Restoring the VA Mission: Prioritizing Health Outcomes for Veterans

Introduction

The Department of Veterans Affairs (VA) healthcare system is in crisis. Despite its mission to serve those who have sacrificed for the nation, the VA has become a system that prioritizes quantity over quality. Driven by metrics that emphasize the number of patients served rather than the effectiveness of care, the VA has created an illusion of efficiency while leaving many veterans without the outcomes they desperately need.

This systemic problem is deeply embedded in how the VA operates—functioning more like an insurance company than a provider of holistic, veteran-focused care. Veterans face a healthcare system that favors speed and standardization over addressing the complex realities of service-related injuries, toxic exposures, and chronic mental health conditions. Meanwhile, misleading metrics such as the veteran trust score obscure the true state of care, perpetuating a dangerous cycle of mismanagement.

To rebuild trust and fulfill its mission, the VA must shift its focus to prioritizing health outcomes. This requires abandoning outdated practices and embracing healthcare models that deliver measurable results for veterans. As the new administration takes charge, this article will outline the systemic issues and offer a path forward, drawing on proven frameworks and emerging models to guide meaningful change.

Andersen’s Behavioral Model of Health Services Use

To understand the potential for reform, it’s essential to revisit Ronald Andersen’s Behavioral Model of Health Services Use. First developed in 1968 and refined in 1995, this model provides a framework for analyzing healthcare utilization based on three critical factors:

1. Predisposing Factors: These include socio-cultural characteristics, such as age, education, gender, and health beliefs, which influence an individual’s likelihood of seeking healthcare.
2. Enabling Factors: These are the logistical resources necessary for accessing care, such as income, insurance coverage, transportation, and the availability of healthcare providers.
3. Need Factors: These encompass both perceived and actual health needs. Perceived needs refer to an individual’s self-assessment of their health, while actual needs are determined by professional evaluations of their health status.

Andersen’s model emphasizes a holistic approach to healthcare, focusing on removing barriers to access and aligning resources with individual and community needs. By addressing predisposing, enabling, and need factors, the model aims to achieve equitable access and improved health outcomes. However, despite the simplicity and adaptability of this framework, the VA has deviated significantly from its principles, adopting practices that prioritize metrics and standardization over individualized care.

How Andersen’s Model Changed in the VA System

The VA’s departure from Andersen’s model highlights a shift away from holistic, patient-centered care toward a system driven by administrative convenience and cost control. This shift can be seen in three critical areas:

1. From Predisposing Factors to Standardized Care: Andersen’s model underscores the importance of socio-cultural factors in shaping healthcare use. However, the VA’s standardized approach fails to account for veterans’ diverse needs, including differences in age, service-related injuries, and mental health conditions. By treating veterans as a homogenous group, the VA neglects the unique circumstances that influence their healthcare decisions.
2. From Enabling Factors to Bureaucratic Barriers: Instead of facilitating access to care, the VA imposes systemic obstacles. Veterans face delayed payments to community providers, lengthy approval processes for specialized treatments, and inadequate access to mental health services. These barriers discourage veterans from seeking care and contribute to the perception of a system that prioritizes red tape over results.
3. From Need Factors to Efficiency Metrics: While Andersen’s model prioritizes addressing actual and perceived health needs, the VA focuses on efficiency metrics such as appointment volumes and wait-time targets. This emphasis on quantity over quality often leaves veterans with unresolved health issues and perpetuates a cycle of inadequate care.

These systemic changes have transformed the VA from a healthcare provider focused on outcomes to an administrative entity driven by metrics and superficial benchmarks. The consequences of this shift are felt most acutely by veterans, who are left underserved and vulnerable.

The Issue of Skewed Metrics and the Veteran Trust Score

One of the most concerning aspects of the VA’s transformation is its reliance on skewed metrics to measure success. Among these, the veteran trust score stands out as a particularly misleading indicator. Marketed as a reflection of veterans’ satisfaction, the trust score fails to account for those who are excluded from the system due to barriers, dissatisfaction, or delayed care. Instead, it creates a selection bias that inflates the perception of the VA’s effectiveness.

This reliance on flawed metrics is not new. The 2014 Phoenix VA scandal exposed the systemic manipulation of wait-time data, revealing that veterans were waiting months for care despite official reports indicating acceptable timelines. Similar practices persist today, where administrative priorities often overshadow the actual needs of veterans. By prioritizing metrics over meaningful reforms, the VA risks perpetuating a dangerous cycle of inefficiency and neglect.

The broader implications of this reliance on skewed metrics are profound. Policymakers and administrators, relying on these metrics, are misled into believing the system is functioning effectively. This not only diverts attention and resources away from critical issues but also erodes public trust in the VA’s ability to fulfill its mission. To rebuild credibility, the VA must prioritize transparency, implement independent audits, and ensure that performance metrics reflect meaningful health outcomes rather than superficial benchmarks.

Recent Scandals and Their Implications

The VA’s history is marred by scandals that underscore the systemic failures of its healthcare model. These scandals are not isolated incidents but symptoms of deeper issues within the organization. For example:

• Chronic Understaffing: Persistent shortages of healthcare providers result in delayed care, rushed appointments, and inadequate treatment. The VA’s inability to recruit and retain skilled professionals exacerbates the strain on its already overburdened system.
• Outdated Technology: Efforts to modernize the VA’s electronic health records (EHR) system have been plagued by delays, cost overruns, and implementation failures. These issues create inefficiencies, compromise patient safety, and hinder coordination between providers.
• Bureaucratic Inefficiencies: Lengthy approval processes, delayed payments to community providers, and rigid administrative structures discourage participation in VA programs. These inefficiencies limit access to care and contribute to the perception of a system more focused on process than outcomes.

The consequences of these systemic flaws are far-reaching. Veterans with complex needs, such as PTSD, toxic exposure injuries, and chronic pain, are disproportionately affected. They often find themselves navigating a fragmented and unresponsive system, compounding their physical and emotional challenges.

Emerging Healthcare Models: A Path Forward

Adopting elements of modern healthcare models could help the VA address its systemic shortcomings. Two such models offer a roadmap for reform:

1. Value-Based Care: By tying payments to health outcomes rather than volume, this model incentivizes providers to focus on long-term improvements. For veterans, this approach could lead to greater access to individualized and preventative care, addressing chronic and complex conditions more effectively.
2. Population Health Models: These approaches aim to improve health outcomes by addressing social determinants of health and proactively identifying disparities. By focusing on veterans as a unique population, this model could expand access to specialized care for service-related conditions and improve coordination between providers.

While no single model can solve the VA’s systemic issues, integrating elements of these frameworks could help realign its priorities with the needs of veterans. By focusing on outcomes rather than metrics, the VA can create a healthcare system that truly serves those who have served.

Privatized Care and the Role of Community Providers

As the VA continues to shift toward greater reliance on privatized care through community provider programs, systemic flaws in the design and implementation of these programs are becoming increasingly apparent. While the goal of privatization is to expand access to care, the approach has instead commoditized veteran healthcare, with profits and budgets taking priority over outcomes.

A significant factor driving this commoditization is the prevalence of poorly structured contracts and misguided lobbying efforts that fail to place veterans at the center of care. Large corporations, rather than smaller community providers, dominate CITC networks, leveraging their lobbying power to secure contracts that prioritize cost-cutting and high patient volume over individualized, quality care. These contracts often lack meaningful performance requirements tied to health outcomes, allowing providers to maximize revenue while delivering substandard services.

The effects of these flawed agreements are evident in the mental health sector, where time-intensive, evidence-based treatments like trauma-focused therapy are often sidelined in favor of high-throughput, generalized approaches. Instead of incentivizing providers to address complex service-related issues such as PTSD and traumatic brain injuries, the system rewards volume, perpetuating a cycle of inadequate care.

Misguided lobbying further exacerbates these issues. Many lobbying efforts are aimed at securing Medicare-aligned reimbursement rates, which inherently attract providers willing to accept lower payments—often at the expense of offering specialized care. These low rates not only discourage highly skilled providers from participating in the system but also promote a race to the bottom in terms of care quality.

To address these issues, the VA must overhaul its approach to contracts and provider selection:

1. Prioritize Veteran Outcomes in Contracts: Future agreements should include clear performance metrics tied to health outcomes, not just the volume of care provided.
2. Ensure Competitive Rates: Payment structures must attract providers who specialize in veterans’ unique healthcare needs, rather than defaulting to Medicare’s low reimbursement rates.
3. Combat Lobbying Influence: Legislation and policies must ensure that lobbying efforts do not undermine the core mission of delivering quality care for veterans.

Without these changes, privatized care will continue to prioritize profits over patients, leaving the most vulnerable veterans to bear the brunt of systemic failures.

The Human Cost: Veteran Incarcerations and Suicide

The systemic failures outlined in this article have devastating human consequences. Veterans unable to access timely care often experience deteriorating mental health, leading to substance abuse, homelessness, and interactions with the criminal justice system. These challenges are compounded by the VA’s inability to address the root causes of these issues, such as PTSD, depression, and substance use disorders, which require sustained, individualized care.

The intersection of these failures often leads to incarceration. Studies show that veterans make up a disproportionate percentage of the incarcerated population, many of whom suffer from untreated or inadequately treated mental health conditions. Without access to comprehensive support systems, these individuals are left to navigate a punitive justice system ill-equipped to address their unique needs, perpetuating a cycle of trauma and recidivism.

Perhaps most alarming is the persistent crisis of veteran suicide. On average, 17 veterans die by suicide each day. This staggering figure is not just a statistic but a reflection of systemic neglect and unmet needs. Veterans who struggle to access timely mental health care often find themselves in crisis, without the support structures needed to cope with their challenges. The VA’s reliance on short-term solutions, such as medication without therapy or insufficient follow-up care, exacerbates the problem, leaving veterans to face their struggles alone.

Addressing these human costs requires more than policy changes; it demands a cultural shift within the VA. The system must prioritize early intervention, long-term care, and holistic approaches that address the root causes of mental health challenges. By investing in preventative measures, strengthening mental health programs, and ensuring continuity of care, the VA can begin to break the cycle of neglect that has led to such devastating outcomes.

Conclusion

The VA healthcare system has lost its way. By prioritizing volume over outcomes, efficiency over quality, and profits over people, it has betrayed the trust of the veterans it was created to serve. The consequences of this systemic failure are not abstract—they are measured in unnecessary suffering, missed opportunities for healing, and lives lost.

To rebuild trust and fulfill its mission, the VA must return to the principles of accountability, transparency, and veteran-centered care. This means dismantling the bureaucratic barriers that prevent veterans from accessing timely and appropriate care. It means shifting from a reliance on misleading metrics and addressing the root causes of inefficiencies. Most importantly, it means recognizing the unique sacrifices of veterans by tailoring care to their complex needs—not treating them as numbers to be managed or costs to be minimized.

The time for incremental change is over. The new administration has a moral obligation to break the cycle of mismanagement, set new standards of care, and hold leadership accountable for delivering on the promises made to veterans. Only by returning to its core mission—providing holistic and effective care—can the VA restore faith and meet the sacred responsibility it owes to those who served.