VA Health Care

The Department of Veterans Affairs (VA) operates 173 hospitals and more than 200 freestanding outpatient clinics nationwide at a cost of about $17 billion a year. Two years ago, VA created 22 networks to help improve service delivery to the 3 million veterans who use its medical facilities each year. So far, networks have begun facility integrations in 18 geographic areas, involving a total of 36 hospitals. This testimony focuses on (1) the role of facility integrations in reshaping VA's health care delivery system and (2) lessons learned that could help enhance VA's process for planning and implementing ongoing and future facility integrations.

GAO noted that: (1) facility integrations are a critical piece of VA's overall strategy to enhance the efficiency and effectiveness of health service delivery to veterans; (2) VA's strategy is similar to how the private sector health care industry is evolving; (3) in essence, integrations can allow VA to provide the same or higher quality services to veterans at a significantly reduced cost; (4) in just 2 years, by unifying management and consolidation services, VA's integrations have produced millions of dollars in savings that can be reinvested in the system to further enhance veterans' care; (5) but VA also faces difficulties in planning and implementing integrations, primarily stemming from the potential adverse impacts on stakeholders such as veterans, facility and medical school personnel, and members of Congress who represent these groups; (6) for example, while integrations will generally enhance VA's ability to serve veterans, they will likely result in, among other things, fewer, less convenient, or less desirable employment opportunities for VA and medical school employees or training opportunities for medical school residents and students; (7) with so much at risk, it is imperative that VA plan and implement integrations to maximize their benefits and minimize the adverse impacts; (8) VA's integration planning approach has many positive features; (9) GAO's work to date, however, indicates areas where improvements could be made; (10) for example, integration decisions are generally made incrementally, that is, on a service-by-service basis, at varying times throughout the process instead of being made on the basis of decisions about all activities across the integrated facilities; (11) also, planning and implementation activities frequently occur simultaneously, which does not allow for consideration of the collective effect of such changes on the integration; (12) in addition, stakeholders are involved at varying times in different ways but are not always provided sufficient information at key decision points; (13) currently, VA is considering ways to improve its facility integration process; and (14) with that in mind, GAO's work suggests that VA could achieve better results by: (a) adopting a more comprehensive planning approach; (b) completing planning before implementing changes; (c) improving the timeliness and effectiveness of communications with stakeholders; and (d) using a more independent planning approach.