Now, at the same time, what I said to the commission is VA doesn’t need to be doing all the things that the private sector is doing well or in some cases even doing better. So what we’ve come up with in my high-performance network plan is to come up with what is the best thing for veterans. And that is to support – have full support for – those services that are unique in the VA health care system that the VA does better for veterans, and utilize and work closely in a seamless way with community health care providers that are doing things that they do better for veterans. So when you put the veteran in the center and you really just answer one question – “What’s the best thing for the veteran?” – then you come up with the right answer, I believe: the idealized system that works seamlessly between the community and the VA.

Well, the Veterans Choice Program was introduced with the idea that it wanted to be part of helping improve access to health care for veterans. And I think that it has been successful in doing that. I think that one of the unintended results of it was that it turned out to be a very complex program to implement. So as we’ve learned about the program, we’ve identified ways to be able to make the program simpler and work better for veterans.

I think in the end, now that you look back and now you see how the whole thing played out, that group who surfaced their ideas did everybody a service because I always think you’re better when you get all the candor and the ideas out on the table and you have a chance to have a healthy debate and look at data and support whether the solution fits with what the data says. And in this case, that’s what happened – that generated a very healthy debate about whether privatization of the VA was a good thing or a bad thing. And ultimately, the commission members did reach consensus on recommendations. I think there were three of the commissioners that withheld their final vote on this. But they still had 12 that did support it. And I think that those recommendations, which now have been sent to the president, and the president will be issuing a statement on Sept. 6 [President Barack Obama issued his statement on the findings of the Commission on Care on Sept. 1, 2016], were important in being able to provide recommendations that ultimately can have benefit to veterans and, frankly, to the Veterans Health Administration as well.

 

How is the Veterans Choice Program progressing? Do you think you can resolve the issues with it in a timely manner in working with Congress? What are the difficulties in implementing it quickly?

Well, the Veterans Choice Program was introduced with the idea that it wanted to be part of helping improve access to health care for veterans. And I think that it has been successful in doing that. I think that one of the unintended results of it was that it turned out to be a very complex program to implement. So as we’ve learned about the program, we’ve identified ways to be able to make the program simpler and work better for veterans. And we actually submitted a proposal on how to make revisions to the Veterans Choice plan that would make it work better. We submitted it to Congress at the end of October of 2015. And we’ve been waiting for Congress to provide legislative changes that would allow us to implement that plan. Many of those recommendations are incorporated in what’s called the Veterans First legislation, which right now has a version before the Senate and a version before the House. And we are waiting to see whether Congress will be able to act and support legislative changes that would make this program work better for us. In the meantime, we had done a number of revisions to the contract, I believe 42 in total, in order to make incremental improvements to the way that the Choice Program works so that it begins to be more responsive to veterans’ needs. And we are seeing some positive movement in the number of appointments that we’re able to schedule for veterans through the Veterans Choice Program. So I think we’re moving in the right direction. But ultimately, we think that in order to make the program truly work better that we are going to have to have legislative action from Congress.

 

On a more personal level, I understand you take time out once a month to simply work as a physician in the system. Could you tell me a little bit about that – how you came to want to do that and where and when it happens?

Well I, No. 1, view myself as a physician, and secondly as an administrator. The reason why I do what I do every day is to be able to help people. And if I lose connection with my primary motivation about why I go to work every day, which is to help people, I would lose something personally, and I think I would be less effective at what I do. I have always, as a chief executive, always seen patients in any of the settings that I’ve worked in or had the privilege to lead. And I do that for a number of reasons, but primarily so that I can feel connected to the primary mission and I can understand what similar people who work in the health system are experiencing – whether the administrative systems that we put in place and the clinical systems that we put in place are actually working or not. And it grounds me with our customer. It allows me to interact with veterans and to hear how they’re doing and hear how we’re doing for them.