Expanding Veteran Health Care: The VA MISSION Act

Anderson: The Veterans Health Administration is the largest integrated healthcare system in the United States, providing services to more than 9 million veterans every year. Hello, and welcome to "Comcast Newsmakers." I'm Tetiana Anderson. For years, VA has worked to address long patient wait times and quality-of-care issues. And in June of 2019, the Mission Act took effect, and it's changed the way healthcare is administered to our nation's veterans. And joining me to discuss the Mission Act is US Secretary of Veterans Affairs Robert Wilkie, and, Secretary Wilkie, thank you so much for making time for us.

Wilkie: Tetiana, thank you for having me.

Anderson: So, give us a little bit of the backstory Explain the climate within VA that led you guys to act so quickly and develop the Mission Act. Wilkie: Well, the climate was not good. For many years, VA was at the -- on the bad end of America's national headlines. Wait times, deaths on wait lists, just overall disarray. The President came in after having campaigned, making veterans the central part of his drive toward the White House. He's continued that through his first three years in office. What he allowed us to do was tell veterans that if they have to wait a certain number of days and if they are a certain distance away from VA,] we give them the option of going into the private sector. That is a sea change. The other thing that we do is that, for the first time, they can have what their neighbors have, and that is urgent care. We're keeping veterans out of the emergency room and allowing them that access that they've never had before.

Anderson: So, this is sort of personal for you. I mean, you are a process guy. You're an organization guy. How did your experience really help you to implement this, which is something that hasn't happened before? Wilkie: Well, it is very personal. In fact, I just spoke to the Association of the United States Army. I became aware of my surroundings at the tail end of the Vietnam War. Father grievously wounded in Cambodia. But when he came back and he recovered from his wounds and went back to the 82nd Airborne Division, he wasn't even allowed to wear his uniform off post. America ignored its veterans, and for a decade or so after Vietnam, America did not want to know about those soldiers. They considered them broken human beings. That was my formative experience. And so in coming to VA, I wanted to reverse the script and make sure that VA was welcoming, but that we went to the country and said, "In our history, there are 41 million people who have put on this uniform. You are safe not because of protesters or pundits or professors, but because your neighbors put on a uniform and sacrificed a great deal." But we had to change the trajectory of VA.

Anderson: And you mentioned being broken, and it strikes me that something that the Mission Act does is to create a whole, and I understand that, with this act, you're really able to address the number-one priority for the VA. What is that and explain how this facilitates --

Wilkie: Well, it's separate and apart from the Mission Act. The President of the United States has made it clear that suicide amongst veterans is unacceptable. It's a problem that the Army started tracing all the way back into the 1890s. 20 veterans a day take their lives, so President Trump created a national task force. I'm the head of it. It involves my cabinet colleagues and the National Institutes for Health and Indian Health, and what we are doing is taking a whole-health approach to veteran suicide. So what does that mean? We're not focusing simply on the last tragic act. If we did that, then this would be another useless federal commission. What we're doing is looking at the things that lead up to that -- homelessness, addiction, mental health. This president has called for the very first national conversation on mental health. We've never talked about it as a nation. The leading cause of what we see happening to our veterans. The saddest part of this, though, is that 14 of those 20 who take their lives are not in touch with VA. So what I see coming out of the task force is opening the aperture for the localities, for charities, to help them help us find those veterans that we have no contact with. That is the least that we can do for those who have sacrificed so much. Last thing about this sad story is that, still, here we are in 2019, 50 years after Lyndon Johnson left office, and the majority of those who take their lives are from the Vietnam era.

Anderson: It's tragic. It's tragic. But with the Mission Act, there is more access to healthcare as a whole and specifically to mental healthcare.

Wilkie: So, a couple of things. The President has allowed me to present the largest budget in the history of this department -- $220 billion, calling for 400,000 employees. That knocks down any arguments that we received that the President was trying to privatize VA. But what we're doing is changing the way we approach mental health. Same-day mental-health services. Everyone who comes to us is screened for mental-health issues. We've screened over a million in the last year, but more importantly, since the majority of our veterans live in rural America -- they don't live in New York or Los Angeles or Atlanta. They live in rural America. In order to get to them, to reach them, we've expanded telehealth. Telehealth is the wave of the future, particularly when we're dealing with issues involving psychologists and psychiatrists. We're spending well over a billion dollars to reach to those places that are hard to get, and to make veterans feel more at home by treating them at home.

Anderson: So you're expanding this to 21st-century technologies. For those who don't understand what the Mission Act does, give us an explanation of how it works and how it's expanding care.

Wilkie: If you come to me and you live -- let's use Los Angeles as an example.
Anderson: Okay. -

Wilkie: In the old days, if you lived 30 miles away, you had to come to VA. Now, 30 miles in Los Angeles is only good as the crow flies. It doesn't take into account how much time it would take you to get to VA. Anderson: Or traffic. -

Wilkie: For traffic. So what we did -- what I did -- was change the regs. I changed it from miles to minutes, and so, now, if you live more than 30 minutes away from VA facility and we don't have the services that you need, we give you the option of going into the private sector. I'll give you another example -- the great state of Minnesota. Someone who would travel hundreds of miles to Minneapolis. In the meantime, on the way, he or she is passing some of the most famous medical clinics in the country. And why do we put veterans through that? But there is another side to this. Veterans are still voting with their feet. We have the highest patient-satisfaction rates that we've ever had, and they've come about in the last few years under this leadership, under this administration.

Anderson: Well, I wanted to ask you about that, how vets are reacting to this new program.

Wilkie: They're voting with their feet. We have had more appointments in the last year at VA than we've ever had. The Veterans of Foreign Wars, the second-largest veterans group in this country, just released its national survey. Over 90% satisfaction rate, but that 90% is saying that they are telling their comrades who don't have any contact with VA to come see us. So we're actually seeing a downward turn in people asking to go into the private sector. But the most important thing for me was to give them that option, to expand the availability of choice so we are taking the veteran as the central part of his care, not worrying about what the needs of the bureaucracy happen to be. Anderson: So, a lot of people like to say government works really slowly, but with this particular program, it seemed to happen at an accelerated level. How is that possible?

Wilkie: A lot of hard work. We have changed out the leadership of VA. Almost all of us who are in the senior leadership positions in VA have extensive military experience. We understand the culture, and we speak the language. We want to make sure that those we have served with are taken care of, and we put a premium on that, and we see that in the way our veterans are responding. We're out of the headlines, for the most part, and people are happy, and we couldn't be more proud, and we thank the President for everything that he's done, too.

Anderson: And veterans from here to the West Coast are no doubt thanking you, too. Secretary Wilkie, thank you so much for joining us.

Wilkie: Thank you. It's a great pleasure.

Anderson: And thank you for joining us, as well. For more great conversations from leaders in your own community and around the nation, be sure to visit ComcastNewsmakers.com. I'm Tetiana Anderson.