WASHINGTON, DC — Two recent investigations by the Government Accountability Office (GAO) have highlighted how seemingly small procedural issues and technical errors can lead to servicemembers and veterans not receiving much-needed mental health services.
A DoD program designed to help newly discharged servicemembers deemed the most at risk connect with VA mental healthcare services is struggling to reach this younger generation of veterans. Investigators found that the program is reaching out too late following transition and using antiquated means that result in a low rate of enrollment in services.
A separate GAO investigation has discovered that active duty servicemembers and their families are facing difficulties in connecting to mental health services, as TRICARE’s network listings are riddled with provider inaccuracies.
VA and DoD have known for years that the time immediately following transition out of the military is a key point of vulnerability for servicemembers who may need mental health support. The suicide rate for veterans during their first year of separation is about 2.5 times higher than the active-duty population.
To help prevent servicemembers from falling through the gap between TRICARE and VA services, DoD created the inTransition program, which assists servicemembers who may need mental health support. Any servicemember who received mental health or traumatic brain injury care in the year prior to separation is automatically enrolled. In 2022, that included 91,000 servicemembers, with another 16,000 referred to the program.
A DoD contractor will contact the servicemember following their transition to see if they want to remain in the program and if they need any assistance in enrolling in mental healthcare services. However, that first call might not come until two or three months after discharge, according to a recent GAO report.
The contractor explained to GAO investigators that there’s a time lag between when someone leaves the military and when their separation data is added to the inTransition list of servicemembers who need to be contacted.
“The delayed timing for automatically enrolling eligible members may leave a gap in assistance to obtain mental health services at a time that coincides with the vulnerable post-separation period,” the GAO report stated.
When those new veterans are contacted by the inTransition contractor, it’s through phone calls. That method resulted in an anemic 30% contact rate.
“[The use of telephone calls] may help explain the program’s difficulty in successfully connecting with its automatically enrolled service members, because cold calls are an outdated form of communication,” the report noted. “When asked about using alternative methods of outreach, program officials said that the program’s policy requires telephone calls as the primary contact method.”
Of those automatic enrollees who were successfully contacted, 30% opted to stay in the program, leaving the door open for further assistance. This is a four-times higher rate than automatic enrollees as a whole.
“This suggests that when more enrollees are successfully contacted, the program will likely see higher acceptance rates,” the report stated. “Setting performance goals and tracking the program’s progress against them could give decision-makers baseline information and longitudinal data to determine whether changes to the program’s outreach approach are needed. This, in turn, could result in more enrollees participating in the program and more transitioning service members obtaining needed assistance.”
Riddled With Inaccuracies
The challenges in linking servicemembers to mental healthcare specialists begins well before discharge, with GAO describing TRICARE’s network provider list as iddled with inaccuracies, including listing providers who no longer are accepting new TRICARE patients.
GAO investigators conducted covert calls to a random selection of behavioral health providers listed in the network directory. Based on the results of the sample, GAO estimates that most provider listings in the directories are inaccurate to some extent, with an 85% inaccuracy rate in TRICARE East and 79% in TRICARE West.
Those inaccuracies can sometimes be as innocuous as an outdated fax number. Other times it’s the provider’s location or phone number.
The Defense Health Agency (DHA) was made aware of inaccuracies in the network directories as early as 2018, after which the agency issued corrective action requests to the two contractors who oversee the network directories.
“While both contractors have shown significant improvements to their directory accuracy rates in their monthly audits, neither has met the thresholds required by the contracts,” the GAO report stated.
DHA does not require the contractors to conduct accuracy audits based on medical specialty. However, behavioral health providers may be more likely to have inaccuracies in their data. In interviews with behavioral health organizations, GAO was told that these providers often operate as solo practitioners or in small group practices and may not have the administrative capacity to maintain accurate directory data.
The report also noted that bad listings for behavioral health providers have an outsized impact, because it’s harder to find ones who will opt in to the TRICARE network.
A DHA survey of providers found that low reimbursement rates, provider burnout and preference for private insurance keep even providers who saw TRICARE patients in the past from accepting new ones.
“Due to the widely-reported shortages of behavioral health providers, finding these providers can be a significant hardship for beneficiaries—including service members and their families who are increasingly in need of behavioral health care, and who move frequently, therefore requiring new providers in different locations,” the report stated.
