Veterans Health Care: VA's Video Telehealth Access Program Would Benefit from Performance Goals and Measures

What GAO Found

The Veterans Health Administration (VHA) has programs to help address veterans' barriers to accessing telehealth. These programs include the Accessing Telehealth at Local Area Stations (ATLAS) Pilot Program. Through ATLAS, VHA partners with non-Department of Veterans Affairs (VA) organizations, including veterans service organizations, to provide private locations with the technology for veterans to have video visits with VHA providers. GAO found that 14 of 24 ATLAS sites active at the time had no veteran visits in fiscal years 2022 and 2023. For the sites that did have visits, VA medical center officials said they helped those veterans who lacked broadband access telehealth and avoid barriers such as long travel distances to VA medical centers.

Veterans Health Administration's (VHA) Accessing Telehealth through Local Area Stations (ATLAS) Program

VHA officials described changes they are making to the ATLAS Program, including transitioning it from a pilot program to a grant program. However, VHA has not measured ATLAS Program effectiveness on an ongoing basis, due to a lack of performance goals and related measures. Setting goals and measures—consistent with GAO's leading practices for measuring performance—and using them to assess effectiveness and efficiency on an ongoing basis would help VHA determine whether it should make changes to the program. Such changes could include adjusting its strategies to address low ATLAS site usage.

VHA has established processes to monitor elements of the quality of its broader telehealth services, such as safety and timeliness, on a regular basis. For example, VHA has standards and measures related to these elements and meets quarterly with its regional networks to discuss their performance. VHA also has efforts underway to develop measures to assess veterans' health outcomes via telehealth compared to in-person care. Officials from selected medical centers and regional networks said that these processes and VHA's collaborative approach have helped improve telehealth quality.

Why GAO Did This Study

VHA telehealth services have expanded significantly in recent years, including during the COVID-19 pandemic. Such services include programs designed to help veterans who may lack broadband or internet-connected devices, such as rural veterans, have video telehealth visits with VHA providers.

The Consolidated Appropriations Act, 2023, includes a provision for GAO to study VHA's telehealth services. This report addresses, among other things, (1) VHA's actions to help address barriers to accessing VHA video telehealth; and (2) VHA's efforts to assess the quality of its telehealth services.

GAO reviewed VHA data, such as telehealth performance and use data for fiscal years 2022 and 2023 (the most recent complete years of data); and interviewed officials from VHA's Office of Connected Care and other relevant VA offices, four VA medical centers and their regional networks selected for variation in telehealth use, rurality, and geography, and four veterans service organizations.