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- Addressed

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- Partially Addressed

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- Not Addressed

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- Consolidated or Other

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- Pending

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- Closed-Partially Addressed

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- Closed-Not Addressed

Year Identified: 2019

Area Number: 4

Area Type: Fragmentation, Overlap & Duplication

Action:

The Secretary of Defense should ensure that the Assistant Secretary of Defense for Health Affairs, in coordination with the Director of the Defense Health Agency (DHA) and the Surgeons General of the military departments, define and analyze the 16 operational readiness and installation-specific medical functions currently excluded from transfer to the DHA to determine whether opportunities exist to reduce or better manage duplicative functions and improve efficiencies in the administration of the military treatment facilities.

Progress:

The Department of Defense (DOD) concurred with GAO’s October 2018 recommendation and has taken some steps to implement it. According to responses provided by DOD officials in December 2019, the department provided guidance on the division of the 16 operational readiness and installation-specific medical functions in a March 2019 memorandum from the Office of the Under Secretary of Defense for Personnel and Readiness. Among other things, the memorandum also identified the roles and responsibilities of the military departments and DHA for the military treatment facilities. Until DOD completes an analysis to assess the 16 functions for duplication, it will not have the necessary information to determine whether opportunities exist to reduce or better manage duplication in the administration of the military treatment facilities. 

Action:

The Secretary of Defense should ensure that the Assistant Secretary of Defense for Health Affairs, in coordination with the Defense Health Agency (DHA) Assistant Director for Health Care Administration and the Secretaries of the military departments, validate headquarters-level personnel requirements to determine that they are established at the minimum levels necessary—per Department of Defense (DOD) guidance—to accomplish missions and achieve objectives before transferring authority, direction, and control of the military treatment facilities to the DHA for the third phase.

Progress:

DOD concurred with GAO’s October 2018 recommendation. In December 2019, DOD officials stated that DOD conducted a review of the DHA personnel requirements; the military departments also conducted reviews; and DOD transferred 1,900 personnel to the military departments for the management of their respective readiness missions. DOD officials also stated that DOD will continue to evaluate the mix of contractors, military, and civilian employees during and after the transition.

As GAO previously reported in GAO-19-53, the Office of the Under Secretary of Defense for Personnel and Readiness report on DHA personnel requirements from September 2018, which DOD officials referenced in their December 2019 responses, did not validate personnel requirements. Further, the Office of the Under Secretary of Defense for Personnel and Readiness report stated that DHA personnel requirements would increase to support an expanded mission and included several recommendations one of which was to conduct a military essentiality review of DHA positions and functions. Until DOD validates headquarters-level personnel requirements, Congress will lack important information to determine the extent to which the transfer of the administration of the MTFs to the DHA is being planned and implemented effectively and efficiently.

Action:

The Secretary of Defense should ensure that the Assistant Secretary of Defense for Health Affairs, in coordination with the Defense Health Agency (DHA) Assistant Director for Health Care Administration and the Secretaries of the military departments, conduct a comprehensive review to identify the least costly mix—per Department of Defense (DOD) guidance—of military, civilian, and contractors needed to meet validated requirements—that is, to perform the functions identified at the DHA headquarters and intermediate management organizations and at the military departments' headquarters and intermediate commands. Additionally, this comprehensive review should be completed before transferring authority, direction, and control of the military treatment facilities to the DHA for the third phase.

Progress:

DOD concurred with GAO’s October 2018 recommendation and commented that it had completed an extensive review of personnel requirements for the management structure of DHA. In its comments, DOD linked the review to a September 2018 Office of the Under Secretary of Defense for Personnel and Readiness report on DHA personnel requirements. In responding to DOD’s comments, GAO highlighted in GAO-19-53 that the Office of the Under Secretary of Defense for Personnel and Readiness report provided initial information concerning DHA’s personnel requirements. However, GAO also reiterated that DOD needed to identify the least costly mix—per DOD guidance—of military, civilian, and contractors once it has validated requirements for DHA. According to the Office of the Under Secretary of Defense for Personnel and Readiness report, it did not validate workload to the level of a technical estimate.  

Further, the report’s focus was DHA and did not include information regarding the military department’s headquarters and intermediate commands. In December 2019, DOD officials stated that through the review of the budget development process, DOD transferred 1,900 personnel to the military departments for the management of their respective readiness missions. Further, in their responses, DOD officials referenced the previously mentioned September 2018 Office of the Under Secretary of Defense for Personnel and Readiness report on DHA personnel requirements. Until DOD conducts a comprehensive review that considers the least costly mix of personnel, DOD may not be able to achieve its goal of reducing headquarters-level personnel by 10 percent while maintaining the efficient and effective provision of healthcare services.