Strategic Goal: Provide One VA world-class service to veterans and their families through the effective management of people, technology, processes, and financial resources. VA will operate as a veteran-focused organization that provides high quality, accessible, and timely information and service through the development and maintenance of a high-performing workforce, the application of state-of-the-art technologies, the continuous improvement of processes, and the effective allocation of dollars.

Objective: Improve VA’s overall governance and operational management, and access to benefits and services to meet or exceed the expectations of veterans and their families, while ensuring full compliance with applicable laws, regulations, and financial commitments.

Performance Goal: Increase the number of unique patients treated in the health care system by 24 percent (FY 1997 baseline = 3,142,000 unique patients).

As part of a three-ply approach to implementing management strategies to become more efficient, VA has for several years achieved its performance targets to increase the number of unique patients treated in the health care system. The original performance goal was to increase the number of unique patients by 20 percent from FY 1997 to FY 2002. VA expects to achieve this during FY 2000. Therefore, prior to developing the FY 2002 Performance Plan, we will reevaluate the appropriateness of maintaining this as one of the Department’s key measures.

VA’s plan to increase the number of unique patients has been part of an overall strategy to become more efficient that includes decreasing the cost (obligations) per patient treated and increasing alternative revenue sources. One of the primary strategies for increasing the number of patients treated by VA is shifting health care resources and patient treatment modalities from inpatient care to outpatient care. This strategy requires a policy of sustained growth that is essential to the well being of the VA health care system. Public Law 104-262, the Veterans’ Health Care Eligibility Reform Act of 1996, represents the single most important factor in opening the way for increasing veterans’ access to VA medical care. Another important strategy is to increase the number and types of access points for medical care services. This will be done through continued expansion of the number of CBOCs at which veterans and eligible dependents can receive outpatient care.

VA has a vast number of sharing agreements with DoD that result in both increased access to, and quality of, medical care for veterans. Many of these collaborative partnerships result in increased levels of care for many of VA’s most important subgroups of patients, including veterans with spinal cord injury, acute traumatic brain injury, Gulf War illnesses, and those in need of prosthetic services.

GAO reviews have recommended that VA improve accuracy, reliability, and consistency of information used to measure the extent to which: (1) veterans are receiving equitable access to care across the country; (2) all veterans enrolled in VA’s health care system are receiving the care they need; and (3) VA is maintaining its capacity to care for special populations.

VA is well along in implementing timely and detailed indicators of change in Veterans Equitable Resource Allocation (VERA) workload measures. VA has added a criterion to its allocation principles (VHA Directive 97-054). The directive states that VISNs’ allocations shall "support the goal of improving access to care." VISNs are required to report on how resources are allocated each year and specifically how the goal of equitable access is addressed.

VA has developed enrollment procedures for gathering and updating information on employment, insurance, and service-connected disabilities. Concerning the effects of health insurance on access to care for the non-insured, VA has implemented procedures to accomplish this goal such as setting the principle of funding allocations to be consistent with eligibility requirements and priorities.

VA is implementing GAO’s recommendation to gather information on current users with and without reasonable access. We have incorporated this as a requirement for applications for new CBOCs. Ensuring reasonable access for high priority veterans is tied to the enrollment process.

GAO recommended we adopt uniform definitions and institute timely reporting of changes in access including waiting times, patient satisfaction, and priority of veterans served. VA is in the early stages of implementing this recommendation with three new performance goals that will provide data on the time to schedule initial primary care and specialty clinic appointments and waiting time to be seen for a scheduled appointment.

The source of these data is the VERA Patient Database in the Boston Allocation Resource Center. A report on the number of unique patients is produced annually and is available at both the national and VISN levels. Internal control systems are in place to ensure that social security numbers are not duplicated and that records are valid.

Based on its audit of unique patients, the IG concluded that we overstated the patient count by 5.7 percent. The IG cited two major reasons for this:

• inaccurate SSNs were entered into the National Patient Care Database
• patients with undocumented appointments or who did not keep their appointments were counted as being treated.

The Acting Under Secretary for Health agreed with the recommendations in the IG’s report and provided an acceptable implementation plan.

(For additional information on this performance goal, refer to Medical Programs, Volume 2, Chapter 2.)