Alaska VA to expand, continue work on wait time issues

Leaders at Alaska’s veterans health care system are planning to expand the agency’s workforce in the state.


The agency, which provides health care services to all veterans in Alaska, currently has about 550 employees but plans to add another 100 soon, said Alaska Veterans Health Care System Director Dr. Timothy Ballard.

He visited Kenai Thursday to meet with staff at the Kenai VA clinic and to host a town hall meeting for veterans at the Kenai Visitors and Cultural Center, which he has done once every three months since taking the job.

President Donald Trump’s administration increased the Veterans Affairs budget by about 6 percent, “the healthiest our budget has been” in the last few years, Ballard said. That’s given the Alaska branch of the department a little more leeway to hire more personnel to improve the wait times for veterans seeking medical appointments. Though one of the primary efforts is to hire more primary care physicians, they also need the support staff to run clinics and the scheduling system, he said.

One of the points in hiring more primary care physicians is to make it easier for veterans to get appointments at the VA clinics instead of at outside clinics, he said. When veterans see other providers or go to non-VA hospitals, the VA reimburses those clinics, known as purchasing care, which is a significant expense for the VA system.

Last year, the Alaska VA health care system purchased about $130 million in care, Ballard said. He said he thought there were potentially $10 million in savings if the VA clinics were better staffed to get more patients there instead of to civilian medical clinics.

“If I had more primary care providers, we wouldn’t have had to purchase that much care,” he said.

Ballard, who has been on the job 16 months, said the Alaska VA has been chipping away at the set of issues veterans brought up about wait times for appointments and access to care. One of the major things that is now in place is assured same-day access for mental health care, part of an initiative to reduce veteran suicides. Ballard told attendees at the town hall meeting that the same-day access infrastructure is going into place now.

The same-day access mandate went into place at the directive of David Shulkin, the VA’s undersecretary of health, as part of an effort to address the wait times for primary care and mental health appointments. The VA documented veteran suicides by state in an analysis released Sept. 15, stating that suicide rates were higher among older veterans, those living in western states and in heavily populated areas, and that of the 20 suicides per day, 14 are not under VA care.

That was a point Ballard hit on during his talk at the town hall meeting. Of Alaska’s approximately 78,000–90,000 veterans, only about 34,000 are enrolled in VA health care, and only about 21,000 actively use it, he said. With more staff to facilitate access, Ballard said they hope to increase that number in Alaska.

Alaska also has the challenge of being incredibly spread out, so veterans in more remote locations may not have easy access to a clinic. Over time, the Alaska VA had worked out a purchasing system, relying on partnerships to efficiently deliver care, but when the systemwide VA Choice program arrived, it layered another system on top of one Alaska had grown on its own.

“We already had a robust referral network,” Ballard said. “….We’ve always purchased care and referred it out. So when Choice came along it was a wrench in a well-working system.”

The Choice program was widely criticized for inefficiency, particularly in scheduling appointments. As part of the solution, the Alaska VA office took back authority over scheduling appointments from the contractor, TriWest, to try to bridge some of the problems of an out-of-state call center booking a veteran in Kenai an appointment in Fairbanks, for example.

The Alaska VA health care system has always struggled with maintaining staffing levels, but a new primary care provider recently started at the clinic in the Matanuska-Susitna Valley and more staff are due to come on board within the next few months, Ballard said. He said he’d eventually like to see the Alaska VA health care system have a long-term care facility and have a third provider at the center in Kenai, which is a relatively small clinic but served just shy of 900 veterans in October.

“We’re really the veterans’ option for their lives,” he said.”We’re supposed to be there for the rest of their lives … It’s a marathon for us.”

At the meeting in Kenai on Thursday, about a dozen veterans turned out to listen and get questions answered, approximately matching the number of VA staffers and other staff present. Most of the comments were appreciative of the VA’s efforts or less heated than at some of the meetings in the past two years.

The town hall meetings have helped connect veterans with what is going on at the system and helped to answer questions, Ballard said. There are some who have continued to have issues with the system, but overall, they take advantage of the chance to come out and get answers. Because of scheduling issues, the Alaska VA hopes to eventually set up a phone line system to have statewide town hall meetings with 500 lines or more so veterans from all areas can participate, he said.

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