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A step in the right direction for Veteran healthcare

On Tuesday, May 28th, 2019, I attended a Town Hall at the Orlando VA Medical Center at Lake Nona.  Dr Gannon, Assistant Chief of Staff, presented an excellent presentation about the new Mission Act 2018 that will officially roll out June 6, 2019.  From my perspective, the meeting was a remarkable success.  I was impressed by the comprehensive impact the new act is going to have on the collaborative way the Veterans Medical Service intends to provide health care to Veterans going forward. 

If you are a Veteran registered to received benefits through the VA, my guess is you received a letter from your physician or the VA in the past few weeks talking about the Mission Act.  I received the same letter.  It was brief, but it did provide a good introduction.  It got my interest up.  I wanted to know more so I went to the Townhall.

Some key components of Mission Act

One of the key components of the Mission Act of 2018 that I heard about at the Town Hall is ACCESS. Community access will now be handled by TriWest Services, the new Third Party Administrator for the VA. TriWest will have a Veteran call center with world-wide coverage open 18-hours per day. It is what I would call “Choice on Steroids.” This call center will have hundreds of dedicated representatives who will be dedicated to providing service to Veterans. I was assured that TriWest has a great reputation handling Veteran Services in states they are already handling. I am excited.

The purpose of community services is not to lose Veteran patients. The VA wants Veterans to receive their healthcare at the closest Veteran Hospital or CBOC. Community care is offered for those who live too far away or if the VA cannot provide the care due to a service level agreement or the service needed isn’t available. In those cases, they will gladly coordinate with the community.  The VA has developed a guideline (not a rule) that says a Veteran may access community providers IF the provider is in the new TriWest network when:

  • Drive time from Veteran home is 30 minutes or appointment for PCP/MH is > 20 days
  • Drive time from Veteran home is 60 minutes or appointment for Specialist is > 20 days

The purpose of the Mission Act is not to privatize Veterans Hospitals, which was my initial fear.  I rely on the system and appreciate the value of the services that are provided by the Veterans Administration Medical Centers.  I do not see a way privatization could replicate many of the most valuable services that veterans receive from Veterans Medical Centers.  Some of the value received by many veterans is not only gained by going into a physician’s office.  A later conversation.

There are many ancillary services offered within the Mission Act. One that stood out that I was very impressed with is the Urgent Care Benefit. Veterans will be able to go to an Urgent Care Clinic in their local community for non-emergent symptoms rather than go to a hospital or travel to the VAMC ER.  For instance, if you sprain your ankle hunting or cut your finger to the bone in the kitchen, you can go to the urgent care.  Should the flu have you down, a visit to the Urgent Care could be your ticket.

According to the VA, eligible Veterans will be able to receive urgent care from an urgent care provider that is part of VA’s contracted network of community providers without prior authorization from VA. VA can pay for an urgent care claim only if:

  • The Veteran is eligible for the benefit;
  • The urgent care provider is part of the VA’s contracted network of community providers; and
  • The services are not excluded under the benefit (excluded services include preventive services and dental services).

This benefit will be available when final Federal regulations are published and effective, on June 6, 2019.  Co-Pays do apply.  If an eligible Veteran goes to an out-of-network urgent care provider, they may be required to pay the full cost of care.  (READ Fact Sheet Carefully, particularly about pharmacy)

You may have already tried Telecare with one of your physicians.  I have used the service to participate in both individual PCP and group sessions such as MOVE.  I highly recommend it to access services without leaving your home.  It works when you do not have to physically be in the same room with the physician or other service providers.  “The value VA derives from telehealth is not in implementing telehealth technologies alone, but how VA uses health informatics, disease management and telehealth technologies to target care/case management thereby facilitating access to care and improving the health of veterans.” Telecare is a big part of the Mission Act.

Of course, the VAMC’s will refer out to the community all medical services that they do not offer in their medical center. I was taking meticulous notes as the presentation went on, so when I heard the Orlando VA referred out Neurosurgery and Open-Heart Surgery, I was not too surprised.  I was not even surprised about the fact that they referred out Maternity Care, which seems like a brilliant idea. 

What had me look up and do a double take was IVG.  I did not know that the VA covered invitro care for Veterans, both women, and men. “Veterans who receive this benefit are those with a service-connected disability that results in the inability of the veteran to procreate without the use of fertility treatment,” the rule says.  Organizations such as the Wounded Warriors Project pushed for and supported the implementation of this legislation.

An additional win is the expansion of Care Giver Services for pre-911 veterans who are eligible. It will cover Veterans who have fallen through the cracks in the past.  The VA offers a vast array of services and resources for Veterans and caregivers alike.  The thing that I like the best about the VA Care Giver Services that I did not know before is the VA offers what I think of as “patient-centric services.’  If a Veteran is determined to stay at home there are an extraordinary amount of services available to make it happen. Of course, the Veteran must have the ability and have the family or social network to support the plan. There is no other private insurance in the United States that would enable this opportunity. 

Why stick with VA Care vs Community Care

According to a study published by NPR in 2018, “Over the years, studies have shown that VA healthcare is as good as or better than private sector care. In this new study, researchers wanted to look at how a given VA hospital compared to private hospitals nearby. They looked at publicly-available data in 121 different areas across the country and compared things like risk-adjusted mortality rates and safety indicators. With a few exceptions, VA hospitals compared favorably.” (Biello, 12/13) This should be good news for Veterans who use the VA Medical Services and those who are thinking about whether they should. I am one Veteran who can say with confidence that I found better care at the VA than I did in the community.

Mission act is real deal

I worked as an executive and internal business consultant for health insurance and hospitals for 17 years, I can attest to the tremendous amount of work being put into implementing the huge Mission Act. It really is phenomenal.  After attending the Town Hall, I believe the MISSION ACT is “THE REAL DEAL.”  I have given you a basic highlight of the Mission Act. 

Please take time to carefully read the Mission act and the supplemental fact sheets, If you have questions, you can call your local Veterans Administration or Veterans Hospital. Or, please let me know by replying to this post. I will go to the experts to get answers, then respond through additional posts.