Purchasing Community-Based Care for Veterans: Lessons from the Department of Defense TRICARE Program : Institute for Defense Analyses , January , 2017
Institute for Defense Analyses
From the document: "The Department of Veterans Affairs (VA) operates one of the largest healthcare delivery systems in the world. Organized around a large network of VA hospitals and clinics, the VA system relies almost exclusively on care it produces itself. A variety of factors, however, have placed the VA at the beginning of what will likely be a long-term fundamental transformation of its delivery structure away from its “brick-and-mortar” foundation towards a system that is more integrated with (and reliant upon) community-based—i.e., private sector—healthcare. Although there are many differences, the changes beginning to occur in the VA healthcare system share similarities with the transformation the Department of Defense (DoD) healthcare system undertook in the 1990s. This paper draws on the DoD experience to provide a set of principles that should guide the VA in its transformation. The paper further provides a range of options that the VA could consider that are informed by lessons from DoD (and other large federal programs purchasing healthcare). DoD did many things well in its transition, but several large decisions that seemed appropriate to DoD at the time have ultimately caused significant challenges that DoD is now struggling to fix. By learning from and avoiding these pitfalls now, the VA’s transformation offers a powerful opportunity to improve access and health outcomes for veterans while controlling cost."