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An integrated purchased care approach is feasible, but it may not be practical

• An integrated purchased care approach (including a joint contract and shared list of providers) would be legally permissible under existing authorities; however, some changes would be required, specifically to how appropriations language refers to the relevant DoD and VA programs for purchasing care.
• Without significant changes to how DoD and, particularly, VA engage with TPAs, any operational efficiencies would be limited.
• An integrated approach to purchasing care may expand the number of providers available to both departments, but it is uncertain whether this expansion would fill health care gaps or provide beneficiaries with a sufficient number of providers in the locations where they are needed.
• It is unlikely that the government will achieve greater cost-efficiency by negotiating lower payments to providers because both departments are already paying near Medicare rates to their contracted providers.

The evolving policy landscape will have implications for an integrated approach to purchased care

• In recent years, there have been significant changes to how DoD and VA manage health care. Additional policies could disrupt ongoing efforts to implement prior changes.
• Policies affecting the U.S. health care system overall also affect DoD and VA. Of particular concern are changes that affect veterans' access to other sources of health insurance and thus affect their demand for VA services.
• Changes in the size of the covered populations or eligibility for DoD or VA health care would affect how DoD and VA balance health care delivery across their direct and purchased care programs.