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Summary for the Evaluation of the Health Care Benefits (Treatment Benefits) Program Management Function

Health Care Benefits (Treatment Benefits) Program Management Function
Audit and Evaluation Division – Veterans Affairs Canada
May 2018

Evaluation Results

1. Are the Treatment Benefits Program Management Unit outputs in line with the original intent of the unit and linked to program objectives?

The evaluation found that there have been a number of program-related and organizational changes in recent years and the Unit would benefit from updating its current governance structure (including documented roles and responsibilities, priorities, and outputs).

2. Is the Treatment Benefits Program Management Unit optimizing its use of resources and producing the required outputs?

The evaluation determined that operational activities have been taking precedent over strategic program management activities within the Unit. As of 2017-18, the Unit has seen a decline in resources and corporate knowledge, while the number of operational enquiries received have increased and the number of required program management related activities (e.g., business process and rule updates) have continued to grow. The evaluation team was unable to fully assess the optimization of resources due to limited information on Unit outputs and numerous shifts in resources.

3. Opportunities to improve efficiencies in the management of the Treatment Benefits Program?

During the evaluation scope period, a departmental committee which reviews and consults on benefits and services for the Program had irregular meetings and continued to have ongoing discussions around membership roles and responsibilities. The evaluation found that this committee is key to efficient and effective program decision making. A thorough review of the rules supporting treatment benefits and services was completed a number of years ago, and there is a strong likelihood that limited updates are contributing to the increase in enquiries received by the Unit.

There have been numerous efficiency-seeking initiatives conducted in relation to the Program in recent years. The evaluation identified additional opportunities that could support improved efficiencies in the management of the Program in the areas of: improved data and trend analysis, formalized incorporation of risk management and lessons learned, enhanced collection of enquiry workload information, and maximization of Benefits Review Committee roles and responsibilities.

Recommendations Management Response and Action Plan
1. It is recommended that the Director General, Service Delivery and Program Management improve the Program governance structure by:
  • Updating the Treatment Benefits Roles and Responsibilities document to reflect changes in the organizational structure, roles and responsibilities of non-program unit staff and relevant committees, program unit objectives, key activities and outputs, and priorities;
  • Producing a mid to long-term strategic and operational plan for the Treatment Benefits Program Management Unit, including resource needs, timelines, goals and linkages to Treatment Benefit Program priorities; and
  • Sharing the above noted documents with departmental staff and third-party health claims processing staff.
The Director General, Service Delivery and Program Management will improve the governance structure of the Program by updating the current Roles and Responsibilities document, developing a strategic and operational plan for the Program, and sharing this information with departmental staff, the third-party health claims processor, and other stakeholders as applicable.
2. It is recommended that the Assistant Deputy Minister, Service Delivery finalize the Benefits Review Committee Terms of Reference (including membership roles and committee purpose), communicate the document with departmental staff and third-party health claims processing staff, and ensure that regular meetings occur on a go-forward basis. The Assistant Deputy Minister, Service Delivery will convene a meeting of the Benefits Review Committee, finalize and distribute the committee terms of reference, and ensure that the committee meetings occur on a regular basis.
3. It is recommended that the Assistant Deputy Minister, Service Delivery work in collaboration with the relevant areas across the department to strengthen the collection and analysis of data to support the management of the Treatment Benefits Program (such as performance measurement, risk areas, trend analysis, and regular monitoring of benefit specific data). The Assistant Deputy Minister, Service Delivery will work in conjunction with the Assistant Deputy Minister, Chief Financial Officer and Corporate Services to review and compile a collection of current available data, strengthen the collection of relevant data by developing a framework to enhance data reporting and monitoring in collaboration with other areas of the department, and perform trend analysis on a regular basis.
4. It is recommended that the Director General, Service Delivery and Program Management implement a cycle of benefit reviews to ensure they are updated on a continuous and efficient basis. The Director General, Service Delivery and Program Management will develop an approach for reviewing treatment benefits and services and implement a review cycle to ensure benefits and services are updated on a continuous and efficient basis. The Director General, Service Delivery and Program Management will also explore options and the feasibility of streamlining the delegated authorities and business rules associated with low-cost/low risk benefits and services.

Program Description

  • The Program provides eligible Veterans and other qualified individuals with financial support to access health care benefits to meet their identified needs. Support is provided under the authority of the Veterans Health Care Regulations.
  • As of March 31, 2017, there were just under 80,000 Veterans accessing the Treatment Benefits Program. Program funding is generated from operating expenditures and totalled $308 million in 2016-17.
  • The Program is administered by VAC field staff in over thirty offices across the country and by a third-party health claims processor. Benefits and services are administered through the Federal Health Care Processing System using VAC policies, processes, and rules established for each benefit or service. The Program is managed and supported by VAC Head Office.

About the Evaluation

Scope and Methodology:

  • Conducted in accordance with VAC’s Multi-Year Risk-Based Evaluation Plan 2017-22 and in compliance with the Treasury Board of Canada’s Policy on Results.
  • Focused on an assessment of operational efficiency of the Treatment Benefits program management function.
  • Scope period was April 1, 2014 to September 30, 2017.
  • Project work was conducted by the VAC Audit and Evaluation Division between June 2017 and March 2018.
  • Scope did not include cannabis for medical purposes, delivery of program benefits, or the FHCPS contract.

Constraints and Limitations:

  • Limited program management data was available regarding the Program Unit’s outputs and activities.
  • Significant staff turnover occurred during the evaluation scope period which impacted workload of staff as new staff were training/learning.
  • Individual perceptions of workload may have influenced opinions from staff on efficiency.
  • Limited program performance was collected and monitored for the two previous years.

Evaluation Report

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