VA Health Care: Clinical Contact Center Modernization Could Benefit from a Shared Schedule and Additional Guidance to Networks
Fast Facts
The Veterans Health Administration's (VHA) clinical contact centers help veterans with services like appointment scheduling, clinical triage, virtual care visits, and pharmacy services. VHA is working to establish these centers in each of its regional networks and standardize the services they offer.
We made recommendations to help VHA improve its planning of this effort. For example, if VHA shared its planning schedule with the regional networks, they could better prioritize their related implementation activities (e.g., hiring).
Highlights
What GAO Found
The Veterans Health Administration (VHA) initiated the Clinical Contact Center Modernization effort in May 2020. Through the effort, VHA aims to improve veterans' access to virtual care and standardize operations of clinical contact centers (contact centers), such as services offered, staffing, training, and how performance is assessed.
VHA's Office of Veterans Access to Care (OVAC)—which is leading the modernization effort—has taken several steps in planning for the modernization effort. One of these steps includes setting a milestone of December 31, 2021, for each of its Veterans Integrated Service Networks to establish a contact center that provides four core services (see table). Officials from six selected networks stated they anticipated meeting this date. OVAC officials stated that modernization is an ongoing effort, and they are working to possibly enhance the four core services with additional capabilities, such as mental health care, in the future. Moving forward, OVAC and networks could benefit from having a shared schedule that includes milestones, activities, and related timelines for networks implementing any future changes. For example, a schedule would provide a shared sequence of events that could help networks better prioritize modernization activities.
Core Services That Veterans Integrated Service Networks Are Expected to Offer by December 31, 2021, as Part of VHA's Clinical Contact Center Modernization Effort
|
Core service |
Veterans should be able to |
|
Primary care scheduling and administration |
Schedule, reschedule, and cancel appointments; and obtain information about VHA services. |
|
Clinical triage |
Discuss symptoms and concerns, and receive recommendations on the best course of action. |
|
Primary care virtual clinic visits |
Meet virtually with providers to discuss health care needs. |
|
Pharmacy |
Request and track the status of medication refills and renewals; and ask medication-related questions. |
Source: GAO analysis of Veterans Health Administration (VHA) guidance I GAO 22-104620
Additionally, OVAC has not developed certain guidance, which may hinder its ability to assess contact centers' performance in providing services, including
- Finalized performance metrics and targets that would clearly define performance expectations for centers and allow OVAC to assess center performance in a standardized way.
- Finalized networks' roles and responsibilities for assessing performance.
According to OVAC officials, upgrades to contact centers' telephone and quality management systems are important components of the modernization effort because they will provide data for assessing center performance. For example, the upgraded telephone system will provide data on call queues for helping to determine staff productivity. Officials told GAO that once the upgrades are fully implemented, which they anticipated would be completed in December 2021, they would have the data they need to finalize performance metrics and targets and define responsibilities for performance assessment. By providing additional guidance to networks, VHA may be able to improve its oversight of centers and determine if centers' performance is improving—two intended benefits of the modernization effort.
Why GAO Did This Study
Veterans reach out to VHA's contact centers via phone, video, and chat to access needed health care services. Historically, these contact centers provided services inconsistently to veterans and operated generally under local oversight. The COVID-19 pandemic saw veterans increasingly reach out to contact centers, which highlighted a need for VHA to examine them.
GAO was asked to review several aspects of clinical contact center operations and oversight. This report examines (1) VHA's modernization planning and (2) VHA's guidance to networks related to assessing contact centers' performance, among other things.
GAO reviewed Department of Veterans Affairs (VA) modernization documents and interviewed officials from OVAC; VA's Office of Information and Technology; VA's Veterans Experience Office; and six networks, selected for variation in geography and their reported progress in implementing the modernization effort.
Recommendations
GAO is making four recommendations, including that VHA (1) update and share a schedule for the Clinical Contact Center Modernization effort beyond December 31, 2021; and provide networks with (2) guidance identifying finalized performance metrics and targets, and (3) guidance defining networks' performance assessment roles and responsibilities. VA concurred with GAO's recommendations and identified actions it is taking to address them.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Veterans Health Administration | The Under Secretary for Health should update and share a schedule with networks for the Clinical Contact Center Modernization effort beyond December 31, 2021, which includes (1) milestones, (2) captures all activities, (3) sequences all activities, and (4) establishes the duration of all activities. (Recommendation 1) |
Closed – Implemented
The Veterans Health Administration (VHA) provided documentation showing that it actively collaborated with networks to develop milestones and expectations beyond December 31, 2021. These milestones are documented in the Integrated Master Schedule (IMS), in addition to the sequence and duration of necessary activities. VHA shared the milestones and expectations with networks on March 31, 2022.
|
| Veterans Health Administration | The Under Secretary for Health should provide networks with guidance identifying finalized performance metrics and performance targets. (Recommendation 2) |
Closed – Implemented
VHA reported that it provided networks with preliminary guidance on performance measures and performance targets in March 2022. National subject matter experts from the Enterprise Contact Center Council and network-level subject matter experts contributed to the guidance. VHA released finalized guidance in September 2022 that included performance measures and targets, such as an average speed to answer of two minutes for nurses.
|
| Veterans Health Administration | The Under Secretary for Health should provide networks with guidance for using the upgraded technology systems to collect contact centers' performance data. (Recommendation 3) |
Closed – Implemented
In September 2022 VHA provided guidance to network directors related to the newly developed national and network-level clinical contact center performance dashboards. The dashboards provide real-time performance data on clinical contact center metrics and targets.
|
| Veterans Health Administration | The Under Secretary for Health should provide networks with guidance defining their performance assessment roles and responsibilities for contact centers. (Recommendation 4) |
Closed – Implemented
As of November 2022, VHA provided networks with a finalized Clinical Contact Center Modernization directive, which outlines performance assessment role and responsibilities at several levels within VHA, including networks.
|