Next year, veterans could have broader access to mental health treatment and specialty care provided by private physicians under a new multibillion-dollar program.
The Veterans Affairs Department on Sept. 4 awarded contracts potentially worth up to $9.3 billion over five years to two companies, Health Net Federal Services and TriWest Healthcare Alliance, to run the VA Patient-Centered Community Care, or PC3.
The initiative aims to provide private inpatient and outpatient care for veterans when services are unavailable through VA.
Health Net manages the Defense Department’s Tricare North Region contract,
and TriWest managed the Tricare West Region from 1996 to April.
VA covers private-sector care for veterans under various programs, including local contracts and agreements between VA networks, individual medical centers and civilian physicians and facilities. But these disparate efforts often have been viewed as inconsistent, inadequate and expensive.
From 2007 to 2011, the number of veterans being treated in the private sector rose from about 615,000 to more than 970,000, according to American Legion officials.
During that time, VA’s costs for purchased care more than doubled to $4.5 billion from $2.2 billion.
The PC3 program is designed to make use of established health care networks and contract negotiations to provide cost-effective, efficient care when an appointment is unavailable at a local VA hospital or the facility is too far from a veteran’s home.
The program is modeled somewhat on a pilot, Project Hero, managed by Health Net, that offered medical and dental contracts in four rural areas.
VA said Project Hero saved the Veterans Health Administration $27 million in private care expenses since fiscal 2009.
Lawmakers have pressed VA to expand contact care to meet rising demands for mental health specialists and advanced care.
House Veterans’ Affairs Chairman Rep. Jeff Miller, R-Fla., has supported allowing veterans to access Tricare for mental health treatment. Maine Rep. Michael Michaud, the committee’s ranking Democrat, has strongly supported another VA pilot, Project Arch, which allowed veterans to get care at civilian medical centers in five rural areas nationwide.
“Our ultimate goal must be to expand availability of health care to all veterans in all rural areas,” Michaud said in a hearing last fall.
TriWest will manage three regions that include parts of 28 states, American Samoa, Guam and the Northern Mariana Islands.
TriWest President David McIntyre said the company will rely heavily on networks it established as Tricare West Region manager.
Health Net will manage networks in three regions that encompass parts or all of 37 states, Puerto Rico and the Virgin Islands.
The company already manages several VA contracts, including VA Community-based Outpatient Clinics and the VA Rural Mental Health program.
Jacob Gadd, deputy director for health care at the American Legion, said his organization supports VA’s efforts to expedite care for veterans but cautions against a rush to privatize care.
“VA must ensure that these providers are licensed, credentialed and have gone through some type of military culture familiarization,” Gadd said. “VA also has very good evidence-based treatments, real knowledge of conditions like post-traumatic stress disorder and traumatic brain injury, and VA must make sure that contractors are trained to provide the same quality of care.”
Health Net and TriWest will oversee veterans’ access to health care services and also will be responsible for referral management, patient appointments, medical documentation, tracking and claims.
VA expects the program will be up and running by next spring.