The Department of Veterans Affairs (VA) Veterans Community Care Program stands as a crucial avenue for eligible veterans to access medical care from community providers, effectively extending healthcare beyond the walls of VA facilities. This program has experienced significant expansion in recent years, now accounting for a substantial portion – nearly 40 percent in fiscal year 2023 – of the VA’s total contract obligations. Managing contracts of this scale and complexity requires robust oversight. Within the VA’s Office of Integrated Veteran Care (IVC), established in 2022, the responsibility for this oversight is distributed across various areas. As IVC continues to refine its structure, roles like Contracting Officer’s Representatives (CORs) are evolving; CORs play a vital role in keeping contracting officers informed and providing technical guidance to contractors.
Community Care Obligations between Fiscal Years 2018 and 2023 (in billions)
Despite the program’s growth and financial significance, the VA’s oversight framework for the Community Care Program faces critical challenges. A key issue identified is the absence of clear and comprehensive documentation to guide contract oversight processes. While IVC has developed internal guidance in the form of desk procedures, these are limited in scope, primarily focusing on administrative tasks and leaving significant gaps in crucial areas. For instance, the existing guidance fails to provide direction on how to assess contract performance when data is incomplete or unreliable. This deficiency directly hinders the ability of CORs to effectively conduct contract oversight, potentially impacting the quality and accountability of care provided through the program.
Further complicating the oversight landscape, IVC has eliminated a program manager position that was initially designated in the oversight plans for these contracts. While VA officials have indicated that alternative processes are in place to address some of the program manager’s former responsibilities, a comprehensive assessment has not been conducted to determine if these alternative processes fully cover all essential functions. Moreover, VA has not updated its oversight plans to reflect these changes in processes, creating potential vulnerabilities and increasing risks to effective contract oversight.
These challenges underscore the urgent need for the VA to strengthen its oversight mechanisms for the Community Care Program. Although discussions are underway within IVC and among other officials to address these issues in the current contracts, a formal process for documenting and learning from past experiences is lacking. As the VA moves forward with establishing the next generation of contracts for community care, the absence of a structured approach to collect, analyze, and validate lessons learned from current contracting efforts poses a significant risk. Without incorporating these lessons, the VA risks perpetuating existing oversight challenges, potentially undermining the program’s effectiveness and its ability to deliver high-quality healthcare to veterans in community settings. Effective oversight is not just about financial accountability; it’s fundamentally about ensuring veterans receive the best possible care through the Community Care Program.
