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United States Government Accountability Office: 
GAO: 

Testimony:

Before the Subcommittee on Health, Committee on Veterans' Affairs, 
House of Representatives:

For Release on Delivery: 
Expected at 8:30 a.m. EDT:
Thursday, October 6, 2011:

DOD and VA Health Care:

Action Needed to Strengthen Integration across Care Coordination and 
Case Management Programs:

Statement of Debra A. Draper:
Director, Health Care:

GAO-12-129T:

GAO Highlights:

Highlights of GAO-12-129T, a testimony before the Subcommittee on 
Health, Committee on Veterans’ Affairs, House of Representatives. 

Why GAO Did This Study:

In a May 2011 testimony before this subcommittee (GAO-11-572T), based 
on a March 2011 report (GAO-11-250), GAO highlighted challenges for 
the Federal Recovery Coordination Program (FRCP), developed by the 
Departments of Defense (DOD) and Veterans Affairs (VA) to assist some 
of the most severely wounded, ill, and injured servicemembers, 
veterans, and their families. Specifically, GAO reported on challenges 
in FRCP enrollment, staffing needs, caseloads, and placement 
locations. GAO also cited challenges faced by the FRCP when 
coordinating with other VA and DOD programs, including DOD’s Recovery 
Coordination Program (RCP), which can result in duplication of effort 
and enrollee confusion. 

In this statement, GAO examines the status of DOD and VA’s efforts to 
(1) implement GAO’s March 2011 recommendations and (2) identify and 
analyze potential options to functionally integrate the FRCP and RCP. 
This statement is based on GAO’s March 2011 report and updated 
information obtained in September 2011. 

What GAO Found:

VA has made progress addressing each of the recommendations from GAO’s 
March 2011 report on program management issues related to enrollment 
decisions, caseloads, and program staffing needs and placement 
decisions for the Federal Recovery Coordinators (FRC) the FRCP uses to 
coordinate care. These recommendations were directed to the Secretary 
of VA because VA maintains administrative control of the program, and 
DOD and VA were asked to provide a response to this subcommittee about 
how the departments could jointly implement these recommendations. DOD 
has provided limited assistance to VA with the implementation of GAO’s 
recommendation about enrollment through an e-mail communication about 
referrals to the FRCP to the commanders of the military services’ 
wounded warrior programs. Despite this effort, however, VA officials 
stated that they have not noticed any change in referral numbers or 
patterns from DOD since the e-mail was sent. 

DOD and VA have made little progress reaching agreement on options to 
better integrate the FRCP and RCP, although they have made a number of 
attempts to address this issue. Most recently, DOD and VA experienced 
difficulty jointly providing potential options for integrating these 
programs in response to this subcommittee’s May 26, 2011, request to 
the deputy secretaries, who co-chair the DOD and VA Wounded, Ill, and 
Injured Senior Oversight Committee (Senior Oversight Committee). On 
September 12, 2011—almost 3 months after the subcommittee requested a 
response—the co-chairs of the Senior Oversight Committee issued a 
joint letter that stated that the departments are considering several 
options to maximize care coordination resources. However, these 
options have not been finalized and were not specifically identified 
or outlined in the letter. The two departments have made prior 
attempts to jointly develop options for improved collaboration and 
potential integration of the FRCP and RCP, but despite the 
identification of various options, no final decisions to revamp, 
merge, or eliminate programs have been agreed upon. This lack of 
progress illustrates DOD’s and VA’s continued difficulty in 
collaborating to resolve duplication and overlap between care 
coordination programs. Furthermore, as we have previously reported, 
there are numerous programs in addition to the FRCP and RCP that 
provide similar services to recovering servicemembers and veterans—
many of whom are enrolled in more than one program and therefore have 
multiple care coordinators and case managers. We found that inadequate 
information exchange and poor coordination between these programs has 
resulted in not only redundancy, but confusion and frustration for 
enrollees, particularly when care coordinators and case managers 
duplicate or contradict one another’s efforts. Consequently, the 
intended purpose of these programs—to better manage and facilitate 
care and services—may actually have the opposite effect. 

What GAO Recommends:

We recommend that the Secretaries of DOD and VA direct the Senior 
Oversight Committee to expeditiously develop and implement a plan to 
strengthen functional integration across all DOD and VA care 
coordination and case management programs, including the FRCP and RCP, 
to reduce redundancy and overlap. We obtained oral comments on the 
content of this statement from both DOD and VA officials, and we 
incorporated their comments as appropriate. 

View [hyperlink, http://www.gao.gov/products/GAO-12-129T]. For more 
information, contact Debra A. Draper at (202) 512-7114 or 
draperd@gao.gov. 

[End of section]

Chairwoman Buerkle, Ranking Member Michaud, and Members of the 
Subcommittee:

I am pleased to be here today as you discuss the actions taken by the 
Departments of Defense (DOD) and Veterans Affairs (VA) to address 
issues of concern that were raised during your May 13, 2011, hearing on 
the Federal Recovery Coordination Program (FRCP). Our statement for 
that hearing,[Footnote 1] based on our March 2011 report,[Footnote 2] 
outlined several implementation issues for the FRCP, which was jointly 
implemented by DOD and VA to assist some of the most severely wounded, 
ill, and injured servicemembers, veterans, and their families with 
access to care, services, and benefits. Specifically, we reported on 
challenges faced by FRCP leadership when identifying potentially 
eligible individuals for program enrollment and determining staffing 
needs and placement locations. We also cited challenges faced by the 
FRCP when coordinating with other VA and DOD care coordination[Footnote 
3] and case management[Footnote 4] programs that support wounded 
servicemembers, veterans, and their families, including DOD's Recovery 
Coordination Program (RCP). Specifically, we reported that poor 
coordination among these programs can result in duplication of effort 
and enrollee confusion because these programs often provide similar 
services and individuals may be enrolled in more than one program.

Based on the concerns raised during the May 2011 hearing, your 
subcommittee requested that DOD and VA provide a detailed response on 
how they plan to jointly implement the recommendations to improve FRCP 
management that were outlined in our report. You also requested that 
the two departments analyze potential options for integrating the FRCP 
and RCP under a single administrative umbrella to reduce redundancy and 
to better fulfill the goal of establishing a seamless transition for 
wounded servicemembers and their families. Although a response was 
requested by June 20, 2011, the departments had not responded by 
September 2, 2011, when this subcommittee announced that it intended to 
hold an oversight hearing on continuing concerns about the care 
coordination issues of the FRCP and RCP.

Our review of DOD's and VA's care coordination and case management 
programs, including the FRCP and RCP, is part of a body of ongoing work 
that is focused on the continuity of care for recovering servicemembers 
and veterans. My testimony today addresses the status of DOD and VA's 
efforts to (1) implement the recommendations to improve FRCP management 
from our March 2011 report and (2) identify and analyze potential 
options to integrate the FRCP and the RCP as requested by this 
subcommittee.

We conducted the original performance audit for our 2011 report from 
September 2009 through March 2011 and obtained updated data and 
additional information in September 2011 for this testimony. 
Specifically, to obtain information on the status of the 
recommendations contained in our March 2011 report, we reviewed 
documentation provided by VA and interviewed the Acting Executive 
Director for the FRCP. Although our recommendations were directed to 
VA, which administers the program, we also obtained information from 
DOD officials that described to what extent they have worked with VA to 
implement them based on your request for the departments to work 
together. To obtain information regarding the status of DOD and VA's 
efforts aimed at identifying and analyzing options for integrating or 
otherwise revamping the FRCP and RCP, we conducted interviews with DOD 
and VA officials and reviewed documents provided by both departments. 
We also obtained updated information about DOD's and VA's care 
coordination and case management programs by reviewing program 
documentation and by interviewing DOD and VA program officials.

We conducted our work for this testimony in accordance with generally 
accepted government auditing standards. Those standards require that we 
plan and perform the audit to obtain sufficient, appropriate evidence 
to provide a reasonable basis for our findings and conclusions based on 
our audit objectives. We believe that the evidence obtained provides a 
reasonable basis for our findings and conclusions based on our audit 
objectives.

Background:

The FRCP was jointly developed by DOD and VA following critical media 
reports of deficiencies in the provision and coordination of outpatient 
services at Walter Reed Army Medical Center. It was established to 
assist severely wounded, ill, and injured Operation Enduring Freedom 
(OEF) and Operation Iraqi Freedom (OIF) servicemembers,[Footnote 5] 
veterans, and their families with access to care, services, and 
benefits provided through DOD, VA, other federal agencies, states, and 
the private sector. The FRCP is intended to serve individuals who are 
highly unlikely to return to active duty and most likely will be 
separated from the military, including those who have suffered 
traumatic brain injuries, amputations, burns, spinal cord injuries, 
visual impairment, and post-traumatic stress disorder. From January 
2008--when FRCP enrollment began--to September 12, 2011, the FRCP has 
provided services to a total of 1,827 servicemembers and veterans; 
[Footnote 6] of these, 777 are currently active enrollees. [Footnote 7]

As the first care coordination program developed collaboratively by DOD 
and VA, the FRCP uses Federal Recovery Coordinators (FRC) to monitor 
and coordinate both the clinical and nonclinical services needed by 
program enrollees; FRCs are intended to accomplish this by serving as 
the single point of contact among case managers of DOD, VA, and other 
governmental and private care coordination and case management 
programs. As of September 12, 2011, there were 21 FRCs located at 
various military treatment facilities and VA medical centers. Although 
the program was jointly created by DOD and VA, it is administered by 
VA, and FRCs are VA employees.

Separately, the RCP was established in response to the National Defense 
Authorization Act for Fiscal Year 2008 to improve the care, management, 
and transition of recovering servicemembers. It is a DOD-specific 
program that uses Recovery Care Coordinators (RCC) to provide 
nonclinical care coordination to both seriously and severely wounded, 
ill, and injured servicemembers. Servicemembers who are severely 
wounded, ill, and injured and who will most likely be medically 
separated from the military, also are to be assigned an FRC. While the 
program is centrally coordinated by DOD's Office of Wounded Warrior 
Care and Transition Policy, it has been implemented separately by each 
of the military services, which have integrated RCCs[Footnote 8] within 
their existing wounded warrior programs.[Footnote 9] According to DOD's 
Office of Wounded Warrior Care and Transition Policy, in September 
2011, there were 162 RCCs and over 170 Army Advocates[Footnote 10] who 
worked in more than 100 locations, including military treatment 
facilities and VA medical centers. As of September 2011, these RCCs 
have assisted approximately 14,000 recovering servicemembers and their 
families and sometimes continue this assistance for those 
servicemembers who separate from active duty.[Footnote 11]

The FRCP and RCP are two of at least a dozen DOD and VA programs that 
provide care coordination and case management services to recovering 
servicemembers, veterans, and their families, as we have previously 
reported.[Footnote 12] Although these programs may vary in terms of the 
severity of injuries or illnesses among the population they serve, or 
in the types of services they provide, many, including the FRCP and 
RCP, provide similar services. (See table 1.) 

Table 1: Characteristics of Selected Department of Defense (DOD) and 
Department of Veterans Affairs (VA) Care Coordination and Case 
Management Programs for Seriously and Severely Wounded, Ill, and 
Injured Servicemembers, Veterans, and Their Families:

Program: VA/DOD Federal Recovery Coordination Program (FRCP); 
Severity of enrollees' injuries[A]: Severe; 
Title of care coordinator or case manager: Federal Recovery 
Coordinator (FRC); 
Type of services provided: 
Clinical: [Check]; 
Nonclinical: [Check]; 
Recovery plan: [Check].

Program: DOD Recovery Coordination Program (RCP); 
Severity of enrollees' injuries[A]: Serious; 
Title of care coordinator or case manager: Recovery Care Coordinator; 
Type of services provided: 
Clinical: [Empty]; 
Nonclinical: [Check]; 
Recovery plan: [Check].

Program: Army Warrior Transition Units; 
Severity of enrollees' injuries[A]: Serious to severe; 
Title of care coordinator or case manager: Nurse case manager, squad 
leader, physician (one of each is assigned); 
Clinical: [Check]; 
Nonclinical: [Check]; 
Recovery plan: [Check].

Program: Military wounded warrior programs[B,C]; 
Severity of enrollees' injuries[A]: Serious to severe; 
Title of care coordinator or case manager: Case manager or Advocate 
(title varies by service); 
Type of services provided: 
Clinical: [Empty]; 
Nonclinical: [Check]; 
Recovery plan: [Check].

Program: VA OEF/OIF Care Management Program[D]; 
Severity of enrollees' injuries[A]: Mild to severe; 
Title of care coordinator or case manager: Case manager, Transition 
Patient Advocate[E]; 
Type of services provided: 
Clinical: [Check]; 
Nonclinical: [Check]; 
Recovery plan: [Check].

Program: VA Spinal Cord Injury and Disorders Program; 
Severity of enrollees' injuries[A]: Mild to severe; 
Title of care coordinator or case manager: Nurse, social worker; 
Type of services provided: 
Clinical: [Check]; 
Nonclinical: [Check]; 
Recovery plan: [Check].

Program: VA Polytrauma System of Care; 
Severity of enrollees' injuries[A]: Serious to severe; 
Title of care coordinator or case manager: Social work and nurse case 
managers; 
Type of services provided: 
Clinical: [Check]; 
Nonclinical: [Check]; 
Recovery plan: [Check].

Source: GAO analysis of DOD and VA program information.

Notes: The characteristics listed in this table are general 
characteristics of each program; individual circumstances may affect 
the enrollees served and services provided by specific programs.

[A] For the purposes of this table, we have categorized the severity of 
enrollees' injuries according to the injury categories established by 
the DOD and VA Wounded, Ill, and Injured Senior Oversight Committee. 
Servicemembers with mild wounds, illness, or injury are expected to 
return to duty in less than 180 days; those with serious wounds, 
illness, or injury are unlikely to return to duty in less than 180 days 
and possibly may be medically separated from the military; and those 
who are severely wounded, ill, or injured are highly unlikely to return 
to duty and are also likely to medically separate from the military. 
These categories are not necessarily used by the programs themselves.

[B] The military wounded warrior programs are the Army Wounded Warrior 
Program, Marine Wounded Warrior Regiment, Navy Safe Harbor, Air Force 
Warrior and Survivor Care Program, Army Reserve Wounded Warrior 
Component, and Special Operations Command's Care Coalition.

[C] An FRC placed at the Special Operations Command's Care Coalition 
headquarters coordinates clinical and nonclinical care for Care 
Coalition and other FRCP enrollees.

[D] OEF/OIF refers to Operation Enduring Freedom and Operation Iraqi 
Freedom, respectively. Since September 1, 2010, OIF is referred to as 
Operation New Dawn.

[E] An OEF/OIF care manager supervises the case managers and transition 
patient advocates and may also maintain a caseload of wounded veterans. 

[End of table] 

VA Has Made Progress in Addressing Our Recommendations to Improve FRCP 
Management Processes, and DOD Has Provided Limited Assistance:

VA has recently made progress addressing the recommendations from our 
March 2011 report, and although our recommendations were directed to 
VA, DOD has provided limited assistance for one of the recommendations. 
We previously reported that the FRCP would benefit from more definitive 
management processes to strengthen program oversight and decision 
making, and that program leadership could no longer rely on the 
informal management processes it had developed to oversee and manage 
key aspects of the program. Because VA maintains administrative control 
of the program, we recommended that the Secretary of VA direct the FRCP 
to take actions to address management issues related to FRC enrollment 
decisions, FRCs' caseloads, and program staffing needs and placement 
decisions. VA concurred with all of our recommendations and its 
progress in addressing them is outlined below:

* FRC enrollment decisions. To ensure that referred servicemembers and 
veterans who need FRC services are enrolled in the program, we 
recommended that the FRCP establish adequate internal controls 
regarding enrollment decisions by requiring FRCs to record the factors 
they consider in making enrollment decisions, to develop and implement 
a methodology and protocols for assessing the appropriateness of 
enrollment decisions, and to refine the methodology as needed.

In May 2011, VA reported that the FRCP had fully implemented an interim 
solution, which requires that FRCs present each enrollment decision to 
FRCP management for review and approval. The discussion between the FRC 
and management and the final decisions are documented in the program's 
data management system. As of September 2011, VA reported that the FRCP 
continues to review and refine the enrollment process and establish 
document protocols.

* FRC caseloads. In an effort to improve the management of FRCs' 
caseloads, we recommended that the FRCP complete the development of a 
workload assessment tool, which would enable the program to assess the 
complexity of services needed by enrollees and the amount of time 
required to provide services.

As of September 2011, the FRCP has implemented a workload intensity 
tool within the program's data management system, and FRCs began using 
it for all new referrals in September 2011. According to the Acting 
Executive Director for the FRCP, the FRCP will be monitoring the 
effectiveness of the workload intensity tool and will be making 
modifications to it as needed.

* Staffing needs and placement decisions. We recommended that the FRCP 
clearly define and document the decision-making process for determining 
when VA should hire FRCs, how many it should hire, and that the FRCP 
develop and document a clear rationale for FRC placement.

In September 2011, VA reported that the FRCP has documented the formula 
that the program currently uses to determine the number of FRC 
positions required. In addition, the FRCP is developing a systematic 
analysis to better inform decisions about the future placement of FRCs. 
This analysis considers referrals received by the program, client 
location upon reintegration into the community, and requests from 
programs or facilities for placing FRCs at particular locations. 
According to the Acting Executive Director for the FRCP, the FRCP will 
report updated information about staffing and placement processes 
annually in its business operation planning document.

Although our recommendations to improve the management of the FRCP were 
directed to the Secretary of VA, both DOD and VA were asked to provide 
a response to this subcommittee about how the departments could jointly 
implement the recommendations. DOD has provided limited assistance to 
VA with the implementation of our recommendation regarding enrollment. 
Specifically, according to DOD and VA officials, an e-mail 
communication was sent on June 30, 2011, to the commanders of the 
military services' wounded warrior programs stating that they should 
refer all severely wounded, ill, and injured servicemembers who could 
benefit from the services of an FRC to the program for evaluation. 
Despite this effort, VA officials stated that they have not noticed any 
change in referral numbers or patterns from DOD since the e-mail was 
sent.

DOD and VA Have Made Little Progress Reaching Agreement on Options to 
Better Integrate Care Coordination Programs:

DOD and VA have made little progress reaching agreement on options to 
better integrate the FRCP and RCP, although they have made a number of 
attempts to address this issue. Most recently, DOD and VA experienced 
difficulty jointly providing potential options for integrating these 
programs in response to this subcommittee's May 26, 2011, request to 
the deputy secretaries, who co-chair the DOD and VA Wounded, Ill, and 
Injured Senior Oversight Committee (Senior Oversight 
Committee).[Footnote 13] The subcommittee requested that the co-chairs 
provide a written response to the subcommittee by June 20, 2011. In the 
absence of such a response, on August 19, 2011, the subcommittee 
contacted the Secretaries of DOD and VA and requested that they 
facilitate moving this matter forward.

On September 12, 2011, the co-chairs of the Senior Oversight Committee 
issued a joint letter that stated that the departments are considering 
several options to maximize care coordination resources. However, these 
options have not been finalized and were not specifically identified or 
outlined in the letter. According to DOD and VA officials, the 
development of this response involved a back-and-forth between the 
departments because of disagreement over its contents. Although 
officials of both departments collaborated on the development of the 
letter, changes were made during the review process that resulted in 
the delay of its release to the subcommittee. According to DOD and VA 
officials, after VA had signed the letter and sent it to DOD for review 
and signature, DOD officials unilaterally modified the wording, to 
which VA officials objected. Officials from both departments told us 
that the resulting impasse caused considerable delay in finalizing the 
letter and was resolved only after DOD agreed to withdraw its changes. 
Issuance of the letter followed notification by the subcommittee that 
it would hold a hearing on the FRCP and RCP care coordination issue in 
September 2011.

The two departments have made prior attempts to jointly develop options 
for improved collaboration and potential integration of the FRCP and 
RCP. Despite these efforts, no final decisions to revamp, merge, or 
eliminate programs have been agreed upon. For example:

* Beginning in December 2010, the Senior Oversight Committee directed 
its care management work group[Footnote 14] to conduct an inventory of 
DOD and VA case managers and perform a feasibility study of 
recommendations on the governance, roles, and mission of DOD and VA 
care coordination. According to DOD and VA officials, this information 
was requested for the purpose of formulating options for improving DOD 
and VA care coordination. DOD officials stated that following 
compilation of this information, no action was taken by the committee, 
and care coordination was subsequently removed from the Senior 
Oversight Committee's agenda as other issues, such as budget 
reductions, were given higher priority. Recently, care coordination has 
again been placed on the committee's agenda for a meeting scheduled in 
October 2011.

* In March 2011, the DOD Office of Wounded Warrior Care and Transition 
Policy sponsored a summit that included a review of DOD and VA care 
coordination issues. This effort resulted in the development of five 
recommendations to improve collaboration between the FRCP and RCP, 
including a more standardized methodology for making referrals to the 
FRCP, and two recommendations to redefine the FRCP and the RCP. 
However, there was no joint response to these recommendations and no 
agreement appears to have been reached to jointly implement them. 
Although DOD officials contend that they have taken action on many of 
these recommendations within DOD's care coordination program, VA 
maintains that no substantive action has been taken to jointly 
implement them. The degree of disagreement that exists between DOD and 
VA on implementing these recommendations may be illustrated by the 
continued disagreement between the departments about when the FRC 
should engage with a seriously wounded, ill, and injured servicemember. 
In discussing one of the outcomes of this coordination summit, DOD 
officials asserted that the FRCP should become engaged with the 
servicemember during rehabilitation after medical treatment has been 
finished. In contrast, VA maintains that the point of engagement should 
be in the early stage of medical treatment to build rapport and trust 
with their clients and their clients' families throughout their course 
of care.

In July 2011, a task force consisting of staff representing different 
VA programs, including the FRCP, began meeting independently of DOD to 
examine more broadly the range of services VA provides to the wounded, 
ill, and injured veterans it serves. VA officials said that this task 
force was formed to provide a critical examination of how VA's care 
coordination and case management programs are meeting the needs of this 
population. However, a VA official stated that this is an ongoing 
effort, and that the task force has not yet identified any options or 
recommendations related to its review. While the task force has not yet 
shared information about its efforts with DOD, a VA official told us 
that it is planning to make a presentation of its efforts to the Senior 
Oversight Committee at a meeting scheduled in October 2011.

The lack of progress to date in reaching agreement on options to better 
integrate the FRCP and the RCP illustrates DOD's and VA's continued 
difficulty in collaborating to resolve care coordination program 
duplication and overlap. We currently have work underway to further 
study this issue and identify the key impediments that continue to 
affect recovering servicemembers and veterans during the course of 
their care. Additionally, as we have previously reported, there are 
numerous programs in addition to the FRCP and RCP that provide similar 
services to recovering servicemembers and veterans--many of whom are 
enrolled in more than one program and therefore have multiple care 
coordinators and case managers. For example, as of September 12, 2011, 
75 percent of active FRCP enrollees also were enrolled in DOD's wounded 
warrior programs. According to one FRC, his enrollees have, on average, 
eight case managers who are affiliated with different programs. We 
found that inadequate information exchange and poor coordination 
between these programs has resulted in not only redundancy, but 
confusion and frustration for enrollees, particularly when care 
coordinators and case managers duplicate or contradict one another's 
efforts. For example, an FRC told us that in one instance there were 
five case managers working on the same life insurance issue for an 
individual. In another example, an FRC and RCC were not aware the other 
was involved in coordinating care for the same servicemember and had 
unknowingly established conflicting recovery goals for this individual. 
In this case, a servicemember with multiple amputations was advised by 
his FRC to separate from the military in order to receive needed 
services from VA, whereas his RCC set a goal of remaining on active 
duty. These conflicting goals caused considerable confusion for this 
servicemember and his family.

Conclusions:

Numerous programs, including the FRCP and RCP, have been established or 
modified to improve care coordination and case management for 
recovering servicemembers, veterans, and their families--individuals 
who because of the severity of their injuries and illnesses could 
particularly benefit from these services. While well intended, the 
proliferation of these programs, which often provide similar services, 
has resulted not only in inefficiencies, but also confusion for those 
being served. Consequently, the intended purpose of these programs--to 
better manage and facilitate care and services--may actually have the 
opposite effect. Particularly disconcerting is the continued lack of 
progress by DOD and VA to more effectively align and integrate their 
care coordination and case management programs across the departments. 
This concern is heightened further as the number of enrollees served by 
these programs continues to grow. Without interdepartmental 
coordination and action to better coordinate these programs, problems 
with duplication and overlap will persist, and perhaps worsen. 
Moreover, the confusion this creates for recovering servicemembers, 
veterans, and their families may hamper their recovery.

Recommendation for Executive Action:

To improve the effectiveness, efficiency, and efficacy of services for 
recovering servicemembers, veterans, and their families, we recommend 
that the Secretaries of DOD and VA direct the Senior Oversight 
Committee to expeditiously develop and implement a plan to strengthen 
functional integration across all DOD and VA care coordination and case 
management programs that serve this population, including the FRCP and 
RCP, to reduce redundancy and overlap.

Agency Comments:

We obtained oral comments on the content of this statement from both 
DOD and VA officials. These officials provided additional information 
and technical comments, which we incorporated as appropriate.

Chairwoman Buerkle, Ranking Member Michaud, and Members of the 
Subcommittee, this completes my prepared statement. I would be pleased 
to respond to any questions that you may have at this time.

GAO Contact and Staff Acknowledgments:

If you or your staff have any questions about this testimony, please 
contact me at (202) 512-7114 or draperd@gao.gov. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this statement. Individuals who made key contributions 
to this testimony include Bonnie Anderson, Assistant Director; Jennie 
Apter; Frederick Caison; Deitra Lee; Mariel Lifshitz; and Elise 
Pressma.

[End of section] 

Footnotes: 

[1] GAO, Federal Recovery Coordination Program: Enrollment, Staffing, 
and Care Coordination Pose Significant Challenges, GAO-11-572T 
(Washington, D.C.: May 13, 2011).

[2] GAO, DOD and VA Health Care: Federal Recovery Coordination Program 
Continues to Expand but Faces Significant Challenges, GAO-11-250 
(Washington, D.C.: Mar. 23, 2011).

[3] According to the National Coalition on Care Coordination, care 
coordination is a client-centered, assessment-based interdisciplinary 
approach to integrating health care and social support services in 
which an individual's needs and preferences are assessed, a 
comprehensive care plan is developed, and services are managed and 
monitored by an identified care coordinator. 

[4] According to the Case Management Society of America, case 
management is defined as a collaborative process of assessment, 
planning, facilitation, and advocacy for options and services to meet 
an individual's health needs through communication and available 
resources to promote quality, cost-effective outcomes. 

[5] OEF, which began in October 2001, supports combat operations in 
Afghanistan and other locations, and OIF, which began in March 2003, 
supports combat operations in Iraq and other locations. Since September 
1, 2010, OIF is referred to as Operation New Dawn. 

[6] In addition to active enrollees in the FRCP, the 1,827 
servicemembers and veterans served includes individuals who were 
evaluated for the program but were not enrolled (in which case the FRCs 
provided temporary assistance to the individual, redirected the 
individual to another program, or both) and enrollees who were 
deactivated from the program because they could not be contacted, no 
longer required FRCP services, or had died.

[7] FRCP enrollment has continued to grow. In September 2010, for 
example, the FRCP had 607 active enrollees and had provided services to 
a total of 1,268 servicemembers and veterans.

[8] RCCs are assigned to and supervised by each of the military 
services' wounded warrior programs.

[9] The military wounded warrior programs are the Army Wounded Warrior 
Program, Marine Wounded Warrior Regiment, Navy Safe Harbor, Air Force 
Warrior and Survivor Care Program, Army Reserve Wounded Warrior 
Component, and Special Operations Command's Care Coalition.

[10] The Army's Wounded Warrior Program refers to its nonclinical care 
coordinators as "Advocates."

[11] According to a DOD official, the number of servicemembers in the 
RCP program has steadily increased over time as conflicts continue and 
people take longer to transition out of the military.

[12] GAO-11-250.

[13] In May 2007, DOD and VA established the Senior Oversight Committee 
to address problems identified with the care of recovering 
servicemembers. The committee is co-chaired by the deputy secretaries 
of DOD and VA and includes military service secretaries and other high-
ranking officials within both departments.

[14] The Senior Oversight Committee is supported by several internal 
work groups devoted to specific issues, such as DOD and VA care 
coordination and case management. Participants in the committee's care 
management work group include officials from the FRCP and the RCP.

[End of section] 

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