Fiscal Year 2005 Performance and Accountability Report Published November 15, 2005
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VA confronts an accelerating need to manage resources and workload by finding more efficient ways to meet veterans' increasing demand for health care. Through its Capital Asset Realignment for Enhanced Services (CARES) process, VA is working toward realigning its capital assets, primarily buildings, to better serve veterans' needs. VA has completed a market-based plan for restructuring its delivery of health care. As a result of CARES, VA will increase the number of community-based outpatient clinics, improve access to inpatient care, and modernize outdated facilities. However, VA has many obstacles to overcome before the restructuring of its health care delivery system is a reality. In addition, VA must continually assess the demand for its services so that it can adequately plan for the number of eligible veterans seeking care. In response to GAO's recommendations, VA has taken steps to better allocate comparable resources for comparable workloads by expanding the number of allocation categories in its Veterans Equitable Resource Allocation system and by incorporating into the allocation system better workload measures.
VA's Program Response to GAO2A:
VA continues to address ways to better allocate comparable resources for comparable workload through ongoing review and analysis of the Veterans Equitable Resource Allocation (VERA) system. VA also uses the VA Enrollee Health Care Projection Model to assess future demand and resource needs for VA health care services by projecting veteran enrollment, enrollees' use of health care services, and the expenditures associated with that utilization. VA uses this actuarial-based model to analyze various health care policies, and the model projections serve as a foundation for VA's health care budget request. To ensure the accuracy of the model, the methodology is continually assessed and refined, and the data sources are regularly updated.
Although VA is becoming more efficient, it must continue its efforts to streamline and improve service delivery. In particular, VA and the Department of Defense (DoD) need to find additional efficiencies through increased sharing of resources and joint purchasing of drugs and medical supplies. VA and DoD are continuing to work together to identify opportunities for increased efficiency in service delivery.
VA's Program Response to GAO2B:
VA and DoD are working to find additional systemic efficiencies through the increased sharing of resources for the joint purchasing of drugs, non-drug medical supplies, equipment, and services. The DoD/VA Joint Executive Council (JEC) meets quarterly to identify and explore opportunities for sharing health care resources and business systems. The highest levels of DoD and VA leadership are represented on the JEC, including the Under Secretary of Defense for Personnel and Readiness and the Deputy Secretary of Veterans Affairs.
A subordinate Health Executive Council (HEC) and Benefits Executive Council (BEC) are chartered to examine how health care delivery and benefits management can be made more efficient. The HEC operates 12 different work groups, one of which is the Pharmacy Work Group evaluating the VA/DoD joint purchasing of drugs and medical supplies. As of July 2005 there were 84 joint national contracts for pharmaceuticals, with 11 more contracts pending and 19 contracts being proposed for review.
The BEC oversees the implementation of a VA/DoD cooperative medical and physical exam through the Cooperative Physical Exam Work Group. To simplify the transition from active military service to veteran status, a single physical examination was developed that meets both the military services' separation requirements and VA's disability compensation examination criteria.
Modifications were completed to all DoD radiology contracts, which now allow VA to order diagnostic imaging services using these contract vehicles. In the third quarter of 2005, DoD and VA issued 100 joint contract orders for non-drug purchases totaling $47 million. In addition, a plan that includes monitoring and tracking of DoD/VA joint purchases of non-drug medical supplies and equipment was developed and implemented.
DoD and VA have begun working with industry to develop standards for uniform nomenclature and identification of medical and surgical products. The two departments are striving to secure a consensus between industry and federal partners on standard formatting for names and labeling through presentations and attendance at national conferences.
The Joint Facility Utilization and Resource Sharing Work Group was established by the HEC to examine issues such as removing barriers to resource sharing and streamlining the process for approving sharing agreements. DoD and VA have cooperated to develop Joint Clinical Practice Guidelines, which contribute to the adoption of common standards that facilitate greater health system interoperability. The two Departments are collaborating in a unique initiative to share services, personnel, and physical plants at the Chicago VA Medical Center and the Great Lakes Naval Medical Center. Working cooperatively, VA and DoD have established a central governing body to manage and oversee opportunities for shared medical services between the two facilities. They are sharing mammography services and have established a shared Women's Health Center for returning female veterans and new Navy recruits. A Construction Planning Committee was formed to identify future opportunities for facility sharing and ensure that related issues are considered as part of VA's CARES process to prepare VA facilities to meet veterans' health care needs in the future.
The VA/DoD Joint Executive Council Annual Report was issued in December 2004. The below chart shows the JEC structure.
Chart showing the organizational structure used by VA and DoD to oversee areas of collaboration such as procurement, medical education, medical examinations, and information technology. The chart identifies a main oversight and policy group -- the VA/DoD Joint Executive Council -- as well as subsidiary committees.
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SECRETARY DEPARTMENT OF VETERANS AFFAIRS / SECRETARY DEPARTMENT OF DEFENSE
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VA/DoD (JEC) JOINT EXECUTIVE COUNCIL
- Construction Planning Committee (CPC)
- Joint Strategic Planning Committee (JSPC)
- VA/DoD JEC Support Staff
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BENEFITS EXECUTIVE COUNCIL (BEC)
- Benefits & Services Workgroup
- Cooperative Physical Exam Workgroup
- Info System / Info Tech Workgroup
- VBA / VHA Seamless Transition
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HEALTH EXECUTIVE COUNCIL (HEC)
- Contingency Response Workgroup
- Deployment Health Workgroup
- Evidence-Based Clinical Practice Guidelines Workgroup
- Financial Management Workgroup
- Geriatric Care Workgroup
- Graduate Medical Education Workgroup
- Information Management Information Technology Workgroup
- Joint Facility Utilization and Resource Sharing Workgroup
- Medical Education & Training Workgroup
- Medical Materiel Management Workgroup
- Patient Safety Workgroup
- Pharmacy Workgroup
TITLE 38 U.S.C. 8111© DOD/VA Health Executive Council 2003 National Defense Authorization Act (PL 107-314)
VA and DoD are involved in two Congressionally mandated programs to improve VA/DoD coordination:
VA/DoD Health Care Sharing Incentive Fund (Section 721): Section 721 of the FY 2003 National Defense Authorization Act (NDAA) requires the establishment of a program to identify, fund, and evaluate creative sharing initiatives at facility, regional, and national levels. Developed as a result of this mandate, the VA/DoD Financial Management Work Group (FMWG) is responsible for evaluating the proposals and reporting its recommendations to the HEC. In 2004, the first year that projects were funded, both departments contributed $15 million to the fund. Twelve projects were selected; total funding for the projects was $37.5 million. These projects involved a wide range of services including tele-health projects, women's health services, a joint cardiac catheterization lab, a joint dialysis unit, and the opening of a joint clinic. Funding was allocated to the selected projects upon certification that they would be self-sustaining. One project totaling $14.9 million has been canceled, and the funding has been returned to the central account. For the 2005 cycle, the FMWG reviewed 56 proposals. The HEC approved 18 projects totaling $31.2 million in September 2005.
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Health Care Resources Sharing and Coordination Project (Section 722): Section 722 of the FY 2003 NDAA requires the two departments to conduct at least three coordinated management systems demonstration projects. Seven sites are participating:
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Budget and financial management systems:
- VA Pacific Islands Health Care System and Tripler Army Medical Center, Hawaii.
- Alaska VA Health Care System and 3rd U.S. Air Force Medical Group, Alaska.
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Coordinated staffing and assignment systems:
- Augusta VA Medical Center and Eisenhower Army Medical Center, Georgia.
- Hampton VA Medical Center and the 1st U.S. Air Force Medical Group, Virginia.
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Medical information/information technology management systems:
- Puget Sound Health Care System and Madigan Army Medical Center, Washington.
- El Paso VA Health Care System and William Beaumont Army Medical Center, Texas.
- South Texas VA Health Care System—two projects—one with Wilford Hall Medical Center and one with Brooke Army Medical Center, Texas.
Each department made $6 million available to the seven sites for eight projects in 2004. Each department is required to make available $9 million annually from 2005 through 2007. Plans are to widely disseminate "lessons learned" when progress merits replication at other settings. GAO has been auditing the implementation of the pilot projects.
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