Veterans Affairs’ inability to manage its workforce suggests benefits of managed care

This week, the U.S. House of Representatives Committee on Veterans’ Affairs celebrated the one-year anniversary of the VA Accountability and Whistleblower Protection Act, with a hearing on implementation of the law since its enactment.

Unfortunately, like the law itself, the hearing was a missed opportunity in terms of meaningful VA reform.

One of the statements that acting VA Secretary Peter O’Rourke made throughout the hearing was that it’s impossible to fully gauge the success of the program after only one year; after all, the VA is a large bureaucracy and it is slow to change. 

O’Rourke is right about this. Yet, time and time again, Congress holds hearings berating the VA for not improving performance and not moving faster.

This begs the question, why aren’t members of Congress and the VA working together to provide more innovative solutions, rather than forcing unrealistic expectations on a struggling bureaucracy currently plagued by a revolving door of leadership.

{mosads}One such innovative idea would be to discuss downsizing the VA.  The idea is not popular in some circles, as noted in an analysis by the American Enterprise Institute, the attachment of some groups “to the existing VHA system appears to be caused by a desire to preserve a tangible, visible symbol of the importance of veterans rather than by careful consideration of what’s best for the health of veterans.”

This week’s hearing was meant to focus on issues related to whistleblower retaliation, but it was clear throughout the testimony and questioning that VA simply lacks the ability to successfully manage its workforce, which consists of more than 366,000 people.

Since VA has not been able to improve internal morale or performance, even with tools such as the Accountability and Whistleblower Protection Act in hand, it is time to move on from the unrealistic expectation that VA is capable of managing itself at its current mass. 

There are some things the VA does very well, and these things should be preserved.  For example, VA’s rehabilitation and prosthetic services are consistently highly rated.  Similarly, VA’s residency and fellowship programs play an important role in training those in the medical profession.

However, and as often dominates the news headlines, there are many other things that the VA does not do well.  Veterans often slip through the cracks when they receive insufficient mental health care or cannot access a standard medical appointment. And, as was highlighted at the HVAC hearing this week, VA does not manage its workforce and the related issues of whistleblower retaliation well, either.

In addition, what is often less discussed is that there are already numerous functions that the VA contracts out. Despite the polarization over the use of non-VA care when necessary, VA has been contracting with private providers since 1945. In addition, VA also outsources compensation and pension medical examinations, the construction and maintenance of its facilities, and numerous IT functions.

The example of the Department of Defense’s Tricare program provides an instructive example for the VA.  Prior to the mid-1990s, DoD managed all aspects of the Tricare program, meaning that military personnel and retirees had to see military physicians at military medical facilities.

In the late 1980s, due to escalating costs and increased demands on the program, the DoD began exploring a reform initiative known as the CHAMPUS Reform Initiative (CRI). The program introduced the concept of civilian-managed care to military medicine, where a contractor provided both access to a healthcare network that included both military and non-military providers, as well as administrative services. 

Due to the success of managed care in terms of providing adequate provider networks and controlling costs, DoD worked on expanding the program throughout the 1990s, and the program now known as Tricare For Life (TFL) was authorized by the 2001 National Defense Authorization Act. Although the Tricare program has had its hiccups through the years, despite some of these administrative complications, by downsizing military medicine, DoD surveys consistently indicate that its beneficiaries’ were satisfied overall with access and in turn, quality of care.

Similarly, the VA would be wise to undergo the type of analysis of its services that DoD in the 1980s and early 1990s. By focusing its efforts and resources on the tasks they do well and welcoming the assistance of outside organizations for the things they do not do as well, VA could provide better overall care for veterans.

Turning back to the one-year anniversary of the VA accountability and Whistleblower Protection Act, as noted by Chairman Phil Roe (R-Tenn.) during his opening remarks, “the only way to bring true accountability to VA is to create a culture where employees want to come to work and serve veterans.” 

It will be easier for employees both to serve veterans and want to work at the VA if VA leadership can better manage its workload, thus subjecting the agency to less fraud, waste and abuse, by partnering with outside organizations to achieve VA’s mission.

Rory E. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.). You can find her on Twitter: @RileyTopping.