VA and DOD Health Care:

Opportunities to Maximize Resource Sharing Remain

GAO-06-315: Published: Mar 20, 2006. Publicly Released: Mar 20, 2006.

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The National Defense Authorization Act for Fiscal Year 2003 required that the Departments of Veterans Affairs (VA) and Defense (DOD) implement programs referred to as the Joint Incentive Fund (JIF) and the Demonstration Site Selection (DSS) to increase health care resource sharing between the departments. The act requires GAO to report on (1) VA's and DOD's progress in implementing the programs. GAO also agreed with the committees of jurisdiction to report on (2) the actions taken by VA and DOD to strengthen resource sharing and opportunities to improve upon those actions and (3) whether VA and DOD performance measures are useful for evaluating progress toward achieving health care resource-sharing goals.

VA and DOD are making progress in implementing two programs required by legislation in December 2002 to encourage health care resource sharing and collaboration--JIF and DSS. While JIF projects experienced challenges because of delays resulting from the initial absence of funding mechanisms and, in some cases, the need for additional acquisition and construction approvals, as of December 2005, 7 of 11 selected 2004 projects were operational. The DSS program also experienced challenges as some sites reported difficulty putting together project submission packages, noting confusion over the timelines and approval process as well as frustration with the amount of paperwork and rework required. Nonetheless, as of December 2005, 7 of the 8 DSS projects were operational. However, the Joint Executive Council (JEC) and Health Executive Council (HEC), VA and DOD entities established to facilitate collaboration and health care resource sharing between the departments, have not established a plan to measure and evaluate the advantages and disadvantages of DSS projects--information that will be useful for determining if projects that produce cost savings or enhance health care delivery efficiencies can be replicated systemwide. VA and DOD are creating mechanisms that support the potential to increase collaboration, sharing, and coordination of management and oversight of health care resources and services. The departments have taken steps to create interagency councils and workgroups to facilitate collaboration and sharing of information, establish working relationships among their leaders, and develop communication channels to further health care resource sharing. In addition, the departments developed a Joint Strategic Plan outlining six goals. However, JEC and HEC have not seized upon a number of opportunities to further collaboration and coordination. For example, JEC and HEC have not developed a system for collecting and monitoring information on the health care services that each department contracts for from the private sector--such as individual VA medical center or military treatment facility contracts for dialysis, laboratory services, or magnetic resonance imaging. If such a system were in place, the departments could use it to identify services that could be exchanged from one another or possibly obtain better contract pricing through joint purchasing of services, thus promoting systemwide cost savings and efficiencies. Furthermore, JEC and HEC have not directed that a joint nationwide market analysis be conducted to obtain information on what their combined future workloads will be in the areas of services, facilities, and patient needs. VA and DOD lack performance measures that would be useful for evaluating how well they are achieving their health care resource-sharing goals. For example, of the 30 measures contained in the departments' joint strategic plan, 5 were not developed at the time the plan was issued and 11 lacked longitudinal information. For the remaining 14 that require periodic measurement, there was variation in the rigor or specificity in the types of data to be collected or the analysis to be performed.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: Health care resource-sharing activities between the Department of Veterans Affairs (VA) and the Department of Defense (DOD) are guided by a joint strategic plan. We previously reported that the VA/DOD Joint Strategic Plan, issued in December 2004, did not contain performance measures that were useful for evaluating how well the departments are achieving their health care resource sharing goals. Therefore, we recommended that VA and DOD develop useful performance measures determining the progress of their health care resource sharing goals. The initial analysis done on the December 2004 plan used 3 categories, "Measurement That Would Be Developed in the Future", "Measurement that Took Place Only Once", and "Measurement that Was Taken Periodically". A fourth category, "Measurement Non-Specific at to Amount or Time" was added for the analysis of the VA/DOD Joint Strategic Plan FY 2007-2009 issued in January 2007 because we found 7 performance measures which were unclear as to what was being specifically measured or as to the time frame in which the measurement was going to occur. Overall though, the analysis of the January 2007 plan shows an improvement in the performance measures used. For instance, while the December 2004 plan had 5 measures in which the measurement was to develop a performance measure in the future, the January 2007 plan had none. We also found a decrease in the number of measurements that only took place once. Specifically, the December 2004 plan had 11 and the January 2007 plan had 3. While one time measurements may provide useful snapshot information of output for a point-in-time prospective, they are not periodic and thus do not provide longitudinal information for evaluating the usefulness of specific activities. Finally, the December 2004 plan had only 14 specific performance measures over a specified period of time, whereas the January 2007 plan had 22--an increase in the number periodic measurements. Thus, there have been improvements in the performance measures used in the January 2007 plan as compared to the December 2004 plan.

    Recommendation: To further advance health care resource sharing within VA and DOD, the Secretaries of Veterans Affairs and Defense should direct JEC and HEC to develop performance measures that would be useful for determining the progress of their health care resource-sharing goals.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: GAO found that while the Demonstration Site Selection (DSS) projects helped increase the number of new sharing agreements between the Department of Veterans Affairs (VA) and the Department of Defense (DOD) partners, VA and DOD had not yet developed a standardized evaluation plan for documenting and recording the advantages and disadvantages of each project and whether they could be replicated at other VA and DOD medical facilities. Therefore, to further advance health care resource sharing with VA and DOD, GAO recommended the VA and DOD develop an evaluation plan for documenting and recording the reasons for the advantages and disadvantages of each DSS project. In response to this recommendation, a lessons learned template, called the NDAA Lessons Learned Input Form, along with a Standard Operating Procedure for collecting the lessons learned have been developed and implemented. Project managers for the DSS projects were trained prior to the Standard Operating Procedure for collecting the lessons learned became operational.

    Recommendation: To further advance health care resource sharing within VA and DOD, the Secretaries of Veterans Affairs and Defense should direct JEC and HEC to develop an evaluation plan for documenting and recording the reasons for the advantages and disadvantages of each DSS project, an activity that will assist VA and DOD in replicating successful projects systemwide.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: GAO found that while the Demonstration Site Selection (DSS) projects helped increase the number of new sharing agreements between the Department of Veterans Affairs (VA) and the Department of Defense (DOD) partners, VA and DOD had not yet developed a standardized evaluation plan for documenting and recording the advantages and disadvantages of each project and whether they could be replicated at other VA and DOD medical facilities. Therefore, to further advance health care resource sharing with VA and DOD, GAO recommended the VA and DOD develop an evaluation plan for documenting and recording the reasons for the advantages and disadvantages of each DSS project. In response to this recommendation, a lessons learned template, called the NDAA Lessons Learned Input Form, along with a Standard Operating Procedure for collecting the lessons learned have been developed and implemented. Project managers for the DSS projects were trained prior to the Standard Operating Procedure for collecting the lessons learned became operational.

    Recommendation: To further advance health care resource sharing within VA and DOD, the Secretaries of Veterans Affairs and Defense should direct JEC and HEC to develop an evaluation plan for documenting and recording the reasons for the advantages and disadvantages of each DSS project, an activity that will assist VA and DOD in replicating successful projects systemwide.

    Agency Affected: Department of Veterans Affairs

  4. Status: Closed - Implemented

    Comments: Health care resource-sharing activities between the Department of Veterans Affairs (VA) and the Department of Defense (DOD) are guided by a joint strategic plan. We previously reported that the VA/DOD Joint Strategic Plan, issued in December 2004, did not contain performance measures that were useful for evaluating how well the departments are achieving their health care resource sharing goals. Therefore, we recommended that VA and DOD develop useful performance measures determining the progress of their health care resource sharing goals. The initial analysis done on the December 2004 plan used 3 categories, "Measurement That Would Be Developed in the Future", "Measurement that Took Place Only Once", and "Measurement that Was Taken Periodically". A fourth category, "Measurement Non-Specific at to Amount or Time" was added for the analysis of the VA/DOD Joint Strategic Plan FY 2007-2009 issued in January 2007 because we found 7 performance measures which were unclear as to what was being specifically measured or as to the time frame in which the measurement was going to occur. Overall though, the analysis of the January 2007 plan shows an improvement in the performance measures used. For instance, while the December 2004 plan had 5 measures in which the measurement was to develop a performance measure in the future, the January 2007 plan had none. We also found a decrease in the number of measurements that only took place once. Specifically, the December 2004 plan had 11 and the January 2007 plan had 3. While one time measurements may provide useful snapshot information of output for a point-in-time prospective, they are not periodic and thus do not provide longitudinal information for evaluating the usefulness of specific activities. Finally, the December 2004 plan had only 14 specific performance measures over a specified period of time, whereas the January 2007 plan had 22--an increase in the number periodic measurements. Thus, there have been improvements in the performance measures used in the January 2007 plan as compared to the December 2004 plan.

    Recommendation: To further advance health care resource sharing within VA and DOD, the Secretaries of Veterans Affairs and Defense should direct JEC and HEC to develop performance measures that would be useful for determining the progress of their health care resource-sharing goals.

    Agency Affected: Department of Defense

 

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