Sponsors (2)
The bill pilots private-sector, value-based coordination between VA and Medicare that could improve care coordination and reduce duplication for some dual-enrolled veterans, but it risks shifting care toward private providers, entails upfront costs and possible delays, and initially benefits only a limited number of veterans.
Dual-enrolled veterans in pilot VISNs will get a dedicated case manager who creates individualized care plans and helps them navigate VA and Medicare services, improving access and care coordination.
The pilot’s use of value-based and commercial care models aims to reduce duplicated services and lower per-capita costs, potentially saving money for taxpayers and health systems if successful.
Targeting rural and medically underserved VISNs may improve access to coordinated care for veterans in rural and underserved communities who face greater barriers to care.
Contracting with private-sector commercial entities could shift management toward private providers, risking fragmentation of care or profit-driven incentives that may not align with veteran priorities.
Because the pilot is limited to 3 years and only 3–5 VISNs, most dual-enrolled veterans won’t immediately benefit and improvements will be confined to a subset of locations.
Implementing commercial/value-based models and contracting may incur administrative and contracting costs, creating taxpayer expense up front before any savings are realized.
Based on analysis of 2 sections of legislative text.
Requires a VA-run pilot assigning case managers to coordinate care and benefits for covered veterans across selected VISNs, using commercial/value-based models and private-sector contracting when practicable.
Official title: Require the Secretary of Veterans Affairs to carry out a pilot program to coordinate, navigate, and manage care and benefits for veterans enrolled in both the Medicare program and the system of annual patient enrollment of the Department of Veterans Affairs.
Introduced February 11, 2025 by Jerry Moran · Last progress February 11, 2025
Creates a VA-run pilot program, in consultation with HHS, to assign case managers and coordinate health care and benefits for "covered veterans" across 3–5 Veterans Integrated Service Networks (including rural and medically underserved areas). The pilot, run by VA's Center for Innovation for Care and Payment, will use existing commercial models (including value-based care), contract with private-sector health program managers where practicable, and focus on improved access to VA, community care, and Medicare services while reducing duplication and costs. The pilot requires individualized needs assessments and care plans with defined treatment goals for each participating veteran, aims to improve outcomes and information sharing, and includes reporting/notification requirements if contracting with private-sector entities is impracticable.