VA Health Care: Action Needed to Improve Fertility Care Communications and Eligibility Determination Process

Executive Summary

The GAO review of VA/VHA fertility care found a notable increase in veterans with infertility diagnoses between fiscal years 2022 and 2025 (from about 19,000 in FY2022 to about 30,000 in FY2025) within a population of roughly 8 million veterans who used VHA health care over that period. In October 2024 VHA shifted eligibility determinations for fertility care from a national-level process to local VA medical center fertility teams. GAO found gaps in communications about available fertility care and variability in how local teams are composed and operate; for example, teams at two facilities did not consistently provide the required written notifications of eligibility decisions.

For government contractors, this creates near-term demand and risk across multiple market segments named in the Tags: clinical and reproductive care providers, healthcare communications and patient outreach, healthcare IT, training and workforce development, and healthcare consulting. Contractors should monitor solicitations and program-level responses as VHA implements changes to eligibility determination and addresses GAO-identified communication and performance-practice gaps. There are opportunities to help VHA standardize eligibility workflows, improve outreach and performance measurement, supply IT solutions that support notifications and recordkeeping while meeting HIPAA and FISMA concerns, and deliver targeted training for local fertility teams.

Impact Matrix

Healthcare Services

• Risk Level: Critical
• Opportunity: Support VHA delivery of fertility-related clinical services and process standardization. Specific opportunities: NAICS codes present in Tags: 621111, 621112, 621399, 621410, 621491, 621498. Contract vehicles listed in Tags: VA FSS, T4NG, VECTOR.
• Timeline: Fiscal years 2022–2025 context; VHA policy change effective October 2024.
• Action Required: Assess clinical staffing models and readiness at local VA medical centers; prepare proposals for supporting standardized eligibility workflows and service delivery support.
• Competitive Edge: Demonstrate experience scaling clinical programs across multiple facilities and propose modular clinical support packages that align with VA FSS/T4NG/VECTOR acquisition approaches.

Medical Services

• Risk Level: High
• Opportunity: Provide clinical specialty support (infertility diagnosis and treatment pathways) and care coordination services. Specific opportunities: NAICS 621111–621498; contract vehicles: VA FSS, T4NG, VECTOR.
• Timeline: FY2022–FY2025 data window; operational change since October 2024.
• Action Required: Map local eligibility decision points to clinical workflows; offer solutions to reduce variability in patient access and notification.
• Competitive Edge: Offer evidence-based clinical protocols and outcome-monitoring services that reduce decision variability across sites.

Reproductive Health

• Risk Level: Critical
• Opportunity: Help VHA expand awareness and access to fertility care; supply clinical and programmatic support specific to reproductive health. Specific opportunities: NAICS 621111–621498; contract vehicles: VA FSS, T4NG, VECTOR.
• Timeline: FY2022–FY2025; October 2024 process change.
• Action Required: Position reproductive-health expertise to assist with eligibility clarification, care pathways, and patient communication materials.
• Competitive Edge: Present integrated reproductive-care packages that include clinical services, patient counseling, and outcome tracking.

Women's Health

• Risk Level: High
• Opportunity: Enhance outreach and service delivery for a subset of fertility care communications currently routed through VHA Office of Women’s Health. Specific opportunities: NAICS 621111–621498; contract vehicles: VA FSS, T4NG, VECTOR.
• Timeline: FY2022–FY2025 context; ongoing communications gaps identified by GAO.
• Action Required: Support tailored communications that avoid creating perception barriers for male veterans and others; assist in expanding inclusive messaging.
• Competitive Edge: Use veteran-focused user research and materials tested across demographics to improve uptake.

Healthcare IT

• Risk Level: High
• Opportunity: Implement systems to document eligibility decisions, support written notifications, and track performance metrics while addressing privacy/security requirements. Specific opportunities: NAICS 541611, 541612, 541990; contract vehicles: VA FSS, T4NG, VECTOR; compliance surfaces in Tags: HIPAA, FISMA.
• Timeline: Timeline anchored to existing data (FY2022–FY2025) and October 2024 process change; implementation timelines TBD pending VHA actions.
• Action Required: Offer solutions for standardized decision documentation, automated notification workflows, and performance dashboards that meet HIPAA and FISMA expectations.
• Competitive Edge: Bundle secure notification and audit-trail capabilities with analytics that demonstrate reduced variability and improved notification compliance.

Healthcare Communications

• Risk Level: Critical
• Opportunity: Redesign VHA communications and outreach about fertility services to reach underinformed groups (GAO noted some veterans, including men, may be unaware). Specific opportunities: NAICS 611430, 541611, 541612; contract vehicles: VA FSS, T4NG, VECTOR.
• Timeline: GAO reviewed FY2022–FY2025 communications; improvements are an immediate priority per GAO findings.
• Action Required: Propose measurable communications strategies that include performance practices and metrics to track reach and effect.
• Competitive Edge: Provide veteran-segmented outreach campaigns with built-in measurement and iterative improvement processes.

Patient Outreach

• Risk Level: High
• Opportunity: Deliver targeted patient outreach, navigation, and education services to increase awareness and appropriate utilization of fertility care. Specific opportunities: NAICS 611430, 541611; contract vehicles: VA FSS, T4NG, VECTOR.
• Timeline: FY2022–FY2025; communication gaps identified by GAO indicate near-term need.
• Action Required: Develop outreach plans that address barriers identified by stakeholders (e.g., message origin perceptions) and include performance metrics.
• Competitive Edge: Use data-driven outreach strategies that can be rapidly piloted and scaled across VA medical centers.

Medical Training

• Risk Level: Medium
• Opportunity: Provide training to standardize fertility-team composition, eligibility determination skills, and required notification processes. Specific opportunities: NAICS 611430, 541611.
• Timeline: Training needs linked to October 2024 process change and ongoing variability observed in FY2022–FY2025.
• Action Required: Prepare curricula and competency assessments for local fertility teams; include train‑the‑trainer models to support rapid institutionalization.
• Competitive Edge: Offer role-specific, competency‑based training tied to measurable reductions in decision variability and missed notifications.

Healthcare Consulting

• Risk Level: High
• Opportunity: Consult on implementation of key performance practices, risk assessment of the eligibility process change, and change management across VHA fertility services. Specific opportunities: NAICS 541611, 541612, 541990.
• Timeline: GAO identified the need to assess the October 2024 process change; consulting engagements could be near-term.
• Action Required: Position consulting services to conduct organizational assessments, design performance frameworks, and advise on policy/process adjustments.
• Competitive Edge: Combine policy analysis, operational redesign, and implementation support in unified offerings tailored to VA/VHA constraints.

Veterans Healthcare

• Risk Level: Critical
• Opportunity: Support VHA-wide responses to increase access and consistency in fertility care across the veterans population. Specific opportunities: all NAICS in Tags (621111, 621112, 621399, 621410, 621491, 621498, 541611, 541612, 541990, 611430); contract vehicles: VA FSS, T4NG, VECTOR.
• Timeline: FY2022–FY2025 data context; eligibility process change effective October 2024; GAO findings point to immediate program attention.
• Action Required: Develop integrated proposals that address clinical care, communications, IT, training, and performance measurement to reduce variability and improve veteran awareness and notification consistency.
• Competitive Edge: Present end-to-end solutions that map to VHA priorities and demonstrate prior success in veteran-serving health systems.

Cross-Segment Implications

• Communication and outreach gaps (Healthcare Communications, Patient Outreach) directly affect demand for clinical services (Healthcare Services, Reproductive Health) — low awareness can suppress appropriate utilization even as diagnoses rise.
• The October 2024 shift of eligibility decision authority to local fertility teams increases reliance on local team composition, training, and consistent processes; Medical Training and Healthcare Consulting are therefore linked to Medical Services and Veterans Healthcare for reducing variability.
• Healthcare IT is a cross-cutting enabler: reliable documentation, notification, and performance measurement systems are needed to make local eligibility decisions auditable and to ensure compliance with HIPAA and FISMA concerns identified as relevant.
• Improved performance practices and metrics (Healthcare Consulting, Healthcare IT) will inform communications strategies and outreach effectiveness, creating a feedback loop across segments that can reduce missed notifications and inconsistent eligibility outcomes.