Opinion | VA can no longer afford ‘missed opportunity’ costs in the post-COVID-19 era

Connecting Vets
June 03, 2020 - 9:00 am

Photo courtesy of House Republicans


Editor's Note: This is an opinion piece. The thoughts expressed are those of the author. 

By Sherman Gillums Jr.


Some missed opportunities are easy to forgive. When the price of Bitcoin surged from $998 to its all-time high of $19,783.06 on December 17, 2017, most people had not even heard of cryptocurrency, much less knew to invest in it. Others are forever regrettable, such as Kodak’s decision to reject the concept of a “digital camera” devised by one of its own engineers in 1975. But some failures to seize the moment, such as the ones being exposed by the COVID-19 pandemic, serve as lessons to be heeded if, or according to some experts when, the next opportunity presents itself.

When veterans began seeing VA outpatient centers shut down and appointments canceled in the effort to contain the spread of COVID-19, it severely blunted the momentum of the VA MISSION Act, which had just been implemented 10 months earlier. New access standards for community care were the release valve for a VA healthcare system under pressure to provide more urgent, routine, and emergency care than its capacity had previously allowed. Had the novel coronavirus never become a factor, we may have never discovered the limits of the VA MISSION Act, as it had been implemented to that point. But at least one of those limits is now glaring.

This major vulnerability in the law was not, in itself, a result of poor foresight. In fact, quite the opposite. But foresight had its limits in this case, as it had empowered the agency to take unprecedented measures that may have unwittingly better prepared VA for the pandemic — had agency leaders availed themselves of it. Section 152, a provision in the VA MISSION Act that called for the development of innovative approaches to payment and service delivery, sat idle for quite a while as other parts of the law took effect. When it did eventually see movement, the only proposal to Congress offered under the section involved care coordination for dental benefits. While better coordinating dental care is certainly important, it has nothing to do with the more vexing problems VA has long faced, such as oversight of care quality within the often-labyrinthine federal healthcare systems in which veterans become lost, particularly those of advanced age who also happen to be the most vulnerable to COVID-19 today.

On balance, it’s not that anyone could have predicted a global pandemic would create a seismic disruption across VA health care. But it was not lost on VA stakeholders and agency leaders that further diversifying health options and streamlining care systems were absolutely critical. It is for these reasons, CareSource, a Dayton, Ohio-based managed care organization, partnered with AMVETS, the nation’s most inclusive congressionally chartered veterans service organization, to pilot an integrated managed care model for VA-Medicare, dual-eligible aging and disabled veterans — those who also happen to suffer the greatest risk of dying from COVID-19. This proposed “Veterans Advantage” pilot, which was presented to VA senior leadership in early 2019, while lauded as a solution to barriers to care access and coordination, costly inefficiencies across federal health programs, and even veteran suicide among those with no connection to VA, saw no further action. But such a plan now appears to be necessary to giving aging veterans more options and protections than they currently have in the wake of the pandemic.

Medicare-eligible veterans, who struggle with navigating the VA-funded hybridized healthcare framework, face breaks or duplication in care, and receive unexpected medical bills, would enjoy more options and control over their care, as well as the support of accredited veterans service organizations who could file clinical appeals on behalf of veterans, track and monitor care quality, and provide assistance with care access. Additionally, having accredited veteran-led organizations in an advisory oversight role to ensure veterans remain informed, supported, and protected throughout may have forestalled the sweeping misinformation many faced when some heard “strategic pause” while others heard “straight-out halt” as it related to uncertainty over whether authorization of VA-funded community care would continue

Without question, the VA MISSION Act has brought much-needed change to the VA healthcare system at a time when waitlists and delays in urgent care threatened to push the agency backward. But Section 152 was added to the statute for a reason — because short-term gains alone weren’t good enough. Any successes had to be accompanied by transformational innovations that do not just sustain success but also level up the agency in terms performance and outcomes. More importantly, these innovations had to be relevant and substantial enough to brace the system for a worst-case, “Fourth VA mission”-invoking scenario, such as the ones America faced during Hurricane Katrina, the September 11th attacks, and now in response to the novel coronavirus pandemic.

While much of this analysis is arguably based on well-informed hindsight and assumptions, what’s clear is innovation must remain imperative and all viable proposals, such as the Veterans Advantage pilot, taken for action, particularly in the absence of better ones. “Safe” innovations have typified the reflexive, oxymoronic manner in which the Department of Veterans Affairs has addressed problems, as the lone dental pilot wrought by Section 152 of the VA MISSION Act yet again proves. However, as we’re now seeing a rising death toll among aging and vulnerable veterans, the agency no longer enjoys the tranquilizing luxury of gradualism in the post-COVID-19 era.

Sherman Gillums Jr. is the chief strategy officer for AMVETS and a Marine veteran.