Report Summary

The Office of Inspector General (OIG) conducted a review to evaluate VA’s implementation of the Referral Coordination Initiative (RCI), a program designed to improve veterans’ timely access to care, empower patients to make informed care decisions, reduce providers’ administrative burden and increase their time on patient care, and enhance access to community care for veterans eligible under the MISSION Act of 2018. In 2019, the Veterans Health Administration began implementing the RCI at 139 VA medical facilities, with expected completion across all facilities and all specialty services by June 30, 2021.

The OIG team conducted 75 interviews with leaders at VA and other offices and performed site visits at four facilities. VHA staff generally agreed the RCI had the potential to achieve its stated goals. However, facilities struggled with implementation for several reasons, including insufficient staffing and resources, unreliable data (such as a lack of accurate wait times for community care), and a lack of required training. The RCI describes two implementation models, centralized and decentralized, but facility staff were sometimes confused which model to apply and noted slow responses to questions. The Office of Integrated Veteran Care predecessor, the program office responsible for overseeing the RCI, also lacked the ability to monitor progress due to insufficient data. Because of these deficiencies, no VA facility had fully implemented the RCI almost a full year after VA’s own June 2021 deadline.

The under secretary for health concurred with the OIG’s seven recommendations to improve RCI implementation by better assigning responsibilities and roles, improving training, establishing local procedures for sharing community care data for informing patients, sharing best practices among all facilities, ensuring accurate tracking of RCI consults, and developing ways to measure how well facilities meet the initiative’s requirements.