Captioning performed by vitac forward to hearing first from sloan gibson. Thank you, mr. Chairman. Chairman isakson Ranking Member blumenthal and the committee, were committed to making the Choice Program work and to providing veterans timely and geographically accessible care, using care in the community whenever necessary. Ill talk shortly about what were doing and the help that we need from congress to make all of that happen. First, i want to talk very briefly about access to care. Most mornings at 9 00 a. M. , for the last year, Senior Leaders from across the department gathered to focus on improving veterans access to care. Weve concentrated on key drivers of access, including increasing Medical Center staffing by 11,000, adding space, boosting care during extended hours and weekends by 10 and increasing staff productivity. The result, 2. 5 million more completed appointments inside va this year than last. Relative value units, a common measure of care delivered that measured care delivered across the industry are also up 9 . Another focus area for us improving access has been increasing the use of care in the community. In 2014, va issued 2. 1 million authorizations for care in the community which resulted in more than 16 million appointments completed. Year to date in 2015, authorizations are up 44 , which will result in millions of appointments for Community Care. Veterans are responding to this improved access. More are enrolling for care at va among those who are enrolled, more are actually using va for care and those using va are increasing their reliance on va care. This is especially the case where weve been investing most heavily due to long wait times. In phoenix, for example, where weve added hundreds of additional staff, weve increased completed appointments 20 this year. I should also note that we have increased care in the community 127 in phoenix over the last year, largely due to the extraordinary effort of triwest in that particular community. But wait times arent down. The wait times are not down because of the surge of veterans coming in for care and the veterans that are there asking for more care from the va. In las vegas, we have a 17 increase of veterans receiving care since we opened the new Medical Center there less than two years ago. In denver, weve opened up clinic and added more than 500 additional staff. Veterans are using va for care there and are up 9 . In fayetteville, North Carolina, wait times continue to be a problem and weve increased appointments 13 , relative value up 19 and veterans using care are up 10 . In all of these locations, weve had dramatic increase in care in the community. As secretary mcdonald has testified, the primary increase for demand are an aging veteran population increases in the number of claims and the rise in the degree of disability and as we can see here, improving access to care. As i mentioned at the outset, Community Care is criminal for critical for ipmproving access. We use it and have for years in programs other than choice. In 2014, that rose to 8. 5 billion and we estimate that at the current rate of growth, va will spend 9. 9 billion, including choice, a 25 increase in care in the community in just two years. At the same time, weve had a large increase in care in the community. Choice hasnt worked as intended. Here are some things were doing to fix it. On april 24th, we changed the measure from Straight Line to driving distance using the fastest route. This roughly doubles the number of veterans eligible for the 40mile program under choice. But there is much more to do. A follow on mailing to all eligible veterans is about to go out. Weve Just Launched a major change in internal processes to make choice the default option for care in the community. Additional staff training and communication, extensive provider communications, improvement to the website and ramped up social networking, new mechanisms to gather timely feedback, directly from both veterans and frontline staff. These are all already in place or about to launch. In the longer term, we must rationalize Community Care into a single channel. The different programs about different rules and reimbursement rates, methods of payment and funding routes are too complicated for veterans, for providers and for va employees who coordinate care. Im confident we will need your help on that. Next, let me touch on the other 40mile issue. Weve completed indepth analysis with patient level data to estimate the cost of legislative change to provide choice to all veterans, more than 40 miles from where they can get the care they need. Weve shared that analysis with some members of the committee, with staff and with the cbo. It confirms the extraordinary cost that had been estimated previously. Weve also briefed the staff on a broad range of other options and believe there are one or more options worthy of discussion and careful consideration. While we are working together on an intermediate term solution, were requesting Congress Grant greater flexibility to expand the hardship beyond just geographic barriers. This authority would allow us to mitt gate the impact of distance and hardships for many veterans. We request greater flexibility among some requirements that preclude us from using choice for obstetrics, dentistry and longterm care. As described above, we accelerated access to care in the community this year, anticipating that a substantial portion would be funded through choice. For various reasons, most touched on previously, we will be unable to sustain that pace without greater Program Flexibility and flexibility to utilize at least some portion of Choice Program funds to cover the cost of other care in the community. We are requesting some measure of funding flexibility to support this care for veterans. On may 1st, va sent to congress a legislative proposal providing major improvements to use provider agreements for the purchase of Community Care. We request your support. Lastly, we are requesting flexibility in one other area of veteran care, hepatitis c treatment. You are all familiar with the impact of this new generation of drugs. Veterans that have been hep c positive for years have a cure within reach with minimal side effects. Because of the newness of these drugs, there was no funding in the budget or appropriation. We moved 688 million from care in the community anticipating the shift in cost to choice to Fund Treatment for veterans with these new drugs. It was the right thing to do but it wasnt enough. Were requesting flexibility to make this cure available to veterans between now and the end of the fiscal year. So, we are improving access to care, notwithstanding the reported wait times that you see. That means we still have work to do on wait times but we are improving access to care. Were committed to making choice work and have very specific actions to do just that and we need some help, especially additional flexibility to allow us to meet the Health Care Needs of our veterans. We look forward to your questions. Mr. Chairman, Ranking Member blumenthal and members of the distinguished committee, im grateful for the opportunity to appear before you this afternoon on behalf of our companies employees and nonprofit owners to discuss triwest work in which were privileged to do in support of the department of Veterans Affairs. I would like to focus my oral testimony on three topics. The realities of this programs implementation, the process of identifying gaps and those that remain to be resolved and what i believe to be the art of the possible going forward. Mr. Chairman, before the veterans Choice Program, there was pc3. As you know and as secretary gibson has said, purchasing care in the community from Community Providers has been a long practice of the va. In fact, in september of 2013, after two years of planning, va sought to change that with the awarding of the Patient CenterCommunity Care contracts that we and health net. That contract was designed to have a consol dated integrated Delivery System built in the commune toy undergird the va facilities across the 28 states in the pacific that were privileged to serve. And make sure at the end of the day that we werent there to replace the va, we were there to supplement it. In fact, it worked as intended. When the furnace lit off in our hometown of phoenix, arizona, 6400 providers under contract leaned forward at the site of the va Medical Center to assist in the backlog and by august, 14,000 veterans had moved through that process. Around the same time, we got a modification to add primary care to those contracts. And within 90 days, we stood up a network of primary care providers. We now have over 100,000 providers across 28 states in the pacific under contract along with 4500 facilities and were not finished. The reason were not finished is we need to make sure that the networks are tailored to match the demand that exists in a particular market that is not able to be met by the va facilities itself. The fact of the matter is, that was a complicated program to set up. It was done under very short order but it was training, if you will, for what was to come next. Because on november 5th, after 30 days of work, we were to stand up in support of va the Choice Program. We had to partner with va to receive a list of all eligible veterans. We had to design and produce a card and put it out with a personalized letter from the secretary. And we had to stand up a Contact Center to handle all of the calls coming in. After two weeks of design and two weeks of hiring and training of 850 people. No one went into threehour waits, the phones were answered but the work had only begun. And weve been on a pathway since to try and mature the operations. The secretary talked about the 40mile issue. Theres additional refinements that may well be needed and desired in that area and, if so, we stand prepared to support what those might look like. Theres some other changes that may well be needed to the program as we go forward. Secondly, we need to aggressively identify and resolve our gaps and fix our Operational Performance and were in the process of doing that together. Were modernizing our i. T. Systems after a 24 7 build, a new portal system that will serve all of the facilities and our own staff as we seek to move the veteran information back and forth between the two facilities as care is rendered downtown. And were in the process of tailoring networks to match the demand that exists in each market across our area. The Choice Program is up, its operational and theres refinement still needed. I believe that because of the collaborative work thats been under way between all of us that are engaged in this, that we are refining the pieces that need to be refined and were identifying the policy gaps that we need to work and those that the secretary said are getting attended to. I think there are a couple of policy issues, though, that remain the jurisdiction of this particular committee. One is, i would encourage a relook at the 60day authorization limitation thats been applied. Secondly, i would respectively submit that there needs to be harmonization between the two programs and between all of the facets of how the va buys its care currently and how the va operates in order to make this work right. At the end of the day, i believe the art of the possible, which you sought, is truly within our grasp. Id like to point to dallas, texas, where under the engaged leadership of the 17 director, a couple of weeks ago, we sat with the medical director and the entire staff there, including behavioral staff, and looked at the full demand that exists for veterans in that market. We then took out and looked at whats the network that is constructed to stand at its side, which is the base on which choice rides. So, in other words, if theres not a network provider, you can set up an engagement with an individual provider to deliver services under choice. We then designed a network map that were now in the process of constructing together and over the next 90 days, from Behavioral Health to primary care to specialty care, we will rack and stack the network to meet the demands that otherwise cannot be met by the va Medical Center in dallas. That is being repeated across our entire 28state area in the pacific as we seek to do our part to ensure the operations of choice. Its a privilege to serve in support of those that serve this country. Its an honor to serve the veterans from the states represented by half of the members of this committee. And mr. Chairman, i look forward to taking questions after my colleague, Donna Hoffmeier is finished with her remarks. Thank you. Miss hoffmeier . Chairman isakson, Ranking Member blumenthal and other members of the committee, i appreciate the honor to testify on behalf of the veterans Choice Program. Health net we are dedicated to ensuring our nations veterans have prompt access to needed Health Care Services and believe there is Great Potential for the Choice Program to deliver timely, coordinated and convenient care to veterans. In september 2013, health net was awarded a contract for three of the six pc 3 regions. Completing implementation at the beginning of april 2014. Then, in october, after Congress Passed and the president signed the veterans access choice and accountability act of 2014, va amended our pc 3 contract to include several components of the Choice Program. With less than a month to implement choice, as dave just mentioned, we literally hit the decks running. Im a navy veteran, to use a navy phrase, and we havent slowed down since. To meet the deadline, we worked closely with the va and triwest to develop an aggressive implementation schedule and timelines. The ambitious schedule required us to hire and train staff quickly and to reconfigure our system for the new program. Despite this very aggressive implementation schedule, on november 5th, veterans started to receive their choice cards and they were able to call into the toll free choice number to speak directly with a Customer Service representative about their questions on the Choice Program or to request an appointment for services. Having said that, there certainly have been challenges that have resulted in veteran frustration as well as frustration on the part of va and, to be honest, even our own staff, including call center and appointing staff. With such an aggressive implementation schedule, there was little time to make system changes. We literally had less than a week from the date we signed a contract modification with veterans to the actual go live date. While the collaboration with the va since the start of the Choice Program has been good, there is still considerable work that needs to be done to reach a state of stability where the program is operating smoothly and the veteran experience is consistent and gratifying. We appreciate the opportunity and offer our thoughts in the future of the Choice Program. The Choice Program is a new program that was implemented in record time. As a result, there are a number of policy and process decisions and issues that are either unresolved or undocumented. If choice is to succeed, these items must be addressed quickly. As i mentioned earlier, weve been working very closely with the va to address these issues. Many of the items simply could not have been anticipated before the start of the Choice Program. Others, however, should have been addressed before the program started but the implementation timeline did not provide adequate time to do so. The issues and concerns have been occurring very quickly. As a result, weve struggled to keep up with developments and adequately train our staff with the most uptodate and accurate information. This situation is not ideal. Based on these dynamics, we have one overall recommendation for moving choice forward. We recommend va develop a comprehensive strategy for choice that clearly defines the program requirements, the process flows and rules of engagement. The strategy should provide a clear road map for all of us to follow. One that is communicated to all of the stakeholders. Va leadership, both contractors, congress and, most importantly, the veterans. While the strategy needs to identify key initiatives and reasonable timelines for implementing those initiatives, it needs to contain the flexibility to address issues as they arise and make necessary course corrections. The strategy must include resolution of outstanding policy and process issues, development of policy and operational guides that are mandated across the program, comprehensive training of both va and contract staff, using consistent process flows, operational guides and scripting. And a clear and responsive process for resolving legitimate issues and challenges. In closing, id like to thank the committee for ensuring our nations veterans have help to the needed services. We believe there is Great Potential to help va deliver appropriate and coordinated convenient care to veterans. We are committed to collaborating with va to ensure the Choice Program succeeds. Working