Veterans Community Care Program: VA Needs to Strengthen Contract Oversight
Fast Facts
The Department of Veterans Affairs allows veterans to get medical care from community providers when they can't access VA facilities. VA must effectively manage 5 contracts with contractors that maintain health care provider networks to deliver consistent, high-quality care—currently to 2.8 million vets.
But program staff don't have clearly defined procedures, such as how to track and communicate about problems, and VA eliminated program manager positions. These issues could ultimately reduce VA oversight of these large contracts and impact the quality of the care provided to vets.
We recommended fixing these and other issues.
Highlights
What GAO Found
The Department of Veterans Affairs' (VA) Veterans Community Care Program allows eligible veterans to receive medical care from community providers instead of VA facilities. The program has grown rapidly in recent years and accounted for nearly 40 percent of VA's total contract obligations in fiscal year 2023. Contract oversight is complex and responsibility for oversight is spread across multiple areas within the Office of Integrated Veteran Care (IVC). IVC was created in 2022, and it continues to restructure some roles, such as the Contracting Officer's Representatives (COR), who keep contracting officers informed and provide technical direction to contractors.
Community Care Obligations between Fiscal Years 2018 and 2023 (in billions)
IVC has not developed a clear and complete set of documentation to guide contract oversight. IVC has developed guidance—called desk procedures—but this guidance is limited to certain administrative processes and is incomplete. For example, it does not address how contract performance should be assessed when performance data are incomplete or unreliable, hindering CORs from conducting contract oversight.
Further, IVC has eliminated a program manager position identified in the oversight plans for the contracts. While IVC officials identified alternative processes for some program manager functions, officials have not assessed whether they fulfill all functions. Additionally, VA has not updated its plans to reflect its current processes. These gaps increase contract oversight risks.
While IVC and other officials have begun discussing how to address oversight challenges with the current contracts, VA does not have a formal process for documenting lessons learned. VA is already working to establish the next set of contracts. VA risks continued contract oversight challenges if it does not collect, analyze, and validate lessons learned from its contracting efforts.
Why GAO Did This Study
VA's Veterans Community Care Program is implemented through five regional contracts with two third-party administrators. Effective contract oversight by VA is essential to providing quality health care to the increasing number of veterans served outside of VA facilities. In 2019, GAO added VA acquisition management to its High-Risk List due to VA's challenges in managing acquisitions, including contract oversight.
GAO was asked to assess VA's Veterans Community Care Program. This report (1) describes the oversight structure VA established for the Community Care contracts, (2) assesses the extent to which VA established clear and complete guidance for contract oversight, and (3) assesses the extent to which VA identified and assessed challenges to the program to inform future contracts.
To conduct this work, GAO reviewed Community Care program contract files, reviewed agency documentation, and interviewed VA officials.
Recommendations
GAO is recommending that VA (1) document a clear and comprehensive set of contract oversight procedures, (2) assess whether all aspects of the program manager role are fulfilled by its current processes, and (3) develop a formal lessons learned process. VA concurred with the three recommendations and identified planned actions to address them.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Secretary of VA should ensure that the Assistant Under Secretary for Health for IVC establishes a complete set of documentation for oversight of the Community Care contracts, including documentation of clear and complete procedures and the identification of roles and responsibilities. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Veterans Affairs | The Secretary of VA should ensure that the Assistant Under Secretary for Health for IVC assesses whether the oversight and reporting responsibilities of the program manager position outlined in the Quality Assurance Surveillance Plans are being effectively fulfilled by current processes and, if not, updates the plans as appropriate. (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Veterans Affairs | The Secretary of VA should ensure that the Assistant Under Secretary for Health for IVC develops a formal lessons learned process, consistent with leading practices, for the Community Care contracts to inform VA's plans for the next set of contracts and its continuing oversight efforts. (Recommendation 3) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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