Scandal pushes officials to redesign the VA healthcare delivery system

Problems within the Department of Veterans Affairs (VA) keep coming even amid efforts to reform the system, with allegations this week that Texas VA facilities engaged in record falsification similar to complaints that kicked off the scandal nearly two years ago. The ongoing issues within the system demonstrate the need for a deeper re-evaluation of the VA's approach to care delivery, argues an opinion piece by VA Under Secretary of Health David Shulkin, M.D.

The continual problems with care delivery within the VA demonstrate fundamental weaknesses in how the department is set up compared to other healthcare systems, Shulkin writes for The New England Journal of Medicine. For example, the VA is almost unique in enrolling patients independent of whether they have geographical access to their facilities. This, he writes, is at odds with the system's mission of establishing lifelong relationships with its patients.

Shulkin and colleagues in the Commission on Care incorporated these insights and others in developing care delivery recommendations, which it will deliver to President Barack Obama later this year. Their recommendations call for developing a three-part provider network to address many of the VA's ongoing issues. The network's central hub would consist of VA facilities as well as similar government-run facilities and teaching hospitals that have existing relationships with the VA.

The second network would encompass private providers and delivery systems that meet VA standards, with an exacting, competitive selection process. The third would aim to ensure private-sector care access to veterans with geographical barriers to the other two networks.

The recommendations also encompass the need to apply best practices to VA care delivery as well as incorporating techniques such as "lean" management, which has helped safety-net providers significantly improve outcomes and reduce costs.

"By rethinking our systems, working with our current partners, and exploring new public-private partnerships, the VA is transitioning from a loose federation of regional systems to a highly integrated enterprise," Shulkin writes.

To learn more:
- read the opinion piece

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