The Veterans Affairs Department hopes to consolidate its programs that administer private health care to veterans with the goal of improving veterans' access to treatment and broadening their choices for health services.
VA sent a proposal to Congress on Friday on the New Veterans Choice Program, or New VCP, which would combine at least eight of the department's community health care programs, including VA Choice, into a single system designed to address gaps and shortcomings in care and administration.
The proposal would focus on improving five core areas in non-VA care: eligibility, access, health care networks, care coordination and provider payments.
Under New VCP, VA would establish a single set of eligibility criteria for private care and expand access to emergency treatment and urgent care.
It also would simplify VA's referral and authorization system and improve claims, billing and reimbursement processes.
And it would expand its health care network, with VA and other government health care networks serving as the core and enhanced by an improved external network of commercial and preferred providers.
VA estimates the cost of the redesign alone would be between $1.2 billion and $2.4 billion over the first three years.
VA spent roughly $7 billion per year on commercial health care services before implementation of the Choice program, and officials say Choice is likely to cost $6.5 billion per year if allowed to continue as is.
The proposed improvements to community care delivery likely "would require additional annual resources between $1.5 billion and $2.5 billion" the first year and increase thereafter, and VA expects that expanding access to emergency services and urgent care also will require an additional $2 billion a year.
The cost estimates in the proposal do not include the price tag for improved medical records management, which VA officials say will be necessary to support effective care coordination.
The proposal was required under the Surface Transportation and Veterans Health Care Improvement Act, which was signed into law in July.
VA Undersecretary for Health Dr. David Shulkin said Wednesday he is "excited to be a part of shaping VA's vision."
"Streamlining processes, finding greater efficiencies and enhancing the way VA partners with other federal agencies, academic affiliates and community providers will allow veterans to receive health benefits where and when they need them," Shulkin said.
VA officials said the proposal will not affect veterans' health benefits and the department is committed to improving the timeliness of health care for those waiting for appointments.
According to VA, the Veterans Health Administration made 2.47 million more patient appointments this year than in the previous 12 months and has reduced its appointment wait list by 27 percent.
"VA is making great progress but understands there is still more work to do," officials said.
To implement the plan, VA needs the OK from Congress, including the passage of at least 10 bills, including amendments to existing law and some legislative proposals already in the works.
House Veterans' Affairs Committee Chairman Rep. Jeff Miller, R-Fla., said Wednesday his committee will give the plan close scrutiny but added that the proposal has merits.
"VA has always had fee-for-services but it wasn't used in the way the veterans expected it to be used. What we are trying to do is not tear down VA brick-by-brick but supplement it," Miller said.
Senate Veterans' Affairs Committee Chairman Sen. Johnny Isakson, R-Ga., called non-VA care a "force multiplier" and said he looks forward to examining the plan.
"This summer, Congress paved the way for the VA to consolidate its non-VA care options into one seamless program to cut down the bureaucracy and streamline the process for veterans to receive care outside of the VA. I look forward to … continuing to work with the VA to help veterans receive quality health care in timely manner," Isakson said.