A second chance to improve veterans health care

Ramsey Sulayman, a retired a Marine Corps infantry officer, served as Senior Advisor to United Veterans Care Alliance and as staff director of the House Committee on Veterans’ Affairs health subcommittee.

The Department of Veterans Affairs is considering one of the largest federal procurement efforts in U.S. history. Through its Community Care Network “NextGen” (CCN) solicitation, VA would award new community care contracts worth nearly $1 trillion over the next decade, fundamentally reshaping how veterans access health care and how U.S. taxpayers finance it.

Few federal decisions carry stakes this high. That is precisely why VA must slow down, broaden engagement, and work closely with veteran service organizations and Congress to get this right.

The CCN program traces its origins to the 2014 wait-time scandal in Phoenix, which exposed a system-wide failure: veterans were waiting months, sometimes years, for basic care inside the VA health system. The scandal prompted bipartisan reforms that codified veterans’ right to seek care from community providers when VA facilities could not meet access standards for wait times, travel distance, or service availability.

Since then, Congress has continued to modify community care authorities, and VA has awarded contracts worth billions of dollars to administer these programs. Progress has been made, but persistent problems remain. The Government Accountability Office and VA’s Office of Inspector General have repeatedly flagged shortcomings in community care, including inconsistent processes, inadequate oversight, and significant information-technology challenges.

 In addition to resolving those issues in CCN, VA is also reorganizing the Veteran Health Administration, which oversees community care and continues a decade-long  implementation of an electronic health record. The current CCN NextGen solicitation represents a rare opportunity to address those weaknesses and strengthen the program before it scales further.

To do that, VA should modify its approach in three specific and practical ways. First, VA should extend the transition period after contract award from 12 months to 18 months. That additional time is essential. Third-party administrators rely on VA data on provider utilization, patient demand, and regional network gaps, to build and tailor provider networks that actually meet veterans’ needs. Compressing that process increases the risk of inadequate networks, provider shortages, and disruptions to care. A longer transition would help ensure maximum access, stronger provider participation, and a smoother handoff for veterans.

Second, VA should adopt a rolling implementation schedule rather than a single nationwide launch. A phased approach would allow VA and its contractors to identify problems early, isolate them, and fix them before they cascade across the entire system. Large health care transitions work best when lessons learned in one region can be applied to the next. Rolling implementation reduces risk, protects continuity of care, and ultimately saves money by preventing systemic failures.

Third, VA should reconsider its decision to limit CCN NextGen awards to just two regions. Historically, only three companies have bid on community care contracts. This time, the program has attracted greater interest, largely because CCN has become more predictable and operationally stable. Yet VA has reduced the number of regions available for award from five to two.

That consolidation comes at a cost. More regions would allow VA to work with more contractors that have distinct regional strengths, expand the industrial base, and retain greater flexibility if a contractor underperforms. Limiting the program to two regions forces VA to rely on just two third-party administrators nationwide. More regions and more bidders mean more competition, stronger regional networks, greater resilience, and — most importantly — better access and choice for veterans.

Veterans themselves are clear about what they want. Recent polling conducted by the United Veterans Care Alliance shows strong support for targeted, practical reforms that improve access, continuity and coordination of care. Veterans are wary of changes that could disrupt services, limit choice, or complicate access. Notably, opposition to excessive consolidation cuts across party lines, service eras, and geography. Veterans want less bureaucracy, stronger community networks, and seamless coordination between VA and community providers.

VA has a chance to deliver the community care program Congress envisioned in the wake of the 2014 crisis. With nearly $1 trillion at stake, the department must ensure that CCN NextGen is structured to succeed, for veterans first, and for taxpayers as well.

previous coverage

• ‘Cost explosion’ or ‘revolutionary idea’? Lawmakers debate VA’s trillion-dollar plan to expand community care