[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
ROLES AND RESPONSIBILITIES:
EVALUATING VA COMMUNITY CARE
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HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
WEDNESDAY, FEBRUARY 12, 2025
__________
Serial No. 119-5
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
60-668 WASHINGTON : 2025
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COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa SHEILA CHERFILUS-MCCORMICK,
GREGORY F. MURPHY, North Carolina Florida
DERRICK VAN ORDEN, Wisconsin MORGAN MCGARVEY, Kentucky
MORGAN LUTTRELL, Texas DELIA RAMIREZ, Illinois
JUAN CISCOMANI, Arizona NIKKI BUDZINSKI, Illinois
KEITH SELF, Texas TIMOTHY M. KENNEDY, New York
JEN KIGGANS, Virginia MAXINE DEXTER, Oregon
ABE HAMADEH, Arizona HERB CONAWAY, New Jersey
KIMBERLYN KING-HINDS, Northern KELLY MORRISON, Minnesota
Mariana Islands
TOM BARRETT, Michigan
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
SUBCOMMITTEE ON HEALTH
MARIANNETTE MILLER-MEEKS, Iowa, Chairwoman
JACK BERGMAN, Michigan JULIA BROWNLEY, California,
GREGORY F. MURPHY, North Carolina Ranking Member
DERRICK VAN ORDEN, Wisconsin SHEILA CHERFILUS-MCCORMICK,
JEN KIGGANS, Virginia Florida
ABE HAMADEH, Arizona MAXINE DEXTER, Oregon
KIMBERLYN KING-HINDS, Northern HERB CONAWAY, New Jersey
Mariana Islands KELLY MORRISON, Minnesota
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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WEDNESDAY, FEBRUARY 12, 2025
Page
OPENING STATEMENTS
The Honorable Mariannette Miller-Meeks, Chairwoman............... 1
The Honorable Julia Brownley, Ranking Member..................... 3
WITNESSES
Panel I
Dr. Steven Braverman, Chief Operating Officer, Veterans Health
Administration, U.S. Department of Veterans Affairs............ 5
Accompanied by:
Dr. Sachin Yende, Chief Medical Officer for Integrated
Veteran Care, Veterans Health Administration, U.S.
Department of Veterans Affairs
Ms. Sharon Silas, Director, Health Care Team, Government
Accountability Office.......................................... 6
Dr. Julie Kroviak, Principal Deputy Assistant Inspector General,
Office of Healthcare Inspections, Office of the Inspector
General, U.S. Department of Veterans Affairs................... 8
Panel II
Dr. Scott Kruger, Physician, Virginia Oncology Associates........ 27
Mr. Dave McIntyre, President and CEO, TriWest Healthcare Alliance 29
Mr. Ed Weinberg, President and CEO, OptumServe................... 31
Mr. Chris Faraji, President, Wellhive............................ 32
APPENDIX
Prepared Statements Of Witnesses
Dr. Steven Braverman Prepared Statement.......................... 47
Ms. Sharon Silas Prepared Statement.............................. 50
Dr. Julie Kroviak Prepared Statement............................. 74
Dr. Scott Kruger Prepared Statement.............................. 86
Mr. Dave McIntyre Prepared Statement............................. 89
Mr. Ed Weinberg Prepared Statement............................... 92
Mr. Chris Faraji Prepared Statement.............................. 97
Statements For The Record
The American Legion Prepared Statement........................... 107
Document for the Record Submitted by Abe Hamadeh................. 110
ROLES AND RESPONSIBILITIES:
EVALUATING VA COMMUNITY CARE
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WEDNESDAY, FEBRUARY 12, 2025
Subcommittee on Health,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:17 p.m., in
room 360, Cannon House Office Building, Hon. Mariannette
Miller-Meeks [chairwoman of the subcommittee] presiding.
Present: Representatives Miller-Meeks, Bost, Bergman,
Murphy, Van Orden, Kiggans, Hamadeh, King-Hinds, Brownley,
Takano, Cherfilus-McCormick, Conaway, and Morrison.
OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN
Ms. Miller-Meeks. Good afternoon. This oversight hearing
for the Subcommittee on Health will now come to order.
It is not often in Washington, DC, you start very early in
the morning shoveling snow, but thank you all for making it
despite the snow.
I understand this hearing focused on community care has
garnered significant member interest, including from committee
members who are not on my Health Subcommittee. Before we get
started, in accordance with committee rule 5(e), I ask
unanimous consent that all off-subcommittee members be
permitted to participate in today's committee hearing.
Without objection, so ordered.
As a 24-year Army veteran and a healthcare provider, I have
seen firsthand the struggles our veterans face in accessing the
care they have earned. I have also experienced the challenges
providers encounter when trying to deliver the care.
Let me make two things perfectly clear at the start of
today's hearing. Veterans should never have to fight through a
maze of bureaucracy to get the healthcare they deserve, and
providers should not be bogged down by administrative hurdles
just to serve them. These two statements should not be
considered partisan.
This subcommittee has received multiple reports regarding
delayed referrals, canceled appointments, lack of
reimbursement, and long wait times for treatment that should be
available much sooner. These are not isolated incidents. These
are systemic failures that have real harmful impacts on the
everyday lives of veterans.
Let me also say that I know that the U.S. Department of
Veterans Affairs (VA) is working very hard and very diligently
to serve our veterans and to remedy these incidents, and it is
why today's hearing is so important. Today is our follow up to
our previous full committee hearing where we heard directly
from veterans and their families about the barriers they
experienced in accessing community care.
With the new administration comes new opportunities. Under
the leadership of Secretary Collins, I have total confidence
that the VA will course correct the failures of the previous
administration to protect healthcare access for veterans.
In our last hearing, we saw attempts by some members to
shift the failures of the Biden-Harris administration to third-
party administrators and providers. There was also yet another
attempt to propagate the myth that Republicans want to
privatize VA. Let me once again address this falsehood and
state the position I share with Chairman Bost: Community care
is VA care. It is designed to supplement VA's direct care
system, not replace it.
The purpose of today's hearing is to provide a refresher on
the roles and responsibilities of the outside providers who are
responsible for administering the community care program (CCP)
so that all members of the committee can refocus efforts on
holding the right people accountable. This is about making sure
the community care program works for veterans, not for
bureaucrats in Washington, DC.
Let me spell out who is responsible for one. Third-party
administrators are tasked with building provider networks and
paying claims for services rendered by community care
providers. Third-party administrators do not determine
veterans' eligibility for community care. They do not authorize
referrals, and they do not manage the transfer of medical
records between VA facilities and community providers. Those
responsibilities belong to the VA. When the VA fails to
authorize referrals in a timely manner or delays sending the
necessary documentation, veterans are the ones that suffer.
We have heard countless stories from veterans who have
waited months for care because their referrals were stuck in
the system or who received approval for care just prior to the
expiration of that care, veterans who have had to navigate
confusing and inconsistent communication because the VA, not
the outside providers, cannot get it together.
One of those veterans is my constituent, Mr. Terry
Barngrover, a Vietnam veteran battling blood cancer. I would
like to take a moment to describe Terry's community care
experience in his own words. ``They just expect us to know all
the rules. No one answers the phone or returns calls. We get
the feeling the VA does all of this extra work so we will give
up and not use the VA at all.'' Just last night and this
morning, I had a veteran in my community text me about his
experience at the VA with a urinary tract infection caused by a
kidney stone.
We cannot allow these issues to persist. Veterans like
Terry and the veterans we all heard from a few weeks ago in
this room deserve better. They deserve a system that works for
them, not against them. That is my number one priority from my
seat as the chairwoman.
Today, we will hear from VA officials and stakeholders
about the steps they are taking to improve the administration
of community care and ensure that the program operates
sufficiently and effectively so veterans can get the care they
need without unnecessary delays.
Thank you all for being here today. I look forward to
hearing from our witnesses on how they can improve the VA
Community Care Program for the veterans who rely upon it.
With that, I yield to Ranking Member Brownley for her
opening statement. The chair recognizes Ranking Member
Brownley.
OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER
Ms. Brownley. Thank you, Madam Chairwoman. I am glad the
subcommittee is holding this hearing today. Prior to last
month, neither the committee nor the subcommittee had held an
oversight hearing on community care since July 2022, nearly 3
years ago when Democrats held the majority.
I want to acknowledge and make clear at the outset that
there will always be a place for community care. VA cannot
provide all the care our veterans need on its own. This is
especially true for women veterans needing specialized women's
health and maternity care.
Community care is an important part of the healthcare that
VA provides. Finding the right balance is important, and I am
concerned that we have not yet found that balance.
Today, I expect we will hear some of my colleagues on the
other side of the aisle say that VA is restricting veterans'
access to community care, but veterans are now receiving more
than 40 percent of their care in the community versus only
about 23 percent in the year before the John S. McCain III,
Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks (MISSION)
Act was implemented. Spending on community care has risen
sharply over that period of time, ballooning to what some have
argued is an unsustainable amount. Yet, in all that time,
particularly over the last 2 years, our committee and this
subcommittee have conducted limited oversight in one of the
most significantly growing segments of the VA's budget.
VA is on track to spend $42 billion on community care
referrals this fiscal year. That should not be a surprising
number to everyone in this room, as more and more veterans are
referred to community care every single year. It should be
shocking to everyone here that VA is sending that much money
out of the door every year to a community care network (CCN)
over which VA and this committee have devoted very little
oversight.
As we will hear from our Office of Inspector General (OIG)
and Government Accountability Office (GAO) witnesses, there are
numerous weaknesses in VA's oversight over the performance of
its third-party administrators Optum and TriWest. These
contractors who we will hear from on the second panel have
contracts with VA worth tens of billions of dollars. Yet our
witnesses from GAO and OIG have detailed in many, many reports
that VA needs to perform additional oversight about how they
are maintaining their provider networks and whether--and
whether their providers are properly coordinating veterans care
with the VA.
Worse still, we do not even know whether patients that are
referred to the community are receiving more timely access to
care or even high-quality care in the community. We do not know
because VA has not established sufficient contractual
requirements and metrics through--through with it--through with
it can hold its contractors accountable.
Three weeks ago at a full committee hearing, my colleagues
and I had the chance to hear from veterans who had difficulties
accessing community care. Unfortunately, the limited witness
list and hasty organization of that hearing meant that we did
not get a chance to hold VA or the third-party administrators
accountable for these failures, nor did we have a chance to
discuss them with the experts at GAO and OIG who have done some
excellent work to find room for improvement in the community
care program.
I am glad we have you all here today.
As I said at the hearing 3 weeks ago, I think there is
absolutely room to improve the coordination of community care.
On Monday, GAO published a report about this very topic, one
that I requested, along with some Democratic colleagues of
mine.
GAO found that there is inconsistency and variation across
facilities in terms of how long it takes to schedule
appointments and that VA lacks a comprehensive national policy
that clearly defines roles and responsibilities for local
facilities. We are rapidly hurdling ahead toward a legislative
hearing and a markup on Chairman Bost's community care
legislation beginning less than 2 weeks from now. My colleagues
and I have many questions about the current state of community
care that I am not sure can all be answered in this one
subcommittee hearing.
I am also concerned that Chairman Bost's bill would--could
exasperate existing challenges in VA community care rather than
equipping VA with the resources it needs to properly operate
the community care program we already have.
This committee, and the health subcommittee in particular,
has an obligation to conduct robust oversight over the
healthcare that VA is providing, including through its
community care program. I am concerned that the committee's
current level of oversight is not sufficient for us to move
straight to legislating.
While this hearing today is an important opportunity to
hear directly from VA, Optum, and TriWest, I sincerely urge my
colleagues to consider what additional oversight is needed to
inform our legislative efforts.
With that, I thank you, and I yield back, Madam Chair.
Ms. Miller-Meeks. Thank you, Ranking Member Brownley.
The chair would also like to acknowledge that the chair of
the full committee, Chairman Bost, is here with us today, and
we will hear from him later.
I would now like to introduce the Panel I witnesses
testifying before us today.
We have Dr. Steven Braverman, chief operating officer of
the Veterans Health Administration (VHA) at the Department of
Veterans Affairs. Accompanying Dr. Braverman representing the
Department of Veterans Affairs is Dr. Sachin Yende, chief
medical officer, Office of Integrated Veteran Care. Also with
us today is Sharon Silas, director of Health Care for the
Government Accountability Office, and Dr. Julie Kroviak,
principal deputy assistant inspector general (IG) for the
Healthcare Inspections for the VA's Office of Inspector
General.
Dr. Braverman, you are now recognized for 5 minutes to
deliver your opening statement.
STATEMENT OF STEVEN BRAVERMAN
Dr. Braverman. Okay. Thank you. Before I get started, I
just want to apologize up front for any coughing or sneezing
that occurs during the discussion, but I thought it was really
important to be here with you today.
I want to recognize Chairman Bost for joining us.
Good afternoon, Chairwoman Miller-Meeks, Ranking Member
Brownley, and members of the subcommittee. Thank you for
inviting me here today to discuss the Department of Veterans
Affairs Community Care Program. I am accompanied by Dr. Sachin
Yende, chief medical officer of the Office of Integrated
Veteran Care, or IVC.
It is an honor to be here representing the Veterans Health
Administration for the first time as its inaugural chief
operating officer. I am responsible for ensuring we continue to
live up to the standard the veterans expect and deserve by
overseeing operations for VA's 18 Veterans Integrated Service
Networks, or VISNs, and providing executive leadership and
oversight to 34 program offices within the Offices of
Integrated Veterans Care, patient care services, and clinical
services.
It is a great responsibility, and I bring to bear the same
philosophy I have shared with my teams as a leader in the Army
and VA, a philosophy I call the four Cs to Success. They are
communication, care of the veteran, customer service, and
common sense.
Over the last decade, our system has been faced with many
challenges. Following my Army retirement, I joined the Edward
Hines, Jr. VA Hospital as its director in 2016. Frustrations
with veteran access to care were at a peak and employee morale
was low. Employing those four Cs to success, we worked hard to
implement the changes necessary to boost morale while keeping
veteran care at the core of every decision we made.
The 2018 MISSION Act passed by this committee gave us the
authority to put processes in place to ensure veterans had
access to timely appropriate care in the community when VA was
unable to provide it in our direct care system. Since the
MISSION Act became law, VA has referred over 5.4 million unique
veterans to community care providers, encompassing more than
228 million community care appointments. As with the
implementation of any law, we have had to make systemic
improvements to ensure timely access and build veterans' trust
in our system.
While serving as the director of the VA Greater Los Angeles
Healthcare System, we hired and trained dedicated staff for
referring and appointing veterans into community care. We
piloted the VA's initial tele-emergency medicine initiative
that enabled most veterans to be evaluated without costly
emergency room visits and receive appropriate follow on
specialty outpatient referrals as needed. It is now a national
program.
During my time as the VISN 22 director, the Phoenix VA
became a model for the referral coordination initiative, a
nurse-led effort to connect veterans eligible for community
care with the right provider for his or her needs.
With implementation of the Sergeant First Class Heath
Robinson Honoring our Promise to Address Comprehensive Toxics
(PACT) Act, demand on the VA has never been greater. Since the
law took effect, nearly 900,000 veterans have enrolled in VA
care, with even more moving into higher priority groups due in
part to the resulting increase in service-connected disability
ratings. The corresponding elimination of copays and increased
eligibility for additional medical services led to more
reliance on VA care that cannot be met in the direct care
system alone.
I can confidently say that we could not meet veteran demand
without the partnership and collaboration among our third-party
administrators and community care providers. Still, challenges
remain with care coordination and the veteran and provider
experience within the community care program.
A recent series of OIG inspections of VISN's community care
programs, including my former network, identified several
similar findings and recommendations. Those included
strengthening community care oversight councils, scanning of
care documents into veterans' electronic health records and
referrals, and timely processing of follow-up requests for
services. Based on these findings, IVC leaders, VISN directors,
and VHA's Office of Integrity and Compliance are working
together to execute consistent action plans across the country
to address OIG's recommendations.
Prior to joining the VA, I served 29 years as a physiatrist
in the Army Medical Corps in both academic and operational
leadership roles. As an Army retiree, a Federal employee, and a
deployed veteran, I have multiple options for my healthcare. I
am proud to say that I receive all my medical care at VA. It is
the best care available.
Madam Chair, Ranking Member Brownley, and members of the
committee, I look forward to working with you to continue to
strengthen our healthcare system and to answering your
questions.
[The Prepared Statement Of Steven Braverman Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Dr. Braverman.
Ms. Silas, you are now recognized for 5 minutes to deliver
your opening statement.
STATEMENT OF SHARON SILAS
Ms. Silas. Chairwoman Miller-Meeks, Ranking Member
Brownley, and members of the subcommittee, thank you for the
opportunity to be here today to discuss VA's efforts to ensure
veterans have timely access to healthcare through the community
care program.
Although the majority of veterans receiving VA healthcare
still receive their care at VA medical facilities, the number
of veterans receiving care through the Veterans Community Care
Program has increased greatly. In Fiscal Year 2023, community
care represented about 40 percent of all VA healthcare.
In 2018, in an effort to help alleviate long wait times for
care at VA medical facilities, Congress created the most recent
version of community care, the Veterans Community Care Program,
expanding access to providers in veterans communities. Since
the implementation of the program, the Veterans Health
Administration has made numerous changes to how the program is
administered, how referrals for appointments for community care
providers are processed, and how the agency tracks data and
information on the performance of the program.
My remarks today address findings and recommendations from
seven reports that we have issued since 2018 and includes 27
recommendations that we have made to improve the community care
program. Although VA has fully implemented some of those
recommendations and taken steps to address others, 17 of the 27
recommendations remain open as of February 2025.
There are a few areas that I would like to focus on today
where we believe that there are opportunities for VA to
continue to make improvements to the community care program.
First, we have long provided oversight of VA's appointment
scheduling processes and monitoring of wait times. VA has taken
some actions to address challenges both with scheduling
appointments with VA and community care providers, such as
establishing timeline standards for scheduling appointments. VA
has also established a timeline standard for when a veteran's
appointment should occur with a VA provider. However, VA has
still not fully implemented our 2018 recommendation to
establish a similar timeline standard for community providers.
Without a complete picture of how long it takes a veteran
to receive care, whether that care is being delivered at the VA
or through a community provider, it will continue to be
difficult for the VA to know whether it is achieving its goal
of providing veterans with timely access to care.
Further, we recently issued a report on VA's referral
coordination initiative, the new process with the potential to
transform the effectiveness of VA medical center's processing
of community care referrals and appointment scheduling. In our
2025 report, we identified challenges with the implementation
of the new program, including needed improvements to the
program's direction, guidance, and performance metrics.
For example, we found that the regional networks and
medical facilities did not have guidance that was aligned with
policy, was evidence-based, nor was it timely or consistent,
resulting in inconsistent implementation of the initiative and
potentially impacting VA medical facility staff's ability to
effectively serve veterans. We made five recommendations based
on our findings.
Second, I would like to highlight VA's oversight of
community of care contracts and network adequacy. Oversight of
these contracts and effective monitoring of the contractor's
network of community providers and their capacity to see
veterans contributes to VA's ability to provide timely access
to care.
The Veterans Health Administration is responsible for
measuring the community care contractor's performance,
including network adequacy. In our August 2024 report, we
reported weaknesses in VA's oversight of these contracts.
Specifically, we found that the continued restructuring within
the office responsible for contract oversight resulted in a
lack of clarity and completeness in oversight procedures and
roles and responsibilities. We made three recommendations to
address the deficiencies that we identified.
We have also found opportunities for VA to better ensure
community care program network adequacy. Specifically in our
2024 report, we found that VA's methodology to calculate
network adequacy for specialty care through the program does
not include all claims in their calculation. This raises
concerns as to whether VA is fully assessing the adequacy of
community care contractors' networks.
As I have highlighted in my remarks and in the statement
that we submitted, GAO will continue to monitor VA's actions
addressing our open community care recommendations. We also
have ongoing and future audits that will build on our existing
body of work in this area, including a review of VA's medical
document exchange with community providers, which we plan to
issue this spring.
Especially as VA has seen an increase in enrollment and
reliance on VA healthcare and the agency prepares for the next
generation of community care contracts, the community care
program will continue to be an important resource for expanded
healthcare options for veterans in ensuring they receive timely
access to care, a key goal for VA. Addressing both our
outstanding and new recommendations will help VA to provide
consistent high-quality healthcare regardless of where veterans
receive their care.
Thank you. That concludes my statement.
[The Prepared Statement Of Sharon Silas Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Ms. Silas.
Dr. Kroviak, you are now recognized for 5 minutes to
deliver your opening statement.
STATEMENT OF JULIE KROVIAK
Dr. Kroviak. Thank you.
Dr. Miller-Meeks, Ranking Member Brownley, Chairman Bost,
and subcommittee members, I am pleased to discuss the OIG's
oversight work related to VA community care.
Since 2020, we have published over 50 reports that
highlight the significant challenges VA faces in ensuring
veterans get timely and high-quality care in the community.
My colleagues in the Office of Healthcare Inspections, or
OHI, include physicians, nurses, pharmacists, clinical
psychologists, and social workers with decades of clinical
experience. This expertise allows in-depth review and analysis
of not only community care's administrative issues, but also a
credible perspective on how these issues affect the actual
quality of care for veterans.
For example, OHI's Care in the Community teams conduct
cyclical VISN-level reviews to evaluate compliance with VHA's
community care referral and coordination processes. These
reviews intentionally evaluate administrative processes that
have direct impact on the healthcare providers' ability to
manage and coordinate a patient's care.
OHI also conducts inspections to evaluate issues specific
to individual episodes of community care, again, through a
clinical lens, for stakeholders to understand exactly how
certain events influence the quality and timeliness of care.
Additionally, OIG's Office of Audits and Evaluations have
conducted multiple national reviews that highlight issues in
community care related to contractor oversight, VA staffing,
Information Technology (IT) systems, and financial management
processes. This oversight work has informed my testimony before
this subcommittee, as well as the many briefings we give to
committee staff, individual members, and VA leaders.
What we have consistently found can be organized into four
areas of concern. First, veterans may not experience timely and
seamless coordinated care when they are referred to the
community. Referrals designated as high risk must be
consistently prioritized. Requests for additional services must
be acted upon quickly to avoid interruptions to care, and
results of that care must be appropriately uploaded in a
patient's medical record to ensure care teams have up-to-date
information and can take action that is needed.
To do this, VHA must further develop administrative
processes to get patients to the right provider in a timely
manner and then follow up to ensure veterans received the
appropriate care.
Second, VHA has inadequate oversight of community care
providers and cannot ensure the quality of care that is being
provided. Unlike care provided at VHA, the community care
program lacks robust quality assurance processes that monitor
the performance of care specific to veterans, such as
screenings for suicidal ideation and military sexual trauma, as
well as real-time oversight of opioid prescribing practices.
For example, community care providers may not be complying with
VHA's opioid safety initiative, risking the close monitoring of
these prescriptions for veterans.
When VA providers cannot even get timely access to basic
clinical documentation detailing a community provider's
management of a referred veteran, any opportunity to monitor
that quality or address additional identified needs is lost.
Basic qualifications of community providers must be thoroughly
reviewed and verified prior to joining the community care
network.
Third, VHA staffing shortages further undermine community
care coordination efforts. Reliance on community providers is
necessary, but as we have seen, it does not guarantee veterans
will get the timely care they need. VHA must commit adequate
staffing and resources to ensure community care is as seamless
as it is in house.
Fourth, substandard IT systems and inaccurate and
incomplete data significantly restrict VA's ability to manage
community care payments. VA has a right and an obligation to
recover community care treatment costs for conditions unrelated
to military service from veterans' private health insurers. The
OIG has found that VHA has not enacted effective processes to
do this, compounded further by the pause of the program
integrity tool which is used to identify billable claims.
OIG teams will continue to conduct meaningful independent
oversight to ensure veterans receive the timely high-quality
care they deserve. We look forward to working with the
subcommittee to advance VHA's provision of care to veterans
regardless of where it is provided.
Dr. Miller-Meeks, Ranking Member Brownley, and members of
the subcommittee, this concludes my statement. I look forward
to your questions.
[The Prepared Statement Of Julie Kroviak Appears In The
Appendix]
Ms. Miller-Meeks. Thank you very much, Dr. Kroviak.
As is customary, I will reserve my time until all of the
members have had a chance to ask their questions.
With that, I now recognize our chair of the full committee,
Chairman Bost, for 5 minutes for any questions he may have.
Mr. Bost. First I want to thank Chairman Dr. Miller-Meeks.
You know, I appreciate your friendship and the continued
leadership that you are due here with the VA. It puts veterans
front and center, and thank you for that.
You know, as chairman, I am deeply committed to our shared
mission of improving, delivering the care and services to our
Nation's veterans. You have all heard me say it before, and I
am going to say it again, VA was built, not for VA bureaucracy,
but for the veterans themselves, and we have to remember that.
That is why, last month, I held a hearing to learn what
veterans and their family members think about community care.
The witnesses put their trust in the VA, and the bureaucracy
burned them in the process.
Mr. Dooley, an Army veteran of 20 years, described his
experience with VA saying, I was treated like I was asking for
charity and not treated as a disabled veteran that was trying
to receive life-saving treatment.
Ms. Locklear, a former VA employee who tragically lost her
son, stated, I believe my child would still be here today if
the VA had lived up to their promise and the promises that were
made to him.
Ms. Diamond, a Navy veteran, struggled with access--
appropriate community care, and she shared this. VA must stop
its practice of rationing inpatient mental healthcare based on
arbitrary seemingly thoughtless guidelines.
You would think that these testimoneys would be sufficient
for anyone to realize that VA community care reforms are
needed.
Some members wanted another hearing to talk about the
community care and accuse us of not conducting oversight on the
community care. This statement is inaccurate. Let me say that
again. These statements are inaccurate.
Last Congress--and I want to be very clear that all members
hear this. Last Congress, we held nine hearings, nine hearings
that focused on community care. For someone to say we are not
focused on it, we held nine hearings. Now, I do not expect
Congress--this Congress to be any different.
Last week, I and 10 cosponsors introduced the ACCESS Act,
because veterans have earned access, timely and quality
healthcare, whether in the VA at home or in the community. The
ACCESS Act would codify care access standards, give veterans a
say in their care choices, and provide access to urgent mental
health residential care.
The VA MISSION Act passed in 2018 with overwhelming
bipartisan support, like the MISSION Act, the ACCESS Act does
nothing to privatize VA. Now, let me say that again. The VA
MISSION Act, like the ACCESS Act, does nothing to privatize VA.
Anyone who suggests otherwise based on how they feel or how
their party feels needs to put a pair of glasses on and read
the bill.
Make no mistake, the ACCESS Act embodies the committee's
position. Community care is VA care. Community care is VA care.
Community care is not a substitute but an essential extension
of VA's mission.
Now, I look forward to working with my good friend, Mr.--
the Secretary, Doug Collins. He and I have been friends a long
time, and we are going to focus on VA and its only mission, and
that is caring for our veterans. That is our only mission.
Now my question. Dr. Braverman, what is the Trump
administration doing to ensure that veterans are at the center
of every VA decision?
Dr. Braverman. Chairman Bost, I think the most important
answer to your question is that that is already the guidance
from Secretary Collins, and it is guidance that we all have and
all believe in in regards to the decision-making. That was also
something that I put in my original opening statement that as I
have gone through my VA career, those decisions really are made
with the best interests of the veterans at heart. We will
continue to do that for every decision that we make along the
way.
Mr. Bost. I look forward to helping you achieve that, not
only with the new Secretary, but everybody that is involved. I
hope that that is the mission of everyone there at the VA, and
know that we are going to be working together to make that
happen.
Madam Chair, I yield back. My time has expired.
Ms. Miller-Meeks. Thank you very much, Chair Bost.
I now recognize Ranking Member Brownley for 5 minutes for
any questions she may have.
Ms. Brownley. Thank you, Madam Chair.
Dr. Braverman, it is really good to see you.
Congratulations on your assignment here in Washington.
I just have to say that I have worked with Dr. Braverman
very closely over the years, and he has done really terrific
work in the Los Angeles Medical Center but for all of VISN 22
and really appreciate your leadership and seeing through the
Community Based Outpatient Clinic (CBOC) in my district as
well. Thank you for that.
Mr. Braverman, Secretary Collins just informed the
committee today that VA does not expect to award a next
generation of community care network contracts. Might be two to
three more years before--before they are ready to do that.
Obviously, the current Optum and TriWest contracts are set to
expire.
In his letter, he said that in the previous administration
there were delayed key programmatic decisions. What were those
delayed key programmatic decisions?
Dr. Braverman. Well, I think the basics to that is that as
we are going through the requirements process to identify and
the decisions to identify what needs to be in these contracts,
we want to make sure that they are done according to
acquisition standards. That is what we will be doing moving
forward.
The timeline that was identified in the letter that you
received is, you know, based on us committing to moving as
quickly as possible to making those decisions and being able to
award the next set of contracts by the summer of 2027.
Ms. Brownley. Thank you. I agree with your remarks as well
that community care is really important and what TriWest and
Optum do is critically important. Those contracts are very
important.
Certainly, GAO has identified areas where we can improve
those contracts and identified a lack of formal lessons
learned, a process of that in the current--for the past and
current community care contracts. I just--you know, maybe today
is not the right day to talk about it, but I want to talk about
what--what we have learned, what we--do you really think--let
me get to this question.
Do you think that we need to include in their contracts our
ability to have stronger oversight in terms of, you know, the
wait times issue and other things like that built in so that--
there have been a lot of recommendations, I think, that we
could make the contracts better, and I believe that they
perform well. I just want to make sure that we are trying to
find what the right balance here is between VA care and
community care, and to really find that out we need a lot more
data to make some, I think, rather tough decisions.
Dr. Braverman. We--we absolutely want to work together with
the next contractors to make sure that that partnership
identifies ways in which we can really focus on the quality of
care that is being delivered within--by the contractors, by the
third-party administrators to be able to ensure that we have a
way to communicate what those wait times are, what those
capabilities are, network adequacy, taking a look at those
areas for improvement that have been identified in the--you
know, from the current contract administration and building on
those to make requirements that will enable us to improve
those.
I will actually yield here to Dr. Yende a moment, who has
some more specific information on the kinds of things that we
are looking at.
Dr. Yende. Appreciate that question.
I would just say we have a lot of lessons learned within
our legacy contract and based on input from both OIG and GAO.
While we cannot discuss acquisition-specific issues today, I
would just like to reassure this committee that we are focusing
for next generation on better approaches to return medical
documents, a more robust----
Ms. Brownley. I do not have much time, so if you cannot
really talk about it, I just would like to move on. Thank you.
In terms of just community care scheduling and care
coordination by the VA in this process, do you think that we
need to do a better job?
Dr. Braverman. Absolutely. One of the things we are doing
now is tracking that at my level to identify what the wait
times are, and then also focus on integration as we reassess
what our whole IVC organization is going to look like moving
forward.
Ms. Brownley. This whole offer to employees for--you know,
to--the buyout for leaving the organization and so forth, a lot
of that--I think most of it has been rescinded now. I am
worried about what--those people who are prepared and ready to
take it, and now that has--that offer has been rescinded.
Dr. Braverman. Well, in the VA, we have been very proactive
in identifying exemptions from the hiring freeze and exemptions
from participation or exclusions from participation in the
deferred resignation program, which accounts for more than 90
percent of the employees that work within our field hospitals
and clinics. That I think that, for the most part, our ability
to care for our veterans is pretty much preserved, and I think
we will be able to continue to move forward.
This is an anxious time for all of our Federal employees,
and we will continue to work with them to move forward.
Ms. Brownley. Thank you.
Ms. Miller-Meeks. Thank you, Ranking Member Brownley.
The chair now recognizes Dr. Murphy for 5 minutes for any
questions he may have.
Mr. Murphy. Thank you, Mr. Chairman. I want to say thank
you to all our witnesses today.
You know, I just--I have to reiterate the chairman's
comment about community care. I just do not understand the
rationale of beating up on it. We do not have enough doctors in
the VA. We have to refer our other patients out into the
community. Making that a seamless process rather than just
beating on the fact that community care is here with us is, my
opinion, just ridiculous. It is a waste of time, and it is just
something that the committee does not need to do. It is just
insult after insult. As a community care provider myself, it is
just ridiculous that we have it.
You know, we have come before this committee--I have been
on this committee now for 5 years, and I have just come up and
I have heard the same litany of excuses, excuses that has gone
on and the same story about delayed care, especially in the
community. I am hopeful that with new leadership coming in and
actually with the tenor of what is going on in Washington, DC,
that we actually get back to not only serving the people of the
country but the veterans who served us so dearly.
Let me ask just a couple of questions. Dr. Kroviak, just,
you know, I am in awe of all the things that you spoke about.
Your testimony highlighted some reported delays in the
processing of community care referrals, even for veterans with
serious conditions. We had--I had a constituent here at our
last meeting that was still waiting 9 months to get a referral.
What changes do you believe, concrete changes, something
that actually not to be talked about, that needs to be done,
should the VA implement to prevent these serious delays
occurring, especially ones with time-sensitive things like
cardiac disease or cancer care?
Dr. Kroviak. Thank you. I think the most important thing is
clear policies on prioritizing the very specialties you are
describing that would be automatically considered high risk,
and then internal oversight that ensures that frontline staff
are following through consistently on those policies and
practices. We have seen that is not happening.
Mr. Murphy. Yes. You know, people say that we want to
privatize the VA. In certain ways, I think the private--the
actions of the healthcare community and the private world
should be mimicked because it is--it is a tone within our VA
that there is no expediency to this. Again, with new leadership
coming in, I think there will be now a different tenor of
expediency.
Follow-up question. What happened at the Buffalo VA? The
staff raised concerns, but the leadership did not do anything
about it. What mechanisms now should be in place to hold the VA
leaders responsible when they ignore or dismiss staff with
concerns about patient safety?
Dr. Kroviak. As we have said in much of our testimony and
in our reports, it is clearly defined roles and
responsibilities that will establish the authority that we are
all looking for. If you know it is your job to follow up and
make sure that your staff are performing certain activities,
and they are not, then you need to have the authority to hold
them accountable. If you are still not getting where you need
to go, you need to know to go to the level above, and that is
just not consistently happening.
Mr. Murphy. Well, I think it needs to, and there needs to
be accountability. I think if one word is describing the tenor
in the country right now, it is called accountability. We know
that delay in care changes outcomes, period. Everybody knows.
Especially in cancer care. You are delayed in diagnosis,
delayed in treatment, your outcome is worse.
Dr. Braverman, when veterans face delays in care due to
administrative failures within the VA, what processes regarding
their lost referrals, miscommunications, delayed
authorizations, what accountability measures are in place or
need to be in place that staff and leadership are responsible
for these failures? Again, accountability, meaning the--in the
word--the imperative word there.
Dr. Braverman. One of the things that we have to do is
identify the why for when these things happen, and is it a
matter of failure to execute, failure to oversee, or just
making errors because the processes are not clear. Once we have
that information at hand, we can fix the processes, if that is
what is going on. Then hold leaders accountable for failure to
take actions when information----
Mr. Murphy. Is the VA aware of something just called a
basic root cause analysis?
Dr. Braverman. Absolutely.
Mr. Murphy. Sentinel events?
Dr. Braverman. Yes, sir.
Mr. Murphy. Okay. In my world where we have had those, if,
God forbid, there was a sentinel event where some patient was
injured, did not get the care, et cetera, there is an action
team that goes in there. That is then a zero recurrent event.
It is deemed to be not to ever occur again.
Sadly enough, we have heard this litany of 5 years--I have
anyway--of these same things being done over and over and over
again. Last 4 years, scandal after scandal after scandal. I do
not think we made one inch of progress toward getting better
care, more efficient care for our VA.
We should not be hearing these stories. Stories occur,
sure. Mistakes happen because we are a human institution. The
fact that these are recurring and over and over again with no
improvement is anathema to what this committee should be all
about.
Thank you, Madam Chairman. I will yield back.
Ms. Miller-Meeks. Thank you, Dr. Murphy.
The chair now recognizes Representative Cherfilus-McCormick
for 5 minutes for any questions she may have.
Ms. Cherfilus-McCormick. Thank you, Chairwoman Miller-Meeks
and Ranking Member Brownley for holding this hearing today.
The VA has faced persistent issues with staffing clinical
and administrative positions essential for managing veterans
community care. Reports from the GAO and VA OIG reveal
challenges, including unreliable data for staffing assessments,
inconsistent staffing practices across facilities, and
inadequate staffing tools.
Facility leaders lack the authority to enforce recommended
staffing levels, and some question whether the suggested
numbers are too high. These ongoing staffing challenges impact
the effective administration of community care for our
veterans. I am deeply concerned that this problem will be
further exacerbated by President Trump's recent executive order
to freeze Federal workforces.
Dr. Braverman, what is your plan to ensure that the VA
medical facility has the staff necessary to coordinate
veterans' care within the community care program?
Dr. Braverman. The Secretary has made it clear that we are
going to have the staff required in order to do our mission,
which is basically taking care of veterans.
Ms. Cherfilus-McCormick. Is there a plan as of right now?
Dr. Braverman. As of right now, there is, in that we have
these exemptions against the hiring freeze for the people that
are necessary in order to coordinate that care, in order to----
Ms. Cherfilus-McCormick. Could you tell us some of the
exemptions?
Dr. Braverman. I have a--all of the medical support
assistants, the nurses, the team that is associated with the
provision and scheduling of these are on the exemption list.
There is--I do not know the exact number of occupations that
are, you know, on that list, but we certainly can provide that
list to you.
Ms. Cherfilus-McCormick. Thank you.
My second question is, since the enactment of the MISSION
Act, the veterans at--the Veterans Community Care Program has
grown exponentially, straining the budget of the VA and
threatening the ability of the VA to provide direct care to our
veterans. In fact, the VA is on track to obligate $42 billion
in Fiscal Year 2025 for the community care program, up from
$14.3 billion before the enactment of the MISSION Act.
If this unsustainable trend continues, the VA will be
unable to fulfill its four core missions, one of which is to
serve a backstop--a backstop for emergencies of hurricanes that
affect my constituents in Florida immensely.
Dr. Yende, would you agree that it is important for the VA
to achieve all of its four key missions?
Dr. Braverman. I am sorry. Who was that referred to?
Ms. Cherfilus-McCormick. Oh, Dr. Yende.
Dr. Braverman. Oh, Okay. Sorry.
Dr. Yende. Yes. Absolutely, Congresswoman. We do agree with
you. Just to be clear, we believe that community care is an
important part of VA care, and we will continue to support when
veterans are eligible for community care that they are offered
community care and veterans, obviously, will have the choice to
determine whether they want to stay in the VA or choose
community care.
Ms. Cherfilus-McCormick. Specifically, what I was asking is
that do you believe that there would be a negative impact to
veterans who are trying to--the VA is supposed to be the
backstop for emergency care, like hurricanes. With this
exponential amount rising consistently, is there a concern for
you?
Dr. Yende. We are not aware of any direct impacts on our
fourth mission due to community care increase, but we can
definitely take that back and give you some more details.
Ms. Cherfilus-McCormick. Would you agree that the rapid
growth of spending on a community care program would
potentially affect VA's ability to achieve its fourth mission,
especially the fourth mission--I guess we already discussed
that.
My next concern then would be, what would you propose that
we could do that would kind of merge and subside the rising
number of community care--community care?
Dr. Yende. Congresswoman, I just want to be clear over
here. Our principles when we discuss care options with the
veterans are, if the veteran is eligible for community care,
our staff should be offering those options to the veterans.
Then if the veteran chooses to stay in the VA, then they would
get their care in the VA. If they are choosing to go into the
community, we should be able to offer that care in the
community.
Having said that, everyday VA facilities are trying to
build capacity within the direct care system to offer more and
more services. A good example of this is residential treatment
programs. We have increased capacity for beds within our VA
direct care system, and that is how we are offering more VA
care in the current system.
We just want to be clear, we do not believe these are
competing. We want to make sure we follow the law in this
particular case.
Ms. Cherfilus-McCormick. Thank you. I yield back.
Ms. Miller-Meeks. Thank you, Representative Cherfilus-
McCormick.
The chair now recognizes Representative Van Orden for 5
minutes for any questions he may have.
Mr. Van Orden. Thank you, Madam Chair. Thanks for having us
here today.
I am the--I am the longest serving enlisted member of the
United States military to ever get elected to Congress in the
history of the Nation. I get all my healthcare through the VA,
and I love the VA. I want everybody to go to the VA who has
served our country. I get these rocking glasses in LaCrosse, I
also get seen in Tomah. When I say I get all of my healthcare
at the VA, I mean also at Crossing Rivers Hospital in Prairie
du Chien, Wisconsin, when I cannot get an appointment.
Again, I cannot stress enough that community care is
Veterans Administration care because the check is coming from
there. I just want to--because I was an enlisted guy, I wanted
to show you something here.
These--these are the recommendations that were made by Ms.
Silas' office. Your reports are fantastic. Fifty reports is a
lot. Okay. These are the things that the VA has not done. If
you look at them sideways, they look like they are just about
exactly the same thickness, don't they?
If we have the--the GAO working hard--sorry, enlisted guy,
almost came out--and Dr. Kroviak working hard, and over years
and years--since 2018, they gave you this stuff. You have 18
out of the 21 have not been done? This is--this is--this is a--
it is endemic, and I have learned this as a chair of the
Subcommittee for Economic Opportunity, that we seem to keep
going in these circles. You know what I mean?
We have got the Government Accountability Office, we have
got the IG doing stuff, and then it goes to the VA and just
falls into a hole. We forget about it for a while, and then
another report--you said you do 50 reports, ma'am? Fifty
reports.
If you are by volume to take the amount of recommendations
in those 50 reports and showed us what was not acted on in any
of those reports, what do you think that ratio would be? There
has got to be--how many recommendations are in 50 reports? A
lot.
Dr. Kroviak. There are hundreds of recommendations.
Mr. Van Orden. To scale, like, how many you think the
Veterans Affairs Administration has not acted on?
Dr. Kroviak. I would be much more comfortable getting that
number back to you formally, but yes----
Mr. Van Orden. Okay. We can do that. I am okay with that.
The point being this: There is zero accountability at the
Veterans Affairs Administration, Doctor. I am glad you are
coming in, and I am glad Secretary Collins is here. There is
zero accountability at the Veterans Affairs Administration. I
do not have--hopefully, this will change. I do not have any
confidence--I mean zero confidence--in the Veterans Affairs
Administration to be able to plan itself even out of a wet
paper sack, because I have seen it to the tune of billions and
billions and billions of dollars of waste.
One example is the electronic GI Bill. The estimate from
the guys at the VA, that it was going to cost $25 million. You
know what they are up to now? $960 million from a $25 million
estimate.
Mrs. Cherfilus-McCormick, we had this hearing the other day
about the electronic service record. Wow. I mean, it is
shocking. I mean, they are up to like $50 billion they think it
is going to take to implement from a $16 billion initial
estimate. Okay. That is unacceptable.
I mean, it begs the question, Ms. Silas and Ms. Kroviak,
you know, why do you guys even exist if you are doing this, and
I mean quality work, if it is not going to be acted on?
This is more of an encouragement, you know, senior enlisted
to--you were probably a colonel or something when you got out?
Dr. Braverman. Yes, I was.
Mr. Van Orden. Okay. There you go. This is your senior
listed adviser to the incoming colonel. Your command is broken,
and it needs to be fixed. It will not be fixed until you hold
people accountable like you would in the military.
The Veterans Affairs Administration has to stop acting on a
long series of suggestions. Those should not be suggestions. We
have got to figure out a way to empower you to hold people
accountable that do not follow the findings in your reports,
and nothing is going to change until that happens.
I do not really have a question. I just--I am offering you
encouragement. I want to thank you ladies for your exceptional
work. If you ever need anything, I am really good at yelling at
people. I can do that all day long. Just reach out to my
office, I will scream at them on the phone for you. Is that
good?
Dr. Braverman. Yes, thank you.
Mr. Van Orden. All right. Thanks, Colonel.
I yield back.
Ms. Miller-Meeks. I would echo that about Representative
Van Orden, and thank you very much Representative Van Orden.
The chair now recognizes Dr. Conaway for 5 minutes for any
questions he may have.
Mr. Conaway. Thank you, Madam Chair.
Thank you, ladies and gentlemen, for presenting yourselves
to us today.
I am--I suspect there is going to be broad agreement on
this committee that community care is VA care and is necessary.
And--but, of course, the devil is in the details and the
implementation, of course, we must, as we always do, have cost
concerns as part of our deliberations.
It has been noted, the rise in the use of community care.
Dr. Braverman--and perhaps Mr. Yende may want to chime in as
well--do you have a concern about the growth of the community
care program and what that might mean for the direct care
program?
What we also know is, what is in our notes and has been
said here at this dais, is that veterans certainly want the
direct care program to continue. They want to have--receive
their healthcare there. Numerous reports show that the quality
of care delivered there is better than you are going to get out
in the private sector.
Do you have a concern about the growth of the community
care program and the potential negative impact on the direct
care program within the VA?
Dr. Braverman. Thank you for the question. The way I would
answer that is, first off, to make sure that we have a direct
care system that provides, to the best of our ability, the
needs for all of the veterans. That their initial justification
for care and availability for care is maximized within our
system, and then continue to use the community care as that
partner as VA care, as many folks have identified that before.
We are venturing on a productivity and efficiency
initiative in order to try to maximize the ability to provide
care in the direct care system, which will then----
Mr. Conaway. Pardon me. Do you have a concern about the
direct care system being able to function in a way that meets
the demand in the eyes of the veteran community--and I think
this committee--that the direct care program thrives and is
there for the veterans well into the future?
Dr. Braverman. I--I do not have concern about the ability
to do that as long as Congress identifies the--and approves
the----
Mr. Conaway. The funds.
Dr. Braverman [continuing]. resources that we need to make
that happen.
Mr. Conaway. Thank you.
My next question is for Dr. Kroviak. You know, one of the
things that we are seeing in our notes which is concerning to
me, when you look at the sort of schematic they lay out for
referrals, getting them done, getting people moved through a
system to get care, one of the things that was noted is that
there is a disconnect between what is in the Veterans
Administration's regulations around referrals and the
timeliness there and what the actual practice is when they get
out into the community setting.
Now, in your investigations, you actually go to the third-
party providers, Third Party Administrators (TPA) and others,
to look at their processes as well as the ones in the VA or no?
Dr. Kroviak. No. We look exclusively at VA.
Mr. Conaway. VA exclusively. Does anybody look at the
processes in--in the third-party community?
Dr. Kroviak. We do not have that authority to look at the--
--
Mr. Conaway. You do not have the authority.
Well, let me--let me bounce back to Dr. Braverman then. Is
there a--as you think about this next--current contract or
perhaps the next contract, recognizing--and first off, I will
ask you--you can agree or disagree--do you recognize there is a
mismatch between what the VA rules are about referral and
getting--and the timeliness and what actually happens in
practice when people are referred to the community? Do you
agree that there is a mismatch there?
Dr. Braverman. I would agree that we have these set of
standards that are identified in the VA access standards and we
do not have those same standards in the community care.
Mr. Conaway. That--that sounds--I mean, am I right, then,
that that is a contracting problem in the way the contracts are
drafted to direct the operations of the vendors, that is, Optum
and, what is it, TriWest and others who are providing community
care? Is that--is that part of the problem here with this--this
disconnect and people not getting timely care in the community?
Dr. Braverman. I will let you respond to that.
Dr. Yende. You are right. In our current contract, we do
not have that requirement. I would just add that, from our
standpoint, community care is a partner when a VA care option
is not available.
Mr. Conaway. Understood.
Dr. Yende. That is a backstop, and these are some of the
challenges within the U.S. healthcare system, so we have to
work within those confines.
Mr. Conaway. Well, it sounds like it might be a contracting
issue. I do wonder whether or not--I mean, contracts, you are
not supposed to change them. Is there a way that--well, let us
just say that--for myself, and maybe there will be others that
disagree or agree with me, that we need to look more carefully
at the contracts--the current contracts, what remedies we might
have within the current contracts if people are not adhering to
the contracts. Then, certainly, when we recontract, that we
take care to make sure there is a match between what we are
requiring and what they actually do.
Thank you, Madam Chair.
Ms. Miller-Meeks. Thank you very much, Dr. Conaway.
The chair now recognizes Representative Hamadeh for 5
minutes for any questions he may have.
Mr. Hamadeh. Thank you, Madam Chairwoman.
As a veteran, I am deeply troubled by reports of systemic
delays veterans face accessing care through the VA's Community
Care Program. As mentioned earlier, we had--a few weeks ago,
really, we heard tragic stories. I mean, it was quite an
emotional hearing of so many failures within the VA system and
referrals to the community care program.
Now, despite reforms, VA mismanagement continues to put
bureaucracy over timely healthcare, using dishonest wait time
metrics, excessive appointment cancellations, and barriers to
community care referrals. The VA fails on its most basic
mission: caring for those who served. My question will focus on
identifying specific actions to streamline care access.
Veterans deserve accountability, transparency, and flexible
care options. We must focus on empowering veterans through
healthcare choice.
My first question is for Ms. Silas. What main factors drive
continued barriers to community care access?
Ms. Silas. There is a number of barriers in terms of
getting timely access to the community care program. One is the
process within VA to determine eligibility for the program to
identify providers of the community that are available to see
veterans for care. The process itself, there is a lot of back
and forth in discussing the options with the veteran,
identifying the provider availability, and then working on an
appointment scheduling time that works for both. There is a lot
of back and forth that can go on during that time. It is the
nature of the process.
Sometimes when there is this back and forth and there may
be challenges in contacting the veteran to get their
preferences of times and availability. Maybe those
appointments, slots may get picked up by other patients not
even in VA care. There is a constant juggle of doing that
within the process itself.
I think one of the other issues is that veterans are
competing with other patients out in the community for these
appointment slots. We know just in general in the healthcare
industry that it is difficult to find providers. There is a
shortage of providers. When you are working in an environment
and the VA is responsible for ensuring that these veterans get
timely care, those create a lot of challenges for them.
Mr. Hamadeh. Would codifying access standards into law help
ensure access?
Ms. Silas. I think establishing--and this goes back to our
2018 recommendation that we made where we recommended VA
establish a standard for when veterans receive care in the
community.
Right now, there is a standard for when an appointment is
scheduled for the veteran in the community, which is great for
holding the VA staff accountable for meeting that standard. We
do not have a similar standard for when the veteran actually
receives care in the community. We have had conversations with
VA officials during our follow up on these recommendations to
see what actions they have taken, and there are concerns that
they do not have any control over the community providers'
schedules and their capacity to see veterans.
I do believe by establishing and fulfilling our
recommendation of establishing a standard for receipt of care
it would at least help VA to better monitor whether or not
veterans are getting timely access to care, and it would
actually provide an indicator to see if they are actually
meeting their goal of providing timely care.
Mr. Hamadeh. That leads me to Dr. Braverman. Why has not
the VA complied with using the date requested versus the
patient indicated dates to ensure the accurate wait times that
Ms. Silas just noted?
Dr. Braverman. I am going to refer that to Dr. Yende,
because he is more familiar with the specifics.
Dr. Yende. Our wait time calculations start from the time
the service is requested. If a primary care physician requested
a cardiology appointment, that is when time zero starts and
that is how we calculate our wait times, at least in the last
few years. It is not from the clinically indicated date as you
are referring to.
Mr. Hamadeh. It just seems like there is a mismatch. I
think what we need is to know what the actual wait time is and
not what is most convenient for the VA. That is something that
has been a frustration for so many people.
Dr. Yende. If I can just clarify----
Mr. Hamadeh. Sure.
Dr. Yende [continuing]. Congressman. Time zero, which is
when the primary care physician requests that appointment, is
the most proximal time. That cannot be fudged. That is saying
the request is made by the primary care physician. I know when
people have used clinically indicated data as you are referring
to, there may be ways to change that, but in general, we start
calculating wait times from the point the request for service
has been made.
I would just submit to you that there is usually no way to
change that time, and that is a very conservative estimate to
look at wait times.
Mr. Hamadeh. My time is up. I yield back.
Ms. Miller-Meeks. I thank you, Representative Hamadeh.
The chair now recognizes Dr. Morrison for 5 minutes for any
questions she may have.
Ms. Morrison. Thank you, Madam Chair, for holding this
hearing. Thanks to the witnesses for being here today. I have
enjoyed this discussion. I think we have all learned a lot.
You know, as one of the five physicians serving on the
subcommittee, I am deeply committed to working with my
colleagues on both sides of the aisle to ensure that our
veterans receive the highest standard of care. As an OB/GYN, I
am especially focused on making sure women veterans get the
quality care that they have earned and deserve.
Last week, I had the opportunity to visit the Minneapolis
VA, learn about its new women's veterans clinic that is
scheduled to open next year. We are lucky in the Twin Cities
our VA is pretty well equipped to meet the needs of our women
veterans, but we know this is not the case everywhere across
the country. In parts of the country where women's healthcare
is not as readily available, we need to take extra care to
ensure that community providers are filling those gaps.
Ms. Silas, in its most recent report on women veterans,
which was actually I believe in 2016, the GAO found that
improving oversight of the community care program is essential
to improving healthcare for women veterans. We know this
because many women specific procedures, like mammograms,
maternity care, and gynecology, are not always available at the
VA. As you know, GAO issued a priority recommendation that the
VA include performance metrics for access to these women
specific procedures in its community care contracts, the
rationale being that it would give VA a mechanism to work with
a third-party administrator to ensure network adequacy for
women's health.
This recommendation was closed in 2023, but did VA ever
actually incorporate any performance metrics into its community
care contracts?
Ms. Silas. Thank you for the question.
No, they did not. They created a dashboard to monitor
access to care for women's veterans care. While that is a good
tool to monitor access, timely access to care, having contract
requirements or performance metrics in a contract would have a
higher level of accountability in place. To do that you would
have to do a contract modification, which is never popular with
existing contracts. There is a window now as VA is gearing up
for the next generation of community care contracts for VA to
take that into consideration.
Ms. Morrison. That is great news, and you answered my next
question so thank you.
Dr. Braverman, thank you for being here today. My question
for you is, why did not VA choose to follow the GAO
recommendation and modify its community care contracts to
implement these performance metrics for women's health, which
as we know disproportionately referred to community providers?
Dr. Braverman. Unfortunately, I cannot answer the why did
not we because I was not there. We are going to take all of the
recommendations that we are hearing here and identify how they
can be incorporated in the next set of contracts.
Ms. Morrison. That is great. It sounds like you are open to
considering this recommendation for future community care
contracts.
Dr. Braverman. We are open to everybody's good ideas, and
some of that will be in the request for information as we move
forward through the process as well.
Ms. Morrison. I appreciate that. Thank you, sir.
Dr. Kroviak, OIG has done a lot of excellent work
identifying any inefficiencies in the community care program
when it comes to getting medical records from community
providers back to VA. In your observation, what are the biggest
challenges facing VA, and how would you recommend that we chip
away at them?
Dr. Kroviak. It is incredibly discouraging but a real
quality of care issue for the providers who refer their
patients to the community. There are delays in receiving those
documents, there are delays in uploading those documents, and
there are issues with uploading those documents to the correct
space in the medical records where providers can access the
results easily.
Again, I would go back to the oversight of these functions,
making sure that frontline staff understand clearly what their
responsibilities are and that there is continuous supervisory
oversight to ensure those functions are happening consistently.
Ms. Morrison. Thank you for that answer.
I yield my time back. Thank you, Madam Chair.
Ms. Miller-Meeks. Thank you very much, Dr. Morrison.
The chair now recognizes Representative King-Hinds for 5
minutes for any questions she may have.
Ms. King-Hinds. Thank you, Chair. Thank you to all of our
witnesses for making it out here today. I know the storm is--
the winter storm is not for me coming from the islands.
I am from the Northern Mariana Islands, and there are
hundreds of veterans facing extreme limitations when accessing
healthcare professionals and resources. In the Northern Mariana
Islands, for context, there are three islands with permanent
populations--Tinian, Rota, and Saipan--with roughly 47,000
people. Covering these regions on a part-time basis is one
doctor who is contracted to treat veterans only 2 days a week
and one nurse. If a veteran lives in Tinian or Rota, they must
travel to Saipan to visit these two healthcare professionals,
costing hundreds of dollars in airfare alone, not to mention
lodging, meals, ground transportation and other expenses.
The VHA will occasionally send specialty care doctors to
the Northern Marianas, but only once every other couple of
months. If a veteran from the Marianas needs more advanced
specialized care from Veterans Affairs directly, the nearest VA
hospital is in Honolulu. These veterans, including many who are
older and living on fixed income, must pay out of pocket to
travel for care and then wait, often too long, to receive their
reimbursements.
Our communities have long been working to establish
community based outpatient clinic, or a CBOC, but the threshold
is 1,000, and because of the lack of care and access to care,
whether it be direct or community based care, we just see these
veterans return home only to leave to look for adequate care
somewhere else.
I am sitting here and I am listening to, you know, my
colleagues argue about whether or not direct care or community
care is the most viable solution. Then I am listening to Ms.
Silas and Ms. Kroviak talk about just the issues and the
challenges with both situations. I am sitting here having to go
back home on a monthly basis and talk to veterans who, one, are
killing themselves, two, are dying because they do not have any
service at all. I say that to go on record because too often
people from the territories are not heard in terms of their
needs being met, and so I thought it was important that you all
hear that directly from me.
Listen, I get how expensive healthcare can be, right. The
challenge is not just for our veterans; we have challenge to
access to healthcare for nonveterans as well. You know, what
would it take, basically, for the VA to provide any type of
service for our veterans that would provide some of this--would
provide some of our people the relief that they are desperately
seeking?
Dr. Braverman. Congresswoman, I have to admit that I do not
know much about the program that you are describing, and I will
get some more information and get back to you.
Ms. King-Hinds. I will refer you to a GAO report that was
published in May 2024. I think that is the problem, right, is
that too often we leave these territories behind. Too often it
is where these territories of these soldiers--you know, we are
basically like a soldier-producing island. In 10 or 20 years
from now, our whole entire island's population will be nothing
but vets. Yet we have to deal with all these restrictive
regulations, one-size-fits-all regulations that may work here,
but obviously it is not working here because we are arguing
about direct services or community--you know, community access
services, right. If you can just please take note of that and
let us try to figure out how to make the situation better.
Also, I have one more question. We had one VHA
administrative specialist whose duties included assisting
patients and securing appointments with a part-time physician
or nurse. She recently retired in 2023, and her position has
been vacant since then. Can you please help us out in terms of
making sure that we fill that position as soon as possible? She
is the only person that provides a direct lifeline to our
veterans and she is badly needed. One person, that is all we
have. All right.
Dr. Yende. If I can just add to what Dr. Braverman said.
Places like Alaska, Pacific Islands have unique challenges that
are different from the rest of the country, and we realize that
sometimes the solutions have to be different.
Ms. King-Hinds. Creative.
Dr. Yende. Yes. We work closely with our TriWest TPA
partners in those regions, so we will commit to looking into
this as a follow up from this hearing. I appreciate the
opportunity to look into it.
Ms. King-Hinds. Thank you. I appreciate it.
Ms. Miller-Meeks. The gentlewoman yields.
Thank you, Representative King-Hinds.
I now yield myself 5 minutes to ask questions.
As I have listened to the dialog, which I think is very
helpful to do, other questions have arisen as we have gone
through this.
Dr. Kroviak, you mentioned some metrics that are required
for care within the VA but not for care within the community. I
found that interesting because one of the things that you
addressed was opioid prescribing. As a person who has provided
community care and as a veteran, for every doctor that is out
in the community, you have to access and go to the prescription
drug monitoring program (PDMP) of your State, and you are
required, in order to get your license, to have familiarity and
continuing education on prescription drug monitoring. Before
you can prescribe a medication, you have to go to the
prescription drug monitoring, especially if it is a opioid.
Have you actually looked at what is required for physicians
within the community that may be the same standard as what the
VA is requesting?
Dr. Kroviak. They might very well be the same standard
based on the State requirements for the license. However, we
have done work that has discovered there was not documentation
or even a reference to a PDMP query or a urine drug screen
within the community when we were trying to verify that those--
--
Ms. Miller-Meeks. You have not accessed the PMPD [sic] or
gone to the State to see if it is accessed?
Dr. Kroviak. Correct.
Ms. Miller-Meeks. Okay. Thank you.
Then I was listening to the dialog over waiting times.
Although I may not have a difficulty with that being part of a
contractual obligation, as I listened to it and heard that we
do not have a standard--so if a veteran tries to make an
appointment for a VA, they either cannot get an appointment
within 30 days or sometimes they are called back on the 29th
day of 30 days to extend the timeline and/or they are greater
than 40 miles away.
If a veteran could not get an appointment within 30 days
and they want to assess community care, but let us say the
appointment at the VA is 6 weeks away, the appointment in
community care is 8 weeks away, is not the standard then the
veteran? Is not it up to the veteran to decide which waiting
time they prefer or not prefer? If they--you know, they can get
an earlier appointment at a VA, they can decide whether or not
they want to travel the distance or, in our case, our Veterans'
Affairs will arrange transportation.
Is not the standard the veteran? Is not there a standard in
place now?
It is okay, Dr. Yende, you can just talk louder.
Dr. Yende. You are absolutely right, that is exactly what
the referral coordination team should be doing is presenting
that information to the veteran and the veteran should be
making that choice. If a veteran chooses VA, we are very happy
to support. If the veteran opts out and goes to the community,
then we will make certain the veteran gets care.
Ms. Miller-Meeks. If there is a holdup in the amount of
time from which a veteran requests community care but the
authorization's not given to the community care provider so
then they cannot request to--or they cannot make an
appointment, that then will lead to further delays.
Additionally--I have got to find my document here, so I
apologize. I have got all these papers because I have
completely changed my testimony.
Since I have been on this committee, I have heard one
insult after another hurled at VA community care. My Democrat
colleagues, with all due respect, and the Biden administration
have described community care as inferior to VA care and
certainly argued that it is more expensive. As I said, I am not
only a veteran, but a community provider.
I know that, you know, community care is ordinarily
excellent care, just like care at the VA is ordinarily
excellent care. In many cases, it is specialty care that is not
available at the VA or at a distance that is, you know,
manageable.
Ms. Silas, your testimony also suggests that community care
is often more affordable than in-house care. Your written
testimony states, and I am going to quote because I think it is
important, ``VA documentation shows that community care
represented about 40 percent of all VA healthcare in Fiscal
Year 2023. According to VHA, the Department spent about $26.7
billion on this care in the same year, out of a total of 126.--
$128.6 billion appropriated for all VA healthcare.''
By my math, 40 percent of the VA's healthcare is community
care but community care costs less than 25 percent of the VA
healthcare budget. Do you agree that community care is more
cost effective than VA care?
Ms. Silas. I would have to see the details of the budget.
What the facts that you are stating are in our report and in
the statement.
Ms. Miller-Meeks. This question may be rhetorical and you
may not be able to answer it, especially Dr. Braverman who is
new in this position, but the important question to ask would
be--especially, Dr. Braverman, you mentioned the PACT Act and
the stress of the PACT Act on to being able to deliver care at
the VA system. What would the cost to the VA be of all of the
care currently provided in the community? We know that it was
$26 billion in 2023. What would the cost be to the VA itself?
Dr. Braverman. I agree that is somewhat rhetorical based on
the information that I have. The one thing that I would
identify in the calculations here is that we do have a lot of
fixed costs that are not directly related to Relative Value
Units (RVU). The actual calculation of what it costs for, you
know, the direct care system for a per patient visit is more
difficult to identify.
Ms. Miller-Meeks. As is the cost to community providers as
well. I would wholeheartedly agree.
Thank you all so much. On behalf of the subcommittee, I
want to thank you for joining us today. You are now excused,
and we will wait for a moment as the second panel comes to the
witness table. Thank you so much.
[Recess.]
Ms. Miller-Meeks. Thank you very much. That is my signal.
Before I introduce Panel II witnesses, I would also like to
acknowledge that the ranking member of the full committee,
Representative Takano, is here with us as well. We will hear
from him later.
I would like now to introduce the Panel II witnesses.
Testifying before us today we have Dr. Scott Kruger, Army
veteran and physician, Virginia Oncology Associates; Dr. Dave
McIntyre, president and CEO, TriWest Healthcare Alliance; Mr.
Ed Weinberg, president and CEO, OptumServe; and Mr. Chris
Faraji, president of Wellhive.
Dr. Kruger, you are now recognized for 5 minutes.
Mr. Takano. Madam Chair, before we begin, I have a point of
parliamentary inquiry.
Ms. Miller-Meeks. So recognized.
Mr. Takano. May I state my inquiry?
Both the House rules and our committee rules require
nongovernment witnesses to submit a truth in testimony form.
These forms include a question about whether the witness is,
quote, a fiduciary, including, but not limited to, a director,
officer, advisor, or resident agent of any organization or
entity that has an interest in the subject matter of the
hearing, end quote.
It has come to my attention that both Mr. Weinberg and Mr.
McIntyre indicated on their truth and testimony forms that they
are not fiduciaries of their respective organizations.
My inquiry is this, Madam Chairwoman, did the majority
advise the witnesses about this form and instruct them to
indicate that they were not fiduciaries of their organizations?
Ms. Miller-Meeks. We did not.
Mr. Takano. If not, does the chairwoman find that these two
witnesses who are CEOs of the third-party administrators who
manage VA's community care network and hold at least $70
billion in VA contracts, that they are not fiduciaries who have
an interest in the subject matter of this hearing?
Ms. Miller-Meeks. I think it is important to hear from the
people that are third-party administrators since we are talking
about contracting, and that is one of the questions that has
been brought up.
Mr. Takano. My question relates to the truth in testimony
form which nongovernment witnesses must fill out. It is
important for us to know whether or not it is accurate that
they are not fiduciaries. It is something that we require of
all of our nongovernment witnesses.
Ms. Miller-Meeks. They said that they are not fiduciaries.
We have asked them to fill out and disclose the form and they
correctly filled out and disclosed on the form.
Mr. Takano. Okay. It is your determination they are not.
Thank you.
Ms. Miller-Meeks. Thank you.
We are now going to hear from our witnesses.
Dr. Kruger, you are recognized for 5 minutes.
STATEMENT OF SCOTT KRUGER
Dr. Kruger. Thank you.
Chairwoman Miller-Meeks, Ranking Members Brownley and
Takano, and distinguished members of the committee, thank you
so much for the opportunity to testify today on the Department
of Veterans program of community care medicine on behalf of my
practice, Virginia Oncology Associates, and a member of the
U.S. Oncology Network. This is one of the largest networks of
integrated community based oncology care in the United States.
I am Scott Kruger, and I am practicing medical oncologist
and hematologist and medical director of Virginia Oncology
Associates. I have had the privilege of providing care to many
of our Nation's veterans through the CCP. I appreciate the
subcommittee's attention to the critical role this program has
in providing care, the highest quality and the best quality of
care to our veterans.
The CCP has helped bridge care gaps; however, there are
significant challenges that must be addressed to enhance its
effectiveness. For veterans with complex medical conditions
like cancer, timely access to cancer care is critical. Many
veterans experience significant delays in receiving
authorizations for community care, which can be particularly
detrimental for patients requiring time-sensitive treatments.
In my area, it can take more than 4 to 6 months to get an
approval for a mammogram and a breast biopsy, and that is due
to the ineffective communication with the Office of Community
Care.
Furthermore, coordination between the VA and the community
provider is often lacking, resulting in fragmented access to
medical records, treatment plans, and follow-up care. This lack
of data sharing can lead to incomplete medical histories,
duplicated tests and procedures. In some cases, delaying
transmitting critical biopsy results, Computed Tomography (CT)
scans, Magnetic Resonance Imaging (MRI) scans, and other vital
data just delays the care even more. These challenges in
coordination and communication are further compounded by the
inefficiencies faced by the third-party administrators.
TPAs are struggling with the high case loads that cause
delayed responses and administrator strain for both providers
and patients. Although TPAs have provided our practice with a
liaison to ease in some of these communication barriers, we
still struggle to reach the community care office effectively.
Regarding reimbursement and financial stability, we used to
face significant delays in receiving reimbursements from the
VA, over 5 years for a payment of one particular claim. We
actually had 5 years of no nonpayments for all claims.
Unfortunately, when you do not pay your bills, it
discourages people like myself from taking care of patients,
and we want to take care of the VA patients. I myself am a
veteran, and we want that to happen.
It is difficult for the veterans because frequently they
encounter difficulties navigating the complexities of the CCP,
including eligibility requirements, scheduling, coordinating
care between the VA and community providers. For instance, I
saw an elderly woman in her seventies who was sent to me for an
evaluation of a blood cancer. Of course, I was only allowed to
see her. I could not do a Complete Blood Count (CBC), I could
not look at her blood. I was not allowed to order any testing.
When I saw her, she had had a stroke. She could not walk, she
had skin breakdown, and she had signs of dementia.
Although I was authorized one clinical visit, I tried to
arrange for her to have home care with physical therapy,
occupational therapy, wound care, and rehabilitation. I set up
it up with two different home healthcare agencies. The VA did
not approve any of the agencies. After 2 months and then 4
months, so far she still has not had any care.
I have a few recommendations for the committee. Basically,
we need to enhance the effectiveness of our communication.
First, I would recognize that we need a better referral process
to help expedite and implement the standardized guidelines and
timeliness for approvals. This would streamline operations and
reduce delays in service.
Second, improving care coordination is crucial. This can be
achieved through sharing of medical records and the use of
effective communication between our platforms. As community
partners, we are committed to collaborating with the VA to
ensure our veterans receive the care that they deserve.
Additionally, the efficiencies of the TPAs can be enhanced
by establishing clear performance benchmarks and accountability
measures. This will ensure that the TPAs operate effectively
and contribute positively to the program.
Furthermore, timely and fair reimbursement for the
community providers is essential, because they will not
participate if there is a financial strain on their own
practice.
Last, we must strengthen and provide education and
navigational resources for the veterans to help them better
understand their care more efficiently and ensuring that they
receive the best possible care.
I briefly want to say, and I have listened to this first
group of testimoneys, and it would be so much easier if you
just say, okay, Dr. Kruger, please take care of my patient.
Here is 6 months, you can order your tests, you can order your
chemotherapy, you can order your biopsy, and I will treat that
veteran and get them treated clearly, efficiently, and do a
great job.
The current system makes me go through so much red tape.
Before I can even start, a month and a half has gone by.
I really want to thank you for the opportunity of
testifying today. I look forward to answering your questions. I
think this subcommittee has the right idea. We have to put the
veteran in the center in order to strengthen the program. Our
job is to work together to help the veteran to get them get the
care they need.
Thank you.
[The Prepared Statement Of Scott Kruger Appears In The
Appendix]
Ms. Miller-Meeks. Thank you very much, Dr. Kruger.
Mr. McIntyre, you are now recognized for 5 minutes for
delivering your opening statement.
STATEMENT OF DAVE MCINTYRE
Mr. McIntyre. Thank you, ma'am.
Chairman Miller-Meeks, Ranking Member Brownley, and
distinguished members of the Health Subcommittee, it is a
privilege to testify before the subcommittee today on behalf of
all associated with TriWest Healthcare Alliance.
For me, this is a return to this witness table, having been
here multiple times in the last 10 years. To those members who
I have not yet had a chance to meet, I look forward to doing so
soon and working closely with you on things that matter,
including in the Marianas and in my home State of Arizona. I
ask that my written statement be entered into the record.
Established nearly 30 years ago by a group of nonprofit
health plans and two university hospital systems, our sole
purpose since then has been supporting VA and DOD in meeting
the healthcare needs of the military and veterans' communities
in our geographic area of operation. Nearly all who work for
TriWest either served this country or their families served.
We began a work in support of VA a couple of months before
the crisis of access in care in our hometown of Phoenix hit the
media. Armed with a mature and robust network from our 18 years
of work for the DOD, we quickly went to work to support the VA
in eliminating the backlogs in needed care. Well, it has been
quite a journey the last decade. Today, we serve in support of
VA through the Community Care Network program across a
geographic space that spans 14 States and the Pacific,
comprising Regions 4 and 5. Our network has delivered more than
65 million community care appointments in support of VA.
Today, we have the privilege of supporting VA in serving
the needs of nearly 4.7 million veterans through our network of
over 300,000 credentialed community care providers, offering in
VA and VA access to care at over 750,000 provider locations.
Each day, they deliver between 12,500 and 16,275 needed
appointments, spanning all areas especially. We pay their bills
in 3 days to an accuracy rate in excess of 99 percent.
We have been working a number of initiatives
collaboratively with VA in our markets to demonstrate the art
of the possible through a tighter partnership to strengthening
VA and allowing them to fully leverage us for the benefit of
veterans that reside in their area. I think of two markets to
highlight that promise, the valley in Texas and Montana, as
they are leading the way.
Second, we are working with many of the VISNs and VA
Medical Center VA Medical Center (VAMC) in our area who have a
responsibility to try and make things more efficient in terms
of how we are doing our work, all with an eye toward how do we
do appointment scheduling more effectively between us and what
provider changes need to be made that impact care delivery in a
positive way.
Fourth [sic], many more collaborative initiatives have been
underway in our geographic area of responsibility, all with the
goal of effective refinement to our collective performance. In
fact, next week, we in the VA team are gathering for 2 days to
discuss what we want to add to our collective list in our
further request to improve collective performance.
Last, I would like to thank this committee and the
leadership for your focus on fixing once and for all the rule
that forces us to reject provider claims that arrive 6 months
after the date of service rather than allowing 12 months, as is
the case for TRICARE, Medicare, Medicaid, and the private
insurance market. It is beyond time that this gets fixed and
that we execute properly and promptly the change once it is
law.
We are proud of the progress that we have made together
over the past decade. It has been painful for many of us, but
we have made progress. Yet we all know that work remains to
achieve our true potential of delivering fully for this
generation's heroes. As we know, this committee is focused on
the refinements necessary to ensuring that what was envisioned
in the yearlong bipartisan effort that led to the passage of
the MISSION Act and the authorities and the resources that have
followed in the years since is going to be delivered on.
From all of us associated with TriWest, we look forward to
doing our part in collaborating with this committee to respond
to those adjustments believed necessary to achieve our
collective potential so that our Nation's heroes, their
families, caregivers, and survivors receive that which we owe
them.
[The Prepared Statement Of Dave McIntyre Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Mr. McIntyre.
We have votes at 4:30, so I am going to remind our
witnesses to be within their 5-minute timeframe. I am also
going to remind all members that I will be gaveling them out at
the 5-minute interval. I thank you.
Mr. Weinberg, you are now recognized for 5 minutes to
deliver your opening statement.
STATEMENT OF ED WEINBERG
Mr. Weinberg. Chairwoman Miller-Meeks, Ranking Member
Brownley, Ranking Member Takano, and distinguished members of
the subcommittee, good afternoon. Thank you for the opportunity
to discuss OptumServe's role as the third-party administrator
for the VA CCN program in Regions 1, 2, and 3, where we have
been supporting veterans' choice and access to care for nearly
6 years.
As a combat veteran, retired Army officer, and a proud
father of a soldier, I have a deep understanding for the
sacrifices made by our Nation's veterans and their families. I
am deeply connected to our purpose, and I am also committed to
the success of the entire VA health ecosystem. I certainly
cannot do it alone. At OptumServe, I am humbled to be
surrounded by 5,000 great Americans, many of whom have serve in
the Armed Forces or in the VA or as military spouses and
caregivers.
Through the VA CCN program, we have the privilege of
supporting nearly 6.5 million veterans across 36 States,
Washington, DC, the U.S. Virgin Islands, and Puerto Rico. We
are making a clear difference.
With our robust network of providers, nearly 2.4 million
credentialed care sites, we have facilitated over 159 million
veteran care visits since we started healthcare delivery in
2019. We also know that building the provider network is only
half the story. It is the maintaining of the network for our
veterans that really matters. Our success in sustaining the
network is in large part due to adjudicating and paying
provider claims in 7 days on average, far exceeding the
requirements set forth by the VA.
Another critical factor in our success story is the
collaborative relationships that we have developed throughout
the veteran community. We enjoy strong relationships with VA at
every level to ensure veterans have access to the right care
wherever and whenever they need it, meeting at least monthly
with each of our 109 VA medical centers and VISNs in our
regions.
We hold quarterly program management review meetings with
VA central office to ensure proper oversight, and we do in-
person updates and engage with our military and veteran service
organizations. We have consistently worked with Congress,
ensuring that you and your staff receive quarterly updates on
the important work that we are leading.
One of the many ways we manage these relationships is
through veteran experience officers who provide boots on the
ground support at each VA medical center and through our
provider advocates who work between VA and community providers
to ensure veteran care needs are being met.
At OptumServe we remain purpose-oriented by keeping the
veteran at the center of everything that we do. While the total
numbers of our impact are interesting, I always remind my team
to focus on the power of one. Each phone call, every pharmacy
transaction, every response to a VA staff member, that is where
the magic happens. While we are laser-focused on our stated
requirements, we also seek ways to help the VA system work
better for everyone.
One such area is in medical records retrieval. While we
fulfill our obligations of educating providers on medical
record return policies, we do not stop there. We have developed
mechanisms for VA staff and providers to escalate if they are
not receiving their records back in a timely manner.
Additionally, we collaborate with VA leadership to identify
ways we can improve existing processes. For example, we are
actively engaged in a VISN 01 pilot with the goal of improving
the exchange of medical record documentation between community
providers and the VA.
I am deeply grateful for the opportunity to share
OptumServe's unwavering dedication to veterans through the VA
CCN program. We look forward to our ongoing collaboration with
the VA, with this subcommittee, and all of the partners that we
work with. We are making a difference. My belief is that we
will always be better together.
Thank you again for the opportunity to be here today, and I
look forward to your questions.
[The Prepared Statement Of Ed Weinberg Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Mr. Weinberg.
Mr. Faraji, you are now recognized for 5 minutes to deliver
your opening statement.
STATEMENT OF CHRIS FARAJI
Mr. Faraji. Chairwoman Miller-Meeks, Ranking Member
Brownley, and distinguished members of the subcommittee, thank
you for the opportunity to speak to you today. My name is Chris
Faraji, and I am the president of Wellhive. We are a healthcare
software company dedicated to modernizing the VA's approach to
community care scheduling.
Our technology is not theoretical. It is real, it is
proven, and it is successful. It was purposely built to address
the VA's long-standing inefficiencies in scheduling, ensuring
veterans receive the care from the right provider at the right
time. This is why VA contracted with us in 2023 to deliver this
technology nationwide.
The issues for tackling is one we all recognize. Veterans
are patiently waiting to get the care they need. Right now,
scheduling a VA community care appointment is like booking a
flight before Expedia or Travelocity even existed. Imagine
needing to fly across the country, but instead of searching
online, you have to call each airline separately. You are
waiting on hold, you are checking availability one by one,
repeating this process until you finally find the flight that
works. That is exactly how the VA community care scheduling
system works today.
Medical support assistants, also known as MSAs, have a hard
job. They spend hours making calls, waiting for responses and
mainly piecing together the appointment availability while
veterans are waiting. This is where things change. With the
External Provider Scheduling (EPS), it allows schedulers to
instantly see real-time appointment availability across
multiple provider groups in the community and book on the spot.
No more phone tag, no more unnecessary delays, just fast,
efficient scheduling that ensures veterans get the care they
need when they need it.
We know it works. At sites using EPS, MSA schedulers book
up to four times as many appointments per day, compared to the
outdated manual methods. The most compelling proof comes from
those from the front lines. One scheduler calls EPS a godsend,
saying, ``Before, I spent hours tracking down appointments.
Now, I see them instantly.'' The time saved is making a world
of difference for veterans. Another shared, ``Before EPS, I
would schedule an appointment, only to find out later that the
provider was not available, forcing me to reschedule. Now, I
know exactly when and where the veteran can be seen, avoiding
unnecessary delays.''
EPS is directly reducing wait times. The current average
wait to schedule a VA community care appointment is 31 days.
With EPS and even without the critical integrations into
systems like HealthShare Referral Manager (HSRM) or Consult
Toolbox, that wait drops by 33 percent. In some locations, the
improvement is even more dramatic. For example, Columbia, South
Carolina, their wait times have dropped by 52 percent. In
Dallas, Texas, the wait times have fallen by 46 percent.
Yet despite these results, EPS remains optional. This means
many schedulers are still relying on outdated methods. Even at
sites where EPS is fully available, more than half the
appointments are still booked manually.
We are encouraged by the direction of this Congress, the
new administration, and Secretary Collins, who have made it
clear to the commitment to ensuring veterans receive the care
they deserve. We at Wellhive stand ready to work side by side,
Secretary Collins, Congress, VA, to ensure an aggressive
rollout of EPS.
Technology is not the obstacle. Bureaucracy is. The
solution is simple. Let us just cut through the red tape and
let us fully integrate EPS into the VA's mission across the
country.
Before concluding, I would like to briefly address some of
the comments from the first panel. There is obviously a pattern
of scheduling that is inherent into the conversations of
today's questions. Ms. Silas mentioned some of the nuances that
these schedulers and veterans are facing when they are not able
to have that information at their fingertips. They are waiting.
They do not know. They will get back to them; they make these
telephone calls.
They also made a comment about the veterans competing with
nonveterans for these appointment slots. What the EPS Wellhive
platform has been able to do is provide and equip these
schedulers with that information so that, hey, if there is a
provider that does not have availability, they are going to see
it. If the provider does have availability, they will also be
able to see it. They are not wasting time calling providers
that do not have availability in the first place.
Another point that I would like to make with my remaining
time is that--you know, from Dr. Morrison. You made mention of
women's health. We are really excited because this week we were
able to activate and provide mammograms where they can now be
scheduled. It is not just providers but it is mammograms, and
in addition to that we also have imaging.
I thank you very much for the time, and I look forward to
your questions.
[The Prepared Statement Of Chris Faraji Appears On In The
Appendix]
Ms. Miller-Meeks. Thank you very much, Mr. Faraji.
I now recognize the ranking member of the full committee,
Representative Takano, for 5 minutes for any questions he may
have.
Mr. Takano. Thank you, Madam Chair, for this courtesy.
I have a question for both Mr. McIntyre and Mr. Weinberg.
You were both paid capitated rates that are calculated on the
basis of how many veterans are directed to your networks. That
means the more veterans referred to you, the more you are paid.
Is that right, Mr. McIntyre?
Mr. McIntyre. We are paid in administra-----
Mr. Takano. Just answer the question. The more they are
referred to you, the more you are paid. Is that right?
Mr. McIntyre. Yes.
Mr. Takano. Yes.
Mr. Weinberg.
Mr. Weinberg. Congressman, we get paid if there is a paid--
--
Mr. Takano. It is a very simple question. The more veterans
are referred to you, the more you are paid. Is that right?
Mr. Weinberg. That is correct for----
Mr. Takano. Thank you. Do either of you conduct assessments
of the quality of care delivered by specific providers in your
networks?
Mr. McIntyre. Yes.
Mr. Weinberg. Yes, we do.
Mr. Takano. You do. You make this information available to
veterans?
Mr. McIntyre. We make the information available to the VA.
Mr. Takano. Mr. Weinberg.
Mr. Weinberg. We as well make it available to the VA.
Mr. Takano. Well, I am going to tell you that VA facilities
are regularly rated on quality of measures, and this public is
provided to veterans and the public.
I find it extremely hard to believe that you actually do
these assessments, since you do not require your network
providers to return medical records to you or the VA. I heard
about all the pilots, but, in general, you do not require this.
I do not know how you could be assessing the quality of care.
What would you be even using to assess the quality of care?
Either one of you have a--Mr. Weinberg?
Mr. Weinberg. Well, thanks for the question.
What I would probably start with is we have got a
credentialed network. Quality starts with verification of State
license. It also--board certifications, education. We do verify
that with all of our providers.
Mr. Takano. Well, thank you very much for that, but I do
not believe it is the kind of rating and assessment that VA the
does.
I know that United Healthcare Group has plenty of
experience reviewing medical records when it is deciding
whether to pay a claim or make a patient prove medical
necessity. It astounds me that there is no conditioning of
payment on the return of records for veterans community care.
Do you conduct audits to identify whether or not your
network providers are opportunistically billing VA for
additional services or requesting additional authorizations
rather than referring veterans back to the VA for coordinated
care? Mr. McIntyre.
Mr. McIntyre. Thank you for the question, sir.
When we started----
Mr. Takano. Do you actually do audits regularly,
systematically of your network?
Mr. McIntyre. Yes, we do.
Mr. Takano. You do.
Mr. McIntyre. If I can----
Mr. Takano. Mr. Weinberg.
Mr. McIntyre. If I can answer----
Mr. Takano. Mr. Weinberg. Mr. Weinberg.
Please, can I reclaim my time?
Mr. Weinberg. Congressman, we not only audit, but we are
audited by independent external auditors quarterly, and those
data are all provided back----
Mr. Takano. I would be interested in knowing whether there
is any opportunistic billing.
Mr. Weinberg, this question is for you. How many veterans
currently enrolled in United Healthcare Group's Medicare
Advantage plans are also receiving care through VA's Community
Care Program?
Mr. Weinberg. Congressman, I appreciate the question. I do
not know the answer to how many.
Mr. Takano. Well, thank you. I would hope that you would
get that answer back to the committee within a week.
Mr. Weinberg. We would be happy to do that.
Mr. Takano. United Healthcare Group operates one of the
largest Medicare Advantage programs in the country, so it is
collecting premiums for veterans. Through its Optum subsidiary
is collecting payments from the VA under the community care
program. Veterans receive the care once, but United Healthcare
ostensibly is getting paid twice.
Do you think the Federal Government and taxpayers are
overpaying because of this double-billing practice?
Mr. Weinberg. Thank you for the question, Congressman.
No, I do not. I believe that veterans have choices for
their healthcare and they have earned the right to use the VA,
as well as any other benefit they----
Mr. Takano. That is really nonresponsive to my question,
because it is really about the double billing. United
Healthcare is receiving Medicare Advantage premiums, but yet
they are also being--you are also receiving money from the
community care program. My question was, is not that double
billing?
Mr. Weinberg. Congressman, we do not view it that way. We
view it as the administrative fees that we need to manage both
programs----
Mr. Takano. I see. Well, Mr. McIntyre, just because you
found a loophole to collect from both Medicare Advantage and VA
for the same veterans care does not make it right. It makes it
a taxpayer-funded windfall for your company at the expense of
veterans and the American people.
Mr. Weinberg, how much revenue does Optum, United
Healthcare Group, and TriWe---well, for both of you, how much
does is generate from the community care contracts over the
past year, 5 years, or the entire time you have held the
community care contracts? Mr. McIntyre.
Mr. McIntyre. I would be glad to get you that information,
Congressman. I would say that----
Mr. Takano. Mr. Weinberg.
Mr. McIntyre [continuing]. we used----
Mr. Takano. Mr. Weinberg, how much money would you say?
Mr. Weinberg. Congressman, can you repeat the question?
Mr. Takano. How much money have you contracts generated
from the community care program?
Mr. Weinberg. I mean, if you want the specific number,
Congressman, I would prefer to come back to you with that for
the record.
Mr. Takano. Okay. Tens of billions of dollars?
Mr. Weinberg. I would say yes. I would also remind you,
sir, that many of those dollars are passthrough dollars so they
are paying the provider directly. They are not coming back to--
--
Mr. Takano. Thank you. I yield back.
Ms. Miller-Meeks. Thank you. The gentleman's time has
expired.
The chair now recognizes Representative Hamadeh for 5
minutes for any questions he may have.
Mr. Hamadeh. Thank you, Madam Chair.
As I sit here in this committee and other committees on the
VA, I am deeply concerned by my Democrat colleagues' attempt to
scapegoat community care providers caused by VA mismanagement.
I feel as if too often some of our colleagues are focused on
protecting the bureaucracy and not veterans' care.
As outlined in the staff memo titled, On Most Alarming
Aspects of VA Document Review: Efforts to mitigate community
care aimed to trap veterans in a broken VA system limiting
choice in access.
Now, Madam chair, at this time I ask unanimous consent to
insert our staff memo into the hearing record.
Ms. Miller-Meeks. No objection.
Mr. Hamadeh. Rather than attacking partners trying to serve
veterans, we must identify solutions to cutting bureaucratic
red tape and empower veterans through accountable, flexible
care options. They deserve nothing less.
Now, my question is for my fellow Arizonian, Mr. McIntyre.
During COVID, you took over appointment scheduling
responsibilities from the VA, correct?
Mr. McIntyre. Yes, sir.
Mr. Hamadeh. Could resuming centralized scheduling improve
access?
Mr. McIntyre. Used to do the things that were to the right
of the line of demarcation and the VA did the work to the left,
and that worked. The current system could be refined, but that
worked.
The second thing that we did is we did not, back in the
day, pay a provider's claim until they submitted their medical
records. We paid the claims in days. Congress felt that it was
problematic because some providers were complaining about that
requirement. 85 percent of the doctors were providing the
medical records to the system under that approach.
Mr. Hamadeh. What obstacles have you faced building robust
provider networks due to burdensome VA administrative barriers?
Mr. McIntyre. We have not faced problems in the development
of network because of that. It is maintaining this network that
is challenging. We are working together with the VA to try and
make sure that those challenges are addressed in the markets
where we face them.
Mr. Hamadeh. It seems like you guys are working together
right now?
Mr. McIntyre. We are trying----
Mr. Hamadeh. Okay.
Mr. McIntyre [continuing]. on both sides.
Mr. Hamadeh. That is good to hear.
Now, Mr. Weinberg, what specific steps can the VA take to
improve the referral process?
Mr. Weinberg. Congressman, great question. I do believe
that a lot of what I heard on Panel I in that discussion was on
point. We are talking about standards, not standardization. I
think we are reminding ourselves that healthcare is local. I
believe that there has got to be accountability in the system.
We need to be measuring, we need to be tracking, and we need to
be holding folks accountable.
Mr. Hamadeh. Thank you. I yield back.
Ms. Miller-Meeks. Thank you, Representative Hamadeh.
The chair now recognizes Dr.--excuse me, Representative
Brownley, Ranking Member Brownley, for 5 minutes.
Ms. Brownley. Thank you, Madam Chair.
Mr. Weinberg, I was concerned to read in Dr. Kruger's
testimony that the reimbursement rates his practice receives
are often lower than those offered by Medicare.
Is Optum reimbursing providers that are lower than Medicare
rate?
Mr. Weinberg. Congresswoman, thank you for the question.
We do follow the strict adherence of the payment rates that
are given to us by the VA, primarily for medical care that
would be in line with Centers for Medicare and Medicaid
Services (CMS)--with the CMS rates.
Ms. Brownley. The MISSION Act clearly states that you must
be paid by Medicare rates. I am just making sure----
Mr. Weinberg. Correct.
Ms. Brownley [continuing]. that that is what you are
paying.
Mr. Kruger, is that inconsistent with what you understand?
Dr. Kruger. The problem is the VA initially--and this has
been happening for about the last 7 years. It got better about
2 years ago--basically did not pay any claims for over 5 years
with multiple submissions and multiple fights between our local
VA and the VA in Salem. Eventually it was paid. They were
paying it on the current rates when they approved the bill----
Ms. Brownley. I see.
Dr. Kruger [continuing]. even though the treatment was done
4 years ago.
Ms. Brownley. I see.
Dr. Kruger. The drugs then----
Ms. Brownley. That has smoothed out?
Dr. Kruger. It has smoothed out.
Ms. Brownley. Okay. I am--so, again, maybe you are
clarifying another question that I had, because Mr. McIntyre is
saying that he is providing a 3-day turnaround on
reimbursements and you were saying sometimes it is up to 5
years. There was a lot of inconsistency there. You are saying
now that that reimbursement process has improved significantly.
Dr. Kruger. It has improved significantly over the last 6
months. What has helped significantly was we have been given a
liaison that we can talk to in Optum, and they are helpful with
the billing, but they do not really get involved with ordering
the care for the patient. That is up to the VA community care
office.
Ms. Brownley. Thank you.
To Optum and TriWest, you know, in the first panel, we
talked about the contract, the delay in the contract, possible
additions to a future contract.
Would you have any issue in terms of transparency around
wait times within community care?
Mr. McIntyre. I believe personally that there needs to be
accountability and transparency on both sides with regard to
wait times. Currently, in our area for last year, it was an
average 7 days to schedule once the appointment request was
given by VA, an average of 20 days to be seen and an average of
15 days to be seen at the date preferred by the veteran.
Ms. Brownley. Right. I mean, but what we would like to see
is really, you know, on sort of a monthly basis, to know what--
what is happening in direct care with the VA and what their
wait times are and what your wait times are, not so much the
averages over, you know, a long period of time.
Mr. McIntyre. Agreed.
Ms. Brownley. That would not be a problem.
Mr. McIntyre. No. We had talked about years ago the----
Ms. Brownley. Yes.
Mr. McIntyre [continuing]. longitudinal look at this and
needed to be doing that.
Ms. Brownley. Mr. Weinberg, do you agree or----
Mr. Weinberg. Congresswoman, I would agree. We do provide
hundreds of deliverables to the VA, which would include, you
know, performance for our network adequacy.
The only other thing I would add is that I think it is
essential, if we are talking about access and choice for
veterans, they need to be able to see those data so they can
make the most informed choice.
Ms. Brownley. It is clear to me that this EPS system that
has been described today is music to my ears, honestly. I think
we need to do a lot of technology outside of the VA to bring it
in. It seems as though this could be a huge improvement in
terms of community care scheduling, although it is optional.
Did the VA decide that it was just going to be optional,
not--or did you decide that it should be optional? I am trying
to understand why it cannot be universal across the board,
because it seems like it really would improve that process.
Mr. Faraji. Sorry. Was that question to me?
Ms. Brownley. Well, I think it needs to be to----
Mr. Faraji. Well, I can answer it. I mean, it is not--it is
actually not coming from the vendor or it is not coming from
the TPAs. It is--it is coming directly from VA. The VA----
Ms. Brownley. Okay. It is VA that is saying----
Mr. Faraji. They have not--no, there has not been any sort
of directive to be able to use----
Ms. Brownley. Okay. For Optum and TriWest, you have not
asked VA to make it optional, that that would be preferable to
you?
Mr. McIntyre. No, ma'am.
Ms. Brownley. Would--Dr. Kruger, would physicians or
providers have a problem putting out their schedules in the
ether?
Dr. Kruger. For us, that would be a little bit of a
challenge because different oncologists specialize in different
areas. A vendor may not know that.
Basically, if they send us a consult, they will get an
answer in 48 hours. All oncology is seen within 24 hours of the
appointment. All hematology is seen within 3 days. That is our
working----
Ms. Brownley. Thank you. I yield back. Sorry. I did not----
Ms. Miller-Meeks. Thank you. If you have other questions,
please submit them in writing. We will make sure that they are
answered.
The chair now recognizes Representative King-Hinds for 5
minutes for any questions she may have.
Ms. King-Hinds. Thank you, Chair.
I just have one quick question for Mr. McIntyre since you
provide--or provide coverage for the Marianas.
Mr. McIntyre. Yes, ma'am.
Ms. King-Hinds. I know that access to healthcare just for
the average, ordinary citizen is a challenge because of the
amount of providers that are available out there, whether it be
mental health or any type of care.
What--can you just share a little bit, if you are having
challenges with insuring, that you have an adequate pool of
providers to be able to provide, you know, the care that we are
trying to give to veterans?
Mr. McIntyre. For your area in the country, ma'am, I made
two visits to Tinian and Rota and to the Marianas. We have the
providers in that community under contract.
As you well stated, it is important to make sure that there
is a footprint at some of those places like Tinian that does
not have healthcare to be able to allow Circuit Riders to come
in and out of that area to meet the needs versus people
traveling.
We look forward to working with you and with the VA to pick
up a topic that we worked on 5 years ago.
Ms. King-Hinds. Okay. We will speak offline. We will have
the office reach out. Thank you.
Mr. McIntyre. Look forward to it.
Ms. King-Hinds. Appreciate it.
I yield back, Chair.
Ms. Miller-Meeks. Thank you, Representative King-Hinds.
The chair now recognizes Dr. Morrison for 5 minutes for any
questions she may have.
Ms. Morrison. Thank you, Madam Chair. Thank you to the
witnesses for being present to answer our questions today.
During the first panel, I think you may have heard me ask
witnesses from VA and GAO about including performance metrics
that would track access to women-specific procedures in
community care contracts. Since women's healthcare is
disproportionately referred to the community, we need to make
sure that our community providers are delivering this essential
care. They indicated that they thought it would be an effective
way to improve care for women veterans.
Mr. Weinberg and Mr. McIntyre, what do you think about this
sort of contractual requirement in TPA contracts?
Mr. Weinberg. Congresswoman, thank you for the question.
Again, I think that transparency is really kind of rule the
day here. I think that the more we know and the more veterans
know, the better choices they will be able to make.
Ms. Morrison. Thank you.
Mr. McIntyre. Agree. I think tracking standards and making
sure that we are being transparent about where we are
juxtaposed to the standards makes a lot of sense.
Ms. Morrison. Appreciate that. Thank you, gentlemen.
Back to the two of you again. We know that community care
is an essential piece of the puzzle, but we also know that, in
general, veterans prefer VA care, in part, because many VA
providers are veterans themselves and understand the military
and veteran experience.
I have trained at a VA during my early medical career, and
I can tell you that even those of us who are not veterans are
still required to take military cultural competency trainings
and a myriad of other trainings that are sensitive to veterans'
needs.
Do you know what percentage of your network providers have
completed optional trainings on military cultural competency,
suicide prevention, and opioid safety?
Mr. Weinberg. Congresswoman, thank you for the question.
While I do not know the exact percentage, what I can tell
you is that we do have a pretty robust suite of training
offerings, to include a partnership we have just formed with
PsychArmor who offers additional ones.
The other thing that I think is really important as we
think about incentivizing providers to take the trainings is to
actually start to offer Continuing Education Units (CEU). We
have done that with a couple of courses now, one for opioids
and the other one on suicide prevention, and we have got a few
others in the queue as well.
Mr. McIntyre. We also have a similar suite of products and
content, to include VA-provided content, and we have been
working with PsychArmor for 5 or 6 years.
I would say that in the area of opioid training, the
question is do the providers need to take VA-specific training
or is it sufficient to use their State licensure requirement,
which is required of all of them.
I think to the last panel, it would be worth all of us
taking a look at what reality is and what is occurring in that
place.
Ms. Morrison. Thank you. Then one final question, Mr.
Weinberg. These same trainings that all VA providers are
required to take are optional but available through Optum,
right?
Mr. Weinberg. That is correct, Congresswoman.
Ms. Morrison. Is there a way for a veteran to know if one
of your providers has completed trainings about suicide
prevention in that spirit of transparency?
Mr. Weinberg. At this time, there is not. We are not
required to transmit those level of data over in our provider
data file, but I think it is a great point, and it is something
that we would be willing to talk through if it becomes a
requirement from the VA. I think it, again, gives more
transparency to the veteran as they are making their choice.
Ms. Morrison. Appreciate that. Thank you for your service.
I yield back. Thank you.
Ms. Miller-Meeks. Thank you very much, Dr. Morrison.
I now recognize myself for 5 minutes.
Dr. Morrison, thank you for that excellent question. I am
going to pose to the VA that I would also like to see the VA
stats on how many veterans ask if a VA provider has completed
and done VA-specific care, whether it is opioid, suicide
prevention, mental health, or any of the other variety of
things that continually get brought up in this hearing as a
difference.
Again, being a veteran who does not access VA care and I
prefer to get my care in the community and a community
provider, we want the best care for veterans where veterans are
located.
Mr. Faraji, I am going to actually go to you first because
the reason you are here is actually the point that Ranking
Member Brownley made. Given the success of External Provider
Scheduling program, or EPS, do you believe EPS should be
adopted across all VISNs to eliminate the inconsistent care
scheduling veterans currently experience?
Mr. Faraji. Thank you for the question. I absolutely
believe that it should be rolled out across the country and
have the equitable care so that there are veterans that do
not--are not able to experience EPS because it is not live in
their sites. They are not being able to take advantage of the
efficiencies that the platform is already doing today for the
sites that do have it by decreasing wait times, allowing the
schedulers to be even more productive.
Ms. Miller-Meeks. I have no fiduciary interest in you or
your product, but--however, would such a scheduling platform be
beneficial even within the VA system for scheduling
appointments?
Mr. Faraji. I am sorry. What was that?
Ms. Miller-Meeks. Would it be beneficial even within the
VA, not just in community care, to schedule such a platform to
schedule appointments?
Mr. Faraji. Yes, that is correct. We actually did a pilot
in January 2023 where we actually integrated into VISN 7 and 8
with 15 instances of Veterans Health Information Systems and
Technology Architecture (VistA), and we were able to
demonstrate to be able to see across those VistA instances and
be able to compare that availability with those providers.
The goal would be to then add on the Community Care Network
to be able to give you the apples-to-apples comparison, which
the comment that you made earlier about it is up to the veteran
if you want to have the VA care or community care because they
are both at the point where it is--they are further out, right.
Being able to have that.
Ms. Miller-Meeks. Thank you for saving me. That was a big
faux pas. I am never supposed to ask a question I do not know
the answer to, and I did not know the answer to that question.
Thank you that it worked out well for us.
Dr. Kruger, could you share some of the difficulties you
have experienced with sending and receiving medical records to
the VA?
Dr. Kruger. Thank you. Sending--we do send the records. I
do not know where they go to, but we do fax them. That is the
only way we are supposed to send them. Our communication
systems and computers do not talk to the VA. In terms of
receiving records, the VA in my community says that we are
their last priority, and they will get around to it when they
can.
The difficulty that I have of taking care of patients is
that, if I have to do a CAT scan, the VA determines where it is
going to be. I do not know where it is going to be. I do not
know where to get the results. I have to wait for the VA to
tell me it has been done and to give me the results. Very
difficult if I find out it has been done at one of the military
hospitals and I am told it is a Health Insurance Portability
and Accountability Act (HIPAA) breach, even though I am the one
who ordered it, it is really the VA who ordered it, but I
cannot get the results.
Ms. Miller-Meeks. Thank you very much for that. It sounds
like there is some work we have to do on both ends on the
medical records and also to have interoperability, which may be
beneficial rather than faxing.
Mr. Weinberg, how do--excuse me. How do delays--I know it
was Dr. Braverman who had the cold, but I am the one that is
stuttering.
How do delays in VA referral authorizations impact your
ability to provide timely care for veterans?
Mr. Weinberg. Yes. Madam Chair, thanks for the question.
You know, one of the things that we try to do is make sure
that there is as much coordination between us and the VA as
possible. I go back to my statements about relationships at the
central office level, VISN level, VA medical center office, to
include sitting down and doing network adequacy meetings every
single month. You know, the impact for me, it is not about our
organization. It is really about the veteran. What we--what we
are trying to do is help make that go as fast as possible.
Ms. Miller-Meeks. Thank you. I yield back.
Ranking Member Brownley, would you like to make any closing
remarks?
Ms. Brownley. Well, I will just be brief. I think that this
has been an important meeting, and I am glad you have called
it. I think we still--there is still a lot for us to learn and
to understand. Now that we have a delay in this contract, I
hope that we can take the time to think about what can be
included in the contract to improve services for our veterans.
I think this EPS system, I think, is--should, you know, be
universal across the board, and if it can be internal within
the VA, I think we need to do that. I mean, this could be a
huge, huge improvement just by doing this.
I think, you know, we still need a lot--I think we still
need more hearings and a deeper understanding of where the
right balance is. This is what I continue to say over and over
and over again in these hearings is the right balance between
community care and VA care. You know, where is that--where is
that balance?
I took offense to Dr. Murphy saying that I am being
critical, always continuing to be critical about community
care. That is quite the opposite. I believe that the community
care is an essential part, which I even said in my opening
comments, but community care is essential to the success of the
VA in providing services to our veterans when they need it and
where they need it.
I just think that we have got to be clear about the
direction that we are going in and trying to find that right
balance. I mean, I would wonder from really the two--two
providers here, Optum and TriWest, if you had a huge increase,
a very significant increase in patients, you know, over a
period of time, is that something that you could actually
handle? You know, I do not know if you----
Ms. Miller-Meeks. You want to submit that question for the
record?
Ms. Brownley. Thank you. That is a question that I would
really like to have answered.
I will yield back.
Ms. Miller-Meeks. Thank you very much, Ranking Member
Brownley.
I would like to thank everyone for their participation in
today's hearing and for the great discussions we have had on
this important topic.
I also would say I would be happy to accommodate Ranking
Member Brownley on having more hearings on community care and
on this topic because, as I stated earlier, our veterans'
biggest barrier to receiving the care they deserve should not
be the VA itself.
Today's hearing reinforced the importance of the clear
roles and responsibilities within the community care program
and the need to focus on solutions that work for veterans, such
as what we heard today with Mr. Faraji and Wellhive, and it
focuses on the veterans and not on the people who run the
system.
I look forward to working with Secretary Collins and the
VA, Dr. Braverman especially, to ensure the high-quality care
is delivered to our veterans.
The complete written statement of today's witnesses will be
entered into the hearing record.
I ask unanimous consent that all members have 5 legislative
days to revise and extend their remarks and include extraneous
material.
Hearing no objection, so ordered.
I thank all members and the witnesses for their attendance
and participation today. The hearing is now adjourned.
[Whereupon, at 4:31 p.m., the subcommittee was adjourned.]
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A P P E N D I X
=======================================================================
Prepared Statements of Witnesses
----------
Prepared Statement of Steven Braverman
Good afternoon, Chairwoman Miller-Meeks, Ranking Member Brownley,
and Members of the Subcommittee. Thank you for inviting me to discuss
how VA ensures that Veterans have access to the excellent, timely care
they have earned. I am accompanied by Dr. Sachin Yende, Chief Medical
Officer of the Office of Integrated Veteran Care, Veterans Health
Administration. We come to work every day with one goal in mind: to
serve Veterans, their families, caregivers, and survivors as well as
they have served our country.
Expanding Health Care Access for Veterans
At VA, we prioritize Veterans. We have expanded health care
services throughout VA facilities, thereby increasing our capacity to
provide direct care across many regions. We see community care as an
integral part of VA care. The Department supports Veterans in choosing
between receiving care directly from VA facilities or from community
providers, as outlined in P.L. 15-182, the VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks (MISSION) Act of
2018. Our integrated approach to total Veteran health is based on the
idea that Veterans have earned the right to choose world-class health
care services when and where they need them as authorized by law. Our
network of community care providers effectively bridges the gaps
between Veteran needs and the limitations of VA's direct care system.
Congress provided authority to VA under the MISSION Act that
extended community care access for Veterans. In 2019, VA began
implementing the MISSION Act and has since referred over 5.4 million
unique Veterans to community care providers. Veterans have accessed
more than 228 million community care appointments. The enactment of
P.L. 117-168, the Sergeant First Class Heath Robinson Honoring our
Promise to Address Comprehensive Toxics (PACT) Act of 2022, enabled VA
to expand its reach and provide health care to even more Veterans.
Since the PACT Act was signed into law in August 2022, nearly 900,000
Veterans have enrolled in VA health care. The combined results of
empowering Veterans to choose providers authorized by the MISSION Act,
in conjunction with the expanded enrollment following enactment of the
PACT Act, has resulted in VA delivering 78.8 million appointments in VA
facilities along with 53.6 million appointments in the community since
August 2022. This unprecedented enrollment and care delivery growth has
resulted in the greatest number of Veterans receiving the world-class
health experiences they have earned.
Enhancing Community Care Coordination
With the rapid expansion of community care eligibility under the
MISSION Act, the Department improved its ability to accommodate the
growing number of Veteran patients referred to our community providers.
Once community care eligibility is established, VA's referral process
includes measures to ensure each Veteran achieves a positive outcome.
Referrals begin when VA receives a request for community care,
managed through the HealthShare Referral Manager (HSRM) system. The
HSRM system is used by facility community care staff to generate
referrals and authorizations for Veterans receiving care in the
community. Clinical and community care staff at VA medical centers,
outpatient clinics, community-based outpatient clinics, and Veterans
Integrated Service Network (VISN) offices use this solution to enhance
Veteran access to care. Each facility's Community Care Integrated Team
(CCIT) determines the appropriate level of care coordination for each
Veteran using VA's Screening Triage Tool to aid in standardizing
episodes of care. The Screening Triage Tool allows Veterans to complete
clinical screenings from any connected device. Patients can report
symptoms or complete standardized screening questions before their
medical appointments, which results in a more efficient visit. Together
with community providers, CCITs develop an individualized care
coordination plan with the Veteran and their care team. Third-Party
Administrator (TPA) services include scheduling, process navigation,
and other follow-up activities. Care coordination involves assessing
the complexity of care needs for Veterans receiving community care,
care delivery, and returning health records back to VA.
Role of Third-Party Administrators
TPA's play a crucial role in the VA Community Care Network by
locating community providers who can provide timely, quality care. TPAs
also process care claims from these providers and work to schedule
appointments and support other technical aspects of Veteran care
coordination. The CCIT facilitates collaboration across each component
of the care coordination process. TPA actions streamline information
flows among Veterans, CCITs, VA providers, and community providers.
After an episode of care concludes, the CCIT connects with the Veteran
to ensure all services were performed appropriately. The CCIT also
facilitates any necessary patient care handoff, closing the consult.
Enhancing Veteran Health Care Through Innovative Technology
As VA advances its mission to care for Veterans, we continually
seek innovative approaches to the future of Veteran health care in the
community. A key component of implementing change is effectively
communicating Veteran needs among various stakeholders. To this end,
VHA is transitioning from a blended network of call centers to a
standard, enterprise-wide system called VA Health Connect. This
clinical contact center modernization supports in-person care and
continues to utilize telehealth capabilities, a core component of VA
Health Connect. Through VA Health Connect, Veterans can engage with
health care delivery at their convenience, any time or day, to discuss
health concerns with a nurse. Veteran patients are empowered to contact
medical support assistants for help with scheduling appointments.
Veterans also have a communications channel with pharmacists to refill
prescriptions and, when clinically appropriate, can meet with a
provider via video appointment.
VA Health Connect is just one component of a technology
modernization effort well underway, with anticipated completion in the
next 2 years. Additionally, we are deploying Clinical Resource Hubs to
provide virtual care options, increasing access to VHA services when
local facilities face limitations in care or service capabilities.
Building Trust and Advancing Toward a Future of Quality Services
VA is a trusted Veteran health care provider, furnishing high-
quality care that surpasses our private sector counterparts. Veterans
notice the difference. In Fiscal Year (FY) 2024, VA internal survey
data showed an unprecedented trust rate of 92 percent in the
Department's health service delivery, surpassing our private sector
counterparts. Our longstanding relationship with Congress, and with
this Subcommittee specifically, has resulted in nearly 70 percent of VA
hospitals receiving 4 or 5 stars in the Overall Hospital Quality Star
Ratings by the Centers for Medicare and Medicaid Services, compared to
only 41 percent of non-VA hospitals. This achievement highlights our
opportunity to further enhance care for Veterans.
Despite our successes, we acknowledge the need for process
improvements to continue achieving positive outcomes for those who have
taken on the mantle of protecting freedom. Building and maintaining
trust with Veteran stakeholders is crucial for enhancing health
outcomes. In 2019, VHA underwent transformational modernization,
becoming a High Reliability Organization (HRO) led by VHA's HRO
Steering Committee. Utilizing HRO practices results in fewer than
expected accidents or harmful events, even in complex, high-risk
environments where minor errors can lead to tragic results. VA
established trust among its leaders and staff by implementing this
effort. This transformation to an HRO unleashed incredible talent and
commitment within our system and strengthened trust in VA from Veterans
and the American people.
We are committed to improving safety and quality of care in VA
facilities and our network of community providers. VISNs and medical
centers are advancing toward HRO maturity, which is defined as
instilling an organization-wide commitment to a zero--harm approach to
medical safety that aims to operate care centers without exposing staff
or non-staff to injury through the implementation of systems.
In Fiscal Year 2024, VA conducted more than 127.5 million
healthcare appointments between direct care and community care, a 6
percent increase over the previous year's record volume of 119.8
million appointments. Thanks to our network of providers, we also
decreased wait times while delivering more care to many Veterans,
caregivers, and survivors.
Conclusion
Madam Chair and Ranking Member Brownley, thank you for your
continued dedication and leadership. We are pleased to share our
efforts to enhance medical outcomes for our Veterans, who served to
safeguard the American way of life. My team and I look forward to
today's discussion.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Introduction
Chairwoman Miller-Meeks, Ranking Member Brownley and Distinguished
Members of the Health Subcommittee, it is a privilege to testify before
this Subcommittee as it examines the roles and responsibilities of the
Department of Veterans Affairs (VA), Third-Party Administrators (TPAs),
and community care providers in administering VA community care. Thank
you for your principled leadership and unwavering commitment to
ensuring America's Veterans receive timely access to the high-quality
care they deserve, both within VA health care facilities and in the
Community Care Network (CCN) that supports VA when it is unable to
provide that care directly.
Background on TriWest
Established nearly 30 years ago by a group of non-profit health
plans and two university hospital systems, TriWest Healthcare
Alliance's sole purpose has been supporting VA and the Department of
Defense (DoD) in meeting the health care needs of the military and
Veteran communities. Since inception, we at TriWest have worked
collaboratively with the Federal Government agencies we have been
privileged to support to fully understand their unique requirements,
down to the local level, to meet the health care needs of military
service members, their families, retirees and Veterans. Our mission has
been - and continues to be - doing Whatever it Takes! to ensure our
Nation's heroes and their families have ready access to needed care
when the Federal systems on which they rely are unable to meet their
needs directly.
Our first 18 years were spent supporting DoD in standing up and
operating the TRICARE program in a 21-State area. I am proud of the
work we did to assist DoD in implementing and refining TRICARE to meet
the needs of millions of TRICARE beneficiaries across the western
United States who relied on us for services and support. The first 24
months was neither an easy nor painless road, which involved a 15-month
preparation for the startup of TRICARE and 9 months to stand up the
program before the demand for services arrived. Getting to success in
TRICARE, just like other new large health programs (e.g., Medicare and
Medicaid), took working closely with DoD and Congress. Through this
partnership, TriWest, DoD and the military services developed many key
process and program improvements that benefited the entire TRICARE
community including in such critical areas as behavioral health and
suicide prevention, as well as case management, disease management and
cross-contractor continuity of care.
Our years of experience with TRICARE were essential to our work
over the last seven and a half years supporting VA's community care
programs beginning in September 2013, when TriWest was awarded a
Patient-Centered Community Care (PC3) contract for a 28-State region.
PC3 was a nationwide program designed to give VA Medical Centers (VAMC)
an efficient and consistent way to provide access to coordinated care
for Veterans from a network of credentialed specialty care providers in
the community when VA was unable to deliver the care directly. With
only 90 days to begin operations, we immediately tapped into our
Whatever it Takes! ethos and our strong commitment to partnership and
leveraged our long-standing relationship with community providers to
deliver a network and service operation designed specifically to
support the VA health care system across 28 states and the Pacific.
Building VA's Community Care Program
From the start, PC3 was a dynamic effort as VA and Congress sought
to refine it. Shortly after access to specialty care from our provider
network began in January 2014, VA expanded PC3 to include primary care
providers. During that expansion of PC3, an access to care crisis
erupted in April 2014 at the Phoenix VA Medical Center which revealed
the fact that 14,700 Veterans were on a wait list for care at VA. This
spurred immediate congressional action and led to the enactment of the
Veterans Access, Choice, and Accountability Act of 2014 (P.L. 113-146)
in August 2014.
Based on the short implementation timeframe for the new VA Choice
Program, and the fact that many in the health care industry said it
couldn't be done in 90 days, VA turned to TriWest and its other PC3
contractor to take on the challenge. Working once again in close
collaboration with VA, we were able to design and implement the Choice
program within the statutory requirement, by November 5, 2014. In just
over 30 days, we created the infrastructure, hired and trained hundreds
of staff, sent Choice cards to 4 million Veterans in our area of
responsibility, and operationalized a state-of-the-art contact center
making sure that callers to the toll-free line were greeted by the
voice of then-Secretary McDonald to underscore the importance of this
new initiative.
Then, in September 2018, TriWest accepted another challenge from VA
- to stabilize and protect VA by expanding our support of VA community
care nationwide after VA elected not to extend the contract of the
other PC3/Choice contractor. We accepted the challenge with one caveat,
that we - TriWest and VA - do it collaboratively to ensure success for
the Veterans ultimately being served. In just 90 days, after working
closely with each VA medical center in the new region, we delivered a
nationwide network of community providers to support VA in serving 9.2
million enrolled Veterans in all 50 states and territories.
At its apex, we provided VA with a consolidated network of over
639,000 individual providers offering more than 1.2 million access
points of care. Monthly, we received more than 400,000 requests for
care in the community and handled roughly 700,000 calls. From the start
of our work supporting VA until the end of Fiscal Year 2019, we
assisted over 1.9 million unique Veterans, scheduling more than 6.2
million initial appointments and 10 million follow-up appointments. We
processed and paid over 19 million health care claims to community
providers. On average, TriWest processed and paid clean claims within
18 days in our legacy area, and within 10 days in the expansion states,
with an accuracy rate of 96 percent.
Subsequent to our national expansion implementation, we were
honored to have been awarded the contract for CCN Region 4 in August
2019 and CCN Region 5 in October 2020. The Region 4 contract was then
amended to include coverage of the Northern Mariana Islands, American
Samoa and Guam. We continue to collaborate closely with VA in the
regions we serve.
VA Community Care Program
The effectiveness of our partnership with VA is evident in the
details of the community care services we have delivered to date. Since
the start of our work supporting VA community care, Veterans have
received more than 75 million community care appointments through our
network provided in support of VA.
We have the privilege of serving nearly 4.7 million Veterans
through our network of over 300,000 credentialed community providers
offering Veterans and VA access to care at over 750,000 provider
locations. The top ten categories of care provided in CCN include
cardiology, chiropractic care, complimentary and integrative health,
emergency care, homemaker/home health aide, mental health,
ophthalmology, orthopedic, physical therapy, and skilled home health
care. And, we are paying claims on average in 3 days to 99 percent
accuracy.
Refining VA Community Care through Collaboration
In our constant effort to better serve VA, local VA facilities,
Veterans and community care providers, we have worked closely with VA
on a number of key initiatives designed to improve the Veteran
experience and the provider experience - both within the community and
in VA - and to enhance VA's capacity to deliver needed health care
services. We would like to highlight a few of these initiatives.
South Texas--In 2017, a collaboration led by the VA Valley Coastal
Bend Health Care System (HCS) in Harlingen, Texas, and TriWest to pilot
a high performing, integrated health care network with preferred
providers in the community resulted in delivering timely, high-quality
care for Veterans. For years, South Texas Veterans were burdened with
having to drive eight or more hours to make the 500-mile round trip to
receive care at the Audie Murphy Memorial VAMC.
This pilot has resulted in key process improvements: same-day
community care authorizations; digital sharing of medical records
between community providers and VA; navigators at preferred provider
sites who assist Veterans with setting appointments; and better
transition of care between providers and medical documentation return
to VA. Only with the commitment and support of other important partners
were these critical changes achieved including from VA Central Office,
Veterans Integrated Services Network (VISN) 17 leadership and Community
Care staff, local congressional offices, Veterans Service Organizations
and community care providers such as Doctors Hospital at Renaissance,
Valley Baptist Medical Center, and Harlingen Regional Academic Health
Center.
The integration of community care under VA's leading role as
primary provider and coordinator of Veteran care resulted in reducing
the hardship on thousands of Veterans traveling hundreds of miles to VA
for specialty care, and dramatically reduced community care claims
processing times, dismissal rates and errors.
This South Texas effort is a good example of the importance of
integrated VA community care. It means coordinated, quality, and timely
care closer to Veterans' homes and stronger partnership between VAMCs,
VA clinics, and community providers.
Customized network and support--We redesigned our engagements with
VAMC staff and leadership to achieve greater effectiveness, improve
issue management, and attain higher satisfaction among our partners at
VA.
Though this new model requires resources and reengineering on our
part, it allows us to provide a more consistent, tailored and direct
engagement with VA, VISNs, and VAMCs to focus on and continually
improve core items such as network adequacy, including access by
specialty by geographic areas, efficient network utilization, timely
appointment scheduling, and provider changes that may impact health
care delivery. Equally important, this model also promotes issue
identification and resolution through close collaboration, careful
review of relevant information and meaningful feedback. Still in the
refinement phase, we are pleased to report improved VAMC satisfaction
with this new collaborative model. VAMCs report greater appreciation
with the direct engagement and improved timeliness of our feedback,
which allows them to focus on their own market to meet the health care
needs of their local Veteran patient population.
Improving access to behavioral health--A VAMC and VISN team-led
collaboration along with a dedicated TriWest team worked together to
improve our network of community behavioral health providers, deliver
better support to VA facilities through direct engagements, more
consistently match the right specialty with the right skillset based on
Veterans' needs and improve Veteran wait times and satisfaction of
community behavioral health care.
We worked with four VAMCs including the Jennifer Moreno VAMC in San
Diego, the Carl T. Hayden VAMC in Phoenix, El Paso VAMC, and Fresno
VAMC. In this partnership, we worked closely with VAMC staff to create
a local network of preferred behavioral health providers, create
markets based on capabilities, improve the speed of appointing, and
review business processes for efficiency and effectiveness. This joint
effort had a simple goal of ensuring no Veteran was waiting in line for
behavioral health care.
Community provider education and training--Our work in support of
VA's health care mission also focuses on community provider education
and training. We will be requiring community providers to certify they
have reviewed the Opioid Safety Initiative guidelines. Also, in our
communication with community providers, we continually promote VA
training and urge network providers to take advantage of free training
on Veteran culture, preventing suicide through lethal means safety and
safety planning, and other topics that help providers understand the
unique needs of Veterans.
We also provide webinars related to claims submission to improve
claims payment accuracy and timeliness, appointing and approved
referrals/authorizations, urgent and emergent care, and other CCN
processes and procedures.
Community provider claims--Veterans' access to care in their local
communities depends in large part on providers being willing to
participate in CCN, and when needed care is rendered, on ensuring these
providers are paid in a timely and consistent manner. A primary reason
for CCN claims denials in the regions we serve (Regions 4 and 5) is the
statutory requirement under 38 U.S.C. section 1703D(b) that CCN
providers file claims to VA within 180 days. This requirement is
inconsistent with Medicare, Medicaid, TRICARE, and the private sector,
which all allow up to 1 year for the filing of a claim to be considered
timely.
Despite our efforts to ensure providers understand this VA-unique
requirement, it continues to create substantial confusion and
complication for community care providers. Additionally, many provider
practices have claims submission systems that are set up to meet
standard 365-day requirements, so the VA-unique 180-day standard
requires expensive process modifications and/or manual overrides of
claims submission. And, at the end of the day, those who are unable to
file within 6 months don't get paid for the care they delivered.
Obviously, this is inconsistent with keeping a strong and stable
network.
As you know, the committees of jurisdiction attempted to address
this issue in the last Congress. However, the provision to align the VA
requirement with other Federal programs was removed from VA
authorization legislation due to a Congressional Budget Office
projection of the cost to extend the deadline.
Based on our experience, we know that unless this issue is
legislatively addressed, it likely will have an impact on community
provider participation in CCN and thus on Veterans' access to care,
especially in rural, highly rural, and remote areas. The requirement
continues to be viewed as a significant administrative burden by many
community health care professionals. As a result, we believe that VA,
and especially Veterans, would be better served by adopting the same
standard used by other Federal programs and private health plans - a
timely filing requirement of 1 year.
We appreciate Chairman Bost for including this modification in the
ACCESS Act of 2025. We strongly encourage Congress adopt this change.
Doing so will result in increased provider satisfaction, reduced re-
work by all parties, and unnecessary delays in claims payment.
Closing
Through nearly three decades of operating in support of DoD and VA,
we have steadfastly sought to work very collaboratively to deliver
tailored solutions designed to best meet the needs of those we serve.
Through these efforts, we have developed crucial experience in helping
these systems implement and mature their programs to provide timely and
convenient access to quality health care services. We have honed
expertise in navigating and supporting the department that was created
to serve the needs of Veterans with the essential services they
deserve. This is sacred work for us. Our mission is to serve those in
need, ensuring they have access to the right services and health care
providers while also supporting community care providers fully as they
serve the needs of our nation's heroes. We know what it takes and will
continue to do Whatever it Takes! to flex in support of these systems
that are critical to meeting the needs of those who sacrifice so much
on our behalf.
Prepared Statement of Ed Weinberg
Chairman Bost, Chairwoman Miller-Meeks, Ranking Member Takano,
Ranking Member Brownley, and members of the sub-committee, thank you
for the opportunity to join you today to discuss the U.S. Department of
Veterans Affairs (VA) Community Care Network (CCN.) I am the Chief
Executive Officer of Optum Serve, the Federal health services business
of UnitedHealth Group (UHG).
I am pleased to submit this written statement for the record
regarding Optum Serve's work administering the VA's CCN program in
regions 1, 2, and 3, since 2018 which provides a comprehensive, high-
quality approach to supporting Veterans' choice and access to the care
they have earned.
On behalf of the dedicated women and men at Optum Serve, who
tirelessly work to deliver solutions that meet the health needs
throughout the Federal Government, we are thankful for our partnership
with the VA, and our collaboration with Veterans and their caregivers,
Veteran Service Organizations, community providers, and our exceptional
program partners.
As a combat Veteran, retired Army officer, and proud father of a
Soldier, I fully recognize the magnitude of the selfless sacrifices
made by our Veterans and their families. Because of this, I am deeply
committed and laser focused on the success of the entire VA health
system, inclusive of the VA Community Care Program and Optum Serve's
role and responsibility in ensuring access to quality care for our
Nation's Veterans. Our commitment is not only demonstrated by meeting
and exceeding our requirements across all three regions, but also
through the partnership we have fostered with VA at every level, and by
building trusted relationships with Military and Veteran Service
Organizations. The invaluable feedback from these key stakeholders
offers us a sharper lens as we seek to continuously fine-tune and
tailor our services to improve the Veteran's experience.
Optum Serve is honored to support health programs that touch
virtually every point in a Veteran's journey, from the time they raise
their right hand to take the oath until the time they separate from
military service and return to civilian life as a Veteran. Here are
some of the programs that we proudly support:
U.S. Military Entrance Processing Command: Providing
specialty consult exams in support of the U.S. Military's recruitment
mission.
Military Health System Nurse Advice Line: Managing the
Military Health System's 24/7/365 Global Nurse Advice Line for active-
duty service members, retirees, and their families.
Veterans Benefits Administration (VBA) Compensation and
Pension Exams: Ensuring quality and timely exams for Veterans and
transitioning military service members through the VBA Medical
Disability Exam program.
VA CCN Program: Delivering quality care in the community
in regions 1, 2, and 3, when and where a Veteran needs it.
Our position supporting Department of Defense (DoD) and VA programs
throughout this entire lifecycle offers Optum Serve a truly unique
perspective as we work restlessly to enhance the overall quality and
experience of the members we serve.
Optum Serve's Support of VA CCN
Since 2019, we have focused on the ever-evolving needs of VA in
support of improving Veteran access to high quality care through
continuous network refinement and optimization. Our provider network
offers a wide range of services including primary and specialty medical
and dental care services, behavioral health, complementary and
integrative health care services (e.g., chiropractic, acupuncture, and
massage therapy), urgent care and transplant services.
Through the VA CCN program, we have the privilege of supporting
approximately 6.5 million eligible Veterans across three regions
comprised of 36 states, the District of Columbia, U.S. Virgin Islands,
and Puerto Rico. I vividly recall meeting with VA leaders and
clinicians in Philadelphia, Pennsylvania, in June 2019 where we began
the phased implementation of the VA CCN program and monitored the first
Veteran referral for care in the community move through our collective
systems. After we successfully deployed region 1 and were making strong
progress deploying in regions 2 and 3, the COVID-19 pandemic struck,
creating significant challenges for us and the entire healthcare
system. Despite these headwinds, Optum Serve remained undeterred.
Today, Optum's VA CCN program is making a clear difference in the lives
of Veterans, having completed over 159 million Veteran care visits
through our robust provider network of 2.4 million care sites.
But it isn't just about building the provider network. What has
become increasingly clear is the importance of preserving the network
for future Veterans. Timely and accurate reimbursement is crucial for
maintaining our strong provider network for Veteran care. Therefore, it
is of highest priority to ensure that community providers, especially
smaller practices in rural areas, have the positive cash-flow needed to
sustain their operations. We're pleased to report that we have
adjudicated over 116 million claims since program inception, and
providers have been paid in an average of 7 days or less. This
efficiency supports future Veteran care and helps providers continue
serving their broader communities.
Improving Veteran Experience & Wellness
The well-being and experiences of Veterans are the driving force
behind everything we do. One Veteran's spouse shared a heart-wrenching
story about how a gun lock, provided by an Optum Serve community care
provider, saved her husband's life. In a moment of crisis, the gun lock
caused just enough of a delay for her to realize what was happening.
Those precious extra minutes allowed her to intervene, preventing
another tragic loss. Thanks to that brief delay, her husband is still
here today.
We share the unwavering belief with this committee and the VA that
even one Veteran suicide is too many; which is why we do what we do. At
Optum Serve, we recognize that Veteran mental health is a national
issue and one of the greatest challenges we must come together to
solve, and we are working hard to move the needle in several impactful
areas. To further promote Lethal Means Safety through our community
providers, Optum Serve partners directly with VA's Office of Mental
Health. This collaboration aims to prevent Veteran suicide by
distributing gun locks to community providers, who then give them
directly to Veterans. Since we began this initiative in September 2023,
we have distributed over 12,000. Additionally, Optum Serve partnered
with our broader organization to create and deliver tailored provider
training courses on topics like Suicide Screenings & Prevention and
Opioid Safety Training. We also ensured these courses provide
continuing education credits, which is a great incentive for providers
to increase participation.
Veteran-Centric Service & Timely Access to Care
Optum Serve is committed to our partnership with VA to identify and
solve challenges which require local level relationships between our
organizations. Even prior to implementation in 2019, Optum Serve
established Community Care Experience Teams (CCET), comprised of
Veteran Experience Officers (VEO), to provide on-the-ground support and
resources to every VAMC and their staff. Optum Serve VEOs maintain
strong relationships with the local VAMC and Veteran Integrated Service
Network (VISN) leaders, and each of the VAMC community care offices to
better meet the needs of the VA at the local level and by extension,
the Veterans we collectively serve. Additionally, each VISN has an
assigned and dedicated Optum Serve Provider Advocate who stands ready
to support with any unique challenges a Veteran may encounter in
connecting with the care they need.
One such example of the power and purpose of having dedicated Optum
Serve VEO and Provider Advocates with a Veteran-centric focus is the
support recently provided to a Veteran in VISN 16. This Veteran had
been suffering from debilitating migraines for over a year and had
recently lost his job. Optum Serve's VEO and Provider Advocate
collaborated with the VAMC registered nurse to identify an out-of-
network provider who offered an individualized treatment plan that the
Veteran had not yet tried. This provider agreed to join CCN based on
the Veteran's case and their onboarding was expedited.. As a result,
the Veteran received successful treatment and experienced a significant
improvement in quality of life. This is just one example of how these
advocates are making a difference in helping the entire system work
better.
As VA shifted their focus to fulfill their fourth mission at the
height of the COVID-19 pandemic, Optum Serve responded to VA's
immediate need for support with appointment scheduling activities and
quickly pivoted to develop a scalable solution to meet individual VAMC
needs. Optum Serve provided high quality appointment scheduling support
to these VAMCs from February 2021 through October 31, 2024. During this
period, Optum Serve supported 29 of the 109 VAMCs within our three
regions, scheduling over 694,000 Veteran appointments with
participating CCN providers in less than 9 days on average.
In response to referral surges based on individual VAMC needs,
Optum Serve quickly adapted by increasing staffing, building
specialized teams based on category of care and built direct
partnerships with individual VAMCs to tailor solutions as needed to
address specific regional challenges and improve care delivery. One of
our specialized teams was dedicated to supporting Veterans with a
behavioral health referral. Every Veteran was assigned a highly trained
Appointment Scheduling Representative (ASR) who helped them identify
the right provider and schedule their appointment with one of our
65,000 behavioral health providers at one of the 50,000 available
locations which include over 1,100 substance abuse centers across all
three regions. Each VAMC was assigned a newly created Veteran
Scheduling Experience Officer (VSEO) whose primary role was staying
connected to local VA staff and ensuring Veterans were appointed with
the community provider to best suit their health care needs. Optum
Serve's scalability and automation enabled us to meet the growing needs
of Veterans while maintaining top-notch performance and service.
Although VA decided to conclude our appointment scheduling activities,
we stand ready to support any VAMC should the need arise again.
Access to care can come in many forms, and the COVID-19 pandemic
sparked a rapid increase in telehealth services. While still small
compared to VA's direct telehealth services, the use of telehealth
through VA CCN has surged from double-digit visits prior to the
pandemic to over 35,000 per month. This significant growth highlights
the value Veterans place on the flexibility to receive care when and
where they need it. To continue this work, license portability is
essential, allowing a provider to deliver quality telehealth services
across State lines. We look forward to working with this body to ensure
they continue to have this choice for future care needs.
Ensuring High-Quality Care
Delivering high quality care for our Nation's Veterans through the
CCN program is our top priority. Our rigorous credentialing and
recredentialing processes ensure providers meet the highest
qualifications through National Committee for Quality Assurance (NCQA)
accreditation. Optum Serve has demonstrated our unwavering commitment
to excellence by consistently achieving 98 percent or higher on our
monthly credentialing audits conducted by VA. Through our ongoing
monitoring of potential provider sanctions and exclusions, and taking
appropriate actions based on the data, we uphold our dedication to
delivering superior healthcare services to our Veterans. This
relentless pursuit of excellence underscores our network's reputation
in delivering quality healthcare. Our network of providers also stands
out for its exceptional commitment to quality, and consistently far
exceeds the VA's high-performing provider (HPP) benchmark of 10
percent. In fact, across all three regions over 60 percent of Optum
Serve's eligible network has been recognized as a HPP as of December
31, 2024.
Optum Serve is firmly invested in upholding the highest standards
by offering a clear pathway for reporting concerns about patient
safety, harm, quality-of-care, and any deviations from national care
standards through our Potential Quality Issue (PQI) process. Our
Clinical Quality Department thoroughly reviews every PQI reported by
Veterans their families, caregivers, VA staff, and providers.
Additionally, our Clinical Quality Department proactively utilizes
measures from the Centers for Medicare and Medicaid Services (CMS)
Hospital Acquired Conditions (HAC) and Hospital Acquired Infections
(HAI), as well as Agency for Healthcare Research and Quality's (AHRQ)
Patient Safety Indicators (PSI) to identify, and address Veteran care
concerns.
Optum Serve's Clinical Quality program is devoted to improving care
by reducing harm, sentinel events, serious reportable events, and
medical errors. A PQI and/or Optum's claims data mining efforts may
result in a provider being reviewed by one of Optum's Peer Review
Committees (Medical-Surgical, Behavioral Health, or Dental). Optum's
Clinical Quality team conducts regular PQI reviews and facilitates
monthly Peer Review Committee meetings to ensure provider adherence to
clinical standards and implement corrective actions as needed. If an
Optum Serve provider does not engage in quality improvement efforts,
the Peer Review Committee may make the recommendation to remove the
provider from the network. It is important to highlight that a non-
voting VA representative is invited to all committee meetings to ensure
transparency in the Veteran safety and quality process within the
Community Care Network. Additionally, to support VA's desire to have
real-time awareness of clinical quality cases moving through the
system, we produced a highly touted dashboard to assist VA users with
tracking, and receiving quality information in near real-time which
allows for enhanced management and coordination of quality oversight
between Optum Serve and VA.
Achieving quality outcomes for Veterans' health depends directly on
the quality-of-care delivery. A key component in this process is the
Veterans' medical record. Optum Serve educates all community providers
on the importance of returning medical records to VA in a timely
manner. The requirements regarding medical documentation are
specifically outlined in the Optum VA CCN Provider Manual, which is an
extension of every provider's contract. We also reinforce this
information through various provider education modalities including
virtual trainings with an Optum Serve Provider Advocate, medical
documentation requirements fact sheets, and our quarterly Optum VA CCN
medical and dental newsletters. To best support VA, Optum Serve
established a standardized process whereby VA may escalate a request
for provider education in the event medical documentation has not been
received. Optum Serve's Provider Advocate team then conducts targeted
educational outreach to the identified provider.
We are aware there are current barriers with this process and have
partnered with the VA to identify and implement efficiencies. We
believe more needs to be done to safeguard seamless sharing of these
records between providers and the VA by streamlining the available
pathways to transmit records and stronger oversight to verify records
have been sent timely in order to create the coordination of care our
Veterans deserve.
Partners in Serving the Veteran Community
We recognize that the well-being of our Nation's heroes extends
beyond the services we provide. To further our mission of ensuring the
holistic well-being of Veterans, Service Members, and their families,
Optum Serve has partnered with numerous Veteran and Military Service
Organizations. Through these partnerships, we provide resources to
address the physical, mental, and emotional health care needs of the
military and Veteran community. Optum Serve has long-standing
partnerships including numerous Veteran centric service organizations.
During our quarterly Program Management Review (PMR) with VA
leadership, we have coordinated a variety of engagements that emphasize
our commitment to the Veteran community. For example, Optum Serve and
VA leaders greeted Honor Flight Veterans from Missouri when they
arrived at the WWII Memorial in Washington D.C., we tie-dyed shirts
with Veterans who reside at a VA Community Living Center, we visited
with Veteran caregivers at the South Carolina Fisher House and recorded
individual Veteran stories which are permanently stored at the Library
of Congress as part of the Veteran History Project. Through these
partnerships, we strive to create a robust support network that
empowers Veterans and their families to lead healthier, more fulfilling
lives while also heightening the sense of purpose and commitment of our
staff.
Closing
We strongly share this Committee's dedication to improving the
lives of Veterans and the well-being of our Nation's heroes, which is
at the center of all we do. Optum Serve has had the distinct honor to
work with this Committee through the passage and/or the implementation
of landmark legislation including the MISSION Act, PACT Act, Cleland
Dole Act, and most recently the Elizabeth Dole Act as Congress has
evolved and improved Veteran benefits and the VA's care ecosystem. We
stand ready to continue working with this Committee and the rest of the
119th Congress on future legislation aimed at improving the benefits
and services for our Veterans.
In closing, I am humbled and deeply grateful for the opportunity to
share this statement, highlighting Optum Serve's unwavering dedication
to Veterans through the VA CCN program. We remain steadfast in our
commitment to enhancing the experiences and outcomes for those we
serve. Our passionate and devoted team eagerly anticipates ongoing
collaboration with the VA, this sub-committee, and all our partners.
Together, we will ensure that our Nation's heroes receive the
exceptional health care they have rightfully earned and truly deserve.
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Statements for the Record
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Prepared Statement of The American Legion
Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished
members of the subcommittee, on behalf of National Commander James A.
LaCoursiere Jr. and more than 1.6 million dues-paying members of The
American Legion, we thank you for the opportunity to comment on the
Department of Veterans' Affairs' Community Care Program. The American
Legion is guided by Legionnaires who dedicate time and resources to
serving veterans and their families. As a resolution-based
organization, our positions are guided by almost 106 years of advocacy
that originate at the grassroots level of our organization. Every time
The American Legion testifies, we offer a direct voice from the veteran
community to Congress.
The American Legion (TAL) advocated for the Maintaining Internal
Systems and Strengthening Integrated Outside Networks (MISSION) Act of
2018 as a much-needed relief valve when the VA was unable to provide a
veteran's healthcare within a reasonable time or distance after the
2014 Phoenix VA waitlist scandal. As TAL stated in a letter with other
VSOs at the time, ``[it] would consolidate VA's community care programs
and develop integrated networks of VA and community providers to
supplement, not supplant VA healthcare . . . This carefully crafted
compromise represents a balanced approach to ensuring timely access to
care while continuing to strengthen the VA healthcare system that
millions of veterans choose and rely on.'' \1\
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\1\ DAV Communications. ``VSO Letter Supporting VA Mission Act of
2018.'' DAV, May 7, 2018. https://www.dav.org/learn-more/news/2018/vso-
letter-supporting-va-mission-act-of-2018/.
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TAL stands by our view that the MISSION Act is intended to
supplement - but not supplant - the VA direct care system. The VA
should remain the center of veteran healthcare with a constant focus on
improvement--keeping the veteran as their North Star. In December 2024,
Veterans Affairs and rehabilitation (VA&R) Division Director Cole Lyle
highlighted The American Legion's staunch support of keeping the VHA as
the coordinator of care for U.S. veterans. Doing so, however, is
becoming harder and harder as the VA continues sending more veterans
into the community with contract oversight spread across multiple areas
within the VA's Office of Integrated Veteran Care (IVC). With the VA
now spending more than 39 percent of its healthcare budget on community
provider reimbursements\2\ and congressional efforts to codify
community care access standards, setting clear guidelines for contract
oversight will be a monumental issue as the VA negotiates a new
community care contract. However, even with clear guidelines for
oversight, the VA will continue sending a larger number of veterans
into the community if Congress does not consider and act upon a
comprehensive plan for infrastructure reform. Congress' disregard for
the Asset & Infrastructure Review (AIR) Commission, housed within the
MISSION Act and designed to address VA's long-standing infrastructure
issues, is a large part of the reason the VA is facing a growing
community care budget\3\. Important changes in policy to improve
infrastructure, reduce barriers to accessing care, streamline
appointment scheduling, support women veterans, and improve
reimbursement requirements are critical to providing veterans with the
healthcare they have earned.
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\2\ ``Veterans Community Care Program: VA Needs to Strengthen
Contract Oversight.'' GAO Report, August 2024. https://www.gao.gov/
assets/gao-24-106390.pdf
\3\ ``VA Recommendations to the AIR Commission.'' VA.gov, March
2022. VA Recommendations to the AIR Commission Home
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The American Legion conducts regular visits to VA facilities each
year as part of our System Worth Saving (SWS) program. In these visits,
we talk to veterans at VA hospitals, along with staff, to find ways to
work with the VA and Congress to improve veteran outcomes. Access
standards were identified as an area for improvement. Who qualifies and
how can sometimes seem unclear, and veterans report facing unexpected
barriers to actually getting referrals. This goes against the spirit of
the MISSION Act, which was to provide veterans with closer and timelier
access to care. Congress and the VA should look closely at codifying
access standards but also ensuring that veterans aren't going out of VA
care just to receive care that is further away, a longer wait, or both,
as we heard about anecdotally multiple times on our SWS visits.
For many Veterans--especially those who are women--community care
is the only viable option for specialized care. The VA is not set up to
provide women veterans with maternity care, obstetric services, or
fertility treatment, therefore necessitating the use of a community
provider to access gender-specific care. Lapses in coverage, unclear
access standards, and lengthy wait times jeopardize the quality of care
that our female Legionnaires already struggle to receive.
At the grassroots level, TAL has been interviewing veterans across
the country, and access to community care under current laws and
regulations continues to be a systemic issue. TAL met with Lillian
Moss, a Legionnaire and member of Post 310 in San Diego, CA, who
highlighted several stark inadequacies of referrals and VA operations.
In addition to being a survivor of combat and military sexual trauma
(MST), Lillian was diagnosed with cancer in December 2017. Thanks to
her VA care, she underwent a double mastectomy in 2020. Her cancer was
removed, but inadequacies with her follow-up reconstructive surgery
were left unresolved for years. She described waiting on various calls
and confirmations that always seemed to be just around the corner and
just out of reach.
Lillian further struggled with financial hardship after her local
VA pulled back her community care referral for her psychologist.
Devastated at the thought of losing a trusted provider, Lillian was
forced to pay out of pocket for her desired mental healthcare. She is
now waiting for what she was told would be another quick call to
requalify her referral but has been waiting for months with no progress
made. This is an unacceptable burden to place on veterans seeking
mental healthcare. For veterans engaged in specialty care, a continuum
of care is critical to the veterans' well-being. We know how
challenging transitions can be for members of the veteran community and
abrupt changes can be devastating to those receiving care.
Another veteran who receives care from the Portland, Oregon VA,
Martha Nava, has faced repeated denials and delays for necessary
medical treatments, including a 3-year wait for back surgery and a
mismanaged kidney procedure that led to severe complications. Despite
VA policy stating that community care should be approved in the ``best
interest of the veteran,'' the patient advocate system has failed to
provide her with necessary referrals, leaving her trapped in a cycle of
inadequate care, prolonged suffering, and a lack of accountability.
When veterans qualify for community care and elect to go that
direction, that decision should be between a veteran and their
providers. While current access standards are not codified, they are
part of VA policy and need to be followed. The Secretary of the VA has
discussed making changes to access standards in the past to keep more
care in the VA\4\. While no official changes to access standards have
been made, there are reports that the VA has been informally
restricting access\5\. We have heard this on our site visits as well,
both from veterans and VA employees. Efforts to keep a veteran in VHA
care should be made before treatment is needed, not at a time when a
veteran is simply trying to get better. Sidelining veterans with
bureaucratic roadblocks requiring extra reviews, referrals, and
conversations does nothing to accomplish VA's mission or improve on it,
nor does it help veterans.
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\4\ Kime, Patricia. ``VA Weighs Limiting Access to Outside Doctors
to Curb Rising Costs.'' Military.com, June 15, 2022. https://
www.military.com/daily news/2022/06/15/va-weighs-limiting-access-
outside-doctors-curb-rising-costs.html.
\5\ ``Sen. Moran Speaks on Senate floor Regarding VA Decisions That
Are Limiting Veterans' Access to Care.'' U.S. Senate Committee on
Veterans' Affairs, June 21, 2024. https://www.veterans.senate.gov/2024/
6/sen-moran-speaks-on-senate-floor-regarding-va-decisions-that-are-
limiting-veterans-access-to-care.
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Improving access to specialty services in VHA facilities for these
two veterans would require the infrastructure reforms previously
highlighted, particularly in urban facilities with large catchment
populations. These assessments could also address proper staffing
levels to help alleviate the VA's capacity problems. We have
continually heard of staff recruitment and retention as an issue on our
SWS visits. Adequate staffing in all areas helps improve veteran health
outcomes and increase VHA capacity.
Furthermore, transportation remains a significant obstacle when it
comes to veterans getting to their appointments for care in the
community. The VA has several programs available to help veterans get
to and from their VA and non-VA appointments such as the Veterans
Transportation Service (VTS), Beneficiary Travel (BT), Highly Rural
Transportation Grants (HRTG) \6\, and a new partnership with Uber, Uber
Health. However, on our SWS visits, TAL found these programs all
suffered from the same issue: a lack of drivers. Even with funding
available and programs in place, highly rural catchment areas struggle
to find enough employees, a problem that exists in nearly all sectors
in some rural communities. TAL urges Congress to understand there is a
gap here that cannot be covered by transportation programs in certain
areas, and to look at providing more in-house services in such
communities.
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\6\ US Department of Veterans Affairs, Veterans Health
Administration. ``Veterans Transportation Program.'' US Department of
Veterans Affairs, January 12, 2015. https://www.va.gov/healthbenefits/
vtp/.
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Infrastructure reform, ensuring adequate transportation, and
addressing provider recruitment and retention are all crucial to
providing veteran healthcare in an effective and timely manner, and TAL
urges Congress to address these issues while holding the VA accountable
for delays and denials of veterans who need healthcare in their
community.
We must, in every effort to properly address balancing VA direct
care with community care, keep the individual veteran as our focus.
While VA's sheer size means agency consideration must sometimes be
weighed in policy decisions, its parochial interest must come second to
those of the end-user.
Chairwoman Miller-Meeks, Ranking Member Brownley, and all the
distinguished members of this committee, on behalf of National
Commander James A. LaCoursiere Jr. and members of The American Legion,
thank you again for the opportunity to amplify the voice of the
veteran. It is together with you that we do the great work of making a
truly modern VA that provides the top-of-the-line healthcare veterans
deserve. We look forward to working together with you to continue this
sacred duty.
For additional information regarding this testimony, please contact
The American Legion Senior Legislative Associate, Bailey Bishop, at
[email protected].
Document for the Record Submitted by Abe Hamadeh
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