VA and DOD Health Care

There have been numerous reports of the Department of Veterans Affairs’ (VA) medical facilities failing to provide timely and accessible care. In some cases, such delays in care or failure to provide care reportedly resulted in harm to veterans. Similarly, there have also been concerns about the Department of Defense’s (DOD) ability to provide care to service members and their dependents.

There are a number of ways that VA and DOD could improve their health care programs.

For instance: 

• Veterans Community Care. The Veterans Community Care Program was implemented in June 2019 to allow eligible veterans to receive care from non-VA providers. However, VA hasn't established a timeliness metric for veterans to receive care from a community provider. Additionally, most VA medical centers in one of VA's new community provider network regions did not have the recommended number of staff to manage appointment scheduling for this program. 
• Modernizing VA infrastructure. VA’s health care system offers services to more than 9.5 million people. However, VA’s facilities are aging and in need of upgrades to meet veterans’ needs. While VA developed more than 1500 recommendations for modernizing and realigning its health care infrastructure, there were gaps in the data VA used to inform its recommendations. VA could also improve its planning and communication with stakeholders.  
• DOD health care. Millions of beneficiaries are eligible for DOD health care. DOD issued a plan in February 2020 to restructure its medical treatment facilities, which called for decreasing capability at 43 of them and closing 5. DOD’s restructuring review included assessing the adequacy of nearby civilian health care. However, the review was based in part on incomplete and inaccurate information and may overstate the adequacy of available civilian care. 
• Quality and safety. The Defense Health Agency is responsible for ensuring the quality and safety of health care delivered by providers at its military medical treatment facilities and in the community through the TRICARE. However, the Defense Health Agency and its TRICARE contractors did not always adhere to DHA’s quality management procedures. For example, TRICARE contractors did not always fully verify providers’ medical licenses. 
• Suicide prevention. DOD and the VA are taking steps to help prevent suicides among service members and veterans by establishing prevention strategies and offices to oversee their efforts. However, DOD needs to establish comprehensive suicide response guidance and training for commanders to better ensure that they are prepared to provide support to suicide attempt survivors and bereaved families. 
• Wartime medical skills. DOD's more than 73,000 enlisted medical personnel serve in roles ranging from paramedics to imaging technicians and must be ready to use their wartime medical skills to care for injured and ill service members. However, DOD could do more to define, track, and assess wartime medical skills. For example, the Army does not consistently track skills training in its official system, and none of the military services have developed targets for training completion.

Army medical personnel conduct medical evacuation training

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• Supply chain management. The VA faced unexpected supply chain challenges during the COVID-19 pandemic. In response, it took steps like establishing central storage facilities for critical medical supplies. The VA has several linked initiatives to update its supply chain but needs to ensure that it has a comprehensive strategy for supply chain management.
• Specialty care. VA uses referral coordination teams at its medical centers to discuss care options with veterans when scheduling specialty care appointments at VA facilities and in the community. However, most VA medical centers did not meet timeliness standards when scheduling specialty care appointments in the community. Additionally, DOD expects that its health care beneficiaries will be able to access specialty care within 3 days after an urgent referral. Analysis of these referrals at military medical treatment facilities found that more than half met the 3-day expectation—but about 9% of these beneficiaries waited 3 weeks or longer. 
• Electronic health records. The VA relies on electronic health records for patient care, risk management for its patient population, and health research. VA started transferring records to a new system, which went live in October 2020.  However, the new system has presented issues for some users. For example, most users in a VA 2021 and 2022 survey were not satisfied with the system’s performance or training. VA has since halted future deployments of its new electronic health record system to focus on making improvements.