Earlier this week, President-elect Trump announced the creation of the Department of Government Efficiency (DOGE) to be headed by Elon Musk and Vivek Ramaswamy. Both Elon and Vivek have publicly called for citizen input on ways we might make the government more efficiently serve we, the people. This short blog is my first input to the DOGE files…
Last week, while traveling away from home, a crown on one of my teeth rather inconveniently fell off. On a Saturday night, of course. My dental care is normally provided through the Department of Veterans Affairs (Hampton, Virginia location), who has managed this care through its Community Care program, which refers care to civilian providers who are reimbursed by the VA. I have generally found this care to be both good quality and responsive.
On Monday afternoon, I called the local (Boise, Idaho) VA Community Care office to seek a provider to cement the crown back on. The representative at Community Care (Biose) informed me that because I am a traveling veteran, that I needed to speak to the Traveling Veteran Coordinator and connected me to that office. I described the problem and desired resolution to the Traveling Veteran Coordinator (Boise), who then informed me that I must speak to the Traveling Veteran Coordinator (Hampton), since that is my VA Primary Care Provider’s location. I described the problem and desired resolution to the Traveling Veteran Coordinator (Hampton), who informed me that because I receive care through the Community Care program, I must speak to the Community Care Coordinator (Hampton) for a referral. I described the problem and desired resolution to the Community Care Coordinator (Hampton), who informed me that because I am traveling in Boise, I must speak to the Community Care Coordinator (Boise). I had completed a full lap of the Boise/Hampton – Community Care/Traveling Veteran matrix!
I informed the representative that I had now completed a complete lap of the VA500 and asked how we might break out of this infinite loop. Somewhere along the way I had been directed to use the VA Community Care provider look-up tool (which I had already done) and found that of the three dental providers listed, one had a link to an SEO-aggregator website and call center that put me in a do-loop of trying to get back to the locally listed office (no luck), and the others could not schedule care without first receiving a Community Care authorization from the VA.
Luckily, I ended up on the line with a kind southern woman (from the Traveling Veteran (Boise) office, I believe, but I was a bit dizzy by now) who took responsibility for my case and told me that the solution required that I send an “e-mail” through the MyHealth secure messaging portal to my PCM in Hampton (but not the Dental Office in Hampton) requesting that she complete a Traveling Veteran referral form and forward it to Boise for action. The kind representative called me back at each step in the process that followed: PCM submits the form, Traveling Veteran (Boise) receives and endorses the form, Community Care (Boise) receives and endorses the form, and Dental (Boise) receives and endorses the form.
At this point (Tuesday midday), my VA Valkyrie kindly informed me that the next call I would receive would come from the VA Dental (Boise) scheduler and that I should take care not to miss the call because they would only call once. VA Dental (Boise) called Tuesday afternoon and scheduled me for an appointment the following morning. Bob’s your uncle, I got my tooth fixed. Easy peasy lemon squeezy.
Recommendations for DOGE consideration:
- Any Veteran who is entitled to medical and dental benefits carries a VA ID card. For any Veteran who is in a community care program, this card should act functionally like an insurance card and be accepted on a walk-in/call-in basis to get an appointment with a community care provider.
- The list of community care providers on the VA website must be updated and must be purged of listings of 3rd party SEO-aggregator websites that don’t belong to or connect with a participating provider.
- Any Veteran who is entitled to medical and dental benefits should be able to call any VA facility and be provided with the needed appointment or referral in one phone call, with no more than one transfer.
- Any Veteran who is entitled to benefits should be able to walk into any VA facility nationwide and either be seen on a walk-in basis if available, be triaged and provided an appointment, or be provided a community care appointment, in one conversation with one representative.
- Any Veteran who is entitled to medical and dental benefits should be able to call any community care provider directly and schedule needed care using the VA ID card as proof-of-benefit, and without needing a prior referral from the VA.
- All of these recommendations support a governing principle: design the VA customer service process(es) to be maximally efficient and friendly to the Veteran, rather than the VA Organizational Chart. A combination of technology solutions and organizational and training solutions to provide single points of entry and service to coordinate the Veteran’s seamless access to all of their benefits is suggested.
- A broader governing principle recommended to the DOGE: If a citizen is entitled to benefits, the Government, who already possesses the data to determine eligibility and complete enrollment, should determine eligibility and complete the enrollment automatically for the citizen, and provide them with an easy-to-understand statement of the benefits for which they have been enrolled, and both a web site and a single point of (human) contact for access, scheduling, assistance, questions, and appeals.