Legion examines streamlining of non-VA care programs

The American Legion believes in a strong, robust veterans health-care system designed to treat the unique needs of those who have served. However, even in the best of circumstances, there are situations where the system cannot meet the needs of the veteran, and the veteran must seek care in the community.

Rather than treating this situation as an afterthought – an add-on to the existing system – the Legion believes the Department of Veterans Affairs must “develop a well-defined and consistent non-VA care coordination program, policy and procedure that includes a patient-centered care strategy which takes veterans’ unique medical injuries and illnesses, as well as their travel and distance, into account,” said Roscoe Butler, deputy director of the Legion's Veteran Affairs & Rehabilitation Division, to members of Congress during a hearing Dec. 2.

Butler presented oral testimony on behalf of The American Legion before the Senate Committee on Veterans’ Affairs regarding consolidation of non-VA care programs.

The VA-purchased care program dates back to 1945 when Gen. Paul R. Hawley, chief medical director of the Veterans Administration, implemented VA’s hometown program. Recognizing that many hospital admissions of World War II veterans could be avoided by treating them before they needed hospitalization, Hawley instituted a plan for "hometown" medical and dental care at government expense for veterans with service-connected ailments.

Under the Hometown Program, eligible veterans could be treated in their community by a doctor or dentist of their choice. Since then, VA has implemented a number of programs to manage veterans’ health care when such care is either not available in a VA health-care facility, cannot be provided in a timely manner, or is more cost effective.

Programs like Fee-Basis, Project ARCH (Access Received Closer to Home), Patient-Centered Community Care, and the Veterans Choice Program were implemented by Congress to ensure eligible veterans could be referred outside the VA for needed health care, said Butler during his testimony.

Recently, VA introduced a proposal to streamline all of the legacy systems for non-VA care and to consolidate them into a single program – as they were directed to do by law when Congress authorized the ability to move funds from the Choice Program to cover shortfalls in the other non-VA care accounts.

“VA states their Community Care Plan would streamline the above programs by transitioning them into a single community health-care program that is seamless and transparent to veterans,” Butler said.

While these goals sound positive, The American Legion believes, by resolution, that a proper plan for non-VA care must:

• Ensure all non-VA care contracted providers complete military culture, awareness and evidence-based training.

• Provide all non-VA providers with full access to VA’s Computerized Patient Record System.

• Ensure VA continues to improve its non-VA care coordination through the Non-VA Care Coordination program office.

• Ensure VA improves collection of non-VA care documentation into the veteran’s medical record.

• Ensure VA develops a national tracking system to avoid national or local purchased care contracts from lapsing.

• Provide an automated claims processing system that fully automates the authorization and payment process.

“We are pleased to see that VA’s plan incorporates many elements of our resolution,” Butler said.

If approved by Congress, the plan will be rolled out using a three-phased approach. The plan will be implemented gradually, much like TRICARE, by developing appropriate provider networks and streamlining business processes.

Additionally, VA’s plan calls for cultivating a provider network to serve veterans utilizing federal health-care providers, academic affiliates and community providers. The Legion believes VA has not yet demonstrated that it has the expertise or experience to establish large provider networks, relying on third-party participants like HealthNet and Tri-West to fulfill these requirements. VA’s plan does not specify whether it would continue utilizing third-party contractors to fulfill this requirement if the plan is approved.

“Serious thought needs to be given to this question,” Butler said to the committee. "VA’s plan is clearly a huge undertaking, and we have concerns about VA’s ability to implement the plan. VA has attempted to roll out or has rolled out numerous projects in past years that required dramatic systems, information technology, and policy changes.”

Butler also urged members of Congress to hold the VA accountable and to ensure great strides will be made to further progress failing programs and processes.

“VA must guarantee Congress, VSO’s and veterans that their community care plan will not result in similar failures like other projects,” Butler said. “Veterans are calling on VA to get it right on their first attempt and not waste tax dollars.”