News & Commentary

Choice Program May Shake Up VHA


One of the responses to the mess surrounding the Veterans Health Administration (VHA) in the last several years was a law passed by Congress in 2014 that would give veterans a chance to receive care outside of VA facilities.

Joel Kupersmith, head of the VA’s office of research and development, noted in a recent Health Affairs blog post that the effect so far of the Veterans Access, Choice, and Accountability Act has been small, but “the nose is in the tent, and the care of veterans may change dramatically.”

The Veterans Choice Program that the act authorized “will potentially move VHA into a distinctive role of payer, insurer, and provider of care.”

The eventual impact on non-VA providers and insurance companies (veterans’ private insurance pays first dollar in the Choice program) could be dramatic; currently about 900,000 veterans are eligible for community care.

There are about 9 million vets enrolled in the VHA. Another 7 million could be enrolled but are not. Kupersmith rattled off a series of questions: “How many of the 7 million eligible veterans who do not now use VHA will be eligible for community care? How many will turn to it if they can thereby receive care from their own physician at minimal or no cost and more easily than going to a VA Medical Center? How many current VHA enrollees will increase their utilization? In addition, the cost of outsourcing specialty care—which is currently limited—is unknown and potentially very large.”

There are certainly things the VA can learn from health plans, Kupersmith argues.

“The community care plan depends heavily on industry-benchmarked goals that have been elusive for the VA—streamlined and integrated administrative process and IT, prompt authorization, billing and reimbursement, audits and appeals vehicles, care coordination, and medical records management.”