountability and whistleblower protection at the Department of
Veterans Affairs
Affairs
(VA) by directing the Secretary of Veterans
(Secretary)
to appoint a Special Assistant to serve as
Executive Director of a newly-created VA Office of
Accountability, Civil Rights, and Whistleblower Protection.
Sec. 2.
Establishing a VA Office of Accountability, Civil
Rights, and Whistleblower Protection.
(a)
Within 45 days of
the date of this order, the Secretary shall establish a new VA
Office of Accountability, Civil Rights, and Whistleblower
Protection (Office), and shall appoint a Special Assistant,
reporting directly to the Secretary, to serve as Executive
Director (Executive Director) of the Office.
(b)
The Executive Director shall advise and assist the
Secretary in using all available authorities to discipline or
terminate any VA manager or employee who has violated the
public's trust and failed to carry out his or her duties on
behalf of Veterans.
(c)
The Executive Director shall work closely with Congress
to identify options for legislative change to improve the
Secretary's authority to discipline or terminate any employee
who has jeopardized the health, safety, or well-being of a
Veteran.
VA-19-0799-D-001166
OS 00002837
2
(d) The Executive Director shall work closely with the
White House Veterans hotline to ensure swift and effective
resolution of Veterans' complaints of wrongdoing at the VA.
(e) The Executive Director will ensure adequate
investigation and correction of wrongdoing throughout VA, and
will ensure that honest employees who highlight wrongdoing are
protected from retaliation.
(f)
In establishing the Office described in paragraph 2(a)
above, the Secretary shall consider, in addition to any other
relevant factors:
(i)
whether some or all of the functions of the
Office are currently being performed by an existing VA
office, component, or program
(ii)
whether certain administrative capabilities
necessary for operating the Office are redundant with
those of another VA office, component, or program;
(iv)
whether combining the Office with another VA
office, component, or program may improve VA's
efficiency, effectiveness, or accountability.
Sec. 3.
General Provisions.
(a)
This order shall be
implemented consistent with applicable law and subject to the
availability of appropriations.
(b)
This order is not intended to, and does not, create
any right or benefit, substantive or procedural, enforceable at
law or in equity by any party against the United States, its
departments, agencies, or entities, its officers, employees, or
agents, or any other person.
THE WHITE HOUSE,
VA-19-0799-D-001167
OS 00002838
168
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/4/2017 2:32:40 PM
To:
(b) (6)
Subject:
[(b) (6)
Fwd: Re: Fwd:
hotmail.com]
John kelly and nicki haley have no money
Rick perry too
Sent from my iPhone
Begin forwarded message:
From: Poonam Alaigh <(b) (6)
hotmail .com>
Date: April 4, 2017 at 9:19:12 AM EDT
To: David shulkin
Subject: Re: Fwd:
Lol- it's just that the press simply loves you and doesn't want you to be dragged into any public
controversy!! Your bubble will only get larger!
Sent from my iPhone
On Apr 4, 2017, at 12: 11 PM, David shulkin wrote:
Its so small it was popped before it made it to the photo
Sent from my iPhone
On Apr 4, 2017, at 3:33 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
What happened to your bubble
Sent from my iPhone
On Apr 4, 2017, at 3:55 AM, David shulkin
wrote:
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
(b) (6)
gmail .com>
Date: April 3, 2017 at 10:04:41 PM
EDT
To: (b) (6)
VA-19-0799-D-001169
OS 00002840
https://www.nytimes.com/interactive
/2017/04/01 /us/politics/how-muchpeople-in-the-trump-administrationare-worth-financialdisclosure.html?smid=fbnytimes&smtyp=cur& r=l
how much every cabinet secretary is
worth
Sent from my iPad
VA-19-0799-D-001170
OS 00002841
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/4/2017 1:19:12 PM
David shulkin [Drshulkin@aol.com]
Re: Fwd:
Lol- it's just that the press simply loves you and doesn't want you to be dragged into any public controversy!!
Your bubble will only get larger!
Sent from my iPhone
On Apr 4, 2017, at 12: 11 PM, David shulkin wrote:
Its so small it was popped before it made it to the photo
Sent from my iPhone
On Apr 4, 2017, at 3:33 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
What happened to your bubble
Sent from my iPhone
On Apr 4, 2017, at 3:55 AM, David shulkin wrote:
Sent from my iPhone
Begin forwarded message:
(b) (6)
From: (b) (6)
gmail.com>
Date: April 3, 2017 at 10:04:41 PM EDT
To: (b) (6)
https://www.nytimes.com/interactive/2017/04/0l /us
/politics/how-much-people-in-the-trumpadministration-are-worth-financialdisclosure.html?smid=fbnytimes&smtyp=cur& r=l
how much every cabinet secretary is worth
Sent from my iPad
VA-19-0799-D-001171
OS 00002842
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/4/2017 11:11:08 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Fwd:
Its so small it was popped before it made it to the photo
Sent from my iPhone
On Apr 4, 2017, at 3:33 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
What happened to your bubble
Sent from my iPhone
On Apr 4, 2017, at 3 :55 AM, David shulkin wrote:
Sent from my iPhone
Begin forwarded message:
(b) (6)
From: (b) (6) (b) (6)
gmail.com>
Date: April 3, 2017 at 10:04:41 PM EDT
To: (b) (6)
https://www.nytimes.com/interactive/2017/04/01 /us/politics/howmuch-people-in-the-trump-administration-are-worth-financialdisclosure.html?smid=fb-nytimes&smtyp=cur& r=l
how much every cabinet secretary is worth
Sent from my iPad
VA-19-0799-D-001172
OS 00002843
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/4/2017 7:33:23 AM
David shulkin [Drshulkin@aol.com]
Re: Fwd:
What happened to your bubble
Sent from my iPhone
On Apr 4, 2017, at 3 :55 AM, David shulkin wrote:
Sent from my iPhone
Begin forwarded message:
(b) (6)
From: (b) (6)
gmail.com>
Date: April 3, 2017 at 10:04:41 PM EDT
To: (b) (6)
https://www.nytimes.com/interactive/2017/04/01 /us/politics/how-much-peoplein-the-trump-administration-are-worth-financial-di sclosure.html? smid=fbnytimes&smtyp=cur& r=l
how much every cabinet secretary is worth
Sent from my iPad
VA-19-0799-D-001173
OS 00002844
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/4/2017 2:55:59 AM
To:
(b) (6)
Subject:
Fwd:
[(b) (6)
gmail.com]
Sent from my iPhone
Begin forwarded message:
(b) (6)
From: (b) (6) (b) (6)
gmail.com>
Date: April 3, 2017 at 10:04:41 PM EDT
To: (b) (6)
https://www.nytimes.com/interactive/2017/04/01 /us/politics/how-much-people-in-the-trumpadministration-are-worth-financial-disclosure.html? smid=fb-nytimes&smtyp=cur& r= l
how much every cabinet secretary is worth
Sent from my iPad
VA-19-0799-D-001174
OS 00002845
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/4/2017 2:55:50 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd:
Sent from my iPhone
Begin forwarded message:
(b) (6)
From: (b) (6)
gmail.com>
Date: April 3, 2017 at 10:04:41 PM EDT
To: (b) (6)
https://www.nytimes.com/interactive/2017/04/01 /us/politics/how-much-people-in-the-trumpadministration-are-worth-financial-disclosure.html? smid=fb-nytimes&smtyp=cur& r= l
how much every cabinet secretary is worth
Sent from my iPad
VA-19-0799-D-001175
OS 00002846
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/19/2017 11:43:18 PM
(b) (6)
[(b) (6)
gmail.com]
Re: Actual cbs clip here. Does this work?
Yes - I'll want it for me to play on the 25 th
Sent from my iPad
On Apr 19, 2017, at 7:37 PM, (b) (6)
<(b) (6)
gmail.com> wrote:
http ://www.cbsnews.com/videos/wounded-vet-frustrated-with-weeks-long-delays-in-localva/?ftag=CNM-OO-l 0aab4i
VA-19-0799-D-001176
OS 00002847
Message
From:
(b) (6)
Sent:
4/19/2017 11:37:47 PM
David Shulkin [drshulkin@aol.com]
Actual cbs clip here. Does this work?
To:
Subject:
[(b) (6)
gmail.com]
http ://www.cbsnews.com/videos/wounded-vet-frustrated-with-weeks-long-delays-in-local-va/?ftag=CNM-OOl0aab4i
VA-19-0799-D-001177
OS 00002848
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/9/2017 12:25:13 AM
(b) (6)
gmail.com
Re: Documents you typed on my computer
thanks
-----Original Message----From: (b) (6)
<(b) (6)
gmail.com>
To: David Shulkin
Sent: Sat, Apr 8, 2017 8:24 pm
Subject: Re: Fwd: Documents you typed on my computer
Folders were put together yesterday for signature on Monday. I will email the letters after you sign them
On Apr 8, 2017 8:23 PM, "David Shulkin" wrote:
Do you know if we have sent out the invites to the Secretarys Advisory Board yet?
-----Original Message----From: (b) (6)
<(b) (6)
gmail.com>
To: David Shulkin
Sent: Mon, Apr 3, 2017 5:28 pm
Subject: Documents you typed on my computer
ACMO is working on doc 1 under MyvA advisory committee
(b) (6)
---------- Forwarded message ---------From: (b) (6)
<(b) (6)
Date: Thu, Mar 30, 2017 at 7:54 PM
Subject: Documents from last night
To: David Shulkin
gmail.com>
attached
VA-19-0799-D-001178
OS 00002849
Message
From:
(b) (6)
Sent:
4/9/2017 12:24:33 AM
To:
David Shulkin [drshulkin@aol.com]
Re: Fwd: Documents you typed on my computer
Subject:
[(b) (6)
gmail.com]
Folders were put together yesterday for signature on Monday. I will email the letters after you sign them
On Apr 8, 2017 8:23 PM, "David Shulkin" wrote:
Do you know if we have sent out the invites to the Secretarys Advisory Board yet?
-----Original Message----From: (b) (6)
<(b) (6)
gmail.com>
To: David Shulkin
Sent: Mon, Apr 3, 2017 5:28 pm
Subject: Documents you typed on my computer
ACMO is working on doc 1 under MyvA advisory committee
(b) (6)
---------- Forwarded message ---------From: (b) (6)
<(b) (6)
Date: Thu, Mar 30, 2017 at 7:54 PM
Subject: Documents from last night
To: David Shulkin
gmail.com>
attached
VA-19-0799-D-001179
OS 00002850
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/9/2017 12:23:24 AM
To:
(b) (6)
Subject:
Attachments:
gmail.com
Fwd: Documents you typed on my computer
advisoryletter.docx; annals.docx
Do you know if we have sent out the invites to the Secretarys Advisory Board yet?
-----Original Message----From: (b) (6)
<(b) (6)
gmail.com>
To: David Shulkin
Sent: Mon, Apr 3, 2017 5:28 pm
Subject: Documents you typed on my computer
ACMO is working on doc 1 under MyvA advisory committee
(b) (6)
---------- Forwarded message ---------From: (b) (6)
<(b) (6)
Date: Thu, Mar 30, 2017 at 7:54 PM
Subject: Documents from last night
To: David Shulkin
gmail.com>
attached
VA-19-0799-D-001180
OS 00002851
As we work to transform the US Department of Veterans Administration, I am seeking your expertise in
guiding us through these efforts. I would be honored if you would serve on our board of advisors to
help us shape the future of VA. This newly formed group will be called the Secretary's Advisory Board
and will be replacing the myVA Committee. As such, it will operate as a FACCA (Federal Advisory
Committee) so that meetings are open to the public.
The Secretrary's Advisory Board will focus on strategic directions and policy issues that facing VA and
veterans. The Board will consist of approximately members and meet three times a year for one day
each. Meetings will usually be held in Washington DC or on occasion in a field location.
I realize that you are busy and I am appreciative of your consideration of this important work. I look
forward to hearing from you.
Sincrerely,
David Shulkin MD
VA-19-0799-D-001181
OS 00002852
Putting Veterans in Control of Their Care
The 2014 access crisis at the Department of Veterans Affairs was a pivotal moment for VA. Daily media
accounts, like non-stop drumbeats- reported that Veterans were on long waitlist for care and at
suggested that some were dying while they. The extent of VA's access problems, like many others in
US Health care, was not immediately clear. The Department had difficult to understand wait time
metrics exacerbated by arbitrary scheduling goals that it could not meet. Those hard-to-meet and hard
to measure goals led to allegations of secret and covert waitlists which resulted in a loss of confidence
and trust in the system.
In, the wake of the crisis and in response to a public outcry VA began publicly posting patient wait time
data on line. Few, if any, health systems were doing this and in its' efforts to be transparent, VA forged
new ground in doing so. We consulted with the National Academy Medicine and a number of other
industry and thought leaders it became clear that no standards for wait times existed and VA would
have to create a new set of terminology. What followed was reports on appointments from the time
they were requested, created, completed, when the patient wanted the appointment, when the
clinician wanted the on (using 31 different preferences to order a consult). With more than 50 million
appointments a year, and descriptive statistics on appointments in a large number of different ways
VA is also transitioning from a system that focused almost exclusively on data that compared its
performance to others in the VA system, to comparisons with the private sector. While numerous
independent assessments have found that overall VA provides care that is comparable with or superior
to the private sector, we recognize that overall metrics obscure weak performance in selected facilities
and furthermore that veterans seek care comparisons in their local community and not at the national
level.
For decades, VA has led the healthcare in reporting on comprehensive performance metrics that are
not readily reported by most other healthcare organizations. We believe our measures enable high
performance and include extensive ambulatory measures, behavioral healthcare metrics, and leadership
and nursing turnover rates. Called Strategic Analytics for Improvement and Learning (SAIL) we invite
others to adopt these metrics so our comparisons to the private sector become more robust.
As part of VA's modernization efforts, focusing on veterans needs and preferences, VA has launched
on line informant on wait times, veteran experience, and quality that veterans can use to make
decisions about their care.
As we continually improve this approach, guided by veterans feedback, we hope others in the
community will join us. This will allow veterans to seek the care that is best for them and to be able to
find care either in the vA, or in the community, that best fits their needs and delivers optimal outcomes.
The VA of the future must be based on what veterans want and how they want to receive care. In his
book, "Best Care Anywhere" author Philip Longman described the VA healthcare system as a model
system of care. Ten years later, as we define our network to include both the VA system and our
federal, academic, and community partners, we seek to expand Longman notion and believe that we
are on the cusp on being able to deliver the best care everywhere.
VA-19-0799-D-001182
OS 00002853
what resulted was tantamount to a data dump. The metrics, while comprehensive and accurate,they
had little meaning to member of Congress that were holding the Department accountable, to medical
reporting on VA to taxpayers who fund it, or most important to Veterans who rely on VA for care.
I recall sitting in a radio interview with a reporter trying to interpret our online wait time data and it
became apparent to me in do so that that we had created metrics so complex that despite my best
efforts few people were likely to understand what I had said.
I realized then and there that there
needed to be a better way
With all of our measurements, VA had never analyzed wait time by clinical urgency. In response to the
2014 wait time crisis, VA initially had focused only on those veterans waiting the longest for care and
failed to differentiate between those waiting for routine care and those that were at greatest risk for
potential harm.
Once we shifted to reporting our data as routne or urgent we began to see the true
extent of our access problems. That led us to be able to define and target solutions to geographic
locations that needed the most help.
VA is now reporting its' data for routine care and urgent care. It is also using a single measure of wait
times- the patient indicated date. This date reflects that outcome of a discussion that the has with
their clinician, as an established relationship exists. Waits are reported from the time that this patient
indicated date. For new patients wait times are reported from the date the veteran requests an
VA is also transitioning from a system that focused almost exclusively on data that compared its
performance to others in the VA system, to comparisons with the private sector. While numerous
independent assessments have found that overall VA provides care that is comparable with or superior
to the private sector, we recognize that overall metrics obscure weak performance in selected facilities
and furthermore that veterans seek care comparisons in their local community and not at the national
level.
For decades, VA has led the healthcare in reporting on comprehensive performance metrics that are
not readily reported by most other healthcare organizations. We believe our measures enable high
performance and include extensive ambulatory measures, behavioral healthcare metrics, and leadership
and nursing turnover rates. Called Strategic Analytics for Improvement and Learning (SAIL) we invite
others to adopt these metrics so our comparisons to the private sector become more robust.
As part of VA's modernization efforts, focusing on veterans needs and preferences, VA has launched
on line informant on wait times, veteran experience, and quality that veterans can use to make
decisions about their care.
As we continually improve this approach, guided by veterans feedback, we hope others in the
community will join us. This will allow veterans to seek the care that is best for them and to be able to
find care either in the vA, or in the community, that best fits their needs and delivers optimal outcomes.
The VA of the future must be based on what veterans want and how they want to receive care. In his
book, "Best Care Anywhere" author Philip Longman described the VA healthcare system as a model
system of care. Ten years later, as we define our network to include both the VA system and our
federal, academic, and community partners, we seek to expand Longman notion and believe that we
are on the cusp on being able to deliver the best care everywhere.
VA-19-0799-D-001183
OS 00002854
appointment. VA also reports on the veterans experience with access to care. Using the Clinical-Group
CAHPS survey, data is reported by site.
VA is also transitioning from a system that focused almost exclusively on data that compared its
performance to others in the VA system, to comparisons with the private sector. While numerous
independent assessments have found that overall VA provides care that is comparable with or superior
to the private sector, we recognize that overall metrics obscure weak performance in selected facilities
and furthermore that veterans seek care comparisons in their local community and not at the national
level.
For decades, VA has led the healthcare in reporting on comprehensive performance metrics that are
not readily reported by most other healthcare organizations. We believe our measures enable high
performance and include extensive ambulatory measures, behavioral healthcare metrics, and leadership
and nursing turnover rates. Called Strategic Analytics for Improvement and Learning (SAIL) we invite
others to adopt these metrics so our comparisons to the private sector become more robust.
As part of VA's modernization efforts, focusing on veterans needs and preferences, VA has launched
on line informant on wait times, veteran experience, and quality that veterans can use to make
decisions about their care.
As we continually improve this approach, guided by veterans feedback, we hope others in the
community will join us. This will allow veterans to seek the care that is best for them and to be able to
find care either in the vA, or in the community, that best fits their needs and delivers optimal outcomes.
The VA of the future must be based on what veterans want and how they want to receive care. In his
book, "Best Care Anywhere" author Philip Longman described the VA healthcare system as a model
system of care. Ten years later, as we define our network to include both the VA system and our
federal, academic, and community partners, we seek to expand Longman notion and believe that we
are on the cusp on being able to deliver the best care everywhere.
VA-19-0799-D-001184
OS 00002855
Message
From:
(b) (6)
Sent:
4/3/2017 9:27:32 PM
David Shulkin [drshulkin@aol.com]
Documents you typed on my computer
advisoryletter.docx; annals.docx
To:
Subject:
Attachments:
[(b) (6)
gmail.com]
ACMO is working on doc I under MyvA advisory committee
(b) (6)
---------- Forwarded message---------From: (b) (6)
<(b) (6)
Date: Thu, Mar 30, 2017 at 7:54 PM
Subject: Documents from last night
To: David Shulkin
gmail.com>
attached
VA-19-0799-D-001185
OS 00002856
As we work to transform the US Department of Veterans Administration, I am seeking your expertise in
guiding us through these efforts. I would be honored if you would serve on our board of advisors to
help us shape the future of VA. This newly formed group will be called the Secretary's Advisory Board
and will be replacing the myVA Committee. As such, it will operate as a FACCA (Federal Advisory
Committee) so that meetings are open to the public.
The Secretrary's Advisory Board will focus on strategic directions and policy issues that facing VA and
veterans. The Board will consist of approximately members and meet three times a year for one day
each. Meetings will usually be held in Washington DC or on occasion in a field location.
I realize that you are busy and I am appreciative of your consideration of this important work. I look
forward to hearing from you.
Sincrerely,
David Shulkin MD
VA-19-0799-D-001186
OS 00002857
Putting Veterans in Control of Their Care
The 2014 access crisis at the Department of Veterans Affairs was a pivotal moment for VA. Daily media
accounts, like non-stop drumbeats- reported that Veterans were on long waitlist for care and at
suggested that some were dying while they. The extent of VA's access problems, like many others in
US Health care, was not immediately clear. The Department had difficult to understand wait time
metrics exacerbated by arbitrary scheduling goals that it could not meet. Those hard-to-meet and hard
to measure goals led to allegations of secret and covert waitlists which resulted in a loss of confidence
and trust in the system.
In, the wake of the crisis and in response to a public outcry VA began publicly posting patient wait time
data on line. Few, if any, health systems were doing this and in its' efforts to be transparent, VA forged
new ground in doing so. We consulted with the National Academy Medicine and a number of other
industry and thought leaders it became clear that no standards for wait times existed and VA would
have to create a new set of terminology. What followed was reports on appointments from the time
they were requested, created, completed, when the patient wanted the appointment, when the
clinician wanted the on (using 31 different preferences to order a consult). With more than 50 million
appointments a year, and descriptive statistics on appointments in a large number of different ways
VA is also transitioning from a system that focused almost exclusively on data that compared its
performance to others in the VA system, to comparisons with the private sector. While numerous
independent assessments have found that overall VA provides care that is comparable with or superior
to the private sector, we recognize that overall metrics obscure weak performance in selected facilities
and furthermore that veterans seek care comparisons in their local community and not at the national
level.
For decades, VA has led the healthcare in reporting on comprehensive performance metrics that are
not readily reported by most other healthcare organizations. We believe our measures enable high
performance and include extensive ambulatory measures, behavioral healthcare metrics, and leadership
and nursing turnover rates. Called Strategic Analytics for Improvement and Learning (SAIL) we invite
others to adopt these metrics so our comparisons to the private sector become more robust.
As part of VA's modernization efforts, focusing on veterans needs and preferences, VA has launched
on line informant on wait times, veteran experience, and quality that veterans can use to make
decisions about their care.
As we continually improve this approach, guided by veterans feedback, we hope others in the
community will join us. This will allow veterans to seek the care that is best for them and to be able to
find care either in the vA, or in the community, that best fits their needs and delivers optimal outcomes.
The VA of the future must be based on what veterans want and how they want to receive care. In his
book, "Best Care Anywhere" author Philip Longman described the VA healthcare system as a model
system of care. Ten years later, as we define our network to include both the VA system and our
federal, academic, and community partners, we seek to expand Longman notion and believe that we
are on the cusp on being able to deliver the best care everywhere.
VA-19-0799-D-001187
OS 00002858
what resulted was tantamount to a data dump. The metrics, while comprehensive and accurate,they
had little meaning to member of Congress that were holding the Department accountable, to medical
reporting on VA to taxpayers who fund it, or most important to Veterans who rely on VA for care.
I recall sitting in a radio interview with a reporter trying to interpret our online wait time data and it
became apparent to me in do so that that we had created metrics so complex that despite my best
efforts few people were likely to understand what I had said.
I realized then and there that there
needed to be a better way
With all of our measurements, VA had never analyzed wait time by clinical urgency. In response to the
2014 wait time crisis, VA initially had focused only on those veterans waiting the longest for care and
failed to differentiate between those waiting for routine care and those that were at greatest risk for
potential harm.
Once we shifted to reporting our data as routne or urgent we began to see the true
extent of our access problems. That led us to be able to define and target solutions to geographic
locations that needed the most help.
VA is now reporting its' data for routine care and urgent care. It is also using a single measure of wait
times- the patient indicated date. This date reflects that outcome of a discussion that the has with
their clinician, as an established relationship exists. Waits are reported from the time that this patient
indicated date. For new patients wait times are reported from the date the veteran requests an
VA is also transitioning from a system that focused almost exclusively on data that compared its
performance to others in the VA system, to comparisons with the private sector. While numerous
independent assessments have found that overall VA provides care that is comparable with or superior
to the private sector, we recognize that overall metrics obscure weak performance in selected facilities
and furthermore that veterans seek care comparisons in their local community and not at the national
level.
For decades, VA has led the healthcare in reporting on comprehensive performance metrics that are
not readily reported by most other healthcare organizations. We believe our measures enable high
performance and include extensive ambulatory measures, behavioral healthcare metrics, and leadership
and nursing turnover rates. Called Strategic Analytics for Improvement and Learning (SAIL) we invite
others to adopt these metrics so our comparisons to the private sector become more robust.
As part of VA's modernization efforts, focusing on veterans needs and preferences, VA has launched
on line informant on wait times, veteran experience, and quality that veterans can use to make
decisions about their care.
As we continually improve this approach, guided by veterans feedback, we hope others in the
community will join us. This will allow veterans to seek the care that is best for them and to be able to
find care either in the vA, or in the community, that best fits their needs and delivers optimal outcomes.
The VA of the future must be based on what veterans want and how they want to receive care. In his
book, "Best Care Anywhere" author Philip Longman described the VA healthcare system as a model
system of care. Ten years later, as we define our network to include both the VA system and our
federal, academic, and community partners, we seek to expand Longman notion and believe that we
are on the cusp on being able to deliver the best care everywhere.
VA-19-0799-D-001188
OS 00002859
appointment. VA also reports on the veterans experience with access to care. Using the Clinical-Group
CAHPS survey, data is reported by site.
VA is also transitioning from a system that focused almost exclusively on data that compared its
performance to others in the VA system, to comparisons with the private sector. While numerous
independent assessments have found that overall VA provides care that is comparable with or superior
to the private sector, we recognize that overall metrics obscure weak performance in selected facilities
and furthermore that veterans seek care comparisons in their local community and not at the national
level.
For decades, VA has led the healthcare in reporting on comprehensive performance metrics that are
not readily reported by most other healthcare organizations. We believe our measures enable high
performance and include extensive ambulatory measures, behavioral healthcare metrics, and leadership
and nursing turnover rates. Called Strategic Analytics for Improvement and Learning (SAIL) we invite
others to adopt these metrics so our comparisons to the private sector become more robust.
As part of VA's modernization efforts, focusing on veterans needs and preferences, VA has launched
on line informant on wait times, veteran experience, and quality that veterans can use to make
decisions about their care.
As we continually improve this approach, guided by veterans feedback, we hope others in the
community will join us. This will allow veterans to seek the care that is best for them and to be able to
find care either in the vA, or in the community, that best fits their needs and delivers optimal outcomes.
The VA of the future must be based on what veterans want and how they want to receive care. In his
book, "Best Care Anywhere" author Philip Longman described the VA healthcare system as a model
system of care. Ten years later, as we define our network to include both the VA system and our
federal, academic, and community partners, we seek to expand Longman notion and believe that we
are on the cusp on being able to deliver the best care everywhere.
VA-19-0799-D-001189
OS 00002860
Message
From:
Poonam Alaigh [(b) (6)
Sent:
5/4/2017 10:08:43 PM
To:
Bruce Moskowitz [(b) (6)
David shulkin [Drshulkin@aol.com]
Re: Suicide prevention
CC:
Subject:
hotmail.com]
mac.com]
Thanks so much- you are such an awesome partner!! We will make a difference in suicide Prevention- that
is our conviction!!
Sent from my iPhone
> on May 4, 2017, at 12:35 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> Very important ultimately we need their resources to have more psychologists and psychiatric services
available to the VA. That is my main goal.
>
> Sent from my iPad
> Bruce Moskowitz M.D.
>
>> on May 4, 2017, at 12:30 PM, David shulkin wrote:
>>
>> We have the most advance analytics on this- called reachvet if its helpful
>>
>> Sent from my iPhone
>>
>>> on May 4, 2017, at 12:29 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>>>
the President of the u of PENN has agreed to work with me to put together a consortium to
>>> (b) (6)
work on early detection of who is at risk and a consortium to have more resources for treatment. We need
more resources for the VA to solve the problem and also this is important to decrease University suicide
risk.
>>>
>>> Sent from my iPad
>>> Bruce Moskowitz M.D.
>>
VA-19-0799-D-001190
OS 00002861
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
5/4/2017 4:30:51 PM
To:
Bruce Moskowitz [(b) (6)
Re: Suicide prevention
Subject:
mac.com]
We have the most advance analytics on this- called reachvet if its helpful
Sent from my iPhone
> on May 4, 2017, at 12:29 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> (b) (6)
the President of the u of PENN has agreed to work with me to put together a consortium to
work on early detection of who is at risk and a consortium to have more resources for treatment. We need
more resources for the VA to solve the problem and also this is important to decrease University suicide
risk.
>
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-001191
OS 00002862
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
5/4/2017 4:29:05 PM
Poonam Alaigh [(b) (6)
hotmail.com]
David shulkin [drshulkin@aol.com]
Suicide prevention
(b) (6)
the President of the u of PENN has agreed to work with me to put together a consortium to
work on early detection of who is at risk and a consortium to have more resources for treatment. We need
more resources for the VA to solve the problem and also this is important to decrease University suicide
risk.
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-001192
OS 00002863
Message
From:
(b) (6)
[(b) (6)
Sent:
To:
4/16/2017 4:04:50 PM
David shulkin [Drshulkin@aol.com]
Subject:
Re:
gmail.com]
Yes
On Sun, Apr 16, 2017 at 11 :58 AM David shulkin wrote:
Can we talk about telling the wsj tommorow about the WH correspondents dinner ?
Sent from my iPhone
Sent from Gmail Mobile
VA-19-0799-D-001193
OS 00002864
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/16/2017 3:58:26 PM
To:
(b) (6)
[(b) (6)
gmail.com]
can we talk about telling the wsj tommorow about the WH correspondents dinner?
Sent from my iPhone
VA-19-0799-D-001194
OS 00002865
Message
David Shulkin [Drshulkin@aol.com]
4/6/2017 1:56:16 AM
Darin Selnick [(b) (6)
@gmail.com]
Re: [EXTERNAL] FW: VA Secretary Praises Congress for Extending Choice Program
From:
Sent:
To:
Subject:
Ok I trust your judgement
Sent from my iPad
On Apr 5, 2017, at 9: 10 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
Yes, he is the guy who has been catching and fixing issues in OCLA despite not having any
authority. We would not have ever fixed the Sen Lee hold without him, he was the guy who
organized and led the quick response for the McCain and Lee staff and they are very
grateful. Once in as Asst Sec, he is ready to overhaul and lead OCLA to be a well run machine.
I do not know what you are hearing that would be of concern about Brooks, if you want to share
them I can give you my perspective.
Darin
Darin
On Wed, Apr 5, 2017 at 6:03 PM, David shulkin wrote:
Im getting some concerns about Brooks- are you confident he is our right choice for
Asst secretary?
Sent from my iPhone
On Apr 5, 2017, at 8:46 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
This was sent to me today from (b) (6)
who works for Sen Moran. I
think you should be aware of this, but I know (b) (6)
well and she has a
tendency to overreact. I do not think we should overreact as well, but use this as
a learning experience for sending out these type of news releases. Neither
Brooks nor I saw the VA press release before it went out and we only found out
about it from (b) (6)
Brooks is checking out who did see it, but we need a better process to ensure we
list all the members who need to be listed based on their support. (b) (6)
is
right that Sen Moran should have been listed as well. I have a phone meeting
with her tomorrow, and I understand from Brooks that he had Sen Moran on the
list for the WH of who should be at the signing ceremony.
Darin
-----Original Message----From: (b) (6) (b) (6)
(Moran) [(b) (6)
moran.senate.gov]
VA-19-0799-D-001195
OS 00002866
Sent: Wednesday, April 05, 2017 05:27 PM Eastern Standard Time
To: Selnick, Darin
Subject: [EXTERNAL] FW: VA Secretary Praises Congress for Extending
Choice Program
This is just poor form. Moran and our office did a lot of work to get this bill moving.
know McCain catches the headlines but Moran is VA's appropriator not to mention
your biggest backer on Choice reforms.
Sorry to vent but this yet another slap by the VA and you're the only person I really
know the send a message that it's unacceptable.
From:
(b) (6)
(Moran)
Sent: Wednesday, April 5, 2017 5:23 PM
(b) (6)
(Moran) <(b) (6)
moran.senate.gov>; (b) (6)
<
moran.senate.gov>
Cc: (b) (6)
(Moran) <(b) (6)
moran.senate.gov>; (b) (6)
(b) (6)
(Moran) <
moran.senate.gov>
Subject: FW: VA Secretary Praises Congress for Extending Choice Program
To:
(b) (6)
(b) (6)
(Moran)
(b) (6)
Boo, VA. Boo.
From: VA Congressional Notifications
fmailto:VACongressionalNotifications@public.govdel ivery.com l
Sent: Wednesday, April 05, 2017 5:20 PM
(Moran) <(b) (6)
moran.senate.gov>
Subject: VA Secretary Praises Congress for Extending Choice Program
To:
(b) (6)
U.S. Department of Veterans Affairs
Office of Congressional and Legislative Affairs
VA Secretary Praises Congress for Extendi1
Choice Program
VA-19-0799-D-001196
OS 00002867
Calls legislation major step toward increasing access to care
WASHINGTON - Today, following the U.S. Senate's passage by unanimous consent last week, the U.S. House
Representatives passed legislation that extends the Veterans Choice Program (VCP) until the funding dedicated I
program is exhausted. The VCP is a critical program that increases access to care for millions of Veterans. Witho
legislation, the ability to use VCP funding would have ended abruptly on Aug. 7 of this year. Secretary of Veteran:
Dr. David J. Shulkin released the following statement of support:
"Congress has once again demonstrated that the country stands firmly united when it comes to supporting our na
Veterans," Secretary Shulkin said. "The Department of Veterans Affairs truly appreciates the quick bipartisan resc
Congress provided with the extension of the Veterans Choice Program.
"I want to thank Chairman Johnny Isakson, Ranking Member Jon Tester, Chairman Phil Roe, Ranking Member Ti
and all the members of our committees for their leadership as we continue to make improvements to increase Ve1
access to care," Secretary Shulkin continued. "I also want to thank Senator John McCain, who has championed c
Veterans and whose work on this issue allowed for swift and successful resolution. "VA looks forward to continue1
bipartisan support as we partner with Congress to not only develop a long-term solution for community care, but ~
toward other critical legislation, such as accountability and appeals modernization to ensure Veterans receive the
quality of care, benefits and support they have earned."
###
U.S. Department
of Veterans Affairs
Office of Congressional
and Legislative Affairs
We value our Congressional partners, and that's wl
have created our VA Casework Guide to help yo
you assist our shared Veteran constituents.
You have received this message because you have been identified as interested in Veterans issues and are subscr
VA's Office of Congressional and Legislative Affairs - Congressional Distribution List. Access your
Subscribers Preferences to make changes to your subscription or unsubscribe.
Get this as aforward? Sign up to receive important updates from the Department of Veterans Affairs. Have
questions or Problems? Please contact subscriberhelp.govdelivery.com for assistance.
This email was sent to (b) (6)
moran.senate.gov using GovDelivery, on behalf of:
U.S. Department of Veterans Affairs, Office of Government Relations
810 Vermont Avenue, NW . Washington, DC 20420
VA-19-0799-D-001197
OS 00002868
Message
David shulkin [Drshulkin@aol.com]
4/6/2017 1:03:02 AM
Darin Selnick [(b) (6)
@gmail.com]
Re: [EXTERNAL] FW: VA Secretary Praises Congress for Extending Choice Program
From:
Sent:
To:
Subject:
Im getting some concerns about Brooks- are you confident he is our right choice for
Asst secretary?
Sent from my iPhone
On Apr 5, 2017, at 8:46 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
This was sent to me today from (b) (6)
who works for Sen Moran. I think you should be
well and she has a tendency to overreact. I do not think we
aware of this, but I know (b) (6)
should overreact as well, but use this as a learning experience for sending out these type of news
releases. Neither Brooks nor I saw the VA press release before it went out and we only found
out about it from (b) (6)
Brooks is checking out who did see it, but we need a better process to ensure we list all the
members who need to be listed based on their support. (b) (6)
is right that Sen Moran should
have been listed as well. I have a phone meeting with her tomorrow, and I understand from
Brooks that he had Sen Moran on the list for the WH of who should be at the signing ceremony.
Darin
-----Original Message----From: (b) (6) (b) (6)
(Moran) [(b) (6)
moran.senate.gov]
Sent: Wednesday, April 05, 2017 05:27 PM Eastern Standard Time
To: Selnick, Darin
Subject: [EXTERNAL] FW: VA Secretary Praises Congress for Extending Choice Program
This is just poor form. Moran and our office did a lot of work to get this bill moving. I know McCain
catches the headlines but Moran is VA's appropriator not to mention your biggest backer on Choice
reforms.
Sorry to vent but this yet another slap by the VA and you're the only person I really know the send a
message that it's unacceptable.
From: (b) (6)
(Moran)
Sent: Wednesday, April 5, 2017 5:23 PM
To: (b) (6) (b) (6)
(Moran) <(b) (6)
(b) (6)
<
moran.senate.gov>
Cc: (b) (6)
(Moran) <(b) (6)
moran.senate.gov>; (b) (6)
moran.senate.gov>;
(b) (6)
(b) (6)
(Moran)
(Moran)
VA-19-0799-D-001198
OS 00002869
<(b) (6)
moran.senate.gov>
Subject: FW: VA Secretary Praises Congress for Extending Choice Program
Boo, VA. Boo.
From: VA Congressional Notifications [mailto:VACongressionalNotifications@public.govdelivery.com ]
Sent: Wednesday, April 05, 2017 5:20 PM
(Moran) <(b) (6)
moran.senate.gov>
Subject: VA Secretary Praises Congress for Extending Choice Program
To:
(b) (6)
U.S. Department of Veterans Affairs
Office of Congressional and Legislative Affairs
VA Secretary Praises Congress for Extending
Choice Program
Calls legislation major step toward increasing access to care
WASHINGTON - Today, following the U.S. Senate's passage by unanimous consent last week, the U.S. House of
Representatives passed legislation that extends the Veterans Choice Program (VCP) until the funding dedicated to the
program is exhausted. The VCP is a critical program that increases access to care for millions of Veterans. Without this
legislation, the ability to use VCP funding would have ended abruptly on Aug. 7 of this year. Secretary of Veterans Affairs
Dr. David J. Shulkin released the following statement of support:
"Congress has once again demonstrated that the country stands firmly united when it comes to supporting our nation's
Veterans," Secretary Shulkin said. "The Department of Veterans Affairs truly appreciates the quick bipartisan resolution
Congress provided with the extension of the Veterans Choice Program.
"I want to thank Chairman Johnny Isakson, Ranking Member Jon Tester, Chairman Phil Roe, Ranking Member Tim Walz
and all the members of our committees for their leadership as we continue to make improvements to increase Veterans'
access to care," Secretary Shulkin continued. "I also want to thank Senator John McCain, who has championed choice for
Veterans and whose work on this issue allowed for swift and successful resolution. "VA looks forward to continued
bipartisan support as we partner with Congress to not only develop a long-term solution for community care, but also work
toward other critical legislation, such as accountability and appeals modernization to ensure Veterans receive the highest
quality of care, benefits and support they have earned."
###
VA-19-0799-D-001199
OS 00002870
U.S. Department
of Veterans Affai rs
Office of Congressional
and Legislative Affairs
We value our Congressional partners, and that's why we
have created our VA Casework Guide to help you as
you assist our shared Veteran constituents.
You have received this message because you have been identified as interested in Veterans issues and are subscribed to
VA's Office of Congressional and Legislative Affairs - Congressional Distribution List. Access your
Subscribers Preferences to make changes to your subscription or unsubscribe.
Get this as aforward? Sign up to receive important updates from the Department of Veterans Affairs. Have
questions or Problems? Please contact subscriberhelp.govdelivery.com for assistance.
This email was sent to (b) (6)
moran.senate .gov using GovDelivery, on behalf of:
U.S. Department of Veterans Affairs, Office of Government Relations
810 Vermont Avenue, NW . Washington, DC 20420
VA-19-0799-D-001200
OS 00002871
Message
David shulkin [Drshulkin@aol.com]
4/6/2017 1:01:55 AM
Darin Selnick [(b) (6)
@gmail.com]
Re: [EXTERNAL] FW: VA Secretary Praises Congress for Extending Choice Program
From:
Sent:
To:
Subject:
Good pick up
Thanks
Sent from my iPhone
On Apr 5, 2017, at 8:46 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
This was sent to me today from (b) (6)
who works for Sen Moran. I think you should be
(b) (6)
well and she has a tendency to overreact. I do not think we
aware of this, but I know
should overreact as well, but use this as a learning experience for sending out these type of news
releases. Neither Brooks nor I saw the VA press release before it went out and we only found
out about it from (b) (6)
Brooks is checking out who did see it, but we need a better process to ensure we list all the
members who need to be listed based on their support. (b) (6)
is right that Sen Moran should
have been listed as well. I have a phone meeting with her tomorrow, and I understand from
Brooks that he had Sen Moran on the list for the WH of who should be at the signing ceremony.
Darin
-----Original Message----From: (b) (6) (b) (6)
(Moran) [(b) (6)
moran.senate.gov]
Sent: Wednesday, April 05, 2017 05:27 PM Eastern Standard Time
To: Selnick, Darin
Subject: [EXTERNAL] FW: VA Secretary Praises Congress for Extending Choice Program
This is just poor form. Moran and our office did a lot of work to get this bill moving. I know McCain
catches the headlines but Moran is VA's appropriator not to mention your biggest backer on Choice
reforms.
Sorry to vent but this yet another slap by the VA and you're the only person I really know the send a
message that it's unacceptable.
From: (b) (6)
(Moran)
Sent: Wednesday, April 5, 2017 5:23 PM
To: (b) (6) (b) (6)
(Moran) <(b) (6)
(b) (6)
<
moran.senate.gov>
(b) (6)
Cc:
(Moran) <(b) (6)
moran.senate.gov>; (b) (6)
moran.senate.gov>;
(b) (6)
(b) (6)
(Moran)
(Moran)
VA-19-0799-D-001201
OS 00002872
<(b) (6)
moran.senate.gov>
Subject: FW: VA Secretary Praises Congress for Extending Choice Program
Boo, VA. Boo.
From: VA Congressional Notifications [mailto:VACongressionalNotifications@public.govdelivery.com ]
Sent: Wednesday, April 05, 2017 5:20 PM
(Moran) <(b) (6)
moran.senate.gov>
Subject: VA Secretary Praises Congress for Extending Choice Program
To:
(b) (6)
U.S. Department of Veterans Affairs
Office of Congressional and Legislative Affairs
VA Secretary Praises Congress for Extending
Choice Program
Calls legislation major step toward increasing access to care
WASHINGTON - Today, following the U.S. Senate's passage by unanimous consent last week, the U.S. House of
Representatives passed legislation that extends the Veterans Choice Program (VCP) until the funding dedicated to the
program is exhausted. The VCP is a critical program that increases access to care for millions of Veterans. Without this
legislation, the ability to use VCP funding would have ended abruptly on Aug. 7 of this year. Secretary of Veterans Affairs
Dr. David J. Shulkin released the following statement of support:
"Congress has once again demonstrated that the country stands firmly united when it comes to supporting our nation's
Veterans," Secretary Shulkin said. "The Department of Veterans Affairs truly appreciates the quick bipartisan resolution
Congress provided with the extension of the Veterans Choice Program.
"I want to thank Chairman Johnny Isakson, Ranking Member Jon Tester, Chairman Phil Roe, Ranking Member Tim Walz
and all the members of our committees for their leadership as we continue to make improvements to increase Veterans'
access to care," Secretary Shulkin continued. "I also want to thank Senator John McCain, who has championed choice for
Veterans and whose work on this issue allowed for swift and successful resolution. "VA looks forward to continued
bipartisan support as we partner with Congress to not only develop a long-term solution for community care, but also work
toward other critical legislation, such as accountability and appeals modernization to ensure Veterans receive the highest
quality of care, benefits and support they have earned."
###
VA-19-0799-D-001202
OS 00002873
U.S. Department
of Veterans Affai rs
Office of Congressional
and Legislative Affairs
We value our Congressional partners, and that's why we
have created our VA Casework Guide to help you as
you assist our shared Veteran constituents.
You have received this message because you have been identified as interested in Veterans issues and are subscribed to
VA's Office of Congressional and Legislative Affairs - Congressional Distribution List. Access your
Subscribers Preferences to make changes to your subscription or unsubscribe.
Get this as aforward? Sign up to receive important updates from the Department of Veterans Affairs. Have
questions or Problems? Please contact subscriberhelp.govdelivery.com for assistance.
This email was sent to (b) (6)
moran.senate .gov using GovDelivery, on behalf of:
U.S. Department of Veterans Affairs, Office of Government Relations
810 Vermont Avenue, NW . Washington, DC 20420
VA-19-0799-D-001203
OS 00002874
Message
From:
Sent:
To:
Subject:
Darin Selnick [(b) (6)
@gmail.com]
4/6/2017 12:46:24 AM
David shulkin [Drshulkin@aol.com]
Fwd: FW: [EXTERNAL] FW: VA Secretary Praises Congress for Extending Choice Program
This was sent to me today from (b) (6)
who works for Sen Moran. I think you should be aware of this,
but I know (b) (6)
well and she has a tendency to overreact. I do not think we should overreact as well, but
use this as a learning experience for sending out these type of news releases. Neither Brooks nor I saw the VA
press release before it went out and we only found out about it from (b) (6)
Brooks is checking out who did see it, but we need a better process to ensure we list all the members who need
to be listed based on their support. (b) (6)
is right that Sen Moran should have been listed as well. I have a
phone meeting with her tomorrow, and I understand from Brooks that he had Sen Moran on the list for the WH
of who should be at the signing ceremony.
Darin
-----Original Message----From: (b) (6) (b) (6)
(Moran) [(b) (6)
moran.senate.gov]
Sent: Wednesday, April 05, 2017 05:27 PM Eastern Standard Time
To: Selnick, Darin
Subject: [EXTERNAL] FW: VA Secretary Praises Congress for Extending Choice Program
This is just poor form. Moran and our office did a lot of work to get this bill moving. I know McCain catches the
headlines but Moran is VA's appropriator not to mention your biggest backer on Choice reforms.
Sorry to vent but this yet another slap by the VA and you're the only person I really know the send a message that it's
unacceptable.
(b) (6)
(Moran)
Sent: Wednesday, April 5, 2017 5:23 PM
(b) (6)
To: (b) (6) (b) (6)
(Moran) <(b) (6)
moran.senate.gov>; (b) (6)
(b) (6)
<
moran.senate.gov>
(b) (6)
Cc:
(Moran) <(b) (6)
moran.senate.gov>; (b) (6)
(b) (6)
<
moran.senate.gov>
Subject: FW: VA Secretary Praises Congress for Extending Choice Program
From:
(Moran)
(Moran)
Boo, VA. Boo.
VA-19-0799-D-001204
OS 00002875
From: VA Congressional Notifications [mailto:VACongressionalNotifications@public.govdelivery.com ]
Sent: Wednesday, April 05, 2017 5:20 PM
(Moran) <(b) (6)
moran.senate.gov>
Subject: VA Secretary Praises Congress for Extending Choice Program
To:
(b) (6)
U.S. Department of Veterans Affairs
Office of Congressional and Legislative Affairs
VA Secretary Praises Congress for Extending
Choice Program
Calls legislation major step toward increasing access to care
Today, following the U.S. Senate's passage by unanimous consent last week, the U.S. House of
Representatives passed legislation that extends the Veterans Choice Program (VCP) until the funding dedicated to the
program is exhausted. The VCP is a critical program that increases access to care for millions of Veterans. Without this
legislation, the ability to use VCP funding would have ended abruptly on Aug. 7 of this year. Secretary of Veterans Affairs
Dr. David J. Shulkin released the following statement of support:
"Congress has once again demonstrated that the country stands firmly united when it comes to supporting our nation's
Veterans," Secretary Shulkin said. "The Department of Veterans Affairs truly appreciates the quick bipartisan resolution
Congress provided with the extension of the Veterans Choice Program.
"I want to thank Chairman Johnny Isakson, Ranking Member Jon Tester, Chairman Phil Roe, Ranking Member Tim Walz
and all the members of our committees for their leadership as we continue to make improvements to increase Veterans'
access to care," Secretary Shulkin continued. "I also want to thank Senator John McCain, who has championed choice for
Veterans and whose work on this issue allowed for swift and successful resolution. "VA looks forward to continued
bipartisan support as we partner with Congress to not only develop a long-term solution for community care, but also work
toward other critical legislation, such as accountability and appeals modernization to ensure Veterans receive the highest
quality of care, benefits and support they have earned."
###
WASHINGTON -
U.S. Department
of Veterans Affairs
Office of Congressional
and Legislative Affairs
We value our Congressional partners, and that's why we
have created our VA Casework Guide to help you as
you assist our shared Veteran constituents.
You have received this message because you have been identified as interested in Veterans issues and are subscribed to
VA's Office of Congressional and Legislative Affairs - Congressional Distribution List. Access your
Subscribers Preferences to make changes to your subscription or unsubscribe.
VA-19-0799-D-001205
OS 00002876
Get this as a forward? Sign up to receive important updates from the Department of Veterans Affairs. Have
questions or Problems? Please contact subscriberhelp.govdelivery.com for assistance.
This email was sent to (b) (6)
moran.senate .gov using GovDelivery, on behalf of:
U.S. Department of Veterans Affairs, Office of Government Relations
810 Vermont Avenue, NW . Washington, DC 20420
VA-19-0799-D-001206
OS
(b) (6)
Message
David shulkin [Drshulkin@aol.com]
3/31/2017 3:47:40 PM
David Shulkin [drshulkin@aol.com]
Marc Sherman [(b) (6)
gmail.com]
Re: Infrastructure
From:
Sent:
To:
CC:
Subject:
Marc- we can discuss more when we meet
David
Sent from my iPhone
On Mar 31, 2017, at 11:32 AM,
(b) (6)
(b) (6)
(b) (6)
va.gov> wrote:
Good Morning Marc,
Dr. Shulkin asked that I share the analysis of the initial realignment proposals for our
facilities ( first attachement). Additionally, please find the recommendation from our staff
(powerpoint) to request congress establish a BRAC to facilitate this process.
(b) (6)
VA-19-0799-D-001207
OS 00002878
Message
From:
(b) (6)
Sent:
To:
3/31/2017 3:32:22 PM
'Marc Sherman' [(b) (6)
gmail.com]; 'drshulkin@aol.com' [drshulkin@aol.com]
Infrastructure
Infrastructure Background - Facilities.pdf; SECVA Briefing Independent Review Commission for VHA Facilities and
Capi .... pptx
Subject:
Attachments:
(b) (6)
[(b) (6)
va.gov]
Good Morning Marc,
Dr. Shulkin asked that I share the analysis of the initial realignment proposals for our facilities ( first
attachement). Additionally, please find the recommendation from our staff (powerpoint) to request
congress establish a BRAC to facilitate this process.
(b) (6)
VA-19-0799-D-001208
OS 00002879
1.
Background
The United States (US) Department of Veterans Affairs (VA} operates one of the largest, integrated
health care systems in the country. It delivers this care through over 1,600 points of care that lt either
leases or owns outright.
Over the decades, as the US Veteran population has migrated, VA's capital infrastructure has not been
able to keep pace with those changes due to the inabi!lty to rapidly divest from its operating locations
where Veterans were moving from (legacy locations) to where Veterans were moving. Additionally, as
care delivery models shifted away from long inpatient stays to greater outpatient care, VA has
increasingly found itself with capital infrastructure not ideally suited to current trends in health care.
VA has initiated or participated in numerous studies over the past decade, or so, focused on better
aligning health care facilities to more efficiently deliver health care to Veterans.
This document provides results of a recent summary data call performed by the Veterans Health
Administration (VHA) that requested input from VHA's operating networks as to viable options to realign
facilities to more efficiently deliver care to Veterans.
The summary contained in this document does not include financial impact of realignments nor does lt
assess the political feasibility of such realignments.
2.
initial Realignment Proposals
Table 2-1 provides a listing of Veterans Integrated Service Network {V!SN) and Facility of potential
realignments. These realignments result in a partial or full closure of a facility. In most all cases, the
realignment would require a short term investment of resources (e.g. establishing a large Community
Based Outpatient Cllnlc-CBOC, expanding services in another VA Medical Center to absorb workload,
etc.). Overall, there are eighteen facilities identified where some form of realignment could be
Implemented, Of these realignments, five realignments result in the outright closure of current major
facilities. Eleven of the proposed realignments result in the discontinuation of inpatient services at a
given facility and then align those inpatient services at another VA facility or within the private sector
community. One propose~ realignment results in adjustment of certain services betwf}en already
existing facilities.
Table 2-1: Proposed Alignment of VA Health Care Facilities
Facility Closure Involved in
Facility
Realignment
VlSN
Canandaigua !S2BA5)
Partial - Canandaigua
V!SN2
VISN3
Bath {528A6)
Partial - Canandaigua
VA Hudson Valley HCS-Cast!e
Point Division !620A4l
Yes - Castle Point
Initial Proposal
Merge facility with Bath; realign
Rochester CBOC to Western New York
Health Care System - HCS (Buffalo)
Merge facility with Canandaigua Oom!c!Uary will fall within current
Bath fac!lity
Propose dosing and vacating Castle
Polnt HCS and transfer care to other
VISN 3 facilities
VA-19-0799-D-001209
OS 00002880
Facility
VJSN
Facility Closure Involved in
Realignment
Initial Proposal
Brooklyn (630A4)
Partial - Brooklyn
Move all Inpatient beds from Brooklyn
to Manhattan campus
St Albans (630A5)
Partial - St. Albans
VISN4
VA Pittsburgh HCS
No
VISN 7
Dublin (557)
Partial- Dublin
VISN9
Middle Tennessee Health Care
System
No
VISN 11
Battle Creek (515)
Partial - Battle Creek
!!liana HCS (Danv!l!e) (550)
Partial - llliana
Saginaw (655)
Partial - Saglnaw
Vacate and develop a multloserv!ce
CBOC on current slte - Inpatient and
community living center care w!U be
transferred to otherV!SN 3 facilities
VA fully discontinued services at the
Highland Drive Campus and retired its
station number, VA seeks to excess
the property through GSA
Close Inpatient services, malntaln
outpatient surgeryo refer complex
cases to Augusta or Atlanta
Close Nashville un!t4B (MH) and
transfer work to York - close all IP
medicine beds at York and transfer
work to Nashville,
Close Inpatient Medical/Surgical beds,
retain !RR & Community Living Center
Close Inpatient Medical/ Surgical and
retain acute Mental Health, IRR
High potential o will become a HCC
Eastern Kansas HCS Leavenworth
Dlvlslon (589A5j
WestTexas HCS (Big Spring) (519)
Partial - Leavenworth
Yes - Big Spring
Prescott (649}
Yes - Prescott
V!SN 19
Grand Junction (575)
Partial -Grand Junction
VlSN 20
Roseburg HCS (653}
Partla! - Roseburg
VISN 21
Livermore (640A4)
Yes - Livermore
V!SN 23
Fort Meade (568)
Partial - Fort Meade
Hot Springs {568A4)
Yes - Hot Springs
VISN 15
VISN 18
Vlable Candidateo no detal!ed plans
given
Close lnpatient services and move
health care to Amarillo; dose
Domiciliary and Community Living
Center- vacate HCS
Close lnpatlent-e!!minate Emergency
Department; a!!gn with Phoenix;
expand Community Living Center
Close Inpatient beds and use
community contracts
Close inpatient (possible! operate as a
CBOC + lRR and Community Living
Center
Planning to dose - move all care to
Stockton and Freemont
Plan to contract Inpatient to
communityo retain Community Living
Center
Plan to dose lP services and contract
with community providerso expand
mult!-speclalty care d!nlc !n Rapid City
The proposed realignment associated with the VISN 23 Hot Springs facility has already been initiated,
and the VA is currently conducting an environmental impact analysis.
The nature of cost savings in the identified realignments may be realized in the reduction of both labor
costs and ln certain other fixed and variable facilities' costs.
VA-19-0799-D-001210
OS 00002881
3.
Further Analysis
The identified facilities represent the result of a data can. Where a realignment has been proposed the
VISN
has developed a notional end-state vision for services to be provided to Veterans, a high-level
project sequence, and very rough estimate timeframe.
It is proposed that further analysis be performed by forming an integrated program of VISN teams
supported by a projects coordinator within VHA's Network Operations (10N). This effort will require
support from VHA's Office of Policy and Planning, and VA's Office of Management.
The effort should be pursued with the assumption that the identified capital realignments will be
included in FY17, 1B and 19 Budget Cycles.
VA-19-0799-D-001211
OS 00002882
\ IA
V l"I
I
~
~
U.S. Department
ofVeterans Affairs
SECVA Morning Report:
Independent Review Commission for
Veterans Health Administration Facilities and Capital Assets
VHA Office of Policy and Planning
VA-19-0799-D-001212
OS 00002883
o Background and Purpose
o Recommendation
o Principles
o Lessons Learned
o Timeline
o Legislative Technical Assistance
o Communications
[Date Ti me]
VA DRAFT DOCUMENT - For Internal Use
2
VA-19-0799-D-001213
OS 00002884
0
BACKGROUND AND PURPOSE
o In February, the VHA NLC recommended establishment of a VHA facilities review
commission (similar to DOD's Base Realignment and Closure (BRAC) Commission) as
a top "big hairy audacious change", which stemmed in part from CARES Commission
lessons learned, the Section 201 Independent Assessments (2014) and Commission
on Care (2016) reports
o SECVA requested a recommended path forward for the review
o A tiger team was established - including Sr. Advisors to SECVA, OPP, OAEM, OCFM,
OCAMES, OGC, OSI - to weigh the options:
Option 1 : a Statutory VA Advisory Commission ~
recommended option
Option 2 : a Discretionary VA Advisory Committee
o The tiger team is now presenting its recommendation to SECVA, including
- Suggested methodology/approach
- Timeline
- Legislative Technical Assistance
- Communications strategy to accompany the initiative
[Date Time]
VA DRAFT DOCUMENT - For Internal Use
3
VA-19-0799-D-001214
OS 00002885
0
RECOMMENDATION
o It is recommended by the tiger team that VA request Congress to pass legislation
requiring VA to establish a Statutory VA Advisory Commission for the realignment
of VHA facilities (i.e. Option 1)
o The recommendation for a Statutory VA Advisory Commission is based on the
following rationale:
- Recommendations from a Statutory VA Advisory Commission would have a
higher likelihood of receiving an approval/disapproval vote from Congress on
the entire recommendations package, since Congress required VA to establish
the Commission
- Congress could appropriate funds for the Commission, to include funds for
staff and Contractors (if necessary); and
- Congress could provide, by statute, that the Commission is FACA-exempt
[Date Time]
VA DRAFT DOCUMENT - For Internal Use
4
VA-19-0799-D-001215
OS 00002886
~
V
PRINCIPLES IN DEVELOPING A NATIONAL
REALIGNMENT PLAN
o Several principles will guide development of the national realignment plan and
subsequent decisions by the Commission. Some include:
- Balance the need for equal or better access, Veteran satisfaction, state-of-theart world-class facilities, and cost-effectiveness
- While addressing VNs health care mission, preserve VHNs other missions education, research and emergency preparedness
- The quality of VA and community care will be examined to ensure suitable
facilities and well-trained health care professionals are available to meet the
needs of Veterans
- Assure a high performing clinically integrated network of VA care and
community care, which may include adding sites of care where population and
referral patterns indicate access needs to be improved
- Leverage lessons learned from CARES Commission and DOD BRAC Commission
[Date Ti me]
VA DRAFT DOCUMENT - For Internal Use
5
VA-19-0799-D-001216
OS 00002887
0
LESSONS LEARNED
o Some lessons learned from the CARES Commission and BRAC Commission process will be
incorporated in the independent review and the National Realignment Plan that VA will
submit to the Commission:
A number of CARES initiatives were never implemented because members of
Congress and special interest groups blocked closure of facilities that the CARES
Commission verified were no longer needed
Avoid adding requirements after implementation begins and fully account for IT
requirements in initial estimates to prevent understating costs
In general, the Commission would not be able to add recommendation
contingencies, but if contingencies are to be permitted, limit them to specific
conditions
Requirements such as environmental clean-up before transfer or re-use and
historical preservation hindered full implementation
BRAC analysis did not give a credible assessment of total excess capacity across
DOD or the potential for achieving greater efficiencies in use of that capacity - this
could be an issue with VHA as well
Not considering property transfer/disposal process once the BRAC closure process
completed seemed to prolong moving of the liability, which slowed realizing cost
savings
[Date Ti me]
VA DRAFT DOCUMENT - For Internal Use
6
VA-19-0799-D-001217
OS 00002888
0
SUGGESTED TIMELINE
o
FY17
Develop
Initiate Technical
Assistance with
Congress or
Appropriate VA and
Request for
White Paper
White House Office
by SecVA
'
'
Conduct National Market-by-
National Facilities
Realignment Plan
Submitted to
Recommendations
Submitted to
Congress and
(1 mo}
Market Assessments ("'12 mo}
Commission
White House
'
'
I
17
I
FY19
Methodology for
Conducting National
Market-by-Market
Health System Design
'
I
2017
o
Ii
I
I
2017
I
2018
I
I
2018
2019
1
White House
o
1
: Approval
I
I
I
I
I
I
'
17
Congressional
Approval
o
2019
EEMNl-o.ol.}MMMt,MHIMF+---.ee++ijlNM.MtjiNo."ift!
I
o
White Paper
Completed
I
o
Congress to Introduce
legislation for, or White
House to Announce,
Independent Commission
I
I
ongomg
-+
o
Midterm Elections
o
I
(Nov 6, 2018)
Finalize Format for
National Facilities
Realignment Plan
(lmo)
o
o
I
Commission
Approves
Recommendations
I
Implement Approved
Commission
Recommendations
(onc:oi nc}
We are here
[Date Ti me]
VA DRAFT DOCUMENT - For Internal Use
7
VA-19-0799-D-001218
OS 00002889
0
LEGISLATIVE TECHNICAL ASSISTANCE
o Establish a Statutory VA Advisory Commission comprised of members appointed by
the WH and Congress with ex-officio expert members from VA facilities and VHA
health care
o Offer legislative assistance on inclusion of review criteria based on access, quality,
safety and community facility standards
o Congress has up or down vote on entire plan as a whole
o Criteria can be used for future decisions on capital by SECVA
o Empower the Commission to assess and approve VA/VHA's national realignment
plan within 45 days of receipt of VHA's recommendations
o Insert language to preclude members of congress from blocking implementation in
their districts
[Date Ti me]
VA DRAFT DOCUMENT - For Internal Use
8
VA-19-0799-D-001219
OS 00002890
0
COMMUNICATIONS
o Need a focused and deliberate communications strategy to accompany the work of
the Commission - before and during the assessments, and during implementation
o Communicate to Congress, the Commission, Veterans, VA employees, VSOs, Union
partners, and other stakeholders
o Requires a comprehensive multi-media strategy
o Expand routine communications between the markets, VISNs and VHACO, to
encourage joint resolution of common challenges, and sharing of best practices and
lessons learned in managing mission changes
o Continually accentuate the benefits in terms of equal or greater access, quality,
satisfaction, and economic benefits
[Date Time]
VA DRAFT DOCUMENT - For Internal Use
9
VA-19-0799-D-001220
OS 00002891
Message
From:
Sent:
To:
Attachments:
David shulkin [Drshulkin@aol.com]
6/12/2017 6:45:35 PM
mac.com]; Ike Perlmutter [(b) (6) frenchangel59.com]
Bruce Moskowitz [(b) (6)
IMG_4068.JPG; Untitled attachment 05908.txt
Roundtable list
VA-19-0799-D-001221
OS 00002892
Committee on Veterans' Affairs
U.S. House of Representatives
115 111 Congress
"Improving Access, Quality, and Efficiency: Exploring Organizational Changes for the
Veterans Health Administration"
Thursday, June 15, 2017, at 8:00 a.m.
334 Cannon House Office Building
I. James B. Peake M.D., LTG (Ret), Senior Vice President, CGI Federal/Former
Secretary, U.S. Department of Veterans Affairs
2. Katrina Armstrong MD, Jickson Professor of Clinical Medicine, Harvard Medical \
School
3. Christine Cassel, M.D., Kaiser Permanente School of Medicine/Former President and
Chief Executive Officer, National Quality Forum
4. George Halvorson, Chair and Chief Executive Officer, Institute for Intergroup
Understanding/Former Chairman and Chief Executive Officer, Kaiser Permanente
Accompanied by: La Verne Council, MITRE Corporation/ Former Chief
Information Officer, U.S. Department of Veterans Affairs
5. Gail Wilensky, Ph.D., Senior Fellow, Project HOPE
6. David Hecht, M.D., M.B.A., Chief of Staff, Mountain Home VA Healthcare System,
U.S. Department of Veterans Affairs
7. Paul Rothman, M.D., Dean and Chief Executive Officer, Johns Hopkins Medicme
8. Peter Pronovost, M.D., Senior Vice President, Patient Safety and Quality, Johns
Hopkins Medicine
9. Sam Hazen, President, HCA
10. The Honorable David Shulkin, Secretary, U.S. Department of Veterans Affairs
Accompanied by: Dr. Poonam Alaigh, Acting Under Secretary for Health, U.S.
Department of Veterans Affairs
11. John Noseworthy, M.D., President and Chief Executive Officer, Mayo Clinic
0
(/)
I
0
0
0
0
~
(X)
c.o
u)
VA-19-0799-D-001222
Sent from my iPhone
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/3/2017 11:30:32 AM
Poonam Alaigh [(b) (6)
hotmail.com]; Bruce Moskowitz [(b) (6)
Fwd: [EXTERNAL] Project Hero launches PTSD device to eliminate suicide
mac.com]
Poonam and Bruce- this is an interesting device that we might want to look atIm not sure if yiu have seen this before. Poonam you may wish to share with out clinical team. i am seeing the
developer on thursday
David
Subject: [EXTERNAL] Project Hero launches PTSD device to eliminate suicide
PROJECT HERO ANNOUNCES PARTNERSHIP WITH
TEXAS A&M UNIVERSITY TO LAUNCH INNOVATIVE PTSD DEVICE
~HGBPR0TRRH
Project Hero, the groundbreaking national non-profit veterans and first responders organization, will
partner with Texas A&M University to introduce the first wearable biometric monitoring device
specifically designed to help veterans and first responders with PTSD, it was announced today by (b) (6)
president and founder of Project Hero.
The device will debut as part of Project Hero's HEROTrak program during the organization's upcoming
2017 UnitedHealthcare Texas Challenge April 3-8.
The partnership features the debut and first non-clinical use of a wristwatch-sized wearable biometric
monitor programmed to respond to and learn the wearer's PTSD-specific physical triggers to predict
episodes and provide tools to strengthen resilience. The device uses heart rate, skin conductance and
heart rate variation, not associated with athletics or normal activities, and interact with the wearer to help
manage the onset of the episode and allow tools including contact peer support or assistance.
VA-19-0799-D-001224
OS 00002895
The unique device and its sophisticated monitoring software have been developed by the Engineering
Department of Texas A&M University. The university has been working with the Project Hero Research
Institute of Mental Health to develop opportunities to test the device using highly-qualified veterans in
non-clinical environments such as Project Hero events.
The organization has selected veteran and first responders who have a VA mental health rating taking
part in the 2017 UnitedHealthcare Texas Challenge for the inaugural study. The riders will wear the
device throughout the 350+-plus mile journey through from San Antonio to Houston.
"Project Hero is honored by our partnership with Texas A&M and thrilled to be the first organization
serving veterans and first responders to use the HERO Trak device that will help wearers identify,
manage and reduce PTSD episodes," said Wordin. "We are also planning to continue working with
Texas A&M using this innovative device at our Challenge Series and other events throughout the year."
Riders will wear the HERO Trak device throughout the 2017 UnitedHealthcare Challenge Series and allow
data generated by the device to collected on an anonymous basis by Project Hero and Texas A&M after
the Challenge has ended. Project Hero and Texas A&M are planning to use the device in the
organization's upcoming 2017 Challenge and Honor Ride events to improve the predictability and
accuracy.
A companion App is being developed with Project Hero, the VA, and other partners. The goal is to
increase resources so that more veterans can take part in the initial study phase to provide more data to
perfect the relevant algorithms.
We appreciate all of the veterans and partners taking part in this groundbreaking initiative and look
forward to a future where all military personnel would have access to this information from the time they
start their military service through their transition into the VA system to provide a more accurate and
personalized continuum care path and eliminate suicide.
Regards,
(b) (6)
President and Founder
Project Hero
Providing Hope Recovery & Resilience
818.888.7(b) (6)
818.710.(b) (6) Fax
ProjectHero.org
VA-19-0799-D-001225
OS 00002896
PFIOJECTHEFICJ
Research Institute of Mental Health
Hope
Recovery
Resilience
Supporters include UnitedHealthcare, GE, United Airlines, USO, Hero Miles, Tawani Foundation,
Disabled Veterans National Foundation, Scott USA, Uhaul, Bike Nashbar, Pactimo, Macy's, Shimano,
Boeing, Strohman Enterprise Garmin, Camelbak, Rocktape, Parktool, Speedplay, Geico, Chamois Butt'r,
Hutchinson, Kenda, Pepsi, Gatorade, Soldier Fuel, ICC, R4 Alliance and is the creator and founding
partner of the Warrior Games.
This message, including any attachments, is solely for the use of the
intended recipient(s) and may contain confidential and/or privileged
information. Any unauthorized review, use, disclosure or distribution of
this communication is expressly prohibited. If you are not the intended
recipient, please contact the sender by reply e-mail and destroy any and all
copies of the original message. Thank you.
VA-19-0799-D-001226
OS 00002897
Message
From:
Sent:
To:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/4/2017 5:02:49 PM
drshulkin@aol.com; Poonam Alaigh [(b) (6)
hotmail.com]
Congressional hearing on VA CRISIS LINE
The staff did a great job under difficult circumstances. The points that stood out in my mind are the
following:
By the time the VA gets the patient who calls there is no prior system within the DOD to let the VA know
who may be at risk and a focus of a mental wellness program.
Telemedicine instant link with a patient who calls may be necessary in many locations.
A focus was on women during the hearing and we should be able to come up with a women's health care
initiative very quickly.
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-001227
OS 00002898
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/4/2017 12:12:31 AM
Bruce Moskowitz [(b) (6)
Re: Academic Affiliations SECVA
mac.com]
Ok ill respond and get back to you
Sent from my iPhone
On Apr 3, 2017, at 8:01 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
It would be my pleasure to take the lead if you believe it to be of benefit and indeed they make a
case for the same issues we have identified.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 3, 2017, at 7: 19 PM, David shulkin wrote:
Bruce- i just wanted you to be aware - so we coordinate efforts
Im ok if you take the lead
David
Sent from my iPhone
Begin forwarded message:
From: DJS
Date: April 3, 2017 at6:58:15 PM EDT
To: 'Shulkin'
Subject: FW: Academic Affiliations SECVA
Sent with Good (www.good.com)
-----Original Message----(b) (6)
From: (b) (6)
Sent: Monday, April 03, 2017 05:23 PM Eastern Standard Time
To: DJS
Subject: FW: Academic Affiliations SECVA
Sent to (b) (6)
already
VA-19-0799-D-001228
OS 00002899
From: (b) (6)
[mailto:(b) (6)
Sent: Monday, April 03, 2017 4:09 PM
To: Shulkin, David J., MD
mssm.edu ]
Cc: (b) (6)
Subject: [EXTERNAL] Academic Affiliations SECVA
Dear Dr. Shulkin,
We would like to take this opportunity to respond to your
call for ideas for building academic partnership for faculty,
training, and research.
The Icahn School of Medicine at Mount Sinai has had a
longstanding affiliation of over 30 years with the Veterans Affairs
Hospital in the Bronx, New York (VA). We have shared a history
of successful achievements including two Lasker Awards and a
Nobel Prize in research. However in order for the VA to continue
its successful 70 year partnership with academic institutions, the
VA must move forward with audaciousness and a renewed energy.
There is a need to streamline and expedite the hiring
processes between the VA and the affiliations. A process is needed
that promotes swift onboarding, functional privileges and efficient
portable Heath IT access. There is a need to develop safe and
secure exchange of patient and research information across the VA
and affiliated institutions for shared patients and for research
information and research protocols. This will require a fresh look
at interoperability between IT platforms at the VA and the affiliate.
It is critical that the VA strongly continues the support of
research development in order to remain viable with a critical mass
of research and also to continue to attract the best research talent in
the community. We must maintain adequate funding of veteran
centric clinical and research development, both in general veteran
focused areas of care delivery and research including women's
health, PTSD, and long term effects of concussion but also in the
highly specialized treatment of veterans and their loved ones that
the VA provides for the more rare but devastating conditions of
spinal cord injury, ALS, MS, Alzheimer's Disease, along with
Centers of Excellence in Suicide prevention.
To more effectively task those important issues we
encourage moving more resource and research decisions to local
director leadership instead of centrally, because facility directors
are able to make more informed decisions based on availability of
local clinical and research expertise and excellence in the local
community, academic affiliation, and the VA medical center.
Sincerely,
VA-19-0799-D-001229
OS 00002900
(b) (6)
(b) (6)
MD
(b) (6)
MD
President & CEO,
(b) (6)
Dean,
Mount Sinai Health System
of Medicine at Mount Sinai
(b) (6)
Icahn School
President for
Academic Affairs,
Mount Sinai
Health System
VA-19-0799-D-001230
OS 00002901
Message
From:
Sent:
To:
CC:
Subject:
Bruce Moskowitz [(b) (6)
mac.com]
4/4/2017 12:01:20 AM
David shulkin [Drshulkin@aol.com]
Poonam Alaigh [(b) (6)
hotmail.com]; Ike Perlmutter [(b) (6) frenchangel59.com]
Re: Academic Affiliations SECVA
It would be my pleasure to take the lead if you believe it to be of benefit and indeed they make a case for the
same issues we have identified.
Sent from my iPad
Bruce Moskowitz M.D.
On Apr 3, 2017, at 7: 19 PM, David shulkin wrote:
Bruce- i just wanted you to be aware - so we coordinate efforts
Im ok if you take the lead
David
Sent from my iPhone
Begin forwarded message:
From: DJS
Date: April 3, 2017 at6:58:15 PM EDT
To: 'Shulkin'
Subject: FW: Academic Affiliations SECVA
Sent with Good (www.good.com)
-----Original Message----(b) (6)
From: (b) (6)
Sent: Monday, April 03, 2017 05:23 PM Eastern Standard Time
To: DJS
Subject: FW: Academic Affiliations SECVA
Sent to (b) (6)
already
[mailto:(b) (6)
From: (b) (6)
Sent: Monday, April 03, 2017 4:09 PM
To: Shulkin, David J., MD
mssm.edu ]
Cc: (b) (6)
Subject: [EXTERNAL] Academic Affiliations SECVA
VA-19-0799-D-001231
OS 00002902
Dear Dr. Shulkin,
We would like to take this opportunity to respond to your call for ideas for
building academic partnership for faculty, training, and research.
The Icahn School of Medicine at Mount Sinai has had a longstanding
affiliation of over 30 years with the Veterans Affairs Hospital in the Bronx, New
York (VA). We have shared a history of successful achievements including two
Lasker Awards and a Nobel Prize in research. However in order for the VA to
continue its successful 70 year partnership with academic institutions, the VA
must move forward with audaciousness and a renewed energy.
There is a need to streamline and expedite the hiring
processes between the VA and the affiliations. A process is needed that promotes
swift onboarding, functional privileges and efficient portable Heath IT access.
There is a need to develop safe and secure exchange of patient and research
information across the VA and affiliated institutions for shared patients and for
research information and research protocols. This will require a fresh look at
interoperability between IT platforms at the VA and the affiliate.
It is critical that the VA strongly continues the support of research
development in order to remain viable with a critical mass of research and also to
continue to attract the best research talent in the community. We must maintain
adequate funding of veteran centric clinical and research development, both in
general veteran focused areas of care delivery and research including women's
health, PTSD, and long term effects of concussion but also in the highly
specialized treatment of veterans and their loved ones that the VA provides for the
more rare but devastating conditions of spinal cord injury, ALS, MS, Alzheimer's
Disease, along with Centers of Excellence in Suicide prevention.
To more effectively task those important issues we encourage moving
more resource and research decisions to local director leadership instead of
centrally, because facility directors are able to make more informed decisions
based on availability of local clinical and research expertise and excellence in the
local community, academic affiliation, and the VA medical center.
Sincerely,
(b) (6)
President & CEO,
Dean,
MD
(b) (6)
MD
(b) (6)
VA-19-0799-D-001232
OS 00002903
Mount Sinai Health System
Mount Sinai
Icahn School of Medicine at
President for Academic
Affairs,
Mount Sinai Health System
VA-19-0799-D-001233
OS 00002904
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/3/2017 11:19:07 PM
Bruce Moskowitz [(b) (6)
mac.com]
Poonam Alaigh [(b) (6)
hotmail.com]; Ike Perlmutter [(b) (6) frenchangel59.com]
Fwd: Academic Affiliations SECVA
Bruce- i just wanted you to be aware - so we coordinate efforts
Im ok if you take the lead
David
Sent from my iPhone
Begin forwarded message:
From: DJS
Date: April 3, 2017 at6:58:15 PM EDT
To: 'Shulkin'
Subject: FW: Academic Affiliations SECVA
Sent with Good (www.good.com)
-----Original Message----(b) (6)
From: (b) (6)
Sent: Monday, April 03, 2017 05:23 PM Eastern Standard Time
To: DJS
Subject: FW: Academic Affiliations SECVA
Sent to (b) (6)
already
[mailto:(b) (6)
From: (b) (6)
Sent: Monday, April 03, 2017 4:09 PM
To: Shulkin, David J., MD
mssm.edu ]
Cc: (b) (6)
Subject: [EXTERNAL] Academic Affiliations SECVA
Dear Dr. Shulkin,
We would like to take this opportunity to respond to your call for ideas for building
academic partnership for faculty, training, and research.
VA-19-0799-D-001234
OS 00002905
The Icahn School of Medicine at Mount Sinai has had a longstanding affiliation of over
30 years with the Veterans Affairs Hospital in the Bronx, New York (VA). We have shared a
history of successful achievements including two Lasker Awards and a Nobel Prize in research.
However in order for the VA to continue its successful 70 year partnership with academic
institutions, the VA must move forward with audaciousness and a renewed energy.
There is a need to streamline and expedite the hiring processes between the VA and the
affiliations. A process is needed that promotes swift onboarding, functional privileges and
efficient portable Heath IT access. There is a need to develop safe and secure exchange of patient
and research information across the VA and affiliated institutions for shared patients and for
research information and research protocols. This will require a fresh look at interoperability
between IT platforms at the VA and the affiliate.
It is critical that the VA strongly continues the support of research development in order
to remain viable with a critical mass of research and also to continue to attract the best research
talent in the community. We must maintain adequate funding of veteran centric clinical and
research development, both in general veteran focused areas of care delivery and research
including women's health, PTSD, and long term effects of concussion but also in the highly
specialized treatment of veterans and their loved ones that the VA provides for the more rare but
devastating conditions of spinal cord injury, ALS, MS, Alzheimer's Disease, along with Centers
of Excellence in Suicide prevention.
To more effectively task those important issues we encourage moving more resource and
research decisions to local director leadership instead of centrally, because facility directors are
able to make more informed decisions based on availability of local clinical and research
expertise and excellence in the local community, academic affiliation, and the VA medical
center.
Sincerely,
(b) (6)
MD
President & CEO,
Mount Sinai Health System
(b) (6)
(b) (6)
MD
Dean,
Icahn School of Medicine at Mount Sinai
President for Academic Affairs,
Mount Sinai Health System
VA-19-0799-D-001235
OS 00002906
Message
From:
Sent:
To:
Subject:
Marc Sherman [(b) (6)
gmail.com]
4/3/2017 3:15:17 PM
IP [(b) (6) frenchangel59.com]; Bruce Moskowitz [(b) (6)
shulkin [drshulkin@aol.com]
Fwd: Thank You
mac.com]; L Perl [(b) (6)
gmail.com]; David
FYI
---------- Message ---------Date: Mon, Apr 3, 2017 at 11 :07 AM
Subject: Thank You
To: "(b) (6)
isakson.senate.gov" <(b) (6)
isakson.senate.gov>
(b) (6)
I waited until today to send this email because I didn't want to disturb your weekend. Again, a special
thanks to you for making our meeting happen, and with a big smile, and thanks for passing this on to the
Senator. My regards to (b) (6) and, if you don't mind, can you confirm that you received this?
Marc
Senator Isakson
Thank you very much for giving of your time last Thursday to talk about the VA and T(b) (6) I know that you fit
that conversation into an otherwise packed day of a one day trip. Some conversations strain to last five minutes
and others fly by. Our time flew by, for me anyway. It was one of those conversations that you hope will take
place, but so often fails to deliver. This one didn't disappoint. I so hope we can meet again ... I would love to
pick up the conversation- about the VA and life in general. On both fronts, there is so much to discuss.
I passed our discussion onto the President, including your need to maintain the momentum that Tom has
brought to you and the Senate Committee, without any impact to that effort. Your message was clear. My
heartfelt wishes for a continued recovery from the surgery. Joan told me that golf is likely not in your near-term
plans because of the surgery, but I belong to a top 75 golf course nearby and would enjoy nothing more than the
opportunity to spend that time with you enjoying the outdoors with good conversation. Please let me know if
that becomes a possibility. It is a standing invitation.
VA-19-0799-D-001236
OS 00002907
With gratitude, all my best,
Marc
Marc B. Sherman I Managing Director
Alvarez & Marsal
Washington Center I 1001 G Street, NW I Suite 1100, West Tower I Washington, DC 20001
Office 202.729.(b) (6)
I Mobile 202.758.(b) (6)
Executive Assistant!(b) (6)
1202.729.(b) (6)
I (b) (6)
@alvarezandmarsal.com
North America + Europe + Latin America + Middle East + Asia
VA-19-0799-D-001237
OS 00002908
Message
From:
Sent:
To:
Subject:
David Shulkin [drshulkin@aol.com]
4/2/2017 11:04:01 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: VA And Apple
Absolutely right
Can we get someone to send us the commas plan on this
Sent from my iPad
On Apr 2, 2017, at 5:47 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Wow!! That's the precise reason we have to make sure we continue to include them regularly.
You should share the comms plan around release of the Transparency Site that includes talking
to congress, 60min and USA Today. I think we get (b) (6)
involved with Marc and Bruce so
that we can get comments from the Academic Affiliate group incorporated in our messaging.
Remember what I told you- they want to give us there valuable time and support but ensure that
they are respected and valued and want to be "in the loop" with constant communication. They
are our biggest allies and have confidence in us- but we have to manage the relationship very
very carefully and with full attention.
Sent from my iPhone
On Apr 2, 2017, at 8:02 PM, David Shulkin wrote:
It's easy to get on the wrong side of this group
Sent from my iPad
Begin forwarded message:
From: "IP" <(b) (6) frenchangel59 .com>
Date: April 2, 2017 at 10:51:54 AM EDT
To: "David shulkin"
Subject: FW: VA And Apple
From: IP [ mailto:(b) (6) frenchanqel59.com]
Sent: Sunday, April 02, 2017 10:16 AM
To: '(b) (6)
EOP/WHO'
Cc: 'Kushner, Jared C. EOP/WHO'; '(b) (6)
Subject: RE: VA And Apple
EOP/WHO'
(b) (6)
My email to (b) (6) on Thursday expressed my frustration and
displeasure in learning about activity and decisions concerning
issues at the VA in a separate and invisible parallel
effort. Regrettably, your response to my email that "(b) (6)
has
VA-19-0799-D-001238
OS 00002909
been working but not communicating" not only fails to recognize
or explain the issue, but merely highlights the very fundamental
problem that is so troubling. While a lack of communication has
certainly exacerbated the problem, the mere fact that there has
been any activity or decision without first coordinating that
activity with our team before taking any action is the
problem. Simply offering to communicate better solves very little.
In your and (b) (6)
first meeting in the West Wing with Marc
Sherman it was clear and agreed that (b) (6) would be the liaison
between our expert team and the White House and provide her IT
counsel to our team related to our initiatives (not as an invisible,
parallel effort). In addition, the White House was to be available
to assist our team with executive and legislative clout when
requested (not conduct an invisible, parallel effort), a threepronged approach, if you recall. This is the program I reported to
the President and the go-ahead we received.
The essential problem at the VA is that 22 veterans die every day
and the system of care and access to care is in need of
repair. This is a medical issue and medical delivery problem. In
order to fix the VA, these medical problems must first be defined
and fixed. All other issues, like IT, are a function of the
determined fix to the medical issues and medical delivery
problems. To transform the VA into the best of class, I assembled
a team that includes the best and brightest minds in the academic
medical community. The restructuring efforts on which we
embark are informed by the advice and participation of those
great medical minds. Parallel (and invisible to us) IT efforts are
not connected to what the medical minds decide are the problem
or the fix and are frustrating the IT solution that deals with the
medical issues. It is also spending the valuable time of volunteers
and delaying the best care that our veterans deserve.
Your email to me underscores this problem. You say that:
"[
efforts have been focused with the VA on ensuring
that an EHMP is completed above their health records so that the
medical records can be pulled into an Apple device. The EHMP
work is in process and is a necessity for Apple to then come in and
provide its services," and
"There is a call on Monday with Apple, the VA, and (b) (6) to
review the ... status of the EHMP work ... [and] to confirm Apple job
scope which includes portability of health records/ data from VA
to Apple products; VA technical changes to how to allow VA
workers to use Apple products; (and potentially portability of
health records/ data to non-VA medical facilities."
However, it is not possible to design an EHMP system or integrate
the system with an Apple device until you know how the medical
experts are going to change the medical delivery system and how
VA-19-0799-D-001239
OS 00002910
they advise a device should be utilized in the medical delivery
system. The academic medical experts on our team are assisting
the VA in designing a sophisticated system of community care
through a public-private delivery system. They are formulating
that system and its inner workings, the creation of which will
dictate the Integration and interoperability of records. Neither
(b) (6)
nor Apple can define a scope or product use without
consulting with our group on how veteran's records used in the
private sector will get integrated into the portable record and
back to the VA.
You mention in your email telehealth. Our team of medical
experts are working on a telehealth initiative and delivered a draft
Executive Order to the President ... while you are working with the
DEA and DOJ, without the courtesy of advising us, which could
have tremendous implications on the wording or, worse yet, the
prudence of an Executive Order in the first place. This parallel
path as well creates the potential for embarrassment for the
President and wasted invaluable time that our veterans can ill
afford.
Lastly, you discuss your parallel meeting on a Military Wellness
program which you apparently already brought in which you
believe focuses on preventative medicine. The program that you
are touting however is surrounded by rumors that are less than
flattering. Moreover, our team's academic medical experts are
already assisting in the active development of a wellness program
for the VA and their views will prevail. Those experts have
already assembled the working parts of a wellness program and
the seamless integration with active service members and
family. There is no need to have a parallel side effort that is not
integrated into the agreed program. Again, the problem is not
about communication.
I had an employee a few years back that meant well but thought
that there was an "I" in team. His work for the company created
value and profits for the company at various times, however, in
spite of those benefits, I advised him that his way was not working
and he should find something else that better met his style.
With all this considered, I think that (b) (6) is a smart woman that
could provide the VA IT experience and benefits, my way ... not as a
renegade player. I am willing to work with her as a team player
on our team. The expert team that I assembled and is sanctioned
by the President will be proceeding with its efforts as planned. All
other parallel efforts should stand down. (b) (6) can participate as
part of that team, not outside of that team or its efforts or its
direction. As agreed on day one, the White House can participate
by providing executive and administrative assistance, when
requested by our expert team. We will arrange and conduct
discussions with Apple (in which (b) (6) should participate if done
within the confines of the expert team). We will work with design
and implementation of a wellness program and we will decide on
VA-19-0799-D-001240
OS 00002911
the proper way to integrate an EMR system, with (b) (6)
team
participation if agreed. Any items that relate to the
transformation of the VA must be funneled through and managed
by the expert team and should be coordinated with Dr.
Moskowitz and Marc Sherman.
Let me know if you have any questions.
Ike
EOP/WHO
From: (b) (6)
[ mailto:(b) (6)
who.eop.gov]
Sent: Friday, March 31, 2017 6:03 PM
To: IP; Kushner, Jared C. EOP/WHO
Cc: (b) (6)
EOP/WHO; (b) (6)
Subject: RE: VA And Apple
EOP/WHO
As we discussed it seems like (b) (6)
has been working
but not communicating. Her efforts have been focused
with the VA on ensuring that an EHMP is completed
above their health records so that the medical records
can be pulled into an Apple device. The EHMP work is in
process and is a necessity for Apple to then come in and
provide its services. There is a call on Monday with
Apple, the VA, and (b) (6)
to review the following:
1. Status of the EHMP work
2. to find a legal mechanism to allow for 3 month
tour of duty from Apple engineers with the
employees staying on Apple payroll. This is being
investigated by USDS lawyers and the VA.
3. To work through an NDA / conflict waiver which is
a necessary legal document.
4. To confirm Apple job scope which includes
portability of health records/ data from VA to
Apple products; VA technical changes to how to
allow VA workers to use Apple products; (and
potentially portability of health records/ data to
non-VA medical facilities.)
I believe we should then schedule a call for mid next
week with Ike, appropriate members of Ike's team, the
VA, Apple and (b) (6)
myself to ensure we are on same
page (I can coordinate the call). I think we should allow
(b) (6)
an opportunity to reset and to act as a true overall
project manager where we allow her to coordinate. She
should communicate with Ike and his designee
consistently and she should professionally coordinate
the team, get everyone working together, and show us
VA-19-0799-D-001241
OS 00002912
progress. I believe she will do a great job, and we will
know quickly if she does not.
As everyone knows huge other hot items at VA in the
works right now including Accountability (legislation and
EO), Choice Reform Act extension and reform; telehealth
(working through the issue with DOJ and DEA; hard to
just slam it through if they oppose but based on meeting
today with VA/DOJ/DEA I believe we can get them there
in next two weeks. Ike, I can explain in detail when we
next talk but having been through this with the Opioid
EO this week we should see if we can get DEA/ DOJ on
board).
Different subject, Ike would also like your advice on NIH
and the idea (I think your idea?) to create a profit
sharing program with our grants. Love this idea.
Yours truly,
(b) (6)
P.S. I need to update you on very exciting meeting on a
Military Wellness program which we brought in; focuses
on preventative medicine and is working for over 20,000
vets currently. Readily scalable.
(b) (6)
Assistant to the President
For lntragovernmental and Technology Initiatives
202.456.(b) (6) (Direct)
(b) (6)
who.eop.gov
From: IP fmailto:(b) (6) frenchangel59.com1
Sent: Friday, March 31, 2017 12:05 AM
To: Kushner, Jared C. EOP/WHO <(b) (6) who.eop.gov>
Cc: (b) (6)
EOP/WHO <(b) (6)
who.eop.gov>;
EOP/WHO <(b) (6) who.eop.gov>
Subject: FW: VA And Apple
(b) (6)
Jared,
As you know lvanka introduced me to (b) (6)
at Apple and (b) (6)
at Johnson & Johnson. Ours Academic team and experts have
has done here
worked so well with them and their teams. What
is really outrageous. She may be very good in social media, but this an
entirely different and very complicated area.
We will fix this.
VA-19-0799-D-001242
DS 00002913
All my Best,
Ike
From: IP [ mailto:(b) (6) frenchanqel59.com]
Sent: Thursday, March 30, 2017 11:56 PM
To: (b) (6)
omb.eop.gov
Cc: (b) (6)
who.eop.gov; lperl(b) (6) @qmail.com ;
brucem(b) (6)
@mac.com ; mbs(b) (6)
@qmail.com
Subject: FW: VA And Apple
(b) (6)
With all due respect, I am shocked and extremely disappointed with the
manner in which you have engaged in individual communications with
Apple - and intentionally excluded our broader team of subject matter
experts. I understand that these backdoor discussions have apparently
been occurring almost daily for weeks, and you have not told anyone
and refuse to return phone calls and emails.
When we first met on February 7th, I personally shared with you our
vision and goals and explained that it is critical that everything we do
must be done as a team.
The very purpose of our Academic team, Dr. Moskowitz, and Marc
Sherman is to ensure proper analysis, sharing of best practices, and
provide a forum for discussion, debate, and ultimately the strongest
collective decisions/recommendations.
You agreed then, but your actions to date regarding Apple prove
otherwise.
When I spoke with (b) (6)
on February 1st we discussed and agreed
on the importance of leveraging our Academic team and experts for the
end goal of creating the best system for our veterans. Further on our
Apple conference call on March 3rd - which we invited you and (b) (6) to
join - we again discussed and all agreed that for us to be successful and
fix all the issues that our great veterans are going through on a daily
basis, we must all unite and work as one team, with only one agenda
and one goal.
What we are seeing from you today is a blatant disregard for that
commitment and clear disrespect to everyone involved. You are putting
yourself, your own agenda, and your own ego ahead of our veterans.
This is unacceptable. There are 22 veterans dying every day. Your
decision to alone discuss IT and technology solutions with Apple for
weeks without the broader team of experts and not informing me and
Dr. Moskowitz is major step backwards and will only cause additional
work and significant delays. As a result of your hijacking of this effort,
Apple has already canceled conference calls.
VA-19-0799-D-001243
OS 00002914
In fact, many of the current problems with the VA is because of this very
reason - the lack of team work within. Let me be clear, I will not allow
this to happen while I am involved.
I want this resolved immediately. First, you must include Dr. Moskowitz
and Marc Sherman on any and all calls or meetings. Additionally, I will
formally ask you again to please respect me and our broader group of
subject matter experts, and immediately cease individual discussions
with Apple and/or any other parties related to the work we have
undertaken regarding the VA.
Ike
-----Original Message----(b) (6)
From: (b) (6)
EOP/OMB
fmailto:(b) (6)
omb.eop.gov]
Sent: Thursday, March 30, 2017 6:48 PM
To: Bruce Moskowitz
Cc: (b) (6)
EOP/WHO; IP; (b) (6) frenchangel59.com
Subject: Re: VA And Apple
Hey team! We're making great progress, which I'm excited to fill you in
on. Will send you more info when I get out of these back-to-back mtgs
and will give you a ring back Ike!
Thanks!
> On Mar 30, 2017, at 6:49 AM, Bruce Moskowitz
<(b) (6)
mac.com > wrote:
>
> In the last email exchange i was supposed to receive information on
your interaction with Apple so that we could rapidly obtain needed
technology from our Academic Center Consortium upcoming discussion
with Apple. I realize there are multiple technology issues on everyone's
desk however we have medical emergencies daily at the VA that can
only be solved by rapid deployment of new technology. I am available
24-7 by phone 561-3466(b) (6) Thank you
>
> Sent from my iPad
> Bruce Moskowitz M.D.
-----Original Message----From: Bruce Moskowitz fmailto:(b) (6)
Sent: Tuesday, March 28, 2017 11:41 AM
To: (b) (6)
who.eop.gov; (b) (6)
Cc: IP
Subject: VA And Apple
mac.com ]
omb.eop.gov
It would be of benefit to discuss what we can accomplish in technology
with Apple for the benefit of the VA. It would be of importance to
understand what discussions the Whitehouse team has already had
VA-19-0799-D-001244
OS 00002915
with Apple so that we have a clear path forward and do not duplicate
what has already been accomplished. Let me know a convenient time to
talk. Thank you
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-001245
OS 00002916
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/2/2017 9:47:59 PM
David Shulkin [drshulkin@aol.com]
Re: VA And Apple
Wow!! That's the precise reason we have to make sure we continue to include them regularly. You should share
the comms plan around release of the Transparency Site that includes talking to congress, 60min and USA
Today. I think we get (b) (6)
involved with Marc and Bruce so that we can get comments from the
Academic Affiliate group incorporated in our messaging.
Remember what I told you- they want to give us there valuable time and support but ensure that they are
respected and valued and want to be "in the loop" with constant communication. They are our biggest allies and
have confidence in us- but we have to manage the relationship very very carefully and with full attention.
Sent from my iPhone
On Apr 2, 2017, at 8:02 PM, David Shulkin wrote:
It's easy to get on the wrong side of this group
Sent from my iPad
Begin forwarded message:
From: "IP" <(b) (6) frenchangel59.com>
Date: April 2, 2017 at 10:51:54 AM EDT
To: "David shulkin"
Subject: FW: VA And Apple
From: IP [mailto:(b) (6) frenchanqel59.com]
Sent: Sunday, April 02, 2017 10:16 AM
To: '(b) (6)
EOP/WHO'
Cc: 'Kushner, Jared C. EOP/WHO'; '(b) (6)
Subject: RE: VA And Apple
EOP/WHO'
(b) (6)
My email to (b) (6) on Thursday expressed my frustration and displeasure in
learning about activity and decisions concerning issues at the VA in a separate
and invisible parallel effort. Regrettably, your response to my email that "(b) (6)
has been working but not communicating" not only fails to recognize or explain
the issue, but merely highlights the very fundamental problem that is so
troubling. While a lack of communication has certainly exacerbated the problem,
the mere fact that there has been any activity or decision without first
coordinating that activity with our team before taking any action is the
problem. Simply offering to communicate better solves very little.
In your and (b) (6)
first meeting in the West Wing with Marc Sherman it was
clear and agreed that (b) (6) would be the liaison between our expert team and
the White House and provide her IT counsel to our team related to our initiatives
VA-19-0799-D-001246
OS 00002917
(not as an invisible, parallel effort). In addition, the White House was to be
available to assist our team with executive and legislative clout when requested
(not conduct an invisible, parallel effort), a three-pronged approach, if you
recall. This is the program I reported to the President and the go-ahead we
received.
The essential problem at the VA is that 22 veterans die every day and the system
of care and access to care is in need of repair. This is a medical issue and medical
delivery problem. In order to fix the VA, these medical problems must first be
defined and fixed. All other issues, like IT, are a function of the determined fix to
the medical issues and medical delivery problems. To transform the VA into the
best of class, I assembled a team that includes the best and brightest minds in
the academic medical community. The restructuring efforts on which we
embark are informed by the advice and participation of those great medical
minds. Parallel (and invisible to us) IT efforts are not connected to what the
medical minds decide are the problem or the fix and are frustrating the IT
solution that deals with the medical issues. It is also spending the valuable time
of volunteers and delaying the best care that our veterans deserve.
Your email to me underscores this problem. You say that:
"[
efforts have been focused with the VA on ensuring that an EHMP
is completed above their health records so that the medical records can be
pulled into an Apple device. The EHMP work is in process and is a necessity for
Apple to then come in and provide its services," and
"There is a call on Monday with Apple, the VA, and (b) (6) to review
the ... status of the EHMP work ... [and] to confirm Apple job scope which includes
portability of health records/ data from VA to Apple products; VA technical
changes to how to allow VA workers to use Apple products; (and potentially
portability of health records/ data to non-VA medical facilities."
However, it is not possible to design an EHMP system or integrate the system
with an Apple device until you know how the medical experts are going to
change the medical delivery system and how they advise a device should be
utilized in the medical delivery system. The academic medical experts on our
team are assisting the VA in designing a sophisticated system of community care
through a public-private delivery system. They are formulating that system and
its inner workings, the creation of which will dictate the Integration and
interoperability of records. Neither (b) (6) nor Apple can define a scope or
product use without consulting with our group on how veteran's records used in
the private sector will get integrated into the portable record and back to the
VA.
You mention in your email telehealth. Our team of medical experts are working
on a telehealth initiative and delivered a draft Executive Order to the
President...while you are working with the DEA and DOJ, without the courtesy of
advising us, which could have tremendous implications on the wording or, worse
yet, the prudence of an Executive Order in the first place. This parallel path as
well creates the potential for embarrassment for the President and wasted
invaluable time that our veterans can ill afford.
VA-19-0799-D-001247
OS 00002918
Lastly, you discuss your parallel meeting on a Military Wellness program which
you apparently already brought in which you believe focuses on preventative
medicine. The program that you are touting however is surrounded by rumors
that are less than flattering. Moreover, our team's academic medical experts are
already assisting in the active development of a wellness program for the VA and
their views will prevail. Those experts have already assembled the working parts
of a wellness program and the seamless integration with active service members
and family. There is no need to have a parallel side effort that is not integrated
into the agreed program. Again, the problem is not about communication.
I had an employee a few years back that meant well but thought that there was
an "I" in team. His work for the company created value and profits for the
company at various times, however, in spite of those benefits, I advised him that
his way was not working and he should find something else that better met his
style.
With all this considered, I think that (b) (6) is a smart woman that could provide
the VA IT experience and benefits, my way ... not as a renegade player. I am
willing to work with her as a team player on our team. The expert team that I
assembled and is sanctioned by the President will be proceeding with its efforts
as planned. All other parallel efforts should stand down. (b) (6) can participate
as part of that team, not outside of that team or its efforts or its direction. As
agreed on day one, the White House can participate by providing executive and
administrative assistance, when requested by our expert team. We will arrange
and conduct discussions with Apple (in which (b) (6) should participate if done
within the confines of the expert team). We will work with design and
implementation of a wellness program and we will decide on the proper way to
integrate an EMR system, with (b) (6)
team participation if agreed. Any items
that relate to the transformation of the VA must be funneled through and
managed by the expert team and should be coordinated with Dr. Moskowitz and
Marc Sherman.
Let me know if you have any questions.
Ike
From: (b) (6)
EOP/WHO [mailto:(b) (6)
Sent: Friday, March 31, 2017 6:03 PM
To: IP; Kushner, Jared C. EOP/WHO
Cc: (b) (6)
EOP/WHO; (b) (6)
Subject: RE: VA And Apple
who.eop.gov]
EOP/WHO
As we discussed it seems like (b) (6)
has been working but not
communicating. Her efforts have been focused with the VA on
ensuring that an EHMP is completed above their health records so
that the medical records can be pulled into an Apple device. The
EHMP work is in process and is a necessity for Apple to then come in
and provide its services. There is a call on Monday with Apple, the
VA, and (b) (6)
to review the following:
1. Status of the EHMP work
VA-19-0799-D-001248
OS 00002919
2. to find a legal mechanism to allow for 3 month tour of duty
from Apple engineers with the employees staying on Apple
payroll. This is being investigated by USDS lawyers and the VA.
3. To work through an NDA / conflict waiver which is a necessary
legal document.
4. To confirm Apple job scope which includes portability of
health records/ data from VA to Apple products; VA technical
changes to how to allow VA workers to use Apple products;
(and potentially portability of health records/ data to non-VA
medical facilities.)
I believe we should then schedule a call for mid next week with Ike,
myself
appropriate members of Ike's team, the VA, Apple and (b) (6)
to ensure we are on same page (I can coordinate the call). I think we
should allow (b) (6)
an opportunity to reset and to act as a true
overall project manager where we allow her to coordinate. She
should communicate with Ike and his designee consistently and she
should professionally coordinate the team, get everyone working
together, and show us progress. I believe she will do a great job, and
we will know quickly if she does not.
As everyone knows huge other hot items at VA in the works right
now including Accountability (legislation and EO), Choice Reform Act
extension and reform; telehealth (working through the issue with
DOJ and DEA; hard to just slam it through if they oppose but based
on meeting today with VA/DOJ/DEA I believe we can get them there
in next two weeks. Ike, I can explain in detail when we next talk but
having been through this with the Opioid EO this week we should see
if we can get DEA/ DOJ on board).
Different subject, Ike would also like your advice on NIH and the idea
(I think your idea?) to create a profit sharing program with our
grants. Love this idea.
Yours truly,
(b) (6)
P.S. I need to update you on very exciting meeting on a Military
Wellness program which we brought in; focuses on preventative
medicine and is working for over 20,000 vets currently. Readily
scalable.
(b) (6)
Assistant to the President
For lntragovernmental and Technology Initiatives
VA-19-0799-D-001249
DS 00002920
202.456.(b) (6) (Direct)
(b) (6)
who.eop.gov
From: IP fmailto:(b) (6) frenchangel59.com1
Sent: Friday, March 31, 2017 12:05 AM
To: Kushner, Jared C. EOP/WHO <(b) (6) who.eop.gov>
Cc: (b) (6)
EOP/WHO <(b) (6)
EOP/WHO <(b) (6) who.eop.gov>
Subject: FW: VA And Apple
who.eop.gov>; (b) (6)
Jared,
As you know lvanka introduced me to (b) (6)
at Apple and (b) (6)
at Johnson &
Johnson. Ours Academic team and experts have worked so well with them and their
teams. What
has done here is really outrageous. She may be very good in social
media, but this an entirely different and very complicated area.
We will fix this.
All my Best,
Ike
From: IP [ mailto:(b) (6) frenchanqel59.com]
Sent: Thursday, March 30, 2017 11:56 PM
To: (b) (6)
omb.eop.gov
Cc: (b) (6)
who.eop.gov; lperl(b) (6) @qmail.com ;
brucem(b) (6)
@mac.com ; mbs(b) (6)
@qmail.com
Subject: FW: VA And Apple
(b) (6)
With all due respect, I am shocked and extremely disappointed with the manner in
which you have engaged in individual communications with Apple - and intentionally
excluded our broader team of subject matter experts. I understand that these backdoor
discussions have apparently been occurring almost daily for weeks, and you have not
told anyone and refuse to return phone calls and emails.
When we first met on February 7th, I personally shared with you our vision and goals
and explained that it is critical that everything we do must be done as a team.
The very purpose of our Academic team, Dr. Moskowitz, and Marc Sherman is to ensure
proper analysis, sharing of best practices, and provide a forum for discussion, debate,
and ultimately the strongest collective decisions/recommendations.
You agreed then, but your actions to date regarding Apple prove otherwise.
When I spoke with (b) (6)
on February 1st we discussed and agreed on the
importance of leveraging our Academic team and experts for the end goal of creating
the best system for our veterans. Further on our Apple conference call on March 3rd which we invited you and (b) (6) to join - we again discussed and all agreed that for us to
be successful and fix all the issues that our great veterans are going through on a daily
basis, we must all unite and work as one team, with only one agenda and one goal.
VA-19-0799-D-001250
OS 00002921
What we are seeing from you today is a blatant disregard for that commitment and
clear disrespect to everyone involved. You are putting yourself, your own agenda, and
your own ego ahead of our veterans. This is unacceptable. There are 22 veterans dying
every day. Your decision to alone discuss IT and technology solutions with Apple for
weeks without the broader team of experts and not informing me and Dr. Moskowitz is
major step backwards and will only cause additional work and significant delays. As a
result of your hijacking of this effort, Apple has already canceled conference calls.
In fact, many of the current problems with the VA is because of this very reason - the
lack of team work within. Let me be clear, I will not allow this to happen while I am
involved.
I want this resolved immediately. First, you must include Dr. Moskowitz and Marc
Sherman on any and all calls or meetings. Additionally, I will formally ask you again to
please respect me and our broader group of subject matter experts, and immediately
cease individual discussions with Apple and/or any other parties related to the work we
have undertaken regarding the VA.
Ike
-----Original Message----(b) (6)
From: (b) (6)
EOP/OMB fmailto:(b) (6)
Sent: Thursday, March 30, 2017 6:48 PM
To: Bruce Moskowitz
Cc: (b) (6)
EOP/WHO; IP; (b) (6) frenchangel59.com
Subject: Re: VA And Apple
omb.eop.gov]
Hey team! We're making great progress, which I'm excited to fill you in on. Will send you
more info when I get out of these back-to-back mtgs and will give you a ring back Ike!
Thanks!
> On Mar 30, 2017, at 6:49 AM, Bruce Moskowitz <(b) (6)
wrote:
mac.com >
>
> In the last email exchange i was supposed to receive information on your interaction
with Apple so that we could rapidly obtain needed technology from our Academic
Center Consortium upcoming discussion with Apple. I realize there are multiple
technology issues on everyone's desk however we have medical emergencies daily at
the VA that can only be solved by rapid deployment of new technology. I am available
24-7 by phone 561-3466(b) (6) Thank you
>
> Sent from my iPad
> Bruce Moskowitz M.D.
-----Original Message----From: Bruce Moskowitz fmailto:(b) (6)
Sent: Tuesday, March 28, 2017 11:41 AM
To: (b) (6)
who.eop.gov; (b) (6)
Cc: IP
mac.com ]
omb.eop.gov
VA-19-0799-D-001251
OS 00002922
Subject: VA And Apple
It would be of benefit to discuss what we can accomplish in technology with Apple for
the benefit of the VA. It would be of importance to understand what discussions the
Whitehouse team has already had with Apple so that we have a clear path forward and
do not duplicate what has already been accomplished. let me know a convenient time
to talk. Thank you
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-001252
OS 00002923
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/2/2017 7:17:35 PM
To:
IP [(b) (6) frenchangel59.com]
Re: VA And Apple
Subject:
Great
Sent from my iPhone
On Apr 2, 2017, at 2:57 PM, IP <(b) (6) frenchangel59.com > wrote:
EOP/WHO [ mailto:(b) (6)
From: (b) (6)
Sent: Sunday, April 02, 2017 2:33 PM
(b)
To: IP;
(6) EOP/WHO
Cc: Kushner, Jared C. EOP/WHO; (b) (6)
Subject: RE: VA And Apple
who.eop.gov]
EOP/WHO
Ike and I had a great conversation and are on the same-page.
From: (b) (6)
EOP/WHO
Sent: Sunday, April 2, 2017 1:13 PM
To: 'IP' <(b) (6) frenchangel59.com >;
(b) (6)
(b) (6)
Cc: Kushner, Jared C. EOP/WHO <
<(b) (6) who.eop.gov>
Subject: RE: VA And Apple
EOP/WHO <(b) (6)
who.eop.gov>;
(b) (6)
who.eop.gov>
EOP/WHO
Call me anytime
From: IP fmailto:(b) (6) frenchangel59.com1
Sent: Sunday, April 2, 2017 1:08 PM
To: (b) (6)
EOP/WHO <(b) (6)
who.eop.gov>; (b) (6)
<
who.eop.gov>
Cc: Kushner, Jared C. EOP/WHO <(b) (6) who.eop.gov>; (b) (6)
<(b) (6) who.eop.gov>
Subject: RE: VA And Apple
EOP/WHO
(b) (6)
EOP/WHO
(b) (6)
Thanks for your email and especially the thoughts on FACA. The good news is that we have
been advised that FACA does not apply because we are not a formal group in any way. I have
identified, as I mentioned, the brightest medical minds in medical system operations. Each of
those people (in their individual capacity) is willing to give of their personal time for the
betterment of the VA when requested by the VA. And each of these people has been willing to
provide advice to the Secretary when he reaches out to any one of them. I have an
understanding of their individual views and could fill you in when we speak since it isn't
practical to continue debating any of this on email.
VA-19-0799-D-001253
OS 00002924
Ike
From: (b) (6)
EOP/WHO [ mailto:(b) (6)
Sent: Sunday, April 02, 2017 11:17 AM
To: IP; (b) (6)
EOP/WHO
Cc: Kushner, Jared C. EOP/WHO; (b) (6)
Subject: RE: VA And Apple
who.eop.gov]
EOP/WHO
Ike, you expressed concern in our call the other day that "we were just posing for
pictures" in this WH but in the below you seem concerned that we are
engaged. You are concerned that we are not communicating but please consider
that I do not receive updates from your team.
Please keep in mind that I have nothing but the utmost respect for what you are
doing and that I know this is a life-and-death topic. But to do what you outlined
below you will need to form a FACA group. One is being formed on
Infrastructure. Please have your attorney reach out to WH Counsel (b) (6)
(copied) to start that process. I have interjected a few thoughts into
your email below:
From: IP [mailto:(b) (6) frenchangel59.com ]
Sent: Sunday, April 2, 2017 10:16 AM
To: (b) (6)
EOP/WHO <(b) (6)
who.eop.gov>
Cc: Kushner, Jared C. EOP/WHO <(b) (6) who.eop.gov>; (b) (6)
<(b) (6) who.eop.gov>
Subject: RE: VA And Apple
EOP/WHO
(b) (6)
My email to (b) (6) on Thursday expressed my frustration and displeasure in learning about
activity and decisions concerning issues at the VA in a separate and invisible parallel
effort. Regrettably, your response to my email that "(b) (6)
has been working but not
communicating" not only fails to recognize or explain the issue, but merely highlights the very
fundamental problem that is so troubling. While a lack of communication has certainly
exacerbated the problem, the mere fact that there has been any activity or decision without
first coordinating that activity with our team before taking any action is the problem. Simply
offering to communicate better solves very little. I AGREE, THAT WAS MY POINT, LACK OF
COMMUNICATION. I WAS FOCUSED ON CHANGE MOVING FORWARD NOT GOING BACKWARD.
In your and (b) (6)
first meeting in the West Wing with Marc Sherman it was clear and agreed
(b) (6)
that
would be the liaison between our expert team and the White House and provide her
IT counsel to our team related to our initiatives (not as an invisible, parallel effort). In addition,
the White House was to be available to assist our team with executive and legislative clout
when requested (not conduct an invisible, parallel effort), a three-pronged approach, if you
recall. This is the program I reported to the President and the go-ahead we received.
VA-19-0799-D-001254
OS 00002925
The essential problem at the VA is that 22 veterans die every day and the system of care and
access to care is in need of repair. This is a medical issue and medical delivery problem. In
order to fix the VA, these medical problems must first be defined and fixed. All other issues, like
IT, are a function of the determined fix to the medical issues and medical delivery
problems. To transform the VA into the best of class, I assembled a team that includes the best
and brightest minds in the academic medical community. The restructuring efforts on which
we embark are informed by the advice and participation of those great medical minds. Parallel
(and invisible to us) IT efforts are not connected to what the medical minds decide are the
problem or the fix and are frustrating the IT solution that deals with the medical issues. It is
also spending the valuable time of volunteers and delaying the best care that our veterans
deserve.
Your email to me underscores this problem. You say that:
"[
efforts have been focused with the VA on ensuring that an EHMP is completed
above their health records so that the medical records can be pulled into an Apple device. The
EHMP work is in process and is a necessity for Apple to then come in and provide its services,"
and
"There is a call on Monday with Apple, the VA, and (b) (6) to review the ... status of the
EHMP work ... [and] to confirm Apple job scope which includes portability of health records/
data from VA to Apple products; VA technical changes to how to allow VA workers to use Apple
products; (and potentially portability of health records/ data to non-VA medical facilities."
However, it is not possible to design an EHMP system or integrate the system with an Apple
device until you know how the medical experts are going to change the medical delivery system
and how they advise a device should be utilized in the medical delivery system. The academic
medical experts on our team are assisting the VA in designing a sophisticated system of
community care through a public-private delivery system. They are formulating that system
and its inner workings, the creation of which will dictate the Integration and interoperability of
records. Neither (b) (6) nor Apple can define a scope or product use without consulting with our
group on how veteran's records used in the private sector will get integrated into the portable
record and back to the VA. RIGHT NOW THERE IS NO MEDICAL DELIVERY SYSTEM THAT CAN
ACCESS THE MEDICAL RECORDS. THE EHMP MUST BE COMPLETED TO ALLOW ANY SUCH
PRODUCT TO EXTRAPOLATE THE DATA.
You mention in your email telehealth. Our team of medical experts are working on a telehealth
initiative and delivered a draft Executive Order to the President ... while you are working with
the DEA and DOJ, without the courtesy of advising us, which could have tremendous
implications on the wording or, worse yet, the prudence of an Executive Order in the first
place. This parallel path as well creates the potential for embarrassment for the President and
wasted invaluable time that our veterans can ill afford. THIS EO (WHICH IS LIKELY TO BE PART
OF A LARGER VA EO) WILL 100% GO THROUGH DOJ AND DEA. IT MAY OR MAY NOT BE
POSSIBLE FOR THE PRESIDENT TO SLAM THROUGH AN EO AGAINST THEIR WISHES HOWEVER IT
IS FAR BETTER FOR THE PRESIDENT TO REACH CONCENSUS. KEEP IN MIND THERE ARE OVER
50,000 PEOPLE PER YEAR DYING FROM DRUG OVERDOSES MUCH OF WHICH IS LINKIED TO THE
OVER-SUBSCRIBING OF OPIOIDS. DEA AND DOJ (I BELIEVE INCORRECTLY) VIEW TELEHEALTH AS
A LESSENING OF CONTROL.
VA-19-0799-D-001255
OS 00002926
Lastly, you discuss your parallel meeting on a Military Wellness program which you apparently
already brought in which you believe focuses on preventative medicine. The program that you
are touting however is surrounded by rumors that are less than flattering. Moreover, our
team's academic medical experts are already assisting in the active development of a wellness
program for the VA and their views will prevail. Those experts have
already assembled the working parts of a wellness program and the seamless integration with
active service members and family. There is no need to have a parallel side effort that is not
integrated into the agreed program. Again, the problem is not about communication. THE
MILITARY WELLNESS INITIATIVE HAS BEEN LAUDED IN EVERY REVIEW, AND BT THE VA, AND
VSO'S. IT IS IN PLACE, THE VA CAN DECIDE TO AMPLIFY ITS EFFORTS OR NOT. IT WOULD IN NO
WAY PREVENT THE VA FROM HAVING A MAJOR WELLNESS INITIATIVE OF ITS OWN; IT IS
SUPPLEMENTAL. I DO NOT HAVE AN OPINION AS TO WHETHER IT SHOULD BE AMPLIFIED, IT IS
SOMETHING FOR THE VA TO DETERMINE.
I had an employee a few years back that meant well but thought that there was an "I" in
team. His work for the company created value and profits for the company at various times,
however, in spite of those benefits, I advised him that his way was not working and he should
find something else that better met his style. I HAD A FEW OF THEM WITH MY 15,000
EMPLOYEES AS WELL!
With all this considered, I think that (b) (6) is a smart woman that could provide the VA IT
experience and benefits, my way ... not as a renegade player. I am willing to work with her as a
team player on our team. The expert team that I assembled and is sanctioned by the President
will be proceeding with its efforts as planned. All other parallel efforts should stand
down. (b) (6) can participate as part of that team, not outside of that team or its efforts or its
direction. As agreed on day one, the White House can participate by providing executive and
administrative assistance, when requested by our expert team. We will arrange and conduct
discussions with Apple (in which (b) (6) should participate if done within the confines of the
expert team). We will work with design and implementation of a wellness program and we will
decide on the proper way to integrate an EMR system, with (b) (6)
team participation if
agreed. Any items that relate to the transformation of the VA must be funneled through and
managed by the expert team and should be coordinated with Dr. Moskowitz and Marc
Sherman. SHE CANNOT REPORT TO NON-GOVERNMENT PEOPLE.
Let me know if you have any questions. AS I EMAILED SOME OF THE BIGGEST ISSUES FOR THE
VA RIGHT NOW ARE LEGISLATIVE. THE ACCOUNTABILITY ACT, THE EXTENSION OF THE CHOICE
ACT, THE CHOICE REFORM ACT (AND THE CORRESPONDING BUDGET ISSUES RAISED BY
ALLOWING CHOICE)
Ike
EOP/WHO [ mailto:(b) (6)
From: (b) (6)
Sent: Friday, March 31, 2017 6:03 PM
To: IP; Kushner, Jared C. EOP/WHO
Cc: (b) (6)
EOP/WHO; (b) (6)
Subject: RE: VA And Apple
who.eop.gov]
EOP/WHO
VA-19-0799-D-001256
OS 00002927
As we discussed it seems like (b) (6)
has been working but not
communicating. Her efforts have been focused with the VA on ensuring that an
EHMP is completed above their health records so that the medical records can be
pulled into an Apple device. The EHMP work is in process and is a necessity for
Apple to then come in and provide its services. There is a call on Monday with
Apple, the VA, and (b) (6)
to review the following:
1. Status of the EHMP work
2. to find a legal mechanism to allow for 3 month tour of duty from Apple
engineers with the employees staying on Apple payroll. This is being
investigated by USDS lawyers and the VA.
3. To work through an NDA / conflict waiver which is a necessary legal
document.
4. To confirm Apple job scope which includes portability of health records/
data from VA to Apple products; VA technical changes to how to allow VA
workers to use Apple products; (and potentially portability of health
records/ data to non-VA medical facilities.)
I believe we should then schedule a call for mid next week with Ike, appropriate
myself to ensure we are on
members of Ike's team, the VA, Apple and (b) (6)
an
same page (I can coordinate the call). I think we should allow (b) (6)
opportunity to reset and to act as a true overall project manager where we allow
her to coordinate. She should communicate with Ike and his designee
consistently and she should professionally coordinate the team, get everyone
working together, and show us progress. I believe she will do a great job, and we
will know quickly if she does not.
As everyone knows huge other hot items at VA in the works right now including
Accountability (legislation and EO), Choice Reform Act extension and reform;
telehealth (working through the issue with DOJ and DEA; hard to just slam it
through if they oppose but based on meeting today with VA/DOJ/DEA I believe
we can get them there in next two weeks. Ike, I can explain in detail when we
next talk but having been through this with the Opioid EO this week we should
see if we can get DEA/ DOJ on board).
Different subject, Ike would also like your advice on NIH and the idea (I think your
idea?) to create a profit sharing program with our grants. Love this idea.
Yours truly,
(b) (6)
P.S. I need to update you on very exciting meeting on a Military Wellness program
which we brought in; focuses on preventative medicine and is working for over
20,000 vets currently. Readily scalable.
(b) (6)
VA-19-0799-D-001257
DS 00002928
Assistant to the President
For lntragovernmental and Technology Initiatives
202.456.(b) (6) (Direct)
(b) (6)
who.eop.gov
From: IP fmailto:(b) (6) frenchangel59.com1
Sent: Friday, March 31, 2017 12:05 AM
To: Kushner, Jared C. EOP/WHO <(b) (6) who.eop.gov>
Cc: (b) (6)
EOP/WHO <(b) (6)
who.eop.gov>; (b) (6)
(b) (6)
<
who.eop.gov>
Subject: FW: VA And Apple
EOP/WHO
Jared,
As you know lvanka introduced me to (b) (6)
at Apple and (b) (6)
at Johnson & Johnson. Ours
has done here
Academic team and experts have worked so well with them and their teams. What
is really outrageous. She may be very good in social media, but this an entirely different and very
complicated area.
We will fix this.
All my Best,
Ike
From: IP [ mailto:(b) (6) frenchanqel59.com]
Sent: Thursday, March 30, 2017 11:56 PM
To: (b) (6)
omb.eop.gov
Cc: (b) (6)
who.eop.gov; lperl(b) (6) @qmail.com ; brucem(b) (6)
mbs(b) (6)
@qmail.com
Subject: FW: VA And Apple
@mac.com ;
(b) (6)
With all due respect, I am shocked and extremely disappointed with the manner in which you have
engaged in individual communications with Apple - and intentionally excluded our broader team of
subject matter experts. I understand that these backdoor discussions have apparently been occurring
almost daily for weeks, and you have not told anyone and refuse to return phone calls and emails.
When we first met on February 7th, I personally shared with you our vision and goals and explained that
it is critical that everything we do must be done as a team.
The very purpose of our Academic team, Dr. Moskowitz, and Marc Sherman is to ensure proper analysis,
sharing of best practices, and provide a forum for discussion, debate, and ultimately the strongest
collective decisions/recommendations.
You agreed then, but your actions to date regarding Apple prove otherwise.
on February 1st we discussed and agreed on the importance of leveraging
When I spoke with (b) (6)
our Academic team and experts for the end goal of creating the best system for our veterans. Further on
our Apple conference call on March 3rd - which we invited you and (b) (6) to join - we again discussed
and all agreed that for us to be successful and fix all the issues that our great veterans are going through
on a daily basis, we must all unite and work as one team, with only one agenda and one goal.
VA-19-0799-D-001258
OS 00002929
What we are seeing from you today is a blatant disregard for that commitment and clear disrespect to
everyone involved. You are putting yourself, your own agenda, and your own ego ahead of our veterans.
This is unacceptable. There are 22 veterans dying every day. Your decision to alone discuss IT and
technology solutions with Apple for weeks without the broader team of experts and not informing me
and Dr. Moskowitz is major step backwards and will only cause additional work and significant delays. As
a result of your hijacking of this effort, Apple has already canceled conference calls.
In fact, many of the current problems with the VA is because of this very reason - the lack of team work
within. Let me be clear, I will not allow this to happen while I am involved.
I want this resolved immediately. First, you must include Dr. Moskowitz and Marc Sherman on any and
all calls or meetings. Additionally, I will formally ask you again to please respect me and our broader
group of subject matter experts, and immediately cease individual discussions with Apple and/or any
other parties related to the work we have undertaken regarding the VA.
Ike
-----Original Message----(b) (6)
From: (b) (6)
EOP/OMB fmailto:(b) (6)
Sent: Thursday, March 30, 2017 6:48 PM
To: Bruce Moskowitz
Cc: (b) (6)
EOP/WHO; IP; (b) (6) frenchangel59.com
Subject: Re: VA And Apple
omb.eop.gov]
Hey team! We're making great progress, which I'm excited to fill you in on. Will send you more info
when I get out of these back-to-back mtgs and will give you a ring back Ike!
Thanks!
> On Mar 30, 2017, at 6:49 AM, Bruce Moskowitz <(b) (6)
mac.com > wrote:
>
> In the last email exchange i was supposed to receive information on your interaction with Apple so
that we could rapidly obtain needed technology from our Academic Center Consortium upcoming
discussion with Apple. I realize there are multiple technology issues on everyone's desk however we
have medical emergencies daily at the VA that can only be solved by rapid deployment of new
technology. I am available 24-7 by phone 561-3466(b) (6) Thank you
>
> Sent from my iPad
> Bruce Moskowitz M.D.
-----Original Message----From: Bruce Moskowitz fmailto:(b) (6)
Sent: Tuesday, March 28, 2017 11:41 AM
To: (b) (6)
who.eop.gov; (b) (6)
Cc: IP
Subject: VA And Apple
mac.com ]
omb.eop.gov
It would be of benefit to discuss what we can accomplish in technology with Apple for the benefit of the
VA. It would be of importance to understand what discussions the Whitehouse team has already had
VA-19-0799-D-001259
OS 00002930
with Apple so that we have a clear path forward and do not duplicate what has already been
accomplished. let me know a convenient time to talk. Thank you
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-001260
OS 00002931
Message
From:
Sent:
To:
Subject:
Attachments:
David Shulkin [drshulkin@aol.com]
4/2/2017 7:02:20 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: VA And Apple
Untitled Attachment; Untitled attachment 05945.htm
It's easy to get on the wrong side of this group
Sent from my iPad
Begin forwarded message:
From: "IP" <(b) (6) frenchangel59.com >
Date: April 2, 2017 at 10:51:54 AM EDT
To: "David shulkin"
Subject: FW: VA And Apple
From: IP [mailto:(b) (6) frenchanqel59.com]
Sent: Sunday, April 02, 2017 10:16 AM
To: '(b) (6)
EOP/WHO'
Cc: 'Kushner, Jared C. EOP/WHO'; '(b) (6)
Subject: RE: VA And Apple
EOP/WHO'
(b) (6)
My email to (b) (6) on Thursday expressed my frustration and displeasure in learning about
activity and decisions concerning issues at the VA in a separate and invisible parallel
effort. Regrettably, your response to my email that "(b) (6)
has been working but not
communicating" not only fails to recognize or explain the issue, but merely highlights the very
fundamental problem that is so troubling. While a lack of communication has certainly
exacerbated the problem, the mere fact that there has been any activity or decision without
first coordinating that activity with our team before taking any action is the problem. Simply
offering to communicate better solves very little.
In your and (b) (6)
first meeting in the West Wing with Marc Sherman it was clear and agreed
(b) (6)
that
would be the liaison between our expert team and the White House and provide her
IT counsel to our team related to our initiatives (not as an invisible, parallel effort). In addition,
the White House was to be available to assist our team with executive and legislative clout
when requested (not conduct an invisible, parallel effort), a three-pronged approach, if you
recall. This is the program I reported to the President and the go-ahead we received.
The essential problem at the VA is that 22 veterans die every day and the system of care and
access to care is in need of repair. This is a medical issue and medical delivery problem. In
order to fix the VA, these medical problems must first be defined and fixed. All other issues, like
IT, are a function of the determined fix to the medical issues and medical delivery
problems. To transform the VA into the best of class, I assembled a team that includes the best
and brightest minds in the academic medical community. The restructuring efforts on which
VA-19-0799-D-001261
OS 00002932
we embark are informed by the advice and participation of those great medical minds. Parallel
(and invisible to us) IT efforts are not connected to what the medical minds decide are the
problem or the fix and are frustrating the IT solution that deals with the medical issues. It is
also spending the valuable time of volunteers and delaying the best care that our veterans
deserve.
Your email to me underscores this problem. You say that:
"[
efforts have been focused with the VA on ensuring that an EHMP is completed
above their health records so that the medical records can be pulled into an Apple device. The
EHMP work is in process and is a necessity for Apple to then come in and provide its services,"
and
"There is a call on Monday with Apple, the VA, and (b) (6) to review the ... status of the
EHMP work ... [and] to confirm Apple job scope which includes portability of health records/
data from VA to Apple products; VA technical changes to how to allow VA workers to use Apple
products; (and potentially portability of health records/ data to non-VA medical facilities."
However, it is not possible to design an EHMP system or integrate the system with an Apple
device until you know how the medical experts are going to change the medical delivery system
and how they advise a device should be utilized in the medical delivery system. The academic
medical experts on our team are assisting the VA in designing a sophisticated system of
community care through a public-private delivery system. They are formulating that system
and its inner workings, the creation of which will dictate the Integration and interoperability of
records. Neither (b) (6) nor Apple can define a scope or product use without consulting with our
group on how veteran's records used in the private sector will get integrated into the portable
record and back to the VA.
You mention in your email telehealth. Our team of medical experts are working on a telehealth
initiative and delivered a draft Executive Order to the President ... while you are working with
the DEA and DOJ, without the courtesy of advising us, which could have tremendous
implications on the wording or, worse yet, the prudence of an Executive Order in the first
place. This parallel path as well creates the potential for embarrassment for the President and
wasted invaluable time that our veterans can ill afford.
Lastly, you discuss your parallel meeting on a Military Wellness program which you apparently
already brought in which you believe focuses on preventative medicine. The program that you
are touting however is surrounded by rumors that are less than flattering. Moreover, our
team's academic medical experts are already assisting in the active development of a wellness
program for the VA and their views will prevail. Those experts have
already assembled the working parts of a wellness program and the seamless integration with
active service members and family. There is no need to have a parallel side effort that is not
integrated into the agreed program. Again, the problem is not about communication.
I had an employee a few years back that meant well but thought that there was an "I" in
team. His work for the company created value and profits for the company at various times,
however, in spite of those benefits, I advised him that his way was not working and he should
find something else that better met his style.
VA-19-0799-D-001262
OS 00002933
With all this considered, I think that (b) (6) is a smart woman that could provide the VA IT
experience and benefits, my way ... not as a renegade player. I am willing to work with her as a
team player on our team. The expert team that I assembled and is sanctioned by the President
will be proceeding with its efforts as planned. All other parallel efforts should stand
down. (b) (6) can participate as part of that team, not outside of that team or its efforts or its
direction. As agreed on day one, the White House can participate by providing executive and
administrative assistance, when requested by our expert team. We will arrange and conduct
discussions with Apple (in which (b) (6) should participate if done within the confines of the
expert team). We will work with design and implementation of a wellness program and we will
team participation if
decide on the proper way to integrate an EMR system, with (b) (6)
agreed. Any items that relate to the transformation of the VA must be funneled through and
managed by the expert team and should be coordinated with Dr. Moskowitz and Marc
Sherman.
Let me know if you have any questions.
Ike
EOP/WHO [ mailto:(b) (6)
From: (b) (6)
Sent: Friday, March 31, 2017 6:03 PM
To: IP; Kushner, Jared C. EOP/WHO
Cc: (b) (6)
EOP/WHO; (b) (6)
Subject: RE: VA And Apple
who.eop.gov]
EOP/WHO
As we discussed it seems like (b) (6)
has been working but not
communicating. Her efforts have been focused with the VA on ensuring that an
EHMP is completed above their health records so that the medical records can be
pulled into an Apple device. The EHMP work is in process and is a necessity for
Apple to then come in and provide its services. There is a call on Monday with
Apple, the VA, and (b) (6)
to review the following:
1. Status of the EHMP work
2. to find a legal mechanism to allow for 3 month tour of duty from Apple
engineers with the employees staying on Apple payroll. This is being
investigated by USDS lawyers and the VA.
3. To work through an NDA / conflict waiver which is a necessary legal
document.
4. To confirm Apple job scope which includes portability of health records/
data from VA to Apple products; VA technical changes to how to allow VA
workers to use Apple products; (and potentially portability of health
records/ data to non-VA medical facilities.)
I believe we should then schedule a call for mid next week with Ike, appropriate
myself to ensure we are on
members of Ike's team, the VA, Apple and (b) (6)
same page (I can coordinate the call). I think we should allow (b) (6)
an
opportunity to reset and to act as a true overall project manager where we allow
her to coordinate. She should communicate with Ike and his designee
VA-19-0799-D-001263
DS 00002934
consistently and she should professionally coordinate the team, get everyone
working together, and show us progress. I believe she will do a great job, and we
will know quickly if she does not.
As everyone knows huge other hot items at VA in the works right now including
Accountability (legislation and EO), Choice Reform Act extension and reform;
telehealth (working through the issue with DOJ and DEA; hard to just slam it
through if they oppose but based on meeting today with VA/DOJ/DEA I believe
we can get them there in next two weeks. Ike, I can explain in detail when we
next talk but having been through this with the Opioid EO this week we should
see if we can get DEA/ DOJ on board).
Different subject, Ike would also like your advice on NIH and the idea (I think your
idea?) to create a profit sharing program with our grants. Love this idea.
Yours truly,
(b) (6)
P.S. I need to update you on very exciting meeting on a Military Wellness program
which we brought in; focuses on preventative medicine and is working for over
20,000 vets currently. Readily scalable.
(b) (6)
Assistant to the President
For lntragovernmental and Technology Initiatives
202.456.(b) (6) (Direct)
(b) (6)
who.eop.gov
From: IP fmailto:(b) (6) frenchangel59.com1
Sent: Friday, March 31, 2017 12:05 AM
To: Kushner, Jared C. EOP/WHO <(b) (6) who.eop.gov>
Cc: (b) (6)
EOP/WHO <(b) (6)
(b) (6)
<
who.eop.gov>
Subject: FW: VA And Apple
who.eop.gov>; (b) (6)
EOP/WHO
Jared,
As you know lvanka introduced me to (b) (6)
at Apple and (b) (6)
at Johnson & Johnson. Ours
has done here
Academic team and experts have worked so well with them and their teams. What
is really outrageous. She may be very good in social media, but this an entirely different and very
complicated area.
We will fix this.
All my Best,
Ike
VA-19-0799-D-001264
DS 00002935
From: IP [ mailto:(b) (6) frenchanqel59.com]
Sent: Thursday, March 30, 2017 11:56 PM
To: (b) (6)
omb.eop.gov
Cc: (b) (6)
who.eop.gov; lperl(b) (6) @qmail.com ; brucem(b) (6)
mbs(b) (6)
@qmail.com
Subject: FW: VA And Apple
@mac.com ;
(b) (6)
With all due respect, I am shocked and extremely disappointed with the manner in which you have
engaged in individual communications with Apple - and intentionally excluded our broader team of
subject matter experts. I understand that these backdoor discussions have apparently been occurring
almost daily for weeks, and you have not told anyone and refuse to return phone calls and emails.
When we first met on February 7th, I personally shared with you our vision and goals and explained that
it is critical that everything we do must be done as a team.
The very purpose of our Academic team, Dr. Moskowitz, and Marc Sherman is to ensure proper analysis,
sharing of best practices, and provide a forum for discussion, debate, and ultimately the strongest
collective decisions/recommendations.
You agreed then, but your actions to date regarding Apple prove otherwise.
When I spoke with (b) (6)
on February 1st we discussed and agreed on the importance of leveraging
our Academic team and experts for the end goal of creating the best system for our veterans. Further on
our Apple conference call on March 3rd - which we invited you and (b) (6) to join - we again discussed
and all agreed that for us to be successful and fix all the issues that our great veterans are going through
on a daily basis, we must all unite and work as one team, with only one agenda and one goal.
What we are seeing from you today is a blatant disregard for that commitment and clear disrespect to
everyone involved. You are putting yourself, your own agenda, and your own ego ahead of our veterans.
This is unacceptable. There are 22 veterans dying every day. Your decision to alone discuss IT and
technology solutions with Apple for weeks without the broader team of experts and not informing me
and Dr. Moskowitz is major step backwards and will only cause additional work and significant delays. As
a result of your hijacking of this effort, Apple has already canceled conference calls.
In fact, many of the current problems with the VA is because of this very reason - the lack of team work
within. Let me be clear, I will not allow this to happen while I am involved.
I want this resolved immediately. First, you must include Dr. Moskowitz and Marc Sherman on any and
all calls or meetings. Additionally, I will formally ask you again to please respect me and our broader
group of subject matter experts, and immediately cease individual discussions with Apple and/or any
other parties related to the work we have undertaken regarding the VA.
Ike
-----Original Message----(b) (6)
From: (b) (6)
EOP/OMB [mailto:(b) (6)
Sent: Thursday, March 30, 2017 6:48 PM
To: Bruce Moskowitz
Cc: (b) (6)
EOP/WHO; IP; (b) (6) frenchangel59.com
Subject: Re: VA And Apple
omb.eop.gov]
VA-19-0799-D-001265
OS 00002936
Hey team! We're making great progress, which I'm excited to fill you in on. Will send you more info
when I get out of these back-to-back mtgs and will give you a ring back Ike!
Thanks!
> On Mar 30, 2017, at 6:49 AM, Bruce Moskowitz <(b) (6)
mac.com > wrote:
>
> In the last email exchange i was supposed to receive information on your interaction with Apple so
that we could rapidly obtain needed technology from our Academic Center Consortium upcoming
discussion with Apple. I realize there are multiple technology issues on everyone's desk however we
have medical emergencies daily at the VA that can only be solved by rapid deployment of new
technology. I am available 24-7 by phone 561-3466(b) (6) Thank you
>
> Sent from my iPad
> Bruce Moskowitz M.D.
-----Original Message----From: Bruce Moskowitz [mailto:(b) (6)
Sent: Tuesday, March 28, 2017 11:41 AM
To: (b) (6)
who.eop.gov; (b) (6)
Cc: IP
Subject: VA And Apple
mac.com ]
omb.eop.gov
It would be of benefit to discuss what we can accomplish in technology with Apple for the benefit of the
VA. It would be of importance to understand what discussions the Whitehouse team has already had
with Apple so that we have a clear path forward and do not duplicate what has already been
accomplished. Let me know a convenient time to talk. Thank you
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-001266
OS 00002937
Message
From:
(b) (6)
EOP/WHO [(b) (6)
Sent:
4/1/2017 12:40:55 PM
To:
Kushner, Jared C. EOP/WHO [(b) (6) who.eop.gov]; (b) (6) frenchangel59.com
who.eop.gov]
To follow up on my email of yesterday (and this may not need clarifying) but
I am suggesting we give (b) (6)
a chance to project manage the IT component
only. And that we quickly ascertain if she is up to it.
obvi the VA needs a great CIO. (b) (6)
USDS has sourced and interviewed 4
candidates and reviewed w David., he has asked 3 to come in to meet with
him. (Ike, Jared said you might have a great person from Cleveland clinic
that would get on team for a period of time? That would be incredible).
Two other hot items: met w shulkin and 0MB. shulkin believes he will need
additional $7.5B in 2018 budget to offer the choice option (part of choice
reform legislation being considered). He had some ideas how to achieve
(charging Medicare) but all have issues, 0MB is going to consider and get
back to us.
I arranged and David is preparing for meeting w Sec Mattis and DOD senior
staff on the myriad of coordination issues. Need to force it but there is
ability to make huge progress there.
Sent from my iPad
VA-19-0799-D-001267
OS 00002938
Message
From:
IP [(b) (6) frenchangel59.com]
Sent:
4/2/2017 5:10:25 PM
To:
David shulkin [drshulkin@aol.com]
FW: VA And Apple
Subject:
From: IP [ mailto:(b) (6) frenchanqel59.com]
Sent: Sunday, April 02, 2017 1:08 PM
To: '(b) (6)
EOP/WHO'; '
Cc: 'Kushner, Jared C. EOP/WHO'; '(b) (6)
Subject: RE: VA And Apple
(b)
(6)
EOP/WHO'
EOP/WHO'
(b) (6)
Thanks for your email and especially the thoughts on FACA. The good news is that we have been advised that
FACA does not apply because we are not a formal group in any way. I have identified, as I mentioned, the
brightest medical minds in medical system operations. Each of those people (in their individual capacity) is
willing to give of their personal time for the betterment of the VA when requested by the VA. And each of
these people has been willing to provide advice to the Secretary when he reaches out to any one of them. I
have an understanding of their individual views and could fill you in when we speak since it isn't practical to
continue debating any of this on email.
Ike
EOP/WHO [ mailto:(b) (6)
From: (b) (6)
Sent: Sunday, April 02, 2017 11:17 AM
(b)
To: IP;
(6) EOP/WHO
Cc: Kushner, Jared C. EOP/WHO; (b) (6)
Subject: RE: VA And Apple
who.eop.gov]
EOP/WHO
Ike, you expressed concern in our call the other day that "we were just posing for pictures" in
this WH but in the below you seem concerned that we are engaged. You are concerned that
we are not communicating but please consider that I do not receive updates from your team.
Please keep in mind that I have nothing but the utmost respect for what you are doing and
that I know this is a life-and-death topic. But to do what you outlined below you will need to
form a FACA group. One is being formed on Infrastructure. Please have your attorney reach
out to WH Counsel (b) (6)
(copied) to start that process. I have interjected a few
thoughts into your email below:
From: IP [mailto:(b) (6) frenchangel59.com ]
Sent: Sunday, April 2, 2017 10:16 AM
To: (b) (6)
EOP/WHO <(b) (6)
who.eop.gov>
Cc: Kushner, Jared C. EOP/WHO <(b) (6) who.eop.gov>; (b) (6)
Subject: RE: VA And Apple
EOP/WHO <(b) (6) who.eop.gov>
(b) (6)
VA-19-0799-D-001269
OS 00002940
My email to (b) (6) on Thursday expressed my frustration and displeasure in learning about activity and
decisions concerning issues at the VA in a separate and invisible parallel effort. Regrettably, your response to
my email that "(b) (6)
has been working but not communicating" not only fails to recognize or explain the
issue, but merely highlights the very fundamental problem that is so troubling. While a lack of communication
has certainly exacerbated the problem, the mere fact that there has been any activity or decision without first
coordinating that activity with our team before taking any action is the problem. Simply offering to
communicate better solves very little. I AGREE, THAT WAS MY POINT, LACK OF COMMUNICATION. I WAS
FOCUSED ON CHANGE MOVING FORWARD NOT GOING BACKWARD.
In your and (b) (6)
first meeting in the West Wing with Marc Sherman it was clear and agreed that (b) (6)
would be the liaison between our expert team and the White House and provide her IT counsel to our team
related to our initiatives (not as an invisible, parallel effort). In addition, the White House was to be available
to assist our team with executive and legislative clout when requested (not conduct an invisible, parallel
effort), a three-pronged approach, if you recall. This is the program I reported to the President and the goahead we received.
The essential problem at the VA is that 22 veterans die every day and the system of care and access to care is
in need of repair. This is a medical issue and medical delivery problem. In order to fix the VA, these medical
problems must first be defined and fixed. All other issues, like IT, are a function of the determined fix to the
medical issues and medical delivery problems. To transform the VA into the best of class, I assembled a team
that includes the best and brightest minds in the academic medical community. The restructuring efforts on
which we embark are informed by the advice and participation of those great medical minds. Parallel (and
invisible to us) IT efforts are not connected to what the medical minds decide are the problem or the fix and
are frustrating the IT solution that deals with the medical issues. It is also spending the valuable time of
volunteers and delaying the best care that our veterans deserve.
Your email to me underscores this problem. You say that:
"[
efforts have been focused with the VA on ensuring that an EHMP is completed above their
health records so that the medical records can be pulled into an Apple device. The EHMP work is in process
and is a necessity for Apple to then come in and provide its services," and
"There is a call on Monday with Apple, the VA, and (b) (6) to review the ... status of the EHMP work ... [and]
to confirm Apple job scope which includes portability of health records/ data from VA to Apple products; VA
technical changes to how to allow VA workers to use Apple products; (and potentially portability of health
records/ data to non-VA medical facilities."
However, it is not possible to design an EHMP system or integrate the system with an Apple device until you
know how the medical experts are going to change the medical delivery system and how they advise a device
should be utilized in the medical delivery system. The academic medical experts on our team are assisting the
VA in designing a sophisticated system of community care through a public-private delivery system. They are
formulating that system and its inner workings, the creation of which will dictate the Integration and
interoperability of records. Neither (b) (6) nor Apple can define a scope or product use without consulting with
our group on how veteran's records used in the private sector will get integrated into the portable record and
back to the VA. RIGHT NOW THERE IS NO MEDICAL DELIVERY SYSTEM THAT CAN ACCESS THE MEDICAL
RECORDS. THE EHMP MUST BE COMPLETED TO ALLOW ANY SUCH PRODUCT TO EXTRAPOLATE THE DATA.
You mention in your email telehealth. Our team of medical experts are working on a telehealth initiative and
delivered a draft Executive Order to the President ... while you are working with the DEA and DOJ, without the
VA-19-0799-D-001270
OS 00002941
courtesy of advising us, which could have tremendous implications on the wording or, worse yet, the
prudence of an Executive Order in the first place. This parallel path as well creates the potential for
embarrassment for the President and wasted invaluable time that our veterans can ill afford. THIS EO (WHICH
IS LIKELY TO BE PART OF A LARGER VA EO) WILL 100% GO THROUGH DOJ AND DEA. IT MAY OR MAY NOT BE
POSSIBLE FOR THE PRESIDENT TO SLAM THROUGH AN EO AGAINST THEIR WISHES HOWEVER IT IS FAR BETTER
FOR THE PRESIDENT TO REACH CONCENSUS. KEEP IN MIND THERE ARE OVER 50,000 PEOPLE PER YEAR DYING
FROM DRUG OVERDOSES MUCH OF WHICH IS LINKIED TO THE OVER-SUBSCRIBING OF OPIOIDS. DEA AND DOJ
(I BELIEVE INCORRECTLY) VIEW TELEHEALTH AS A LESSENING OF CONTROL.
Lastly, you discuss your parallel meeting on a Military Wellness program which you apparently already brought
in which you believe focuses on preventative medicine. The program that you are touting however is
surrounded by rumors that are less than flattering. Moreover, our team's academic medical experts are
already assisting in the active development of a wellness program for the VA and their views will
prevail. Those experts have already assembled the working parts of a wellness program and the seamless
integration with active service members and family. There is no need to have a parallel side effort that is not
integrated into the agreed program. Again, the problem is not about communication. THE MILITARY
WELLNESS INITIATIVE HAS BEEN LAUDED IN EVERY REVIEW, AND BT THE VA, AND VSO'S. IT IS IN PLACE, THE
VA CAN DECIDE TO AMPLIFY ITS EFFORTS OR NOT. IT WOULD IN NO WAY PREVENT THE VA FROM HAVING A
MAJOR WELLNESS INITIATIVE OF ITS OWN; IT IS SUPPLEMENTAL. I DO NOT HAVE AN OPINION AS TO
WHETHER IT SHOULD BE AMPLIFIED, IT IS SOMETHING FOR THE VA TO DETERMINE.
I had an employee a few years back that meant well but thought that there was an "I" in team. His work for
the company created value and profits for the company at various times, however, in spite of those benefits, I
advised him that his way was not working and he should find something else that better met his style. I HAD A
FEW OF THEM WITH MY 15,000 EMPLOYEES AS WELL!
With all this considered, I think that (b) (6) is a smart woman that could provide the VA IT experience and
benefits, my way ... not as a renegade player. I am willing to work with her as a team player on our team. The
expert team that I assembled and is sanctioned by the President will be proceeding with its efforts as
planned. All other parallel efforts should stand down. (b) (6) can participate as part of that team, not outside
of that team or its efforts or its direction. As agreed on day one, the White House can participate by providing
executive and administrative assistance, when requested by our expert team. We will arrange and conduct
discussions with Apple (in which (b) (6) should participate if done within the confines of the expert team). We
will work with design and implementation of a wellness program and we will decide on the proper way to
integrate an EMR system, with (b) (6)
team participation if agreed. Any items that relate to the
transformation of the VA must be funneled through and managed by the expert team and should be
coordinated with Dr. Moskowitz and Marc Sherman. SHE CANNOT REPORT TO NON-GOVERNMENT PEOPLE.
Let me know if you have any questions. AS I EMAILED SOME OF THE BIGGEST ISSUES FOR THE VA RIGHT NOW
ARE LEGISLATIVE. THE ACCOUNTABILITY ACT, THE EXTENSION OF THE CHOICE ACT, THE CHOICE REFORM ACT
(AND THE CORRESPONDING BUDGET ISSUES RAISED BY ALLOWING CHOICE)
Ike
From: (b) (6)
EOP/WHO [ mailto:(b) (6)
Sent: Friday, March 31, 2017 6:03 PM
To: IP; Kushner, Jared C. EOP/WHO
Cc: (b) (6)
EOP/WHO; (b) (6)
Subject: RE: VA And Apple
who.eop.gov]
EOP/WHO
VA-19-0799-D-001271
OS 00002942
As we discussed it seems like (b) (6)
has been working but not communicating. Her efforts
have been focused with the VA on ensuring that an EHMP is completed above their health
records so that the medical records can be pulled into an Apple device. The EHMP work is in
process and is a necessity for Apple to then come in and provide its services. There is a call on
to review the following:
Monday with Apple, the VA, and (b) (6)
1. Status of the EHMP work
2. to find a legal mechanism to allow for 3 month tour of duty from Apple engineers with
the employees staying on Apple payroll. This is being investigated by USDS lawyers and
the VA.
3. To work through an NDA / conflict waiver which is a necessary legal document.
4. To confirm Apple job scope which includes portability of health records/ data from VA
to Apple products; VA technical changes to how to allow VA workers to use Apple
products; (and potentially portability of health records/ data to non-VA medical
facilities.)
I believe we should then schedule a call for mid next week with Ike, appropriate members of
Ike's team, the VA, Apple and (b) (6)
myself to ensure we are on same page (I can coordinate
(b) (6)
the call). I think we should allow
an opportunity to reset and to act as a true overall
project manager where we allow her to coordinate. She should communicate with Ike and his
designee consistently and she should professionally coordinate the team, get everyone
working together, and show us progress. I believe she will do a great job, and we will know
quickly if she does not.
As everyone knows huge other hot items at VA in the works right now including Accountability
(legislation and EO), Choice Reform Act extension and reform; telehealth (working through the
issue with DOJ and DEA; hard to just slam it through if they oppose but based on meeting
today with VA/DOJ/DEA I believe we can get them there in next two weeks. Ike, I can explain
in detail when we next talk but having been through this with the Opioid EO this week we
should see if we can get DEA/ DOJ on board).
Different subject, Ike would also like your advice on NIH and the idea (I think your idea?) to
create a profit sharing program with our grants. Love this idea.
Yours truly,
(b) (6)
P.S. I need to update you on very exciting meeting on a Military Wellness program which we
brought in; focuses on preventative medicine and is working for over 20,000 vets
currently. Readily scalable.
(b) (6)
Assistant to the President
For lntragovernmental and Technology Initiatives
202.456.(b) (6) (Direct)
(b) (6)
who.eop.gov
VA-19-0799-D-001272
DS 00002943
From: IP fmailto:(b) (6) frenchangel59.com1
Sent: Friday, March 31, 2017 12:05 AM
To: Kushner, Jared C. EOP/WHO <(b) (6) who.eop.gov>
Cc: (b) (6)
EOP/WHO <(b) (6)
Subject: FW: VA And Apple
who.eop.gov>; (b) (6)
EOP/WHO <(b) (6) who.eop.gov>
Jared,
As you know lvanka introduced me to (b) (6)
at Apple and (b) (6)
at Johnson & Johnson. Ours Academic team
has done here is really outrageous. She may
and experts have worked so well with them and their teams. What
be very good in social media, but this an entirely different and very complicated area.
We will fix this.
All my Best,
Ike
From: IP [ mailto:(b) (6) frenchanqel59.com]
Sent: Thursday, March 30, 2017 11:56 PM
To: (b) (6)
omb.eop.gov
Cc: (b) (6)
who.eop.gov; lperl(b) (6) @qmail.com ; brucem(b) (6)
Subject: FW: VA And Apple
@mac.com ; mbs(b) (6)
@qmail.com
(b) (6)
With all due respect, I am shocked and extremely disappointed with the manner in which you have engaged in individual
communications with Apple - and intentionally excluded our broader team of subject matter experts. I understand that
these backdoor discussions have apparently been occurring almost daily for weeks, and you have not told anyone and
refuse to return phone calls and emails.
When we first met on February 7th, I personally shared with you our vision and goals and explained that it is critical that
everything we do must be done as a team.
The very purpose of our Academic team, Dr. Moskowitz, and Marc Sherman is to ensure proper analysis, sharing of best
practices, and provide a forum for discussion, debate, and ultimately the strongest collective
decisions/recommendations.
You agreed then, but your actions to date regarding Apple prove otherwise.
When I spoke with (b) (6)
on February 1st we discussed and agreed on the importance of leveraging our Academic
team and experts for the end goal of creating the best system for our veterans. Further on our Apple conference call on
March 3rd - which we invited you and (b) (6) to join - we again discussed and all agreed that for us to be successful and fix
all the issues that our great veterans are going through on a daily basis, we must all unite and work as one team, with
only one agenda and one goal.
What we are seeing from you today is a blatant disregard for that commitment and clear disrespect to everyone
involved. You are putting yourself, your own agenda, and your own ego ahead of our veterans. This is unacceptable.
There are 22 veterans dying every day. Your decision to alone discuss IT and technology solutions with Apple for weeks
without the broader team of experts and not informing me and Dr. Moskowitz is major step backwards and will only
cause additional work and significant delays. As a result of your hijacking of this effort, Apple has already canceled
conference calls.
VA-19-0799-D-001273
OS 00002944
In fact, many of the current problems with the VA is because of this very reason - the lack of team work within. Let me
be clear, I will not allow this to happen while I am involved.
I want this resolved immediately. First, you must include Dr. Moskowitz and Marc Sherman on any and all calls or
meetings. Additionally, I will formally ask you again to please respect me and our broader group of subject matter
experts, and immediately cease individual discussions with Apple and/or any other parties related to the work we have
undertaken regarding the VA.
Ike
-----Original Message----(b) (6)
From: (b) (6)
EOP/OMB [mailto:(b) (6)
Sent: Thursday, March 30, 2017 6:48 PM
To: Bruce Moskowitz
Cc: (b) (6)
EOP/WHO; IP; (b) (6) frenchangel59.com
Subject: Re: VA And Apple
omb.eop.gov]
Hey team! We're making great progress, which I'm excited to fill you in on. Will send you more info when I get out of
these back-to-back mtgs and will give you a ring back Ike!
Thanks!
> On Mar 30, 2017, at 6:49 AM, Bruce Moskowitz <(b) (6)
mac.com > wrote:
>
> In the last email exchange i was supposed to receive information on your interaction with Apple so that we could
rapidly obtain needed technology from our Academic Center Consortium upcoming discussion with Apple. I realize
there are multiple technology issues on everyone's desk however we have medical emergencies daily at the VA that can
only be solved by rapid deployment of new technology. I am available 24-7 by phone 561-3466(b) (6) Thank you
>
> Sent from my iPad
> Bruce Moskowitz M.D.
-----Original Message----From: Bruce Moskowitz [mailto:(b) (6)
Sent: Tuesday, March 28, 2017 11:41 AM
To: (b) (6)
who.eop.gov; (b) (6)
Cc: IP
Subject: VA And Apple
mac.com ]
omb.eop.gov
It would be of benefit to discuss what we can accomplish in technology with Apple for the benefit of the VA. It would be
of importance to understand what discussions the Whitehouse team has already had with Apple so that we have a clear
path forward and do not duplicate what has already been accomplished. Let me know a convenient time to talk. Thank
you
Sent from my iPad
Bruce Moskowitz M.D.
VA-19-0799-D-001274
OS 00002945
Message
From:
IP [(b) (6) frenchangel59.com]
Sent:
4/2/2017 2:51:54 PM
To:
David shulkin [drshulkin@aol.com]
FW: VA And Apple
Untitled Attachment
Subject:
Attachments:
From: IP [mailto:(b) (6) renchanqel59.com ]
Sent: Sunday, April 02, 2017 10:16 AM
To: '(b) (6)
EOP/WHO'
Cc: 'Kushner, Jared C. EOP/WHO'; '(b) (6)
Subject: RE: VA And Apple
EOP/WHO'
(b) (6)
My email to (b) (6) on Thursday expressed my frustration and displeasure in learning about activity and
decisions concerning issues at the VA in a separate and invisible parallel effort. Regrettably, your response to
my email that "(b) (6)
has been working but not communicating" not only fails to recognize or explain the
issue, but merely highlights the very fundamental problem that is so troubling. While a lack of communication
has certainly exacerbated the problem, the mere fact that there has been any activity or decision without first
coordinating that activity with our team before taking any action is the problem. Simply offering to
communicate better solves very little.
In your and (b) (6)
first meeting in the West Wing with Marc Sherman it was clear and agreed that (b) (6)
would be the liaison between our expert team and the White House and provide her IT counsel to our team
related to our initiatives (not as an invisible, parallel effort). In addition, the White House was to be available
to assist our team with executive and legislative clout when requested (not conduct an invisible, parallel
effort), a three-pronged approach, if you recall. This is the program I reported to the President and the goahead we received.
The essential problem at the VA is that 22 veterans die every day and the system of care and access to care is
in need of repair. This is a medical issue and medical delivery problem. In order to fix the VA, these medical
problems must first be defined and fixed. All other issues, like IT, are a function of the determined fix to the
medical issues and medical delivery problems. To transform the VA into the best of class, I assembled a team
that includes the best and brightest minds in the academic medical community. The restructuring efforts on
which we embark are informed by the advice and participation of those great medical minds. Parallel (and
invisible to us) IT efforts are not connected to what the medical minds decide are the problem or the fix and
are frustrating the IT solution that deals with the medical issues. It is also spending the valuable time of
volunteers and delaying the best care that our veterans deserve.
Your email to me underscores this problem. You say that:
"[
efforts have been focused with the VA on ensuring that an EHMP is completed above their
health records so that the medical records can be pulled into an Apple device. The EHMP work is in process
and is a necessity for Apple to then come in and provide its services," and
VA-19-0799-D-001275
OS 00002946
"There is a call on Monday with Apple, the VA, and (b) (6) to review the ... status of the EHMP work ... [and]
to confirm Apple job scope which includes portability of health records/ data from VA to Apple products; VA
technical changes to how to allow VA workers to use Apple products; (and potentially portability of health
records/ data to non-VA medical facilities."
However, it is not possible to design an EHMP system or integrate the system with an Apple device until you
know how the medical experts are going to change the medical delivery system and how they advise a device
should be utilized in the medical delivery system. The academic medical experts on our team are assisting the
VA in designing a sophisticated system of community care through a public-private delivery system. They are
formulating that system and its inner workings, the creation of which will dictate the Integration and
interoperability of records. Neither (b) (6) nor Apple can define a scope or product use without consulting with
our group on how veteran's records used in the private sector will get integrated into the portable record and
back to the VA.
You mention in your email telehealth. Our team of medical experts are working on a telehealth initiative and
delivered a draft Executive Order to the President ... while you are working with the DEA and DOJ, without the
courtesy of advising us, which could have tremendous implications on the wording or, worse yet, the
prudence of an Executive Order in the first place. This parallel path as well creates the potential for
embarrassment for the President and wasted invaluable time that our veterans can ill afford.
Lastly, you discuss your parallel meeting on a Military Wellness program which you apparently already brought
in which you believe focuses on preventative medicine. The program that you are touting however is
surrounded by rumors that are less than flattering. Moreover, our team's academic medical experts are
already assisting in the active development of a wellness program for the VA and their views will
prevail. Those experts have already assembled the working parts of a wellness program and the seamless
integration with active service members and family. There is no need to have a parallel side effort that is not
integrated into the agreed program. Again, the problem is not about communication.
I had an employee a few years back that meant well but thought that there was an "I" in team. His work for
the company created value and profits for the company at various times, however, in spite of those benefits, I
advised him that his way was not working and he should find something else that better met his style.
With all this considered, I think that (b) (6) is a smart woman that could provide the VA IT experience and
benefits, my way ... not as a renegade player. I am willing to work with her as a team player on our team. The
expert team that I assembled and is sanctioned by the President will be proceeding with its efforts as
planned. All other parallel efforts should stand down. (b) (6) can participate as part of that team, not outside
of that team or its efforts or its direction. As agreed on day one, the White House can participate by providing
executive and administrative assistance, when requested by our expert team. We will arrange and conduct
discussions with Apple (in which (b) (6) should participate if done within the confines of the expert team). We
will work with design and implementation of a wellness program and we will decide on the proper way to
integrate an EMR system, with (b) (6)
team participation if agreed. Any items that relate to the
transformation of the VA must be funneled through and managed by the expert team and should be
coordinated with Dr. Moskowitz and Marc Sherman.
Let me know if you have any questions.
Ike
VA-19-0799-D-001276
OS 00002947
From: (b) (6)
EOP/WHO [ mailto:(b) (6)
Sent: Friday, March 31, 2017 6:03 PM
To: IP; Kushner, Jared C. EOP/WHO
Cc: (b) (6)
EOP/WHO; (b) (6)
Subject: RE: VA And Apple
who.eop.gov]
EOP/WHO
As we discussed it seems like (b) (6)
has been working but not communicating. Her efforts
have been focused with the VA on ensuring that an EHMP is completed above their health
records so that the medical records can be pulled into an Apple device. The EHMP work is in
process and is a necessity for Apple to then come in and provide its services. There is a call on
to review the following:
Monday with Apple, the VA, and (b) (6)
1. Status of the EHMP work
2. to find a legal mechanism to allow for 3 month tour of duty from Apple engineers with
the employees staying on Apple payroll. This is being investigated by USDS lawyers and
the VA.
3. To work through an NDA / conflict waiver which is a necessary legal document.
4. To confirm Apple job scope which includes portability of health records/ data from VA
to Apple products; VA technical changes to how to allow VA workers to use Apple
products; (and potentially portability of health records/ data to non-VA medical
facilities.)
I believe we should then schedule a call for mid next week with Ike, appropriate members of
Ike's team, the VA, Apple and (b) (6)
myself to ensure we are on same page (I can coordinate
(b) (6)
the call). I think we should allow
an opportunity to reset and to act as a true overall
project manager where we allow her to coordinate. She should communicate with Ike and his
designee consistently and she should professionally coordinate the team, get everyone
working together, and show us progress. I believe she will do a great job, and we will know
quickly if she does not.
As everyone knows huge other hot items at VA in the works right now including Accountability
(legislation and EO), Choice Reform Act extension and reform; telehealth (working through the
issue with DOJ and DEA; hard to just slam it through if they oppose but based on meeting
today with VA/DOJ/DEA I believe we can get them there in next two weeks. Ike, I can explain
in detail when we next talk but having been through this with the Opioid EO this week we
should see if we can get DEA/ DOJ on board).
Different subject, Ike would also like your advice on NIH and the idea (I think your idea?) to
create a profit sharing program with our grants. Love this idea.
Yours truly,
(b) (6)
P.S. I need to update you on very exciting meeting on a Military Wellness program which we
brought in; focuses on preventative medicine and is working for over 20,000 vets
currently. Readily scalable.
VA-19-0799-D-001277
OS 00002948
(b) (6)
Assistant to the President
For lntragovernmental and Technology Initiatives
202.456.(b) (6) (Direct)
(b) (6)
who.eop.gov
From: IP fmailto:(b) (6) frenchangel59.com1
Sent: Friday, March 31, 2017 12:05 AM
To: Kushner, Jared C. EOP/WHO <(b) (6) who.eop.gov>
Cc: (b) (6)
EOP/WHO <(b) (6)
who.eop.gov>; (b) (6)
Subject: FW: VA And Apple
EOP/WHO <(b) (6) who.eop.gov>
Jared,
As you know lvanka introduced me to (b) (6)
at Apple and (b) (6)
at Johnson & Johnson. Ours Academic team
has done here is really outrageous. She may
and experts have worked so well with them and their teams. What
be very good in social media, but this an entirely different and very complicated area.
We will fix this.
All my Best,
Ike
From: IP [ mailto:(b) (6) frenchanqel59.com]
Sent: Thursday, March 30, 2017 11:56 PM
To: (b) (6)
omb.eop.gov
Cc: (b) (6)
who.eop.gov; lperl(b) (6) @qmail.com ; brucem(b) (6)
Subject: FW: VA And Apple
@mac.com ; mbs(b) (6)
@qmail.com
(b) (6)
With all due respect, I am shocked and extremely disappointed with the manner in which you have engaged in individual
communications with Apple - and intentionally excluded our broader team of subject matter experts. I understand that
these backdoor discussions have apparently been occurring almost daily for weeks, and you have not told anyone and
refuse to return phone calls and emails.
When we first met on February 7th, I personally shared with you our vision and goals and explained that it is critical that
everything we do must be done as a team.
The very purpose of our Academic team, Dr. Moskowitz, and Marc Sherman is to ensure proper analysis, sharing of best
practices, and provide a forum for discussion, debate, and ultimately the strongest collective
decisions/recommendations.
You agreed then, but your actions to date regarding Apple prove otherwise.
When I spoke with (b) (6)
on February 1st we discussed and agreed on the importance of leveraging our Academic
team and experts for the end goal of creating the best system for our veterans. Further on our Apple conference call on
March 3rd - which we invited you and (b) (6) to join - we again discussed and all agreed that for us to be successful and fix
all the issues that our great veterans are going through on a daily basis, we must all unite and work as one team, with
only one agenda and one goal.
VA-19-0799-D-001278
OS 00002949
What we are seeing from you today is a blatant disregard for that commitment and clear disrespect to everyone
involved. You are putting yourself, your own agenda, and your own ego ahead of our veterans. This is unacceptable.
There are 22 veterans dying every day. Your decision to alone discuss IT and technology solutions with Apple for weeks
without the broader team of experts and not informing me and Dr. Moskowitz is major step backwards and will only
cause additional work and significant delays. As a result of your hijacking of this effort, Apple has already canceled
conference calls.
In fact, many of the current problems with the VA is because of this very reason - the lack of team work within. Let me
be clear, I will not allow this to happen while I am involved.
I want this resolved immediately. First, you must include Dr. Moskowitz and Marc Sherman on any and all calls or
meetings. Additionally, I will formally ask you again to please respect me and our broader group of subject matter
experts, and immediately cease individual discussions with Apple and/or any other parties related to the work we have
undertaken regarding the VA.
Ike
-----Original Message----(b) (6)
From: (b) (6)
EOP/OMB fmailto:(b) (6)
Sent: Thursday, March 30, 2017 6:48 PM
To: Bruce Moskowitz
Cc: (b) (6)
EOP/WHO; IP; (b) (6) frenchangel59.com
Subject: Re: VA And Apple
omb.eop.gov]
Hey team! We're making great progress, which I'm excited to fill you in on. Will send you more info when I get out of
these back-to-back mtgs and will give you a ring back Ike!
Thanks!
> On Mar 30, 2017, at 6:49 AM, Bruce Moskowitz <(b) (6)
mac.com > wrote:
>
> In the last email exchange i was supposed to receive information on your interaction with Apple so that we could
rapidly obtain needed technology from our Academic Center Consortium upcoming discussion with Apple. I realize
there are multiple technology issues on everyone's desk however we have medical emergencies daily at the VA that can
only be solved by rapid deployment of new technology. I am available 24-7 by phone 561-3466(b) (6) Thank you
>
> Sent from my iPad
> Bruce Moskowitz M.D.
-----Original Message----From: Bruce Moskowitz fmailto:(b) (6)
Sent: Tuesday, March 28, 2017 11:41 AM
To: (b) (6)
who.eop.gov; (b) (6)
Cc: IP
Subject: VA And Apple
mac.com ]
omb.eop.gov
It would be of benefit to discuss what we can accomplish in technology with Apple for the benefit of the VA. It would be
of importance to understand what discussions the Whitehouse team has already had with Apple so that we have a clear
path forward and do not duplicate what has already been accomplished. Let me know a convenient time to talk. Thank
you
VA-19-0799-D-001279
OS 00002950
Bruce Moskowitz MD.
Message
From:
(b) (6)
EOP/WHO [(b) (6)
Sent:
4/1/2017 12:40:55 PM
To:
Kushner, Jared C. EOP/WHO [(b) (6) who.eop.gov]; (b) (6) frenchangel59.com
who.eop.gov]
To follow up on my email of yesterday (and this may not need clarifying) but
I am suggesting we give (b) (6)
a chance to project manage the IT component
only. And that we quickly ascertain if she is up to it.
obvi the VA needs a great CIO. (b) (6)
USDS has sourced and interviewed 4
candidates and reviewed w David., he has asked 3 to come in to meet with
him. (Ike, Jared said you might have a great person from Cleveland clinic
that would get on team for a period of time? That would be incredible).
Two other hot items: met w shulkin and 0MB. shulkin believes he will need
additional $7.5B in 2018 budget to offer the choice option (part of choice
reform legislation being considered). He had some ideas how to achieve
(charging Medicare) but all have issues, 0MB is going to consider and get
back to us.
I arranged and David is preparing for meeting w Sec Mattis and DOD senior
staff on the myriad of coordination issues. Need to force it but there is
ability to make huge progress there.
Sent from my iPad
VA-19-0799-D-001281
OS 00002952
Message
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/12/2017 1:39:51 AM
(b) (6)
[(b) (6)
mayo.edu]
David Shulkin [drshulkin@aol.com]; Marc Sherman [(b) (6)
Fwd: FYI I Follow-up: VA Public-facing Web site
Sensitivity:
Company Confidential
From:
Sent:
To:
CC:
gmail.com]; brucem(b) (6)
@mac.com
Chris- on behalf of the secretary and the VA, I want to thank you for your support. Your leadership in rallying the other
academic centers and your strategic advice has been invaluable. We are really excited about tomorrow when we go-live!
This is new turn for us as we embark upon our transformation journey together.
Marc- good catching up today- looking forward to dinner next week
Sent from my iPhone
Begin forwarded message:
From: "(b) (6)
<(b) (6)
mayo.edu >
Date: April 11, 2017 at 2:44:20 PM EDT
To: "Poonam Alaigh ((b) (6)
hotmail.com )" <(b) (6)
(b) (6)
Cc: "
Subject: FYI
(b) (6)
(
I
(b) (6)
gmail.com )" <
hotmail.com >
gmail.com >
Follow-up: VA Public-facing Web site
From: (b) (6)
Sent: Tuesday, April 11, 2017 1:44 PM
(b) (6)
To: '(b) (6)
va.gov
(b) (6)
(b) (6)
Cc: (b) (6)
Subject: Follow-up: VA Public-facing Web site
Sensitivity: Confidential
Hi - thanks (b) (6)
connecting you w/ (b) (6)
((b) (6)
qmail.com)
at the VA. ...
From: (b) (6)
[ mailto:(b) (6)
jhmi.edu]
Sent: Tuesday, April 11, 2017 1:20 PM
To: (b) (6)
(b) (6)
Cc: (b) (6)
Subject: MORE I Your Input: VA Public-facing Web site
Sensitivity: Confidential
Hello, (b) (6)
I spoke with (b) (6) about this and we have reached out to Dr. (b) (6)
patient safety and quality and he has agreed to speak about this.
senior vice president of
(b) (6)
(b) (6)
Executive Assistant to SVP
Marketing & Communications, JHM
901 S. Bond Street, Baltimore, MD 21231
P: 410-955-(b) (6)
F: 410-955-(b) (6)
VA-19-0799-D-001282
OS 00002953
From: (b) (6)
fmailto:(b) (6)
mayo.edu]
Sent: Tuesday, April 11, 2017 1:34 PM
To: (b) (6)
<(b) (6)
PARTNERS.ORG>; (b) (6)
<(b) (6)
(b) (6)
mayo.edu>; (b) (6)
mayo.edu>; (b) (6)
(b) (6)
(b) (6)
@PARTNERS.ORG>; (b) (6)
@jhmi.edu>; (b) (6)
ccf.org; (b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(b) (6)
(
ccf.org) <
ccf.org>;
<
jhu.edu>;
(b) (6)
@PARTNERS.ORG>; (b) (6)
kp.org; (b) (6)
kp.org; (b) (6)
(b) (6)
(b) (6)
@mayo.edu>; (b) (6)
@mayo.edu>; (b) (6)
(b) (6)
@mayo.edu >
Subject: MORE I Your Input: VA Public-facing Web site
Sensitivity: Confidential
Hi - sharing an additional update from the team at the VA:
o
o
o
o
o
The site will not be active outside of the VA firewall until late early tomorrow morning.
However, the VA team is finalizing a video that walks people through the site. Will have that for
you as soon as it is finished and online.
The VA team is "most interested" in your CEO; or someone you designate in your organization
(perhaps a Quality lead; or "digital care/web" lead be open to speaking w/ the news media,
sharing perspective on how this reflects a step forward for veterans and reflects what patients
are seeking from healthcare providers?
The VA team would also welcome our organizations sharing this on our various social media
platforms.
Would you also consider sharing a "heads up" to your local/regional medical/health reporters encouraging coverage.
The VA team would is also exploring a "day three" story about this - Dr. Shulkin had a "sit
down/exclusive" w/ USA Today (story will hit tomorrow); possibilities they are exploring include
an extended conversation w/ a designated reporter that would pair Dr. Shulkin w/ one of the
academic partner CEOs (think National Public Radio, or another outlet); or possibly an op-ed
submission. Again, focus would be on sharing perspective on how this reflects a step forward
for veterans and reflects what patients are seeking from healthcare providers.
Let me know of your interest in participating in the above - in follow-up, will link you directly w/
the VA Communications "point."
(b) (6)
Thanks, (b) (6)
From: (b) (6)
Sent: Monday, April 10, 2017 4:59 PM
(b) (6)
(b) (6)
To: (b) (6)
(b) (6)
(b) (6)
(b) (6)
ccf.org ;
jhu.edu ;
((b) (6)
(b) (6)
(b) (6)
(b) (6)
kp.org ;
kp.org ;
(b) (6)
(b) (6)
(b) (6)
ccf.org);
[RO PA]; (b) (6)
(b) (6)
Subject: URGENT I Your Input: VA Public-facing Web site
Sensitivity: Confidential
*PLEASE TREAT AS BUSINESS CONFIDENTIAL*
VA-19-0799-D-001283
OS 00002954
Hi - on Wednesday, the VA will announce a web site designed for Veterans to make informed decisions
about where they receive their health care. The overview of the plan and the project objectives are
attached.
Dr. Bruce Moskowitz routed the plan in late March to the CEO of the five academic medical center
organizations, encouraging that the CEOs "express support/confidence" in the plan. Several CEOs
expressed in follow-up emails that they would be willing to "voice support for the approach, that it's
reflective of the direction the VA needs to move to best support the care of veterans, etc."
Dr. Poonam Alaigh, VA Acting Under Secretary for Health, Dr. Moskowitz and I spoke late this afternoon
- the question: as this rolls out (going public on Wednesday), would your CEO; or someone you
designate in your organization (perhaps a Quality lead; or "digital care/web" lead be open to speaking
w/ the news media, sharing perspective on how this reflects a step forward for veterans and reflects
what patients are seeking from healthcare providers? If not someone from your organization, would
you recommend an industry expert that can talk to these issues w/ news media?
The timeline for this would be tomorrow (Tuesday) or Wednesday, as this news goes public.
Thanks for your consideration.
(b) (6)
Chair I Mayo Clinic Department of Public Affairs
200 First Street S.W. I Rochester, MN 55905
cell: 507 .269.(b) (6) I office: 507 .284.(b) (6)
e-mail: (b) (6)
mayo. ed u
VA-19-0799-D-001284
OS 00002955
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/2/2017 6:46:30 PM
Va David [vacodjsl@va.gov]
Fwd: Medical Student Proposal for VA system
Osteopathic _Training in The VA.docx; Untitled attachment 05981.htm
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
gmail .com>
Date: April 2, 2017 at 2:00:26 PM EDT
To: David shulkin
Subject: Fwd: Medical Student Proposal for VA system
From: (b) (6)
<(b) (6)
gmail.com >
Subject: Medical Student Proposal for VA system
Date: April 2, 2017 at 1:52:30 PM EDT
Cc: Poonam Alaigh <(b) (6)
hotmail.com >, "(b) (6)
FACOFP dist."<(b) (6)
aol.com >
DO, MPH,
Dear David,
Hope all is well with you and that you are adjusting to your new
whirlwind life in D.C.
Commensurate with my brief discussion to you last month I have been
working with (b) (6)
who will likely represent the American Osteopathic
Association and their subgroups in a proposal I wanted to send to you in its raw
form. I spoke to Poonam at the banquet about it briefly so I am copying her on the
proposal (b) (6)
and I wrote. If you want to wait for its final form you don't have
to read it, but if you read it and either you or Poonam have any thoughts , any and
all changes to form and content are welcome.
Be Well and as always , it was great to see you in NJ Q Q)
(b) (6)
(b) (6)
DO F ACOI,F ASVM
Associate Professor Internal Medicine
VA-19-0799-D-001285
DS 00002956
Medical Director Vascular Technology Training program
Rutgers School of Medicine
Attending Gagnon Heart Center
Director Anticoagulation Service
Morristown Medical Center
Morristown ,NJ
VA-19-0799-D-001286
OS 00002957
Osteopathic Training in The VA System
Since the Advent of the Viet Nam war Osteopathic
Physicians have played an increasingly important role in the
Military healthcare system with Physicians Enlistees
participating in a progressively disproportionate responsibility
for healthcare for our serviceman and women in the United
States.
The Profession takes great pride in our military and
the sacrifices they have made. In this, the American
Osteopathic Association feels strongly we should play a role
vital in the health care of the armed forces, and also with those
who serve if in their times to follow.
Medical students provide a hearty source of academic
posture which vitalize their staff counterparts and enhance
patient care and patient experience. The role of a medical
student thus is thus not parasitic but symbiotic.
The last decade has found American trained students in an
increasingly contracted healthcare academic delivery
environment.
Our proposal would be to arrange an academic,
contractual relationship with the VA System on a national scale
which would provide high level Medical students, all of whom
have completed Part I of the boards and who would engage in
the VA system as a Whole.
We would agree to provide students from around the
United States and would be responsible for their presence,
behavior, and provide a uniform platform upon which their
training would commence.
VA-19-0799-D-001287
OS 00002958
Given the distinction in governance of the Osteopathic
profession as an organization, with regard to its relationship to
their colleges of medicine, an agreement could be crafted
which would provide a fixed and constant workforce minimal or
no cost.
We would provide a number of students of which we
would agree, and they would be at their posts each month and
a schedule would be applied which would include on call, the
appropriate number of patients which would benefit the
patient population, and enhance the workload experience of
the VA personnel. We will apply established standards to
mitigate against undue burdens on both sides.
Our hope would be a relationship which will provide high
level staffing for patients in a time of fiscal contraction. Our
fervent belief is that setting will provide the students with a
lifelong understanding of both the medical problems which are
many times unique and the dynamic issues which Veterans
face.
We provide students arrange transportation in potentially
all 50 states. Taken on a large scale; there could be between
1000 and 2500 OMS rotating/month at a VA institutions.
Rotations could be set up in internal medicine, psychiatry
and/or addiction medicine as well as others, depending upon the
programs in place at the individual VA. We will need to further
discuss details of housing etc. If It Is available this would greatly
enhance the programing and facilitate an seamless start to the
program.
We should also add aside from the basic platform an
elective program for students who wish to do other rotations
VA-19-0799-D-001288
OS 00002959
we can ask for all VA institutions to partner with our COMs.
The VA has been noted to profound need of primary care
physicians.
The Colleges of Osteopathic Medicine are in need of training
slots for 3rd and 4th year osteopathic medical students (OMS).
Those OMS are primary care oriented and could eventually feed
the workforce need of the VA.
This would provide a mutually synergistic aim: to provide quality
healthcare to VA patients and quality rotations to OMS,
and potentially seed the next generation of physicians into the VA.
We would arrange for AOIA to coordinate these rotations
and would take complete responsibility for their actions .
The rotations would be guaranteed by all COMs participating
and we will provide continuous monitoring for the VA institutions.
References
1.
Osteopathic physicians for military service: hearing before the Committee on Military Affairs. 65th
Cong 1 2nd sess ( 1918) (testimony of George W. Riley, DO).
2
Pub L No. 65-12., 40 Stat 76.
3
Swope C. Public relations committee: selective compulsory military training and service bill. J
Am Osteopath Assoc. 1941i40(1):16-17.
4
Willard A Where our students come from. J Am Osteopath Assoc. 1947;46:313.
Clinical Careo In FY 2011, 70 percent of VA physicians (20,527) had a faculty appointment at
a U.S. medical school.2 o In FY 2012, AAMC-member VA teaching hospitals (37 percent of all
VA hospitals) accounted for 50 percent of the total admissions at all VA hospitals, 51 percent of
the total inpatient days, and 49 percent of the emergency visits. They also performed 41 percent
of the total surgeries at VA hospitals.3 o In FY 2007, the Veterans Health Administration
reported 669 noncompetitive clinical sharing agreements (i.e., sole source contracts) with
affiliated institutions, including medical schools and teaching hospitals, to provide care for
veterans outside of the VA valued at $575 million.4 Research With an annual budget of nearly
$590 million,5 the VA Office of Research and Development sponsors veteran-centric research
VA-19-0799-D-001289
OS 00002960
on numerous topics, including post-traumatic stress disorder, traumatic brain injury, and
prosthetics.
VA researchers have joint appointments at VA hospitals and medical schools. Recent
studies include: o
Sophisticated VA-invented eye- tracking tests to determine a method that could
provide physicians with a simpler and more accurate way to diagnose Parkinson's
disease. o
A recent VA-sponsored trial for a drug that provided relief for veterans from
Operations Iraqi Freedom, Enduring Freedom, and New Dawn who were
suffering from nightmares. o
The Million Veteran Program, which was launched in 2011 to recruit a million
veterans to collect data on genetics, lifestyle, and health. This information will
help clinicians better understand how genetic factors contribute to conditions like
post-traumatic stress disorder and traumatic brain injury.
1 FY2015 VA Budget Submission Volume 11 Medical Programs and
Information Technology Programs, http://www.va.gov/
budget/docs/summary/Fy2015-VolumeII-MedicalProgramsAndin
formationTechnology.pdf 2
Annual Report of Residency Training Programs (ARRTP) database, estimate
provided by the VA Office of Academic Associations (OAA) 3 AAMC Data
Book:
Medical Schools and Teaching Hospitals by the Numbers 4 2008 Office of
Inspector General (OIG) Audit of VHA Noncompetitive Clinical Sharing
Agreements 5 Friends of VA Medical Care and Health Research
Recommendations for FY2015, http://www.friendsofva.org/
resources/2014/20 l 5fovarecommendations.pdf.
(b) (6)
(b) (6)
D.O., MPH, FACOFP
D.O. FACOI, FSVM
VA-19-0799-D-001290
OS 00002961
Message
From:
Sent:
To:
CC:
Subject:
(b) (6)
David shulkin [Drshulkin@aol.com]
4/2/2017 6:46:19 PM
(b) (6)
[(b) (6)
gmail.com]
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Medical Student Proposal for VA system
- we will get out acadmic affiliations group involved-
Thanks for pulling this together
David
Sent from my iPhone
On Apr 2, 2017, at 2:00 PM, (b) (6)
<(b) (6)
gmail.com> wrote:
From: (b) (6)
<(b) (6)
gmail.com >
Subject: Medical Student Proposal for VA system
Date: April 2, 2017 at 1:52:30 PM EDT
Cc: Poonam Alaigh <(b) (6)
hotmail.com >, "(b) (6)
FACOFP dist."<(b) (6)
aol.com >
DO, MPH,
Dear David,
Hope all is well with you and that you are adjusting to your new
whirlwind life in D.C.
Commensurate with my brief discussion to you last month I have been
working with (b) (6)
who will likely represent the American Osteopathic
Association and their subgroups in a proposal I wanted to send to you in its raw
form. I spoke to Poonam at the banquet about it briefly so I am copying her on the
proposal (b) (6)
and I wrote. If you want to wait for its final form you don't have
to read it, but if you read it and either you or Poonam have any thoughts , any and
all changes to form and content are welcome.
Be Well and as always, it was great to see you in NJ Q Q)
(b) (6)
(b) (6)
DO F ACOI,F ASVM
Associate Professor Internal Medicine
VA-19-0799-D-001292
DS 00002963
Medical Director Vascular Technology Training program
Rutgers School of Medicine
Attending Gagnon Heart Center
Director Anticoagulation Service
Morristown Medical Center
Morristown ,NJ
VA-19-0799-D-001293
OS 00002964
Message
(b) (6)
From:
Sent:
To:
Subject:
Attachments:
[(b) (6)
gmail.com]
4/2/2017 6:00:26 PM
David shulkin [drshulkin@aol.com]
Fwd: Medical Student Proposal for VA system
Osteopathic _Training in The VA.docx; Untitled attachment 05988.htm
From: (b) (6)
<(b) (6)
gmail.com >
Subject: Medical Student Proposal for VA system
Date: April 2, 2017 at 1:52:30 PM EDT
Cc: Poonam Alaigh <(b) (6)
hotmail.com >, "(b) (6)
dist."<(b) (6)
aol.com >
DO, MPH, FACOFP
Dear David,
Hope all is well with you and that you are adjusting to your new whirlwind life in D.C.
Commensurate with my brief discussion to you last month I have been working with
who will likely represent the American Osteopathic Association and their
subgroups in a proposal I wanted to send to you in its raw form. I spoke to Poonam at the
banquet about it briefly so I am copying her on the proposal (b) (6)
and I wrote. If you want to
wait for its final form you don't have to read it, but if you read it and either you or Poonam have
any thoughts , any and all changes to form and content are welcome.
(b) (6)
Be Well and as always , it was great to see you in NJ Q Q)
(b) (6)
(b) (6)
DO F ACOI,F ASVM
Associate Professor Internal Medicine
Medical Director Vascular Technology Training program
Rutgers School of Medicine
Attending Gagnon Heart Center
Director Anticoagulation Service
Morristown Medical Center
Morristown ,NJ
VA-19-0799-D-001294
DS 00002965
Osteopathic Training in The VA System
Since the Advent of the Viet Nam war Osteopathic
Physicians have played an increasingly important role in the
Military healthcare system with Physicians Enlistees
participating in a progressively disproportionate responsibility
for healthcare for our serviceman and women in the United
States.
The Profession takes great pride in our military and
the sacrifices they have made. In this, the American
Osteopathic Association feels strongly we should play a role
vital in the health care of the armed forces, and also with those
who serve if in their times to follow.
Medical students provide a hearty source of academic
posture which vitalize their staff counterparts and enhance
patient care and patient experience. The role of a medical
student thus is thus not parasitic but symbiotic.
The last decade has found American trained students in an
increasingly contracted healthcare academic delivery
environment.
Our proposal would be to arrange an academic,
contractual relationship with the VA System on a national scale
which would provide high level Medical students, all of whom
have completed Part I of the boards and who would engage in
the VA system as a Whole.
We would agree to provide students from around the
United States and would be responsible for their presence,
behavior, and provide a uniform platform upon which their
training would commence.
VA-19-0799-D-001296
OS 00002967
Given the distinction in governance of the Osteopathic
profession as an organization, with regard to its relationship to
their colleges of medicine, an agreement could be crafted
which would provide a fixed and constant workforce minimal or
no cost.
We would provide a number of students of which we
would agree, and they would be at their posts each month and
a schedule would be applied which would include on call, the
appropriate number of patients which would benefit the
patient population, and enhance the workload experience of
the VA personnel. We will apply established standards to
mitigate against undue burdens on both sides.
Our hope would be a relationship which will provide high
level staffing for patients in a time of fiscal contraction. Our
fervent belief is that setting will provide the students with a
lifelong understanding of both the medical problems which are
many times unique and the dynamic issues which Veterans
face.
We provide students arrange transportation in potentially
all 50 states. Taken on a large scale; there could be between
1000 and 2500 OMS rotating/month at a VA institutions.
Rotations could be set up in internal medicine, psychiatry
and/or addiction medicine as well as others, depending upon the
programs in place at the individual VA. We will need to further
discuss details of housing etc. If It Is available this would greatly
enhance the programing and facilitate an seamless start to the
program.
We should also add aside from the basic platform an
elective program for students who wish to do other rotations
VA-19-0799-D-001297
OS 00002968
we can ask for all VA institutions to partner with our COMs.
The VA has been noted to profound need of primary care
physicians.
The Colleges of Osteopathic Medicine are in need of training
slots for 3rd and 4th year osteopathic medical students (OMS).
Those OMS are primary care oriented and could eventually feed
the workforce need of the VA.
This would provide a mutually synergistic aim: to provide quality
healthcare to VA patients and quality rotations to OMS,
and potentially seed the next generation of physicians into the VA.
We would arrange for AOIA to coordinate these rotations
and would take complete responsibility for their actions .
The rotations would be guaranteed by all COMs participating
and we will provide continuous monitoring for the VA institutions.
References
1.
Osteopathic physicians for military service: hearing before the Committee on Military Affairs. 65th
Cong 1 2nd sess ( 1918) (testimony of George W. Riley, DO).
2
Pub L No. 65-12., 40 Stat 76.
3
Swope C. Public relations committee: selective compulsory military training and service bill. J
Am Osteopath Assoc. 1941i40(1):16-17.
4
Willard A Where our students come from. J Am Osteopath Assoc. 1947;46:313.
Clinical Careo In FY 2011, 70 percent of VA physicians (20,527) had a faculty appointment at
a U.S. medical school.2 o In FY 2012, AAMC-member VA teaching hospitals (37 percent of all
VA hospitals) accounted for 50 percent of the total admissions at all VA hospitals, 51 percent of
the total inpatient days, and 49 percent of the emergency visits. They also performed 41 percent
of the total surgeries at VA hospitals.3 o In FY 2007, the Veterans Health Administration
reported 669 noncompetitive clinical sharing agreements (i.e., sole source contracts) with
affiliated institutions, including medical schools and teaching hospitals, to provide care for
veterans outside of the VA valued at $575 million.4 Research With an annual budget of nearly
$590 million,5 the VA Office of Research and Development sponsors veteran-centric research
VA-19-0799-D-001298
OS 00002969
on numerous topics, including post-traumatic stress disorder, traumatic brain injury, and
prosthetics.
VA researchers have joint appointments at VA hospitals and medical schools. Recent
studies include: o
Sophisticated VA-invented eye- tracking tests to determine a method that could
provide physicians with a simpler and more accurate way to diagnose Parkinson's
disease. o
A recent VA-sponsored trial for a drug that provided relief for veterans from
Operations Iraqi Freedom, Enduring Freedom, and New Dawn who were
suffering from nightmares. o
The Million Veteran Program, which was launched in 2011 to recruit a million
veterans to collect data on genetics, lifestyle, and health. This information will
help clinicians better understand how genetic factors contribute to conditions like
post-traumatic stress disorder and traumatic brain injury.
1 FY2015 VA Budget Submission Volume 11 Medical Programs and
Information Technology Programs, http://www.va.gov/
budget/docs/summary/Fy2015-VolumeII-MedicalProgramsAndin
formationTechnology.pdf 2
Annual Report of Residency Training Programs (ARRTP) database, estimate
provided by the VA Office of Academic Associations (OAA) 3 AAMC Data
Book:
Medical Schools and Teaching Hospitals by the Numbers 4 2008 Office of
Inspector General (OIG) Audit of VHA Noncompetitive Clinical Sharing
Agreements 5 Friends of VA Medical Care and Health Research
Recommendations for FY2015, http://www.friendsofva.org/
resources/2014/20 l 5fovarecommendations.pdf.
(b) (6)
(b) (6)
D.O., MPH, FACOFP
D.O. FACOI, FSVM
VA-19-0799-D-001299
OS 00002970
300
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/8/2017 12:24:11 PM
To:
Poonam Alaigh [(b) (6)
Re: (b) (6)
Subject:
hotmail.com]
Great
Sent from my iPhone
> on Apr 8, 2017, at 8:15 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Spoke to him last night and he has initial interest- will speak to him in more details next week
>
> Sent from my iPhone
VA-19-0799-D-001301
OS 00002972
Message
To:
Poonam Alaigh [(b) (6)
hotmail.com]
4/8/2017 12:15:52 PM
David Shulkin [drshulkin@aol.com]
Subject:
(b) (6)
From:
Sent:
Spoke to him last night and he has initial interest- will speak to him in more details next week
Sent from my iPhone
VA-19-0799-D-001302
OS 00002973
Message
From:
Sent:
To:
David shulkin [Drshulkin@aol.com]
4/19/2017 11:29:50 PM
(b) (6)
[(b) (6)
gmail.com]
can we ask our team to track down the clip from cbs evening news tonight that ran on VA
Sent from my iPhone
VA-19-0799-D-001303
OS 00002974
Message
From:
Sent:
To:
CC:
Subject:
bruce moskowitz [(b) (6)
gmail.com]
4/1/2017 5:03:29 PM
David shulkin [Drshulkin@aol.com]
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
Re: UPDATED VERSION
gmail.com]
Amazing that it takes a case
Like this to get it done
Sent from my iPhone
On Apr 1, 2017, at 12:24 PM, David shulkin wrote:
Im taking an unusual and aggressive stance to push for accountability legislation using this
outrageous case. I had to fight my lawyers to do this. Already congress has released a statement
of support fir my position and Fox news wants a live interview Sunday morning- see the release
below
VA-19-0799-D-001304
OS 00002975
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/1/2017 4:24:18 PM
brucem(b) (6)
@gmail.com; Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
Fwd: UPDATED VERSION
Press Release - Accountability Final Draft-jeh (3).docx; Untitled attachment 06027.htm
gmail.com]
Im taking an unusual and aggressive stance to push for accountability legislation using this outrageous case. I
had to fight my lawyers to do this. Already congress has released a statement of support fir my position and Fox
news wants a live interview Sunday morning- see the release below
VA-19-0799-D-001305
OS 00002976
VA
News Release
0 ice Public Aff ,rs
Media Rela ions
W hington, DC 20 20
(202) 461-7600
.va.gov
FOR IMMEDIATE RELEASE
March 31, 2017
VA Forced to Delay Removing Employee Caught Watching Pornography
VA Supports Congress's Effort to Change Legislation to Expedite Process
WASHINGTON - After a through internal review of an employee of the Michael DeBakey Veterans
Affairs Medical Center in Houston was caught watching porn while with a patient, the designated
proposing official recommended removal from federal service.
The VA immediately removed the Veteran in question from patient care and placed on administrative
duties. Due to current law, the deciding official cannot affect a final determination for 30 days from the
date the proposal for removal was made. VA is committed to ensuring every employee retains their
right to due process while at the same time reducing the time it takes to remove employees who have
engaged in misconduct.
"This is an example of why we need accountability legislation as soon as possible," said Secretary of
Veterans Affairs David J. Shulkin. "It's unacceptable that VA has to wait 30 days to act on a proposed
removal."
Under current law, the Department of Veterans Affairs (VA) must continue to pay employees who are
in the process of being removed. During this advance notice period, at least 30 days from the date that
the employee's removal has been proposed, assuming there is no evidence that the employee has
committed a crime, an employee must be paid. If the employee has been assessed as a potential danger
to Veterans, the employee should be placed on administrative leave with pay. If the employee does not
pose an immediate threat to Veterans, they are typically placed on administrative duties, which limits
their contact with Veterans and their families while ensuring that they aren't sitting at home collecting
a pay check without providing any services to the government.
VA is grateful that Congress has made this a priority. VA has been working with Congress to ensure
any legislation would provide VA the ability to expedite removals while still preserving an employee's
right to due process. Without these legislative changes, VA will continue to be forced to delay
immediate actions to remove employees from federal service.
"Current legislation in Congress reduces the amount of time we have to wait before taking action,"
continued Secretary Shulkin. "I look forward to working with both the Senate and the House to ensure
final legislation gives us the flexibility we need."
VA-19-0799-D-001306
OS 00002977
307
Message
From:
Darin Selnick [(b) (6)
Sent:
4/9/2017 8:28:02 PM
To:
David shulkin [Drshulkin@aol.com]
Re: TEDVA Talk
Subject:
@gmail.com]
Thanks, most people would not get it by just looking at the slides, that is why I have to walk them through it.
Darin
On Sun, Apr 9, 2017 at 1: 17 PM, David shulkin wrote:
I didnt appreciate how this model achieved the goals- brilliant
1
Sent from my iPhone
Begin forwarded message:
From: Darin Selnick <(b) (6)
@gmail.com>
Date: April 8, 2017 at 6:44:27 PM EDT
To: David shulkin
Subject: TEDVA Talk
Hi David
Attached are the two slides from my TEDVA talk. The second slide answers the questions on
how the VHA providers, as a purely providers group, can get all of the OHi $ just like a
Cleveland Clinic can, including the Federal (Medicare, Medicaid and TRICARE).
Key is to have VHA internally fully separate the payer and provider functions and then have
Congress designate the provider function as a Federal ACO. That way the$ follows the veteran
patients, and the VHA provider has contracts with all OHi and VHA payer. Using this method
the eligibility issue goes away since VHA providers are paid for all services from all payers,
including all Federal. VHA providers have to become efficient since they have to run their
operations on the same payer reimbursement payments as the private sector like Cleveland
Clinic gets. For VAMCs that have extra capacity, they can take non-eligible veterans and
family members since they are getting full reimbursement from their Health Insurance.
Just my out of the box thinking, key is the legislation which at the same time we can ask for
legislative relief on Government regulations on personnel, contracting, acquisition, and other
items we identify that stop us from being competitive with the private sector. Time to level the
playing field.
Darin
VA-19-0799-D-001308
OS 00002979
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/9/2017 8:18:58 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: TEDVA Talk
VA TED Talk 2.pptx; Untitled attachment 06063.htm; VA TED Talk 2.pptx; Untitled attachment 06066.htm
Tommorow on your way down look at this
Its actually pretty smart
We may need to tweak it- but starting a new business line might be the key to billing medicare
Sent from my iPhone
Begin forwarded message:
From: Darin Selnick <(b) (6)
@gmail.com>
Date: April 8, 2017 at 6:44:27 PM EDT
To: David shulkin
Subject: TEDVA Talk
Hi David
Attached are the two slides from my TEDVA talk. The second slide answers the questions on
how the VHA providers, as a purely providers group, can get all of the OHi $ just like a
Cleveland Clinic can, including the Federal (Medicare, Medicaid and TRICARE).
Key is to have VHA internally fully separate the payer and provider functions and then have
Congress designate the provider function as a Federal ACO. That way the$ follows the veteran
patients, and the VHA provider has contracts with all OHi and VHA payer. Using this method
the eligibility issue goes away since VHA providers are paid for all services from all payers,
including all Federal. VHA providers have to become efficient since they have to run their
operations on the same payer reimbursement payments as the private sector like Cleveland Clinic
gets. For V AMCs that have extra capacity, they can take non-eligible veterans and family
members since they are getting full reimbursement from their Health Insurance.
Just my out of the box thinking, key is the legislation which at the same time we can ask for
legislative relief on Government regulations on personnel, contracting, acquisition, and other
items we identify that stop us from being competitive with the private sector. Time to level the
playing field.
Darin
VA-19-0799-D-001309
OS 00002980
t
.= =--
~- ~
VHA-Today
: :
-.-;,,
#-~
- --=- - - _ 1r..-----
Eligibility+ Facilities+ Footprint
@
$ + Healthcare Model + Control
$ 34% Reliance+ Staff Model + Congress
Medicare
51 .3%
$0
Congress
34% Reliance
$65B
ii? TII
IAlKING DEAD
Staff Model
HMO
SURVIVAL INSTINCT
VA-19-0799-D-001310
OS 00002981
Veterans Clinic - Future
Operate Like the Cleveland Clinic
Eligibility+ Facilities+ Footprint
=
$ + Healthcare Model + Control
$ Follows the Veteran + Federal ACO + Board of Directors
Medicare
51 .3%
100% Services
VHA Payer
TBD 3/4
100% HC Services
Other Services
Veterans
Clmic
~
Fecl~ral
ACO
TBD 3/4
100% Services
VA-19-0799-D-001311
OS 00002982
312
31 3
t
.= =--
~- ~
VHA-Today
: :
-.-;,,
#-~
- --=- - - _ 1r..-----
Eligibility+ Facilities+ Footprint
@
$ + Healthcare Model + Control
$ 34% Reliance+ Staff Model + Congress
Medicare
51 .3%
$0
Congress
34% Reliance
$65B
ii? TII
IAlKING DEAD
Staff Model
HMO
SURVIVAL INSTINCT
VA-19-0799-D-001314
OS 00002985
Veterans Clinic - Future
Operate Like the Cleveland Clinic
Eligibility+ Facilities+ Footprint
=
$ + Healthcare Model + Control
$ Follows the Veteran + Federal ACO + Board of Directors
Medicare
51 .3%
100% Services
VHA Payer
TBD 3/4
100% HC Services
Other Services
Veterans
Clmic
~
Fecl~ral
ACO
TBD 3/4
100% Services
VA-19-0799-D-001315
OS 00002986
316
317
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/9/2017 8:17:31 PM
David Shulkin [drshulkin@aol.com]
Fwd: TEDVA Talk
VA TED Talk 2.pptx; Untitled attachment 06071.htm; VA TED Talk 2.pptx; Untitled attachment 06074.htm
Sent from my iPhone
Begin forwarded message:
From: Darin Selnick <(b) (6)
@gmail.com>
Date: April 8, 2017 at 6:44:27 PM EDT
To: David shulkin
Subject: TEDVA Talk
Hi David
Attached are the two slides from my TEDVA talk. The second slide answers the questions on
how the VHA providers, as a purely providers group, can get all of the OHi $ just like a
Cleveland Clinic can, including the Federal (Medicare, Medicaid and TRICARE).
Key is to have VHA internally fully separate the payer and provider functions and then have
Congress designate the provider function as a Federal ACO. That way the$ follows the veteran
patients, and the VHA provider has contracts with all OHi and VHA payer. Using this method
the eligibility issue goes away since VHA providers are paid for all services from all payers,
including all Federal. VHA providers have to become efficient since they have to run their
operations on the same payer reimbursement payments as the private sector like Cleveland Clinic
gets. For V AMCs that have extra capacity, they can take non-eligible veterans and family
members since they are getting full reimbursement from their Health Insurance.
Just my out of the box thinking, key is the legislation which at the same time we can ask for
legislative relief on Government regulations on personnel, contracting, acquisition, and other
items we identify that stop us from being competitive with the private sector. Time to level the
playing field.
Darin
VA-19-0799-D-001318
OS 00002989
t
.= =--
~- ~
VHA-Today
: :
-.-;,,
#-~
- --=- - - _ 1r..-----
Eligibility+ Facilities+ Footprint
@
$ + Healthcare Model + Control
$ 34% Reliance+ Staff Model + Congress
Medicare
51 .3%
$0
Congress
34% Reliance
$65B
ii? TII
IAlKING DEAD
Staff Model
HMO
SURVIVAL INSTINCT
VA-19-0799-D-001319
OS 00002990
Veterans Clinic - Future
Operate Like the Cleveland Clinic
Eligibility+ Facilities+ Footprint
=
$ + Healthcare Model + Control
$ Follows the Veteran + Federal ACO + Board of Directors
Medicare
51 .3%
100% Services
VHA Payer
TBD 3/4
100% HC Services
Other Services
Veterans
Clmic
~
Fecl~ral
ACO
TBD 3/4
100% Services
VA-19-0799-D-001320
OS 00002991
321
322
t
.= =--
~- ~
VHA-Today
: :
-.-;,,
#-~
- --=- - - _ 1r..-----
Eligibility+ Facilities+ Footprint
@
$ + Healthcare Model + Control
$ 34% Reliance+ Staff Model + Congress
Medicare
51 .3%
$0
Congress
34% Reliance
$65B
ii? TII
IAlKING DEAD
Staff Model
HMO
SURVIVAL INSTINCT
VA-19-0799-D-001323
OS 00002994
Veterans Clinic - Future
Operate Like the Cleveland Clinic
Eligibility+ Facilities+ Footprint
=
$ + Healthcare Model + Control
$ Follows the Veteran + Federal ACO + Board of Directors
Medicare
51 .3%
100% Services
VHA Payer
TBD 3/4
100% HC Services
Other Services
Veterans
Clmic
~
Fecl~ral
ACO
TBD 3/4
100% Services
VA-19-0799-D-001324
OS 00002995
325
326
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/9/2017 8:17:16 PM
Darin Selnick [(b) (6)
@gmail.com]
Fwd: TEDVA Talk
VA TED Talk 2.pptx; Untitled attachment 06079.htm; VA TED Talk 2.pptx; Untitled attachment 06082.htm
I didnt appreciate how this model achieved the goals- brilliant
Sent from my iPhone
Begin forwarded message:
From: Darin Selnick <(b) (6)
@gmail.com>
Date: April 8, 2017 at 6:44:27 PM EDT
To: David shulkin
Subject: TEDVA Talk
Hi David
Attached are the two slides from my TEDVA talk. The second slide answers the questions on
how the VHA providers, as a purely providers group, can get all of the OHi $ just like a
Cleveland Clinic can, including the Federal (Medicare, Medicaid and TRICARE).
Key is to have VHA internally fully separate the payer and provider functions and then have
Congress designate the provider function as a Federal ACO. That way the$ follows the veteran
patients, and the VHA provider has contracts with all OHi and VHA payer. Using this method
the eligibility issue goes away since VHA providers are paid for all services from all payers,
including all Federal. VHA providers have to become efficient since they have to run their
operations on the same payer reimbursement payments as the private sector like Cleveland Clinic
gets. For V AMCs that have extra capacity, they can take non-eligible veterans and family
members since they are getting full reimbursement from their Health Insurance.
Just my out of the box thinking, key is the legislation which at the same time we can ask for
legislative relief on Government regulations on personnel, contracting, acquisition, and other
items we identify that stop us from being competitive with the private sector. Time to level the
playing field.
Darin
VA-19-0799-D-001327
OS 00002998
t
.= =--
~- ~
VHA-Today
: :
-.-;,,
#-~
- --=- - - _ 1r..-----
Eligibility+ Facilities+ Footprint
@
$ + Healthcare Model + Control
$ 34% Reliance+ Staff Model + Congress
Medicare
51 .3%
$0
Congress
34% Reliance
$65B
ii? TII
IAlKING DEAD
Staff Model
HMO
SURVIVAL INSTINCT
VA-19-0799-D-001328
OS 00002999
Veterans Clinic - Future
Operate Like the Cleveland Clinic
Eligibility+ Facilities+ Footprint
=
$ + Healthcare Model + Control
$ Follows the Veteran + Federal ACO + Board of Directors
Medicare
51 .3%
100% Services
VHA Payer
TBD 3/4
100% HC Services
Other Services
Veterans
Clmic
~
Fecl~ral
ACO
TBD 3/4
100% Services
VA-19-0799-D-001329
OS 00003000
330
331
t
.= =--
~- ~
VHA-Today
: :
-.-;,,
#-~
- --=- - - _ 1r..-----
Eligibility+ Facilities+ Footprint
@
$ + Healthcare Model + Control
$ 34% Reliance+ Staff Model + Congress
Medicare
51 .3%
$0
Congress
34% Reliance
$65B
ii? TII
IAlKING DEAD
Staff Model
HMO
SURVIVAL INSTINCT
VA-19-0799-D-001332
OS 00003003
Veterans Clinic - Future
Operate Like the Cleveland Clinic
Eligibility+ Facilities+ Footprint
=
$ + Healthcare Model + Control
$ Follows the Veteran + Federal ACO + Board of Directors
Medicare
51 .3%
100% Services
VHA Payer
TBD 3/4
100% HC Services
Other Services
Veterans
Clmic
~
Fecl~ral
ACO
TBD 3/4
100% Services
VA-19-0799-D-001333
OS 00003004
334
335
Message
From:
Darin Selnick [(b) (6)
Sent:
4/8/2017 10:44:27 PM
To:
David shulkin [Drshulkin@aol.com]
TEDVA Talk
VA TED Talk 2.pptx; VA TED Talk 2.pptx
Subject:
Attachments:
@gmail.com]
Hi David
Attached are the two slides from my TEDVA talk. The second slide answers the questions on how the VHA
providers, as a purely providers group, can get all of the OHI $ just like a Cleveland Clinic can, including the
Federal (Medicare, Medicaid and TRICARE).
Key is to have VHA internally fully separate the payer and provider functions and then have Congress designate
the provider function as a Federal ACO. That way the$ follows the veteran patients, and the VHA provider has
contracts with all OHI and VHA payer. Using this method the eligibility issue goes away since VHA providers
are paid for all services from all payers, including all Federal. VHA providers have to become efficient since
they have to run their operations on the same payer reimbursement payments as the private sector like
Cleveland Clinic gets. For V AJ\tICs that have extra capacity, they can take non-eligible veterans and family
members since they are getting full reimbursement from their Health Insurance.
Just my out of the box thinking, key is the legislation which at the same time we can ask for legislative relief on
Government regulations on personnel, contracting, acquisition, and other items we identify that stop us from
being competitive with the private sector. Time to level the playing field.
Darin
VA-19-0799-D-001336
OS 00003007
t
.= =--
~- ~
VHA-Today
: :
-.-;,,
#-~
- --=- - - _ 1r..-----
Eligibility+ Facilities+ Footprint
@
$ + Healthcare Model + Control
$ 34% Reliance+ Staff Model + Congress
Medicare
51 .3%
$0
Congress
34% Reliance
$65B
ii? TII
IAlKING DEAD
Staff Model
HMO
SURVIVAL INSTINCT
VA-19-0799-D-001337
OS 00003008
Veterans Clinic - Future
Operate Like the Cleveland Clinic
Eligibility+ Facilities+ Footprint
=
$ + Healthcare Model + Control
$ Follows the Veteran + Federal ACO + Board of Directors
Medicare
51 .3%
100% Services
VHA Payer
TBD 3/4
100% HC Services
Other Services
Veterans
Clmic
~
Fecl~ral
ACO
TBD 3/4
100% Services
VA-19-0799-D-001338
OS 00003009
339
t
.= =--
~- ~
VHA-Today
: :
-.-;,,
#-~
- --=- - - _ 1r..-----
Eligibility+ Facilities+ Footprint
@
$ + Healthcare Model + Control
$ 34% Reliance+ Staff Model + Congress
Medicare
51 .3%
$0
Congress
34% Reliance
$65B
ii? TII
IAlKING DEAD
Staff Model
HMO
SURVIVAL INSTINCT
VA-19-0799-D-001340
OS 00003011
Veterans Clinic - Future
Operate Like the Cleveland Clinic
Eligibility+ Facilities+ Footprint
=
$ + Healthcare Model + Control
$ Follows the Veteran + Federal ACO + Board of Directors
Medicare
51 .3%
100% Services
VHA Payer
TBD 3/4
100% HC Services
Other Services
Veterans
Clmic
~
Fecl~ral
ACO
TBD 3/4
100% Services
VA-19-0799-D-001341
OS 00003012
342
Message
From:
(b) (6)
Sent:
4/11/2017 9:10:44 PM
Bruce Moskowitz [(b) (6)
David Shulkin [drshulkin@aol.com]
Re: Pacemaker
To:
CC:
Subject:
[(b) (6)
gmail.com]
mac.com]
Good afternoon,
Yes, there are national contracts that individual medical centers can use to order to orthopedic implantables and
neuro implantables.
Here are just a few names of the national contracts:
Zimmer
Smith & Nephew
Biomet orthopedics
Depuy orthopedics
On Tue, Apr 11, 2017 at 4:46 PM (b) (6)
Yes checking for you now
<(b) (6)
On Tue, Apr 11, 2017 at 4:45 PM Bruce Moskowitz <(b) (6)
We are referring to orthopedic and neuro
gmail.com> wrote:
mac.com> wrote:
Sent from my iPhone
> On Apr 11, 2017, at 4:39 PM, (b) (6)
<(b) (6)
gmail.com> wrote:
>
> Hi Dr. Moskowitz,
>
> On behalf of Dr. Shulkin, we have a national pacemaker contract, each medical center individually orders
off of that national contract.
>
> (b) (6)
VA-19-0799-D-001343
OS 00003014
> -> Sent from Gmail Mobile
Sent from Gmail Mobile
Sent from Gm ail Mobile
VA-19-0799-D-001344
OS 00003015
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/7/2017 8:26:39 PM
To:
Jennifer Lee [(b) (6)
This is your idea
Subject:
gmail.com]
https ://www.meritalk.com/the-situation-report-is-the-cio-job-at-va-about-to-lose-its-influence/
Sent from my iPhone
VA-19-0799-D-001345
OS 00003016
Message
From:
Sent:
To:
Subject:
IP [(b) (6) frenchangel59.com]
3/31/2017 4:16:00 AM
David shulkin [drshulkin@aol.com]
FW: VA And Apple
From: IP [mailto:(b) (6) frenchangel59.com]
Sent: Friday, March 31, 2017 12:05 AM
To: (b) (6)
who.eop.gov
Cc: (b) (6)
who.eop.gov; '
Subject: FW: VA And Apple
(b
)
EOP/WHO'
Jared,
As you know lvanka introduced me to (b) (6)
at Apple and (b) (6)
at Johnson & Johnson. Ours Academic team
has done here is really outrageous. She may
and experts have worked so well with them and their teams. What
be very good in social media, but this an entirely different and very complicated area.
We will fix this.
All my Best,
Ike
From: IP [ mailto:(b) (6) frenchangel59.com]
Sent: Thursday, March 30, 2017 11:56 PM
To: (b) (6)
omb.eop.gov
Cc: (b) (6)
who.eop.gov; lperl(b) (6) @qmail.com ; brucem(b) (6)
Subject: FW: VA And Apple
@mac.com ; mbs(b) (6)
@qmail.com
(b) (6)
With all due respect, I am shocked and extremely disappointed with the manner in which you have engaged in individual
communications with Apple - and intentionally excluded our broader team of subject matter experts. I understand that
these backdoor discussions have apparently been occurring almost daily for weeks, and you have not told anyone and
refuse to return phone calls and emails.
When we first met on February 7th, I personally shared with you our vision and goals and explained that it is critical that
everything we do must be done as a team.
The very purpose of our Academic team, Dr. Moskowitz, and Marc Sherman is to ensure proper analysis, sharing of best
practices, and provide a forum for discussion, debate, and ultimately the strongest collective
decisions/recommendations.
You agreed then, but your actions to date regarding Apple prove otherwise.
on February 1st we discussed and agreed on the importance of leveraging our Academic
When I spoke with (b) (6)
team and experts for the end goal of creating the best system for our veterans. Further on our Apple conference call on
March 3rd - which we invited you and (b) (6) to join - we again discussed and all agreed that for us to be successful and fix
all the issues that our great veterans are going through on a daily basis, we must all unite and work as one team, with
only one agenda and one goal.
VA-19-0799-D-001346
OS 00003017
What we are seeing from you today is a blatant disregard for that commitment and clear disrespect to everyone
involved. You are putting yourself, your own agenda, and your own ego ahead of our veterans. This is unacceptable.
There are 22 veterans dying every day. Your decision to alone discuss IT and technology solutions with Apple for weeks
without the broader team of experts and not informing me and Dr. Moskowitz is major step backwards and will only
cause additional work and significant delays. As a result of your hijacking of this effort, Apple has already canceled
conference calls.
In fact, many of the current problems with the VA is because of this very reason - the lack of team work within. Let me
be clear, I will not allow this to happen while I am involved.
I want this resolved immediately. First, you must include Dr. Moskowitz and Marc Sherman on any and all calls or
meetings. Additionally, I will formally ask you again to please respect me and our broader group of subject matter
experts, and immediately cease individual discussions with Apple and/or any other parties related to the work we have
undertaken regarding the VA.
Ike
-----Original Message----(b) (6)
From: (b) (6)
EOP/OMB fmailto:(b) (6)
Sent: Thursday, March 30, 2017 6:48 PM
To: Bruce Moskowitz
Cc: (b) (6)
EOP/WHO; IP; (b) (6) frenchangel59.com
Subject: Re: VA And Apple
omb.eop.gov]
Hey team! We're making great progress, which I'm excited to fill you in on. Will send you more info when I get out of
these back-to-back mtgs and will give you a ring back Ike!
Thanks!
> On Mar 30, 2017, at 6:49 AM, Bruce Moskowitz <(b) (6)
mac.com > wrote:
>
> In the last email exchange i was supposed to receive information on your interaction with Apple so that we could
rapidly obtain needed technology from our Academic Center Consortium upcoming discussion with Apple. I realize
there are multiple technology issues on everyone's desk however we have medical emergencies daily at the VA that can
only be solved by rapid deployment of new technology. I am available 24-7 by phone 561-3466(b) (6) Thank you
>
> Sent from my iPad
> Bruce Moskowitz M.D.
-----Original Message----From: Bruce Moskowitz fmailto:(b) (6)
Sent: Tuesday, March 28, 2017 11:41 AM
To: (b) (6)
who.eop.gov; (b) (6)
Cc: IP
Subject: VA And Apple
mac.com ]
omb.eop.gov
It would be of benefit to discuss what we can accomplish in technology with Apple for the benefit of the VA. It would be
of importance to understand what discussions the Whitehouse team has already had with Apple so that we have a clear
path forward and do not duplicate what has already been accomplished. Let me know a convenient time to talk. Thank
you
VA-19-0799-D-001347
OS 00003018
Sent from my iPad
Bruce Moskowitz MD.
348
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/3/2017 12:51:49 AM
To:
Darin Selnick [(b) (6)
@gmail.com]
Re: CVA Support of your statement today
Subject:
Thanks
Sent from my iPhone
On Apr 2, 2017, at 7: 14 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
Good job on Fox and Friends today. I received some feedback from people who saw it who said
you did well. Your effort is working on changing the narrative, as per this article from daily
caller.
http ://dailycaller.com/2017/04/02/va-secretary-backs-maj or-legislation-to-fire-incompetentcorrupt-employees-in-historic-move/
Besides fox and friends, I understand a lot of Republican members read the Daily Caller, so it
will be interesting to see how much movement we get this week. Bottom line, public, veterans
and VA staff know you are serious about accountability and that is important and a win.
Darin
On Sat, Apr 1, 2017 at 12:31 PM, Darin Selnick <(b) (6)
Great, happy to assist.
@gmail.com> wrote:
On Sat, Apr 1, 2017 at 12:22 PM, David shulkin wrote:
I like this idea
Up until now I wasnt sure who could do this but i agree
Sent from my iPhone
On Apr 1, 2017, at 3:15 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
Just a thought, as part of being proactive with the press we could have both an
internal and external surrogate program in order to drive our VA narrative.
That is what we did at VA and why CVA is in the media so much.
Internally we can have besides you, a few trusted senior staff to meet with the
media, they can be trained. Externally we can people like Newt Gingrich. We
all would have talking points so we drive our message.
For example on this story, I could have gone on Fox and Friends as your
surrogate. I did this all the time at CVA and was on a number of Fox shows and
CNN. I can do again if you want in the future.
Something to explore with your new Asst Sec OPIA and WH.
VA-19-0799-D-001349
OS 00003020
Darin
On Sat, Apr 1, 2017 at 6:22 AM, Darin Selnick <(b) (6)
wrote:
Will do
@gmail.com>
On Sat, Apr 1, 2017 at 5:08 AM, David shulkin wrote:
This is really great to see
Please thank them on behalf of all of us at the Department
Sent from my iPhone
On Mar 31, 2017, at 10:50 PM, Darin Selnick <(b) (6)
wrote:
@gmail.com>
FYI
I thought you would want to see the CVA statement supporting
you. Starting Monday they will be pushing on Senate
members to move the bill.
Darin
---------- Forwarded message---------From: CVA - Press
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA
Secretary Demands Accountability Legislation Is Taken Up
To: (b) (6)
@gmail.com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire PornWatching Employee, VA
Secretary Demands
VA-19-0799-D-001350
OS 00003021
Accountability Legislation Is
Taken Up
Arlington, VA - After the Department of Veterans Affairs
(VA) failed to quickly remove an employee caught watching
pornography with a VA patient, VA Secretary David Shulkin
is demanding strong VA accountability measures.
"VA has been working with Congress to ensure legislation
would provide VA the ability to expedite removals while still
preserving an employee's right to due process. Without these
legislative changes, VA will continue to be forced to delay
immediate actions to remove employees from federal service,"
the VA wrote in a statement. The VA Secretary is referring to
the VA Accountability First Act of 201 7, a measure that would
shorten the termination and appeals process for removing bad
employees while protecting whistleblowers who speak up
about wrongdoings.
Concerned Veterans for America (CVA) Policy Director
Dan Caldwell issued the following statement:
"It is incredibly refreshing to see Dr. Shulkin emphatically
calling for strong accountability measures at the VA
Under the previous administration, the Secretaries spent
most of their time denying that problems within the
department existed. By acknowledging the need for
systemic reform, Secretary Shulkin has taken a bold and
courageous step in helping veterans push Congress to pass
meaningful accountability legislation.
"An employee caught watching pornography with a VA
patient should be escorted out of the building
immediately, never to return. The VA is forced to retain
employees like this due to incredibly cumbersome and
bureaucratic regulations. To change this, the Senate must
move quickly on the VA Accountability First Act of 2017,
a bill supported by the President, VA Secretary, major
veteran organizations, and veterans around the country
who need and deserve better care than what they're
getting from the VA"
CVA supports the VA Accountability First Act of 2017, which
passed through the House with bipartisan support earlier this
month. The Senate version of the bill, introduced by Senator
Marco Rubio (R-FL), has not yet been scheduled for a vote.
If passed, the 2017 VA Accountability First Act would
drastically shorten the overall termination and appeals process
VA-19-0799-D-001351
OS 00003022
for Department of Veterans Affairs (VA) employees who are
found to have engaged in misconduct. Currently, that process
can take months or even years. The bill also empowers the VA
Secretary to recoup bonuses awarded in error or given to
employees who were later found to have engaged in
misconduct. Additionally, the bill gives the VA Secretary the
ability to reduce the pensions of VA employees who are
convicted of felonies that influenced their job performance.
Earlier this week, it was reported that one VA hospital held a
job open for its accountant while he served a prison term for
killing someone and hired a convicted child molester, keeping
him on VA payroll while he repeatedly reoffended.
###
If you would rather not receive future communications from
Concerned Veterans for America, please go to
https://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsd
uCrVLSqatgFsbFtqqHnuD2i86vPbmc7itP AXk5bAdJu3mdaBt
8dckgr5uUi38Kh8cYRBWyhYbBHxWNZEQ6CXY6EmzF9N
QvsnV3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd,
Arlington, 2220 I VA, USA
VA-19-0799-D-001352
OS 00003023
Message
From:
Darin Selnick [(b) (6)
Sent:
4/2/2017 11:14:41 PM
To:
David shulkin [Drshulkin@aol.com]
Re: CVA Support of your statement today
Subject:
@gmail.com]
Good job on Fox and Friends today. I received some feedback from people who saw it who said you did well.
Your effort is working on changing the narrative, as per this article from daily caller.
http ://dailycaller.com/2017/04/02/va-secretary-backs-major-legislation-to-fire-incompetent-corrupt-employeesin-historic-move/
Besides fox and friends, I understand a lot of Republican members read the Daily Caller, so it will be interesting
to see how much movement we get this week. Bottom line, public, veterans and VA staff know you are serious
about accountability and that is important and a win.
Darin
On Sat, Apr 1, 2017 at 12:31 PM, Darin Selnick <(b) (6)
Great, happy to assist.
@gmail.com> wrote:
On Sat, Apr 1, 2017 at 12:22 PM, David shulkin wrote:
I like this idea
Up until now I wasnt sure who could do this but i agree
Sent from my iPhone
On Apr 1, 2017, at 3:15 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
Just a thought, as part of being proactive with the press we could have both an internal and
external surrogate program in order to drive our VA narrative.
That is what we did at VA and why CVA is in the media so much.
Internally we can have besides you, a few trusted senior staff to meet with the media, they can
be trained. Externally we can people like Newt Gingrich. We all would have talking points so
we drive our message.
For example on this story, I could have gone on Fox and Friends as your surrogate. I did this
all the time at CVA and was on a number of Fox shows and CNN. I can do again if you want
in the future.
Something to explore with your new Asst Sec OPIA and WH.
Darin
On Sat, Apr 1, 2017 at 6:22 AM, Darin Selnick <(b) (6)
Will do
@gmail.com> wrote:
On Sat, Apr 1, 2017 at 5:08 AM, David shulkin wrote:
VA-19-0799-D-001353
OS 00003024
This is really great to see
Please thank them on behalf of all of us at the Department
Sent from my iPhone
On Mar 31, 2017, at 10:50 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
FYI
I thought you would want to see the CVA statement supporting you. Starting
Monday they will be pushing on Senate members to move the bill.
Darin
---------- Forwarded message ---------From: CVA - Press
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA Secretary
Demands Accountability Legislation Is Taken Up
To: (b) (6)
@gmail. com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire PornWatching Employee, VA Secretary
Demands Accountability Legislation
Is Taken Up
Arlington, VA - After the Department of Veterans Affairs (VA) failed to
quickly remove an employee caught watching pornography with a VA
patient, VA Secretary David Shulkin is demanding strong VA accountability
measures.
"VA has been working with Congress to ensure legislation would provide VA
the ability to expedite removals while still preserving an employee's right to
due process. Without these legislative changes, VA will continue to be forced
VA-19-0799-D-001354
OS 00003025
to delay immediate actions to remove employees from federal service," the
VA wrote in a statement. The VA Secretary is referring to the VA
Accountability First Act of 2017, a measure that would shorten the
termination and appeals process for removing bad employees while protecting
whistleblowers who speak up about wrongdoings.
Concerned Veterans for America (CVA) Policy Director Dan Caldwell
issued the following statement:
"It is incredibly refreshing to see Dr. Shulkin emphatically calling for
strong accountability measures at the VA Under the previous
administration, the Secretaries spent most of their time denying that
problems within the department existed. By acknowledging the need for
systemic reform, Secretary Shulkin has taken a bold and courageous step
in helping veterans push Congress to pass meaningful accountability
legislation.
"An employee caught watching pornography with a VA patient should be
escorted out of the building immediately, never to return. The VA is
forced to retain employees like this due to incredibly cumbersome and
bureaucratic regulations. To change this, the Senate must move quickly
on the VA Accountability First Act of 2017, a bill supported by the
President, VA Secretary, major veteran organizations, and veterans
around the country who need and deserve better care than what they're
getting from the VA"
CVA supports the VA Accountability First Act of 2017, which passed
through the House with bipartisan support earlier this month. The Senate
version of the bill, introduced by Senator Marco Rubio (R-FL), has not yet
been scheduled for a vote.
If passed, the 2017 VA Accountability First Act would drastically shorten the
overall termination and appeals process for Department of Veterans Affairs
(VA) employees who are found to have engaged in misconduct. Currently,
that process can take months or even years. The bill also empowers the VA
Secretary to recoup bonuses awarded in error or given to employees who were
later found to have engaged in misconduct. Additionally, the bill gives the VA
Secretary the ability to reduce the pensions of VA employees who are
convicted of felonies that influenced their job performance.
Earlier this week, it was reported that one VA hospital held a job open for its
accountant while he served a prison term for killing someone and hired a
convicted child molester, keeping him on VA payroll while he repeatedly
reoffended.
###
If you would rather not receive future communications from Concerned
VA-19-0799-D-001355
OS 00003026
Veterans for America, please go to
https://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsduCrVLSqatgF
sbFtqqHnuD2i86vPbmc7itP AXk5bAdJu3mdaBt8dckgr5uUi3 8Kh8cYRBWy
hYbBHxWNZEQ6CXY6EmzF9NQvsnV3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd, Arlington, 22201
VA, USA
VA-19-0799-D-001356
OS 00003027
Message
From:
Darin Selnick [(b) (6)
Sent:
4/1/2017 7:31:30 PM
To:
David shulkin [Drshulkin@aol.com]
Re: CVA Support of your statement today
Subject:
@gmail.com]
Great, happy to assist.
On Sat, Apr 1, 2017 at 12:22 PM, David shulkin wrote:
I like this idea
Up until now I wasnt sure who could do this but i agree
Sent from my iPhone
On Apr 1, 2017, at 3:15 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
Just a thought, as part of being proactive with the press we could have both an internal and
external surrogate program in order to drive our VA narrative.
That is what we did at VA and why CVA is in the media so much.
Internally we can have besides you, a few trusted senior staff to meet with the media, they can
be trained. Externally we can people like Newt Gingrich. We all would have talking points so
we drive our message.
For example on this story, I could have gone on Fox and Friends as your surrogate. I did this all
the time at CVA and was on a number of Fox shows and CNN. I can do again if you want in
the future.
Something to explore with your new Asst Sec OPIA and WH.
Darin
On Sat, Apr 1, 2017 at 6:22 AM, Darin Selnick <(b) (6)
Will do
@gmail.com> wrote:
On Sat, Apr 1, 2017 at 5:08 AM, David shulkin wrote:
This is really great to see
Please thank them on behalf of all of us at the Department
Sent from my iPhone
On Mar 31, 2017, at 10:50 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
FYI
I thought you would want to see the CVA statement supporting you. Starting
Monday they will be pushing on Senate members to move the bill.
VA-19-0799-D-001357
OS 00003028
Darin
---------- Forwarded message ---------From: CVA - Press
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA Secretary
Demands Accountability Legislation Is Taken Up
To: (b) (6)
@gmail. com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire PornWatching Employee, VA Secretary
Demands Accountability Legislation
Is Taken Up
Arlington, VA - After the Department of Veterans Affairs (VA) failed to
quickly remove an employee caught watching pornography with a VA patient,
VA Secretary David Shulkin is demanding strong VA accountability
measures.
"VA has been working with Congress to ensure legislation would provide VA
the ability to expedite removals while still preserving an employee's right to
due process. Without these legislative changes, VA will continue to be forced
to delay immediate actions to remove employees from federal service," the VA
wrote in a statement. The VA Secretary is referring to the VA Accountability
First Act of 2017, a measure that would shorten the termination and appeals
process for removing bad employees while protecting whistleblowers who
speak up about wrongdoings.
Concerned Veterans for America (CVA) Policy Director Dan Caldwell
issued the following statement:
"It is incredibly refreshing to see Dr. Shulkin emphatically calling for
strong accountability measures at the VA Under the previous
administration, the Secretaries spent most of their time denying that
VA-19-0799-D-001358
OS 00003029
problems within the department existed. By acknowledging the need for
systemic reform, Secretary Shulkin has taken a bold and courageous step
in helping veterans push Congress to pass meaningful accountability
legislation.
"An employee caught watching pornography with a VA patient should be
escorted out of the building immediately, never to return. The VA is
forced to retain employees like this due to incredibly cumbersome and
bureaucratic regulations. To change this, the Senate must move quickly on
the VA Accountability First Act of 2017, a bill supported by the President,
VA Secretary, major veteran organizations, and veterans around the
country who need and deserve better care than what they're getting from
the VA"
CVA supports the VA Accountability First Act of 2017, which passed through
the House with bipartisan support earlier this month. The Senate version of the
bill, introduced by Senator Marco Rubio (R-FL), has not yet been scheduled
for a vote.
If passed, the 2017 VA Accountability First Act would drastically shorten the
overall termination and appeals process for Department of Veterans Affairs
(VA) employees who are found to have engaged in misconduct. Currently, that
process can take months or even years. The bill also empowers the VA
Secretary to recoup bonuses awarded in error or given to employees who were
later found to have engaged in misconduct. Additionally, the bill gives the VA
Secretary the ability to reduce the pensions of VA employees who are
convicted of felonies that influenced their job performance.
Earlier this week, it was reported that one VA hospital held a job open for its
accountant while he served a prison term for killing someone and hired a
convicted child molester, keeping him on VA payroll while he repeatedly
reoffended.
###
If you would rather not receive future communications from Concerned
Veterans for America, please go to
https://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsduCrVLSqatgFs
bFtqqHnuD2i86vPbmc7itP AXk5bAdJu3mdaBt8dckgr5uUi3 8Kh8cYRBWyh
YbBHxWNZEQ6CXY6EmzF9NQvsnV3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd, Arlington, 22201
VA, USA
VA-19-0799-D-001359
OS 00003030
360
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/1/2017 7:22:51 PM
To:
Darin Selnick [(b) (6)
@gmail.com]
Re: CVA Support of your statement today
Subject:
I like this idea
Up until now I wasnt sure who could do this but i agree
Sent from my iPhone
On Apr 1, 2017, at 3:15 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
Just a thought, as part of being proactive with the press we could have both an internal and
external surrogate program in order to drive our VA narrative.
That is what we did at VA and why CVA is in the media so much.
Internally we can have besides you, a few trusted senior staff to meet with the media, they can be
trained. Externally we can people like Newt Gingrich. We all would have talking points so we
drive our message.
For example on this story, I could have gone on Fox and Friends as your surrogate. I did this all
the time at CVA and was on a number of Fox shows and CNN. I can do again if you want in the
future.
Something to explore with your new Asst Sec OPIA and WH.
Darin
On Sat, Apr 1, 2017 at 6:22 AM, Darin Selnick <(b) (6)
Will do
@gmail.com> wrote:
On Sat, Apr 1, 2017 at 5:08 AM, David shulkin wrote:
This is really great to see
Please thank them on behalf of all of us at the Department
Sent from my iPhone
On Mar 31, 2017, at 10:50 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
FYI
I thought you would want to see the CVA statement supporting you. Starting
Monday they will be pushing on Senate members to move the bill.
Darin
---------- Forwarded message ---------From: CVA - Press
VA-19-0799-D-001361
OS 00003032
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA Secretary
Demands Accountability Legislation Is Taken Up
To: (b) (6)
@gmail.com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire PornWatching Employee, VA Secretary
Demands Accountability Legislation
Is Taken Up
Arlington, VA - After the Department of Veterans Affairs (VA) failed to
quickly remove an employee caught watching pornography with a VA patient,
VA Secretary David Shulkin is demanding strong VA accountability measures.
"VA has been working with Congress to ensure legislation would provide VA
the ability to expedite removals while still preserving an employee's right to
due process. Without these legislative changes, VA will continue to be forced to
delay immediate actions to remove employees from federal service," the VA
wrote in a statement. The VA Secretary is referring to the VA Accountability
First Act of 2017, a measure that would shorten the termination and appeals
process for removing bad employees while protecting whistleblowers who
speak up about wrongdoings.
Concerned Veterans for America (CVA) Policy Director Dan Caldwell
issued the following statement:
"It is incredibly refreshing to see Dr. Shulkin emphatically calling for
strong accountability measures at the VA Under the previous
administration, the Secretaries spent most of their time denying that
problems within the department existed. By acknowledging the need for
systemic reform, Secretary Shulkin has taken a bold and courageous step in
helping veterans push Congress to pass meaningful accountability
legislation.
VA-19-0799-D-001362
OS 00003033
"An employee caught watching pornography with a VA patient should be
escorted out of the building immediately, never to return. The VA is forced
to retain employees like this due to incredibly cumbersome and
bureaucratic regulations. To change this, the Senate must move quickly on
the VA Accountability First Act of 2017, a bill supported by the President,
VA Secretary, major veteran organizations, and veterans around the
country who need and deserve better care than what they're getting from
the VA"
CVA supports the VA Accountability First Act of 2017, which passed through
the House with bipartisan support earlier this month. The Senate version of the
bill, introduced by Senator Marco Rubio (R-FL), has not yet been scheduled for
a vote.
If passed, the 2017 VA Accountability First Act would drastically shorten the
overall termination and appeals process for Department of Veterans Affairs
(VA) employees who are found to have engaged in misconduct. Currently, that
process can take months or even years. The bill also empowers the VA
Secretary to recoup bonuses awarded in error or given to employees who were
later found to have engaged in misconduct. Additionally, the bill gives the VA
Secretary the ability to reduce the pensions of VA employees who are convicted
of felonies that influenced their job performance.
Earlier this week, it was reported that one VA hospital held a job open for its
accountant while he served a prison term for killing someone and hired a
convicted child molester, keeping him on VA payroll while he repeatedly
reoffended.
###
If you would rather not receive future communications from Concerned
Veterans for America, please go to
https://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsduCrVLSqatgFsb
FtqqHnuD2i86vPbmc7itP AXk5bAdJu3mdaBt8dckgr5u Ui3 8Kh8cYRBWyh Yb
BHxWNZEQ6CXY6EmzF9NQvsnV3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd, Arlington, 22201
VA, USA
VA-19-0799-D-001363
OS 00003034
Message
From:
Wright, Vivieca (Simpson) [Vivieca.Wright@va.gov]
Sent:
4/1/2017 3:00:10 PM
To:
'David shulkin' [Drshulkin@aol.com]
RE: [EXTERNAL] Fwd: CVA Support of your statement today
Subject:
Great!
-----Original Message----From: David shulkin [Drshulkin@aol.com]
Sent: Saturday, April 01, 2017 10:58 AM Eastern Standard Time
To: Wright, Vivieca (Simpson)
Subject: Re: [EXTERNAL] Fwd: CVA Support of your statement today
Yup and something we can fix
Fox wants me on in the mornjng to discuss
Sent from my iPhone
On Apr 1, 2017, at 10:42 AM, Wright, Vivieca (Simpson) wrote:
Good article. Steve has a job ahead of him. The discussion on April 25 with all leaders has to go
into detail on this matter. This is the number 1 issue that is holding back the agency.
-----Original Message----From: David shulkin [Drshulkin@aol.com]
Sent: Saturday, April 01, 2017 08:09 AM Eastern Standard Time
To: Wright, Vivieca (Simpson)
Subject: [EXTERNAL] Fwd: CVA Support of your statement today
Sent from my iPhone
Begin forwarded message:
From: Darin Selnick <(b) (6)
@gmail.com>
Date: March 31, 2017 at 10:50: 15 PM EDT
To: David shulkin
Subject: CVA Support of your statement today
VA-19-0799-D-001364
OS 00003035
FYI
I thought you would want to see the CVA statement supporting you. Starting
Monday they will be pushing on Senate members to move the bill.
Darin
---------- Forwarded message ---------From: CVA - Press
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA Secretary
Demands Accountability Legislation Is Taken Up
To: (b) (6)
@gmail.com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire PornWatching Employee, VA Secretary
Demands Accountability Legislation
Is Taken Up
Arlington, VA-After the Department of Veterans Affairs (VA) failed to quickly
remove an employee caught watching pornography with a VA patient, VA
Secretary David Shulkin is demanding strong VA accountability measures.
"VA has been working with Congress to ensure legislation would provide VA the
ability to expedite removals while still preserving an employee's right to due
process. Without these legislative changes, VA will continue to be forced to delay
immediate actions to remove employees from federal service," the VA wrote in a
statement. The VA Secretary is referring to the VA Accountability First Act of
201 7, a measure that would shorten the termination and appeals process for
removing bad employees while protecting whistleblowers who speak up about
wrongdoings.
Concerned Veterans for America (CVA) Policy Director Dan Caldwell issued
the following statement:
VA-19-0799-D-001365
OS 00003036
"It is incredibly refreshing to see Dr. Shulkin emphatically calling for strong
accountability measures at the VA Under the previous administration, the
Secretaries spent most of their time denying that problems within the
department existed. By acknowledging the need for systemic reform,
Secretary Shulkin has taken a bold and courageous step in helping veterans
push Congress to pass meaningful accountability legislation.
"An employee caught watching pornography with a VA patient should be
escorted out of the building immediately, never to return. The VA is forced
to retain employees like this due to incredibly cumbersome and bureaucratic
regulations. To change this, the Senate must move quickly on the VA
Accountability First Act of 2017, a bill supported by the President, VA
Secretary, major veteran organizations, and veterans around the country who
need and deserve better care than what they're getting from the VA"
CVA supports the VA Accountability First Act of 2017, which passed through the
House with bipartisan support earlier this month. The Senate version of the bill,
introduced by Senator Marco Rubio (R-FL), has not yet been scheduled for a
vote.
If passed, the 2017 VA Accountability First Act would drastically shorten the
overall termination and appeals process for Department of Veterans Affairs (VA)
employees who are found to have engaged in misconduct. Currently, that process
can take months or even years. The bill also empowers the VA Secretary to
recoup bonuses awarded in error or given to employees who were later found to
have engaged in misconduct. Additionally, the bill gives the VA Secretary the
ability to reduce the pensions of VA employees who are convicted of felonies that
influenced their job performance.
Earlier this week, it was reported that one VA hospital held a job open for its
accountant while he served a prison term for killing someone and hired a
convicted child molester, keeping him on VA payroll while he repeatedly
reoffended.
###
If you would rather not receive future communications from Concerned Veterans
for America, please go to
https://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsduCrVLSqatgFsbFt
qqHnuD2i86vPbmc7itPAXk5bAdJu3mdaBt8dckgr5uUi3 8Kh8cYRBWyh YbBHx
WNZEQ6CXY6EmzF9NQvsn V3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd, Arlington, 22201 VA,
USA
VA-19-0799-D-001366
OS 00003037
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/1/2017 2:57:48 PM
To:
Wright, Vivieca (Simpson) [Vivieca.Wright@va.gov]
Re: [EXTERNAL] Fwd: CVA Support of your statement today
Subject:
Yup and something we can fix
Fox wants me on in the mornjng to discuss
Sent from my iPhone
On Apr 1, 2017, at 10:42 AM, Wright, Vivieca (Simpson) wrote:
Good article. Steve has a job ahead of him. The discussion on April 25 with all leaders has to go
into detail on this matter. This is the number 1 issue that is holding back the agency.
-----Original Message----From: David shulkin [Drshulkin@aol.com]
Sent: Saturday, April 01, 2017 08:09 AM Eastern Standard Time
To: Wright, Vivieca (Simpson)
Subject: [EXTERNAL] Fwd: CVA Support of your statement today
Sent from my iPhone
Begin forwarded message:
From: Darin Selnick <(b) (6)
@gmail.com>
Date: March 31, 2017 at 10:50: 15 PM EDT
To: David shulkin
Subject: CVA Support of your statement today
FYI
I thought you would want to see the CVA statement supporting you. Starting
Monday they will be pushing on Senate members to move the bill.
Darin
---------- Forwarded message ---------From: CVA - Press
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA Secretary
Demands Accountability Legislation Is Taken Up
VA-19-0799-D-001367
OS 00003038
To:
(b) (6)
@gmail.com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire PornWatching Employee, VA Secretary
Demands Accountability Legislation
Is Taken Up
Arlington, VA-After the Department of Veterans Affairs (VA) failed to quickly
remove an employee caught watching pornography with a VA patient, VA
Secretary David Shulkin is demanding strong VA accountability measures.
"VA has been working with Congress to ensure legislation would provide VA the
ability to expedite removals while still preserving an employee's right to due
process. Without these legislative changes, VA will continue to be forced to delay
immediate actions to remove employees from federal service," the VA wrote in a
statement. The VA Secretary is referring to the VA Accountability First Act of
2017, a measure that would shorten the termination and appeals process for
removing bad employees while protecting whistleblowers who speak up about
wrongdoings.
Concerned Veterans for America (CVA) Policy Director Dan Caldwell issued
the following statement:
"It is incredibly refreshing to see Dr. Shulkin emphatically calling for strong
accountability measures at the VA Under the previous administration, the
Secretaries spent most of their time denying that problems within the
department existed. By acknowledging the need for systemic reform,
Secretary Shulkin has taken a bold and courageous step in helping veterans
push Congress to pass meaningful accountability legislation.
"An employee caught watching pornography with a VA patient should be
escorted out of the building immediately, never to return. The VA is forced
to retain employees like this due to incredibly cumbersome and bureaucratic
regulations. To change this, the Senate must move quickly on the VA
VA-19-0799-D-001368
OS 00003039
Accountability First Act of 2017, a bill supported by the President, VA
Secretary, major veteran organizations, and veterans around the country who
need and deserve better care than what they're getting from the VA"
CVA supports the VA Accountability First Act of 2017, which passed through the
House with bipartisan support earlier this month. The Senate version of the bill,
introduced by Senator Marco Rubio (R-FL), has not yet been scheduled for a
vote.
If passed, the 2017 VA Accountability First Act would drastically shorten the
overall termination and appeals process for Department of Veterans Affairs (VA)
employees who are found to have engaged in misconduct. Currently, that process
can take months or even years. The bill also empowers the VA Secretary to
recoup bonuses awarded in error or given to employees who were later found to
have engaged in misconduct. Additionally, the bill gives the VA Secretary the
ability to reduce the pensions of VA employees who are convicted of felonies that
influenced their job performance.
Earlier this week, it was reported that one VA hospital held a job open for its
accountant while he served a prison term for killing someone and hired a
convicted child molester, keeping him on VA payroll while he repeatedly
reoffended.
###
If you would rather not receive future communications from Concerned Veterans
for America, please go to
https://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsduCrVLSqatgFsbFt
qqHnuD2i86v Pbmc7itPAXk5bAdJu3mdaBt8dckgr5uUi3 8Kh8cYRBWyh YbBHx
WNZEQ6CXY6EmzF9NQvsnV3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd, Arlington, 22201 VA,
USA
VA-19-0799-D-001369
OS 00003040
Message
From:
Wright, Vivieca (Simpson) [Vivieca.Wright@va.gov]
Sent:
4/1/2017 2:42:36 PM
To:
'David shulkin' [Drshulkin@aol.com]
RE: [EXTERNAL] Fwd: CVA Support of your statement today
Subject:
Good article. Steve has a job ahead of him. The discussion on April 25 with all leaders has to go into detail on
this matter. This is the number 1 issue that is holding back the agency.
-----Original Message----From: David shulkin [Drshulkin@aol.com]
Sent: Saturday, April 01, 2017 08:09 AM Eastern Standard Time
To: Wright, Vivieca (Simpson)
Subject: [EXTERNAL] Fwd: CVA Support of your statement today
Sent from my iPhone
Begin forwarded message:
From: Darin Selnick <(b) (6)
@gmail.com>
Date: March 31, 2017 at 10:50: 15 PM EDT
To: David shulkin
Subject: CVA Support of your statement today
FYI
I thought you would want to see the CVA statement supporting you. Starting Monday they will
be pushing on Senate members to move the bill.
Darin
---------- Forwarded message ---------From: CVA - Press
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA Secretary Demands
Accountability Legislation Is Taken Up
To: (b) (6)
k@gmail.com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
VA-19-0799-D-001370
OS 00003041
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire Porn-Watching
Employee, VA Secretary Demands
Accountability Legislation Is Taken Up
Arlington, VA-After the Department of Veterans Affairs (VA) failed to quickly remove an
employee caught watching pornography with a VA patient, VA Secretary David Shulkin is
demanding strong VA accountability measures.
"VA has been working with Congress to ensure legislation would provide VA the ability to
expedite removals while still preserving an employee's right to due process. Without these
legislative changes, VA will continue to be forced to delay immediate actions to remove
employees from federal service," the VA wrote in a statement. The VA Secretary is referring to
the VA Accountability First Act of 2017, a measure that would shorten the termination and
appeals process for removing bad employees while protecting whistleblowers who speak up
about wrongdoings.
Concerned Veterans for America (CVA) Policy Director Dan Caldwell issued the following
statement:
"It is incredibly refreshing to see Dr. Shulkin emphatically calling for strong accountability
measures at the VA Under the previous administration, the Secretaries spent most of their
time denying that problems within the department existed. By acknowledging the need for
systemic reform, Secretary Shulkin has taken a bold and courageous step in helping veterans
push Congress to pass meaningful accountability legislation.
"An employee caught watching pornography with a VA patient should be escorted out of
the building immediately, never to return. The VA is forced to retain employees like this
due to incredibly cumbersome and bureaucratic regulations. To change this, the Senate must
move quickly on the VA Accountability First Act of 2017, a bill supported by the President,
VA Secretary, major veteran organizations, and veterans around the country who need and
deserve better care than what they're getting from the VA"
CVA supports the VA Accountability First Act of 2017, which passed through the House with
bipartisan support earlier this month. The Senate version of the bill, introduced by Senator Marco
Rubio (R-FL), has not yet been scheduled for a vote.
If passed, the 2017 VA Accountability First Act would drastically shorten the overall termination
and appeals process for Department of Veterans Affairs (VA) employees who are found to have
engaged in misconduct. Currently, that process can take months or even years. The bill also
VA-19-0799-D-001371
OS 00003042
empowers the VA Secretary to recoup bonuses awarded in error or given to employees who were
later found to have engaged in misconduct. Additionally, the bill gives the VA Secretary the
ability to reduce the pensions of VA employees who are convicted of felonies that influenced
their job performance.
Earlier this week, it was reported that one VA hospital held a job open for its accountant while
he served a prison term for killing someone and hired a convicted child molester, keeping him on
VA payroll while he repeatedly reoffended.
###
If you would rather not receive future communications from Concerned Veterans for America,
please go to
https://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsduCrVLSqatgFsbFtqqHnuD2i86v
Pbmc7itP AXk5bAdJu3mdaBt8dckgr5uUi3 8Kh8cYRBWyh YbBHx WNZEQ6CXY6EmzF9NQv
snV3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd, Arlington, 22201 VA, USA
VA-19-0799-D-001372
OS 00003043
Message
From:
Darin Selnick [(b) (6)
Sent:
4/1/2017 1:22:22 PM
To:
David shulkin [Drshulkin@aol.com]
Re: CVA Support of your statement today
Subject:
@gmail.com]
Will do
On Sat, Apr 1, 2017 at 5:08 AM, David shulkin wrote:
This is really great to see
Please thank them on behalf of all of us at the Department
Sent from my iPhone
On Mar 31, 2017, at 10:50 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
FYI
I thought you would want to see the CVA statement supporting you. Starting Monday they will
be pushing on Senate members to move the bill.
Darin
---------- Forwarded message ---------From: CVA - Press
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA Secretary Demands
Accountability Legislation Is Taken Up
To: (b) (6)
k@gmail.com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire Porn-Watching
Employee, VA Secretary Demands
Accountability Legislation Is Taken Up
VA-19-0799-D-001373
OS 00003044
Arlington, VA-After the Department of Veterans Affairs (VA) failed to quickly remove an
employee caught watching pornography with a VA patient, VA Secretary David Shulkin is
demanding strong VA accountability measures.
"VA has been working with Congress to ensure legislation would provide VA the ability to
expedite removals while still preserving an employee's right to due process. Without these
legislative changes, VA will continue to be forced to delay immediate actions to remove
employees from federal service," the VA wrote in a statement. The VA Secretary is referring to
the VA Accountability First Act of 2017, a measure that would shorten the termination and
appeals process for removing bad employees while protecting whistleblowers who speak up
about wrongdoings.
Concerned Veterans for America (CVA) Policy Director Dan Caldwell issued the
following statement:
"It is incredibly refreshing to see Dr. Shulkin emphatically calling for strong accountability
measures at the VA Under the previous administration, the Secretaries spent most of their
time denying that problems within the department existed. By acknowledging the need for
systemic reform, Secretary Shulkin has taken a bold and courageous step in helping
veterans push Congress to pass meaningful accountability legislation.
"An employee caught watching pornography with a VA patient should be escorted out of
the building immediately, never to return. The VA is forced to retain employees like this
due to incredibly cumbersome and bureaucratic regulations. To change this, the Senate
must move quickly on the VA Accountability First Act of 2017, a bill supported by the
President, VA Secretary, major veteran organizations, and veterans around the country who
need and deserve better care than what they're getting from the VA"
CVA supports the VA Accountability First Act of 2017, which passed through the House with
bipartisan support earlier this month. The Senate version of the bill, introduced by Senator
Marco Rubio (R-FL), has not yet been scheduled for a vote.
If passed, the 2017 VA Accountability First Act would drastically shorten the overall
termination and appeals process for Department of Veterans Affairs (VA) employees who are
found to have engaged in misconduct. Currently, that process can take months or even years.
The bill also empowers the VA Secretary to recoup bonuses awarded in error or given to
employees who were later found to have engaged in misconduct. Additionally, the bill gives the
VA Secretary the ability to reduce the pensions of VA employees who are convicted of felonies
that influenced their job performance.
Earlier this week, it was reported that one VA hospital held a job open for its accountant while
he served a prison term for killing someone and hired a convicted child molester, keeping him
on VA payroll while he repeatedly reoffended.
###
If you would rather not receive future communications from Concerned Veterans for America,
VA-19-0799-D-001374
OS 00003045
please go to
https://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsduCrVLSqatgFsbFtqqHnuD2i86v
Pbmc7itP AXk5bAdJu3mdaBt8dckgr5uUi3 8Kh8cYRBWyh YbBHxWNZEQ6CXY6EmzF9NQ
vsn V3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd, Arlington, 22201 VA, USA
VA-19-0799-D-001375
OS 00003046
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/1/2017 12:09:24 PM
To:
Vivieca Wright Simpson [vivieca.Wright@va.gov]
Fwd: CVA Support of your statement today
Subject:
Sent from my iPhone
Begin forwarded message:
From: Darin Selnick <(b) (6)
@gmail.com>
Date: March 31, 2017 at 10:50: 15 PM EDT
To: David shulkin
Subject: CVA Support of your statement today
FYI
I thought you would want to see the CVA statement supporting you. Starting Monday they will
be pushing on Senate members to move the bill.
Darin
---------- Forwarded message ---------From: CVA - Press
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA Secretary Demands
Accountability Legislation Is Taken Up
To: (b) (6)
k@gmail.com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire Porn-Watching
Employee, VA Secretary Demands
Accountability Legislation Is Taken Up
VA-19-0799-D-001376
OS 00003047
Arlington, VA-After the Department of Veterans Affairs (VA) failed to quickly remove an
employee caught watching pornography with a VA patient, VA Secretary David Shulkin is
demanding strong VA accountability measures.
"VA has been working with Congress to ensure legislation would provide VA the ability to
expedite removals while still preserving an employee's right to due process. Without these
legislative changes, VA will continue to be forced to delay immediate actions to remove
employees from federal service," the VA wrote in a statement. The VA Secretary is referring to
the VA Accountability First Act of 2017, a measure that would shorten the termination and
appeals process for removing bad employees while protecting whistleblowers who speak up
about wrongdoings.
Concerned Veterans for America (CVA) Policy Director Dan Caldwell issued the following
statement:
"It is incredibly refreshing to see Dr. Shulkin emphatically calling for strong accountability
measures at the VA Under the previous administration, the Secretaries spent most of their
time denying that problems within the department existed. By acknowledging the need for
systemic reform, Secretary Shulkin has taken a bold and courageous step in helping veterans
push Congress to pass meaningful accountability legislation.
"An employee caught watching pornography with a VA patient should be escorted out of
the building immediately, never to return. The VA is forced to retain employees like this
due to incredibly cumbersome and bureaucratic regulations. To change this, the Senate must
move quickly on the VA Accountability First Act of 2017, a bill supported by the President,
VA Secretary, major veteran organizations, and veterans around the country who need and
deserve better care than what they're getting from the VA"
CVA supports the VA Accountability First Act of 2017, which passed through the House with
bipartisan support earlier this month. The Senate version of the bill, introduced by Senator Marco
Rubio (R-FL), has not yet been scheduled for a vote.
If passed, the 2017 VA Accountability First Act would drastically shorten the overall termination
and appeals process for Department of Veterans Affairs (VA) employees who are found to have
engaged in misconduct. Currently, that process can take months or even years. The bill also
empowers the VA Secretary to recoup bonuses awarded in error or given to employees who were
later found to have engaged in misconduct. Additionally, the bill gives the VA Secretary the
ability to reduce the pensions of VA employees who are convicted of felonies that influenced
their job performance.
Earlier this week, it was reported that one VA hospital held a job open for its accountant while
he served a prison term for killing someone and hired a convicted child molester, keeping him on
VA payroll while he repeatedly reoffended.
###
If you would rather not receive future communications from Concerned Veterans for America,
VA-19-0799-D-001377
OS 00003048
please go to
https://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsduCrVLSqatgFsbFtqqHnuD2i86v
Pbmc7itP AXk5bAdJu3mdaBt8dckgr5uUi3 8Kh8cYRBWyh YbBHx WNZEQ6CXY6EmzF9NQv
snV3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd, Arlington, 22201 VA, USA
VA-19-0799-D-001378
OS 00003049
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/1/2017 12:08:56 PM
To:
Darin Selnick [(b) (6)
@gmail.com]
Re: CVA Support of your statement today
Subject:
This is really great to see
Please thank them on behalf of all of us at the Department
Sent from my iPhone
On Mar 31, 2017, at 10:50 PM, Darin Selnick <(b) (6)
@gmail.com> wrote:
FYI
I thought you would want to see the CVA statement supporting you. Starting Monday they will
be pushing on Senate members to move the bill.
Darin
---------- Forwarded message ---------From: CVA - Press
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA Secretary Demands
Accountability Legislation Is Taken Up
To: (b) (6)
k@gmail.com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire Porn-Watching
Employee, VA Secretary Demands
Accountability Legislation Is Taken Up
Arlington, VA-After the Department of Veterans Affairs (VA) failed to quickly remove an
VA-19-0799-D-001379
OS 00003050
employee caught watching pornography with a VA patient, VA Secretary David Shulkin is
demanding strong VA accountability measures.
"VA has been working with Congress to ensure legislation would provide VA the ability to
expedite removals while still preserving an employee's right to due process. Without these
legislative changes, VA will continue to be forced to delay immediate actions to remove
employees from federal service," the VA wrote in a statement. The VA Secretary is referring to
the VA Accountability First Act of 2017, a measure that would shorten the termination and
appeals process for removing bad employees while protecting whistleblowers who speak up
about wrongdoings.
Concerned Veterans for America (CVA) Policy Director Dan Caldwell issued the following
statement:
"It is incredibly refreshing to see Dr. Shulkin emphatically calling for strong accountability
measures at the VA Under the previous administration, the Secretaries spent most of their
time denying that problems within the department existed. By acknowledging the need for
systemic reform, Secretary Shulkin has taken a bold and courageous step in helping veterans
push Congress to pass meaningful accountability legislation.
"An employee caught watching pornography with a VA patient should be escorted out of
the building immediately, never to return. The VA is forced to retain employees like this
due to incredibly cumbersome and bureaucratic regulations. To change this, the Senate must
move quickly on the VA Accountability First Act of 2017, a bill supported by the President,
VA Secretary, major veteran organizations, and veterans around the country who need and
deserve better care than what they're getting from the VA"
CVA supports the VA Accountability First Act of 2017, which passed through the House with
bipartisan support earlier this month. The Senate version of the bill, introduced by Senator Marco
Rubio (R-FL), has not yet been scheduled for a vote.
If passed, the 2017 VA Accountability First Act would drastically shorten the overall termination
and appeals process for Department of Veterans Affairs (VA) employees who are found to have
engaged in misconduct. Currently, that process can take months or even years. The bill also
empowers the VA Secretary to recoup bonuses awarded in error or given to employees who were
later found to have engaged in misconduct. Additionally, the bill gives the VA Secretary the
ability to reduce the pensions of VA employees who are convicted of felonies that influenced
their job performance.
Earlier this week, it was reported that one VA hospital held a job open for its accountant while
he served a prison term for killing someone and hired a convicted child molester, keeping him on
VA payroll while he repeatedly reoffended.
###
If you would rather not receive future communications from Concerned Veterans for America,
please go to
https://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsduCrVLSqatgFsbFtqqHnuD2i86v
VA-19-0799-D-001380
OS 00003051
Pbmc7itP AXk5bAdJu3mdaBt8dckgr5uUi3 8Kh8cYRBWyh YbBHx WNZEQ6CXY6EmzF9NQv
snV3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd, Arlington, 22201 VA, USA
VA-19-0799-D-001381
OS 00003052
Message
From:
Darin Selnick [(b) (6)
Sent:
4/1/2017 2:50:15 AM
To:
David shulkin [Drshulkin@aol.com]
CVA Support of your statement today
Subject:
@gmail.com]
FYI
I thought you would want to see the CVA statement supporting you. Starting Monday they will be pushing on
Senate members to move the bill.
Darin
---------- Forwarded message---------From: CVA - Press
Date: Fri, Mar 31, 2017 at 5:35 PM
Subject: Unable to Quickly Fire Porn-Watching Employee, VA Secretary Demands Accountability Legislation
Is Taken Up
To: (b) (6)
@gmail.com
For Immediate Release: March 31, 2017
Media Contact: press@cv4a.org
CONCERNED
VETERANS
FOR AMERICA
Unable to Quickly Fire Porn-Watching Employee,
VA Secretary Demands Accountability Legislation
Is Taken Up
Arlington, VA-After the Department of Veterans Affairs (VA) failed to quickly remove an employee caught
watching pornography with a VA patient, VA Secretary David Shulkin is demanding strong VA accountability
measures.
"VA has been working with Congress to ensure legislation would provide VA the ability to expedite removals
while still preserving an employee's right to due process. Without these legislative changes, VA will continue to
be forced to delay immediate actions to remove employees from federal service," the VA wrote in a statement.
The VA Secretary is referring to the VA Accountability First Act of 2017, a measure that would shorten the
termination and appeals process for removing bad employees while protecting whistleblowers who speak up
about wrongdoings.
VA-19-0799-D-001382
OS 00003053
Concerned Veterans for America (CVA) Policy Director Dan Caldwell issued the following statement:
"It is incredibly refreshing to see Dr. Shulkin emphatically calling for strong accountability measures at the
VA Under the previous administration, the Secretaries spent most of their time denying that problems
within the department existed. By acknowledging the need for systemic reform, Secretary Shulkin has
taken a bold and courageous step in helping veterans push Congress to pass meaningful accountability
legislation.
"An employee caught watching pornography with a VA patient should be escorted out of the building
immediately, never to return. The VA is forced to retain employees like this due to incredibly cumbersome
and bureaucratic regulations. To change this, the Senate must move quickly on the VA Accountability First
Act of 2017, a bill supported by the President, VA Secretary, major veteran organizations, and veterans
around the country who need and deserve better care than what they're getting from the VA"
CVA supports the VA Accountability First Act of 2017, which passed through the House with bipartisan
support earlier this month. The Senate version of the bill, introduced by Senator Marco Rubio (R-FL), has not
yet been scheduled for a vote.
If passed, the 2017 VA Accountability First Act would drastically shorten the overall termination and appeals
process for Department of Veterans Affairs (VA) employees who are found to have engaged in misconduct.
Currently, that process can take months or even years. The bill also empowers the VA Secretary to recoup
bonuses awarded in error or given to employees who were later found to have engaged in misconduct.
Additionally, the bill gives the VA Secretary the ability to reduce the pensions of VA employees who are
convicted of felonies that influenced their job performance.
Earlier this week, it was reported that one VA hospital held a job open for its accountant while he served a
prison term for killing someone and hired a convicted child molester, keeping him on VA payroll while he
repeatedly reoffended.
###
If you would rather not receive future communications from Concerned Veterans for America, please go to
https ://optout.cision.com/en/2LlqdTrCUnjiC2jNYlbavkvLLsduCrVLSqatgFsbFtqqHnuD2i86vPbmc7itPAXk5
bAdJu3mdaBt8dckgr5uUi38Kh8cYRBWyhYbBHxWNZEQ6CXY6EmzF9NQvsnV3NcjWkfc.
Concerned Veterans for America, 1310 N. Courthouse Rd, Arlington, 22201 VA, USA
VA-19-0799-D-001383
OS 00003054
Message
From:
Sent:
To:
CC:
Subject:
David shulkin [Drshulkin@aol.com]
4/3/2017 4:29:13 PM
(b) (6)
[(b) (6)
pcommgroup.com]
(b)
(6)
IP [
frenchangel59.com]; Marisol Garcia [(b) (6) frenchangel59.com]; (b) (6)
Simpson [(b) (6)
gmail.com]
Re: DRAFT: VA COMMUNICATIONS TASK FORCE
[(b) (6)
pcommgroup.com]; Vivieca
I like the way you think
Sent from my iPhone
On Apr 3, 2017, at 12:02 PM, (b) (6)
<(b) (6)
pcommgroup.com> wrote:
Thank you. Understood. We can also call it a volunteer communications advisory committee etc.
On Apr 3, 2017, at 9:00 AM, David shulkin wrote:
(b) (6)
thanks so much . Like many things in government- its always a bit
complicated. There are rules around task forces so let me get some internal guidance
on the least complex way to approach this.
Thanks
David Shulkin
Sent from my iPhone
On Apr 3, 2017, at 11:21 AM, (b) (6)
<(b) (6)
pcommgroup.com > wrote:
Thank you Dr. Shulkin.
I am glad the list works, we agree it is a good start.
As per below the only target I socialized the idea with was (b) (6)
who heads communications for 2P1 Century Fox and
the Murdochs.
I think the approach is critical, from my POV it is important we
outline the task force's specific goals, time commitment and if
applicable the corporate approval/support/relationship that exists
(i.e. Apple, Johnson & Johnson, Disney, Fox, etc).
To this end, I suggest the following:
1) We will draft an outline of
the Task Force's role, commitment and goals.
2) We will create an excel
grid so you may input existing relationships with each
associated C-Suite. The goal is to really get a commitment
from the "host" company.
Where you have an
existing relationship, (i.e. (b) (6)
the invitation
VA-19-0799-D-001384
OS 00003055
letter can go to the target+ CC the C-Suite relationship
(ex. (b) (6)
Where there is no
existing C-Suite relationship, we can navigate the best
route to reach each target, in many or most cases we
can provide.
I assume all costs associated with travel and accommodations
would be subsidized by the host company.
Available to speak as needed.
Best,
(b) (6)
David shulkin [mailto:Drshulkin@aol.com]
Sent: Monday, April 3, 2017 3:59 AM
(b) (6)
To:
<(b) (6)
pcommgroup.com>
(b) (6)
Cc: IP <
frenchangel59.com >; Marisol Garcia
<(b) (6) frenchangel59.com >; (b) (6)
<(b) (6) pcommgroup.com>
Subject: Re: DRAFT: VA COMMUNICATIONS TASK FORCE
From:
(b) (6)
once again thank you. This is a perfect list and you did an
amazing job pulling it together.
As a next step - is this a group of prospects or is this a group that has
already agreed to help?
Should i reach out to them to invite them to join an advisory group? Or
do you have a different suggestion?
David Shulkin
Secretary, US Department of Veterans Affairs
Sent from my iPhone
On Mar 28, 2017, at 3:41 PM, (b) (6)
<(b) (6)
pcommgroup.com > wrote:
Dr. Shulkin:
It was a privilege to speak last week. Per our
conversation, please see a DRAFT list of proposed
names to target for the Communications
Committee- whose responsibility it will be to
identify near term and intermediate VA
Communications goals, specific near term
opportunities and evaluate, and if necessary staff
and resource.
Please note, the only name we approached was (b) (6)
of 2P1 Century Fox, who is committed
to the idea and involvement and shared that her
VA-19-0799-D-001385
OS 00003056
leadership team (the Murdoch(s)) consider the VA a
priority focus.
We look forward to discussing next steps and defer
to Ike on positioning and final thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001386
OS 00003057
Message
(b) (6)
[(b) (6)
pcommgroup.com]
4/3/2017 4:02:27 PM
David shulkin [Drshulkin@aol.com]
IP [(b) (6) frenchangel59.com]; Marisol Garcia [(b) (6) frenchangel59.com]; (b) (6)
Simpson [(b) (6)
gmail.com]
Re: DRAFT: VA COMMUNICATIONS TASK FORCE
From:
Sent:
To:
CC:
Subject:
[(b) (6)
pcommgroup.com]; Vivieca
Thank you. Understood. We can also call it a volunteer communications advisory committee etc.
On Apr 3, 2017, at 9:00 AM, David shulkin wrote:
(b) (6)
thanks so much . Like many things in government- its always a bit complicated. There are
rules around task forces so let me get some internal guidance on the least complex way to approach
this.
Thanks
David Shulkin
Sent from my iPhone
On Apr 3, 2017, at 11:21 AM, (b) (6)
<(b) (6)
pcommgroup.com > wrote:
Thank you Dr. Shulkin.
I am glad the list works, we agree it is a good start.
As per below the only target I socialized the idea with was (b) (6)
heads communications for 2P1 Century Fox and the Murdochs.
who
I think the approach is critical, from my POV it is important we outline the task
force's specific goals, time commitment and if applicable the corporate
approval/support/relationship that exists (i.e. Apple, Johnson & Johnson, Disney,
Fox, etc).
To this end, I suggest the following:
1) We will draft an outline of the Task
Force's role, commitment and goals.
2) We will create an excel grid so you may
input existing relationships with each associated C-Suite. The goal is to
really get a commitment from the "host" company.
Where you have an existing
the invitation letter can go to the target+
relationship, (i.e. (b) (6)
CC the C-Suite relationship (ex. (b) (6)
Where there is no existing C-Suite
relationship, we can navigate the best route to reach each target, in
many or most cases we can provide.
I assume all costs associated with travel and accommodations would be
subsidized by the host company.
Available to speak as needed.
Best,
VA-19-0799-D-001387
OS 00003058
Melissa
From: David shulkin [mailto :Drshulkin@aol.com ]
Sent: Monday, April 3, 2017 3:59 AM
<(b) (6)
pcommgroup.com>
Cc: IP <(b) (6) frenchangel59.com >; Marisol Garcia <(b) (6) frenchangel59.com >;
<(b) (6)
pcommgroup.com >
Subject: Re: DRAFT: VA COMMUNICATIONS TASK FORCE
To:
(b) (6)
(b) (6)
(b) (6)
once again thank you. This is a perfect list and you did an amazing job pulling
it together.
As a next step - is this a group of prospects or is this a group that has already agreed to
help?
Should i reach out to them to invite them to join an advisory group? Or do you have a
different suggestion?
David Shulkin
Secretary, US Department of Veterans Affairs
Sent from my iPhone
On Mar 28, 2017, at 3:41 PM, (b) (6)
<(b) (6)
pcommgroup.com > wrote:
Dr. Shulkin:
It was a privilege to speak last week. Per our conversation, please
see a DRAFT list of proposed names to target for the
Communications Committee- whose responsibility it will be to
identify near term and intermediate VA Communications goals,
specific near term opportunities and evaluate, and if necessary staff
and resource.
of
Please note, the only name we approached was (b) (6)
21 st Century Fox, who is committed to the idea and involvement
and shared that her leadership team (the Murdoch(s)) consider the
VA a priority focus.
We look forward to discussing next steps and defer to Ike on
positioning and final thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001388
OS 00003059
Message
David shulkin [Drshulkin@aol.com]
4/3/2017 4:00:56 PM
(b) (6)
[(b) (6)
pcommgroup.com]
(b)
(6)
IP [
frenchangel59.com]; Marisol Garcia [(b) (6) frenchangel59.com]; (b) (6)
Simpson [(b) (6)
gmail.com]
Re: DRAFT: VA COMMUNICATIONS TASK FORCE
From:
Sent:
To:
CC:
Subject:
[(b) (6)
pcommgroup.com]; Vivieca
(b) (6)
thanks so much . Like many things in government- its always a bit complicated. There are rules around task
forces so let me get some internal guidance on the least complex way to approach this.
Thanks
David Shulkin
Sent from my iPhone
On Apr 3, 2017, at 11:21 AM, (b) (6)
<(b) (6)
pcommgroup.com > wrote:
Thank you Dr. Shulkin.
I am glad the list works, we agree it is a good start.
As per below the only target I socialized the idea with was (b) (6)
communications for 2P1 Century Fox and the Murdochs.
who heads
I think the approach is critical, from my POV it is important we outline the task force's specific
goals, time commitment and if applicable the corporate approval/support/relationship that exists
(i.e. Apple, Johnson & Johnson, Disney, Fox, etc).
To this end, I suggest the following:
1) We will draft an outline of the Task Force's role,
commitment and goals.
2) We will create an excel grid so you may input existing
relationships with each associated C-Suite. The goal is to really get a commitment from
the "host" company.
Where you have an existing relationship, (i.e. (b) (6)
the invitation letter can go to the target+ CC the C-Suite relationship (ex. (b) (6)
Where there is no existing C-Suite relationship, we
can navigate the best route to reach each target, in many or most cases we can
provide.
I assume all costs associated with travel and accommodations would be subsidized by the host
company.
Available to speak as needed.
Best,
(b) (6)
From: David shulkin [mailto:Drshulkin@aol.com ]
Sent: Monday, April 3, 2017 3:59 AM
(b) (6)
<(b) (6)
pcommgroup.com >
To:
VA-19-0799-D-001389
OS 00003060
Cc: IP <(b) (6) frenchangel59.com >; Marisol Garcia <(b) (6) frenchangel59.com >;
<(b) (6)
pcommgroup.com >
Subject: Re: DRAFT: VA COMMUNICATIONS TASK FORCE
(b) (6)
(b) (6)
once again thank you. This is a perfect list and you did an amazing job pulling it together.
As a next step - is this a group of prospects or is this a group that has already agreed to help?
Should i reach out to them to invite them to join an advisory group? Or do you have a different
suggestion?
David Shulkin
Secretary, US Department of Veterans Affairs
Sent from my iPhone
On Mar 28, 2017, at 3:41 PM, (b) (6)
<(b) (6)
pcommgroup.com > wrote:
Dr. Shulkin:
It was a privilege to speak last week. Per our conversation, please see a DRAFT
list of proposed names to target for the Communications Committee- whose
responsibility it will be to identify near term and intermediate VA
Communications goals, specific near term opportunities and evaluate, and if
necessary staff and resource.
Please note, the only name we approached was (b) (6)
of 21 st Century
Fox, who is committed to the idea and involvement and shared that her leadership
team (the Murdoch(s)) consider the VA a priority focus.
We look forward to discussing next steps and defer to Ike on positioning and final
thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001390
OS 00003061
Message
(b) (6)
CC:
[(b) (6)
pcommgroup.com]
4/3/2017 3:21:01 PM
David shulkin [Drshulkin@aol.com]
IP [(b) (6) frenchangel59.com]; Marisol Garcia [(b) (6) frenchangel59.com]; (b) (6)
Subject:
RE: DRAFT: VA COMMUNICATIONS TASK FORCE
From:
Sent:
To:
Thank you Dr. Shulkin.
I am glad the list works, we agree it is a good start.
As per below the only target I socialized the idea with was (b) (6)
Century Fox and the Murdochs.
[(b) (6)
pcommgroup.com]
who heads communications for 21 st
I think the approach is critical, from my POV it is important we outline the task force's specific goals, time
commitment and if applicable the corporate approval/support/relationship that exists (i.e. Apple, Johnson &
Johnson, Disney, Fox, etc).
To this end, I suggest the following:
1) We will draft an outline of the Task Force's role, commitment and goals.
2) We will create an excel grid so you may input existing relationships with each associated C-Suite. The
goal is to really get a commitment from the "host" company.
Where you have an existing relationship, (i.e. (b) (6)
the invitation letter can go to the target+
(b) (6)
CC the C-Suite relationship (ex.
Where there is no existing C-Suite relationship, we can navigate the best route to reach each target,
in many or most cases we can provide.
I assume all costs associated with travel and accommodations would be subsidized by the host company.
Available to speak as needed.
Best,
(b) (6)
From: David shulkin [mailto:Drshulkin@aol.com]
Sent: Monday, April 3, 2017 3:59 AM
<(b) (6)
pcommgroup.com>
Cc: IP <
frenchangel59.com>; Marisol Garcia <(b) (6) frenchangel59.com>;
Subject: Re: DRAFT: VA COMMUNICATIONS TASK FORCE
To:
(b) (6)
(b) (6)
(b) (6)
(b) (6)
<(b) (6)
pcommgroup.com>
once again thank you. This is a perfect list and you did an amazing job pulling it together.
As a next step - is this a group of prospects or is this a group that has already agreed to help?
Should i reach out to them to invite them to join an advisory group? Or do you have a different suggestion?
David Shulkin
Secretary, US Department of Veterans Affairs
Sent from my iPhone
On Mar 28, 2017, at 3:41 PM, (b) (6)
<(b) (6)
pcommgroup.com > wrote:
Dr. Shulkin:
VA-19-0799-D-001391
OS 00003062
It was a privilege to speak last week. Per our conversation, please see a DRAFT list of proposed
names to target for the Communications Committee- whose responsibility it will be to identify
near term and intermediate VA Communications goals, specific near term opportunities and
evaluate, and if necessary staff and resource.
of 21 st Century Fox, who is
Please note, the only name we approached was (b) (6)
committed to the idea and involvement and shared that her leadership team (the Murdoch(s))
consider the VA a priority focus.
We look forward to discussing next steps and defer to Ike on positioning and final thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001392
OS 00003063
Message
David shulkin [Drshulkin@aol.com]
From:
Sent:
4/3/2017 10:58:39 AM
To:
(b) (6)
[(b) (6)
[(b) (6) frenchangel59.com];
pcommgroup.com]
Marisol Garcia [(b) (6) frenchangel59.com]; (b) (6)
CC:
IP
Subject:
Re: DRAFT: VA COMMUNICATIONS TASK FORCE
(b) (6)
[(b) (6)
pcommgroup.com]
once again thank you. This is a perfect list and you did an amazing job pulling it together.
As a next step - is this a group of prospects or is this a group that has already agreed to help?
Should i reach out to them to invite them to join an advisory group? Or do you have a different suggestion?
David Shulkin
Secretary, US Department of Veterans Affairs
Sent from my iPhone
On Mar 28, 2017, at 3:41 PM, (b) (6)
<(b) (6)
pcommgroup.com > wrote:
Dr. Shulkin:
It was a privilege to speak last week. Per our conversation, please see a DRAFT list of proposed
names to target for the Communications Committee- whose responsibility it will be to identify
near term and intermediate VA Communications goals, specific near term opportunities and
evaluate, and if necessary staff and resource.
Please note, the only name we approached was (b) (6)
of 21 st Century Fox, who is
committed to the idea and involvement and shared that her leadership team (the Murdoch(s))
consider the VA a priority focus.
We look forward to discussing next steps and defer to Ike on positioning and final thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001393
OS 00003064
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/3/2017 1:47:23 AM
To:
Vivieca Simpson [(b) (6)
Subject:
Re: DRAFT: VA COMMUNICATIONS TASK FORCE
gmail.com]
Tommorow- im on a train from 7 am to 9 am and free again 1130- 12 est
Sent from my iPhone
On Apr 2, 2017, at 9: 12 PM, Vivieca Simpson <(b) (6)
gmail.com> wrote:
Do you want to talk tonight or tomorrow.
On Mar 30, 2017 12: 19, "David shulkin" wrote:
We need to discuss somewhat urgently
Sent from my iPhone
Begin forwarded message:
From: David shulkin
Date: March 28, 2017 at 3: 13: 49 PM CDT
To: Vivieca Wright Simpson
Subject: Fwd: DRAFT: VA COMMUNICATIONS TASK FORCE
Lets discuss
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
pcommgroup.com>
Date: March 28, 2017 at 3: 41: 44 PM EDT
To: David shulkin , IP
Cc: Marisol Garcia <(b) (6) frenchangel59 .com>, (b) (6)
<(b) (6)
pcommgroup.com>
Subject: DRAFT: VA COMMUNICATIONS TASK FORCE
Dr. Shulkin:
It was a privilege to speak last week. Per our conversation, please
see a DRAFT list of proposed names to target for the
Communications Committee- whose responsibility it will be to
identify near term and intermediate VA Communications goals,
specific near term opportunities and evaluate, and if necessary
staff and resource.
VA-19-0799-D-001394
OS 00003065
Please note, the only name we approached was (b) (6)
of
st
21 Century Fox, who is committed to the idea and involvement
and shared that her leadership team (the Murdoch(s)) consider the
VA a priority focus.
We look forward to discussing next steps and defer to Ike on
positioning and final thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001395
OS 00003066
Message
From:
Sent:
To:
Subject:
Vivieca Simpson [(b) (6)
gmail.com]
4/3/2017 1:12:06 AM
David shulkin [Drshulkin@aol.com]
Re: Fwd: DRAFT: VA COMMUNICATIONS TASK FORCE
Do you want to talk tonight or tomorrow.
On Mar 30, 2017 12: 19, "David shulkin" wrote:
We need to discuss somewhat urgently
Sent from my iPhone
Begin forwarded message:
From: David shulkin
Date: March 28, 2017 at 3: 13: 49 PM CDT
To: Vivieca Wright Simpson
Subject: Fwd: DRAFT: VA COMMUNICATIONS TASK FORCE
Lets discuss
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
pcommgroup.com>
Date: March 28, 2017 at 3: 41: 44 PM EDT
To: David shulkin , IP <(b) (6) frenchangel59.com>
Cc: Marisol Garcia <(b) (6) frenchangel59.com>, (b) (6)
<(b) (6)
pcommgroup.com>
Subject: DRAFT: VA COMMUNICATIONS TASK FORCE
Dr. Shulkin:
It was a privilege to speak last week. Per our conversation, please see a DRAFT
list of proposed names to target for the Communications Committee- whose
responsibility it will be to identify near term and intermediate VA
Communications goals, specific near term opportunities and evaluate, and if
necessary staff and resource.
of 2P1 Century
Please note, the only name we approached was (b) (6)
Fox, who is committed to the idea and involvement and shared that her
leadership team (the Murdoch(s)) consider the VA a priority focus.
We look forward to discussing next steps and defer to Ike on positioning and
final thoughts.
VA-19-0799-D-001396
OS 00003067
Best
7
- Paul
397
Message
From:
Sent:
To:
CC:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
3/30/2017 5:19:45 PM
Vivieca Simpson [(b) (6)
gmail.com]
(b) (6)
[(b) (6)
gmail.com]
Fwd: DRAFT: VA COMMUNICATIONS TASK FORCE
VA Comms Committee Draft 1 3.28.17.docx; Untitled attachment 06181.htm
We need to discuss somewhat urgently
Sent from my iPhone
Begin forwarded message:
From: David shulkin
Date: March 28, 2017 at 3:13:49 PM CDT
To: Vivieca Wright Simpson
Subject: Fwd: DRAFT: VA COMMUNICATIONS TASK FORCE
Lets discuss
Sent from my iPhone
Begin forwarded message:
<(b) (6)
pcommgroup.com >
Date: March 28, 2017 at 3:41:44 PM EDT
To: David shulkin , IP <(b) (6) frenchangel59.com >
Cc: Marisol Garcia <(b) (6) frenchangel59.com >, (b) (6)
<(b) (6)
pcommgroup.com >
From:
(b) (6)
Subject: DRAFT: VA COMMUNICATIONS TASK FORCE
Dr. Shulkin:
It was a privilege to speak last week. Per our conversation, please see a DRAFT
list of proposed names to target for the Communications Committee- whose
responsibility it will be to identify near term and intermediate VA
Communications goals, specific near term opportunities and evaluate, and if
necessary staff and resource.
Please note, the only name we approached was (b) (6)
of 21 st Century
Fox, who is committed to the idea and involvement and shared that her leadership
team (the Murdoch(s)) consider the VA a priority focus.
We look forward to discussing next steps and defer to Ike on positioning and final
thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001398
OS 00003069
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
(b) (6)
- Facebook, Inc.
Vice President- Communications and Public Policy at Facebook
Mr. (b) (6)
serves as Vice President of Global Communications, Marketing and Public Policy at Facebook,
is responsible for developing and coordinating key messages about products,
Inc. At Facebook, Mr. (b) (6)
corporate business and partnerships. He also oversees Facebook's public policy strategy worldwide. He served
as Strategic Advisor of luminate, Inc. He served as Vice President of Public Affairs and Global Communications at
Google Inc. since October 2005. He served as a Board Observer of luminate, Inc. He helped broaden and
coordinate Google's messaging from a focus on product PR to include all aspects of corporate, financial, policy,
philanthropic and internal communications. Prior to Google, he was the Bernard l. Schwarz Senior Fellow in
business and foreign policy at the New York-based Council on Foreign Relations. In his career, he served as
Senior Vice President of Global Affairs at Gap Inc. and an Adjunct Professor at Columbia University and Columbia
law School. He is a contributor to the Harvard Business Review and the Financial Times. Mr. (b) (6)
holds a
bachelor's degree from Harvard University, a master's degree in public policy from the Kennedy School of
Government and a J.D. from Harvard law School. He studied at Ecole Normale Superieure.
(b) (6)
- NH
Executive vice president of communications
(b) (6)
a former press secretary for President Bill Clinton, will join the NFL as the league's executive vice
joins the NFL from a Washington, D.C.-based communications and
president of communications. (b) (6)
government affairs firm he co-founded. He was Clinton's press secretary from 1998 to 2000 and an advisor and
press secretary to several presidential campaigns over two decades. Reports to NFL chief operating officer Tod
leiweke
(b) (6)
Apple
Vice president of Communications
(b) (6)
(b) (6)
is Apple's vice president of Communications, reporting to CEO (b) (6)
is responsible
for Apple's worldwide media relations and communications strategy, leading the public relations team as well as
employee communications and corporate events. He previously led Apple's corporate public relations team for
ten years. Before joining Apple in 2003, (b) (6)
worked as a broadcast journalist at CNBC, first as a writer and
producer in the network's Washington, D.C. bureau. He later established CNBC's Silicon Valley bureau and
holds a bachelor's degree in Political Science from
served as bureau chief. A native of Massachusetts, (b) (6)
the University of Minnesota
(b) (6)
- WME
Chief Communications Officer
(b) (6)
is chief communications officer for WME and IMG. In his position, (b) (6)
serves as the
companies' chief communications strategist, handling media relations, internal communication, advertising, and
events for all of WM E's divisions and offices. (b) (6)
also serves as an advisor to many of the agency's clients,
providing communication and marketing services to some of the world's leading artists and brands, including
Hasbro, Mark Wahlberg, M. Night Shyamalan, Usher and James Frey. As a specialist in entertainment trade and
has secured corporate and client profiles in such publications as the New York Times,
business press, (b) (6)
1
VA-19-0799-D-001399
OS 00003070
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
Wall Street Journal, Los Angeles Times, Fast Company, Forbes, Financial Times, Fortune, Vanity Fair, The
Hollywood Reporter and Variety. (b) (6)
also oversees WM E's philanthropic initiatives, including the launch
of an annual all-company volunteer day and the adoption of Foster Elementary School in Compton, California.
WME is helping transform the school's campus, resources and overall academic performance. Named to The
Hollywood Reporter's "Next Generation" list, which recognizes the top entertainment executives under 35,
(b) (6)
was previously the head of Corporate Communications for the William Morris Agency. At WMA, he
handled all corporate press for the agency, including coverage of its 2009 merger with Endeavor which resulted
worked in international
in the creation of WME. Prior to joining the William Morris Agency in 2004, (b) (6)
publicity and marketing at Warner Bros. Pictures, helping to launch campaigns for such films as "Harry Potter,"
"Matrix Reloaded," "Ocean's Eleven" and "Mystic River." (b) (6)
graduated from Boston University with a
Bachelor's Degree in International Relations.
(b) (6)
- AT&T
Senior Vice President, Corporate Communications
(b) (6)
senior vice president of corporate communication, oversees reputation management, media
relations, executive communications, financial communications, digital and social media and employee
communications for AT&T Inc. He has worked more than 30 years in corporate communications, most of it in the
telecommunications industry. (b) (6) provided strategic media relations and crisis communications counsel to
Fortune 100 clients while working as senior vice president and senior partner at Fleishman Hillard from 1996 to
2007. Before that, he spent five years leading media relations, marketing and advertising for the Oklahoma
Bankers Association. He holds a bachelor's degree in journalism and public relations from Oklahoma State
University
(b) (6)
- McDonalds Restaurants Ltd.
Senior Vice President, Chief Marketing Officer
In January 2014 (b) (6)
was promoted to Senior Vice President, Chief Marketing Officer, with responsibility for
McDonald's UK, Ireland, Norway, Denmark, Sweden and Finland. (b) (6)
also holds responsibility for the UK's
Business Strategy & Insight function. (b) (6)
joined McDonald's in 2007 and was promoted to Vice President,
Marketing in September 2010 with responsibility for Marketing and Food Development. Since joining the
Company, he has led his team and agency partners in the development of some of the highest performing
campaigns in McDonald's UK history, including its award-winning consumer trust and 'Favourites' advertising
campaigns. (b) (6)
has a strong pedigree in retail having started his career in Store Management for both Marks
went on to cover a variety of roles culminating in the
& Spencer and Debenhams. At Marks & Spencer (b) (6)
position of Corporate Marketing Planning Manager. He then moved to Blockbuster where he took up the role of
Marketing Director before starting up and establishing Blockbuster Online, as Managing Director.
(b) (6)
- Nike, Inc.
Chief Communications Officer
(b) (6)
was named Chief Communications Officer in June 2013. (b) (6)
joined Nike in 1999 as communications
director for the company's EMEA region. He was named head of US communications in 2002, global brand
communications director in September 2004, and vice president of global communications in November 2005.
2
VA-19-0799-D-001400
OS 00003071
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
(b) (6)
- Johnson & Johnson
Worldwide Vice President, Global Corporate Affairs & Chief Communication Officer
(b) (6)
is Worldwide Vice President, Global Corporate Affairs & Chief Communication Officer and a
member of the Corporation's Management Committee. In his role he leads the Corporation's global marketing,
communication, equity and philanthropy functions. He assumed his position in January 2012. Previous to this
role, Mr. (b) (6)
was a Company Group Chairman for Johnson & Johnson and a member of the Medical Devices &
Diagnostics Group Operating Committee, a role he assumed in January 2007. He had primary responsibility for
the global vision care franchise. (b) (6)
joined Johnson & Johnson in 1983 as a Marketing Assistant for Personal
Products Company. He held positions of increasing responsibility in the marketing organization. In 1991 Mr.
(b) (6)
moved to McNeil Consumer Products as a Group Product Director and was promoted to Vice President,
Worldwide Consumer Pharmaceuticals in 1995 to lead the company's growth in the Asia Pacific, Eastern
relocated to Europe as Managing Director, McNeil
European and Latin American regions. In 1998 (b) (6)
Consumer Nutritionals Europe. He returned to the U.S. as President, McNeil Nutritionals Worldwide, in 2000. In
2002 he was named Global President, Personal Products Company. (b) (6)
was promoted to Company Group
Chairman and a member of the Consumer and Personal Care Group Operating Committee in 2004, with North
American responsibility for the Personal Products Company, Johnson & Johnson Sales and logistics Company
and Johnson & Johnson Consumer Canada. In his role he also had North American responsibility for the IT,
Finance and HR organizations within the Consumer & Personal Care group. (b) (6)
is a member of the board of
trustees at Macalester College and a member of the Executive Committee of the Board of Directors of Family
Service Association. He also serves on the Executive Committee of the Ad Council. He holds a Master's degree in
business administration from the Tuck School of Business at Dartmouth College and a Bachelor of Arts' degree,
cum laude, from Macalester College.
(b) (6)
- American Express Company
Executive Vice President, Corporate Affairs & Communications
(b) (6)
is Executive Vice President, Corporate Affairs & Communications, American Express
Company. He is a member of the Company's Operating Committee, with responsibility for Public and
Shareholder Communications, International Government Affairs, Corporate Social Responsibility and Public
Policy. Mr. (b) (6)
joined American Express in 1991 from Shearson Lehman Brothers Inc., where he had been
Senior Vice President, Corporate Affairs and Communications. Prior to joining the securities industry in 1987,
is a director and former
Mr. (b) (6)
worked for Manufacturers Hanover Trust Company in New York. Mr. (b) (6)
Chairman of the Public Relations Seminar. He has also served as Chairman of The Wisemen, an organization of
senior public relations executives founded in New York in 1938. Mr. (b) (6)
is a former director of Kids in a Drug
Free Society and a 2005 David Rockefeller Fellow. A graduate of the State University of New York at Buffalo, Mr.
(b) (6)
is married and resides in New York City.
(b) (6)
- 21 st Century Fox
Executive Vice President and Chief Communications Officer for 21st Century Fox
(b) (6)
is the Executive Vice President and Chief Communications Officer for 21st Century Fox. In this
role, Ms. (b) (6)
serves as the chief spokesperson for the Company, leading all global communications
initiatives, specifically in support of corporate financial matters, mergers and acquisitions, regulatory issues and
3
VA-19-0799-D-001401
OS 00003072
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
litigation. She is also responsible for leading the Company's efforts to build and manage the 21st Century Fox
corporate brand among key audiences worldwide. She has served as Chief Communications Officer since
January 2012. Prior to her current post, Ms. (b) (6)
was the Company's Senior Vice President of
Communications and Corporate Strategy. In addition to her communications responsibilities, she was called
upon to develop company-wide marketing and distribution strategies designed to drive greater value from the
Company's deep portfolio of media and publishing assets. Previously, Ms. (b) (6)
served as the Company's
Senior Vice President Corporate Communications and Public Affairs, focusing on its West Coast businesses. She
first joined the Company as Senior Vice President of Corporate Communications for Fox Interactive Media (FIM)
was a Senior Vice President at MPRM Public
and MySpace. Before joining the Company, Ms. (b) (6)
Relations from 1994 to 2006. At MPRM, she ran the digital practice, working with companies at the intersection
of media and technology. Ms. (b) (6)
resides in Los Angeles with her husband and two children.
(b) (6)
- Walt Disney Company
Executive Vice President and Chief Communications Officer
(b) (6)
is responsible for global communications for The Walt Disney Company, including acting
as chief spokesperson and overseeing communication strategy and media relations for the company, its
various business segments and its philanthropic and environmental initiatives. Her role also includes
oversight of internal communications, the Walt Disney Archives and D23.
Since 2002, Ms. (b) (6)
has led the communications and positioning strategy for all of Disney's strategic
business initiatives including the acquisitions of Pixar, Marvel and Lucasfilm; the Company's leadership
in leveraging digital technology to connect consumers to creative content in new and exciting ways; and
its expansion and growth in international such as the landmark opening of Disney's first theme park and
resort in Mainland China, Shanghai Disney Resort.
Under her direction, Disney launched D23, the first-ever official Disney fan club, with members in all
50 states and 35 countries. Since its 2009 debut, D23 has delighted Disney fans with experiences such as
the bi-annual D23 Expo: The Ultimate Disney Fan Event, year-round member-only insider access
events, and the award-winning quarterly magazine, Disney Twenty-three.
Ms. (b) (6)
originally joined the Company in 2001, as senior vice president, Communications, for the
ABC Broadcast Group and the ABC Television Network. In this role, she oversaw the communication
strategy and implementation of all external and internal communications. She also had oversight of
public service campaigns, audience information, internal publication and the ABC Foundation.
Prior to joining The Walt Disney Company, Ms. (b) (6)
served as director of communications and
senior policy advisor to New York State Governor George Pataki. In these roles, she counseled him on a
broad range of public policy and other issues and successfully positioned him for re-election, earning a
national reputation for her communication strategy and political expertise in the process. The New York
Times described her role as expanded beyond communications, "to include virtually every major
decision made by the Governor."
Ms. (b) (6)
previously served as communications director for United States Senator Alfonse D' Amato,
managing his successful re-election campaigns in 1986 and 1992. She originally joined Senator
D' Amata's team in 1982 as a press representative.
In 2012 Ms. (b) (6)
received the prestigious Matrix Award from New York Women in Communications,
Inc. She has also been named one of the 100 Most Important In-House Communicators in the World by
The Holmes Report, PR Week's Top 50 Industry Elite and was recognized on PR Week's Power List for
2014.
4
VA-19-0799-D-001402
OS 00003073
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
3/29/2017 12:45:36 AM
(b) (6)
va.gov
Fwd: DRAFT: VA COMMUNICATIONS TASK FORCE
VA Comms Committee Draft 1 3.28.17.docx; Untitled attachment 06186.htm
Please print
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
pcommgroup.com >
Date: March 28, 2017 at 3:41:44 PM EDT
To: David shulkin , IP <(b) (6) frenchangel59 .com >
Cc: Marisol Garcia <(b) (6) frenchangel59.com >, (b) (6)
<(b) (6)
pcommgroup.com >
Subject: DRAFT: VA COMMUNICATIONS TASK FORCE
Dr. Shulkin:
It was a privilege to speak last week. Per our conversation, please see a DRAFT list of proposed
names to target for the Communications Committee- whose responsibility it will be to identify
near term and intermediate VA Communications goals, specific near term opportunities and
evaluate, and if necessary staff and resource.
Please note, the only name we approached was (b) (6)
of 21 st Century Fox, who is
committed to the idea and involvement and shared that her leadership team (the Murdoch(s))
consider the VA a priority focus.
We look forward to discussing next steps and defer to Ike on positioning and final thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001404
OS 00003075
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
(b) (6)
- Facebook, Inc.
Vice President- Communications and Public Policy at Facebook
Mr. (b) (6)
serves as Vice President of Global Communications, Marketing and Public Policy at Facebook,
is responsible for developing and coordinating key messages about products,
Inc. At Facebook, Mr. (b) (6)
corporate business and partnerships. He also oversees Facebook's public policy strategy worldwide. He served
as Strategic Advisor of luminate, Inc. He served as Vice President of Public Affairs and Global Communications at
Google Inc. since October 2005. He served as a Board Observer of luminate, Inc. He helped broaden and
coordinate Google's messaging from a focus on product PR to include all aspects of corporate, financial, policy,
philanthropic and internal communications. Prior to Google, he was the Bernard l. Schwarz Senior Fellow in
business and foreign policy at the New York-based Council on Foreign Relations. In his career, he served as
Senior Vice President of Global Affairs at Gap Inc. and an Adjunct Professor at Columbia University and Columbia
law School. He is a contributor to the Harvard Business Review and the Financial Times. Mr. (b) (6)
holds a
bachelor's degree from Harvard University, a master's degree in public policy from the Kennedy School of
Government and a J.D. from Harvard law School. He studied at Ecole Normale Superieure.
(b) (6)
- NH
Executive vice president of communications
(b) (6)
a former press secretary for President Bill Clinton, will join the NFL as the league's executive vice
joins the NFL from a Washington, D.C.-based communications and
president of communications. (b) (6)
government affairs firm he co-founded. He was Clinton's press secretary from 1998 to 2000 and an advisor and
press secretary to several presidential campaigns over two decades. Reports to NFL chief operating officer Tod
leiweke
(b) (6)
Apple
Vice president of Communications
(b) (6)
(b) (6)
is Apple's vice president of Communications, reporting to CEO (b) (6)
is responsible
for Apple's worldwide media relations and communications strategy, leading the public relations team as well as
employee communications and corporate events. He previously led Apple's corporate public relations team for
ten years. Before joining Apple in 2003, (b) (6)
worked as a broadcast journalist at CNBC, first as a writer and
producer in the network's Washington, D.C. bureau. He later established CNBC's Silicon Valley bureau and
holds a bachelor's degree in Political Science from
served as bureau chief. A native of Massachusetts, (b) (6)
the University of Minnesota
(b) (6)
- WME
Chief Communications Officer
(b) (6)
is chief communications officer for WME and IMG. In his position, (b) (6)
serves as the
companies' chief communications strategist, handling media relations, internal communication, advertising, and
events for all of WM E's divisions and offices. (b) (6)
also serves as an advisor to many of the agency's clients,
providing communication and marketing services to some of the world's leading artists and brands, including
Hasbro, (b) (6) Wahlberg, M. Night Shyamalan, Usher and James Frey. As a specialist in entertainment trade and
has secured corporate and client profiles in such publications as the New York Times,
business press, (b) (6)
1
VA-19-0799-D-001405
OS 00003076
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
Wall Street Journal, Los Angeles Times, Fast Company, Forbes, Financial Times, Fortune, Vanity Fair, The
Hollywood Reporter and Variety. (b) (6)
also oversees WM E's philanthropic initiatives, including the launch
of an annual all-company volunteer day and the adoption of Foster Elementary School in Compton, California.
WME is helping transform the school's campus, resources and overall academic performance. Named to The
Hollywood Reporter's "Next Generation" list, which recognizes the top entertainment executives under 35,
(b) (6)
was previously the head of Corporate Communications for the William Morris Agency. At WMA, he
handled all corporate press for the agency, including coverage of its 2009 merger with Endeavor which resulted
worked in international
in the creation of WME. Prior to joining the William Morris Agency in 2004, (b) (6)
publicity and marketing at Warner Bros. Pictures, helping to launch campaigns for such films as "Harry Potter,"
"Matrix Reloaded," "Ocean's Eleven" and "Mystic River." (b) (6)
graduated from Boston University with a
Bachelor's Degree in International Relations.
(b) (6)
- AT&T
Senior Vice President, Corporate Communications
(b) (6)
senior vice president of corporate communication, oversees reputation management, media
relations, executive communications, financial communications, digital and social media and employee
communications for AT&T Inc. He has worked more than 30 years in corporate communications, most of it in the
telecommunications industry. (b) (6) provided strategic media relations and crisis communications counsel to
Fortune 100 clients while working as senior vice president and senior partner at Fleishman Hillard from 1996 to
2007. Before that, he spent five years leading media relations, marketing and advertising for the Oklahoma
Bankers Association. He holds a bachelor's degree in journalism and public relations from Oklahoma State
University
(b) (6)
- McDonalds Restaurants Ltd.
Senior Vice President, Chief Marketing Officer
In January 2014 (b) (6)
was promoted to Senior Vice President, Chief Marketing Officer, with responsibility for
McDonald's UK, Ireland, Norway, Denmark, Sweden and Finland. (b) (6)
also holds responsibility for the UK's
Business Strategy & Insight function. (b) (6)
joined McDonald's in 2007 and was promoted to Vice President,
Marketing in September 2010 with responsibility for Marketing and Food Development. Since joining the
Company, he has led his team and agency partners in the development of some of the highest performing
campaigns in McDonald's UK history, including its award-winning consumer trust and 'Favourites' advertising
campaigns. (b) (6)
has a strong pedigree in retail having started his career in Store Management for both Marks
(b) (6)
went on to cover a variety of roles culminating in the
& (b) (6)
and Debenhams. At Marks & (b) (6)
position of Corporate Marketing Planning Manager. He then moved to Blockbuster where he took up the role of
Marketing Director before starting up and establishing Blockbuster Online, as Managing Director.
(b) (6)
- Nike, Inc.
Chief Communications Officer
(b) (6)
was named Chief Communications Officer in June 2013. (b) (6)
joined Nike in 1999 as communications
director for the company's EMEA region. He was named head of US communications in 2002, global brand
communications director in September 2004, and vice president of global communications in November 2005.
2
VA-19-0799-D-001406
OS 00003077
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
(b) (6)
- Johnson & Johnson
Worldwide Vice President, Global Corporate Affairs & Chief Communication Officer
(b) (6)
is Worldwide Vice President, Global Corporate Affairs & Chief Communication Officer and a
member of the Corporation's Management Committee. In his role he leads the Corporation's global marketing,
communication, equity and philanthropy functions. He assumed his position in January 2012. Previous to this
role, Mr. (b) (6)
was a Company Group Chairman for Johnson & Johnson and a member of the Medical Devices &
Diagnostics Group Operating Committee, a role he assumed in January 2007. He had primary responsibility for
the global vision care franchise. (b) (6)
joined Johnson & Johnson in 1983 as a Marketing Assistant for Personal
Products Company. He held positions of increasing responsibility in the marketing organization. In 1991 Mr.
(b) (6)
moved to McNeil Consumer Products as a Group Product Director and was promoted to Vice President,
Worldwide Consumer Pharmaceuticals in 1995 to lead the company's growth in the Asia Pacific, Eastern
relocated to Europe as Managing Director, McNeil
European and Latin American regions. In 1998 (b) (6)
Consumer Nutritionals Europe. He returned to the U.S. as President, McNeil Nutritionals Worldwide, in 2000. In
2002 he was named Global President, Personal Products Company. (b) (6)
was promoted to Company Group
Chairman and a member of the Consumer and Personal Care Group Operating Committee in 2004, with North
American responsibility for the Personal Products Company, Johnson & Johnson Sales and logistics Company
and Johnson & Johnson Consumer Canada. In his role he also had North American responsibility for the IT,
Finance and HR organizations within the Consumer & Personal Care group. (b) (6)
is a member of the board of
trustees at Macalester College and a member of the Executive Committee of the Board of Directors of Family
Service Association. He also serves on the Executive Committee of the Ad Council. He holds a Master's degree in
business administration from the Tuck School of Business at Dartmouth College and a Bachelor of Arts' degree,
cum laude, from Macalester College.
(b) (6)
- American Express Company
Executive Vice President, Corporate Affairs & Communications
(b) (6)
is Executive Vice President, Corporate Affairs & Communications, American Express
Company. He is a member of the Company's Operating Committee, with responsibility for Public and
Shareholder Communications, International Government Affairs, Corporate Social Responsibility and Public
Policy. Mr. (b) (6)
joined American Express in 1991 from Shearson Lehman Brothers Inc., where he had been
Senior Vice President, Corporate Affairs and Communications. Prior to joining the securities industry in 1987,
is a director and former
Mr. (b) (6)
worked for Manufacturers Hanover Trust Company in New York. Mr. (b) (6)
Chairman of the Public Relations Seminar. He has also served as Chairman of The Wisemen, an organization of
senior public relations executives founded in New York in 1938. Mr. (b) (6)
is a former director of Kids in a Drug
Free Society and a 2005 David Rockefeller Fellow. A graduate of the State University of New York at Buffalo, Mr.
(b) (6)
is married and resides in New York City.
(b) (6)
- 21 st Century Fox
Executive Vice President and Chief Communications Officer for 21st Century Fox
(b) (6)
is the Executive Vice President and Chief Communications Officer for 21st Century Fox. In this
role, Ms. (b) (6)
serves as the chief spokesperson for the Company, leading all global communications
initiatives, specifically in support of corporate financial matters, mergers and acquisitions, regulatory issues and
3
VA-19-0799-D-001407
OS 00003078
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
litigation. She is also responsible for leading the Company's efforts to build and manage the 21st Century Fox
corporate brand among key audiences worldwide. She has served as Chief Communications Officer since
January 2012. Prior to her current post, Ms. (b) (6)
was the Company's Senior Vice President of
Communications and Corporate Strategy. In addition to her communications responsibilities, she was called
upon to develop company-wide marketing and distribution strategies designed to drive greater value from the
Company's deep portfolio of media and publishing assets. Previously, Ms. (b) (6)
served as the Company's
Senior Vice President Corporate Communications and Public Affairs, focusing on its West Coast businesses. She
first joined the Company as Senior Vice President of Corporate Communications for Fox Interactive Media (FIM)
was a Senior Vice President at MPRM Public
and MySpace. Before joining the Company, Ms. (b) (6)
Relations from 1994 to 2006. At MPRM, she ran the digital practice, working with companies at the intersection
of media and technology. Ms. (b) (6)
resides in Los Angeles with her husband and two children.
(b) (6)
- Walt Disney Company
Executive Vice President and Chief Communications Officer
(b) (6)
is responsible for global communications for The Walt Disney Company, including acting
as chief spokesperson and overseeing communication strategy and media relations for the company, its
various business segments and its philanthropic and environmental initiatives. Her role also includes
oversight of internal communications, the Walt Disney Archives and D23.
Since 2002, Ms. (b) (6)
has led the communications and positioning strategy for all of Disney's strategic
business initiatives including the acquisitions of Pixar, Marvel and Lucasfilm; the Company's leadership
in leveraging digital technology to connect consumers to creative content in new and exciting ways; and
its expansion and growth in international such as the landmark opening of Disney's first theme park and
resort in Mainland China, Shanghai Disney Resort.
Under her direction, Disney launched D23, the first-ever official Disney fan club, with members in all
50 states and 35 countries. Since its 2009 debut, D23 has delighted Disney fans with experiences such as
the bi-annual D23 Expo: The Ultimate Disney Fan Event, year-round member-only insider access
events, and the award-winning quarterly magazine, Disney Twenty-three.
Ms. (b) (6)
originally joined the Company in 2001, as senior vice president, Communications, for the
ABC Broadcast Group and the ABC Television Network. In this role, she oversaw the communication
strategy and implementation of all external and internal communications. She also had oversight of
public service campaigns, audience information, internal publication and the ABC Foundation.
Prior to joining The Walt Disney Company, Ms. (b) (6)
served as director of communications and
senior policy advisor to New York State Governor George Pataki. In these roles, she counseled him on a
broad range of public policy and other issues and successfully positioned him for re-election, earning a
national reputation for her communication strategy and political expertise in the process. The New York
Times described her role as expanded beyond communications, "to include virtually every major
decision made by the Governor."
Ms. (b) (6)
previously served as communications director for United States Senator Alfonse D' Amato,
managing his successful re-election campaigns in 1986 and 1992. She originally joined Senator
D' Amata's team in 1982 as a press representative.
In 2012 Ms. (b) (6)
received the prestigious Matrix Award from New York Women in Communications,
Inc. She has also been named one of the 100 Most Important In-House Communicators in the World by
The Holmes Report, PR Week's Top 50 Industry Elite and was recognized on PR Week's Power List for
2014.
4
VA-19-0799-D-001408
OS 00003079
Message
CC:
David shulkin [Drshulkin@aol.com]
3/28/2017 8:14:16 PM
(b) (6)
[(b) (6)
pcommgroup.com]
(b)
(6)
IP [
frenchangel59.com]; Marisol Garcia [(b) (6) frenchangel59.com]; (b) (6)
Subject:
Re: DRAFT: VA COMMUNICATIONS TASK FORCE
From:
Sent:
To:
Thanks so much (b) (6)
[(b) (6)
pcommgroup.com]
and Paul
Ill be in touch soon
Sent from my iPhone
On Mar 28, 2017, at 3:41 PM, (b) (6)
<(b) (6)
pcommgroup.com > wrote:
Dr. Shulkin:
It was a privilege to speak last week. Per our conversation, please see a DRAFT list of proposed
names to target for the Communications Committee- whose responsibility it will be to identify
near term and intermediate VA Communications goals, specific near term opportunities and
evaluate, and if necessary staff and resource.
Please note, the only name we approached was (b) (6)
of 21 st Century Fox, who is
committed to the idea and involvement and shared that her leadership team (the Murdoch(s))
consider the VA a priority focus.
We look forward to discussing next steps and defer to Ike on positioning and final thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001410
OS 00003081
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
3/28/2017 8:13:49 PM
Vivieca Wright Simpson [vivieca.Wright@va.gov]
Fwd: DRAFT: VA COMMUNICATIONS TASK FORCE
VA Comms Committee Draft 1 3.28.17.docx; Untitled attachment 06193.htm
Lets discuss
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
pcommgroup.com >
Date: March 28, 2017 at 3:41:44 PM EDT
To: David shulkin , IP <(b) (6) frenchangel59 .com >
Cc: Marisol Garcia <(b) (6) frenchangel59.com >, (b) (6)
<(b) (6)
pcommgroup.com >
Subject: DRAFT: VA COMMUNICATIONS TASK FORCE
Dr. Shulkin:
It was a privilege to speak last week. Per our conversation, please see a DRAFT list of proposed
names to target for the Communications Committee- whose responsibility it will be to identify
near term and intermediate VA Communications goals, specific near term opportunities and
evaluate, and if necessary staff and resource.
Please note, the only name we approached was (b) (6)
of 21 st Century Fox, who is
committed to the idea and involvement and shared that her leadership team (the Murdoch(s))
consider the VA a priority focus.
We look forward to discussing next steps and defer to Ike on positioning and final thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001411
OS 00003082
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
(b) (6)
- Facebook, Inc.
Vice President- Communications and Public Policy at Facebook
Mr. (b) (6)
serves as Vice President of Global Communications, Marketing and Public Policy at Facebook,
is responsible for developing and coordinating key messages about products,
Inc. At Facebook, Mr. (b) (6)
corporate business and partnerships. He also oversees Facebook's public policy strategy worldwide. He served
as Strategic Advisor of luminate, Inc. He served as Vice President of Public Affairs and Global Communications at
Google Inc. since October 2005. He served as a Board Observer of luminate, Inc. He helped broaden and
coordinate Google's messaging from a focus on product PR to include all aspects of corporate, financial, policy,
philanthropic and internal communications. Prior to Google, he was the Bernard l. Schwarz Senior Fellow in
business and foreign policy at the New York-based Council on Foreign Relations. In his career, he served as
Senior Vice President of Global Affairs at Gap Inc. and an Adjunct Professor at Columbia University and Columbia
law School. He is a contributor to the Harvard Business Review and the Financial Times. Mr. (b) (6)
holds a
bachelor's degree from Harvard University, a master's degree in public policy from the Kennedy School of
Government and a J.D. from Harvard law School. He studied at Ecole Normale Superieure.
(b) (6)
- NH
Executive vice president of communications
(b) (6)
a former press secretary for President Bill Clinton, will join the NFL as the league's executive vice
joins the NFL from a Washington, D.C.-based communications and
president of communications. (b) (6)
government affairs firm he co-founded. He was Clinton's press secretary from 1998 to 2000 and an advisor and
press secretary to several presidential campaigns over two decades. Reports to NFL chief operating officer Tod
leiweke
(b) (6)
Apple
Vice president of Communications
(b) (6)
(b) (6)
is Apple's vice president of Communications, reporting to CEO (b) (6)
is responsible
for Apple's worldwide media relations and communications strategy, leading the public relations team as well as
employee communications and corporate events. He previously led Apple's corporate public relations team for
ten years. Before joining Apple in 2003, (b) (6)
worked as a broadcast journalist at CNBC, first as a writer and
producer in the network's Washington, D.C. bureau. He later established CNBC's Silicon Valley bureau and
holds a bachelor's degree in Political Science from
served as bureau chief. A native of Massachusetts, (b) (6)
the University of Minnesota
(b) (6)
- WME
Chief Communications Officer
(b) (6)
is chief communications officer for WME and IMG. In his position, (b) (6)
serves as the
companies' chief communications strategist, handling media relations, internal communication, advertising, and
events for all of WM E's divisions and offices. (b) (6)
also serves as an advisor to many of the agency's clients,
providing communication and marketing services to some of the world's leading artists and brands, including
Hasbro, (b) (6) Wahlberg, M. Night Shyamalan, Usher and James Frey. As a specialist in entertainment trade and
has secured corporate and client profiles in such publications as the New York Times,
business press, (b) (6)
1
VA-19-0799-D-001412
OS 00003083
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
Wall Street Journal, Los Angeles Times, Fast Company, Forbes, Financial Times, Fortune, Vanity Fair, The
Hollywood Reporter and Variety. (b) (6)
also oversees WM E's philanthropic initiatives, including the launch
of an annual all-company volunteer day and the adoption of Foster Elementary School in Compton, California.
WME is helping transform the school's campus, resources and overall academic performance. Named to The
Hollywood Reporter's "Next Generation" list, which recognizes the top entertainment executives under 35,
(b) (6)
was previously the head of Corporate Communications for the William Morris Agency. At WMA, he
handled all corporate press for the agency, including coverage of its 2009 merger with Endeavor which resulted
worked in international
in the creation of WME. Prior to joining the William Morris Agency in 2004, (b) (6)
publicity and marketing at Warner Bros. Pictures, helping to launch campaigns for such films as "Harry Potter,"
"Matrix Reloaded," "Ocean's Eleven" and "Mystic River." (b) (6)
graduated from Boston University with a
Bachelor's Degree in International Relations.
(b) (6)
- AT&T
Senior Vice President, Corporate Communications
(b) (6)
senior vice president of corporate communication, oversees reputation management, media
relations, executive communications, financial communications, digital and social media and employee
communications for AT&T Inc. He has worked more than 30 years in corporate communications, most of it in the
telecommunications industry. (b) (6) provided strategic media relations and crisis communications counsel to
Fortune 100 clients while working as senior vice president and senior partner at Fleishman Hillard from 1996 to
2007. Before that, he spent five years leading media relations, marketing and advertising for the Oklahoma
Bankers Association. He holds a bachelor's degree in journalism and public relations from Oklahoma State
University
(b) (6)
- McDonalds Restaurants Ltd.
Senior Vice President, Chief Marketing Officer
In January 2014 (b) (6)
was promoted to Senior Vice President, Chief Marketing Officer, with responsibility for
McDonald's UK, Ireland, Norway, Denmark, Sweden and Finland. (b) (6)
also holds responsibility for the UK's
Business Strategy & Insight function. (b) (6)
joined McDonald's in 2007 and was promoted to Vice President,
Marketing in September 2010 with responsibility for Marketing and Food Development. Since joining the
Company, he has led his team and agency partners in the development of some of the highest performing
campaigns in McDonald's UK history, including its award-winning consumer trust and 'Favourites' advertising
campaigns. (b) (6)
has a strong pedigree in retail having started his career in Store Management for both Marks
(b) (6)
went on to cover a variety of roles culminating in the
& (b) (6)
and Debenhams. At Marks & (b) (6)
position of Corporate Marketing Planning Manager. He then moved to Blockbuster where he took up the role of
Marketing Director before starting up and establishing Blockbuster Online, as Managing Director.
(b) (6)
- Nike, Inc.
Chief Communications Officer
(b) (6)
was named Chief Communications Officer in June 2013. (b) (6)
joined Nike in 1999 as communications
director for the company's EMEA region. He was named head of US communications in 2002, global brand
communications director in September 2004, and vice president of global communications in November 2005.
2
VA-19-0799-D-001413
OS 00003084
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
(b) (6)
- Johnson & Johnson
Worldwide Vice President, Global Corporate Affairs & Chief Communication Officer
(b) (6)
is Worldwide Vice President, Global Corporate Affairs & Chief Communication Officer and a
member of the Corporation's Management Committee. In his role he leads the Corporation's global marketing,
communication, equity and philanthropy functions. He assumed his position in January 2012. Previous to this
role, Mr. (b) (6)
was a Company Group Chairman for Johnson & Johnson and a member of the Medical Devices &
Diagnostics Group Operating Committee, a role he assumed in January 2007. He had primary responsibility for
the global vision care franchise. (b) (6)
joined Johnson & Johnson in 1983 as a Marketing Assistant for Personal
Products Company. He held positions of increasing responsibility in the marketing organization. In 1991 Mr.
(b) (6)
moved to McNeil Consumer Products as a Group Product Director and was promoted to Vice President,
Worldwide Consumer Pharmaceuticals in 1995 to lead the company's growth in the Asia Pacific, Eastern
relocated to Europe as Managing Director, McNeil
European and Latin American regions. In 1998 (b) (6)
Consumer Nutritionals Europe. He returned to the U.S. as President, McNeil Nutritionals Worldwide, in 2000. In
2002 he was named Global President, Personal Products Company. (b) (6)
was promoted to Company Group
Chairman and a member of the Consumer and Personal Care Group Operating Committee in 2004, with North
American responsibility for the Personal Products Company, Johnson & Johnson Sales and logistics Company
and Johnson & Johnson Consumer Canada. In his role he also had North American responsibility for the IT,
Finance and HR organizations within the Consumer & Personal Care group. (b) (6)
is a member of the board of
trustees at Macalester College and a member of the Executive Committee of the Board of Directors of Family
Service Association. He also serves on the Executive Committee of the Ad Council. He holds a Master's degree in
business administration from the Tuck School of Business at Dartmouth College and a Bachelor of Arts' degree,
cum laude, from Macalester College.
(b) (6)
- American Express Company
Executive Vice President, Corporate Affairs & Communications
(b) (6)
is Executive Vice President, Corporate Affairs & Communications, American Express
Company. He is a member of the Company's Operating Committee, with responsibility for Public and
Shareholder Communications, International Government Affairs, Corporate Social Responsibility and Public
Policy. Mr. (b) (6)
joined American Express in 1991 from Shearson Lehman Brothers Inc., where he had been
Senior Vice President, Corporate Affairs and Communications. Prior to joining the securities industry in 1987,
is a director and former
Mr. (b) (6)
worked for Manufacturers Hanover Trust Company in New York. Mr. (b) (6)
Chairman of the Public Relations Seminar. He has also served as Chairman of The Wisemen, an organization of
senior public relations executives founded in New York in 1938. Mr. (b) (6)
is a former director of Kids in a Drug
Free Society and a 2005 David Rockefeller Fellow. A graduate of the State University of New York at Buffalo, Mr.
(b) (6)
is married and resides in New York City.
(b) (6)
- 21 st Century Fox
Executive Vice President and Chief Communications Officer for 21st Century Fox
(b) (6)
is the Executive Vice President and Chief Communications Officer for 21st Century Fox. In this
role, Ms. (b) (6)
serves as the chief spokesperson for the Company, leading all global communications
initiatives, specifically in support of corporate financial matters, mergers and acquisitions, regulatory issues and
3
VA-19-0799-D-001414
OS 00003085
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
litigation. She is also responsible for leading the Company's efforts to build and manage the 21st Century Fox
corporate brand among key audiences worldwide. She has served as Chief Communications Officer since
January 2012. Prior to her current post, Ms. (b) (6)
was the Company's Senior Vice President of
Communications and Corporate Strategy. In addition to her communications responsibilities, she was called
upon to develop company-wide marketing and distribution strategies designed to drive greater value from the
Company's deep portfolio of media and publishing assets. Previously, Ms. (b) (6)
served as the Company's
Senior Vice President Corporate Communications and Public Affairs, focusing on its West Coast businesses. She
first joined the Company as Senior Vice President of Corporate Communications for Fox Interactive Media (FIM)
was a Senior Vice President at MPRM Public
and MySpace. Before joining the Company, Ms. (b) (6)
Relations from 1994 to 2006. At MPRM, she ran the digital practice, working with companies at the intersection
of media and technology. Ms. (b) (6)
resides in Los Angeles with her husband and two children.
(b) (6)
- Walt Disney Company
Executive Vice President and Chief Communications Officer
(b) (6)
is responsible for global communications for The Walt Disney Company, including acting
as chief spokesperson and overseeing communication strategy and media relations for the company, its
various business segments and its philanthropic and environmental initiatives. Her role also includes
oversight of internal communications, the Walt Disney Archives and D23.
Since 2002, Ms. (b) (6)
has led the communications and positioning strategy for all of Disney's strategic
business initiatives including the acquisitions of Pixar, Marvel and Lucasfilm; the Company's leadership
in leveraging digital technology to connect consumers to creative content in new and exciting ways; and
its expansion and growth in international such as the landmark opening of Disney's first theme park and
resort in Mainland China, Shanghai Disney Resort.
Under her direction, Disney launched D23, the first-ever official Disney fan club, with members in all
50 states and 35 countries. Since its 2009 debut, D23 has delighted Disney fans with experiences such as
the bi-annual D23 Expo: The Ultimate Disney Fan Event, year-round member-only insider access
events, and the award-winning quarterly magazine, Disney Twenty-three.
Ms. (b) (6)
originally joined the Company in 2001, as senior vice president, Communications, for the
ABC Broadcast Group and the ABC Television Network. In this role, she oversaw the communication
strategy and implementation of all external and internal communications. She also had oversight of
public service campaigns, audience information, internal publication and the ABC Foundation.
Prior to joining The Walt Disney Company, Ms. (b) (6)
served as director of communications and
senior policy advisor to New York State Governor George Pataki. In these roles, she counseled him on a
broad range of public policy and other issues and successfully positioned him for re-election, earning a
national reputation for her communication strategy and political expertise in the process. The New York
Times described her role as expanded beyond communications, "to include virtually every major
decision made by the Governor."
Ms. (b) (6)
previously served as communications director for United States Senator Alfonse D' Amato,
managing his successful re-election campaigns in 1986 and 1992. She originally joined Senator
D' Amata's team in 1982 as a press representative.
In 2012 Ms. (b) (6)
received the prestigious Matrix Award from New York Women in Communications,
Inc. She has also been named one of the 100 Most Important In-House Communicators in the World by
The Holmes Report, PR Week's Top 50 Industry Elite and was recognized on PR Week's Power List for
2014.
4
VA-19-0799-D-001415
OS 00003086
Message
(b) (6)
From:
Sent:
To:
CC:
Subject:
Attachments:
[(b) (6)
pcommgroup.com]
3/28/2017 7:41:44 PM
David shulkin [Drshulkin@aol.com]; IP [(b) (6) frenchangel59.com]
Marisol Garcia [(b) (6) frenchangel59.com]; (b) (6)
[(b) (6) pcommgroup.com]
DRAFT: VA COMMUNICATIONS TASK FORCE
VA Comms Committee Draft 1 3.28.17.docx
Dr. Shulkin:
It was a privilege to speak last week. Per our conversation, please see a DRAFT list of proposed names to target
for the Communications Committee- whose responsibility it will be to identify near term and intermediate VA
Communications goals, specific near term opportunities and evaluate, and if necessary staff and resource.
Please note, the only name we approached was (b) (6)
of 21 st Century Fox, who is committed to the
idea and involvement and shared that her leadership team (the Murdoch(s)) consider the VA a priority focus.
We look forward to discussing next steps and defer to Ike on positioning and final thoughts.
Best,
(b) (6)
& Paul
VA-19-0799-D-001417
OS 00003088
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
(b) (6)
- Facebook, Inc.
Vice President- Communications and Public Policy at Facebook
Mr. (b) (6)
serves as Vice President of Global Communications, Marketing and Public Policy at Facebook,
is responsible for developing and coordinating key messages about products,
Inc. At Facebook, Mr. (b) (6)
corporate business and partnerships. He also oversees Facebook's public policy strategy worldwide. He served
as Strategic Advisor of luminate, Inc. He served as Vice President of Public Affairs and Global Communications at
Google Inc. since October 2005. He served as a Board Observer of luminate, Inc. He helped broaden and
coordinate Google's messaging from a focus on product PR to include all aspects of corporate, financial, policy,
philanthropic and internal communications. Prior to Google, he was the Bernard l. Schwarz Senior Fellow in
business and foreign policy at the New York-based Council on Foreign Relations. In his career, he served as
Senior Vice President of Global Affairs at Gap Inc. and an Adjunct Professor at Columbia University and Columbia
law School. He is a contributor to the Harvard Business Review and the Financial Times. Mr. (b) (6)
holds a
bachelor's degree from Harvard University, a master's degree in public policy from the Kennedy School of
Government and a J.D. from Harvard law School. He studied at Ecole Normale Superieure.
(b) (6)
- NH
Executive vice president of communications
(b) (6)
a former press secretary for President Bill Clinton, will join the NFL as the league's executive vice
joins the NFL from a Washington, D.C.-based communications and
president of communications. (b) (6)
government affairs firm he co-founded. He was Clinton's press secretary from 1998 to 2000 and an advisor and
press secretary to several presidential campaigns over two decades. Reports to NFL chief operating officer Tod
leiweke
(b) (6)
Apple
Vice president of Communications
(b) (6)
(b) (6)
is Apple's vice president of Communications, reporting to CEO (b) (6)
is responsible
for Apple's worldwide media relations and communications strategy, leading the public relations team as well as
employee communications and corporate events. He previously led Apple's corporate public relations team for
ten years. Before joining Apple in 2003, (b) (6)
worked as a broadcast journalist at CNBC, first as a writer and
producer in the network's Washington, D.C. bureau. He later established CNBC's Silicon Valley bureau and
holds a bachelor's degree in Political Science from
served as bureau chief. A native of Massachusetts, (b) (6)
the University of Minnesota
(b) (6)
- WME
Chief Communications Officer
(b) (6)
is chief communications officer for WME and IMG. In his position, (b) (6)
serves as the
companies' chief communications strategist, handling media relations, internal communication, advertising, and
events for all of WM E's divisions and offices. (b) (6)
also serves as an advisor to many of the agency's clients,
providing communication and marketing services to some of the world's leading artists and brands, including
Hasbro, (b) (6) Wahlberg, M. Night Shyamalan, Usher and James Frey. As a specialist in entertainment trade and
has secured corporate and client profiles in such publications as the New York Times,
business press, (b) (6)
1
VA-19-0799-D-001418
OS 00003089
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
Wall Street Journal, Los Angeles Times, Fast Company, Forbes, Financial Times, Fortune, Vanity Fair, The
Hollywood Reporter and Variety. (b) (6)
also oversees WM E's philanthropic initiatives, including the launch
of an annual all-company volunteer day and the adoption of Foster Elementary School in Compton, California.
WME is helping transform the school's campus, resources and overall academic performance. Named to The
Hollywood Reporter's "Next Generation" list, which recognizes the top entertainment executives under 35,
(b) (6)
was previously the head of Corporate Communications for the William Morris Agency. At WMA, he
handled all corporate press for the agency, including coverage of its 2009 merger with Endeavor which resulted
worked in international
in the creation of WME. Prior to joining the William Morris Agency in 2004, (b) (6)
publicity and marketing at Warner Bros. Pictures, helping to launch campaigns for such films as "Harry Potter,"
"Matrix Reloaded," "Ocean's Eleven" and "Mystic River." (b) (6)
graduated from Boston University with a
Bachelor's Degree in International Relations.
(b) (6)
- AT&T
Senior Vice President, Corporate Communications
(b) (6)
senior vice president of corporate communication, oversees reputation management, media
relations, executive communications, financial communications, digital and social media and employee
communications for AT&T Inc. He has worked more than 30 years in corporate communications, most of it in the
telecommunications industry. (b) (6) provided strategic media relations and crisis communications counsel to
Fortune 100 clients while working as senior vice president and senior partner at Fleishman Hillard from 1996 to
2007. Before that, he spent five years leading media relations, marketing and advertising for the Oklahoma
Bankers Association. He holds a bachelor's degree in journalism and public relations from Oklahoma State
University
(b) (6)
- McDonalds Restaurants Ltd.
Senior Vice President, Chief Marketing Officer
In January 2014 (b) (6)
was promoted to Senior Vice President, Chief Marketing Officer, with responsibility for
McDonald's UK, Ireland, Norway, Denmark, Sweden and Finland. (b) (6)
also holds responsibility for the UK's
Business Strategy & Insight function. (b) (6)
joined McDonald's in 2007 and was promoted to Vice President,
Marketing in September 2010 with responsibility for Marketing and Food Development. Since joining the
Company, he has led his team and agency partners in the development of some of the highest performing
campaigns in McDonald's UK history, including its award-winning consumer trust and 'Favourites' advertising
campaigns. (b) (6)
has a strong pedigree in retail having started his career in Store Management for both Marks
(b) (6)
went on to cover a variety of roles culminating in the
& (b) (6)
and Debenhams. At Marks & (b) (6)
position of Corporate Marketing Planning Manager. He then moved to Blockbuster where he took up the role of
Marketing Director before starting up and establishing Blockbuster Online, as Managing Director.
(b) (6)
- Nike, Inc.
Chief Communications Officer
(b) (6)
was named Chief Communications Officer in June 2013. (b) (6)
joined Nike in 1999 as communications
director for the company's EMEA region. He was named head of US communications in 2002, global brand
communications director in September 2004, and vice president of global communications in November 2005.
2
VA-19-0799-D-001419
OS 00003090
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
(b) (6)
- Johnson & Johnson
Worldwide Vice President, Global Corporate Affairs & Chief Communication Officer
(b) (6)
is Worldwide Vice President, Global Corporate Affairs & Chief Communication Officer and a
member of the Corporation's Management Committee. In his role he leads the Corporation's global marketing,
communication, equity and philanthropy functions. He assumed his position in January 2012. Previous to this
role, Mr. (b) (6)
was a Company Group Chairman for Johnson & Johnson and a member of the Medical Devices &
Diagnostics Group Operating Committee, a role he assumed in January 2007. He had primary responsibility for
the global vision care franchise. (b) (6)
joined Johnson & Johnson in 1983 as a Marketing Assistant for Personal
Products Company. He held positions of increasing responsibility in the marketing organization. In 1991 Mr.
(b) (6)
moved to McNeil Consumer Products as a Group Product Director and was promoted to Vice President,
Worldwide Consumer Pharmaceuticals in 1995 to lead the company's growth in the Asia Pacific, Eastern
relocated to Europe as Managing Director, McNeil
European and Latin American regions. In 1998 (b) (6)
Consumer Nutritionals Europe. He returned to the U.S. as President, McNeil Nutritionals Worldwide, in 2000. In
2002 he was named Global President, Personal Products Company. (b) (6)
was promoted to Company Group
Chairman and a member of the Consumer and Personal Care Group Operating Committee in 2004, with North
American responsibility for the Personal Products Company, Johnson & Johnson Sales and logistics Company
and Johnson & Johnson Consumer Canada. In his role he also had North American responsibility for the IT,
Finance and HR organizations within the Consumer & Personal Care group. (b) (6)
is a member of the board of
trustees at Macalester College and a member of the Executive Committee of the Board of Directors of Family
Service Association. He also serves on the Executive Committee of the Ad Council. He holds a Master's degree in
business administration from the Tuck School of Business at Dartmouth College and a Bachelor of Arts' degree,
cum laude, from Macalester College.
(b) (6)
- American Express Company
Executive Vice President, Corporate Affairs & Communications
(b) (6)
is Executive Vice President, Corporate Affairs & Communications, American Express
Company. He is a member of the Company's Operating Committee, with responsibility for Public and
Shareholder Communications, International Government Affairs, Corporate Social Responsibility and Public
Policy. Mr. (b) (6)
joined American Express in 1991 from Shearson Lehman Brothers Inc., where he had been
Senior Vice President, Corporate Affairs and Communications. Prior to joining the securities industry in 1987,
is a director and former
Mr. (b) (6)
worked for Manufacturers Hanover Trust Company in New York. Mr. (b) (6)
Chairman of the Public Relations Seminar. He has also served as Chairman of The Wisemen, an organization of
senior public relations executives founded in New York in 1938. Mr. (b) (6)
is a former director of Kids in a Drug
Free Society and a 2005 David Rockefeller Fellow. A graduate of the State University of New York at Buffalo, Mr.
(b) (6)
is married and resides in New York City.
(b) (6)
- 21 st Century Fox
Executive Vice President and Chief Communications Officer for 21st Century Fox
(b) (6)
is the Executive Vice President and Chief Communications Officer for 21st Century Fox. In this
role, Ms. (b) (6)
serves as the chief spokesperson for the Company, leading all global communications
initiatives, specifically in support of corporate financial matters, mergers and acquisitions, regulatory issues and
3
VA-19-0799-D-001420
OS 00003091
VETERANS AFFAIRS: DRAFT COMMUNICATIONS COMMITTEE TARGETS
PRESENTED BY: (b) (6)
OF PRINCIPAL COMMUNICATIONS GROUP
DATE: 3/28/17
litigation. She is also responsible for leading the Company's efforts to build and manage the 21st Century Fox
corporate brand among key audiences worldwide. She has served as Chief Communications Officer since
January 2012. Prior to her current post, Ms. (b) (6)
was the Company's Senior Vice President of
Communications and Corporate Strategy. In addition to her communications responsibilities, she was called
upon to develop company-wide marketing and distribution strategies designed to drive greater value from the
Company's deep portfolio of media and publishing assets. Previously, Ms. (b) (6)
served as the Company's
Senior Vice President Corporate Communications and Public Affairs, focusing on its West Coast businesses. She
first joined the Company as Senior Vice President of Corporate Communications for Fox Interactive Media (FIM)
was a Senior Vice President at MPRM Public
and MySpace. Before joining the Company, Ms. (b) (6)
Relations from 1994 to 2006. At MPRM, she ran the digital practice, working with companies at the intersection
of media and technology. Ms. (b) (6)
resides in Los Angeles with her husband and two children.
(b) (6)
- Walt Disney Company
Executive Vice President and Chief Communications Officer
(b) (6)
is responsible for global communications for The Walt Disney Company, including acting
as chief spokesperson and overseeing communication strategy and media relations for the company, its
various business segments and its philanthropic and environmental initiatives. Her role also includes
oversight of internal communications, the Walt Disney Archives and D23.
Since 2002, Ms. (b) (6)
has led the communications and positioning strategy for all of Disney's strategic
business initiatives including the acquisitions of Pixar, Marvel and Lucasfilm; the Company's leadership
in leveraging digital technology to connect consumers to creative content in new and exciting ways; and
its expansion and growth in international such as the landmark opening of Disney's first theme park and
resort in Mainland China, Shanghai Disney Resort.
Under her direction, Disney launched D23, the first-ever official Disney fan club, with members in all
50 states and 35 countries. Since its 2009 debut, D23 has delighted Disney fans with experiences such as
the bi-annual D23 Expo: The Ultimate Disney Fan Event, year-round member-only insider access
events, and the award-winning quarterly magazine, Disney Twenty-three.
Ms. (b) (6)
originally joined the Company in 2001, as senior vice president, Communications, for the
ABC Broadcast Group and the ABC Television Network. In this role, she oversaw the communication
strategy and implementation of all external and internal communications. She also had oversight of
public service campaigns, audience information, internal publication and the ABC Foundation.
Prior to joining The Walt Disney Company, Ms. (b) (6)
served as director of communications and
senior policy advisor to New York State Governor George Pataki. In these roles, she counseled him on a
broad range of public policy and other issues and successfully positioned him for re-election, earning a
national reputation for her communication strategy and political expertise in the process. The New York
Times described her role as expanded beyond communications, "to include virtually every major
decision made by the Governor."
Ms. (b) (6)
previously served as communications director for United States Senator Alfonse D' Amato,
managing his successful re-election campaigns in 1986 and 1992. She originally joined Senator
D' Amata's team in 1982 as a press representative.
In 2012 Ms. (b) (6)
received the prestigious Matrix Award from New York Women in Communications,
Inc. She has also been named one of the 100 Most Important In-House Communicators in the World by
The Holmes Report, PR Week's Top 50 Industry Elite and was recognized on PR Week's Power List for
2014.
4
VA-19-0799-D-001421
OS 00003092
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
3/31/2017 10:39:22 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Take care
No finger pointing but people simply atnt listening and continuing old patterns
Sent from my iPhone
> on Mar 31, 2017, at 5:23 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> I agree that this is something you have to be involved in with me. The field is now feeling the urgency
and welcome the ability for definitive action thanks to your strong messaging, but they need support in
their actions at the VA level since all of this gets stalled by the legal and statutory interpretation
amongst other things David, as leaders we have to stay calm and give them the support they need. This is
a culture change and doesn't happen with just showing frustration. We need to also give them the tools
for execution and free them of the shackles. It's a system change, even though I know how impatient we
are. And that's why you have this job- remember what everyone says including POTUS- it's the hardest job
in the USA. The message today is that given the current environment, how do we take the risk and bring
about change in accountability. How can we make today different from the past? No finger pointing when
you have the discussion today please- it will only make things difficult. Just a collaborative discussion
that will result in fast and urgent sustainable change
>
> Sent from my iPhone
>
>> on Mar 31, 2017, at 2:09 AM, David shulkin wrote:
>>
>> The accountability stuff is out of control and killing vha
>>
>> Remember how everyone laughed when fox asked me about employees watching porn
>>
>> And we actually allow this?
>>
>> This was easy - employee should have been fired on the spot- instead we detailed them to A desk job
and then pay them to do nothing
>>
>> Then i read that ridiculous email from skye that says because it was regular porn and not child porn
we have to wait weeks
>>
>>
>>
>> By the way the shrevsport director is still our employee and has nit been fired and you should hear
about how bad he is
>>
>> This is easy- really easy - and it just takes leadership to say that this stops here
>>
>> I will handle this
>>
>> Sent from my iPhone
>>
>>> on Mar 30, 2017, at 7:56 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>>>
>>> Anything else brewing besides these accountability issues? Getting a little worried about things
there now- and you. Take care of yourself- I will stay connected
>>>
>>> Sent from my iPhone
>>
VA-19-0799-D-001422
OS 00003093
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
3/31/2017 9:23:36 AM
David shulkin [Drshulkin@aol.com]
Re: Take care
I agree that this is something you have to be involved in with me. The field is now feeling the urgency
and welcome the ability for definitive action thanks to your strong messaging, but they need support in
their actions at the VA level since all of this gets stalled by the legal and statutory interpretation
amongst other things David, as leaders we have to stay calm and give them the support they need. This is
a culture change and doesn't happen with just showing frustration. We need to also give them the tools
for execution and free them of the shackles. It's a system change, even though I know how impatient we
are. And that's why you have this job- remember what everyone says including POTUS- it's the hardest job
in the USA. The message today is that given the current environment, how do we take the risk and bring
about change in accountability. How can we make today different from the past? No finger pointing when
you have the discussion today please- it will only make things difficult. Just a collaborative discussion
that will result in fast and urgent sustainable change
Sent from my iPhone
> on Mar 31, 2017, at 2:09 AM, David shulkin wrote:
>
> The accountability stuff is out of control and killing
vha
>
> Remember how everyone laughed when fox asked me about employees watching porn
>
> And we actually allow this?
>
> This was easy - employee should have been fired on the spot- instead we detailed them to A desk job and
then pay them to do nothing
>
> Then i read that ridiculous email from skye that says because it was regular porn and not child porn we
have to wait weeks
>
>
>
> By the way the shrevsport director is still our employee and has nit been fired and you should hear
about how bad he is
>
> This is easy-
really easy - and it just takes leadership to say that this stops here
>
> I will handle this
>
> Sent from my iPhone
>
>> on Mar 30, 2017, at 7:56 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>>
>> Anything else brewing besides these accountability issues? Getting a little worried about things there
now- and you. Take care of yourself- I will stay connected
>>
>> Sent from my iPhone
>
VA-19-0799-D-001423
OS 00003094
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
3/31/2017 12:59:02 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Take care
The accountability stuff is out of control and killing
vha
Remember how everyone laughed when fox asked me about employees watching porn
And we actually allow this?
This was easy - employee should have been fired on the spot- instead we detailed them to A desk job and
then pay them to do nothing
Then i read that ridiculous email from skye that says because it was regular porn and not child porn we
have to wait weeks
By the way the shrevsport director is still our employee and has nit been fired and you should hear about
how bad he is
This is easy-
really easy - and it just takes leadership to say that this stops here
I will handle this
Sent from my iPhone
> on Mar 30, 2017, at 7:56 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Anything else brewing besides these accountability issues? Getting a little worried about things there
now- and you. Take care of yourself- I will stay connected
>
> Sent from my iPhone
VA-19-0799-D-001424
OS 00003095
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
3/30/2017 11:56:22 PM
David Shulkin [drshulkin@aol.com]
Take care
Anything else brewing besides these accountability issues? Getting a little worried about things there
now- and you. Take care of yourself- I will stay connected
Sent from my iPhone
VA-19-0799-D-001425
OS 00003096
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/3/2017 1:52:14 AM
To:
(b) (6)
Did we send
(b) (6)
[(b) (6)
gmail.com]
the last eo thst was not cut off
Sent from my iPhone
VA-19-0799-D-001426
OS 00003097
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
3/29/2017 9:51:19 AM
Bruce Moskowitz [(b) (6)
mac.com]
David Shulkin [drshulkin@aol.com]
Re: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
Thanks that is great to hear and will be a part of our communications strategy
From: Bruce Moskowitz <(b) (6)
mac.com>
Sent: Wednesday, March 29, 2017 5:42 AM
To: Poonam Alaigh
Cc: David Shulkin
Subject: Re: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
All are enthusiastically standing behind this important initiative
Sent from my iPad
Bruce Moskowitz M.D.
hotmail.com> wrote:
> On Mar 28, 2017, at 10:23 PM, Poonam Alaigh <(b) (6)
>
>Bruce-any feedback from the Big Five? Would want to also see if they can send out a public statement after the launch on 4/12
>
> Sent from my iPhone
>
>> On Mar 25, 2017, at 12:49 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>>
>> Please see attached power point for our discussion tomorrow - thanks
>>
>>
>> - - - - - - - - - - - - - >> From: Bruce Moskowitz <(b) (6)
rnac.com>
>> Sent: Saturday, March 25, 2017 8:52 AM
>> To: Poonam Alaigh
>> Cc: David Shulkin
>> Subject: Re: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
>>
>> Ok
>>
>> Sent from my iPhone
>>
>> On Mar 25, 2017, at 8:46 AM, Poonam Alaigh <(b) (6)
>>
hotmail.com> wrote:
>>
>> Bruce and David- confirming our conference call tomorrow at 11am. I will dial both of you in at that time.
>>
>>
>> David, will you please send the slides to both of all of us- if you dont have them, I will try to get them today.
>>
>>
VA-19-0799-D-001427
OS 00003098
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
3/29/2017 2:23:52 AM
Bruce Moskowitz [(b) (6)
mac.com]
David Shulkin [drshulkin@aol.com]
Re: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
Bruce- any feedback from the Big Five? Would want to also see if they can send out a public statement
after the launch on 4/12
Sent from my iPhone
> on Mar 25, 2017, at 12:49 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
> Please see attached power point for our discussion tomorrow - thanks
>
>
>
>
>
>
>
>
From: Bruce Moskowitz <(b) (6)
mac.com>
Sent: Saturday, March 25, 2017 8:52 AM
To: Poonam Alaigh
cc: David shulkin
subject: Re: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
>
> Ok
>
> Sent from my iPhone
>
> on Mar 25, 2017, at 8:46 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
>
> Bruce and David- confirming our conference call tomorrow at 11am. I will dial both of you in at that
time.
>
>
> David, will you please send the slides to both of all of us- if you dont have them, I will try to get
them today.
>
>
VA-19-0799-D-001428
OS 00003099
Message
From:
Sent:
To:
Subject:
Attachments:
Poonam Alaigh [(b) (6)
hotmail.com]
3/26/2017 3:00:45 PM
David Shulkin [drshulkin@aol.com]
Fw: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
Access and Quality Metric Screenshots.pptx
From: Poonam Alaigh <(b) (6)
hotmail.com>
Sent: Saturday, March 25, 2017 12:49 PM
To: Bruce Moskowitz
Cc: David Shulkin
Subject: Re: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
Please see attached power point for our discussion tomorrow - thanks
From: Bruce Moskowitz <(b) (6)
Sent: Saturday, March 25, 2017 8:52 AM
mac.com>
To: Poonam Alaigh
Cc: David Shulkin
Subject: Re: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
Ok
Sent from my iPhone
On Mar 25, 2017, at 8:46 AM, Poonam Alaigh <(b) (6)
hotmail.com > wrote:
Bruce and David- confirming our conference call tomorrow at 11am. I will dial both of you in at
that time.
David, will you please send the slides to both of all of us- if you dont have them, I will try to get
them today.
VA-19-0799-D-001429
OS 00003100
How quickly does my VA see
patients?
How satisfied are veterans like
me with the timeliness of their
care?
How well does my VA's care
compare to other hospitals?
VA Pre-Decisional
VA-19-0799-D-001430
OS 00003101
Home > Healthcare ) Access
How quickly does my local VA see patients?
Click below to see how we do.
My Local Care Times
Same-Day Service Options
How qu1ckty can my VA hospital see
Does my VA hospita l or clinic have
memc lmJC?
same-day services?
How is the VA doing overall?
National Care Times
How timely 1s VA care right now?
Access to Specialty Care
How quickly are patients seeing a
specialist for care needed right away?
VA Pre-Decisional
VA-19-0799-D-001431
OS 00003102
Wait Times for Appointments at VA Facilities
Location (zip, city/state, fu ll address)
Appointment Type
Radius
50N6
Establistlecl Visit
SPECIALTY CARE
AUDIOLOGY
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OPTOMETRY
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search
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MENTAL HEALTH
OPHTHALMOLOGY
Note- Your personal waibng time may differ-these wait bmes reflect A
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VA-19-0799-D-001432
OS 00003103
Same Day Services in VA for Primary Care and Mental Health
Location (zip, city/state-, full 3ddress)
R3dius
501-iEJ
Sort Results By
I 1o(R)t.1i1a-
-
Search
More search
Back to US Map
Same Day Services report as of 3/21/2017 using filters: 50 mile radius of 'Richmond'
SAME DAY SERVICES IN PRIMARY CARE AND MENTAL HEALTH DEFINITION: \o\lhen you contact us we will either address your need that day or schedule appropnate follow up care, depending on
the urgency We may address your health care need by PfOVld1ng a face to face v1s1t retummg a phone call arranging a telehea!th or video care visit, responding by secure email or scheduhng a future
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VA Pre-Decisional
VA-19-0799-D-001433
OS 00003104
Home > Healthcare , Access , National Care Times
How timely is VA care right now?
Note: Data updated 3/1/17
Veterans currently have 8.02 mill ion appointments scheduled
9-1% (7.5 million) are
scheduled to be seen no lat
than 30 days after the
6% (484,603) are
scheduled to be seen 30 days
or greater after the requested
requested date fPatient Indicated Datel.
~
< 1% (of total scheduled) are
considered 'priority'*.
o How is this figure calculated? ..
VA Pre-Decisional
VA-19-0799-D-001434
OS 00003105
Home , Healthcare
i
Access , Access to Specialty Care
Access to Specialty Care
Note: Data updated 311117
How q uickly are patients seeing a specialist fo r care needed right away7
Veterans currently have 32 549 referra ls to a special ist for care needed right away.
I
l
93% (30 4151 are
99% (31.190) are addressed
within 30 days
add ressed within 7days
What do we mean by "care needed right away"" or "referrals needed right away''?
VA Pre-Decisional
VA-19-0799-D-001435
OS 00003106
What Veterans Say About Access to Care at VA facilities
Loc3tion (zip, city/st.1te, fu ll 3ddress)
r~
Appointment "fYpe
Radius
l
X
sort Results By
Facility Name
Primary Care (Routine)
50 Miles
Searc h
E3ack lo US Map
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - < Found facilities will be ordered according to your
Percent of Veterans who reported that they were Always or Usually able to get an appointment when needed . The choice here
7/1/2016 - 12/31 /2016. At least 30 Veterans have responded to this question for a site to be included . The filters used W!miffirnlW.Wll!Trnfflllff"llT'_ _ _T"'
'BAY PINES', Primary Care (Routine)
Note - Tne data shows what Veterans have said aoout tnelr own Access experiences over the preceding 6 months Your own experience may t>e different For urgent problems there onen are
options to t>e seen sooner, such as a same...e longer than 30 days, you may request a referral to care in ttle community.
o N o
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able to gel an appombnenl when needed fOf 'Pnrnary Care
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VA Pre-Decisional
VA-19-0799-D-001436
OS 00003107
Home , Healthcare , Health Care Quality Information and Resources
How well does my VA perform compared to
other hospitals?
How well does my VA medical
center compare to surrounding
hospitals?
How well does my VA medical center
compare against other clinics that can
treat me as an outpatient?
[COMING SOON]
We are posting this data here lemporarily until
Medicare uploads our submitted data into "Hospital Compare"
VA Pre-Decisional
VA-19-0799-D-001437
OS 00003108
Horne ) Healthcare > Hospital Compa re Data
Hospital Compare Data
Select your hospital from the list below to compare.
More hospitals COMI NG SOON
(402) Togus VA Medical Center (NEW)
(402) Togus VA Medical Center
(501) VA New Mexico Healthcare System
(508) Decatur (Atlanta) VA Medical Center
(528) Upstate New York VA Healthcare System
(537) Jesse Brown VA Medical Center - VA Chicago Healthcare
(573A4) VA North Florida and South Georg ia Healthcare System
(578) Hines VA Medical Center
(580) Housto n VA Medical Center
VA Pre-Decisional
VA-19-0799-D-001438
OS 00003109
Hospital Compare Data
x
"!B lonvert ..- ~ ~elect
A wound that splits open Accidental cuts and tears
after surgery on the
from medica l treatment
abdomen or pelvis
Blood stream infection
after surgery
Broken hip from a fall after
surgery
Collapsed lung due to
medical treatment
Deaths among
with serious
compl1catio
surge
Data date range (Preferred direction)
7113 6115
I
--
1113 6115
I
mi
--
6115
I
1In 6115
I
1113 6115
I
1113 611
National Average
2.32
1.43
10.21
0.06
0.41
136.48
National Median
21
1.4
9.3
0.1
0.4
1l5.6
Portland {HRR) Average
2.4
2.2
0.1
0.5
m .2
Pon.land (HRR) Median
2.2
1.6
8.7
9.6
0.1
0.4
137.3
National Top 10 Percent
1.98
0.92
8.00
0.06
0.32
114.)5
National Top 25 Percent
2.13
1.14
9.04
0.06
O.JG
124.46
(402) Togus VA Medtcal Center
BRIDGTON HOSPITAL
4.52
1.67
6.41
0.00
0.00
Not Available
Not Avail.able
Not Available
Nol Available
Not Available
0.00
NotAvaila
CENTRAL MAINE MEDICAL CENTER
197
239
9 93
0 06
035
14561
FRANKIJ N MEMORIAL HOSPITAL
2.26
1.34
9.76
0.06
0.39
NotAvaila
FRISBIE MEMORIAL HOSPITAL
2.19
1.48
9.45
0.06
0.36
NotAvail a
INLAND HOSPITAL
227
138
9 72
0 06
039
Not Availa
MAINE MEDICAL CENTER
278
333
7 30
0 06
064
12989
MAINEGENERAL MEDICAL CENTER
2.06
1.60
8.75
0.06
0.42
Not Available
Not Available
Not Available
Not Available
Not Available
MERCY HOSPITAL
212
207
9 64
0 06
0 33
121 38
MID COAST HOSPITAL
2.21
1.18
Not Available
0.06
0.40
Not Availa
MEMOR W. HOSPITAL. THE
PENOBSCOT BAY MEDICAL CENTER
RUMFORD HOSPITAL
SOUTHERN MAINE HEALTH CARE
ST ANDREWS HOSPITAL
ST MARYS REGIONAL MEDICAL CENTER
125.1l
Not Availa
2.22
1.61
9.46
0.06
0.47
Not Availa
No1AvailablEUR
Not Available
Not Available
Not Available
Not Available
NotAvaila
261
1.62
927
0 06
033
Not Available
Not Available
Not Available
Not Available
Not Available
144-61
Not Availa
219
220
10 82
0 06
0.46
Not Available
Nol Avail.able
Not Available
Not Available
Not Available
WENTWORTH-OOUGLASS HOSPITAL
212
1.85
1031
0 06
0.46
14525
YORK HOSPITAL
217
1.04
8 76
0 06
039
14464
STEPHENS MEMORIAL HO SPITAL
12172
Not Availa
VA Pre-Decisional
VA-19-0799-D-001439
OS 00003110
Message
Poonam Alaigh [(b) (6)
hotmail.com]
3/25/2017 2:07:24 PM
David shulkin [Drshulkin@aol.com]
Re: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
From:
Sent:
To:
Subject:
I didnt get the slides
From: David shulkin
Sent: Saturday, March 25, 2017 10:00 AM
To: Poonam Alaigh
Cc: Bruce Moskowitz
Subject: Re: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
Confirmed
I sent slides
Sent from my iPhone
On Mar 25, 2017, at 8:46 AM, Poonam Alaigh <(b) (6)
hotmail.com > wrote:
Bruce and David- confirming our conference call tomorrow at 11am. I will dial both of you in at
that time.
David, will you please send the slides to both of all of us- if you dont have them, I will try to get
them today.
VA-19-0799-D-001440
OS 00003111
Message
David shulkin [Drshulkin@aol.com]
3/25/2017 2:00:05 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Bruce Moskowitz [(b) (6)
mac.com]
Re: Publicly Facing Transparency Website- Confirming call tomorrow at 11am
From:
Sent:
To:
CC:
Subject:
Confirmed
I sent slides
Sent from my iPhone
On Mar 25, 2017, at 8:46 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Bruce and David- confirming our conference call tomorrow at 11am. I will dial both of you in at
that time.
David, will you please send the slides to both of all of us- if you dont have them, I will try to get
them today.
VA-19-0799-D-001441
OS 00003112
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
3/25/2017 12:46:53 PM
Bruce Moskowitz [(b) (6)
mac.com]; David Shulkin [drshulkin@aol.com]
Publicly Facing Transparency Website- Confirming call tomorrow at 11am
Bruce and David- confirming our conference call tomorrow at 11am. I will dial both of you in at that time.
David, will you please send the slides to both of all of us- if you dont have them, I will try to get them today.
VA-19-0799-D-001442
OS 00003113
Message
From:
Sent:
To:
Subject:
Attachments:
David shulkin [Drshulkin@aol.com]
4/7/2017 11:22:24 PM
(b) (6)
R. (b) (6)
[(b) (6)
va.gov]
Fwd: Hopkins CIO
(b) (6)
pdf; Untitled attachment 06221.htm
Last one
Sent from my iPhone
Begin forwarded message:
From: Bruce Moskowitz <(b) (6)
Date: April 7, 2017 at 7: 19:34 PM EDT
To: drshulkin@aol .com
Subject: Hopkins CIO
mac.com>
He now is in a private venture excellent to include
VA-19-0799-D-001443
OS 00003114
(b) (6)
MSE, CIIP
(b)
(6)
@ jhmi .edu
(b) (6)
Glen Burnie, MD (b) (6)
(785) 218-(b) (6)
CURRENT WORK:
(b) (6)
August 2011 - present
o
o
(b) (6), (b) (2)
(b) (6), (b) (2)
0
(b) (6), (b) (2)
0
(b) (6)
January 2014 - present
(b) (6)
(b) (6)
September 2011 - present
(b) (6), (b) (2)
(b) (6), (b) (2)
December 2016 - present
(b) (6), (b) (2)
(b) (6), (b) (2)
July 2016 - present
(b) (6), (b) (2)
(b) (6), (b) (2)
June 2016 - present
(b) (6), (b) (2)
February 2016 - present
VA-19-0799-D-001444
OS 00003115
PAST WORK:
(b) (6), (b) (2)
o
July 20 l O - August 2011
(b) (6), (b) (2)
(b) (6), (b) (2)
o
(b) (6), (b) (2)
(b) (6), (b) (2)
o
o
o
o
(b) (6), (b) (2)
o
.
March 2007 - May 2008
(b) (6), (b) (2)
(b) (6), (b) (2)
o
September 2009 - May 20 l 0
August 2009 - May 20 l 0
June 2009 - September 2009
September 2009 - December 2009
s
(b) (6), (b) (2)
e
o
o
January 2008 - May 2008, January 2007 - May 2007
(b) (6), (b) (2)
(b) (6), (b) (2)
August 2004 - January 2005
January 2005 - May 2006
EDUCATION:
(b) (6), (b) (2)
SKILLS:
o
(b) (6), (b) (2)
o
o
o
o
o
o
o
VA-19-0799-D-001445
OS 00003116
l\1EMBERSHIPS:
o
(b) (6), (b) (2)
o
o
o
o
ACHIEVEMENTS:
(b) (6), (b) (2)
o
o
o
o
o
o
o
PUBLICATIONS:
Peer-Reviewed Publications:
(b) (6), (b) (2)
Abstracts:
(b) (6), (b) (2)
(b) (6)
VA-19-0799-D-001446
OS 00003117
Sent ?om my iPhone
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/7/2017 11:22:07 PM
To:
Bruce Moskowitz [(b) (6)
Re: Hopkins CIO
Subject:
mac.com]
Got it
Sent from my iPhone
> on Apr 7, 2017, at 7:19 PM, Bruce Moskowitz <(b) (6)
mac.com> wrote:
>
> He now is in a private venture excellent to include
>
> <(b) (6)
pdf>
>
>
>
> Sent from my iPhone
VA-19-0799-D-001448
OS 00003119
Message
From:
Bruce Moskowitz [(b) (6)
Sent:
To:
4/7/2017 11:19:34 PM
Subject:
Attachments:
mac.com]
drshulkin@aol.com
Hopkins CIO
(b) (6)
pdf; Untitled attachment 06227.txt
He now is in a private venture excellent to include
VA-19-0799-D-001449
OS 00003120
(b) (6), (b) (2)
MSE, CIIP
(b)
(6)
@ jhmi .edu
(b) (6),
(b) (2)
(6), (b)
Glen Burnie, MD (b)
(2)
(785) 218-(b) (6)
CURRENT WORK:
(b) (6), (b) (2)
August 2011 - present
0
(b) (6), (b) (2)
0
(b) (6), (b) (2)
January 2014 - present
(b) (6), (b) (2)
(b) (6), (b) (2)
September 2011 - present
(b) (6), (b) (2)
(b) (6), (b) (2)
(b) (6), (b) (2)
December 2016 - present
)
July 2016 - present
(b) (6), (b) (2)
(b) (6), (b) (2)
June 2016 - present
(b) (6), (b) (2)
February 2016 - present
VA-19-0799-D-001450
OS 00003121
PAST WORK:
(b) (6), (b) (2)
o
July 20 l O - August 2011
(b) (6), (b) (2)
o
o
o
o
(b) (6), (b) (2)
(b) (6), (b) (2)
o
September 2009 - May 20 l 0
August 2009 - May 20 l 0
June 2009 - September 2009
September 2009 - December 2009
March 2007 - May 2008
(b) (6), (b) (2)
January 2008 - May 2008, January 2007 - May 2007
o
(b) (6), (b) (2)
August 2004 - January 2005
January 2005 - May 2006
EDUCATION:
(b) (6), (b) (2)
SKILLS:
o
(b) (6), (b) (2)
o
o
o
o
o
o
o
VA-19-0799-D-001451
OS 00003122
l\1EMBERSHIPS:
o
(b) (6), (b) (2)
o
o
o
o
ACHIEVEMENTS:
o
o
(b) (6), (b) (2)
o
o
o
o
o
PUBLICATIONS:
Peer-Reviewed Publications:
(b) (6), (b) (2)
Abstracts:
(b) (6), (b) (2)
(b) (6)
VA-19-0799-D-001452
OS 00003123
Sent from my iPhone
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/9/2017 2:06:30 PM
To:
(b) (6)
Subject:
hotmail.com
Re: Tough to do on the phone But ..
your version is the final draft
-----Original Message----From: Poonam Alaigh <(b) (6)
hotmail.com>
To: David Shulkin
Sent: Sun, Apr 9, 2017 10:02 am
Subject: Re: Tough to do on the phone But..
K- send me a initial final version if you can and I will forward on for a quick turn around by mid week at the latest. Trying to
head home in the afternoon from the wedding stuff- if you can't get to coming up with a final draft, I will do it later. Also
have scheduled a conference call in prep of the website stuff at 2pm today with the team and will give you an update
accordingly
Sent from my iPhone
On Apr 9, 2017, at 9:36 AM, David Shulkin wrote:
If you think it might be helpful- yes
-----Original Message----From: Poonam Alaigh <(b) (6)
hotmail.com>
To: David shulkin
Sent: Sun, Apr 9, 2017 9:02 am
Subject: Re: Tough to do on the phone But..
Do you want me to have Kate and her consultants do a quick review before making it official - I think we
should
Sent from my iPhone
On Apr 8, 2017, at 7:02 PM, David shulkin wrote:
Good edits
Sent from my iPhone
On Apr 8, 2017, at 6:50 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Almost there- my edits in italics
Greater Choice for Veterans
-Redesign the 40/30 Rule
-Build a High Performing Integrated Network of Care
- Empower veterans through transparency of information
Modernize our System
-Infrastructure Improvements and Streamlining
-EMR Interoperability and IT Modernization
oFocus Resources More Efficiently
-strengthening of Foundational Services in VA
-VA/DOD/Community Coordination
VA-19-0799-D-001454
OS 00003125
-Deliver on Accountability and Effective Management
practices
Improve Timeliness of Services
- Wait times and Access to Care
- Decisions on Appeals
- Performance on Disability Claims
Suicide Prevention
Getting to Zero Suicides
Sent from my iPhone
On Apr 8, 2017, at 4:11 PM, David Shulkin wrote:
revised to 5
VA-19-0799-D-001455
OS 00003126
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/9/2017 2:02:46 PM
David Shulkin [drshulkin@aol.com]
Re: Tough to do on the phone But ..
K- send me a initial final version if you can and I will forward on for a quick turn around by mid week at the
latest. Trying to head home in the afternoon from the wedding stuff- if you can't get to coming up with a final
draft, I will do it later. Also have scheduled a conference call in prep of the website stuff at 2pm today with the
team and will give you an update accordingly
Sent from my iPhone
On Apr 9, 2017, at 9:36 AM, David Shulkin wrote:
If you think it might be helpful- yes
-----Original Message----From: Poonam Alaigh <(b) (6)
hotmail.com>
To: David shulkin
Sent: Sun, Apr 9, 2017 9:02 am
Subject: Re: Tough to do on the phone But..
Do you want me to have Kate and her consultants do a quick review before making it official - I think we
should
Sent from my iPhone
On Apr 8, 2017, at 7:02 PM, David shulkin wrote:
Good edits
Sent from my iPhone
On Apr 8, 2017, at 6:50 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Almost there- my edits in italics
Greater Choice for Veterans
-Redesign the 40/30 Rule
-Build a High Performing Integrated Network of Care
- Empower veterans through transparency of information
Modernize our System
-Infrastructure Improvements and Streamlining
-EMR Interoperability and IT Modernization
oFocus Resources More Efficiently
-strengthening of Foundational Services in VA
-VA/DOD/Community Coordination
-Deliver on Accountability and Effective Management
practices
Improve Timeliness of Services
- Wait times and Access to Care
- Decisions on Appeals
- Performance on Disability Claims
Suicide Prevention
Getting to Zero Suicides
VA-19-0799-D-001456
OS 00003127
Sent from my iPhone
On Apr 8, 2017, at 4:11 PM, David Shulkin wrote:
revised to 5
VA-19-0799-D-001457
OS 00003128
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/9/2017 1:36:29 PM
To:
(b) (6)
Subject:
hotmail.com
Re: Tough to do on the phone But ..
If you think it might be helpful- yes
-----Original Message----From: Poonam Alaigh <(b) (6)
hotmail.com>
To: David shulkin
Sent: Sun, Apr 9, 2017 9:02 am
Subject: Re: Tough to do on the phone But..
Do you want me to have Kate and her consultants do a quick review before making it official - I think we should
Sent from my iPhone
On Apr 8, 2017, at 7:02 PM, David shulkin wrote:
Good edits
Sent from my iPhone
On Apr 8, 2017, at 6:50 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Almost there- my edits in italics
Greater Choice for Veterans
-Redesign the 40/30 Rule
-Build a High Performing Integrated Network of Care
- Empower veterans through transparency of information
Modernize our System
-Infrastructure Improvements and Streamlining
-EMR Interoperability and IT Modernization
oFocus Resources More Efficiently
-strengthening of Foundational Services in VA
-VA/DOD/Community Coordination
-Deliver on Accountability and Effective Management practices
Improve Timeliness of Services
- Wait times and Access to Care
- Decisions on Appeals
- Performance on Disability Claims
Suicide Prevention
Getting to Zero Suicides
Sent from my iPhone
On Apr 8, 2017, at 4:11 PM, David Shulkin wrote:
revised to 5
VA-19-0799-D-001458
OS 00003129
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/9/2017 1:02:41 PM
David shulkin [Drshulkin@aol.com]
Re: Tough to do on the phone But ..
Do you want me to have Kate and her consultants do a quick review before making it official - I think we
should
Sent from my iPhone
On Apr 8, 2017, at 7:02 PM, David shulkin wrote:
Good edits
Sent from my iPhone
On Apr 8, 2017, at 6:50 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Almost there- my edits in italics
o
Greater Choice for Veterans
o
-Redesign the 40/30 Rule
o
-Build a High Performing Integrated Network of Care
- Empower veterans through transparency of information
Modernize our System
o
-Infrastructure Improvements and Streamlining
o
-EMR Interoperability and IT Modernization
oFocus Resources More Efficiently
o
-strengthening of Foundational Services in VA
o
-VA/DOD/Community Coordination
o
-Deliver on Accountability and Effective Management practices
Improve Timeliness of Services
- Wait times and Access to Care
- Decisions on Appeals
- Performance on Disability Claims
Suicide Prevention
Getting to Zero Suicides
Sent from my iPhone
On Apr 8, 2017, at 4: 11 PM, David Shulkin wrote:
revised to 5
VA-19-0799-D-001459
OS 00003130
Message
From:
(b) (6)
Sent:
4/8/2017 11:03:21 PM
David shulkin [Drshulkin@aol.com]
Re: Tough to do on the phone But ..
To:
Subject:
[(b) (6)
gmail.com]
Ok
On Sat, Apr 8, 2017 at 7:02 PM David shulkin wrote:
I like her edits - lets use these
Sent from my iPhone
Begin forwarded message:
From: Poonam Alaigh <(b) (6)
hotmail.com>
Date: April 8, 2017 at 6:50:56 PM EDT
To: David Shulkin
Subject: Tough to do on the phone But..
Almost there- my edits in italics
Greater Choice for Veterans
VA-19-0799-D-001460
OS 00003131
o
-Redesign the 40/30 Rule
o
-Build a
High Pe1forming Integrated Network of Care
o
- Empower veterans through
transparency of information
1\fodernize our System
o
-Infrastructure Improvements and
Streamlining
o
-El\fR Interoperability and
IT Modernization
VA-19-0799-D-001461
OS 00003132
oFocus Resources More Efficiently
o
-strengthening
of Foundational Services in VA
o
-VA/DOD/Community Coordination
o
-Deliver on Accountability and Effective Management practices
Improve Timeliness of Services
- Wait times and
Access to Care
- Decisions on Appeals
VA-19-0799-D-001462
OS 00003133
- Performance on Disability Claims
Suicide Prevention
Getting to Zero Suicides
Sent from my iPhone
On Apr 8, 2017, at 4: 11 PM, David Shulkin wrote:
revised to 5
VA-19-0799-D-001463
OS 00003134
Sent from Gmail Mobile
Message
David shulkin [Drshulkin@aol.com]
4/8/2017 11:02:32 PM
(b) (6)
[(b) (6)
Fwd: Tough to do on the phone But ..
From:
Sent:
To:
Subject:
gmail.com]
I like her edits - lets use these
Sent from my iPhone
Begin forwarded message:
From: Poonam Alaigh <(b) (6)
hotmail .com>
Date: April 8, 2017 at 6:50:56 PM EDT
To: David Shulkin
Subject: Tough to do on the phone But..
Almost there- my edits in italics
o
Greater Choice for Veterans
o
-Redesign the 40/30 Rule
o
-Build a High Performing Integrated Network of Care
- Empower veterans through transparency of information
Modernize our System
o
-Infrastructure Improvements and Streamlining
o
-EMR Interoperability and IT Modernization
oFocus Resources More Efficiently
o
-strengthening of Foundational Services in VA
o
-VA/DOD/Community Coordination
o
-Deliver on Accountability and Effective Management practices
Improve Timeliness of Services
- Wait times and Access to Care
- Decisions on Appeals
- Performance on Disability Claims
Suicide Prevention
Getting to Zero Suicides
Sent from my iPhone
On Apr 8, 2017, at 4: 11 PM, David Shulkin wrote:
revised to 5
VA-19-0799-D-001465
OS 00003136
Message
David shulkin [Drshulkin@aol.com]
4/8/2017 11:01:56 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Tough to do on the phone But ..
From:
Sent:
To:
Subject:
Good edits
Sent from my iPhone
On Apr 8, 2017, at 6:50 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Almost there- my edits in italics
o
Greater Choice for Veterans
o
-Redesign the 40/30 Rule
o
-Build a High Performing Integrated Network of Care
- Empower veterans through transparency of information
Modernize our System
o
-Infrastructure Improvements and Streamlining
o
-EMR Interoperability and IT Modernization
oFocus Resources More Efficiently
o
-strengthening of Foundational Services in VA
o
-VA/DOD/Community Coordination
o
-Deliver on Accountability and Effective Management practices
Improve Timeliness of Services
- Wait times and Access to Care
- Decisions on Appeals
- Performance on Disability Claims
Suicide Prevention
Getting to Zero Suicides
Sent from my iPhone
On Apr 8, 2017, at 4: 11 PM, David Shulkin wrote:
revised to 5
VA-19-0799-D-001466
OS 00003137
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/8/2017 10:50:56 PM
David Shulkin [drshulkin@aol.com]
Tough to do on the phone But ..
Almost there- my edits in italics
o
Greater Choice for Veterans
o
-Redesign the 40/30 Rule
o
-Build a High Performing Integrated Network of Care
- Empower veterans through transparency of information
Modernize our System
o
-Infrastructure Improvements and Streamlining
o
-EMR Interoperability and IT Modernization
oFocus Resources More Efficiently
o
-strengthening of Foundational Services in VA
o
-VA/DOD/Community Coordination
o
-Deliver on Accountability and Effective Management practices
Improve Timeliness of Services
- Wait times and Access to Care
- Decisions on Appeals
- Performance on Disability Claims
Suicide Prevention
Getting to Zero Suicides
Sent from my iPhone
On Apr 8, 2017, at 4: 11 PM, David Shulkin wrote:
revised to 5
VA-19-0799-D-001467
OS 00003138
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
3/31/2017 12:54:21 AM
Darin Selnick [(b) (6)
@gmail.com]
Re: Important Sen Lee Intel
Got it
Thats what I figured
Im speaking toLee tommorow
Sent from my iPhone
> on Mar 30, 2017, at 8:14 PM, Darin selnick <(b) (6)
@gmail.com> wrote:
>
> A friend of mine on the Hill talked to Sen Lee staff and just told me what the real problem is that is
causing the hold on the choice Act extension.
>
> He was told by Sen Lee staff that some VA career staff, a Sen Moran staffer and some Sen Isakson SVAC
staff are saying that choice 2.0 and all of the community care programs should have VA as primary payer.
>
> They also said that VA should not ever be the 2nd payer, including choice.2.0. what has Sen Lee and
staff concerned is that they were also told by this same Sen staff, that they want Section 2 in the bill
so that it will be a precedent and a way to have VA be primary payer for choice 2.0. Hearing that from
the other Sen staff plus hearing from some VA staff that VA should be primary payer with choice 2.0. is
why they have kept the hold on the legislation. They are very concerned and have mixed signals from VA.
>
> To release the hold Sen Lee wants reassurance from you on two things:
> 1. To hear directly from you that you will not have VA be the primary payer for choice 2.0.
> 2. For you to give him some written reassurances that VA will not be primary payer for choice 2.0.
>
> I now understand why Sen Lee and his staff changed their tune after what they heard from other Sen
Staff and VA staff.
>
> There is nothing we can do about Sen staff other than to educate them. I am very concerned that there
are VA staff still saying about primary payer what you told them not to say.
>
> We will never get choice 2.0 passed if we do not fix this.
>
> Darin
>
>
VA-19-0799-D-001468
OS 00003139
Message
From:
Darin Selnick [(b) (6)
Sent:
3/31/2017 12:14:05 AM
To:
David shulkin [Drshulkin@aol.com]
Important Sen Lee Intel
Subject:
@gmail.com]
A friend of mine on the Hill talked to Sen Lee staff and just told me what the real problem is that is causing the
hold on the Choice Act extension.
He was told by Sen Lee staff that some VA career staff, a Sen Moran staffer and some Sen Isakson SVAC
staff are saying that Choice 2.0 and all of the community care programs should have VA as primary payer.
They also said that VA should not ever be the 2nd payer, including Choice.2.0. What has Sen Lee and staff
concerned is that they were also told by this same Sen staff, that they want Section 2 in the bill so that it will be
a precedent and a way to have VA be primary payer for Choice 2.0. Hearing that from the other Sen staff plus
hearing from some VA staff that VA should be primary payer with Choice 2.0. is why they have kept the hold
on the legislation. They are very concerned and have mixed signals from VA.
To release the hold Sen Lee wants reassurance from you on two things:
1. To hear directly from you that you will not have VA be the primary payer for Choice 2.0.
2. For you to give him some written reassurances that VA will not be primary payer for Choice 2.0.
I now understand why Sen Lee and his staff changed their tune after what they heard from other Sen Staff and
VA staff
There is nothing we can do about Sen staff other than to educate them. I am very concerned that there are VA
staff still saying about primary payer what you told them not to say.
We will never get Choice 2.0 passed if we do not fix this.
Darin
VA-19-0799-D-001469
OS 00003140
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
4/5/2017 10:35:35 PM
To:
Ike Perlmutter [(b) (6) frenchangel59.com]
Great meeting today with Jared and the Department of Defense. Jared pushed hard and cut out what has
been probably decades of red tape and we got to "yes" on finally working with DoD on electronic records.
Its never been done before and if we can get this working it wi 77 be a game changer.
David
Sent from my iPhone
VA-19-0799-D-001470
OS 00003141
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/19/2017 10:25:27 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: No story now
3 am?
Sent from my iPhone
On Apr 19, 2017, at 3:01 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
You did it!!
Sent from my iPhone
On Apr 18, 2017, at 10:43 PM, David Shulkin wrote:
Between us
Sent from my iPad
Begin forwarded message:
From: Donovan Slack
Date: April 18, 2017 at 9:44:53 PM EDT
To: David Shulkin
Subject: No story now
I wanted, between us as always, to make sure not to leave you in
limbo. Given everything, I decided it's not fair to do a story right
now about what visn/vaco officials did or didn't do in three weeks
leading up to last weeks PR crisis.
I would normally tell someone else this, who could relay it to you
(ie: Linda), but honestly haven't found a person I feel comfortable
with yet in your new orbit.
I'm sure I will at some point but didn't want to leave u hanging in
the meantime.
VA-19-0799-D-001471
OS 00003142
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/19/2017 10:16:21 AM
David Shulkin [drshulkin@aol.com]
Re: No story now
Maybe (b) (6)
can also be the one who is on point for both you and I for these critical and high visibility
relationships- don't know that there is anyone else we can trust for these sensitive situations
Sent from my iPhone
On Apr 18, 2017, at 10:43 PM, David Shulkin wrote:
Between us
Sent from my iPad
Begin forwarded message:
From: Donovan Slack
Date: April 18, 2017 at 9:44:53 PM EDT
To: David Shulkin
Subject: No story now
I wanted, between us as always, to make sure not to leave you in limbo. Given
everything, I decided it's not fair to do a story right now about what visn/vaco
officials did or didn't do in three weeks leading up to last weeks PR crisis.
I would normally tell someone else this, who could relay it to you (ie: Linda), but
honestly haven't found a person I feel comfortable with yet in your new orbit.
I'm sure I will at some point but didn't want to leave u hanging in the meantime.
VA-19-0799-D-001472
OS 00003143
Message
Poonam Alaigh [(b) (6)
hotmail.com]
4/19/2017 7:01:22 AM
David Shulkin [drshulkin@aol.com]
Re: No story now
From:
Sent:
To:
Subject:
You did it!!
Sent from my iPhone
On Apr 18, 2017, at 10:43 PM, David Shulkin wrote:
Between us
Sent from my iPad
Begin forwarded message:
From: Donovan Slack
Date: April 18, 2017 at 9:44:53 PM EDT
To: David Shulkin
Subject: No story now
I wanted, between us as always, to make sure not to leave you in limbo. Given
everything, I decided it's not fair to do a story right now about what visn/vaco
officials did or didn't do in three weeks leading up to last weeks PR crisis.
I would normally tell someone else this, who could relay it to you (ie: Linda), but
honestly haven't found a person I feel comfortable with yet in your new orbit.
I'm sure I will at some point but didn't want to leave u hanging in the meantime.
VA-19-0799-D-001473
OS 00003144
Message
David Shulkin [drshulkin@aol.com]
4/19/2017 2:43:00 AM
Poonam Alaigh [(b) (6)
hotmail.com]; Vivieca Simpson [(b) (6)
Fwd: No story now
From:
Sent:
To:
Subject:
gmail.com]
Between us
Sent from my iPad
Begin forwarded message:
From: Donovan Slack
Date: April 18, 2017 at 9:44:53 PM EDT
To: David Shulkin
Subject: No story now
I wanted, between us as always, to make sure not to leave you in limbo. Given everything, I
decided it's not fair to do a story right now about what visn/vaco officials did or didn't do in three
weeks leading up to last weeks PR crisis.
I would normally tell someone else this, who could relay it to you (ie: Linda), but honestly
haven't found a person I feel comfortable with yet in your new orbit.
I'm sure I will at some point but didn't want to leave u hanging in the meantime.
VA-19-0799-D-001474
OS 00003145
Message
From:
Sent:
To:
CC:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
5/2/2017 11:56:28 AM
Bruce Moskowitz [(b) (6)
mac.com]
drshulkin@aol.com; darin.selnick@va.gov; IP [(b) (6) frenchangel59.com]; l Perl [(b) (6)
mbs(b) (6)
@gmail.com; (b) (6)
aol.com
Re: Apple
Thanks - Darin, copying
point for us here at VA
(b) (6)
gmail.com];
my Senior Advisor, on my end so that the two of you can be on
Sent from my iPhone
> on May 2, 2017, at 7:37 AM, Bruce Moskowitz <(b) (6)
>
> I think the number one priority with Apple will be
health records available to Veterans. If they choose
what the evaluation and treatment is, not was or the
needs important data from the VA records The 5 CEO's
mac.com> wrote:
to have what they are already working on, portable
the choice program then we need to know in realtime
cost can be prohibitive. Also the health provider
have committed resources also to get this done.
>
> We will need their assistance to have a patient centric program for preventive medicine that can also
tract progress
>
> Tracking mechanism for opioid prescriptions within and outside of the VA
>
> Organize mental health early detection and treatment strategies. currently there are too many
unorganized initiatives and no feed back on effectiveness.
>
> Approved choice services geotagged to the Veterans location hospitals, providers walk in clinics etc.
>
> The CEO's want to have their teams work with Apple for strategies to reduce health care costs. This is
very important and we need to take advantage of everyone's intellectual capital.
>
> I am available to discuss 24/7 and the academic team is ready to move now.
>
>
>
>
>
>
> Sent from my iPad
> Bruce Moskowitz M.D.
VA-19-0799-D-001475
OS 00003146
Message
From:
(b) (6)
Sent:
3/29/2017 7:48:48 PM
To:
David [drshulkin@aol.com]
Fwd:
Subject:
[(b) (6)
hotmail.com]
U c this is her entertainment that she gets to do everything u do
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
Date: March 29, 2017 at 2:59:20 PM EDT
To: (b) (6) <(b) (6)
hotmail.com>
gmail.com>
Dr. Shulkin will probably be the only cool Secretary in history. I appreciate him very much, even
when he keeps us on our toes.
Today was fun. We left the WH at 12:14, Reggie got us to the airport by 12:23. We made our
12:50 flight. Yes! I of course ran to the gate like a crazy person I was determined to save the
flight. Not needed, we made it. By far the best crazy experience ever...well except for meeting
Barack and michelle, traveling to the Greek isles, etc. But it's up there :-)
VA-19-0799-D-001476
OS 00003147
Message
From:
David Shulkin [drshulkin@aol.com]
Sent:
4/8/2017 8:11:45 PM
To:
(b) (6)
Attachments:
hotmail.com
priorities.pptx
revised to 5
VA-19-0799-D-001477
OS 00003148
The Secretary's 5 Priorities
Greater Choice for Veterans
-Revise the 40/30 Rule
-Build an Integrated Network of Care
- Empower veterans through transparency of information
Modernize our System
-Infrastructure Improvements and Consolidations
-EMR Interoperability and Modernization
Focus Resources More Efficiently
-Foundational Services in VA
-VA/DOD/Community Coordination
-Deliver on Accountability and Effective Management practices
Improve Timeliness of Services
- Wait times and Accessibility for Care
- Decisions on Appeals
- Performance on Disability Claims
Suicide Prevention
VA-19-0799-D-001478
OS 00003149
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
3/30/2017 12:06:10 PM
Ike Perlmutter [(b) (6) frenchangel59.com]; Laurie Perlmutter [(b) (6)
gmail.com]; Bruce Moskowitz
[(b) (6)
mac.com]
Fwd: VA Is On A Path Toward Recovery, Secretary Of Veterans Affairs Says: Shots - Health News: NPR
This morning on national public radio
VA Is On A Path Toward Recovery, Secretary Of Veterans Affairs Says: Shots - Health News:
NPR
http ://www.npr.org/sections/health-shots/201 7/03/30/52193 7557/the-va-is-on-a-path-towardrecovery-secretary-of-veterans-affairs-says
VA-19-0799-D-001479
OS 00003150
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
3/30/2017 12:05:04 PM
(b) (6)
[(b) (6)
hotmail.com]; (b) (6)
[(b) (6)
gmail.com]; (b) (6)
gmail.com
Fwd: VA Is On A Path Toward Recovery, Secretary Of Veterans Affairs Says: Shots - Health News: NPR
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
gmail.com>
Date: March 30, 2017 at 5:29:19 AM CDT
To: drshulkin@aol .com
Subject: VA Is On A Path Toward Recovery, Secretary Of Veterans Affairs Says: Shots Health News : NPR
VA Is On A Path Toward Recovery, Secretary Of Veterans Affairs Says: Shots - Health News:
NPR
http ://www.npr.org/sections/health-shots/2017/03/30/52193 7557/the-va-is-on-a-path-towardrecovery-secretary-of-veterans-affairs-says
VA-19-0799-D-001480
OS 00003151
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
3/30/2017 12:04:40 PM
(b) (6)
[(b) (6)
sunnyshulkin.com]; (b) (6)
[(b) (6)
sunnyshulkin.com]; (b) (6)
(b)
(6)
[
gmail.com]
Fwd: VA Is On A Path Toward Recovery, Secretary Of Veterans Affairs Says: Shots - Health News: NPR
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
gmail .com>
Date: March 30, 2017 at 5:29:19 AM CDT
To: drshulkin@aol .com
Subject: VA Is On A Path Toward Recovery, Secretary Of Veterans Affairs Says: Shots Health News : NPR
VA Is On A Path Toward Recovery, Secretary Of Veterans Affairs Says: Shots - Health News:
NPR
http ://www.npr.org/sections/health-shots/2017/03/30/52193 7557/the-va-is-on-a-path-towardrecovery-secretary-of-veterans-affairs-says
VA-19-0799-D-001481
OS 00003152
Message
From:
(b) (6)
Sent:
3/30/2017 10:29:19 AM
drshulkin@aol.com
VA Is On A Path Toward Recovery, Secretary Of Veterans Affairs Says: Shots - Health News: NPR
To:
Subject:
[(b) (6)
gmail.com]
VA Is On A Path Toward Recovery, Secretary Of Veterans Affairs Says: Shots - Health News: NPR
http ://www.npr.org/sections/health-shots/201 7/03/30/52193 7557/the-va-is-on-a-path-toward-recoverysecretary-of-veterans-affairs-says
VA-19-0799-D-001482
OS 00003153
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
3/29/2017 6:54:49 PM
Bruce Moskowitz [(b) (6)
Fwd: Problems at the WPB VA
mac.com]
Fyi- im handling
Sent from my iPhone
Begin forwarded message:
From: DJS
Date: March 29, 2017 at 11 :59:42 AM CDT
To: 'Shulkin'
Subject: FW: Problems at the WPB VA
Sent with Good (www.good.com)
-----Original Message----From: (b) (6)
Sent: Wednesday, March 29, 2017 11 :51 AM Eastern Standard Time
To: Shulkin, David J., MD
Subject: Problems at the WPB VA
Dear Dr. Shulkin,
I am writing to inform you of the problems at the West Palm Beach V AMC in regard to
recruiting and retaining nurse practitioners.
For almost nine years I have been working as a psychiatric nurse practitioner at this facility. My
duty station for the past 7 years has been in the PTSD clinic. It is an honor to care for veterans
like my father whose lives were changed forever by the horrors of combat.
There are two issues of concern. First, there is a problem with recruiting NP' s as the salary is not
commensurate with the private sector. Second there is no mechanism to retain qualified NP' s
like myself Despite having a doctoral degree and outstanding performance reviews, attempts to
attain a step increase have been denied.
Here lies the problem. Once a nurse is "boarded" he/she cannot be "re-boarded." In 2008, I was
"boarded" in an obsolete manner. Thus, I am literally "stuck" with a very low salary. In order to
VA-19-0799-D-001483
OS 00003154
get "re-boarded" I was informed by HR that I must leave the VA for one year and then
return. This policy does not make sense for a facility that has been struggling to recruit
psychiatric nurse practitioners. To date, I believe we have 7 unfilled NP positions. Dr.
Casariego, my immediate supervisor can verify how difficult it is to recruit NP' s once they learn
the salary. This shortage puts a strain on the existing staff More importantly, it affects the
veteran who gets shifted from provider to provider which results in poor of continuity of care.
Recently at a conference I learned that a 27 year old new graduate (who I trained) is earning
$120,000 per year at a local facility. With my education and experience, nurse practitioners in
the private sector are earning $150,000 - $160,000. I earn $98,107.00 after 34 years of being a
nurse! It is quite disheartening that the VA devalues the contribution that NP's make in caring
for our veterans.
Many people ask why I remain in such a low paying job. I tell them it is because I am devoted to
my patients whom I have a long standing relationship with. However, the time has come that I
must start looking after my best interests. As such, I am aggressively seeking employment in
other government agencies.
Dr. Shulkin, we have a mutual acquaintance, Dr. Bruce Moskowitz, whom I have known for 30
years. He can vouch for my integrity. My efforts at the local level have been futile. I am hoping
that during your administration you will find a way to rectify this inequitable pay scale system.
Respectfully,
(b) (6)
DNP, ARNP, PMHNP-BC
PTSD Clinic (lF-108)
(561) 422-(b) (6)
VA-19-0799-D-001484
OS 00003155
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
3/30/2017 2:53:43 AM
Marc Sherman [(b) (6)
gmail.com]
Re: AIPAC
Yes - i enjoyed meeting him
Sent from my iPhone
> on Mar 29, 2017, at 9:32 PM, Marc Sherman <(b) (6)
>
> I heard that you spent some time with my friend
he was telling me.
gmail.com> wrote:
(b) (6)
at AIPAC.
We played tennis tonight and
>
> Marc Sherman
(202) 758-(b) (6)
>
VA-19-0799-D-001485
OS 00003156
Message
From:
Sent:
To:
Subject:
Marc Sherman [(b) (6)
gmail.com]
3/30/2017 2:32:06 AM
David shulkin [drshulkin@aol.com]
AIPAC
I heard that you spent some time with my friend (b) (6)
was telling me.
at AIP AC. We played tennis tonight and he
Marc Sherman
(202) 758-(b) (6)
VA-19-0799-D-001486
OS 00003157
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/8/2017 1:35:40 AM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Google Alert - david shulkin
These were the rogue vaco employees that did this without our knowledge
When i found out i canceled it
I was looking to terminate these employees who are really crooked - havnt been able to do yet
Sent from my iPhone
On Apr 7, 2017, at 9:25 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
How did that happen- why would we give MVP data to a start up company - maybe I don't
understand everything, but looks like a close call. You will have to fill me in on this
Sent from my iPhone
On Apr 7, 2017, at 5:35 PM, David shulkin wrote:
See first articlE
Sent from my iPhone
Begin forwarded message:
From: Google Alerts
Date: April 7, 2017 at 4:02:59 PM EDT
To: drshulkin@aol .com
Subject: Google Alert - david shulkin
Google
Alerts
david shulkin
Daily update o April 7, 2017
NEWS
Home Ben's Blog Veterans Affairs Almost Gave Away Veteran MVP Genomic Data
Russian ...
DisabledVeterans.org
VA-19-0799-D-001487
DS 00003158
In a letter signed by then Under Secretary for Health David Shulkin, MD, the now VA Secretary canceled an a
that would have allowed an ...
Flag as irrelevant
The Situation Report: Is the CIO Job at VA About to Lose Its Influence?
MeriTalk (blog)
It is a truly stunning detail overlooked by most observers during the confirmation process of David Shulkin to I
secretary of Veterans Affairs.
Flag as irrelevant
Trump: 'We Wouldn't Be Here If It Weren't For' Veterans [VIDEO]
Daily Caller
"They have not been taken care of properly. David [Shulkin], who you know is the new secretary [of Veterans
going to do a fantastic job." ...
Congress passes bill to save Veterans Choice Program - Beckley Register-Herald
VA to Expand Mental Health Care Eligibility to Discharged Veterans - Law Firm Newswire (press release)
Full Coverage
Flag as irrelevant
WEB
David Shulkin
IMDb
David Shulkin. Personal Details. Biography. Other Works . Publicity Listings . Official Sites . Contact Info (IM
Filmography. by Year. by Job ...
@
I] CJ
Flag as irrelevant
See more results I Edit this alert
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VA-19-0799-D-001488
DS 00003159
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
4/8/2017 1:25:12 AM
David shulkin [Drshulkin@aol.com]
Re: Google Alert - david shulkin
How did that happen- why would we give MVP data to a start up company - maybe I don't understand
everything, but looks like a close call. You will have to fill me in on this
Sent from my iPhone
On Apr 7, 2017, at 5:35 PM, David shulkin wrote:
See first articlE
Sent from my iPhone
Begin forwarded message:
From: Google Alerts
Date: April 7, 2017 at 4:02:59 PM EDT
To: drshulkin@aol .com
Subject: Google Alert - david shulkin
Google Alerts
david shulkin
Daily update o April 7, 2017
NEWS
Home Ben's Blog Veterans Affairs Almost Gave Away Veteran MVP Genomic Data To
Russian ...
DisabledVeterans.org
In a letter signed by then Under Secretary for Health David Shulkin, MD, the now VA Secretary canceled an agreemen
that would have allowed an ...
@
11 CJ
Flag as irrelevant
The Situation Report: Is the CIO Job at VA About to Lose Its Influence?
MeriTalk (blog)
It is a truly stunning detail overlooked by most observers during the confirmation process of David Shulkin to become
secretary of Veterans Affairs.
@
11 CJ
Flag as irrelevant
VA-19-0799-D-001489
DS 00003160
Trump: 'We Wouldn't Be Here If It Weren't For' Veterans [VIDEO]
Daily Caller
"They have not been taken care of properly. David [Shulkin], who you know is the new secretary [of Veterans Affairs], i
going to do a fantastic job." ...
Congress passes bill to save Veterans Choice Program - Beckley Register-Herald
VA to Expand Mental Health Care Eligibility to Discharged Veterans - Law Firm Newswire (press release)
Full Coverage
Flag as irrelevant
WEB
David Shulkin
IMDb
David Shulkin. Personal Details. Biography. Other Works. Publicity Listings. Official Sites. Contact Info (IMDbPro).
Filmography. by Year. by Job ...
@
I] CJ
Flag as irrelevant
See more results I Edit this alert
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VA-19-0799-D-001490
DS 00003161
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/7/2017 9:24:27 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Fwd: Google Alert - david shulkin
See first articlE
Sent from my iPhone
Begin forwarded message:
From: Google Alerts
Date: April 7, 2017 at 4:02:59 PM EDT
To: drshulkin@aol .com
Subject: Google Alert - david shulkin
Google Alerts
david shulkin
Daily update o April 7, 2017
NEWS
Home Ben's Blog Veterans Affairs Almost Gave Away Veteran MVP Genomic Data To
Russian ...
DisabledVeterans.org
In a letter signed by then Under Secretary for Health David Shulkin, MD, the now VA Secretary canceled an agreement
that would have allowed an ...
@
11 CJ
Flag as irrelevant
The Situation Report: Is the CIO Job at VA About to Lose Its Influence?
MeriTalk (blog)
It is a truly stunning detail overlooked by most observers during the confirmation process of David Shulkin to become
secretary of Veterans Affairs.
@
11 CJ
Flag as irrelevant
Trump: 'We Wouldn't Be Here If It Weren't For' Veterans [VIDEO]
Daily Caller
"They have not been taken care of properly. David [Shulkin], who you know is the new secretary [of Veterans Affairs], is
going to do a fantastic job." ...
Congress passes bill to save Veterans Choice Program - Beckley Register-Herald
VA to Expand Mental Health Care Eligibility to Discharged Veterans - Law Firm Newswire (press release)
VA-19-0799-D-001491
DS 00003162
Full Coverage
Flag as irrelevant
WEB
David Shulkin
IMDb
David Shulkin. Personal Details. Biography. Other Works. Publicity Listings. Official Sites. Contact Info (IMDbPro).
Filmography. by Year. by Job ...
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VA-19-0799-D-001492
OS 00003163
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
3/29/2017 12:38:52 AM
To:
(b) (6)
Subject:
Re: Meds
[(b) (6)
gmail.com]
Sent from my iPhone
> on Mar 28, 2017, at 8:14 PM,
(b) (6)
<(b) (6)
gmail.com> wrote:
>
> Sir,
>
> The agents wanted to build their emergency kit and came by to express the seriousness of the request in
case something unforeseen happens.
>
> Do you have food allergies?
No
> Are you on any medications?
No
> Blood type?
Ill check
> Preferred foods to eat
granola bars.
I said salad, fish, poultry and vegetables. Snacks -mini pretzels, trail mix,
> --
sounds good
> Sent from Gmail Mobile
VA-19-0799-D-001493
OS 00003164
Message
From:
(b) (6)
Sent:
3/29/2017 12:14:29 AM
To:
David Shulkin [drshulkin@aol.com]
Meds
Subject:
[(b) (6)
gmail.com]
Sir,
The agents wanted to build their emergency kit and came by to express the seriousness of the request in case
something unforeseen happens.
Do you have food allergies?
Are you on any medications?
Blood type?
Preferred foods to eat : I said salad, fish, poultry and vegetables. Snacks -mini pretzels, trail mix, granola bars.
Sent from Gm ail Mobile
VA-19-0799-D-001494
OS 00003165
Message
From:
David shulkin [Drshulkin@aol.com]
Sent:
3/31/2017 1:49:28 PM
To:
Jennifer Lee [(b) (6)
Re: Next steps
Subject:
Yes lets move this forward-
gmail.com]
agree vivieca
can help with the details
Sent from my iPhone
> on Mar 31, 2017, at 7:14 AM, Jennifer Lee <(b) (6)
gmail.com> wrote:
>
> Hi David
> I would like to move forward with what we discussed earlier this week- I think the fastest route would
be to begin as a detail? Would also allow me to keep working clinically at DC VAMC on weekends.
> what do you see as next steps? should I discuss w Vivieca again?
> Thank you for the opportunity
> Jen
>
VA-19-0799-D-001495
OS 00003166
Message
From:
Jennifer Lee [(b) (6)
Sent:
3/31/2017 11:14:36 AM
To:
David Shulkin [drshulkin@aol.com]
Next steps
Subject:
gmail.com]
Hi David
I would like to move forward with what we discussed earlier this week- I think the fastest route would be to
begin as a detail? Would also allow me to keep working clinically at DC V AMC on weekends.
What do you see as next steps? Should I discuss w Vivieca again?
Thank you for the opportunity
Jen
VA-19-0799-D-001496
OS 00003167
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/3/2017 4:46:31 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: Me and ma precious baby
Great picture!
Sent from my iPhone
> on Apr 3, 2017, at 11:21 AM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
>
>
>
>
>
>
>
> Sent from my iPhone
VA-19-0799-D-001497
OS 00003168
Message
From:
Sent:
To:
Subject:
Attachments:
Poonam Alaigh [(b) (6)
hotmail.com]
4/3/2017 3:21:48 PM
David Shulkin [drshulkin@aol.com]
Me and ma precious baby
IMG_0036.JPG; ATT0000l.txt
VA-19-0799-D-001498
OS 00003169
.1411 .
bl ICE-I1 I ail-F4?
. r; -
Sent from my iPhone
Message
From:
Sent:
To:
Subject:
David shulkin [Drshulkin@aol.com]
4/6/2017 2:01:56 AM
SreyRam Kuy [(b) (6)
@gmail.com]
Re: Thank you!
Were working on opportunities
Thanks for your patience
Sent from my iPhone
> on Apr 3, 2017, at 11:36 AM, SreyRam Kuy <(b) (6)
@gmail.com> wrote:
>
> Secretary shulkin,
>
> It was such a pleasure getting to meet you a week ago. Thank you for
> chatting with me about my passion for excellence in healthcare for
> veterans.
>
>
>
>
>
>
I would love the opportunity to serve on your executive leadership
team at the VA. I believe my experiences leading medical efforts in
Louisiana's Medicaid, which serves 1.6 million lives in a $10.7
billion system, and my decade of experience working in the VA system
can be valuable as a national VA healthcare executive leader.
>
> I've attached my OI, and if you would like to talk with some of my
> mentors, here are their contacts:
>
> Dr. Harlan Krumholz
> Board of Governors, PCORI
> Harold H Hines Professor of Medicine, Yale school of Medicine
> Phone: 203-641-2501
>Email: Harlan.Krumholz@yale.edu
>
> Dr. Elizabeth Bradley
> President-Elect, Vassar college
>Email: Elizabeth.Bradley@yale.edu (until June 30, 2017)
>
> Dr. Ramon Romero
> chief, surgical Service, Overton Brooks VA Medical Center
> Phone: 318-990-9674
>Email: Ramon.Romero@va.gov
>
> Dr. Quyen Chu
> Charles Knight, Sr Endowed Professor of surgery
> chief, surgical Oncology, Louisiana State University - Shreveport
> Phone: 318-655-1358
>Email: qchu@lsuhsc.edu
>
> Again, thank you so much for all you do for our veterans.
It inspires me.
>
> Respectfully, SreyRam
>
> SreyRam Kuy, MD, MHS, FACS
> chief Medical officer, Medicaid, Lou1s1ana Department of Health
> RWJ clinical scholar, Yale 2007-2009
>
>
> On Tue, Mar 28, 2017 at 2:15 PM, Shulkin, David J., MD
> wrote:
> Thanks I enjoyed our meeting and your passion for this work
>
>>
>>
>>
>>
>>
>>
>>
-----original Message----From: SreyRam Kuy [mailto:(b) (6)
@gmail .com]
Sent: Friday, March 24, 2017 4:43 PM
To: shulkin, David J., MD; David shulkin
Subject: [EXTERNAL] Thank you!
Secretary shulkin,
>>
>> It was such a pleasure talking with you today, and thank you for taking the time to meet with me.
VA-19-0799-D-001501
OS 00003172
>>
>> Here is the link to the "save A Spot, Give a slot to Your Battle Buddy" poster a veteran helped us
design, as part of my initiative to reduce clinic no shows. Here is also the template of the letter sent
to veterans. I would be honored if you utilized them.
>> https://www.avasnews.com/single-post/2016/05/16/REDUCING-NO-SHOWS
>> https://media.wix.com/ugd/04bfb6_bb75c2d33e714fadae596bd4a300f325.pdf
>> https://media.wix.com/ugd/04bfb6_096148d38d354faba5bba809a4bfb3a0.pdf
>>
>> Also, here's a link to the VA article about my work to reduce surgical mortality at the VA.
>> http://www.patientsafety.va.gov/features/shreveport_A_Success_Story.asp
>>
>> Again, it was wonderful to get to meet you and Dr. Alaigh. Thank you so much for all you do for our
veterans!
>>
>> I'll reach out again in 1 week. Thanks, -SreyRam
>>
>>
>> SreyRam Kuy, MD, MHS, FACS
>> chief Medical officer, Medicaid
>> Louisiana Department of Health
>> Phone: 210-535-(b) (6)
>>Email: (b) (6)
@gmail.com
>
VA-19-0799-D-001502
OS 00003173
Message
SreyRam Kuy [(b) (6)
@gmail.com]
Sent:
4/3/2017 3:36:50 PM
To:
Shulkin, David J., MD [David.Shulkin@va.gov]; David shulkin [DrShulkin@aol.com]
Thank you!
Subject:
Attachments: Dr. SreyRam Kuy CV - VA 2017.pdf
From:
Secretary shulkin,
It was such a pleasure getting to meet you a week ago. Thank you for
chatting with me about my passion for excellence in healthcare for
veterans.
I would love the opportunity to serve on your executive leadership
team at the VA. I believe my experiences leading medical efforts in
Louisiana's Medicaid, which serves 1.6 million lives in a $10.7
billion system, and my decade of experience working in the VA system
can be valuable as a national VA healthcare executive leader.
I've attached my 0./, and if you would like to talk with some of my
mentors, here are their contacts:
Dr. Harlan Krumholz
Board of Governors, PCORI
Harold H Hines Professor of Medicine, Yale school of Medicine
Phone: 203-641-2501
Email: Harlan.Krumholz@yale.edu
Dr. Elizabeth Bradley
President-Elect, Vassar college
Email: Elizabeth.Bradley@yale.edu (until June 30, 2017)
Dr. Ramon Romero
chief, surgical Service, Overton Brooks VA Medical Center
Phone: 318-990-9674
Email: Ramon.Romero@va.gov
Dr. Quyen Chu
Charles Knight, Sr Endowed Professor of surgery
chief, surgical Oncology, Louisiana State University - Shreveport
Phone: 318-655-1358
Email: qchu@lsuhsc.edu
Again, thank you so much for all you do for our veterans.
It
inspires me.
Respectfully, SreyRam
SreyRam Kuy, MD, MHS, FACS
chief Medical officer, Medicaid, Lou1s1ana Department of Health
RWJ clinical scholar, Yale 2007-2009
On Tue, Mar 28, 2017 at 2:15 PM, Shulkin, David J., MD
wrote:
Thanks I enjoyed our meeting and your passion for this work
>
>
>
>
>
-----original Message----From: SreyRam Kuy [mailto:(b) (6)
@gmail .com]
Sent: Friday, March 24, 2017 4:43 PM
To: shulkin, David J., MD; David shulkin
Subject: [EXTERNAL] Thank you!
>
> Secretary shulkin,
>
> It was such a pleasure talking with you today, and thank you for taking the time to meet with me.
>
> Here is the link to the "save A Spot, Give a slot to Your Battle Buddy" poster a veteran helped us
design, as part of my initiative to reduce clinic no shows. Here is also the template of the letter sent
to veterans. I would be honored if you utilized them.
> https://www.avasnews.com/single-post/2016/05/16/REDUCING-NO-SHOWS
> https://media.wix.com/ugd/04bfb6_bb75c2d33e714fadae596bd4a300f325.pdf
> https://media.wix.com/ugd/04bfb6_096148d38d354fabaSbba809a4bfb3aO.pdf
VA-19-0799-D-001503
OS 00003174
>
> Also, here's a link to the VA article about my work to reduce surgical mortality at the VA.
> http://www.patientsafety.va.gov/features/shreveport_A_Success_Story.asp
>
> Again, it was wonderful to get to meet you and Dr. Alaigh.
veterans!
>
> I'll reach out again in 1 week.
Thank you so much for all you do for our
Thanks, -SreyRam
>
>
> SreyRam Kuy, MD, MHS, FACS
> chief Medical officer, Medicaid
> Louisiana Department of Health
> Phone: 210-535-(b) (6)
>Email: (b) (6)
@gmail.com
VA-19-0799-D-001504
OS 00003175
SreyRam Kuy, MD, MHS, FACS
Medicaid Chief Medical Officer, Louisiana Department of Health
Associate Professor of Surgery, Louisiana State University- New Orleans
PROFILE:
?
As Chief Medical Officer of Louisiana :Medicaid, I lead the state's drive to improve
healthcare quality, engage healthcare providers and stakeholders in both managed
care and fee for service systems, develop quality performance metrics and integrate
cost effectiveness into a $10.7 billion health system which serves 1.6 million lives.
?
Supervise staff members comprising the Quality Team, Pharmacy Team, Clinical
Policy Team, Health Information Technology Team and Benefits & Covered
Services Team.
?
Advise the Secretary of Health on critical public health issues, communicate policies
and vision to state legislators and the Governor and represent Medicaid to the
media on issues ranging from opioids to zika and healthcare quality.
?
Lead initiatives for emerging public health threats such as coordinating medical
efforts at Flood Shelters, developing a Zika transmission prevention policy, and
working with the Governor's office and state legislators to implement strategies
tackling the opioid crisis.
?
Oversee Cl\fS grant for state Health Information Technology projects; including
increasing EHR adoption among providers, ED discharge data linkage to primary
care physicians, advancing a Telehealth network, implementing an EHR system in
the Department of Corrections, and enabling providers to achieve meaningful use
HIT.
?
More than a decade of experience in the VA systems in Oregon, Texas, Connecticut,
Wisconsin and Louisiana as a trainee, provider and administrator. Served as
Assistant Chief of the General Surgery Section, Director of the Center for
Innovations in Quality, Outcomes and Patient Safety, Chair of the Systems Redesign
Committee and Board Member on the Quality, Safety and Value Board at Overton
Brooks VA Medical Center. Worked with the Pentad on SAIL performance
reports, HEDIS and Joint Commission ORYX core measures. Led initiatives to
improve veterans' access to care through a 50% reduction in surgery clinic no
shows.
?
Worked to successfully decrease veteran mortality and reduce patient safety adverse
events at Overton Brooks VA Medical Center. Developed biweekly provider
educational series, broadcast remotely to outlying VA Community Based Outpatient
Clinics in Louisiana and East Texas.
VA-19-0799-D-001505
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PERSONAL:
Office Address:
Mobile Telephone:
Office Telephone:
Email Address:
Citizenship:
Louisiana Medicaid, Department of Health
628 North 4th Street, Baton Rouge, LA 70802
210-53 5-(b) (6)
225-342-53 81
(b) (6)
@gmail.com
SreyRam.Kuy@LA. Gov
United States
EDUCATION:
2017
Presidential Leadership Scholars Program
Nominated and selected to be a Presidential Leadership Scholar - a joint
executive leadership training program by Presidents Bush and Clinton and run by
the presidential centers of Lyndon B. Johnson, George H. W Bush, William J
Clinton and George W Bush
2016
Healthcare Executive Leadership Program in Health Policy and Management
Heller School of Policy and Management, Brandeis University
2009
M.H.S. (Master of Health Science)
Yale University School ofMedicine, Robert Wood Johnson Clinical Scholar
2005
M.D. (Medical Degree)
Oregon Health & Sciences University School ofMedicine
2000
B.S. (Bachelor of Science, Philosophy), magna cum laude
Oregon State University
2000
B.S. (Bachelor of Science, Microbiology), magna cum laude
Oregon State University
POSTGRADUATE TRAINING:
2009-2012
Residency, General Surgery (PGY 3-5)
Medical College of Wisconsin
2007-2009
Robert Wood Johnson Clinical Scholar Fellowship
Yale University School ofMedicine
2005-2007
Residency, General Surgery (PGY 1-2)
University of Texas Health Sciences Center at San Antonio
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APPOINTMENTS:
2016-present Chief Medical Officer, Medicaid, Louisiana Department of Health and Hospitals
As ClvfO ofLouisiana lvfedicaid I lead the drive to improve healthcare quality,
cost effectiveness and Health Information Technology in a $10. 7 billion health
system which serves 1.6 million lives in both managed care and fee for service
systems. My work includes managing the Quality Team, Pharmacy Team,
Clinical Policy Team, Health Information Technology Team and a Bene.fits &
Covered Services Team. In addition, I lead initiatives for emerging public health
threats such as coordinating medical efforts at Flood Shelters, developing a Zika
transmission prevention policy, and working with the Governor's office and
legislatures to implement strategies tackling the opioid crisis.
o Health Information Technology Team: lead the state's electronic health
record adoption initiative and health information technology strategy,
oversee CMS grant for Health Information Technology and a National
Governors' Association HIT grant
o Quality Team: Develop and evaluate incentivized quality performance
measures for providers & health plans to improve outcomes, safety, and
quality of care for the state of Louisiana. Manage a Quality Team
comprised of physicians, nurses & policy analysts addressing health care
quality. Creation of a "Search by Score" site that promotes quality,
transparency and adoption in Louisiana healthcare.
o Clinical Policy Team overseeing the evidence based approach for
coverage of new benefits and services for Medicaid beneficiaries
o Benefits and Covered Services Team: manage all covered services and
benefits in the Louisiana Medicaid system
o Pharmacy Team: overseeing Medicaid prescription coverage
o Rapidly respond to emergent public health issues (such as Zika virus,
Opioid epidemic, drug shortages, flooding and emergency natural
disasters) and develop guidance for providers and health plans
o Work with Louisiana healthcare stake holders, including Managed Care
Organizations, hospital associations, healthcare providers, health facilities
and institutions, patient advocacy groups to ensure high quality care for
Louisiana's Medicaid population, and efficient use ofresources
2014-2016
Director, Center for Innovations in Quality, Outcomes and Patient Safety,
OBVAMC
o Develop and lead initiatives to meet Joint Commission ORYX core
measures, SAIL performance measures, and monitor PSI occurrences.
o Develop programs that lead to sustained improvement in quality,
outcomes and safety in the Surgical Services at the OBVAMC.
o Work on reducing mortality and adverse events profiled in the VA
National Center for Patient Safety newsletter and website. Work on
decreasing clinic no-shows featured in the Association of VA Surgeons
newsletter and website.
o Collaborate with section chiefs to assess needs for quality improvement;
develop, monitor and assess quality measures and initiatives; monitor
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o
analyze and assess surgical outcomes; integrate quality improvement tools
and surgical outcome measures to create a cohesive program for the
OBV AMC Surgical Services.
Partner with VA clinical, policy and operational leaders to implement and
evaluate different ways to make surgical healthcare safer, more effective
and more affordable.
2015-2016
Assistant Chief, General Surgery Section
Overton Brooks VA Medical Center (OBV AMC)
o Integrate quality improvement tools and surgical outcome measures to
create a cohesive program for General Surgery Section, leading to
improved patient safety with a decrease in patient mortality and reduction
in Critical Incident Network Tracking adverse events
o Work on SAIL and Joint Commission performance measures (pressure
ulcer prevention, accidental puncture monitoring, smoking cessation/flu
immunization documentation)
Led
initiative to improve veterans access to care through decreased
o
surgery clinic no shows, with more than 50% reduction in clinic no shows
Develop,
monitor and assess quality and efficiency measures and
o
initiatives for the General Surgery Section
o Monitor, analyze and assess surgical outcomes for the General Surgery
Section
o Review Quality Improvement tools and surveys
o Collaborate with other section chiefs (Anesthesiology, ENT, General
Surgery, ENT, Neurosurgery, Ophthalmology, Orthopedics, Podiatry,
Urology, Vascular and Thoracic Surgery) to assess needs for a
collaborative, comprehensive surgical care
2014-2016
Director, Surgical Services Grand Rounds Lecture Series, OBVAMC
o Developed a CME accredited academic curriculum for Grand Rounds
Lecture Series; recruited local and national speakers
o Incorporated telecommunication to broadcast Grand Rounds Lectures
remotely, available to outlying VA Community Based Outpatient Clinics
(CBOCs) in Louisiana and Texas and also to employee's computer
desktops to allow greater educational reach
2017-present Attending Surgeon, LSU Health - Perkins Surgery Center and Surgery Clinic
2017-present Associate Professor, Department of Surgery
Louisiana State University - New Orleans
2014-2016
Assistant Professor, Department of Surgery
Louisiana State University - Shreveport
2014-2016
(OBVAMC)
Attending Surgeon, Overton Brooks Veterans Affairs Medical Center
VA-19-0799-D-001508
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o
o
o
2014-2015
Had highest RYU' s and total number of cases in general surgery section
Performed first laparoscopic assisted Low Anterior Resection at
OBYAMC
Developed a laparoscopic training course for residents, OR staff and
surgeons; taught at OBYAMC and LSU
Consultant, Parkland Center for Clinical Innovation
Consultant on surgical site infection risk prediction modeling
BOARD CERTIFICATION
2014 American Board of Surgery# 059382
MEDICAL LICENSURE:
State of Texas# P9893 -Expiration 5/31/2017
State of Wisconsin #53724-20 -Expiration 10/3/2017
State of Tennessee #~ID00000 50960 - Expiration 3/3 l /2018
State of Louisiana #300710 -Expiration 3/31/2017
POSTGRADUATE COURSES:
10/2014
Cleveland Clinic, Advanced Laparoscopic Colorectal Master Class
11/2014
Florida Hospital, Laparoscopic General Surgery Master Class
7/2015
University of South Florida, Laparoscopic Colectomy Mini-Fellowship
9/2015
Methodist MITE, Advanced Hernia and Abdominal Wall Repair Master Class
2/2016
Life Cell, Complex Abdominal Wall Reconstruction Bioskills Lab
LEADERSHIP/HEALTHCARE POLICY TRAINING & EXPERIENCE:
June 12-18, 2016
American College of Surgeons Health Policy Award
"Leadership Program in Health Policy and Management" Executive
Education Program at Brandeis University Heller School for Social Policy
and Jvfanagement.
2013
American Medical Association Campaign School
Training in healthcare policy, legislation and politics in Washington, D.C.
American College of Surgeons Advocacy Grant
2012
2007 -2009
Robert Wood Johnson Clinical Scholar, Yale University School of Medicine
Fellowship in healthcare policy & management, public health and research.
Healthcare Policy Synergy Workshop, Institute of Medicine. Washington, D.C.
2008
Healthcare policy training, development of health disparities proposal
Robert Wood Johnson Foundation Cover the Uninsured Week Oregon Committee
2003
Organized symposium on the uninsured in Oregon, ::,peaker Governor Kitzhaber
American Academy of Family Physicians National Congress
2000
Authored resolution on "Presentation of the AAFP Universal Health Care
Coverage Task Force Report and Inclusion of Resident and Student Feedback
2000
Kaiser Family Foundation Barbara Jordan Health Policy Scholar
Worked in Washington DC office of US Senator Tom Harkin. Wrote speeches
on The Breast & Cervical Cancer Treatment Act and Re-authorization of the
VA-19-0799-D-001509
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Older Americans Act, attended hearings, wrote briefs on prescription drug
coverage, coveragefor experimental studies, and healthcare instrument safety.
HEALTH POLICY PANELS/KEY NOTE SPEAKER/PRESENTATIONS
The Louisiana Story: Tackling Preterm Birth through Collaboration and Innovation
CMS Quality Conference, Baltimore, MD
Achieving Viral Load Suppression through Collaboration - The Louisiana Story
HIV Affinity Group National Conference, Washington DC
Medicaid Expansion and Access to Healthcare: Leaming from Louisiana
Louisiana Public Health Institute
Bridging the Gap Between Health Care and Health Equity
National Academy for State Health Policy, Pittsburgh, PA
HIV Affinity -The Louisiana Story
HIV Health Improvement Affinity Group National Webinar
Medicaid Industry Who's Who Series, "Mostly Medicaid"
State Spotlight Series: Achieving Healthcare Quality
Medicaid Expansion and Improving Healthcare Quality in Louisiana
American Association on Intellectual & Developmental Disabilities,Alexandria,LA
Panel Member: Using National Data Sources to Understand Healthcare Quality,
Access and Disparities Among Women
AcademyHealth 2015 Annual Research Meeting, Minneapolis, Jvfinnesota
Panel Member: Emerging Issues in Gender-Based and Women's Health.
AcademyHealth 2009 Annual Research A1eeting, Chicago, Illinois.
Moderator, Robert Wood Johnson Alumni Careers in Health Policy.
Robert Wood Johnson Clinical Scholars National Conference, Washington, D. C.
Panel Member: The Many Avenues to Pursuing a Career in Health Policy.
Barbara Jordan Health Policy Scholars Conference, Washington, D.C.
TOWN HALLS
Town Hall Meeting
Flood Recovery, Mold and Tetanus Vaccination, Mental Health Crisis Hotline
Town Hall Meeting
Flood Recovery, Prescription Co-Pay Waivers, Early Refills for Prescriptions
Rotary Club of Shreveport
Key Note Speaker: Medicaid Expansion
Shreveport Medical Society
Key Note Speaker: Medicaid Expansion
COMMITTEE SERVICE AND ORGANIZATIONS
National Quality Forum
Medicaid Innovation Accelerator Committee
Alliance for a Healthier Generation
Obesity Prevention Task Force
Opioid Commission
Comparing Outcomes of Drugs and Appendectomy (CODA)
National Stakeholder Advisory Board
Dec 2016
Dec 2016
Dec 2016
Oct 2016
Nov 2016
Sept 2016
Sept 2016
2015
2009
2008
2007
August 2016
August 2016
July 2016
July 2016
2016-present
2016-present
2016-present
2016-present
VA-19-0799-D-001510
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National Academy for State Health Policy
Public and Population Health Advisory Group
AcademyHealth
State Health Research and Policy Interest Group Advisory Committee
American College of Surgeons
Committee on Diversity Issues
Robert Wood Johnson Foundation Clinical Scholars Alumni Association
Co-President
Chair, Medicaid Quality Committee
Louisiana Commission on HIV, AIDS and Hep C
Office ofPublic Health designee, appointed by Governor Edward-.,
Louisiana Task Force on Telehealth Access
Appointed by Secretary
Executive Committee, Medicaid Evidence-based Decisions Project, Portland, OR
Chair, Improving Veterans Access to Care Committee
Board Member, Quality, Safety and Value Board, OBV AMC
Chair, Systems Redesign Committee, OBVAMC
Chair, General Surgery Faculty Recruitment Committee, OBVAMC
Federation of State Medical Boards (FSMB)
Appointed Representative to Accreditation Council/or Continuing Medical
Education Accreditation Review Committee (revie,t' accreditation for ClvJE)
National Board of Medical Examiners (NBME)
NBA1E Board A1ember
Appointed by American Medical Association as one of 80 Board
Members governing the NBME, overseeing a $100 million annual budget
that governs the USMLE, the Post-Licensure Assessment System, and
works with specialty boards to protect the public health.
NBME Diversity and Inclusion Task Force
Tasked to improve diversity and inclusion in the executive leadership of
the NBME and the USMLE exam contents.
Association for Academic Surgery
Membership Committee
Information and Technology Committee
Program Committee
Association of Women Surgeons, Communications Committee, Vice-Chair
Medical Society of Milwaukee County, Board of Directors
American Medical Association
Chair, Wisconsin Resident & Fellow Governing Council
AMA Surgical Caucus, Executive Committee
Wisconsin Medical Society, AN1A Resident Delegate
Robert Wood Johnson Clinical Scholars National Conference, Planning Committee
Oregon Health & Science University Medical School First Year, Class President
Habitat for Humanity, Oregon State University Campus Chapter President
Science Student Council, President
Phi Eta Sigma National Honor Society, Oregon State University Chapter President
Oregon State University Undergraduate Senate, Senator
2016-present
2016-present
2016-2019
2016-2018
2016-present
2016-present
2016-present
2016-present
2015
2015-2016
2015-2016
2015-2016
2015-2016
2011 - 2015
2013 - 2015
2013 - 2015
2010 - 2012
2016 - present
2012 - 2014
2012 - 2014
2011 - 2013
2010 - 2011
2010 - 2011
2008
2000 - 2001
1988-1999
1997-1998
1997-1998
1997-1998
VA-19-0799-D-001511
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Talons Women's Leadership & Service Honorary Society, Vice-President
Medical Careers Explorer Scouts, Corvallis Chapter President
1997-1998
1995-1996
PEER-REVIEWED PUBLICATIONS
l. Kuy S, Romero R. Decreasing 30 Day Surgical Mortality Utilizing the ACS NSQIP Surgial Risk
Calculator. Journal of Surgical Research. In Press
2. Kuy S, Romero R. Eliminating Critical Incident Tracking Network Patient Safety Events at a
Veterans Affairs Institution through Crew Resource Management Training. American Journal of
lvfedical Quality. In Press
3. Kuy S, Romero R. Improving Staff Perception of a Safety Climate with Crew Resource
Management Training. Journal of Surgical Research. In Press
4. Kuy S. Rapidly Growing, Bleeding Mass on a Golfer's Back. JAMA Surgety. In Press
5. Kuy S, Romero R, Rose K, Vincent L. Perineal Pain and Malodorous Drainage in a Rectal
Cancer Patient. BMJ Postgraduate Medical Journal. In Press
6. Koo D, Kuy S, Ogunleye A, Sangji N. A Tradition of Advocacy in the American College of
Surgeons: Protecting our patients, advancing our profession. Bull Am Coll Surg. In Press
7. Eskander M, Neuwirth M, Kuy S, Keshava H, Meizoso J. Technology for Teaching: New Tools
for 21st Century Surgeons. Bull Am Coll Surg. In Press
8. Kuy S, Dua A, Rieland J, Cronin D. Cavernous Transformation of the Portal Vein. Journal of
Vascular Swgery. 2016 Feb;63(2):529.
9. Kuy S, Jenkins P, Romero R, Samra N, Kuy S. The Rising Incidence and Mortality of
Clostridium Difficile Associated Megacolon. JAlvfA Surgery. 2015 Oct 7: 1-2.
10. Kuy S, Romero R, Kuy S. Gas Gangrene in a Diabetic Foot. Journal of the Louisiana State
A4edical Society. 2015 Sep-Oct; 167(5):213-214. Epub 2015 Oct 15.
11. Kuy S. Carotid Body Tumor. Journal of the Louisiana State Medical Society. 2015 JulAug;l67(4):165. Epub 2015 Aug 15.
12. Busch K, Keshava H, Kuy S, Nezgoda J, Picou A Teaching in the Operating Room: New
Lessons for Training Surgical Residents. Bull Am Coll Surg. 2015 Aug; 100(8):29-34.
13. Ogunleye A, Bliss L, Kuy S, Leichtle S. Political Advocacy in Surgery: The Case for Individual
Engagement. Bull Am Coll Surg. 2015 Aug; 100(8):40-4.
14. Dua A, Kuy S, Desai S, Heller J, Lee C. Diagnosis and Management of a Ruptured Mycotic
Popliteal Pseudoaneurysm. Vascular. 2015 Aug;23(4):419-21
15. Kuy S, Dua A Uncertainty in management of carotid stenosis in women - reply. JAMA Surgery.
2014; 149(4):402-3.
16. Kuy S, Dua A, Desai S, Chappidi Rohit, Patel B, Seabrook G, Brown K, Lewis B, Rossi P, Lee C.
The Increasing Incidence of Thromboembolic Events among Hospitalized Patients with
Inflammatory Bowel Disease. Vascular. 2014 Jul l.pii: l 708538114541799.
17. Kuy S, Dua A, Lee C, Patel B, Desai S, Dua A, Szabo A, Patel P. National Trends in Utilization
of IVC Filters in the United States, 2000-2009. Journal of Vascular Surgery: Venous and
Lymphatic Disorders. 2014 Jan;2(1): 15-20.
18. Dua A, Kuy S, Lee CJ, Upchurch G Jr, Desai S. Epidemiology of Aortic Aneurysm Repair in the
United States from 2000 to 2010. Journal a/Vascular Surge1y. 2014;59(6):1512-7.
19. Dua A, McMaster J, Desai P, Desai S, Kuy S, Mata M, Cooper J. The Association between Blunt
Cardiac Injury and Isolated Sternal Fracture. Journal of Cardiology Research and Practice.
2014;2014:629687
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20. Dua A, Dua A, Jechow S, Desai S, Kuy S. Idiopathic Spontaneous Rupture of an Intercostal
Artery. Wisconsin Medical Journal. 2014; 113(3): 116-8.
21. Dua A, Aziz A, Desai S, McMaster J, Kuy S. National Trends in the Adoption of Laparoscopic
Cholecystectomy over 7 years in the United States and Impact of Laparoscopic Approaches
Stratified by Age. Minimally Invasive Surgery. 2014;2014:635461.
22. Kuy S, Juern J, Weigelt J. Laparoscopic Primary Repair of Traumatic Intrapericardial
Diaphragmatic Hernia. Journal o.fLaparoscopic Surgeons 2014;18(2):333-7.
23. Kuy S, Dua A, Rossi P, Seabrook G, Lewis B, Patel B, Lee C, Desai S, Brown K. Carotid
Endarterectomy National Trends Over a Decade: Does gender matter? Annals of Vascular
Surgery. 2013 Dec 6. pii: SO89O-5O96(13)OO641-9.
24. Dua A, Desai SS, Dua A, Charlton-Ouw K, Dongerkery SP, Patel B, Kuy S, McMaster J, Darlow
M, Shapiro ML. The Impact of Co-Morbid Conditions and Insurance Status on Trauma Patient
Outcomes. TRAUMA. 2013, Vol. 15 Issue 3, p239
25. Kuy S, Rossi P, Seabrook G, Brown K, Lewis B, Rilling W, Martin G, Patel B, Dua A, McMaster
J, Desai S, Lee C. Endovascular Management of a Traumatic Renal-Caval Arteriovenous Fistula
in a Pediatric Patient. Annals of Vascular Surgery. Dec 2013. pii: SO89O-5O96(13)OO472-X.
26. Kuy S, Dua A, Desai S, Dua A, Patel B, Tondravi N, Seabrook G, Brown K, Lewis B, Lee C, Kuy
S, Subbarayan R, Rossi P. Surgical Site Infections Following Lower Extremity Revascularization
Procedures Involving Groin Incisions. Annals o_f Vascular Surge1y. 2013 Nov 1. doi:pii: SO89O5O96(13)OO423-8.
27. Dua A, Dua A, Desai S, Kuy S, Sharma R, Jechow S, McMaster J, Patel B, Kuy S. Gender Based
Differences in Management and Outcomes of Cholecystitis. American Journal of Surgery. 2013
Nov;2O6(5):641-6.
28. Kuy S, He C, Cronin D. Renal Mucormycosis: A Rare and Potentially Lethal Complication of
Kidney Transplantation. Case Reports in Transplantation. October 2013;2013:915423
29. McMaster J, Dua A, Desai S, Kuy S. Short Term Outcomes Following Breast Cancer Surgery in
Pregnant Women. Gynecologic Oncology. 2013 Sep 13. doi:pii: SOO9O-8258(13)O1 l 77-3.
30. Kulaylat AN, Zheng F, Kuy S, Bittner JG. Early Surgical Specialization: a new paradigm. Bull
Am Coll Surg. 2013 Aug;98(8):43-9.
31. Baker J, Misra S, Manimala NJ, Kuy S, Gantt G. The Role of Politics in Shaping Surgical
Training. Bull Am Coll Surg. 2013 Aug;98(8): 17-25 ..
32. Kuy S, Seabrook G, Rossi P, Lewis B, Dua A, Brown K. Management of Carotid Stenosis in
Women. JAMA Surgery. 2013 Aug;l48(8):788-9O. Epub June 26, 2013.
33. Dua A, Patel B, Kuy S, Seabrook G, Tondravi N, Brown K, Lewis B, Rossi P. Asymptomatic
50-75% Internal Carotid Artery Stenosis in 288 Patients: Risk Factors for Disease Progression
and Ipsilateral Neurological Symptoms. Perspectives in Vascular Surgery and Endovascular
Therapy. 2013 Dec; 24(4): 165-70. doi: 1O. ll 77/1531OO3513491986.
34. Dua A, Patel B, Heller J, Kuy S, Dubose J, Tomasek JS, Larssen EM, Desai S. Variability in the
Management of Superficial Venous Thrombophlebitis between Phlebologists and Vascular
Surgeons. Perspectives in Vascular Surgery and Endovascular Therapy. 2013 Jun;25(1-2):5-1O.
35. Desai P, Dua A, McMaster J, Patel B, Dua A, Kuy S, Desai S, Krzowski-Firych J. Infectious
Mononucleosis-Like Syndrome Presented in Toxoplasmosis Infection. J Surg Rad 2013:134136.
36. Kuy S, Vickery M, Dua A, Rosner G. Appendiceal endometriosis mimicking appendicitis. JAMA
Surgery. 2013 May 1;148(5):481.
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37. Kuy S, Samberg L, Paul J, Brown N, Saving A, Codner P. Undetected Penetrating Bladder
Injuries Presenting as a Spontaneously Expulsed Bullet During Voiding: A Rare Entity and
Review of the Literature. Journal of Emergency Medicine. 2013 May 25: S0736-4679(13)003569.
38. Dua A, Desai S, Kuy S, Patel B, Dua A, Desai P, Darlow M, Shirqavi J, Charlton-Ouw K,
Shortell C. Predicting outcomes using the national trauma data bank: Optimum management of
traumatic and blunt thoracic injury. Per::,pectives in Vascular Surgery and Endovascular Therapy.
Sep;24(3): 123-127, ePub: March 26, 2013.
39. Kuy S, Dua A, Desai SS, Baraniewski H, Lee C. Ruptured Mycobacterial Aneurysm of the
Carotid Artery. Perspectives in Vascular Surgery and Endovascular Therapy. 2013;25(3-4):53-6.
40. Dua A, Desai S, McMaster J, Aziz A, Dua A, Kuy S. The Role of Platelets in Vascular Trauma
Patients Compared to Patients with Chronic Vascular Disease. Vascular Disease Management.
2013; 10(1 l):E240-E243.
41. Kuy S, Codner P, Guralnick M, Dua A, Paul J. Combined rectovesicular injuries from low
velocity penetrating trauma in an adult. Wisc A1ed J. 2013; 112(1):32-34.
42. Kuy S, Greenberg C, Gusani N, Dimick J, Kao L, Brasel K. Health services research resources for
surgeons. J Surg Res. 2011; l 71(1):e69-73.
43. Kuy S, Sosa J, Desai R, Roman S, Rosenthal R. Age matters: A study of clinical and economic
outcomes following cholecystectomy in elderly Americans. Am J Swg. 2011;201(6):789-796.
44. Kuy S, Roman SA, Desai R, Sosa JA. Outcomes Following Cholecystectomy in Pregnant and
Non-pregnant Women. Surgery. 2009; 146(2):358-366.
45. Kuy S, Roman S, Desai R, Sosa J. Outcomes following thyroid and parathyroid surgery in
pregnant women. Arch Stag. 2009;144(5):399-406. Commentary by F Moore.
46. Kuy S. Stand up for patients. Bull Am Coll Surg. 2008;93(8):23-24.
47. Franks K, Li H, Kuy S, Kong W. Photodissociation ofICN at 266 nm and BrCN at 230 nm using
brute force orientation. Chemical Physics Letters. 1999;302: 151-156.
EDITORIALS/TECHNICAL NOTES/NEWSLETTER ARTICLES/lvIEDICAL BLOGS
l.
2.
3.
4.
5.
6.
7.
Kuy S, Romero R, Cypher E. Shreveport: A Success Story. Creating a Culture of
Safety at the Overton Brooks VA Medical Center. Topics in Patient Safety.
Veterans Affairs National Center for Patient Safety. September 2014; 14(5): 1,4.
Kuy S. Profiles in Leadership. Association of Women Surgeons Blog. September
2014.
Kuy S. Health Services Research for Surgeons. Association of Women Surgeons
Website. 2014.
Kuy S. Women Surgeon Leaders for the 21 st Century. Association of Women
Surgeons Newsletter. July 25, 2014
Kuy S. The Imperative to Improve Gallbladder Disease Treatment and Outcomes
for Men. Robert Wood Johnson Foundation Human Capitol Blog. November 22,
2013.
Kuy S. Society for Vascular Surgery Trainee Advocacy Award Essay. Society for
Vascular Swgery website. 2012.
Kuy S. Information & technology review: Online health resources for surgeons.
Association for Academic Surgery Newsletter. Fall, 2010: 6-7.
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8. Kuy S. Stand up for patients. Los Angeles Times. February 28, 2008.
BOOKS AND BOOK CHAPTERS
1. Kuy S (senior editor), Kwon R, Hochman M. 50 Studies Every Surgeon Should
Know. Oxford Press. (Planned release 2017)
2. Provo B, Kuy S. Venous insufficiency ulcers. In Domino FJ (Ed.), The 5-Minute
Clinical Consult 2015, Philadelphia: Lippincott Williams and Wilkins.
3. Aljoudi M, Dua A, Kuy S. Cervical Bruit. In Domino FJ (Ed.), The 5-Minute
Clinical Consult 2016, Philadelphia: Lippincott Williams and Wilkins.
4. Dua A, Aljoudi M, Kuy S. Absent or Diminished Pulse. In Domino FJ (Ed.), The 5Minute Clinical Consult 2016, Philadelphia: Lippincott Williams and Wilkins.
1. Aljoudi M, McMaster J, Kuy S. Breast Cancer and Pregnancy. In Domino FJ (Ed.),
The 5-Minute Clinical Consult 2016, Philadelphia: Lippincott Williams and Wilkins.
2. Dua A, Desai S, Kuy S. Inguinal Mass. In Domino FJ (Ed.), The 5-Minute Clinical
Consult 2016, Philadelphia: Lippincott Williams and Wilkins.
PRESENTATIONS
1. Reducing Surgery Cancellations in a Tertiary Hospital: A Three Year Review.
Association of VA Surgeons 2016 Meeting; Virginia Beach, VA April 2016.
2. Why We Don't Come to Clinic: Patient Perspectives. Association of VA Surgeons
2016 Meeting; Virginia Beach, VA April 2016.
3. The Myth of Sisyphus: Is Reducing Surgery Clinic No-Shows Impossible?
Association of VA Surgeons 2016 Meeting; Virginia Beach, VA April 2016.
4. It Takes a Village: Referring Providers Impact Patient No Shows. Association of VA
Surgeons 2016 Meeting; Virginia Beach, VA April 2016.
5. Reducing Surgical Site Infections Utilizing a Prevention Bundle and a
Multidisciplinary Approach at a Veterans Affairs Hospital. The American College of
Surgeons NSQIP 2015 Meeting; Chicago, IL; July 2015.
6. Transformational Change: Creating a Culture of Safety in the Operating Room.
Presented at: The American College of Surgeons NSQIP 2015 Meeting; Chicago, IL;
July 2015.
7. Outlier to Leader: Designing a Risk Stratification Intervention to Decrease 30 Day
Surgical Mortality in a Veterans Affairs Hospital. The American College of Surgeons
NSQIP 2015 Meeting; Chicago, IL; July 2015.
8. Outlier to Leader: Designing a Risk Stratification Intervention to Decrease 30 Day
Surgical Mortality in a Veterans Affairs Hospital. Presented at: The Association of VA
Surgeons 2015 Meeting; Miami, FL; May 2015.
9. Transformational Change: Creating a Culture of Safety in the Operating Room.
Presented at: The Association of VA Surgeons 2015 Meeting; Miami, FL; May 2015.
10. The Rising Incidence and Mortality of Clostridium Difficile Associated Megacolon.
Presented at: The Association of VA Surgeons 2015 Meeting; Miami, FL; May 2015.
11. The Increasing Incidence of Thromboembolic Events Among Patients with
Inflammatory Bowel Disease. Presented at: American College of Surgeons 2013
Clinical Congress; Washington DC; October 2013.
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12. Diagnosis and Management of a Ruptured Popliteal Mycotic Pseudoaneurysm.
Presented at: Eastern Vascular Society. Sulfur Springs, West Virginia. September 21,
2013. (First Place Winner of the 2013 Resident Award)
13. Ruptured Carotid Mycotic Tuberculoid Aneurysm from Intravesical BCG. Presented
at: Midwestern Vascular Surgical Society. Chicago, Illinois; September 8, 2013
14. Do women experience delays in carotid endarterectomy? Presented at: Society for
Vascular Surgery Annual Meeting; San Francisco, California; May 31, 2013. (Winner
of Sectional Poster Competition)
15. National trends in utilization of IVC filters over a decade in the United States, 20002009. Presented at: Society for Vascular Surgery Annual Meeting; San Francisco,
California; May 31, 2013.
16. Surgical site infections and complications following vascular groin procedures.
Presented at: Peripheral Vascular Surgery Society meeting; Park City, Utah; February
1, 2013.
17. Endovascular management of a traumatic renal-caval arteriovenous fistula in a
pediatric patient. Presented at: International Symposium on Endovascular Therapy;
Miami, Florida; January 22, 2013.
18. Carotid endarterectomy national trends over a decade: Does gender matter? Presented
at: Midwestern Vascular Surgery annual meeting; Milwaukee, Wisconsin; September
6, 2012.
19. Asymptomatic 50-75% internal carotid artery stenosis in 288 patients: Risk factors for
disease progression and ipsilateral neurological symptoms. Presented at: Midwestern
Vascular Surgery annual meeting; Milwaukee, Wisconsin; September 6, 2012.
20. A study of clinical and economic outcomes following cholecystectomy in elderly
Americans. Presented at: Department of Surgery grand rounds, Medical College of
Wisconsin; Milwaukee, Wisconsin; June 10, 2010.
21. Predictors of in-hospital mortality following cholecystectomy among hospitalized
patients. Presented at: 5th annual Academic Surgical Congress; San Antonio, Texas;
February 3, 2010.
22. Predictors of in-hospital mortality following cholecystectomy. Presented at: American
Medical Association 2010 research symposium; San Diego, California; November 5,
2010 (Honorable Mention Prize).
23. Outcomes following breast surgery in pregnant women. Presented at: 90th annual
meeting of the New England Surgical Society; Newport, Rhode Island; September 13,
2009.
24. Outcomes following breast surgery in pregnant women. Presented at: Department of
Surgery grand rounds, Yale University School of Medicine; New Haven, Connecticut;
September 9, 2009.
25. Gender based differences in management and outcomes of cholecystitis. Presented at:
AcademyHealth 2009 annual research meeting; Chicago, Illinois; June 28, 2009.
26. Gender based disparities in outcomes of cholecystitis. Presented at: New England
science symposium; Boston, Massachusetts; April 3, 2009.
27. Women have better outcomes in cholecystitis. Presented at: American Medical
Women's Association conference, Women's Health 2009, 17th Annual Congress;
Williamsburg, Virginia; March 27-29, 2009.
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28. Outcomes following cholecystectomy in pregnant and non-pregnant women. Presented
at: 4th Annual Academic Surgical Congress; Fort Myers, Florida; February 3-6, 2009.
29. Outcomes following thyroid and parathyroid surgery in pregnant women. Presented at:
Robert Wood Johnson Clinical Scholars 2008 National Conference; Washington, D.C.;
November 18-21, 2008.
30. Disparities in outcomes following thyroid and parathyroid surgery in pregnant and nonpregnant women. Presented at: Disparities in Surgical Care symposium; Boston,
Massachusetts; Oct 27-28, 2008.
31. Outcomes following thyroidectomy and parathyroidectomy in pregnant women in the
US, 1999-2005. Presented at: 89th annual meeting of the New England Surgical
Society; Boston, Massachusetts; September 26-28, 2008.
32. Outcomes following thyroid and parathyroid surgery in pregnant women. Presented at:
Department of Surgery grand rounds, Yale University School of Medicine; New
Haven, Connecticut; September 24, 2008.
33. Are Drains Necessary After Craniosynostosis Surgery? American Society of Plastic
Surgeons: Plastic Surgery Senior Residents Conference. Houston, Texas. March 1719, 2005.
34. The Effects of Heat Treatment on Lactoferrin Concentration in Breast Milk.
International Health Medical Education Consortium Conference. Havana, Cuba.
March 12-15, 2002
JOURNAL REVIEWER
JAJvfA Surgery Reviewer
Journal of Surgical Research Reviewer
British Medical Journal Case Reports Reviewer
2016-present
2016-present
2014-present
TEACHING EXPERIENCE:
Louisiana State University - New Orleans, Associate Professor of Surgery
Louisiana State University - Shreveport, Assistant Professor of Surgery
Lecturer, Surgery Resident SCORE Curriculum
Lecturer, Third Year Medical Student Curriculum
Clinical Preceptor, First Year Medical Students
Yale University School of Medicine
Course Facilitator, Introduction to Research
Oregon State University
Teaching Assistant, General Microbiology
Teaching Assistant, Introduction to Microbiology
Teaching Assistant, Biology
2017-present
2014-2016
2016
2014-2016
2014-2016
2007-2009
1999
1998 - 1999
1997
HONORS, AW ARDS & GRANTS
Early Career Achievement Award, Oregon Health & Sciences University,
School of Medicine Alumni Association.
Awarded to an alumnus who has made significant career contributions in
improving health.
2017
2017
Presidential Leadership Scholar
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Executive Leadership Training led by President Bush and President Clinton,
held over 6 months onsite at the George H. W Bush Presidential Center,
William .J Clinton Presidential Center, George W Bush Presidential Center &
Lyndon B. Johnson Presidential Center.
American College of Surgeons Health Policy Scholar
Award provides $8,000 grant, one of two general surgeons awarded to attend
the "Leadership Program in Health Policy and Management" Executive
Education Program at Brandeis University Heller School for Social Policy
and Jvfanagement.
2016
Business Report's 2016 "Forty Under 40" Award
Award in recognition qf leadership, community service and career
accomplishments
2016
Ford Family Foundation Gerald E. Bruce Leadership & Community Service
Award
Award recognizing excellence in leadership & service, provides $5,000 grant
which Dr. Kuy donated to a nonprofit serving veterans.
2016
Certificate of Appreciation, Overton Brooks VA Medical Center
Presented by A1edical Center Director for lt'ork in promoting diversity, invited
Keynote Speaker for VA 's Asian Pacific American Celebration A1onth
2015
Making a Difference Award, Overton Brooks VA Medical Center
Recognition of excellence in clinical care
2014
Certificate of Appreciation, Overton Brooks VA Medical Center
Presented by Jvfedical Center Director for Surgical Services' Achievement in
Reducing Adverse Events and Mortality
2014
American College of Surgeons Advocacy Travel Grant
2012
American Medical Association 2010 Research Symposium Honorable
Mention Prize
2010
Medical College of Wisconsin Affiliated Hospitals (MCW AH) Research
Award
2010
New England Surgical Society 89th Annual Resident Research Competition Award
2008
Robert Wood Johnson Foundation Clinical Scholars Fellowship. National
award providing two years of training in health services research, Yale
University School of Medicine
2007 -2009
VA-19-0799-D-001518
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Surgery Intern of the Year Award, Department of Surgery, University of Texas
Health Sciences Center at San Antonio
2006
Oregon Health & Science University ROSE Award (Recognition of
Outstanding Service and Excellence)
2001
Ralph Bosworth, MD Memorial Scholarship
2000
Dr. JoAnne J. Trow Woman of Distinction Award
2000
Wal do-Cummings Outstanding Student Award
2000
Phi Kappa Phi Honor Society Tunison Award
1999
OSU Department of Microbiology Mark H. MiddleKauf Scholarship
1999
OSU Department of Microbiology Joseph E. Simmons Scholarship
1999
OSU College of Agricultural Science Jesse Hanson Scholarship
1999
OSU College of Science Heitmeyer Scholarship
1996
Presidential Scholar
1996
Laurel G. Case, MD Memorial Scholarship
1996
Robert C. Byrd Honors Scholar
1996
Valedictorian, Crescent Valley High School
1996
NEWS ARTICLES:
Read about Dr. Kuy's work reducing mortality and patient safety adverse events profiled in the
VA National Center for Patient Safety here:
http ://www.pati entsafety.va.gov/features/Shreveport A Success Story.asp
Read about Dr. Kuy's work improving veterans' access to care through clinic efficiency profiled
by the Association of VA Surgeons here: http ://www.avasnews .com/singlepost/2016/05/16/REDUCING-NO-SHOWS
Read about Dr. Kuy's work at Louisiana Medicaid improving healthcare quality profiled by
Mostly Medicaid here: http ://www.mostlymedicaid.com/? p=l82l
Read about Dr. Kuy's work with Medicaid Expansion to improve patient health profiled by
Business Reports 40 Under 40 here: https://www.businessreport.com/article/forty-40-qasreyram-kuy
VA-19-0799-D-001519
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GRANTS AWARDED:
Zero to Three Grant
"Text4Baby"
$10,000 grant for Technical Assistance implementing Text4Baby, a program
aimed at improving birth outcomes for pregnant women in Louisiana
Medicaid.
2016
National Governors Association Grant
"Getting the Right Information to the Right Health Care Providers, at the Right
Time- How States Can Improve Data Flow"
Awarded to Louisiana Medicaid's Health Information Technology Team, one
of three states to receive this grant in the form of Technical Assistance
2016
Centers for Medicare & Medicaid Services Grant
"Louisiana's Health Information Technology (HIT) and Health Information
Exchange (HIE) Implementation Advance Planning".
Support adoption and meaningful use of certified EHR technology activities,
promote interoperability among EHRs, state HIEs and the Medicaid system;
and provide for the design, development and implementation of the
appropriate data infrastructure for FY 2017 and 2018.
Total grant awarded: $25,900,382
2016
GRANT APPLICATION IN SUBMISSION
Submitted to PCORI 12/2016
"Provider-Targeted Strategies to Improve Patient-Centered Care for a Medicaid-Insured
Population by Reducing Opioid Over-Prescribing and Increasing Provider Knowledge of Opioid
Harms and Alternative Therapies for Chronic Non-Cancer Pain"
Principal Investigator:
SreyRam Kuy, MD, MHS, FACS (Louisiana Department of Health)
Total Project Cost: $4 million
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REFERENCES
Dr. Harlan Krumholz
Board of Governors, PCORI
Harold H Hines Professor of Medicine, Yale School of Medicine
Director, Yale Robert Wood Johnson Foundation Clinical Scholars Program
Director, Center for Outcomes Research and Evaluation
Phone: 203-641-2501
Email: Harlan.Krumhol z@yale.edu
Dr. Elizabeth Bradley
President-Elect, Vassar College
Professor of Public Health
Faculty Director of the Yale Global Health Leadership Institute
Brady-Johnson Professor of Grand Strategy
Master of Branford College, Yale University - School of Public Health
Yale Email: Elizabeth.Bradley@yale.edu (until June 30, 2017)
Vassar Email: Elizabeth.Bradley@vassar.edu (After July 1, 2017)
Dr. Ramon Romero
Chief, Surgical Service, Overton Brooks VA Medical Center
Associate Professor, Louisiana State University - Shreveport
Phone: 318-990-9674
Email: Ramon.Romero@va.gov
Dr. Quyen Chu
Charles Knight, Sr Endowed Professor of Surgery
Chief, Surgical Oncology, Louisiana State University - Shreveport
Phone: 318-655-1358
Email: qchu@lsuhsc.edu
Dr. Ashley Ferraro
Associate Program Director of Pulmonary & Critical Care Medicine Fellowship
Overton Brooks VA Medical Center
Associate Professor, Louisiana State University - Shreveport
Phone: 816-591-9866
VA-19-0799-D-001521
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Message
David shulkin [Drshulkin@aol.com]
3/29/2017 11:21:29 PM
Poonam Alaigh [(b) (6)
hotmail.com]
Re: POLITICO's Morning eHealth, presented by the Coalition to Protect America's Health Care: A new notion for
telemedicine funding? - New studies build the case - Shuren promises 'black belt' regulatory excellence
From:
Sent:
To:
Subject:
Or hire (b) (6)
Sent from my iPhone
On Mar 29, 2017, at 6: 13 PM, Poonam Alaigh <(b) (6)
hotmail.com> wrote:
Not at all- it's strange how (b) (6)
has become our source of information about the VA- we will
need to change things around here
Sent from my iPhone
On Mar 29, 2017, at 7: 10 PM, David shulkin wrote:
Did u know?
Sent from my iPhone
Begin forwarded message:
From: (b) (6)
<(b) (6)
nyu.edu>
Date: March 29, 2017 at 4:30:29 PM CDT
To: (b) (6)
Subject: Fwd: POLITICO's Morning eHealth, presented by
the Coalition to Protect America's Health Care: A new notion
for telemedicine funding? - New studies build the case Shuren promises 'black belt' regulatory excellence
VA ALLOWS RELEASE OF NEGATIVE HIV RECORDS:
A recent rule from the Department of Veterans' Affairs will allow
VA personnel to share veterans' negative HIV tests - and sickle cell
test results - with outside providers. The rule explains that some of
the stigma is gone from both diseases, and the previous regulation
"causes delays and an unnecessary burden on veterans" when the
VA tries to share EHR data through electronic health information
exchanges. VA will continue to require a "qualifying written
authorization from the veteran" prior to sharing positive HIV or
sickle cell test results, per the rule.
Sent from my iPhone
Begin forwarded message:
VA-19-0799-D-001522
OS 00003193
From: "Morning eHealth"
Date: March 29, 2017 at 10:06:20 AM EDT
To: <(b) (6)
nyu.edu>
Subject: POLITICO's Morning eHealth,
presented by the Coalition to Protect America's
Health Care: A new notion for telemedicine
funding? - New studies build the case Shuren promises 'black belt' regulatory
excellence
Reply-To: "POLITICO subscriptions"
VA ALLOWS RELEASE OF NEGATIVE HIV
RECORDS: A recent rule from the Department of
Veterans' Affairs will allow VA personnel to share
veterans' negative HIV tests - and sickle cell test
results - with outside providers. The rule explains
that some of the stigma is gone from both diseases,
and the previous regulation "causes delays and an
unnecessary burden on veterans" when the VA tries
to share EHR data through electronic health
information exchanges. VA will continue to require
a "qualifying written authorization from the
veteran" prior to sharing positive HIV or sickle cell
test results, per the rule.
VA-19-0799-D-001523
OS 00003194
Message
From:
Sent:
To:
Subject:
Poonam Alaigh [(b) (6)
hotmail.com]
3/29/2017 11:13:21 PM
David shulkin [Drshulkin@aol.com]
Re: POLITICO's Morning eHealth, presented by the Coalition to Protect America's Health Care: A new notion for
telemedicine funding? - New studies build the case - Shuren promises 'black belt' regulatory excellence
Not at all- it's strange how (b) (6)
things around here
has become our source of information about the VA- we will need to change
Sent from my iPhone
On Mar 29, 2017, at 7: 10 PM, David shulkin