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VA and DOD Health Care: Opportunities to Maximize Resource Sharing Remain

GAO-06-315 Published: Mar 20, 2006. Publicly Released: Mar 20, 2006.
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Highlights

The National Defense Authorization Act for Fiscal Year 2003 required that the Departments of Veterans Affairs (VA) and Defense (DOD) implement programs referred to as the Joint Incentive Fund (JIF) and the Demonstration Site Selection (DSS) to increase health care resource sharing between the departments. The act requires GAO to report on (1) VA's and DOD's progress in implementing the programs. GAO also agreed with the committees of jurisdiction to report on (2) the actions taken by VA and DOD to strengthen resource sharing and opportunities to improve upon those actions and (3) whether VA and DOD performance measures are useful for evaluating progress toward achieving health care resource-sharing goals.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense To further advance health care resource sharing within VA and DOD, the Secretaries of Veterans Affairs and Defense should direct JEC and HEC to develop an evaluation plan for documenting and recording the reasons for the advantages and disadvantages of each DSS project, an activity that will assist VA and DOD in replicating successful projects systemwide.
Closed – Implemented
GAO found that while the Demonstration Site Selection (DSS) projects helped increase the number of new sharing agreements between the Department of Veterans Affairs (VA) and the Department of Defense (DOD) partners, VA and DOD had not yet developed a standardized evaluation plan for documenting and recording the advantages and disadvantages of each project and whether they could be replicated at other VA and DOD medical facilities. Therefore, to further advance health care resource sharing with VA and DOD, GAO recommended the VA and DOD develop an evaluation plan for documenting and recording the reasons for the advantages and disadvantages of each DSS project. In response to this recommendation, a lessons learned template, called the NDAA Lessons Learned Input Form, along with a Standard Operating Procedure for collecting the lessons learned have been developed and implemented. Project managers for the DSS projects were trained prior to the Standard Operating Procedure for collecting the lessons learned became operational.
Department of Veterans Affairs To further advance health care resource sharing within VA and DOD, the Secretaries of Veterans Affairs and Defense should direct JEC and HEC to develop an evaluation plan for documenting and recording the reasons for the advantages and disadvantages of each DSS project, an activity that will assist VA and DOD in replicating successful projects systemwide.
Closed – Implemented
GAO found that while the Demonstration Site Selection (DSS) projects helped increase the number of new sharing agreements between the Department of Veterans Affairs (VA) and the Department of Defense (DOD) partners, VA and DOD had not yet developed a standardized evaluation plan for documenting and recording the advantages and disadvantages of each project and whether they could be replicated at other VA and DOD medical facilities. Therefore, to further advance health care resource sharing with VA and DOD, GAO recommended the VA and DOD develop an evaluation plan for documenting and recording the reasons for the advantages and disadvantages of each DSS project. In response to this recommendation, a lessons learned template, called the NDAA Lessons Learned Input Form, along with a Standard Operating Procedure for collecting the lessons learned have been developed and implemented. Project managers for the DSS projects were trained prior to the Standard Operating Procedure for collecting the lessons learned became operational.
Department of Defense To further advance health care resource sharing within VA and DOD, the Secretaries of Veterans Affairs and Defense should direct JEC and HEC to develop performance measures that would be useful for determining the progress of their health care resource-sharing goals.
Closed – Implemented
Health care resource-sharing activities between the Department of Veterans Affairs (VA) and the Department of Defense (DOD) are guided by a joint strategic plan. We previously reported that the VA/DOD Joint Strategic Plan, issued in December 2004, did not contain performance measures that were useful for evaluating how well the departments are achieving their health care resource sharing goals. Therefore, we recommended that VA and DOD develop useful performance measures determining the progress of their health care resource sharing goals. The initial analysis done on the December 2004 plan used 3 categories, "Measurement That Would Be Developed in the Future", "Measurement that Took Place Only Once", and "Measurement that Was Taken Periodically". A fourth category, "Measurement Non-Specific at to Amount or Time" was added for the analysis of the VA/DOD Joint Strategic Plan FY 2007-2009 issued in January 2007 because we found 7 performance measures which were unclear as to what was being specifically measured or as to the time frame in which the measurement was going to occur. Overall though, the analysis of the January 2007 plan shows an improvement in the performance measures used. For instance, while the December 2004 plan had 5 measures in which the measurement was to develop a performance measure in the future, the January 2007 plan had none. We also found a decrease in the number of measurements that only took place once. Specifically, the December 2004 plan had 11 and the January 2007 plan had 3. While one time measurements may provide useful snapshot information of output for a point-in-time prospective, they are not periodic and thus do not provide longitudinal information for evaluating the usefulness of specific activities. Finally, the December 2004 plan had only 14 specific performance measures over a specified period of time, whereas the January 2007 plan had 22--an increase in the number periodic measurements. Thus, there have been improvements in the performance measures used in the January 2007 plan as compared to the December 2004 plan.
Department of Veterans Affairs To further advance health care resource sharing within VA and DOD, the Secretaries of Veterans Affairs and Defense should direct JEC and HEC to develop performance measures that would be useful for determining the progress of their health care resource-sharing goals.
Closed – Implemented
Health care resource-sharing activities between the Department of Veterans Affairs (VA) and the Department of Defense (DOD) are guided by a joint strategic plan. We previously reported that the VA/DOD Joint Strategic Plan, issued in December 2004, did not contain performance measures that were useful for evaluating how well the departments are achieving their health care resource sharing goals. Therefore, we recommended that VA and DOD develop useful performance measures determining the progress of their health care resource sharing goals. The initial analysis done on the December 2004 plan used 3 categories, "Measurement That Would Be Developed in the Future", "Measurement that Took Place Only Once", and "Measurement that Was Taken Periodically". A fourth category, "Measurement Non-Specific at to Amount or Time" was added for the analysis of the VA/DOD Joint Strategic Plan FY 2007-2009 issued in January 2007 because we found 7 performance measures which were unclear as to what was being specifically measured or as to the time frame in which the measurement was going to occur. Overall though, the analysis of the January 2007 plan shows an improvement in the performance measures used. For instance, while the December 2004 plan had 5 measures in which the measurement was to develop a performance measure in the future, the January 2007 plan had none. We also found a decrease in the number of measurements that only took place once. Specifically, the December 2004 plan had 11 and the January 2007 plan had 3. While one time measurements may provide useful snapshot information of output for a point-in-time prospective, they are not periodic and thus do not provide longitudinal information for evaluating the usefulness of specific activities. Finally, the December 2004 plan had only 14 specific performance measures over a specified period of time, whereas the January 2007 plan had 22--an increase in the number periodic measurements. Thus, there have been improvements in the performance measures used in the January 2007 plan as compared to the December 2004 plan.

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