THE PEOPLE MAKING IT HAPPEN - WE'VE GOT YOUR SIX

Management & Operations Team

Niels Andersen

President & CEO/Founder

U.S. Navy Veteran

Mark Goto, MD

Chief Medical Advisor

CAPT, U.S Navy Ret.

Brad Hussung

SVP Claims Strategy & Process Transformation

John Razen, MHA, FACHE

SVP Population Health

CAPT, USN Ret.

Claims Strategy and Process Transformation Strategic Services

VetCV's Strategic Services Mission is to support the Government, the Department of Government Efficiency, and private sector Organizations by delivering expert consulting services that identify and eliminate waste, streamline processes, and drive measurable improvements.

With a focus on VA healthcare, TRICARE claims management, population health, and provider practice management, we provide innovative solutions to optimize resources, reduce costs, and improve care outcomes. By enhancing efficiency and care delivery, we help fulfill the VA’s mission of caring for Veterans, Active Service personnel, and their families while serving as good stewards of the people’s resources.

'Medical care is estimated to account for only 10-20 percent of the modifiable contributors to healthy outcomes for a population. The other 80 to 90 percent are sometimes broadly called the SDoH: health-related behaviors, socioeconomic factors, and environmental factors.'


Cost savings and process improvement opportunities that utilize industry best practices


  • Improved healthcare funding strategy and processes
  • Claims processing improvements that eliminate dual processing and reduces expenses
  • Increase electronic claims processing and streamline payments to reduce transaction costs
  • Improved receivable management to reduce waste from incorrect payments
  • Claims overpayment management and recovery of over billed charges
  • Suggest and implement audit strategies and programs to better manage the entire financial process from cradle to completion
  • Improve additional services authorization process by utilizing a set menu of authorized care per occurrence which reduces back and forth and wait time for care
  • Improve remittance advice process and payment identification process so providers understand what they are being paid and why amounts are not

  1. Assure Veteran needs are heard by using VetCV as a vehicle to capture and report the voice of the customer (Veteran)
  2. Assure VA resources are fully utilized by adopting civilian productivity standard for VA providers.
  3. Optimize utilization of VA funds by removing inefficiencies from the claims processing function.
  4. Eliminate gaps in Veterans’ care by instituting individual care plans and VA accountability for care plan execution.
  5. Optimize Veteran health outcomes by expanding care plans beyond medical services to meet their behavioral, environmental, and social needs.


  1. Healthcare costs funding strategies
  2. Claims processing redundancy reductions
  3. Administrative savings opportunities related to processing
  4. Additional authorization request process
  5. Audit programming and strategies
  6. Overpayment management and recovery
  7. Receivables management
  8. Remittance advice strategies
  9. Electronic processing and payment adoptions
  10. Review of current PWS for VA outsourced contracts to find efficiencies
  1. Problem
  2. Solution
  3. VA Provider Productivity
  4. Utilize RVU benchmarks to set productivity standards
  5. Gaps in care
  6. Individual care plans with VA accountability for care plan execution
  7. Poor Outcomes
  8. *The annual care plan will expand beyond medical care to identify the behavioral and social services needed throughout the year to optimize the Veteran's health.
  9. **See the "My Annual Care Plan" program below:
  10. Provider Shortage
  11. Utilize a care team to expand the physicians' capacity. (Nurse Care Manager, Community Health Advocate, Social Workers, Dieticians)
  12. *Medical care is estimated to account for only 10-20 percent of the modifiable contributors to healthy outcomes for a population. The other 80 to 90 percent are sometimes broadly called the
  13. $DOH: health-related behaviors, socioeconomic factors, and environmental factors.
  16. Population Health
  17. Problem
  18. Solution
  19. Low VA Provider Productivity
  20. Utilize Relative Value Unit benchmarks to set productivity standards for each specialty.
  21. Gaps in care
  22. Individual Veteran care plans with VA accountability for care plan execution. 
  23.  Poor Outcomes
  24. *The annual care plan will expand beyond medical care to identify the behavioral, social, and environmental services needed to optimize the Veteran’s health. 
  25.  
  26. **See the “My Annual Care Plan” program below
  27. Provider Shortage
  28. Utilize a care team to expand the physicians’ capacity. (Nurse Care Manager, Community Health Advocate, Social Worker, Dietician)
  29.  
  30. *Medical care is estimated to account for only 10-20 percent of the modifiable contributors to healthy outcomes for a population. The other 80 to 90 percent are sometimes broadly called the SDoH: health-related behaviors, socioeconomic factors, and environmental factors. 
  31.  
  32. **Components of the “My Annual Care Plan” program include
  33. 1
  34. The annual care plan will list all the services (medical, behavioral, and social) the Veteran needs throughout the year to optimize his/her health. 
  35. 2
  36. The care plan will be established by a Nurse Care Manager (NCM) with guidance and sign-off by the primary care physician (PCP)
  37. 3
  38. The annual plan should also list resources available to the Veteran if he/she runs into barriers.
  39. 4
  40. The Veteran should commit to playing his/her part in completing the plan as well as monitor completion of the plan by other participants and reach out for resources when needed. 
  41. 5
  42. The complete care plan with participant services, needed resources, and timelines will be documented in a Care Plan Accountability System (CPAS).
  43. 6
  44. The CPAS will identify the annual care plan costs based on the participant services and resources in the care plan.
  45. 7
  46. The CPAS will use tools such as home monitoring devices as well as Veteran & Participant input (dual confirmations) to continually detect when the annual care plan compliance.
  47. 8
  48. A Community Health Advocate (CHA) will utilize the CPAS to monitor completion of the care plan and, with support from the NCM, intervene when there is variation from the plan. 
  49. 9
  50. The PCP will be available to support and conduct interventions as needed.
  51. 10
  52. The CPMS will capture data on plan variations and root causes to establish a system for learning and improving.
  53. 11
  54. The CPAS will capture the cost variation due to variation from the plan as well as changes in service and resources costs.
  55. 12
  56. The CPAS will integrate the root cause analysis findings with cost variation data to assign financial responsibility for annual care plan variation
  57.  
  58.  

Old Mission Statement:


VetCV’s mission is to support the Government and the Department of Government Efficiency by providing expert consulting services to identify and eliminate waste, streamline processes, and drive measurable improvements. With a focus on VA healthcare, TRICARE claims management, population health, and provider practice management, we deliver innovative solutions that enhance efficiency, optimize resources, and improve outcomes for Veterans and their families.

Improve the Veteran and Military healthcare experience and care outcomes by providing consulting services that identify and eliminate waste, streamline processes and drive measurable improvements both administratively and from a provider care perspective. Creating these efficiencies and optimizing resources will lead to reduced costs and these savings cab be used to provide a higher level of care, as well as increased levels of services. Innovative solutions will enhance efficiency, optimize resources, and improve outcomes for Veterans, Service personnel, and their families.


o help fulfill the VA’s mission of caring for our veterans and their families by assuring all their healthcare needs are met and to serve as good stewards of the peoples’ resources.