Veterans Community Care Program: VA needs to strengthen its oversight and improve data on its community care network providers

What the GAO found

The Department of Veterans Affairs (VA) uses two contractors to manage its regional networks of community providers, called Community Care Networks, to provide care to veterans under the Veterans Community Care Program. VA requires its contractors to meet two network adequacy standards that specify maximum driving time distances and waiting times for appointments.

VA monitors contractor compliance with network adequacy requirements by reviewing analysis of contractor claim data against standards. VA officials determined that contractors generally met the standards for the period of April 2020 through May 2022. However, GAO found that VA’s assessment was based on incomplete data, as contractors did not include all complaints. Additionally, VA was unaware of this as it did not have a mechanism to ensure contractors submitted complete data, which limited VA’s performance evaluation for Regions 1-4. .

GAO’s analysis of responses from VA leaders from 127 of 138 VA medical facilities and undercover calls to 80 community providers in Regions 1-4 of the Community Care Network, revealed potential challenges with planning meetings. Specifically, officials cited scheduling issues with certain types of providers under the VA’s routine appointment availability standard (care not deemed urgent or emergent by a VA provider). (See fig. below.) Responding managers raised concerns about insufficient staff at the VA facility to schedule appointments and inaccurate provider information in the provider directory. VA, including vendors no longer participating in the network (also confirmed by GAO undercover calls). These issues may delay scheduling. The GAO has previously flagged these issues and recommended in 2020 and 2021 that VA (1) direct its medical facilities to evaluate community care staff and (2) improve controls to address the risks associated with inaccurate provider addresses, respectively. VA has taken some action, but has not yet implemented these recommendations.

Number of VA medical facilities reporting more than half of scheduled routine appointments within 30 days by type of care, April 2022

Why GAO Did This Study

As part of the Veterans Community Care Program, the two VA Community Care Network contractors are responsible for maintaining networks of providers that are adequately sized and capable of ensuring veterans have timely access to care.

The GAO was asked to review VA community care networks. This report, for Regions 1-4 of the Community Care Network, (1) describes how VA monitors contractor compliance with network adequacy standards and related requirements; (2) examines the extent to which VA contractors adhere to network adequacy standards; and (3) examines the experiences of VA medical facility managers when scheduling routine appointments for veterans.

The GAO reviewed documentation, such as community care network contracts and network adequacy performance data, and assessed relevant VA processes. GAO conducted a survey of VA medical facility managers in Regions 1-4 and made covert calls to a non-generalizable sample of community providers. GAO also interviewed VA officials and contractor representatives.

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