A blue ribbon panel studying the future of Veterans Affairs health care is poised to recommend an overhaul to the system that would create a structure similar to the Pentagon's Tricare program, where veterans could choose to use either the VA for their care or see a network provider.

The goal, according to Commission on Care members, would be a more efficient version of the VA's current system, in which the department provides direct care to most veterans, and those who live more than 40 miles from a VA facility or who cannot get an appointment in a month offered private care.

Under the draft of the commission's final report, all veterans enrolled in VA care would choose a primary care provider at the VA or from a civilian network.

The plan would do away with the 30-day and 40-mile restrictions of the Veterans Choice program and create networks of physicians to care for former troops who prefer to see non-VA doctors.

The Commission on Care was created by Congress in 2014 under the legislation that established the Veterans Choice program. It is tasked with reviewing the VA health system and making recommendations on its future.

The panel's final report is due by the end of June but on Tuesday, commissioners met in Washington, D.C. to revise a rough draft of the final.

That draft calls for creating a new structure, the VHA Care System, responsible for overseeing VHA facilities as well as preferred provider networks managed by contractors. An appointed board of directors would provide oversight to the entire Veterans Health Administration.

The draft calls for phasing in the new system, starting in areas where it is most needed. It also calls for giving VA the authority to close underperforming VA hospitals and clinics.

"Under this proposal, [VHA] becomes a care system, a more integrated model where every component of it is designed to deliver the best care to veterans," Ccommission chairwoman Nancy Schlichting said.

The report also calls for giving some veterans who received other than honorable discharges access to VA health services. Under the draft, troops who have "substantial honorable service" before they got bad paper discharges would be considered for VA health care eligibility.

The proposal also considers allowing VA to establish pilot programs that would provide veterans and spouses the option to purchase health care at VA.

The estimated costs of these reform proposals were not available on Tuesday, but commissioners tossed out figures ranging from $100 billion to $1 trillion over 20 years.

Schlichting said many factors contribute to cost estimates, including demand, cost savings from closures and realignments and improving information technology systems.

But, she concurred, the reforms could be pricey.

"I think we all agree if we increase choice, we increase costs," Schlichting said. "Given the level of reform we are recommending, [VA] is going to need resources."

The department last year began a reform process known as MyVA, which aims to fix issues ranging from health care quality and access problems to information technology problems and the benefits appeals backlog.

The 14-member commission has met 12 times since last September. Its work has been contentious, with veterans organizations, the White House and the VA speaking against any proposals to expand private care for veterans at the expense of VA medical centers and clinics.

The commission will send its final report to Congress this month. Whether lawmakers will act on it remains to be seen, however. The Senate and House are considering legislative proposals to change the Veterans Choice program, ranging from expanding it to all enrolled veterans to requiring most veterans use private care.

Patricia Kime covers military and veterans health care and medicine for Military Times. She can be reached at pkime@militarytimes.com

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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