The Department of Veterans Affairs (VA) and the Indian Health Service (IHS) have developed mechanisms to implement and monitor their memorandum of understanding (MOU); however, the performance metrics developed to assess its implementation do not adequately measure progress made toward its goals. VA and IHS have defined common goals for implementing the MOU and developed strategies to achieve them. Native Americans who have served in the military may be eligible for health care services from both VA and IHS. This book examines the extent to which the agencies have established mechanisms through which the MOU can be implemented and monitored; and key challenges the agencies face in implementing the MOU and the progress made in overcoming them.