Expanded Collaboration in Military Health Care Services Faces Challenges in Assessing Results
The Department of Veterans Affairs (VA) and the Department of Defense (DoD) are taking steps to improve the effectiveness of their health care sharing agreements, aiming to increase veterans' access and reduce federal costs.
Data Integration and Interoperability
The biggest challenge identified is the incompatibility of health data systems between VA and DoD, which hinders tracking of veterans’ care continuity and outcomes. Creating unified or fully interoperable electronic health records (EHR) across both agencies would allow shared access to timely, accurate patient data, improving care coordination and reducing duplicative services.
Streamlining Administrative Processes
Modifications such as extending veterans' authorizations for one year to receive private or community care without repeated reauthorization simplify access and reduce administrative burden on VA staff and partner providers. This also supports cost savings and consistent care.
Expanding Shared Agreements
The 185 existing sharing agreements permit veterans to receive care at DoD facilities for specialized services. Expanding these agreements thoughtfully and easing operational hurdles, like credentialing and base access for VA providers, can improve access while leveraging existing public resources efficiently.
Standardizing Billing and Cost Practices
Transparency and uniformity in billing practices among VA, DoD, and community providers can reduce costly errors, disputes, and administrative overhead. Creating a consistent framework for cost-sharing and aligning financial management can help control escalating spending, especially amid recent expansions in community care funding.
Balancing VA Direct Care and Community Care
While expanding community care improves veteran access, there is concern that it might undermine VA’s direct care system stability and increase costs. Policies must ensure community care supplements rather than supplants VA infrastructure, maximizing value and quality while controlling expenditures.
Data-Driven Performance Metrics
Implementing robust analytics to track cost savings, health outcomes, access metrics, and patient satisfaction under sharing agreements will identify weaknesses and inform continuous improvement.
In summary, improving effectiveness demands integrated health IT systems, streamlined administrative processes, expanded but well-managed sharing agreements, standardized billing, and balanced funding approaches that sustain VA services while leveraging DoD and community resources efficiently. These measures collectively can enhance veteran access and care quality while reducing federal costs associated with fragmented care.
The Government Accountability Office (GAO) recently completed a review of these agreements and found that the VA and DoD fail to assess the effectiveness of these agreements and identify opportunities for new or expanded sharing agreements. Identifying new opportunities for sharing remains a challenge, with most new agreements being initiated at the local level.
Alyssa Hundrup, the health care director at the GAO, emphasized the opportunity for increased access to health care and cost savings through shared agreements. She also highlighted the potential for cost employment avoidance as a key area where assessment is important, as there are opportunities for cost savings with these agreements.
The Defense Department has limited the use of non-reimbursable agreements, following concerns in 2020 that some were not mutually beneficial. When the VA refers a veteran to a Defense Department medical facility, it reimburses DoD at a 20% discounted rate, which represents a cost-avoidance measure. However, a backlog of over $87 million in unpaid claims from the VA to DoD facilities existed from 2018 to 2022, but was cleared in 2024.
The use of non-reimbursable agreements, or arrangements to share health care resources instead of billing each other, is an emerging area of concern. The DoD agreed with a recommendation to finalize guidance on when and how to pursue non-reimbursable agreements but did not provide a timeline for issuing new procedures.
Accessing military bases for veterans persists as a challenge, with constant efforts being made to ensure access at individual bases. Incompatibility of health data systems between the VA and DoD remains a barrier, with the VA yet to fully implement its electronic health record system.
The Defense Department continues to face administrative hurdles despite clearing the backlog of unpaid claims. Despite these challenges, the potential for increased access to health care and cost savings through shared agreements remains a promising avenue for improving veterans' health care.
- The lack of compatibility in electronic health records between the VA and DoD creates obstacles in tracking veterans' care continuity and outcomes, necessitating the development of unified or interoperable records for improved care coordination and reduced duplicative services.
- Streamlining administrative processes, such as extending veterans' authorizations for one year to access private or community care without repetitive reauthorization, simplifies access, reduces administrative burden, and supports cost savings.
- Expanding health care sharing agreements with the DoD not only improves veterans' access to specialized services but also leverages existing public resources efficiently, provided operational hurdles like credentialing and base access for VA providers are eased.
- Standardizing billing practices among the VA, DoD, and community providers can minimize costly errors, disputes, and administrative overhead, paving the way for cost control, especially in the context of recent expansions in community care funding.
