Letter to Veterans Affairs Secretary Eric Shinseki - Continue the ARCH Program in Caribou

Letter

Dear Secretary Shinseki:

The Access Received Closer to Home (ARCH) pilot program provides health care services to rural populations of veterans through non-VA health care providers. Absent an extension, ARCH will conclude on September 30, 2014. Given its proven record of improving access to quality health care for our veterans, we request that you indefinitely extend the ARCH pilot program.

As you know, the ARCH program is operating at five pilot sites in Arizona, Kansas, Maine, Montana, and Virginia. Veterans who utilize these services and veterans service organizations (VSOs) have communicated to us that ARCH is an overwhelming and unqualified success. They note that ARCH helps to meet the primary care needs of veterans without the long travel day that can be required to reach the nearest VA Medical Center (VAMC). Particularly for ailing and elderly veterans, travel to VAMCs can be more expensive, more time-consuming, and less safe than a trip to the local ARCH location. The ARCH program is also reducing the cost of mileage reimbursement for the VA.

In addition, because veterans are more willing to make a local trip for primary care rather than an all-day trip to a VAMC, ARCH is helping to provide preventive and early intervention care rather than acute care, which can be more costly, resource-intensive, and physically straining for veterans. The July 2013 ARCH program evaluation states that program's cost effectiveness has only begun to be properly evaluated due to limited available data. As more data becomes available, we encourage you to ensure that the second and third-order cost benefits of the ARCH program, such as mileage reimbursement cost avoidance and reduced costs associated with preventive care and early intervention, are evaluated.

In a recent article on the unique needs of rural veterans, John Gale of the Maine Rural Health Research Center at the University of Southern Maine identified transportation issues as a significant barrier to health care access. One-way travel distances to access VA primary care average 45 to 54 miles, but in Maine these distances are frequently exceeded. For example, Togus VAMC, the only VAMC in Maine, is located approximately 250 miles from the ARCH site in the northern part of the state. As Senators from a state with a large elderly population, we are all too familiar with the numerous transportation challenges faced by seniors, which are rarely addressed in a comprehensive way. In a November 6 hearing of the Senate Special Committee on Aging, witnesses testified to the enormous challenges associated with seniors having access to the transportation options they need in order to maintain their independence. The ARCH program is a notable success in this respect, as it has lessened the average estimated one-way drive time by four hours for Maine veterans, reducing the need for physically taxing travel and unnecessary travel costs. While the VA and VSOs have tried other methods to transport veterans to the Togus VAMC, these programs are limited. For example, the Togus VAMC operates a popular volunteer program to transport veterans to appointments, which is coordinated and funded by Disabled American Veterans. Unfortunately, age and disability restrictions on drivers threaten to reduce this program's availability. The ARCH program in Caribou is clearly helping meet the needs of veterans in the northern part of Maine.

As you evaluate the effectiveness of the ARCH program and make a determination about its extension, we ask that you consider the experiences of the many veterans who are accessing their health care through the ARCH site in Caribou. The ARCH program improves coordination with community-based health services, which increases access to cost-effective care for veterans in rural areas. Given its success, we believe ARCH is a model that may be worth extending to other parts of the country, as nearly half of VA-enrolled veterans live in rural areas. In addition, the higher rate of military service among this country's rural population suggests that the need for access to rural services will grow in the future.

Thank you for considering our request to indefinitely extend the ARCH program at all five sites. We appreciate your prompt attention to this request. Should you have any questions, please have your staff contact Ryan Kaldahl with Senator Collins at 202-228-6119 and Steve Smith with Senator King at 202-224-3980. Thank you again for your consideration.

Sincerely,

__________________ __________________

Susan M. Collins Angus S. King

United States Senator United States Senator

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