Vets care program meets with struggles and success

Last week this column covered the Veterans Health Administration’s new Choice Program, which enables veterans to obtain health care services in the civilian sector. Since then there has been a flurry of mixed comments and questions about the program.

Many veterans, including some who have been treated here at Manakai, have expressed relief and gratitude at the enhanced access to collaborative, multidisciplinary diagnostics and treatment. This includes not only conventional medicine and specialty care such as sleep studies, but also acupuncture, chiropractic and medical massage therapy. Others in the community have complained of continued delays in authorization for care under the new program. Many veterans have asked about whether they might be eligible and how to access Choice benefits. Much remains to be done and information must still be disseminated, but the Choice Program is beginning to help millions of veterans nationwide to obtain timely access to needed health care.

The Choice Program was authorized in 2014 as a $5 billion, temporary two-year program. However, the Department of Veterans Affairs is streamlining community care programs and now envisions a program like Choice continuing for quite some time, particularly in areas where access to health care is a major issue. That includes Hawaii.

At a national level the VA is planning to consolidate community care programs, only one of which is the Choice Program. This is being done with the awareness that the health care market is complex and dynamic.

At the same time, the VA is seeing a sharp increase in demand with evolving needs on the part of the veterans. The VA recognizes that it cannot excel in all services in every community.

The best care for veterans moving forward will involve partnerships with community providers. To get it right, the VA intends to establish a simplified program that is easy to understand and administer, one that will meet the needs of veterans and community providers.

The Choice Program was launched toward the end of last year because of excessively long wait times at Veterans Health Administration facilities and widespread cover-ups to meet performance goals.

Manipulation of records was brought to light by investigations including those conducted by the Veterans Affairs Office of the Inspector General, the House Veterans Affairs Committee, the Obama administration, the Office of Special Counsel and the Federal Bureau of Investigation.

To be eligible for Choice Program benefits, veterans must have been enrolled in the VA health care system before Aug. 1, 2014, or must be eligible to enroll as a recently discharged combat veteran. Additionally, each veteran must meet at least one of the following criteria:

1. Has waited more than a 30 days for an appointment.

2. Residence is more than a 40-mile driving distance from the closest VA medical facility.

3. Need to travel by plane or boat to the VA medical facility closest to residence.

4. Veteran faces an unusual or excessive burden in traveling to the closest facility.

5. Veteran resides in a state or a U.S. territory without a full-service VA medical facility that provides hospital care, emergency services and certain surgical care. (This criterion applies to veterans residing in Hawaii.)

Veterans in the Choice Program must still obtain authorization to receive health care from civilian providers. When veterans come to Manakai for care, for example, their visit to this facility must first be authorized. After the initial visit any additional diagnostics, treatment or referrals must also be pre-authorized. So far, with some exceptions, our staff has found the authorization process to be reasonable and timely.

The VA is actively seeking to expand its network of community providers. If a veteran wishes to see a provider who is not enrolled in the Choice Program, the program staff will reach out to see whether that provider wishes to enroll. If the preferred provider is not available under the program, then other providers near the veteran’s home will be recommended.

Hawaii veterans do not need a Choice Card to access the Choice Program.

If you are a veteran living in Hawaii and did not receive a Choice Card, call 866-606-8198 to determine eligibility and make an appointment.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrated Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Submit your questions to info@manakaiomalama.com.