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Health: Military and Veterans Health Care

The Departments of Defense and Veterans Affairs need to improve integration across care coordination and case management programs to reduce duplication and better assist servicemembers, veterans, and their families.

Action:

To improve the effectiveness, efficiency, and efficacy of services for recovering servicemembers, veterans, and their families by reducing duplication and overlap, the Secretaries of Defense and Veterans Affairs should direct their Senior Oversight Committee to expeditiously develop and implement a plan to strengthen functional integration across all Department of Defense (DOD) and Department of Veterans Affairs (VA) care coordination and case management programs that serve this population.

Progress:

In September 2012, the VA/DOD Joint Executive Council (into which the Senior Oversight Committee has been merged) approved an integrated, interagency approach that is intended to reduce redundancy and overlap and strengthen functional integration between the departments’ care coordination and case management programs for recovering servicemembers, veterans, and their families, as GAO recommended in October 2011. However, DOD and VA have not fully implemented this approach.

DOD and VA began collaborating to address GAO’s recommendation in May 2012, following completion of VA’s internal assessment of its care coordination and case management activities. At that time, the departments agreed to establish a joint task force to recommend interdepartmental action. In September 2012, the Joint Executive Council approved recommendations made by this task force, urged the departments to accelerate implementation of the recommended changes, and created the Interagency Care Coordination Council (IC3) to oversee development and implementation of joint DOD/VA care coordination initiatives.

Under the IC3, DOD and VA agreed to jointly implement two initiatives—1) the Lead Coordinator process and 2) a single, comprehensive care coordination plan for each recovering servicemember—both intended to improve care coordination procedures by improving communication between the departments and eliminating duplicative efforts.

In 2014, DOD and VA identified Lead Coordinator responsibilities and began the national rollout of the Lead Coordinator process. During 2015 and 2016, the IC3 continued its national rollout of Lead Coordinator training at DOD and VA facilities. By November 2017, DOD and VA had administered in-person training to more than 4,500 staff in both departments and had continued Lead Coordinator implementation through online training efforts.

To support interagency comprehensive plans for recovering servicemembers, veterans, and their families, DOD and VA have explored different methods for establishing interoperability between the information technology systems that support their care coordination programs. In the fall of 2016, DOD and VA began testing the interoperability between their information technology systems. In December 2017, DOD officials told us that the departments were taking steps to validate the adequacy of information transmitted from DOD to VA. DOD officials stated that this validation process will determine if the comprehensive planning process is ready to be deployed to DOD and VA field staff, and they expect to complete this validation process in early 2018.

DOD and VA acknowledged that full implementation of the Lead Coordinator model is dependent upon achieving interoperability for the interagency comprehensive care coordination plans.

Full implementation of the interagency care coordination/case management approach is important to the departments’ goal of reducing duplication between programs, fragmentation of programmatic efforts, and confusion and frustration among recovering servicemembers, veterans, and their families. Without better alignment and integration, problems with duplication and overlap could persist and perhaps worsen, and the intended purpose of these programs—to better manage and facilitate care and services—might not be achieved.

Implementing Entity:

Department of Defense, Department of Veterans Affairs