 Well, good morning everybody. Wow Great to see everybody up up Brighton early and all excited for another great conference. I really look forward to spending this time with you Danny, thank you so much. You're doing such a great job in Oklahoma and supporting everybody and thanks for that great introduction So let me get right into it This has not been the easiest Last week or so for me or my wife, and we've gotten a good sense about what Washington's all about and so sometimes you look towards history to try to help you understand what this environment's about and certainly as Harry Truman said if you want a friend in Washington find a dog, so we've been out looking for a dog and and The problem is I'm not home very much So who's gonna feed the dog so but then as I thought about it who needs a dog when you have DAV. I mean Veterans and the VA have no better friend than DAV I have to tell you that and Your leadership is there for you and for veterans Every single day and so I just really want to acknowledge That especially when times are tough when the VA is under attack having Delfine is your national commander having Mark Burgess having Gary Augustine as your executive director Having all of your leadership at DAV You can count on DAV to do the right thing for veterans You can count on them doing their homework and I have to tell you You should be very very proud of your leadership I am and I really want to thank them for that and your organization. This is you I know this work comes from all of you in this room around the country You are working on things that really matter a lot if it wasn't for DAV's Legislative leadership and your support and I know all of you are going to be out over the next couple days talking to members of Congress We have to make sure that the legislation works for veterans and your support of our Review and sort of revamping of the choice program what we call the care program is essential We with your support and the president's leadership have recently Put into place a plan from the president's executive order to make sure that every Active service member who transitions to being a veteran is going to get a mental health benefit up until now Only 40% of those that leave the service are eligible for VA mental health care, but that's going to be a hundred percent We're presenting that plan and DAV has been there with us on March 9th back to the president It's DAV that's really been making us and pushing us to improve the disability benefits questionnaire the DBQ process that Wasn't working. We're getting that to work much better again. We wouldn't be doing that if it wasn't for DAV Caregiver expansion. I see some of your leadership and some of you wearing the caregiver buttons We need that our every veteran who needs a caregiver should have access to it today As you know only post 9-11 veterans do we're going to get that changed. We're working together to do that No, nobody has done more to help us reduce the claims backlog and fix the appeals process than DAV We know you are the organization that is really carrying a lot of that work and we thank you for that 8,000 DAV volunteers We just couldn't be doing the work helping the veterans around the country if it wasn't for all the volunteers that come out of your Organization and of course, you know my favorite event ever is the winter sports clinic in Aspen How many of you have been to the winter sports clinic? You know Washington's nice, but I'll tell you Aspen is even nicer So the rest of you have to get there just to see what it means I I forget whether I'm presenting it here But my single favorite picture that I own and I've taken so many great pictures of events with veterans is a picture from Aspen With all these empty wheelchairs Nobody in them because they're all out on the mountain skiing. I mean it is the most powerful thing so So I really can't thank you enough It's been a great year And I think we have to remember that that under this president's leadership We have gotten more done for veterans working so closely with DAV and other veteran service organizations We now have a brand new advisory group for veterans and families and caregivers that fortunately Senator Dole who is so busy has agreed to chair and and her leadership on this is important We now have a 24-hour 7 vet White House hotline to make sure that we're getting Direct feedback and that we're working closely with the White House the forever GI bill one of 11 pieces of legislation That we got passed last year in a bipartisan way We do everything by making sure that VA and veterans aren't politicized that we're working together with both sides The accountability legislation really important 1,100 people that already have been removed from service We've worked hard to make sure that the choice funding has been expanded and that's been important so we can get this right 28 new leases opening around the country. We haven't had new leases approved by Congress in years and years So that's important other than honorable discharges making sure that The people that need our help that may be there because of emotional or mental issues are getting the types of services They need prior to this. They were just we see them on the streets and without any access to hope And national ID cards for veterans, which is now something that's available to everybody Free of charge. So what I wanted to do is just talk about where we're focused And we're focused on five major priorities And this is where I'm putting all of our energy to make sure that we get this done The first is is that I believe strongly that all veterans should have a say They should have a choice in how they want their care delivered in the VA Or if they need to leave the VA to get the right type of care outside the VA and what we have now is we have a program in choice which Thanks to Congress's leadership. I think have have provided us the ability to address the access issue But we have a program that right now is Administratively based you have to live 40 miles away or you have to wait 30 days before you even have a chance to enter this system I'm a physician. I don't believe that that's what a health care system is about I believe it should be based on your clinical need when and where you should get the very best care and Matching it. So with DAV support, we're changing this We're we're working to get this done so that we get rid of rules Administrative rules and we change it into a clinical care system, which is really what it's designed to be The second of our priorities is to modernize the VA Many of the problems that we see in VA and there are many problems as well as many really good things about VA But many of the problems we see date back decades. So this isn't a Republican issue or a Democratic issue This is spanning multiple administrations decades decades ago And we just need to get on in to fix the problems And we need to make sure that the VA is the best most modern system that That we can develop because that's what our veterans deserve. So we're making some of those decisions We've recently made the decision to Get a new electronic health record and that means picking the best that's out there and Working with the Department of Defense to have the same system this idea that When you have all of your records and they can't even talk to the VA the DOD and the VA have separate systems That just doesn't make sense. And so working together with Secretary Mattis We're moving to have the same system so that from the time you enlist through the time that you decide to Get care in the VA. It's going to be a seamless process without your information dropping off We are working hard To make sure that we're taking the very best of what we see across the country and Working like a system sharing our best practices in fact We've just written a book called best care everywhere Which are filled with how the VA is leading those best practices across the country some of the best care anywhere you can find in America and We're now implementing these to make sure that everybody has access to these types of best practices We're updating our facilities. This is the Palo Alto VA I think every VA should be looking like this with private rooms Places where family members can stay and making you feel like you're getting the best type of environment possible and So this is what we're doing with our new leases and we're doing business differently. We're doing public private partnerships in Omaha, we've just announced a new VA that we're going to be putting up that Works with the private sector and philanthropists to make sure that we can build these things faster better Less expensive but do more of these types by working with the private sector rather than VA being in the construction business alone I've announced that we're going to be getting rid of close to 1100 facilities that We're not really using they're empty or vacant or underutilized and Reinvesting that money back in the VA in the infrastructure Bill that the president's talking about people aren't mentioning this But in that is a section that says that a VA gets rid of its properties It can retain those proceeds retain those savings and reinvested in the VA We don't have that today, but that's an important piece of us modernizing our system And that's one of the ways the president is supporting us The third priority of the five is to make sure that we do things in a timely fashion We all know in 2014 we got into an access problem or a wait time crisis starting in Phoenix Today we have same-day services in every single VA in primary care and mental health if you have a Urgent problem you can get that addressed on a same-day basis in every VA in mental health and in primary care But overall including all of our specialty services 98% of our appointments are now seen within 30 days 85% within seven days and 22% of all the care that we provide in the VA on the same-day basis We are the only health system in the country There is no other that publicly posts us wait times if you want to see your wait time at your seabock or your medical Center for any specialty go on to the website you can see exactly what that is and you can see where your choices are if There are places that you want to go to that have Have less of a wait time no other system does that we update this every two weeks with real-time data so that you can keep up and see exactly what's happening and in fact people don't like to talk about this but It's not always easy to get an appointment with private doctors either Many of you know this when you're dealing with your family members and sometimes when you go outside so When we take a look at where VA is on wait times compared to the private sector We're actually in many cases 40% better It varies by location. So these are national data averages But we are comparing ourselves to what the private sector is doing. We're not happy with where we are We have to continue to get better. We're focused on this but People don't often say that there is a issue Throughout America with shortages of health care professionals particularly in some areas like rural areas But VA overall is doing fairly well One of the ways that we're improving access is by using technology Using telehealth no other system in the country uses telehealth the way that VA does over a billion dollars a year 720,000 veterans getting their care through telehealth so you can get specialists from Different parts of the country right into small little C-box and rural parts of the country. This is the president and I I'm showing him I actually I'm an internist a primary care doctor. I practice in two places I practice in person in Manhattan in New York City and I practice out of my office in Washington here Where I'm a primary care doctor in Grants Pass, Oregon. Anybody ever been to Grants Pass? Couple yeah, I've never been there, but but I know a lot of people there You know, that's my Grants Pass team right there with a veteran in the middle. We're talking to the president That's how I usually care. He's my patient He gave us permission and that's my team from Grants Pass And so we now have the ability to provide specialists from Washington, DC to Oregon Outside of the VA you can't do that because you're not allowed to cross state lines with medical licensing But we've used our federal supremacy to be able to allow us to use doctors anywhere in the country to anywhere in the country And this is the way Thank you We're also working on timeliness on disability claims as you know, not too long ago We had over 600,000 disability claims greater than 125 days today. We're at about 75,000 We hope to be at less than 50,000 by the end of the year and our goal is to get that down to zero This is where DAV is working with us very very Hard to help us achieve that We've just introduced decision-ready claims where we can get a decision on a claim within 30 days That's really what our goal is to get that number down not 125 days But down the 30 days and this process while every new process has its bumps Looks like we're learning how to do this better and we're getting more and more veterans to opt into Decision-ready claims because we want to get those decisions back as quick as possible Thanks to our appeals modernization legislation We're changing the way that we're doing appeals and you can see the red line there. This is our target for the end of the year over 81,000 decisions that will be a significant number Increase an increase in the number of appeals decisions that we're going to be doing this year from last year And as we begin to implement this appeals modernization process again working very closely with DAV We're going to get many many more appeals done and get them done much much faster before the appeals modernization It would take six years to get a decision. That's just unacceptable The fourth of the five priorities is to make sure that we are Focusing our resources on the things that matter the most to veterans And while we're going to continue to provide full services There are certain things that we should be doing better than anyone else in the country that should be world-class Services because veterans need it It's the reason why the VA is there because the private sector Doesn't have the expertise of their capacity and certain things that matter most to veterans These are things like spinal cord injury blind rehabilitation post-traumatic stress traumatic brain injury environmental hazards of war and things that frankly the expertise needs to be world-class and The way that we're showing this now is by making sure that everybody understands the quality in the VA compared to the quality in the private sector if You go to our website and you look at wherever you're getting care You will be able to see how the VA ranks in terms of standardized quality measures to the community hospitals and the private sector facilities in the area and wherever We have an opportunity to improve quality where we are not where we need to be that is where we're focused we've we've put targeted resources towards that right now under dr. Clancy's leadership and We are committed to being open about where we continue to struggle and where we are far exceeding the private sector And let me give you some examples of where we're focusing our resources Hepatitis C we know that veterans Have a higher incidence of hepatitis C than the general population given some of the exposures that they've had Fortunately, there are now drugs that can cure hepatitis C when I went to medical school incurable we just had a watch as people's livers failed But now 95% plus cure 8 And so we are the only system in the country that has the opportunity to end Hepatitis C to essentially make sure that we have cured everybody possible So we have aggressive outreach. We've developed teams to go out into contact veterans We had about a year and a half ago close to a hundred and fifty thousand veterans with Hepatitis C we will soon in the next couple months have 20,000 and then we're going to continue to focus on that We all know again that pain management is a core competency We need to be really good at that and the issue of getting people addicted to opioids with overuse is a key issue We we believe there's a real Role for opioids and pain management, but we certainly don't want to be reaching for it as the first option If there are alternatives, so again, we are the only system in the country I know of nobody else who is now publishing our opioid use rates So that we are showing where we're going you can see here. These are our highest opioid rates in the country and you can see where we were in 2012 when we began to focus on this issue and where we are now in 2017 you take a look at the other end places like Cleveland, Ohio or Coatesville, Pennsylvania that are at the 3% opioid use rate. We know the answer is not zero But we also know that we have opportunities to improve and we're going to be committed to sharing this data publicly To make sure that we are moving in the right direction The fifth and final priority is to prevent veteran suicide 20 veterans a day taking their life through suicide. It's a number that nobody in this room thinks is acceptable We just have to be focused on this and doing more and we can see that When people get their care in the VA system when they get access to the right help that that's saving lives that For all US veterans over the last 14 years The rate of suicide increase if you got care in the VA system was 5.4 percent But if you weren't getting care in VA it was 38.4 percent Take a look at female veterans over the last 14 years if you got care in the VA down 2.4 percent, but if you weren't getting care at VA 81 percent So those who say the VA isn't necessary. Let's just privatize it. Let's let veterans just go out and fend for themselves Aren't really understanding what the data is suggesting This is a system that while it's got problems and needs to improve is saving lives is focused on Where the needs of veterans are and we're doing more and more we've just launched a new campaign Tom Hanks is our National spokesperson called hashtag be there be there for veterans com and It is trying to make sure that everybody understands in the community that if you see a veteran who is struggling or suffering or feeling isolated or hopeless that Please reach out and make sure that they know that we are there for them and that we do have the help to be able to provide care This is the president as he signed our executive order saying that every Service member who leaves the service will have access to mental health. This is part of our initiative What we do know from the data is is that there are two periods of time that veterans are greatest risk for suicide as They get older But that first 12 months from discharge is the highest single incidence It's not the highest number But in terms of percent incidents of suicide by far those first 12 months when people Lose their identity and sense of belonging and feel hopeless and isolated So that's why we've targeted this executive order to those first 12 months following discharge We're also focused in decreasing veteran homelessness. We know that the highest Risk population or those that don't have access to stable environments and to care and those that are homeless So we've reduced veteran homelessness by close to 50% in the last four and a half years But we're not anywhere near where we need to be there is 45 there are 45,000 homeless veterans today And so we are focused on getting that number to zero and we'll continue to work very very hard at that I've already mentioned that we have expanded coverage now to other than honorable veterans other than honorable discharge Discharges as you know up to 15% of people who leave the military have a other than honorable status This is not dishonorable discharges. We're not talking about people who've committed crimes. We're talking about people that have done Things that may be related to to experiences that they've had during their service that have caused Them to have received this type of status and finally, let me just mention that This year as DAV goes on Tuesday to talk about the budget and other issues We feel very good about where the president has proposed the 2019 budget it shows his commitment to veterans to keeping the VA strong 198.6 billion dollars It allows us to invest in our infrastructure it allows us to invest in Getting the right people on board and also allows us to continue to support our choice program So that we are at the same time Increasing the strength of VA while we're giving veterans greater choice to make sure their needs are met in the community and While we don't have a Stock price while we don't have a way of tracking how we're doing in terms of a Dow Jones industrial index our equivalent is really what you say and We monitor How people's trust is in the VA we in 2014? Were at a low of 46 percent of veterans felt that they had trust in the VA today. We're at about 70 percent Not anywhere near where we need to be and we're going to continue to work at this by being Transparent and telling people about problems when there are problems and fixing those problems But we're moving in the right direction The only reason we're moving in the right direction is because of the support of all of you and your leadership and working together to make this Responsibility of the countries to honor all of you and to make sure that we're doing the right thing by you Come to be a reality. So thank you very much. I appreciate the time with you this morning