Access to affordable, timely health care is a national problem, and San Antonio residents in underserved areas like South Bexar County are familiar with the health issues that come with lack of care.
In Military City USA, veterans are not immune to the challenges that face those living in “care deserts,” despite being eligible for some of the best medical care in the nation.
San Antonio’s population surged by more than 20% between 2010 and 2022, and health care availability has not kept pace, according to a report on military and veteran families commissioned by the United Way of San Antonio and Bexar County.
There are about 160,000 veterans in Bexar County, according to the Veterans Administration, and the South Texas Veterans Health Care System is the fastest growing VA health care system in the nation.
The standard of care for Veterans Affairs medical clinics is to provide most health care appointments within 20 days and half an hour of the patient’s home, provisions included in 2018’s MISSION Act, aimed at giving veterans timely access to care. If the wait time for a primary care appointment exceeds 20 days, and 28 days for specialty care appointments, patients have the option to see non-VA providers in the Community Care Network.
“We look to provide veterans with an appointment within 20 days, and within that 30-minute drive time,” said Shane Soto, chief of administration services at the South Texas Veterans Health Care System. “Where we don’t have that opportunity, because again, this is Military City and we are seeing an increase in our veteran enrollment, we want to make sure that we provide the choice for our veterans to go to the community as well.”
Veterans may also use private practices that take Medicare insurance (military retirees are automatically enrolled in Medicare when they turn 65), without giving up any of their care benefits through the VA.
The South Texas Veterans Health Care System officially opened the Southeast Pecan Valley Community Based Outpatient Clinic on February 15, with hopes of serving 2,000 veterans on the city’s Southeast Side. But appointment wait times, especially for veterans who transfer to the VA after leaving active duty, can remain stubbornly long.
The average wait time for new primary care appointments within 13 South Texas Veterans Health System facilities the same day of the ribbon-cutting was 50 days, according to the VA’s public database. Veterans already in the system have it better, waiting on average 11 days for an appointment.
Veterans seeking their first appointment locally wait the longest at the new Pecan Valley clinic — an average of 98 days, according to the database. Patients seeking a first appointment at the Kerrville VA Medical Center have the shortest wait of 23 days.
For existing patients, the longest wait is also at the Pecan Valley clinic and the shortest waits, only three days, are at the Kerrville, Seguin and Victoria clinics.
In hopes of filling some of the gaps, newly formed San Antonio-based Flagship Health opened a clinic on Culebra Road on the Far West Side in January to serve senior veterans, who make up one-third of local veterans, and their spouses. The provider previously opened a mobile clinic in November 2022, with two exam rooms offering primary care, screenings and advice on how to get the most benefits and care from the VA health system or organizations serving veterans.
The mobile clinic goes to events typically popular with veterans like Bexar County job fairs, veterans’ health fairs, city veterans parades and Veterans of Foreign Wars or American Legion events.
“There are studies that show only about 2% of providers are fully trained to treat veterans,” said Dr. Sunny Ramchandani, Flagship Health’s CEO. “We’re veterans. We’re in the system, so we try to hire vets.”
The two doctors, staff of medical assistants, licensed vocational nurse, benefits coordinators and practice manager are committed to treating physical and behavioral conditions as well as connecting patients with services that promote full wellness, said Ramchandani, a physician who deployed to Afghanistan as the senior medical mentor for the Afghan National Security Forces and was a White House fellow in 2010.
Flagship’s brick-and-mortar clinic seems more like a community center than a doctor’s office. Lounge chairs, cocktail tables and barstools around a TV and a kitchen ready for nutrition classes take the place of typical rows of firm chairs and a receptionist behind a plexiglass screen. Exam rooms are decorated with pictures of service members in uniform and families, and they call those who walk in the door “members” instead of patients.
“There’s a lot of great primary care out there,” Ramchandani explained. “We want to provide a community where people can come and get their primary care, but we’ll also help them connect to the veteran ecosystem.”
Flagship Health’s team includes benefits advisers, who are well-versed in programs offered by veteran services organizations and military-focused clinics like Endeavors, which offers homeless prevention, parenting skills, financial assistance and mental health care for veterans and families in San Antonio.
They also help navigate care provided through Medicare, TRICARE, or military treatment facilities in the area.
Flagship’s launch coincides with efforts to improve coordination among government, nonprofits and healthcare providers for military and veteran care. Hundreds of people, including Mayor Ron Nirenberg and military and VA staff, gathered Feb. 14 for the Bob Woodruff Foundation’s Got Your 6 Summit in San Antonio, during which panelists discussed the challenges facing service members and veterans when it comes to care.
“There is a plethora of resources out there available, and there are plenty of nonprofits who want to serve military-connected families,” said Delia Johnson, vice president of operations for the Military Family Advisory Network, at last week’s summit. “What we’ve heard through our data, through our families is that they sometimes struggle getting connected to those resources because there is still the stigma, this fear of reaching out for help.”
Flagship Health’s doctors have taken their mobile clinic to Floresville and Poth to seek veterans with less access to health care.
Retired Maj. Gen. Juan Ayala, the director of San Antonio’s Office of Military and Veteran Affairs, said he anticipates the city’s Veterans Advisory Commission representatives who advise the mayor and city councilmembers advocating for solutions like Flagship Health’s mobile clinic.
“We have a lot of underserved areas in our community, and education and taking better care of people would be good,” the 36-year Marine Corps veteran said.
Veterans typically choose their path for care — from VA providers or outside the system through the VA’s Community Care Network or providers like Flagship Health — when they enroll in the South Texas VA Health Care System, then stay in that path for most future care.
“Continuity is very important to the delivery of health care that we provide,” Soto said. “We have resources that are available to our veterans to help bridge the care while they wait for their first appointment. … If I need medication refills, I need something looked at that may not have the opportunity to wait that duration, we afford that opportunity to our veterans where you can take advantage of the same-day service, just to make sure we don’t have a lapse in care while you wait for your appointment.”
Flagship’s Ramchandani agreed that clinics like his aren’t meant to be an indictment of the VA’s health care offerings, rather, a supplement to them.
“We don’t think the military system is bad or the VA system is bad,” said Ramchandani, who uses VA services himself. “We just found that there needed to be more access, and a system in which we could build this community together.”