Title: How Does VA Ensure Veterans' Access to Timely Mental Health Care?

Description: In recent years, more veterans have sought treatment for
mental health conditions. Providing them with timely access to this care
is a top priority for the Department of Veterans Affairs. But the VA has
struggled to meet this growing demand for services at its medical
facilities and within its community care network, which provides health
care access to veterans in the communities where they live. What's the
VA doing to address this issue? We'll find out from GAO's Alyssa
Hundrup.

Related work: GAO-24-106410, Veterans Health Care: Opportunities Exist
to Improve Assessment of Network Adequacy for Mental Health

Issuance: June 2024

{Music}

[Alyssa Hundrup:] VA needs to improve its monitoring of Community Care
Networks for mental health, and this is especially important given the
growing demand for these services.

[Holly Hobbs:] Hi and welcome to GAO's Watchdog Report. Your source for
fact-based, nonpartisan news and information from the U.S. Government
Accountability Office. I'm your host, Holly Hobbs. In recent years, more
veterans have sought treatment for mental health conditions. Providing
them with timely access to this care is a top priority for the
Department of Veterans Affairs. But the VA has struggled to meet this
growing demand for services at its medical facilities and within its
Community Care Network, which provides health care access to veterans in
the communities where they live. What's the VA doing to address this
issue? We'll find out from GAO's Alyssa Hundrup, an expert on veterans'
health care, who has a new report out about this topic. Thanks for
joining us.

[Alyssa Hundrup:] Thanks for having me, Holly.

[Holly Hobbs:] So, Alyssa, as more veterans are seeking treatment for
their mental health, has the VA been able to meet this demand?

[Alyssa Hundrup:] Yeah, we are definitely seeing an increasing demand
for mental health services at VA. This is not unlike what we're seeing
in the civilian population as well. Veterans of course go to the VA for
care,  ut when they can't readily receive that care there, such as
because the wait is too long, they can go to the community through VA's
specific Community Care Program. And that also helps address some of the
demand. And in our report, we're looking at how VA maintains networks of
providers in the community to meet this increasing demand.

[Holly Hobbs:] So I think the report says that VA can provide services
within its own medical facilities. But, when needed, it also can use two
contractors to provide services through its Community Care Network
nationwide, right? Do we know if the contractors are tracking access?

[Alyssa Hundrup:] Yeah. So, the contractors track access in a few
different ways. For example, they'll meet regularly, which is about
monthly with individual VA medical facilities to discuss the networks
and see if there are any gaps that they're seeing and work to address
those. They're also looking at data. So, data such as on the demand for
different types of care and then data on the numbers of community
providers that provide that care. And then they'll look for potential
gaps in coverage and where they may need to bulk up and maybe recruit
new community providers. 

[Holly Hobbs:] Did we interview the contractors for this report, and did
they tell us about any challenges they face in ensuring access to care?

[Alyssa Hundrup:] Yes, and they did say they do face challenges. So, for
instance, recruiting mental health providers in some parts of the
country, especially in rural areas, they said was challenging. And I
think that's partly due to the ongoing nationwide shortage that we're
seeing in this area and that's something that, of course, impacts the
ability of the VA and the contractors as well, to recruit enough
providers. Another challenge that they cited was that many mental health
providers can operate as individual providers, or they have very small
practices. So, they may not have the support staff to deal with being in
the network and dealing with submitting claims and going through the
administrative parts of it.

[Holly Hobbs:] What about the VA itself? How is it overseeing these two
contractors? 

[Alyssa Hundrup:] Yeah. So, the VA holds them to two primary standards
or two metrics. The first standard is based on geographic location. So,
VA has established maximum drive times for how long it should take a
veteran to drive to a community provider. In an urban area that
typically is about a 45-minute drive time. And then the other standard
is based on appointment availability. So, VA has established a limit on
how long veterans should have to wait for an appointment. And for the
most part, the standard is about 30 days for mental health appointments.

[Holly Hobbs:] So those are the two standards, but how is VA tracking to
make sure standards are met?

[Alyssa Hundrup:] Yeah. So first, the VA tracks how quickly its staff
can schedule appointments for community care. So, before even getting an
appointment, the VA has to schedule that. And it's supposed to do that
within about 7 days of when a provider creates a referral. However, we
found that the majority of the facilities are not meeting this standard.
According to the most recent VA data we looked at, it's taking an
average of more than 14 days to schedule community care referrals
specific to mental health. Also, VA is tracking the drive time and
appointment availability metrics. So, it has the contractors submit
reports on a monthly basis, and those contractors are supposed to meet
those drive time and appointment availability standards at least 90% of
the times. And then if it doesn't, if the reports are showing that
they're not meeting those standards, they have to submit corrective
action plans to the VA.

{MUSIC}

[Holly Hobbs:] Alyssa told us that as the VA is trying to meet the
growing demand for mental health services. But that there have been
delays in getting this care, even through its Community Care program,
which was meant to increase access. So, Alyssa, what more do we think
the Department of Veterans Affairs should be doing to ensure veterans
have access to mental health care?

[Alyssa Hundrup:] So,  VA needs to take steps to help its facility
schedule appointments for care more quickly and it also needs to better
monitor its contractors to help ensure they have enough mental health
providers in their network. And we made two recommendations targeting
both of these issues. So first, we recommended that the VA track the
reasons for scheduling delays and then use that information to take
steps to address the different reasons that it finds. So, for example,
if they're finding provider shortages in certain areas and they can work
with a contractor to more proactively recruit those providers. And then
second, we recommended that VA reexamine its methodology for calculating
that specialty care network adequacy. So, what we had found was that in
assessing contractor performance, the VA excluded certain claims from
its drive time and wait time metrics, and that could lead to the
contractor performance appearing better than it really is in reality.

[Holly Hobbs:] And last question, what's the bottom line of this report.

[Alyssa Hundrup:] The bottom line is that VA needs to improve its
monitoring of Community Care Networks for mental health. And this is
especially important given the growing demand for these services and the
troubles that VA has had in scheduling appointments.

[Holly Hobbs:] That was Alyssa Hundrup talking about our new report on
veterans' mental health care access in communities. Thanks for your
time, Alyssa. 

[Alyssa Hundrup:] Thank you. 

[Holly Hobbs:] And thank you for listening to the Watchdog Report. To
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