    [House Hearing, 119 Congress]
    [From the U.S. Government Publishing Office]

                           IMPROVING ACCESS TO EXTERNAL
                            VA CARE THROUGH ENHANCED
                             SCHEDULING TECHNOLOGY

    =======================================================================

                                    HEARING

                                   BEFORE THE

                            SUBCOMMITTEE ON TECHNOLOGY
                                  MODERNIZATION

                                     OF THE

                         COMMITTEE ON VETERANS' AFFAIRS

                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                              MONDAY, MAY 5, 2025

                                   __________

                               Serial No. 119-19

                                   __________

           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
    61-152                     WASHINGTON : 2025

    -----------------------------------------------------------------------------------

     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 TECHNOLOGY MODERNIZATION

                        TOM BARRETT, Michigan, Chairman

    NANCY MACE, South Carolina           NIKKI BUDZINSKI, Illinois, Ranking
    MORGAN LUTTRELL, Texas                   Member
                                         SHEILA CHERFILUS-MCCORMICK,
                                             Florida

    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

                                  ----------

                              MONDAY, MAY 5, 2025

                                                                       Page

                               OPENING STATEMENTS

    The Honorable Tom Barrett, Chairman..............................     1
    The Honorable Nikki Budzinski, Ranking Member....................     3

                                   WITNESSES
                                    Panel I

    Dr. Lisa Arfons, M.D., Acting Deputy Assistant Under Secretary
      for Integrated Veteran Care, Veterans Health Administration,
      U.S. Department of Veterans Affairs............................     6

    Mr. Chris Faraji, President, WellHive............................     7

    Mr. Jed Hansen, Executive Director, Nebraska Rural Health
      Association....................................................     9

                                    APPENDIX
                        Prepared Statements Of Witnesses

    Dr. Lisa Arfons, M.D. Prepared Statement.........................    33
    Mr. Chris Faraji Prepared Statement..............................    35
    Mr. Jed Hansen Prepared Statement................................    41

                          IMPROVING ACCESS TO EXTERNAL
                            VA CARE THROUGH ENHANCED
                             SCHEDULING TECHNOLOGY

                                  ----------

                              MONDAY, MAY 5, 2025

      Subcommittee on Technology Modernization,
                        Committee on Veterans' Affairs,
                                 U.S. House of Representatives,
                                                        Washington, DC.
        The subcommittee met, pursuant to notice, at 3:01 p.m., in
    room 360, Cannon House Office Building, Hon. Tom Barrett
    (chairman of the subcommittee) presiding.
        Present: Representatives Barrett, Luttrell, and Budzinski.

               OPENING STATEMENT OF TOM BARRETT, CHAIRMAN

        Mr. Barrett. Good afternoon. The Subcommittee on Technology
    Modernization will come to order. Appreciate everybody who is
    here today. Appreciate our witnesses for being here and to the
    members that are here today for this subcommittee hearing.
        The purpose of today's hearing is about scheduling and what
    goes on at the U.S. Department of Veterans Affairs (VA) for
    Community Care and access to that for our veterans, which is
    certainly a growing need that is taking place out there to make
    things more convenient and more conducive to veterans where
    they are and where they live.
        When veterans are referred to Community Care, the
    scheduling process should be simple, fast, and focused on their
    healthcare and getting them through in a timely and efficient
    manner, but for too long that has not been the case. It has
    been something that has been fraught with inefficiencies,
    challenges, and a back-and-forth between veterans, the VA, and
    ultimately the Community Care partner where they are receiving
    their care.
        To schedule an appointment, VA staff must pick up the phone
    again and again often calling the veteran and the provider
    multiple times to schedule an appointment. It is a tedious,
    manual, multi-step process that can stretch over hours into
    weeks, delaying care for the men and women who earned it. It is
    inefficient and unsustainable.
        Community Care is VA care and will remain a critical
    component of effectively delivering veteran healthcare.
        Approximately 2.8 million veterans used Community Care in
    2023 alone, and the outdated telephone model for scheduling
    these appointments is being crushed by the volume of requests
    from veterans for healthcare in their communities.
        VA's External Provider Scheduling, or EPS, is supposed to
    fix that and in many ways it is fixing it. EPS eliminates a
    large portion of the time and labor intensive aspects of
    Community Care scheduling by giving VA schedulers direct access
    to a provider's appointment availability, allowing them to
    directly interface with them to schedule their appointments.
        Through EPS, providers agree to share their scheduling
    grids with VA and allow schedulers to search and sort
    appointments by distance, drive time, availability, and more.
    With available Community Care appointments on one screen, a VA
    scheduler can book the appointment directly with a Community
    Care provider with just one call to the veteran.
        The average schedule for an appointment using EPS is 7
    minutes. Without having to rely on making multiple phone calls,
    some schedulers have been able to book up to four times as many
    appointments per day. Spending less time scheduling each
    appointment means VA schedulers can be more efficient, and
    veterans can get their appointments faster.
        Here is the problem: EPS is only active at about 20 percent
    of VA medical hospitals. Some facilities have only had EPS for
    a few months. While the program is adding new providers almost
    every day, there are roughly 6,000 provider services currently
    active in EPS, and that number will need to keep growing if the
    program is going to reach its potential.
        Provider participation is absolutely critical. EPS is only
    a few years old, and I understand that it takes time to adopt
    new technology, and certainly we have had issues of healthcare
    delivery since the pandemic that have complicated rollouts in
    technology modernization and all kinds of things.
        With strong leadership and a commitment from the VA, I fear
    that this will be yet another Information Technology (IT)
    project that withers on the vine with unrealized potential to
    improve veterans' lives. Without strong leadership, that could
    be the outcome.
        Despite EPS' promising results, the Biden administration
    repeatedly placed roadblocks in front of the program. In 2024,
    VA paused recruitment of community providers into EPS,
    deactivated sites where EPS was already up and running, and
    canceled plans to expand nationwide, all while blaming fake
    budget shortfalls.
        Turning off EPS at active sites does not just hurt
    veterans. It burns bridges with the community providers who may
    not trust VA to follow through again later.
        The technology works, and this subcommittee is not going to
    allow the VA bureaucracy to stand in the way of its own
    success.
        As the demand for Community Care continues to grow, VA
    cannot afford to continue scheduling millions of appointments
    over the phone.
        EPS is not just about scheduling faster. It is about
    reducing administrative burdens on VA staff.
        We are fighting every day to keep pace with scheduling
    Community Care appointments on behalf of veterans that the VA
    serves.
        It is about letting veterans make informed decisions by
    comparing VA and community provider availability.
        It is about honoring the basic promise that when a veteran
    needs care the system does not stand in the way.
        That is exactly what House Republicans are focused on and
    why this subcommittee hearing is so important to me.
        With the Trump administration in place, I expect VA to tell
    us what their plans are to reverse the Biden administration's
    protocols and expand the program to the rest of the VA, in
    addition to what they are doing to bring more Community Care
    providers into EPS.
        With strong leadership from the Trump administration,
    planning and oversight from this subcommittee, VA has a real
    opportunity to improve veterans' lives with this technology.
        Thank you again for being here, and I look forward to your
    testimony.
        Before I turn it over to the ranking member, I just want to
    say from a personal standpoint I had an issue with this not
    long ago where I was called by a provider vendor about
    scheduling an appointment and I gave them dates that I was not
    available because I was going to be here, not at home in
    Michigan, and they turned around and scheduled me an
    appointment on a date where I was not even going to be at home.
        When I called to inquire about that, they said, ``Well, our
    protocol is if we cannot get you scheduled on a date that you
    have requested, our procedure is to give you the next available
    appointment date.''
        Well, that did not help me, and I am questioning, all
    right, well, now I am calling into this call center, which is
    taking up some other person's time on the other end of the
    phone to try and schedule this, and it does not ultimately
    yield the outcome, what the purpose of this is, which is
    supposed to schedule the veteran for the care that they have
    been scheduled or referred for. They said it was about meeting
    their required metrics with the VA.
        This turned into a whole kind of chaotic thing. In fact,
    the culmination of this was they called me one morning when I
    was actually at a breakfast with members of this committee with
    Secretary Collins, and I was very tempted to just put this on
    speaker phone and see how it played out.
        Anyway, there are certainly a lot of efficiencies to be
    had, a lot of lessons to be learned. I want to make sure that
    we are not looking at this through a clear, ``if this, then
    that'' metric-driven mindset and more of a how do we get this
    veteran the appointed time that can work for them, meet their
    schedule, and meet the outcome of actually getting them the
    care that they have been referred to.
        With that, I will refer it over to the ranking member for
    your remarks.
        Thank you again for being here.

          OPENING STATEMENT OF NIKKI BUDZINSKI, RANKING MEMBER

        Ms. Budzinski. Thank you. Thank you, Chairman. Thank you
    for sharing that.
        I want to also thank the witnesses for being here today. I,
    too, look forward to this afternoon's conversation about
    referral management and VA's modernization effort for Community
    Care scheduling with the External Provider Scheduling solution,
    or otherwise as we have been referring to it as EPS.
        While I have grave concerns about the expansion of
    Community Care supplanting VA's ability to provide direct care,
    there is no denying that it is an important tool in ensuring
    veterans' access to healthcare, especially in rural America.
        It is incumbent upon Congress and VA to ensure that both
    Community Care and VA direct care are properly resourced so
    that one does not diminish the other.
        I am concerned that the technology that helps these
    programs run will be undermined by the Trump administration's
    proposed cuts of almost half a billion dollars to the VA's IT
    budget in Fiscal Year 2026.
        That being said, VA's current practice for scheduling
    Community Care appointments is archaic and time consuming.
        Referral management personnel call around looking for
    available appointments with Community Care, as the chairman
    talked about, and then coordinate with the veteran to find the
    right slot, added at the right time, in the right location,
    with the right doctor. Then they gather the appropriate medical
    record data and transmit it--frequently using a fax machine--to
    the Community Care provider.
        I have heard this process averages around 20 days. That is
    an incredibly lengthy process given that it is in addition to
    the wait times many providers already have.
        We can and must do better for our veterans.
        WellHive boasts that through their system they connect
    Community Care provider calendars with VA referral management
    teams. The scheduling process can take as little as 6 minutes.
    That is great to hear. I hope the subcommittee can work with
    our Health Subcommittee colleagues to address the rest of the
    process.
        To be clear, the technology is only one part of the
    solution. We should also be looking at the workflows leading up
    to the point of scheduling.
        For instance, how can we help VA streamline tasks, like
    eligibility reviews, the development of the referral document,
    and the transmission of clinical documentation?
        How can we improve the training and guidance provided to
    essential referral coordination teams to ensure they are able
    to do their jobs adequately?
        How can we make appointment scheduling faster and easier
    for veterans?
        How can we improve the workflows before and after the point
    of scheduling so that veterans are not sitting around just
    waiting for an appointment to be scheduled?
        We owe it to our veterans to speed up this process so that
    they are receiving timely access to the care that they need and
    they deserve, whether that is at a VA facility or a community
    provider.
        WellHive is only as effective as the network of providers
    connected to the tool, which has been inconsistent across the
    34 sites currently using the solution. I have heard that some
    sites have hundreds of providers signed up while last fall at
    least one site only had two.
        I hope to better understand the gaps in this network and
    what VA and WellHive plan to do to address it.
        I look forward to hearing from our departmental employees
    here today, vendor partners like WellHive, and those
    organizations that bring community providers into the fold,
    like Mr. Hansen, on how we can further engage providers on the
    WellHive system.
        Additionally, Congress has been calling for the VA to be
    able to provide an apples-to-apples comparison of wait times in
    VA direct care versus Community Care.
        WellHive has that capability, so I would urge VA to utilize
    it. For example, with this tool, veterans could know that VA's
    first available appointment is in 22 days, making them eligible
    for Community Care. EPS' fully integrated scheduling solution
    might also tell them that the first available appointment in
    the community is in 35 days.
        VA should give veterans that fuller picture of their
    options. This would let the veterans themselves make the
    informed choices among available Community Care appointments
    and VA direct care appointments.
        Community Care is a critical tool for ensuring veterans'
    access to care, but for large swaths of our country community
    access is not any better than the VA access. VA has always
    struggled to communicate that to veterans because it did not
    have the tools to back it up.
        As we work to modernize the Department of Veterans Affairs,
    veterans should be able to make decisions about their
    healthcare with the full breadth of information available.
        Providing that access means ensuring veterans are educated
    on their options, the VA is adequately staffed and funded,
    modern systems are in place, and VA's employees know how to use
    them.
        I thank the witnesses for being here, and I look forward to
    our conversation today.
        Thank you, Mr. Chairman. I yield back.
        Mr. Barrett. Thank you, Ranking Member Budzinski. I think
    we both gave our remarks in just slightly more time than it
    takes them to schedule an appointment with their system. Look
    forward to hearing more about that.
        I will now introduce our witnesses.
        From the Department of Veterans Affairs, we have Dr. Lisa
    Arfons--did I say that correct, Doctor? Very good--Acting
    Deputy Assistant Under Secretary for Integrated Veteran Care.
        That is a great title. Look forward to hearing from you.
        Also joining us today is Mr. Chris Faraji, President of
    WellHive.
        Is that right? Did I say your name correctly? Very good.
        Finally, we have Mr. Jed Hansen--I did not have to ask on
    that one--Executive Director of the Nebraska Rural Health
    Association.
        I will ask all the witnesses to please stand and raise your
    right hands.
        [Witnesses sworn.]
        Mr. Barrett. Thank you.
        Let the record reflect that all witnesses have answered in
    the affirmative.
        Dr. Arfons, you are now recognized for 5 minutes for your
    opening statement on behalf of VA. Thank you again for being
    here.

                        STATEMENT OF LISA ARFONS

        Dr. Arfons. Thank you.
        Good afternoon, Chairman Barrett, Ranking Member Budzinski,
    and distinguished members of the subcommittee. Thank you for
    the opportunity to testify on VA's work to enhance veterans'
    experiences through modern and efficient scheduling
    technologies.
        My name is Dr. Lisa Arfons, and I am the acting deputy
    assistant under secretary for health for integrated veteran
    care. My testimony today will focus on the External Provider
    Scheduling program, its successes, its opportunities for
    improvements, and VA's plans for expansion.
        Since the enactment of the John S. McCain III, Daniel K.
    Akaka, and Samuel R. Johnson VA Maintaining Internal Systems
    and Strengthening Integrated Outside Networks (MISSION) Act, VA
    has significantly expanded veteran access to healthcare. As of
    this past March, we have provided over 39.6 million Community
    Care referrals to more than 5.4 million veterans.
        To improve service delivery, VA is focusing on innovations
    that put veterans first. EPS is an initiative aimed at
    improving veterans' experience and access to care through
    enhanced scheduling technology.
        Recognizing the urgent need to prioritize veterans, this
    administration, under the leadership of Secretary Collins,
    reinforced the need for quick EPS implementation. In just the
    first 100 days, we expanded EPS from 16 sites last fall to 36
    sites today, rapidly improving access and bringing more
    facilities and providers online.
        VA recognizes the need to provide veterans with clear,
    concise, comparable information about their healthcare options,
    whether within VA or in the community. To support this goal,
    VA's exploring EPS capabilities for both VA direct and
    Community Care scheduling, furthering the Secretary's
    commitment as promised under the VA MISSION Act.
        EPS allows VA staff to schedule veterans directly into
    available Community Care provider appointment slots through a
    single user interface, seamlessly connecting veterans to
    Community Care providers.
        This single user interface displays provider availability
    and reduces back-and-forth communication delays. By providing
    detailed information on who, where, how, and when care is
    available, EPS helps veterans make timely and informed
    decisions about their healthcare.
        Early examples demonstrate key benefits of EPS, including
    an enhanced veteran experience, streamlined coordination, and
    strengthened partnerships.
        As of May 1, EPS has been successfully implemented in 36 VA
    medical centers with 18 medical centers scheduled to go live by
    the end of this fiscal year. Over 6,000 provider services are
    active in EPS across 62 specialties.
        To realize the full capability of EPS, we do recognize the
    need for better change management and training. VA developed an
    online training program enabling VA staff to take the training
    as needed. The EPS team also provides office hours and
    immediate live support for those users requiring assistance.
        Implementing EPS has presented many opportunities,
    particularly in onboarding Community Care providers. Many
    providers are understandably concerned about new systems
    integrating within their existing workflows and whether
    additional training or resources will be required.
        We have addressed these concerns by demonstrating that EPS
    eliminates the need for phone calls, minimizes burdens on
    administrative staff, and streamlines the Community Care
    authorization process.
        Providers retain control over their scheduling system
    visibility and they are able to display as many appointments as
    they wish.
        This approach benefits providers and puts veterans first by
    mitigating barriers to accessing the healthcare choices they
    have earned.
        In conclusion, the EPS program is no longer an experiment.
    It is a proven tool of fundamentally transforming how veterans
    access care.
        Thanks to renewed focus and leadership, EPS is now reaching
    more veterans, at more sites, faster than ever before.
        We are committed to building on this momentum, expanding
    EPS nationally, and continuing to refine the system based on
    real world feedback from veterans, VA staff, and community
    providers.
        By removing barriers, minimizing delays, and placing
    veterans at the center of the scheduling process, EPS helps
    deliver the timely high quality care veterans deserve.
        We look forward to working with the subcommittee to ensure
    continued improvements in the scheduling process and overall
    care for veterans.
        Thank you for the opportunity to testify today. I am
    prepared to answer any questions you may have.

        [The Prepared Statement Of Lisa Arfons Appears In The
    Appendix]

        Mr. Barrett. Thank you, Doc. I appreciate that.
        The written statement of Dr. Arfons will be entered into
    the hearing record.
        Mr. Faraji, you are now recognized for 5 minutes to deliver
    your opening statement on behalf of WellHive. Thank you again
    for being here.

                       STATEMENT OF CHRIS FARAJI

        Mr. Faraji. Chairman Barrett, Ranking Member Budzinski, and
    distinguished members of the subcommittee, thank you for the
    opportunity to testify today.
        WellHive is a healthcare software technology company and we
    are proud to support the Department of Veterans Affairs through
    our role in the External Provider Scheduling program. Our
    fundamental goal is to partner with VA to modernize scheduling,
    improve care navigation, and ensure veterans receive timely,
    high quality healthcare.
        Our platform seamlessly integrates across health systems,
    providing real-time visibility and access to provider schedules
    into a single intuitive interface, much like how platforms such
    as Expedia simplify finding and booking travel.
        The journey to modernize scheduling for Veterans Health
    Administration (VHA) began with a pilot program launched in
    2020. This pilot, starting in Orlando, Florida, and expanding
    to Columbia, South Carolina, sought to answer critical
    questions. Can this technology work reliable with VHA? Is it
    scalable? Most importantly, does it enable faster access to
    care for veterans?
        A structured evaluation process, including input from
    integrated project teams and industry Request for Information
    (RFIs), confirmed the potential and led to a competitive award
    of the External Provider Scheduling contract to WellHive in
    September 2023.
        In my February testimony, I emphasized the importance of
    aligning people, process, and technology. Today, under
    Secretary Collins' leadership and with bipartisan support of
    Congress and these committees, we are finally seeing that
    alignment deliver real progress for veterans through the
    External Provider Scheduling.
        This program is fundamentally transforming how the VA
    connects veterans with Community Care. By offering real-time
    scheduling visibility across their vast, diverse provider
    network, including major health systems, academic affiliates,
    and individual practices, it empowers VA scheduling teams to
    act faster with greater insights. This significantly reduces
    veteran wait times and delivers a more veteran-centric
    experience.
        Yes, like many ambitious initiatives, the External Provider
    Scheduling program has faced challenges since its award,
    including shifting priorities and coordination issues. Despite
    these hurdles, the underlying technology has consistently
    delivered on the original commitment to reduce wait times and
    enhance the scheduling process for veterans, VA staff, and
    Community Care providers.
        Now, with renewed commitment and strong leadership, we are
    seeing significant momentum. This program is currently live in
    36 VA medical centers across the Community Care Network regions
    and is on track to expand to the additional 18 VA medical
    centers with the potential for nationwide implementation by the
    end of fiscal 2025.
        These results are clear and measurable, demonstrating
    tangible benefits. The average time to schedule an appointment
    using EPS is 7 minutes. We are seeing up to a four-times
    increase in productivity for VA staff using the program even
    without critical integration in the VA systems.
        Since January, active provider services participating in
    digital scheduling through EPA have increased at a rate of 21
    percent month over month.
        Most importantly, appointments scheduled through EPS have
    increased by 121 percent in the first 4 months of this year.
    This means veterans are receiving care faster.
        Community providers are also finding the model
    transformative and are actively participating. As one partner
    shared, ``Partnering with WellHive has improved our scheduling
    process and has increased timely access to care for our veteran
    population.''
        This program has a strong backing from key stakeholders,
    including leading veteran service organizations and state
    directors who recognize its critical role in reducing delays
    and enhancing care navigation.
        EPS is also paving the way for future advancements, such as
    integrating VA and Community Care scheduling into a single
    view, offering that apples-to-apples comparison which
    ultimately gives the veterans choice.
        Achieving widespread veteran self-scheduling is enabled by
    a nationwide rollout of this program. Think of it as laying the
    digital tracks. The more tracks you lay across the country, the
    more veterans can ride the self-scheduling train.
        This year, in collaboration with the VA.gov team, the
    program is helping VA make significant advancements in
    fulfilling the Cleland-Dole Act by introducing self-scheduling
    pilots in July 2025.
        Before concluding, I would briefly like to address some of
    the comments that were made by the chairman and the ranking.
        Mr. Chairman, you mentioned that your preference is that
    you had to provide to that call center agent or that Medical
    Support Assistant (MSA) was cumbersome, right, and having EPS
    on that phone call would have prohibited the back-and-forth,
    because you would have been able to make informed decisions,
    and that is what a lot of veterans are experiencing today with
    EPS.
        Ranking Member, you mentioned about key integration with
    things like the referral management system. We also truly
    believe that that integration will help also streamline the
    process.
        The External Provider Scheduling program is no longer just
    a promise. It is a proven, scalable solution addressing one of
    the VA's most persistent challenges.
        Under Secretary Collins' strong leadership and with the
    enduring bipartisan commitment from Congress, we can and will
    fulfill the promise that this program holds, delivering timely,
    effective care for every veteran across the Nation.
        Thank you again, and I look forward to your questions.

        [The Prepared Statement Of Chris Faraji Appears In The
    Appendix]

        Mr. Barrett. Thank you.
        The written statement of Mr. Faraji will be entered into
    the record.
        To your point, I think I would have been better off if they
    had just told me here are three providers you can go through,
    call them and see if you can schedule an appointment, instead
    of going through the endless loop. I have some strong opinions
    about it, as you can probably tell. Thank you again.
        Mr. Hansen, you are now recognized for 5 minutes to deliver
    your opening statement on behalf of the Nebraska Rural Health
    Association.

                        STATEMENT OF JED HANSEN

        Mr. Hansen. Thank you, Chairman Barrett.
        Chairman Barrett, Ranking Member Budzinski, and
    distinguished members of the subcommittee, thanks for the
    opportunity to speak with you today.
        I am Jed Hansen. I am executive director of Nebraska's
    Rural Health Association where I work closely with our rural
    hospitals, clinics, and providers across our State.
        I have spent over a decade clinically in emergency care
    nursing and as a nurse practitioner and more recently as an
    advocate for improving rural health systems.
        I am here today to talk about the External Provider
    Scheduling program, or EPS as we are calling it, and why it is
    working for Nebraska's veterans and how it can be scaled
    nationally.
        I first learned about EPS in 2023 during its pilot phases
    in South Carolina and Florida. I was impressed by the program's
    approach to streamline scheduling for veterans needing
    Community Care, and recognizing some of the unique challenges
    that we face in Nebraska and rural Nebraska, I pushed for a
    rural pilot.
        Thanks to appropriations and policy support from one of our
    Senators, Senator Fischer, along with Senator Moran out of
    Kansas, the EPS program transitioned to a national rollout.
        In 2024, the Nebraska Rural Health Association, along with
    our hospital association, launched a statewide effort to raise
    awareness and support for EPS adoption. We used our
    association's reach to accelerate implementation with
    newsletters, regional meetings, webinars, and even a technical
    session with members of the WellHive team at our annual
    conference.
        Simply, the model is delivering results. Nebraska's two
    largest academic medical centers, Catholic Health Initiatives
    (CHI) Health Creighton and the University of Nebraska Medical
    Center, are actively implementing EPS.
        We have 50 independent provider groups that are live today,
    including those in mental health, optometry, physical therapy,
    and chiropractic services. We also have 35 critical access
    hospitals engaged, with eight now in active onboarding.
        We have also been fortunate to partner with national
    organizations like the National Rural Health Association and
    the National Organization of State Offices of Rural Health,
    which have both helped amplify EPS awareness regionally and
    nationally.
        Just as importantly, we have maintained strong
    relationships with our local VA medical center leadership teams
    in Omaha, our State VA director, and the VA Office of Rural
    Health, all of whom have been critical partners in ensuring
    alignment and success.
        I would like to share briefly why this matters.
        I recently spoke with Mr. Gregory Hake, a Navy SEAL and
    Nebraska native, and he shared his story with me. He recalled
    long drives just to receive some basic care in rural Nebraska,
    something that he said was manageable when he was younger and
    healthier but now he sees those as potentially devastating
    barriers for older veterans, particularly those who rely on
    sometimes inconsistent transportation for services.
        Now living in San Diego, Mr. Hake waited 9 months for an
    Magnetic Resonance Imaging (MRI) through the VA. He describes a
    system where treatment was only offered on an episodic basis
    and where specialty care was sometimes inconsistent.
        As he put it, many veterans, especially those living in
    rural areas, are stuck navigating a fragmented, slow-moving
    healthcare experience when they are already vulnerable.
        Unfortunately, I do have other stories to share.
        He was, however, very quick to point out when we were
    talking that this was despite the kind and dedicated providers
    and staff of the VA.
        Based on our experience, I would like to respectfully offer
    the following recommendations.
        One, support our rural providers with Federal
    appropriations to help offset some of the IT staffing shortages
    and burdensome interfaces that they face.
        Two, look to incentivize academic and tertiary providers
    with a time-limited enhanced payment model that could possibly
    speed adoption.
        Three, looking to ensure Electronic Health Record (EHR)
    vendor alignment, especially with those large organizations,
    such as Epic and Oracle Cerner, to make sure that EPS
    integration is more accessible and affordable across all care
    spectrums.
        Four, looking to leverage state-level organizations.
        Rural health associations such as mine, hospital
    associations, and State offices of rural health are well-
    positioned to serve as liaisons for local implementation.
        In States like Michigan, your State office is extremely
    active. In States like Illinois, you have organizations like
    Illinois Critical Access Hospital Network (ICAHN) that could
    easily fulfill this work in a similar fashion that we are doing
    in Nebraska.
        Finally, we need to continue to engage our national
    partners, including the National Rural Health Association,
    American Hospital Association, and others, and very
    importantly, to continue to work with local VA teams and the VA
    Office of Rural Health to make sure that we are providing broad
    reach and awareness of the program and to ensure that EPS
    remains connected to the communities it is meant to serve,
    which are our veterans.
        In closing, Nebraska's success shows that national
    innovation, when paired with local engagement, along with
    trusted partners, can produce some meaningful results for our
    veterans.
        Thank you for the opportunity to testify, and I am truly
    honored to be a part of the conversation today.

        [The Prepared Statement Of Jed Hansen Appears In The
    Appendix]

        Mr. Barrett. Thank you. Thank you for your recommendations
    as well.
        The written statement of Mr. Hansen will also be entered
    into the hearing record.
        We are now going to proceed with questioning, and I will
    recognize myself for 5 minutes.
        I really appreciate, again, the testimony of those of you
    that are here today.
        Starting out, I had a question about the implementation of
    how WellHive organizes all this.
        You sign up basically Community Care partners that will
    interface with your system, that then a scheduler can look at
    and see the availability that is out there for a particular
    veteran for the service that they are referred for.
        Is that kind of a starting point of how it operates?
        Mr. Faraji. That is correct. We meet the providers where
    they are at. They continue to use their EHR systems and we have
    direct integrations into those systems.
        Mr. Barrett. Is every EHR, the scheduling component of
    that, is that a portion within the EHR or is that a stand-alone
    add-on that is usually available?
        Mr. Faraji. It is different from every EHR system and
    different manufacturers.
        Mr. Barrett. Okay. There is not like one scheduling system
    that every provider uses. They are all going to be a little bit
    different.
        Is a portion, I guess, or the barrier to entry to get more
    providers signed up, is it the portal that needs to exist to
    get your ability to see their availability, is that something
    you have to code specifically for each individual provider that
    signs up?
        Mr. Faraji. Really, it becomes more of an awareness issue
    and understanding the benefits of the EPS platform.
        Once providers understand that, it becomes--the technical
    part is very straightforward. We are merely putting connections
    in and establishing that so that we are able to see those
    clinical grids.
        Mr. Barrett. Okay. Then does the provider pay for that
    technical upgrade, if you will, to be able to interface, or is
    that done by WellHive?
        Mr. Faraji. There is no charge.
        Mr. Barrett. Okay. WellHive does that.
        Mr. Faraji. That is right.
        Mr. Barrett. You have just got enough people, and you built
    it for enough systems that you have probably got most of them
    interoperability-wise figured out at this point?
        Mr. Faraji. Correct. We have a formula of things where we
    are doing direct. We use partners, et cetera, to be able to
    make those connections happen.
        Mr. Barrett. Okay. Okay.
        For Mr. Hansen, is the reimbursement rate that the VA pays
    pretty lucrative for rural hospitals? Like, if you have a
    procedure that is being referred out, obviously you would not
    want to be signed up in a part of this if it was not something
    that you felt was at least fair and equitable for the services
    you are providing.
        Mr. Hansen. Yes. I do not know that there is really much of
    anything that we would say is lucrative in rural healthcare.
        [Laughter.]
        Mr. Barrett. Yes. If I ask any hospital that, they will say
    no.
        Mr. Hansen. There are certainly drivers, and volume is
    vitality when we are talking rural healthcare. Really what I
    found when I am working with our critical access hospital
    leaders is that is not the driver.
        We have a number of our leadership teams where they are
    veterans or maybe their parent was a veteran or grandparent.
    Really in any rural community you do not have to go too far
    until you have that veteran connection. Really, the driver has
    been that they are wanting to improve access for their
    neighbors.
        Mr. Barrett. Sure. I know that, especially in rural
    communities, you might be separated a significant distance from
    the nearest VA larger facility that would afford you that
    opportunity then to go more locally and receive that service
    that already might be predominantly done through the rural
    hospital network, but for this one service-connected condition
    you might be getting treated for at the VA, for example, or
    something. I know that has happened multiple times in my own
    district where people have that.
        Mr. Hansen. Yes, that is correct, Chairman.
        I can speak to Nebraska. I do not have some of the national
    data behind me. In Nebraska the average drive time for a
    veteran to a VA facility is about 39 minutes one way. On
    average, every rural veteran in Nebraska is going to be
    eligible under the MISSION Act for care in the community.
        Mr. Barrett. Sure. Okay. Thank you.
        Dr. Arfons, roughly how many Community Care referrals were
    created in Fiscal Year 2024? I assume that is our last year of
    data that we have available.
        Dr. Arfons. I have Fiscal Year 2024 through Fiscal Year
    2025 to date pulled up as of this morning. Fourteen million,
    just over 14 million.
        Mr. Barrett. Okay. Fourteen million. Has that volume
    trended up or down in recent years?
        Dr. Arfons. Increased.
        Mr. Barrett. Okay. Do you attribute that more to expanded
    programs, Sergeant First Class Heath Robinson Honoring our
    Promise to Address Comprehensive Toxics (PACT) Act, other
    things of that nature, veterans coming home and conditions from
    war on terror service connection, things like that, or do you
    attribute it more to awareness, more availability of Community
    Care? Where do you kind of land that mostly? Or all of the
    above?
        Dr. Arfons. All of the above.
        Mr. Barrett. Okay. Yes. All right. Thank you.
        I am running short on time, but I will come back with a few
    more questions, I am sure.
        I want to yield to Ranking Member Budzinski for 5 minutes
    for her questions.
        Ms. Budzinski. Great. Thank you, Mr. Chairman.
        Thank you again to the witnesses for your testimony.
        As we have been talking about VA modernization, it is
    really come down to three different topics. It is either
    people, process, or technology.
        I do want to spend a little bit of time in my opening
    questions on the people part, and so my questions are for Dr.
    Arfons.
        I do remain very concerned about the Trump administration's
    actions over these last 3 months, and I fear that the VA is now
    being asked to do even more with less.
        In particular, serving on this committee, and the
    importance of really these technology efforts and the amount of
    staff and the specialty of the staff, the technology staff, the
    IT staff that we need to successfully get these off the ground.
    Very concerned about those.
        I was just curious if you could answer: Were any of the
    individuals with these referral coordination teams impacted by
    the probationary terminations that happened back in February?
        Dr. Arfons. The referral coordination team members are
    facility staff, so I cannot speak to that. I can take for the
    record.
        Ms. Budzinski. Okay. Would you know if any of those staff
    were rehired at all if they were probationary and terminated?
        Dr. Arfons. I would not know that either because they are
    facility staff.
        Ms. Budzinski. Okay. Have any of the individuals with the
    teams been targeted under the Secretary's reduction in force
    that you know of to plan to cut the VA's workforce by the
    additional 15 percent?
        Dr. Arfons. No, not that I am aware of.
        Ms. Budzinski. Okay. How many people in these teams have
    opted into the Deferred Resignation Program that you might know
    of?
        Dr. Arfons. I have no numbers related to that either. It is
    all facility led.
        Ms. Budzinski. Okay. Have referral coordination team
    positions been exempt from the hiring freeze?
        Dr. Arfons. I am not aware of that. In general, our
    frontline staff are exempt.
        Ms. Budzinski. Okay. Then a couple other questions.
        What kind of assessments has the VA done to ensure that VA
    medical facilities have the necessary staff to support the
    rollout of the EPS system beyond the pilot sites?
        Dr. Arfons. We work closely with sites when we are looking
    to see their readiness. It is really two sides of one coin.
        The first is assuring that sites themselves are ready. We
    look at their referral patterns, where they need assistance in
    terms of their workflows, referring veterans out, and what sort
    of leadership support that we have.
        The other side of the coin then, of course, is matching it
    then with the provider network and assuring that we are able
    then with WellHive support to have at least enough providers on
    the network to start so we can begin to see with new go-live
    how we are able to use the system and then integrate it more
    fully.
        This is a continuous process. We do not go live and leave.
    We continue to follow metrics. We look at veteran and staff
    feedback to ensure that we are rolling out correctly and then
    adjust if needed.
        Ms. Budzinski. Okay. As a part of that assessment that you
    make, do you take into account then my concerns around the
    Deferred Resignation Program, any impact that that might have
    on the assessments that you are making before a site goes live?
        Dr. Arfons. We have not incorporated that.
        Ms. Budzinski. Okay. Okay.
        Then I have another question for you. This is more on the
    data side of things.
        Dr. Arfons, prior to the WellHive pilot, how many days did
    it take from order placement to appointment scheduling for a
    Community Care referral?
        Dr. Arfons. If I can answer that a little bit differently.
    What we see at the sites that have gone live for those
    referrals that are being scheduled, using traditional means, it
    is taking on average about 33 days.
        For those staff members, the veterans then who are
    scheduling referrals using EPS, it has cut that down by about a
    week to 25 days.
        Ms. Budzinski. Okay. Okay.
        Then my next question is for Dr. Faraji.
        As you connect Community Care providers to veterans, what
    kind of information do you share with the veterans as it
    relates to that provider?
        Mr. Faraji. Thank you for the question.
        Right now the MSAs facilitate that conversation with the
    veteran, and they are using EPS to populate the information of
    the providers, their availability and what works best for them,
    where it calculates the drive time and distance.
        Ms. Budzinski. Okay. Does it share--do they share any
    information as far as, like, how much work that that provider
    has done with the veterans community, any of the specific
    training as it relates to military sexual trauma awareness,
    Post-Traumatic Stress Disorder (PTSD) awareness, things like
    that that that provider might have had experience with? Do you
    share that knowledge with the veteran when you are making the
    referral?
        Mr. Faraji. Thank you for that question.
        The EPS program does not have those details inside the
    platform. It is primarily providing the information for
    availability----
        Ms. Budzinski. Scheduling. Yes, of scheduling.
        Mr. Faraji. That is right. The platform has an abundance of
    capabilities, but right now at that time is what it provides.
        Ms. Budzinski. Okay. Okay.
        Oh, I am sorry. I am over time. I will come back.
        I yield to the chairman. Sorry. Thank you.
        Mr. Barrett. Thank you, Ranking Member Budzinski. We will
    have more time for more questions as we go through.
        I want to recognize Mr. Luttrell for 5 minutes.
        Mr. Luttrell. Thank you, Mr. Chairman.
        I am going to piggyback off your earlier statement.
        Mr. Faraji, we have an institution in the State of Texas
    that we engage with about EPS, and their response was we have
    multiple scheduling platforms inside our organization and we
    are looking at EPS for the veteran space.
        I do not understand the roadblock. Is that different
    institutions not wanting to onboard something because of
    complexity or is that just out of sheer laziness? I am going to
    say it that way.
        Mr. Faraji. Sir, thank you for the question.
        Every health system, provider practice, they all work in
    different ways. Sometimes it is a very straightforward
    conversation. Sometimes it requires a multitude of people to be
    able to provide that integration and show the availability.
        Mr. Luttrell. Dr. Arfons--actually, this is probably going
    to be for you, too, Mr. Faraji.
        We have 36 sites that are going to be--we are going from 16
    to 36, correct, 18 sites going live this year? Did you say
    that?
        Dr. Arfons. We are at 36 right now and going up to 54 by
    the end of the fiscal year.
        Mr. Luttrell. Dr. Faraji, you said potentially all of our
    VA sites, correct, 170-plus? That is the idea, correct?
        Mr. Faraji. At this time it is the 36 and 18.
        Mr. Luttrell. What is our projection to get every single
    site uploaded and on board?
        Dr. Arfons. VA is working through that right now.
        Mr. Luttrell. You got to give me something better than
    that.
        How long have you been in this position, Dr. Arfons?
        Dr. Arfons. Acting, since February.
        Mr. Luttrell. Okay. I am going to make the assumption or
    assume that the VA is completely on board with WellHive and the
    implementation of their software program inside the VA system
    is what we want?
        Dr. Arfons. We definitely recognize the benefits to
    veterans and connecting them to care sooner, yes, with EPS.
        Mr. Luttrell. Can you clarify the answer? That sounds like
    a political statement. Can you clarify that answer for me a
    little bit more?
        I think my concern is that how I understand it is this
    system works. If it is beneficial to the veterans, I do not
    understand why we are not moving forward. I am sure the
    Secretary will be 100 percent on board.
        Now, do we have to talk to the individual VA facility to
    say, ``Are you willing to onboard this?'' Or is this command
    and control from the secretarial level, and says, ``This is
    what we are doing''?
        Dr. Arfons. We are going to be continuing to roll out to
    the 18, so we have a total of 54. We will continue expanding
    throughout this Fiscal Year and then continuing to look at how
    those 54 sites have deployed to help guide us into the future.
        Mr. Luttrell. Mr. Hansen, you kind of command and
    coordinate all the Community Care facilities inside Nebraska
    for WellHive, correct?
        Mr. Hansen. I work with our----
        Mr. Luttrell. You bring all the Community Care facilities
    to WellHive or bring WellHive to those communities?
        Mr. Hansen. Correct. I provide the information on the EPS
    program out to our community hospitals.
        Mr. Luttrell. It is very--is it well received?
        Mr. Hansen. It is. Kind of to maybe tip in a little bit on
    the conversation, I became aware of the EPS program before our
    Veterans Integrated Service Network (VISN) leadership team in
    Omaha did, and so I actually approached them to ask them what
    their thoughts were on the program.
        I wanted to make sure that I was not missing something,
    because like yourself, it seems like this is just a good
    program for veterans.
        Overall we had very good buy-in at Omaha. I cannot speak to
    other VAs. I think part of what we are doing----
        Mr. Luttrell. You are sitting in front of me so just--has
    any of it blown up? I probably should not say it that way since
    we are in the House of Representatives. I mean, has any of it
    failed?
        Mr. Hansen. No. We have not had any points of failure right
    now. Really there is largely been goodwill with this program.
    It is just the right thing to do.
        Mr. Luttrell. Do you have buddies that are just like you in
    the other 49 States across the country that you are talking to?
        Mr. Hansen. I have a lot of buddies in other States.
        There is not really any secret sauce to what we are doing
    in Nebraska. In Texas you have Texas Organization of Rural and
    Community Hospitals (TORCH) as an example that would be an
    organization. I had mentioned the State office in Michigan. You
    have another private entity like ICAHN in Illinois. Every State
    has someone that is a good liaison.
        Mr. Luttrell. You seem to be handling Nebraska, though.
        Mr. Faraji, do you have to market this to all the community
    sites as well as the VA by, with, and through Mr. Hansen? I am
    sure that is pretty burdensome if you are the one--if you are
    the two doing it. It seems like something the VA should jump on
    board with. Is that happening?
        Mr. Faraji. As far as working--yes, we are individually
    going out and reaching out to providers and we have got a great
    recipe to that. We have seen a 21 percent increase month over
    month with the providers being onboarded.
        Working with Mr. Hansen is one example. We have been able
    to replicate that with the Arkansas Hospital Association, which
    was able to produce similar results with these larger health
    systems.
        It is definitely a team effort, but we are tackling this
    together.
        Mr. Luttrell. Thank you. I yield.
        Mr. Barrett. Thank you.
        I will recognize myself again. We will do more rounds for
    members who have further follow-up questions.
        Dr. Arfons, I think it was you that said in answer to an
    earlier question that the average time had gone down from 33
    days down to 25, I think.
        Did you look anywhere at all about the distance traveled?
    Like, so going from 33 to 25 days, about a week give or take,
    depending on the thing you are referred for, that may or may
    not make a substantial difference to you.
        Another aspect of that or another dimension of it that
    might be more important is the distance traveled or the time
    available for that veteran to get that appointment more close
    to home, especially in rural communities like Nebraska or parts
    of Michigan that I represent.
        Dr. Arfons. No, we have not. We can take that for the
    record.
        Mr. Barrett. Okay. I would be curious on that. I have only
    been to Nebraska once. I was in fifth grade. I did go to
    Creighton, and I saw Ozzie Canseco play a baseball game, minor
    league baseball game there, Jose Canseco's twin brother. It was
    definitely a Rural State. I can attest to that.
        I am curious, in Nebraska, do you find that there is a
    suitable partnership between the VA and your efforts to take on
    some of that Community Care in Nebraska, there is not a
    hesitation to involve Community Care through the VA system or
    the VA network?
        Mr. Hansen. I would say largely no. There is always some
    concern on the speciality side within the VA. That is really
    not what we are looking to achieve in Nebraska with this,
    especially in our rural communities.
        We want to make sure that things like primary care are
    covered, things like emergency care. Maybe after they have
    received specialized care at the VA that they can come back and
    receive their Physical Therapy (PT) in the community.
        We are trying to close that gap. If we have an access into
    our community for that veteran to receive care and if that is
    where they would like to get care, that is what we are trying
    to achieve.
        Mr. Barrett. Okay. Thank you.
        Dr. Arfons, is there any correlation at all or any thought
    process behind the kind of integrating this EPS model with the
    already existing rollout through EHR?
        When a facility gets the new EHR rollout, they will also
    get EPS with it, so we are kind of doing this all at once when
    we are dealing with change management, or is there no rhyme or
    reason to how we are doing that?
        Dr. Arfons. As of this point, no. We certainly are open to
    that. We have gone live in Spokane, as I believe the committee
    is aware.
        Mr. Barrett. Oh, yes.
        Dr. Arfons. Definitely looking at opportunities for fuller
    integration with our technology systems, including EHR, so we
    can realize the benefits of EPS.
        Mr. Barrett. Okay.
        Mr. Faraji, following up on my earlier point and Mr.
    Luttrell's point, let us say I am a large hospital network in
    Michigan and you approach me about being part of this EPS
    network and I give you the keys to integrate into my system.
        You have got some adaptability that can probably do that.
    Whether I have EPIC, whether I have Oracle Cerner, whether I
    have one of the big ones, any large network is going to have
    one of only a few of these systems in all likelihood.
        What if I am the small audiology clinic and I have got one
    or two practitioners there and we schedule through Microsoft
    Outlook, or something like that--I do not know if people even
    do that nowadays, but let us suppose they do--are you able to
    integrate down to that more small, granular Community Care
    provider that might not be a large hospital system somewhere?
        Mr. Faraji. Thank you for that question.
        The answer, in short, is yes. We look at every site, every
    health system, every Practice Management System into the
    example that you provided, and we work closely with those
    providers and their team to understand what works best for
    them.
        What we will do is we will come up with a plan that says,
    hey, we are going to do it this way or we are going to do
    option B, so that we are able to produce their grids, and so
    they are able to show up with the availability to the VA.
        Mr. Barrett. Okay. To Mr. Luttrell's earlier point about
    how a provider in his district says, yes, we are looking at
    adding this type of interfacing or a veterans scheduling, I
    would imagine, not being in that industry, that you would want
    one scheduling application for everything so you are not
    getting mixed up and turned around and double booking and all
    the other things.
        Is it common to have multiple scheduling applications in
    one practice?
        Mr. Faraji. Again, it really depends case by case.
    Typically, it is streamlined. In some cases it is not. We do
    our best to make sure that that is all unified so there is no
    duplication.
        Mr. Barrett. Okay. All right. Thank you.
        I will now turn to Ranking Member Budzinski for another 5
    minutes.
        Ms. Budzinski. Thank you, Mr. Chairman.
        I just kind of wanted to pick up a little bit of where I
    left off. To Mr. Faraji, if WellHive had access to the data on
    cultural competency, wait times, et cetera, for Community Care
    providers, would you have the capacity to share that
    information with MSAs?
        Mr. Faraji. Yes. Thank you for the question.
        We will take the direction of VA with what they would like
    to display and share with the medical support assistance. Our
    platform is very dynamic and agnostic, so whatever you would
    like to have us provide, we can do so.
        Ms. Budzinski. Okay.
        My next question is for Dr. Arfons, then.
        Does VA collect any quality of care metrics from the
    Community Care providers, like data on wait times, the return
    of clinical documents, and completion of VA's required
    trainings?
        Dr. Arfons. We do look at some required training
    completion. We do not collect national-level data on document
    return at this point. Then other quality data, we are building
    a more robust quality program.
        Ms. Budzinski. For the data that you might be collecting
    that might be a more fuller picture, would this be something
    that as the VA negotiates the new Third Party Administrators
    (TPA) contract, VA requiring the TPAs to collect and report
    this information to the VA, would that be possible?
        Dr. Arfons. I cannot speak to any acquisition-sensitive
    work right now, but we are definitely looking at what is most
    important to deliver quality care to veterans in direct and
    Community Care.
        Ms. Budzinski. Okay. Okay.
        As I stated, I think it is really important for veterans to
    be able to make decisions about their healthcare with really
    the full breadth of information available.
        This includes information about the timeliness and quality
    of the care they would be accessing. I appreciate I did not
    hear a no, so maybe there could be some room to work out more
    additional information collected.
        Can I ask, Dr. Arfons, in 2021, the Government
    Accountability Office (GAO) released a report that identified
    approximately 1,600 Community Care providers who were not
    eligible to participate in the Community Care program, but were
    included on the provider list anyway.
        Has the VA developed the necessary controls to identify
    such providers that should be removed from the VA's patient
    care environments?
        Dr. Arfons. Through EPS, we actually run the exclusions
    list daily.
        Ms. Budzinski. Okay. Dr.--I am sorry, Mr. Faraji--does
    WellHive perform any kind of regular assessment of the
    providers on its system to measure utilization or other
    metrics?
        Mr. Faraji. Thank you for the question.
        Yes, we do measure utilization of the platform.
        Ms. Budzinski. Okay. Okay.
        Dr. Arfons, on this point, GAO has also made a number of
    recommendations to VA that identify the need to establish
    timeliness standards for care received in the community, like
    timeframes for when appointments should occur. Many of GAO's
    recommendations remain open today.
        Does VA intend to establish a standard for when veterans'
    appointments should occur?
        Dr. Arfons. We have that within the direct care system,
    namely how quickly we would like veterans to be scheduled and
    have their Community Care referrals processed within our
    system.
        Currently, our network adequacy is not measured by
    individual Community Care providers, it is done through the
    TPAs, who then have different standards not related to MISSION
    Act standards that do outline those requirements.
        Ms. Budzinski. Okay. Well, given that, how does the
    department measure access for Community Care if they do not
    collect data on when or if appointment occurs?
        Dr. Arfons. We do collect that data. At this point we use
    it in two ways.
        First of all, we have network adequacy standards. We work
    with our TPAs to understand their performance.
        We also use it operationally at medical centers to
    understand how we can assist sites to improve their data and
    use their data to guide us to where we can improve people and
    processes.
        Ms. Budzinski. Okay. I understand the VA cannot fully
    control when appointments occur, but as we send more and more
    veterans into the community for care, we should have an idea of
    the quality of care that they are receiving and when they are
    receiving it.
        Establishing guidelines and metrics would help make sure
    the veterans receive quality care. I really do urge the VA to
    implement such standards to ensure that veterans can make
    informed decisions about their own healthcare.
        With that, I will pause and yield back, Mr. Chairman.
        Mr. Barrett. Thank you, Ranking Member Budzinski.
        Mr. Luttrell, you are recognized for 5 minutes.
        Mr. Luttrell. Thank you, Mr. Chairman.
        Dr. Arfons, I am reading here that in order to schedule a
    Community Care appointment it takes nine different steps. Is
    that correct?
        Dr. Arfons. Yes.
        Mr. Luttrell. With the implementation of WellHive, that is
    substantially reduced.
        Dr. Arfons. Yes, that is correct.
        Mr. Luttrell. To how many?
        Dr. Arfons. Steps, I cannot say.
        Mr. Luttrell. Plus or minus. Nine to three? Nine to two?
        Dr. Arfons. What it cuts out is the back-and-forth.
        Mr. Luttrell. Well, I think--okay. I am going to speak as a
    veteran real quick.
        There is expectations that I have. I can say we have,
    because the chairman is a veteran as well. We live and breathe
    off of that good order and discipline and that proper chain of
    command and kind of a good infrastructure surrounding us to get
    us what we want and what we need. I think we deserve that right
    serving our military.
        I get it, the VA is this big machine. It is. What we are
    trying to do is drop drill this thing into a point where it is
    successful.
        My question to you is, what does VA consider success since
    we have nine--and I can promise you, if you are walking around
    with me in my district talking to all my veterans, one of the
    things they complain about is this.
        I think we are sitting here with the opportunity to course
    correct this ship right now, and I do not want to kick that
    proverbial can down the road.
        My question is, what does success look like in the VA?
        Now, this looks--the conversations that we are having, this
    seems like this has got 70 percent, hey, if it looks good, we
    are rolling, that is mission success.
        Can you walk me through this?
        Dr. Arfons. Success is always going to be delivering
    veterans the care that they want when they want it.
        Mr. Luttrell. You should write that down and put it on a T-
    shirt, young lady. I got it. That is not what we are doing
    right now.
        Dr. Arfons. Yes. We are working toward success and this
    program is moving us toward that.
        Mr. Luttrell. Now, I am never going to kind of force an
    answer out of anybody. What my ask is, I think we are kind of
    positioned to do something great here, and I do not want you to
    walk out of the room and go back to the VA and this thing die
    on the vine.
        I can assure you, the 40,000 veterans in my community right
    now are watching this video and they demand the same thing that
    I would demand as a veteran, and I want to know if this seems
    solid. Why is not this implementation going to happen the way
    that it should?
        Dr. Arfons. We have made marked transit improvement since
    we last presented to this committee in September--more
    providers, more appointments scheduled, shorter timeliness to
    schedule--and every month and week we see increase over the
    prior.
        Since September, we have onboarded more than 4,000
    providers than we were here in September reporting. Just as of
    this month, we have made more than 3,000 appointments in EPS,
    which is more than any month prior.
        We will continue to work to not only roll out the
    additional 18 sites, but also maximize and optimize the
    integration of EPS at existing sites.
        Mr. Luttrell. Is this your sole responsibility in the VA?
    Are you the one in charge of this?
        Dr. Arfons. I am the executive sponsor. I have a team. That
    is their responsibility.
        Mr. Luttrell. If I am going to somebody, you are who I am
    going to be speaking with?
        Dr. Arfons. Absolutely.
        Mr. Luttrell. I look forward to--I do not even know what
    month it is now. Let us just say at the end of the year when
    these 36 sites go up and running and we are in a good place, I
    look forward to hearing where we have gone and where we intend
    to go.
        Thank you very much.
        Mr. Chairman, I yield back.
        Mr. Barrett. Thank you.
        I will recognize myself again for 5 minutes.
        Dr. Arfons, kind of piggybacking on that, why have not we
    already gone to every VA facility?
        Like, if we know this works, if it is seemingly fairly
    plug-and-play, I do not want to oversimplify, Mr. Faraji, how
    the system works, but it sounds like it is not overly
    complicated to get someone signed up.
        What is holding us back from just doing this everywhere
    tomorrow?
        Dr. Arfons. The redesign of the deployment efforts----
        Mr. Barrett. The what? Can you say that again?
        Dr. Arfons. The redesign, so our plan for deployment
    efforts in Fiscal Year 2025 that we started in September of
    this year really focused on fewer number of VISNs; we were able
    to be more regional and focus then on hopefully making it more
    attractive to larger providers in the community, provider
    networks, who then could serve more medical centers within a
    VISN or even potentially more VISNs given their geographic
    adjacencies.
        This focus on having 6 VISNs rolled out by the end of
    Fiscal Year 2025, and the sites rolled out there, has proven to
    be successful given the trends that we are seeing. Then this,
    then, I think will allow us to plan in the future for further
    deployment from here.
        Mr. Barrett. Okay. I got some of that. I guess I am
    confused on a little bit of it. A lot of areas where perhaps
    you might find a more correlation of need for Community Care
    are going to be areas that are probably going to have smaller,
    not larger, providers already embedded in those communities,
    given the more disparate rural nature that they have. If we can
    make some assumptions there, why are we focusing so much on
    bigger providers? That is going to attract a certain segment of
    the healthcare industry, but what about, like I said, the small
    provider in my community that I live in, or the one in the town
    adjacent to mine or the one, two counties over that I also
    represent that is particularly rural.
        Dr. Arfons. It is still a both/and, we are working with
    those individual, our smaller providers, through sites, but
    then looking more regionally to understand if we can then get
    some of those larger providers because we are covering more
    sites within a VISN.
        Mr. Barrett. So, if, though, if we know we want to get
    there, we want to get every VA site loaded into this, and we
    want to get everybody through, and I guess you could even
    foresee scenarios where people, probably not as common in
        Mr. Luttrell's district, but where I live, and maybe where
    you do, people spend a considerable amount of time out of
    State, like people in Michigan travel to Florida. A lot of
    veterans do that. What if they are in one VISN that has this
    service and the other one does not? It just--it could get into
    a weird scenario for people.
        To me, it does not seem--like we have the ability, through
    the work you do, through Mr. Faraji, through the work here on
    this committee, to just kind of speed this up and get this
    done. Part of me feels like there may have been an element--I
    do not want to call it sabotage because that is a pretty strong
    word--but an element of artificially slowing this down in the
    last administration from being rolled out. I want to make sure
    that we are not encountering that potential slow down or
    resistance currently. I tend to believe that that is not the
    case, but then I would like to see us accelerate some of the
    adoption of this.
        Dr. Arfons. From September, we have not slowed. We have
    sped up. Definitely. With the sites that we have with the 36
    sites, we have continued to learn and optimize our own
    deployment with every site.
        Mr. Barrett. Could not we roll it out and then add the
    providers over time instead of saying we want a bunch of
    providers before we roll it out? It seems like a chicken and
    the egg thing. Like we roll it out; we get it in place; and
    then, over time, we add and collectively build more providers
    that are participating as more veterans become aware of it, as
    more providers become aware of it, and the thing naturally
    takes more shape.
        Dr. Arfons. That is what we are doing. With initial
    deployment, what we have learned, going back to the two sides
    of the coin, that the timing of having VA staff readiness to
    work in the system and then having a provider network that then
    has expectations for us to use the system is key. Focusing on
    that timing for better integration to go live is very
    important. I think what we have learned as a lessons learned is
    misalignment, going out too soon with having a site go live
    without the provider network, or having too many providers
    waiting for us to go live on the VA side only hurts further
    acceptance.
        Mr. Barrett. I have only got 15 more seconds. I want to ask
    quickly. What is the training, like the amount of time it takes
    to learn this system? I saw an example of it. It looked pretty
    intuitive to me, but probably there is some training that goes
    into that.
        For Dr. Arfons, Mr. Faraji, maybe either one of you could
    explain, from the scheduler vantage point, what is that--what
    does that look like, and how long does it take because that to
    me does not seem like it would be a large barrier to getting
    this done?
        Dr. Arfons. From the VA side, we have an initial 30-minute
    training. That is all it takes to receive your keys to use EPS.
    We also, then, it is interactive training that will be about an
    hour so we can work virtually with teams, so----
        Mr. Barrett. Less than an afternoon still.
        Dr. Arfons. Yes. Yes.
        Mr. Barrett. Okay.
        Dr. Arfons. Yes. Then other opportunities to, after they
    are logged in and using the system, to improve their abilities.
        Mr. Barrett. Okay. Doctor Mr. Faraji, from the provider's
    standpoint, it is visible to them; they just see that an
    appointment got loaded into their system on the back end by
    somebody else, correct?
        Mr. Faraji. That is correct.
        Mr. Barrett. Okay. All right. Thank you. Ranking Member
    Budzinski.
        Ms. Budzinski. Thank you, Mr. Chairman. Mr. Hansen, I
    wanted to say thank you for being here. I really appreciated
    your testimony highlighting some of the unique challenges that
    it sounds like all of us face representing rural communities
    and access to rural healthcare. Obviously also highlighting, I
    think, some of the concerns around potential cuts to Medicare,
    Medicaid, and other community services.
        I just was wondering if you could give the VA and maybe us
    as Members of Congress advice on just how we can help
    streamline implementation of programs like EPS, especially when
    we know that, oftentimes, Community Care providers can be
    somewhat limited in their resources? Any advice you might have
    for us.
        Mr. Hansen. Yes. I really appreciate the question,
    Congresswoman. As we have been going back and forth with
    questioning, Chairman Barrett actually brought up a really good
    point about Cerner--Oracle, Cerner, and Epic, and whether you
    are talking a tertiary center or you are talking a critical
    access hospital, the services that WellHive are providing are
    included with the appropriation and the work they are doing.
    However, there still are interface fees that can be challenging
    for the smallest to small providers, including some of our
    critical access hospitals.
        Potentially partnering or working with some of our other
    vendors so that, when they do have an update that is rolling
    out, so that interface could be more in line or more friendly
    to connecting with WellHive would be significant or providing
    some sort of an appropriation to our critical access hospital
    partners so that they can--so that they do not have to, they
    are not burdened with, with some of that extra cost.
        Then some of it is just good old-fashioned awareness and
    getting out. We spend an awful lot of time--I live on the
    eastern side of the State. We will make this 7, 8-hour trek
    into our northwest panhandle often to work with teams, and some
    of it is just that, that level of elbow grease that needs to go
    in to making sure that programs that really matter get out to
    our communities.
        Ms. Budzinski. Okay. Okay. That is helpful.
        Mr. Hansen. I also wanted to--I really loved your idea on
    the quality initiatives, and that is something that we are
    starting to look at in Nebraska to make sure that we are doing
    that apples-to-apples, and we are working to align the VA
    ambulatory quality measures with some of those that are seen--
    that we are used to on the critical access hospital side. I am
    learning a lot, actually, through the questions that you are
    providing, which I appreciate.
        Ms. Budzinski. Thank you very much. Thank you. Can I go
    back to the VA and Dr. Arfons. Yes. In 2023, I wanted to
    highlight, committee staff was able to visit WellHive's pilot
    sites in Orlando and Columbia and saw two different pictures.
    Looking at data provided to this committee last fall, it seems
    that the success and use of this tool still varies from
    facility to facility. How do you account for that variation?
        Dr. Arfons. With any diffusion of innovation, you are going
    to see a different range of adopters. This is not a surprise.
    We see this with any initiative that we have.
        In terms of Columbia, they were, I think, a little bit
    quicker out of the gate. Orlando has been more slow and steady
    and continues to evolve and improve.
        As Mr. Faraji mentioned, they both answered in the
    affirmative the intent of our pilot questions and have been
    helpful.
        They also then have very different veteran populations,
    community network needs that they are working toward, and so it
    does not surprise us. We obviously work toward standardization
    as much as we can but then have to adapt to the unique facility
    needs with their unique veteran populations.
        Ms. Budzinski. Just following up--you are leading into my
    next question--one of the things, I think, was observed is that
    the success--or increased success--was really seen when VA
    leadership and its employees are adequately engaged in the
    efforts to recruit Community Care practitioners onto the tool.
        As the VA plans to roll out this tool across more VISNs,
    how do you hope to standardize? You mentioned standardization.
    How do you hope to standardize these approaches and support the
    recruitment of Community Care providers?
        Dr. Arfons. One lesson that has been important over the
    past several months, I think, is the importance of having
    medical center directors engaged. It is important because, not
    only are medical center directors leaders within VA, but they
    also are healthcare leaders within their communities. Many of
    them have trusted relationships already with community
    providers. When we approach them--to answer Congressman
    Luttrell's question, VA does feel it is our responsibility to
    enroll providers--it helps that they have a trusted voice
    encouraging them to explore the opportunities for EPS.
        Also, medical center directors are setting the culture and
    the strategy and the tone for their medical centers, and their
    staff very much look to them to set that direction. Moving
    forward, I think this will be, continues to be a key piece of
    the success of EPS moving forward.
        Ms. Budzinski. Thank you. I yield back.
        Mr. Barrett. Thank you.
        Mr. Luttrell.
        Mr. Luttrell. Mr. Faraji, how many VA facilities do you
    have on your list to incorporate your software with? You could
    say all of them, but I was curious if you have a number because
    we are putting those numbers together right now, and I think it
    is 1,380 VA facilities across the country.
        Mr. Faraji. Actual VA facilities?
        Mr. Luttrell. Yes, sir. We are in the VA----
        Mr. Faraji. I am sorry. I do not understand. Could you
    clarify?
        Mr. Luttrell. Well, I mean, you are implementing yourself
    in the VA hospitals, Community-Based Outpatient Clinics (CBOCs)
    and everything; correct? It is not just the main hospitals. It
    is all in the rural little CBOCs and satellite campuses?
        Mr. Faraji. From my awareness, it is specific to the actual
    VA medical centers.
        Mr. Luttrell. Just the big ones?
        Mr. Faraji. The Community Care, right, which encompasses
    all----
        Mr. Luttrell. That is just 172.
        Mr. Faraji. That is correct.
        Mr. Luttrell. Just 172. My question is, if I was to give
    you--how do you--I need to bring that back. Off the record. I
    misspoke. I do not know how to do that officially. Okay. If you
    had the opportunity to jump in front of--or jump inside of 172
    facilities and I said ``go,'' could you do that right now?
        Mr. Faraji. Thank you for your question. What we found, and
    Dr. Arfons touched on this, is that every site we are learning
    every time.
        Mr. Luttrell. I know. I got it. Every one of them is
    different.
        Mr. Faraji. No, but it is a lessons learned because those
    lessons learned compound, and we are able to take that to the
    next site, into the next site. What you are seeing is much more
    speed behind these rollouts because of everything that we have
    been able to do, and the preparation.
        For us, as far as the technology and making sure that we
    have everything, the answer is yes. There is other things that
    have to move behind the scenes, and that is what Dr. Arfons is
    alluding to with the different people and the training and the
    providers.
        Mr. Luttrell. What is the--give me a--can I get a left and
    right flank on, hey, like if I was to say, ``You are coming
    down into Houston into DeBakey, ready, go,'' how long would it
    take to implement your system inside the DeBakey Medical
    Center?
        Mr. Faraji. We would need to look at the site. We would
    have conversations. Let me back up a second. When we go to
    these sites, we are having conversations with the chiefs of
    Community Care and the staff to understand the data: What are
    the referrals? Who are the providers that they refer out to----
        Mr. Luttrell. This is specifically on scheduling alone,
    right?
        Mr. Faraji. That is right. Yes. We need this information
    because it is important because what we do is we then take that
    information and go back to see what we already have in network,
    and then who do we need to bring on board? Right. To then go
    reach out to medical centers and----
        Mr. Luttrell. Bring on board, you mean the Community Care
    providers?
        Mr. Faraji. That is right. Correct. The Community Care
    providers.
        Mr. Luttrell. Would not it be better if you found a
    facility that did not have that many Community Care providers
    and implemented your system because then the spiderweb is not
    that big, instead of going into a facility that has got
    thousands of them?
        Mr. Faraji. Again, it varies per site.
        Mr. Luttrell. Quit saying that. Okay. I got it. All right.
    It varies. I got it a hundred percent. Go ahead.
        Mr. Faraji. Once we--once we have that information at our
    fingertips, then we are then off to the races, then, at that
    point. The VA is doing their thing for training, getting the
    site up to speed, and we are bringing on providers daily.
        Some of them are large health systems. Some of them are the
    small mom and pops that we are bringing online, and those grids
    start digitally connecting.
        In between that, because we have an integration into the
    provider profile management system, which is the main system
    that provides the credentialing of all of the Community Care
    providers, we are able to see all 1.4 million providers inside
    of----
        Mr. Luttrell. You have to--Doctor, you said it takes, let
    us just say an afternoon to train whomever on the system, and
    then you have to train all the Community Care providers on the
    system as well?
        Mr. Faraji. No. No. No. There is no training on the
    Community Care providers. They are going to keep using the EHR
    that they have always been using.
        Mr. Luttrell. Okay. I really have no idea why we are not in
    every single facility right now. This is me looking back at you
    waiting for somebody to say something.
        Mr. Hansen. Congressman, I can maybe provide a little bit
    of insight on this. We have two academic medical centers in
    Nebraska, both are in the onboarding process. One of the
    facilities----
        Mr. Luttrell. What day did that start?
        Mr. Hansen. What day did that start? Started last October.
        Mr. Luttrell. To onboard this?
        Mr. Hansen. It is. With these academic medical centers, the
    complexity is that they have specialists, subspecialists. They
    have--they have layers of bureaucracy on their end as well, and
    it can even vary from medical center.
        We have one medical center that has taken the approach to
    go a full onboard. They are just bringing in--they are doing
    what you are wanting to do. They are applying the gas pedal,
    and they are going to move forward with it.
        Our other academic medical center feels they have some
    unique scheduling protocols in place, and so they are going to
    start with a smaller subset of specialties, like dermatology,
    ophthalmology, physical therapy, where there is high volume and
    less complexity to the schedule, and then scale it up.
        They are trying to use kind of your spiderweb, where they
    are starting with some of those high-volume, high-impact areas
    to relieve backlog in the VA, and then expand out from there.
        For critical access hospitals, it is maybe a--it is a
    slightly simpler process than what we are going to see
    tertiary, where you have got some of your primary care; you
    might have some colonoscopies; you might have some PT; and then
    you have some--maybe you have got a local PT or just medical
    clinic, and they do not have any of the prior authorizations,
    prerequisites to get into that specialty.
        It can vary, and it is somewhat dependent on the partner,
    the community partner that you are working with.
        Mr. Luttrell. Thank you.
        I apologize for going over, Mr. Chairman.
        Mr. Barrett. Thank you. I appreciate that.
        I am confused a little bit. Dr. Arfons said it takes, let
    us call it an afternoon, to train a person at the VA to
    integrate--or interface with this system. You are saying it
    will take more than 7 months to onboard. You can birth a human
    in 9 months. I do not know why it takes so long to do that, but
    it slows down the rollout for this if things are taking 9
    months to do it--or 8 months or 7 or however long we are up to
    from last October. That is hardly giving me confidence that we
    are going to be able to expedite this or roll it out in a way
    that will be a meaningful improvement soon.
        Mr. Hansen. Some of those--those were first conversations
    that were taking place. These are when our academic--like in
    the case of our academic medical centers, the first time that
    they are hearing about EPS was last October. Some of those
    challenges were we did not know which--if Nebraska or VISN 23,
    which encompasses Omaha, if that was going to be included in
    the initial rollout. We thought we were. Then we heard that
    there were going to be some budget drawbacks, and then going--
    --
        Mr. Barrett. Yes. That is some of the frustration I felt is
    that there were mixed signals sent about this that I think gave
    Community Care providers the belief that maybe this is not
    going to happen; why go through the process of figuring it out
    if it is not actually going to roll out or get used?
        I am hoping, through Dr. Arfons' testimony today, that is
    hopefully put to rest and that there is full confidence going
    forward that we are going to integrate these scheduling things
    in a really expedited fashion or as quickly as possible going
    forward to hopefully alleviate that.
        I had a few more follow-up questions just quickly, too, and
    I do not want my time to expire. Mr. Faraji, does your software
    have the capability of exchange referrals and authorizations
    with Community Care providers?
        Mr. Faraji. Thank you for that question. Currently, right
    now, VA sends these referral authorizations through fax or
    secure email. We have to--WellHive's platform needs to move to
    the next security level, which is high. We just completed our
    Federal Risk and Authorization Management Program (FedRAMP)
    high authorization. We submitted our security assessment to VA.
    They are reviewing it, and that should be completed by fall of
    this year.
        Once that is completed, we are going to take an integral
    part--key steps into going and working with the referrals, and
    so, at the point where the scheduled appointment is booked, we
    will also be including that referral package with the
    appointment.
        Mr. Barrett. Okay. The upgraded security, I assume that is
    an industry standard that is pretty clear.
        Mr. Faraji. That is correct. Like the--it is FedRAMP
    certification.
        Mr. Barrett. Okay.
        Mr. Faraji. Yes.
        Mr. Barrett. That is something that is pre-established. You
    are not reinventing the wheel doing that. You are just making
    sure that your protocols are appropriate.
        Mr. Faraji. Correct.
        Mr. Barrett. If that is the case, and maybe this is a
    question for Dr. Arfons--I do not even know if you have the
    answer to this--why does it take us through the fall if this is
    a standardized security measure to get that piece of it done?
        Dr. Arfons. I will just take that for the record back to
    IT.
        Mr. Barrett. Okay. Then would the--would, I guess for Mr.
    Hansen, assuming that you could--assuming your security
    protocol is going to pass, because I assume it is a ``if this,
    then that'' kind of thing, Mr. Hansen, would Community Care
    providers like those that you represent benefit from obviously
    upgrading these from a fax or a secured email that is basically
    a PDF of a fax to something that is more electronically
    delivered with the appointment?
        Mr. Hansen. They would. For a lot of our rural providers,
    it just comes down to human capital. Any time that you can
    streamline a process, that is going to help them out.
        Mr. Barrett. Sure. That was an easy one. Thank you. Dr.
    Arfons, does VA have any plans to utilize EPS software to send
    referrals and authorizations to Community Care providers,
    assuming we have the security that meets adequate protocols?
        Dr. Arfons. Yes. We are working with our Office of
    Information Technology (OIT) partners and looking at that
    capability.
        Mr. Barrett. Is that the same process that is used to
    determine the security nature, like where--I get the kink in
    the hose right now is getting the security authorization. Once
    that clears, is there another protocol that needs to be passed,
    or is that the last hurdle?
        Dr. Arfons. There will have to be software integration from
    there of our systems with WellHive.
        Mr. Barrett. Okay. How, assuming this security, like let us
    say we start moving that direction because we assume the
    security measures will be passed, are we going to start
    integrating then, or can we start building integration models
    now so that, when the security thing is done, we are already
    partway ready to go?
        Dr. Arfons. IT dictates that. We can take that back for the
    record.
        Mr. Barrett. Okay. I would appreciate a little bit of an
    understanding. I think we can walk and chew gum at the same
    time on that and maybe have a little bit of a jump start on
    that. Thank you. Very good.
        I will recognize Ranking Member Budzinski for your closing
    remarks.
        Ms. Budzinski. Okay. Great. I have actually just one quick
    question, and then I am going to move to closing. A question
    just for Mr. Faraji and Dr. Arfons, do you know what percentage
    of Community Care Network providers have shared their schedules
    with WellHive and the VA? Let us start with Mr. Faraji.
        Mr. Faraji. I do not have that number off the top of my
    head, but we could get that for you.
        Ms. Budzinski. Great. Okay. Thank you.
        I do want to say thank you to Chairman Barrett, again, and
    I really do appreciate the witnesses and their testimony today.
        Last week marked the first 100 days of the Trump
    administration, and I do worry that the Department that is now
    less prepared than ever to modernize its service offerings.
        As I had mentioned before, we have focused on all the
    pieces of the puzzle here, not just the technology. As members
    of this committee, we must use our role to ensure that veterans
    have top-of-the-line access wherever they decide to receive
    care.
        We continue this oversight role, and I hope we continue to
    hear of an adequately staffed and funded VA, clarity in the
    referral work flows, relieving these teams and veterans of
    burdensome and prolonged processes, an increase of data being
    returned by community providers, improving the continuity of
    veterans care, and that facilities, both VA and those in
    community, have the resources they need to implement the
    technology at hand.
        I look forward to performing this work with Chairman
    Barrett, our witnesses today, and, most importantly, hand-in-
    hand with our veterans.
        Thank you so much, and I yield back.
        Mr. Barrett. Thank you, Ranking Member Budzinski.
        Thank you to the members for your presence today. I
    appreciate that.
        To our folks here testifying as well, thank you for your
    participation in answering so many questions.
        I want to thank you all for appearing today to provide your
    expertise on the EPS program. What we heard today was clear,
    the technology to modernize VA scheduling exists, and it is a
    proven tool to fix one of the most frustrating barriers
    veterans face, getting timely access to care. I mentioned this
    even from a personal experience I had very recently.
        This system is simpler It is easier, and it gets veterans
    scheduled with their doctors faster and with fewer obstacles,
    and it is making a real difference for veterans of VA staff
    where it is available. Despite the success in the data, only a
    fraction of veterans benefit from it, and it appears that there
    is not going to be a substantial adoption of this for quite
    some time. Only a fraction of VA medical centers are using it.
        If VA is serious about improving access to care and
    fulfilling the MISSION Act, then it must make EPS a priority
    and expand it to the rest of the VA. I think that we can look
    at this as less of a competitive thing between VA and Community
    Care and more of a comprehensive and collaborative effort to
    provide care for veterans where they are that suits them best.
        Every day VA continues to rely on its outdated scheduling
    process, thousands of veterans are stuck navigating a maze of
    phones calls and missed opportunities, and thousands of
    veterans are forced to wait too long for the care they have
    already earned and received and been referred for. VA simply
    cannot continue with the status quo when the technology
    solution exists that can make a meaningful lasting impact on
    veterans' healthcare.
        Thank you again for your participation in today's hearing.
    I look forward to working with the Trump administration to make
    EPS a success for our veterans with each of the stakeholders
    that are here today as well.
        I ask unanimous consent that all members have 5 legislative
    days to revise and extend their remarks and include extraneous
    material.
        Without objection, so ordered.
        This hearing is adjourned.
        [Whereupon, at 4:25 p.m., the subcommittee was adjourned.]

    =======================================================================

                             A  P  P  E  N  D  I  X

    =======================================================================

                        Prepared Statements of Witnesses

                                  ----------

                       Prepared Statement of Lisa Arfons

        Good afternoon, Chairman Barrett, Ranking Member Budzinski, and
    distinguished Members of the Subcommittee, thank you for the
    opportunity to testify on VA's work to enhance Veterans' experiences
    through modern and efficient scheduling technologies. My testimony
    today will focus on the External Provider Scheduling (EPS) Program, its
    status, challenges, and future plans for expansion and improvement.

    Introduction

        Since the enactment of the VA Maintaining Internal Systems and
    Strengthening Integrated Outside Networks Act of 2018 (P.L. 15-182), VA
    has significantly expanded Veteran access to health care. The Veterans
    Community Care Program, launched on June 6, 2019, has been a
    cornerstone of this effort. As of March 2025, we have provided over
    39.6 million community care referrals to more than 5.4 million
    Veterans. To improve service delivery, VA is focusing on innovations
    that put Veterans first. EPS is an initiative aimed at improving the
    Veteran's experience and access to care through enhanced scheduling
    technology.
        Last year, Veterans faced unnecessary delays in accessing community
    care due to the Biden Administration's decision to pause the
    implementation plan of the EPS program. This slowdown limited Veterans'
    ability to quickly and easily schedule appointments with community
    providers. Recognizing the urgent need to put Veterans first, this
    Administration, under the leadership of Secretary Collins, reenforced
    the need of EPS implementation quickly. In just the first 100 days, we
    have expanded EPS from 16 sites last fall to 34 sites as of today,
    increasing access, and we are rapidly bringing more facilities and
    providers online. This renewed commitment reflects VA's belief that
    Veterans deserve a streamlined, reliable experience when accessing
    community care. EPS represents a critical step toward ensuring timely
    access to high-quality health care choices that Veterans deserve.
        In addition to expanding EPS in the community care setting, VA
    recognizes the critical need to provide Veterans with clear, complete,
    and comparable information about their care options, whether within VA
    or in the community. To support this goal, VA is exploring EPS
    capabilities for both VA direct care and Community Care scheduling.
    This furthers the Secretary's commitment to delivering on the health
    care choices and transparency promised to Veterans under the VA MISSION
    Act.

    Overview of EPS

        EPS allows VA staff to schedule Veterans directly into available
    community care provider appointment slots through a single user
    interface, thereby more seamlessly connecting Veterans to appointments
    with community care providers. This single user interface displays
    provider availability information in one place and reduces the back-
    and-forth communication that often contributes to delays in care. By
    providing detailed information about who, where, how, and when care is
    available, EPS plays a vital role in helping Veterans make timely and
    informed decisions about their health care. Early examples demonstrate
    key benefits of using EPS. Some of these benefits include the
    following:

          Enhanced Veteran Experience: EPS improves access to high-
    quality care, minimizing the challenges Veterans face when scheduling
    multiple appointments. It ensures that appointments are made
    efficiently, taking Veterans' preferences into account. VA Schedulers
    using the EPS system are booking appointments in less than 10 minutes,
    compared to up to an hour without EPS.

          Streamlined Coordination: Community Care providers and VA
    staff have real-time updates on rescheduled, canceled, or completed
    appointments thereby eliminating the need to call and verify status
    with the providers or Veteran.

          Strengthened Partnerships: The EPS system improves
    coordination between VA and Community Care providers.

    Implementation Status

        As of April 18, 2025, EPS has been successfully implemented in 34
    VA medical centers (VAMC) with 20 additional VAMCs scheduled to go-live
    by the end of Fiscal Year 2025. Since October 2024, EPS has onboarded
    over 3,300 provider services. This is more than 60 percent of total
    provider services since the pilot began in December 2021.
        Over 5,200 provider services are active in EPS across over 60
    specialties, including primary care, mental/behavioral health,
    dermatology, optometry, chiropractic care, dental, and orthopedics. EPS
    continues to onboard new provider services at a rate of over 100 per
    week, prioritizing based on initial site feedback and referral data.

    Training

        To realize the full capability of EPS, we have recognized the need
    for better change management and training. VA developed an online
    training process enabling VA staff to take the training, as needed. The
    EPS team provides office hours and immediate live support for users who
    require assistance.

    Enhancing Provider Collaboration

        Implementing EPS has not been without its challenges, particularly
    in onboarding Community Care providers. Many providers are
    understandably concerned about how new systems will integrate with
    their existing workflows and whether additional training or resources
    will be required. We have addressed these concerns through targeted
    solutions such as:

          Efficiency at no cost to providers: EPS eliminates the
    need for phone calls and waiting for authorization numbers.

          Control and compatibility: Providers retain control over
    their scheduling system visibility to VA, ensuring no electronic health
    record information is shared except for appointment availability. This
    integration is designed to be hassle-free, requiring no additional
    staff training.

          Immediate authorization: Referral authorization numbers
    are provided at the time of appointment scheduling, simplifying
    administrative tasks and reducing the workload for provider staff.

        These features save providers significant time and allow them to
    maintain their existing systems without incurring any upfront or
    ongoing fees, making it both an attractive and practical solution. This
    approach not only benefits the providers but also puts Veterans first
    by reducing wait times and eliminating barriers to accessing the health
    care choices they have earned.

    Conclusion

        In conclusion, the EPS Program is no longer an experiment - it is a
    proven tool that is fundamentally transforming the way Veterans access
    care. Thanks to the renewed focus and leadership of the Trump
    Administration, EPS is now reaching more Veterans, at more sites,
    faster than ever before. We are committed to building on this momentum,
    expanding EPS nationally, and continuing to refine the system based on
    real-world feedback from Veterans, VA staff, and community providers.
        By removing barriers, minimizing delays, and putting Veterans at
    the center of the scheduling process, EPS helps deliver the timely,
    high-quality care Veterans deserve. We look forward to working with the
    Subcommittee to ensure continued improvements in the scheduling process
    and overall care for Veterans. Thank you for the opportunity to testify
    today. We are prepared to answer any questions you may have.

                       Prepared Statement of Chris Faraji
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                        Prepared Statement of Jed Hansen
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                                     [all]