VA Health Care: The Medically Underserved Initiative

What the GAO found

The Department of Veterans Affairs (VA) Medical Underserved Initiative began in fiscal year 2019 to address the needs of veterans whose requests for care exceed the facility’s ability to meet those needs in a timely manner. VA has developed and implemented models to identify medical facilities that are underserved for primary care and mental health services. In fiscal year 2022, VA (1) ranked all VA medical facilities from most to least underserved, (2) designated five facilities as most underserved for primary care and five medical facilities as most underserved for mental health and (3) requires those facilities to develop action plans to address access needs.

GAO officials interviewed from all 10 designated underserved facilities described their experiences providing access to care for veterans. Officials from seven of these facilities reported varying experiences with the overall effect of the initiative’s ability to improve access—that it was a benefit to the facility, a hindrance, or in some cases both. These range from drawing attention to facility needs to too much effort with limited effect on access to care.

The Experience of VA Medical Facilities Employees with the Medical Facilities Initiative

Installation

A

b

° С

e

e

Well

Z

advantage

x

x

x

obstacle

x

x

x

No or limited effect on access to care

x

x

x

Source: GAO analysis of interviews with Department of Veterans Affairs (VA) medical facility officials. | GAO-24-106306

Note: Due to staff turnover, officials from three of the 10 facilities were not sufficiently familiar with the initiative to characterize its overall effect because they were not typically involved in the initiative in fiscal year 2022.

According to the VA, its Medicare underservicing initiative has yet to produce clear indicators of success. Although there is some movement in facility rankings from year to year, VA noted that any such changes in underserved rankings are due to a combination of changes in model criteria and implemented action plans, not necessarily a change in the degree of insufficient maintenance of a facility. Additionally, VA’s 2022 evaluation of the initiative and interviews with officials revealed differing perspectives on actions that can be taken to improve the effectiveness of the initiative for underserved facilities. These actions were to either (1) increase resources allocated to underserved facilities or (2) reduce the overall number of agency-wide initiatives related to access to allow VA to better identify and address major challenges to providing access. Given the mixed response to the underserved facility initiative, the VA reported in its 2022 evaluation report in a section on expanding the initiative to other specialties that “perhaps the transparency of [initiative] bringing these issues to bear is the best possible outcome rather than expecting the underserved [initiative] can actually move the needle on access” to care for veterans.

Why did the GAO do this study?

According to the VA, most veterans enrolled in VA health care live in areas with limited access to some health care services. Each year, the VA designates certain facilities to participate in the Primary Care or Mental Health Underserved Initiative based on criteria it develops.

GAO was asked to review VA’s facility medical underservicing initiative, which the agency implemented in response to section 401 of the VA MISSION Act of 2018. This report describes (1) the criteria VA used to identify medical underserved service and which facilities are designated as undeserved; (2) what officials from the designated underserved facilities reported about their experiences with the initiative; and (3) what VA information indicates about the effectiveness of the initiative.

GAO reviewed documentation related to the Medical Understaffing Initiative. This includes evaluation reports. The GAO also interviewed officials from the VA Office of Integrated Veteran Care, which is responsible for implementing the initiative. GAO analyzed data on underserved medical facilities from fiscal years 2019 to 2022. GAO interviewed staff from the 10 medical facilities designated by the VA as most underserved in fiscal year 2022, as well as staff from the Integrated Services Networks of the veterans who oversee these 10 establishments.

For more information, contact Sharon M. Silas at (202) 512-7114 or [email protected].

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