Congress Examines VA Choice Consolidation Plan’s Tiered Provider Network
May 12, 2016 12:47 PM
Congress continues toexamine the details of a proposal announced last year by the Department of Veterans Affairs (VA) to expand the use of private health care arrangements in order to improve VA's ability to keep up with the growing need for care among veterans (see previous NAHC Report article here). VA has since provided additional details regarding the new Choice program, which would allow veterans to choose from a tiered network to receive care in a VA facility or select a community provider that has been pre-approved by VA.
Under the new proposal, the network available to veterans would include three tiered groupings of providers. The first tier, the VA Core Network, would include all VA-run facilities, as well as certain facilities run by the Department of Defense, Indian Health Service, Tribal Health Programs, Federally Qualified Health Centers, and academic teaching affiliates. The additional community provider groups would be a Preferred tier of community providers that have demonstrated high-value care, as well as a Standard tier of providers that meet minimumstandards.
In March, the U.S. House of Representatives Veterans’ Affairs Subcommittee on Health held a hearing on the topic.“For the preferred designation, providers must meet quality and value metrics that are based on evidence-based care guidelines,” said hearing witness Baligh Yehia M.D., Assistant Deputy Under Secretary for Health for Community Care at the Veterans Health Administration.“VA plans to uniformly apply best practices to determine criteria for both tiers. VA will work to determine specific metric reporting and performance benchmarks using recognized institutions.”
While acknowledging that the VA has achieved progress in improving access to community providers, some members of the Committee questioned the VA’s proposed tiered network and expressed concern that under the proposal veterans would not be able to schedule their own appointments with community providers but instead need to rely on VA to do so.
“I understand the advantage of a tiered network, namely that it allows the VA to organize and differentiate between providers by type and quality,” said Rep. Dan Benishek (R-MI-1), chairman of the Subcommittee. “However, I'm concerned that the tiered network the VA has proposed will hold government and academic affiliate providers to a different, perhaps less stringent, standard than private sector providers will be held to. That is fundamentally unfair. It's also unnecessary.” Dr. Yehia responded that the VA will listen to the veteran’s preference and then contact the community provider in order to “link the two up.”
In responding to a question about the tiered network, Dr. Yehia said the value-based tier approach was necessary because the VA needs “as many providers to partner with us as possible. And so, I think at minimum we want to set the standards. You have to have a license. You have to be able to practice in that state.” He continued: “But by just setting one bar and not being able to reward those providers that perform really well, I don't think that goes far enough… If you meet the quality and satisfaction metrics of the VA, anyone can become a preferred provider.”
The hearing followed reports last year of veterans across the country facing delays and denials in services. The National Association for Home Care & Hospice (NAHC) received reports of VA denying authorizations and renewal authorizations of home health and other services due to funding shortages. NAHC contacted VA officials along with Congressional staff responsible for VA health care, reporting the problems facing veteran’s in need of home care. Overall, VA health care has been in the spotlight with repeated instances of care access problems and quality of care concerns. The home care issues are another example of those problems.