Title: Veterans Health--Improving Access Through the Community Care Program Description: The Veterans Community Care Program was created to improve veterans' access to health care. Under the program, veterans can receive health care services through community providers when they face challenges accessing care at VA facilities. But how does the Department of Veterans Affairs monitor access? We'll find out from GAO's Sharon Silas. Related GAO Work: GAO-23-105290, Veterans Community Care Program: VA Needs to Strengthen Its Oversight and Improve Data on Its Community Care Network Providers Released: November 2022 [Music] [Sharon Silas:] VA needs to have complete and accurate information on the providers participating in these networks and be effectively monitoring their contractor's performance. [Holly Hobbs:] Hi, and welcome to GAO's Watchdog Report. Your source for news and information from the U.S. Government Accountability Office. I'm your host, Holly Hobbs. The Veterans Community Care Program was created to improve veteran's access to health care. Under the program, veterans can receive health care services through community providers when they face challenges accessing care at VA facilities. We've previously reported about concerns of how the VA oversees the community care program. And our new report looks at how VA monitors contractors to ensure they are providing timely access to health care, which is the goal of the program. Today, we'll find out more from Sharon Silas, an expert on veterans health issues. Thanks for joining us. [Sharon Silas:] Thanks for having me, Holly. [Holly Hobbs:] So, Sharon, one of the unusual things about this report is we made undercover phone calls to 80 community providers. Why did we do this? Why did we think it was necessary? And what did we find out? [Sharon Silas:] So we have some prior work in this area where we had learned about various challenges in scheduling appointments with community care providers. And so we wanted to use the undercover phone calls because we thought it would be a good method for us to help better understand appointment scheduling challenges firsthand and to corroborate with some of our other findings. And what we found out is that we did indeed have some similar results to what we had been hearing about appointment scheduling. So for example, using VA system to identify providers to schedule appointments, we specifically called a selection of gastroenterologists and dentists to schedule appointments. And we found numerous examples of inaccurate information about these providers, including incorrect addresses, phone numbers, and even some providers who said that there were no longer participating in the community care program. [Holly Hobbs:] Were there some health services or types of appointments that were harder or took longer to schedule? [Sharon Silas:] So we surveyed 127 VA medical centers about their experiences in scheduling specialty care appointments within 30 days for veterans with community care providers. And we did learn that there are a variety of specialty medical care services with the least appointment availability. And those services were in gastroenterology, neurology, rheumatology, dermatology and endocrinology. [Holly Hobbs:] We also interviewed VA officials and contractor representatives. What did they tell us about some of the scheduling and other access issues? [Sharon Silas:] Both VA and the contractors generally had positive perspectives on the adequacy of the community care networks. And for the time period that we reviewed, the contractors were generally meeting the standards. But when we really dug into some of this data, we found that the data were incomplete. So it was potentially providing a misleading picture of network adequacy. We also, through our survey, learned that VA medical centers were encountering a number of challenges, including inaccurate provider information, insufficient number of providers in the networks, limited appointment availability, and insufficient staff to schedule veteran's appointments. In fact, only 6% of our 127 facilities that we surveyed said that they had enough staff to schedule veteran's appointments for community care. [Holly Hobbs:] So VA has two contractors that have established regional networks. What are the requirements for these contractors in running these networks? And what is VA doing to monitor them? [Sharon Silas:] So there are a number of contract requirements. And for our review we focused on network adequacy. And we identified two key requirements that contractors must comply with. The first is that they're supposed to generate reports on the adequacy of their network of community care providers. And they use claims data to generate these reports to show how the contractor performed against VA's drive time standards and also their appointment availability standards. The second requirement is for the contractors to develop corrective action plans when the performance does not meet VA's expectations. And the VA reviews both of these documents on a monthly or quarterly basis, depending on the region. {MUSIC} [Holly Hobbs:] So community care providers can increase veterans' access to health care. But Sharon just told us that--while the VA collects data about how contractors manage networks, that information was incomplete and potentially providing a misleading picture of adequacy. So, Sharon, what can the VA do to improve its oversight of community care networks? [Sharon Silas:] Well, in our report, we make two recommendations. Our first recommendation is for VA to ensure contractors report complete claims data when calculating performance against VA's network adequacy standards. And our second recommendation was for VA to implement strategies to increase accuracy of information on providers who are participating in the community care networks. [Holly Hobbs:] And last question, what's the bottom line of this report? [Sharon Silas:] Well, the bottom line of the report is that it is important contractors for the community care program are maintaining a robust network of providers to meet the health care needs of veterans. It could potentially impact veterans' ability to receive timely access to medical care. And to do this, VA needs to have complete and accurate information on the providers participating in these networks and be effectively monitoring the contractor's performance. [Holly Hobbs:] That was Sharon Silas talking about GAO's review of the Veterans Community Care Program. Thanks for your time, Sharon. [Sharon Silas:] Thanks, Holly. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts, Spotify, or wherever you listen and make sure to leave a rating and review to let others know about the work we're doing. For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.