The next Veterans Affairs secretary faces a tough job. The agency's ability to meet the special healthcare needs of a rapidly changing veteran population hangs in the balance.
Amid all the overwrought claims about the VA's failures, not enough attention has been paid to the three major challenges facing the VA:
- Many of its legacy facilities are underutilized and far from the homes of many veterans.
- Its electronic health record system, once a leader in the field, badly needs an overhaul that enables interoperability with both military and private-sector healthcare providers.
- Its clinically integrated network of salaried physicians, one of the system's strengths, needs to retool to accommodate the advancing technologies that are pushing more care to outpatient settings.
Moreover, the VA's next leader must tackle these challenges while continuing to deliver what every objective study has found is high-quality, low-cost care for its 9 million patients. That includes its world-class program for rehabilitating the severely wounded.
This is a huge management challenge at a healthcare system that employs 25,000 physicians and 95,000 nurses at 179 hospitals and 1,061 outpatient clinics. Successfully tackling these issues will require deep knowledge about how healthcare works and a clear vision for where the VA needs to go.
Sadly, most of the names being bandied about for the job do not meet those job requirements. A former congressman? A former governor? A Koch brothers-funded privatization advocate turned "Fox & Friends" commentator?
If President Donald Trump wants to hold onto veterans' votes—they gave him a 61%-to-34% edge in the 2016 election—he should name a top healthcare executive as the next VA secretary. Choosing another unqualified candidate like former White House physician Ronny Jackson will only put him at loggerheads with mainstream veteran groups, all of which want to strengthen the VA, not undermine it through excessive privatization.
Fortunately, there are several senior healthcare leaders who fit the bill. If the president could rise above politics, none would be better qualified than Nancy Schlichting, former CEO of Henry Ford Health System. She chaired the Obama administration's Commission on Care, whose 2016 report provided a detailed road map for improving the agency. However, she financially backed Democratic Party candidates, including Hillary Clinton, which probably disqualifies her from consideration.
Perhaps the most politically acceptable candidate is 68-year-old Anthony Tersigni, the CEO of Ascension. Not only does he run the second-largest not-for-profit healthcare system in the country, he brings Republican credentials (he once worked in President Gerald Ford's campaign) and served in the National Guard.
Whomever Trump chooses, here are the realities he or she will face. The ranks of veterans will be shrinking steadily over the next two decades, from about 20 million today to under 14 million in 2037. Future vets will be more likely to come from rural areas, small towns and inner cities, where joining the military remains one of the few decent career choices for youths who don't go to college. This is all driving the need to close facilities, which will run into a buzz saw of opposition.
On-time and affordable EHR implementation is tricky under the best of circumstances. The tug-of-war between the Pentagon, the VA and vendor lobbyists could turn the VA project into a quagmire unless it is given constant attention by a details-oriented leader.
Renewal of the VA Choice funding and expansion program is a necessary response to the growing mismatch between where vets live and the VA's existing facilities. But in many ways, it's a sideshow.
What the next leader really needs to focus on are the needs of the majority of veterans who rely on the VA for care. The way to do that is by building on the proven strengths of its clinically integrated network, which is more aligned with delivering value-based care than further privatization.