Title: How Does VA Ensure Veterans' Access to Timely Mental Health Care? Description: In recent years, more veterans have sought treatment for mental health conditions. Providing them with timely access to this care is a top priority for the Department of Veterans Affairs. But the VA has struggled to meet this growing demand for services at its medical facilities and within its community care network, which provides health care access to veterans in the communities where they live. What's the VA doing to address this issue? We'll find out from GAO's Alyssa Hundrup. Related work: GAO-24-106410, Veterans Health Care: Opportunities Exist to Improve Assessment of Network Adequacy for Mental Health Issuance: June 2024 {Music} [Alyssa Hundrup:] VA needs to improve its monitoring of Community Care Networks for mental health, and this is especially important given the growing demand for these services. [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report. Your source for fact-based, nonpartisan news and information from the U.S. Government Accountability Office. I'm your host, Holly Hobbs. In recent years, more veterans have sought treatment for mental health conditions. Providing them with timely access to this care is a top priority for the Department of Veterans Affairs. But the VA has struggled to meet this growing demand for services at its medical facilities and within its Community Care Network, which provides health care access to veterans in the communities where they live. What's the VA doing to address this issue? We'll find out from GAO's Alyssa Hundrup, an expert on veterans' health care, who has a new report out about this topic. Thanks for joining us. [Alyssa Hundrup:] Thanks for having me, Holly. [Holly Hobbs:] So, Alyssa, as more veterans are seeking treatment for their mental health, has the VA been able to meet this demand? [Alyssa Hundrup:] Yeah, we are definitely seeing an increasing demand for mental health services at VA. This is not unlike what we're seeing in the civilian population as well. Veterans of course go to the VA for care, ut when they can't readily receive that care there, such as because the wait is too long, they can go to the community through VA's specific Community Care Program. And that also helps address some of the demand. And in our report, we're looking at how VA maintains networks of providers in the community to meet this increasing demand. [Holly Hobbs:] So I think the report says that VA can provide services within its own medical facilities. But, when needed, it also can use two contractors to provide services through its Community Care Network nationwide, right? Do we know if the contractors are tracking access? [Alyssa Hundrup:] Yeah. So, the contractors track access in a few different ways. For example, they'll meet regularly, which is about monthly with individual VA medical facilities to discuss the networks and see if there are any gaps that they're seeing and work to address those. They're also looking at data. So, data such as on the demand for different types of care and then data on the numbers of community providers that provide that care. And then they'll look for potential gaps in coverage and where they may need to bulk up and maybe recruit new community providers. [Holly Hobbs:] Did we interview the contractors for this report, and did they tell us about any challenges they face in ensuring access to care? [Alyssa Hundrup:] Yes, and they did say they do face challenges. So, for instance, recruiting mental health providers in some parts of the country, especially in rural areas, they said was challenging. And I think that's partly due to the ongoing nationwide shortage that we're seeing in this area and that's something that, of course, impacts the ability of the VA and the contractors as well, to recruit enough providers. Another challenge that they cited was that many mental health providers can operate as individual providers, or they have very small practices. So, they may not have the support staff to deal with being in the network and dealing with submitting claims and going through the administrative parts of it. [Holly Hobbs:] What about the VA itself? How is it overseeing these two contractors? [Alyssa Hundrup:] Yeah. So, the VA holds them to two primary standards or two metrics. The first standard is based on geographic location. So, VA has established maximum drive times for how long it should take a veteran to drive to a community provider. In an urban area that typically is about a 45-minute drive time. And then the other standard is based on appointment availability. So, VA has established a limit on how long veterans should have to wait for an appointment. And for the most part, the standard is about 30 days for mental health appointments. [Holly Hobbs:] So those are the two standards, but how is VA tracking to make sure standards are met? [Alyssa Hundrup:] Yeah. So first, the VA tracks how quickly its staff can schedule appointments for community care. So, before even getting an appointment, the VA has to schedule that. And it's supposed to do that within about 7 days of when a provider creates a referral. However, we found that the majority of the facilities are not meeting this standard. According to the most recent VA data we looked at, it's taking an average of more than 14 days to schedule community care referrals specific to mental health. Also, VA is tracking the drive time and appointment availability metrics. So, it has the contractors submit reports on a monthly basis, and those contractors are supposed to meet those drive time and appointment availability standards at least 90% of the times. And then if it doesn't, if the reports are showing that they're not meeting those standards, they have to submit corrective action plans to the VA. {MUSIC} [Holly Hobbs:] Alyssa told us that as the VA is trying to meet the growing demand for mental health services. But that there have been delays in getting this care, even through its Community Care program, which was meant to increase access. So, Alyssa, what more do we think the Department of Veterans Affairs should be doing to ensure veterans have access to mental health care? [Alyssa Hundrup:] So, VA needs to take steps to help its facility schedule appointments for care more quickly and it also needs to better monitor its contractors to help ensure they have enough mental health providers in their network. And we made two recommendations targeting both of these issues. So first, we recommended that the VA track the reasons for scheduling delays and then use that information to take steps to address the different reasons that it finds. So, for example, if they're finding provider shortages in certain areas and they can work with a contractor to more proactively recruit those providers. And then second, we recommended that VA reexamine its methodology for calculating that specialty care network adequacy. So, what we had found was that in assessing contractor performance, the VA excluded certain claims from its drive time and wait time metrics, and that could lead to the contractor performance appearing better than it really is in reality. [Holly Hobbs:] And last question, what's the bottom line of this report. [Alyssa Hundrup:] The bottom line is that VA needs to improve its monitoring of Community Care Networks for mental health. And this is especially important given the growing demand for these services and the troubles that VA has had in scheduling appointments. [Holly Hobbs:] That was Alyssa Hundrup talking about our new report on veterans' mental health care access in communities. Thanks for your time, Alyssa. [Alyssa Hundrup:] Thank you. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts, Spotify or wherever you listen. And make sure to leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog, the US Government Accountability Office, visit us at GAO.gov.