VERA Improves Resource Allocation to Regional Networks

VERA shows promise for improving the equity of veterans’ access to care because it makes VA’s allocation of resources to networks more equitable. If fully implemented in fiscal year 1999 as planned, VERA could substantially shift regional allocations. High-priority veterans— commonly referred to as Category A veterans—are those with service-connected disabilities, low incomes, or special health care needs. VERA provides more comparable levels of resources to each network for each high-priority veteran served than the process it replaced, which allocated resources primarily on the basis of facilities’ historical budgets.VERA provides more comparable levels of resources by classifying patients on the basis of the cost of their health care into two workload groups— basic care and special care. VA Continues to Explore Ways to Improve VERA Allocations

VA is exploring several options for improving allocations. As a result, it is difficult for VA to ensure that VERA’s capacity to allocate resources equitably is not compromised and that veterans receive appropriate health care. For example, VA has not been monitoring changes in the number of one-time users of VA health care. VA headquarters is considering improving the timeliness and detail of indicators used for monitoring changes in allocations and VA health care delivery, officials said. VISN resource allocation methods are crucial to veterans’ equitable access to services. Furthermore, headquarters has done little to monitor network efforts to improve veterans’ equitable access to services. VA has not established an adequate monitoring system, however, to identify changes in workload and medical practices that could compromise VERA’s ability to allocate resources in the future or affect the appropriateness of services delivered. VISNs are using various methods to allocate their resources in fiscal year 1997. Recommendations

We recommend that the Secretary for Veterans Affairs direct the Under Secretary for Health to develop more timely and detailed indicators of changes in key VERA workload measures and medical care practices to maintain VERA’s ability to equitably allocate resources in the future and help ensure that veterans receive the most appropriate care and improve oversight of VISNs’ allocation of resources to their facilities by (1) developing criteria for use in designing VISN resource allocation methods, (2) reviewing and approving these methods, and (3) monitoring the impact of the methods on veterans’ equitable access to care. First, we examined how VA allocates resources through the Veterans Equitable Resource Allocation (VERA) system to the 22 Veterans Integrated Services Networks (VISN).
Why GAO Did This Study

Pursuant to a congressional request, GAO assessed the Department of Veterans Affairs' (VA): (1) implementation of the Veterans Equitable Resource Allocation System (VERA); (2) monitoring of changes in health care delivery resulting from VERA; and (3) oversight of the network allocation process used to give veterans equitable access to services.

What GAO Found

GAO found that: (1) VERA shows promise for correcting long-standing regional funding imbalances that have impeded veterans' equitable access to services; (2) specifically, VERA allocates more comparable amounts of resources to the 22 networks for high-priority VA health service users--those with service-connected disabilities, low incomes, or special health care needs--than the resource allocation process it has replaced; (3) as a result, if fully implemented as planned, VERA could substantially shift funding among regions by fiscal year (FY) 1999; (4) in addition, VA continues to explore ways to improve VERA's capacity to more equitably allocate resources in the future; (5) among the improvements being considered are better measures of network workloads and adjustments for justifiable differences in network costs for providing health services; (6) although it is early in VERA's implementation, VA headquarters has not established an adequate monitoring system to identify changes in workload and medical practices that could negatively affect allocation equity and the appropriateness of care that veterans receive; (7) in addition, VA headquarters lacks the information to adequately review networks' planned facility services; (8) Veterans Integrated Service Networks (VISN) that GAO contacted are using varying methods to allocate resources to facilities; (9) for example, some VISNs allocate resources on the basis of the number of veterans using a facility; others negotiate changes in funding for programs or services from the preceding fiscal year to reach a new allocation; (10) VISNs, however, lack criteria on how to develop methods to give veterans equitable access; (11) to address these deficiencies, GAO has identified corrective actions for VA to take to enhance its ability to ensure that resources are allocated to improve veterans' equitable access to health care services and ensure that the care received is appropriate; and (12) these actions include improving the timeliness and thoroughness of overseeing changes in health care delivery resulting from the allocation process to the networks and to the facilities.