▶ 0:17:13>> good afternoon, thank you for your presence. Welcome to this week's hearing. Two weeks ago, we had the opportunity to discuss with secretary collins his vision for bringing the organizational and governance structure of the v.a. Directly into the 21st century. We are here to discuss that goal for the community care system. Health care is local.
▶ 0:17:42And for many veterans in kansas across the country, the ability to see a doctor in their community is not a luxury, it is an essential part of their health care and well-being. And the ability to use the v.a. Health care benefits they earned through their service. Congress recognized the reality of this circumstance in 2018 with the enactment of the mission act.
▶ 0:18:04It intended to make certain no veteran would be limited by geography, long wait times, and bureaucratic barriers, the need for specific kind of care in seeking care from the v.a., and everyone would have the opportunity for meeting full choice when and how they see the care they require. We will discuss how to be a made strides in delivering on that promise and words falling short. We will also discuss where improvements are needed to make the v.a.
▶ 0:18:31Community care program stronger, more sustainable, and more successful. By putting the veteran first, expanding meaningful choice, and providing care when and where veterans need and want it. To that end, I was encouraged to see the v.a. Release proposals in december for the next generation of community care network contract. Followed yesterday by a separate request for proposals to establish a national dental community care contract.
▶ 0:18:57In many ways, these procurements reflect a welcome focus on innovation, competition, and accountability. They also signal long-overdue progress toward upholding industry standards, embracing value-based care, strengthening program integrity, and persistent challenges such as return of medical documentation that have frustrated veterans, providers, and policymakers alike. Achieving these lofty goals can't be easy.
▶ 0:19:26The contracts must do more than look good on paper. The v.a. Must deliver results for veterans, staff, and community care providers, and taxpayers by leading to real measurable improvements in access, choice, outcomes, and cost. I look forward to hearing from you to be a witness is about how the department can meet that mission and how the committee can support them. With that I recognize ranking member senator blumenthal.
▶ 0:19:52>> thank you to our witnesses for being here today and of being service to our country and the men and women who work with you, veterans among them, dedicated to the mission of providing gold standard health care to all of our veterans. We are here to discuss the v.a.'s next generation of care contracts, which will total about $1 trillion.
▶ 0:20:23To be alive as I understand in 2027, which gives us time to assess what the needs are for community care on contracts that will be in -- indefinite delivery and indefinite quality. -- quantity. Which is kind of scary when you think of all of the indefinite's.
▶ 0:20:46It emphasizes the need for strong oversight on the part of congress and the inspector of the v.a.. And we can't really talk about community care without talking about its impact on the v.a. Direct care budget because for many veterans, care and v.a. Facilities is veterans care.
▶ 0:21:15What they are seeing now is losses of staff through caps on workforce, attrition, of many of the skill and dedicated men and women who have served. And the potential for lower quality if we take our eye off the ball of direct patient care through v.a. Facilities.
▶ 0:21:46My feeling is the v.a. Has to prioritize resources for expanding access to direct care by adding and expanding existing facilities, increasing staff to reduce wait times and supporting the v.a. Gap services such as telehealth, emergent, and urgent care capabilities. Communicator is a critical component and a supplement to v.a. Direct care. It is veterans care. Community care is veterans care. No question.
▶ 0:22:17But it cannot supplant v.a. Direct care. For all of the reasons everybody here knows well, it is the preference veterans have to seek care directly at v.a. Facilities, at least for many of them through v.a. Providers. It matches or outperforms the quality of community care in many instances.
▶ 0:22:46And it is a more efficient use of taxpayer dollars. First and foremost, we need access to information. The chairman and I submitted a letter to the secretary after his appearance with specific requests for information that he promised to provide. There has been no response so far.
▶ 0:23:18We are hoping, or I will speak for myself that the information will be forthcoming. It is essential to judgments that will be made about community care as well as direct v.a. Care. I would oppose a blank check for community care without real guardrails and establishing those guardrails depend on getting straight answers from the department that enable us to do basic oversight.
▶ 0:23:49Including the requests that we made on the record. I was a committee staff has not received a briefing from the office of integrated veterans care, the office overseeing the v.a. Community care system. And I'm hopeful we will see responsiveness on that score as well. In short, information and communication must be a two-way street.
▶ 0:24:21Not just with us, but with veterans. They are the most important constituency here. And I know they expect straight answers promptly to questions that are raised in committee hearings and also in the inquiries that we raised. My thanks for being here today. And I'm going to put that letter -- if there is no objection, the letter that we did in the record.
▶ 0:24:54>> in regard to senator blumenthal's comments in his opening statement, would you remind the secretary of his commitment? This committee is always looking for information. It is always difficult, slow to obtain. I want to encourage the department to respond soon to the letter that senator blumenthal and I sent.
▶ 0:25:17It simply outlined what the secretary committed to providing the answers -- the information he committed to providing to us when he appeared before the committee recently. I agree with the senator from connecticut that lots of unknowns in the future what we are talking about with oversight by this committee, oversight by the inspector general remain hugely valuable to getting the right result.
▶ 0:25:48I will encourage the cooperation between an ig and gao, but more important, continued dialogue with and this committee, its members, particularly its staff. With that, I think we're ready for your testimony, Mr. topping.
▶ 0:26:05Mr. Topping: I will take that commitment to get the information you requested. Mr. chairman, ranking member, ranking members of the committee, thank you for the opportunity to discuss the community care program. The nexgen contract procurement. I'm accompanied by alicia skolrood, executive director for v.a.. The world-class health care we provide to veterans across more than 1500 medical facilities.
▶ 0:26:31Mr. Topping: In addition to the direct care system, we've been a purchaser of health care since before the world war ii era. As a health-care care payer, via partners with local hospitals, doctors, and health care providers to ensure veterans have access to the care they need, where they need it, and when they need it.
▶ 0:26:48Mr. Topping: It is about more than a brain hospitals, it is about supporting veterans physical and mental health and wellness, their families, caregivers, mental health requirements, community requirements, and leveraging community services beyond the walls of our services. Recognizing the key role in the v.a. Plays to provide care for veterans health and wellness, president trump and congress passed the bipartisan mission act of 2010 which expanded access and choice for veterans and reinforce v.a.'s mission is both a health care provider and payer.
▶ 0:27:20Mr. Topping: Today, v.a. Is the country's largest single health care provider and the fourth largest health care pair. In fiscal year 2025, 41% of all will be care appointments were in the community. Nexgen is v.a.'s first major procurement effort to support that program. Our opportunity to increase competition, upgrade and modernize the provider network, and services that ensure veterans receive the best care possible, whether at a via facility or in their community from a local health care provider. We did not design it alone.
▶ 0:27:52Mr. Topping: We talked to our veterans who overwhelmingly want the choice to choose between direct care and community care based on medical interest, availability, and convenience. We talked to other government agencies, the department of health and human services have decades of experience providing health care quality, reducing cost, and better health and wellness. We talked to industry, which is constantly innovating new delivery models, striving to become consumer-oriented while addressing costs that remain too high.
▶ 0:28:22Mr. Topping: Combining the v.a. History, the data, and the external input, the v.a. Successfully issued the rfp on december 15, 2025. We are leading the nation with a 10 year multiple word iq. The country vehicle which has several key advantages over traditional federal health care contracts. First, it drives competition for stability by allowing national and regional health plans to successfully bid and be awarded a spot. It is the best of both.
▶ 0:28:53Mr. Topping: We will have vendors with national reach and scale, but regional plans with unique capabilities that are locally adaptable. Second, the use of multiple rounds allows them to you to really adapt nexgen to meet veterans of all the needs over time, changing demographics and infrastructure, and improve sophistication to manage the program over the 10 performance of the contract. That id iq is the how of this procurement. The most exciting part is the what.
▶ 0:29:21Mr. Topping: It is designed on five pillars, quality, value, alternative payments, utilization management, and program integrity. The v.a. Will implement company and have quality programs for community care providers based on nationally recognized measures from the agency for health care research and quality and the health care state and information set. Contractors will track patient safety events, identify veterans at risk and you -- avoid emergency visits through predictive analytics and while inspecting the choice guide veterans to high-performing providers.
▶ 0:29:54Mr. Topping: Second, it will modernize how v.a. Pays for the care furnished to veterans by implementing value-based payment models. We will begin with episode-based payments for lower joint replacements, and as we gain the data and expertise to manage alternative payments, we will introduce at least three additional models. The contract continually improved care. These models will shift away from volume and tort outcomes in the cost of care that aligns incentives with system sustainability.
▶ 0:30:24Mr. Topping: We will introduce utilization management, active management of inpatient admissions, emergency department use, concurrent hospital reduce and -- clinical settings. This will reduce unnecessary hospitalization and appropriate care while protecting veterans access to medically necessary services. Nexgen will include department -- program into ready function to determine v.a. Services are maximized.
▶ 0:30:46Mr. Topping: We will identify providers of higher risk and improper billing, formalize and site processes, expand data and technology used for improper payment detection, and use audits to ensure veterans receive what v.a. Is paying for. Nexgen state -- changes how to incentivize outcomes. It will incorporate incentives based on the total cost of care, quality performance, care option, and payment integrity.
▶ 0:31:16Mr. Topping: He will share in the past where the creeper veterans. Speaking of costs, along with improved care, nexgen provides real savings for taxpayers. The estimates based on independently verifiable data show significant savings of 18% to 14% over the life of the contract. They range from a low end of $54 billion 21 hundred billion dollars over the life of a contract. These are gained by fewer unnecessary hospitalizations, improved management of high cost choice drugs, stronger fraud prevention and payment controls.
▶ 0:31:48Mr. Topping: Nexgen is leading the way in federal quote -- federal health care programs are designed to be operated. I appreciate the opportunity and answering other members of the committee may have. >> thank you very much. >> chairman moran, ranking member blumenthal, and committee members. Thank you for the opportunity to discuss oversight of the v.a. Community care network contracts.
▶ 0:32:16Mr. Topping: Our auditors focus on providing finding and recommendations that help the v.a. Improve the efficiency and timeliness of direct and community care. Our health care inspectors were to elevate the quality of the health care and increase patient safety while our investigators leverage data analytics to prevent and stop health care fraud and related crimes. In our oversight work we routinely see v.a. Staff committed to providing patients with the care they need, but challenges persist.
▶ 0:32:45Mr. Topping: As the reorganization unfolds, the oig will monitor it simple mentation to understand the impact on veterans, v.a., and stakeholders. The v.a.'s new community care network contract solicitation provides an opportunity to enhance services to millions of veterans.
▶ 0:33:00Mr. Topping: The oig has noted positive steps in the requests for proposals and the work statement such as a requiring community providers to use a central submission system for sharing medical records and to use the electronic visit verification for home health services. The changes could improve care coordination and reduce the risk of fraud. The v.a. Must remain vigilant to these contracts to prevent the recurrence of risks previously addressed through implementation of our recommendations.
▶ 0:33:29Mr. Topping: The oig reports have highlighted four general challenges and community care program management. Various to veterans getting timely and coordinated care, and adequate visibility over the resolution of quality care concerns. Third, workforce gaps and lack of vha management controls. Lastly, outdated and incomplete financial systems impede effective payment management. Our work has identified risks to the quality and continuity of veteran care through the v.a.
▶ 0:33:59Mr. Topping: Current tpa contracts. For instance, the tpas are required to ensure the community care providers send patient records back to v.a.. However this was not enforced. The contract performance metrics do not do enough to help track where there is a lack of qualified community providers and needed specialties. Further I.t. Solutions can resolve delays and barriers to getting v.a. Patients additional community care services identified after the addition of v.a. Referral.
▶ 0:34:27Mr. Topping: It is critical to next-generation contracts have actionable steps to move behind portals for sharing records and also create measures and reliable tools to address these and other identified problems. Regarding opioid prescription -- prescriptions, congress laid out guidelines for community care providers to follow. Tpas must ensure providers adhere to the opioid safety guidelines and conduct checks of state prescription drug monitoring programs.
▶ 0:34:54Mr. Topping: The oig has identified previous noncompliance that warrants ongoing monitoring. Vha must intensify oversight of the tpas regarding the adequacy of community care provider networks, which we have sometimes found do not fully meet veterans needs or demand.
▶ 0:35:11Mr. Topping: Our previous work has also identified overpayments to tpas or not adherence to fee schedules and inconsistencies between the tpa contracted billing structures, all of these should be addressed in the new contracts proactively. The oig has been in discussion with v.a. Officials over the last three years about improvements in the next generation contracts that can enhance oversight, prevent fraud, and advance health care delivery. Including the following.
▶ 0:35:38Mr. Topping: Tpa and care providers should not require a subpoena from the oig to turn over documents. Contract provisions should ensure community providers are responsive to v.a.. Provided training and standards should align with the v.a., and fee schedules shall be established and tpas rigorously followed. In conclusion, v.a.
▶ 0:36:00Mr. Topping: Will need to strengthen efforts to work with the health-care industry and stakeholders to develop contracts that help veterans receive care when and where they need it. We will be monitoring those efforts closely. The oig remains committed to providing independent oversight of v.a. And delivering actionable recommendations to help v.a. Deliver the health care veterans have earned. Chairman moran, ranking number blumenthal, and committee members, thank you and I'm happy to answer any questions.
▶ 0:36:28Mr. Topping: >> thank you both for your testimony. Mr. topping or miss ssearight, does the potential of the described efforts by the v.a. In the new contracts meet the requirements of inspector general has recommended be included as part of those contracts? Do we know that yet? Have we reviewed to see if the contracts will meet the request. He reviewed the suggestions to make sure they would --
▶ 0:37:00Ms. Skolrood: We have done --
▶ 0:37:02Ms. Searight: We have done preliminary reviews of the language, and it does have a good indication of that information. Until these contracts are actually awarded in negotiations finalize, we will remain diligent in reviewing that information. >> diligence is fine. Do you agree with the Mr.
▶ 0:37:36Topping: Recommendations? Absolutely. Ig has been a great partner. The recommendations about 90% I fully agree with. We are working on implementing them and the rest will work it out. >> and ig office last april issued a report about the omaha v.a. Medical center and found the staff or limiting veterans access to community care by manipulating clinically indicated dates in violation of the mission act. We are just this week, my officer to similar allegation at another facility. So I'm interested in knowing if there's been a follow-up.
▶ 0:38:08Topping: Will you commit to looking into these allegations and quickly make a course correction as needed? >> yes, we will. >> I've had this sense for quite some time through numerous administrations -- I think we learned it is true, there was a concerted effort to discourage the use of community care, it came from v.a.
▶ 0:38:35Topping: Officials and employees and affected the capability of veterans who qualify for community care to receive that community care. Do you know of what I speak and if there's a problem that exists, and has it been corrected or will it be? >> here's what we're doing Mr. chairman. As I said in my opening statement, v.a. Is a direct care provider, our hospital and clinic system, and v.a. Is a payer.
▶ 0:39:07Topping: These are different systems, different purposes, different tasks. We have done is combine management of these programs together. What secretary collins has said is an operational vertical community care will be its own payer vertical within the system. We will account for and manage the funding of that system independently of the direct care system and there will be leadership focused directly on community care. It will go a long way to remedying the confusion between the role of a direct care provider versus what a payer is.
▶ 0:39:39Topping: And ensuring we can meet the requirements, the program in the mission act and anything congress wants us to make. >> there are graphs, charts, allegations -- I don't like that word, there's indications the community care costs are rising more rapidly than the direct care costs. I would say the cost is a misleading word in my view.
▶ 0:40:07Topping: Could be more spending is occurring in one category over the other. But what I know about that is first of all, the mission act allowed veterans to receive care if it was in their best interest to do so. Determined by the veteran and his or her provider, not by the v.a., and there were no artificial limitations on the amount of community care that can be provided in the mission act.
▶ 0:40:39Topping: So a number of categories by which one could receive care, but one of them is is it in the best interest of the veteran? I want you to confirm or indicate that I should be looking at additional ways of describing this, but there ought to be the opportunity to receive care if it is in the veteran's best interest, and the idea we are spending more money -- I don't think spending is the right word, more patients are choosing or being cared for by
▶ 0:41:12Topping: -- in community care. I also want to point out, and you can correct me if I'm wrong, but what I know from information I have seen that I believe to be accurate is the largest increases, and there's been 26 point $7 billion increased in community care spending. Fi 19 to 23. We've had the largest components of that, number one is emergency care.
▶ 0:41:43Topping: It is perhaps not even a decision made for the veteran, it might just be the ambulance service is taking a veteran. Most approximate need for community care originates. The second is geriatric and extended care. Which is in-home care for veterans, family members caring for them is commuted -- considered community care and included in the statistics about spending on community care.
▶ 0:42:13Topping: It is really half of the increase in spending on community care. It has been emergency services and geriatric and extended care carrying the home for veterans. Part of that comes with a very bipartisan passage of the elizabeth dole act that provides opportunities for that care to be increased. What am I missing? How can I be corrected?
▶ 0:42:42Topping: I know the veterans health care administration -- this is a question for you. But tell me the facts that make sense when we have this discussion. >> I think everything you said was true. There has been an increase in spending, but also in utilization. Those numbers you see that we show are not risk-adjusted. It doesn't show the type of care we are purchasing.
▶ 0:43:12Topping: We are purchasing more care for veterans in the community, higher cost and higher value care for veterans in the community. That is number one. Number two, it is not necessarily a negative. It means we are adjusting where veterans receive care to ensure we are meeting their needs, including locally, not just within the v.a. System. The last point is those numbers taken in a vacuum belie the overall spending.
▶ 0:43:38Topping: When we talk about it being a $10 trillion contract it is, we will spend $2 trillion in direct care over that same. It is the overall continuum of care, these work to ensure veterans receive the care they need, where they need it, when they need it. Making sure we are accountable for that it's a different task than whether or not they are right or wrong. The last is the intention of the community care and nexgen program to give v.a.
▶ 0:44:05Topping: The tools to manage the quality of care so that we know what we are getting , the best possible quality care for our veterans, and to manage the cost to be responsible for that. So the tools we need to manage the program are included so we can be responsive to these concerns and questions. >> thank you for your answer.
▶ 0:44:26Topping: I will indicate that I share the concerns about what we have seen in the inspector general's report about quality, medical records, there needs to be improvements that I believe your efforts here are designed to achieve in community care. It is not that it is -- that it doesn't have its faults and challenges. We need the v.a. To be watchful in regard to providing care in the community of veterans.
▶ 0:44:56Topping: >> since 2019, the funding for -- disregard this chart for a moment -- since 20 19, funding for the v.a. Community care program has increased from $9 billion to more than $48 billion in the v.a. Fiscal year 20 26 requests.
▶ 0:45:27Topping: An increase of 530%. A staggering increase. Wouldn't you agree? >> ranking member, that is a large increase. >> funding for v.a. Direct care over that same time is increased by far less, about 200% from approximately $50 billion, to $97 billion. Why the disparity?
▶ 0:45:55Topping: >> I think that goes to my prior comments that these numbers are not risk-adjusted. What they show is more veterans receiving care. It doesn't account for the type of care they are receiving. Back to the point the chairman made, they are receiving disproportionate emergency care which are expensive services to provide. I would say the measure of it is not just the gross spending what the difference is, I would say what is v.a. Getting for it, and does v.a.
▶ 0:46:23Topping: Have the tools to ensure we are getting the highest value for those dollars and we are maximizing those dollars to get the most we can? Under the current program, we do not have those tools. We have the only government pair program that doesn't have the ability to manage quality, to use value-based, alternative bait -- payments, to have program integrity. We are the only program that doesn't have these controls.
▶ 0:46:54Topping: We are introducing bills. I share your concerns about the expenditures and ensuring we are maximizing the value. This program gives us the tools to do that and to be accountable to veterans to be able to do that.
▶ 0:47:07Topping: >> so I understand, you agree more needs to be done to maximize oversight, to make sure we get quality for the dollars being spent on veterans care, and your explanation is it is a different type of care, more specialized care that is provided in the community as opposed to the v.a. Direct facilities? Is it an accurate summary?
▶ 0:47:39Topping: I'm trying to put it in --
▶ 0:47:40Mr. Topping: That is possible, but there are two issues. We don't risk-adjusted that after what is the care that is received and what is driving the costs. That is a dollar amount. What is behind it is not adjusted. That is number one. Number two, because we don't measure quality in the community care program right now, I can't tell you the care is less or more different or better than community versus direct care. We don't do that today. Nexgen includes our ability to do this.
▶ 0:48:08Mr. Topping: It is a huge movement forward so we can compare. Are we getting more or less, the best value or not? I cannot answer because the program is not built to do that. >> this chart indicates the rate of increase in the numbers of veterans served has been far less than the rate of increase in the amount of spending.
▶ 0:48:37Mr. Topping: Do you have an explanation for that fact?
▶ 0:48:40Ms. Searight: No, we have not evaluated that in our ongoing audit. So I cannot speak to that exactly. >> Mr. topping, do you?
▶ 0:48:54Mr. Topping: What those charts show me his veterans receiving more care. The ability to dive into what the care is, whether it is the appropriate care, whether there is good value for that care, that does not show me that. The program today is not built to do that. Nexgen is, which is why it is so exciting for us. >> I would suggest we need to answer those kind of questions. You don't have answers right now .
▶ 0:49:24Mr. Topping: You say the program is not designed to provide those private answers. But any run of the program would say would you agree? >> I want to answer those questions, which is why I would design nexgen to remove these tools and capabilities. I want to ask -- -- answer those questions.
▶ 0:49:49Mr. Topping: >> talking about next generation , your report indicates that -- and I'm quoting community care providers should be incentivized to meet the same training and quality standards as a providers.
▶ 0:50:16Mr. Topping: Isn't the word incentivize a little bit light on the requirements? Should we guarantee that they meet the same training and quality standards as v.a. Providers? >> providers, whether in the v.a. Or the community have a standard they are all trained to.
▶ 0:50:44Mr. Topping: Within v.a., they have additional standards they train to the culture of the veteran to serve the veteran. In our position, the v.a. Is asking the community providers to do more to have a higher level of education or awareness of the community they are serving.
▶ 0:51:06Mr. Topping: >> I guess saying instead of incentivizing them, shouldn't they be absolutely required to meet the same standards of quality and training and efficiency? All of the criteria of the veteran going to be a facility has a right to expect. >> if it is in the contract, they should be required. >> as a matter of definite provisions and requirements?
▶ 0:51:37Mr. Topping: >> correct. >> let me just ask very quickly, have you looked into amounts of overpayments or lack of contract enforcement related to community care since the enactment of the mission act? >> we have done quite of work -- quite a bit of work since enactment of the mission act.
▶ 0:52:09Mr. Topping: That worked varies from payment oversight to services provided on -- our investigative decision looks at fraud investigations and things that evolve from hotlines. In the payment integrity world, we also do annual reviews of the reports that v.a. Provides on underpayments and overpayments to community care.
▶ 0:52:37Mr. Topping: >> do you have an estimate as to how many taxpayer dollars have been lost to improper payments or lack of enforcement? >> since 2021, v.a. Has reported $4 billion in overpayments to the gpa, which is about 4% of the total amount paid out. >> $4 billion? >> yes. >> thank you, my time is expired. Thank you.
▶ 0:53:09Mr. Topping: >> thank you, Mr. chairman. I want to thank the witnesses for their service. I think you're doing a good job over there, it is never an easy job. But I appreciate your hard work. I want to talk about the effort to move to a multivendor framework. I want to be focusing on my state.
▶ 0:53:37Mr. Topping: More -- more veterans in alaska, and also on the mission act, I was able to get a provision for states like mine in new hampshire that don't have a full service va hospital to have the ability to go get community care. In the bill people can go get that immediately. A lot of times the v.a. Has not read the bill.
▶ 0:54:06Mr. Topping: It is not always easy to get those appointments. But it is a challenge. I'm always reminding the v.a. We are different because we don't have that. Keep spreading the word on that. That is important from my perspective. I have a concern, in some ways I understand the multi-framework approach.
▶ 0:54:30Mr. Topping: But I also have concerns, particularly in a place like my state where health care care is very expensive and it is a very big state. Our experience when obamacare initially passed, we lost almost all of our health insurers. We went from four in an individual market to one. And we almost lost that one.
▶ 0:54:58Mr. Topping: So we have a challenge where a small population, very expensive health care, very expansive territory to cover. And I worry that if you move to a multivendor framework given the cost, it might create alaska without bidders. Which would put veterans access to care that real risk. I know you put a lot of thought into the model.
▶ 0:55:31Mr. Topping: But I'm concerned, high costs, remote areas, you might have nobody who steps up. How will the v.a. Can that vendors will bid for these areas , these in particular with a lot of vets but a lot of ground to cover, high costs, how cool contracts or reimbursements be adjusted to reflect the higher cost without discouraging participation.
▶ 0:55:59Mr. Topping: In that issue of discouraging participation, it is a real one. We have seen it before in other settings. >> thank you for the question. I love the question because it gives us a chance to highlight the best aspects of how we are doing this with the multiple award id iq. The program itself from all of the vendors who participate in this, we will have the five pillars.
▶ 0:56:24Mr. Topping: But what it allows us to do is invite bidders who are both national and regional and put them on the vehicle. We currently don't have that. We pick a vendor and we picked two. That means we don't have any of those tools we talked about, the five pillars, but we operate largely the same program and wherever else we do in alaska. All health care is local. >> one-size-fits-all.
▶ 0:56:56Mr. Topping: For my state it never matches. >> it does not. All health care is local and based on local needs, infrastructure, alaska very unique. What this multiple award iq allows us to do is solicit bids from vendors who have an expertise and the ability to serve that region. Understand the local populations, the difference to bid and be on the vehicle. And most importantly, it allows us to have a regional model that is different from the way we operate.
▶ 0:57:29Mr. Topping: So very much it is possible what we would do in alaska would be different. One example would be I don't think we would change our quality requirements in alaska, we want providers to provide the very best care wherever it is. But because of the distance and the geography, the rural nature of it, costs may be less of an issue. We might pay more to get the care our veterans need under this model we can do that and account for it.
▶ 0:57:54Mr. Topping: We don't have to do the same thing in alaska we are doing in l.a. >> that is a good answer. So you are going to tailor this to meet the needs of each individual state. Let me give you another example. We have a very large native population, almost 20% of the population. They serve at higher rates in the military than any other ethnic group in the country.
▶ 0:58:21Mr. Topping: That is another reason we have so many veterans and that is a great heritage and culture of our alaska native community in my state and all of the military service. And the tribal health organizations are often do -- I met with community leadership yesterday and they just recently inked a compact and agreement with the v.a., which many of our tribal health organizations do. That extends the ability for the v.a.
▶ 0:58:47Mr. Topping: To reach into real rural communities, have access to native populations and non-native populations when they do these compacts with you guys. So will the v.a. Continue to coordinate with tribal health providers under the new multivendor framework? I think that is a model that is working it is very unique and gets to what you said earlier. >> yes we will and we have the ability to do that. >> thank you, Mr. chairman.
▶ 0:59:20Mr. Topping: >> thank you, and I want to thank the ranking member for this hearing and to our witnesses, thank you for being here and your service to our veterans. As the v.a. Looks to draft and commence its next generation of community care contracts, it is really important veterans remain the focus of this effort. That is why I think you are hearing from all members of this community. One area I want to make sure that the v.a. Is planning for is the continuity of care.
▶ 0:59:49Mr. Topping: If a veteran is receiving high-quality care from a community provider and they are satisfied, they should be able to keep seeing that provider. What is the v.a. Doing to ensure the next generation of community care contracts come online? Veterans can continue to see their preferred current community care doctors without interruption.
▶ 1:00:13Mr. Topping: >> senator, the short answer to your question is we have extended the authorization period, so when the veteran is referred out, they can remain with a provider for the full episode of care. Number two, we have made it easier for the best medical interests for veteran and the v.a. Provider to select that veteran would go and remain with that provider for the treatment. Those are the controls that are in place.
▶ 1:00:38Mr. Topping: We are also able under nexgen, to have regional models, it will work in alaska and it will be different than new hampshire our ability to adapt to the local infrastructure and local capabilities. Without a full-service v.a. Currently in new hampshire, we do leverage community care to pay for the hospital systems that sit around. Manchester sits in the boston medical market. Unique region capabilities. We are able to leverage those in a way that will not be one fit.
▶ 1:01:10Mr. Topping: We will be able to adjust to do that. As we work on capacity, we will be able to do that and respond to that. >> I appreciate that and the regional and specific approach. I do want to point out that for some people, the continuity of care is going to be more than an episode of treatment, they will have a condition where they've developed a relationship and a treatment plan with the doctor with the condition that will last the rest of their lives.
▶ 1:01:41Mr. Topping: And the notion that because v.a. Changes its contracting relationships that all of a sudden that person has to transition to a new provider, which does happen in the private insurance market and is a problem. It is something I want you to think about because I want veterans to have that continuity of care. In a place like new hampshire, where there are shortages of physicians, it is going to be important we continue to focus on that issue. Does that make sense?
▶ 1:02:10Mr. Topping: It does. I think secretary collins implemented practices, this is a type of intimate -- he saw to address to ensure care and veterans have the ability to do that. >> let me ask you another question. Because it certainly won't get overlooked in alaska, but I want to make sure that in all our areas, all of our states have a lot of veterans in rural areas thinking about access for rural benefits.
▶ 1:02:42Mr. Topping: Where a veteran lives should not determine whether they can get the care and support they have earned. And because rural veterans are not able to easily reach a v.a. Facility, they often rely on community care, particularly in, a mountainous wintry place like new hampshire, only 10 miles, but might as will be 100 miles away. How is the v.a. Planning to address care for rural veterans in these updated v.a.
▶ 1:03:09Mr. Topping: Contracts, and what mechanisms will you put in place to ensure that the recipients of these contracts are providing a robust network of provider options for rural veterans?
▶ 1:03:20Mr. Topping: Thanks for the question. 10 miles in the white mountains feels like 100, that is for sure. Part of what we are doing -- even for rural veterans, there is a community provider usually local. It may not be full-service, but there is a community provider near, in the veterans community, the next community over.
▶ 1:03:41Mr. Topping: One of the pain points on the contract has been it is difficult for providers to get referrals, authorizations, it is hard to get reimbursed. And we have unique requirements. What we are doing in this program is trying to make va the fourth largest payor, but to make power payer program operate like other programs, including medicare. We use the medicare fee schedules, and medicare drg's. The codes we use our medicare.
▶ 1:04:10Mr. Topping: Every single provider, rural, new hampshire, likely provides medic -- accepts medicare and provides medical treatment. To the extent we can operate our program so that it operates like that, in the provider ease of doing business, that means our veterans can go local. If the veteran needs a higher level of care or specialized care, we might move to the v.a. Or a specialty provider further away.
▶ 1:04:37Mr. Topping: The idea is any provider that participates in other government programs, medicare or medicaid, can participate in via community care and provide the same service to our veterans. >> I appreciate that, and I appreciate over time, I will submit a question for the record on making sure the community care providers are getting the veterans updated. Medical records back to the v.a. Before the case is close out. I think you've done a look at that and there is a real problem.
▶ 1:05:05Mr. Topping: Cases are getting close without the community provider getting the records updated back to the v.a.. I will also just point out for my colleagues that one of the challenges we have in rural new hampshire is because of the medicaid cuts that came along with the big bill. Two of my rural health clinics where veterans might be referred have had to close. That is a problem related to the medicaid cuts.
▶ 1:05:34Mr. Topping: It just leaves a dearth of providers in certain regions. Thanks. -- >> what you talked about is the difficulty a provider has in providing services to veterans. It is what we live with. Choice -- in my view, the v.a. Has always been reluctant to promote choice. In some instances, it has made it difficult to be utilized.
▶ 1:06:05Mr. Topping: And I understand that, nobody wants to visit patients and veterans, the people who work in the health care system and continue to do so. But the mission act was a replacement for choice. And the mission act was designed to make it more easily attainable that the providers in the community would want to provide services to a veteran through a now mission.
▶ 1:06:32Mr. Topping: It was designed to eliminate the barriers that a private provider would face in dealing with the v.a., the referrals, the record-keeping, the rates charged. There's a whole list of things that we attempted requiring the payment of medicare rates. We still have a long way to go. I visited every hospital in kansas numerous times.
▶ 1:07:03Mr. Topping: And I always ask this question, the answer is generally it is getting better. But we still have problems in getting authorizations. We need another referral for an x-ray or lab work. I hope that in the process not only related to these contracts, that we are simplifying the opportunity for community care providers to provide that meet the needs of veterans. Does that make sense and is true? >> it does.
▶ 1:07:33Mr. Topping: I have yet to meet a provider that says they don't want to provide care to veterans. Most providers do. It is incumbent among the v.a. To make this program is easy to participate in and as smooth. There are ways to do that. We addressed that in this program design, working on how we do the referral, the eligibility, and the authorization. Most important, how we make sure payments are made promptly, correctly, and accurately.
▶ 1:08:02Mr. Topping: >> senator hassan also talked about continuation of care. It is an issue. Two years ago, I brought to attention to the v.a. That a veteran in my hometown was receiving cancer treatments, he was required to receive 17. After the 15th one, the v.a. Decided they should move the care out of the community. The first 15 treatments he did, the last two he was required by the v.a. To return to the hospital for those treatments.
▶ 1:08:32Mr. Topping: The explanation was you don't live 60 miles from the v.a., you live 59 -- the drive is 59 minutes, not 60. Therefore, you are ineligible to continue to have the care provided for by the doctor, the provider you have been using for the first 17 of your treatments. I assume this is an anomaly, I assume it doesn't happen, that people have common sense.
▶ 1:09:01Mr. Topping: I don't know how you legislate this stuff. But the idea that senator hassan raised about once you start with a community care provider, and most recently, I would say time and again, chiropractic care has been called back to the v.a. After a veteran has been receiving chiropractic care in the community for months or years, and the v.a. Wants to change the provider by breaking them back in house.
▶ 1:09:28Mr. Topping: I assume we will attempt to avoid those kind of circumstances. And I mostly want to make sure that you know that circumstance has existed. >> --Mr. topping: I do and I'm aware of that case. It was an unacceptable anomaly. One of the things we are doing in nextgen's use of management in which the treatment management -- manages a diagnosis. The part we have now is the authorization does not necessarily match. These have been separate from each other.
▶ 1:09:58Mr. Topping: The idea is when we refer a veteran out for cancer treatment, that the care provided to that veteran and community would match the diagnosis. We will be able to manage to that and the quality and the cost. Particularly as we look at how we manage this program internally. It is very manual it now. Between the referral, which is a relatively well understood process, treating physician says we will refer the veteran out.
▶ 1:10:23Mr. Topping: But the eligibility process, the appointment making process, the time and distance process has been a very manual. That needs to be automated. That entire process should be relatively seamless. It should not be something the veteran has to get involved in. It should be something between v.a. As the program manager and the payor works out directly with the provider. We are working on those. >> further questions about it should be to make sure it will be.
▶ 1:10:50Mr. Topping: Senator duckworth -- >> boston secretary, according to the v.a. Survey of health care expenses of patients on most measures, does v.a. Outpatient care score higher than private sector care experiences?
▶ 1:11:06Mr. Topping: We don't measure quality in community care, so I can't answer that. >> okay. What I have seen is veterans report better communication, more trust, and higher satisfaction with ba clinicians compared to private sector clinicians. That is not in your own survey of health care experiences of patients?
▶ 1:11:26Mr. Topping: What I'm saying is currently in the community care program, it does not have quality measures, so I cannot benchmark between direct care and community care. I can't answer that question based on data. >> why would you not collect that data on community care expenses?
▶ 1:11:42Mr. Topping: The community care program does not manage data at the community care provider level. So I can't answer the question based on data. >> so we are just going to trust patients -- how do you compare the community -- care satisfaction to direct care satisfaction? You are not taking -- collecting the data? Perhaps you can better explain it to me why you don't measure patients experiences in community care?
▶ 1:12:11Mr. Topping: I think what you're asking about is survey data. I'm referring to quality data, or we measure the quality of the care the veteran receives in the community. In the current community care program, we don't have quality measures or requirements. In next gen, we do, we use industry-standard measures to report like with like, measure and track, so we will know the quality of the care of a veteran receives from the community provider, and that we can date it today to benchmark it against what the veteran receives.
▶ 1:12:41Mr. Topping: >> do you have data that vso's -- consistent with vso's testimony that veterans want va as their primary care provider? >> I'm not aware of the specific survey results, but generally that sounds right, that many veterans do enjoy the ability to use the direct care system and the community care system as it best meets with them.
▶ 1:13:11Mr. Topping: >> I believe in theory that community care providers can serve a valuable complementary role to fill the gaps that exist for role veterans, also skill gaps. I'm one of those veterans. I go to ba as my primary care, but I get my prosthetics made by a specialty provider that has a level of expertise not available at my local v.a. I think it is important to increase patient access to specialty care providers.
▶ 1:13:37Mr. Topping: I have not yet seen a comprehensive plan to invest in the most efficient, effective veteran pervert health care, rv medical facilities. You had met with some of my staffers the other day, and you said there was going to be a plan for a $1 trillion investment into direct care. We have not yet seen it. When can we expect to see a part three of this series on direct care investments?
▶ 1:14:07Mr. Topping: Is that $1 trillion amount correct?
▶ 1:14:10Mr. Topping: First of all, direct care versus community care. I will come back to community care in a minute. On direct care, what we have done is reduce backlogs some war veterans have access to ba care. We've opened 25, about to be 30, new clinics. We spent $800 million already. In fiscal 2026, I'm investing $5 billion in deferred maintenance on v.a. Facilities to get those up to par.
▶ 1:14:37Mr. Topping: That includes minor construction, major construction, and leasing. We are investing in the direct care system. >> do you have a plan?
▶ 1:14:45Mr. Topping: Yes, we can provide that. C1
▶ 1:14:54Sen. Duckworth: Community care spending doubled over that same time. To the v.a. Double in that same timeframe? You were sitting at 50% staffing and contracting oversight. I worry that if you are doubling the amount of community care spending that we are keeping the same number of workforce in the oversight role. Did you double the number of contract workforce in that same time?
▶ 1:15:22Sen. Duckworth: >> what we are doing is focusing on program design. How do we manage this? We have moved to community care team into an office designed to focus on this. We will do a cost accounting for this directly.
▶ 1:15:49Sen. Duckworth: In the past what we have done is taken direct care staff folks and asked them as an extra duty so we can be accountable for the cost and the quality.
▶ 1:16:03Sen. Duckworth: I agree that the director staff should not be doing is extra work. We went from 32 billion in 2018 to 62 billion in 2023 and we are still not staffed up. Where we should be. I worry about oversight and all of those contracts. What percentage of authorizing these general networks and contracts management and performance goals?
▶ 1:16:32Sen. Duckworth: >> I don't know the exact answer.
▶ 1:16:36Sen. Duckworth: Can you get it to me? >> I can.
▶ 1:16:42Sen. Duckworth: These contracts seem to lack guardrails. >> I will commit to building the office we need. Staffing admitted to be successful.
▶ 1:17:09Sen. Duckworth: As he was spending on community care. I don't want to be out here spending all of this money and you are still building the plane. >> we are building that as we speak. There will be a one year implementation time. The secretary has directed the internal design. In terms of financial management to be accountable for these costs.
▶ 1:17:38Sen. Duckworth: As we can manage this as we go forward.
▶ 1:17:39Pres. Trump: When do you think that whatever program you come up with will be in place in operation that will provide oversight for all of these contracts that we are allowing this procurement cycle right now? >> we are working on this real time. They are expected to come in january of 2027.
▶ 1:17:59Sen. Duckworth: Thank you, Mr. chairman. >> thank you, Mr. chairman. I am attempting to better understand what it is you are here to explain to us. You already have these private contracts and you are about to go into renewals of these contracts. So what you are here to explain to us regarding these renewal of these contracts you already have?
▶ 1:18:29Sen. Duckworth: >> we are here and we are excited to talk about the design of what we are doing to improve the care veterans received.
▶ 1:18:40Sen. Hirono: That is not a particularly specific kind of response because of course what you are supposed to be focused on in care for veterans. Are we basically moving toward a more privatized model? >> we are not.
▶ 1:19:07Sen. Hirono: That is kind of like what we are looking we are creating opportunity of. We would much rather receive care in the v.a. Settings. I understand the need for community care. They don't always have all providers on site.
▶ 1:19:36Sen. Hirono: There is always this concern that we are moving toward a prioritized -- privatized model. I don't even know what that is. How is that different from what you are already doing through these contractual agreements with providers? >> a couple of major differences.
▶ 1:20:06Sen. Hirono: We have been introducing five pillars in the program. We will do utilization management. Those are the five tools that every program has had for decades. We are introducing those tools so they can be accountable for the cost of care. That is number one. We are issuing this so it allows the v.a. To have competition.
▶ 1:20:43Sen. Hirono: What this allows us to do is have regional models that are adapted to the needs of veterans where they live. And allows us to do that.
▶ 1:20:55Sen. Hirono: Explained to me about competition among providers. When I think of providers I am thinking of what is the definition of providers that you want to have more competition among? >> there will be two types of contractors. There will be a vendor who manages the payer program. The v.a. Operates it. We are the funding agency.
▶ 1:21:23Sen. Hirono: This will be responsible for claims payment measuring data etc.. And we will have the community providers themselves. They will actually deliver the care.
▶ 1:21:34Sen. Hirono: So when you talk about competition, are you mainly focused on how much those levels, is it the competition by the cost? >> I want everyone to compete.
▶ 1:22:05Sen. Hirono: I want payment vendors. Plant partners. I want them to be focused on the community providers who provide care.
▶ 1:22:15Sen. Hirono: The thing is there are certain areas of commerce activities that lend itself to competition. Usually in things like price where you look at the product. In the medical field, it is not that easy. I like the idea of competition.
▶ 1:22:46Sen. Hirono: Giving us the best bang for the buck. I don't know how easy it will be to determine whether we are getting the best services. I have a question about that. You explained everything in a way that sounds reasonable. But the question would be how these things be implemented in a time when the v.a. Is cutting its people and who is supposed to oversee all these contracts?
▶ 1:23:20Sen. Hirono: Who is supposed to be providing that oversight when you are cutting back on employees and there is a whole on vacancies? When you put a hold on it, these vacancies don't go away. There has always been a problem. When finding people to work for the v.a.. I know that in the hawaii situation. It is hard for us to key primary care people in hawaii.
▶ 1:23:51Sen. Hirono: When you get rid of the positions, I don't know what that says. Does it make the bottom line look better? I don't know. Why would you do that? What would you freeze the hiring of people that the system needs? Obviously they need to be filled. What would you put it -- why would you put a freeze on it? >> this is about the program design of community care.
▶ 1:24:24Sen. Hirono: That we have a structure and the people and expertise. Including the tools and technology to be able to manage this program. We are competing on those. We are competing on quality. We want the very best care. We want to lower the cost of the program.
▶ 1:24:43Sen. Hirono: It is nice that you have those goals. It is implementing all of those that I have some serious questions about. >> thank you for coming today. Health record transfer from active duty, where are we on taking active duty service members who have a very finitely documented records when they are
▶ 1:25:13Sen. Hirono: Separating. There is no reason that those records should be thrown in the trash bin. I think it is about time that instead of having them show up with a car and taking the car apart and then putting together a new car, they should be able to take that physical exam and have it seamlessly transferred to the v.a.
▶ 1:25:42Sen. Hirono: To eliminate that leap of faith. For disabilities as well as health care. I would like your comments on what the pathway forward for that would be. >> this is called a zero day record issue. This is something they are personally engaged on.
▶ 1:26:16Sen. Hirono: I know there was a meeting on this issue yesterday. How those records automatically come over. The service member then becomes the veteran. >> you know that will save you a lot of money. They can spend on other things instead of having to pay for another health exam to happen.
▶ 1:26:47Sen. Hirono: Community care, as it has been referred to, has been the law for a long time. I just left a meeting of montana rural hospitals. In the opinion of a state like ours, the v.a. Has intentionally made itself a very our customer to do business with. Both too qualified and potentially for patients to come in.
▶ 1:27:17Sen. Hirono: In a state where he could be a 30 minute drive or a 5 hour drive. Having to wait weeks or months to get the care they need because they're waiting for authorization is unacceptable. How are you going to knock down those barriers that are blocking veterans in those places? >> access to care should be seamless for the veteran. Especially in a place like montana where you have a very rural areas. You have rural care.
▶ 1:27:46Sen. Hirono: You have community providers want to dissipate in the program. We have made it difficult. The goal of this program is to make this program operate. Maybe every provider you talk to is a medicare provider. They treat medicare patients. It already looks like medicare.
▶ 1:28:16Sen. Hirono: But it doesn't operate like that. It makes it very easy for provider to do business with us. That allows the veteran to go down the street is to make this seamless. In things like measuring quality. We spent a lot of time talking about that. Our industry standards.
▶ 1:28:50Sen. Hirono: >> a follow-up to any of you who want to carry -- who care to jump in, no one is perfect but they have active duty members who have health care systems that is seamless. They will tell you it is pretty seamless. It is frustrating.
▶ 1:29:26Sen. Hirono: How come one can be so easy? Let's not reinvent the wheel if we do not have to. Let's just use some that work already. Thank you. >> thank you. I now recognize the ranking member.
▶ 1:29:56Sen. Hirono: >> just a couple of quick questions. I think you told the committee staff that the v.a. Uses $6 billion and supplement funding last year to handle payouts and expenditures for the deferred resignation program. An early retirement. I think that v.a.
▶ 1:30:21Sen. Hirono: Now says that none of these funds were spent on that program. >> I did not say that to staff.
▶ 1:30:48Sen. Hirono: Of the 6 billion supplemental appropriations, 5.8 billion was used to purchase community care services. In 200 million of it was used to purchase medical.
▶ 1:30:56Sen. Blumenthal: So the vast bulk of it was spent on community care? >> yes, senator.
▶ 1:31:04Sen. Blumenthal: Does your office have the access it needs to all of the information that you need to make proper evaluation of community care? >> we have had no issues getting that information to support our audits.
▶ 1:31:32Sen. Blumenthal: We have had challenges getting necessary information from the providers directly. In regard to eliminating that.
▶ 1:31:41Sen. Blumenthal: You need more information from the providers? >> correct.
▶ 1:31:46Sen. Blumenthal: Thank you. >> do you intend to have a provision as you just described to make sure they do that? >> we do.
▶ 1:32:00Sen. Moran: Thank you. You've talked a lot about measures of quality. In the absence of measures of quality. Is there a standard way, how do you define the criteria for determining quality of care? How do you measure that? >> thank you.
▶ 1:32:27Sen. Moran: In a managed care setting, quality of care is measured differently than in a direct care setting. It is equally important. In our setting, we are not handing over lives. We maintain the responsibility for the veterans.
▶ 1:32:52Sen. Moran: The veterans outcome measurements, their quality metrics, that measures internal quality and external care quality. Whether that is cancer treatment or cardiovascular or diabetes. The outcomes are what we want to reach for. What we are measuring. That would be indicative of both direct and external care.
▶ 1:33:20Sen. Moran: The outcomes or whether prison got better? If they recovered? >> exactly. They are direct outcomes from their disease pathway. Also an external care there are national quality metrics, inpatient hospitalizations. Hospital acquired infections.
▶ 1:33:50Sen. Moran: National metrics that we can pull systematically that we will require them to pull that. When you get down to direct providers like primary care providers, it does get more difficult. That is where you need to rely on the outcome of the veterans disease process. That is ultimately the measure of quality of care, did the patients get better? Did the care work?
▶ 1:34:18Sen. Moran: All of that is what is really exciting about what we are building. That will be wrapped into the next generation and we do not have that now. We don't have the capabilities to measure that.
▶ 1:34:28Sen. Moran: What you're really saying is we have never had that. Since the mission act or maybe since choice. The ability to compare has not existed. But maybe that quality measure has not been present. >> they have a very robust quality metric system. I can't speak to it personally but there are people who can and it is very robust for veteran outcomes.
▶ 1:34:56Sen. Moran: That is indicative of direct and community care because they are getting both. If the outcomes are good, that is measuring both. What is new in our current legacy contracts, we do not require that they measure quality. We have put that into our next-generation contracts. That is something we will be able to hold them accountable for.
▶ 1:35:24Sen. Moran: A current existing contract has an expiration date. Is there a plan for when you want to replace them? That they will be available to people at the correct time? >> yes, sir. There is rolling termination of the contracts. They don't all in one time.
▶ 1:35:50Sen. Moran: The first contract will end at the end of this year and we will have to work with them to make sure we bridge those and have plans in place so by the time the next generation of contracts are in place, there is seamless coverage.
▶ 1:36:04Sen. Moran: No one has raised to the topic of dental care. I believe that is becoming a new opportunity within the contract. Would you explain that to the committee? >> in the current state, we have pulled dental out. This is a specialty service.
▶ 1:36:32Sen. Moran: We feel that one national contract for dental will help us build a more robust network. That will help us with those situations. So there will be a national dental contract.
▶ 1:36:50Sen. Moran: Does this cover a wide gamut of dental care? >> it does. I will have to phone a friend on that. I cannot speak to all of the dental coverage is. But it is robust to services.
▶ 1:37:04Sen. Moran: One of my legislative priorities is adoption of the access act. Particularly for veterans with mental health. I want to express my appreciation for the feedback you have provided.
▶ 1:37:38Sen. Moran: It passed this committee last year. The ranking member and I are working to reach an agreement on how to get it passed in the senate. Does the v.a. Continue to support that? >> the access act was the first firefight I was dropped into after being confirmed.
▶ 1:38:07Sen. Moran: I had a chance to work with your staff. Everybody supports the goals of increased access for veterans. When we came and there were issues and how would we do this? How would we pay it? How do we operationalize it? This is absolutely the type of thing we should be working on.
▶ 1:38:37Sen. Moran: Paying for requires and how we will do that. What are the tools that the v.a. Needs to operationalize this? What we have laid it on to the types of regional opportunities. Those are the tools and capabilities built in.
▶ 1:39:15Sen. Moran: We have the ability and the contract. They stand ready to implement that.
▶ 1:39:20Sen. Moran: They are compatible? >> yes, sir.
▶ 1:39:24Sen. Blumenthal: Is there a lot of variation among the contracts that you have with individual suppliers? At present? >> there is great variation. We hold the contracts with the payment of vendors. Our payment vendors hold the contracts with the individual's health care providers.
▶ 1:39:59Sen. Blumenthal: Some of those variations are good things some of that is because we have different systems. They are very hard to administer. They have networks in an area that may not have a provider. But they may be able to improve the quality of care.
▶ 1:40:30Sen. Blumenthal: That is the intent. That is behind this.
▶ 1:40:34Sen. Blumenthal: The next generation of contracts will have some variation as well? >> variation is not a bad thing. Variation adopted to the needs of the veterans. Where we have clinics. Where we do not. Variation is not necessarily a bad thing.
▶ 1:40:57Sen. Blumenthal: Having a program like to be flexible and do different things , that is the ability we have in that contract. But we do not have an v.a. Community care.
▶ 1:41:08Sen. Blumenthal: The variation may be to accommodate specific needs in different communities. But the standards should be uncompromising. >> the standards should be the same and the goals should be the same. The goal is the highest quality of care for veterans at the lowest costs.
▶ 1:41:29Sen. Blumenthal: And the oversight should be as rigorous forward contracts all over the country.
▶ 1:41:37Sen. Blumenthal: We are committed to building those so it operates a contract of this size and complexity. >> thank you. That conversation ended up where I like it. The standard of care would be the same whether it is directed care or community care. >> yes, sir.
▶ 1:42:06Sen. Moran: Is there anything that any of you would like to say that you have not had the opportunity to say? >> we are delighted to have the opportunity to come in and talk about this program. Thank you.
▶ 1:42:21Sen. Moran: We are pleased that you are here. I think this is another in a series of hearings we have had that have been very beneficial to the committee. Senators who would like to submit questions for today's witnesses for additional statements to the record have one week to do so. We request a witnesses to respond to any questions for the record received in a timely manner.
▶ 1:42:48Sen. Moran: Please remind the department that we are still awaiting responses to previously asked questions. With that, the hearing is adjourned.