A 'fused, integrated system' of veterans healthcare

On June 6, the VA MISSION Act went into effect, with the intent of giving the Department of Veterans Affairs the ability to allow veterans increased access to care through outlets such as telehealth and VA-approved community care providers.

On Aug. 24, Legionnaires attending The American Legion National Convention in Indianapolis were given an update on the MISSION Act from those at the forefront of the initiative: Dr. Jennifer MacDonald, VA MISSION Act lead, and Dr. Kameron Matthews, Deputy Under Secretary for Health/Community Care.

The pair spoke to the Legion’s Veterans Affairs and Rehabilitation Division about VA’s core tenets and approach to implementing the MISSION Act, which included creating a community care network and veterans care agreement.

“We’ve actually been providing community care since 1945,” MacDonald said. “This is a step forward, and it’s an expansion in access to care. It’s a way to meet the needs of our population that was really, really necessary. But that doesn’t stop us from being one fused, integrated system.”

Matthews said the MISSION Act replaces a program, Choice, that wasn’t good answer to expand access to care. “We did not do that program well,” she said. “It was an imperfect piece of legislation … and then we chose a very difficult and unnecessary set of rules to implement. Many of the changes that we put in place (through the MISSION Act) … were really meant to improve upon a lot of the lessons learned that we had in the Choice Program.”

Matthews said VA is making it clear access to community care isn’t a program on its own. “The idea is we wanted it to be unbranded,” she said. “We want community care to eventually become invisible. It is a supplemental form of care that really helps you receive care when you do have access in the VA. But it’s supplemental to the VA system. We don’t want it to be this separate, free-standing, separate-branded program.”

That community care is now subjected to new standards and expectations for the providers. “As a former community care provider, I wholeheartedly believe in this: expectations of competency when they are treating our veterans,” Matthews said. “They need to have a better understanding of veteran-specific conditions (such as PTSD, military sexual trauma and traumatic brain injury). If community providers are treating those conditions, we expect them to undergo training. We built that training. We expect them to have the appropriate qualification. We must have a higher standard from a quality standpoint, because we want the same exact expectations of the care that we provide in the VA as it would be found in our community network.”

Those standards include guidelines for community care providers prescribing opioids to patients. “There is training that all prescribers in the community care network are expected to take,” Matthews said.

There is a copay for veterans seeking urgent care from a community provider. “This was not an easily come-to decision,” Matthews said. “We looked at it in the sense (that) there needs to be some sort of disincentive to using urgent care more regularly.”

MacDonald said the goal is for veterans to get the best care they can via any arm of VA. “We are evolved into what we call a high reliability organization that veterans get the same experience, the same high-quality ease and pleasant emotional experience any time they access care – no matter what facility, and whether that’s in person or by telehealth, and any extent of our system they choose to access,” she said.

MacDonald also stressed that increased access to community care isn't a step toward privatizing. “We intend to not just not be privatized – that’s not what’s happening here – but rather be the centerpiece of this and grow,” she said. “We’re actually starting to see growth in both our direct care system, as well the interest (in community care) but coordinated by VA. We need to embrace the whole spectrum of partners that we have. Community providers are part of that. We want to stay in the middle of this, and stay coordinating that care. This is not only not privatization. We are growing for the future, and we intend to lead.”

Also during the meeting, Lee Becker – VA’s Veterans Experience Office chief of staff – shared how his office is helping VA transform the way it deals with its stakeholders.

“The biggest thing we have to figure out is how we shift from a customer service to a customer experience mindset,” he said. “It has to be provide effective care or benefits, it has to be easy. It cannot be difficult, filling out 20 different forms you pass over a wall and are told ‘oh, you missed one part of the block.’ And it has to feel good.”

Randy Reeves, VA’s Under Secretary for Memorial Affairs, praised The American Legion and other veterans service organizations for keeping both VA and Congress “honest … and make sure we do the right thing. So thank you what you’re doing every day to protect and serve our veterans.”

Reeves said the National Cemetery Administration (NCA) continues to excel at providing service to the nation’s veterans and their families. The agency recently was awarded a score of 97 by ACSI (American Customer Satisfaction Index), the only national, cross-industry measure of satisfaction with the quality of goods and services available in the United States.

“No one has ever scored higher than the National Cemetery Administration in providing service to those it cares for,” Reeves said. “The reason for that is not because of me, and it’s not because of our folks in Washington. It’s because of our personnel who are on the ground across the country in our cemeteries, our scheduling offices, our Memorial Products Services Division and all the other services that we do.

“Eighty percent of our workforce are veterans. If they’re not veterans, they’re connected to veterans in some way. And each and every person in the National Cemetery Administration knows we only have one chance to get it right.”

During a panel discussion, American Legion Past National Commander Ron Conley urged commission members to both participate in and spread the word about the Legion’s online mental health survey. More than 13,000 respondents have participated in the survey.

“It helps us understand how many veterans are out there dealing with (mental health issues),” Conley said.