The Department of Veterans Affairs (VA) stands alone in purpose and scale — tasked with caring for millions who’ve served. For all its significance, the VA is hobbled by a truth no one in Washington wants to say: it was built for the last century, not this one.
The cracks are deeply human. A Marine needs to see a cardiologist. The nearest hospital has openings, but he’s routed to a facility hours away. Across the country, a doctor has openings but no way to reach patients. In the private sector, gaps like these would raise alarms. At the VA, it’s all too common.
Committed professionals fill the ranks, but even the best can’t outrun the system around them. The VA’s regional structure is a patchwork of networks, each with its own priorities and patchy methods to move care where it’s needed most. A 2019 GAO report found no consistent way to assess how the networks perform. More recently, in a 2024 hearing, Rep Dr. Miller-Meeks, who chairs the House VA Health Subcommittee, expressed frustration that veterans often receive different care based on where they live, not what they need.
VA schedulers navigate legacy platforms, often unable to see the full network of available providers. And clinicians, trained for everything from combat trauma to mental health, are caught in a system where access depends more on geography than on need.
• Washington’s answer? Spend more or cut deeper.
The latest budget sets a goal to reduce the VA workforce by 15%. Meanwhile, the $50 billion electronic health record overhaul, led by Oracle, has faced setbacks. It’s no surprise that even the most advanced companies struggle to keep pace when decades of records have turned the VA’s digital backbone into one of the most complex in the world. No single system can modernize it alone.
The data’s there. What’s missing is the ability to read it, act on it, and move the supply of care dynamically. Today, some facilities are crowded, others underused, and too often, they’re miles apart. The capacity exists yet goes untapped without the infrastructure to shift care across regions, professionals, or venues.
Private health systems faced a similar reckoning. They now use data to anticipate patient demand and surface availability across markets. Scheduling a quick check-up is a tap away online. Kaiser Permanente built a national virtual care network, offering round-the-clock care by phone, video, or email —no in-person visit required.
What’s stopping the VA from creating a single virtual network where a doctor in Arizona can meet the needs of a veteran in Florida? For years, the solution to access gaps was to expand referrals outside the system. The MISSION Act opened more doors through Community Care. By 2022, 44 percent of VA care was delivered through these private partnerships. As of 2025, some VA facilities now deliver more than half of all services through Community Care.
But even with more options, delays persist. In 2023, veterans referred to outside providers waited, on average, 10 days longer for primary care than those seen within the VA. Community Care is vital and so is strengthening the VA’s own infrastructure to meet veterans where they are, when they need it.
• The fix starts with strengthening the VA’s digital foundation.
Healthcare now generates nearly a third of the world’s data. But volume isn’t value, and turning data into care—personalized and at scale—requires more than horsepower. It demands precision. That’s why tech giants often team up with gazelles. Think NASA and SpaceX. Oracle has the reach to modernize a massive system, but monoliths alone can’t keep pace. Gazelles fill the gap: building nimble care networks that translate data into access and make scheduling seamless – and fast.
The same approach can restore the VA by reactivating capacity and rebuilding trust with veterans. But that demands more than austerity measures, as real innovation builds smarter and connects what’s already there to create a network that’s digital and borderless.
The Dole Act — recently signed into law — gives the VA Secretary the runway to build a plan that books appointments during the first call, aims for same-day access, and puts veteran preferences at the center of every decision. The law gives the new administration a concrete target to move on and upgrade how veterans get care.
VA Secretary Doug Collins recently said the path forward starts with a better structure to get more clinicians the resources they need to see more patients. He’s correct, and with the right foundation, the VA can become the model for what American healthcare should be.
No more wasted capacity. No more isolated regions. No more digital vacuums swallowing up care. The VA has the scale and people. Now, it needs the infrastructure—and the will—to deliver.
(Sean O’Connor is the founder of DexCare and a former lieutenant in the U.S. Navy.)
