Expanded Collaboration in Military Health Care, Yet Challenges in Assessing Results Persist
The Departments of Veterans Affairs (VA) and Defense (DoD) are exploring strategies to enhance the evaluation process for healthcare sharing agreements, aiming to better understand cost savings and effectiveness.
Enhance Data Integration and Analysis
A key strategy involves leveraging and expanding the Joint Health Information Exchange (HIE) to integrate health records across different departments. This comprehensive data will aid in assessing the outcomes of healthcare sharing agreements and identifying areas for improvement. Advanced data analytics tools will also be utilised to analyse the integrated data from the HIE, helping to track patient outcomes, costs, and the effectiveness of care delivered through sharing agreements.
Streamline Processes and Policies
To reduce administrative burdens, the VA has recently implemented a policy that allows veterans to receive continuous care from private providers without frequent reauthorizations. This policy change can serve as a model for simplifying authorization processes in healthcare sharing agreements. Standardized protocols for these agreements across both departments will also ensure consistency and make it easier to evaluate their effectiveness.
Foster Collaboration and Feedback
Enhanced collaboration between the VA and DoD is essential to align policies and share best practices. Regular meetings and workshops can facilitate this collaboration. Feedback from healthcare providers and patients will also be crucial in understanding the strengths and weaknesses of current healthcare sharing agreements and identifying areas for improvement.
Address Existing Recommendations
Addressing longstanding healthcare-related recommendations from the DoD Office of Inspector General can help improve the efficiency and effectiveness of healthcare services. Regular assessments and evaluations of the impact of healthcare sharing agreements will ensure they are meeting their intended goals and identify opportunities for improvement.
Promote Innovation and Learning
Supporting initiatives like the VA's Accelerating VA Innovation and Learning (AVAIL) program can help explore new ways to enhance healthcare processes and outcomes. Using evidence-based Clinical Determinations and Indications (CDIs) to guide coverage decisions will also ensure that treatments are medically necessary and appropriate.
Despite progress, challenges remain. Identifying new opportunities for sharing remains a challenge, with most new agreements initiated at the local level. Accessing military bases continues to be a challenge for veterans in implementing these shared agreements. Incompatibility between health data systems of VA and DoD continues to cause duplicative work and fragmented patient records for clinicians.
The Defense Department faces administrative hurdles in implementing shared agreements, even after clearing the backlog of unpaid claims. The Government Accountability Office (GAO) has suggested that the VA and DoD should track cost-avoidance measures to understand the types of cost avoidance, cost savings, and potential areas for improvement in the agreements.
As of April 2025, there are 185 active health care sharing agreements between the VA and DoD, a 14% increase from 162 agreements in 2022. The types of services covered under the agreements vary widely, with about a quarter being basic arrangements, 30% involving regular collaboration, about 30% involving embedded personnel, and less than 1% representing fully integrated healthcare operations.
Alyssa Hundrup, health care director at the GAO, emphasized the opportunity for increased access to health care and potential cost savings through shared agreements, specifically in the reimbursement rate for veterans being referred to Defense Department medical facilities.
In 2020, the DoD limited the use of non-reimbursable agreements due to concerns that some were not mutually beneficial. Despite this, these agreements allow the two agencies to share facilities, medical staff, administrative personnel, and provide non-medical services like training or laundry services.
In conclusion, by focusing on these strategies, the VA and DoD can improve their evaluation process for healthcare sharing agreements, leading to better cost savings and effectiveness in healthcare delivery.
- The adoption of Clinical Determinations and Indications (CDIs) to guide coverage decisions in healthcare sharing agreements is a way to ensure that treatment is medically necessary and beneficial, promoting innovation and learning during the process.
- Aligning policies between the Departments of Veterans Affairs (VA) and Defense (DoD) through regular meetings and workshops can help share best practices and foster collaboration, which is essential for improving the efficiency and effectiveness of healthcare services.
- The GAO's recommendation for the VA and DoD to track cost-avoidance measures in healthcare sharing agreements can help identify areas of improvement in cost savings, effectiveness, and types of agreements, promoting better policymaking and legislative decisions related to health care and general news.
