Veterans' Health Care: Limited Progress Made to Address Concerns That Led to High-Risk Designation
Published: 2017-03-15T00:00:00

Fast Facts:
We added Department of Veterans Affairs' health care to our High-Risk List in 2015 over concerns about the timeliness, quality, and safety of veterans' health care.
It remains on our 2017 list.
In today's testimony, we discussed how VA partially met 2 of our 5 criteria for getting off the list, and the more than 100 recommendations that remain open, reflecting our areas of concern for VA health care:
(1) Ambiguous policies and inconsistent processes,
(2) Inadequate oversight and accountability,
(3) Information technology challenges,
(4) Inadequate training for VA staff, and
(5) Unclear resource needs and allocation priorities.

Highlights:
section_title: Why GAO Did This Study
paragraphs: VA operates one of the largest health care delivery systems in the nation, including 168 medical centers and more than 1,000 outpatient facilities organized into regional networks. Enrollment in the VA health care system has grown significantly, from 7.9 million in fiscal year 2006 to almost 9 million in fiscal year 2016. Over that same period, VA's Veterans Health Administration's total budgetary resources have increased substantially, from $37.8 billion in fiscal year 2006 to $91.2 billion in fiscal year 2016.
Since 1990, GAO has regularly updated the list of government operations that it has identified as high risk due to their vulnerability to fraud, waste, abuse, and mismanagement, or the need for transformation to address economy, efficiency, or effectiveness challenges. VA health care was added as a high-risk area in 2015 because of concerns about VA's ability to ensure the timeliness, cost-effectiveness, quality, and safety of veterans' health care. GAO assesses High-Risk List removal against five criteria: (1) leadership commitment, (2) capacity, (3) action plan, (4) monitoring, and (5) demonstrated progress.
This statement, which is based on GAO's February 2017 high-risk report, addresses (1) actions VA has taken over the past 2 years to address the areas of concern that led GAO to designate VA health care as high risk, (2) the number of open GAO recommendations related to VA health care, and (3) additional actions VA needs to take to address the concerns that led to the high-risk designation.
section_title: What GAO Found
paragraphs: The Department of Veterans Affairs (VA) has taken action to partially meet two of the five criteria GAO uses to assess removal from the High-Risk List (leadership commitment and an action plan), but it has not met the other three (agency capacity, monitoring efforts, and demonstrated progress). Specifically, VA officials have taken leadership actions such as establishing a task force, working groups, and a governance structure for addressing the issues that led to the high-risk designation. VA provided GAO with an action plan in August 2016 that acknowledged the deep-rooted nature of the five areas of concern GAO identified: (1) ambiguous policies and inconsistent processes; (2) inadequate oversight and accountability; (3) information technology challenges; (4) inadequate training for VA staff; and (5) unclear resource needs and allocation priorities. Although VA's action plan outlined some steps VA plans to take over the next several years, several sections were missing analyses of the root causes of the issues, resources needed, and clear metrics to measure progress.
Also of concern are the more than 100 open recommendations GAO has made between January 2010 and February 2017 related to VA health care, almost a quarter of which have been open for 3 or more years. Since February 2015, GAO has made 74 new recommendations relating to the areas of concern.
To address its high-risk designation, additional actions are required of VA, including: (1) demonstrating stronger leadership support as it continues its transition under a new administration; (2) developing an action plan to include root cause analyses for each area of concern, clear metrics to assess progress, and the identification of resources for achieving stated outcomes; and (3) implementing GAO's recommendations, not only to remedy the specific weaknesses identified, but because they may be symptomatic of larger underlying problems that also need to be addressed. Until VA addresses these serious underlying weaknesses, it will be difficult for the department to effectively and efficiently implement improvements addressing the five areas of concern that led to the high-risk designation.

section_title: Letter
paragraphs: I am pleased to be here today to discuss the status of the Department of  Veterans Affairs’ (VA) actions to address the concerns that led to the  high-risk designation we made related to VA health care. We added  managing risks and improving VA health care to our High Risk List in  2015 due to our concern about VA’s ability to ensure the cost-effective  and efficient use of resources to improve the timeliness, quality, and  safety of health care for veterans. We expressed continued concerns  about VA health care in our 2017 high-risk report.
VA’s Veterans Health Administration (VHA) operates one of the largest  health care delivery systems in the nation, with 168 medical centers and  more than 1,000 outpatient facilities organized into regional networks. VA  has faced a growing demand by veterans for its health care services— due, in part, to servicemembers returning from military operations in  Afghanistan and Iraq and the needs of an aging veteran population—and  that trend is expected to continue. The total number of veteran enrollees  in VA’s health care system rose from 7.9 million to almost 9 million from  fiscal year 2006 through fiscal year 2016. Over that same period, VHA’s  total budgetary resources have increased substantially, from $37.8 billion  in fiscal year 2006 to $91.2 billion in fiscal year 2016.
Although VA’s budget and enrollees have substantially increased for at  least a decade, there have been numerous reports during this same  period—by us, VA’s Office of the Inspector General, and others—of VA  facilities failing to provide timely health care. In some cases, the delays  in care or VA’s failure to provide care at all reportedly have resulted in  harm to veterans. In response to these serious and longstanding  problems with access to VA health care, the Veterans Access, Choice,  and Accountability Act of 2014 was enacted, which provided temporary  authority and $10 billion in funding through August 7, 2017 (or sooner, if  those funds are exhausted) for veterans to obtain health care services  from community (non-VA) providers to address long wait times, lengthy  travel distances, or other challenges they may face accessing VA health  care. Under this authority, VA introduced the Veterans Choice Program  in November 2014, which offers veterans the option to receive hospital  care and medical services from a non-VA provider when a VA facility  cannot provide an appointment within 30 days, or when veterans reside  more than 40 miles from the nearest VA facility.
In addition to concerns about timely access to care, VA faces challenges  regarding the reliability, transparency, and consistency of its budget  estimates for medical services, as well as weaknesses in tracking  obligations for medical services and estimating budgetary needs for future  years. These challenges were evident in June 2015, when VA requested  additional funds from Congress because agency officials projected a  fiscal year 2015 funding gap of about $3 billion in its medical services  appropriation account. The projected funding gap was largely due to  administrative weaknesses that slowed the utilization of the Veterans  Choice Program in fiscal year 2015 and resulted in higher-than-expected  demand for VA’s previously established VA community care programs.  To address the projected funding gap in fiscal year 2015, the VA Budget  and Choice Improvement Act provided VA temporary authority to use up  to $3.3 billion from the Veterans Choice Program appropriation for  obligations incurred for other specified medical services. In our June  2016 report on VA’s health care budget, we reported that VA officials  anticipated requesting another increase in funding for health care  services in the budget request for fiscal year 2018. Over the course of  fiscal year 2016, utilization of the Veterans Choice Program increased  considerably, and the Veterans Choice Fund had a $4.5 billion remaining  balance at the start of fiscal year 2017 to cover community care  services. However, in February 2017, a VA official told us that VA would  need an estimated $2 billion in addition to its fiscal year 2018 advance  appropriation of about $70 billion to continue providing services.
My statement today, which is based on our February 2017 High-Risk  Series: Progress on Many High-Risk Areas, While Substantial Efforts  Needed on Others, will address (1) actions VA has taken over the past 2  years to address the areas of concern that led us to place VA health care  on our High-Risk List in 2015, (2) the number of open GAO  recommendations related to VA health care, and (3) additional actions VA  needs to take to address the concerns that led to the high-risk  designation. We conducted the work on which this statement is based in  accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives.
subsections: section_title: Background
paragraphs: Since 1990, we have regularly reported on government operations that  we have identified as high risk due to their vulnerability to fraud, waste,  abuse, and mismanagement, or the need for transformation to address  economy, efficiency, or effectiveness challenges. Our high-risk program— which is intended to help inform the congressional oversight agenda and  to guide efforts of the administration and agencies to improve government  performance—has brought much-needed focus to problems impeding  effective government and costing billions of dollars. In 1990, we  designated 14 high-risk areas. Since then, generally coinciding with the  start of each new Congress, we have reported on the status of progress  to address previously designated high-risk areas, determined whether  any areas could be removed or consolidated, and identified new high-risk  areas.
Since 1990, a total of 60 different areas have appeared on the High-Risk  List, 24 areas have been removed, and 2 areas have been consolidated.  On average, high-risk areas that have been removed from the list  remained on it for 9 years after they were initially added. Our experience  has shown that the key elements needed to make progress in high-risk  areas are top-level attention by the administration and agency leaders  grounded in the five criteria for removal from the High-Risk List, as well as  any needed congressional action. The five criteria for removal that we  issued in November 2000 are as follows:
Leadership Commitment. The agency demonstrates strong  commitment and top leadership support.
Capacity. The agency has the capacity (i.e., people and resources) to  resolve the risk(s).
Action Plan. A corrective action plan exists that defines the root  cause and solutions, and provides for substantially completing  corrective measures, including steps necessary to implement  solutions we recommended.
Monitoring. A program has been instituted to monitor and  independently validate the effectiveness and sustainability of  corrective measures.
Demonstrated Progress. The agency is able to demonstrate  progress in implementing corrective measures and in resolving the  high-risk area.
These five criteria form a road map for efforts to improve and ultimately  address high-risk issues. Addressing some of the criteria leads to  progress, while satisfying all of the criteria is central to removal from the  list. In our April 2016 report, we provided additional information on how  agencies had made progress addressing high-risk issues. Figure 1  shows the five criteria for removal for a designated high-risk area and  examples of actions taken by agencies as cited in that report.
Importantly, the actions listed are not “stand alone” efforts taken in  isolation from other actions to address high-risk issues. That is, actions  taken under one criterion may also be important in meeting other criteria.  For example, top leadership can demonstrate its commitment by  establishing a corrective action plan including long-term priorities and  goals to address the high-risk issue and using data to gauge progress— actions which are also vital to monitoring criteria.
section_title: VA Has Made Limited Progress in Addressing the Concerns That Led to the 2015 VA Health Care High-Risk Designation
paragraphs: VA officials have expressed their commitment to addressing the concerns  that led to the high-risk designation for VA health care. As part of our  work for the 2017 high-risk report, we identified actions VA had taken,  such as establishing a task force, working groups, and a governance  structure for addressing the five areas of concern contributing to the  designation: (1) ambiguous policies and inconsistent processes; (2)  inadequate oversight and accountability; (3) information technology (IT)  challenges; (4) inadequate training for VA staff; and (5) unclear resource  needs and allocation priorities. For example, in July 2016, VA chartered  the GAO High Risk List Area Task Force for Managing Risk and  Improving VA Health Care to develop and oversee implementation of  VA’s plan to address the root causes of the five areas of concern we  identified in 2015.
VA’s task force and associated working groups are responsible for  developing and executing the department’s high-risk mitigation plan for  each of the five areas of concern we identified. VA also executed two  contracts with a total value of $7.8 million to support its actions to address  the concerns behind the high-risk designation. These contracts—with the  MITRE Corporation and Atlas Research, LLC—are intended to provide  additional support for actions such as developing and executing an action  plan, creating a plan to enhance VA’s capacity to manage the five areas,  and assisting with establishing the management functions necessary to  oversee the five high-risk-area working groups.
On August 18, 2016, VA provided us with an action plan that  acknowledged the deep-rooted nature of the areas of concern, and stated  that these concerns would require substantial time and work to address.  Although the action plan outlined some steps VA plans to take over the  next several years to address the concerns that led to its high-risk  designation, several sections were missing critical actions that would  support our criteria for removal from the High-Risk List, such as analyzing  the root causes of the issues and measuring progress with clear metrics.  In our feedback to VHA on drafts of its action plan, we highlighted these  missing actions and also stressed the need for specific timelines and an  assessment of needed resources for implementation. For example, VA  plans to use staff from various sources, including contractors and  temporarily detailed employees, to support its high-risk-area working  groups, so it is important for VA to ensure that these efforts are  sufficiently resourced.
subsections: section_title: Overall Rating for Managing Risks and Improving VA Health Care
paragraphs: As we reported in the February 2017 high-risk report, when we applied  the five criteria for High-Risk List removal to each of the areas of concern,  we determined that VA has partially met two of the five criteria: leadership  commitment and an action plan. VA has not met the other three criteria  for removal: capacity to address the areas of concern, monitoring  implementation of corrective actions, and demonstrating progress. It is  worth noting that although both criteria were rated as partially met, the  department made significantly less progress in developing a viable action  plan than it has in demonstrating leadership commitment. Specifically, VA  partially met the action plan criterion for only one of the five areas of  concern—ambiguous policies and inconsistent processes—whereas VA  partially met the leadership commitment criterion for four out of five areas  of concern.
The following is a summary of the progress VA has made in addressing  the five criteria for removal from the High-Risk List for each of the five  areas of concern we identified.
section_title: Ambiguous Policies and Inconsistent Processes
paragraphs: Summary of concern. When we designated VA health care as a high- risk area in 2015, we reported that ambiguous VA policies led to  inconsistent processes at local VA medical facilities, which may have  posed risks for veterans’ access to VA health care. Since then, we  highlighted the inconsistent application of policies in two recent reports  examining mental health and primary care access at VA medical facilities  in 2015 and 2016, respectively. In both reports, we found wide variation  in the time that veterans waited for primary and mental health care, which  was in part caused by a lack of clear, updated policies for appointment  scheduling; therefore, we recommended that VA update these policies.  These ambiguous policies contributed to errors made by appointment  schedulers, which led to inconsistent and unreliable wait-time data. For  mental health, we also found that two policies conflicted, leading to  confusion among VA medical center staff as to which wait-time policy to  follow. In 2015, VA resolved this policy conflict by revising its mental  health handbook, but other inconsistent applications of mental health  policy have not yet been addressed, such as our recommendation to  issue guidance about the definitions used to calculate veteran  appointment wait times, and communicate any changes to those  definitions within and outside VHA.  2017 assessment of VA’s progress. Based on actions taken since  2015, VA has partially met our criteria for removal from the High-Risk List  for this area of concern for leadership commitment and action plan. VA  has partially met the leadership commitment criterion because it  established a framework for developing and reviewing policies—with the  goal of ensuring greater consistency and clarity—and set goals for  making the policy-development process more efficient. VA has partially  met the action plan criterion for this high-risk area of concern because its  action plan described an analysis of the root causes of problems related  to ambiguous policies and inconsistent processes, an important aspect of  an action plan. However, VA has not met our criteria for removal from the  High-Risk List for capacity, monitoring, and demonstrated progress for  this area of concern because it has not addressed gaps that exist  between its stated goals and available resources, addressed inconsistent  application of policies at the local level, or demonstrated that its actions  are linked to identified root causes.
section_title: Inadequate Oversight and Accountability
paragraphs: Summary of concern. In our 2015 high-risk report, we found that VA had  problems holding its facilities accountable for their performance because  it relied on self-reported data from facilities, its oversight activities were  not sufficiently focused on compliance, and it did not routinely assess  policy implementation. We continued to find a lack of oversight in our  October 2015 review of the efficiency and timeliness of VA’s primary care.  For example, we found inaccuracies in VA’s data on primary care panel  sizes, which are used to help medical centers manage their workload and  ensure that veterans receive timely and efficient care. We found that  while VA’s primary care panel management policy required facilities to  ensure the reliability of their panel size data, it did not assign  responsibility for verifying data reliability to regional- or national-level  officials or require them to use the data for monitoring purposes. As a  result, VA could not be assured that local panel size data were reliable, or  know whether its medical centers had met VA’s goals for efficient, timely,  and quality care. We recommended that VA incorporate an oversight  process in its primary care panel management policy that assigns  responsibility, as appropriate, to regional networks and to VA’s central  office for verifying and monitoring panel sizes.  2017 assessment of VA’s progress. VA has partially met the leadership  commitment criterion for this area of concern because it established a  high-level governance structure and adopted a new model to guide the  department’s oversight and accountability activities. However, VA has not  met our criteria for removal from the High-Risk List for capacity, action  plan, monitoring, or demonstrated progress for this area of concern  because the department continues to rely on existing processes that  contribute to inadequate oversight and accountability.
section_title: Information Technology Challenges
paragraphs: Summary of concern. In our 2015 high-risk report, we identified  limitations in the capacity of VA’s existing IT systems, including the  outdated, inefficient nature of certain systems and a lack of system  interoperability as contributors to VA’s IT challenges related to VA health  care. We have continued to report on the importance of VA working with  the Department of Defense to achieve electronic health record  interoperability. In August 2015, we reported on the status of these  interoperability efforts and noted that the departments had engaged in  several near-term efforts focused on expanding interoperability between  their existing electronic health record systems. However, we were  concerned by the lack of outcome-oriented goals and metrics that would  more clearly define what VA and the Department of Defense aim to  achieve from their interoperability efforts. Accordingly, we recommended  that the departments establish a time frame for identifying outcome- oriented metrics and define related goals for achieving interoperability. In  February 2017, we reported that VA has begun to define an approach for  identifying outcome-oriented metrics focused on health outcomes in  selected clinical areas, and it also has begun to establish baseline  measurements. We intend to continue monitoring the departments’  efforts to determine how these metrics define and measure the results  achieved by interoperability between the departments.  2017 assessment of VA’s progress. VA has partially met our leadership  commitment criterion by involving top leadership from VA’s Office of  Information & Technology in this area of concern, but it has not met our  four remaining criteria for removing IT challenges from the High-Risk List.  For example, VA has not demonstrated improvement in several capacity  actions, such as establishing specific responsibilities for its new functions,  improving collaboration between internal and external stakeholders, and  addressing skill gaps. VA also needs to conduct a root cause analysis  that would help identify and prioritize critical actions and outcomes to  address IT challenges.
section_title: Inadequate Training for VA Staff
paragraphs: Summary of concern. When identifying this area of concern in our 2015  high-risk report, we described several gaps in VA’s training, as well as  burdensome training requirements. We have continued to find these  issues in our subsequent work. For example, in our December 2016  report on VHA’s human resources (HR) capacity, we found that VA’s  competency assessment tool did not address two of the three personnel  systems under which VHA staff may be hired. We recommended that  VHA (1) develop a comprehensive competency assessment tool for HR  staff that evaluates knowledge of all three of VHA’s personnel systems  and (2) ensure that all VHA HR staff complete it so that VHA may use the  data to identify and address competency gaps among HR staff. Without  such a tool, VHA will have limited insights into the abilities of its HR staff  and will be ill-positioned to provide necessary support and training.  2017 assessment of VA’s progress. VA has not met any of our criteria  for removing this area of concern from the High-Risk List. VA intends to  establish a comprehensive health care training management policy and a  mandatory annual training process; however, as of December 2016, VA  officials said they had not begun drafting a new policy to replace an  outdated document from 2002 that contains training requirements that are  no longer relevant. The high-level nature of the descriptions in the action  plan and lack of action to update outdated policies and set goals for  improving training shows that VA lacks leadership commitment to address  the concerns that led to our inclusion of this area in the 2015 high-risk  report.
section_title: Unclear Resource Needs and Allocation Priorities
paragraphs: Summary of concern. In our 2015 high-risk report, we described gaps in  the availability of data needed for VA to identify the resources it needs  and ensure they are effectively allocated across VA’s health care system  as contributors to our concern about unclear resource needs and  allocation priorities. We have continued to report on this concern. For  example, in our September 2016 report on VHA’s organizational  structure, we found that VA devoted significant time, effort, and funds to  generate recommendations for organizational structure changes intended  to improve the efficiency of VHA operations. However, the department  then either did not act or acted slowly to implement the recommendations.  Without robust processes for evaluating and implementing  recommendations, there was little assurance that VHA’s delivery of health  care to the nation’s veterans would improve. We recommended that VA  develop a process to ensure that it evaluates organizational structure  recommendations resulting from internal and external reviews of VHA.  This process should include documenting decisions and assigning  officials or offices responsibility for ensuring that approved  recommendations are implemented. We concluded that such a process  would help VA ensure that it is using resources efficiently, monitoring and  evaluating implementation, and holding officials accountable.  2017 assessment of VA’s progress. VA’s actions have partially met our  criterion for leadership commitment but not met the other four criteria for  removing this area of concern from the High Risk List. VA’s planned  actions do not make clear how VHA, as the agency managing VA health  care, is or will be incorporated into VA’s new framework for the strategic  planning and budgeting process. It is also not clear how the framework  will be communicated and reflected at the regional network and medical  center levels. VA also has not identified what resources may be  necessary to establish and maintain new functions at the national and  local levels, or established performance measures based on a root cause  analysis of its unclear resource needs and allocation priorities.
section_title: More than 100 GAO Recommendations for Improving VA Health Care Remain Open
paragraphs: Since we added VA health care to our High-Risk List in 2015, VA’s  leadership has increased its focus on implementing our prior  recommendations, but additional work is still needed. Between January  2010 and February 2015 (when we first designated VA health care as a  high-risk area), we made 178 recommendations to VA related to VA  health care. When we made our designation in 2015, the department only  had implemented about 22 percent of them. Since February 2015, we  have made 74 new recommendations to VA related to VA health care, for  a total of 252 recommendations from January 1, 2010 through February  15, 2017 (when we issued the 2017 high-risk report). VA has  implemented about 50 percent of these recommendations. However,  there continue to be more than 100 open recommendations related to VA  health care, almost a quarter of which have remained open for 3 or more  years. We believe that it is critical that VA implement our  recommendations not only to remedy the specific weaknesses we  previously identified, but because they may be symptomatic of larger  underlying problems that also need to be addressed. Since the 2015  high-risk report, we have made new recommendations to VA relating to  each of the five areas of concern. (See table 1.)
section_title: Sustained Leadership Support and Strategic Focus Needed to Meet High-Risk Removal Criteria
paragraphs: VA has taken an important step toward addressing our criteria for removal  from the High-Risk List by establishing the leadership structure necessary  to ensure that actions related to the High-Risk List are prioritized within  the department. It is imperative, however, that VA demonstrate strong  leadership support as it continues its transition under a new  administration, address weaknesses in its action plan, and continue to  implement our open recommendations.
As a new administration sets its priorities, VA will need to integrate those  priorities with its high-risk-related actions, and facilitate their  implementation at the local level through strategies that link strategic  goals to actions and guidance. In its action plan, VA separated its  discussion of department-wide initiatives, like MyVA, from its description  of High-Risk List mitigation strategies. We do not view high-risk  mitigation strategies as separate from other department initiatives; actions  to address the High-Risk List can, and should be, integrated in VA’s  existing activities.
VA’s action plan did not adequately address the concerns that led to the  high-risk designation because it lacked root cause analyses for most  areas of concern, as well as clear metrics and identified resources  needed for achieving VA’s stated outcomes. This is especially evident in  VA’s plans to address the IT and training areas of concern. In addition,  with the increased use of community care programs, it is imperative that  VA’s action plan include a discussion of the role of community care in  decisions related to policies, oversight, IT, training, and resource needs.  VA will also need to demonstrate that it has the capacity to sustain efforts  by devoting appropriate resources—including people, training, and  funds—to address the high-risk challenges we identified. Until VA  addresses these serious underlying weaknesses, it will be difficult for the  department to effectively and efficiently implement improvements  addressing the five areas of concern that led to the high-risk designation.
We will continue to monitor VA’s institutional capacity to fully implement  an action plan and sustain needed changes in all five of our areas of  concern. To the extent we can, we will continue to provide feedback to VA  officials on VA’s action plan and areas where they need to focus their  attention. Additionally, we have ongoing work focusing on VA health care  that will provide important insights on progress, including the policy  development and dissemination process, implementation and monitoring  of VA’s opioid safety, Veterans Choice Program implementation,  physician recruitment and retention, and processes for enrolling veterans  in VA health care.
Finally, we plan to also continue to monitor VA’s efforts to implement our  recommendations and recommendations from other reviews such as the  Commission on Care. To this end, we believe that the following GAO  recommendations require VA’s immediate attention:  improving oversight of access to timely medical appointments,  including the development of wait-time measures that are more  reliable and not prone to user error or manipulation, as well as  ensuring that medical centers consistently and accurately implement  VHA’s scheduling policy.  improving oversight of VA community care to ensure—among other  things—timely payment to community providers.  improving planning, deployment, and oversight of VA/VHA IT  systems, including identifying outcome-oriented metrics and defining  goals for interoperability with DOD. ensuring that recommendations resulting from internal and external  reviews of VHA’s organizational structure are evaluated for  implementation. This process should include the documentation of  decisions and assigning officials or offices responsibility for ensuring  that approved recommendations are implemented.
Moreover, it is critical that Congress maintain its focus on oversight of VA  health care to help address this high-risk area. Congressional committees  responsible for authorizing and overseeing VA health care programs held  more than 70 hearings in 2015 and 2016 to examine and address VA  health care challenges. As VA continues to change its health care service  delivery in the coming years, some changes may require congressional  action—such as VA’s planned consolidation of community care programs  after the Veterans Choice Program expires. Sustained congressional  attention to these issues will help ensure that VA continues to improve its  management and delivery of health care services to veterans.
Chairman Isakson, Ranking Member Tester, and Members of the  Committee, this concludes my statement. I would be pleased to respond  to any questions you may have.
section_title: GAO Contacts and Staff Acknowledgments
paragraphs: For further information about this statement, please contact Debra A.  Draper at (202) 512-7114 or draperd@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on  the last page of this statement. Key contributors to this statement were  Malissa G. Winograd (Analyst-in-Charge), Jennie Apter, Jacquelyn  Hamilton, and Alexis C. MacDonald.
section_title: Related GAO Products
paragraphs: High-Risk Series: Progress on Many High-Risk Areas, While Substantial  Efforts Needed on Others. GAO-17-317. Washington, D.C.: February 15,  2017.
VA Health Care: Actions Needed to Ensure Medical Facility Controlled  Substance Inspection Programs Meet Agency Requirements.  GAO-17-242. Washington, D.C.: February 15, 2017.
Veterans Affairs Information Technology: Management Attention Needed  to Improve Critical System Modernizations, Consolidate Data Centers,  and Retire Legacy Systems. GAO-17-408T. Washington, D.C.: February  7, 2017.
Veterans Health Administration: Management Attention Is Needed to  Address Systemic, Long-standing Human Capital Challenges.  GAO-17-30. Washington, D.C.: December 23, 2016.
VA Health Care: Improved Monitoring Needed for Effective Oversight of  Care for Women Veterans. GAO-17-52. Washington, D.C.: December 2,  2016.
Veterans Health Care: Improvements Needed in Operationalizing  Strategic Goals and Objectives. GAO-17-50. Washington, D.C.: October  21, 2016.
VA Health Care: Processes to Evaluate, Implement, and Monitor  Organizational Structure Changes Needed. GAO-16-803. Washington,  D.C.: September 27, 2016.
Veterans’ Health Care: Improved Oversight of Community Care  Physicians’ Credentials Needed. GAO-16-795. Washington, D.C.:  September 19, 2016.
VA IT Management: Organization Is Largely Centralized; Additional  Actions Could Improve Human Capital Practices and Systems  Development Processes. GAO-16-403. Washington, D.C.: August 17,  2016.
Veterans Affairs: Sustained Management Attention Needed to Address  Numerous IT Challenges. GAO-16-762T. Washington, D.C.: June 22,  2016.
VA’s Health Care Budget: In Response to a Projected Funding Gap in  Fiscal Year 2015, VA Has Made Efforts to Better Manage Future  Budgets. GAO-16-584. Washington, D.C.: June 3, 2016.
Veterans Crisis Line: Additional Testing, Monitoring, and Information  Needed to Ensure Better Quality Service. GAO-16-373. Washington,  D.C.: May 26, 2016.
Veterans’ Health Care: Proper Plan Needed to Modernize System for  Paying Community Providers. GAO-16-353. Washington, D.C.: May 11,  2016.
VA Health Care: Actions Needed to Improve Newly Enrolled Veterans’  Access to Primary Care. GAO-16-328. Washington, D.C.: March 18,  2016.
DOD and VA Health Care: Actions Needed to Help Ensure Appropriate  Medication Continuation and Prescribing Practices. GAO-16-158.  Washington, D.C.: January 5, 2016.
VA Mental Health: Clearer Guidance on Access Policies and Wait-Time  Data Needed. GAO-16-24. Washington, D.C.: October 28, 2015.
VA Primary Care: Improved Oversight Needed to Better Ensure Timely  Access and Efficient Delivery of Care. GAO-16-83. Washington, D.C.:  October 8, 2015.
VA Health Care: Oversight Improvements Needed for Nurse Recruitment  and Retention Initiatives. GAO-15-794. Washington, D.C.: September 30,  2015.
Electronic Health Records: Outcome-Oriented Metrics and Goals Needed  to Gauge DOD’s and VA’s Progress in Achieving Interoperability.  GAO-15-530. Washington, D.C.: August 13, 2015.
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