Commission on Care

Commission on Care
Name	Commission on Care
Formed	2015
Jurisdiction	United States Department of Veterans Affairs
Headquarters	Washington, D.C.
Chief	Robert L. Wilkie
Parent agency	United States Department of Veterans Affairs

Commission on Care

The Commission on Care was a 2015 federal advisory body convened to review health care delivery within the United States Department of Veterans Affairs and to recommend reforms to improve access, quality, and efficiency for veterans. It produced a report with recommendations that influenced policies under the Obama administration transition period and the subsequent Trump administration. The commission's work intersected with debates involving the Veterans Health Administration, congressional committees such as the United States Senate Committee on Veterans' Affairs, and advocacy groups like the American Legion and the Veterans of Foreign Wars.

Background and Establishment

The commission was established amid scrutiny following the 2014 Veterans Health Administration scandal that involved wait-time manipulation at VA facilities, prompting investigations by the United States House Committee on Veterans' Affairs, the Office of Inspector General (United States Department of Veterans Affairs), and media outlets including The Washington Post and The New York Times. In response, Secretary of Veterans Affairs Robert A. McDonald announced reforms and the creation of the commission to advise on structural changes alongside ongoing legislative activity such as the Veterans Access, Choice, and Accountability Act of 2014. The establishment drew on precedents like the Conyers hearings and earlier blue-ribbon panels including the Independent Budget process and the President's Commission on Care for America's Returning Wounded Warriors.

Mandate and Objectives

Mandated by Secretary McDonald and formalized under VA directives, the commission's objectives included assessing the Veterans Health Administration health system infrastructure, evaluating access to specialty services, and recommending models that could involve partnerships with entities such as the Department of Defense, private health systems like Kaiser Permanente, and nonprofit organizations including Disabled American Veterans. It was charged to consider options related to facility consolidation, staffing models influenced by practices at institutions like the Mayo Clinic and Johns Hopkins Hospital, and to address long-term care needs similar to those overseen by the National Institutes of Health and the Centers for Medicare & Medicaid Services.

Membership and Leadership

Membership comprised clinicians, administrators, and veterans' advocates drawn from organizations such as the American Hospital Association, academic centers like the University of Pennsylvania Health System, and insurers with experience at Centers for Medicare & Medicaid Services. Leadership included former officials and subject-matter experts with ties to nodes of policy such as the Brookings Institution, the Heritage Foundation, and the RAND Corporation. Prominent members had backgrounds at institutions like the Department of Defense, the Office of Personnel Management, and academic appointments at universities including Harvard University and Georgetown University.

Key Findings and Recommendations

The commission's report recommended a range of reforms: consolidating underutilized facilities modeled after consolidations in the Department of Defense Healthcare System, expanding access through partnerships akin to the TRICARE network, and adopting electronic health record interoperability goals comparable to initiatives at the Department of Health and Human Services and the Office of the National Coordinator for Health Information Technology. It advocated strengthening community care options, aligning workforce planning with benchmarks used by Veterans Affairs Medical Centers affiliated with institutions like Stanford Health Care and Duke University Hospital, and enhancing performance accountability mechanisms similar to those enacted following the Veterans Choice Program. The report also proposed financing shifts informed by fiscal analyses from the Congressional Budget Office.

Implementation and Impact

Some recommendations informed policy decisions by subsequent VA leaders, contributing to legislative proposals debated in the United States Congress and operational changes at VA facilities in metropolitan areas including Los Angeles, Chicago, and Washington, D.C.. Elements influenced the expansion of community care networks and modernization efforts akin to the VA MISSION Act of 2018, and spurred initiatives to modernize the VA electronic health record through partnerships with the Department of Defense and private contractors. The commission's work was cited in hearings before the United States Senate Committee on Veterans' Affairs and in oversight by the Government Accountability Office.

Criticism and Controversies

Critics from veterans' service organizations such as the American Legion and policy centers like the Center for American Progress raised concerns that recommendations could lead to privatization trends similar to controversies around TRICARE for Life and reduce direct VA clinical capacity. Members of Congress including both Republicans and Democrats debated the report's proposals, invoking examples from the Veterans Health Administration scandal and disputes over implementation of the Veterans Choice Program. Legal challenges and scrutiny by inspectors such as the Office of Inspector General (United States Department of Veterans Affairs) and commentary in outlets like The Atlantic and Politico highlighted tensions over transparency, stakeholder engagement, and potential impacts on rural veterans served by facilities in states such as Iowa and West Virginia.

Category:United States Department of Veterans Affairs Category:Veterans health care in the United States