Veterans Affairs Committee on Dec. 1st, 2022

[Patricia Morand]

That's right.

Also, I'm a private provider, so I'm a fee-for-service OT. Veterans Affairs refer if they want me to see a veteran. That's how being a service provider works. I have a lot of experience. I worked directly with Veterans Affairs. I'm not sure, with the new provider, whether I will still be able to do that, or have to provide service under the umbrella of the new provider.

I've worked in a lot of different areas, not just with veterans. My experience is, when that happens, the whole fee structure changes, so—

[Rachel Blaney, NDP, North Island—Powell River, BC]

I'm sorry to interrupt you, but I think that's very interesting. I've done a bit of research and had some conversations. I heard from a couple of service providers who are very concerned, because, of course—please correct me if I'm wrong—the process that was in place was this: The provider goes directly to Blue Cross, bills, then gets reimbursed.

[Patricia Morand]

That's right.

[Rachel Blaney, NDP, North Island—Powell River, BC]

We're hearing that, in the new process, service providers will go to PCVRS, and they will be billing VAC, so the timeline gets longer. Until they get the money from VAC, the service provider doesn't get the amount. We're hearing that what used to be a $195 fee.... They are now only willing to pay $160, for example. We are hearing that.

That is one of the questions you said you wanted answered, I believe. Am I correct? It's knowing what that fee structure will look like. Are you worried about the money, or the timeline for getting that money, as a private person, or—

[Patricia Morand]

No, I'm not worried about that.

I'm more worried about.... I've always been able to provide my services autonomously. I have been able to collaborate with the case manager or whomever is needed regarding the veteran with whom I'm working. The vets I see, in this role, are quite complex. Their needs are complex. What I do, working from one veteran to another, is quite variable, depending on their needs, so what you're going to do with each person is not cut and dried. I don't know how going under the umbrella of a company will impact that. That's part of it. I want to still be able to provide the same kind of service I do.

Compensation, for sure, is another piece of it. I don't know anyone who would want to provide—

[Rachel Blaney, NDP, North Island—Powell River, BC]

That's so reasonable. If you're going to be doing that service, you need to be compensated, so you can do it well. I think that's completely fair.

[Patricia Morand]

When you've done it with a certain level of compensation, which is then going to be—I don't know—cut in half, it's a concern.

[Rachel Blaney, NDP, North Island—Powell River, BC]

I have one last question for you. Currently you just work with the case manager. This model would mean that the case manager was working with another person from the provider, so it would be like you're working with two people. As a provider, do you have any concerns about adding extra people?

[Patricia Morand]

I don't, but I don't even know that, and I don't know, if this role continues—which I hope it would because I think it is really quite helpful for the veterans—how that will look.

I don't really have—

[Rachel Blaney, NDP, North Island—Powell River, BC]

Thank you. I appreciate it so much.

My time is up.

[Patricia Morand]

Thank you.

[The Chair, Liberal, Emmanuel Dubourg]

Yes, thank you, Ms. Blaney.

Now let's go to a second round of questions. I would like to invite Mrs. Cathay Wagantall for five minutes, please.

Go ahead.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you, Chair.

My understanding of the situation is that VAC has a huge backlog. The goal here is to deal with that by taking it out of house to lighten the administrative burden of case managers.

In speaking with case managers who came as witnesses as well, and knowing what the Auditor General's report said, there was never what I would call a “significant effort” by VAC to build up our case managers to where we have enough of them so that they could meet that criteria that VAC promised them of 25 veterans per caseload. Many or most of them are at 40 to 60.

I would like to ask you each to briefly comment on that. This is a lot of money going out the door, a quarter—I believe $25 million—of which is profit for these companies that were supposed to be in place already. If you go to the VAC website, it says that they are working towards having this information available, and thanked people for their patience. I don't see a lot of hope here.

Be very brief, each of you. I'll start with Scott, then go to Patricia and Carolyn. That would be great.

[Scott Maxwell]

There are the same concerns. I don't like what I'm hearing when people say this is a new model. VAC has been outsourcing. They're not a service provider; they've always done this. We work with hundreds and hundreds of health care providers who service the population who refer to us in this case. That's not new. This is not a new thing. They've just given a contract to a massive provider, and we're expecting better results. I don't see how that changes the outbound side of care. What we've been talking about as a country for a long time, every Remembrance Day or around that period of time, for example, is the backlog on adjudication of awards, claims and benefits.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Scott, do you see this as an added level of bureaucracy, then?

[Scott Maxwell]

It absolutely has the chance to be. I'm not looking at the provider and saying that that's going to be the case, because I know they're in health care and want to streamline access to care, no doubt, but the proof is in the pudding.

All I'm trying to say is that the way that VAC has been doing business is not a new way. They're not a service provider.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you. That's very helpful.

I'll go to Patricia and then Carolyn.

[Patricia Morand]

Can you ask your question again?

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Sure. Basically what we have here is a scenario where a significant amount of responsibility has been transferred away from case managers, with the understanding that it's to lighten their burden, but we know that they don't see it that way because they have been told and told they'd have a caseload of 25 veterans. You know how complex their situations are. They're still at a caseload of 40 to 60, which, of course, if that burden of administration was removed by having more case managers, it would probably deal with the issue in the same way and not be spending taxpayers' money on funding another organization.

How do you see that?

[Patricia Morand]

I'm a provider for veterans, but I'm not an employee of veterans, so that's really difficult for me to answer. I don't think I can.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

One thing I'll mention, Patricia, is that the case managers, when they say there are going to be 9,000 providers.... One of them commented that that's way fewer than what we have now to service our veterans. Would that concern you, if that means that there will be fewer people and fewer organizations to be included in this new method of providing services for veterans?

Just answer very briefly; I want to get to Carolyn.

[Patricia Morand]

I think you want to maintain or improve the service to veterans however it's going to look. I think it also important to give veterans the choice of who they would like to be their provider.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Wonderful. Thank you.

Carolyn.

[Carolyn Hughes]

I completely agree with Scott that this is not new. Medavie Blue Cross is a third party, so they've had third party contractors for quite a while. As Scott said, they're not service providers. They don't do the medical treatment and things like that.

As to the number of providers they're going to use, from what I have learned, they're not going to be telling somebody that they can't go to that doctor anymore, but have to go to this one. They're still going to be allowed to go to the providers they have now.

I wanted to highlight one thing, though. The disability claims and the backlog are a separate department from case management withing Veterans Affairs, so there's no overlapping responsibilities in that way.

[The Chair, Liberal, Emmanuel Dubourg]

Mrs. Wagantall, your time is up, so thank you so much.

Now I'd like to invite MP Darrell Samson for five minutes or less, please.