Mental-health care solutions for veterans

Republican presidential nominee Mitt Romney has proposed opening military Tricare networks of civilian health care providers to veterans who can’t get timely mental health care from the Department of Veterans Affairs.

Tricare networks currently exist to provide health care to military personnel and retirees, their families and survivors.

Two days after Romney’s pledge, President Barack Obama signed an executive order with several new initiatives to improve access to mental health care services for veterans, service members and their families.

One directs the VA and the Department of Health and Human Services to establish at least 15 pilot programs involving community-based health providers to expand mental health services in areas not well served by the VA. Another establishes an interagency task force on military and veterans’ mental health co-chaired by the VA, Defense Department and HHS.

Not mentioned is an initiative to allow the VA to refer veterans in need of immediate mental health care to Tricare network. But Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, said the Romney idea has real merit. The former Massachusetts governor unveiled it in a speech recently to the American Legion conference in Indianapolis.

Miller, in an interview, suggested Romney’s notion is a reasonable step on a path Miller wants to travel — giving veterans more access to private sector health care, at VA expense, rather forcing them to commute long distances to a VA facility or to endure long delays to get a VA appointment.

Romney’s idea, Miller said, would swiftly address the VA’s shortage of mental health care providers — to treat post-traumatic stress and traumatic brain injury and the epidemic of suicides among veterans — by immediately doubling the number of available mental health care providers.

The VA in April announced plans to hire 1,600 more mental health care providers and 300 support staff. But Miller is skeptical that the VA can do so in a timely way, given that it already had 1500 vacancies for mental health providers when it announced the new hiring effort.

“If you can’t fill those 1,500,” Miller said from his Florida district Thursday, “it’s hard to imagine that the VA would be able to double that number and be able to hire them any quicker. Their hiring process is more than cumbersome. It takes a tremendous amount of time … and in many cases, (applicants) are being lost to the private sector because they just can’t wait for the VA to make a decision.”

The VA already has authority to refer patients to civilian providers when they can’t get timely care inside the VA. But it has used this authority sparingly to hold down costs.

Some veterans’ service organizations worry that forcing the VA to spend a larger share of its budget on care delivered by private sector physicians will drive up costs and, over time, leave the VA without enough operating dollars or patients to sustain a full service, high quality health system.

“It costs VA more money to act as an insurer (than as) a provider,” said Joseph Violante, legislative director for Disabled American Veterans. “VA has the authority to use contract care when needed. Unfortunately, they rarely believe it’s necessary. They need to find a balance that won’t force VA to ration care to those using the system.”

Miller knows why some veterans groups oppose pulling more patients out of the VA health system to get VA-funded care elsewhere. But with the number of veterans needing care, and the shortage of VA providers, Miller said, he hopes veterans groups are more willing now to consider expansion of health care options.

With Tricare networks, he added, fee discounts have already been negotiated with providers. Also many veterans know and trust Tricare networks from their years in service.

“Obviously, under Gov. Romney’s proposal, the veteran would go to VA first,” he added. Only if the VA could not provide timely care, would the patient be referred to Tricare.

“We’ve got veterans waiting 50 to 60 days to see a doctor in regards to their mental health and well being and that clearly is not working,” Miller said. As veterans reach out, he added, “they need the help then, not down the road.”

Miller predicted that the three companies responsible for running provider networks for Tricare in its separate North, South and West regions would “seamlessly transition” into providing care to veterans.

Officials at Tricare headquarters had no immediate comment.

Retired Rear Adm. Thomas Carrato, president of Health Net Federal Services, Tricare’s support contractor for its 23-state North Region, said the North Region, with more than 50,000 behavioral-health care providers, is ready to care for more veterans who can’t otherwise get timely care.

He noted that Health Net has had a separate support contract for the Military Family Life Counseling Program, resulting in a network of more than 5,200 licensed counselors “who have been carefully selected, are fully trained, and ready to deploy on short notice as needed.”

To address VA’s “dramatically increasing need for veterans health care, particularly behavioral health care,” Carrato suggested a multi-prong approach. One would be for VA to acquire “standby capacity to address urgent, short-term demand” at VA medical centers and outpatient clinic, similar to the model the Department of Defense has used with Health Net to provide rapid deployment of behavioral health resources to military units during deployment or on return of deployed units.

A second prong would be a network of community-based providers to augment VA capacity and deliver care to veterans who do not live near a VA medical center or clinic. “Since this capacity already exists, providers could be made available for service relatively quickly,” Carrato said.

Violante worries that as VA dollars are shifted to pay Tricare physicians or other private sector providers, overall VA budgets won’t expand to keep pace. Instead, funds to operate the VA health care system will fall.

“It will be another vicious cycle of costing more for care, and of Congress telling us they won’t be able to give us as much money as they have been,” he predicted.

To comment, write Military Update, P.O. Box 231111, Centreville, VA, or send email to

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