By Rear Admiral Ken Carodine, USN(Ret.) – This post has been reprinted with permission from the author.

Since its official inception in 1930, the Department of Veteran’s Affairs or Veterans Administration (VA) has struggled to keep up with servicing America’s Veterans. World War II, Vietnam, and Korea created their own challenges to the organization’s ability to provide services. However, the Global War on Terror has caused almost overwhelming surges in the number of Veterans requiring health assistance as well as those seeking educational and other benefits offered by a country grateful for their service. 2014’s scandal that culminated in the VA Secretary’s resignation serves as the most recent major outing of VA failures to consistently provide quality healthcare to its Veterans. This article asserts that the organization is not operating nor is it structured for finding and maintaining on-going success in the new millennium.

With almost four hundred thousand employees distributed across the United States and its territories, VA stands as the Nation’s second largest governmental organization. The Department has three main subdivisions, known as Administrations, each headed by an Undersecretary:

  • Veterans Health Administration (VHA): responsible for providing health care in all its forms, as well as for biomedical research, Community Based Outpatient Clinics and Regional Medical Centers
  • Veterans Benefits Administration (VBA): responsible for initial Veteran registration, eligibility determination, Home Loan Guarantee, Insurance, Vocational Rehabilitation and Employment, Education (GI Bill), and Compensation & Pension
  • National Cemetery Administration (NCA): responsible for providing burial and memorial benefits, as well as for maintenance of VA cemeteries

In the FY 2019 Budget, President Trump proposes a total of $198.6 billion for the Department of Veterans Affairs. This request, an increase of $12.1 billion over 2018, is designed to ensure the Nation’s Veterans receive high-quality health care and timely access to benefits and services. The 2020 AA request includes $79.1 billion in discretionary funding for Medical Care including collections and $121.3 billion in mandatory funding for Veterans benefits programs.

Veterans Administration reports there are 18.8 million veterans currently living in the United States, and that they serve 9 million of them each year. At the time of this writing, it was not possible to determine how many Veterans were serviced at their 1,065 outpatient sites and 170 VA Medical Centers. Presumably, VA services the remaining 9.8 million Vets through contracted private sector resources. No information could be found amplifying this area, as well. If these numbers are correct, the US is spending $196.B to service vets at a cost between $10, 425 and $21,777 per Veteran per Year. Either way, these numbers are troubling because even with the use of VA-owned facilities and private sector resources, the Veteran population remains underserved.

Further, Veterans need a “Continuum of Care” patient care model where the system guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity. The current VA healthcare delivery system falls short in this area. Unnecessary tests are often performed because the VA does not accept military health care records for use in designing care and addressing issues encountered while Veterans were on active duty. Rather, the VHA only uses military records to determine eligibility through their disability rating system.

The VHA does not operate as a “Best Practices” system. They do not systematically benchmark medical treatment by diagnosis. Benchmarking leads to better care, better outcomes and improved efficiency (i.e., saving money). Private sector healthcare systems began benchmarking care over 20 years ago. Medicare’s payment system was modified in the 1980’s to reflect analyses of care data and they transitioned to using Diagnosis Related Groupings (DRGs). Data continues to drive the system and is used by private insurers as well to effect improvements in the healthcare delivery to patients, simultaneously improving lives and money.

The US Department of Health and Human Services runs the Agency for Healthcare Research and Quality. AHRQ runs a metrics system that measures the quality of service of 656 healthcare systems. VA is not one of them. Why? Further, in 2016 the VA quietly stopped sharing data on the quality of care at its facilities with a national database for consumers, despite a 2014 law requiring the agency to report more comprehensive statistics to the site so veterans can make informed decisions about where to seek care. Rather than take part in public and benchmarked rating systems, VA uses its own platform, Strategic Analytics for Improvement and Learning (SAIL). The biggest issue with SAIL is that it does not show key metrics by facility over time. Rather, it shows a vague chart of “Star” ratings by facility and whether, in the VA’s opinion, it improved, stayed the same or declined. To truly report how well the Agency serves Vets, they must institute transparency and benchmarking against other healthcare systems.

SAIL is designed to include actionable metrics that are important to assess healthcare delivery and quality. However, many of these metrics are not publicly reported. But many are the same as public hospitals and care systems. How do those compare? Therefore, it is not possible to directly compare evaluation findings derived from SAIL with other systems published by public and private sectors. Instead, SAIL is developed for the VA to drive internal system-wide improvement.

Because of metrics and issues like the ones cited above, growing choruses of voices are shouting for the privatization of the agency, specifically the Veterans Health Administration. Proponents cite the fiscal gains and agency’s overall failure to effectively and efficiently utilize its resources. Opponents cite concerns over the private sector’s failure to provide adequate access to quality healthcare and its inability to deal with the mental issues caused by battlefield experiences.

Perhaps the best path ahead is an expanded public-private partnership with Government oversight.

A New Way Ahead

As stated above, VA’s three main organizations are managed from its headquarters in Washington. Examining each organization to determine how much of their function can be “contracted out,” and managed by Headquarters as a “program” with Government oversight constitutes a new and untried approach to managing the agency….

Read the full post here.

Ken is an Executive Leader who lives at the intersection of business and technology; futures and actionable goals; and engaging with people and accountable decision-making. He understands complex situations quickly and sees the world as multiple interconnected systems. As a Navy Reserve Admiral, Ken successfully managed two demanding careers and is a combat veteran, Operation Desert Storm. Today Ken serves as an Ab Initio Technology Evangelist advising senior information technology leaders in the use of Ab Initio’s Data Management and Data Integration product suite.



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