Transforming VA care: A way forward

The Commission on Care, commissioned by Congress in 2014 to reform the troubled Veterans Health Administration (VHA), issued its final report on July 6. In an accompanying statement, Commission Chair Nancy Schlichting writes that the report offers “bold recommendations that set a foundation for ensuring our nation’s veterans receive the care they need and deserve, both now and in the future.”

If only that were the case. In reality, the Commission on Care’s final report is far from bold, and falls far short of transforming the dysfunctional VHA  into a world-class, veteran-centric health care organization. 

{mosads}As military veterans and advocates for the veterans’ community, we served on the commission, but dissented from the final findings, which we found to be incomplete and inadequate, as we explained recently in The Hill. (We detail the commission’s shortcomings in our full dissent letter published here.)

While the Commission on Care missed its opportunity to deliver a true transformation plan for the VHA, it’s not enough to dwell on past mistakes. What’s needed is a viable plan for the future.

To transform the VHA, we must look beyond the outdated health maintenance organization model the division is built around, and instead look toward a new model better suited to the needs of today’s veterans.

The good news is that the policy components for VHA transformation are readily available — but it’s up to Congress to assemble them into a cohesive and actionable package. Here’s how to achieve that goal.

First, while we criticized the Commission on Care’s final report as flawed, it does contain several proposals with merit that Congress should carefully review.

Expanded health care choice, allowing veterans to seek purchased care from private sector providers, establishing a board of directors and realigning VA facilities to eliminate vacant and underutilized properties along the lines of the Pentagon’s Defense Base Close and Realignment Commission (BRAC), are among the reforms we believe should be at the center of any transformation plan.

Second, we need to complete the transformation roadmap the commission failed to provide by adding the key changes required to modernize the veterans health care system. Among those changes:

·      Expanding and strengthening multiple private-sector choice options (e.g., Fee-For-Service, Preferred Provider Organization and HMO) in a fiscally responsible way for veterans who prefer care outside the VHA system. Providing choice among a variety of options empowers veterans to select the plan that best suits their needs, creates competition and improves program performance. Other government-run health care programs, such as Medicare Advantage, TRICARE and the Federal Employees Health Benefits Program use similar approaches.

·      Identifying actions to address VHA changes the final report neglected. Changes to the system are incomplete unless critical matters like eligibility, changes to the overall health benefits package, existing program structure and cost mitigation strategies are addressed.

Third, tie these proposals to an existing legislative vehicle. The most promising is the Caring for Our Heroes in the 21^st Century Act, a draft discussion proposal from Rep. Cathy McMorris Rodgers (R-Wash.) that includes all the needed health care system components, thereby laying out the best path for transformation.

The McMorris Rodgers package would establish a new Veterans Accountable Care Organization (VACO), a federally chartered non-profit entity that will manage VA facilities and streamline the provision of hospital care and clinical services to veterans. This will allow for greater independence and accountability, which will ensure improved service to veterans. A separate Veterans Health Insurance program would administer VHA insurance programs.

The Caring for Our Heroes Act also expands the universe of choice programs, giving more options and control to those veterans who would like to seek purchased care outside the VHA system. These options would reconfigure how veterans receive care, while allowing those veterans who are satisfied with their current VHA care to remain in the existing system using the new VACO.

Currently, the McMorris Rodgers Caring for Our Heroes Act is the only legislative proposal that offers a truly new way of looking at veterans’ health care. It goes beyond the VA’s current centralized model that traps veterans into a deficient system of unresponsive and inconsistent care, instead offering a system that is flexible and adaptable to the needs of the individual veteran.

The approach outlined here, which prioritizes the needs of the veteran over the prerogatives of the bureaucracy, represents a dramatic change in how the VHA does business. It’s a change that’s long overdue, and one that our veterans deserve. Congress should start now to make this transformation a reality.

Darin Selnick is a U.S. Air Force veteran and served as special assistant to the Secretary of Veterans Affairs from 2001-2009. Stewart Hickey, a U.S. Marine Corps veteran, served as national executive director of AMVETS from 2011-2015. Both served as members of the Commission on Care.

The view expressed by Contributors are their own and are not the views of The Hill.