Chairman Bost Delivers Remarks at Hearing on Next Generation of Health Care Access for Millions of Veterans

Chairman Bost Delivers Remarks at Hearing on Next Generation of Health Care Access for Millions of Veterans

Today, House Committee on Veterans' Affairs Chairman Mike Bost (R-Ill.), delivered the following opening remarks, as prepared, at the start of the Full Committee's oversight hearing to examine the planning and management of the Department of Veterans Affairs' (VA) impending trillion-dollar Community Care Network Next Generation (CCN-Next Gen) contract to ensure that it effectively benefits veterans' healthcare access for today and tomorrow's veterans. This hearing comes as House Republicans continue to work to reverse the Biden administration's actions that restricted VA community care referrals and community-based health care for veterans across the country - directly undercutting the intent of the 2018 MISSION Act.

Good morning.

The Committee will come to order.

Without objection, the Chair may declare a recess at any time.

Before we proceed, I would like to clarify the purpose of this hearing.

Article I of the Constitution grants Congress the authority over financial matters, the power to create laws governing the Executive Branch, and the responsibility to oversee the execution of those laws.

This Committee is neither a stakeholder in this contract, a bidder, nor a regulator.

We are the constitutional body responsible for authorizing, funding, and overseeing the Department of Veterans Affairs.

Our duty does not diminish simply because a contract is large, complex, or currently active.

I also want to raise the issue of timeliness with the testimony for today's hearing.

This is the second time this week that we have not received testimony from VA in a timely manner.

It is incredibly frustrating for staff and Members to try to prepare for a hearing without having the testimony to review prior to the hearing.

If this were not such an incredibly important hearing, I would consider preventing V.A. from testifying today.

However, given the importance of this hearing and the need for this Committee to conduct critical oversight over this contract, I plan to proceed for the hearing. But rest assured that I will not be so forgiving in the future.

Now, I want to thank Mr. Richard Topping for being here today.

Mr. Topping is V.A.'s Assistant Secretary for Management, and Chief Financial Officer.

Before V.A., he was Chief Legal Officer for CareSource, which is a Medicaid Managed Care Organization.

He was also President of CareSource Military and Veterans, which is piloting competitive health plans for TRICARE.

More importantly, Mr. Topping is also a veteran.

An Army veteran, but I guess that still counts.

I believe this background makes him a good fit to lead the Trump administration's efforts to manage V.A.'s Community Care Next Generation contract.

However, this contract is going to cost the American taxpayer an estimated $1 trillion dollars.

I want to make sure this money goes where it needs to go: improving health care access for veterans nationwide - no matter who at V.A. is in charge.

This hearing is the beginning of the conversation between V.A. and Congress to ensure this contract will maximize health care access and choice for veterans.

The Community Care Next Generation Contract, or "C-C-N Next Gen," is one of the largest government contracts in the nation's history.

It is also a unique type of I-D-I-Q contract being used to purchase health care.

I am sure that Mr. Topping will explain that in detail in his testimony, but long story short, this is a revolutionary idea.

If done properly, this contract would allow unprecedented flexibility for V.A. to award contracts and task orders that would leverage competition for the benefit of our veterans.

It is an ambitious idea. If it works, it may be one of the most important innovations in government-run health care programs.

Unlike the first generation contract, C-C-N Next Gen would award multiple contracts at the outset.

Rather than being stuck with just one contractor, this will allow different contractors to compete for new task orders.

As I understand it, the idea is that V.A. would be able to leverage new ideas and innovations for the benefit of veterans.

This contract structure would also provide a way to "off-ramp" poor performing contractors.

C-C-N Next Gen will also feature Value Based Care, or "V.B.C.," as a base requirement.

V.B.C. has long been an effective way for health systems to control costs while promoting quality care.

It is a concept that is fully vetted and tested by Medicare, and it is long overdue in health care access for veterans in the communities where they live.

I am glad that we will be paying providers for the health they deliver, rather than the services they bill.

Another new feature of this contract is Utilization Management, or "U.M."

This is an important cost control tool, but it is also sometimes seen as a burden placed on providers and patients.

One example of U.M. is the dreaded "prior authorization."

Without it, payers would have no way of stopping unnecessary spending.

But with it, some doctors have to move Heaven and Earth to get the right treatments for their patients.

Needless to say, we are interested to know how V.A. plans to strike the proper balance that ensures veterans receive the care they need and deserve, while also preserving and maintaining program integrity.

V.B.C. and U.M. are only two of the many new features of the C-C-N Next Gen contract.

I bring up these two because they are both rich in opportunity and in need of congressional oversight.

Neither of these are new concepts in American health care, but they are new to V.A.

I want to know how well V.A. is prepared to implement these features in the Community Care Program.

Having Mr. Topping at the helm does give me confidence. But, as a great man once said, "trust, but verify."

I want assurances, backed with details and explanations, that V.A. will make every effort to ensure that the real-world execution matches the vision.

I need to know that V.A. will innovate where necessary and lean on existing resources and expertise.

For instance, the Department of War is constantly managing complex contracts, and the Department of Health and Human Services has whole divisions dedicated to payment policy.

There will be new ground that V.A. must break, but let's not reinvent the wheel.

Mr. Topping, we are all eager to hear how you will bring this together for the millions of veterans V.A. serves.

We are eager to hear what your team has been working on, from the C.F.O. all the way down to the contracting officer.

And also, we are eager to hear in detail how you will implement such a complex system and bring veterans' care into the next generation.

As I understand it, there are some topics that V.A. will choose not to get into.

I understand that V.A. finds it unprecedented to hold a hearing on an active contract solicitation.

I appreciate the sensitivity of contracting, but it is also unprecedented to avoid Congressional oversight of $1 trillion dollars of spending.

My staff and the ranking member's staff have been told that some topics are "off limits" because of the sensitive nature of contract solicitations.

Well, we have tried to create a venue in which V.A. would feel comfortable to speak candidly to our members but unfortunately, V.A. failed to assure us of such candor.

As such we are not able to close portion of this hearing for a more candid conversation.

I would like to thank Ranking Member Takano and his staff for working with us to exercise this oversight.

Mr. Takano, I assure you that this hearing is only the beginning of congressional oversight.

Community care is an extension of V.A. care: it should go without saying that V.A. must get this right.

When veterans call my Committee, they want to know how they can access their earned health benefits at V.A.

They don't ask what contracts V.A. uses to provide that care. But that's the core of the next generation contract and why we must have this hearing.

We must deliver modern health care access and choice to veterans without run-around or red tape.

Veterans have been enrolling in V.A. at unprecedented rates in every part of the country.

Community care is the only way that V.A. can keep up with its mission.

It is the best way we have to get health care to veterans with the right treatment, at the right time, at the right place.

If we don't do our due diligence to maintain and improve Community Care, we dishonor the memory of the countless veterans who lingered on secret wait lists at V.A. Medical Centers without receiving the care they earned.

Let me say this again: we must get this right.

Before turning to the Ranking Member, I would like to take a moment to thank Representative Brownley for her years of service on this Committee.

You have done amazing work on the Health subcommittee relating to suicide prevention and improving services for women veterans.

Thankfully I know we have you for the rest of the session, but I hope you enjoy your retirement and everything God has in store for your future.

Ranking Member Takano, I now recognize you for your opening statement.

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