Thursday, March 5, 2015
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

VA ‘outside care’ being fused under two networks

By
From page B10 | September 08, 2013 |

Veterans should see more timely access to mental health providers and other civilian medical specialists under a new Patient Centered Community Care initiative, aka PC3, which the Department of Veterans Affairs will phase in across the country during the next six months.

The initiative is centered on two five-year contracts worth a combined $9.3 billion and awarded Tuesday to separate health management companies tasked with consolidating and standardizing quality of providers to which veterans are referred when the VA can’t deliver in-house care in a timely way.

Health Net Federal Services LLC of Arlington, Va., and TriWest Healthcare Alliance Corp. of Phoenix will establish vast non-VA provider networks across all six VA medical regions, taking three apiece.

Health Net, the current Tricare support contractor for military beneficiaries in that system’s North Region, will be responsible for VA regions that span the New England states, the Northern Midwest states and all Eastern seaboard states down through Florida and Alabama. Health Net’s combined regional contracts are valued at $5 billion.

TriWest, which supported a provider network across the Tricare West Region until last April, landed VA contracts worth $4.4 billion to provide networks of mental health and specialty care in Western states, including Alaska, Hawaii, and all South Central states from Texas to Mississippi.

State borders don’t neatly define VA’s six regions, so Health Net will have responsibility for 38 states or parts of states as well as Puerto Rico. TriWest will provide non-VA provider networks for 28 states or parts of states as well as U.S. territories in the Pacific.

Today, when VA facilities lack capacity to provide care in house, patients are referred to private sector care under different purchased care mechanisms, including local contracts, sharing agreements and medical care authorizations. This is viewed as inefficient.

Future referrals will be consolidated under PC3 contracts so veterans see more coordinated and timely access to comprehensive networks of providers, all of them screened to meet uniform VA quality standards.

The contractors will provide inpatient and outpatient specialty care and mental health care services when local VA medical centers cannot, either because VA specialists aren’t available except after long waits for appointments or because veterans live far from the nearest VA facilities.

The new networks must screen providers to meet or exceed VA standards for credentialing, licensing and specialty care requirements. They must establish customer service and complaint procedures, and they must see patients within a specified period and be geographically convenient. Also, medical files generated by network specialists must be shared with VA promptly to ensure that all VA care is closely monitored and coordinated.

The Veterans Health Administration has conducted a pilot program of non-VA provider networks since 2009 called Project Hero. It involves only four of 56 Veteran Integrated Service Networks. Through 2012, it reportedly saved VHA $27 million by more effectively purchasing care from private sector specialists using prenegotiated rates.

The PC3 contracts will take six months to implement starting next month. Networks are to be operating across the country by April 2014.

Rep. Jeff Miller, R-Fla., has pushed for Tricare-like provider networks for VA patients since he became chairman of the House Veterans Affairs Committee in 2011, noting how far veterans in his own district have to travel to get VA care, which so many quality providers available locally. Some veteran service organizations have worried that a big shift to private sector care, over time, will dilute VA medical expertise and also impact continuity of care being delivered to veterans having multiple medical conditions.

VHA officials said they heard these concerns during meetings with stakeholders last year and they helped to shape final design of the contracts.

Joseph Violante, legislative director of Disabled American Veterans, said his organization wants VA to ensure all enrolled veterans get “quality medical care when they need it and in the appropriate setting.”

That will require VA closely managing any care provided including, as circumstances warrant, care delivered in the private sector, he said.

“DAV would be concerned if VA merely sent veterans out into the private sector without overseeing and managing the medical care to ensure veterans’ needs are being met,” said Violante.

David J. McIntyre, Jr., chief executive officer and president of TriWest, recalled in a phone interview how the military came to rely more heavily on Tricare support contractors during the Iraq and Afghanistan wars when so many providers in the direct care system had to be deployed.

The new, non-VA provider networks will give VA the same sort of flexibility to respond to gaps in timely care including mental health treatments for veterans with post-traumatic stress, McIntyre said.

“The first step for the VA is much like it was for DOD when they started doing Tricare. That is to buy care on an efficient and effective basis across a broad geographic space (and) from one entity that can provide what they need,” McIntyre said.

It will take a while for VA to figure out its demand for civilian health care and what volume of care should be bought through these networks for maximum quality and efficiency, he said.

“But this gives them the ability, like DOD has, to turn on the spigot pretty quickly if they need to,” McIntyre said.

“I hold to the same philosophy I have held for 18 years” operating provider networks for military beneficiaries, McIntyre said. “That is, the government should determine where government resources, taxpayer dollars, optimally are used and if there’s enough demand, the government should provide that service directly.”

But there will be times when it is cheaper and for patients more convenient for VA to buy care from the civilian networks, McIntyre said.

VA does buy care “in the marketplace right now. They just don’t do it on a consolidated basis. And that’s what this is going to give them,” he said.

“We’re there to supplement the direct care system, not to replace it.”

To comment, write Military Update, P.O. Box 231111, Centreville, VA, email [email protected] or tweet Tom Philpott @Military_Update.

LEAVE A COMMENT

Discussion | No comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

.

Solano News

 
Show resilience in the face of adversity

By Mayrene Bates | From Page: A2

 
Students sample industry choices during school career fair

By Glen Faison | From Page: A3 | Gallery

 
Real McCoy II Ferry set for maintenance

By Kevin W. Green | From Page: A3

 
Vacaville police slate annual awards ceremony

By Kevin W. Green | From Page: A3

Limited damage to apartment from carport fire

By Kevin W. Green | From Page: A3 | Gallery

 
Friday concert benefits Families Helping Families

By Amy Maginnis-Honey | From Page: A4

 
Vallejo police arrest 4 in connection with 3 killings

By Kevin W. Green | From Page: A4

 
National Red Cross Month celebrates heroes

By Susan Hiland | From Page: A4

 
Il Fiorello schedules citrus class

By Susan Hiland | From Page: A4, 1 Comment

Jury convicts ex-con who served as own lawyer

By Jess Sullivan | From Page: A4

 
Red Carpet Gala to benefit theater foundation

By Amy Maginnis-Honey | From Page: A4

Pet remembrance event set in Vallejo

By Amy Maginnis-Honey | From Page: A4

 
Suisun City police log: Tuesday, March 3, 2015

By Susan Hiland | From Page: A10

Fairfield police log: Tuesday, March 3, 2015

By Susan Hiland | From Page: A10

 
.

US / World

 
Justices sharply divided over health care law subsidies

By The Associated Press | From Page: A1

 
Children in Southern California breathing easier, study says

By The Associated Press | From Page: A4 | Gallery

Failures by 3 governments preceded homeless man’s death

By The Associated Press | From Page: A4, 1 Comment | Gallery

 
Second Los Angeles hospital reports ‘superbug’ infections

By The Associated Press | From Page: A4

 
California lawmaker pushes child care worker vaccinations

By The Associated Press | From Page: A4

 
Obama signs Homeland Security funding bill into law

By The Associated Press | From Page: A5, 1 Comment

House panel issues subpoena for Clinton’s personal emails

By The Associated Press | From Page: A5

 
 
A defiant Alabama regains ground against gay marriage

By The Associated Press | From Page: A5

How much sugar is in that? 7 foods with added sugar

By The Associated Press | From Page: A5 | Gallery

 
Microsoft co-founder says he found sunken Japan WWII warship

By The Associated Press | From Page: A6

 
Coal mine blast kills at least 24 in war-torn east Ukraine

By The Associated Press | From Page: A6 | Gallery

.

Living

Today in History: March 5, 2015

By The Associated Press | From Page: A2

 
Community Calendar: March 5, 2015

By Susan Hiland | From Page: A2

Horoscopes: March 5, 2015

By Holiday Mathis | From Page: A9

 
I can’t tell if I still want to be married, or just don’t want to be alone

By Kathy Mitchell and Marcy Sugar | From Page: A9

.

Entertainment

DiCaprio partners with Netflix for series of documentaries

By The Associated Press | From Page: B4

 
‘Guardians of the Galaxy’ tops MTV Movie Awards nominations

By The Associated Press | From Page: B4

Glen Campbell children fighting wife’s control of affairs

By The Associated Press | From Page: B4 | Gallery

 
.

Sports

 
Posey has 2-run double in Giants’ 9-2 loss to A’s

By The Associated Press | From Page: B1

Local report: Vanden softball slips by Rodriguez with late run

By Daily Republic staff | From Page: B1

 
Curry shoots Warriors to 102-93 victory over Bucks

By The Associated Press | From Page: B1

 
Former player Nate Jackson calls for NFL to allow marijuana

By The Associated Press | From Page: B2

Phoenix to install tire barriers before NASCAR visit

By The Associated Press | From Page: B2

 
Pirelli sticks with same tire choices for first 4 F1 races

By The Associated Press | From Page: B2

AP Source: Peyton Manning returning for 18th NFL season

By The Associated Press | From Page: B2

 
NCAA reports big jump in home runs with new flat-seam ball

By The Associated Press | From Page: B2

MLS, players agree in principle to 5-year deal

By The Associated Press | From Page: B2

 
Prosecutors can’t bring up Florida shooting in ex-NFLer case

By The Associated Press | From Page: B2

Vikings agree to trade Cassel to Bills

By The Associated Press | From Page: B2

 
Scott opens a season of change at Doral

By The Associated Press | From Page: B2

‘It WAS him': Defense admits Tsarnaev bombed Boston Marathon

By The Associated Press | From Page: B2

 
With Peterson’s status in question, Vikings pay a visit

By The Associated Press | From Page: B2

NFL stadium supporters in LA suburb file ballot paperwork

By The Associated Press | From Page: B2

 
Alex Johnson, AL batting champ in 1970, dies at age 72

By The Associated Press | From Page: B2

Goodell: NFL responsible for Super Bowl seating problems

By The Associated Press | From Page: B2

 
.

Business

.

Obituaries

Aaron D. Malave

By Nancy Green | From Page: A4, 1 Comment

 
Thelma A. Roche

By Nancy Green | From Page: A4

Cesar Luis Garcia-Regalado

By Susan Hiland | From Page: A4

 
Rodolfo Landabora Porquez

By Susan Hiland | From Page: A4, 1 Comment

.

Comics

Garfield

By Daily Republic Syndicated Content | From Page: A8

 
Rose is Rose

By Daily Republic Syndicated Content | From Page: A8

For Better or Worse

By Daily Republic Syndicated Content | From Page: A8

 
Zits

By Daily Republic Syndicated Content | From Page: A8

Blondie

By Daily Republic Syndicated Content | From Page: A8

 
Wizard of Id

By Daily Republic Syndicated Content | From Page: A8

Get Fuzzy

By Daily Republic Syndicated Content | From Page: A8

 
Sally Forth

By Daily Republic Syndicated Content | From Page: A8

Peanuts

By Daily Republic Syndicated Content | From Page: A8

 
Pickles

By Daily Republic Syndicated Content | From Page: A8

Baldo

By Daily Republic Syndicated Content | From Page: A8

 
Dilbert

By Daily Republic Syndicated Content | From Page: A8

Baby Blues

By Daily Republic Syndicated Content | From Page: A8

 
Beetle Bailey

By Daily Republic Syndicated Content | From Page: A8

Frank and Ernest

By Daily Republic Syndicated Content | From Page: A8

 
B.C.

By Daily Republic Syndicated Content | From Page: A8

Bridge

By Daily Republic Syndicated Content | From Page: A9

 
Word Sleuth

By Daily Republic Syndicated Content | From Page: A9

Sudoku

By Daily Republic Syndicated Content | From Page: A9

 
Cryptoquote

By Daily Republic Syndicated Content | From Page: A9

Crossword

By Daily Republic Syndicated Content | From Page: A9