if it is beyond 30 days, they keep the appointment and they call triwest or healthnet and explore what their options are in the private sector. that means they are making an informed decision when they decide to essentially reject the va appointment. if you change that to having the veteran make the election before exploring their private sector options, it is not an informed decision. and actually leads to veterans, if they go to the private sector having to go in the back of the line and restart their va

just a more seamless way of triwest and healthnet notifying va that the veteran has accepted a private sector appointment. >> i want to open a hornet's nest but i'm going to go ahead and do it anyway. i had to pay $30 penalty for not keeping an appointment in atlanta for health care i was getting. we can't put everything on the shoulder of triwest or the va. if somebody doesn't do their job, by letting va or tricare know which appointment they're going to keep, there should be a penalty to the person for not keeping the appointment. that way, the communication is complete. i know there will be some that don't like that idea but it gets everybody's attention. if we are going to be more efficient i think everyone has to be part of the efficiency including the veteran getting the benefits. i just wanted to put that in there. not to start a hornet's nest but thank you for raising the question. very helpful. senator blumenthal. >> thanks, mr. chairman. you know we have been talking a little bit about how to pay for the denver crossover. >> we just figured it out. >> the chairman has told me

i feel a process could work but just a more seamless way of triwest and healthnet notifying va that the veteran has accepted a private sector appointment. >> i want to open a hornet's nest but i'm going to go ahead and do it anyway. i had to pay $30 penalty for not keeping an appointment at glanna for health care was getting and i think you can't put everything on the shoulder of triwest or the va. if somebody doesn't do their job by letting va or tri-care to know which one they are going to keep i would be the first person to say there ought to be a penalty for not keeping that appointment that way the communication is complete. i know there will be some that don't like that idea but it gets everybody's attention. if we are going to be more efficient i think everyone has to be part of the efficiency including the veteran getting the benefits. i just wanted to put that in there. not to start a hornet's nest but thank you for raising the question. it's very help pull. senator blumenthal. >> thanks mr. chairman. you know we have been talking a little bit about how to pay for the denver cr

and health did the net thenet. -- healthnet. it was designed to have an integrated system in the community to undergird the v.a. facilities across the 28 states in the pacific that we're privileged to serve and make sure at the end of the day that we weren't there to replace the v.a., that we were there to supplement it. in fact, it worked as intended. when the furnace lit off in our hometown of phoenix, arizona 6,300 providers under contract under pc-3 leaned forward at the site of the v.a. medical center to assist in eliminating 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 and the pacific under contract along with 4,500 facilities and we're not finished. the reason why we're not finished is that we need to make sure the networks are tailored to match the demand that exists in a particular market

if it is beyond 30 days, they keep the appointment and they call triwest or healthnet and explore what their options are in the private sector. that means they are making an informed decision when they decide to essentially reject the va appointment. if you change that to having the veteran make the election before exploring their private sector options, it is not an informed decision. and actually leads to veterans, if they go to the private sector having to go in the back of the line and restart their va scheduling process all over again. >> i want to make sure i understand this. i'm a veteran that lives more than 40 miles from the clinic and i'm eligible for veterans choice. you are saying i should make a private appointment through the midwest, what's the name? triwest. and make the va appointment and i can choose which one i want and not automatically go to the private provider? >> for 40 miles i believe they should continue to contact triwest. however, 30-dayers. so if va can't find me an appointment within 30 days -- right now, the va schedules the appointment. let's say it's 60

outside of choice for all of our other purchase care appointments will work directly with triwest and healthnet to get that patient an appointment through the choice program, and at that time we hope we have learned from our pilots in 8 and 17 how to do this smarter and better so that we will greatly reduce the volume of people that we are referring to the tpa and are only providing medical record documentation for those patients who actually choose to go out the system. >> that sounds excellent. >> the pilot is a very good idea. sitting at the table in the initial design when we were getting ready to launch, we had two days to make a decision. and the question was how do you make sure that all the right information is in the right place to be able to serve people on the front end? the back end consequences are now obvious and making the change makes a lot of sense and we're looking forward to supporting it. >> okay. >> the pilot has been going exceptionally well in our area and, in fact, we just approved a schedule with va to move forward with implementing the concept across all of our regions