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    Subject Term: "Health care delivery"

    2 publications with a total of 3 open recommendations
    Director: Wise, David J
    Phone: (202) 512-2834

    2 open recommendations
    Recommendation: To improve VA's ability to plan for and facilitate the alignment of its facilities with veteran needs, the Secretary of Veterans Affairs should direct the appropriate offices and administrations to address identified limitations to the SCIP process, including limitations to scoring and approval, and access to information.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA partially concurred with this recommendation. In their 60-day letter dated August 3, 2017, VA noted that it has made process changes in those areas that it concurred with. This includes both access to information, improving communication and timing of SCIP results, and lessoning the administrative burden of providing SCIP documents to SCIP users. For fiscal year (FY) 2018 SCIP, including the projects that were funded, the results were provided prior to the 2018 budget release, and prior to the development of SCIP 2019 business cases. In the past, these results were not released to planners until after the budget was publicly released. In addition, the threshold for inclusion of projects into the SCIP process was raised from $1 M to $3M for the Veterans Health Administration (VHA) nonrecurring maintenance (NRM) projects. This was done to lessen the administrative burden and provide more flexibility to the field to manage their operational needs. Although VA has made some progress towards this recommendation, they have not satisfied the full intent. Specifically, VA has not yet made changes to improve the visibility and prioritization of sequenced projects or the scoring and approval process. VA noted that it disagreed that the SCIP scoring and approval process introduces subjectivity through the use of its business cases, but we will follow up over the next year to see if they made any changes that would help address this portion of the recommendation.
    Recommendation: To improve VA's ability to plan for and facilitate the alignment of its facilities with veteran needs, the Secretary of Veterans Affairs should direct the appropriate offices and administrations to assess the value of VAIP's facility master plans as a facility-planning tool. Based on conclusions from the review, either 1) discontinue the development of VAIP's facility master plans or 2) address the limitations of VAIP's facility master plans.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In its 60-day letter dated August 3, 2017, VA noted that its VAIP facility master plans have been discontinued while VA pursues a congressionally-directed National Realignment Strategy, which will last a minimum of 18 months. VA will be evaluating service delivery opportunities in each contiguous United States (CONUS) market, to improve the networks of complementary community care providers, best coordinate Veteran healthcare, and move certain components of care into the community when appropriate. Once a National Realignment Plan is submitted and approved by Congress, future facility master plans will be adjusted accordingly, and incorporate pertinent information. Such information will include community care realignment opportunities. We will follow-up with VA to obtain additional information regarding this recommendation.
    Director: Debra Draper
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: The Secretary of Defense should require the Director of the Defense Health Agency to enhance existing guidance for the TROs to include more specificity on assessing nonenrolled beneficiaries' access to care. Specifically, the guidance should contain criteria for analyzing and interpreting the nonenrolled beneficiary and civilian provider surveys' results and the beneficiary population sizing model to facilitate a more rigorous and consistent approach across regions for identifying locations with potential access problems and determining whether actions should be taken.

    Agency: Department of Defense
    Status: Open

    Comments: In April 2016, DHA informed us that it has taken action to ensure a consistent approach across the regions for identifying locations with potential access problems and determining whether actions should be taken. Specifically, the TROs agreed in April 2014 to utilize the congressionally directed Survey of Civilian Provider Acceptance of, and Beneficiary Access to TRICARE Standard and Extra survey results as the source to identify areas of low awareness, acceptance and access scores. Once an area has been confirmed as an area of low awareness, acceptance and access, the SME will work with the respective managed care support contractor to develop an improvement action plan. In addition, to standardize analysis and provide for more specificity, in May 2014 the three TROs agreed upon a standardized Beneficiary Population Sizing Model (BPSM), an analytical tool to monitor access to care and beneficiary satisfaction for Standard beneficiaries outside PSAs. The standardized BPSM was implemented in the last TRO TRICARE Standard annual brief to the DHA Deputy Director in January 2016. DHA has noted that they took these actions as a result of our recommendation. Although they have taken these actions, we are awaiting further information regarding whether they enhanced existing guidance for the TROs to include this additional specificity on assessing nonenrolled beneficiaries' access to care. We will update this recommendation once we obtain additional information from DHA.