We propose a new framework to meet the needs of the next generation of America’s veterans based on Rebuilding, Restructuring, Realigning and Reforming the VA health care system.

First, Rebuild and sustain VA’s capacity to provide timely, high quality health care.

  • VA must able to recruit, hire and maintain clinical staff in a more expedient manner.
  • VA must gain the commitment and funding to implement a long-term strategy to repair, maintain, expand and locate, as necessary, usable treatment space to maximize access points where and when veterans need to receive their care.
  • VA must build upon its temporary access initiatives implemented last year by permanently extending hours of operations around the country at CBOCs and other VA treatment facilities to increase access for veterans outside traditional working hours.
  • To provide the highest quality care, VA must sustain and strengthen clinical and biomedical research programs to prepare for veterans’ future health care needs.
  • To support the teaching and research programs and to help support future staffing recruitment efforts, VA must sustain its academic affiliations programs.

Second, Restructure all non-VA care programs into a single integrated extended care network.

  • VA must develop an integrated VA Extended Care Network which incorporates the best features of fee-basis, contract care, ARCH, PC3, “choice,” and other purchased care programs to assure that veterans have timely access to all necessary care when VA is unable to provide such care.
  • VA must develop an appropriate and effective decision mechanism that ensures that veterans are able to access VA’s Extended Care Network whenever medially-necessary, as well as a new, transparent, and dedicated review and appeal process capable of making rapid decisions to ensure veterans have timely access.’
  • VA and Congress must continue to analyze the effect of the temporary “choice” program to assess how it affects veterans health outcomes, commission new, independent research to review private sector access standards and recommend new VA access standards, and allow the Commission on Care to complete its study before making permanent legislative or regulatory changes to the VA health care system.
  • Congress must create a single, separate and guaranteed funding mechanism for the VA Extended Care Network in order to protect it and the VA health care system from funding shortfalls.

Third, Realign and expand VA health care services to meet the diverse needs of future generations of veterans:

  • VA must establish a nationwide system of “urgent care” services, beginning with VA expanding urgent care clinics with extended operating hours. The VA, like any large health care system should provide walk-in capability to meet the urgent care needs of enrolled veterans. Different than emergency care, these services would be delivered by dedicated doctors and nurses in existing VA facilities, or smaller urgent care clinics strategically situated in new locations around the country, such as in shopping malls.
  • VA must extend access to care further through enhanced web-based and tele-medicine options to reach even the most remote and rural veterans.
  • With veteran demographics continuing to change, VA must eliminate barriers and expand services to ensure that women veterans have equal access to high quality, gender-specific, holistic, preventative health care.
  • VA must also rebalance its long-term supports and services to provide greater access to home- and community-based services to meet current and future needs, including expanding support for caregivers of veterans from all generations.

Fourth, Reform VA’s management of the health care system by increasing efficiency, transparency and accountability in order to become a veteran-centric organization.

  • VA must begin by developing a new patient-driven scheduling system, including web and app-based programs that allow veterans to self-schedule (and re-schedule) health care appointments, with built-in reminders, rather than only relying on VA scheduling systems.
  • VA must reform and strengthen its Patient Advocate program to achieve greater independence from VA facility leadership and greater authority to perform their duties to ensure that veterans receive timely, high-quality medical care services.
  • VA must redesign its Performance and Accountability Report (PAR) to establish new metrics that are focused on veteran-centric outcomes with clear transparency and accountability mechanisms.
  • To increase transparency and accountability in budgeting, VA should implement a PPBE (planning, programming, budgeting and execution) financial control system, which is already working for the Departments of Defense and Homeland Security. Congress should approve pending legislation to bring this PPBE system to the VA.
  • Finally, VA must hold all of its employees – from the Secretary to receptionists – to the highest standards, while always balancing the need to make the VA an employer of choice among federal agencies and the private sector.