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Clint Hailey, Tenet chief managed care officer

Veterans gain Tenet system access in five states

By Bob Herman
Posted: June 26, 2014 - 1:00 pm ET

Veterans in five Sun Belt states now have access to Tenet Healthcare Corp.'s civilian facilities—an announcement that comes as lawmakers grapple with legislation to expand medical care outside the Veterans Affairs Department—and as the geographic mismatch of VA facilities to the veteran population draws more attention.

Dallas-based Tenet struck an agreement with TriWest Healthcare Alliance, in which veterans in Arizona, California, Missouri, Tennessee and Texas can receive specialty care, and potentially primary care, effective this month. Officials estimate about 1.8 million veterans live in Tenet's service area in those five states, where the system operates 41 hospitals, employs 600 physicians and encompasses dozens of outpatient centers.

The deal fills a growing need, as more veterans live in states below the Mason-Dixon Line. Of the approximately 20.8 million veterans living in the U.S., 9.6 million live in 14 Sun Belt states. Yet only about a third of the VA's 152 hospitals are located in those states.

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Tenet's contract builds off the Veteran Health Administration's Patient-Centered Community Care program (PDF). PC3—developed under now-ousted VA Secretary Eric Shinseki and VA Undersecretary for Health Dr. Robert Petzel—allows VA medical centers to pay for non-VA inpatient and outpatient care for veterans when that care is not otherwise readily available. For example, a VA facility can utilize the PC3 program if a needed medical specialty is not nearby, if veterans live in rural areas, or if there is a long wait time for care —a problem currently at the forefront of the VA.

PC3 uses two contracted intermediaries to create non-VA provider networks. Last fall, the department awarded a five-year, $4.3 billion PC3 contract to Phoenix-based TriWest to coordinate healthcare for veterans living in the South, West and Pacific states. Health Net Federal Services received a five-year, approximately $5.1 billion deal to help veterans in the Midwest, East and Atlantic coast states.

Clint Hailey, Tenet's chief managed care officer, told Modern Healthcare the arrangement with TriWest is structured like other managed-care contracts, allowing local VA systems to contact TriWest when veterans need extra care. TriWest will then look to its provider network, which now includes Tenet, to refer patients for appropriate care.

“Our belief is that being in this network, the system we have in place, is the way you help supplement the VA and the veterans who need care,” Hailey said.

Rates undisclosed but 'fair'

TriWest will reimburse Tenet and then bill the VA for covered services. Hailey did not disclose what rates Tenet will be paid but called the payments “fair.”

William Cahill, vice president of government relations for TriWest, said the agreement capitalizes on PC3's goals. “A patient gets the care, a provider gets paid, and the VA gets the access to a relief valve it may need in those important times,” he said.

Lawmakers in Congress are working on a bill that would make it easier for VA enrollees to receive care at civilian facilities. They've also grilled the VA over why the agency hasn't made better previous use of the private healthcare sector. But some veterans' groups think private healthcare is only part of the VA's solution to its woes.

Joe Davis, a spokesperson for Veterans of Foreign Wars, said the VFW supports efforts like those between Tenet and TriWest. But he believes far more needs to be done internally to rectify the VA's problems. “It's a good initiative but should not be seen as a panacea to the VA's current crisis in access and confidence,” he said, adding that the VA should focus on restoring veterans' faith in the system.

Follow Bob Herman on Twitter: @MHbherman

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