The Veterans Administration (VA) Health Care System is a health care maintenance organization (HMO) comparable to Kaiser Permanente or Cleveland Clinics or Mayo Clinic. The only practical difference is the stakeholders – tax payers rather than shareholders.
Strip away the VA’s historic mission, what is left is a corporation – a corporation in crisis.
Congress can solve the VA crisis following these three well-established steps to solving a corporate crisis.
First Assemble the Facts
Nothing clarifies thinking like the facts.
Congress is debating spending another $17 billion on 26 new facilities and thousands of doctors but the VA’s own numbers don’t support that decision.
68 percent of current clients of VA Healthcare are draftee citizen-soldiers from World War II, Korea and Vietnam. They came home, joined the civilian work force. Now they are suffering from the same geriatric ailments as the larger USA population – Type II diabetes, irritable bowel syndrome, hypertension, gout, lower back pain and worn out joints.
4.4 percent of current VA clients are veterans of Iraq and Afghanistan.
The total number of living veterans, including Iraq and Afghanistan, is declining about 5 percent a year. In 25 years VA projects the number of living US veterans will fall by close to 50 percent – from +20 million to + 10 million.
While a statistical majority of VA patients will be 55 or older throughout this period, the absolute number of veteran patients will decline annually requiring fewer doctors, fewer hospital beds, and fewer clinical visits.
During the last decade Congress has increased annual VA Budget by over 50% without any measurable improvement in veteran services.
VA health care computer systems are 30 years behind current-in-industry tools. On a day-to-day basis they do not work. Which veteran will be the last to die unnecessarily – a victim VistA scheduling system and when?
Isolate the Crisis Cause from Industry-wide Challenges
Knowing a client’s industry sector – for example managed health care – isn’t a substitute for active listening to the customer’s unique issues. Your solution must address the specific customer’s unique problems – within the context of the larger industry segment.
Before Congress acts, they must compare the VA to other efficient programs in the healthcare sector. Beyond specific combat related injury, does VA manage physician and physical capacity as well as average private HMO?
How do HMO peers use purchased software and other technology to drive efficiency?
Isolate the Crisis Cause from Government-wide Challenges
VA Health System began as the fulfillment of a moral guarantee made to American veterans since Revolutionary War to care for them when they could not care for themselves.
Fast forward a century. There is a strong social safety net – Medicare/Medicaid/Obamacare/Social Security Disability/Social Security Retirement/Food Stamps and Unemployment Insurance – available to all Americans.
The vast majority of our veterans are citizen soldiers. Why not consider integrating rather than duplicating these programs?
The majority of Veteran’s Affairs Healthcare clients are classified as low income. Many are eligible for Medicare but can’t afford either supplemental insurance coverage or 20 percent Medicare co-pays.
Military retirees participate in Tricare health insurance program which allows them to choose military or civilian health care providers. At age 65, Tricare becomes their Medicare Part B Supplemental Insurance carrier.
It’s Not a Solution Unless Its Specific, Responsive and Rapidly Achievable
In the private sector, a response to a crisis that threatens lives (or livelihoods) is measured in days or weeks not months and years. There are no vacations, no postponements, and no excuses.
Congress must pass the Miller/Sanders Bill to allow VA patients to get care in their local community before leaving on August recess. The bill can be structured as a pilot program supervised by Centers for Medicare and Medicaid Services (CMS) and the VA Inspector General.
Before hiring one new permanent doctor or negotiating for one new facility, Robert McDonald, incoming Secretary of Veterans Affairs, should invite Jeff Miller, House Veterans Affairs Chairman to a meeting with the CEOs of Kaiser, Sutter, Humana and Cleveland Clinic and just say HELP! l
Outsourcing the VA Healthcare System to any one – or a consortium – of these managed healthcare industry leaders would save veteran’s lives.
These organizations are Best-Practice. Each devotes significant resources to continuously improving efficiency – integrating people, process, and technology – as a key component of quality healthcare.
Does it Make Sense?
The patient population at the VA is steadily declining, the Veterans Administration operating model is outdated and insular, and the pace of change measured in decades. No private HMO could survive.
America’s private HMOs provide the highest standard of care in the world.
Isn’t that exactly what our veterans deserve – especially if it can be done with less bureaucracy and more patient satisfaction?
Photo Credit: Karen Bleier/AFP/Getty Images
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