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December 20, 2018

Veterans still face long wait times as costs for private care program soar, investigation finds

Daily Briefing

    Veterans Affairs (VA) four years ago launched the VA Choice Program (VCP) to expand veterans' access to private health care providers and cut down appointment wait times, but VA claims data show veterans continue to experience long wait times, according to a ProPublica/PolitiFact investigation published Tuesday.

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    About VCP

    VCP aimed to increase veterans' access to health care by providing them with federally subsidized care at non-VA facilities. Veterans were eligible to use the program if they had been waiting more than 30 days for a VA health care appointment, if they lived 40 miles or farther from a VA facility, or if they faced undue burdens accessing care at VA medical centers.

    However, the program faced funding issues, and veterans advocates had said the program's eligibility requirements were cumbersome and cited delays in reimbursements for care provided by private providers.

    Investigation finds veterans continued to face long wait times under VCP

    The ProPublica/PolitiFact investigation highlights the difficulties VA faced working with private contractors as the agency prepares to launch a new program, called the Veterans Community Care Program, in June 2019 that aims to further expand veterans' access to private care.

    According to ProPublica/PolitiFact, a total of 1.9 million veterans have received private care under VCP since 2014. During that time, analyses by VA's Office of Inspector General (OIG) and the Government Accountability Office have found that veterans' wait times through VCP were longer than legally permitted. In addition, the analyses found issues with how veterans were booked for care. For instance, one of the analyses found that a veteran living in Idaho was scheduled to see a physician in New York, and a veteran living in Florida was scheduled to see a specialist in California. In another instance, a veteran was supposed to see a urologist, but was booked an appointment with a neurologist.

    Despite those access to care problems, ProPublica/PolitiFact found that costs under VCP have soared, largely benefitting two private companies, Health Net and TriWest Healthcare Alliance, that were hired to administer the program. According to ProPublica/PolitiFact, those two companies since 2014 have received "nearly $2 billion for overhead, including profit." ProPublica/PolitiFact report, "That's about 24% of the companies' total program expenses—a rate that would exceed the federal cap that governs how much most insurance plans can spend on administration in the private sector."

    According to ProPublica/PolitiFact, VA's OIG found that department "was paying the contractors at least $295 every time it authorized private care for a veteran," with that fee sometimes reaching "as much as $318 per referral." But an analysis of VA data showed that, in some instances, that fee was more than enough to cover the bill for the services rendered, ProPublica/PolitiFact report. Audits by VA's OIG found that Health Net and TriWest Healthcare Alliance overcharged VA by $140 million from November 2014 to March 2017. The companies currently are under investigation for those overcharges, ProPublica/PolitiFact report.

    ProPublica/PolitiFact report that Health Net, which stopped working on VCP in September, did not respond to requests for comment.

    TriWest Healthcare Alliance, which currently is the only contractor working on VCP, said it has worked with VA to improve VCP and has made significant investments in the program. The company in a statement said, "We believe supporting VA in ensuring the delivery of quality care to our nation's veterans is a moral responsibility, even while others have avoided making these investments or have withdrawn from the market."

    According to ProPublica/PolitiFact, TriWest did not dispute their "estimated overhead rate, which used total costs, but suggested an alternate calculation, using an average cost, that yielded a rate of 13% to 15%." The company also defended its minimum $295 service fee, saying it provides "highly manual" services, such as coordinating medical records and scheduling appointments, that are not usually performed for other programs, such as the Department of Defense's Tricare program.

    According to ProPublica/PolitiFact, TriWest declined to provide a breakdown of how much of its fees are used for each service the company provides under VCP.

    Where does this leave the new program?

    According to ProPublica/PolitiFact, VA already has missed deadlines for awarding contracts for its new Community Care program set to take effect in 2019, meaning TriWest initially will be the program's only contractor. TriWest also will be required to take on a heavier patient referral load under the current program, as the contractor will take over referrals for regions previously run by Health Net and the Trump administration plans to increase the number of veterans eligible for private care.

    VA is expected to select contractors for the new program early in 2019, but ProPublica/PolitiFact report that those contracts include a one-year ramp-up period, meaning they are unlikely to ready for the June start date.


    The investigation brought to light several of the concerns critics have with the administration's plans to move the VA toward more privatized care, ProPublica/PolitiFact report.

    Sen. Jon Tester (D-Mont.), the ranking member on the Senate Veterans' Affairs Committee, said, "This is what happens when people try and privatize the VA." He added, "The VA has an obligation to taxpayers to spend its limited resources on caring for veterans, not paying excessive fees to a government contractor. When VA does need the help of a middleman, it needs to do a better job of holding contractors accountable for missing the mark."

    Rick Weidman, policy director at Vietnam Veterans of America, called the findings "unacceptable." He said, "There are people constantly banging on the VA, but this was the private sector that made a total muck of it."

    Curt Cashour, a VA spokesperson, declined to be interviewed on the matter, ProPublica/PolitiFact report (Arnsdorf/Greenberg, ProPublica/PolitiFact, 12/18; Herman, "Vitals," Axios, 12/19).

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