VA plans a sweeping overhaul of the health system, cutting the number of networks from 18 to 5

The VA will reorganize its health care management system. The proposal reduces the number of Veterans Integrated Service Networks from 18 to 5 to streamline operations and improve uniformity across the nation's most extensive integrated health care system.

The VA unveiled the idea this week as the largest restructure of the Veterans Health Administration since 1995. The five remaining VISNs will report to the VA undersecretary for health under the plan. The agency proposes eliminating the VHA chief operating officer and simplifying the central office staff hierarchy.

“The existing leadership framework within the VHA is fraught with redundancies that hinder decision-making, generate confusion, and establish conflicting priorities,” VA Secretary Doug Collins said Monday. “In a revamped VHA structure, decision-makers will set policies, regional authorities will execute them, and clinical leaders will focus on providing exceptional veteran care.”

VA officials stressed that the realignment will improve operations rather than reduce employment at medical centers or clinics. Briefing documents state that clearly identifying system responsibilities reduces redundancy, enhances accountability, and speeds up care.

The idea comes as the VA prepares to slash 25,000 VHA personnel, mostly those left over from COVID-19. VA press secretary Peter Kasperowicz said the decision will not affect patient care. It will not affect veteran care, he wrote in an email.

The idea has received mixed reviews from Capitol Hill lawmakers. Rep. Mike Bost, R-Ill., chairman of the House Veterans Affairs Committee, supported measures to cut bureaucracy and modernize the organization. The committee's top Democrat, Rep. Mark Takano of California, opposed the procedure and called for hearings.

“The process of redesigning the organizational structure of the nation’s largest integrated health care system must be transparent and inclusive, not a secretive, partisan affair,” Takano told Military Times.

Veterans' service agencies are cautiously waiting. Paralyzed Veterans of America CEO Carl Blake said activists have frequently raised concerns about VA administrative expansion. He called the changes “promising” if they were implemented appropriately.

The VA has announced a regional consolidation from five to two, along with new contracts worth up to $1 trillion over the next decade for its community care program. Authorities said this program will expand veterans' options for non-VA care.

Beginning in early 2026, the VHA reform will last two years. The VA said medical facility staffing and operations will continue as usual during the transition.