Health Care Delivery and Quality Issue Area Plan--Fiscal Years 1996-98
(Letter Report, 09/01/95, GAO/IAP-95-35).
GAO presented its Health Care Delivery and Quality issue area plan for
fiscal years 1996 through 1998.
GAO plans to assess: (1) ways to improve the quality of and access to
health care financed by federal agencies; (2) how the Departments of
Veterans Affairs' (VA) and Defense's (DOD) programs and systems could
operate more efficiently and effectively and whether they should be
restructured in the face of declining patient workloads; (3) how well
DOD is implementing its managed care program; (4) how to control health
care costs without compromising quality and access; (5) the
applicability of private sector best practices; and (6) pension and
disability programs, particularly regarding their eligibility
requirements and duplication of and reimbursement from other programs.
--------------------------- Indexing Terms -----------------------------
REPORTNUM: IAP-95-35
TITLE: Health Care Delivery and Quality Issue Area Plan--Fiscal
Years 1996-98
DATE: 09/01/95
SUBJECT: Managed health care
Veterans benefits
Veterans hospitals
Health care services
Military personnel
Dependents
Health care programs
Health care cost control
Quality assurance
Health services administration
IDENTIFIER: Medicaid Program
Civilian Health and Medical Program of the Uniformed
Services
Medicare Program
DOD TRICARE Program
VA Veterans Integrated Service Network
Federal Employees Health Benefits Program
CHAMPUS
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Cover
================================================================ COVER
Health, Education, and Human Services Division
September 1995
HEALTH CARE DELIVERY AND QUALITY
ISSUE AREA PLAN
FISCAL YEARS 1996-98
GAO/IAP-95-35
Abbreviations
=============================================================== ABBREV
FOREWORD
============================================================ Chapter 0
As the investigative arm of Congress and the nation's auditor, the
General Accounting Office is charged with following the federal
dollar wherever it goes. Reflecting stringent standards of
objectivity and independence, GAO's audits, evaluations, and
investigations promote a more efficient and cost-effective
government; expose waste, fraud, abuse, and mismanagement in federal
programs; help Congress target budget reductions; assess financial
and information management; and alert Congress to developing trends
that may have significant fiscal or budgetary consequences. In
fulfilling its responsibilities, GAO performs original research and
uses hundreds of databases or creates its own when information is
unavailable elsewhere.
To ensure that GAO's resources are directed toward the most important
issues facing Congress, each of GAO's 35 issue areas develops a
strategic plan that describes the significance of the issues it
addresses, its objectives, and the focus of its work. Each issue
area relies heavily on input from congressional committees, agency
officials, and subject-matter experts in developing its strategic
plan.
The Health Care Delivery and Quality issue area covers health care
services provided to veterans and military beneficiaries through the
Departments of Veterans' Affairs' (VA) and Defense's (DOD) systems of
hospitals and clinics. Our quality of care work includes the care
provided directly by the federal government (VA, DOD, Indian Health
Service, and Bureau of Prisons) and care financed under Medicare and
Medicaid. Our work at VA also evaluates programs providing certain
nonhealth benefits, such as disability compensation and pensions, to
veterans and their dependents or survivors.
The principal issues in this issue area are
-- improving the quality of the nation's health care;
-- improving the efficiency and effectiveness of VA and DOD health
care systems and VA benefit programs;
-- restructuring the VA and DOD health care and VA benefits systems
to better accomplish their missions; and
-- improving the implementation of managed care in DOD.
In the pages that follow, we describe our key planned work on these
issues.
Because events may significantly affect even the best of plans, our
planning process allows for updating the plan and responding quickly
to emerging issues. If you have any questions or suggestions about
this plan, please call me at (202) 512-7101.
David P. Baine
Director
Health Care Delivery and Quality Issues
CONTENTS
============================================================ Chapter 1
FOREWORD
---------------------------------------------------------- Chapter 1:1
1
TABLE I: KEY ISSUES
---------------------------------------------------------- Chapter 1:2
4
TABLE II: PLANNED MAJOR WORK
---------------------------------------------------------- Chapter 1:3
6
TABLE III: GAO CONTACTS
---------------------------------------------------------- Chapter 1:4
7
TABLE I: KEY ISSUES
============================================================ Chapter 2
Issue Significance
----------------------- -------------------------------------------------------
Quality of care: How The federal government delivers health care to millions
can the quality of the of people each year through the huge DOD and VA health
nation's health care be care systems as well as through smaller programs such
improved? as the Indian Health Service and the Bureau of Prisons.
Millions more are affected by the health care funded by
Medicare and Medicaid. As Congress considers ways to
curb rising health care costs and make further cuts to
control the deficit, information about existing quality
problems and ways Congress can safeguard quality of
care will be crucial.
VA and DOD efficiency DOD and VA operate two of the largest health care
and effectiveness: How systems in the world. For example, VA has 173
can VA and DOD health hospitals, 376 outpatient clinics, 136 nursing homes,
care systems and VA and 39 domiciliaries. DOD also funds a major insurance
benefits programs, as program for care in private-sector facilities, the
currently structured, Civilian Health and Medical Program of the Uniformed
operate more Services (CHAMPUS). It costs about $30 billion each
efficiently and year to operate the federal systems and CHAMPUS. VA
effectively? also provides other benefits to veterans and their
dependents or survivors. For example, compensation and
pension benefits to about 3.3 million recipients cost
over $16 billion in fiscal year 1994 and were
administered through 58 regional offices. Ensuring the
efficient and effective delivery of these health and
other benefits is a major challenge.
VA and DOD VA and DOD health care systems face increasing
restructuring: Can the challenges from a changing health care marketplace as
missions of the VA and well as pressures to reduce health care costs. A
DOD health care and VA continuing decline in patient workload threatens the
benefits systems be economic viability of VA hospitals while, at the same
better accomplished in time, veterans have unequal access to health care. The
the future by military health care system must adjust to new post-
restructuring the Cold War planning scenarios and substantial reductions
systems? in the overall size of the nation's military forces.
Pressure to reduce the deficit also increases attention
on nonhealth benefits for veterans, military retirees,
and their dependents and survivors, where there are
significant issues regarding eligibility and potential
overlap and duplication in delivery systems.
DOD managed care By May 1997, DOD expects to have implemented nationwide
implementation: its new TRICARE program, offering managed health care
How well is managed to more than 5 million beneficiaries at a cost of $17
care being implemented billion over 5 years. Designing and implementing a
in DOD? managed care program on this scale is unprecedented and
poses significant challenges. At the same time,
understanding the lessons learned from DOD's experience
will benefit the private sector and other government
programs.
--------------------------------------------------------------------------------
Objectives Focus of work
---------------------------- --------------------------------------------------
--Identify ways to improve � Health care provider quality
quality of care provided by
federal agencies or financed � Direct care processes
with federal funds.
�Measurement of health care quality, especially
--Enhance the current body outcomes
of knowledge and discussion
on evaluation and delivery
of quality care.
--Identify the quality
implications of anticipated
or proposed legislative
health care initiatives.
--Identify more effective � Changes in operating procedures
management controls to
minimize fraud, waste, and � Quality assurance and improvement efforts
abuse.
� Budgeting and spending activities
--Identify ways to save
millions of dollars through
legislative or
administrative changes that
improve overall operational
efficiency.
--Identify ways to improve
services to veterans.
--Evaluate management
initiatives to determine how
well they address underlying
problems.
--Identify options for � Organizational relationships within VA and among
restructuring service VA, DOD, and other government programs
delivery systems.
� Eligibility for health care and nonhealth
--Identify options for benefits
better targeting benefits to
veterans and military �Size and structure of military health services
personnel and their system
dependents.
--Identify needed changes in
military medicine
requirements, organization,
or structure in response to
changing military force
structure and demographics.
--Identify lessons learned � TRICARE policies
from DOD's managed care
experience. �TRICARE implementation issues
--Identify needed changes in
DOD's managed care
strategies, designs,
policies, and plans.
--Identify ways to improve
the implementation of
managed care for
beneficiaries and the
government.
--------------------------------------------------------------------------------
TABLE II: PLANNED MAJOR WORK
============================================================ Chapter 3
Issue Planned major job starts
------------------ --------------------------------------------------
Quality of care --Examine quality implications of increased use of
nonphysician providers.
--Examine potential of telemedicine to improve
delivery of quality care.
--Assess appropriateness of physician workloads in
VA, DOD, and the private sector.
--Identify alternative useful quality assurance
models for Medicare programs.
VA and DOD --Evaluate VA's internal processes for sharing
efficiency and information about innovations.
effectiveness --Assess VA's efforts to improve its benefit
claims processing functions.
--Evaluate use of "best practices" in the VA and
DOD health care systems.
--Assess VA's central office quality assurance and
oversight of benefits programs.
--Review VA and DOD budget submissions and
controls over spending activities.
--Assess DOD and VA third party collection
programs.
--Identify extent of duplicate billings under VA's
fee basis and contract hospital and nursing home
programs.
--Examine VA's purchase and use of high technology
and durable medical equipment.
--Assess status of improvements in VA's
construction program.
VA and DOD --Evaluate implications of VA's new Veterans
restructuring Integrated Service Network.
--Evaluate implementation/effect of VA's increased
emphasis on primary care.
--Monitor effects of state health reforms on VA
health care facilities.
--Assess the need for separate VA and DOD
disability compensation systems.
--Assess the relationship between VA's pension
program and Social Security.
--Evaluate VA's health care eligibility reform
proposals.
--Evaluate adequacy of VA's disability rating
schedule to meet congressional intent.
--Determine impact on the budget and individuals
of reducing or ending compensation for low-rated
disabilities.
--Assess proposals for VA to be reimbursed for
serving Medicare-eligible veterans.
--Identify options for DOD's serving Medicare-
eligible retirees.
--Compare analyses and recommendations of the
Commission on Base Closure and Realignment's Joint
Cross-Service Working Group on Military Hospitals
and the Services.
--Assess the merit of consolidating the three
military medical departments into a single
department.
--Assess the desirability of including military
health care beneficiaries in the Federal Employees
Health Benefits Program.
DOD managed care --Examine TRICARE Prime's enrollment system.
implementation --Examine cost-effectiveness of TRICARE.
--Assess progress toward a more uniform military
health care benefit package.
--Examine the financing of TRICARE.
----------------------------------------------------------------------
TABLE III: GAO CONTACTS
============================================================ Chapter 4
DIRECTOR
-------------------------------------------------------- Chapter 4:0.1
David Baine (202) 512-7101
ASSOCIATE DIRECTOR
-------------------------------------------------------- Chapter 4:0.2
Carlotta Joyner (202) 512-7101
ASSISTANT DIRECTORS
-------------------------------------------------------- Chapter 4:0.3
Daniel Brier
James Carlan
Irene Chu
Ruth Ann Heck
Sandra Isaacson
James Linz
Clarita Mrena
George Poindexter
Paul Reynolds
*** End of document. ***