Veterans Health Care: VA's Video Telehealth Access Program Would Benefit from Performance Goals and Measures
Fast Facts
The Veterans Health Administration has significantly expanded its telehealth services—offering health care appointments via video, for example. Telehealth can help veterans avoid traveling long distances for care, including those living in rural areas.
In 2019, VHA launched a program to help veterans who don't have internet access get telehealth services by providing private locations equipped with high-speed internet. But in 2022 and 2023, 14 of 24 locations had no visits. While VHA plans to expand the program, it hasn't established how it will assess whether the program is making progress.
We recommended that VHA address these issues.
Veterans Health Administration Telehealth Access Program
Highlights
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.
Recommendations
GAO is making two recommendations for VHA to 1) develop performance goals and related measures for the ATLAS program that reflect leading practices and 2) use these goals and measures to assess the effectiveness and efficiency of the ATLAS program on an ongoing basis. VA concurred with both recommendations and identified planned actions to address them.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Office of the Under Secretary for Health | The Under Secretary of Health should ensure the Office of Connected Care develops performance goals and related measures for the ATLAS Program that are objective, quantifiable, and measurable. (Recommendation 1) |
As of September 2024, we have not received an update from VA on actions taken to address this recommendation. When we confirm what action the agency has taken in response to this recommendation, we will provide updated information.
|
| Office of the Under Secretary for Health | The Under Secretary of Health should ensure the Office of Connected Care uses the information collected for the performance goals and measures to assess program effectiveness and efficiency on an ongoing basis and make any needed improvements. (Recommendation 2) |
As of September 2024, we have not received an update from VA on actions taken to address this recommendation. When we confirm what action the agency has taken in response to this recommendation, we will provide updated information.
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