MTPR

Billings Clinic Explains Why It’s Cautious On VA Mission Act Rollout

Jun 6, 2019

The federal government’s big, new effort to allow veterans to use their VA health benefits to pay for healthcare from private doctors, clinics and hospitals launched Thursday. But the last effort went so badly in Montana that many are worried that the private sector won’t want to participate. That doesn’t appear to be happening, but the whole deal is still very much in pencil here.

Six weeks ago, in Senate committee room in Washington, DC, the Secretary of Veterans Affairs was testifying about the rollout of the new private sector care program, called the Mission Act, and efforts to recruit healthcare providers to it. Montana Sen. Jon Tester told him he was worried.

"The largest health provider in Montana is not signing up, and it’s a problem."

That provider is Billings Clinic.

Fast forward to June 6, and Tester, talking to reporters outside Ft. Harrison in Helena, said he now thinks it’s not a problem.

"As long as they’ll take veterans, that’s the issue. If they weren’t taking veterans I would be very, very worried, but they’re taking veterans, we need to get them in the network."

Billings Clinic in Billings, MT.
Credit Courtesy Billings Clinic

It sounds like a disconnect: Billings Clinic, one of Montana’s biggest hospitals, is not in the network to serve veterans under the Mission Act, but they are serving veterans using Mission Act benefits.

Billings Clinic executive JJ Carmody says that while it’s true they haven’t signed a contract to be part of the Mission Act network, there actually is no disconnect.

"We are definitely actively seeing veterans."

Carmody says that to her knowledge, Billings Clinic has never turned a veteran away, and that they never want to. But, like a lot of other healthcare providers in Montana and across the country, Billings Clinic got burned by the VA’s last attempt help vets get private sector care, which was called Veterans Choice.

"There were payment delays and payment problems with the Choice program. However there were also problems in just getting care approved and the referrals made. So I think our biggest frustration beyond the payment problem -- because we can always deal with those on our end -- was the actual impact on the veterans getting their care approved or getting that continuity of care."

Those problems were with a third party that stood between hospitals and the VA, called a “third party administrator,” or “TPA.” A TPA’s job is to set up a network of doctors, clinics and hospitals that will accept VA payments, and then process those payments. The private sector uses TPAs too, to run networks for private insurance companies

The problem with the Veterans Choice Act of 2014 was that when Congress passed it, it demanded that it be launched in 90 days, and no TPAs bid for the contract to do it, saying 90 days wasn’t enough time. The VA managed to get a couple of companies to do it, and the one responsible for the region Montana was in, called HealthNet, made both health care providers and veterans very unhappy. The system it set up to help vets get care faster actually ended up being slower.

So Billings Clinic’s Carmody says they want to be cautious, especially since all the rules for the Mission Act itself are still not final.

"So it’s kind of like signing on with an unknown entity. We would rather wait and see what happens with the final rules for the Mission Act."

Also not yet final is which company is going to be the TPA for Montana. Right now one called TriWest is doing the work on a temporary basis, and it’s been busy signing up doctors, hospitals and clinics to be part of the new Mission Act network.

Billings Clinic has an arrangement directly with the VA to take vets under the Mission Act.

Sen. Jon Tester meets with Veterans Administration officials at Ft Harrison in Helena, June 6, 2019.
Credit Courtesy Sen. Tester

Following a meeting with VA officials from Washington, D.C. at Ft Harrison on Thursday, Sen. Tester, who wrote the Mission Act, said that at this point, network appears to big enough in Montana to serve veterans here well.

Overall says it’s going to take some time to see if the Mission Act works as intended, and that he expects a few hiccups along the way.

"I think the people are gonna kick the tires, and I think that there’ll be a surge. Look, the VA is the biggest health care system in the country and they provide incredibly good quality care. I think there’ll be some veterans that go out and try to get access to community care. If it works for them they’ll stay there, if it doesn’t work they’ll come back to the VA."