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Transforming the Future of VA Community Care

American Legion BriefingFebruary 22, 2016

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VA Community Care Today

• Community Care today is complicated and consists of multiple programs that don’t work well for Veterans, community providers and VA staff

• Because of this problem, VA proposed a plan to Congress to consolidate Community Care

VA Community Care “Individual Arrangements”

PC3

Veterans Choice Program

Project ARCH

Emergency Care

Dialysis Contracts

Academic Affiliations

Federal Partnerships

Other Authorities(e.g., Dependent Programs)

Multiple, disjointed approaches

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Simplify and Consolidate Community Care Programs

The vision is to build a program that is easy to understand, simple to administer, and meets the needs of Veterans, community providers and VA staff

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Stakeholder Feedback

VA Community Care Plan

VA Staff and CliniciansHealth Care LeadersVeterans and

Veteran Service Organizations

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Veterans We Serve (Eligibility)

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Provide timely, accurate, and easy-to-understand eligibility information to Veterans, community providers, and VA staff

VA Medical Centers

What we want to hear from Veterans: “With the New VCP I understand when and where I am eligible for care.”

Emergency Treatment

Veterans

Community Care Provider

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Access to Community Care (Referrals & Authorizations)

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Deliver timely access to care through appointment scheduling and health information exchange

What we want to hear from Veterans: “I was easily and quickly referred to a community provider for my care.”

Veteran requests care

Veteran receives care from Community

Provider

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Care Coordination

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Deliver personalized Veteran-centric care coordination supported by an industry standard health information exchange

What we want to hear from Veterans: “I knew what to expect and I had everything I needed from my doctor.”

Community Providers

VAProviders

Veterans

Clinical Information

Clinical Information

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Community Care Network

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Implement a high performing network and management systems that provide access to seamless, high quality care options inside and outside the VA, to better meet the needs and preferences of the Veterans we serve

What we want to hear from Veterans: “I now have many options when seeking community care and I feel confident that there will always be a provider when and where I need one.”

Utilize VA’s network of VA and Non-VA

providersProvide access to high-quality care

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Provider Payment (Claims)

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Support accurate and timely payment of community providers

Provider Claim

Auto Processing

Check

What we want to hear from Veterans: “I am billed accurately within a reasonable time of my visit. I know my financial responsibility and understand how to pay my bills.”

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Congressional Partnership

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The proposed changes will improve the Veteran and community provider experience for Community Care. But VA cannot move to the future state of Community Care without Congressional action.

Proposed Legislative Changes

Immediate Improvements to the Veterans Choice Program

Process and Organizational Structure Improvements

Improving VA’s Partnerships with Community Providers to Increase Access to Care (Provider Agreements)

Improving Access to Community Care through Choice Fund Flexibility

Increasing Accuracy of Funding by Recording Community Care Obligations at Payment

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Improving Veterans Access to Community Care by Establishing the New VCP

Increasing Access and Transparency by Requesting Budget Authority for a Community Care Account

Streamlining Community Care Funding

Improving Veterans Experience by Consolidating Existing Programs

Improving Veterans Access to Emergency Treatment and Urgent Care

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Improving Care Coordination for Veterans through Exchange of Certain Medical Records

Aligning with Best Practices on Collection of Health Insurance Information

Formalizing VA’s Prompt Payment Standard to Promote Timely Payments to Providers

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Establishing a Single Program for Community Care

Immediate Improvements to the Veterans Choice Program

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What Can American Legion Do to Help?

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Contact Congress

Provide support for the plan

Educate Veterans on the program

Support outreach

Provide actionable feedback

Understand things will take time

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Closing Remarks

Thank you for your dedicated support. We look forward to continued collaboration in the future.

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