The Department of Veterans Affairs (VA) is embarking on a significant reorganization of its health care management system, marking the most extensive overhaul since 1995. This initiative will reduce the number of Veterans Integrated Service Networks (VISNs) from 18 to five, streamlining operations to enhance efficiency and communication across the Veterans Health Administration (VHA).
Under this new structure, the VISNs will report directly to the VA under secretary for health. The plan also involves the elimination of the VHA chief operating officer position, with staff in the VHA Central Office being reassigned under the authority of the under secretary, deputy under secretary for health, or associate deputy under secretary. These changes aim to simplify what VA officials describe as a “complex bureaucracy,” fostering direct communication and consistent policy-making.
Doug Collins, VA Secretary, emphasized the need for this reorganization in a statement. He noted, “The current VHA leadership structure is riddled with redundancies that slow decision making, sow confusion, and create competing priorities.” The intent is clear: policymakers will focus on setting policies, while regional leaders will implement these policies and clinical leaders will concentrate on patient care.
VA officials underscored that this restructuring is not intended to reduce staff. They have indicated that the reorganization is a response to a decade-long need for improved accountability and patient service. According to internal documents, the plan draws from models of national health care systems and leading health care organizations to ensure effective implementation.
Legislative Support and Concerns
House Veterans Affairs Committee Chairman Mike Bost, a Republican from Illinois, has introduced legislation addressing the VA’s organizational structure. His proposal suggests reducing the number of VISNs to eight, three more than the VA’s current plan. Bost expressed support for Collins’ initiative, stating, “Change can be a good thing. Veterans and their families gave us a clear mandate last November that business as usual is not cutting it.”
Conversely, Mark Takano, the committee’s ranking Democrat from California, has called for hearings to scrutinize the proposal. He criticized the lack of consultation with Congress and veterans service organizations throughout the planning process. Takano stated, “Redesigning the organizational structure of the nation’s largest integrated health care system should not be a secretive, partisan, closed-door process.”
The VA has also announced changes to its community care program, seeking proposals for contracts valued up to $1 trillion over ten years. This initiative aims to expand options for veterans to receive care outside the VA system, while plans include reducing community care regions from five to two, supported by multiple health care networks.
Reactions from Veteran Advocacy Groups
Reactions from veteran advocacy groups have been measured as they review the implications of these changes. Following a VA briefing, Carl Blake, CEO of Paralyzed Veterans of America, expressed cautious optimism. He noted that the planned changes appear “promising” and could help alleviate bureaucratic barriers that have hindered effective health care decisions.
The National Commander of the Disabled American Veterans, Coleman Nee, conveyed support for efforts aimed at improving VA health care for veterans with service-connected conditions. He stated a commitment to closely working with the VA, Congress, and other stakeholders to enhance the quality of care for veterans.
A blue-ribbon panel created in 2016 had recommended that the VA redesign its central office to ensure proper oversight of the VISNs. The Commission on Care’s final report pointed out the lack of clarity regarding the roles of VISNs and the need for standardized responsibilities. These concerns were echoed in a recent report from the VA’s own inspector general, which found that the VISN structure lacked defined roles and accountability.
The VA plans to eliminate 25,000 vacant positions in the VHA, a move that has raised concerns among some lawmakers. Critics argue that this could exacerbate staffing shortages, particularly after the loss of 30,000 jobs earlier this year due to various incentives and administrative changes. VA press secretary Peter Kasperowicz characterized the vacancies as “mostly COVID-era roles that are no longer necessary,” assuring that this will not impact veteran care.
The reorganization of the VHA is anticipated to take place over the next two years, starting in early 2026. As the VA navigates this substantial transition, the focus remains on enhancing the health care experience for veterans while addressing the complexities of its operational structure.
