 Dr. David J. Shulkin was confirmed as the 9th Secretary of Veteran Affairs on February 13, 2017, after having served 18 months as VA's Undersecretary for Health, leading the nation's largest integrated healthcare system with over 1,700 sites of care serving 9 million veterans. Dr. Shulkin's priorities as Undersecretary were improving access, engaging employees, and building a high-performance healthcare network. He identifies and implements best practices and restores public trust in VA's healthcare. During his tenure, staffing grew, clinical workload increased, wait times for urgent care improved, and veterans' trust in VA rose. Before joining VA, Dr. Shulkin served in numerous chief executive roles at Beth Israel Medical Center, Morristown Medical Center, and Atlantic Health System Accountable Care Organization. He has also served in numerous academic, entrepreneurial, executive roles and he maintains an active practice of internal medicine in the VA system. A board-certified internist, Dr. Shulkin received his medical degree from the University of Medical College, Pennsylvania. He completed his internship at Yale University School of Medicine, a residency and fellowship in general medicine at the University of Pittsburgh Presbyterian Medical Center, and he was a Robert Wood Johnson Foundation clinical scholar at the University of Pennsylvania. Dr. Shulkin has been named among the 50 most influential physician executives in the country, and among the 100 most influential people in American healthcare by Modern Healthcare Magazine. Ladies and gentlemen, the Secretary of Veteran Affairs, David J. Shulkin. Good morning. Good morning, everybody. It's great to see so many of you here, and thank you all for getting up early on a Sunday morning and being here, but I know this is your passion and this is your commitment, so it doesn't surprise me that all of you are here bright and early. Dave, I just wanted to thank you. You're really an inspiration not only to probably so many of us here, but certainly to me. Dave is, I don't need to tell you about him, but not only obviously stepped up to serve the country, but has never stopped serving and committed to serving all of you in the roles that he plays, so thank you very much. I want to thank Teresa. Where's Teresa? Right. Francis Costa, Mark Burgess, Pat Kemper, Barry Jezanowski, and of course Gary Augustine. They serve all of you so well, and you're so lucky to have them in leadership positions. You know, when you're secretary, you can have favorites among VSOs, of course, so you have to love them all, but you guys are the first that I'm talking to as secretary, just so. But I have to tell you, not only are you represented by your leadership so well, but this is such an extraordinary organization that I really have tremendous admiration for, you know. And I will say this, I am absolutely convinced that you have the very, very best communications team and your videos are done in a way that every time I see one of your videos, I go back to my team at VA and I say, why can't you be like DAV? I mean, you guys, the keeping the promise videos, your recent video on choice, I mean, the messages are perfect. They're done in a way that makes us extraordinarily proud, and it's a way that we partner together. And I just have to mention a couple other things. Your support and your leadership in the Winter Sports Clinic, how many of you have ever had a chance to go out to the Winter Sports Clinic? For me, it was life-changing when my family and I went out there last year. It's just an incredible event. And obviously the work that all of you do in your transportation services, so many ways that DAV is such an extraordinary partner and helps veterans. I'm very proud of it. So what I wanted to do this morning is just talk a little bit about the plans for the VA and my perspective on VA. I'm going to try to get through this in the next 25 minutes or so. And as I said, this is the first time that I've given a public address as Secretary. And so I wanted to talk a little bit about my hopes and plans for modernizing the VA healthcare system. As Secretary, it's really my greatest privilege to be able to help fulfill the mission that President Lincoln set out for us. And this is really the way that I wake up every day and make sure that we're going to make progress in the VA by committing to this type of mission. And one of the things that you get a lot and that you're hearing a lot in the news is, well, why do we need the VA healthcare system? And why can't we figure out ways that the private sector can just take over this role for us? And so it's important, and I think all of you know this, that the VA system is a very, very different system than what you would see in the private sector. And for me, as I begin to travel and I have been out and visiting VA systems and you see things like this, the final salute, where you can see how we honor and respect those who have served the country, you know that you wouldn't see things like this out in the private sector. So this is a veteran who had passed away and instead of just what private hospitals would do is sort of put a white sheet over them and sort of wheel them, you know, down the elevator to the morgue, you can see the type of respect that's given to people throughout the VA system in what's called the final salute. The VA system is clearly a different system. You can see when you go out into the private sector just one in five providers have any real type of military cultural competency. So if you're being treated in a behavioral health clinic in the private sector and you say, well, you know, I was injured with an IED blast and your psychologist says, well, what's an IED? You can see that's an example where there aren't high levels of cultural military competency. Only 13 percent of private sector mental health providers actually have proficiency in deployment issues and military issues. And as I came just about 19 months ago from the private sector, one of the things I began to realize is how so many of the things offered in the VA healthcare system are not readily available in the private sector. And so it became clear to me that why the VA is such a unique resource and why it's so important for us to be able to maintain a strong VA. So when you look at things like peer support, crisis lines, transportation, caregivers, our homelessness services and the list go on, these are things that the VA does every day but aren't readily available in the private sector. I had already mentioned our adaptive sports programs and the winter sports clinic, the DAV is so strong and leading. But we have seven other adaptive sports programs. This summer I was out in San Diego. Actually, I got to serve for the first time. It's not very easy. But the veterans who were out there showing me how to do it made it look easy. And these are just fantastic ways of getting people to feel good about their lives and getting that ability to challenge themselves. And this really is part of our definition of well-being. It's not just medications and surgical procedures. It's treating the whole spirit of a veteran. And adaptive sports is clearly something that VA excels in. Another area that VA excels in is technology. And nobody else in the country, in the entire country is using technology the way that the VA healthcare system is. We by far are using telehealth services in a way that no other system even begins to approach. Nine million episodes, 717,000 veterans having the chance to benefit from this technology. Even in mental health, 336,000 telemental health visits a year. And in our ICUs, if you're in a small city ICU where you don't have 24-hour intensivists, we can provide that for you. So there's a doctor who is critically, is trained in critical care medicine who is watching you and monitoring you from places around the country using telehealth. One of the things that I learned when I came to VA is how to use telehealth. I'd never done this before. But for my office in Washington, I actually take care of patients in Grants Pass Aragon, where they don't have many primary care doctors. That's the type of doctor I am. So I've begun to start using this technology and seeing how powerful it really is. Of course, you know that VA has four healthcare missions. The stool over there are the traditional three legs, all serving veterans. Our clinical care, our education, our research. But we also have a fourth mission of emergency preparedness. And I don't think many people in the country understand that with what's happened in the private sector, with hospitals gobbling up one another and decreasing bed size, if there is a national emergency, either a type that's a military emergency or a medical emergency, there's not much capacity left in our hospital systems to take care of the American public. Well, the VA healthcare system is that safety net. It is that backbone. We respond to national emergencies and we're prepared for it. We train for it every day. And that's a really important mission that you never think about until you need it. But if that system wasn't there, I know the country wouldn't be as safe. Now let's talk a little bit about modernization because that's really what I'm focused on as secretary to make sure that we have a modern VA healthcare system and that we invest in the right way. And when you start to think about modernization, it's often important to go back in history and understand the contributions that the VA healthcare system has had for America. So when you start in the very beginning, I actually go back to the civil war. And during the civil war is, you know, that was one of the bloodiest battles that ever occurred in America because the not only were so many people fighting in that war, but the types of injuries were so intense because they were bayonets and people were shot at very close ranges. And the doctors in the civil war were learning almost on a daily basis how to start treating these injuries and deal with the types of trauma that they were seeing. So they actually had a book where they were writing down how to treat these injuries. And it was on the battlefield and the book was growing so much as they were adding different ways of treatment that they would begin to start stuffing the book and the binding would break. And in order to keep the binding together, they would wrap it with red tape just to keep it together. So the VA was the one who invented red tape in government. But actually going back to more recent history, the VA in trying to modernize has had lots and lots of studies and assessments on what we need to do to improve. And you can see just starting back in the 2000s, we've had the VHA vision. We've had transformation documents. We've had more recently, of course, our strategic plans, the Commission on Care, the all the GAO reports. So we've had over, I can count, 140 different assessments on how we should improve and modernize the VA. We do not need any more assessments, any more commissions, or any more study groups. I think we've seen every recommendation written multiple ways. What we now need to do is just start executing. We need to actually take the recommendations that we know that we need to do and focus on actually getting them done. And that's what I'm going to be focusing on. So in terms of the structure of the VA, we have to make this system actually with a lot less red tape. We have to actually streamline the organization to make it work better for all of you. And our vision is to become a very highly integrated network of what works in the VA and what works in the community to make it work for veterans. And so we're going to be focusing on redesigning and the implementation is the big area. Now, the 10 priorities that I plan to focus on as the Secretary are, first of all, to work with our Congress on accountability legislation. What this means is that the employees in the VA, the 365,000 employees, the vast, vast majority of our employees, as you know, as you come into contact with, are really unbelievably dedicated, hardworking, patriotic employees. Many of them veterans themselves, as you know, and they do a great job every day. But there are, when you have a workforce that big, employees that deviate from the ethics and values that we all hold dear. And those employees should not be working in the VA. And we're going to make sure that the Secretary has the authority to make sure that those employees, when they deviate from those values, are leaving the VA system. The second priority I'm going to focus on is making sure that the resources that were made available from the choice program, the $10 billion that Congress authorized, are there so that we can continue to use them because we really need all the resources that we've been getting from Congress. And that program expires August 7th. So if we don't act, if Congress doesn't act, we will see essentially a significant amount of resources that are dedicated to caring for veterans be removed. And we can't let that happen. So we're working with Congress to make sure that we extend that deadline past August. And we hope in the next few weeks to be able to have successful legislation. After that, our focus is going to be on making sure that we redesign the choice program after it's reauthorized. We redesign the program. I'm calling it choice 2.0 until we find a better name for it. To make it work better for veterans. We know that this program, even though it was well-intentioned, was extremely complex and bureaucratic. And it was too hard to get the care that you all deserve to get when you need to go into the community. So we want to simplify it. We want to make it easier to use to work better for you. And we're going to work hard to do that. The next focus is going to be on improving our infrastructure. Our buildings are too old. Many of the facilities, frankly, should have been remodeled or even torn down and rebuilt. And we need to make sure that we have the very, very best types of facilities and equipment and people to care for our country's veterans. And so we're going to focus on reinvigorating our efforts to rebuild our infrastructure. The next priority I'm going to focus on is what I call enhancing our foundational services. These are services that are available for veterans that aren't available outside of the VA. Specialized programs that we have in areas like spinal cord injury, in areas like traumatic brain injury, in PTSD, and other types of conditions that are really important for veterans that don't exist in ways that are easily accessible to veterans outside of the VA. We're going to make sure that we are focusing on having those to be world-class. I believe it is important that VA and DOD and federal facilities work together in ways that are closer together. We have several great examples of this where VA and DOD are sharing facilities, sharing resources. I want to continue to expand those types of opportunities. Our electronic medical record and interoperability with the Department of Defense, we've made a lot of progress, but there's still much more work that we can do. And we are now focused on modernizing our information technology systems. And so you're going to see some new and bold proposals to be able to make sure that VA continues to have high-quality modern IT systems. Suicide prevention. This is an area we're going to talk about just in a second, but we have not been able to make the type of progress that we need to make on preventing suicides. And so this is our top clinical priority. You're going to see some bold programs. Appeals modernization. We know the appeals process is broken. We can only fix it through legislation. We're going to make sure that we work hard to get that done this year. And then in VBA, our benefits, we are not satisfied with our performance. Even though we've made terrific progress on bringing down our backlog, we think we can do a lot better. And Tom Murphy, who's here today, is going to lead us through those efforts to make progress in veterans' claims. The focus on the modernization then is really infrastructure, making sure that we work well with the private sector in an integrated format, improving quality, and investing in those services that continue to make VA a unique national resource. Now, one of the things that people who've worked with me in the past when I've worked in the private sector, I've been known to be impatient at the lack of progress or the speed at which we make progress. So I used to always say to my teams when I worked in the private sector, what's it going to take to get this done in active Congress? And now, of course, the irony is everything that I do takes an active Congress. So we're going to work hard as partners with Congress to get all these changes done. I mentioned infrastructure. I don't think people realize the differences that you see in the VA system. You can see the pictures of the 1895 house that still is an active VA building, as well as our 1932 outpost that's in Minneapolis. And then down in the bottom right, you can see what every VA should be looking like now. This is Palo Alto with the rooms that they have single rooms. And that's really where we need every VA to get to. So we're going to be working to do that. When you take a look at the DOD and VA, you can see we have maps where we know where our facilities are close together. We could be working closer together. I mentioned this integration of VA hospitals and community care. We've been working hard to get that done. 31 percent of care we deliver now is out in the community. We're looking to make that so it's actually a coordinated integrated system. This is not privatization. This is actually how do we get the veteran, the very best care in the VA and the very best care in the private sector and working to build that into an integrated system of care. So how am I going to track whether we're making progress? Well, these four areas, quality access, progress in the areas that we think are priorities and what veterans actually experience. On the quality side, we actually measure quality in a pretty sophisticated way. And I'm pleased to say that 82 percent of VA's last year made significant improvements in quality of care. That's a pretty good and significant statistic. It's actually confirmed by outside groups. This isn't just VA saying that we're making this progress. This is the RAND Corporation, which is a well respected national independent organization who released reports last year saying that the quality of care in VA is actually as good or better than what you find in the private sector setting. VA is continuing to lead in issues that are important not only to veterans but to all Americans in terms of the opioid crisis while the rest of America is seeing a large increase in opioid use. VA, because we started on this over five years ago, saw a 22 percent reduction in the use of opioids. In hepatitis C, I'm pleased to say we now have the resources to make sure that any veteran who wants to be treated for hepatitis C will and can be treated. So we hope to eliminate this essentially from all veterans that seek care in the VA within the next year, year and a half. We've made terrific progress on this. This is a condition that now, because of the drugs available, we can cure at a 95 percent cure rate. So overall, tracking our statistics and quality, when you take a look at it, we've seen a 20 percent reduction this past year in mortality rates in our hospitals. Our productivity is up 12 percent. So anybody who says VA workers aren't working hard, this is 12 percent increase in productivity is probably the best that I've seen in my years in the private sector. And in areas of service like VBA or benefits, where we used to have 59 percent of our calls into our call centers blocked today, people are going to be answering your phone calls less than one percent block rate. So significant improvements. Where we're heading to is to make it easier to compare VA quality to the private sector rather than having government systems that are hard to understand. We're going to start making this a lot easier for all of you to be able to say, this is the care you get in VA. This is the care I can get in the community. So you can make the decisions about what's best for you and have that easily understood. Our focus on access, when I arrived in VA, we had 57,000 veterans waiting more than 30 days for urgent consults, totally unacceptable. Today that number would be close to zero. We have really focused, if you have an urgent medical issue, whether it's a psychological issue or a physical issue, you shouldn't be waiting for care. And the way that we're doing this now is same day services. Every one of your VA medical centers has same day access to services for mental health and primary care. So if you have an urgent issue and you go to one of your VA medical centers, you should be able to be seen in mental health and primary care that day. Our progress in access you can see is pretty considerable. We've had a significant improvement in the amount of time that people are waiting for care. 96% of appointments are now within 30 days, 86% are within seven days. I don't think the private sector is doing that. 23% of our veterans are seen on the same day. And you can see our wait times in various areas are really getting much better. But most important is what veterans are saying about access. And you can see that about 90% of veterans say that they're satisfied with the ability to get the care that they want. Now we want that to be 100%, so we still have work to do. In homelessness, we've seen a 46% decline in veterans homelessness since we began our efforts under Secretary Shinseki several years ago. Last year we saw our biggest decline in veterans homelessness, a 17% reduction in homelessness throughout the country. And so we're going to continue to stick at that. I mentioned that suicide prevention is our top clinical priority right now. It's an area that we are not satisfied. Too many people are taking their lives every day. We are going to be refocusing and redoubling our efforts in this area and you're going to see some announcements coming out in the next couple weeks where once again, I think VA will be taking a leadership role in this across the country. I do want to just highlight this. I'm good. I'm good. I'm good. But I have a story and I don't know where to start. I'm good. But I feel alone in a crowd. I'm good. But nobody understands. I'm good. But the past keeps coming back. But I can't get out of bed. But I can't sleep. I'm good. But I feel overwhelmed. I'm good. But I don't feel safe. But I don't even know who I am anymore. But I still have nightmares. But I don't need any help. I'm good. But I don't feel anything anymore. I'm good. But I can't live like this anymore. I'm really not so good. But are you ready to listen? In suicide, we need everyone's help. We need to work with the community. We need to get messages out to get people help. Our Veterans Crisis Line, we've added hundreds of new responders. We essentially do not have a rollover problem anymore. We are answering the phones. We're there. Same day access and mental health. We're hiring new mental health professionals, tele-mental health. But we need help in the community. And so we're going to be reaching out to all of you as partners to step up and to try to see what else we can do. VA continues to lead in innovation. Our research is cutting edge. We were named the 11th most innovative organization in the world as measured by the number of patents and research publications that are put out by an organization. Examples of our innovation are this mobile hearing aid app. So you may not have to go into your VA anymore to be able to get your hearing aid adjusted, but you can do it right at home from your phone if you want. Or of course, you could choose to still come into the VA. So we continue to work on these types of innovations to make sure that we're making contributions. Our research efforts in our Million Veterans Program now almost 550,000 veterans with their genomic material stored and combined with the electronic medical record is the largest data bank of its type in the country to be able to do new scientific discovery advances. And you'll begin to see the benefits of this over the next couple years as we come out with new types of research using genomics. We're working across the country to get our best practices from one VA spread to other VA's. That's an important part of our mission. So when you see something in one VA that's working, we hope to make sure that that's now seen in every VA across the country. And finally, our biggest measure, since we don't have a stock price, since we don't run like a for-profit corporation, our currency is your trust. And we know that that trust was eroded in the wait time crisis in April 2014. And we're slowly now beginning to build that back up. We understand when you lose people's trust, it's hard to build it back up, but we're working hard to do that. We think that the actions that we're taking should help us in regaining trust. So we started about a year and a half ago at 47 percent of veterans felt that they could trust the VA. Now that number is actually 61 percent, not 60 percent. So we're seeing it move in the right direction. We are clearly working to get that up to be much higher levels, and we track that on a regular basis. We think VA can do that. There are examples, like in our drug dispensing, that VA rates number one from JD powers above commercial entities in terms of our service. Our national cemeteries actually ranks number one even when in customer satisfaction compared to private companies. So we know we can do it in parts of VA. We need to do it across VA. And to do that, we're partnering with corporations across the country to be able to say help us, serve veterans better, teach us ways, work with us to be able to get to that level of trust and service. And finally, you're part of that. You know, your leadership at DAV is so important to giving us the advice and feedback and to say, here's where we think you need to go to regain that trust. And so we rely on your leaders. You can see Gary's up there. That was actually, I think, my first day of work as Under Secretary. But I was told right from the beginning, you can't do this job without your VSO partners. And I certainly have taken that advice. And I believe that as strongly today as I did when I started. And so I just wanted to thank everybody and thank you for giving me this time this morning. I appreciate it very much. Thank you, Mr. Secretary. On behalf of DAV, I would like to take this opportunity to present you with a special award. Before you were appointed secretary, you served for nearly two years as Under Secretary for Health, coming in at a very difficult and challenging time. As Under Secretary, you introduced a new leadership team, improved veterans health access to health, including same day access, and developed a plan to move VA forward into the 21st century. Throughout your tenure, you are closely with the DAV and have always put the needs of veterans first. So when it came time to us decide who should receive the award for Outstanding Federal Executive of the Year, it was an easy call. I'm pleased to present you with DAV's 2017 Outstanding Federal Executive of the Year Award in recognition of your achievements as Under Secretary for Health in support of injured and ill veterans, their families, and survivors. Congratulations.