The planned reorganization of the Veterans Affairs health system should result in improvements to VA medical facilities, increased oversight of hospitals and clinics and better access to care at the VA and with civilian providers in the department’s community networks, VA officials said during appearances before Congress this month.
In what will be the largest reorganization of the Veterans Health Administration since the 1990s, the VA plans to restructure VHA’s administration, realign staff and resources and invest in medical facilities.
At the same time, the VA will award new contracts for community care — its program that covers medical care for eligible veterans at civilian facilities — using a new structure the VA hopes will give the department better flexibility to choose and change contracted provider networks.
According to VA Secretary Doug Collins, the restructuring will “eliminate the glut of VA administrative overhead” and put more resources directly into VA facilities and community care.
Collins said in his first year of office, he has toured VA medical facilities and found significant differences in delivery of health care.
“We didn’t act like the largest healthcare provider in the world in many ways because we were trapped internally into our own policies, procedures, things that have been added on — none which added up to taking care of veterans but ended up taking care of the VA itself,” Collins told members of the Senate Veterans Affairs Committee on Wednesday.
Under the reorganization, known as the Restructure for Impact and Sustainability Effort, or RISE initiative, the VA will decrease the number of Veterans Integrated Service Networks, or VISNs, which provide oversight, administrative, budgetary services and support to VA medical centers, from 18 to 5, with the VISNs focused namely on oversight and governance.
The reforms will create health service areas, or HSAs, within the VISNs to focus on medical centers and the communities where veterans get their health services.
And they will create a medical operations center that will ensure that policies are implemented and followed throughout the system.
Regarding the community care program, the VA issued a call for contract proposals earlier this month to provide medical services, agreements worth nearly $1 trillion over the next 10 years.
The Community Care Network Next Generation contract, with its indefinite delivery/indefinite quantity structure, is meant to give the department more flexibility in overseeing the program, currently managed by two health contractors, Optum and TriWest Healthcare Alliance.
According to VA Chief Financial Officer Richard Topping, the new contracts will ensure that network providers will “compete and improve continually” to serve veterans.
“The government will have the ability to bring on multiple vendors and multiple contractors,” Topping said during a hearing before the House Veterans Affairs Committee Jan. 22. “Those contractors can then compete across the life of the contract for different task orders. That allows VA to change program design to learn from mistakes, to increase our capabilities and capacities to innovate and evolve the program over time.”
Veterans advocates and congressional Democrats have raised concerns that any reductions in personnel related to restructuring or expanded contracts for community care will erode the VA’s medical system and lead to privatization of VA health care.
“While veterans are going to go unserved and uncared for in his actions, we see exactly who Secretary Collins really serves, driving the VA towards privatization,” said Rep. Delia Ramirez, D-Ill., during the House hearing. “We know it only serves corporate interests, and it puts profits over veterans.”
But VA officials have said that the restructuring will streamline the administration and provide better services to veterans. Topping noted that while the community care contracts are worth up to $1 trillion over 10 years, the VA plans to spend $2 trillion for care in its own facilities during the same time frame.
“We’re opening new facilities. We’ve invested $800 million last year alone. We are investing in our direct care capabilities. And so, for veterans who either need to go to VA for direct care because it’s a unique capability that VA has, or who choose to go, they have that ability, and they have that choice,” Topping said.
The VA has lost 30,000 personnel in the past year as a result of resignations, retirements and attrition, as well as plans for an additional reduction of 24,000 jobs, which officials say were mainly positions created during the COVID-19 pandemic that are no longer required and have been vacant for at least a year.
Collins said the reorganization will allow the department to shift staff where they are needed and trim excess at underutilized locations. He added that the effort is moving forward with VA leadership taking into account input from staff, Congress and others.
“This is not an effort to diminish direct care for veterans. This is a reorganization that will eliminate the glut of VA administrative overhead and push more resources directly into the field,” Collins said.
The VA announced Wednesday it will spend $4.8 billion this year to make repairs and modernize numerous health care facilities, including upgrades to elevators, electrical and climate control systems and improvements to help accommodate the rollout of the department’s electronic health record system.
Republican and Democrat lawmakers alike promised close scrutiny of the VA reforms over the coming months, with the Senate Veterans Affairs Committee planning another hearing on the modernization efforts and House members saying their hearing on Jan. 22 was “only the beginning” of oversight.
“It should go without saying that VA must get this right. When veterans call my committee, they want to know how they can access their earned health benefits at VA,” House Veterans Affairs Committee Rep. Mike Bost, R-Ill., said.
Proposals for the new community care contract are due to the government in March.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
