The Department of Veterans Affairs has built a nationwide network of walk-in community providers for urgent care of minor ailments such as colds, strep throat or sprained ankles. It's now looking to recruit more clinics to plug gaps in coverage.
As of this week, the new urgent care system has more than 5,000 participating local providers brought on board by the TriWest Healthcare Alliance, and the VA wants 2,000 more, Dr. Kameron Matthews, the VA's deputy under secretary of Health for Community Care, said in an interview Wednesday.
She described the urgent care network as the result of one of the "lesser-known provisions" of the Mission Act, which went into effect June 6 to replace the troubled Choice program, with the intent of streamlining and expanding access for veterans to private-sector care.
"Prior to the launch of the Mission Act, VA didn't have an urgent care benefit" for treatment of ailments that don't require emergency room facilities, Matthews said.
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"We had [TriWest] build a new urgent care network for us with a lot of urgent care providers, retail clinics and other providers around the country so that veterans could access that care closer to home," she said.
Matthews acknowledged some veterans' complaints that providers in the new system are too far away for easy access in some areas, adding that the VA is looking to expand coverage.
"Urgent care, of course, is not available in all markets," she said, explaining that TriWest is currently aiming at coverage for about 90 percent of eligible veterans.
Even when the system is fully in place, "We can't guarantee that in 100% of the cases that there will be a provider available within a 30-minute drive time," one of the standards for private care eligibility under the Mission Act, Matthews said.
She stressed that the new benefit is for minor illnesses and injuries, "but if they need a higher level of care, they would be referred to an emergency room" with the cost covered by the VA.
As with most VA programs, there is an array of rules and regulations on access, eligibility and co-pays, including:
- To be eligible for urgent care, the veteran must be enrolled in VA health care and have received care through the VA within the last 24 months. Family members are ineligible.
- The urgent care provider must be part of the VA's contracted network of community health care providers, or the veteran may have to pay the full cost of care. The VA won't pay for preventive or dental services.
More information on the urgent care system, eligibility and rules can be found here.
Since the system only went into effect June 6, the verdict is still out on how well it is working.
"We've never had this benefit before so there's really nothing to compare it to," Matthews said.
Providers in the new system have made about 17,000 eligibility checks thus far, which may represent actual visits, said Matthews, a family medicine physician whose work with underserved patient populations has been recognized by the National Academy of Medicine.
"We're still tracking the data," she said, but preliminary figures indicate increases in veterans' use of VA facilities as well as private-care options.
However, that didn't stop VA Secretary Robert Wilkie from taking a victory lap in an op-ed Wednesday on the implementation of the Mission Act, formally known as the Maintaining Internal Systems and Strengthening Integrated Outside Networks Act.
He wrote, "Thanks to thousands of dedicated VA workers around the country and President Donald J. Trump's support for this historic reform, elements of the MISSION Act took effect on June 6, and veterans immediately began benefiting from the largest transformation in veterans health care since the end of World War II."
-- Richard Sisk can be reached at Richard.Sisk@Military.com.