	Background

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. Monitoring. Demonstrated Progress. VA Has Made Limited Progress in Addressing the Concerns That Led to the 2015 VA Health Care High-Risk Designation

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. 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. Overall Rating for Managing Risks and Improving VA Health Care

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. 2017 assessment of VA’s progress. 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. 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. 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. 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. 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. VA Health Care: Actions Needed to Ensure Medical Facility Controlled  Substance Inspection Programs Meet Agency Requirements.
Why GAO Did This Study

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.

What GAO Found

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.