Is your health system ready to deliver veterans community care?
By Tom Aiello
In December 2025, the U.S. Department of Veterans Affairs announced the most consequential restructuring of Veteran health care delivery in decades. While headlines focused on internal reorganization, the signal to the private sector was unmistakable: VA Community Care is being streamlined, normalized, and expanded—and the transformation will occur over the next 18–24 months.
For hospitals and health systems, this is not a distant policy change. It is a near-term market shift with material revenue implications. Systems that begin preparing now will shape referral patterns, operational standards, and reimbursement norms. Those that wait will watch others serve more patients, while they lament increasing Medicare cuts.
Community Care Is No Longer Optional
VA capacity is capped. That is the foundational constraint driving this restructuring. Federal mandates already require the VA to place veterans into community care when access or timeliness thresholds are not met. What the December announcement makes clear is that the VA intends to remove friction—administrative, clinical, and procedural—that historically slowed community referrals.
This is not a pilot environment. It is an execution phase.
For large integrated systems, the opportunity is substantial. In a representative large U.S. metro market, modeling based on retrospective claims data shows a $90 million annual revenue opportunity, achievable once workflows, credentialing, and outreach are aligned.
Chicagoland is one such example—but not an outlier. Similar demand dynamics exist across major metropolitan and regional markets nationwide, driven by the same structural constraints on VA capacity and the same federal access mandates. This is margin-positive revenue, heavily concentrated in high-acuity service lines such as cardiology, oncology, and orthopedics—areas where VA reimbursement frequently exceeds commercial or Medicare benchmarks.
What this means is a wave of new, well covered patients is coming. Veterans will increasingly be routed to community system. The only question is which systems are ready.
The 18–24 Month Window Is a Competitive Battleground
The VA has been explicit about the timeline. Transformation will unfold over the next two years. That window creates a first-mover advantage that hospitals rarely get with federally backed demand.
Early adopters will:
Establish themselves as preferred VA partners.
Influence how referral, documentation, and payment processes are operationalized.
Capture veteran demand before it is absorbed by competing systems.
Late adopters will still participate, but as price takers, not standard setters. This is why preparation cannot be limited to contracting alone. Veteran Community Care must be treated as a new business line, not a side channel.
Veteran Patient Acquisition Is Not General Healthcare Marketing
One of the most common failure points we see is assuming veterans will “find” community providers once access improves. They will not—at least not at scale—without intentional, culturally fluent outreach.
Veterans are not a generic healthcare audience. Trust, clarity, and familiarity with VA processes matter. Systems that succeed invest in:
Precision identification of veteran-dense ZIP codes and service cohorts.
Messaging that explains how community care works, not just that it exists.
Alignment between outreach and high-value service lines.
Done correctly, veteran acquisition is not speculative. It is a repeatable, measurable funnel with a clear CAC-to-revenue relationship. MARCH has spent decades building this playbook across national VA campaigns, and the difference between systems that apply it and those that do not is dramatic.
Operational Readiness Determines Whether You Get Paid
Revenue opportunity is meaningless if payment cycles break down. VA Community Care reimbursement is reliable—but only for systems that align their accounting, credentialing, and documentation workflows to VA requirements from day one. The most common delays stem from:
Incomplete provider credentialing at referral intake
Mismatched authorization documentation
Coding workflows not optimized for VA adjudication.
Health systems that treat VA billing like just another payer experience stranded revenue and long AR tails. Systems that operationalize VA-specific processes get paid—fast.
In the attached modeling, over $400M in VA claims across 65+ systems have been managed with industry-leading speed when these processes are built correctly from the outset.
The Cost of Waiting Is Real
The risk is not policy reversal. The risk is inaction. Every month a system delays:
Competing hospitals establish veteran referral momentum.
High-margin cases are routed elsewhere.
Institutional learning curves steepen.
The opportunity, by contrast, is to become the VA’s model community partner—capturing federally funded volume, shaping operational norms, and building durable veteran trust. This is not about readiness in theory. It is about positioning to lead while the system is being rebuilt.
The VA has opened the door. Hospitals that step through now will define what Veteran Community Care looks like for the next generation.