Two Major Veterans Healthcare Initiatives
November 8, 2023
In my experience, the most impactful initiatives often begin by trying to solve a seemingly small problem. As you work through that problem, you begin to pull on a thread—and that thread leads to a much larger challenge that ultimately must be addressed.
NAMI Montana currently has two major veterans health care advocacy efforts, and both began with relatively small but persistent questions.
Two Questions That Sparked Broader Reform Efforts
1. Why Is the VA Struggling to Implement Precision Brain Health Research?
The first question emerged from our work on the Hannon Precision Brain Health Initiative. Despite being:
Mandated by Congress, and
Aligned with the VA’s stated clinical priorities in mental health and traumatic brain injury,
the VA research system struggled to fully implement the initiative.
This raised deeper questions about how the VA conducts, translates, and applies large-scale health research.
2. Why Is the VA Slow to Integrate Peer Support and Other Essential Roles?
The second question focused on workforce roles. Why does the VA struggle to fully implement and scale:
Peer support specialists
Health coaches
Behavioral health technicians
Chaplains
These roles are widely recognized as valuable—but remain difficult to fund and operationalize within the VA system.
Learning from Federal Advisory Work
We explored these questions through years of participation in:
The Creating Options for Veterans Expedited Recovery (COVER) Commission, and
The VA’s National Research Advisory Council (NRAC)
That work led to two clear areas where structural reform is urgently needed.
Transitioning VA Health Research to Expand Access and Improve Outcomes
Last week, NAMI Montana testified before the U.S. Senate Veterans’ Affairs Committee, chaired by Senator Jon Tester, at the invitation of Senator Jerry Moran.
You can watch the hearing here (testimony begins around the 19-minute mark):
https://www.veterans.senate.gov/2023/11/foundation-of-care-examining-research-at-the-department-of-veterans-affairs
Three Research Priorities We Urged the Committee to Require
NAMI Montana asked Congress to direct the VA to focus on three complementary categories of research:
Large-Scale Veteran Health Studies
The VA excels at big-data initiatives such as:The Million Veteran Program
The Hannon Precision Brain Health Initiative
Precision oncology efforts
These are areas where the VA should double down.
Commercialization Matching Grants
These grants would help VA research findings:Partner with private-sector innovators
Navigate the FDA approval process
Reach veterans more quickly through real-world treatments
Implementation and Quality Improvement Grants
These grants would ensure the VA:Rapidly adopts evidence-based care models
Improves operations using proven best practices
Functions as a true learning health system
Together, these three categories strengthen the VA’s internal research ecosystem without limiting innovation to it.
Moving the VA Away from an Outdated Fee-For-Service Model
Our second line of advocacy stems from the realization that the VA’s difficulty integrating peer support and non-traditional roles is rooted in an outdated funding model.
The Problem
The VA’s current fee-for-service reimbursement system dates back to 1997, when that model was the norm in health care financing. Today:
Most private insurers and government programs are moving toward value-based care
Workforce shortages make fee-for-service increasingly unsustainable
Fee-for-service rewards volume, not outcomes or team-based care
The Legislative Solution
Section 109 of Senate Bill 1315 — the
Veterans’ Health Empowerment, Access, Leadership, and Transparency (HEALTH) Act of 2023 — would transition the Veterans Health Administration toward value-based reimbursement.
This shift would:
Better support peer support and care teams
Encourage innovation in service delivery
Align incentives with veteran outcomes, not billing volume
Additional Resources
NAMI Montana authored a detailed white paper on this topic, which you can read here:
https://www.dropbox.com/scl/fi/pk1y0a1m9mutxtrh22l0f/NAMI-Montana-Value-Based-Care-White-Paper.pdf
Gratitude and Reflection
As Veterans Day approaches, we are deeply grateful to:
Veterans and their families
The policymakers willing to tackle complex system reforms
Our supporters who make this work possible—especially the Trans-Montana Snowmobile Charity Ride
We could not pursue these critical veterans health care initiatives without you.
Thank you,
Matt Kuntz, JD, MHA
Executive Director
NAMI Montana