Reforming the Veterans Health Administration-Beyond Palliation of Symptoms

The Veterans Health Administration (VHA) is one of the largest health care delivery systems in the United States, with 9.1 million enrollees, 20,000 physicians, 1600 facilities, 288,000 employees, and a $59 billion budget. In response to highly publicized concerns regarding delayed access to care, preventable deaths in patients awaiting care, and falsification of lists to make waiting times appear shorter, Congress passed and President Barack Obama signed the Veterans Access, Choice, and Accountability Act of 2014. In addition to expanding non-VHA treatment options for veterans, this law requires a comprehensive, independent assessment of 12 areas of VHA care delivery and management (see box). Eleven assessments were conducted under the Centers for Medicare and Medicaid Services Alliance to Modernize Healthcare, operated by the MITRE Corporation; the assessment of one area, “Access Standards,” was conducted by the Institute of Medicine. An independent blue-ribbon panel of experts was formed to examine and advise on all aspects of data collection and review, best practices, assessments, and recommendations. That panel, which we chaired, unanimously endorsed an integrated report, which was delivered to Secretary of Veterans Affairs Robert McDonald and Congress on September 1, 2015, and publicly released on September 18.