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VA Health Care: Incomplete Information Hinders Usefulness of Market Assessments for VA Facility Realignment

GAO-22-104604 Published: Feb 02, 2022. Publicly Released: Mar 04, 2022.
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Fast Facts

VA provides health care to a veteran population that is growing older and more diverse. These demographic shifts will drive changes in veterans' needs.

How is VA preparing to meet those needs? VA is trying to identify potential ways to realign its medical facilities by assessing 96 health care markets nationwide.

Our review of VA's assessments to date found more information was needed to determine the supply of, and demand for, care from non-VA providers when care cannot be delivered at a VA facility. VA also did not compile information on the quality of the data it collected. Our recommendations address these issues.

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What GAO Found

The Department of Veterans Affairs (VA) conducted assessments of its capacity within 96 markets to deliver health care to veterans through VA providers and, when the Department cannot provide the care needed, through non-VA providers, known as community care. For these assessments, markets are designated geographic areas made up of a set of contiguous counties that contain one or more VA medical centers and associated clinics. For an overview of VA's approach, see the figure.

Overview of Department of Veterans Affairs' Approach to Its Market Assessments

Overview of Department of Veterans Affairs' Approach to Its Market Assessments

VA officials described the department's process of developing proposals as iterative in that VA continually reviewed and revised draft proposals throughout the market assessments process. The VA Secretary plans to transmit recommendations to the Asset and Infrastructure Review Commission by March 14, 2022—that is, no later than 6 weeks from the statutory deadline of January 31, 2022. The Commission will then review these recommendations, hold public hearings, and prepare and issue their own recommendations to the President.

GAO identified gaps in the data VA compiled and certified for the market assessments that were relevant to determining both the supply of and demand for non-VA care. For example, VA lacked complete data on the extent to which its contractors maintain an adequate number of non-VA providers to ensure veterans have timely access to community care. VA officials told GAO that they determined supply and demand based on the most recently available data at the time of data compilation—December 2018 to November 2020. In addition, while VA officials told GAO the end-of-assessment analyses included updated data on community care, these data did not address the gaps GAO identified. Without such information, VA lacks a full understanding of the extent to which community care is able to supplement VA facility care to meet veterans' current and future demand.

GAO also found that VA's approach to the market assessments did not include steps to collect information on the quality of VA data compiled from numerous VA data sources or other steps to understand any relevant data limitations. Instead, VA officials leading the market assessments said they relied on VA offices responsible for the databases to ensure the data quality. As a result, VA is unable to communicate to external stakeholders, such as the Asset and Infrastructure Review Commission, all relevant information on the quality of VA data used in market assessments, including any limitations affecting these data and the resulting proposals for realignment.

Why GAO Did This Study

The VA MISSION Act of 2018 required VA to assess its capacity to deliver health care to veterans. This was done in response to challenges facing the department such as an aging veteran population, antiquated health care infrastructure, and limitations with VA's capital planning processes. VA officials said these market assessments—conducted at the VA health care market level—will inform the Secretary's planned recommendations on modernizing and realigning VA health care delivery that the VA MISSION Act requires VA to issue by January 31, 2022.

GAO was asked to review VA's market assessment methodology. This report (1) describes VA's approach to its market assessments; and (2) identifies limitations in that approach.

GAO reviewed VA documents and data used to inform the market assessments and interviewed VA officials responsible for conducting the market assessments.


GAO is making two recommendations for the VA Secretary: (1) to improve the completeness of VA community care data, and (2) to externally communicate to the Asset and Infrastructure Review Commission information about VA data reliability and any limitations of information used in the market assessments. VA concurred with the recommendations, and identified steps it will take to implement them. For example, VA noted that the department will provide the Commission information outlining the completeness and limitations of VA data used in the market assessments.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Secretary of Veterans Affairs should review the data on community care to identify any gaps and take steps to address data completeness. (Recommendation 1)
As of January 2023, VA reported that the department had conducted working sessions with key VA stakeholders and gathered lessons learned from the initial market assessment and insights on future market assessments. VA plans to fully incorporate feedback received into a final Lessons Learned document to help improve future iterations of the market assessments. VA expects to complete refinements to the community care data sets that include appointments in December 2023.
Department of Veterans Affairs The Secretary of Veterans Affairs should externally communicate to the Commission information about the completeness and reliability of VA data used to inform the assessments and about how VA considered any data limitations in developing proposals for the modernization and realignment of VA facilities. (Recommendation 2)
Closed – No Longer Valid
As of July 2023, the Asset and Infrastructure Review Commission was not established and the timeframes for its actions related to VA's proposals for modernization and realignment have expired. As such, we are closing the recommendation as no longer valid.

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