Few federal agencies are as beloved and scrutinized the U.S. Department of Veterans. Though the VA healthcare system provides quality care to more than 9 million veterans every year, pervasive performance issues such as long wait times and backlogs of claims needing review have garnered a significant amount of negative attention over the years. While many of these claims are exaggerated or outdated, the problems are substantial enough that Congress passed the 2018 MISSION Act, designed to give "...veterans greater access to health care in VA facilities and the community, expands benefits for caregivers, and improves the VA's ability to recruit and retain the best medical providers."

2018 MISSION Act - Community Care Program

The VA Maintaining Internal Systems and Strengthing Integrated Outside Networks (MISSION) Act was passed with widespread bipartisan support by Congress and signed into law on June 6th, 2018. A key piece of this legislation is the Community Care Program, designed to give certain eligible veterans the ability to receive care from private, community-based primary or specialty care providers. The program also requires that the VA enter into contracts with private insurance networks to ensure that these veterans are getting the care they need.

MISSION Act FY20 Budget

Before any discussion can happen on solutions, it is important to understand the budget being devoted to this program. Per the official 2020 budget request, the program is funded for $8.9 Billion in 2020. That is further broken down to:

• $5.5 Billion for the continued care of veterans grandfathered into the Veteran's Choice Program, which the Community Care Program replaced
• $2.9 Billion for expanded access for care, based on average drive time and wait time standards, and expanded transplant care
• $271 Million for Urgent Care
• $150 Million to expand Caregivers
• $36 Million for MISSION Act IT Implementation

Community Care Program Needs

Enabling Technologies

This program revolutionizes the current face of VA healthcare and is part of a significant modernization effort - one that requires substantial work. There are many needs to fill, starting with the most simple - enabling communication between VA systems and outside providers. Though the VA has always worked with private insurance companies and providers - they are required by law to bill veterans private insurance provider for any and all care and supplies/medicines they provide for non-service-connected conditions - the Community Care Program will exponentially increase the number of veterans eligible for care of service-connected conditions within the private sector. This increase requires a major upgrade to the systems and technologies the VA currently uses - it now needs to be able to communicate and connect with virtually any service provider in the U.S. or its territories. The VA needs to be able to link up with the oft-custom systems used by the various doctor's offices and medical groups around the U.S. to ensure that veteran's claims are processed quickly and that the providers are promptly paid for their care.

Payment Solutions

In point of fact, payment solutions are another area in which the VA needs a boost. Prior to the MISSION Act, relatively few veterans were authorized to seek treatment at non-VA facilities, which made arranging, authorizing, and distributing payments to community providers comparatively simple. With the criteria expansion under the Community Care Program, this ability will have to rapidly expand to ensure that care rendered is being promptly authorized and compensated. Payment solutions, particularly those that can automate aspects of the authorization process and those that expand the VA's ability to swiftly distribute payment, are necessary additions.

Decision Support Tool

To support the expanded claims criteria, the Veterans Health Administration released the Decision Support Tool (DST), a software designed to help VA staff and veterans quickly determine their eligibility for the Community Care Program. According to the VA Chief Information Officer Jim Gfrerer's testimony before the House of Representatives, the tool "...looks at the Master Veteran Index, it then establishes some level of eligibility, [and] it looks at the provider database and makes a determination around drive- and wait-time eligibility." Efforts to field this tool, however, were marred by highly critical reports by U.S. Digital Services. The report claimed that there were significant interoperability concerns integrating the DST into the six legacy systems within the VA it was required to interact with.

Continued development and enhancement of this tool will be a positive step forward for the VA. The prevalence of legacy systems within the VA, however, means that this is not a simple procedure, and it provides ample opportunity for industry providers with experience upgrading such systems. In an April 2019 meeting of the House Veterans Affairs Technology Modernization Subcommittee, it was noted that nearly 90% of the VA's IT spend was devoted to the operation and maintenance of these legacy systems. Such systems provide a significant challenge for the integration of any new software or technology. Efforts towards improving the interoperability of the DST into these systems, along with the modernization of the legacy systems wholesale, will go a long way towards improving the VA's ability to support veterans and quickly approve veteran use of the

Community Care Program.

Healthcare Service Providers

Perhaps the single biggest area the VA needs assistance in for the Community Care Program is in partnering with Healthcare Service Providers. One of the primary concerns noted by a 2016 report by the Commission for Care was that allowing veterans unrestricted choice of providers, absent substantial bureaucratic controls, would be incredibly expensive to taxpayers. Healthcare service providers can ameliorate much of this issue by partnering with the VA to provide consistent, high-quality, cost-effective care for veterans.

Through a concerted effort to work with the VA and learn their rules, regulations, and standards of care, healthcare service providers can position themselves to become a preferred choice for veterans under the Community Care Program. Widespread efforts nationwide by service providers could even create a de-facto network for veterans using VHA services - a key recommendation of the Commission for Care towards improving the now-replaced Veterans Choice Program.

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MISSION ACT Update by Elizabeth Mixson