The Department of Veterans Affairs (VA) Veterans Community Care Program is designed to offer eligible veterans the option to receive healthcare services from community providers instead of solely relying on VA facilities. This program has experienced substantial growth in recent years, now representing a significant portion of VA’s financial commitments, reaching almost 40 percent of VA’s total contract obligations in fiscal year 2023. Managing contracts of this scale is inherently complex, and the responsibility for oversight is distributed across various sections within the Office of Integrated Veteran Care (IVC). Established in 2022, IVC is still in the process of refining its organizational structure and roles, including those of Contracting Officer’s Representatives (CORs). CORs play a crucial role in keeping contracting officers informed and providing technical guidance to the contractors involved in the Veterans Community Care Program.
Growth of Community Care Contract Obligations (Fiscal Years 2018-2023)
Chart illustrating the increase in VA Community Care Program contract obligations from fiscal year 2018 to 2023, highlighting program growth.
One of the key challenges identified is the lack of comprehensive and clear documentation to guide contract oversight for Veterans Community Care Program Providers. While IVC has developed some guidance in the form of desk procedures, these are currently limited in scope, primarily focusing on certain administrative processes and are not yet fully complete. Critically, this guidance does not provide direction on how to evaluate contract performance when data is incomplete or unreliable. This deficiency significantly hinders the ability of CORs to effectively oversee contracts and ensure that Veterans Community Care Program providers are meeting the required standards of care and service.
Another significant issue is the elimination of a program manager position that was initially identified as essential in the oversight plans for these critical contracts. Although IVC officials have indicated that alternative processes are in place to cover some of the program manager’s responsibilities, a formal assessment has not been conducted to determine if these alternative processes adequately fulfill all the necessary functions. Furthermore, VA has not updated its oversight plans to accurately reflect the current operational processes. These gaps introduce increased risks to the effective oversight of contracts with Veterans Community Care Program providers, potentially impacting the quality of care veterans receive.
While discussions are underway within IVC and among other relevant officials to address the challenges in overseeing the current contracts with Veterans Community Care Program providers, VA currently lacks a formalized system for documenting lessons learned from these experiences. As VA is already in the process of establishing the next set of contracts for the Veterans Community Care Program, there is a risk of repeating past oversight challenges. To mitigate these risks, it is crucial for VA to implement a systematic approach to collect, analyze, and validate lessons learned from its ongoing contracting efforts. This proactive approach will be essential to improve contract oversight and ensure that Veterans Community Care Program providers are effectively managed, ultimately benefiting the veterans who rely on these services.
Understanding the Context: Why GAO Studied the Veterans Community Care Program
The U.S. Government Accountability Office (GAO) conducted this study to assess the VA’s Veterans Community Care Program due to its increasing importance in delivering healthcare to veterans. The program’s reliance on community providers necessitates robust contract oversight to guarantee that veterans receive high-quality healthcare outside of traditional VA facilities. In recognition of ongoing challenges within VA acquisition management, including contract oversight, GAO added VA acquisition management to its High-Risk List in 2019. This designation underscores the critical need for improvements in how VA manages acquisitions and oversees contracts, especially within programs like the Veterans Community Care Program.
The GAO report specifically aimed to:
- Describe the established oversight structure within VA for the Veterans Community Care Program contracts.
- Evaluate the completeness and clarity of the guidance provided by VA for contract oversight of community providers.
- Assess VA’s efforts to identify and analyze challenges within the program to inform and improve future contracts with Veterans Community Care Program providers.
In conducting this comprehensive assessment, GAO reviewed pertinent Community Care program contract files, examined relevant agency documentation, and conducted interviews with key VA officials. This rigorous approach ensured a thorough understanding of the current state of contract oversight and identified areas needing improvement to better serve veterans through the Veterans Community Care Program.
