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Co-Chair, President’s Task Force

to Improve Health Care Delivery 

for Our Nation’s Veterans

Mr. Chairman, Members of the Subcommittees, thank you for inviting me to appear before you today to discuss health care sharing between the Department of Defense and the Department Veterans Affairs.   For those of you I haven’t met, my name is Gail Wilensky.  In addition to serving as the Co-Chair of the President’s Task Force to Improve Health Care Delivery for Our Nation’s Veterans, I am a John M. Olin Senior Fellow at Project HOPE, an international health education foundation, former administrator of what used to be known as HCFA, the Health Care Financing Administration, and former chair of two congressional advisory commissions on Medicare.

President Bush created the Task Force last May 28 to honor a campaign commitment he made to improve health care for veterans who have served this Nation.    In the Executive Order, President Bush charged the Task Force with identifying the following: 1) ways to improve benefits and services to veterans and military retirees; 2) barriers and challenges to making those improvements; and 3) opportunities for more efficient resource sharing by the VA and DOD, the two largest agencies in the Federal Government, with two distinct cultures and missions.

The Task Force had its own challenges to overcome.    The tragic events of September 11 forced postponement of the inaugural meeting an entire month.   The October 26 unexpected death of your former colleague and my Co-Chair, Congressman Jerry Solomon was a terrible loss.    We all miss his wise counsel, but we are determined to honor his legacy by carrying on with our duty and crafting recommendations the President and Congress will judge to be as wise as they are practical.   

I can tell you that the cooperation and support I’ve gotten from the gentlemen with me today at the witness table has been excellent, and I am grateful.

As mandated in the Executive Order, we will give you the first round of those recommendations in July.    We expect to issue our final report, with more specific recommendations, in March of 2003.

With each meeting we’ve focused more sharply on both the barriers and opportunities for greater cooperation and sharing between VA and DOD.   We’ve done that by organizing the Task Force

into seven “workgroups” to break down an enormous wealth of data into digestible parts for

analysis and action.  Those workgroups are: Benefits Services, Leadership and Productivity, Information Management/Information Technology, Facilities, Pharmaceuticals, Acquisition and Procurement, and finally, Resources and Budgeting.  

The Benefits Services Workgroup will study eligibility, access, the impact of TRICARE for Life, reducing waiting times, and the different benefit structures of the two departments.   The Leadership and Productivity Workgroup will concern itself primarily with ways to establish accountability and responsibility for greater coordination and sharing between the VA and DOD.   The IM/IT Workgroup will examine the review and approval processes for major IT systems, and look for ways to build bridges between two very different technical architectures in the VA and DOD IT systems.

As their title suggests, the Facilities Workgroup will recommend ways to improve the maintenance of infrastructure and improve the capacity of the VA and DOD to respond to future changes in health care.   Their scope will include the approval process for major construction projects and the potential for greater collaboration in future projects.   The Pharmaceutical Workgroup will take a close look at the 57 joint VA/DOD national contracts, the 35 pending and 30 proposed joint contracts.   The assumption is that jointly contracting for pharmaceuticals will lead to better prices than if done by each agency alone.   The workgroup will also study mail order pharmacy systems, possible joint formularies, and how an additional workload of DOD beneficiaries would affect the VA.

The Acquisition and Procurement Workgroup will concern itself not so much with what should be jointly purchased, but what processes should be followed to allow joint buying when both agencies think it is appropriate.   They will take a very close look at the next generation of TRICARE contracts.   The Resources and Budgeting Workgroup will focus on how to achieve the most efficient use of health care resources.  They will examine five types of sharing: direct, VA as a network provider under TRICARE, joint ventures, joint purchasing, and collaboration in other areas. 

We have staffed these workgroups with consultants who have both VA and DOD expertise as well as substantial subject matter expertise.    The work of the consultants is being supplemented by detailees from the VA and DOD selected because of their expertise in each of the workgroup areas.   The job of the combined staff is to analyze previous reports on VA/DOD sharing and to determine the status of recommendations in those reports.   In addition to our regular Task Force hearings, we’ve held and will continue to hold, less formal meetings with veterans and military retiree organizations, the Surgeons General of the military branches, congressional staffers, VA and DOD staffers, and a variety of other experts in health care and related fields.

Task Force Members and staff have also taken three trips to sites where VA and DOD already have joint ventures and sharing arrangements of varying kinds, and more site visits are planned for the future.   These visits are just as important as studying the available literature, because they allow us to examine what works and what doesn’t, and to get first-hand accounts from the very people asked to carry out sharing activities.  

We’ve found that these joint ventures are great targets of opportunity, especially when it comes to expansion and construction of facilities.    When VA and military facilities are located close to each other, it often happens that what one lacks the other has to share.   It’s simply a matter of creating as many “win-win” situations as the imagination can conceive.

One thing needs to be emphasized.   The recommendations in our final report will go far beyond the mechanics of sharing and joint ventures.    Task Force staff and members are focusing on ways to increase collaboration and coordination between the two departments as well as ways to improve business processes that enhance the services of both departments in a way that is transparent to the health care user in transition from one system to the other.    VA and DOD need to continue thinking in broader terms than sharing and joint ventures, important as those two activities may be.

Success in these activities and in everything else the Task Force is considering is contingent on leadership.   When both the VAMC director and commander of the military hospital are determined to make such arrangements succeed, you can be sure they will, whether or not they have the support and resources they need from further up the chain of command.   The Task Force wants to issue recommendations that, if carried out, will transcend personalities and become so institutionalized that leadership turnovers have no negative impact on sharing arrangements.

I would like the Chairmen and all Members of the two subcommittees to know that our concern goes far beyond the two departments to the very object of the President’s Executive Order and our Task Force Charter.   Our concern is for the veteran and military retiree who have served their Nation, often at considerable sacrifice.    These men and women need to be able to access health care from the VA and DOD through a process that should be seamless and transparent.

The mission of the Task Force is not to lay blame, nor is it to remake the health care systems of the VA and DOD.   But when we are finished, we intend to present to the President and the American people recommendations that, if carried out, will improve the delivery of health care to our nation’s veterans.   I will be happy to respond to your questions.

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