VA and DOD Health Care Collaboration
In a report released in June 2025, the U.S. Government Accountability Office (GAO) examines the current state of health care sharing agreements between the Department of Veterans Affairs (VA) and the Department of Defense (DOD), urging both agencies to move beyond mere participation and toward rigorous evaluation and strategic expansion. Authored by Alyssa M. Hundrup and her team, the report—titled VA and DOD Health Care: Agreements to Share Services and Other Resources Should be Evaluated (GAO-25-107497)—calls for a more intentional, data-driven approach to maximize the value of these cooperative arrangements.
VA and DOD operate two of the largest health care systems in the country, collectively serving more than 18 million individuals. As of April 2025, the agencies had established 185 sharing agreements, ranging from patient referrals and staff sharing to facility space and nonmedical services. These agreements are designed to provide mutual benefits, such as increased access to specialty care for veterans and opportunities for DOD providers to maintain clinical readiness—often at a 20% discount compared to civilian providers.
Despite these promising synergies, GAO found a critical shortfall: neither agency evaluates the effectiveness of the sharing agreements. VA and DOD currently rely on simplistic metrics, such as the number of agreements in force and their renewal rates. However, these measures provide little insight into whether the agreements are delivering improved access, cost savings, or clinical benefits. GAO recommends that both agencies implement performance management practices—setting clear goals, establishing metrics, and using data to drive improvements. Without this, opportunities to optimize care delivery and reduce costs may be lost.
Another key area of concern lies in the identification of new opportunities for sharing. While local officials are largely responsible for initiating agreements, this decentralized approach may result in missed chances for collaboration. GAO suggests the need for a more systematic, department-level strategy that leverages data and national oversight to identify gaps, match needs with resources, and expand successful models.
The report also revisits long-standing challenges that continue to impede progress. These include inconsistent access for veterans to military installations, electronic health record interoperability issues, and difficulties in billing and reimbursement between the two systems. Though some efforts have been made to address these issues—such as the implementation of the Joint Longitudinal Viewer and new billing software—critical barriers remain. Particularly, DOD’s lack of clear guidance on non-reimbursable agreements has created confusion and delayed implementation of beneficial partnerships. At one site, for example, a non-reimbursable arrangement involving a PET scan technician saved over $100,000 in FY24, but officials were uncertain whether the program could continue without clearer guidance.
The report concludes with five recommendations, including establishing a performance evaluation framework and developing a systematic process to identify and implement new or expanded agreements. Encouragingly, both VA and DOD concurred with GAO’s findings and recommendations.
This report not only highlights the importance of interagency collaboration but underscores the need for deliberate, strategic oversight. With rising federal health care costs and a shared obligation to serve those who’ve worn the uniform, the time is ripe for VA and DOD to transform good intentions into measurable outcomes. By adopting GAO’s recommendations, both departments can unlock the full potential of their shared resources—for the benefit of service members, veterans, and taxpayers alike.
Disclaimer: This blog post is a summary and interpretation of GAO-25-107497, authored by the U.S. Government Accountability Office. It is provided for informational purposes only and does not constitute legal, financial, or medical advice. Readers are encouraged to consult the official GAO report for complete details: GAO-25-107497.