Report: Faulty Data Limits VA Oversight of Community Care Network

Report: Faulty Data Limits VA Oversight of Community Care Network
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VA oversight of its community care network provides an incomplete picture of how the network serves veterans, according to a recent Government Accountability Office (GAO) report which highlighted inaccurate and unchecked data provided by contractors.

 

VA’s internal performance assessments of the two community care contractors showed them meeting contract standards, but the GAO audit revealed VA’s assumptions were based on incomplete information – details  the department was not aware of because it did not have a mechanism in place to validate contractor data.

 

MOAA believes seeking the right balance in strengthening and modernizing VA’s direct care system and integrating community care are essential to the long-term sustainability of VA health care system, as well as the health and well-being of veterans and their families, caregivers, and survivors who depend on that care.

 

[RELATED: New VA Health Chief Discusses Priorities With MOAA, Other Veterans Groups]

 

What the Report Found

Two contractors, Optum Public Sector Solutions and TriWest Healthcare Alliance,  are responsible for maintaining VA’s health system community care networks (CCNs) for five regions. These contractors are responsible for ensuring CCNs can provide veterans timely access to care – improvements directed by the 2018 VA MISSION Act. The standard for that access is based on maximum distances veterans must drive to a community provider and the maximum wait times for an appointment.      

 

While the VA regularly collects and reviews regional contract performance data for four of the five regions, and it generally believed the contractors were meeting required standards at the time of the audit, GAO found VA’s assessment was not based on all claims in the contractor network, which can provide an inaccurate view of network adequacy.

 

Additionally, GAO’s survey responses from 127 of 138 VA medical facilities, and undercover calls to 80 community providers, revealed challenges with scheduling appointments and provider information within the networks.

 

Medical facility officials cited challenges in scheduling appointments with certain types of providers within the required VA standards for non-urgent or emergent care. Further, officials had concerns about not having sufficient VA facility staff to schedule appointments, as well as incomplete VA provider directory information, including listing of providers no longer participating in the network.

 

[RELATED: No News Might Not Mean Good News for VA’s New Electronic Records System]

 

This is not the first GAO report to highlight similar challenges. In 2020 and 2021, GAO reported on these issues and made recommendations for the VA to address community care staffing and improve accuracy of provider contact information. While the VA did take some action, according to GAO, the department has yet to implement these recommendations.

 

“It takes too long to schedule a community appointment, and VA is working to streamline those work processes,” VA Secretary Denis McDonough said during a September Senate oversight hearing on VA community care. “Part of the issue is the department continues to experience a shortage of schedulers — one of the hardest jobs to fill.”

 

Incomplete Reports

GAO highlight two specific instances of incomplete data submitted by contractors during the period of review:

  • One contractor excluded 50% of claims that failed to meet network adequacy standards each month from its performance reports. According to contractor representatives, this was done in agreement with VA officials to account for the lack of veterans’ preference data. The other contractor did not exclude these claims.

  • One contractor did not submit required appointment availability performance data from May 2020 through August 2021, with representatives stating they had submitted a waiver to suspend reporting because of the onset of COVID-19. VA officials confirmed receipt of the waiver but not its approval – instead, they had provided guidance to the contractor to begin providing the data in May 2020.

 

“Despite stating that they review the contractors’ network adequacy performance report on a monthly and quarterly basis, we found that VA officials were not aware of this incomplete data,” according to the GAO report. “If VA’s current monitoring processes are unable to ensure the contractors submit complete data that complies with contract requirements, VA may be unable to reliably assess network adequacy performance. This could ultimately affect veterans’ access to community care if the networks are not meeting identified adequacy standards.”

 

[RELATED: Progress Continues as VA Implements New Model to Improve Access to Care]

 

GAO reiterated its earlier report recommendations and advised the VA to ensure contractors report complete performance data and implement strategies to increase the accuracy of community provider information.

 

Quality Cannot Suffer

While MOAA supports the GAO recommendations for the VA to improve staffing and set tighter controls around contractor performance to ensure veterans’ access to care, VA also needs to ensure community care is quality care.

 

During the Senate hearing, Carrie Farmer, co-director of the Epstein Family Veterans Policy Research Institute and Senior Policy Researcher at the RAND Corp., emphasized the importance of getting quality care, not just fast care.

 

“Prior research has demonstrated VA typically provides care equal to or better than the private sector,” she said, adding the VA should:  

  • Publicly report average wait times for VA community care appointments using the same data and methodology used to report average wait times for VA direct care.

  • Make use of existing data to systematically monitor and publicly report the quality of community care.

 

Over 3 million veterans have used VA community care, Farmer said, and the secretary has acknowledged almost half of veterans’ care is being delivered through the community. She encouraged the VA to publicly report direct care and community care comparisons to dispel a myth that getting care in the community is faster than VA.

 

Like our VSO partners, MOAA believes VA’s foundational missions of health care need to be preserved and strengthened, and that timeliness of care needs to be linked directly to quality of care. Shifting too much care to the community will have an impact on VA’s clinical care, research, education, and emergency preparedness missions.

 

MOAA is committed to ensuring veterans have access to high quality health care while preserving the long-term viability of VA’s health care system.

 

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About the Author

Cmdr. René Campos, USN (Ret)
Cmdr. René Campos, USN (Ret)

Campos currently serves as MOAA's Senior Director of Government Relations, managing matters related to military and veterans’ health care, wounded, ill and injured, and caregiver policy.