From the U.S. Government Accountability Office, www.gao.gov Transcript for: Veterans' Care--Challenges in Accessing Community Care and Counseling Services Description: The VA has taken steps to improve access to quality, timely health care. But veterans still report challenges in accessing this care. We talk with GAO's Debra Draper and Sharon Silas, two experts on veterans' health care issues, to find out more. Related GAO Work: GAO-20-652, VA Vet Centers: Evaluations Needed of Expectations for Counselor Productivity and Centers' Staffing; and, GAO-20-643, Veterans Community Care Program: Improvements Needed to Help Ensure Timely Access to Care Released: September 2020 [Intro Music] [Debra Draper:] There's been a 90% increase in the number of veterans receiving mental health care, which is three-times the rate of increase for all VA health care services. [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office--I'm Holly Hobbs. Veterans often face unique health challenges because of their military service. This includes mental health issues, which--according to the Department of Veterans Affairs--have increased dramatically during the past decade. The VA has taken steps to improve access to quality, timely health care. But veterans still report challenges in accessing this care. Today we talk with two GAO experts on Veterans' health care issues--Debra Draper and Sharon Silas. Both are directors in our Health Care Team, and have two new reports out about challenges veterans face when accessing health care. Thank you for joining us ladies! [Debra Draper:] Thank you, Holly. [Sharon Silas:] Thanks, Holly. [Holly Hobbs:] So Sharon, your report looks at a new effort by the VA--its community care program--that is meant to reduce delays some veterans see when trying to access care. How does this program work, and is it reducing delays? [Sharon Silas:] So, the Veterans Community Care program provides veterans that meet certain eligibility criteria with an opportunity to access care from providers in their communities. For example, if a veteran wanted to see provider in a VA facility and it's going to take more than 20 days to see them--and this is for a primary care provider--then the VA health care provider will create a referral for the veteran. And then VA staff will work with that veteran to schedule an appointment with a provider in their community. In terms of whether or not the program is achieving its goal--it's not really clear because, first of all there are a number of steps between establishing a referral and a veteran receiving care from a community provider. And what we found in our review is that the VA has not established maximum timeframes to account for all of the steps in the appointment scheduling process. They also haven't established an overall wait-time measure that specifies the maximum amount of time it should take a veteran to receive care through the Veterans Community Care program. So, without addressing these issues, VA is not really able to monitor and measure whether the program is providing veterans with timely access to care. [Holly Hobbs:] And Debra, your report looks specifically at counseling services provided by the VA's Vet Centers. The VA reported a dramatic increase in the number of veterans seeking mental health services. Do we know the impact that increase has had on the Vet Centers and their ability to provide counseling services? [Debra Draper:] Since 2006, there's been a 90% increase in the number of veterans receiving mental health care, which is three-times the rate of increase for all VA health care services. And, as we discuss in our report, vet centers help augment VA's mental health care by offering services such as marriage, family, and individual counseling. And these centers have continued to see an increased demand for their services, and have increased their capacity over the years to serve more veterans. There are currently 300 vet centers located throughout the United States, Puerto Rico, American Samoa, and Guam. In addition, vet centers also have a fleet of mobile units and satellite locations. And the purpose of these is to increase the number of ways that veterans may access services. [Music:] [Holly Hobbs:] So, it sounds like the Department of Veterans Affairs has taken a number of steps to improve veterans' access to care, including counseling. But that there are still a number of challenges, like increased demand for services, which are impacting veterans' ability to gain access to timely, quality care. Debra, does your report include recommendations to the VA on how it could better respond to the increases in veterans' request for counseling services? [Debra Draper:] So, we made a number of recommendations to VA about vet centers, including developing and implementing a staffing model to ensure that these centers have the right number and type of staff to help meet the needs of veterans. [Holly Hobbs:] And Sharon, did your report on VA's new community care program make any recommendations? [Sharon Silas:] Similar to Debbie's report, some of the recommendations are addressing issues with staffing and resources. We also made a recommendation that VA should align any monitoring metrics with timeframes established for the program's appointment scheduling process. And then lastly, we recommended that VA should address any challenges to community providers using their web-based system that they use to manage community care referrals. [Holly Hobbs:] So ladies, last question and the bottom line--what should people know about the challenges veterans face when trying to access health care? [Debra Draper:] You know, I think that veterans often face the same challenges as others when trying to access needed health care. For example, accessing care can be challenging when trying to maneuver complex health care systems like the VA. They can also be challenging in rural locations where the number of providers--particularly specialists--may be limited. And for mental health care in particular, stigma may pose a challenge--that is, the fear of being viewed negatively because of a health care condition. [Holly Hobbs:] And Sharon? [Sharon Silas:] The issues that we identified in our review are longstanding and predate the Veterans Community Care program. And so, it's important to remember the impetus for expanding veterans' access to care in the community. It was to mitigate wait times at VA facilities and help ensure veterans received access to care. [Debra Draper:] As we're speaking about mental health care, I would be remiss if I didn't mention an important resource for veterans, which is the Veterans Crisis Line. And this is available to veterans, families and friends. And it's intended to help those in crisis or who are needing to talk to someone. And Veterans Crisis Line can be reached by calling 1-800-273-8255, and pressing 1. [Holly Hobbs:] That was GAO's Debra Draper and Sharon Silas talking about GAO's review of veterans' care issues. Thank you for your time, ladies! [Debra Draper:] Thank you, Holly. [Sharon Silas:] Yes, thanks Holly. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts. And make sure you leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at gao.gov.