WASHINGTON, D.C. – U.S. Senator Susan Collins, the Ranking Member of the Aging Committee and one of the top Republicans on the Military Construction and Veterans Affairs Appropriations Subcommittee, and U.S. Senator Angus King have sent a letter to Secretary Eric Shinseki of the Department of Veterans Affairs (VA), which requests that the VA indefinitely extend the Access Received Closer to Home (ARCH) pilot program in Caribou. 

“Maine has one of the highest ratios in the nation of veterans to overall population, and in a large, rural state like Maine, it is critically important that the VA goes the extra mile to see that our veterans have access to and receive the treatment they need and deserve,” said Senator Collins.  “For veterans in northern Maine, a one-way drive to the Togus VA Medical Center in Augusta can take four hours or more to complete.  Especially for our ailing and elderly veterans, such a trip can be physically taxing, painful, or detrimental to their health, and we must do all that we can to improve access to health care they receive through the VA.”

“For generations, Mainers have proudly and honorably shouldered the heavy responsibility of defending our country, and as a result, our state today is home to more veterans per capita than most other states. It is incumbent upon us to ensure that we provide these men and women the highest quality care and support that our country can offer,” Senator King said. “In a rural state like Maine, however, accessing vital and deserved healthcare resources can be both physically and logistically challenging for our veterans, especially those who are disabled or elderly. That’s why it’s so important the VA continue outreach programs, like the ARCH initiative in Caribou, that bring these critical care and support services directly to their communities.”

According to information provided to Senator Collins and the Senate Committee on Veterans’ Affairs by the VA, the three-year ARCH pilot program is scheduled to conclude at the end of the current fiscal year on September 30, 2014.  The VA has made no final decision on whether to extend the ARCH program or the services it provides at the five original sites beyond this date.  The VA’s final decision to extend the ARCH program or the services it provides at the five original sites or to expand the program to additional sites is pending the collection and analysis of further data.

Below is the full text of the letter:

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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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