By Garry J. Augustine
For more than two years, ever since the scandal over secret waiting lists at some Department of Veterans Affairs (VA) hospitals erupted, we have been debating how to reform the delivery of health care to veterans. The men and women who sacrificed serving this country need real and lasting solutions, but until now they have received only temporary measures and partisan debate. Finally the time for talk is over because there is now widespread agreement on how to ensure veterans get the best possible care that meets their unique needs.
The debate has never been about the quality of care that veterans receive from VA. Independent assessments by organizations such as the RAND Corporation and the American Psychological Association agree that VA care overall is as good as—and often better—than private care. And VA is the recognized leader when it comes to many specific areas, such as PTSD, TBI, prosthetics and integrated primary mental health care. The challenge has been how to ensure veterans can access this high-quality care on a consistent basis.
Despite beginningg from vastly different perspectives, the major Veterans Service Organizations (VSOs), the VA, bipartisan leaders in Congress, and most recently the independent Commission on Care are all in agreement on how to fix the access problem and end long wait times. We are all proposing the same basic policy solution: create local integrated health care networks that combine the strength of the VA system with the best of community care, whenever and wherever gaps in coverage exist.
These networks will be designed on a community-by-community basis, matching veterans needs to local resources using both VA and private sector clinicians. As a result, veterans can be assured that when they need an appointment, t
hey can get an appointment, with a highly-qualified, culturally competent doctor. With VA health care facilities playing the lead management and clinical role, we can ensure that medical care for ill and injured veterans will be coordinated and veteran-centric. When a veteran sees a doctor in the network, whether at VA or in the community sector, the care will be focused on the health of the “whole veteran,” which will lead to the best health outcomes for the men and women who served.
The VA-community integrated networks will replace the current Choice Program, which was always meant to be a temporary fix and has been plagued by poor coordination, scheduling problems, and payment delays. Community providers will get paid on a timely basis because the networks will be operated by the local VA. The days of bills not getting paid on time by a government contractor, resulting in negative credit reports for veterans, will end.
In order to create high-performing networks, all clinicians in the network must have immediate, electronic access to medical records to prevent fragmented care and reduce the incidence of over-treatment or under-treatment. And by organizing locally, these networks will better adapt to changing local needs. If, for example, actuarial projections indicate a significant increase in elderly veterans or women veterans, VA health care facilities have the flexibility to add appropriate clinicians to their local networks quickly and efficiently.
There is still work to be done to flush out all of the necessary details to move in this new policy direction, and there must be significant new investment to provide the IT systems and capital infrastructure necessary to build and operate the networks. But after more than two years of debate, there is finally agreement about how best to meet the health care needs of veterans today and over the next 20 years. It’s time to stop talking and get to work creating the health care system our veterans deserve.