In just a few weeks, the Department of Veterans Affairs will begin implementing one of the largest overhauls in the history of the VA. The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act goes into effect on June 6th, and is intended to modernize veteran healthcare as a wave of younger vets are beginning to access services.
So, what does this mean for Alaska?
In practical terms, lot of the biggest changes ahead for VA care don’t actually matter in Alaska. That’s because the state was in a lot of ways the model for the system that the MISSION Act tries to streamline across the country. Under the act, veterans will have faster, more flexible access to healthcare services that aren’t available at VA facilities, according to VA Secretary Robert Wilkie.
“Alaska has probably the most comprehensive support system for veterans of any state in the country,” Wilkie said Wednesday during a phone interview. “For the rest of the county, it means that if VA cannot provide you a service, then we will help you get that service in the private sector.”
In the last decade, Alaska has been a testing ground for getting veterans healthcare at outside providers when the VA couldn’t — whether that was because rural veterans lived far away, or because facilities lacked certain services. To do that, the VA has essentially outsourced healthcare to private providers, the Indian Health Service, and the Defense Department, then reimbursed the costs.
Critics have said this approach amounts to gradually privatizing the VA. But Wilkie disputes that characterization. He pointed to the $220 billion budget he requested this year, and the workforce of 390,000 it pays for as evidence the institution’s public financing is not going away.
“That’s a very strange way of going about privatizing this institution,” Wilkie said.
One of the major changes ahead for Alaskans will be increasing financial support to family caregivers of veterans from the Vietnam War era.
As part of its push to modernize, the VA is gradually moving towards an electronic health records system that it is planning to test in Alaska over the next few years. The new system means service records will all be in one place and accessible to private providers for a more comprehensive picture of an individual’s health. That’s part of the VA’s effort to better serve younger veterans, who are quickly becoming a larger share of the institutions patients.
“For the first time since the end of the Vietnam War, more than half of our veterans are under the age of 65,” Wilkie said.
Meeting the healthcare needs of that younger population has entailed overhauling the VA’s website, changing how appointments are scheduled and offering different services. One structural shift is the increasing number of female veterans accessing care.
“Ten percent of the veterans we treat are women, and last year we spent about $9 billion on women’s health,” Wilkie said. “I believe that will go up.”
That has meant specialists like gynecologists are in short supply within the VA. Another example is pain: after years of criticism about the over-prescribing of highly addictive opioids, VA has dramatically reduced its use of narcotic pain meds, according to Wilkie. The organization is trying to guide pain management away from pills and toward alternative therapies.
Wilkie pointed to his own family as an example of how the military’s culture makes some of those changes difficult. His father was a paratrooper who spent decades in the Army, causing him tremendous physical pain for much of his life. Wilkie said that if he’d offered to treat his father with “tai chi and acupuncture and yoga, my nose would have been flat against my face. Because that was not part of the ethos.”
But that is exactly what VA is hoping to do more of. Whether it’s gynecologists, acupuncturists or rheumatologists, the MISSION Act’s aim is to get veterans a wider range of care more quickly.
The VA also remains focused on veteran suicide and traumatic brain injuries, issues that Wilkie believes the healthcare system is only beginning to grasp.