Friday, July 17, 2015

FW: DAV Framework for Building a Better VA



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From: lbogle@dav.org
To: rserge1@outlook.com
Date: Thu, 16 Jul 2015 08:43:42 -0500
Subject: DAV Framework for Building a Better VA


As mentioned in our message last week, we propose a new framework to meet the needs of America's veterans based on rebuilding, restructuring, realigning and reforming the VA health care system.  We have received numerous comments from our first alert, some with very positive comments and experiences with VA that illustrate that the VA health care system is capable of improving the lives of ill and injured veterans.  However, we also received some comments that clearly showed areas that are in dire need of improvement.  DAV believes all veterans who seek care in the VA should have a positive health care experience, which can only happen with a robust VA health care system that is capable of providing timely, high quality health care when needed by eligible veterans, both inside VA and in the community. Our proposed reforms are intended to ensure VA can provide that kind of care.

VA needs to rebuild and sustain its internal capacity to provide timely, high-quality health care. This begins with a long-term strategy to recruit, hire and retain sufficient clinical staff at all facilities to meet the needs of all enrolled veterans. In addition, VA must secure the funding to implement a long-term strategy to repair, maintain, relocate and expand, as necessary, usable treatment space to maximize access points where veterans can receive care.  VA must build on temporary initiatives implemented last year by permanently extending hours of operation outside traditional working hours.  It also should strengthen its research programs to prepare for veterans' future health care needs.  In addition, academic affiliations support the teaching and research programs for future staffing and recruitment, and improve the quality of VA care.

VA needs to restructure and consolidate all non-VA care programs, into a single integrated Extended Care Network. A single program means VA remains accountable for the health care, whether delivered by VA or by a community provider. It would guarantee non-VA health care is coordinated. Consolidation would provide comprehensive access instead of simply giving veterans a payment card. Restructuring will require VA to complete the research and analysis related to the "choice" program.  Based on research and data, VA must develop an integrated Extended Care Network which incorporates the best features of fee-basis, contract care, ARCH, PC3, "choice," and other purchased care programs.  However, this will only work if Congress provides a single, separate and guaranteed funding mechanism.  To be veteran-centric, VA must establish a new clinically based access policy. In addition, VA must develop an appropriate and effective decision mechanism that ensures that veterans who need medical care are able to access the extended care network, and make rapid decisions to ensure they gain access quickly.

VA must realign and expand its health care services to meet the diverse needs of all generations of veterans, beginning with new urgent care and extended operating hours. Like any large health care system, VA should provide walk-in capability.  Urgent care services could be delivered in existing facilities, or smaller urgent care clinics situated in new locations.   It should give veterans the ability to self-schedule appointments through web and app-based programs and expand web-based and tele-medicine options to reach rural veterans. It should also eliminate barriers and expand services to ensure that women veterans gain equal access to high quality, gender-specific, holistic, and preventative care. VA must also rebalance long-term care services to provide greater access to home- and community-based services, including expanding support for caregivers of veterans from all generations.

VA must reform its management culture through increased transparency and accountability. It should implement a new, transparent multi-year budgeting process that tracks funding and ties it to health outcomes. This approach is already working for the Departments of Defense and Homeland Security and legislation is pending in Congress to bring the same program to VA.  Another improvement would be to establish new performance standards for VA leaders and employees that focus on veteran-centric outcomes. VA should modernize and streamline hiring and human resources policies to more effectively compete with the private sector and other federal agencies. VA must reform and strengthen its Patient Advocate program to achieve greater independence from VA facility leadership and greater authority to cut through barriers and perform their duties to ensure that veterans receive timely, high-quality medical care services. Finally, VA must hold all of its employees - from the Secretary to receptionists - to the highest standards, while balancing the need to make the VA an employer of choice among federal agencies and the private sector.

The framework outlined here offers a new pathway that could lead toward a more responsive and better managed system. DAV is convinced that the VA health care system must be the centerpiece of how our nation delivers health care to America's wounded, injured and ill veterans.

Next week, DAV will explain why some current proposals to reform VA health care might appear beneficial, but in reality could be devastating for meeting veterans' health care needs.


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