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    Subject Term: "Military health services"

    8 publications with a total of 27 open recommendations including 4 priority recommendations
    Director: Brenda S. Farrell
    Phone: (202) 512-3604

    7 open recommendations
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to assess the Triad of Care model's effectiveness in light of the changes in WTU diagnoses and take the appropriate action.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to exercise oversight responsibility to track full adherence to selection processes for squad leaders and platoon sergeants, including the requirement to conduct interviews for these positions.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to develop a mechanism to conduct post-training assessments on squad leaders and platoon sergeants' application of training to the work environment and incorporate the results into the training program.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to develop plans to adjust staff levels, if needed, to accommodate a potential future surge in demand.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to establish a process that assigns oversight responsibility for tracking instances in which Commanders make exceptions to WTU entrance criteria so that the Army Surgeon General is aware of the extent Commanders' decisions are consistent with program goals.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase oversight of the Army's Warrior Transition Unit program, the Secretary of the Army should direct the Army Surgeon General to develop and implement an approach and associated procedures for providing senior leadership, such as the Warrior Transition Command, with complaints information concerning the WTU program and WTU soldiers.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To help ensure the best use of resources for managing the medical care of soldiers recovering from serious medical conditions, the Secretary of the Army should direct the Chief of the Army Reserve, in conjunction with the Army Surgeon General, to develop an analysis that compares the costs and benefits of maintaining the current system of Community Care Units with the costs and benefits of expanding the Reserve Component Managed Care program.

    Agency: Department of Defense: Department of the Army
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Valerie C. Melvin
    Phone: (202) 512-6304

    4 open recommendations
    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should ensure related goals are defined to provide a basis for assessing and reporting on the status of interoperability-related activities and the extent to which interoperability is being achieved by the departments' modernized electronic health record systems.

    Agency: Department of Defense
    Status: Open

    Comments: The Department of Defense (DOD) and the Department of Veterans Affairs (VA) are working to define goals to provide a basis for assessing and reporting on the status of interoperability-related activities and the extent to which interoperability is being achieved by the departments' modernized electronic health record systems. Specifically, according to the DOD/VA Interagency Program Office (IPO), the office, in conjunction with the departments, has employed use cases in the Joint Interoperability Plan to define the interoperability-related goal areas, which are to be used as the basis for the development of outcome-oriented metrics, assessments, and reporting. The departments, the IPO, and workgroups within the Health Executive Committee's data sharing areas have focused on the feasibility and development of metrics aligned to six use cases as they relate to electronic health record interoperability between DOD and VA and outcomes to service members, veterans, and healthcare providers. The IPO reports that the work to establish these goals will be completed by December 2017. GAO will continue to review the results of these efforts.
    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should ensure related goals are defined to provide a basis for assessing and reporting on the status of interoperability-related activities and the extent to which interoperability is being achieved by the departments' modernized electronic health record systems.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) and the Department of Defense (DOD) are working to define goals to provide a basis for assessing and reporting on the status of interoperability-related activities and the extent to which interoperability is being achieved by the departments' modernized electronic health record systems. Specifically, according to the DOD/VA Interagency Program Office (IPO), the office, in conjunction with the departments, has employed use cases in the Joint Interoperability Plan to define the interoperability-related goal areas, which are to be used as the basis for the development of outcome-oriented metrics, assessments, and reporting. The departments, the IPO, and workgroups within the Health Executive Committee's data sharing areas have focused on the feasibility and development of metrics aligned to six use cases as they relate to electronic health record interoperability between VA and DOD and outcomes to service members, veterans, and healthcare providers. The IPO reports that the work to establish these goals will be completed by December 2017. GAO will continue to review the results of these efforts.
    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should update IPO guidance to reflect the metrics and goals identified.

    Agency: Department of Defense
    Status: Open

    Comments: According to the Department of Defense (DOD)/Department of Veterans Affairs (VA) Interagency Program Office (IPO), the office has issued an update to the Health Data Interoperability Management Plan that documents the IPO's role and outlines governance for supporting interoperability between the departments. The IPO is also in the process of updating additional guidance to describe the benefits of interoperability and reflect associated outcome-oriented metrics and goals. Specifically, IPO officials reported that the IPO's Joint Interoperability Plan is transitioning to the Joint Interoperability Strategic Plan and is expected to be finalized in November 2017. GAO will review this guidance once it is approved by DOD and VA.
    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should update IPO guidance to reflect the metrics and goals identified.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: According to the Department of Defense (DOD)/Department of Veterans Affairs (VA) Interagency Program Office (IPO), the office has issued an update to the Health Data Interoperability Management Plan that documents the IPO's role and outlines governance for supporting interoperability between the departments. The IPO is also in the process of updating additional guidance to describe the benefits of interoperability and reflect associated outcome-oriented metrics and goals. Specifically, IPO officials reported that the IPO's Joint Interoperability Plan is transitioning to the Joint Interoperability Strategic Plan and is expected to be finalized in November 2017. GAO will review this guidance once it is approved by VA and DOD.
    Director: Vijay D'Souza
    Phone: (202) 512-7114

    2 open recommendations
    including 2 priority recommendations
    Recommendation: To better assess and address the full extent of improper payments in the TRICARE program, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to implement a more comprehensive TRICARE improper payment measurement methodology that includes medical record reviews, as done in other parts of its existing postpayment claims review programs.

    Agency: Department of Defense
    Status: Open
    Priority recommendation

    Comments: The Department of Defense's Defense Health Agency (DHA) has taken some action to incorporate medical record reviews in its improper payment estimate, as GAO recommended in February 2015. In October 2016, DHA released a request for proposals for claim record reviews, including medical record reviews, that the agency plans to use to support the agency's requirement to identify and report on the potential of improper payments to the Office of Management and Budget. This is a good first step. Once DHA incorporates medical record reviews in its improper payment rate calculation methodology, GAO will be able to close this recommendation.
    Recommendation: To better assess and address the full extent of improper payments in the TRICARE program, and once a more comprehensive improper payment methodology is implemented, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to develop more robust corrective action plans that address underlying causes of improper payments, as determined by the medical record reviews.

    Agency: Department of Defense
    Status: Open
    Priority recommendation

    Comments: Until the department implements a more comprehensive TRICARE improper payment measurement methodology and identifies the underlying causes of improper payments, the full extent of improper payments in the TRICARE program will likely not be identified and addressed. As of October 2016, the Department of Defense's Defense Health Agency has not yet implemented a more comprehensive TRICARE improper payment measurement methodology, and has, therefore, not developed more robust corrective action plans.
    Director: Randall B. Williamson
    Phone: (202) 512-7114

    4 open recommendations
    Recommendation: To ensure DHA can accurately and consistently assess mental health provider staffing needs across each of the military services, the Secretary of Defense should direct the Secretaries of the Army, Air Force, and Navy to require the medical commands of each military service to include its estimated mental health provider staffing needs generated through PHRAMS in the requirements fields of DHA's quarterly mental health staffing reports.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to ensure DHA, through the PHRAMS contractor, continue to refine PHRAMS to incorporate the needs of the military services to reduce the need for additional service-specific methods of determining mental health provider staffing needs.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To ensure the Defense Health Agency (DHA) can accurately and consistently assess mental health provider staffing needs across each of the military services, the Secretary of Defense should direct the Secretaries of the Army, Air Force, and Navy to require the medical commands of each military service to report any additional service-specific methods they use to determine their final estimates of mental health provider staffing needs.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to require the National Capital Region Medical Directorate to include its estimated mental health provider staffing needs generated through PHRAMS in the requirements fields of DHA's quarterly mental health staffing reports.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Director: Williamson, Randall B
    Phone: (206)287-4860

    3 open recommendations
    including 2 priority recommendations
    Recommendation: To ensure that servicemembers have equitable access to the military services' wounded warrior programs, including the RCP, and to establish central accountability for these programs, the Secretary of Defense should establish or designate an office to centrally oversee and monitor the activities of the military services' wounded warrior programs to include the following: (1) Develop consistent eligibility criteria to ensure that similarly situated recovering servicemembers from different military services have uniform access to these programs; (2) Direct the military services' wounded warrior programs to fully comply with the policies governing care coordination and case management programs and any future changes to these policies; (3) Develop a common mechanism to systematically monitor the performance of the wounded warrior programs--to include the establishment of common terms and definitions--and report this information on a biannual basis to the Armed Services Committees of the House of Representatives and the Senate.

    Agency: Department of Defense
    Status: Open
    Priority recommendation

    Comments: DOD did not concur with our part (1) of our recommendation to develop consistent eligibility criteria, explaining that the three military department secretaries should have the ability to control entrance criteria into their wounded warrior programs and that varying eligibility criteria have not resulted in noticeable differences in access to these programs by recovering servicemembers or their families. In attachments to a memo dated April 8, 2014, DOD provided an update on progress made to implement parts (2) and (3) of the DOD-specific recommendation made in GAO-13-5. Regarding part (2), DOD reported that budget constraints had delayed its plan to conduct oversight visits to 63 service sites over a 12-month period to ensure that military wounded warrior programs were operating in compliance with DOD Recovery Coordinator Program policy. DOD stated that the Warrior Care Policy office, in coordination with the military service branches, had intended to begin these oversight visits and interviews in September 2013; that as of March 2014, five sites had been reviewed; and that results of the compliance visits would be available upon completion. Regarding part (3) of the recommendation, DOD's memo stated that DOD and VA continue work on developing policies on clinical and non-clinical care coordination. It also noted that interagency metrics for monitoring complex care coordination performance were under development by the DOD/VA Interagency Care Coordination Committee. Further, DOD stated that because the Joint Executive Council publishes an annual report, that reporting the progress in developing common terms and definitions used by wounded warrior programs to congressional committees would be of limited value. As of October 2016, when we determine what additional steps the agency has taken to implement this recommendation, we will update this information.
    Recommendation: To ensure that persistent challenges with care coordination, disability evaluation, and the electronic sharing of health records are fully resolved, the Secretaries of Defense and Veterans Affairs should ensure that these issues receive sustained leadership attention and collaboration at the highest levels with a singular focus on what is best for the individual servicemember or veteran to ensure continuity of care and a seamless transition from DOD to VA. This should include holding the Joint Executive Council accountable for (1) ensuring that key issues affecting recovering servicemembers and veterans get sufficient consideration, including recommendations made by the Warrior Care and Coordination Task Force and the Recovering Warrior Task Force; (2) developing mechanisms for making joint policy decisions; (3) involving the appropriate decision-makers for timely implementation of policy; and; (4) establishing mechanisms to systematically oversee joint initiatives and ensure that outcomes and goals are identified and achieved.

    Agency: Department of Defense
    Status: Open
    Priority recommendation

    Comments: As of October 2016, under the joint DOD/VA Interagency Care Coordination Committee, the departments have made progress to improve nonclinical care coordination procedures, primarily through the development of two initiatives?the Lead Coordinator initiative (in which a single care coordinator serves as the primary point of contact for a recovering servicemember) and through the use of a single, interagency care plan (ICP) for each recovering servicemember. As of March 2016, the departments were continuing the national rollout of the Lead Coordinator initiative and had trained nearly 3,700 DOD and VA personnel on the new process. In addition, DOD and VA continued the development of the ICP initiative, which will depend upon their ability to electronically exchange the information needed to implement servicemembers' care plans. In December 2015, DOD awarded a contract to support the ICP and to create electronic interoperability with VA. The departments anticipate testing their ability to exchange information digitally in June 2016 and achieving full operational capability by September 2016. We will continue to monitor progress to implement the joint Lead Coordinator and the ICP care coordination initiatives.
    Recommendation: To ensure that persistent challenges with care coordination, disability evaluation, and the electronic sharing of health records are fully resolved, the Secretaries of Defense and Veterans Affairs should ensure that these issues receive sustained leadership attention and collaboration at the highest levels with a singular focus on what is best for the individual servicemember or veteran to ensure continuity of care and a seamless transition from DOD to VA. This should include holding the Joint Executive Council accountable for (1) ensuring that key issues affecting recovering servicemembers and veterans get sufficient consideration, including recommendations made by the Warrior Care and Coordination Task Force and the Recovering Warrior Task Force; (2) developing mechanisms for making joint policy decisions; (3) involving the appropriate decision-makers for timely implementation of policy; and; (4) establishing mechanisms to systematically oversee joint initiatives and ensure that outcomes and goals are identified and achieved.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of October 2016, under the joint DOD/VA Interagency Care Coordination Committee, the departments have made progress to improve nonclinical care coordination procedures, primarily through the development of two initiatives?the Lead Coordinator initiative (in which a single care coordinator serves as the primary point of contact for a recovering servicemember) and through the use of a single, interagency care plan (ICP) for each recovering servicemember. As of March 2016, the departments were continuing the national rollout of the Lead Coordinator initiative and had trained nearly 3,700 DOD and VA personnel on the new process. In addition, DOD and VA continued the development of the ICP initiative, which will depend upon their ability to electronically exchange the information needed to implement servicemembers' care plans. In December 2015, DOD awarded a contract to support the ICP and to create electronic interoperability with VA. The departments anticipate testing their ability to exchange information digitally in June 2016 and achieving full operational capability by September 2016. We will continue to monitor progress to implement the joint Lead Coordinator and the ICP care coordination initiatives.
    Director: Williamson, Randall B
    Phone: (206)287-4860

    5 open recommendations
    Recommendation: To address weaknesses in DCOE's strategic plan, the Secretary of Defense, through the Director of TMA, should direct the DCOE director to revisit and revise as necessary the organization's goals for completing statutorily required responsibilities.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To address weaknesses in DCOE's strategic plan, the Secretary of Defense, through the Director of TMA, should direct the DCOE director to require the directorates to align their day-to-day activities to support DCOE's mission and goals.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To address weaknesses in DCOE's strategic plan, the Secretary of Defense, through the Director of TMA, should direct the DCOE director to improve the performance measures in the plan to enable DCOE to determine if achievement of each measure fully supports attainment of its associated goal.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To ensure that DCOE obligations are properly classified and recorded in accordance with OMB guidance, the Secretary of Defense, through the Office of the Assistant Secretary of Defense (Health Affairs) (ASD(HA)), should direct TMA to develop written procedures with detailed steps to be performed for ensuring proper classification and recording of obligations in TMA's financial management systems.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To ensure that DCOE obligations are properly classified and recorded in accordance with OMB guidance, the Secretary of Defense, through the ASD(HA), should direct TMA to assign responsibility for updating and maintaining procedural guidance and systems codes to assure consistency with annual OMB guidance.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Director: Farrell, Brenda S
    Phone: (202)512-3604

    1 open recommendations
    Recommendation: To better understand the extent to which deployed DOD civilian employees have access to needed medical care, as appropriate, the Secretary of Defense should direct the Combatant Commander of U.S. Central Command to clarify the level of care that deployed DOD civilian employees can expect in theater, including their eligibility for routine care.

    Agency: Department of Defense
    Status: Open

    Comments: As of September 2016, DOD has not taken all the steps to close this recommendation. A DOD official stated that, as a result of changes in theater, there have been changes in guidance regarding medical care and they believe the guidance is clear, but they have not received guidance from the Secretary of Defense directing them to clarify the level of care that deployed civilian employees can expect in theater, including their eligibility for routine care.
    Director: Williamson, Randall B
    Phone: (206)287-4860

    1 open recommendations
    Recommendation: To help DOD obtain reasonable assurance that all active and Reserve component servicemembers to whom the PDHRA requirement applies are provided the opportunity to have their health concerns identified, the Assistant Secretary of Defense for Health Affairs and the military services should take steps to ensure that PDHRA questionnaires are included in DOD's central repository for each of these servicemembers.

    Agency: Department of Defense
    Status: Open

    Comments: In its comments to this report, the Department of Defense (DOD) concurred with this recommendation. On October 2009, DOD's Force Health Protection and Response Office sent a memo to each of the military service Surgeons General emphasizing the need for the post-deployment health reassessment (PDHRA) to be offered to all service members who are eligible to complete the assessment. In 2010, DOD's noted that the services would work with the Armed Forces Health Surveillance Center (AFHSC) repository to ensure PDHRAs are submitted correctly, without transmission errors. DOD's 2011 case records showed that the Air Force and Army had developed data verification processes to ensure that AFHSC received PDHRAs. Further, the Defense Medical Data Center (DMDC) had planed to create a file consisting of the date of deployment for deployed personnel, and that the file would be available to the services in order to match DMDC with data from each of the service-specific systems, in accordance to requirements. In September 2011, although DMDC and the services had agreed to match rosters of deployed service members, there were still inconsistencies in deployment dates. In March 2012, DOD was still verifying data inconsistencies which, until resolved, leads to inaccurate reporting based on errors in the deployment dates.