Amber Walsh on the VA, Veteran Healthcare, and the Business of the VHA 5-28-26

Summary

Becker Business Podcast Episode: Amber Walsh on the VA, Veteran Healthcare, and the Business of the VHA
Date: May 28, 2026
Host: Scott Becker | Guest: Amber Walsh

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Episode Overview

In this episode, Scott Becker welcomes Amber Walsh, a leading figure at the crossroads of healthcare and private equity, to discuss the often misunderstood world of the U.S. Department of Veterans Affairs (VA), specifically the Veterans Health Administration (VHA). Walsh offers a deep dive into the structure, spending, operational scale, public-private relationships, and policy nuances that define the business of veteran healthcare. The conversation aims to broaden understanding among industry stakeholders, investors, and healthcare professionals about the vast impact and complexities of the VHA.

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Key Discussion Points and Insights

1. The Scope and Structure of the VA and VHA

[01:30–03:55] Amber Walsh

• Emphasis on the timely relevance post-Memorial Day, reflecting on veterans’ service and federal budget priorities.
• Department of Veterans Affairs (VA): A Cabinet-level agency split into three main divisions.
  • Veterans Health Administration (VHA): Administers healthcare and represents $40B of the VA’s roughly $450B budget.
  • Scale: About 9 million enrolled U.S. veterans, with ~6.1 million actively using benefits at any time.
  • This makes the VHA “the largest integrated healthcare system in the country.” Yet, many stakeholders lack a thorough understanding of its inner workings.
• A surprising aspect: a significant share of VA healthcare is actually delivered by private, non-VHA providers.

“It’s produced the largest integrated healthcare system in the country. And yet I think a lot of people don’t have an understanding of exactly how it works.”
— Amber Walsh [02:40]

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2. Quality and Modes of VA Healthcare Delivery

[03:55–07:43] Amber Walsh & Scott Becker

• Veterans fall into eight different priority groups for benefits, based on service history, injury, need, etc.
• VHA System: Over 1,300 sites of care nationwide and in U.S. territories.
• Notably, around 40% of care is provided via “community care” (private, non-VA providers).
  • Community care includes everything from prosthetics and assistive devices to primary and urgent care, especially in rural areas.
  • Large portions of VA hospital staffing are by private equity-backed companies like Team Health and Envision.
  • Care coordination involves two major third-party administrators: OptumServe and TriWest.

“About 40% of the care is provided by what they call community care… anything from on the device side, prosthetics… primary care… particularly in rural communities if there’s not a VHA hospital nearby.”
— Amber Walsh [04:45]

• Role of major EMR/EHR vendors: Companies like Cerner (Oracle Cerner) are embedded as contractors within the VA’s infrastructure.
• Payment and claims for community care are handled by the two TPAs, making the VHA a complex, multi-channel health system.

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3. The Business Side: Contracts and Compliance

[07:43–09:40]

• The VA (and VHA) award massive, multi-year contracts to private sector companies—these are highly coveted and competitive.
• Federal procurement rules apply: contracting involves rigorous processes, requirements, and regulations—“a whole host of requirements” even post-streamlining efforts.
• The magnitude brings challenges: only specialized legal and procurement experts can navigate the VHA’s intricate contracting, compliance, and reporting landscape.

“When you are contracting with the VHA, you’re contracting with the federal government. And so you have to go through the federal procurement process and there are all of these different regulations…”
— Amber Walsh [08:10]

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4. Policy, Advocacy, and Budget Evolution

[09:40–12:05]

• VA/VHA funding was once mostly discretionary, requiring yearly appropriations debates. As of 2022 (after the PACT Act), it has shifted to predominantly mandatory spending, guaranteeing ongoing funding.

  • Now, only about 30% of the budget is discretionary.
  • Moves like these are driven by an active veterans’ advocacy community and the ongoing healthcare needs of aging veteran cohorts.

• Political and public perceptions: Any attempts to cut or change VA healthcare spending, regardless of administration, prompt immediate public and political pushback.

“You’re gonna have reflexive negativity to it—amount of public opinion built up saying, ‘Oh, you’re taking away care from the veterans…’”
— Scott Becker [09:46]

“After the PACT Act in 2022, it’s dominantly now mandatory… Only about 30% every year that’s discretionary.”
— Amber Walsh [10:25]

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5. Specialized Expertise Required

[12:05–13:43]

• Doing business with the VA isn’t just about healthcare expertise—it demands proficiency in federal procurement, compliance, and reporting.
  • Successful teams combine healthcare regulatory lawyers with government procurement experts.
  • Requirements have become more demanding recently, including new diversity and reporting standards.

“It really takes a very specialized legal team and procurement team to put those deals together… It’s a whole other level of operations and compliance of which you should be mindful.”
— Amber Walsh [12:43]

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Notable Quotes & Memorable Moments

• “It’s produced the largest integrated healthcare system in the country. And yet I think a lot of people don’t have an understanding of exactly how it works.”
  — Amber Walsh [02:40]

• “About 40% of the care is provided by what they call community care… particularly in rural communities if there’s not a VHA hospital nearby.”
  — Amber Walsh [04:45]

• “When you are contracting with the VHA, you’re contracting with the federal government. And so you have to go through the federal procurement process and there are all of these different regulations…”
  — Amber Walsh [08:10]

• “After the PACT Act in 2022, it’s dominantly now mandatory… Only about 30% every year that’s discretionary.”
  — Amber Walsh [10:25]

• “It really takes a very specialized legal team and procurement team to put those deals together… It’s a whole other level of operations and compliance of which you should be mindful.”
  — Amber Walsh [12:43]

• “When I follow healthcare every single day of my life, I know so little about how the VA and the VHA actually runs…”
  — Scott Becker [12:05]

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Key Takeaways

• The VHA is the largest integrated healthcare system in the U.S., serving a vast and diverse veteran population.
• Almost half of all care is delivered through private providers in the community, not just VA facilities.
• Doing business with the VHA requires not only medical but also significant legal, procurement, and compliance expertise.
• Funding for VA healthcare is now largely mandatory, shaping how policy is debated and services are delivered.
• Understanding the business, policy, and operational nuances of the VHA is crucial for anyone in healthcare, law, private equity, or business who touches the veteran space.

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For further detailed insights or direct legal/business guidance on VA and VHA operations, contracting, or policy implications, Amber Walsh and her team provide highly specialized support.

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End of summary. Non-content sections, advertisements, and non-relevant chatter have been excluded for clarity and focus.

Transcript

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[Scott Becker]

This is Scott Becker with the Becker Business and the Becker Private Equity Podcast. I'm thrilled today to be joined by brilliant leader Amber Walsh. Amber works at the intersection of healthcare and private equity. She's also a remarkable leader and probably the most quintessential professional that I know. Amber's going to talk to us today about some of the thoughts that she's watching coming out of the Veterans Healthcare Administration, the va. Amber, let me tee it up and have you take it away. What are some of the core thoughts that's top of mind for you about the VA in healthcare?

[Amber Walsh]

Yeah, I'm happy to share. It seems appropriate coming right out of the Memorial Day weekend where we spent a lot of time honoring veterans service. And there's also been a lot of attention going back a couple of years, including with government trips, I mean by doge, but also more recently in establishing the 2026 budget and looking towards the 2027 budget. Veterans affairs have definitely been one of the big discussion points in government dollars. And so I've really been thinking about and querying actually some of my colleagues the how much does the industry understand about the va? And I'll just start by just sharing some of the basics that I think probably every healthcare industry stakeholder needs to understand. And some of the basics of the organization are that obviously the Department of Veterans affairs is a cabinet level, but it's split into three divisions. The HA Veterans Healthcare Administration is what administers veterans health care, and that comprises about 40 of the roughly $450 billion Veterans affairs budget. So it's a huge part of what Veterans affairs does for veterans. There are about 9 million enrolled US veterans with at any given time estimated about 6.1 million actively using their healthcare benefits. So the result of this, with the dollars and the magnitude of the number of US current and former servicemen and women who are using these benefits, is that it's produced the largest integrated healthcare system in the country. And yet I think a lot of people don't have an understanding of exactly how it works. And what's really interesting, the extent to which you have so much of the care provided by private, non VHA owned healthcare providers.

[Scott Becker]

Thank you. And talk for a second about the va, the quality of health care. I know my father still gets care from the va, seems to me sort of all over the board in terms of what they do and how they do it. Any thoughts there? And, and are there opportunities for. I know some of the big EMR companies obviously are deeply vested with the va. Cerner, of course, Oracle, Cerner, I know there's other businesses that go on with the va, but talk a little bit about what is the situation the va, because it seems like good at some things, not so good at other things. How do people think about that?

[Amber Walsh]

Absolutely, I think that's exactly right. So I mentioned, you know, at any given time, 6.1 million veterans actively using their health care benefits. They fall into eight different priority groups depending on their, you know, whether or not their injuries were combat battle ridden injuries. There's a need based component. There's all different ways that veterans fall into the eight different categories. And then of course there are separate, like campus and Tricare for active service men and women. But in terms of the care provided, how it's provided and kind of the feedback from veterans, it's very interesting. So the System has over 1300 sites of care around the country and obviously in US territories as well. But 40% of the care is provided by what they call community care. And community care is essentially private, non VA employed, non VA owned health care providers. And so you mentioned EMR companies of course, that have different relationships as contractors, but the other type of contractor with the VHA or are healthcare providers that essentially enter into the VHA network through contracts. And again it's about 40% of the care is provided in that way. And so you're talking about anything from on the device side, prosthetics, the exoskeletons, the assistive devices, you have primary care in some areas provided that way because particularly in rural communities, if there's not a VHA hospital nearby, you can have privately contracted primary care, urgent care. And then a lot of the VHA hospitals, possibly all of them are staffed by Team Health and Envision, which are obviously large private equity backed emergency medicine and hospitalist companies. And so they've built this network of care that's both a component of employed and owned VHA providers and then these contracted providers to supplement. And then layered over all of that, you have two TPAs, OptumServe and TriWest, which are the two third party administrators for the claims submitted by the private. And so it all comes together when we talk about an integrated health system. That's what we mean in that you have the individual providers, both owned and contracted, and then you have the claims that are submitted through the process to ensure that veterans are able to get their care and providers get paid for providing that care.

[Scott Becker]

Thank you. So those must be huge contracts for the envisions of the world and so forth. Those must be mega contracts for some of these providers and operators that sell into the va.

[Amber Walsh]

Absolutely. And you know, that was part of some of the controversy in the early days when DOGE was doing its work. Some of the VHA contracts were cut and then some of the cuts were paused pretty quickly after that when you had some congressional intervention. But yes, those are huge contracts, multi year contracts, typically. And that's one of the, the other thing that industry, industry stakeholders need to understand, of course, is that when you are contracting with the vha, you're contracting with the federal government. And so you have to go through the federal procurement process and there are all of these different regulations. Of course, not surprisingly, even with the Federal Streamlining act to make procurement a little bit easier, you still have the federal acquisition regulation, you have the va, you have very specific programs for very specific types of VHA healthcare that you have to contract with. And there's a whole host of requirements, of course, that you have to meet. So for the Team Health and Envision and Oracle, obviously those are big, major contracts that the VHA needs to service population, but those are pretty extensive and massive. And then you have individual providers and individual sites too. But it's just a really large, large system that obviously has such a huge impact on US Healthcare, certainly.

[Scott Becker]

And fascinating you mentioned about the DOGE situation because no matter what the administration tries to cut, and this is whether it's the Doge Republican or Democratic administration, without any deep thought, you're gonna have reflexive negativity to it in amount of public opinion built up saying, oh, you're taking away care from the veterans, you're taking away care from the veterans. Where at least a good thinking bureaucrat or professional would say, how do we do it more efficiently, but it doesn't really matter. You're gonna have reflexive action against it. That's, of course, to be backed up by some of these money sources that profit from it too, I assume.

[Amber Walsh]

Yeah, no, that's exactly right. And the other interesting component too, about the spending, the VHA spending, is that it used to be more discretionary spending where Congress would have to debate in appropriations every single year what the entire department was going to get, the entire Department of Veteran affairs, but specifically also the VHA. And now after the Pact act in 2022, it's dominantly now mandatory. It's built right into legislation so that there's roughly only about 30% every year. That's discretionary. And so when DOGE is doing its work, its work was really limited to on the VHA side by the fact that you had more mandatory spending than discretionary spending. So that's been another interesting part of the development of the VHA just over time. And a lot of that, of course, is driven by a very, very active advocacy community. Of course, you have more and more aging that they even talk about now. One of the biggest driving forces for the PACT act in 2022 was actually the 9 11, post 911 veterans community that is now aging and needs this health care. So it's been a very interesting development. And I circle back to that point I made at the beginning. I think it's something that anyone who is in the healthcare industry, be it lawyers like us or private equity investors or private practicing physicians should understand how it works.

[Scott Becker]

No, Absolutely fascinating. And I have to tell you, for all the things out there, you know, when I follow healthcare every single day of my life, I know so little about how the VA and the VHA actually runs of them. Periodically seeing news of these huge contracts or controversies or seeing it anecdotally through my dad's care. That's what I know. So your thoughts on it are so helpful. And notice there's lots of people that do business with the VA in different ways. Obviously, some mega companies do business with the VA and are very. It's a very important customer to that. Fascinating.

[Amber Walsh]

It is. And it really takes a very specialized legal team and procurement team to put those deals together as well. At our firm, it's not just the healthcare lawyers that do those deals. We really lean heavily on our government procurement colleagues. Ned Childs, Todd Steggerda, Pat Rowan. I'm not going to be able to advise a client through the intricacies of negotiating with the VHA without their. Because it's so very rigorous and the expectations for what you have to fulfill once you have contracted with the vha, the reporting requirements, obviously the diversity requirements have changed in the past two years, kind of famously, but there are a lot of rigorous standards and it's a whole other level of operations and compliance of which you should be mindful. But with the largest integrated health system in the country, how can you not consider DHA as a viable partner?

[Scott Becker]

No. Absolutely fascinating. Thank you so much, Amber. You're literally the best professional I know. Thank you for joining us today on the Vector Business and the Vector Private Equity podcast and shining some thoughts for us around the idea of the VA and how it works and what's going on with the va, the VHA and more. Thank you so much for joining us and speaking with us.

[Amber Walsh]

Thank you. Scott.

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