Veterans Health Care: Opportunities Exist to Improve Assessment of Network Adequacy for Mental Health
Fast Facts
As the demand for mental health care grows, the Veterans Community Care Program allows eligible veterans to receive care through networks of providers in the community when they can't access timely care at VA facilities.
VA aims to limit how long veterans should have to travel to, or wait for, an appointment. It collects data on VA facilities' timeliness in scheduling appointments with community providers but doesn't have staff document reasons for scheduling delays or an inability to schedule an appointment.
Our recommendations would help VA assess whether it has enough mental health care providers in the community to provide care.
Highlights
What GAO Found
The Department of Veterans Affairs (VA) has five regional networks of community providers, known as Community Care Networks (CCN), to deliver care to veterans outside of VA facilities. VA oversees two contractors that developed and are responsible for maintaining the CCNs. (See figure.)
Map of Community Care Network Regions
Under the CCN contracts, VA requires its contractors to meet two primary network adequacy standards for specialty care, which includes mental health. These standards establish limits on how long veterans should have to travel to, or wait for, an appointment. VA uses claims data to assess contractor performance against the standards. GAO found that VA's methodology excludes certain claims if the claims do not meet the applicable standard, such as when veterans prefer a specific provider or appointment day or time. In contrast, VA includes these claims if they meet the standard. As a result, VA's methodology may result in an incomplete, and potentially misleading, assessment of network adequacy. This poses a risk to VA's ability to fully assess the extent to which its CCNs are adequate to meet veterans' needs, including for mental health care.
VA collects information on its facilities' timeliness in scheduling veterans' community care appointments, including for mental health. However, VA does not have comprehensive information on the factors that contribute to scheduling challenges. These factors could be network adequacy-related, such as difficulty identifying a community provider. This is because it does not ensure that facility staff systematically capture a reason when they encounter scheduling delays or are unable to schedule an appointment. Having this information would help VA determine whether an insufficient number of providers could be affecting veterans' access to community care. It could also help VA take targeted actions, including actions to strengthen the CCN, if appropriate.
Why GAO Did This Study
The demand for mental health care at VA has increased in recent years. VA's Veterans Community Care Program allows eligible veterans to receive care in the community when they have challenges accessing timely care at VA. Since VA implemented the program in 2019, the number of veterans receiving mental health care in the community has also increased.
GAO was asked to review VA's CCN adequacy for mental health. Among other objectives, this report examines (1) how VA assesses CCN adequacy for mental health and (2) the extent to which VA collects information on the factors that contribute to scheduling timeliness challenges for community care appointments, including for mental health.
GAO reviewed relevant documentation, such as the CCN contracts. GAO also analyzed the most recent data available, including mental health care claims from April 2022 through March 2023, and the first three quarters of fiscal year 2023 data on community care scheduling timeliness. GAO also interviewed officials from VA, contractors, and four VA facilities selected for regional variation.
Recommendations
GAO is making two recommendations to VA: (1) assess the risks of its methodology for calculating specialty care network adequacy and revise its approach accordingly and (2) capture the reasons for community care appointment scheduling challenges and use the information to address those challenges. VA concurred with the first recommendation and concurred in principle with the second, as discussed in this report.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Undersecretary for Health should assess the risks associated with VA's methodology for calculating specialty care network adequacy and revise its approach accordingly. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Undersecretary for Health should ensure that VA facility staff systematically capture the reasons for community care appointment scheduling challenges and use this information to help address those challenges. (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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