Tester, Brown, King to VA: Fix ‘Ineffective’ Oversight of Community Care Network Administrators

Following OIG report detailing VA’s inability to oversee Community Care Network contracts, Senators demand VA take immediate steps to remedy the issues outlined in the report

(U.S. Senate) – Following a recent report from VA’s Office of Inspector General, Senate Veterans’ Affairs Committee Chairman Jon Tester (D-Mont.), U.S. Senators Sherrod Brown (D-Ohio), and Angus King (I-Maine) are pressing VA to take immediate action to improve oversight of its Community Care Network contracts to ensure veterans have timely access to providers in the community.

“We write today to express our frustration with the Department of Veterans Affairs’ (VA) lack of oversight of Community Care Network adequacy,” the Committee members wrote in a letter to VA Secretary McDonough. “The Community Care Network was designed to improve care coordination and make it easier for community providers and VA staff to serve veterans by expanding access to health care...Ineffective oversight, however, left VA medical facilities with insufficient access to a network of community providers who meet the needs of veterans.”

The Senators’ letter cited the VA OIG report, which detailed how VA’s Office of Integrated Veteran Care (IVC), the office responsible for overseeing community care access, “provided ineffective oversight” of its Community Care Network’s third-party administrators (TPAs), TriWest and Optum. It found that IVC did not ensure these administrators maintained provider networks accepting VA patients—a requirement in their contact with VA. This requirement is in place to ensure VA facilities have enough community providers to deliver care to veterans within the defined timelines and drive-time standards.

Underscoring their concerns with the report’s findings, the Senators continued, “[D]ue to network inadequacies, VA medical center staff reported spending hours trying to find community providers who will accept veteran patients and cite this issue as one of the biggest roadblocks to the timely scheduling of appointments. Staff at many facilities created their own provider lists on spreadsheets to ensure they have accurate and complete information for community providers…VA staff should not be put in a position where they need to rely on workarounds to schedule appointments in the community.”

They highlighted examples of VA community care managers in Montana, Maine, and Ohio who maintain their own internal lists of Community Care Network providers who will accept VA patients. In addition to relying on inaccurate provider lists, the Senators also noted how VA medical facility staff have reported that the Community Care Network administrators refuse to update inaccurate provider information and deny requests to add more providers to the network.

The Senators concluded, “When the OIG asked the TPAs why they didn’t add more providers to the network, both TriWest and Optum cited the costs associated with adding providers. This is completely unacceptable. The TPAs are contractually obligated to build and maintain an adequate network of community providers that actually accept veteran patients. IVC has failed to oversee the Community Care Network contracts and must immediately take steps to remedy the issues outlined in the report.”

Read the Senators’ full letter HERE.