In my experience, the best really big initiatives start by trying to address a relatively small challenge. The issues around that challenge reveal a thread. That you can begin to pull on and that thread will lead you to the larger challenge that you need to address.
NAMI Montana has two current veterans healthcare advocacy issues that we are working on. Both of these issues started with something small. The first was the question of why the VA research apparatus had so much trouble implementing the Hannon Precision Brain Health Initiative - despite it being mandated by Congress and in their midst of their major clinical priorities fo mental health and traumatic brain injury.
The second question was why does the VA struggle so badly to implement peer support and other valuable roles such health coaches, behavioral health technicians, and chaplains?
We studied these questions through our years of work on the Creating Options for Veterans Expedited Recovery (COVER) Commission and the VA's National Research Advisory Council. Those years of work led to the following NAMI Montana insights and advocacy efforts.
Transitioning Healthcare Research at the Veterans Administration to Expand Access and Strengthen Outcomes
NAMI Montana testified last week at the Senate Veterans Affairs Committee in front of Chairman Jon Tester and at the invitation of Senator Jerry Moran. You can find the hearing video at this link. (It starts about 19 minutes in)
In that hearing, NAMI Montana asked the Senate Veterans Affairs Committee to require the VA to focus its efforts on three categories of studies.
Large veteran health care studies, like Million Veteran Program, the Hannon Precision Brain Health Initiative, and Precision Oncology are what VA research does best. It is time to double down on those large, big-data veteran health studies.
Commercialization matching grants - To make it easier for VA research insights find commercial partners to bring them through the FDA approval process.
Implementation and Quality Improvement Grants - Making sure VA healthcare is scientifically adopting the best currently available care methods and operations.
These categories take the best of what the VA is currently doing and expands upon it. These categories feed into each other to create a true learning system within ORD. These categories honor the value of the VA's internal research ecosystem without being single-mindedly shackled to it.
Moving the Veterans Administration Away From An Outdated Fee-For-Service Funding System
The question of why the VA system struggles to incorporate peer support and other valuable roles such health coaches, behavioral health technicians, and chaplains led to the realization that the VA is operating on an outdated resource allocation model.
The current legislative effort in Section 109 of Senate Bill 1315 - Veterans' Health Empowerment, Access, Leadership, and Transparency for our Heroes (HEALTH) Act of 2023 would transition the Veterans Healthcare Administration's (VHA) resource reimbursement from fee-for-service to value-based care. The current fee-for-service system was implemented in 1997, when the fee-for-service methodology was the standard practice for healthcare funding. Private and non-VHA government funders are moving away from fee-for-service and towards funding models that focus more on tracking and incentivizing value for the healthcare investment, rather than maximizing the treatment hours completed by licensed healthcare clinicians. This transition from fee-for-service to a value-based focus is important for many healthcare reasons, but the shortage of clinical staff around the country makes this necessary transition all the more urgent.
We put together a white paper on this complex, but important issue. You can find the link to that white paper here.
We are grateful to all veterans and the people who love them on this coming Veterans Day and every day. We also are grateful to all of our supporters who allow NAMI Montana to work on critical veterans healthcare projects - especially the Trans-Montana Snowmobile Charity Ride. We could not do this without you.
Matt Kuntz JD, MHA
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