When the scandal erupted last year over long wait lists at the Phoenix VA, Alaska was found to have quite short wait times. The Alaska VA has for years been buying care for veterans outside the VA, at community and private-sector clinics, and especially through the Native health care system. The concept is dubbed “Care Closer to Home.” That’s the model Congress chose when it passed the Veterans Choice Act last year, aimed at solving the backlog for VA services in the Lower 48. But as the new Choice program spreads across the country and takes hold in Alaska, vets and providers say it’s undoing parts of the Alaska-grown system that have worked well.
Damita Duplantis is an Air Force vet and has back pain. She didn’t know about the Choice program until she got a call from the office of the neurosurgeon she hoped would operate on her back.
“And they called and told me that they had to cancel my appointment, because the VA was doing some kind of new funding thing and they were not accepting that type of funding that the VA was changing over to,” she says.
So Duplantis called the VA. She eventually learned that for an appointment outside the VA, now she has to go through something called the Veterans Choice program. In Alaska and 27 other states, Choice is administered by a company called TriWest. DuPlantis says she probably spent five hours on the phone, bouncing between TriWest and the VA.
“The thing that frustrated me, is one, my appointment is being canceled, I’m in pain,” she said. “And two, they changed over to this new program and didn’t even tell the veterans what they were doing.”
Alaska’s congressional delegation has received dozens of calls from angry veterans. Vets say clinics they’d been going to aren’t accepting Choice, and that appointments elsewhere are hard or impossible to get. They tell of long hold times to reach TriWest call centers, emails that get no response and broken links on VA websites.
Sen. Lisa Murkowski was furious when she learned of the changes in late May.
“This is a threat to a collaborative effort that has been built over a period of years that has been very beneficial to our veterans,” she said earlier this month.
She fired off a four-alarm letter to the VA secretary. Congressman Don Young sent his own this week, and Sen. Dan Sullivan called for a congressional hearing. By late this week, the VA relented, in part: They’ve restored funds for non-Native veterans to get care at Native hospitals and clinics.
Andy Teuber, president of the Alaska Native Tribal Health Consortium, says last year, some 1400 Alaska vets used their VA benefits to get care at Native health facilities, and most of those vets were non-Natives. The VA reimbursement came to nearly $6 million, a small part of the $100 million or so the Alaska VA spends each year to purchase care outside the VA system.
Before the VA restored money for tribal providers this week, Teuber said he didn’t see the utility of TriWest, the contractor for the Choice program. By inserting a private company in the administration of VA care, Teuber says, you add a middleman that needs to make a profit.
“And it’s a wasteful layer of bureaucracy that effectively rations care of the veterans here in Alaska,” he said.
Hal Blair, deputy program manager at TriWest, says the company provides an important service, or the VA wouldn’t have asked the contractor to take on the Choice Program for much of the country, and on short notice.
“We had basically 30 days, with our VA partners, to go from a blank sheet of paper to having contact centers that could respond to the Choice requirements,” he said.
Blair says TriWest is working hard to sign up more providers in Alaska. Thanks to a special amendment to the Choice Act, they can now pay Alaska providers above the Medicare rate. Blair and VA officials say that should help.
Saving the government money is a big part of the mission at TriWest, Blair says.
“We like to think of ourselves as taxpayers first and businessmen second,” he says.
But contracts like this are expensive to administer, especially, he says, in their initial phases. A recent VA Inspector General’s report found that, for a related contract TriWest has with the VA, the government paid TriWest $8.4 million last year to buy $2.3 million worth of medical care for veterans.
Blair says he hadn’t seen the IG report, but he says TriWest’s value will become clear once more veterans sign up.
In Alaska, the new Choice program is baffling for some vets not well situated to cope with it. Jesse Gotschall, of Anchorage, was a truck driver in the Army. He served in both Iraq and Aghanistan.
“I have back problems, right? And I need help with it,” he says.
He says accupuncture and chiropractic care help him stand up straight so he can work. He also has PTSD, and trouble remembering things. It was hard enough for him to learn how to use the VA system before the rules changed. Now, he says, he feels like he’s trying to play chess on a Scrabble board.
“I honestly don’t know. And like, that’s part of the problem,” he said. “I try to figure this stuff out and I don’t know where to call, and you try to talk to someone and (you’re told) ‘you gotta do this, you gotta do that.’”
He’s beyond frustrated. He says sometimes he feels like giving up on the mortgage he’s trying to pay and leaving the country. One person who has helped him was his acupuncturist, Valerie DeLaune. He says she explained the VA programs to him, and also encouraged him to get treatment for his PTSD. Gottschall, though, will soon have to find treatment somewhere else. DeLaune was a TriWest provider, but says she dropped out due to a messy accounting dispute with the company.
The Alaska VA director says they’re planning a big campaign to explain the Choice program to veterans.