Is to see to it that veterans get world cap worldclass health care and they get it in a timely way. However we do that the important thing is to get it done. We had some bumps i have met with some of our private contractors and i appreciate those meetings and their confidence in the job that they can do. They may not have been cooperating before. See to it that the two are working seamlessly and if they cant, they will never work. You have to understand their contracts are not just subject to their performance for the veterans but their willingness to work cooperatively. There are some who do not like the nonhealth care v. A. Provisions anyway. They will have to get used to it. We will make this thing work and we will not put a square peg in a round hole. Today, the hearing is important to your report from the v. A. And contractors and later from the v is so vsos they risked their lives for each and everyone of us to be here today we can expect no less at the get the best health care. I will turn it to the Ranking Member senator blumenthal. Thank you, mr. Chairman. Thank you for having this hearing. We went through a terrible tragedy and debacle not long ago that prompted the veterans access choice and accountability act which sought to relieve some of the problems and underlying issues, including deceit and fraud that caused delays and misreporting within the va system. The discussion today is centered on the remaining flaws and failings in the va healthcare program, particularly the veterans Choice Program. And as much as this program was established to deal with the immediate crisis of access to care in the short term with an investment of 10 billion to 10 billion to provide direct Care Services in the community and 5 billion to provide a Choice Program, there is still a lot to be done the program was just a down payment, just a 1st step. I believe that it has to be improved even further. There remains underutilization of the Choice Program. The underutilization may well be the result of the failure to sufficiently publicize or make aware veterans. It may it may be the result of other more fundamental issues within the program, and i share the chairmans view that changing the 40mile rule was certainly a welcome step. The most important fact that brings us here today that we cannot lose sight of is, we still have not solved the crisis that led to this Program Veterans still way too long for appointments, healthcare delayed in effect is healthcare denied for veterans who suffer from healthcare conditions that require immediate treatment. The va most recent data as of may 1 1st indicates weightless numbers have increased significantly since the same time last month. As of april 2 300,000 veterans 2nd 300,000 veterans had appointment scheduled more than 30 days from the preferred date. As of the may 1 release that number jumped to nearly 434,000. Anyone believes this crisis has resolved is living in an alternate universe. It is not the universe that our veterans and have it. Reallife consequences that cannot be tolerated. Too many veterans are waiting too long for appointments and i am glad that the va is finally going out to facilities with long wait times trying to determine why exactly they are not utilizing non va care options. I notice a lot of the testimony today talked about further changes to geographic criteria. Every time there is an additional change more of the 10 billion allocated will be devoted to paying for access but this money is due to our veterans because better healthcare is due to them. I we will i will close on this note we still do not have accountability. The Inspector General has not completed his work. We have no reports on disciplinary action for delays that or intolerable and still are unacceptable. Accountability is absolutely necessary, and i believe the Inspector General needs more resources to effectively implement accountability. I will continue to press reports and for action by the Inspector General that will send a message to the healthcare apparatus and professionals that we mean what we say when accountability is our launch word. Thank you, mr. Chairman. Thank you, senator blumenthal. Our 1st panel is made up of the following individuals. Sloan gibson. I want to thank him for his willingness to take on tough situations. I appreciate the fact he is approaching it in a positive way. I hope you will maintain that attitude. To reiterate secretary mcdonald and undersecretary gibson invited the Ranking Member and myself for what they call a standup which we did in february and have been invited to come back in june. As many members as want to come i will make sure they are invited. Benchmark itself against itself to try to find better ways to do things to flesh out problems in advance and get themselves earlier. We have big problems to solve. We appreciate you being here to assist. I am sure that everyone appreciate you being here. Providers, mr. Mcintyre, i enjoyed our meeting earlier this week. I appreciate your being here today. Thank you, mr. Chairman. Chairman, Ranking Member members of the community, we are committed to making the program work and provide veterans timely and geographically accessible quality care using care in the community whenever necessary. I we will talk i will talk shortly about what were doing and the help we need to make it happen. First i want to talk about access to care. Most mornings at 9 00 a. M. For the last years Senior Leaders from across the department gather to focus on improving veterans access to care. We concentrate on we concentrate on key drivers of access including increasing Medical Center staffing by 11,000, adding space, boosting care during extended hours and weekends and increasing staff productivity. The result, 2. 5 million more completed appointments inside the va this year than last. Of relative value units to make common measure of care used to measure care delivered across the industry is also up 9 percent. Another another focus area and improving access has been increasingly use of care in the committee. Va issued 2. 1 million which resulted in more than 16 million appointments completed. Here today authorizations are up 44 percent which will result in millions of additional appointments for Community Care. Veterans are responding to this improved access. Among those enrolled more are using va for care, and those using va are increasing their reliance. This is especially the case where we have been investing most heavily. In phoenix we have invested hundreds of additional staff i should note that we have increased care in the committee 127 percent in phoenix over the last year, largely due to the extraordinary effort of tri west in a particular community. Wait times are not down. The surge and in addition to five the surgeon additional veterans coming in those there asking for more care. In las vegas we have a 17 percent increase in veterans receiving care. In denver we have opened Outpatient Clinics and that it more than 500 additional staff. Veterans are using va for care there up 9 percent. In North Carolina were wait times continue to be a problem we have increased appointments 13 percent to my relative value units up 19 percent command veterans using va for care up 10 percent. In all these locations we have had dramatic increases in care for the committee. The primary reason for increasing demand, increases in the number of medical conditions and a rise in the degree of disability and improving access to care. Community care is critical for improving access. We use it and have for years and programs other than choice. We spent approximately 7. 9 billion on committee care other than choice. In 2014 that row state and a half billion command reestimate at the current rate of growth va will spend 9. 9 billion. At the same time we have had a large increase. It has not worked as intended. Here are some things we are doing to fix it. We changed the measure using the fastest route. Roughly doubles the number of veterans eligible. There is much more to do. Follow on mailing will go out. We Just Launched a major change to make choice the default option for care. Additional additional staff training and communication to make sense of provider communication, improvement improvement to the website and ramped up social networking, knew mechanisms to gather feedback from veterans as well as frontline staff. These are all in place or are about to launch. In the longterm we must rationalize Community Care into a single channel. The different programs with different rules and reimbursement rates, methods of payment and funding routes are too complicated, too complicated for veterans, providers, and for employees who coordinate care. We will need your help. Let me touch on the other issue. We have completed and that indepth analysis to provide choice to all veterans more than 40 miles from where they can get the care that they need. We have sure that analysis. It confirms the extraordinary costs that have been estimated previously. We have briefed the staff on a broad range of other options and believe there are one or more worthy of discussion and careful consideration. While we are working together on an intermediate Term Solution we are requesting greater flexibility to expand hardship criteria and choice beyond geographic barriers. This would allow us to mitigate the impact of distance and hardship. We request greater flexibility around requirements that preclude us from using choice for services such as obstetrics, dentistry command longterm care. As described above, we accelerated access to care in the committee anticipating that a substantial portion would be funded through choice. For various reasons for various reasons most touched on previously we will be unable to sustain that pace without greater Program Flexibility and flexibility to utilize at least some portion of Program Funds to cover the cost of care in the committee. We are requesting some measure of funding flexibility to support this care. On may 1 the va sent a legislative proposal. We request your support. Lastly, we are requesting flexibility in one other area, hepatitis c treatment. You are familiar with the miraculous impact of this new generation of drugs, veterans that have been have see positive for years now have a cure within reach with minimal side effects. There is no funding provided in our 2015 budget request or appropriation. Remove 688 billion from care in the community anticipating the shift in cost to choice to Fund Treatment for veterans with these new drugs. Was the right thing to do, but it was not enough. We are requesting flexibility to use a limited amount of dollars to make this available to veterans between now and the end of the fiscal year. So we are improving access to care. Now a standing airport of great times the we still have work to do, but we are improving access to care. Were committed to making choice work. We need help, especially additional flexibility to allow us to make the healthcare needs of our veterans met. We look forward to your questions. Mr. Chairman, Ranking Member, members of the community, i am grateful for the opportunity to appear before you on behalf of our companys employees and its nonprofit owners to discuss the work which we are privileged to do in support of the department of Veterans Affairs. I would like to focus my testimony on three topics, the reality of this programs implementation, process of identifying and resolving gaps and those which remain to be solved, and what i believe to be the art of the possible. As you know and as secretary gibson has said, purchasing care in the community has been a lot of practice. In fact, in september of 2013 after two years of planning va sought to change that. That that contract was designed to have a consolidated integrated Delivery System built in the committee to undergird the facilities across the 28 states. Make sure at the end of the day they were not there to replace the va but supplement. It worked as intended. When the furnace went off in our hometown 6300 providers under contract Going Forward at the side of the Medical Center to assist them in eliminating the backlog. By august 14000 veterans moved through that process. Around the same time we are modification that we had primary care. We now have over a hundred thousand providers across 28 states under contract along with 4500 facilities. We are not finished. The reason why we are not it we need to make sure the networks are tailored to match demand that exists in a particular market that is not able to be met by the v. A. Facilities itself. That was a complicated program to set up, done in short order but it was training for what was to come next. On november 5, after 30 days of work, we were to stand up and in support of the v. A. Choice program, partner to receive a list of eligible veterans, design and produce a card and put it out with a personalized letter from the secretary, and stand up a Contact Center to handle all the calls coming in. After two weeks of design and hiring and training of 850 people. No one went into threehour waits. The phones were answered, but the work had only begun. We have been on a pathway since to try to secure the operation. The secretary talked about the 40 mile issue. There are additional refinements that may be needed or desired so we stand prepared to support what they might look like. There are there are other changes that may be needed to the program as we go forward. Secondly, we need to aggressively identify and resolve gaps and fix operational performance. We are in the process of doing that together. We are modernizing our i. T. Systems rolling out after memorial day after a 20 47 build. A new portal system that will serve all facilities and our own staff as we seek to move the veteran information back and forth between facilities as care is rendered downtown. We are in the process of tailoring networks to match the demand that exists in each market across our area. The Choice Program is up. It is operational. There are refinements still needed. I believe that because of the collaborative work that has been underway between all of us that are engaged in this that we are refining the pieces that need to be refined, identifying policy gaps that need to work and those things as the , secretary said, are getting attended to. I think there are a couple policy issues that remain the jurisdiction of this particular committee. One is, i would encourage you to relook at the 60 day authorization limitation that has been applied. Secondly, i respectively submit that there needs to be harmonization between the two programs and between all of the facets of how the v. A. Buys its care currently as well as how the v. A. Operates itself in engagement with us to make sure this works right. At the end of the day, i believe the art of the possible is truly within our grasp. I would like to point to dallas, texas if you permit me to do do to do so. We are under the engaged a couple of weeks ago, we sat with the director and entire staff there, including Behavioral Health, it and looked at the full demand that exists for veterans in that market. We then took out and looked at what is the network that is constructed to stand aside which is the basis on which choice runs. If there is not a network provider, you can set up an engagement with an individual provider to deliver services under choice. We then design a network map we are under the process of constructing together. Over the next 90 days, from Behavioral Health to primary care to specialty care, we will rack and stack the network to meet the demands that otherwise cannot be met by the va Medical Center in dallas. That is being repeated across our entire 28 state area and the pacific as we seek to do our part to mature the operations of choice. It is a privilege to serve in support of those who serve this country. It is an honor to serve the veterans from the states represented by half the members of this committee. Mr. Chairman, i look forward to taking questions after my colleague is finished with her remarks. Thank you. I appreciate the opportunity to testify on the health net imagination of the veterans Choice Program. Health net is proud to be one of the longestserving we are dedicated to ensuring our nations veterans have prompt access to needed healthCare Services and believe there is Great Potential to the Choice Program to help the v. A. Deliver timely, coordinated, and quality care. We were awarded a contract for three to six string regions and implemented pc 3. At the beginning of april 2014. In october, after Congress Passed and the president signed the veterans axis choice and accountability act of 2014, v. A. Amended our contract to include several parts of the Choice Program. With less than a month to implement, we hit the deck running to use a navy phrase, and we have not slowed down since. To meet the required start date of november 5, we worked closely with v. A. To develop an aggressive implementation schedule and timeline. The ambitious schedule required us to hire and train staff quickly and to reconfigure our systems for the new program. Despite this aggressive implementation schedule, on november 5, veterans started to receive their choice cards and were able to call into the Choice Program to speak directly with a Customer Service representative about their questions on the Choice Program or to request an appointment for services. Having said that, there are challenges that have resulted in veteran frustration, as well as on