VA Hospitals Step In as Federal Program Hits "Growing Pains"

Jul 3, 2017

Recently, VA Secretary David Shulkin told a Senate Committee that an important program designed to help veterans get care at private hospitals was running out of money sooner than expected. He was talking about the Veterans Choice program.

Meanwhile, here in New Hampshire, the program has slowly required more and more administrative help from employees at the Manchester VA. Assistant Director of the medical center, Kevin Forest, recently said as much to the State Veterans Advisory Committee.

“I think, as the medical center moves forward, and as Choice matures, we’re going to see the medical centers playing a more active role in appointing and directing that care.”

For more on what that means for the hospital and the veterans it serves, NHPR’s Peter Biello spoke with Forrest.

You said at the SVAC meeting that the hospital is going to play a more active role in getting Choice program care to veterans. So what is that role going to be?

I think as the Choice program matures, we’re going to see the hospital take a more active role in the appointing process. So, as the next generation of Choice contracts rolls out, we are already building a more robust care coordination cell, with appointing clerks and care managers to handle that increased level of appointing.

What will veterans who get care under the program now notice, if anything, about the hospitals role? Will it be more interaction with employees at the hospital and less interaction with folks at the other end of a 1-800 number?

Yes, I think as we see the care coordination cell build and we take more responsibility for that appointing, you’ll see a more coordinated, seamless care, where our providers may refer to the community and we’re responsible for booking that care. We’ll provide that care, we’ll make sure that veterans are informed of when they’ll receive that care, and it will just be overall better coordination.

The federal government hires a third-party contractor to do some of that appointing now. Health Net is who that company is now, though I think that could change. Is it fair to the Manchester VA have employees do some of this work, especially since Health Net is in theory supposed to be doing it already?

We already do a lot of that work. Choice isn’t the only program we use to provide care to veterans in the community. We coordinate care for veterans who receive care at other VAs, we coordinate care for veterans who receive care out in the local area hospitals, and we work closely with Health Net now to make sure veterans receive appointments through their provider network.

So we already do some of that, I think we’ll continue to do that and probably more in the future.

Is the Manchester VA slowing Choice spending right now for any reason?

We’re not slowing Choice spending. I think, you know, most New Hampshire veterans are Choice mileage eligible. And it’s up to those veterans, should they want to seek care in the community through Choice, that they opt in and are able to do so.

So I’d say the demand for Choice is driven by veterans and where they want to receive that care.

There are two ways that veterans can get care at provide hospitals through the Department of Veterans of Affairs. One is Veterans Choice, and the other is a separate pool of funds for a program called Care in the Community. Is the hospital making an effort to shift veterans away from Choice and to Care in the Community?

What we look, I guess as far as shift—We try to get veterans to the right level of care at the right time. And sometimes that does involve Care in the Community. Certainly for more urgent care, that’s where we would go.

Meaning, if a veteran has an emergency situation, that would come out of Care in the Community, in part because there’s no time to get authorizations for Choice.

That’s correct. The Choice program is not set up to provide emergency care.

Recent changes with the private company Health Net caused more than 500 returned requests for appointments with doctors a few months ago. Explain if you could what happened to those veterans their appointments. Did they eventually get their appointments?

They did. When we looked at a number of the returns that we had, we had a group of providers here at the hospital as well as some clinical experts at the VA New England Healthcare System go through every single one of those returns. They looked at them for clinical necessity, and coordinated that care and worked with each of those veterans to find out the best place for them to receive that care, and they’ve been coordinating that care since the time of receiving the returns. 

And why were they returned?

Returns happen for a number of reasons through Health Net. Primarily, they look at Health Net not being able to book an appointment in the contractual time frame, which is 10 days. So if Health Net is unable to book that care, it comes back to the facility, and then it’s our responsibility to reach out to those veterans and coordinate their care from there.

Overall, if you could give a grade to the Veterans Choice program, what grade would you give it?

I think I’d give it a C. I think, I made reference back at the SVAC, that this feels similar to the first generation of TRICARE when I was in the army. Certainly, starting huge programs like the Choice program or TRICARE, it takes time, so, similar to some of the growing pains we had back then, we see some of those growing pains now.

I think the good thing is that, over time and with lessons learned, the TRICARE program has become a very robust, well-respected program, and let’s hope that we follow suit with the VA.

If you had the ear of your Congresswoman or your Senator, what would you tell them about how they could improve the Veterans Choice program?

You know, the ways to improve the Veterans Choice program is to improve on the education level for those who use the system. It’s a complex system, and I think the more that we can simplify the system and probably have one type of care that we access in the community would be beneficial for all. It’s tough to navigate multiple avenues to coordinating care in the community.