Key Issues > Duplication & Cost Savings > GAO's Action Tracker > Joint Veterans and Defense Health Care Services
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Health: Joint Veterans and Defense Health Care Services

The Departments of Veterans Affairs and Defense should enhance their collaboration to reduce costs, overlap, and potential duplication in the delivery of health care services.

Action:

The Secretaries of Veterans Affairs and Defense should further develop a systematic process for identifying and enhancing collaboration opportunities, including reviewing the portfolios of the departments’ health care facilities; ensuring information necessary to identify collaboration opportunities is available; identifying both new and expanded opportunities for collaboration; and assigning responsibility to ensure identified opportunities are explored and implemented as appropriate.

Progress:

The Department of Veterans Affairs (VA) and the Department of Defense (DOD) have developed a systematic process for identifying and enhancing collaboration opportunities, as GAO recommended in September 2012. VA officials told GAO that in 2014 the Office of Management and Budget directed both departments to undertake a study to systematically identify opportunities for efficiencies across both health care delivery systems. As part of this study, in November 2014, the departments began 1-year pilots to increase provider productivity and patient access in selected locations where the departments share resources to deliver care. The pilots were completed in the first quarter of fiscal year 2016. In April 2016, VA briefed the Health Executive Committee on the results of the pilots, which included an upward trend in the number and complexity of cases referred to DOD for target specialties; expanded use of a data-driven model to identify further market sharing opportunities; and collaboration on an agreement to standardize current DOD and VA sharing reimbursement and reconciliation of medical services. VA officials told GAO in November 2016 that the pilots measured the effect of VA and DOD sharing on VA access and on the number and complexity of cases referred from VA to DOD.  According to VA, the metrics supported the assessment that VA and DOD sharing decreased VA wait times and increased the number and complexity of patients referred to DOD. These collaboration efforts provide important opportunities for improving health care access, quality, and costs.

Implementing Entity:

Department of Veterans Affairs, Department of Defense

Action:

The Secretaries of Veterans Affairs and Defense should require collaboration sites to develop and implement a process for using performance measures to gauge their progress in achieving goals related to access, quality of care, and costs.

Progress:

The Department of Veterans Affairs (VA) and the Department of Defense (DOD) have identified a process for using performance measures to gauge the progress of their collaboration sites, as GAO recommended in September 2012.  VA awarded a contract in November 2013 to evaluate one of the departments’ collaboration sites. In November 2016, VA officials told GAO that the departments have completed their review of the evaluation results of the collaboration site and decided to pursue another evaluation model. Specifically, the evaluation model the departments chose is based on the model they used as part of a 2013 Office of Management and Budget (OMB) directed study. OMB directed VA and DOD to conduct a comparability study with the intent of increasing collaboration between the two department’s health care systems.  As part of this study, in November 2014, the departments began 1-year pilots to increase provider productivity and patient access in selected locations where the departments share resources to deliver care. In April 2016, VA briefed the Health Executive Committee on the results of the pilots. The pilots included an upward trend in the number and complexity of cases referred to DOD for target specialties; expanded use of a data-driven model to identify further market sharing opportunities; and collaboration on an agreement to standardize current DOD and VA reimbursement and reconciliation of shared medical services. Based on the results of the OMB-directed study, the departments have information to help ensure that collaboration sites’ progress in meeting goals related to access, quality of care, and costs for health care services can be measured.

Implementing Entity:

Department of Veterans Affairs, Department of Defense
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    • Brenda S. Farrell
    • Director, Defense Capabilities and Management
    • farrellb@gao.gov
    • (202) 512-3604