The Department of Veterans Affairs (VA) Veterans Community Care Program offers eligible veterans the option to receive medical care from local community providers instead of VA medical facilities. This program has seen significant growth, now representing nearly 40 percent of VA’s total contract obligations in fiscal year 2023. Effective management and oversight of these contracts are crucial to ensure veterans receive timely, high-quality care. However, a recent report from the Government Accountability Office (GAO) has highlighted critical challenges in how VA oversees this rapidly expanding program.
Growth of Community Care Obligations (Fiscal Years 2018-2023)
Chart showing the significant increase in VA Community Care Program obligations from fiscal year 2018 to 2023, reaching nearly 40% of VA’s contract obligations.
The responsibility for contract oversight falls under the Office of Integrated Veteran Care (IVC), established in 2022. Despite the IVC’s creation, GAO’s findings reveal significant gaps in their oversight framework. One key issue is the lack of comprehensive and clear guidance for those responsible for monitoring these contracts, particularly Contracting Officer’s Representatives (CORs). These CORs are vital as they act as the eyes and ears on the ground, informing contracting officers and providing technical direction to the community providers.
Incomplete Guidance for Contract Oversight
While the IVC has developed internal guidance documents called “desk procedures,” these are limited in scope and incomplete. Crucially, they fail to provide direction on how to assess contract performance when data is unreliable or missing. This deficiency directly hinders the ability of CORs to effectively monitor contract performance and ensure veterans are receiving the care they need. Without clear procedures to navigate data gaps, VA’s oversight capabilities are significantly weakened.
Program Management Gaps
Adding to the oversight concerns, GAO found that IVC eliminated a program manager position that was originally identified as essential in the contract oversight plans. While VA officials stated that alternative processes were put in place to cover some of the program manager’s responsibilities, there has been no assessment to determine if these alternative processes adequately fulfill all the necessary functions. Furthermore, VA has not updated its oversight plans to reflect these changes, creating a disconnect between planned oversight and actual practice. This lack of clarity and potential gaps in program management further elevate the risks to effective contract oversight.
Lack of Formal Lessons Learned Process
As VA continues to rely heavily on community care and moves towards establishing new sets of contracts, the absence of a formal system for documenting and applying lessons learned from current contracts poses a significant risk. Although discussions about addressing current oversight challenges have begun, VA lacks a structured approach to collect, analyze, and validate these lessons. Without such a process, VA risks repeating past mistakes and facing continued challenges in overseeing the Veterans Community Care Program contracts, potentially impacting the quality and accessibility of care for veterans.
In conclusion, while the VA Community Care Program plays a vital role in providing healthcare to veterans, GAO’s findings underscore the urgent need for VA to strengthen its contract oversight mechanisms. Developing complete and actionable guidance, addressing program management gaps, and implementing a formal lessons learned process are critical steps to ensure the program operates effectively and efficiently, ultimately delivering the best possible care to veterans in their communities.
