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▶ 0:21:18All right, good afternoon. The subcommittee on technology modernization will come to And appreciate everybody who is here today. Appreciate our witnesses for being here and to the members that are here today for this committee hearing.
▶ 0:21:33Purpose of today's hearing is about scheduling and what goes on at the the VA for community care and access to that for our veterans, which is certainly a growing need that is taking place out there to make things more convenient and more conducive to veterans where they are and where they Uh when veterans are referred to community care, the scheduling process should be simple, fast, and focused on their health care and getting them through in a timely and efficient manner, but for too long that has not been the case and it's been something that has been fraught with inefficiencies, challenges, and a back and forth
▶ 0:22:03between veterans, the VA, and ultimately uh the community care partner where they're receiving their care. To schedule an appointment, VA staff must pick up the phone again and again, often calling the veteran and the provider multiple times to schedule an appointment. It's a tedious, manual, multi-step process that can stretch over hours into weeks, delaying care for the men and women who earned it. It's inefficient and unsustainable.
▶ 0:22:28Community care is VA care and will remain a critical component of effectively delivering veteran health Approximately 2.8 million veterans used community care in 2023 alone, and the outdated telephone model for scheduling these appointments is being crushed by the volume of requests from veterans for health care in their communities. VA's external provider in scheduling or EPS is supposed to fix that, and in many ways it is fixing it.
▶ 0:22:55EPS eliminates a large portion of the time and labor-intensive aspects of community care scheduling by giving VA schedulers direct access to providers' appointment availability, allowing them to directly interface um with them to schedule their appointments.
▶ 0:23:10Through EPS, providers agree to share their scheduling grids with VA and allow VA schedulers to search and and sort appointments by distance, drive time, availability, and With available community care appointments on one screen, a VA scheduler can book the appointment directly with a community care provider with just one call to the veteran. The average schedule for an appointment using EPS is 7 minutes.
▶ 0:23:36Without having to rely on making multiple phone calls, some schedulers have been able to book up to four times as many appointments per day. Spending less time scheduling each appointment means VA schedulers can be more efficient and veterans can get their appointments faster. But here's the problem. EPS is only active at about 20% of VA medical Some facilities have only had EPS for a few months.
▶ 0:24:00While the program is adding new providers almost every day, there are roughly 6,000 6,000 provider services currently active in EPS, and that number will need to keep growing if the program is going to reach its Provider participation is absolutely EPS is only a few years old, and I understand that it takes time to adopt new technology, and certainly we've had issues of health care delivery since the pandemic that have complicated rollouts and technology modernization and all kinds of things.
▶ 0:24:29But with strong leadership and a commitment from the VA, I fear that this will be yet another IT project that withers on the vine with unrealized potential to improve veterans' lives. Without strong leadership, that could be the outcome. Despite EPS's promising results, the Biden administration repeatedly placed roadblocks in front of the program.
▶ 0:24:48In 2024, VA paused recruitment of community providers into EPS, deactivated sites where EPS was already up and running, and canceled plans to expand nationwide, all while blaming fake budget shortfalls. Turning off EPS at active sites doesn't just hurt veterans. It burns bridges with the community providers who may not trust VA to follow through again later. The technology works, and this subcommittee is not going to allow VA bureaucracy to stand in the way of its own success.
▶ 0:25:17As the demand for community care continues to grow, VA can't afford to continue scheduling millions of appointments over the phone. EPS isn't just about scheduling faster. It's about reducing administrative burdens on VA staff who are fighting every day to keep pace with scheduling community care appointments on behalf of veterans VA serves. It's about letting veterans make informed decisions by comparing VA and community provider availability. It's about honoring the basic promise that when a veteran needs care, the system does not stand in the way.
▶ 0:25:47That's exactly what House Republicans are focused on and why this committee hearing is so important to me. With the Trump administration in place, I expect VA to tell us what their plans are to reverse the Biden administration's protocols and expand the program to the rest of the VA in addition to what they are doing to bring more community care providers into With strong leadership from the Trump administration planning and oversight from this committee, VA has a real opportunity to improve veterans' lives with this technology. Thank you again for being here, and I look forward to your testimony.
▶ 0:26:18And uh before I turn it over to the ranking member, I just wanted to say from a personal standpoint, I had an issue with this um not long ago where I was called um by a uh provider vendor about scheduling an appointment, and I gave them dates that I was not available cuz I was going to be here, not at home in Michigan, and uh they turned around and scheduled me an appointment on a date where I was not even going to be at home.
▶ 0:26:40And when I called to inquire about that, they said, "Well, our protocol is if we can't get you scheduled on a date that you've requested, our our procedure is to give you the next available appointment date." Well, that didn't help me, and I'm questioning, all right, well now I'm calling into this, you know, call center, which is taking up some other person's time on the other end of the phone to try and schedule this, and it doesn't ultimately yield the outcome that what the purpose of this is, which is supposed to schedule veteran for the care that they've been, you know, have scheduled or or
▶ 0:27:11referred for. Um and they said it was about meeting their, you know, required metrics with the VA, and this turned into a whole kind of chaotic thing. In fact, the culmination of this was they called me one morning when I was actually at a breakfast with members of this committee with Secretary Collins, and I was very tempted to just put this on speakerphone and see how it played out.
▶ 0:27:32But um but anyway, there are a lot of certainly a lot of efficiencies to be had, a lot of lessons to be learned, and I want to make sure that we're not looking at this through a clear like if this then that metric-driven mindset, and more of a how do we get this veteran the appointed time and that can work for them, meet their schedule, and meet the outcome of actually getting them the care that they've been referred to. So, uh with that, I'll refer it over to the ranking member for your remarks, and thank you again for being here. Thank you. Thank you, Chairman, and thank you for sharing that.
▶ 0:28:00Um I want to also thank you to the thank the witnesses for being here today. Um I too look forward to this afternoon's conversation about referral management and VA's modernization effort for community care scheduling with the external provider scheduling solution or otherwise as we've been referring to it as EPS.
▶ 0:28:19While I have grave concerns about the expansion of community care supplanting VA's ability to provide direct care, there is no denying that it is an important tool in ensuring veterans' access to health care, especially in rural America. It is incumbent upon Congress and VA to ensure that both community care and VA direct care are properly resourced so that one does not diminish the other.
▶ 0:28:44But I am concerned that the technology that helps these programs run will be undermined by the Trump administration's proposed cuts of almost half a billion dollars to the VA's IT budget in fiscal year 2026. That being said, VA's current practice for scheduling community care appointments is archaic and time-consuming.
▶ 0:29:05Uh referral management personnel call around looking for available appointments with community care as the Chairman talked about, and then coordinate with the veteran to find the right slot slot at it right at the right time in the right location with the right doctor. Um then they gather the appropriate medical record data and transmit it, frequently using a fax machine, to the community care provider. I've heard this process averages around 20 days.
▶ 0:29:34That's an incredibly lengthy process given that it's in in addition to the wait times many providers already have. We can and must do better for our veterans. Well, Hive boasts that through their system, they connect community care provider calendars with VA referral management teams, the scheduling process can take as little as 6 minutes. Um that's great to hear, but I hope the subcommittee can work with a with our health subcommittee colleagues to address the rest of the process.
▶ 0:30:03To be clear, the technology is only one part of the solution. We should also be looking at the workflows leading up to the point of scheduling. For instance, how can we help VA streamline tasks like eligibility reviews, the development of the referral document, and the transmission of clinical documentation? How can we improve the training and guidance provided to essential referral coordination teams to ensure they are able to do their jobs adequately?
▶ 0:30:34How can we make appointment scheduling faster and easier for veterans? How can we improve the workflows before and after the point of scheduling so that that trans aren't sitting around just wait waiting for an appointment to be scheduled? We owe it to our veterans to speed up this process so that they're receiving timely access to the care that they need and they deserve, whether that's at a VA facility or a community provider.
▶ 0:31:04WellHive is only as effective as the network of providers connected to the tool, which has been inconsistent across the 34 sites currently using the solution. I've heard that some sites have hundreds of providers signed up, while last fall at least one site only had two. I hope to better understand the gaps in this network and what VA and WellHive plan to do to address it.
▶ 0:31:29I look forward to hearing from our departmental employees here today, vendor partners like WellHive, and those organizations that bring community providers into the fold like Mr. Hansen's on how we can further engage providers on the WellHive system. Additionally, Congress has been calling for the VA to be able to provide an apples-to-apples comparison of wait times in VA direct care versus community care.
▶ 0:31:57WellHive has that capability, so I would urge VA to utilize it. For example, with this tool, veterans could know that VA's first available appointment is in 22 days, making them eligible for community care. UPS's fully integrated scheduling solution might also tell them that the first available appointment in the community in the community is in 35 days. VA should give veterans that fuller picture of their options.
▶ 0:32:26This would let the veterans themselves make the informed choices among available community care appointments and VA direct care appointments. Community care is a critical tool for ensuring veterans access to care, but for large swaths of our country, community access isn't any better than the VA access. VA has always always struggled to communicate that to veterans because it didn't have the tools to back it up.
▶ 0:32:53As we work to modernize the Department of Veterans Affairs, veterans should be able to make decisions about their health care with the full breadth of information Providing that access means ensuring veterans are educated on their options, the VA is adequately staffed and funded, modern systems are in place, and VA's employees know how to use them. I thank the witnesses for being here, and I look forward to our conversation today. Thank you, Mr.
▶ 0:33:23Chairman, and I yield back. Thank you, Ranking Member Biskupski. I think we uh both uh gave our remarks in um just slightly more time than it takes them to schedule an appointment with their system. So, um but look forward to uh hearing more about that. Now, I'll now introduce our witnesses from the Department of Veterans Affairs, who are Dr. Lisa Arfons. Did I say that correctly, doctor? Very good. Acting Deputy Assistant Under Secretary for Integrated Veteran Care. That's a great title.
▶ 0:33:52Forward to uh hearing from you. Also joining us today is Mr. Chris Firraji, President of WellHive. Is that right? Say your name correctly? Very good. Finally, we have Mr. Jed Hansen. I didn't have to ask on that one. Uh Executive Director of the Nebraska Rural Health Association. So, I'll ask uh all the witnesses to please stand and raise your right hands. Do you swear under penalty of perjury that the testimony you're about to provide is the truth, the whole truth, and nothing but the truth? I do.
▶ 0:34:21Thank you, and let the record reflect that all witnesses have answered in the affirmative. Dr. Arfons, you are now recognized for 5 minutes to deliver your opening statement on behalf of VA, and thank you again for being here. Thank Good afternoon, Chairman Barrett, Ranking Member Biskupski, and distinguished members of the Thank you for the opportunity to testify on VA's work to enhance veterans' experiences through modern and efficient scheduling technologies. My name is Dr.
▶ 0:34:46Lisa Arfons, and I'm the Acting Deputy Assistant Under Secretary for Health for Integrated Veteran Care. My testimony today will focus on the external provider scheduling program, its successes, its opportunities for improvement, and VA's plans for Since the enactment of the MISSION Act, VA has significantly expanded veteran access to health care. As of this past March, we have provided over 39.6 million community care referrals to more than 5.4 million veterans.
▶ 0:35:17To improve service delivery, VA is focusing on innovations that put veterans first. EPS is an initiative aimed at improving veterans' experience and access to care through enhanced scheduling technology. Recognizing the urgent need to prioritize veterans, this administration, under the leadership of Secretary Collins, reinforced the need for quick EPS implementation.
▶ 0:35:40In just the first 100 days, we expanded EPS from 16 sites last fall to 36 sites today, rapidly improving access and bringing more facilities and providers VA recognizes the need to provide veterans with clear, concise, comparable information about their health care options, whether within VA or in the To support this goal, VA is exploring EPS capabilities for both VA direct and community care scheduling, furthering the Secretary's commitment
▶ 0:36:11as promised under the VA MISSION Act. EPS allows VA staff to schedule veterans directly into available community care provider appointment slots through a single user interface, seamlessly connecting veterans to community care This single user interface displays provider availability and reduces back-and-forth communication delays.
▶ 0:36:33By providing detailed information on who, where, how, and when care is available, EPS helps veterans make timely and informed decisions about their health care. Early examples demonstrate key benefits of EPS, including an enhanced veteran experience, streamlined coordination, and strengthened partnerships. As of May 1st, EPS has been successfully implemented in 36 VA medical centers with 18 medical centers scheduled to go live by the end of this fiscal year.
▶ 0:37:03Over 6,000 provider services are active in EPS across 62 specialties. To realize the full capability of EPS, we do recognize the need for better change management and training. VA developed an online training program, enabling VA staff to take the training as needed. The EPS team also provides office hours and immediate live support for those users requiring assistance. Implementing EPS has presented many opportunities, particularly in onboarding community care providers.
▶ 0:37:33Many providers are understandably concerned about new systems integrating within their existing workflows and whether additional training or resources will be required. We have addressed these concerns by demonstrating that EPS eliminates the need for phone calls, minimizes burdens on administrative staff, and streamlines the community care authorization Providers retain control over their scheduling system visibility, and they are able to display as many appointments as they wish.
▶ 0:38:01This approach benefits providers and puts veterans first by mitigating barriers to accessing the health care choices they have earned. In conclusion, the EPS program is no longer an experiment. It is a proven tool fundamentally transforming how veterans access care. Thanks to renewed focus and leadership, EPS is now reaching more veterans at more sites faster than ever before.
▶ 0:38:23We are committed to building on this momentum, expanding EPS nationally, and continuing to refine the system based on real-world feedback from veterans, VA staff, and community providers. By removing barriers, minimizing delays, and placing veterans at the center of the scheduling process, EPS helps deliver the timely, high-quality care veterans deserve. We look forward to working with the subcommittee to ensure continued improvements in the scheduling process and overall care for veterans. Thank you for the opportunity to testify today.
▶ 0:38:53I am prepared to answer any questions you may have. Thank you, doc. I appreciate that. Um and the written statement of Dr. Arfons will be entered into the hearing record. Mr. Firraji, you are now recognized for 5 minutes to deliver your opening statement on behalf of WellHive. Thank you again for being here. Chairman Barrett, Ranking Member Biskupski, and distinguished members of the subcommittee. Thank you for the opportunity to testify today.
▶ 0:39:18WellHive is a health care software technology company, and we are proud to support the Department of Veterans Affairs through our role in the external provider scheduling program. Our fundamental goal is to partner with VA to modernize scheduling, improve care navigation, and ensure veterans receive timely, high-quality health care.
▶ 0:39:36Our platform seamlessly integrates across health systems, providing real-time visibility and access to provider schedules into a single intuitive interface, much like how platforms such as Expedia simplify finding and booking travel. The journey to modernize scheduling for VHA began with a pilot program launched in 2020. This pilot starting in Orlando, Florida and expanding to Columbia, South Carolina sought to answer critical Can this technology work reliably with VHA?
▶ 0:40:06Is it scalable? And more most importantly, does it enable faster access to care for veterans? A structured evaluation process including input from integrated project and industry RFIs confirmed the potential and led to a competitive award of the external provider scheduling contract to WellHive in September of In my February testimony, I emphasized the importance of aligning people, process, and technology.
▶ 0:40:33Today, Under Secretary Colon's leadership and with bipartisan support of Congress and these committees, we are finally seeing that alignment deliver real progress for veterans through the external provider scheduling. This program is fundamentally transforming how the VA connects with veterans with community care. By offering real-time scheduling visibility across their vast diverse provider network including major health systems, academic affiliates, and individual practices, it empowers VA scheduling teams to act faster with greater insights.
▶ 0:41:04This significantly reduces veteran wait times and delivers a more veteran-centric experience. Yes, like many ambitious initiatives, the external provider scheduling program has faced challenges since its award including shifting priorities and coordination issues.
▶ 0:41:18But despite these hurdles, the underlying technology has consistently delivered on the original commitment to reduce wait times and enhance the scheduling process for veterans, VA staff, and community care Now, with renewed commitment and strong leadership, we are seeing significant This program is currently live in 36 VA medical centers across the community care network regions and is on track to expand to the additional 18 VA medical centers with the potential for nationwide implementation by the end of fiscal 2025.
▶ 0:41:49These results are clear and measurable demonstrating tangible benefits. The average time to schedule appointment using EPS is 7 minutes. We're seeing up to four times increase in productivity for VA staff using the program even without critical integrations into VA Since January, active provider services participating in digital scheduling have increased at a rate of 21% month over Most importantly, appointments scheduled through EPS have increased by 121% in the first 4 months of this year.
▶ 0:42:17This means veterans are receiving care Community providers are also finding the model transformative and are actively participating. As one partner shared, "Partnering with WellHive has improved our scheduling process and has increased our timely access to care for our veterans population." This program has a strong backing from key stakeholders including leading veteran service organizations and state directors who recognize its critical role in reducing delays and enhancing care navigation.
▶ 0:42:45EPS is also paving the way for future advancements such as integrating VA and community care scheduling into a single view offering that apples-to-apples comparison which ultimately gives the veterans choice. Achieving widespread veteran self-scheduling is enabled by a nationwide rollout of this program. Think of it as laying the digital tracks. The more tracks you lay across the country, the more veterans can ride the self-scheduling train.
▶ 0:43:10This year, in collaboration with the VA.gov team, the program is helping VA make significant advancements in fulfilling the Cleveland Dole Act by introducing self-scheduling pilots in July of 2025. Before concluding, I briefly like to address some of the comments that was made by the chairman and the ranking. Um Mr. Chairman, you mentioned that uh your preference is that you had to provide to the that call center agent or that MSA um was cumbersome, right?
▶ 0:43:35And having EPS on that phone call would have prohibited uh the back and forth because you would have been able to make informed decisions. And that's what a lot of veterans are experiencing today with EPS. And Ranking Member, you mentioned about key integrations with things like the referral management system. We also truly believe that that integration will help also streamline the process. The external provider scheduling program is no longer just a promise. It's proven scalable solution addressing one of VA's most persistent challenges.
▶ 0:44:01Under Secretary Colon's strong leadership and with the enduring bipartisan commitment from Congress, we can and will fulfill the promise that this program holds delivering timely effective care for every veteran across the nation. Thank you again and I look forward to your Thank you and uh the written statement of Mr. Faraji will be entered into the record.
▶ 0:44:22Um to your point, I think I would have been better off if they had just told me here are three providers you can go through, call them and see if you can schedule an appointment instead of going through the, you know, endless loop and um I have some strong opinions about it as you can probably tell. But thank you again. Uh Mr. Hanson, you're now recognized for 5 minutes to deliver your opening statement on behalf of Nebraska Rural Health Association. Yeah, thank you, Chairman Barr.
▶ 0:44:48Chairman Barr, Ranking Member Bostinsky, and distinguished members of the subcommittee, thanks for the opportunity to speak with you today. I'm Jed Hanson and I'm executive director of Nebraska's Rural Health Association where I work closely with our rural hospitals, clinics, and providers across our state. I've spent over a decade clinically in emergency care nursing and as a nurse practitioner and more recently as an advocate for improving rural health systems.
▶ 0:45:12I'm here today to talk about the external provider scheduling program or EPS as we're calling it and why it's working for Nebraska's veterans and how it can be scaled nationally. I first learned about EPS in 2023 during its pilot phases in South Carolina and I was impressed by the program's approach to streamline scheduling for veterans needing community care and recognizing some of the unique challenges that we face in Nebraska in rural Nebraska, I pushed for a rural Thanks to appropriations and policy
▶ 0:45:42support from one of our senators, Senator Fischer, along with Senator Moran out of Kansas, the EPS program transitioned to a national rollout. In 2024, the Nebraska Rural Health Association along with our hospital association launched a statewide effort to raise awareness and support for EPS adoption. We used our association's reach to accelerate implementation with newsletters, regional meetings, webinars, and even a technical session with uh members of the WellHive team at our annual conference.
▶ 0:46:13Simply the the model is delivering Nebraska's two largest academic medical centers, CHI Health Creighton and the University of Nebraska Medical Center, are actively implementing EPS. We have 50 independent provider groups that are that are live today including those in mental health, optometry, physical therapy, and chiropractic services. We also have 35 critical access hospitals engaged with eight now in active onboarding.
▶ 0:46:42We've also been fortunate to partner with the national organizations like the National Rural Health Association, the National Organization of State Offices of Rural Health, which have both helped amplify EPS awareness regionally and nationally. And just as important importantly, we've maintained strong relationships with our local VA medical uh center leadership teams in Omaha, our state VA director, and the VA Office of Rural Health, all of whom have been very have been critical partners in ensuring alignment alignment and success.
▶ 0:47:12I'd like to share briefly why this I recently spoke with a Mr. Gregory Hockey who was a Navy who is a Navy SEAL, former Navy SEAL and Nebraska and he shared his story with me. He recalled long drives just to receive some basic care in rural Nebraska, something that he said was manageable when he was younger and healthier, but now he sees those as potentially devastating barriers for older veterans, particularly those who rely on sometimes inconsistent transportation for
▶ 0:47:42Now living in San Diego, Mr. Hockey waited 9 months for an MRI through the He describes a system where treatment was only offered on an uh episodic basis and where specialty care was sometimes inconsistent. As he put it, many veterans, especially those living in rural areas, are stuck navigating a fragmented slow-moving health care experience when they're already And unfortunately, I do have other stories to share.
▶ 0:48:09He was, however, very quick to point out when we were talking that this was despite the kind and dedicated providers and staff of the VA. Based on our experience, I'd like to respectfully offer the following recommendations. One, support our rural providers with federal appropriations to help offset some of the IT staffing shortages and burdensome interfaces that they face.
▶ 0:48:32Two, look to incentivize academic and tertiary providers with a time-limited enhanced payment model that could possibly speed adoption. Three, looking to ensure EHR vendor alignment especially with those large organizations such as Epic and Oracle Cerner to make sure that EPS integration is more accessible and affordable across all care spectrums. Four, looking to leverage state-level organizations.
▶ 0:48:58Rural health associations like such as such as mine, hospital associations, and state offices of rural health are well positioned to serve as liaisons for local implementation. In areas like Michigan uh states like Michigan, your state office is extremely active. States like Illinois, you have organizations like I CAN um that could easily um fulfill this work um in a similar fashion that we're doing in Nebraska.
▶ 0:49:22And finally, need to continue to engage our national partners including the National Rural Health Association, American Hospital Association, and And very importantly, to continue to work with local VA teams and the VA Office of Rural Health to make sure that we're providing broad reach and awareness of the program and to ensure that EPS remains connected to the communities it's meant to serve, which are veterans.
▶ 0:49:47In closing, Nebraska's success shows that national innovation, when paired with local engagement along with trusted partners, can produce some meaningful results for our veterans. Thank you for the opportunity to testify and I'm truly honored to be a part of the conversation today. Thank you and thank you for your recommendations as Um and the written statement of Mr. Hanson will also be entered into the hearing record. Excuse me.
▶ 0:50:14We're now going to proceed with questioning and I'll recognize myself for 5 minutes. really appreciate again the testimony of those of you that are here today. Starting out I had a question about the implementation of, you know, kind of how WellHive organizes all of this.
▶ 0:50:31So you sign up basically community care partners that will interface with your system that then a scheduler can look at and see the availability that is out there for a particular veteran for the service that they're referred for. Is that kind of a starting point of how it operates? That's correct. We meet the providers where they're at, so they continue to use their EHR systems and we have direct integrations into those systems.
▶ 0:50:56And is every EHR the scheduling component of that, is that a a a portion within the EHR or is that a standalone add-on that is usually It's different from every EHR system and different manufacturers. So there's not like a a one scheduling system that every provider uses. They're all going to be a little bit different.
▶ 0:51:19So is a is a portion, I guess, or the barrier to entry to get more providers signed up, is it the portal that needs to exist to get your ability to see their availability? Is that something you have to code specifically for each individual provider that signs up? Really becomes more of an awareness issue and understanding the benefits of the EPS platform.
▶ 0:51:41Once providers understand that, it becomes that the technical part is very straightforward and it's near we're merely putting connections in and establishing establishing that so that we're able to see those clinical grids. Okay, so there's not a and then does the provider pay for that technical upgrade, if you will, to to be able to interface or is that done by WellHive? There's no charge.
▶ 0:52:03Okay, so WellHive does that and you just got enough people and you've built it for enough systems that you've probably got most of them interoperability wise figured out at this point. Correct. We have a formula of things where we're doing direct, we use partners, etc. to be able to make those connections happen. Okay. Okay. For Mr. Hanson, is the reimbursement rate that the VA pays pretty lucrative for rural hospitals?
▶ 0:52:27Like if you have a procedure that is being referred out, obviously you wouldn't want to be signed up and a part of this if it wasn't something that you felt was at least fair and equitable for the services you're providing. Yeah, I don't know that there's really much of anything that we'd say is lucrative in rural health care, but uh If I ask any hospital that, they'll say You know, there are certainly drivers and and volume is vitality when we're talking rural health care, but really what I've found when I'm working with our critical
▶ 0:52:57access hospital leaders is that's not the Um you know, we have a number of our of our leadership teams where they are veterans or maybe they're you know, their their parent was a veteran or grandparent and really in any rural community, you don't have to go too far until you have that veteran connection. Really the driver has has been that they're wanting to improve access for for their neighbors. Mhm. Sure.
▶ 0:53:22And I know that especially in rural communities, you might be separated a significant distance from the nearest VA larger facility that would afford you that opportunity then go more locally and and receive that service that already might be predominantly done through the rural hospital network, but for this one service connected condition, you might be getting treated for at the VA, for example or something. I know that's happened multiple times in in my own district where people have that. So Yeah, that's correct, Chairman. And and I can speak to Nebraska.
▶ 0:53:52I don't have some of the national data behind me, but in Nebraska, the average drive time for a veteran to a VA facility is about 39 minutes one way. So on average, every veteran in Nebraska is a rural veteran in Nebraska is going to be eligible under the Mission Act for for care in the community. Sure. Okay. Thank you. And Dr. Arfons, roughly how many community care referrals were created in fiscal year 24?
▶ 0:54:20I assume that's our last year of data that we have available. So I have fiscal year 24 through fiscal year 25 to date. Okay. We've had as of this morning 14 million, just over 14 14 million and has that volume trended up or down in in recent years? Increased. Okay.
▶ 0:54:40And you attribute that more to expanded programs, PACT Act, other things of that nature, veterans coming home and, you know, conditions from war on terror service connection, things like that or do you attribute it more to awareness, more availability of community care? Where do you kind of land that mostly or all of the above? All of the above. Okay. Yeah. All right. Thank you. I am running short on time, but I will come back with a few more questions, I'm sure. Want to yield to ranking member Buszinski for 5 minutes for her questions.
▶ 0:55:10Great. Thank you, Mr. Chairman, and thank you again to the witnesses for your testimony. As we're we've been talking about VA modernization, it's really come down to three different topics. It's either people, process or technology. And so I do want to spend a little bit of time in my opening questions on the people part. And so my questions are for Dr. Arfons, you know, I do remain very concerned about the Trump administration's actions over these last 3 months.
▶ 0:55:39Um and I fear that the VA is now being asked to do even more with less. In particular, serving on this committee and the importance of really these technology efforts and the amount of staff and the specialty of the staff, the technology staff, the IT staff that we need to successfully get these off the ground. Very concerned about about those.
▶ 0:56:04And so I was just curious if you could answer, you know, were any of the individuals with these referral coordination teams impacted by the probationary terminations that happened back in So referral coordination team members are facility staff, so I cannot speak to that. You can take for the record. Okay. Do you would you know if any of those staff were rehired at all if they were given if they were probationary and terminated?
▶ 0:56:33I would not know that either because they're facility staff. Okay. Have any of the individuals with the teams been targeted under the secretary's reduction in force that you know of to plan to cut the VA's workforce by the additional 15%? No, not that I'm aware of. Okay. How many people in these teams have opted into the deferred resignation program that you might know of? I have no numbers related to that either. It's all facility led. Okay.
▶ 0:57:00Have referral coordination team positions been exempt from the hiring I am not aware of that. In general, our frontline staff are exempt. Okay. And then a couple other questions. So what kind of assessments has the VA done to ensure that VA medical facilities have the necessary staff to support the rollout of the EPS system beyond the pilot sites? So we work closely with sites when we are looking to see their readiness.
▶ 0:57:31It's really two sides of of one coin. The first is assuring that sites themselves are are ready. So we look at their referral patterns, where they need assistance in terms of their workflows, referring veterans out and what sort of leadership support that we have.
▶ 0:57:50The other side of the coin then, of course, is matching it then with the provider network and assuring that we are able then with WellHive support to have at least enough providers on the network to start so we can begin to see with new go live how we're able to use the system and then integrate it more fully. This is a continuous process. We do not go live and leave. We continue to follow metrics.
▶ 0:58:16We look at veteran and staff feedback to ensure that we are, rolling out correctly and then adjust as needed. Okay. And as a part of that assessment that you make, do you take into account then, you know, my concerns around the deferred resignation program, any impact that that might have on the assessments that you're making before a site goes live? We have not incorporated that. We've not. Okay. So and then I have another question for you.
▶ 0:58:45This is more on the data side of things. So Dr. Arfons, prior to the WellHive pilot, how many days did it take from order placement to appointment scheduling for a community care if I can answer that a little bit differently. What we see at the sites that have gone live for those referrals that are being scheduled using traditional means, it's taking on average about 33 days. Crazy.
▶ 0:59:13For those staff members, the veterans then who are scheduling referrals using EPS, it has cut that down by about a week to 25 days. Okay. And then my next question is for Dr. Faraji. As you connect community care providers to veterans, um, what kind of information do you share with the veterans as it relates to that provider?
▶ 0:59:42Uh, so, um, thank you for that question. Um, right now the MSAs facilitate that conversation with the veteran and they're using EPS to populate the information of the providers, their availability, and what works best for them where it calculates the drive time and distance. Okay.
▶ 1:00:01Does it, um, share do they share any information as far as like how much work that that provider has done with the with the veterans community, any of the specific training, as it relates to military sexual trauma awareness, PTSD awareness, things like that that that provider might have had experience with? You share that knowledge with the veteran when you're making the referral. Yeah, thank you for that question. The EPS program does not have those details inside the platform.
▶ 1:00:29It's primarily providing the information for availability. That's right. The platform has an abundance of capabilities, but right now at that time is what it provides. Okay. Um, okay. Um, Oh, I'm sorry. And I'm over time. So, I will go back to I yield to the chairman. Sorry, thank Thank you, ranking member Brzezinski. We'll have more time for more questions as we go through. I want to recognize, uh, Mr. Luttrell for 5 minutes. Thank you, Mr. Chairman.
▶ 1:00:59I'm going to piggyback off of your your earlier statement, Mr. Faraji. Um, I have an institution in the state of Texas that we engaged with about EPS and their response was we have multiple scheduling platforms inside our organization and we're looking at EPS for the veteran space. What's the I don't understand the roadblock. Is that just is that different in institutions not wanting to onboard something cuz of complexity or is that just out of sheer laziness? And I'm just going to say it that way.
▶ 1:01:29Sure, thank you for the question. Every health system, provider practice, they all work in different ways. Sometimes it's a very straightforward conversation. Sometimes it requires a multitude of people to be able to provide that integration and show the Um, Dr. Arfons, actually this is probably going to be for you, too, Mr. Faraji.
▶ 1:01:52So, we have 36 sites that are going to be We're going from 16 to 36, correct? 18 sites going live this year. Is that Did you say that? We are at 36 right now and going up to 54 by the end of the fiscal year. Oh, and we're and Dr. Faraji, you said potentially all of our VA sites, correct? At 170 plus is that's the idea, correct? Right. At this time it's the 36 and 18.
▶ 1:02:22What's what's our projection to get every single site uploaded and onboard? VA's working through that right now. All right, you got to give me something better than that. How long have you been in this position, Dr. Arfons? Uh, acting since February. Okay. I'm going to I'm going to make the assumption or assume that the VA is completely onboard with WellHive and that the implementation of their software program inside the VA system is what we want.
▶ 1:02:51We definitely recognize the benefits to veterans and connecting them to care sooner. Yes, with EPS. Can you clarify that answer for that that that sound like a political statement? Can you clarify that answer for me a little bit more? I think my concern is that from what I how I understand is this system works and if it's beneficial to the veterans, I don't understand why we're not moving forward. I don't and I'm sure the will be 100% onboard.
▶ 1:03:16Now, do we have to talk to the individual VA facilities to say, "Are you willing to onboard this?" Or is this, uh, command and control from the secretarial level and says, "This is what we're doing." We are going to be continuing to roll out to the 18, so we have a total of 54. So, we will continue expanding throughout this year and then continuing to look at how those 54 sites have deployed to help guide us into the Mr.
▶ 1:03:45Hansen, you kind of command and coordinate all the community care facilities inside Nebraska for WellHive, Uh, I I work with our You bring all the community care facilities to WellHive or what bring WellHive to those community sites? Uh, correct. I I provide the information on on the EPS program out to our community hospitals. And it's very is it well received?
▶ 1:04:08It is and, um, kind of to to, um, uh, tip in a little bit on on the Um, I became aware of the EPS program before our, um, our VISN leadership team in Omaha did and so I actually approached them to ask them what their thoughts were on the program. Um, I wanted to make sure that I wasn't missing something because like yourself, it seems like this is just a good program for veterans.
▶ 1:04:36Um, and overall we had very good buy-in at Omaha. Um, I can't speak to to other VAs, but I think part of of what we're doing in the in front of me, so just It Is there has any of it blown up? I probably shouldn't say it that way since we're in the House of Representatives, but I mean did any of it fail? Uh, no, no. We haven't had any points of of failure right now and really there's largely been goodwill with this program. It's just the right thing to do.
▶ 1:05:06Do you have buddies that are just like you and in the other 49 states across the country that you're talking to? Um, I have a lot of buddies in other states. Uh, but you know, there isn't really any secret sauce what we're doing in Um, there's, you know, in in Texas you have like you have torch as an example that would be an organization. I'd mentioned the state office in Michigan. Um, you have another private entity like I can in in Illinois. Every state has someone that is a a good liaison.
▶ 1:05:37You seem to be handling Nebraska though is well is it you Mr. Faraji, do you have to market this to all the community sites as well as the VA by with and through Mr. Hansen and I'm sure that's pretty burdensome and if you're the one you're the two doing it, it seems like something the VA should jump onboard with. Is that happening? So, as far as working, yes, we are we are individually going out and reaching out to providers and we've got a great recipe to that.
▶ 1:06:05We've seen a 21% increase month over month with the providers being onboarded and working with Mr. Hansen is one example. We've been able to replicate that with the Arkansas Hospital Association which was able to produce the similar results with these larger health systems. So, it's definitely a team effort, but we are we are tackling this together. Thank you. I yield. Thank you. Well, I'll recognize myself again, um, and we will do more rounds for members who have, uh, further follow-up questions.
▶ 1:06:36Um, Dr. Arfons, I think it was you had said that, um, in answer to an earlier question that the average time had gone down for from 33 days down to 25, I think. Um, did you look anywhere at all about the distance traveled?
▶ 1:06:55Like so, going from 33 to 25 days, you know, about a week, uh, give or take depending on the thing you're referred for that may or may not make a substantial difference to you, but another aspect of that or another dimension of it that might be more important is the distance traveled or the time available for that veteran to get that appointment more close to home, especially in rural communities like Nebraska or parts of Michigan that I represent. No, we have not. We can take that for the record. Okay. I'd be, uh, curious on that. I've only only been in Nebraska once.
▶ 1:07:25I was in fifth grade and, uh, I did go to Creighton and I saw Asdrúbal Cabrera play a baseball game, minor league baseball game there. José Canseco's twin brother. So, it was, uh, definitely a rural state. Uh, I can attest to that.
▶ 1:07:40Um, and, uh, I'm curious in in Nebraska, do you find that there is a a suitable partnership between the VA and and your efforts to take on some of that community care, um, in Nebraska? Like there's not a um, a a hesitation to involve community care, uh, through the VA system or the VA network. Uh, the I would say largely no.
▶ 1:08:09I mean, there's always some concern on the specialty side, uh, within the VA, uh, but that's really not what we're looking to achieve in Nebraska with this, especially in our rural communities. We want to make sure that things like primary care are covered, things like emergency care. And maybe after they've received specialized care at the VA that they can come back and receive their PT, um, in in the community. Mhm. It it We're we're trying to close that gap.
▶ 1:08:36If we have an access into our community for that veteran to receive care and if that's where they'd like to get care, that's what we're trying to achieve. Mhm. Okay. Thank you. Um, Dr. Arfons, is there any correlation at all or any thought process behind, um, kind of integrating this EPS model with the already existing rollout through EHR?
▶ 1:09:02So, when a facility gets the new EHR rollout, they'll also get EPS with it. So, we're kind of doing this all at once when we're dealing with change management or is there no rhyme or reason to how we're doing that? As of this point, no. We certainly are open to that. We have gone live at Spokane as I believe this committee is aware. Also, definitely looking at at opportunities for fuller integration with our technology systems including EHR so we can realize the benefits of EPS. Okay. And Dr.
▶ 1:09:32Faraji, following up on my earlier point and Mr. Luttrell's point, let's say I'm a large hospital network in Michigan and you approach me about being part of this EPS network and I give you the keys to integrate into my system, you've got some adaptability that can probably do that and you know, whether I have Epic, whether I have Oracle Cerner, whether I have one of the big ones, any large network is going to have one of only a few of these systems in all likelihood.
▶ 1:10:02But what if I'm this small audiology clinic and I've got one or two practitioners there and we schedule through Microsoft Outlook or something like that. I don't know if people even do that nowadays, but let's suppose they do. Are you able to integrate down to that more small granular community care provider that might not be a large hospital system somewhere? Thank you for that question. Uh the answer in short is yes.
▶ 1:10:26Uh we look at every site, every health system, every practice management system into the example that you provided and we work closely with those providers and their team to understand what works best for them. And what we'll do is we'll come up with a plan that says, "Hey, we're going to do it this way or we're going to do option B." So that we're able to produce their grids and so they're able to show up with the availability to the eye. Okay. And to Mr.
▶ 1:10:48Luttrell's earlier point about how a provider in his district says, "Yeah, we're looking at adding this type of interfacing or a veteran's scheduling." I would imagine, not being in that industry, that you would want one scheduling application for everything, so you're not getting mixed up and turned around and double booking and all the other things. Is it common to have multiple scheduling applications in one Uh again, it really depends case by case. Uh typically it's streamlined.
▶ 1:11:18In some cases it is, in some it isn't. But um we do our best to make sure that that it's all unified, so there is no duplication. Okay. All right. Um thank you. I'll now turn to our ranking member Mrs. Kim for another 5 minutes. Thank you, Mr. Chairman. Um I just kind of wanted to pick up a little bit of where I left off and and to Mr. Faraji, if WellHive had access to the data on cultural competency, wait times, etc.
▶ 1:11:44for community care providers, would you have the capacity to share that information with MSAs? Yeah, thank you for the question. Um we will take the direction of VA right with what they would like to display and share with the medical support assistants. Um our platform is very dynamic and agnostic. So whatever you would like to have us provide, we can do so. Okay. And my next question is for Dr.
▶ 1:12:09Alfons, then does VA collect any quality of care metrics um from the community care providers like data on wait times, the return of clinical documents and completion of VA's required trainings? Uh we do look at some required training completion. We do not collect national level data on document return at this point.
▶ 1:12:32And then other quality data, um we are building a more robust quality So for for the data that you might be collecting that might be a more fuller picture, um would this be something that, you know, as the VA negotiates the new TPA contracts, uh VA requiring the TPAs to collect and report this information to the VA, would that be possible? I can't speak to any acquisition sensitive work right now, but we are definitely looking at what is most important to deliver quality care to veterans in direct and community care.
▶ 1:13:02Okay. Okay. And as I stated, I think it is really important for veterans to be able to make decisions about their health care with really the full breadth of information available. So this includes information about the timeliness and quality of the care they would be accessing. So I appreciate um I didn't hear a no, um so maybe there could be some some room to work out um more additional information collected. Um can I ask Dr.
▶ 1:13:29Alfons, in 2021, um the Government Accountability Office released a report that identified approximately 1,600 community care providers who were not eligible to participate in the community care program, but were included on the provider list anyway. Has the VA developed the necessary controls to identify such providers that should be removed from the VA's patient care environments? Through EPS, we actually run the exclusions list daily. Okay.
▶ 1:13:59Um and Dr. I'm sorry, Mr. Faraji, does WellHive perform any kind of regular assessment of the providers on its system to measure utilization or other metrics? Thank you for the question. Uh yes, we do measure utilization of the Okay. Okay. Uh Dr.
▶ 1:14:20Alfons, on this point, um uh GAO has also made a number of recommendations to VA that identify the need to establish timeliness standards for care received in the community like time frames for when appointments should Many of GAO's recommendations remain open today. Does VA intend to establish a standard for when veterans' appointments should occur?
▶ 1:14:45We have that within the direct care system, namely how quickly we would like veterans to be scheduled and have their community care referrals processed within our system. Um currently, uh our network adequacy is not measured by individual community care providers. It is done through the TPAs who then have different standards, not related to Mission Act standards, that do outline those requirements. Okay.
▶ 1:15:13But so given that, how does the department measure access for community care if they do not collect data on when or if appointment occurs? We we do collect that data. At this point, we use it um in two ways. First of all, we have network adequacy standards, so we work with our TPAs to understand their performance.
▶ 1:15:32We also use it operationally at medical centers to understand how we can assist sites to improve their data and use their data to guide us to where we can improve people and processes. Um I understand the VA cannot fully control when appointments occur, but as we send more and more veterans into the community for care, we should have an idea of the quality of care that they are receiving and when they are receiving it.
▶ 1:15:59Establishing guidelines and metrics would help make sure that veterans receive quality care. I really do urge the VA to implement such standards to ensure that veterans can make informed decisions about their own uh health care. And with that, I'll pause and and yield back, Mr. Chairman. Thank you, uh ranking member Mrs. Kim. Mr. Luttrell, you're recognized for Thank you, Mr. Chairman. Dr.
▶ 1:16:20Alfons, I'm I'm reading here in in order to schedule a community care appointment, it it takes nine different steps. Is that correct? But with the implementation of WellHive, that's substantially reduced. Yes, to how many? Um steps, I cannot say. We do Uh the Nine to three? Nine to two?
▶ 1:16:49What it cuts out is the back and forth. Well, I think okay, I'm going to speak as a veteran real quick. There's there's there's there's expectations that I have. I could say we have cuz the chairman's a veteran as Now, we we live and breathe off of that good order and mission, that proper chain of command and kind of a a good infrastructure surrounding us to get us what we want and what we need. I think we deserve that right for serving our military and and I get it, the VA is this this big machine. It is.
▶ 1:17:14But what we're trying to do is to rock drill this thing to a point where it's successful. My question to you is, what does VA consider success since we have nine and I can promise you if you're walking around with me in my district talking to all of my veterans, the one of the things they complain about is this. And I I I think we're sitting here with the opportunity to course correct this ship right now.
▶ 1:17:43And I I don't want to kick that proverbial can down the road. So my question is, what does success look like in the VA? Now, this looks the conversations that we're having, this seems like this is you know, 70% Hey, if it looks good, we're rolling. You know, that's mission success. So can you can you can you walk me through this? Success is always going to be delivering veterans the care that they want when they want it. Uh you should write that down put it on a t-shirt, young lady. I got it.
▶ 1:18:14That's not what we're doing right now. We're working towards success and this program is work is is moving us towards Well, I I I'm never going to kind of force an answer out of anybody, but what my ask is I think I think we're kind of positioned to do something great here and I don't want you to walk out of the room and go back to the VA and this thing die on the vine cuz I can assure you the 40,000 veterans in my community right now are watching this video and they demand the same thing that I would demand as a veteran and I I
▶ 1:18:44want to know if this seems solid, why why isn't this implementation going to happen the way that that it should? So we have made marked trends and improvements since we last presented to this committee in September. More providers, more appointments scheduled, shorter timeliness to schedule. Uh in every month and week, we see increased over the prior.
▶ 1:19:10since September, we have onboarded more than 4,000 providers uh than we we we were here in September reporting. Um and just as of this month, uh we have um made more than 3,000 appointments in EPS, which is more than any month prior. Uh so we will continue to work to not only roll out the additional 18 sites, but also maximize and optimize the integration of EPS at existing sites.
▶ 1:19:41Is this your sole responsibility in the VA? Are you the one in charge of this? I am the executive sponsor. I have a team that that is their responsibility. But if I'm going to somebody, I'm you're who I'm you're who I'm going to be speaking with? Absolutely. I look forward to I don't even know what month it is now, but let's just say at the end of the year when these 36 sites are up and running and we're and we're in good place. I look forward to hearing where we have gone and where we intend to go. So thank you very much, Mr. Chairman. I yield back. Thank you. I'll recognize myself again for 5 minutes. Um Dr.
▶ 1:20:11Alfons, um kind of piggybacking on that, why haven't we already gone to every VA facility? Like if we know this works, if it's seemingly fairly plug and play, I don't want to oversimplify um Mr. Faraji how the system works, but it sounds like it's not overly complicated to get someone signed up. What is holding us back from just doing this everywhere So the redesign of the deployment efforts The what? Excuse me, say that again?
▶ 1:20:41The redesign, so our plan for deployment efforts in fiscal year 25 that we started in September of this year really focused on um fewer number of VISNs where we were able to be more regional um and focus then on uh hopefully making it more attractive to larger providers in the community provider networks who then could serve um more medical centers within a VISN or even potentially more VISNs given their geographic adjacencies.
▶ 1:21:10And so this focus on having six VISNs rolled out by the end of fiscal year 25 and the sites rolled out there has proven to be successful given the trends that we are seeing. Um and then this then I think will allow us to plan in the future for further deployment from here. Okay. I um I got some of that. I guess I'm confused on a little bit of it.
▶ 1:21:35Um a lot of areas where perhaps you might find a more correlation of need for community care are going to be areas that are probably going to have smaller and not larger providers already embedded in those communities given the more disparate rural nature that they have. So if we can make some assumptions why are we focusing so much on bigger providers?
▶ 1:21:56That's going to attract a certain segment of the health care industry, but what about, like I said, the small, you know, provider in my community that I live in or the one in the town adjacent to mine or the one, you know, two counties over that I also represent that's particularly rural? It still a both and.
▶ 1:22:16And so we are working with those individual or smaller providers through sites, but then looking more regionally to understand if we can then get some of those larger providers because we are covering more sites within a VISN. So if though um if we know we want to get there, we want to get every VA site loaded into this and we want to get everybody through and I guess you could even foresee scenarios where people um probably not as common in Mr.
▶ 1:22:41Luttrell's district, but where I live and maybe where you do, people spend a considerable amount of time out of state. Like people in Michigan travel to Florida. Veterans do that. What if one what if they're in one VISN that has this service and the other one doesn't? Uh you know, it just could get into a weird scenario for people. And to me it doesn't seem like we have the ability through the work you do, through Mr.
▶ 1:23:07Faraji, through the work here on this committee to just kind of speed this up and get this done. Part of me feels like there may have been an element I don't want to call it sabotage cuz that's a pretty strong word, but an element of artificially slowing this down in the last administration from being rolled out. And I want to make sure that we're not encountering that that potential slowdown or resistance currently. I I tend to believe that that's not the case, but then I'd like to see us accelerate some of the adoption of this.
▶ 1:23:36From September, we have not slowed. We have sped up, definitely. Um with the sites that we have, with the 36 sites, we have continued to learn um and optimize our own deployment with every site. But couldn't we roll it out and then add the providers over time instead of saying we want a bunch of providers before we roll it out? It seems like a chicken and the egg thing.
▶ 1:23:59Like we roll it out, we get it in place, and then over time we add and collectively build more providers that are uh participating as more veterans become aware of it, as more providers become aware of it, and the thing naturally, you know, takes more shape.
▶ 1:24:14And that is what we are doing with initial deployment, what we have learned uh is like going back to the two sides of the coin, that the timing of having VA staff readiness to work in the system and then having a provider network that then has expectations for us to use the system is key. And so focusing on that timing for better integration to go live is very important.
▶ 1:24:38And I think um what we have learned as a lessons learned is misalignment, going out too soon with having a site go live without the provider network, or having two providers waiting for us to go live on the VA side only hurts further acceptance. I've only got 15 more seconds, so I want to ask quickly, what is the training like the the amount of time it takes to learn this system?
▶ 1:25:05It I saw an example of it, it looked pretty intuitive to me, but probably there's some some, you know, training that goes into that. For Dr. Alfons, Mr. Faraji, maybe either one of you could explain from the scheduler vantage point, what is that what does that look like and how long does it take? Cuz that to me doesn't seem like it would be a large barrier to to getting this done. From the VA side, we have um an initial 30-minute training. That's all it takes to receive your keys to use EPS. Mhm.
▶ 1:25:34Uh we also then have interactive training uh that will be about an hour, so we can work virtually with teams. So less than an afternoon still? Yes. Yes. Okay. Yes. And then other opportunities to after they're logged in and using the system to improve their abilities. Okay. And Dr. or Mr. Faraji, it's um from the provider standpoint, it's invisible to them. They just see that an appointment got loaded into their system on on the back end by somebody else, correct? That's correct. Okay. All right. Thank you.
▶ 1:26:03Ranking Member Bisinski. Thank you, Mr. Chairman. Um Mr. Hansen, I wanted to say thank you for being here. Um really appreciated your testimony highlighting some of the unique challenges that it sounds like all of us face representing rural communities and access to rural health um and and obviously also, you know, highlighting I think some of the concerns around potential cuts to Medicare, Medicaid, and other community I just was wondering if you could give um the VA and maybe us as members of Congress
▶ 1:26:34advice on, you know, just how we can help streamline implementation of programs like EPS um especially when we know that often times community community care providers can be somewhat limited in their resources. Any advice you might have for us?
▶ 1:26:52Yeah, really appreciate the question, Congressman as we've been going back and forth with questioning um uh Chairman Barr actually brought up a really good point about Cerner and Oracle Cerner and Epic. And whether you're talking a tertiary center or you're talking a critical access hospital, the services that WellHive are providing are included with the appropriation and the work they're doing.
▶ 1:27:19However, there still are interface fees that can be challenging for the smallest of small providers, including some of our critical access And so potentially partnering or working with some of our EHR vendors so that when they do have an update that's rolling out, so that that interface could be more um in line or more friendly to connecting with WellHive would be would be significant.
▶ 1:27:45Or providing some sort of an appropriation to our critical access hospital partners so that they can uh so that they don't have to they're not burdened with with some of that extra cost. and then some of it it's just good old-fashioned awareness and getting out and and um we spend an awful lot of time um I live on the eastern side of the state, but we'll make this 7-8 hour trek um into our northwest panhandle often to work with teams.
▶ 1:28:15And um some of it is just that that level of of I don't know, elbow grease that needs to go into making sure that programs that really matter um get out to our communities. Okay. Okay. That's helpful. I also wanted to point I really loved your idea on on the quality initiatives. Um and that's something that we're starting to look at in Nebraska to make sure that we are doing that apples to apples.
▶ 1:28:41And we're um we're working to align the VA ambulatory quality measures with some of those that are seen that we're used to on on the uh our critical access hospital sites. So um I'm I'm learning a lot actually through the questions that you're providing, which I appreciate. Yeah, thank you very much. Thank you. Um can I go back to the VA and Dr. Alfons? Yeah.
▶ 1:29:02In 2023, I wanted to highlight committee staff was able to visit uh WellHive's pilot sites in Orlando and Columbia and saw two different pictures. Um looking at data provided to this committee last fall, it seems that the success and use of this tool still varies from facility to facility. How do you account for that variation? So with any diffusion of innovation, you're going to see a different range of adopters.
▶ 1:29:32This is not a surprise. We see this with any initiative that we have. In terms of Columbia, they were I think a little bit quicker out of the gate. Orlando has been more slow and steady and continues to evolve and improve. As Mr. Farage mentioned, they both answered in the affirmative the intent of our our pilot questions and have been helpful.
▶ 1:29:59They also then have very different veteran populations, community network, needs that they are working towards and so it doesn't surprise us. We obviously work towards standardization as much as we can but then have to adapt to the unique facility needs with their unique veteran populations. And and just following up you're leading into my next question.
▶ 1:30:21You one of the things I think was observed is that the success or increased success was really seen when VA leadership and its employees are adequately engaged in the efforts to recruit community care practitioners onto the tool. As the VA plans to roll out this tool across more VISNs, how do you hope to standardize and you mentioned standardization but how do you hope to standardize these approaches and support the recruitment of community care providers?
▶ 1:30:50So one lesson that has been important over the past several months I think is the importance of having medical center directors engaged and is an important because not only are medical center directors leaders within VA but they also are health care leaders within their communities. And so many of them have trusted relationships already with community providers.
▶ 1:31:12And so when we approach them to answer Congressman Luttrell's question, VA does feel it's our responsibility to to enroll providers. It helps that they have a trusted voice encouraging them to explore the opportunities for EPS. Also, medical center directors are setting the culture and the strategy and the tone for their medical centers and their staff very much look to them to set that direction.
▶ 1:31:41And so moving forward, I think this will be continues to be a key piece of the success of of EPS moving forward. Thank you and I yield back. Thank you, Mr. Luttrell. Mr. Farage, how many how many VA facilities do you have on your list to incorporate your software with? You can say all of them but I'm curious if you have a number cuz we're putting the we're putting those numbers together right now and I think it's 1,380 VA facilities across the country.
▶ 1:32:12Actual VA facilities? Yes, sir. So I I'm not sure. I don't Could you clarify? Well, I mean you're implement you're implementing your software in the VA facility in the VA hospitals, C-box and everything, correct? It's not just the main hospitals. It's all in the rural little C-box and satellite campuses. From my awareness, it's specific to the actual VA medical centers. Just the big ones. The community care right which just 172. That's correct. Just 172.
▶ 1:32:44My question is if I was to give you How do you I need to I need to bring that back off the record. I misspoke. I don't know how to do that officially. Okay, so if you had the opportunity to jump in a jump in front of or jump inside of 172 facilities and I said go, could you do that right now? So thank you for your question. What what we found and Dr.
▶ 1:33:13Arfons touched on this is that every site we're learning every time. I know. I got it. Everyone of them's different. No but no but it's a lessons learned because those lessons learned compound and we're able to take that to the next site into the next site. And what you're seeing is much more speed behind these rollouts because of everything that we've been able to do and the preparation. So for us as far as the technology and making sure that we have everything, the answer is yes but there is other things that have to move behind the scenes and that's what Dr.
▶ 1:33:41Arfons is alluding to with the different people and the training and the providers. So what's the what's the Give me a kind of left and right flank on hey look if I was to say you're coming down into Houston into DeBakey, ready go. How long would it take to implement your system inside DeBakey Medical Center? We would need to look at the site. We would have conversations. So let me back up a second.
▶ 1:34:06When we go to these sites, we're having conversations with the chiefs of medical chiefs of community care and the staff to understand the data. What are the referrals? Who are the providers that they were referred out to? This is specifically on scheduling alone, right? That's right. Yes. So we we need this information cuz it's important because what we do is we then take that information and go back to see what we already have in network and then who do we need to bring on board, right? To then go reach out to these medical And Bring on board you mean the other the community care provider? That's right. Correct. Community care providers.
▶ 1:34:34Would it be better if you found a facility didn't have that many community care providers and implemented your system because then the the spider web's not that big instead of going into a facility that's got thousands of them? Again, it varies per site. Quit saying that. Okay, I got it. All right. It varies. Got it. 100%. Go ahead. So once we once we are once we have that information at our fingertips, then we're then off to the races then at that point. VA is doing their thing for training and getting the site up to speed and we are bringing on providers daily.
▶ 1:35:04And some of them are large health systems, some of them are the small mom and pops that we're bringing online and those grids start digitally connecting. In between that, because we have an integration into the provider profile management system which is the main system that provides the credentialing of all of the the community care we're able to see all 1.4 million providers inside of VA.
▶ 1:35:27So you Doctor, you said it takes let's just say an afternoon to train whomever on the And then you have to train all the community care providers on the system as well. No no no. There's no training on the community care providers. They they're going to keep using the EHR that they've always been using. Okay, so I really have no idea why we're not in every single facility right now. This is me looking back at you waiting for somebody to say something.
▶ 1:35:54Congressman, I can maybe provide a little bit of insight on this. We have two academic medical centers in Both are in the onboarding process. One of the facilities did that start? What date did that Started last October. To onboard this? It is but with these academic medical centers, the complexity is that they have specialist subspecialists.
▶ 1:36:24They have they have layers of bureaucracy on their end as well and it can even vary from medical center. So we have one medical center that has taken the approach to go a full onboard. They're just bringing in they're doing what you're wanting to do. They're they're applying the gas pedal and they're going to move forward with it.
▶ 1:36:43Our other academic medical center feels that they have some unique scheduling protocols in place and so they're going to start with a smaller sub set of sub set of specialties like dermatology, ophthalmology, physical therapy where there's high volume and less complexity to the schedule and then scale it up.
▶ 1:37:04So they're trying to use kind of your spider web where they're starting with some of those high volume high impact areas to relieve backlog in the VA and then expand out from there. For critical access hospitals, it's a maybe a it's a slightly simpler process than what we're going to see tertiary where you've got some of your primary care, you might have some colonoscopies, you might have some PT and then you have some of maybe you've got a local PT or just medical clinic
▶ 1:37:34and they don't any of the you know prior authorizations, prerequisites to get into that specialty. So it it it it can vary and it it's somewhat dependent on on the partner the community partner that you're working with. Thank you. I apologize for going over, Mr. Chairman. Thank you. I appreciate that. I I'm confused a little bit. Um Dr.
▶ 1:37:56Arfons said it takes let's call it an afternoon to train a person at the VA to integrate with or interface with the system. You're saying it'll take more than 7 months to onboard.
▶ 1:38:11you know, you can birth a human in 9 I don't know why it takes so long to do that but it slows down the the rollout for this if if things are taking 9 months to do it or 8 months or 7 or however long we're up to from last October. That's hardly giving me confidence that we're going to be able to expedite this or roll it out in a way that will be a meaningful improvement soon.
▶ 1:38:39Some of those those were first conversations that were taking place. So these are when our academic like in our case of our academic medical centers, the first time that they're hearing about EPS was last October. And some of those challenges were we didn't know which if Nebraska or VISN 23 which encompasses Omaha if that was going to be included in the initial rollout.
▶ 1:38:58We thought we were then we heard that there were going to be some drawbacks and then going forward Yeah, that's some of the frustration I felt is that there were mixed signals sent about this that I think gave community care providers the belief that maybe this isn't going to happen. Why go through the process of figuring it out if it's not actually going to roll out or get used. So, I'm hoping through Dr.
▶ 1:39:22Arfons' testimony today that is hopefully put to rest and that there is full confidence going forward that we are going to integrate these scheduling things in an a really expedited fashion or or as quickly as possible going forward to hopefully alleviate that. Um, I did want to I had a few more follow-up questions just quickly, too, and I don't want my time to expire, but um, Mr. Faraji, does your software have the capability to exchange referrals and authorizations with community care providers?
▶ 1:39:53Thank you for that question. Um, currently right now, VA sends these referral authorizations through fax or secure email. Yep. Um, we have to WellHive's platform needs to move to the next security level, which is high. We just completed our FedRAMP high authorization. We submitted our uh, security assessment to VA. They're reviewing and that should be completed by fall of this year.
▶ 1:40:15Once that's completed, we're going to take them into inter uh, integral part of uh, step uh, key steps into going and working with the uh, referrals. And so, at the point where the scheduled appointment is booked, we will also be including that referral package with the appointment. Okay, and the upgraded um, I assume that's an industry standard that is pretty clear. That's right. Like the it's the it's FedRAMP certification, right? So, it's yeah.
▶ 1:40:45That's the So, that's something that's pre-established. You're not reinventing the wheel doing that. You're just making sure that your protocols are appropriate. Correct. If that's the case, um, and maybe this is a question for Dr. Arfons, I don't even know if you have the answer to this. Why does it take us through the if this is a standardized security measure to get that piece of it done? I'll take that for the record back to IT. Okay. Um, and then would the would I guess for Mr.
▶ 1:41:14Hansen, assuming that you could assuming your security protocol is going to pass cuz I assume it's a if this then that kind of thing. Um, Mr. Hansen, would community care uh, providers like those that you represent benefit from obviously upgrading these from an, you know, a fax or a security email that's basically a PDF of a fax to something that is more electronically delivered with the uh, appointment? They would.
▶ 1:41:42And for a lot of the our rural providers, I mean, it just comes down to human capital and any any time that you can streamline a process, that's going to help them out. Sure. That was an easy one. Um, thank you. Dr. Arfons, does VA have any plans to utilize EPS software to send referrals and authorizations to community care providers assuming we have the security that meets adequate uh, protocols? Yes, we're working with our OIT partners on looking at that capability.
▶ 1:42:09Is that the same process that is used to determine the security nature? Like where I get the kink in the hose right now is getting the security Once that clears, is there another protocol that needs to be passed or is that the last hurdle? There'll have to be software integration from there of our systems with WellHive. Okay, and how assuming this security like let's say we we start moving that direction cuz we assume the security measures will be passed.
▶ 1:42:37Are we going to start integrating then or can we start building integration models now so that when the security thing is done, we're already partway ready to go? IT dict- dictates that. We can take that back for the record. Okay. I would uh, appreciate a little bit of understanding. I think we can walk and chew gum at the same time on that and maybe have a little bit of a jump start on it. So, thank you. Very good. Um, and uh, I will recognize ranking member Bilirakis for your closing remarks. Okay, great.
▶ 1:43:06I have actually just one quick question and then I am going to move to uh, closing a question just for Mr. Farashi and uh, Dr. Arfons. Do you know what percentage of community care network providers have shared their schedules with WellHive and the VA? I'll just start with Mr. Farashi. I don't have that number off the top of my head, but we could could get that for Great. Great. Thank you. Um, I do want to say thank you to Chairman Barrett again and I really do appreciate the witnesses and their testimony today.
▶ 1:43:37Um, last week marked the first 100 days of the Trump administration and I do worry that the department that is now less prepared than ever is now less prepared than ever to modernize its service offerings. As I've mentioned before, we have focused on all the pieces of the puzzle here, not just the technology. As members of this committee, we must use our role to ensure that veterans have top-of-the-line access wherever they decide to receive care.
▶ 1:44:03We continue this oversight role and I hope we continue to hear of an adequately staffed and funded VA, clarity in the um, referral workflows, relieving these teams and veterans of burdensome and prolonged processes, an increase of data being returned by community providers, improving the continuity of veterans' care, and that facilities both VA and those in community have the resources they need to implement the technology at hand.
▶ 1:44:31I look forward to performing this work with Chairman Barrett, our witnesses today, and most importantly, hand-in-hand with our veterans. Thank you so much and I yield Thank you, ranking member Bilirakis, and uh, thank you to committee members for your presence today. I appreciate that. And to our uh, uh, our folks here testifying as well, thank you for your uh, participation answering so many questions. Uh, I want to thank you all um, for appearing today to provide your expertise on the EPS program.
▶ 1:45:01What we heard today was clear. The technology to modernize VA scheduling exists and it's a proven tool to fix one of the most frustrating barriers veterans face getting timely access to care. I mentioned this even from a personal uh, experience I had very recently. Uh, this system is simpler, it's easier, and it gets veterans scheduled with their doctors faster and with fewer obstacles. And it's making a real difference for veterans and VA staff where it is available. But despite the success and the data, only a fraction of veterans benefit from it.
▶ 1:45:31And it appears that there's not going to be a substantial adoption of this for quite some time. Only a fraction of VA medical centers are using it. If VA is serious about improving access to care and fulfilling the Mission Act, then it must take make EPS a priority and expand it to the rest of the VA. I think that we can look at this as less of a competitive thing between VA and community care and more of a comprehensive and collaborative effort to provide care for veterans where they are that suits them best.
▶ 1:46:01Every day, VA continues to rely on its outdated scheduling process. Thousands of veterans are stuck navigating a maze of phone calls and missed opportunities. And thousands of veterans are forced to wait too long for the care they've already earned and received and been referred for. VA simply cannot continue with the status quo when the technology solution exists that can make a meaningful, lasting impact on veterans' health care. Thank you again for your participation today's hearing.
▶ 1:46:27I look forward to working with the Trump administration make EPS a success for our veterans with each of the stakeholders that are here today as well. I ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material without objection. So ordered. And this hearing is