In response to highly publicized concerns regarding Veteran deaths and Veterans? access to care in the Veterans Health Administration (VHA), Congress enacted the Veterans Access, Choice and Accountability Act (VACAA) in 2014 to establish the Veterans Choice Program (VCP) and expand the availability of community care for eligible Veterans. Since its inception, VCP has grown considerably, comprising nearly half a million providers, and Veterans using VCP now account for represents 17% of all users of VHA care. Due to the recency of VCP implementation, research on its impacts is limited but highlights issues with inadequacies of community provider networks to meet Veterans? healthcare needs. Simultaneously, Veterans have also not been given access to information regarding VCP provider networks and can be uncertain of which providers are available to them. As a result, further investigation is needed to better understand how Veterans receive information regarding community care and how this information informs their decision to seek VA-purchased community care. This is required in conjunction with a concerted effort define, measure, and evaluate network adequacy for non-VA community care networks. Taken together, these steps will ensure that the needs of Veterans carefully assessed and appropriate standards are developed to meet the healthcare needs among Veterans seeking and requiring non-VA community care. This project will use a mixed methods design to identify healthcare market, medical center, Third Party Administrator, and Veteran characteristics and preferences that support or impede network adequacy and therefore, Veterans? access to care. We will use quantitative methods to leverage standardized national data and processes combined with qualitative methods to account for individual VA medical center contexts and Veteran preferences. Using this design, the project will complete three main objectives. The first objective of this study is to develop and validate measures of network adequacy for non-VA community care and evaluate regional variations in network adequacy across VAMCs and VA?s 98 markets. Relatedly, the project seeks to examine the process by which Community Care decisions are made at individual VA facilities, and to identify existing and potential opportunities to expand community partnerships to deliver Community Care. The project will also interview Veterans regarding Community Care, including preferences for a network directory of providers and quality ratings of providers to more completely understand their perspectives on Community Care. These objectives have important implications for VHA healthcare and the development of strong community networks and connections between VHA and surrounding community providers to provide quality healthcare to Veterans. As a result, this study team and project will address an important priority with VHA and, in the long-term, improve community services for Veterans who receive care in the VHA.

Public Health Relevance

In 2014, Congress enacted the Veterans Access, Choice, and Accountability ACT (VACAA) to establish the Veterans Choice Program (VCP) and expand the availability of community care for eligible Veterans. VCP has grown by 138% since its inception to include more than half a million providers. This rapid growth has led to concerns within VA related to the adequacy of non-VA provider networks and a need to develop appropriate measures of network adequacy. In the context of these questions is also the need to better understand organizational decision-making processes regarding Community Care at the local level as these decisions affect which Veterans receive care within the VA or in the community. This service directed research proposal aims to develop standardized measures of network adequacy and examine VAMC characteristics associated with high rates of Community Care provision. Upon completion of this project, we will be poised to assist policymakers in decisions shaping community care standards for the VHA.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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Northampton VA Medical Center
United States
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